How Not to Die Read online

  In public health school, students learn that there are three levels of preventive medicine. The first is primary prevention, as in trying to prevent people at risk for heart disease from suffering their first heart attack. An example of this level of preventive medicine would be your doctor prescribing you a statin drug for high cholesterol. Secondary prevention takes place when you already have the disease and are trying to prevent it from becoming worse, like having a second heart attack. To do this, your doctor may add an aspirin or other drugs to your regimen. At the third level of preventive medicine, the focus is on helping people manage long-term health problems, so your doctor, for example, might prescribe a cardiac rehabilitation program that aims to prevent further physical deterioration and pain.23 In 2000, a fourth level was proposed. What could this new “quaternary” prevention be? Reduce the complications from all the drugs and surgery from the first three levels.24 But people seem to forget about a fifth concept, termed primordial prevention, that was first introduced by the World Health Organization back in 1978. Decades later, it’s finally being embraced by the American Heart Association.25

  Primordial prevention was conceived as a strategy to prevent whole societies from experiencing epidemics of chronic-disease risk factors. This means not just preventing chronic disease but preventing the risk factors that lead to chronic disease.26 For example, instead of trying to prevent someone with high cholesterol from suffering a heart attack, why not help prevent him or her from getting high cholesterol (which leads to the heart attack) in the first place?

  With this in mind, the American Heart Association came up with “The Simple 7” factors that can lead to a healthier life: not smoking, not being overweight, being “very active” (defined as the equivalent of walking at least twenty-two minutes a day), eating healthier (for example, lots of fruits and vegetables), having below-average cholesterol, having normal blood pressure, and having normal blood sugar levels.27 The American Heart Association’s goal is to reduce heart-disease deaths by 20 percent by 2020.28 If more than 90 percent of heart attacks may be avoided with lifestyle changes,29 why so modest an aim? Even 25 percent was “deemed unrealistic.”30 The AHA’s pessimism may have something to do with the frightening reality of the average American diet.

  An analysis of the health behaviors of thirty-five thousand adults across the United States was published in the American Heart Association journal. Most of the participants didn’t smoke, about half reached their weekly exercise goals, and about a third of the population got a pass in each of the other categories—except diet. Their diets were scored on a scale from zero to five to see if they met a bare minimum of healthy eating behaviors, such as meeting recommended targets for fruit, vegetable, and whole-grain consumption or drinking fewer than three cans of fizzy drinks a week. How many even reached four out of five on their Healthy Eating Score? About 1 percent.31 Maybe if the American Heart Association achieves its goal of an “aggressive”32 20 percent improvement by 2020, we’ll get up to 1.2 percent.

  Medical anthropologists have identified several major eras of human disease, starting with the Age of Pestilence and Famine, which largely ended with the Industrial Revolution, or the stage we’re in now, the Age of Degenerative and Man-Made Diseases.33 This shift is reflected in the changing causes of death over the last century. In 1900 in the United States, the top-three killers were infectious diseases: pneumonia, tuberculosis, and diarrheal disease.34 Now, the killers are largely lifestyle diseases: heart disease, cancer, and chronic lung disease.35 Is this simply because antibiotics have enabled us to live long enough to suffer from degenerative diseases? No. The emergence of these epidemics of chronic disease was accompanied by dramatic shifts in dietary patterns. This is best exemplified by what’s been happening to disease rates among people in the developing world over the last few decades as they’ve rapidly Westernized their diets.

  In 1990 around the world, most years of healthy life were lost to undernutrition, such as diarrheal diseases in malnourished children, but now the greatest disease burden is attributed to high blood pressure, a disease of overnutrition.36 The pandemic of chronic disease has been ascribed in part to the near-universal shift toward a diet dominated by animal-sourced and processed foods—in other words, more meat, dairy, eggs, oils, fizzy drinks, sugar, and refined grains.37 China is perhaps the best-studied example. There, a transition away from the country’s traditional, plant-based diet was accompanied by a sharp rise in diet-related chronic diseases, such as obesity, diabetes, cardiovascular diseases, and cancer.38

  Why do we suspect these changes in diet and disease are related? After all, rapidly industrializing societies undergo multitudes of changes. How are scientists able to parse out the effects of specific foods? To isolate the effects of different dietary components, researchers can follow the diets and diseases of large groups of defined individuals over time. Take meat, for example. To see what effect an increase in meat consumption might have on disease rates, researchers studied lapsed vegetarians. 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. During the twelve years after the transition from vegetarian to omnivore, meat-eating was associated with a 3.6 year decrease in life expectancy.39

  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.

  To this end, a dietary quality index was developed that simply reflects the percentage of calories people derive from nutrient-rich, unprocessed plant foods41 on a scale of zero to one hundred. The higher people score, the more body fat they may lose over time42 and the lower their risk may be of abdominal obesity,43 high blood pressure,44 high cholesterol, and high triglycerides.45 Comparing the diets of 100 women with breast cancer to 175 healthy women, researchers concluded that scoring higher on the whole plant food diet index (greater than about thirty compared to less than about eighteen) may reduce the odds of breast cancer more than 90 percent.46

  Sadly, most Americans hardly make it past a score of ten. The standard American diet rates eleven out of one hundred. According to estimates from the U.S. Department of Agriculture, 32 percent of our calories comes from animal foods, 57 percent comes from processed plant foods, and only 11 percent comes from whole grains, beans, fruits, vegetables, and nuts.47 That means on a scale of one to ten, the American diet would rate about a one.

  We eat almost as if the future doesn’t matter. And, indeed, there is actually data to back that up. A study entitled “Death Row Nutrition: Curious Conclusions of Last Meals” analyzed the last meal requests of hundreds of individuals executed in the United States during a five-year period. It turns out that the nutritional content didn’t differ much from what Americans normally eat.48 If we continue to eat as though we’re having our last meals, eventually they will be.

  What percentage of Americans hit all the American Heart Association’s “Simple 7” recommendations? Of 1,933 men and women surveyed, most met two or three, but hardly any managed to meet all seven simple health components. In fact, just a single individual could boast hitting all seven recommendations.49 One person out of nearly two thousand. As a recent past president of the American Heart Association responded, “That sh
ould give all of us pause.”50

  The truth is that adhering to just four simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases: not smoking, not being obese, getting half an hour of exercise a day, and eating healthier—defined as consuming more fruits, veggies, and whole grains and less meat. Those four factors alone were found to account for 78 percent of chronic disease risk. If you start from scratch and manage to tick off all four, you may be able to wipe out more than 90 percent of your risk of developing diabetes, more than 80 percent of your risk of having a heart attack, cut by half your risk of having a stroke, and reduce your overall cancer risk by more than one-third.51 For some cancers, like our number-two cancer killer, colon cancer, up to 71 percent of cases appear to be preventable through a similar portfolio of simple diet and lifestyle changes.52

  Maybe it’s time we stop blaming genetics and focus on the more than 70 percent that is directly under our control.53 We have the power.

  Does all this healthy living translate into a longer life as well? The Centers for Disease Control and Prevention (CDC) followed approximately eight thousand Americans aged twenty years or older for about six years. They found that three cardinal lifestyle behaviors exerted an enormous impact on mortality: People can substantially reduce their risk for early death by not smoking, consuming a healthier diet, and engaging in sufficient physical activity. And the CDC’s definitions were pretty laid-back: By not smoking, the CDC just meant not currently smoking. A “healthy diet” was defined merely as being in the top 40 percent in terms of complying with the wimpy federal dietary guidelines, and “physically active” meant averaging about twenty-one minutes or more a day of at least moderate exercise. People who managed at least one of the three had a 40 percent lower risk of dying within that six-year period. Those who hit two out of three cut their chances of dying by more than half, and those who scored all three behaviors reduced their chances of dying in that time by 82 percent.54

  Of course, people sometimes fib about how well they eat. How accurate can these findings really be if they’re based on people’s self-reporting? A similar study on health behaviors and survival didn’t just take people’s own word for how healthy they were eating; the researchers measured how much vitamin C participants had in their bloodstreams. The level of vitamin C in the blood was considered a “good biomarker of plant food intake” and hence was used as a proxy for a healthy diet. The conclusions held up. The drop in mortality risk among those with healthier habits was equivalent to being fourteen years younger.55 It’s like turning back the clock fourteen years—not with a drug or a DeLorean but just by eating and living healthier.

  Let’s talk a little more about aging. In each of your cells, you have forty-six strands of DNA coiled into chromosomes. At the tip of each chromosome, there’s a tiny cap called a telomere, which keeps your DNA from unraveling and fraying. Think of it as the plastic tips on the end of your shoelaces. Every time your cells divide, however, a bit of that cap is lost. And when the telomere is completely gone, your cells can die.56 Though this is an oversimplification,57 telomeres have been thought of as your life “fuse”: They can start shortening as soon as you’re born, and when they’re gone, you’re gone. In fact, forensic scientists can take DNA from a bloodstain and roughly estimate how old the person was based on how long their telomeres are.58

  Sounds like fodder for a great scene in CSI, but is there anything you can do to slow the rate at which your fuses burn? The thought is that if you can slow down this ticking cellular clock, you may be able to slow down the aging process and live longer.59 So what would you have to do if you wanted to prevent this telomere cap from burning away? Well, smoking cigarettes is associated with triple the rate of telomere loss,60 so the first step is simple: Stop smoking. But the food you eat every day may also have an impact on how fast you lose your telomeres. The consumption of fruits,61 vegetables,62 and other antioxidant-rich foods63 has been associated with longer protective telomeres. In contrast, the consumption of refined grains,64 fizzy drinks,65 meat (including fish),66 and dairy67 has been linked to shortened telomeres. What if you ate a diet composed of whole plant foods and stayed away from processed foods and animal foods? Could cellular aging be slowed?

  The answer lies in an enzyme found in Methuselah. That’s the name given to a bristlecone pine tree growing in the White Mountains of California, which, at the time, happened to be the oldest recorded living being and is now nearing its 4,800th birthday. It was already hundreds of years old before construction of the pyramids in Egypt began. There’s an enzyme in the roots of bristlecone pines that appears to peak a few thousand years into their life span, and it actually rebuilds telomeres.68 Scientists named it telomerase. Once they knew what to look for, researchers discovered the enzyme was present in human cells too. The question then became, how can we boost the activity of this age-defying enzyme?

  Seeking answers, the pioneering researcher Dr. Dean Ornish teamed up with Dr. Elizabeth Blackburn, who was awarded the 2009 Nobel Prize in Medicine for her discovery of telomerase. In a study funded in part by the U.S. Department of Defense, they found that three months of whole-food, plant-based nutrition and other healthy changes could significantly boost telomerase activity, the only intervention ever shown to do so.69 The study was published in one of the most prestigious medical journals in the world. The accompanying editorial concluded that this landmark study “should encourage people to adopt a healthy lifestyle in order to avoid or combat cancer and age-related diseases.”70

  So were Dr. Ornish and Dr. Blackburn able to successfully slow down aging with a healthy diet and lifestyle? A five-year follow-up study was recently published in which the lengths of the study subjects’ telomeres were measured. In the control group (the group of participants who did not change their lifestyles), their telomeres predictably shrank with age. But for the healthy-living group, not only did their telomeres shrink less, they grew. Five years later, their telomeres were even longer on average than when they started, suggesting a healthy lifestyle can boost telomerase enzyme activity and reverse cellular aging.71

  Subsequent research has shown that the telomere lengthening wasn’t just because the healthy-living group was exercising more or losing weight. 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.72 In contrast, individuals on the plant-based diet exercised only half as much, enjoyed the same amount of weight loss after just three months,73 and achieved significant telomere protection.74 In other words, it wasn’t the weight loss and it wasn’t the exercise that reversed cell aging—it was the food.

  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.75 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.

  What about our other leading killers? It turns out a more plant-based diet may help prevent, treat, or reverse every single one of our fifteen leading causes of death. In this book, I’ll go through this list, with a chapter on each:

  Mortality in the United States

  Annual Deaths

  1. Coronary heart disease76

  375,000

  2. Lung diseases (lung cancer,77 COPD, and asthma78)

  296,000

  3. You’ll be surprised! (see chapter 15)

  225,000

  4. Brain diseases (stroke79 and Alzheimer’s80)

  214,000

  5. Digestive cancers (col
orectal, pancreatic, and esophageal)81

  106,000

  6. Infections (respiratory and blood)82

  95,000

  7. Diabetes83

  76,000

  8. High blood pressure84

  65,000

  9. Liver disease (cirrhosis and cancer)85

  60,000

  10. Blood cancers (leukemia, lymphoma, and myeloma)86

  56,000

  11. Kidney disease87

  47,000

  12. Breast cancer88

  41,000

  13. Suicide89

  41,000

  14. Prostate cancer90

  28,000

  15. Parkinson’s disease91

  25,000

  Certainly there are prescription medications that can help with some of these conditions. For example, you can take statin drugs for your cholesterol to lower risk of heart attacks, pop different pills and inject insulin for diabetes, and take a slew of diuretics and other blood pressure medications for hypertension. But there is only one unifying diet that may help prevent, arrest, or even reverse each of these killers. 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. Unlike drugs—which only target specific functions, can have dangerous side effects, and may only treat the symptoms of disease—a healthy diet can benefit all organ systems at once, has good side effects, and may treat the underlying cause of illness.

  That one unifying diet found to best prevent and treat many of these chronic diseases is a whole-food, plant-based diet, defined as an eating pattern that encourages the consumption of unrefined plant foods and discourages meats, dairy products, eggs, and processed foods.92 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.