Caldwell Esselstyn

What Caldwell says, topic by topic

Vitamin B12

In a talk posted in 2009, Esselstyn named folate, B6 and B12 as the nutrients that keep homocysteine, a heart risk factor, in check, and said it should not be a problem on a sensible plant based diet¹.

His 2014 paper on 198 heart patients reports that the program encouraged them to take a multivitamin and a B12 supplement². His site’s FAQ, as read in 2026, still asks for B12 but calls a multivitamin unnecessary for people who eat large amounts of leafy greens³.

What all the experts say about vitamin B12

Vitamin D

His FAQ sets no routine dose. It advises a blood test for vitamin D and a supplement only as needed to keep the level in the low normal range⁴.

What all the experts say about vitamin D

Omega-3 fats

In a 2012 video with T. Colin Campbell, Esselstyn argued that people are not short of omega-3, pointing out that fish get theirs from algae, and named green leafy vegetables and flaxseed meal as the sources for his patients⁵. His 2014 paper says patients were advised to use flaxseed meal as an extra source of both omega-6 and omega-3 fats².

His FAQ says fish oil is not essential, adds that it raises the risk of bleeding and that studies now show no benefit for heart patients, and finds one to two tablespoons of ground flax or chia a day enough⁶. It rules out flaxseed oil⁷.

What all the experts say about omega-3 fats

Oil

No added oil is the best known rule of his program. In a talk posted in 2009 he put it first on the list of what to leave out, next to fish, fowl, meat and dairy⁸. He argued that short studies showing olive oil improving cholesterol had misled doctors, and cited longer studies in people and in monkeys where arteries clogged as much on monounsaturated fat as on saturated fat⁹.

He names every kind. In a lecture posted in 2014 he listed olive, corn, soybean, safflower and sunflower oil, and the oil hidden in crackers, bread and dressings¹⁰; on a 2023 cooking show he added coconut and palm oil¹¹. In his 2014 paper patients counted as adherent only if they gave up added oil along with meat, fish and dairy².

His FAQ says oils injure the endothelium, the inner lining of the arteries, and calls all oil empty calories¹². It has no objection to skin lotions that contain oil¹³.

What all the experts say about oil

Protein

In the 2012 video he said that people who eat a variety of whole grains, beans, vegetables and fruit will not run short of protein¹⁴. His 2014 paper reassured patients that varied plant foods cover their amino acid needs².

His FAQ advises against protein drinks, calling the extra protein unnecessary and possibly harmful when it comes from animals¹⁵.

What all the experts say about protein

Calcium, dairy and bones

His FAQ calls calcium supplements unnecessary, saying whole grains, legumes and above all leafy greens supply plenty¹⁶.

He excludes all dairy. In the lecture posted in 2014 he named every dairy food, from milk and butter to cheese, yogurt and ice cream, among the foods that injure the arteries¹⁰. His FAQ rules out fat free milk and yogurt as well, on the ground that all animal protein harms the artery lining¹⁷.

What all the experts say about calcium, dairy and bones

Nuts, seeds and avocado

In his 2014 paper nuts and avocado were on the list of foods the program avoided².

In a webinar with John McDougall recorded in December 2018, Esselstyn said he had long seen saturated fat as the main culprit in heart disease and found a lot of it in nuts¹⁸. He called nuts addictive and said he rarely sees a patient eat just one¹⁹. He said his book does not object to nuts for people without diagnosed heart disease, but that once the disease is established he wants none, since no study has shown nuts reversing serious heart disease²⁰. He also said many published nut studies were funded by nut companies²¹.

His FAQ puts the line in numbers: people with no heart disease who keep total cholesterol at 150 and LDL at 80 or lower without drugs may have some nuts and avocado, and chestnuts, being very low in fat, are allowed²². One to two tablespoons of ground flax or chia a day are fine for everyone, heart patients included²³.

What all the experts say about nuts, seeds and avocado

Salt

In the 2012 video he cited the Framingham finding that most people with normal blood pressure at 50 had high blood pressure by 70, and said plant based eating helps keep it under control, above all once salt is cut out²⁴. His 2014 paper lists excess salt among the foods the program avoided².

What all the experts say about salt

Sugar

His 2014 paper asked patients to avoid sugary foods such as sucrose, fructose, refined carbohydrates, fruit juice and syrups, and says caffeine and fructose were later excluded too². In the lecture posted in 2014 he listed maple syrup, molasses and honey taken in excess, and said fructose injures the cells lining the arteries²⁵.

In 2013 he told the dietitian Jeff Novick that he never meant an absolute sugar ban: he wants people to know sugar can harm the arteries and to cut back sensibly, without a fixed number²⁶. His FAQ rules out fruit juice, saying fructose separated from fiber is absorbed too fast, while whole fruit is fine²⁷.

What all the experts say about sugar

Starches

In a 2023 talk he listed what his patients eat: whole grains for cereal, bread and pasta, many kinds of beans and lentils, vegetables, white and sweet potatoes, and some fruit²⁸.

In 2013 Novick, after asking him, reported that Esselstyn fully supports intact whole grains and potatoes even for weight loss, and only advises people who struggle to lose weight to cut back on flour products such as bread, bagels and crackers²⁹.

What all the experts say about starches

Supplements

He wants protective substances to come from food. In the lecture posted in 2014 he said antioxidant pills bought at a health food store will not work and may do harm, so he relies on natural antioxidants instead³⁰. In the same talk he said patients eating large amounts of greens will not end up in an emergency room with a vitamin overdose³¹.

His written advice is short. The 2014 paper encouraged a multivitamin and a B12 supplement². His FAQ, as read in 2026, keeps B12, drops the multivitamin for people who eat plenty of leafy greens, and calls calcium pills and fish oil unnecessary³¹⁶⁶. For vitamin D it asks for a blood test first⁴.

What all the experts say about supplements

Fish and eggs

He puts fish with meat and fowl. In the 2012 video he said that all muscle, from animals with hooves, wings or fins alike, brings animal protein, cholesterol and fat³². In the 2023 talk he listed meat, fish, chicken, turkey and eggs among the foods to remove³³. His FAQ excludes egg whites as well, as animal protein¹⁷.

What all the experts say about fish and eggs

Fiber

His FAQ links fiber to how food is eaten. It opposes juicing because fruit sugar loses its fiber²⁷, and opposes smoothies because pureed food is not chewed, which he says matters both for the fiber and for the greens³⁴.

What all the experts say about fiber

Fruit

Fruit is part of his core diet, in a smaller role than grains, beans and vegetables: describing what his patients eat in the 2018 webinar, he ended the list with potatoes and some fruit³⁵. In the lecture posted in 2014 he said berries on cereal every day are great, while ranking green leafy vegetables above them for antioxidants³⁶.

His FAQ, as read in 2026, is about form: whole fruit is fine, fruit juice is not³⁷. People whose triglycerides rise are told to cut back on dried fruit, juice and too much fruit along with other simple carbohydrates³⁸.

What all the experts say about fruit

Vegetables and greens

Green leafy vegetables are the signature of his program. In the lecture posted in 2014 he named bok choy, Swiss chard, kale, collards, beet and mustard greens, spinach, arugula and others, and said nothing beats them for antioxidants³⁶. He asked heart patients to eat a cooked portion about the size of their fist, with a few drops of balsamic vinegar, at each meal and snack, six times a day³⁹. His 2014 paper says the program insisted on generous daily portions of greens².

In the 2023 talk he described the routine as six chewed servings a day of roughly a quarter of a fist, steamed or boiled for five and a half to six minutes, so the portion he named had changed since 2014⁴⁰. He gave three reasons: the vinegar’s acetic acid helps the enzyme that makes nitric oxide, greens help the bone marrow produce cells that repair the artery lining, and chewing lets bacteria on the tongue start turning the greens’ nitrate into nitric oxide⁴⁰. He added that fluoride toothpaste or water, mouthwash and antacids can get in the way of that pathway⁴¹.

In a talk posted in 2011 he cited an Okinawan study in which women given five extra servings of local leafy greens a day had higher blood levels of the cells that repair the artery lining⁴².

What all the experts say about vegetables and greens

Beans and lentils

Beans and lentils are one of the main food groups he asks patients to eat. His 2014 paper lists legumes and lentils with whole grains, other vegetables and fruit as the major part of the diet², and in the lecture posted in 2014 he spoke of the many kinds of beans patients can choose from⁴³. His FAQ, as read in 2026, tells people who lose too much weight or feel tired to eat more beans, lentils and whole grains to replace the calories that meat, dairy and oil used to supply⁴⁴.

What all the experts say about beans and lentils

Whole grains, bread and flour

Whole grains head his list of what to eat. In the lecture posted in 2014 he named whole grains for cereal, bread and pasta⁴³, and in the 2018 webinar he added rolls and bagels³⁵. In 2013 Novick reported, after asking him, that Esselstyn supports intact whole grains even for weight loss and only advises cutting back on flour products for people who struggle to lose weight²⁹. His FAQ lists white flour products among the simple carbohydrates to reduce when triglycerides are high³⁸.

What all the experts say about whole grains, bread and flour

Potatoes

In his 2009 talk he described the Papua New Guinea highlanders, heavy smokers whose arteries were found clean at autopsy after age 60, and said they lived on 19 varieties of sweet potato⁴⁵. In the 2018 webinar he listed sweet and white potatoes among the foods his patients eat³⁵, and in 2013 Novick reported that he supports potatoes even for people trying to lose weight²⁹.

What all the experts say about potatoes

Meat

He excludes all meat and poultry. In his 2009 talk he described how deaths from heart disease in Norway fell sharply when the occupying Germans took the country’s livestock in the Second World War, and rose again once the war ended⁴⁶. In the lecture posted in 2014 he said that anything “with a mother or face” injures the artery lining, naming meat, fish, chicken and turkey⁴⁷.

In the same lecture he cited Cleveland Clinic research showing that the gut bacteria of meat eaters turn compounds in animal foods into TMAO, a molecule linked to heart disease, while people fully plant based make none even after eating a steak; he said this validates the plant based approach⁴⁸. His 2014 paper makes the same point².

He rejects eating less meat as a halfway step. In 2009 he compared a cardiologist’s advice to have lean roast beef only once or twice a week to pouring gasoline on a fire⁴⁹.

What all the experts say about meat

Low-fat eating

His diet is very low in fat. In his 2009 talk he placed his program at about 11 to 12% of calories from fat⁵⁰, and said the American Heart Association’s allowance of 30% of calories from fat would cost millions of American lives⁵¹.

He distrusts fat free labels. In the same talk he described a patient who slipped after six years by eating packaged foods marked fat free, explained that US rules allow a zero fat claim when a serving holds under half a gram, and urged people to read ingredient lists rather than the label⁵².

What all the experts say about low-fat eating

Saturated fat

He sees saturated fat as a main cause of artery disease but does not accept unsaturated oils as the answer. In the 2018 webinar he said saturated fat was the culprit he had long focused on, and the reason he rejects nuts¹⁸. In 2009 he cited a human angiogram study and long monkey studies in which arteries clogged as much on monounsaturated fat as on saturated fat⁹. His FAQ, as read in 2026, says both kinds of fat in oils harm the artery lining⁵³, and advises against coconut water because of its saturated fat and sugar⁵⁴.

What all the experts say about saturated fat

Cholesterol

He sets low targets. In his 2009 talk he said he asked his first patients to keep total cholesterol under 150 and LDL under 80, the range he saw in rural China⁵⁵, and he told audiences, vegans included, to “know your numbers” and check them without drugs⁵⁶. He cited his own 2000 paper whose message was that in lowering cholesterol “moderation kills”⁵⁷, and asked why the large 1990s statin trials, which cut heart attacks by about 30%, were treated as success when 70% of events still happened⁵⁸.

He does not see numbers alone as protection. In a 2011 talk he pointed to the journalist Tim Russert, who he said ate poorly and was not protected by an LDL of 70 reached with a large statin dose, since what people eat matters more than the numbers⁵⁹. In a panel posted in 2026 he said statins do lower cholesterol and may slow the disease, but patients who rely on them often keep eating the western diet, so the injury to the artery lining goes on⁶⁰.

His FAQ, as read in 2026, is more flexible than his 2009 targets: it aims for LDL near 80 to 85 or lower, but says people who cannot take statins and stay around 95 to 105 on plant food seem to do fine⁶¹. It says HDL often falls on plant food and need not alarm anyone⁶², and describes statins as of modest value for prevention, of some help in established disease, and absent from many of his best reversals⁶³.

What all the experts say about cholesterol

Carbohydrates and low-carb diets

He separates whole starches from refined carbohydrates. His 2014 paper built the diet on whole grains and legumes while asking patients to avoid refined carbohydrates, sugars and syrups². His FAQ, as read in 2026, tells people with high triglycerides to cut simple carbohydrates such as alcohol, white flour products, sugars, dried fruit, juice and an excess of fruit³⁸.

What all the experts say about carbohydrates and low-carb diets

Coffee, tea and caffeine

In the lecture posted in 2014 he said he is “a little bit fussy on caffeine”, citing a 2010 Italian study in which young people given caffeinated coffee, but not those given decaf, showed impaired artery widening on the arm cuff test⁶⁴. His 2014 paper says caffeine was later excluded from the program².

What all the experts say about coffee, tea and caffeine

Juicing and smoothies

He is against both. His FAQ, as read in 2026, says not to juice, because fruit sugar separated from fiber is absorbed too fast²⁷, and to avoid smoothies, because blended food is not chewed, which he says matters for both the fiber and the greens³⁴. In the 2023 talk he made the same point about greens: patients should chew them six times a day, “not smoothies”⁴⁰.

What all the experts say about juicing and smoothies

Mediterranean diet

He does not see the Mediterranean diet as protection for the heart. In a talk excerpt posted in 2016 he compared his results with other studies: in the Lyon Diet Heart Study a quarter of patients died or had a heart attack or stroke within four years, against well under 1% recurrent events among his adherent patients⁶⁵.

In the 2018 webinar he gave his view of the PREDIMED trial: its Spanish participants had no diagnosed heart disease at the start, yet every group, including those given extra nuts or olive oil, had many heart attacks, strokes and deaths after five years, so he said the title should have spoken of creating heart disease rather than preventing it⁶⁶.

What all the experts say about mediterranean diet

Weight loss

In his program weight loss comes as a side effect. His 2014 paper reports an average loss of 18.7 pounds among the 135 patients whose weight was recorded², and in a talk excerpt posted in 2016 he gave the figure as about 18 pounds⁶⁷. In the lecture posted in 2014 he said patients know they will never gain weight from green leafy vegetables³¹.

His FAQ, as read in 2026, covers the opposite problem: patients who lose too much weight are told to eat more, with bigger portions, snacks and more grains and beans⁴⁴. For people who struggle to lose weight, Novick reported in 2013 that Esselstyn advises cutting back on flour products²⁹.

What all the experts say about weight loss

Cravings and food addiction

In his 2009 talk he cited a Monell Chemical Senses Center study that compared diets at about 34%, 20% and 11 to 12% fat, and said only the lowest fat group lost its craving for fat, after about 12 weeks⁵⁰. His FAQ, as read in 2026, says the brain’s fat receptor down regulates within 8 to 12 weeks, after which patients stop craving fat⁶⁸. He makes the same argument against nuts, which he calls addictive¹⁹.

What all the experts say about cravings and food addiction

Exercise

Exercise was left out of his first study on purpose. In 2009 he said structured exercise, meditation and relaxation were not part of the program, because he found that cultures free of heart disease owed it to their food, and because he wanted patients to spend all their capacity for change on diet; extra time on an exercise bike, he said, does not earn a hot fudge sundae⁶⁹. His 2014 paper says exercise was encouraged but not required². His FAQ, as read in 2026, suggests exercise to people who feel tired on the diet⁷⁰.

What all the experts say about exercise

Heart disease

Heart disease is the centre of his work. In a talk posted in 2007 he explained that most heart attacks come not from the tightest blockages but from smaller plaques whose thin cap tears and sets off a clot⁷¹. He called the disease a “paper tiger” that need not exist, and said a change of diet can make a person heart attack proof, so the cap no longer ruptures, in about three or four weeks⁷².

His evidence comes from his own patients. In 2009 he said the 18 patients who stayed in his first study had suffered 49 cardiac events in the eight years before it, and 17 of them had none over the following 12 years⁷³. He also showed PET scans in which blood flow to the heart muscle improved within weeks of patients lowering their cholesterol⁷⁴. His 2014 paper followed 198 patients: 177 kept to the diet and had one recurrent event, a stroke, while 13 of the 21 who did not keep to it had adverse events².

He is critical of stents and bypass outside emergencies. In a 2011 talk he said stents can save lives during a heart attack but otherwise neither prevent future attacks nor prolong life, and he estimated the yearly deaths from stents and bypass operations⁷⁵. His FAQ, as read in 2026, says patients who are not emergencies should first try an intensive plant based program instead of surgery⁷⁶.

What all the experts say about heart disease

High blood pressure

In the 2012 video he cited Framingham data showing that 90% of 1,000 people with normal blood pressure at 50 had high blood pressure by 70, and said plant based eating helps control it, especially without salt²⁴. On the 2023 cooking show he said nitric oxide from a healthy artery lining keeps the artery wall from becoming thick, stiff or inflamed, and so protects against high blood pressure⁷⁷. He described high blood pressure, diabetes, heart disease and stroke as the names doctors give to injuries from food that build up over many years⁷⁸.

What all the experts say about high blood pressure

Cancer

Cancer is what first turned him to nutrition. In 2009 and again in a lecture posted in 2014 he said that as a breast cancer surgeon at the Cleveland Clinic he grew frustrated that surgery did nothing for the next patient⁷⁹. Looking abroad, he found breast cancer far rarer in Kenya and in rural Japan in the 1950s, rising to American rates in the descendants of Japanese migrants, and only 18 autopsy proven prostate cancer deaths in all of Japan in 1958⁸⁰. He put the Kenya gap at 20 times in 2009 and at 30 to 40 times in 2014⁷⁹⁸⁰.

He chose to study heart disease because he expected quicker results, hoping that people who ate to save their hearts would also be less likely to get the breast, prostate, colon and pancreatic cancers that are common in the West⁸¹. In a 2021 panel he described cancer as a matter of initiation and promotion⁸², and cited Dean Ornish’s lab finding that blood serum from people eating plant based slowed prostate cancer cells far more than serum from omnivores⁸³. His FAQ, as read in 2026, says plant based eating greatly lessens prostate cancer, citing the Japanese figure from 1958⁸⁴.

What all the experts say about cancer

Dementia and the brain

He links dementia to damaged blood vessels. In his 2009 talk he cited a Swedish study in which a third of people over 85 had dementia, half of it from vascular disease, and MRI research from 2001 showing small white spots, tiny strokes, in the brains of Americans from about age 50⁸⁵. In the 2012 video he said plant based eating could greatly reduce senile dementia, since it protects the vessels of the brain as well as those of the heart⁸⁶.

He also warned in 2009 that bypass surgery can loosen debris from the aorta that travels to the brain, and cited a report that many bypass patients lose part of their cognitive capacity⁸⁷.

What all the experts say about dementia and the brain

Longevity and aging

In his 2009 talk he said arteries at 90 should look as they did at age nine⁸⁸. In the 2023 talk he said the artery lining’s production of nitric oxide falls with age, to half by 50 of what it was at 25 and by 70% at 80, which is why he increased the greens in his program⁸⁹. In a panel posted in 2026 he described his oldest patient, who started the program at 87 after being told he needed bypass surgery and was still phoning at 103⁹⁰.

What all the experts say about longevity and aging

Each small number links to its reference at the bottom of the page: the video at the exact second, or the page where it was said.