GlassHospital

Demystifying Medicine One Week at a Time

Lifestyle Modification

I made a New Year’s resolution to become a vegetarian.  Or a mostly vegetarian.

I’ve been thinking about it for a long time, but with young children who love meat and don’t have the broadest palates, I think it’s important to feed them protein any way I can get it in them.

Having passed 40, I’ve finally realized that I can no longer eat what I want with impunity.  Further, as a doctor, I believe in practicing what I preach, and my legs could no longer straddle the gap between action and rhetoric.

That, and I hit 192 lbs. on the gym scale.

I calculated my own BMI at 26, edging toward 27.  I was officially overweight, just like two-thirds of Americans.

I have a sweet tooth.  I’ve been known to polish off a whole plate of cookies, a la Ziggy, just so they won’t be there tempting me.

Another rude awakening was my cholesterol. Total 254, LDL 177 (!).

I was in disbelief. When I thought about how I would treat a patient with my numbers, I’d reach right for a prescription pad and start a statin drug (like simvastatin [Zocor] or atorvastatin [Lipitor]).

But like a lot of doctors, I’ve long felt impervious to the maladies that I treat.

No more.

Over the holidays I read a New Yorker profile of John Mackey, founder & CEO of Whole Foods, in which he mentioned a book called “The Engine 2 Diet,” by a Texas firefighter and former pro triathlete named Rip Esselstyn.

Since I grew up in the same Cleveland suburb as Esselstyn’s family, I was intrigued enough to buy the book.

For the last four weeks, I changed my eating habits accordingly:

1. No meat (surprising:  no fish or poultry, either.  Strictly vegetarian.  “Nothing with a face or a mother.”  Eggs are out, too.  Esselstyn does permit tapering down the meat habit, allowing small portions of chicken or fish the first couple of weeks to acclimate.  I went cold tofu, though.).

2. No dairy (even yogurt, which I frequently tout to patients as a healthy food).

3. All the fruit and vegetables I want.

4. No oils (this surprised me, given all the attention to olive oil and things like flax seed oil that are high in unsaturated fats).

5. No refined grains (whole grain is ok, high in fiber!)

6. Sweets: only acceptables are fruits (“nature’s candy”), a little bit of sorbet, and a small amount of Dark (>70% cocoa) chocolate (avoid milk!).

The book promises much to those that follow its contents: more vigor, lower weight, lower cholesterol, and by inference (and looking at the exercise photographs near the middle) greater accomplishment and happiness.

Esselstyn is bursting with optimism that his diet can prevent (and even reverse) heart disease. He bases his ideas on the work of luminaries like Dean Ornish at UCSF, who has shown in the medical literature that extremely low fat diets (less than 12% of total calories from fat) improve symptoms, longevity (reducing heart attacks) and cause coronary plaques to actually regress. Esselstyn’s own father, a longtime Cleveland Clinic surgeon, published his own similarly themed book, “Prevent and Reverse Heart Disease.”

Esselstyn says that his data shows that total and LDL cholesterol can be significantly lowered, with a weight loss in the range of ten pounds in four weeks.

Staying on the diet requires planning.  I needed to change the way I shop for groceries, and scour nutrition labels more carefully than I ever used to.  By planning ahead, you have a small nutritious snack (e.g. a handful of healthy nuts) at the ready so that you don’t resort to junk food or quick, easy thought-free eating.

How’d I do?

After exactly four weeks of following the Engine 2 diet (with only a bit of cheating–a splash of non-fat milk in my coffee, occasional cheese on a whole wheat sandwich, a cupcake for my sister-in-law’s birthday), I was astonished:

I’ve dropped ten pounds.  I feel remarkably different:  More energetic.  I sleep better.  I have few dips in energy throughout the day.  Aside from one day each of the first two weeks (where to satisfy my sweet tooth I overindulged in peanut butter or almond butter), I find I’m no longer craving any of the junkier things that I used to.  I feel much more in control of my eating–both what I eat and the quantity.  I’m reminded how as a culture we habitually overeat.  We could all get by on so much less.

Here’s the stunner:  Remember my total cholesterol of 254, LDL 177?  After four weeks, the new numbers are total cholesterol 160, LDL 103. I think I’m going to keep this up.

21 Comments

  1. Seems kind of gimmicky to me. I have been a vegetarian for 20 years – mostly because I enjoy the food.

    1. Nothing is forbidden…I usually don’t eat large chunks of meat but will eat a dish made with animal products to be polite. If I am traveling or a guest at someone’s home, I don’t worry too much about the refined grains and the bad oils.

    2. I eat foods that (if I wanted to) I could raise or grow. No corn oil, hydrogentated oils,…high fructose corn syrup. My great grandmother (or someone’s great grandmother) would recognize it as food.

    3. I eat foods that are sustainable and humane. Local if possible.

    4. I cook. I sometimes get busy and I don’t cook. I try not to let that happen too often. I never buy sweets. I make them myself. Making the time to cook and eat with family is the most important lifestyle change one can make for health.

    5. I eat when I am hungry and stop when I am not. Food will be available later so there is no reason to stuff myself…even at Thanksgiving.

    6. I only eat things I really like. Homemade chocolate chip cookies are so much better than Chips Ahoy. I never settle for a Twinkie…not even to be polite.

    7. I am active…

  2. John,

    Your numbers astonish me. One question: you’ve listed all the things you can’t eat. Can you provide a rundown of the things you can and do?

    • glasshospital

      February 8, 2010 at 7:57 pm

      Breakfast: fruits, soy milk, oatmeal, any of many whole grain cereals, mixed or plain–with or without nuts; flax

      Lunches: vegetables, hummus, whole grain rice cakes, soy yogurt, legumes
      Snacks: nuts, fruit

      Dinners: veggie proteins–tofu, seitan, green salads, homemade soups with whole grains like quinoa, barley, whole grain pastas, sauces.

      This is just a recent week’s menu for me–I tend to vary it by week. I tend to make a big pot of something delicious on Sunday, and freeze some for a future quick meal and eat some leftover during the week.

      Looking at this list, it doesn’t sound all that appealing with new eyes–but one of the reasons I bought Engine 2 is that it has excellent recipes in the back third of the book.

    • I did pretty much the same thing, but allowed myself chicken, in modest amounts. Eat a ton of fruits and veggies, lots of water, and nuts (raw) when I was about to fall off the wagon. I did cheat on occassion, and dropped by TCHOL from 248 to 158 in a couple of months. Even my doc and nurses were asking me what I did. It can be done, but it takes discipline. The key is, fill up on the good stuff, carry around healthy snacks so you don’t cheat ,and always have a bottle of water handy. If you find yourself craving something, take a good chug of water, it generally does the trick.

  3. Good luck to you! I’ve been vegan for 22 years and am now 46; I’m certain that I would be markedly unhealthy had I not made an ethical decision upon learning about the horrors of factory farming to the animals and to the environment. I was lucky, too, to be guided by knowledgeable whole foods advocates – Frances Moore Lappe (even though she mistakenly promoted the importance of protein combining) and Dr. John McDougall. Information on healthy, plant-based diets has been around for decades — I’m so glad to see that the flag is being taken up by physicians like yourself.

    There are a lot of great vegan cookbooks out there now; alas, not all of them are low-fat, but most often the recipes are easily modified and very tasty. It’s a lot easier to make a vegan recipe heart-healthy than it is to make a meat-based recipe heart healthy. 🙂

    Finally, you may want to check out the blog of a vegan cardiologist – http://veganheartdoc.blogspot.com/ (I don’t know her personally at all, but I’ve enjoyed her blog.)

  4. Dr. Schumann,

    I’m in awe. . . .Could do it if I was compelled by a credible doc, but otherwise would have trouble. My LDL has traditionally been high, but so has my HDL count. Last year, my then doc put me on a statin. I’m too cheap to have had my cholesterol checked in the interim, but have my annual checkup later this week. So, we’ll see what the statin has done for me. I do want to lose a few pounds, 7 or 8 probably. So will continue to watch your progress.

  5. This is very interesting to me. I recently had all of my lab work and came back very healthy. But, Izzy can’t eat any dairy and Julian won’t eat any meat. The idea of everyone eating the same thing each night is appealing. Did the whole family adopt this diet with you?

    • glasshospital

      February 9, 2010 at 6:40 pm

      My wife likes the fringe benefit of getting to eat the healthy vegetarian meals that I prepare. The kids, well, not so much.
      They’re very interested in my newish diet and why I’m eating differently, so I think it’s had some educational value. We’ve talked a lot about healthier choices and food that both tastes good and is healthy. They’re pretty stubborn about white pasta and meat, though, and I’m not ready to force them to change. Yet.

  6. Good for you for walking the talk…. And it paid off! Keep it up!!!

  7. What about exercise? Isn’t that a big part of a long-term, sustainably healthy lifestyle?

  8. glasshospital

    February 10, 2010 at 9:54 am

    RobH: thanks for the softball. To answer your questions,

    1. Exercise is crucial.
    2. Yes!!

    In trying to keep the post brief, I focused on what is for me is the more radical lifestyle modification component–diet. But exercise is also key.

    Engine 2 diet author Esselstyn, a collegiate All-American swimmer at U Texas and professional triathlete for a decade, gives exercise plenty of attention. A brief middle section in the book emphasizes exercise–his recommendation is at least three aerobic workouts per week in addition to two calisthenic/weightlifting sessions. All of these should be a minimum of 20-30 minutes. He has beginner exercises and suggestions for the more fit. You can build up to a lot more, but he sets this as a minimum.

    As part of my ‘lifestyle modification,’ I’ve been much more rigorous and reliable in my exercising, which has undoubtedly contributed to my numbers.

  9. My husband’s cholesterol also plummeted via changing his eating habits, but by eliminating all sugar, white flour, and potatoes per the advice of his physician. Unfortunately, he still eats way too much meat.

    • glasshospital

      February 22, 2010 at 2:23 am

      Your comment shows that there are many ways of improving cholesterol through dietary measures.

      What surprised me was that over the years as I’ve cut back on red meat in favor of chicken, turkey, and fish, is that though they are much LOWER in saturated fat than red meat, they still generally contain a lot of saturated fat and cholesterol.

  10. Great article, thank you. I am very interested in finding a diet that lowers my sugar intake. I currently have a sweet-tooth, and am finding it difficult to find meal plans, what to eat for snacks, etc. While diabetes is not something that runs in my family, I am still concerned and would like to be smart and take a proactive approach to my health.

  11. I would suggest looking at http://drmcdougall.com (and Dr. John McDougall’s books). Dr. McDougall has worked closely with Rip and his father over the years. Dr. McDougall has promoted a low fat vegetarian lifestyle for years.

  12. Congrats on your improved health, keep it up. Based on this post and the fact that you are a doctor I think you would like the book “The China Study” by T. Colin Campbell. I’d like to hear your opinion on the book.

  13. Thank you for this post! Dr. Esselstyn is on the Advisory Board for the American College of Lifestyle Medicine, as is Dr. McDougall. It is nice to see their good work promoted by such a great personal testimony.

  14. Well done, but as a committed low-carber I believe you have achieved this by cutting out sugar and refined carbs. Unless you have an real reason to be veggie due to animal rights of something try adding in saturated fats (not polyunsaturated) and meat, dairy and eggs and I bet your blood numbers would stay just as good, cut back on the grains and you could even improve them further – maybe test it for 4 weeks – you can always go back to your current way of eating. But I guess the key is to find something you can do forever without feeling hungry. Higher fat and protein is satisfying and markedly reduces hunger. Please read to low carb literature too and you might just give up the low fat myth. And if you are committed vegetarian now you can follow a vegetarian low carb diet – which is probably what you have been doing to be honest. But it is cutting the refined carbs that have achieved you your health not cutting the fat, meat and diary.

  15. It’s nice that this diet makes you feel better Doctor, but I strongly suspect that anyone who gives up the worst of the SAD (Standard American Diet) feels much better for at least a while. The lowered cholesterol level is impressive, but I think you should do a little research on all cause mortality for very low cholesterol levels, which you have now achieved. More is better does not necessarily apply to lowering cholesterol levels.

    You might also be interested in recent research showing that saturated fats do not contribute to CVD, such as this one from Dr. Ronald Kraus, one of the leading lipid researchers in the world, which states that “A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.” The research was conducted by Dr. Kraus’ team at Children’s Hospital in Oakland, and with researchers at Harvard.

    http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1

    This is just one piece of evidence I have come across recently that seems to indicate the erosion of belief in the lipid hypothesis.

    From the Children’s Hospital Oakland Research Institute Oakland CA (PWS-TRMK)the Departments of Nutrition (QSFBH)Epidemiology (FBH) Harvard School of Public Health Boston MA.

  16. The last statement in the article cited by Lee is crucial.

    “More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.”

    It is a consistent finding of clinical trials is that replacing saturated fat with refined carbohydrates does not lead to improved cardiovascular health. However, most studies show that replacing saturated fat with polyunsaturated fat DOES lead to improved cardiovascular health.

    There are many studies which compared persons eating a high saturated fat meal with those eating polyunsaturated fat meals show that the persons eating high saturated fat shows impaired arterial health.

    In contrast to Eleanor Bell, high fiber foods provide much more satiety than high saturated fat foods. The animal foods she suggests eating provide absolutely no fiber. Foods like this also promote constipation. It is also crazy to suggest that not eating whole grains with its soluble fiber is good for heart health. There are zillions of studies which demonstrate that soluble fiber, such as found in oatmeal, lowers cholesterol. I think the Atkins crowd, out of complete ignorance, confuses fiberless refined grains with whole grains. Beans, which are also not allowed on the Atkins diet, have a lot of fiber that meat does not have and therefore promote heart health.

    I think the example of Robert Atkins pretty much demolishes the worth of his diet. He died of heart disease and he had a body mass index of 26- exactly where glass hospital started.

    • Daniel, you would do well to check your facts before posting. Dr. Robert Atkins died after incurring a head injury and a heart infection. His heart trouble was not related to his diet, although the committee of physicians sponsored by PETA, PCRM, certainly promulgated that myth.

      High fiber foods might promote satiety for you, but they promote gas for most people, when eaten in excess.

      My blood work has been flawless since I started eating copious amounts of coconut oil, organic butter, organic egg yolks, and the occasional drizzle of olive oil and bacon fat. There’s nothing more satisfying than paleolithic style eating, and I suspect the doctor’s improvement in health came about due to giving up the “white stuff.” Excess sugar is, after all, causes synthesis of the “bad” blood lipids, and inflammation.

      It is likely that Dr. Schumann would have achieved similar good results eating organic, full fat animal products whilst scaling back the carbs from legumes and grains.

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