Bill Clinton: Former President with Heart Problems or Engine 2 Case-in-Point?

Former heartthrob and President Bill Clinton is back in the news after undergoing surgery to insert two stents into arteries around his heart this weekend. When he left the White House in 2000, his cholesterol level was 233, well above the recommended threshold and way, way above the Engine 2 "heart-attack proof" ceiling of 150, which probably led to the President being lampooned on Saturday Night Live for his conflicting loves of McDonald's hamburgers and jogging (see photo above). My own sense is that hamburgers carried the day. CNN has the story and they've managed to tell it without their usual hedging on key facts to appear overly moderate and balanced. (If Wolf Blitzer had gotten hold of it, the lead-in would have been, "Reports tentatively suggest that alleged former President Bill Clinton may have suffered from purported chest pains and has possibly undergone what some are describing as a surgical procedure which may or may not -- depending on your political allegiance -- be designed to address such issues.")

It's precisely these types of health problems and resultant surgeries that led Dr. Caldwell Esselstyn to research whether a change in diet might prevent and reverse heart disease. It will.

Dr. Esselstyn has said the following in a terrific interview about his research into heart problems and diet (kudos to an obsessive, borderline-creepy fan of the blog for the link):

My own feeling is that if you were to summarize where we stand on this epidemic, we have a great many brilliant minds that are focussed on mechanisms, drugs, and procedures, and we've sort of abandoned the capacity of the public to take care of this epidemic on their own. I would like to say right now that perhaps there can be no greater condemnation of 21st century medicine than its refusal to share with the public the causation and cure of its most frightening chronic illnesses.

How in the world can we have someone who's had two or three heart attacks and a couple of bypasses, and not say to them
-- look them in the eye and say "Look. I'm tired of doing these bypasses for you. Why don't you cure yourself? I mean, it's not that these people can't do it, it's just that they don't have the information available. It's extremely difficult to in any way applaud what medicine is doing in this arena because the public just isn't being told what they can do to cure themselves.

Wait a second, you mean the fee-for-service medical practices in this country are leading doctors to overemphasize in-house treatments and surgeries and gloss over the benefits of their patients not eating four or five times a day like Brian Wilson at an IHOP? This is a fascinating interview, especially if you want to know more about the medical bases for, and benefits of, a plant-based vegan dietary regimen. Spoiler alert: They include staving off cancer and extending your life.

Week One Update

After one week on Engine 2, I went from weighing 204.6 to 199.4, a total loss of 5.2 pounds. I also worked for essentially 15 straight hours yesterday, sans my usual 5 o'clock headache and less the post-meal crash that transitions me from insatiable academic to couch-hungry loaf. I have also gone from taking one Prilosec OTC pill a day to taking one Prilosec OTC pill a week -- and this development while still eating acidic fruits and plants like oranges, strawberries, hot peppers, and tomatoes.

And I'm not really one for discussing regularity in public, but I've noticed this is something people over 50 (and Meghan and Benjamin, apparently) are fascinating with, so I'll address it with a brief Q and A.

Q: Are you more regular?
A: Yes.

The primary reaction I've gotten from most people is, "So, how are you holding up not eating meat?" Well, hate to say it for all those red-state Americans out there who hate their bodies and work daily to undermine their health, but meat isn't that hard to do without. Sure, there have been moments of weakness where I was tempted to scarf down a two-inch-thick, medium-rare hamburger patty that was screaming my name (a desire left over from my ignorant, uninformed days), but I persevered. And there was a time yesterday when my roommate was eating slices of pepperoni pizza where the old Kevin wanted to jump in and say, "Hey let me have some of that fake combination meat" -- because who doesn't love fake combination meat that combines the byproducts and wastes of two or more animals? But I didn't, I held strong. Plant-strong.

So while it's been pretty liberating to toss meat out, the truly difficult part (as a fellow Engine 2 dieter and I have discussed) has been the separation from added salts and sugars. Oils I can do without. Salts and sugars are proving more trying.

I would put this test to you: keep track of your sodium intake for a day. You need about 500 mg of sodium per day in your diet. I would bet that if you're able to get an accurate headcount on how much sodium you actually consume (which could be tricky, particularly if you eat out frequently) and don't switch up your daily routine for this experiment, you're consuming between five and ten times that much.

In fact, the average seasoned-to-taste American diet can contain 5000 mg or more of sodium per day (source: Wikipedia). Hey, whatever, it's probably true. Let's face it: the average American diet is extremely unhealthy. So any example drawn from the typical American diet is probably out of proportion with that which is healthy. For example, before 1900, heart disease was not among the top 10 killers in the United States. Today it is #1. Let's think about what's happened since 1900: the massive industrialization of American society, the advent of the freezer, refrigerator, and packaged, overly processed foods, and the dearth of all self-control or concern with anything other than indulging the whims and desires of the overweight, self-absorbed individual.

But sodium also provides a good example of how food labeling grossly misleads the American public. Grab something with a nutrition label. (Or don't! Just sit there on your chair, couch, or recliner while the plaque from the food you eat attaches itself to the walls of your blood vessels.) That nutrition label suggests you should consume about 2500 mg of sodium per day on a 2,000 calorie diet. Physiologically, we only need 500 mg of sodium a day, yet our FDA-approved labeling states otherwise. Why is this so? To head down the path of understanding and enlightenment, you can read my published article in the Administrative Law Review, Thank You for Regulating: Why Philip Morris's Embrace of FDA Regulation Helps the Company but Harms the Agency, 61 Admin. L. Rev. 197 (2009), which in part exposes the extent to which FDA is "captured" by the very industries it regulates (thus the agency promotes the interests of regulated industries, not those of the public), and which has received critical praise from Dr. Michael Siegel, a long-time tobacco expert and professor at Boston University’s School of Public Health. And that's pretty much it. The government agencies we trust to regulate our products and ensure that accurate information is conveyed to the American public are subject to the political demands of Congress and the President, who set the statutory bounds of an agency's ability to govern and dictate regulatory priorities, respectively.

But I digress. Salt and sugars have been the most difficult to give up. As I ate a bowl of Jocelyn-made vegan chili yesterday, while it was extremely, extremely good and I would not have wanted for a single thing to be changed, if there was something to be changed, it would have been tossing in a scoop of table salt. The same is true with my morning bowl of cereal. In preparation for this diet, I began drinking soy milk a week before the February 1 start date. This was sweetened soy milk. I thought, wow, this isn't going to be so bad. This is every bit as good as my regular morning bowl of cereal. Upon starting the diet, I took Engine 2's advice and purchased unsweetened soy milk. Big change. Those 20 grams of added sugar per serving make all the difference. My morning cereal is no longer as enjoyable and just to make the whole-grain shredded wheat drowning in a bland, Maalox-style liquid palatable, I have to add bananas and blueberries. Otherwise it very nearly resembles cardboard.

But this is when phase 2 of the Engine 2 revolution should kick in: your palate can be changed. Over time, eating a no-salt-added, no-sugar-splashed diet becomes the norm. As a federal judge in Louisiana remarked after going on a raw food diet, "You feed your dog Alpo every day, and what does it want? It wants Alpo." Your body will desire what you give it. You will not notice the "tastelessness" of your healthy, life-giving food and the overly salted, overly sugared "foods" of others will become repulsive.

Let the condescension begin anew.

On "Healthy" Eaters

I've noticed that some of the strongest pushback to Engine 2 has been from "healthy" eaters rather than red-meat homers. The typical response from the McDonald's/Taco Bell crowd is, "Yes, you're right, I should eat better. But I'm not going to." My dad (Joe), perhaps realizing how far beyond food salvation he was, had this to say, showing particular concern for his prized "Joe Burgers," a tasty concoction of greasy beef, slow-cooked chili, oil-slathered onions, and mayonnaised buns:

I took a look at this diet. How do you make a Joe Burger as a veggie burger? What about the chili? I've been working on my homemade cinnamon rolls with butter creme icing. You know I love ice cream. This weekend I fixed country fried steak, mashed potatoes, gravy and homemade biscuits. That doesn't include the Joe Burgers, chili, home fries, sweet tea and the lemon icebox pie. Would I have to give that up?

I'm planning a Super Bowl party with a pulled pork butt, Dreamland BBQ Sauce, Brunswick Stew, potato salad, baked beans topped with bacon, cole slaw, sweet tea and some chocolate pies for dessert. How do I replace this? Now I love veggies, pinto beans, turnip greens, but you gotta season them with some bacon drippings, sugar and salt and serve some good Mexican cornbread with 'em to really make 'em good. Who wants to live to be 100?

So from the unpretentious crowd, the response is something like, "Your diet may be all well and good, but it's not for me." From self-proclaimed healthy eaters, the reaction has been more visceral.

I think we should all step back at this point and recognize one thing, which I realized after thoughtful conversations with a much older friend: eating, for lack of a better word, is personal. The diets that we choose for ourselves are intertwined with who we are as people. You share meals with your friends and family; a special occasion merits a special meal; celebratory news is met with celebratory food. Especially in law school, I can recall instances where I got dessert with my lunchtime sandwich upon achieving one thing or another (and thus being given more things to achieve; law school is a pie-eating contest where the prize is more pie). Point being, though: meals cut straight down to, and are marbled within, the tissue of our person.

So when you announce to friends and family that you are drastically changing your diet -- empirical research shows that your diet is likely to track that of your friends and family -- it can be an indirect dig on the food habits and choices that they themselves make. And since food cuts straight down to the tissue of their person, it can be a dig on who they are as people.

And then you've got these so-called healthy people. They not only subconsciously identify with their food (as we all do), but they've actively chosen to make their diets a part of their persona and identity. A conversation with a healthy eater (HE) might go like this:

You: Who are you?
HE: I'm someone who cares about what I put into my body.
You: Sure -- who doesn't?
HE: Well, most people. Most people sit in their dim, gray cubicles watching the flavorless minutes that are their lives tick by on the clock, shove horrifying foods down their throats at lunch, grab a pack of nutrient-free Doritos and a Coca-Cola for an afternoon snack, and then head home in their average cars to kiss their average wives and ignore the desperate pleadings of their average children (suffering from childhood obesity) to toss a ball around their grassless front yard because they are too tired and too overweight and too careless to be bothered by anything other than "What's coming on TV tonight?" and "What are we going to eat while we watch it?" Then they laugh when they watch the stupid little people tell their stupid little jokes and then they fall into their dumb little catatonic comas because they have once again feed-tubed way too much artificially flavored piles of junk into their fat, disgusting bodies.

So these healthy eaters differentiate themselves from the world by the virtue of their being healthy. (And we all differentiate ourselves in some way: excepting people who are running for office, who honestly appraises himself as just one of the masses? So it's not to unfairly single out healthy eaters, but this is a blog about a diet, and healthy eaters distinguish themselves based on their diets.)

And so when you tell these healthy eaters -- implicitly or explicitly, remember, because people interpret food decisions departing from their own as inherently condemnatory -- that perhaps they aren't eating the best diet they could be, you get . . . a reaction. There is knee-jerk skepticism. There is disbelief. There is shock and insecurity, and yes, there is bed-wetting. You may not realize it, but a war has begun and you are the unwitting aggressor. In a biting, gnashing-of-teeth sort of way, what you have said has cut to the core.

But for football fans out there, you know that the best defense is a good offense. (That's not true but this little gem of idiot sports announcers works to advance the narrative here.) And so what are these champions of healthy eating to do? They go on the offensive. They point out that raw nuts have saturated fat. They contend that olive oil can be good for you. They postulate that oils help us in the absorbing of nutrients. They venture that fish really aren't that bad. Wildly thrashing about, they footnote the "latest" medical studies in a "journal" that is "gaining respect among 'health groups,'" and these studies hint that there might not be a direct correlation between food cholesterol ingested and blood cholesterol realized, and thus their unhealthy consumption of eggs is rationalized. QED. They say, more frequently and more loudly than anything else in this rumbling echo chamber of questionable dietary advice that is the United States of America in the year 2010, that Engine 2 can't possibly be right -- can't possibly -- because in order for that to be true (and, really, it can't actually be true), in order for Engine 2 to make holistic, all-things-considered, NPR-in-the-mornings-while-listening-to-jazz-and-slicing-fresh-fruits sense, they would have to be wrong. And if they're wrong on their diet, then they're wrong as people. And that just can't be the case.

Engine 2 Criticism and Responses

I'd like to begin by clearing up a misconception about this blog. The self-righteous, holier-than-thou attitude is a shtick. I'm toying with the stereotype that vegans and vegetarians are smug and condescending about their diets by getting in your face with over-the-top smugness and unprecedented condescension. It's just a joke, people. I just happen to be someone who has chosen a food path that will make me a better person. I don't judge those who stubbornly continue to make the world a worse place to live through their poor dietary choices. In fact, if you want heart disease, obesity, cancer, a low energy level, and the early onset of senile dimensia in return for being able to pitchfork rancid foods spiked with HGH and synthetic steroids into your stomach, I think that ought to be your own personal judgment-free choice.

But now I'd like to talk about the nutritional bases for Engine 2. The foundation for the Engine 2 diet was developed by a world-famous cardiologist at the Cleveland Clinic, Dr. Caldwell B. Esselstyn Jr., the father of Olympic swimmer, triathlete, firefighter, and Engine 2 Diet author, Rip Esselstyn. Rip implemented the plant-based regimen conceived by his father at an Austin, Texas firehouse -- the eponymous Engine 2 firehouse -- after noticing that his fellow firefighters ate horribly, were generally overweight, and suffered from a number of health ailments traceable to a diet high in saturated fats and cholesterol.

While it seems obvious to us today, Dr. Esselstyn was one of the first physicians to make the connection between diet and health. He saw his patients' chronic illnesses halt and cholesterol levels dive after putting them on a plant-strong diet free of animal fats and calorie-rich, nutrient-bankrupt processed foodstuffs. When his son Rip persuaded the burly, chest-hair-having firefighters at Engine 2 to adopt plant-based diets, he replicated his father's results. (One firefighter, JR, saw his cholesterol fall from a heart-attack-begging 344 to a doctor-desired 196 after a few months of eating meals with Rip.)

But after maintaining this blog for only a few days, I've experienced the same conventional-wisdom nutritional pushbacks as the Esselstyns. Brief responses are in order.

Criticism #1. You can't get enough protein without eating meat.

While it's true that some vegans and vegetarians can be short on protein and therefore unhealthy, if you eat beans, green, leafy vegetables, soy products, and other whole-wheat grains (think bagels), you get more than enough protein. Spinach is 51% protein; mushrooms, 35%; beans, 26%; oatmeal, 16%; whole-wheat pasta, 15%; corn, 12%; and potatoes, 11%. Source: The Engine 2 Diet, p. 32. And don't be misled: plant proteins are complete proteins. The myth that you need to consume meat to receive your full daily allotment of protein can be traced to meat- and dairy-industry-funded studies on rats in the early 1900s. The fact is that plants provide the body with all the requisite amino acids. The only vital nutrition that cannot be derived from plants is Vitamin B12, which you can get from fortified soy milk or cereal.

Criticism #2. I'm thin, why would I need to change my eating habits?

Don't be confused by appearances: you can be thin and have all the appearances of being healthy, but that doesn't necessarily mean you're healthy. Thirty-five percent of heart attacks happen to people with "desirable" cholesterol levels (between 150-199), while Engine 2 often lowers cholesterol to below 150, which actually repairs arteries and makes you virtually heart-attack proof. In one famous nutritional study known as The Framingham Study, which to date has tracked 5,209 residents of Framingham, Massachusetts over a period of sixty years, not a single person with a cholesterol level under 150 (attained without cholesterol-reducing drugs) has had a heart attack. Lesson: no matter your looks or body-fat percentage, if your cholesterol level isn't under 150, you aren't as healthy as you could be. Of course, this doesn't consider the reduction in stroke, cancer, diabetes, Alzheimer's Disease, and dimensia risk that has been found with a meat-free, plant-strong diet.

And I haven't even mentioned the short-term health benefits. Since beginning the diet 2 days ago, I have experienced two positive health consequences: (i) a reduction in intensity/frequency of headaches (which I've typically gotten from the demanding reading grind of law school -- or so I thought); and (ii) a more consistent level of energy throughout the day.

Criticism #3. I would do it, but it's too much money.

Most people save a ton of money eating on Engine 2, largely due to not going out to eat. One Engine 2 disciple who originally worried about the cost of the diet ended up saving $120 a month. I'll perform a comparative cost analysis of my own expenditures on March 1.

Criticism #4. I'm on board with no red meat and agree that a healthy diet should be plant-strong, but why eliminate fish, eggs, and oils?

As Esselstyn notes, "Fish . . . which everyone is fond of for its healthy omega-3 fatty acids, can contain more cholesterol than either red meat or chicken." A typical egg yolk contains 212 milligrams of cholesterol and 5 grams of fat. The egg white? Pure animal protein, which is bad for your kidneys and bones.

Why no oil, though? Engine 2 is based on a whole-food, nutrient-rich diet. Oil is refined and processed from the corruption of whole foods. Let's take olive oil, for example. The process begins with an olive. Then all the nutritious parts of the olive are discarded and the nutrient-sparse oil is extracted. In fact, olive oil has around 4,100 calories per 16 ounces (120 calories per tablespoon). It's low in nutrients and high in saturated fats. Plus it disguises the true, natural flavor of food, which is actually quite great once you wean your mental palate from the notion that food must be sauced and slathered to "bring out the taste."

Tomorrow we'll begin a very mature discussion of increased male virility as a result of Engine 2.

Morning Briefing

Let's get one thing straight: Engine 2 is not about weight loss, it's about changing your life. But it just so happens that sometimes weight loss and life change converge around green, leafy vegetables and raw flaxseed. In case studies, subjects on Engine 2 (who often were not overweight and began the program solely for its touted health benefits), lost between 2 and 31 pounds on the 28-day plan.

Since persuasion is usually about the details, I'll share my own Engine 2 weight-loss story. I weighed 204.6 pounds yesterday morning. Today, I weigh 202.2 pounds. That wasn't a typo: I lost 2.4 pounds on the first day of the diet. At first blush, I'm a little worried about the long-term sustainability of such rapid weight loss. I mean, sure, it's fine to lose 2.4 pounds on the first day; but what about after 20 days? That's 48 pounds. And how about after 28 days? That's a whopping 67.2 pounds! I may have some extra weight now, but I'm worried about losing 67.2 pounds in such a small window of time. It would take me from a robust 6 feet tall, 204.6 pounds to a bean-pole 6 feet tall and 137.4 pounds.

I will not let fear carry the day, though. Even if I have to buy all new clothes, I'm going to see this through.

Here's what I ate on day one:

Breakfast

Organic whole-grain bran cereal
Soy milk
Chopped organic banana
Organic Red Delicious apple
Glass of orange juice
Coffee

Lunch

Eight oz. organic, no-salt-added canned black beans
One steamed organic collard green
Steamed organic squash
Steamed organic cucumber
Steamed organic carrot
Chopped raw celery
Two slices of Ezekiel 4:9 Low Sodium bread drizzled with organic honey
Glass of water

Dinner

One raw organic collard green
One organic banana
Organic strawberries and conventional blueberries
Raw, no-salt-added pecans
Glass of water

10 p.m. Snack

One organic orange
One organic apple
Raw, no-salt-added cashews and peanuts
4 oz. soy milk

As you can see, Engine 2 is not about calorie counting. It's not about controlling how much food you put into your body. In fact, let me clue you in on something: you can eat as much as you want, as often as you want on this diet. Engine 2 is about controlling what you put into your body. Curiously enough, for most people, when they stop shoveling gross processed foods and meat laced with saturated fat and cholesterol down their throats, an incidental benefit is that they lose weight. The only fear I have is that for me it will be too much weight.

Engine 2, As Informed by Gatsby

As I write this, I am munching on a raw organic collard green. I just got back from walking through my law school's cafeteria, sneering at all the idiots who are still eating meat and saucing up their vegetables. This collard green reminds me of a line from the final page of the Great Gatsby:

And as the moon rose higher the inessential houses began to melt away until gradually I became aware of the old island here that flowered once for Dutch sailors' eyes -- a fresh, green breast of the new world.

I'm sure that those who have foresworn meat are smart enough to draw clean, precise parallels, but I'll elaborate for the carnivores out there who are able to read.

The moon, which is rising higher in the night sky, is a source of light that is increasingly elucidating the protagonist's surroundings. Engine 2, my source of light, is increasingly allowing me to see the world clearly. As the moon lights up the world, "the inessential houses" -- unimportant, garish material possessions -- are melting away. As Engine 2 elucidates my world, repulsive, unimportant things -- meat, animal byproducts, excess oils and salts -- are fading. After the artificial and unimportant melts away, the protagonist becomes aware of the raw and primal, the "fresh, green breast of the new world": the undisturbed nature that dazzled and nurtured humanity before industrial settlement ruined it. Without the artificial and unimportant (meat and processed ingredients), I am cognizant of natural, nurturing delights (raw organic collard greens), unspoiled by society and uncorrupted by industrial process.

In two hours, it will have been twenty-four hours since I renounced my omniverous nature and began eating vegan minus (vegan-). I feel energetic, mentally alert, and insatiably alive. Tomorrow I'll go into some detail about Engine 2, including the backstory of the diet and my meal list from the first day.

I'm Better Than You Now

I should begin by explaining that my life is at a crossroads. Down one road lies ignorance, medium-rare filet mignon, and death. Down another road lies arterial freedom, green, leafy vegetables, the ability to be insufferably smug, and life. Beginning tomorrow, I will choose life.

After reading an article from the New Yorker about Whole Foods' CEO leaving his already-healthy diet for a food death march known as Engine 2, I decided to take a look for myself. To follow Engine 2 is to eat like a rabbit with a skillet. It's a vegan style of eating, which, for the uninitiated, combines the no-meat ethos of vegetarianism with an additional ban on all products derived from animals.

But Engine 2 isn't just vegan. It attempts to eliminate the oils, sugars, and salts surreptitiously added to even "healthy" foods (like organic beans) by profit-hungry food behemoths.

You eat, as closely as is possible, food as it comes from the earth. A label-scrutinizing trip to Whole Foods will demonstrate that it is impossible to eat a diet free of added canola oil and dashed-in sodium. But, to paraphrase Scott Fitzgerald, we must realize that things are hopeless yet be determined to make them otherwise. Engine 2's mainstays are fresh fruits, vegetables, legumes, whole-wheat grains, and raw nuts. Its occasional mistresses are organic soy and organic, no-salt-added canned soups and beans.

My own personal Engine 2 journey began tonight with a trip to Whole Foods. Jocelyn, who obviously didn't spend much time on her personal appearance today, was driving. We pulled into the store's parking garage, walked up two flights of stairs (no elevators on this diet!), and found ourselves swimming in labyrinthine stacks of gleaming fruits and vegetables.

One hundred ninety-one dollars later, I had amassed the healthiest crop of groceries in my twenty-five years of life. I looked at the woman behind me in line buying organic fat-free milk and an array of gourmet cheeses and felt nothing but sympathy. I'm better than her now, I thought, with a quick wink and knowing smile.

I stacked the Ezekiel 4:9 bread I had just bought in my reusable, sustainable Whole Foods grocery bags and took one last look back at my former dietary life. For the first time ever, I realized that I don't need animal toxins, saturated fat, and tablespoons of bubbling grease to be happy. I can be happy knowing that unlike 99% of the U.S. population still chained in the darkness of Plato's cave, I'm no longer a part of the problem.

Engine 2 has set me free.