How Not to Die Read online

  Most doctor visits are for lifestyle-based diseases, which means they’re preventable diseases.93 As physicians, my colleagues and I were trained not to treat the root cause but rather the consequences by giving a lifetime’s worth of medications to treat risk factors like high blood pressure, blood sugar, and cholesterol. This approach has been compared to mopping up the floor around an overflowing sink instead of simply turning off the faucet.94 Drug companies are more than happy to sell you a new roll of paper towels every day for the rest of your life while the water continues to gush. 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.”95

  Treating the cause is not only safer and cheaper but it can work better. So why don’t more of my medical colleagues do it? Not only were they not trained how, doctors don’t get paid for it. No one profits from lifestyle medicine (other than the patient!), so it’s not a major part of medical training or practice.96 That’s just how the current system works. 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.”97

  Though there are vested interests, such as the processed food and pharmaceutical industries, which fight hard to maintain the status quo, there is one corporate sector that actually benefits from keeping people healthy—namely, the insurance industry. Kaiser Permanente, the largest managed-care organization in the country, published a nutritional update for physicians in their official medical journal, informing their nearly fifteen thousand physicians that healthy eating may be “best achieved with a plant-based diet, which we define as a regimen that encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all refined and processed foods.”98

  “Too often, physicians ignore the potential benefits of good nutrition and quickly prescribe medications instead of giving patients a chance to correct their disease through healthy eating and active living. . . . Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.”99 Physicians should give their patients a chance to first correct their disease themselves with plant-based nutrition.

  The major downside Kaiser Permanente’s nutritional update describes is that this diet may work a little too well. If people begin eating plant-based diets while still taking medications, their blood pressure or blood sugar could actually drop so low that physicians may need to adjust medications or eliminate them altogether. Ironically, the “side effect” of the diet may be not having to take drugs anymore. The article ends with a familiar refrain: Further research is needed. In this case, though, “Further research is needed to find ways to make plant-based diets the new normal. . . .”100

  We’re a long way off from Thomas Edison’s 1903 prediction, but it is my hope that this book can help you understand that most of our leading causes of death and disability are more preventable than inevitable. 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.101 As well, dramatic changes in disease rates within a single generation highlight the primacy of external factors. Colon cancer mortality in Japan in the 1950s was less than one-fifth that of the United States (including Americans of Japanese ancestry).102 But now colon cancer rates in Japan are as bad as they are in the United States, a rise that has been attributed in part to the fivefold increase in meat consumption.103

  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.104 You share 50 percent of your genes with each of your parents, so if one parent dies of a heart attack, you know you’ve inherited some of that susceptibility. But even among identical twins who have the exact same genes, one could die early of a heart attack and the other could live a long, healthy life with clean arteries depending on what she ate and how she lived. Even if both your parents died with heart disease, you should be able to eat your way to a healthy heart. Your family history does not have to become your personal destiny.

  Just because you’re born with bad genes doesn’t mean you can’t effectively turn them off. As you’ll see in the breast cancer and Alzheimer’s disease chapters, even if you’re born with high-risk genes, you have tremendous control over your medical destiny. Epigenetics is the hot new field of study that deals with this control of gene activity. Skin cells look and function a lot differently from bone cells, brain cells, or heart cells, but each of our cells has the same complement of DNA. What makes them act differently is that they each have different genes turned on or off. That’s the power of epigenetics. Same DNA, but different results.

  Let me give you an example of how striking this effect can be. Consider the humble honeybee. Queen bees and worker bees are genetically identical, yet queen bees lay up to two thousand eggs a day, while worker bees are functionally sterile. Queens live up to three years; workers may live only three weeks.105 The difference between the two is diet. When the hive’s queen is dying, a larva is picked by nurse bees to be fed a secreted substance called royal jelly. When the larva eats this jelly, the enzyme that had been silencing the expression of royal genes is turned off, and a new queen is born.106 The queen has the exact same genes as any of the workers, but because of what she ate, different genes are expressed, and her life and life span are dramatically altered as a result.

  Cancer cells can use epigenetics against us by silencing tumor-suppressor genes that could otherwise stop the cancer in its tracks. So even if you’re born with good genes, cancer can sometimes find a way to turn them off. A number of chemotherapy drugs have been developed to restore our bodies’ natural defenses, but their use has been limited due to their high toxicity.107 There are, however, a number of compounds distributed widely throughout the plant kingdom—including beans, greens, and berries—that appear to have the same effect naturally.108 For example, dripping green tea on colon, oesophageal, or prostate cancer cells has been shown to reactivate genes silenced by the cancer.109 This hasn’t just been demonstrated in a petri dish, though. Three hours after eating 50 grams of broccoli sprouts, the enzyme that cancers use to help silence our defenses is suppressed in your bloodstream110 to an extent equal to or greater than the chemotherapy agent specifically designed for that purpose,111 without the toxic side effects.112

  What if we ate a diet chock-full of plant foods? In the Gene Expression Modulation by Intervention with Nutrition and Lifestyle (GEMINAL) study, Dr. Ornish and colleagues took biopsies from men with prostate cancer before and after three months of intensive lifestyle changes that included a whole-food, plant-based diet. Without any chemotherapy or radiation, beneficial changes in gene expression for five hundred different genes were noted. Within just a few months, the expression of disease-preventing genes was boosted,
and oncogenes that promote breast and prostate cancer were suppressed.113 Whatever genes we may have inherited from our parents, what we eat can affect how those genes affect our health. The power is mainly in our hands and on our plates.

  This book is divided into two parts: the “why” and the “how.” In part 1—the “why” to eat healthfully section—I will explore the role diet can play in the prevention, treatment, and reversal of the fifteen leading causes of death in the United States. I’ll then take a closer look at more practical aspects of healthy eating in the “how” to eat healthfully section presented in part 2. For example, we’ll see in part 1 why beans and greens are among the healthiest foods on earth. Then, in part 2, we’ll take a look at how best to eat them—we’ll explore such issues as how many greens to eat every day and whether they’re best cooked, tinned, fresh, or frozen. We’ll see in part 1 why it’s important to eat at least nine servings of fruits and vegetables daily, and then part 2 will help you decide whether to buy organic or conventional produce. I’ll try to answer all the common questions I receive daily and then offer real-world tips for grocery shopping and meal planning to make it as easy as possible to best feed yourself and your family.

  Besides writing more books, I intend to keep lecturing at medical schools and speaking at hospitals and conferences for as long as I can. I’m going to keep trying to ignite the spark that led my colleagues into the healing profession in the first place: to help people get better. There are tools missing from too many doctors’ medical toolboxes, powerful interventions that can make many of our patients well again instead of merely slowing their decline. I’ll keep working on trying to change the system, but you, the reader, don’t have to wait. You can start now by following the recommendations within the following chapters. Eating healthier is easier than you think, it’s inexpensive, and it might just save your life.

  PART 1

  CHAPTER 1

  How Not to Die from Heart Disease

  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.

  So what’s going on here? If this epidemic is present on such a massive scale, yet so preventable, why aren’t we doing more about it?

  The killer I’m talking about is coronary heart disease, and it’s affecting nearly everyone raised on the standard American diet.

  Our Top Killer

  America’s number-one killer is a different kind of terrorist: fatty deposits in the walls of your arteries called atherosclerotic plaque. For most Americans raised on a conventional diet, plaque accumulates inside the coronary arteries—the blood vessels that crown the heart (hence “coronary”) and supply it with oxygen-rich blood. This buildup of plaque, known as atherosclerosis, from the Greek words athere (gruel) and sklerosis (hardening), is the hardening of the arteries by pockets of cholesterol-rich gunk that builds up within the inner linings of the blood vessels. This process occurs over decades, slowly bulging into the space inside the arteries, narrowing the path for blood to flow. The restriction of blood circulation to the heart muscle can lead to chest pain and pressure, known as angina, when people try to exert themselves. If the plaque ruptures, a blood clot can form within the artery. This sudden blockage of blood flow can cause a heart attack, damaging or even killing part of the heart.

  When you think about heart disease, you may think of friends or loved ones who suffered for years with chest pain and shortness of breath before they finally succumbed. However, for the majority of Americans who die suddenly from heart disease, the very first symptom may be their last.1 It’s called “sudden cardiac death.” This is when death occurs within an hour of symptom onset. In other words, you may not even realize you’re at risk until it’s too late. You could be feeling perfectly fine one moment, and then an hour later, you’re gone forever. That’s why it’s critical to prevent heart disease in the first place, before you even necessarily know you have it.

  My patients often asked me, “Isn’t heart disease just a consequence of getting old?” I can see why this is a common misconception. After all, your heart pumps literally billions of times during the average life span. Does your ticker just conk out after a while? No.

  A large body of evidence shows there were once enormous swaths of the world where the epidemic of coronary heart disease simply didn’t exist. For instance, in the famous China-Cornell-Oxford Project (known as the China Study), researchers investigated the eating habits and incidence of chronic disease among hundreds of thousands of rural Chinese. In Guizhou province, for example, a region comprising half a million people, over the course of three years, not a single death could be attributed to coronary artery disease among men under sixty-five.2

  During the 1930s and 1940s, Western-trained doctors working throughout an extensive network of missionary hospitals in sub-Saharan Africa noticed that many of the chronic diseases laying waste to populations in the so-called developed world were largely absent across most of the continent. In Uganda, a country of millions in eastern Africa, coronary heart disease was described as “almost non-existent.”3

  But were the people of these nations simply dying early of other diseases, never living long enough to come down with heart disease? No. The doctors compared autopsies of Ugandans to autopsies of Americans who had died at the same age. The researchers found that out of 632 people autopsied in Saint Louis, Missouri, there had been 136 heart attacks. But in 632 age-matched Ugandans? A single heart attack. The Ugandans experienced more than one hundred times fewer heart attacks than the Americans. The doctors were so blown away that they examined another 800 deaths in Uganda. Out of more than 1,400 Ugandans autopsied, researchers found just one body with a small, healed lesion of the heart, meaning the attack wasn’t even fatal. Then and now, in the industrialized world, heart disease is a leading killer. In central Africa, heart disease was so rare it killed fewer than one in a thousand.4

  Immigration studies show that this resistance to heart disease is not just something in the Africans’ genes. When people move from low-risk to high-risk areas, their disease rates skyrocket as they adopt the diet and lifestyle habits of their new homes.5 The extraordinarily low rates of heart disease in rural China and Africa have been attributed to the extraordinarily low cholesterol levels among these populations. Though Chinese and African diets are very different, they share commonalities: They are both centered on plant-derived foods, such as grains and vegetables. By eating so much fibre and so little animal fat, their total cholesterol levels averaged under 150 mg/dL,6,7 similar to people who eat contemporary plant-based diets.8

  So what does all of this mean? It means heart disease may be a choice.

  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.9 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. I certainly enjoy the occasional indulgence—I’ve got a good dental plan! But what if instead of the dental plaque on our teeth, we’re talking
about the atherosclerotic plaque building up in our arteries? We’re not just talking about scraping tartar anymore. We’re talking about life and death.

  Heart disease is the number-one reason we and most of our loved ones will die. Of course, it’s up to each of us to make our own decisions as to what to eat and how to live, but shouldn’t we try to make these choices consciously by educating ourselves about the predictable consequences of our actions? Just as we could avoid sugary foods that rot our teeth, we can avoid the trans fat, saturated fat, and cholesterol-laden foods that clog up our arteries.

  Let’s take a look at the progression of coronary heart disease throughout life and learn how simple dietary choices at any stage may prevent, stop, and even reverse heart disease before it’s too late.

  Is Fish Oil Just Snake Oil?

  Thanks in part to the American Heart Association’s recommendation that individuals at high risk of heart disease should ask their physicians about omega-3 fish oil supplementation,10 fish oil pills have grown into a multibillion-dollar industry. We now consume more than one hundred thousand tons of fish oil every year.11

  But what does the science say? Are the purported benefits of fish oil supplementation for the prevention and treatment of heart disease just a fish tale? A systematic review and meta-analysis published in the Journal of the American Medical Association looked at all the best randomized clinical trials evaluating the effects of omega-3 fats on life span, cardiac death, sudden death, heart attack, and stroke. These included studies not only on fish oil supplements but also studies on the effects of advising people to eat more oily fish. What did they find? Overall, the researchers found no protective benefit for overall mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke.12