Finally, the long promised paper from Caldwell B. Esselstyn et. al providing follow-up data for a larger sample (than his original cohort) of heart disease sufferers following his very low fat plant-based diet:
A Way to Reverse CAD? Caldwell B. Esselstyn et al. The Journal of Family Practice, July 2014;Vol.63,No.7:p356-364
The diet is certainly a tough prescription from many people’s perspectives: no meat, fish or fowl, no eggs or dairy, no oils or hard fats (including coconut), no nuts or avocados, no added salt or refined sugars (including refined carbohydrates, fruit juices, honey, syrups and molasses), no caffeine. In fact, the only allowable things are fruits, vegetables, whole grains, legumes and flax seeds. There was no specific exercise requirement, no specific stress-relief and no prescribed psychosocial support (other than through contacts for education and monitoring).
This study is a case series of 198 subjects (+ two that were lost to follow-up) who volunteered themselves to trial the diet over variable time-periods. As such it is certainly methodologically flawed. Nevertheless the results are thought-provoking. 89% were adherent to the dietary prescription, and the adherent group had between a 0.6% and 10% event rate (depending on inclusion criteria), while the non-adherent participants had an event rate of 62% (including two sudden cardiac deaths). This gives a relative risk of having an event in the adherent group of 0.16 compared to the non-adherent group (my calculation) for the maximum 10% event rate. For the 0.6% event rate in adherent participants (one event – a stroke – which the authors suggest is the only one that resulted from disease progression) the relative risk is 0.01.
Just to explain, a relative risk of one indicates no difference between the two groups being compared. A value of less than one indicates a lower risk of cardiac events in the adherent group. A figure of more than one would indicate a greater risk. Calculating relative risk allows the results of different studies to be compared.
I appreciate that many people are not keen to acknowledge the implications of these albeit preliminary results – even less to put them to a proper test in case they turn out to be true and we then have to deal with the implications of formally acknowledging them. However, I believe that as healthcare professionals and scientists it is our duty to establish the biological truth. Only then can we discuss its various social implications and how far we are willing to travel in that direction (both as individuals and as a society). Meanwhile, to fail to inform patients of this information is wrong, as we fail to give them the choice and opportunity to take control of their disease and their destiny.
I’m not sure if Dr Esselstyn and his team are planning the RCT they recommend in their closing lines*, but I have a strong feeling that when it is eventually done it will prove to be a landmark paper in the history of cardiovascular disease research. I would love to be a part of it, if I can find anyone in high places who agrees with me!
*”We think the time is right for a controlled trial. But in the meantime, the data are sound and strong enough that patients should be informed of this option.”