I had the pleasure last week of hearing Dr. Caldwell and Anne Esselstyn speak on plant-based eating. Their strategy, which works beautifully for them, is to include among their food options only those items that belong to the macronutrient category I term “intact carbohydrates,” i.e., carbs with an intact fiber matrix. This is in contrast to “stripped carbs,” which have had their fiber matrix removed. Their diet is very similar to the vegan diet, with one major exception as enumerated below.

Intact carbs are rich in fiber, and consist of these four food categories: vegetables, beans, fruits and [whole] grains. In addition to fiber, a second major benefit of intact carbs is their color. No other food group contains fiber, and no other food group has such a tremendous variety of colors. Each color represents a different phytonutrient, so the more colorful your food, the more antioxidant power your diet will provide. All good.

Like virtually every other popular diet out there, the plant-based diet recommends that you avoid stripped carbs. Stripped carbs include white flour, white rice, corn starch & syrup, and sugar. I concur! The stripped carb category consists primarily of grains whose fiber has been removed. The stripping process also results in the loss of significant numbers of other nutrients. Have you ever wondered why it’s so easy to take extra helpings of dessert, to eat a whole plate of cookies, to finish off an enormous box of candy at the movies? These things may taste great, but it’s very difficult to get full or feel satisfied on a product with little or no nutritive value. So your brain tells you to keep eating. There are very few if any stripped carbs in the plant-based diet.

The Esselstyns recommend, specifically, that you get six daily servings of green, leafy vegetables. That would include the many varieties of kale, lettuce, and even dandelion greens. Although you can’t see it with your naked eye, green leaves aren’t just green. They also contain a lot of other phytonutrients, with their corresponding colors. But they are masked by the bright green, so you can’t see them. Just remember that even though you can’t see them, they’re still there. You get a lot of bang for your nutritional buck when you eat greens. The Esselstyns are big fans of oats, too, and they eat them for breakfast pretty much every day. 

Dr. Esselstyn has taught his dietary strategy to a select group of lucky individuals who have found their way to him. This is a very specific group of people, all of whom unfortunately have developed severe vascular disease, often at a very young age. In addition, they are either 1) poor surgical candidates for some reason, or 2) already on maximal medical therapy, or 3) of the opinion that they strongly prefer to heal themselves without medication and/or surgery. The phrase “severe vascular disease” is also known as “hardening of the arteries.” It refers to people who have had a heart attack, stroke, or other blockage (such as in the legs), especially while still relatively young, which I would define as about 50 years old or younger. Erectile dysfunction (from blockage in the penile artery) and certain types of dementia are two additional well-described consequences of vascular disease. In those individuals who start immediately and adhere to it strictly, the plant-based diet has been shown to have a remarkable ability to reverse these conditions.

Anne Esselstyn provided some great food suggestions, including sorbet made from frozen mangoes and bananas; a salad dressing made with hummus, mustard, balsamic vinegar and the juice of an orange; and romaine lettuce hearts for scooping hummus while traveling on the road. Here’s what I like about this diet, which meets all the criteria to which I adhere:

1) Intact carbs only, and no stripped carb (unless it’s a very special occasion).

2) Nourishing fats only (they eat a tiny bit of nuts).

3) High-quality protein only (just beans on the plant-based diet).

I part company with the Esselstyns in a few specific ways. The first is with regard to the macronutrient category of fats. In contrast to vegans, who usually include avocados, olive oil, dark chocolate, nuts and nut butters in their diet, the Esselstyns avoid fats almost completely. Except for a very small amount of nuts, they eat virtually no food from the fats/oils category, even olive oil. Frankly, this doesn’t sit right with me. I’m simply not convinced that it’s necessary for absolutely everyone to avoid olives, olive oil, avocados, sesame seeds, dark chocolate, or deep-sea fish. Maybe it’s a necessary step in the reversal of severe vascular disease. Maybe the lack of these nourishing fats, in favor of highly processed industrial fats, is what got these patients into trouble in the first place. Can’t say, don’t know.

Next, I think about protein differently as well. While I adore beans (hummus, edamame, lentils, tofu, peanuts and more), and I incorporate as many as possible into my own diet, when it comes to animal protein, I believe there is an enormous difference between grain-fed vs. grass-fed, farmed vs. wild, confined vs. pastured, feedlot vs. free-range. It may or may not be smart to eat meats, game, fish and poultry frequently, but I think there is a huge difference between sometimes and never.

Most of the protein in the plant-based diet comes from beans, which constitute the single high-protein food in this approach to eating. Remember that beans/legumes are also the only high-protein item in the category of intact carbs. The Esselstyns like to say they eat “nothing with a mommy and nothing with a face.” Very cute. And one quick look will tell you everything you need to know about the plant-based diet: it is working for them.

The only other comment I have about their diet is about the fact that they eat oats every day. Why restrict yourself when there are so many different kinds of grains from which to choose? I think it’s unwise to eat only a single grain when you can also be eating amaranth, buckwheat, barley, bulgur wheat, brown rice, millet, oats and more. In a way, this reminds me of the agribusiness-related standard American dietary preoccupation with soy, wheat and corn. It’s not good nutrition to restrict your options unnecessarily.

In the years and decades to come, as we learn more and more about genetic differences, I expect we will discover that certain populations with particular genetic inheritances do better with certain specific types of diets whereas others function better with different types of diets. Clearly, the marine fish and mammals eaten by individuals whose ancestors came from the northernmost climates supplied a diet very high in certain particular types of fat. It makes sense to me that their descendants are likely to benefit from a diet that continues to include some, if not many, of these nutrient sources. Certain other communities of individuals, notably those from Central America, thrived on a diet consisting primarily of beans, squash and corn. Vive la différence! In the meantime, you must figure out what works best for you by trial and error. Do your best, and keep trying.

Finally, remember that every different food you eat supplies a different nutrient profile. The greater the variety of fruits, vegetables, beans and grains you eat (not to mention protein and fats), the more thoroughly you nourish yourself. To be well and nourished is a worthy goal.