My Reading Notes:

• Only a quarter of medical schools appear to offer a single dedicated course on nutrition. During my first interview for medical school, at Cornell University, I remember the interviewer emphatically stating, “Nutrition is superfluous to human health.” And he was a pediatrician! I knew I was in for a long road ahead.
• During my medical training, I was offered countless steak dinners and fancy perks by Big Pharma representatives, but not once did I get a call from Big Broccoli. There is a reason you hear about the latest drugs on television: Huge corporate budgets drive their promotion
• The California medical board does have one subject requirement: twelve hours on pain management and end-of-life care for the terminally ill. This disparity between prevention and mere mitigation of suffering could be a metaphor for modern medicine. A doctor a day may keep the apples away.
• A study of thousands of patient visits found that the average length of time primary-care doctors spend talking about nutrition is about ten seconds.
• Many people assume that our manner of death is preprogrammed into our genes. High blood pressure by fifty-five, heart attacks at sixty, maybe cancer at seventy, and so on. . . . But for most of the leading causes of death, the science shows that our genes often account for only 10–20 percent of risk at most.
• Are Americans living longer now compared to about a generation ago? Yes, technically. But are those extra years necessarily healthy ones? No. And it’s worse than that: We’re actually living fewer healthy years now than we once did. Here’s what I mean: A twenty-year-old in 1998 could expect to live about fifty-eight more years, while a twenty-year-old in 2006 could look forward to fifty-nine more years. However, the twenty-year-old from the 1990s might live ten of those years with chronic disease, whereas now it’s more like thirteen years with heart disease, cancer, diabetes, or a stroke. So it feels like one step forward, three steps back. The
• In 1900 in the United States, the top-three killers were infectious diseases: pneumonia, tuberculosis, and diarrheal disease. Now, the killers are largely lifestyle diseases: heart disease, cancer, and chronic lung disease.
• People who once ate vegetarian diets but then started to eat meat at least once a week experienced a 146 percent increase in odds of heart disease, a 152 percent increase in stroke, a 166 percent increase in diabetes, and a 231 percent increase in odds for weight gain.
• Even vegetarians can suffer high rates of chronic disease, though, if they eat a lot of processed foods. Take India, for example. This country’s rates of diabetes, heart disease, obesity, and stroke have increased far faster than might have been expected given its relatively small increase in per capita meat consumption. This has been blamed on the decreasing “whole plant food content of their diet,” including a shift from brown rice to white and the substitution of other refined carbohydrates, packaged snacks, and fast-food products for India’s traditional staples of lentils, fruits, vegetables, whole grains, nuts, and seeds.40 In general, the dividing line between health-promoting and disease-promoting foods may be less plant-versus animal-sourced foods and more whole plant foods versus most everything else.
• Maybe it’s time we stop blaming genetics and focus on the more than 70 percent that is directly under our control. We have the power.
• Weight loss through calorie restriction and an even more vigorous exercise program failed to improve telomere length, so it appears that the active ingredient is the quality, not quantity, of the food eaten. As long as people were eating the same diet, it didn’t appear to matter how small their portions were, how much weight they lost, or even how hard they exercised; after a year, they saw no benefit.
• Some people have expressed concern that boosting telomerase activity could theoretically increase cancer risk, since tumors have been known to hijack the telomerase enzyme and use it to ensure their own immortality. But as we’ll see in chapter 13, Dr. Ornish and his colleagues have used the same diet and lifestyle changes to halt and apparently reverse the progression of cancer in certain circumstances. We will also see how the same diet can reverse heart disease too.
• Unlike with medications, there isn’t one kind of diet for optimal liver function and a different diet to improve our kidneys. A heart-healthy diet is a brain-healthy diet is a lung-healthy diet. The same diet that helps prevent cancer just so happens to be the same diet that may help prevent type 2 diabetes and every other cause of death on the top-fifteen list.
• In this book, I don’t advocate for a vegetarian diet or a vegan diet. I advocate for an evidence-based diet, and the best available balance of science suggests that the more whole plant foods we eat, the better—both to reap their nutritional benefits and to displace less healthful options.
• As Dr. Walter Willett, the chair of nutrition at Harvard University’s School of Public Health, put it: “The inherent problem is that most pharmacologic strategies do not address the underlying causes of ill health in Western countries, which are not drug deficiencies.”
• As Dr. Walter Willett, the chair of nutrition at Harvard University’s School of Public Health, put it: “The inherent problem is that most pharmacologic strategies do not address the underlying causes of ill health in Western countries, which are not drug deficiencies.”
• The medical system is set up to financially reward prescribing pills and procedures, not produce. After Dr. Ornish proved that heart disease could be reversed without drugs or surgery, he thought that his studies would have a meaningful effect on the practice of mainstream medicine. After all, he effectively found a cure for our number-one killer! But he was mistaken—not about his critically important findings regarding diet and disease reversal but about how much influence the business of medicine has on the practice of medicine. In his words, Dr. Ornish “realized reimbursement is a much more powerful determinant of medical practice than research.”
• The primary reason diseases tend to run in families may be that diets tend to run in families.
• For most of our leading killers, nongenetic factors like diet can account for at least 80 or 90 percent of cases. As I noted before, this is based on the fact that the rates of cardiovascular disease and major cancers differ fivefold to a hundredfold around the world. Migration studies show this is not just genetics. When people move from low- to high-risk areas, their disease risk nearly always shoots up to match the new setting. As well, dramatic changes in disease rates within a single generation highlight the primacy of external factors.
• Research has shown us that identical twins separated at birth will get different diseases based on how they live their lives. A recent American Heart Association-funded study compared the lifestyles and arteries of nearly five hundred twins. It found that diet and lifestyle factors clearly trumped genes.
• Your family history does not have to become your personal destiny.
• Imagine if terrorists created a bioagent that spread mercilessly, claiming the lives of nearly four hundred thousand Americans every year. That is the equivalent of one person every eighty-three seconds, every hour, around the clock, year after year. The pandemic would be front-page news all day, every day. We’d marshal the army and march our finest medical minds into a room to figure out a cure for this bioterror plague. In short, we’d stop at nothing until the terrorists were stopped. Fortunately, we’re not actually losing hundreds of thousands of people each year to a preventable threat . . . are we? Actually, we are. This particular biological weapon may not be a germ released by terrorists, but it kills more Americans annually than have all our past wars combined. It can be stopped not in a laboratory but right in our supermarkets, kitchens, and dining rooms. As far as weapons go, we don’t need vaccines or antibiotics. A simple fork will do.
• If you looked at the teeth of people who lived more than ten thousand years before the invention of the toothbrush, you’d notice they had almost no cavities. They never flossed a day in their lives, yet no cavities. That’s because chocolate bars and sweets hadn’t been invented yet. The reason people get cavities now is that the pleasure they derive from sugary treats may outweigh the cost and discomfort of the dentist’s chair.
• Later studies of accidental death victims between the ages of three and twenty-six found that fatty streaks—the first stage of atherosclerosis—were found in nearly all American children by age ten. By the time we reach our twenties and thirties, these fatty streaks can turn into full-blown plaques like those seen in the young American GIs of the Korean War. And by the time we’re forty or fifty, they can start killing us off.
• To drastically reduce LDL cholesterol levels, you need to drastically reduce your intake of three things: trans fat, which comes from processed foods and naturally from meat and dairy; saturated fat, found mainly in animal products and junk foods; and to a lesser extent dietary cholesterol, found exclusively in animal-derived foods, especially eggs. Notice a pattern here? The three boosters of bad cholesterol—the number-one risk factor for our number-one killer—all stem from eating animal products and processed junk.
• The optimal LDL cholesterol level is probably 50 or 70 mg/dL, and apparently, the lower, the better. That’s where you start out at birth, that’s the level seen in populations largely free of heart disease, and that’s the level at which the progression of atherosclerosis appears to stop in cholesterol-lowering trials.28 An LDL around 70 mg/dL corresponds to a total cholesterol reading of about 150, the level below which no deaths from coronary heart disease were reported in the famous Framingham Heart Study, a generations-long project to identify risk factors for heart disease.29 The population target should therefore be a total cholesterol level under 150 mg/dL. “If such a goal was created,” Dr. Roberts wrote, “the great scourge of the Western world would be essentially eliminated.” The average cholesterol for people living in the United States is much higher than 150 mg/dL; it hovers around 200 mg/dL. If your blood test results came back with a total cholesterol of 200 mg/dL, your physician might reassure you that your cholesterol is normal. But in a society where it’s normal to die of heart disease, having a “normal” cholesterol level is probably not a good thing.
• The cholesterol-lowering statin drug Lipitor has become the bestselling drug of all time, generating more than $140 billion in global sales. This class of drugs garnered so much enthusiasm in the medical community that some U.S. health authorities reportedly advocated they be added to the public water supply like fluoride is.
• Let me share with you what has been called the “best kept secret in medicine”: Given the right conditions, the body heals itself. If you whack your shin really hard on a coffee table, it can get red, swollen, and painful. But your shin will heal naturally if you just stand back and let your body work its magic. But what if you kept whacking it in the same place three times a day—say, at breakfast, lunch, and dinner? It would never heal.
• You could go to your doctor and complain that your shin hurts. “No problem,” he or she might say, whipping out a pad to write you a prescription for painkillers. You’d go back home, still whacking your shin three times a day, but the pain pills would make it feel so much better. Thank heavens for modern medicine! That’s what happens when people take nitroglycerin for chest pain. Medicine can offer tremendous relief, but it’s not doing anything to treat the underlying cause.
• Your body wants to regain its health if you let it. But if you keep reinjuring yourself three times a day, you interrupt the healing process. Consider smoking and lung cancer risk: One of the most amazing things I learned in medical school was that within about fifteen years of stopping smoking, your lung-cancer risk approaches that of a lifelong nonsmoker. Your lungs can clear out all that tar buildup and, eventually, it’s almost as if you never smoked at all. Your body wants to be healthy. And every night of your smoking life, as you fall asleep, that healing process is restarted until . . . bam!—you light up your first cigarette the next morning. Just as you can reinjure your lungs with every puff, you can reinjure your arteries with every bite. You can choose moderation and hit yourself with a smaller hammer, but why beat yourself up at all? You can choose to stop damaging yourself, get out of your own way, and let your body’s natural healing process bring you back toward health.
• Research showing that coronary heart disease can be reversed with a plant-based diet—with or without other healthy lifestyle changes—has been published for decades in some of the most prestigious medical journals in the world. Why hasn’t this news translated into public policy yet? In 1977, the U.S. Senate Committee on Nutrition and Human Needs tried to do just that. Known as the McGovern Committee, they released Dietary Goals for the United States, a report advising Americans to cut down on animal-based foods and increase their consumption of plant-based foods. As a founding member of Harvard University’s nutrition department recalls, “The meat, milk and egg producers were very upset.” That’s an understatement. Under industry pressure, not only was the goal to “decrease meat consumption” removed from the report but the entire Senate nutrition committee was disbanded. Several prominent senators reputedly lost their election bids as a result of supporting the report. In more recent years, it was uncovered that many members of the U.S. Dietary Guidelines Advisory Committee had financial ties to everything from chocolate bar companies to entities like McDonald’s Council on Healthy Lifestyles and Coca-Cola’s Beverage Institute for Health and Wellness. One committee member even served as “brand girl” for cake-mix maker Duncan Hines and then as the official Crisco “brand girl” before going on to help write the official Dietary Guidelines for Americans.
• Men who smoke are twenty-three times more likely and women thirteen times more likely to develop lung cancer than nonsmokers. And smokers aren’t just harming themselves; thousands of deaths each year have been attributed to secondhand smoke. Nonsmokers have a 20–30 percent higher risk of developing lung cancer if they’re regularly exposed to cigarette smoke.
• If it’s the antioxidants, why not just take an antioxidant supplement? After all, popping a pill is easier than eating an apple. The reason is simple: Supplements don’t appear to work. Studies have repeatedly shown that antioxidant supplements have no beneficial effects on respiratory or allergic diseases, underscoring the importance of eating whole foods rather than trying to take isolated components or extracts in pill form. For example, the Harvard Nurses’ Health Study found that women who obtained high levels of vitamin E from a nut-rich diet appeared to have nearly half the risk of asthma of those who didn’t, but those who took vitamin E supplements saw no benefit at all.
• Bananas, although they’ve been marketed for their potassium content, aren’t actually particularly rich in the mineral. According to the current U.S. Department of Agriculture database, bananas don’t even make the list of the top-thousand foods with the highest levels of potassium; in fact, they come in at number 1,611, right after Reese’s Pieces. You’d have to eat a dozen bananas a day just to get the bare minimum recommended amount of potassium.
• Sixteen researchers spanning the globe published a database of the antioxidant power of more than a whopping three thousand foods, beverages, herbs, spices, and supplements. They tested everything from Cap’n Crunch cereal to the crushed dried leaves of the African baobab tree. They tested dozens of brands of beer to see which has the most antioxidants. (Santa Claus beer from Eggenberg, Austria, tied for first place.)46 Sadly, beer represents Americans’ fourth-largest source of dietary antioxidants. You can check out the list to see where your favorite foods and beverages rank at this link: https://bit.ly/antioxidantfoods.
• We generally think of atherosclerosis as a condition of the heart, but it’s been described as “an omnipresent pathology that involves virtually the entire human organism.” You have blood vessels in every one of your organs, including your brain. The concept of “cardiogenic dementia,” first proposed in the 1970s, suggested that because the aging brain is highly sensitive to a lack of oxygen, lack of adequate blood flow may lead to cognitive decline. Today, we have a substantial body of evidence strongly associating atherosclerotic arteries with Alzheimer’s disease.
• Animal fat intake shot up nearly 600 percent between 1961 and 2008.
• Your brain is only about 2 percent of your body weight but may consume up to 50 percent of the oxygen you breathe, potentially releasing a firestorm of free radicals.116 Special antioxidant pigments in berries and dark-green leafies may make them the brain foods of the fruit and vegetable kingdom.
• Every year, Americans lose more than five million years of life from cancers that may have been prevented. Only a small percentage of all human cancers are attributable to purely genetic factors. The rest involve external factors, particularly our diet.
• Imagine the logistics of following more than 100,000 people for decades. Now imagine a study five times that size. The largest study of diet and health in history is the NIH-AARP study, cosponsored by the National Institutes of Health and the American Association of Retired Persons. Over the course of a decade, researchers followed about 545,000 men and women aged fifty to seventy-one in the largest study of meat and mortality ever conducted. The scientists came to the same conclusion as the Harvard researchers: Meat consumption was associated with increased risk of dying from cancer, dying from heart disease, and dying prematurely in general. Again, this was after controlling for other diet and lifestyle factors, effectively excluding the possibility that people who ate meat also smoked more, exercised less, or failed to eat their fruits and veggies.
• In one study, researchers asked athletes to eat about 180 grams of blueberries every day for six weeks to see if the berries could reduce the oxidative stress caused by long-distance running.
• The blueberries succeeded, unsurprisingly, but a more important finding was their effect on natural killer cells. Normally, these cells decrease in number after a bout of prolonged endurance exercise, dropping by half to about one billion. But the athletes consuming blueberries actually doubled their killer cell counts, to more than four billion.
• Babies delivered via cesarean section appear to be at increased risk for various allergic diseases, including allergic runny nose, asthma, and perhaps even food allergies. (Allergy symptoms are caused when your immune system overreacts to normally harmless stimuli, such as tree pollen.) Normal delivery leads to the colonization of the baby’s gut with the mother’s vaginal bacteria. C-section babies, on the other hand, are deprived of this natural exposure. The resulting difference in gut flora may affect the way the baby’s immune system develops, accounting for the difference in allergy rates.
• Thankfully, a number of foods may help maintain your immunity to keep the germs at bay. First up is chlorella, a single-celled, freshwater, green algae typically sold as a powder or compressed into tablets. Researchers in Japan were the first to show that mothers given chlorella saw increased IgA concentrations in their breast milk.62 Although chlorella extract supplements failed to boost overall immune function, there is evidence that whole algae may be effective.
• Another option for athletes who want to sustain their immune function is nutritional yeast. A 2013 study reported that you may more effectively maintain your levels of white blood cells after exercise by consuming a special type of fibre found in baker’s, brewer’s, and nutritional yeast.67 Brewer’s yeast is bitter, but nutritional yeast has a pleasant, cheese-like flavor. It tastes particularly good on popcorn.
• In terms of healthy years of life lost, the top five most devastating pathogen food combinations are Campylobacter and Salmonella bacteria in poultry, Toxoplasma parasites in pork, and Listeria bacteria in deli meats and dairy products. One of the reasons animal foods are the leading culprits is that most foodborne pathogens are fecal pathogens. Because plants don’t poop, the E. coli you may get from spinach didn’t actually originate in the spinach; E. coli is an intestinal pathogen, and spinach doesn’t have intestines. The application of manure to crops has been found to increase the odds of E. coli contamination by more than fifty fold.
• In vitro studies have shown that a variety of mushrooms, including plain white button mushrooms, appear to blunt the inflammatory response, potentially offering a boost in immune and anticancer function without aggravating diseases of inflammation. The first randomized, double-blind, placebo-controlled clinical study of its kind, published in 2014, confirmed an apparent antiallergy effect in children with a history of recurrent upper-respiratory-tract infections. Food Poisoning Pathogens (from the Greek pathos, for “suffering,” and genes, meaning “producer of”) can also be found in what you eat. Foodborne illness, or food poisoning, is an infection caused by eating contaminated food. According to the CDC, about one in six Americans develops food poisoning every year. Roughly forty-eight million people are sickened annually—larger than the combined populations of California and Massachusetts. More than one hundred thousand of them are hospitalized, and thousands die, just because of something they ate. In terms of healthy years of life lost, the top five most devastating pathogen food combinations are Campylobacter and Salmonella bacteria in poultry, Toxoplasma parasites in pork, and Listeria bacteria in deli meats and dairy products. One of the reasons animal foods are the leading culprits is that most foodborne pathogens are fecal pathogens. Because plants don’t poop, the E. coli you may get from spinach didn’t actually originate in the spinach; E. coli is an intestinal pathogen, and spinach doesn’t have intestines. The application of manure to crops has been found to increase the odds of E. coli contamination by more than fiftyfold. Eggs and Salmonella The single greatest public health burden in the United States in terms of food poisoning is Salmonella. It’s the leading cause of food poisoning-related hospitalizations, as well as the number-one cause of food poisoning-related death. And it’s on the rise. Over the past decade, the number of cases has increased by 44 percent, particularly among children and the elderly. Within twelve to seventy-two hours after infection, the most common symptoms appear—fever, diarrhea, and severe abdominal cramps. The illness typically lasts between four and seven days, but among children and the elderly, the disease can be severe enough to require hospitalization—or funeral arrangements. Many people associate Salmonella with eggs—and for good reason. In 2010, for instance, more than half a billion eggs were recalled due to Salmonella outbreaks. However, the egg industry mantra remained: Stop whining; eggs are safe. Responding to cries for a recall in an op-ed published in USA Today, the chairman of the industry trade group United Egg Producers insisted that “completely cooked eggs are completely safe eggs.” But what exactly does “completely cooked” mean?
• The disease called diabetes mellitus comes from two words: diabetes (Greek for “to pass through or siphon”) and mellitus (Latin for “honey sweet”). Diabetes mellitus is characterized by chronically elevated levels of sugar in your blood. This is because either your pancreas gland isn’t making enough insulin (the hormone that keeps your blood sugar in check) or because your body becomes resistant to insulin’s effects. The insulin-deficiency disease is called type 1 diabetes, and the insulin-resistance disease is called type 2 diabetes. If too much sugar builds up in your blood, it can overwhelm the kidneys and spill into your urine.
• So why aren’t more parents feeding their kids plant-based diets? There’s a common misconception in America that their growth will be stunted. However, the opposite may be true. Loma Linda University researchers found that children who eat vegetarian diets not only grow up leaner than kids who eat meat but taller, too, by about an inch. In contrast, meat intake is associated more with horizontal growth: The same researchers found a strong link between consumption of animal foods and increased risk of being overweight.
• Not all fats affect our muscle cells in the same way. For example, palmitate, the kind of saturated fat found mostly in meat, dairy, and eggs, causes insulin resistance. On the other hand, oleate, the monounsaturated fat found mostly in nuts, olives, and avocados, may actually protect against the detrimental effects of the saturated fat. Saturated fats can wreak all sorts of havoc in muscle cells and may result in the accumulation of more toxic breakdown products (such as ceramide and diacylglycerol)39 and free radicals and can cause inflammation and even mitochondrial dysfunction—that is, interference with the little power plants (mitochondria) within our cells.40 This phenomenon is known as lipotoxicity (lipo meaning fat, as in liposuction).41 If we take muscle biopsies from people, saturated fat buildup in the membranes of their muscle cells correlates with insulin resistance. Monounsaturated fats, however, are more likely to be detoxified by the body or safely stored away.
• Many population studies have shown that people who eat significant amounts of legumes (e.g., beans, split peas, chickpeas, and lentils) tend to weigh less. They also have slimmer waists, less obesity, and lower blood pressure compared to people who don’t eat many legumes.47 But couldn’t these benefits be due not to the legumes themselves but to the fact that people who eat more legumes may eat a healthier diet in general? To tease out the connection, researchers used the most powerful tool in nutrition research: the interventional trial. Instead of just observing what people eat, you change their diets to see what happens. In this case, they put legumes to the test by comparing extra legume consumption head-to-head against calorie restriction. Reducing belly fat may be the best way to prevent prediabetes from turning into full-blown diabetes. Though calorie cutting has been the cornerstone of most weight-loss strategies, evidence suggests that the majority of individuals who lose weight by portion control eventually regain it. Starving ourselves almost never works long term. So wouldn’t it be great if instead we could find a way to eat more food to get the same weight-loss benefit? The researchers divided overweight subjects into two groups. The first group was asked to eat one kilogram a week of lentils, chickpeas, split peas, or haricot beans—but not to change their diets in any other way. The second group was asked to simply cut out five hundred calories a day from their diets. Guess who got healthier? The group directed to eat more food. Eating legumes was shown to be just as effective at slimming waistlines and improving blood sugar control as calorie cutting. The legume group also gained additional benefits in the form of improved cholesterol and insulin regulation.48 This is encouraging news for overweight individuals at risk of type 2 diabetes. Instead of just eating smaller portions and reducing the quantity of the food they eat, they can also improve the quality of their food by eating legume-rich meals.
• Do those who avoid meat completely get enough nutrients? To find out, researchers looked at a day in the life of thirteen thousand people all across America. They compared the nutrient intake of those who ate meat to those who didn’t. The study found that, calorie for calorie, those eating vegetarian diets were getting higher intakes of nearly every nutrient: more fibre, more vitamin A, more vitamin C, more vitamin E, more of the B vitamins thiamin, riboflavin, and folate, as well as more calcium, magnesium, iron, and potassium. Furthermore, many of the nutrients that are so rich in plant-based diets are among the very ones that most Americans normally don’t get enough of—namely, vitamins A, C, E, not to mention fibre, calcium, magnesium, and potassium. At the same time, people who avoided meat also ingested fewer harmful substances, such as sodium, saturated fat, and cholesterol.
• Insulin treatments themselves may accelerate aging, worsen diabetic vision loss, and promote cancer, obesity, and atherosclerosis. Insulin can promote inflammation in the arteries, which may help explain the increased death rate in the intensively treated group. So rather than trying to overcome insulin resistance by brute force—just pumping in more and more insulin—isn’t it better to treat the disease itself by eliminating the unhealthy diet that caused it? That reminds me of people who undergo bypass surgery for clogged arteries. If they keep eating unhealthfully, their bypasses will eventually get clogged too. It’s better to treat the cause than the symptoms.
• So why didn’t I learn about any of this in medical school? There’s little money to be made from prescribing plants instead of pills. The neuropathy pain reversal study was published more than twenty years ago, and the blindness reversal studies more than fifty years ago. As one commentator wrote, “The neglect of this important work by the broader medical community is little short of unconscionable.”
• There may be an even better tool than BMI that we can use to gauge the health risks of body fat. It’s called Waist-to-Height Ratio, or WHtR.
• Unfortunately, doctors don’t tend to educate their patients about diabetes prevention. Only about one in three prediabetic patients reports ever being told by their doctors to exercise or to improve their diets. Possible reasons for not counseling patients include a lack of insurance reimbursement for the extra time spent, a lack of resources, a lack of time, and a lack of knowledge. We’re just not training doctors how to empower the people they serve.
• The current medical education system has yet to adapt to the great transformation of disease from acute to chronic. Medicine is no longer about just setting broken bones or curing strep throat. Such chronic diseases as diabetes are now the principal cause of death and disability in America, consuming three-quarters of the nation’s health care budget. Medical education has yet to recognize and respond to the changing nature of disease patterns, which now requires a focus on prevention and lifestyle change. How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education has not changed since 1910.
• The two most prominent dietary risks for death and disability in the world may be not eating enough fruit and eating too much salt. Nearly five million people appear to die every year as a result of not eating enough fruit, while eating too much salt may kill up to four million. Salt is a compound made up of about 40 percent sodium and 60 percent chloride. Sodium is an essential nutrient, but vegetables and other natural foods provide the small amounts of sodium you need in your diet. If you consume too much, it can cause water retention, and your body may respond by raising your blood pressure to push the excess fluid and salt out of your system.
• The salt industry has its own PR and lobbying firms to play tobacco-industry-style tactics to downplay the dangers of its product. But the real villains aren’t necessarily the salt-mine barons—it’s the processed food industry. The trillion-dollar processed food industry uses dirt-cheap added salt and sugar to sell us their junk. That’s why it’s not easy avoiding sodium on the typical American diet, since three-quarters of salt comes from processed foods rather than a saltshaker. By hooking you on hypersweet and hypersalty foods, your taste buds get so dampened that natural foods can taste like cardboard. Indeed, the ripest fruit may not be as sweet as a high-sugar cereal snack such as Froot Loops.
• As we discussed earlier, the ideal blood pressure, defined as the level at which lowering it further yields no additional benefit, is probably around 110/70.
• Do omnivores who are as slim as vegans enjoy the same blood pressure? To answer this question, researchers would have to find a group of individuals who eat the standard American diet but are also as thin as people eating plant-based diets. To find an omnivorous group that fit and trim, researchers recruited long-distance endurance athletes who had run, on average, forty-eight miles per week for twenty-one years. Running almost two marathons a week for twenty years, pretty much anyone can become as slim as a plant eater no matter what they eat! The researchers then compared these hard-core athletes to two groups: sedentary meat eaters who exercised less than an hour per week and sedentary vegans who ate mostly unprocessed, uncooked plant foods. How did the numbers come out? Not surprisingly, the endurance runners on a standard American diet had a better blood pressure average than their sedentary, meat-eating counterparts: 122/72 compared with 132/79, which fits the definition of prehypertensive. But the sedentary vegans? They averaged an extraordinary 104/62. Apparently, eating standard American fare even when running two thousand miles a year may not bring down your blood pressure as low as a being a couch-potato vegan.
• Everyone agrees that heavy drinking, drinking during pregnancy, and binge drinking are bad ideas, but what about “moderate” drinking? Yes, excessive drinkers appear to significantly shorten their lives, but so can teetotalers.16 While smoking is bad for you and smoking a lot is worse, that logic may not hold for alcohol consumption. There actually appears to be a beneficial effect on overall mortality by drinking some alcohol—but only, it seems, for those who are not taking good care of themselves already. Moderate drinking does appear to protect against heart disease, perhaps because of a blood-thinning effect, but even light drinking (less than one drink a day) has been found to increase cancer risk, as you’ll see in chapter 11. How could something that increases cancer risk still prolong life? Cancer is “only” our second-leading killer disease. Because heart disease is the leading cause of death, it explains why people who drink moderately may live longer lives than those who abstain. But this advantage may be restricted only to those who fail to practice a bare modicum of healthy behaviors.19 To find out who might benefit from moderate alcohol consumption, researchers recruited close to ten thousand men and women and followed them for seventeen years after assessing their drinking and lifestyle habits. The results were published in a paper entitled “Who Benefits Most from the Cardioprotective Properties of Alcohol Consumption—Health Freaks or Couch Potatoes?” What constituted a “health freak”? According to the researchers’ definition, anyone who exercises thirty minutes a day, doesn’t smoke, and eats at least one serving of fruits or vegetables daily.(What does that say about our current diets if eating a single apple means you’re a “health freak”?) One to two drinks a day did lower the risk of heart disease for the “couch potatoes,” those living unhealthy lifestyles. But people who practiced even the bare minimum of healthy behaviors showed no benefit from alcohol. The lesson: Grapes, barley, and potatoes are best eaten in their nondistilled form, and Johnnie Walker is no substitute for actual walking.
• Drinking just one can of soda a day appears to raise the odds of getting fatty liver disease by 45 percent.
• The green algae chlorella looks promising for the treatment of hepatitis C. A randomized, double-blind, placebo-controlled study found that about two teaspoons a day of chlorella boosted the activity of natural killer cells in participants’ bodies, which can naturally kill hepatitis C-infected cells.37 A clinical study of hepatitis-C patients found that chlorella supplementation may lower the level of liver inflammation, but the study was small and uncontrolled. There is a desperate need for alternative treatments for hepatitis C, as older, less expensive therapies frequently fail due to their unbearable side effects, whereas newer, more tolerable drugs cost as much as $1,000 (£650) per pill.39 Chlorella may help as an adjunct (additional) therapy or for those who can’t tolerate or afford conventional antiviral therapy but may not be without risk (see here).
• We’ve all seen those marketing schemes involving products espousing all sorts of health claims. And given the pyramid-like multilevel structure of those types of distribution programs—you earn money by selling products and also for recruiting others to sell—word can spread pretty fast, which is particularly troubling when PR outruns the truth. Indeed, while the vast majority of drug-induced liver injuries are caused by conventional medications, liver damage caused by certain classes of dietary supplements can be even more serious and may lead to higher rates of liver transplants and death.50 Multilevel marketers of products later linked to toxic reactions (such as noni juice51 and Herbalife52) have pointed to scientific studies to support their health claims. However, a public health review found that such studies often seemed “deliberately created for marketing purposes” and were presented in such a way as to appear “designed to mislead potential consumers.” Often, multilevel marketing study researchers didn’t disclose their funding sources, but a little detective work can expose a web of financial conflicts of interest. These suspect studies were the same ones cited to provide proof of safety for their products. For example, a multilevel marketing company that sells mangosteen juice cited a study they paid for to support its assertion that their product is “safe for everyone.” The study involved exposing just thirty people to their product with another ten people given a placebo. With so few people tested, the stuff could literally kill 1 or 2 percent of users and you wouldn’t know. A study that the multilevel marketing company behind a supplement called Metabolife cited for safety placed thirty-five people on the stuff. Metabolife has since been withdrawn from the market after being linked to heart attacks, strokes, seizures, and deaths. Hydroxycitric acid, a component of such products as Hydroxycut, was studied on forty people. No serious adverse effects were found, but the story ended the same way: Hydroxycut was withdrawn after dozens of verified cases of organ damage were brought to light—including massive liver failure requiring transplantation and even death. Until the multibillion-dollar herbal supplement industry is better regulated, you’re better off saving your money—and your health—by sticking to real food.
• Specific plant foods have been found to be protective of the liver. For instance,
• Specific plant foods have been found to be protective of the liver. For instance, starting out the day with a bowl of oatmeal and (surprisingly) coffee may help safeguard our liver function. Oatmeal In numerous population studies, consumption of whole grains has been associated with reduced risk for a range of chronic diseases, but it’s hard to tease out whether eating whole grains may just be a marker for
• Specific plant foods have been found to be protective of the liver. For instance, starting out the day with a bowl of oatmeal and (surprisingly) coffee may help safeguard our liver function. Oatmeal In numerous population studies, consumption of whole grains has been associated with reduced risk for a range of chronic diseases, but it’s hard to tease out whether eating whole grains may just be a marker for a healthier lifestyle in general.
• The key to cancer prevention and treatment is to keep tumor cells from multiplying out of control while allowing healthy cells to grow normally. Chemotherapy and radiation can do a great job of wiping out cancer cells, but healthy cells can get caught in the crossfire. Some compounds in plants, though, may be more discriminating. For instance, sulforaphane, considered one of the more active components in cruciferous vegetables, kills human leukemia cells in a petri dish while having little impact on the growth of normal cells. As we’ve discussed, cruciferous vegetables include broccoli, cauliflower, and kale, but there are many others in this family, such as collard greens, watercress, bok choy, kohlrabi, rutabaga, turnips, rocket, radishes (including horseradish), wasabi, and all types of cabbage.
• In terms of antioxidant bang for your buck, açai berries get honorable mention, beating out other superstars, such as walnuts, apples, and cranberries. The bronze for best bargain, though, goes to cloves, the silver to cinnamon, and the gold for most antioxidants per pound—according to a USDA database of common foods—goes to purple cabbage. Açai berries, however, would probably make a tastier smoothie.
• Researchers at Harvard University followed thousands of healthy women, their diets, and their kidney function for more than a decade to look for the presence of protein in the women’s urine. Healthy kidneys work hard to retain protein and other vital nutrients, preferably filtering toxic or useless wastes out of the bloodstream via our urine. If the kidneys are leaking protein into urine, it’s a sign that they may be starting to fail. The researchers found three specific dietary components associated with this sign of declining kidney function: animal protein, animal fat, and cholesterol. Each of these is found in only one place: animal products. The researchers found no association between kidney function decline and the intake of protein or fat from plant sources.9
• Cholesterol too high from eating a diet unnaturally high in saturated fat and cholesterol? Take a statin drug to cripple your cholesterol-making enzyme. Diet unnaturally high in acid-forming foods? Swallow some bicarbonate of soda pills to balance that right out.
• Historically, the only accepted risk factor for kidney cancer has been tobacco use.99 A class of carcinogens in cigarette smoke called nitrosamines are considered to be so harmful that even so-called thirdhand smoke is a concern. The risks of tobacco smoke do not end when a cigarette is extinguished, as residual smoke can stick to walls and other surfaces.100 Around 80 percent of nitrosamines from cigarette smoke can remain in a room, even with normal ventilation,101 so always try to choose smoke-free hotel rooms. Nitrosamines are one of the reasons you can’t smoke indoors without endangering others, even if you smoke without anyone present. As one of the leading scholars in the tobacco control movement recently wrote, “Carcinogens of this strength in any other consumer product designed for human consumption would be banned immediately.”
• Did you know that one hot dog has as many nitrosamines (and nitrosamides, which are similar tobacco carcinogens) as four cigarettes and that these carcinogens are also found in fresh meat, including beef, chicken, and pork? This may help explain the rising rates of kidney cancer over the last few decades despite the falling rates of smoking.
• Current controversy over the cost and effectiveness of mammograms10 misses an important point: Breast cancer screening, by definition, does not prevent breast cancer. It can just pick up existing breast cancer. Based on autopsy studies, as many as 39 percent of women in their forties already have breast cancers growing within their bodies that may be simply too small to be detected by mammograms. That’s why you can’t just wait until diagnosis to start eating and living healthier. You should start tonight.
• In 2010, the official World Health Organization body that assesses cancer risks formally upgraded its classification of alcohol to a definitive human breast carcinogen. In 2014, it clarified its position by stating that, regarding breast cancer, no amount of alcohol is safe.
• The carcinogen isn’t alcohol itself. The culprit is actually the toxic breakdown product of alcohol called acetaldehyde, which can form in your mouth almost immediately after you take a sip. Experiments show that even holding a single teaspoon of spirits in your mouth for five seconds before spitting it out results in the production of potentially carcinogenic levels of acetaldehyde that lingers for more than ten minutes.
• The Harvard Nurses’ Health Study found that even less than one drink a day may be associated with a small increase in breast cancer risk. Interestingly, drinking only red wine was not associated with breast cancer risk. Why? A compound in red wine appears to suppress the activity of an enzyme called estrogen synthase, which breast tumors can use to create estrogen to fuel their own growth. This compound is found in the skin of the dark-purple grapes used to make red wine, which explains why white wine appears to provide no such benefit,25 since it’s produced without the skin.
• It’s good (and delicious) to know that strawberries, pomegranates, and plain white mushrooms may also suppress the potentially cancer-promoting enzyme.
• The gut bacteria’s role may help explain why women with frequent urinary tract infections may be at a higher risk of breast cancer: Every course of antibiotics you take can kill bacteria indiscriminately, meaning it may stymie the ability of the good bacteria in your gut to take full advantage of the lignans in your diet. (Yet another reason you should take antibiotics only when necessary.)
• Nearly forty thousand Americans take their own lives each year,1 and depression appears to be a leading cause. Thankfully, lifestyle interventions can help repair your mind as well as your body.
• Higher consumption of vegetables may cut the odds of developing depression by as much as 62 percent. A review in the journal Nutritional Neuroscience concluded that, in general, eating lots of fruits and veggies may present “a non-invasive, natural, and inexpensive therapeutic means to support a healthy brain.”
• Even on a day-to-day basis, studies have shown that the more fruits and vegetables you eat, the happier, calmer, and more energetic you may feel that day—and this positivity can spill over into the next day. For your diet to have a meaningful psychological impact, though, you may need to consume approximately seven servings of fruits or eight servings of vegetables each day.
• Among the carotenoids, lycopene (the red pigment in tomatoes) has the highest antioxidant activity. Indeed, a study of nearly one thousand elderly men and women found that people who ate tomatoes or tomato products daily had just half the odds of depression compared with those who ate them once a week or less.
• Thousands of published studies seem to have demonstrated that antidepressant drugs are effective. The key word here, though, may be published. What if drug companies decided to publish only those studies that showed a positive effect but quietly shelved and concealed any studies showing the drugs didn’t work? To find out if this was the case, researchers applied to the Food and Drug Administration under the U.S. Freedom of Information Act (FOIA) to get access to the published and unpublished studies submitted by pharmaceutical companies. What they found was shocking. According to the published literature, the results of nearly all antidepressant trials were positive. In contrast, FDA analysis of trial data—including the unpublished studies—demonstrated that roughly half of the trials showed the drugs didn’t work after all. When all the data—published and unpublished—was combined, antidepressants failed to show a clinically significant advantage over placebo sugar pills. This finding suggests that the placebo effect explains the apparent clinical effectiveness of antidepressants. In other words, improvements in mood may be a result of the patient’s belief in the power of the drug—not the drug itself.
• The researchers found that cow’s milk stimulated the growth of human prostate cancer cells in each of fourteen separate experiments, producing an average increase in cancer growth rate of more than 30 percent. In contrast, almond milk suppressed the growth of the cancer cells by more than 30 percent.
• But what cancer-promoting substance is there in eggs? How could eating less than an egg a day double the risk of cancer invasion? The answer may be choline, a compound found concentrated in eggs. Higher levels of choline in the blood have been associated with increased risk of developing prostate cancer in the first place. This may explain the link between eggs and cancer progression. But what about cancer mortality? In a paper entitled “Choline Intake and Risk of Lethal Prostate Cancer,” the same Harvard team found that men who consumed the most choline from food also had an increased risk of cancer death. Men who consume two and a half or more eggs per week—basically an egg every three days—may have an 81 percent increased risk of dying from prostate cancer.
• Ironically, the presence of choline in eggs is something the egg industry boasts about even though most Americans get more than enough choline. Mind you, the industry executives are aware of the cancer connection. Through the Freedom of Information Act, I was able to get my hands on an e-mail from the executive director of the Egg Nutrition Board directed to another egg industry executive that discussed the Harvard study suggesting that choline is a culprit in promoting cancer progression. “Certainly worth keeping in mind,” he wrote, “as we continue to promote choline as another good reason to consume eggs.”
• How does your body keep itself in balance? By sending chemical signals called hormones to all the cells. A key signal is a growth hormone called IGF-1. It sounds like a droid from Star Wars, but IGF-1 is actually a crucial factor in regulating cell growth. Levels go up when you’re a kid in order to power your development, but when you reach adulthood, IGF-1 levels diminish. It’s your body’s cue to stop producing more cells than it kills off. Should your levels of IGF-1 remain too high when you reach adulthood, however, your cells will constantly receive a message to grow, divide, and keep going and growing. Not surprisingly, the more IGF-1 you have in your bloodstream, the higher your risk for developing cancers, such as prostate cancer.
• The release of IGF-1 appears to be triggered by the consumption of animal protein. This may explain why you can so dramatically bolster the cancer-fighting power of your bloodstream within weeks of eating a plant-based diet. Remember the experiments in which dripping the blood from people eating healthy diets onto cancer cells wiped more of them out? Well, if you add back to the cancer cells the amount of IGF-1 that left the plant eaters’ systems, guess what happens? The diet-and-exercise effect disappears. The cancer cell growth comes surging back. This is how we suspect plant-based eating boosts our blood defenses: By reducing animal protein intake, we reduce our levels of IGF-1.91 After just eleven days of cutting back on animal protein, your IGF-1 levels can drop by 20 percent, and your levels of IGF-1 binding protein can jump by 50 percent. One of the ways your body tries to protect itself from cancer—that is, excessive growth—is by releasing a binding protein into your bloodstream to tie up any excess IGF-1. Think of it as the body’s emergency brake. Even if you’ve managed to down-regulate production of new IGF-1 through diet, what about all that excess IGF-1 still circulating from the bacon and eggs you may have eaten two weeks before? No problem: The liver releases a snatch squad of binding proteins to help take it out of circulation.
• I do not recommend that people ignore their doctors’ advice. Whatever you and your medical team decide together, healthy diet and lifestyle changes can presumably only help. That’s the nice thing about lifestyle interventions—they can be implemented in addition to whatever other treatment options are chosen. In a research setting, that can complicate matters, as you don’t know which action may be responsible for any improvement. But when facing a cancer diagnosis, you may want to opt for all the help you can get. Regardless of whether cancer patients elect for chemo, surgery, or radiation, they can always improve their diets. A prostate-healthy diet is a breast-healthy diet is a heart-healthy diet is a body-healthy diet.
• As the saying goes, an ounce of prevention is worth a pound of cure. That’s quaint, but a pound isn’t all that heavy. Why change your diet and lifestyle when you can just let modern medicine do its job of fixing you back up? Unfortunately, modern medicine isn’t nearly as effective as most people think.1 Doctors excel at treating acute conditions, such as mending broken bones and curing infections, but for chronic diseases, which are the leading causes of death and disability, conventional medicine doesn’t have much to offer and, in fact, can sometimes do more harm than good. For example, side effects from medications given in hospitals kill an estimated 106,000 Americans every year.2 That statistic alone effectively makes medical care the sixth-leading cause of death in the United States. And this number reflects only the number of deaths from taking the drugs as prescribed. An additional 7,000 people die every year from receiving the wrong medication by mistake, and 20,000 others die from other hospital errors.3
• “If it came from a plant, eat it. If it was made in a plant, don’t.”
• Sometimes, however, processing can make foods healthier. For example, tomato juice appears to be the one common juice that may actually be healthier than the whole fruit. The processing of tomato products boosts the availability of the antioxidant red pigment lycopene by as much as fivefold. Similarly, the removal of fat from cacao beans to make cocoa powder improves the nutritional profile, because cocoa butter is one of the rare saturated plant fats (along with coconut and palm kernel oils) that can raise your cholesterol.
• Foods are not so much good or bad as they are better or worse. All I’m saying is that unprocessed foods tend to be healthier than processed ones. Think of it this way: Eating almonds is healthier than drinking almond milk.
• Sometimes people’s diets take on a religiosity of their own. I remember a man once telling me that he could never “go plant based” because he could never give up his grandma’s chicken soup. Huh? Then don’t! After I asked him to say hello to his bubby for me, I told him that enjoying her soup shouldn’t keep him from making healthier choices the rest of the time. The problem with all-or-nothing thinking is that it keeps people from even taking the first steps.
• We cannot let the “perfect” be the enemy of the good.
• From a nutrition standpoint, the reason I don’t like the terms vegetarian and vegan is that they are only defined by what you don’t eat.
• There’s a concept in psychology called “decision fatigue” that marketers use to exploit consumers. It appears humans have a limited capacity to make many decisions in one short stretch of time, and the quality of our decisions will deteriorate to the extent that we eventually begin making downright irrational choices. Ever wonder why supermarkets stack the junk food at the checkout counter? After wading through the forty thousand items in the average supermarket, we end up with less willpower to resist impulse purchases.
• Whenever I was sitting down to a meal, I would ask myself, Could I add greens to this? Could I add beans to that? (I always have an open tin of beans in the fridge.) Can I sprinkle on some flax or pumpkin seeds, or maybe some dried fruit? The checklist just got me into the habit of thinking, How can I make this meal even healthier?
• Lentils are already one of the most nutrient-dense legumes. But when sprouted, their antioxidant power doubles (and even quintuples for chickpeas). Lentils can be easily sprouted into one of the healthiest possible snacks.
• Tinned beans are convenient, but are they as nutritious as home cooked? A recent study discovered that indeed tinned beans are as healthy as boiled beans—with one exception: sodium. Salt is often added to tinned beans, resulting in sodium levels up to one hundred times more than if you cooked them without any salt.
• America’s favorite fruits are apples and bananas, with antioxidant power of about 60 units and 40 units, respectively. Mangos, the preferred fruit around the world outside of the United States, have even more antioxidant punch at around 110 units. (It makes sense when you consider how much more colorful they are on the inside.) But none of these fruits are a match for berries. Strawberries weigh in at about 310 units per 120 grams, cranberries at 330, raspberries at 350, blueberries at 380 (though wild blueberries may have twice as much7), and blackberries at a whopping 650 units.
• Are frozen berries as nutritious as fresh ones? Studies on cherries, raspberries, and strawberries suggest that most of their nutrition is retained even when frozen. I usually opt for frozen berries since they last longer, are available year round, and tend to be cheaper. If you looked in our freezer right now, you’d see it’s about half frozen greens and half frozen berries. What do I do with those berries? Make ice cream, of course.
• Of course making berry ice cream or at least a berry-banana mix is even healthier. My favorite is chocolate. To make it, blend dark, sweet cherries or strawberries mixed with a tablespoon of cocoa power, a splash of a milk of your choice (more if you want a milkshake), a capfull of vanilla extract, and some pitted dates. If you didn’t yet get your nuts for the day, you can add some almond butter. Either way, you get an instant, decadent, chocolate dessert so nutritious that the more you eat, the healthier you are. Let me repeat that: The more you eat, the healthier you are
• A note of caution: For the same reason that high doses of anti-inflammatory drugs such as aspirin should be avoided during the third trimester of pregnancy, cocoa, berries, and other foods high in anti-inflammatory polyphenols should only be eaten in moderation in late pregnancy.