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Originally Posted by Raev [You must be logged in to view images. Log in or Register.]

It's definitely an impressive result, but at the same time it's easy for me to come up with some counter arguments.

First, it looks like Esselstyn recommends a diet of about 10-15% calories from fat. This will taste like cardboard, and as a result people will eat far fewer calories which will activate intermittent fasting/low calorie genes that are thought to be very effective vs heart disease and cancer.

Second, the study is on very shaky methodological ground. The participants are self-selected, not randomized, which instantly completely invalidates it as a tool for average people with heart disease. For obvious reasons there is no control group, and aside from the placebo effect the comparison of the adherent vs non-adherent groups is very misleading. Considering the willpower required to eat cardboard all day, it would not surprise me at all if the causality ran the other way: the people where the diet was failing got depressed or disgusted and hit the ice cream aisle.

Third, the Standard American Diet is just so so so so so fucking bad. Literally not a single thing the average American eats (confinement animal products, soybean oil, soda, wheat) is healthy. For example, we don't know what fraction of the results are due to the massive increase in vegetable consumption which probably fixed numerous nutrient deficiencies, or the reduction in inflammatory omega-6 fatty acids, etc.

Anyway, I don't say this to detract from Dr. Esselstyn's work (he seems like quite a boss, by the way. Olympic gold in rowing, tour in Vietnam, hundreds of peer reviewed publications). I think there is no question that his diet is healthier than the SAD (not hard to do, of course). But at the same time, I hope you can see why I don't find this kind of thing super convincing as the holy grail.

Definitely not the holy grail, as you say lack of controls, which is unfortunate. One can come up with many many possible reasons why it worked so well. And he does admit the limitations at the end. But there is a kind of overall trend I see, where vegetarian seems to help overall health a little and complete plant-based seems to help it even more (like, an incredible amount more). There are biochemical analogues for their propositions as to what the data might indicate by the way (we know some mechanisms of fiber on heart disease for example), which is where mechanisms of nutrition comes into play to give viable explanations for what's happening in the general study (why I mentioned my opinion on science going all ways). So I guess I'm just saying that this study doesn't happen in a vacuum where explanations can be proposed ad. infinitum. Again, readily admit I'm no expert. There wasn't one study in particular that just blew me away, but an overall trend and some decent science. More to come I'm sure in the future. If it happens that Campell and Esseltyn are correct, the dairy and animal agribusiness isn't going to like that very much.

Forgot to mention that I make some meals from the China Study cookbook and there are some tasty meals in there which meet his criteria. Maybe if you go straight from standard American diet to that it might be a challenge, I did it in slow increments.