From Table to Able: Combating Disabling Diseases with Food

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

For those of you unfamiliar with my work, every year I read through every issue of every English-language nutrition journal in the world—so you don’t have to. Every year my talks are brand new, because every year the science is brand new.

I then compile all the most interesting, the most groundbreaking, the most practical findings to create new videos and articles every day for my nonprofit site, NutritionFacts.org.

Everything on the website is free. There’s no ads, no corporate sponsorship. It’s strictly noncommercial; I’m not selling anything. I just put it up as a public service.

It exists because thousands of people donate to support the 501(c)(3) nonprofit charity that keeps it alive. And, thanks to your support, in less than three years NutritionFacts.org has ramped up to a total of 25 million pageviews—now with more than a million new hits a month. People are hungry for evidence-based nutrition.

In my 2012 year-in-review, I explored the role a healthy diet may play in preventing, treating, and reversing our deadliest diseases. In 2013, I covered our most common conditions. This year, I’d like to address some of our leading causes of disability. We want to live a long healthy life, not a long miserable one.

Heart disease is not only our leading cause of death, but also our leading cause of death, and disability.

Dr. Dean Ornish proved, with his plant-based diet and lifestyle program, that cardiac patients had “91% reduction in…angina” attacks (that’s the crushing chest pain that some people with advanced heart disease can get). In contrast, control group patients, who were instead told to listen to the advice of their doctors, had “a 186% increase” in attacks.

This “marked reduction” in chest pain “was sustained” five years later—a “long-term reduction in [pain] comparable [to that of] bypass surgery”—but without the knife, or the saw, used to cut our chest in half. Forks over knives; soup over saws.

But this was back in the 90s, when Ornish was only studying a few dozen patients at a time. How about a thousand patients on a whole food, plant-based diet? Within three months, nearly three-quarters of angina patients became “angina-free.” 74% cured without a single scalpel or side effect. 

Now, Ornish didn’t just put people on a plant-based diet. He also advised moderate exercise, like walking. So, how do we know what role the diet played?

Well, if you go back to Ornish’s first publication, he put cardiac patients on a quasi-vegan diet, with no added exercise—just diet and stress management—and got a 91% reduction in attacks in less than a month. And Dr. Esselstyn was able to improve angina using a plant-based diet as the only lifestyle intervention. So, we know diet is the active ingredient.

But you know, they weren’t the first. There are case series going back to the 1970s. We’ve known about this for decades. “Angina and [the] Vegan Diet.” Like Mr. “F.W.” here. Chest pain so severe he “had to stop every nine or ten [steps].” “Started [on a] vegan diet”—not even a low-fat vegan diet—and months later: “Climbed mountains, no…pain.”

Now, this may be because vegetarian arteries dilate four times better than arteries of omnivores. Put people on a plant-based diet for a year, and their clogged arteries literally get cleaned out—20% less plaque in their arteries at the end of the year than at the beginning. Put people on a low-carb diet—a meat-heavy, Atkins-like diet, though—and their condition worsens. 40 to 50% more artery-blocking at the end of the year.

Here’s some representative heart scans. The yellow, and particularly red, represents blood flow to the actual heart muscle through the coronary arteries. This patient went on a plant-based diet, and their arteries opened right up, increasing blood flow. This person, however, started out with pretty good flow, but after a year on a meat-based diet, their blood flow significantly clogged down.

This isn’t measuring risk factors, but actual blood flow to the heart muscle—plant-based versus meat-based diets. No wonder a recent meta-analysis found that low-carb diets “associated with…significantly higher risk of [death] all-cause mortality in the long run,” meaning those on low-carb diets live, on average, significantly shorter lives.

Now, there is a new category of anti-angina drugs, but “[b]efore committing billions of dollars” to dishing them out, maybe “we should take a more serious…look at dietary strategies.” “To date, these strategies have been marginalized by the ‘drug pusher’ mentality of orthodox medical practice; presumably, doctors feel…most patients will be unwilling or unable to make the substantial dietary changes required.”

Now, “[w]hile this may be true of many patients, [it’s] certainly…not true for all. And, in any case, angina patients deserve to be offered the [plant-based] diet alternative before being shunted to expensive surgery or drug therapies that can have a range of side effects and never really get to the [heart] of the problem.”

Now, in response to this paper, a drug company executive wrote a letter to the medical journal: “Although diet and lifestyle modifications should be a part of disease management,” he said, “many patients may not be able to comply with the substantial dietary changes required to achieve a vegan diet.” So, of course, everyone should go on their fancy new drug, called ranolazine, sold as Ranexa. Costs about $2,000 a year to take it, but the side effects aren’t horrible, and the drug works. Collectively, the studies show that at the highest dose, the drug may prolong exercise duration in angina patients as long as “33.5 seconds.”

It does not look like those choosing the drug route will be climbing mountains anytime soon. Plant-based diets aren’t just safer and cheaper, but can work better.

I’ve talked about COPD as a leading killer. What about low back pain, like sciatica?

Now, “[l]ow back pain became one of the biggest problems for public health systems in the western world [just in] the second half of the 20th century.” Chronic low back pain affects about one in five, disabling 30 million Americans; it’s an epidemic. Are people just lifting more heavy stuff? No. “Mechanical factors, such as lifting and carrying, probably do not have a major…role” in the disease. Well, then, what causes it?

I’ve touched on it before. “Atherosclerosis can obstruct [the] arteries [that] feed the spine,” and this restriction in blood flow can cause “back problems.” This can be seen on angiography—showing normal spinal arteries on the left; clogged on the right—or on autopsy, where you can see how the openings to the spinal arteries can get squeezed shut by these cholesterol-filled plaques, on the right.

Autopsy, because back pain can predict fatal heart disease, just like clogs in the penile arteries—erectile dysfunction—can precede heart attacks, because it’s the same disease: inflamed, crippled, clogged arteries throughout our body.

Now, we have MRI imaging, which can show the narrowing of spinal arteries in people with back pain, and the degeneration of the discs—all linked to high cholesterol. Those with narrowed arteries appeared about eight-and-a-half times “more likely to [suffer] from chronic…low back pain.” This makes sense. You know, the discs in our low back are “the largest avascular tissue in the body”—meaning they have no blood vessels. So, nutrition just kind of has to diffuse in from the edges, so they’re particularly vulnerable to deprivation. Using MRIs, you can measure the effects of this impaired blood flow on the diffusion, and you can see how this can turn into that. By age 49, “97% of [the] discs” of those eating a Standard American Diet “show… at least” stage 2 degradation. Starting in our teens! Our discs are already starting to degenerate by age 11. As I’ve talked about, nearly all kids eating the Standard American Diet have the beginnings of atherosclerosis “by age 10.”

And, sadly, low back pain is now “common [among] children and adolescents,” and it’s getting worse. Just like children getting adult-onset diabetes; teenagers starting out their life with a chronic disease. That’s why it’s never too early to start eating healthy. To get you back into circulation, you need to get circulation, to your back.

Skipping down a few in the interest of time, having a stroke can be severely disabling. Thankfully, a “high dietary fiber intake,” which is to say whole plant foods, may help “prevent…stroke[s]” as well. This “belief that dietary fiber intake” is protectively associated with some chronic diseases was “postulated” 40 years ago, and since has been “enormously fuelled and kept alive by a great” body of science since. Today, we therefore believe that eating lots of fiber—eating a lot of whole, unprocessed plant foods—helps “prevent….obesity, diabetes and cardiovascular diseases,” such as stroke.

Stroke is the second leading cause of death worldwide; a “leading cause of disability.” And so, preventing strokes in the first place—what’s called “primary prevention”—”should…be a key public health priority.” Based on all the best studies to date, different strokes for different folks—depending, evidently, on how much fiber they’ve been eating. Notably, increasing fiber just seven grams a day may decrease stroke risk 7%. And seven grams is easy—like a small serving of whole-grain pasta with tomato sauce, and an apple. Easy.

But, if you really don’t want a stroke, we should all try to get 25 grams a day of soluble fiber, which is found in beans, oats, nuts, and berries, and 47 grams a day of insoluble fiber, found primarily in whole grains. One would have to eat an extraordinarily healthy diet to get 72 grams a day—huge amounts of plants. Yet, “[t]hese cut-off values could…be considered the [minimum recommended] daily intake of…fiber…to prevent stroke[s].” Now, they admit these minimums are “higher than [is] commonly and arbitrarily proposed as adequate.” But do we want to be patronized to, as to what authorities think is practical? Or, do we just want to have them tell us what the science says, as they did here, so we can make up our own minds?

Now, someone funded by Kellogg’s wrote in to complain that, in practice, such fiber intakes are unachievable. “Rather the message [should just] be the more, the better.” You know, have a bowl of cereal or something!

The real Dr. Kellogg—who was actually one of our most famous physicians, credited for being one of the first to sound the alarm about smoking—may have been “the first American physician to have recognized the field of nutrition as a science,” would today be rolling in his grave, if he knew what his company has become.

Diabetes, our seventh leading cause of loss of life, is also our eighth leading cause of loss of health. “[U]p to 50% of diabetics…eventually develop neuropathy’—damage to the nerves. It can be “very painful, and the pain is frequently resistant to conventional treatments.” In fact, supposedly, “no effective treatment [exists] for diabetic neuropathy.” Us doctors are just left with steroids and opiates and antidepressants—anything to try to mediate the suffering.

But, 20 years ago, a remarkable study was published on the “regression [the reversal] of diabetic neuropathy with a [plant-based] diet.” Twenty-one diabetics suffering with moderate or worse painful neuropathy for up to ten years were placed on a whole food, plant-based diet. Years and years of suffering, and then, “[c]omplete relief of the…pain in 17 [out] of the 21 patients,” within days. “[N]umbness…noticeably improved,” too. And the side effects were all good. They lost ten pounds; blood sugars got better; “insulin needs…dropped in half,” and in five of the patients, not only did their painful diabetic neuropathy was cured, so apparently, was their diabetes. Normal blood sugars; off of all medications. Diabetics for up to 20 years, and then, off all their drugs, in a matter of weeks.

And, their triglycerides and cholesterol improved, too. High blood pressures got better. In fact, gone in about half the hypertensives—an 80% drop overall in the need for high blood pressure medications within three weeks.

Now, we’ve known plant-based diets can reverse (cure) type 2 diabetes and hypertension, but this was new. Years of painful suffering, then complete relief of pain in 80% within days.

Now, this was a live-in program, where, you know, patients were actually given meals. You know, what happened when they were sent home, and kind of had to go back to the real world? Well, the 17 folks were followed for years, and in all except one, the relief of painful neuropathy continued, or improved even further. How’d they get that kind of compliance with a strict plant-based diet? Because it works.

One of the most painful and frustrating conditions to treat in all of medicine, and three-quarters cured in a couple days with a natural, nontoxic—in fact, beneficial—treatment, a diet composed of whole plant foods. Should have been front page headline news.

So, how could nerve damage be reversed so suddenly? Well, it didn’t appear to be the improvement in blood sugars, because it took about ten days for the diet to control the diabetes, whereas the pain was gone in as few as four. “There are several mechanisms by which a [total vegetarian diet] can alleviate the problem of diabetic neuropathy as well as [diabetes] itself.”

Now, their most interesting speculation was that they thought it could be the trans fats naturally found in meat and dairy that could be causing an inflammatory response. They found a significant percentage of the fat under the skin of those who eat meat, or even just dairy and eggs, was trans fats. Trans fats stuck inside their bodies, under their skin, whereas those who had been on a strictly plant-based diet, whole food plant-based diet, “had no detectable trans fats” within their body.

The researchers stuck needles in the buttocks of people eating different diets, and nine months or more on a strict plant-based diet appeared to remove all trans fat from their bodies, or at least their butts. But their pain didn’t take nine months to get better; more like nine days, right?

So, more likely, the amazing reversal was due to an improvement in blood flow. “[N]erve biopsies [taken from] diabetics with severe progressive neuropathy,…shown [to have arterial] disease within the nerve.” There are blood vessels within our nerves that can get clogged up too, depriving the nerves of oxygen, presumably leading them to cry out in pain.

Within months, though, improvements in “blood rheology,” meaning the ease at which blood flows, on a plant-based diet may play “a prominent role” in the reversal of diabetic neuropathy.

Plant-based diets may also lower the level of IGF-1 within the eyeballs of diabetics, and decrease the risk of retinopathy—diabetic vision loss—as well. But, what about treating retinopathy?

Kempner at Duke used a plant-based diet composed mostly of rice and fruit, to document, for the first time, the reversal of diabetic retinopathy in a quarter of his patients—something never even thought possible. For example, 60-year-old diabetic woman, already blind in one eye, can only see “contours of large objects” with the other; effectively blind. Five years later, on the diet, instead of it getting worse, it got better. She “could [then] make out faces[, see] signs,” start to “read large newspaper print”—in addition to being off all insulin, normal blood sugars, and a 100-point drop in her cholesterol.

“[T]he most [effective] way to avoid diabetic complications is to eliminate the diabetes [in the first place], and this is often feasible for those type 2 [diabetics] who [can] make an abiding commitment to daily exercise and a [healthy-enough] diet.” Type 2 diabetes can be reversed, can be cured, eliminated with diet, and so can some of its complications. Since the initial report of neuropathy reversal was published twenty years ago, it’s been replicated by other researchers. So, why didn’t we learn about this in medical school? “[T]he neglect of this important work by the broader medical community is little short of unconscionable.”

Alzheimer’s disease perhaps best captures the difference between lifespan and healthspan. Who cares if you live to be 100 if, in the final years, you don’t recognize yourself in the mirror?

In 1901, Auguste was taken to an insane asylum by her husband. She was described as a “delusional, forgetful, disoriented…woman” who, tragically, “could not carry out her homemaking duties” anymore. She was seen by a Dr. Alzheimer, and was to become the case that made his a household name.

On autopsy, he described the plaques and tangles that would go on to characterize the disease. But, lost in the excitement of discovering a new condition, a clue may have been overlooked. He described “atherosclerotic change[s]”—hardening of the arteries—within her brain.

We typically think of artery clogging in the heart, but as we saw with the spine and the nerves, “[a]therosclerosis involves virtually the entire human organism”—our whole vascular tree, from top to bottom, including our brain. “One of the most poignant examples of [the] systemic nature of [clogged arteries] is the link between coronary heart disease…, degenerative brain disease…, and [Alzheimer’s—] dementia.

“Just as a heart attack or brain attack (stroke) can be significantly prevented,” one can think of Alzheimer’s as a ‘‘mind attack.” “Mind attack, like heart attacks and strokes, need[s] to be prevented by…[controlling] vascular risk factors,” like high blood pressure and cholesterol, controlling chronic blood hypoperfusion, the lack of adequate blood flow to the brain in the years before the onset of Alzheimer’s.

We now have a substantial body of evidence strongly associating atherosclerotic vascular disease with Alzheimer’s. Autopsy studies, for example, have shown that individuals with Alzheimer’s have significantly more atherosclerotic narrowing of arteries within their brain. This is what cerebral arteries should look like: open, clean, allowing blood to flow. This is what atherosclerosis in our brain arteries looks like: clogged with fat and cholesterol, closing off the artery, restricting blood flow within our brain. What kind of arteries do you want in your brain?

This reduction in blood flow can starve the brain of oxygen, causing silent little mini-strokes, brain atrophy, shrinkage. “The cumulative effects” appear to play “a pivotal role in” the development of Alzheimer’s.

But what about the role of metals in Alzheimer’s? Well, the metals appear to just “aggravate the detrimental effects of [the] high intake of [saturated fat and] cholesterol.”

What about the so-called Alzheimer’s gene—ApoE4? Diet trumps genes. The highest frequency of Alzheimer’s gene in the world is Nigeria, but they also have some of the lowest Alzheimer’s rates. To understand why, one has to understand the role of ApoE. What does the gene do?

The Alzheimer’s gene makes “the principal cholesterol carrier…in the brain.” But if your cholesterol is low enough, because your diet is low enough in animal fat, if you center your diet around grains and vegetables, then changes in cholesterol can lead to changes in gene expression.

Just because we’ve been dealt some bad genetic cards doesn’t mean we can’t reshuffle the deck with diet.

According to the latest “guidelines for the prevention of Alzheimer’s,” the two most important things we can do is cut down our consumption of meat, dairy, and junk, and replace them with “vegetables, [beans,] fruits, and whole grains.” That’s the best science we have for the prevention of Alzheimer’s disease.

Wait, grains protective of the brain?

I had the distinction this year of serving on a panel with Grain Brain author Dr. Perlmutter, who sold lots of books claiming carbs are destroying our brain. But what does the science show?

Take Japan, for example, where the prevalence of dementia has shot up over the last few decades. And the blame for this increase in Alzheimer’s? “[I]ncreases in animal products.” Traditional diets “weighted toward vegetable products,” like grains; “away from animal products.” But “[s]ince 1960, the diet in Japan has changed from [a more] traditional [rice-based] diet…to one with a preponderance of meat.” So, less grain equalled more Alzheimer’s. The dietary factor most strongly associated with Alzheimer’s was the consumption of animal fat. So, the link between diet and dementia can be characterized less as grain brain, and more as meathead.

A similar analysis in China arrived at the same conclusion. “On the basis of [these] findings…, the rate[s of Alzheimer’s disease] and dementia will continue to [increase] unless dietary patterns change to those with less reliance on animal products.” This is consistent with data showing that those who eat vegetarian are two to three times less likely to develop dementia. And, the longer one eats meat-free, the lower one’s risk falls.

In fact, where are the lowest rates of Alzheimer’s in the world? Rural India. It may be no coincidence that the country with the lowest rates of Alzheimer’s has among the lowest rates of meat consumption. About 40% eat meat-free and egg-free diets that are high-grain, high-bean, high-carb diets. Population studies have found a protective,  strongly protective, role of grains in relation to Alzheimer’s disease, and, including gluten-containing grains, not just rice. The science shows the exact opposite of what one might read in the popular press. In other words, don’t pass on the grain; “[p]ass the grain [to] spare the brain.”

The link between arterial blockage and Alzheimer’s is good news, because atherosclerosis can be prevented and treated. So, maybe Alzheimer’s can be prevented and treated, as well.

Well, let’s put it to the test. If you follow people who are just starting to lose their mental faculties, the cognition of those with the least artery clogging in their brain remains pretty stable over the years. But, those with more cholesterol buildup got worse, and those with the most blockage rapidly declined. And, the same with the ability to carry out activities of daily living, like dressing oneself. And, arterial disease doubled the progression to Alzheimer’s. In summary: “An inefficient blood supply to the brain [can have] very grave consequences on brain function.”

But, does treatment of vascular risk factors, like high blood pressure and high cholesterol, make a difference? We didn’t know, until now. 300 patients with Alzheimers, and those with their vascular risk factors treated showed significantly less decline; slowed progression of their disease. It is often said that “[T]he goal of medicine is to provide patients with hope, and when there is no hope to offer understanding.” Well, “[f]or the first time in the history of this disorder, we have the chance to provide Alzheimer patients with hope…”

Let me close with cancer, a leading cause of death and disability. How many years of life are lost to potentially preventable cancers? Every year, more than five million expected years of life, in the United States, are lost to those three disabling cancers alone: lung cancer, colorectal cancer, and breast cancer. “Therefore, identifying and improving strategies for prevention of cancer remains a priority,” especially since “no…more than 2% of all human cancer is attributable to purely genetic…factors.” So, 2% may be in our genes, but the rest may involve external factors, particularly our diet.

You know, our skin is about 20 square feet. Our lungs, if you actually flatten them out, are like a thousand square feet of surface area. But our intestines? Three thousand feet if you include all the little folds; three thousand square feet.  So, what we eat is our primary interface with the outside world, with our external environment.

The most comprehensive study, summary of evidence, on diet and cancer ever compiled recommends we “[e]at foods of plant origin” to help prevent cancer. This means centering our diet around whole plant foods. Not just whole grains and beans every day, but “every meal.”

And, when it came to foods that increase cancer risk, they were similarly straightforward. Unlike some other dietary changes that kind of wimp out and just advise people to moderate their intake of bad foods (like “Eat less…candy”), the cancer guidelines didn’t mince words when it came to the worst of the worst. For example, don’t just minimize soda intake; “avoid” it. Don’t just cut back on bacon and hot dogs, and ham, and sausage, lunch meat. “Avoid processed meat[s],” period, because “data do not show any level of intake that can confidently be shown not to be associated with risk.” Even small amounts may be risky.

Processed meat cannot only be thought of as “a powerful multiorgan carcinogen,” but may increase the risk of heart disease and diabetes. Red meat was bad, but processed meat was worse, and that included white meat, like chicken, and turkey slices. So, with more heart disease, cancer, and diabetes, it’s no surprise “[p]rocessed meat consumption [is] associated with increased risk of death”—even at small amounts.

In Europe, they calculated that “reduction of processed meat consumption to less than [a half a hot dog’s worth a day] would prevent more than 3% of all deaths.”

This was the second largest prospective study on diet and cancer ever, a study of 400,000 people. Well, the largest ever—600,000—was done right here in the U.S.: the AARP study. They found “the preventable fraction…to be [even] higher,” suggesting that 20% of heart disease deaths among women, for example, could be averted if the highest consumers cut down to less than like a quarter strip of bacon’s-worth a day. That’s a lot of death.

So, what does the industry think about all this? In the journal Meat Science, the industry acknowledged that the cancer prevention guidelines now urge people to “avoid processed meat”—a statement that “represents ‘a clear and present danger’ [for] the meat industry.” Processed meat, they say, is “a social necessity.” How could anyone live without bologna, right? The challenge for the meat industry is to find a way to maintain the consumption of these products while somehow not “damaging public health.”

30:22 Well, they’ve considered removing the nitrites for decades, because of the long-known toxic effects (the industry adds them to keep the meat pink). There are, evidently, other coloring additives available. Nevertheless, it’s going to be hard for the industry to change. You have to balance all the cancer with the positive effects of these substances as preservatives, “and desirable flavour and red colour-developing ingredients.” No one wants green eggs and ham.

It’s like salt reduction in meat products. They’d like to, but one of the biggest barriers to salt replacement within the meat industry is cost, as salt is one of the cheapest food ingredients available. Now, there a number of taste enhancers you can inject into the meat to help compensate for the salt reduction, but some of the compounds leave a bitter aftertaste. So, they can also inject a patented bitter-blocking chemical that can prevent taste nerve stimulation at the same time—the first of what may become a stream of products that are produced due to the convergence of food technology and biotech.

Or, they can always start adding non-meat materials to the meat. You could add fiber, or resistant starch from beans, that have protective effects against cancer. After all, in the United States, dietary fiber is under-consumed. This is Meat Science, saying under-consumed, fiber, indicating that fiber fortification in meat products could have health benefits—failing to note, of course, that their products are one of the reasons the American diet is so deficient in fiber in the first place.

The industry is all in favor of causing less cancer, but obviously, such optimization has to achieve a healthier product without affecting the hedonic aspects. It’s important to realize that nutritional and technological quality in the meat industry are inversely related. An improvement in one leads to a deterioration of the other. So, you got to balance it out, right?

They know that consumption of lard is not the best thing in the world, heart disease being our #1 killer. However, those downsides are in sharp contrast to lard’s technological qualities, which makes saturated fats indispensable in the manufacture of meat products. Otherwise, you just don’t get the same lard consistency. See, the pig fat doesn’t get hard enough, and as a result, a fatty smear upon cutting or slicing can be observed on the cutting surface of the knife, right? So, look, you got to get your priorities straight, right?

Although the evidence for the relationship between colorectal cancer (at least!) and processed meats cannot be denied, the meat industry suggests further research. For example, compare the risk of eating meat to other risky practices—alcohol, inactivity, obesity, smoking. Compared to lung cancer and smoking, maybe meat wouldn’t look so bad.

But, don’t worry, consumers probably won’t even hear about the latest cancer prevention guidelines. Consumers today are overloaded with information. Thus, the industry can hope that the dissemination of the update on meat and cancer drowns out in this information cloud. And, even if the sconsumers do see it, the industry doesn’t think they’ll much care. For many consumers in the Western world, the role of healthfulness, although important, is not close to taste satisfaction in shaping their final choice of meat products. It is hence questionable whether the revised recommendations, based on the carcinogenic effects of meat consumption, will yield substantial changes in consumer behavior.

You know, doctors and nutrition professionals feed into this patronizing attitude that people just don’t care enough about their own health to change. This paper, from a leading nutrition journal, scoffed at the idea that people would ever switch to a “prudent diet,” reducing their intakes of animal protein and fat, no matter how much cancer was prevented. The chances of reducing consumption to avoid colon cancer? Virtually nil. Consider heart disease. We know we can prevent and treat heart disease with the same kind of diet, but the public won’t do it. “The diet,” they say, “would lose too much of its palatability.”

In other words, the great palatability of ham largely outweighs other considerations, although health and wellbeing are increasingly important factors in consumer decisions. This 1998 industry article feared that unless meat eating becomes compatible with eating that is healthy and wholesome, it could be consigned to a minor role in the diet in the coming decade. Their prediction didn’t quite pan out. Here’s meat consumption per person over the last 30 years. Rising, rising. Now, 1998 was when the Meat Science article was published, worrying about the next decade of meat consumption, which continued to rise even further, but then did kind of, did sort of flatten out, before it fell off a cliff. Per-capita meat consumption down about 10%. Millions of Americans are reducing their consumption of meat.

So, don’t tell me people aren’t willing to change their diets. Yet, we continue to get diluted dietary guidelines, because authorities are asking themselves: what dietary changes could be acceptable to the public, rather than just telling us what the science says, and letting us make up our own minds as to whether, you know, pig fat-smearing on knives should trump our families’ health.

What we eat doesn’t just affect cancer risk in the colon. Why do constipated women appear to be at higher risk for breast cancer, whereas women who have three or more bowel movements a day—superpoopers I call them (sounds like an ABBA song, doesn’t it?)—appeared to cut their risk of breast cancer in half? This could be because constipation means a greater contact time between your waste and the intestinal wall, which can increase the formation and absorption of fecal mutagens, these compounds that can cause DNA mutations and cancer, into the circulation, and then into the breast.

We know that breasts actively take up chemicals from the bloodstream, so researchers are concerned that substances originating in the colon might enter the bloodstream and reach the breast. Specifically bile acids, which are formed as a way of getting rid of excess cholesterol. Our liver dumps bile acids into the intestines for disposal, assuming our intestines will be packed with fiber to trap it and flush it out of the body. But, if we haven’t been eating whole plant foods all day, it can get reabsorbed back into the body, and build up in the breast.

Carcinogenic bile acids are found concentrated in the breast at up to a hundred times the level found in the bloodstream; they just concentrate it, pull it out of the system. By radioactively tagging bile acids, they were able to show that intestinal bile acids rapidly gain access to the breast, where they can exert an estrogen-like cancer-promoting effect on breast tumor cells.

This could explain why we see 50% higher bile acid levels in the bloodstream of newly diagnosed breast cancer victims. So, how can we facilitate the removal of bile acids from our body? Well, we could speed up the so-called oral-anal transit time, the speed at which food goes from mouth to toilet, because slowed colon transit can lead to increased absorption of bile acids. But we can speed things up by eating lots of fiber, right? A diet packed with plants greatly increases bile acid excretion.

Fiber can bind up and remove toxic elements like lead and mercury, as well as cholesterol and bile acids. But plants can even bind bile acids independent of fiber. Vegan diets had significantly more bile acid bind up, significantly more bile acid, than lacto-ovo or nonvegetarian diets, even at the same fiber intake—which could explain why it appears that individuals eating vegetarian might excrete less mutagenic (less mutation-causing) feces in the first place.

Now, you’ll notice that the same type of diet used to help lower cancer risk is the same type of diet used to help lower Alzheimer’s risk, and diabetes, and diabetic complications, and high blood pressure, and stroke, and back pain, and heart disease, right? A diet centered around whole plant foods—the type of diet eaten by populations that are largely free of our deadliest and most disabling diseases.

Heart disease was so rare among those eating these traditional plant-based diets, there were papers published like this: “A Case of Coronary Artery Disease in an African.” After 26 years of medical practice, they finally recorded their first case of coronary heart disease among a population of 15 million—a judge, who had started consuming a partially Westernized diet. Now, some thought it was the preponderance of plant foods that was protecting these populations. Others thought it was the avoidance of animal foods. But either way, we couldn’t prove it was the diet, until it was put to the test. Pritikin, Ornish, Esselstyn, and others took people with heart disease, and put them on the kind of plant-based diet followed by populations that had no, that didn’t suffer from heart disease, hoping it would stop the disease process, keep it from progressing further.

But, instead, something miraculous happened. Their disease started to reverse, to get better. As soon as they stopped eating an artery-clogging diet, their bodies started, were able to start dissolving away some of that plaque. Even in some cases of severe triple-vessel disease, arteries opening up without drugs, without surgery—suggesting their bodies wanted to heal all along, but were just never given the chance.

This is Esselstyn’s new study, published four days ago. This increase in blood flow to the heart muscle on the left happened within just three weeks of eating healthy.

Let me share with you the best-kept secret in medicine. The best-kept secret in medicine is that, under the right conditions, the body can heal itself.

You know, if you whack your shin really hard on a coffee table, it can get all red, hot, swollen, painful, but it’ll heal naturally if you just stand back and let your body work its magic. But, what if you kept whacking your poor shin against that coffee table in the same place, over and over, three times a day (breakfast, lunch, and dinner)? It would never heal.

You’d go to your doctor and be like, “Oh, my shin hurts.” And the doctor would be like, “No problem,” whip out their pad, and write you a prescription for painkillers. You’re still whacking your shin three times a day, and it still hurts like heck, but oh, feels so much better with the pain pills. Thank heavens for modern medicine.

It’s like when people take nitroglycerin for chest pain—tremendous relief, but doesn’t do anything to treat the underlying cause.

Our body wants to come back to health, if we let it. But if we keep reinjuring it three times a day, we may never heal.

It’s like smoking. One of the most amazing things I learned in medical school was that within ten years of stopping smoking, your lung cancer risk approaches that of a lifelong nonsmoker. Isn’t that amazing? Your lungs can get rid of all that tar, and eventually, it’s almost like you never started smoking at all.

Our body wants to be healthy. And, every morning of our smoking life, that healing process started until bam, our first cigarette, reinjuring our lungs with every puff, just like we can reinjure our arteries with every bite, when all we had to do all along—the miracle cure—is just stop re-damaging ourselves, get out of the way, and let our bodies’ natural healing process bring us back towards health.

There is only one diet that’s ever been proven to reverse heart disease in the majority of patients: a plant-based diet. Anytime anyone tries to sell you on some new diet, ask them, do me a favor; ask them one simple question: “Has your diet been proven to reverse heart disease (you know, the most likely reason you and everyone you love will die?)? Does it reverse heart disease?” If it doesn’t, why would you even consider it?

And if that’s all a plant-based diet could do—reverse our #1 killer—well, then, shouldn’t that be the default diet until proven otherwise? And, the fact that it can also be effective in preventing, treating, reversing other leading killers, such as diabetes and high blood pressure, would seem to make the case for plant-based eating overwhelming. So, why don’t more doctors prescribe it?

Available time is a reason frequently cited by physicians. But if you probe a little deeper, yes, they complain about not having enough time to give their patients dietary advice. But, the number one reason was their perception that patients fear being 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.”

Dr. Neal Barnard wrote a compelling editorial in the American Medical Association’s Journal of Ethics. When he stopped smoking in the 80s, the lung cancer death rate was peaking in the U.S., but has since dropped, with dropping smoking rates. No longer were doctors telling patients to give their throat a vacation by smoking a fresh cigarette.

Doctors realized that they were more effective at counseling patients to quit smoking if they no longer had tobacco stains on their own fingers. In other words, doctors went from bystanders—or even enablers—to leading the fight against smoking. And today, he says, “Plant-based diets are the nutritional equivalent of quitting smoking.”

This is not vegetarianism. Vegetarians often consume all sorts of junk. Vegans too, for that matter, right? This new paradigm is exclusively plant-based nutrition. Whole plant foods. Why exclusively? Well, as reported in the Cornell-Oxford-China Study, there does not appear to be a threshold beyond which further benefits did not accrue with increasing proportions of plant foods in the diet. It appears the more plant-based foods and less animal-based foods, the better.

It took five decades after the initial studies linking tobacco and cancer for effective public health policies to be put into place, with enormous cost to human health. Must we wait another 50 years to respond to the epidemics of dietary diseases?

They do have money on their sides. The chemical, tobacco and food industries have the luxury to share similar tactics with the drug companies, because they have the resources to do so. In contrast, powerful and cheap health-promoting activities (like eating healthy) are too cheap, can’t be patented, aren’t profitable.

And, they throw that money around.

The American Dietetic Association, for example, promotes a series of Nutrition Fact Sheets. Who writes them? Industry sources pay $20,000 per fact sheet to the ADA, and explicitly take part in writing the documents. So, you can learn about eggs from the egg industry, the benefits of chewing gum from the Wrigley Science Institute. I didn’t know Wrigley’s had a Science Institute.

In 2008, the ADA announced that the Coca-Cola Company had become an official partner to give them prominent access to key influencers and decision makers, and share the Coca-Cola Company’s research findings. For example: did you know that there are no harmful effects of different Coca-Cola beverages on rat testicles? Was that even a concern? Thou doth protest too much, methinks.

When the American Academy of Family Physicians was called out on their proud new corporate relationship with Coke to support patient education on healthy eating, an executive vice-president of the Academy tried to quell the protest by explaining that the alliance was not without precedent. They had relationships with Pepsi and McDonald’s for some time. Reminiscent of similar types of relationships in the past.

This didn’t seem to placate the critics, so the exec assured them that the American Dietetic Association has made a policy statement that “[t]here are no good or bad foods.” A position that the food industry has then exploited. You know, in the early years, the tobacco industry sounded a similar theme: smoking per se wasn’t bad—just “excess” smoking. Sound familiar? Everything, in moderation.

Is this what family docs and dietitians have been reduced to? To justify unholy financial alliances, they deny that there are actually unhealthy foods?

Thankfully, there is a corporate sector that actually benefits from healthy people—the insurance industry.

Last year, a Nutritional Update for Physicians was published in the official journal of Kaiser Permanente, the largest managed-care organization in the country, covering about nine million people, with about 15,000 physicians, who were told that healthy eating may be best achieved with a plant-based diet—defined as a regimen that encourages whole, plant-based foods, and discourages meats, dairy, and eggs, as well as all refined and processed junk.

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

The major downside is that it may work a little too well. If people are on medications, their blood pressure or blood sugar could actually drop too low, so physicians may need to adjust medications, or eliminate them altogether. The side effects, ironically, may be not having to take drugs.

Despite the strong body of evidence favoring plant-based diets, many physicians are not stressing the importance of plant-based diets as a first-line treatment for chronic illnesses. (That’s a bit of an understatement.) Now, this could be because of lack of physician awareness, or a lack of patient education materials. So, Kaiser sought to change that.

Want to lose weight, feel better, improve, stabilize, or even reverse chronic disease, get off some of your medications? If you answered yes to any of these questions, then a plant-based eating plan may be right for you. Side effects may include lower cholesterol, blood pressure, and blood sugar, reversal or prevention of our #1 killer, a longer life, healthier weight, lower risk of cancer, diabetes, even slow the progression of cancer, improve inflammatory conditions, like rheumatoid arthritis. They offer tips to get started, meal plan ideas, and, I’m honored to say, a good taste in websites.

The paper ends with a familiar refrain: “[f]urther research is needed.” In this case, though, further research is needed—to find ways to make plant-based diets the new normal.

Thank you.

I have both of my last two annual reviews on DVD—all proceeds to charity, and all of my work is available free on NutritionFacts.org.

Thanks again.

For all the individual transcripts, see the daily videos in which each subject is covered. Browse through all the topics at https://nutritionfacts.org/topics/.

Please consider volunteering to help out on the site.

• For all the sources (and links to the full-text PDFs if available!), see the individual daily videos in which each subject is covered.

Recorded live at the University of Pittsburgh on July 5, 2014 thanks to NAVS and Aaron Wissner. Images thanks to Monica Trzaska.

• Academy of Nutrition and Dietetics
• aging
• alcohol
• alternative medicine
• Alzheimer’s disease
• animal fat
• animal products
• animal protein
• back pain
• bacon
• beans
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• bowel movements
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• Coca-Cola
• colon cancer
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• complementary medicine
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• Dr. Caldwell Esselstyn
• Dr. Dean Ornish
• Dr. Neal Barnard
• eggs
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• fiber
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• India
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• Plant-Based Diets
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• Pritikin
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