Going on ten years ago now, I had the pleasure of seeing Dr. Caldwell and Anne Esselstyn present on plant-based eating. The plant-based diet, which they began many decades ago, means eating only those items that belong to the category of “intact” carbohydrates, i.e., carbs with an intact fiber matrix. The plant-based diet is similar to the vegan diet, with several exceptions as enumerated below.
Intact carbs are rich in fiber, and consist of four subcategories: vegetables, beans, fruits and [whole] grains. Besides fiber, a second major feature of intact carbs is their color. No other food group has such a tremendous variety of colors. Each color represents its own phytonutrient; the more colorful your meal, the more antioxidant power your diet provides. All good.
In contrast to intact carbs, “stripped” carbs have had their fiber matrix removed. Like most popular diets, the plant-based diet recommends limiting stripped carbs: white flour, white rice, corn starch and syrup, sugar, and the like. It’s not a coincidence that white flour looks exactly like corn starch and powdered sugar; the original identities of these products have been stripped away, so all that remains is a pile of white powder. This category of stripped carbs consists primarily, though not exclusively, of grains whose fiber has been removed. The stripping process also results in significant losses of other nutrients.
Have you ever thought about why it is so easy to take a second slice of cake, to finish off a whole plate of cookies, or to make your way through a giant-sized box of candy at the movies? These items may taste great, but it’s nearly impossible to feel satisfied on a product with little or no nutritive value. So your brain tells you to keep eating. There are few, if any, stripped carbs in the plant-based diet. Like black bean soup on a cold day, nutritious calories tend to be satisfying.
The Esselstyns also recommend 6 servings daily of green, leafy vegetables. That would include vegetables like kale, lettuce, broccoli, arugula, cabbage, purslane, alfalfa sprouts, kohlrabi, Brussels sprouts, and even dandelion greens. I recall that they recited a long and impressive list of greens at their presentation. What about greens is so special? Although you can’t see it with your naked eye, green leaves aren’t just green. They contain many other colors, along with their corresponding phytonutrients. But those other colors are masked by the bright green, so you cannot actually see them. In other words, you get a lot of bang for your nutritional buck when you eat greens.
Over the years, the Esselstyns have taught the plant-based diet to many people, mostly a select group diagnosed with severe vascular disease, and often at a comparatively young age. The members of this group have tended to be 1) poor surgical candidates for one reason or another; 2) already on maximal medical therapy; or 3) individuals who strongly prefer to heal themselves without medication or surgery. The phrase “severe vascular disease,” also called “hardening of the arteries,” refers to people who may have had a heart attack, stroke, or other blockage (such as in the legs), especially while still relatively young, which I might call under 50. Erectile dysfunction (blockage in the penile artery) and certain types of dementia are other consequences of vascular disease. In individuals who start immediately and adhere strictly, the plant-based diet has been shown to reverse these conditions.
At the presentation, I learned a few tricks: recipes like frozen mango and banana sorbet; salad dressing made from hummus, mustard, balsamic vinegar and the juice of an orange; and romaine lettuce hearts for scooping hummus when traveling on the road. The plant-based diet meets all the criteria to which I myself adhere. Here is what I like most about it:
1) Intact carbs only, and no stripped carbs except for special occasions.
2) Nourishing fats only, and no ultraprocessed fats. In the Esselstyns’ case, they interpret this to mean that it’s okay to eat a small amount of olives and nuts. I draw my circle more broadly, but I agree: no ultraprocessed fats of any kind.
3) High-quality protein only. On a plant-based diet, that means beans only. As the Esselstyns say: “Nothing with a face. Nothing with a mommy.” Beans, or legumes, are therefore their primary source of protein.
Like vegans, I part company with the Esselstyns in a few specific ways. Unlike vegans, who include avocados, olive oil, dark chocolate, and nut butters in their diet, the Esselstyns avoid fats almost completely. Except for a small amount of olives and nuts, they eat virtually no fats, including olive oil.
Frankly, this doesn’t sit right with me. I’m simply not convinced that it’s necessary for everyone to avoid olives, olive oil, avocados, sesame seeds, dark chocolate, or deep-sea fish, not to mention the occasional egg. Of course my patient population was quite different from theirs. While my patients were trying to prevent the development of serious disease, they were trying to reverse serious disease in patients already manifesting its symptoms. Clearly, they see the removal of all fats as an essential step in the reversal of severe vascular disease. But is it possible that the glut of ultraprocessed fats and relative lack of nourishing fats is what got their patients into such trouble in the first place?
I think about protein slightly differently as well. I do adore beans of all kinds (chickpeas, edamame, lentils, tofu, peanuts, adzuki, great northern, cannellini, black — you name it), and I incorporate a great many into my diet. Nevertheless, 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 not be wise to eat large amounts of meats, game, poultry and fish, but I do believe there is a huge difference between sometimes and never. And if higher costs lead us to eat quality meats less often and in smaller quantities, perhaps that’s a compromise worth making.
One last thing — the Esselstyns eat oatmeal for breakfast every day. I am not sure whether it’s necessary to restrict yourself when you could be rotating among amaranth, buckwheat, barley, bulgur wheat, brown rice, millet, and other grains to potentially enhance your nutritional profile. In years to come, perhaps we will discover that certain populations’ genetic inheritances predispose them to thrive with certain food sources. For example, marine fish and mammals eaten by individuals whose ancestors originated in northernmost climates supplied a diet high in particular types of fat. Are their descendants likely to benefit from a diet that includes these nutrient sources? Other communities, notably from Central America, thrived on diets containing beans, squash and corn. Each different food supplies its own nutrients. I wonder if the greater the variety of fruits, vegetables, beans and grains you eat, the more thoroughly you nourish yourself. To be well, and well nourished, is a worthy goal.