The Esselstyn Protocol: Why So Many Greens?
Dr. Caldwell B. Esselstyn Jr., a surgeon and author, developed a revolutionary diet for preventing and reversing heart disease. A cornerstone of his protocol is the aggressive consumption of leafy greens, specifically up to six times per day, particularly for patients with advanced heart disease. The reasoning is rooted in the physiological function of the endothelium, the inner lining of blood vessels.
The Science Behind Nitric Oxide
When a person chews leafy green vegetables, the nitrates present in the plants are converted into nitric oxide (NO) in the body. Nitric oxide is a potent vasodilator, a compound that helps relax and widen blood vessels, promoting better blood flow. In patients with heart disease, the endothelium is often damaged, impairing its ability to produce sufficient nitric oxide. By consuming a large and frequent quantity of high-nitrate greens, Dr. Esselstyn's diet aims to restore and maximize the body's nitric oxide production, thereby helping to heal the damaged endothelium and reverse the progression of coronary artery disease.
Key to this process is the chewing and proper preparation of the vegetables. Dr. Esselstyn emphasizes cooking greens, such as steaming them for about 5 to 6 minutes, and adding a few drops of balsamic vinegar. The vinegar is believed to assist in the conversion process. Crucially, he also advises against using antiseptic mouthwash, which can kill the bacteria in the mouth necessary for the initial conversion of nitrates.
Which Greens Are Preferred?
While a wide variety of leafy greens are beneficial, Dr. Esselstyn highlights specific 'magic greens' known for their high nitrate content. These include:
- Kale
- Spinach
- Swiss Chard
- Arugula
- Beet Greens
- Beets (often included for their high nitrate levels)
He also includes others like bok choy, collard greens, mustard greens, and broccoli, encouraging a diverse intake. The recommended serving size is approximately one-third the size of a closed fist, after cooking. This portion, consumed six times daily, ensures a steady supply of nitric oxide-boosting nitrates throughout the day.
Practical Implementation for Daily Life
Consuming greens six times a day requires deliberate planning. Integrating greens into every meal and even as standalone snacks is the key. Here are some strategies:
- Breakfast: Mix cooked kale or spinach into oatmeal. Dr. Esselstyn's wife, Ann, famously incorporates greens into her breakfast dishes.
- Mid-morning snack: A small, cooked fistful of beet greens with balsamic vinegar.
- Lunch: A large salad with a base of arugula and other leafy greens, topped with beans and other non-starchy vegetables.
- Mid-afternoon snack: A small portion of steamed swiss chard.
- Dinner: Add a substantial amount of cooked greens, like collard greens or bok choy, to a stir-fry or soup.
- Before bed: A small, cooked serving of spinach with vinegar.
Cooking the greens is crucial not only for the nitric oxide conversion but also for managing volume. A large quantity of raw greens cooks down to a much more manageable size. For instance, 50 grams of raw kale shrinks significantly when steamed. The Esselstyn approach also strictly eliminates oil, as it can damage the endothelium and negate the benefits of the plant-based diet.
Comparison: Raw vs. Cooked Greens in the Esselstyn Diet
| Feature | Raw Greens | Cooked Greens (Esselstyn Method) |
|---|---|---|
| Nitric Oxide Production | Lower bioavailability due to less nitrate release during chewing alone. | Higher bioavailability; chewing, coupled with balsamic vinegar, maximizes nitric oxide conversion. |
| Nutrient Preservation | Higher levels of water-soluble vitamins like C, B-vitamins, and certain antioxidants. | Lower levels of certain heat-sensitive vitamins, but increases absorption of minerals like calcium and iron. |
| Volume | High volume, making it difficult to consume the required quantity six times a day. | Significantly reduced volume, making it easier to meet the six-serving daily target. |
| Digestibility | Can be more difficult to digest for some people due to high fiber content. | Softer fiber structure is easier to digest and gentler on the digestive system. |
| Oxalate Content | Higher levels in certain greens like spinach, which can be a concern for those prone to kidney stones. | Cooking can reduce the oxalic acid content in greens like spinach. |
The Broader Context of the Diet
The six-times-a-day greens are a powerful component, but they are part of a larger, comprehensive dietary strategy. The overall Esselstyn program is a whole-food, plant-based diet that excludes all meat, dairy, eggs, and added oils. It also restricts calorie-dense items like nuts and avocados for those in the reversal program, and emphasizes whole grains, fruits (other than avocado), and legumes. This holistic approach is crucial for achieving the kind of cardiovascular reversal documented in Dr. Esselstyn's studies. The frequent consumption of greens is not a magic bullet on its own but works synergistically with the entire diet to restore endothelial function.
Potential Considerations and Precautions
While the benefits are significant, it is important to be aware of potential issues. Some leafy greens, especially spinach and beet greens, are high in oxalates, which can contribute to kidney stone formation in susceptible individuals. A key to mitigating this is to vary the types of greens consumed and not rely solely on high-oxalate vegetables like spinach. The high concentration of nitrates and certain minerals can also pose issues, though studies in controlled environments suggest overall risks from dietary intake remain low. Patients on blood-thinning medication like warfarin should also consult their doctor, as vitamin K-rich greens can interfere with medication.
Conclusion
In summary, the answer to the question "can Dr Esselstyn eat greens 6 times a day?" is not only yes, but it is a fundamental pillar of his therapeutic approach for reversing heart disease. By strategically consuming multiple servings of cooked leafy greens with vinegar, he and his patients leverage the power of dietary nitrates to boost nitric oxide production, restore endothelial function, and improve cardiovascular health. While this intensive regimen is specifically designed for serious health conditions, the principle of incorporating frequent, nutrient-dense plant foods into one's diet offers profound benefits for broader health. For those seeking to follow this regimen, careful planning and consistent adherence to the full whole-food, plant-based protocol are essential for success.
For more information, visit the Esselstyn Family Foundation website at: https://esselstynfamilyfoundation.org/.
