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Rip Esselstyn Talk on Engine 2 Diet

This article is derived from personal notes made during a talk by Rip Esselstyn in Palo Alto in June 2012. Rip is the author of The Engine 2 Diet: The Texas Firefighter's 28-Day Save-Your-Life Plan that Lowers Cholesterol and Burns Away the Pounds (288 pages, 2009). For this article, I dug out other articles, medical studies and YouTube videos that support the points made by Rip.

In 2012, Whole Foods is heavily promoting its Health Starts Here — 28-Day Challenge program. Engine 2 Diet principles lie at the core of this program: see Four Pillars of "Health Starts Here" for details.

Curiously, Rip never defined the term 'plant-strong' during his talk. I imagine it means eating lots of vegetables, fruits, grains, beans, herbs, seeds and nuts. Many issues related to diet were untouched. For example, how much to eat raw, how much to cook, in what proportion to mix ingredients, how much water to drink, and so on, were not discussed. Perhaps these are addressed in his book, which I have not read. Still, Rip's talk was insightful. Through this article, I share these insights with others.

Rip's Personal Story

Much of Rip's talk revolved around his personal story. During his formative years, Rip's family ate plenty of meat and dairy. His life journey is in four phases:

1) Professional Triathlete: In 1986, at the age of 23, Rip started competing in triathlons. At the start of his career, he switched to a plant-strong diet. He was influenced by two individuals: (a) Dr Caldwell Esselstyn, his dad, whose research had demonstrated that plant based diet was key to prevention and reversal of heart disease, and (b) Dave Scott, a legendary triathlete, who was vegan.

2) Fireman: By 1997, Rip had spent eleven years as a professional triathlete. He was 34 and decided to get a "real job". He became a fireman in Austin, Texas. At that time, he was the only plant-strong firefighter in the entire state of Texas! He was endlessly ridiculed by his fellow firemen for his food habits.

Rip noticed that 80% of firefighting was actually in response to medical emergencies involving diseases caused by modern diet and lifestyle. These includes cardiac arrests and alcohol related incidents.

One day, Rip had a bet with his fellow firefighters. They would all get tested and find out who had the lowest cholesterol levels. When the results came out, a fireman named "JR" had a cholesterol level of 340. JR was distressed. Out of solidarity for JR, his teammates decided to adopt Rip's plant strong diet for a limited number of days. Pretty quickly, JR's cholesterol dropped to 196. Others improved too. These changes encouraged Rip's team to continue eating plan-strong foods at the firestation. Rip described his "vegetarian firehouse" as an "island of health in a sea of fast food restaurants".

3) Writer: The story of a bunch of Texan firefighters adopting plant-strong diet was too fascinating. It was picked up by the local newspaper, then some other media magazine. Finally, the New York Times published an article: Firefighters Gone Vegan? Even Austin Is Impressed. Rip said that the publication of the New York Times article triggered an avalanche of phone calls and requests for media appearances and book writing. At first, Rip thought that he had no innate talent for public speaking or book writing. However, in a few weeks, he changed his mind and agreed to write a book. He felt that he had the potential to connect with at least some segments of the American population, especially the firefighting community. In fact, he felt that he had a moral obligation to reach out to others and help them improve their lives. The book writing effort took a few years, culminating in the The Engine 2 Diet (288 pages, 2009).

4) Partnership with Whole Foods: In 2009, Rip left his job as a firefighter. The book's success brought him in touch with Whole Foods, who has licensed the 'Engine 2 Diet' brandname and is now coming up with an impressive array of hundreds of products aligned with the 'Engine 2 Diet'.

Overview of Modern Diseases

Plant Weak Diets: Only 12% of calories in the Standard American Diet come from plants. Half of these, about 6% of calories, are from french fries. So only 6% of calories are derived from fruits, vegetables, nuts and seeds.

Preventable and reversible diseases: Five diseases contribute to 75% of total healthcare cost in USA, which is about 2.3 trillion USD (about 15% of GDP). These diseases are heart disease, breast cancer, prostate cancer, obesity and diabetes. According to Rip, each of these diseases is preventable or reversible by adopting a plant-strong diet:

Heart Disease: Rip shared with us a bunch of statistics (CDC Heart Disease Facts has many more):

  1. About half of us (Americans) will die of heart disease.
  2. About half of the heart attacks result in instant death.
  3. About 15 million Americans are taking statins to control cholesterol. Only that subgroup of people with prior heart attack will actually have a significant positive effect! Among others, only 1 out of 100 people taking statins benefit over two years. This comment by Rip prompted a friend and me to explore statins further — see the section titled 'Efficacy of Statins'.
  4. Only about 10% of heart attacks occur due to blocked arteries. The other 90% of heart attacks occur because a little 'juvenile plaque' that looks like a pimple on the inside of the arteries, ruptures and the resulting fluid blocks off the artery. So even if arteries are not significantly blocked, the risk of heart attack is not low because the true health of arteries should be measured by how many such 'juvenile plaques' (pimples on the inside of the arteries) are present — these are time bombs that can go off any moment. Caldwell Esselstyn's Talk on Reversing Heart Disease explains this mechanism quite clearly.
  5. Bypass surgeries entail grafting a vein from the leg and placing it in the heart to bypass clogged arteries. Rip mentioned that these procedures do little or nothing to extend life. Most patients do not know that a large fraction of bypass surgeries fail within the first 18 months.

Breast and Prostate Cancer: Cancer is projected to surpass heart disease as #1 killer of America in a few years. We have been pouring money into cancer since Nixon declared a 'war on cancer'. Rip jested that we are 'flying for cure', 'walking for cure', 'climbing for cure' (referring to charity efforts to collect funds for cancer research), without realizing that cure lies in eating the right foods!

For cancer, the Talk by Dean Ornish is quite informative. Studies have demonstrated that early stage prostate cancer can be reversed by diet and lifestyle changes alone. An interesting aspect of such research is that gene expression of cancer promoting and cancer inhibiting genes can be controlled by the food we put into our bodies! This blog article explains the concept of gene expression.

Type 2 diabetes: One in three children born after 2000 will have type 2 disease, which is a spring board for myriad other ailments like kidney failure, heart disease and amputation of limbs. Neal Barnard has shown that type 2 diabetes can be reversed by plant strong diet. His book Dr. Neal Barnard's Program for Reversing Diabetes gets rave reviews on Amazon.

Obesity: The fifth major disease mentioned by Rip was obesity, which can be also be addressed by diet and lifestyle changes.

Food Labels: 100% fat or 1% fat?

The example below was showcased by Rip to highlight misleading labels put on the front of food packages.

Imagine that I sell you a mixture of 99 tablespoons of water (0 calories) and 1 tablespoon of olive oil (about 120 calories: 100% fat, 0% proteins, 0% carbs) as one serving.

Do you know that the Nutritional Facts (the food label) will say "Calories 120 — Calories from fat 120" but that I can advertise my mixture as "99% fat free" in big bold letters on the front of the package? The "99% fat free", which is the same as "1% fat", refers to proportion by weight, not calories.

Erectile Dysfunction and Heart Disease

A leading indicator of heart disease is erectile dysfunction (ED), which affects 30 million men in America. Most men don't talk about ED and it's not life threatening. However, a heart attack is only a few months away.

Explanation: Blood vessels in the penis are 1mm in diameter, about the size of a coffee stirrer. Blood vessels in the heart at 5mm wide, about the size of a drinking straw. When plaque builds up in blood vessels, it affects blood vessels everywhere in the body in general. The arteries supplying blood to the penis typically get clogged earlier than the blood vessels in the heart. Google search for erectile dysfunction and heart disease comes up with several articles.

Rip promotes the slogan 'real men eat plants', an euphimistic reminder of erectile dysfunction caused by plant-weak, animal-strong diets.

Heart Disease: Progressive or Preventible?

Rip pointed out that many doctors continue to believe that heart disease is a 'progressive disease', a 'natural degradation' of the heart as we age, even though doctors like Dean Ornish and Caldwell Esselstyn have demonstrated through clinical trials that it is totally preventable and even reversible in patients who have gone through multiple bypass surgeries. Medicare and several health insurance companies now cover the Dean Ornish Program for heart rehab. But you don't have to wait to get a heart attack! Heart disease is preventable - Caldwell Esselstyn says that you can become 'heart attack proof' by following such programs. Caldwell Esselstyn's Talk on Reversing Heart Disease explains his research into the relationship between plant-strong diet and heart disease clearly.

CNN Documentary: Esselstyn and Ornish are featured prominently in CNN Documentary: The Last Heart Attack by Dr Sanjay Gupta. The documentary showcases US President Bill Clinton's journey: he had a heart attack while in office, had a bypass surgery, had a followup surgery many years later, and eventually started following a plant-strong diet.

Efficacy of Statins

The famous JUPITER study demonstrated that "statins reduce the risk of heart disease by 50%", which sounds quite impressive. At the same time, it is also true that "it takes about 100 individuals to take statins for 2 years for 1 individual to show a positive effect", as Rip Esselstyn mentioned in his talk. Let's see how.

A paragraph from Expanding the Orbit of Primary Prevention — Moving beyond JUPITER by Mark A. Hlatky, M.D., N Engl J Med 2008; 359:2280-2282) explains:

"The relative risk reductions achieved with the use of statin therapy in JUPITER were clearly significant. However, absolute differences in risk are more clinically important than relative reductions in risk in deciding whether to recommend drug therapy, since the absolute benefits of treatment must be large enough to justify the associated risks and costs. The proportion of participants with hard cardiac events in JUPITER was reduced from 1.8% (157 of 8901 subjects) in the placebo group to 0.9% (83 of the 8901 subjects) in the rosuvastatin group; thus, 120 participants were treated for 1.9 years to prevent one event."

Basically, the incidence of heart disease over two years dropped from 1.8% to 0.9%. At the same time, incidence of diabetes went up from 2.4% to 3.0% (mentioned in the same paper but not quoted above).

On the whole, is it worthwhile to take statins? For many people, the tradeoff is significant enough that they would opt in for statins. For many others, the tradeoff is not worthwhile. What's important is that consumers should get information to let them make informed decisions.

TED Talk

In February 2010, Rip gave a 17-minute talk at Texas, Austin:

Superfoods

Rip is not fond of 'superfoods' - these come into fashion and go out of fashion. Many of the current superfoods are actually unhealthy. Rip mentioned that olive oil, for example, has 14.5% saturated fat and 80% mono + saturated fat. Coconut oil has 91% saturated fat, half of which is short chains. See Do Cooking Oils Contain Saturated Fats?.

Milk and Cheeee

Cheese is loaded with cholesterol and casomorphins, which have opioid like effects on humans. Neal Barnard's video: Chocolate, Cheese, Meat and Sugar: Physically Addictive explains this further.

Rip mentioned that over 51 thousand mammals exist on the planet. We are the only mammal which drinks somebody else's milk. He asked the audience: "Would you drink milk extracted from babboons, chimps and orangutans? If we were to set them up on machines, take milk out of their breasts, store them in bottles and distribute them in super markets, would you buy such milk?" Some members of the audience said that this sounded gross! Rip explained that we are psychologically conditioned to be comfortable drinking milk derived from cows but we find the idea of replacing the cow by another mammal repulsive.

Plant-Strong Diet

Rip is not pleased when people ascribe the 'V' labels (vegetarian or vegan) to him. He calls himself 'plant-strong' and promotes the slogan 'real men eat plants!'

10 Jul 2012
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