A doctor discovers the heart-smart joys of eating vegan

by Carolyn Thomas  ♥ @HeartSisters

Dr. John Henning Schumann, who blogs at the always-intriguing Glass Hospital, is a general internist and medical educator at the University of Oklahoma School of Community Medicine. This year, he made a personal New Year’s resolution to become a vegetarian. Or a ‘mostly vegetarian’, as he calls it.

“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 pounds 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 (!).  (Note: To convert from American to Canadian units, just divide by 40).

“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.”

Dr. Schumann heard about a book called The Engine 2 Diet by a Texas firefighter and former pro triathlete named Rip Esselstyn.  He bought the book, and over a four-week period, reports these changes in his eating habits as a result:

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!).”

He says that his typical daily diet would now look something like this:

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

• Lunch: vegetables, hummus, whole grain rice cakes, soy yogurt, legumes

• Snacks: nuts, fruit

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

Dr. S explains that this menu varies week by week, and that he tends to make “a big pot of something delicious on Sunday, and then freeze some for a future quick meal and eat some leftover during the week”.

Staying on such a diet requires planning, he warns. He needed to change the way he shopped for groceries, and to scour nutrition labels more carefully than ever before. By planning ahead, he always kept a small nutritious snack (e.g. a handful of healthy nuts) at the ready instead of resorting to junk food.

How did he do?

“After exactly four weeks of this new regime, (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.”

Make no mistake – Dr. John’s program is based on a “diet book”, those four-letter words that together describe advice that doesn’t work longterm.

Rip Esselstyn’s book and diet program in fact recommend this for a 28-day period. Any book that pushes a miracle weight loss plan for a limited time (LOSE TEN POUNDS IN TEN DAYS! LOSE FOUR POUNDS BY THIS WEEKEND!) is not a realistic way to live healthily for the rest of your natural life.

The no-fish* rule of this essentially vegan diet may also be controversial for heart health. A 1999 meta-study published in the American Journal of Clinical Nutrition, for example, compared vegetarian and non-vegetarian mortality rates in Western countries. (Appleby P.N. et al. “The Oxford Vegetarian Study: An Overview”, American Journal of Clinical Nutrition, 1999, 70 (suppl):525S–531S).  Researchers found that in comparison with regular meat eaters, mortality from ischemic heart disease was:

• 34% lower in pescetarians (those who do eat fish, eggs and dairy)
• 34% lower in vegetarians (eat eggs and dairy)
• 26% lower in vegans (no meat, fish, eggs, dairy)
• and 20% lower in occasional meat eaters

And the ‘no oil’ recommendation** in the Esselstyn diet should also raise red flags all over the field.  As the Canadian Dietetic Association recommends:

“Your body needs fat for many important functions. Replacing saturated and trans fat with healthier unsaturated fats can help improve your cholesterol levels and lower your risk for heart disease and stroke. Unsaturated fats include monounsaturated and polyunsaturated fats.“

The core of this Esselstyn diet likely came naturally to the Texas firefighter/author. His Dad is one Dr. Caldwell Esselstyn of the Cleveland Clinic Wellness Institute, who himself has followed a plant-based diet for decades.

The senior Esselstyn has been well-known for his advocacy in promoting lifestyle changes to manage heart disease instead of aggressive surgical or drug treatment options. He’s also the author of the book Prevent and Reverse Heart Disease, along with some controversial medical journal publications like Is The Present Therapy For Coronary Artery Disease the ‘Radical Mastectomy’ of the 21st Century?” (Am J Cardiol. 2010 Sep 15;106 (6): 902-4)

If you decide, like Dr. John Schumann did, to give this diet a try, consider these cautionary warnings from nutritionists Susan Dingott and Dr. Johanna Dwyer, originally published in Nutrition Forum.

“Unless they choose a proper balance of foods, strict vegans are at risk for several deficiencies, especially vitamin B12. Since B12 is present only in animal foods and a limited number of specially fortified foods, dietary vegans should probably take B12 supplements prescribed by a physician. The other nutrients at risk are riboflavin, calcium, iron, and the essential amino acids lysine and methionine.

“Small amounts of animal foods, such as milk and eggs, also increase the bioavailability of iron from plant foods eaten at the meal.

“Plant sources of iron include dried figs, prunes and raisins, pumpkin seeds, sesame seeds, and soy nuts. Iron-fortified cereals also are good sources of iron. To ensure that iron intake is satisfactory, eat good sources of vitamin C, such as tomato, broccoli, melon, or orange or other citrus juice at each meal. These foods enhance absorption of the iron in legumes and grains by making it more soluble.

Since B12 is present only in animal foods and a limited number of specially fortified foods, vegans should probably take B12 supplements prescribed by a physician.”

See also: 

• Here’s Your Basic Heart-Healthy Grocery Shopping List
• Vegetarian-Friendly Religions
• De-Junk Your Kitchen to Start Heart-Smart Eating
• Mediterranean Diet: It’s All Greek to Me