How Not to Die Read online

  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.55

  As one commentator noted in the Food and Drug Law Journal, historically, the Dietary Guidelines Advisory Committee reports contained:

  No discussion at all of the scientific research on the health consequences of eating meat. If the Committee actually discussed this research, it would be unable to justify its recommendation to eat meat, as the research would show that meat increases the risks of chronic diseases, contrary to the purposes of the Guidelines. Thus, by simply ignoring that research, the Committee is able to reach a conclusion that would otherwise look improper.56

  What about the medical profession, though? Why haven’t my colleagues fully embraced this research demonstrating the power of good nutrition? Sadly, the history of medicine holds many examples of the medical establishment rejecting sound science when it goes against the prevailing conventional wisdom. There’s even a name for it: the “Tomato Effect.” The term was coined in the Journal of the American Medical Association in reference to the fact that tomatoes were once considered poisonous and were shunned for centuries in North America, despite overwhelming evidence to the contrary.57

  It’s bad enough that most medical schools don’t even require a single course on nutrition,58 but it’s even worse when mainstream medical organizations actively lobby against increased nutrition education for physicians.59 When the American Academy of Family Physicians (AAFP) was questioned on their proud new corporate relationship with Coca-Cola to support patient education on healthy eating, an executive vice president of the academy tried to quell protests by explaining that this alliance was not without precedent. After all, they’d had relationships with PepsiCo and McDonald’s for some time.60 Even before that, they had financial ties to cigarette maker Philip Morris.61

  This argument didn’t seem to placate the critics, so the AAFP executive quoted them the American Dietetic Association’s policy statement that “[t]here are no good or bad foods, just good or bad diets.” No bad foods? Really? The tobacco industry used to broadcast a similar theme: Smoking per se wasn’t bad, only “excess” smoking.62 Sound familiar? Everything in moderation.

  The American Dietetic Association (ADA), which produces a series of nutrition fact sheets with guidelines on maintaining a healthy diet, also has its own corporate ties. Who writes these fact sheets? Food industry sources pay the ADA $20,000 per fact sheet to explicitly take part in the drafting process. So we can learn about eggs from the American Egg Board and about the benefits of chewing gum from the Wrigley Science Institute.63

  In 2012, the American Dietetic Association changed its name to the Academy of Nutrition and Dietetics but didn’t appear to change its policies. It continues to take millions of dollars every year from processed junk food, meat, dairy, fizzy drink, and confectionery companies. In return, the academy lets them offer official educational seminars to teach dietitians what to say to their clients.64 When you hear the title “registered dietitian,” this is the group they are registered through. Thankfully, a movement within the dietitian community, exemplified by the formation of the organization Dietitians for Professional Integrity, has started to buck this trend.

  What about individual doctors, though? Why aren’t all my colleagues telling their patients to lay off the KFC? Insufficient time during office visits is a common excuse physicians cite, but the top reason doctors give for not counseling patients with high to eat healthier is that they think patients may “fear privations related to dietary advice.” 65 In other words, doctors perceive that patients would feel deprived of all the junk they’re eating. Can you imagine a doctor saying, “Yeah, I’d like to tell my patients to stop smoking, but I know how much they love it”?

  Neal Barnard, M.D., president of the Physicians Committee for Responsible Medicine, recently wrote a compelling editorial in the American Medical Association’s journal of ethics, describing how doctors went from being bystanders—or even enablers—of smoking to leading the fight against tobacco. Doctors realized they were more effective at counseling patients to quit smoking if they no longer had tobacco stains on their own fingers.

  Today, Dr. Barnard says, “Plant-based diets are the nutritional equivalent of quitting smoking.”66

  CHAPTER 2

  How Not to Die from Lung Diseases

  The worst death I ever witnessed was that of a man dying of lung cancer. I was interning at a public health hospital in Boston. Evidently, people dying behind bars looked bad for prison statistics, so terminally ill prisoners were shipped to my hospital for their final days, even if there was little we could do for them.

  It was summer, and the prisoners’ ward had no air-conditioning, at least for the inmates. We doctors could retreat to the chilled confines of the nursing station, but the inmates, handcuffed to their beds, just lay prostrate in the heat on that top floor of the tall, brick building. When they were shuffled down the hall in front of us, ankles chained together, they left a trail of sweat.

  The night the man died, I was on one of my thirty-six-hour shifts. We worked 117-hour weeks back then. It’s amazing we didn’t kill more people ourselves. Overnight, there were only two of us—myself and a moonlighting doctor who preferred to sleep for his $1,000 paycheck. So most of the time I was on my own to cover the hundreds of patients there, some of the sickest of the sick. It was on one of those nights that, staggering through a sleep-deprived haze, I got the call.

  Up until then, all the deaths I had seen were those in which the patient was either dead on arrival or had died during cardiac “codes,” when we try desperately, and nearly always unsuccessfully, to resuscitate.

  This man was different.

  He was wide-eyed, gasping for air, his cuffed hands clawing at the bed. The cancer was filling up his lungs with fluid. He was being drowned by lung cancer.

  While he thrashed desperately, pleading, my mind was in medical mode, all protocols and procedures, but nothing much could be done. The man needed morphine, but that was held on the other side of the ward, and I’d never get to it in time, let alone back to him. I was not popular on the prison floor. I had once reported a guard for beating a sick inmate and was rewarded with death threats. There was no way they’d let me through the gates fast enough. I begged the nurse to try to get some, but she didn’t make it back in time.

  The man’s coughing turned to gurgling. “Everything’s going to be okay,” I said. Immediately, I thought, What a stupid thing to say to someone choking to death. Just another lie in probably a long line of condescension from other authority figures throughout his life. Helpless, I turned from doctor back to human being. I took his hand in my own, which he then gripped with all his might, tugging me toward his tear-streaked, panic-stricken face. “I’m here,” I said. “I’m right here.” Our gaze remained locked as he suffocated right in front of me. It felt like watching someone being tortured to death.

  Take a deep breath. Now imagine what it would feel like not to be able to breathe. We all need to take care of our lungs.

  America’s number-two killer, lung disease, claims the lives of about 300,000 people each year. And like our number-one domestic killer, heart disease, it’s largely preventable. Lung disease can come in many forms, but the three types that kill the most people are lung cancer, chronic obstructive pulmonary disease (COPD), and asthma.

  Lung cancer is our number-one cancer killer. Most of the 160,000 lung cancer deaths every year are the direct result of smoking. However, a healthy diet may help mitigate the DNA-damaging effects of tobacco smoke, as well as perhaps help prevent lung cancer from spreading.
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  COPD kills approximately 140,000 people annually, from either damage to the walls of tiny air sacs in the lungs (emphysema) or from inflamed and thickened airways plugged with thick mucus (chronic bronchitis). Although there is no cure for the permanent lung scarring that COPD causes, a diet rich in fruits and vegetables may help slow the progression of the disease and improve lung function for its thirteen million sufferers.

  Finally, asthma, which claims 3,000 lives each year, is one of the most common chronic diseases among children, yet it may be largely preventable with a healthier diet. Research suggests a few extra daily servings of fruits and vegetables can reduce both the number of cases of asthma during childhood and the number of asthma attacks among people with the disease.

  Lung Cancer

  Lung cancer is diagnosed about 220,000 times each year in the United States and causes more deaths annually than the next three cancers combined—those of the colon, breast, and pancreas.1 At any given moment, nearly 400,000 Americans are living under lung cancer’s dark shadow.2 Unlike with heart disease, which has yet to be fully acknowledged as the direct result of an artery-clogging diet, there is widespread recognition that tobacco is by far the most common cause of lung cancer. According to the American Lung Association, smoking tobacco contributes to up to 90 percent of all lung cancer deaths. 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.3

  Those warning labels on cigarette packs are everywhere now, but for a long time, the link between smoking and lung cancer was suppressed by powerful interest groups—much as the relationship between certain foods and other leading killers is suppressed today. For example, in the 1980s, Philip Morris, the nation’s leading cigarette manufacturer, launched the notorious Whitecoat Project. The corporation hired doctors to publish ghostwritten studies purporting to negate links between secondhand smoke and lung disease. These papers cherry-picked various scientific reports to conceal and distort the damning evidence of the dangers of secondhand smoke. This whitewashing, coupled with the tobacco industry’s clever marketing campaigns, including cartoonlike ads, helped hook generations of Americans onto their products.4

  If, despite all the evidence and warnings, you’re currently a smoker, the most important step you can take is to stop. Now. Please. The benefits of quitting are immediate. According to the American Cancer Society, just twenty minutes after quitting, your heart rate and blood pressure drop. Within a few weeks, your blood circulation and lung function improve. Within a few months, the sweeper cells that help clean the lungs, remove mucus, and reduce the risk of infection start to regrow. And within a year of quitting, your smoking-related risk of coronary heart disease becomes half that of current smokers.5 As we saw in chapter 1, the human body possesses a miraculous ability to heal itself as long as we don’t keep reinjuring it. Simple dietary changes may help to roll back the damage wrought by the carcinogens in tobacco smoke.

  Load Up on Broccoli

  First, it’s important to understand the toxic effects of cigarettes on the lungs. Tobacco smoke contains chemicals that weaken the body’s immune system, making it more susceptible to disease and handicapping its ability to destroy cancer cells. At the same time, tobacco smoke can damage cell DNA, increasing the chance for cancer cells to form and flourish in the first place.6

  To test the power of dietary interventions to prevent DNA damage, scientists often study chronic smokers. Researchers rounded up a group of longtime smokers and asked them to consume twenty-five times more broccoli than the average American—in other words, a single stalk a day. Compared to broccoli-avoiding smokers, the broccoli-eating smokers suffered 41 percent fewer DNA mutations in their bloodstream over ten days. Is that just because the broccoli boosted the activity of the detoxifying enzymes in their livers, which helped clear carcinogens before they even made it to the smokers’ cells? No, even when DNA was extracted from the subjects’ bodies and exposed to a known DNA-damaging chemical, the genetic material from the broccoli eaters showed significantly less damage, suggesting that eating vegetables like broccoli may make you more resilient at a subcellular level.7

  Now, don’t think this means that eating a stalk of broccoli before smoking a pack of Marlboro Reds is going to completely erase the cancer-causing effects of cigarette smoke. It won’t. But as you’re trying to quit, such vegetables as broccoli, cabbage, and cauliflower may help prevent further damage.

  The benefits of broccoli-family (cruciferous) vegetables may not stop there. While breast cancer is the most common internal cancer among American women, lung cancer is actually their number-one killer. About 85 percent of women with breast cancer are still alive five years after diagnosis, but the numbers are reversed when it comes to lung cancer: 85 percent of women die within five years of a lung cancer diagnosis. Ninety percent of those deaths are due to metastasis, the spread of the cancer to other parts of the body.8

  Certain compounds in broccoli may have the potential to suppress this metastatic spread. In a 2010 study, scientists laid down a layer of human lung cancer cells in a petri dish and cleared a swath down the middle. Within twenty-four hours, the cancer cells had crept back together, and within thirty hours, the gap had closed completely. But when the scientists dripped some cruciferous-vegetable compounds onto the cancer cells, the cancer creep was stunted.9 Whether or not eating broccoli will help prolong survival in cancer patients has yet to be tested in clinical trials, but the nice thing about healthy dietary interventions is that since they have no downsides, they can be added to whatever other treatments one chooses.

  Smoking Versus Kale

  Researchers have found that kale—that dark-green, leafy vegetable dubbed the “queen of greens”—might help control cholesterol levels. Researchers took thirty men with high cholesterol and had them consume three to four shots of kale juice a day for three months. That’s like eating thirty pounds’ worth of kale, or the amount the average American consumes in about a century. So what happened? Did they turn green and start to photosynthesize?

  No. What the kale did do was substantially lower their bad (LDL) cholesterol and boost their good (HDL) cholesterol10 as much as running three hundred miles.11 By the end of the study, the antioxidant activity in the blood of most participants had shot up. But curiously, the antioxidant activity in a minority remained flat. Sure enough, these were the smokers. The free radicals created by the cigarettes were thought to have actively depleted the body of antioxidants. When your smoking habit erases the antioxidant-boosting effects of almost 50 kilograms of kale, you know it’s time to quit.

  Carcinogen-Blocking Effects of Turmeric

  The Indian spice turmeric, which gives curry powder its characteristic golden color, may also help prevent some of the DNA damage caused by smoking. Since 1987, the National Cancer Institute has tested more than a thousand different compounds for “chemopreventive” (cancer-preventing) activity. Only a few dozen have made it to clinical trials, but among the most promising is curcumin, the bright-yellow pigment in turmeric.12

  Chemopreventive agents can be classified into different subgroups based on which stage of cancer development they help to fight: Carcinogen blockers and antioxidants help prevent the initial triggering DNA mutation, and antiproliferatives work by keeping tumors from growing and spreading. Curcumin is special in that it appears to belong to all three groups, meaning it may potentially help prevent and/or arrest cancer cell growth.13

  Researchers have investigated the effects of curcumin on the DNA-mutating ability of various carcinogens and found that curcumin was indeed an effective antimutagen against several common cancer-causing substances.14 But these experiments were done in vitro, meaning effectively in a laboratory test tube. After all, it wouldn’t be ethic
al to expose humans to nasty carcinogens to observe whether they got cancer. However, someone got the bright idea of finding a group of people who already, of their own accord, had carcinogens coursing through their veins. Smokers!

  One way to measure the level of DNA-mutating chemicals in peoples’ bodies is dripping their urine on bacteria growing in a petri dish. Bacteria, like all life on Earth, share DNA as a common genetic language. Unsurprisingly, scientists who tried this experiment found that the urine from nonsmokers caused far fewer DNA mutations—after all, they had a lot fewer carcinogens flowing through their systems. But when the smokers were given turmeric, the DNA-mutation rate dropped by up to 38 percent.15 They weren’t given curcumin pills; they merely got less than a teaspoon a day of just the regular turmeric spice you’d find at the supermarket. Of course, turmeric can’t completely mitigate the effects of smoking. Even after the participants ate turmeric for a month, the DNA-damaging ability of the smokers’ urine still exceeded that of the nonsmokers’. But smokers who make turmeric a staple of their diets may help lessen some of the damage.

  The anticancer effects of curcumin extend beyond its ability to potentially prevent DNA mutations. It also appears to help regulate programmed cell death. Your cells are preprogrammed to die naturally to make way for fresh cells through a process known as apoptosis (from the Greek ptosis, falling, and apo, away from). In a sense, your body is rebuilding itself every few months16 with the building materials you provide it through your diet. Some cells, however, overstay their welcome—namely, cancer cells. By somehow disabling their own suicide mechanism, they don’t die when they’re supposed to. Because they continue to thrive and divide, cancer cells can eventually form tumors and potentially spread throughout the body.