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The Tomato Effect

Why does the medical establishment sometimes ignore highly efficacious therapies such as plant-based diets for heart disease prevention and treatment?

October 14, 2011 |
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The Tomato Effect, 5.0 out of 5 based on 10 ratings

Sources Cited

Esselstyn CB Jr. Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition. Prev Cardiol. 2001 Autumn;4(4):171-177.

Goodwin JS, Goodwin JM. The tomato effect. Rejection of highly efficacious therapies. JAMA. 1984 May 11;251(18):2387-90.

Bartholomew M. James Lind's Treatise of the Scurvy (1753). Postgrad Med J. 2002 Nov;78(925):695-6.

Kong MH, Fonarow GC, Peterson ED, Curtis AB, Hernandez AF, Sanders GD, Thomas KL, Hayes DL, Al-Khatib SM. Systematic review of the incidence of sudden cardiac death in the United States. J Am Coll Cardiol. 2011 Feb 15;57(7):794-801.

Martin W. The beriberi analogy to myocardial infarction. Med Hypotheses. 1983 Feb;10(2):185-98.

McCarty MF. Vegan proteins may reduce risk of cancer, obesity, and cardiovascular disease by promoting increased glucagon activity. Med Hypotheses. 1999 Dec;53(6):459-85.

Acknowledgements

Images thanks to Lestath and Brinerustle via Wikipedia Commons as well as the University of Virginia.

Transcript

In his landmark article "Resolving the Coronary Artery Disease Epidemic Through Pant-Based Nutrition,  Dr. Caldwell Esselstyn notes how fortunate we are to possess the knowledge of how to prevent, arrest, and selectively reverse this disease. However, he goes on to lament, we are not fortunate in the capacity of our institutions to share this information with the public.  He blames ties to industry and politics result in conflicts of interest within our private and governmental health institutions, compromising the accuracy of their public message. This is in total violation of the moral imperative of the medical profession. Now is the time for us to have the courage for legendary work, he concludes, Science must dictate dietary recommendations.

 After all, "The fact that a low-fat, fiber-rich vegan diet is likely to reduce risk for most types of cancer, ischemic heart disease and its complications, obesity… diabetes, hypertension, osteoporosis, multiple sclerosis, gallstones, renal stones, appendicitis, diverticulitis, hiatal hernia, varicose veins, hemorrhoids, and possibly the chief metabolic complications of pregnancy—disorders which collectively are responsible for the majority of the deaths and hospitalizations in Western society—should be sufficient to recommend it.

Of course, Those who are only willing to make less striking changes in their lifestyle can be encouraged to reduce their consumption of animal products as much as they can.

 In the process of writing this paper on the comparative endocrinological effect of plant versus animal proteins, the researcher himself was overwhelmed by the balance of evidence and  disclosed that in “During the course of researching and writing this article, my findings impelled me to become a vegan.” Why don’t more within the scientific and medical community similarly embrace a plant-based diet? Part of the reason may be the Tomato Effect.

 Coined in the Journal of the American Medical Association 27 years ago, the Tomato Effect describes the rejection of highly efficacious therapies by the medical establishment because they go against the prevailing conventional wisdom.

Imported from the New World,  “By the year 1560, the tomato, was becoming a staple of the continental European diet.  At the same time it was actively shunned in North America for literally centuries.  The reason… is simple:  they were poisonous.  Everyone knew they were poisonous, at least everyone in North America.

 It was obvious.

Evidently it was  not until 1820 when some dude ate a tomato on the steps of some courthouse— and survived, did things finally change. And today, in the United States, tomatoes are a billion dollar crop.

Examples of this "Tomato Effect"—a slavish devotion to orthodoxy, are described in medicine,  for example ignoring the successful use of this plant in the treatment of gout for a thousand years before modern medicine quote unquote “discovered” it was  the drug colchicine.  Aspirin was also ignored for almost 3,000 years of  successful use as willow tree bark extract.

But I'd like to extend this analogy into the field of nutrition.  For example, thousands of died of scurvy, vitamin C deficiency, for a hundred years after lemon juice was found to cure it, because disease at the time was considered an imbalance of the humors; what role could eating fruit possibly play?

A century later, in the mid-1800’s, humanity came up with the brilliant idea to polish rice from brown to white,  causing a epidemic of sudden death from heart attack in Asia. Millions died of beriberi, a vitamin B deficiency that affects the heart muscle, Again the cure was discovered—rice bran, or rice bran tea, yet decades of death before the medical community finally woke up.

Today,  there is another epidemic of sudden death from heart attack. It too is caused by diet, and it too has a cure. How long must we wait?...

 McCarty ends his paper: “I suspect that the simple injunction, ‘Do not eat animal products’ has the potential to do more for world health than all of the abstruse wisdom in all of the world’s medical libraries.” 

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by Dianne Moore.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Be sure to check out all the videos on heart disease, as well as the videos on nutrition myths. And don't forget, there are 1,449 subjects covered in my other videos–please feel free to explore them!

For more context, check out my associated blog posts: Eating To Extend Our Lifespan, Preventing and Treating Kidney Failure With Diet, and Heart Disease: there is a Cure.

  • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

    Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Be sure to check out all the videos on heart disease, as well as the videos on nutrition myths. And don’t forget, there are 1,449 subjects covered in my other videos–please feel free to explore them!

  • http://nutritionfacts.org/members/bpcveg/ BPC

    Thanks for another excellent video, Dr. Greger!
    I agree that the tomato effect – or dogmas, in general – are at the core of why less than 5% of people in North America have embraced vegetarianism, despite enormous scientific support for plant-based diets. One example of non sequitur reasoning that I’m sure you will recognize, goes something like:

    1) we have been eating meat for eons as proven by the anthropological record;

    2) therefore, we have evolved to eat meat and require it.

    Hmm…maybe if the discredited theory of Lamarck had been proven true, but #2 does not follow automatically according to the well supported model of Darwinian evolution.

    Yet meat proponents as sophisticated as Michael Pollan will suggest that following the current science of nutrition, pejoratively referred to as nutritionism (http://en.wikipedia.org/wiki/Nutritionism), will lead people astray. Instead they suggest that we should use common sense intuition to eat according to the pattern of our ancestors.

    I feel that even rather rational people, with limited time to explore the literature, would buy into flawed arguments, like the above, and ultimately avoid vegetarianism.

    • http://nutritionfacts.org/members/2rhealth/ 2RHealth

      It is certainly an educational challenge to make major changes in the way people view the foods they eat. In my reading of Michael Pollan, I was understanding his mantra of “Eat food, mostly plants, and not too much,” is certainly advocating for a plant based diet as the primary food source. Although he may eat meat, his writings, seem to clearly decry the traditional western diet and the “food industry”.

      As he says in his “Food Rules”, Eat foods from plants, not food made in plants.

      • http://nutritionfacts.org/members/bpcveg/ BPC

        I feel that ‘Mostly plants’ does not say much since most people of the world, including those from developed nations, already get most of their calories from plant sources. The food balance tables (http://faostat.fao.org/site/368/default.aspx#ancor) provide ample support for this.

        In his ‘Six rules for eating wisely’ (http://michaelpollan.com/articles-archive/six-rules-for-eating-wisely/), I think Pollan sums up his attitude when he writes: “The more I learn about the science of nutrition, the less certain I am that we’ve learned anything important about food that our ancestors didn’t know.”

        Concerns about the sincerity of Pollan’s support for vegetarianism have been well-covered elsewhere, including: (http://www.theatlantic.com/magazine/archive/2007/09/hard-to-swallow/6123/4/)

        • http://nutritionfacts.org/members/2rhealth/ 2RHealth

          I would agree that the majority of the world has historically obtained the majority of calories from plant sources. The problems facing us here in the USA are we have really made a shift in the last century and it has been detrimental to our health.

          Pollan’s statement about nutrition is one I took as a critique of our reductionist approach, basically we have been taught to look at eating nutrients rather than whole food. Although being concerned about nutrients we need or don’t need can be helpful, most of the research seems to show eating whole foods is most beneficial.

          I am not too concerned about Pollan’s personal philosophy and whether he eats meat or not. I find his writing stimulated my own thought about what I eat – so his writings have been beneficial to me!

          concerned about Pollan’s sincerity

          • http://nutritionfacts.org/members/bpcveg/ BPC

            Nicely said! … I agree with you that Pollan makes an excellent point about the nutritional value of whole foods, which is well-supported by current research. If he is inspiring others to think more critically about the food they eat, then he is making a valuable contribution.

            Thank you.

          • http://nutritionfacts.org/members/dirty-cyclist/ Dirty Cyclist

            I started down my healthier path by just adding 3 pieces of fruit a day to my diet. Then I started reading and adding more veggies, then less sugar, then less meat and so on. Pollen’s writings have helped me along with Furman, McDougle and Gregers. It’s good to not forget that we all start in different places and most people can not go from the Standard American Diet to a vegan diet in one swoop…

          • http://nutritionfacts.org/members/bpcveg/ BPC

            I’m amazed by how much some vegetarians love Michael Pollan!

            If you doubt that Pollan is a meat-proponent, come talk to me after you watch the The Oprah Winfrey Show: Oprah and 378 Staffers Go Vegan: The One-Week Challenge (Feb 1st, 2011) where Pollan goes head to head with the veganist Kathy Freston and even remarks in his backstage appearance that “meat is a perfectly nutritious enjoyable food…its not like you’re hurting yourself eating meat”.

            Pollan’s scientific errors and anti-vegetarianism have been well documented on Adam Merberg’s blog ‘Say what, Michael Pollan’.

            Most amazing of all is why anyone would take dietary advice from an english major who has no scientific credentials!

  • JJ

    On one hand, you have people like the doctor in this video who educated himself and then felt compelled to go vegan.

    On the other hand, you have people like my morbidly obese, diabetic co-worker who takes pride in never eating vegetables, who can’t stand to go a day without a burger or two, and who would rather die than change her eating. I lent her Dr. Bernard’s book on Reversing Diabetes. She read it just far enough. She said she returned it to me before getting to the end because she knew that she would never make that change. She didn’t deny the science. She didn’t say everything is going well for her on her current path. She only said that she isn’t willing to eat healthily.

    Even my parents, who have listened to a lot of nutritional information and don’t really doubt it’s validity, are not willing to do much change.

    So, on one hand, we do need the medical community to wake up. On the other hand, I suspect that there are a large number of people who won’t change no matter what the medical community says. It may not be too late to help the kids. But I suspect that it is way too late to help most adults. Us adults outside the medical community all have our own tomato affect going on.

    • http://nutritionfacts.org/members/toxins/ Toxins

      The people who don’t care for their own body’s health has always baffled me

      • http://nutritionfacts.org/members/dirty-cyclist/ Dirty Cyclist

        It could be like smoking where once the tide really started to change, people did stop smoking.

  • http://nutritionfacts.org/members/EricNeeds/ Eric Needs

    This was fantastic. More videos like this please. We need rhetoric like this so vegans can properly defend themselves.

  • http://nutritionfacts.org/members/sonali/ Sonali

    Do you have a presentation on gout?

    • http://nutritionfacts.org/members/drdons/ DrDons

      Dr.Greger hasn’t done a specific video on gout. Gout is associated with higher blood uric acid levels. Increased consumption of meat, poultry and fish result in higher or uric acid. People getting most of their protein from plants have lower uric acid levels. I have had patients markedly decrease the number of gouty attacks or eliminate them altogether by going a a whole plant food based diet. Low fat dairy has been shown in men to decrease uric acid but you can’t recommend dairy because of its association with other diseases plus all the other non health arguments unnecessary suffering and environmental concerns. Go to browse all topics and click on Dairy for a number of excellent videos on the effects of dairy.

  • http://nutritionfacts.org/members/Jan-KristianMarkiewicz/ Jan-Kristian Markiewicz

    Another one: The fact that cleaning your hands would prevent the spread of disease was ignored and ridiculed for about 50 years…

    Semmelweis reflex:
    http://en.wikipedia.org/wiki/Semmelweis_reflex

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      Oh that’s a great example! Everyone should know about Ignaz Phillip Semmelweis. Quoting from the Proceedings of the Royal Society of Medicine: “Many men have been endowed with clear intellects and hearts full of love for their fellow men, with the enthusiasm of humanity, and they have been enabled to achieve some signal service for the human race in their day and generation; but in the whole history of medicine there is only one Semmelweis in the magnitude of his services to Mankind, and in the depths of his sufferings from contemporary jealous stupidity and ingratitude.”

      Let me set the scene:

      The year was 1846. The place, Viennese General Hospital, the largest of its kind in the world. Semmelweis gets a job as obstetrical assistant. He notices that three times as many women are dying at the hands of the medical students than at the hands of the midwifery students from puerperal fever, commonly known at the time as, “the black death of the childbed.” Semmelweis describes: “In the medical school division the mortality from puerperal fever was so terrifying that this division became notorious….There were heart rendering scenes when [pregnant] patients knelt down, wringing their hands, to beg for a transfer [to the midwifery division]….”

      Why the discrepancy? The food and ventilation was the same in both divisions. If anything, surgical skill was better in the medical school and overcrowding less. The idea at the time was that the excess mortality was due to the emotional strain of being examined by male students, since the midwives were all female. So the elders of the Medical School met in council and proceeded to exclude the foreign students from the hospital on the ground that they were, “rougher in their examination than the Viennese.” Death rates didn’t change.

      Before Lister, before Pasteur, Semmelweis made the connection between the autopsies the medical students were doing and the, “examining finger which introduces the cadaveric particles.” In May 1847 he required every medical student to wash his hands with a chlorine solution before making an examination and the death rate plummeted. For the first time in the history of the Vienna Hospital, the mortality rate at the medical school fell below that of the school of midwives.

      Knighted, no doubt, for the discovery of the century? Hardly. Historians believe his doctrine was unpalatable to colleagues since it implied that the obstetricians were the cause of death. He shared this knowledge with his superiors. From the Proceedings: “The suggestion was unheard of! Indeed, it was sheer impertinence to suggest that the Accoucheur to the Imperial household should carry contagion upon his hands.” Semmelweis was summarily dismissed.

      So he lectured, he wrote papers; he continued to be ridiculed. Doctors regarded antisepsis as a poor joke. His successor in Vienna publicly stated that the doctrine was, “discredited and universally rejected.” Semmelweis wrote a book, The Cause, Nature, and Prevention of Puerperal Fever, expecting it to save thousands of lives, but it was ignored.

      So he turned from academics to polemics. He started to publish open letters to midwifery professors. “Your teaching… is based on the dead bodies of… women slaughtered through ignorance. If… you continue to teach your students and midwives that puerperal fever is an ordinary epidemic disease, I proclaim you before God and the world to be an assassin….”

      By the summer of 1865 he had taken to the streets of Budapest thrusting circulars into the hands of startled pedestrians. “The peril of childbed fever menaces your life! Beware of doctors for they will kill you…. Unless everything that touches you is washed with soap and water and then chlorine solution, you will die and your child with you!”

      Semmelweis, at the age of 47, the father of three young children was committed to an insane asylum in Vienna. He attempted to escape, but was forcibly restrained by several guards, secured in a straight jacket, and confined in a darkened cell. The asylum guards beat him severely.

      Quoting from the Bulletin of the History of Medicine, “He was not in the asylum for long. Thirteen days after admission he was dead.” From the autopsy report: “It is obvious that these horrible injuries were… the consequences of brutal beating, tying down, trampling underfoot.”

  • http://nutritionfacts.org/members/tony-wright/ Tony Wright

    If you dig a little deeper you find the cause of dogma and stupidity is also a chronic deficiency of complex plant biochemistry.

    http://beyond-belief.org.uk/node/8

  • http://nutritionfacts.org/members/working-at-it/ working at it

    Dr. Greger, your website is a treasure; thank you.

    On a personal note: I have IBS, and am following Dr. Barnard’s advice on conducting an Elimination Diet to identify potential triggers. Tomatoes, it turns out, really are poison for me. In fact, many foods that have much to recommend them cause problems for me……wheat, oats, onions, tomatoes, squash…… Sometimes I get excited about something you discuss on a video, but evenutally find that I have to avoid it, if I want to feel good.
    Again, thanks for the information you provide; it’s wonderful.

  • Michael Greger M.D.

    For some context, please check out my associated blog post Heart Disease: there is a Cure!

  • Karen A

    It really is frustrating to have the weight of culture against you. Having been vegetarian for 23 years and vegan for 14 years, I’m an “extremist”. That I’d 3 major chronic health problems by the age of 15 which have probably been kept to some extent in check by diet, several years BEFORE going veggie doesn’t stop the comments that I’d feel better if I ate some meat.

    And worst of all is the argument that, “There’s no point to life if you don’t enjoy it while you can”; pointing out that it’s easier to enjoy life when you don’t have major health problems doesn’t cut it.

    As a young person, I tried angry outright argument when provoked; then I turned to refusing to discuss it; then I went through a phase of being cheerily fact-based and then changing the subject. Now I’m mentally noting the videos and articles on this site most likely to get emailed next time a member of the family and social circle complains about their asthma/gout/rheumatoid arthritis/type 2 diabetes/high cholesterol/high blood pressure, or asserts that soya products will make them infertile/less manly/gay/die from breast cancer. There’s something about a good-humoured short graphical representation by an MD specialising in clinical nutrition that packs more of a punch than “extreme” claims by someone you know. You’ve made my life a lot easier.  And how much do I love your video on cocoa solids as a treatment for chronic fatigue? – there are no words!

  • EC

     Great Website! Is it true that the consumption of ground flax seeds for men may be beneficial but that flax seed oil should not be consumed? Thanks.

  • Cerraw

    I recently turned vegan.  I have lost 15 pounds in 4 months.  I feel so much better since I stopped consuming meat and dairy.  I have asthma and am a smoker but since not eating dairy I can breath much better.

  • InterestedParty

    I would really appreciate seeing more videos on gout.  There is a ton of conflicting information (or misinformation) about diet and gout: eat soy/don’t eat soy; avoid wheat bread/eat whole-grain bread; eat tomatoes/don’t eat tomatoes; eat lots of cherries, etc.  I’d love to get the real scoop on whether and how diet can prevent gout and whether diet can impact gout attacks when they occur.

    Many thanks for responding to my requests in the past!

  • http://twitter.com/be47 dave johnston

    Dearest docta’ G!

    I and many others would love a LINK to McCarty’s vital report that concludes:

    “I suspect that the simple injunction, ‘Do not eat animal products’ has the potential to do more for world health than all of the abstruse wisdom in all of the world’s medical libraries.”

    So sorry if I missed it, as you source your facts almost as thouroughly as another favorite writer/healer/thinker truth-teller…Noam Chomsky [ http://www.chomsky.info ]¡

    Please re-post or post a link to McCarty’s paper, if you would, or simply its title, so we might be able to hunt it down.

    Thank you Noblest of Physicians!
    I am 2 months into being primarilly vegen, and truly love it.
    THANKS for your wisdom, joyful guidance and subtle encouragement!

    Life! Dave in harrisburg, PA

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