11
Kindred Spirits
T. COLIN CAMPBELL, the Cornell University professor who directed and cowrote The China Study, observes that there are “two worlds” of medicine—two radically different visions of how to approach health. “One consensus favors drugs as the cure, the other favors food,” he explains; Western medicine, for the most part, has chosen drugs. As he sees it, we got it wrong.
I agree. However, over the last couple of decades there has been some movement in the West toward recognizing the importance of nutrition to health. That is a development to be welcomed. And I much admire all the pioneers who have dared to stand up to the establishment. Their work has nourished my own, and although we may disagree on some fine points, for the most part we represent different paths up the same mountain.
Colin Campbell himself is one of these pioneers. He went to Cornell planning to study how to make more and better milk and meat protein. Once there, however, he discovered—through his own research and that of others—that those products were disastrous to human health. And with the sort of intellectual honesty that is much too rare in this age, he quickly switched his focus to follow where the science led. The New York Times called his China Study the “grand prix” of epidemiological nutrition research. He is utterly fearless, candidly analyzing the backroom deals and politics of a paranoid animal food industry that will stop at nothing to maintain the dominance of its products in the American diet. And he has played what is almost certain to be a critical role in the future of how we eat. For years, he has taught America’s foremost course in undergraduate nutrition, and his students will form the foundation of American nutrition in the twenty-first century.
Nathan Pritikin is another example of those who have bravely bucked the nutrition establishment. I never met him, but I did read his books and over the years, I have worked with some whom he trained. Pritikin was an engineer who had a lifelong interest in medicine and nutrition. In the course of his studies, he learned about the Tarahumara Indians of northern Mexico, whose diet consisted almost entirely of complex carbohydrates and who suffered from almost no heart disease or cancer. Pritikin became convinced that these Indians set an example Americans should follow, and devoted much of his life to spreading that message. The diet he promoted emphasized consumption of vegetables, fruits, whole grains, and small amounts of meat, poultry, and fish—all told, a low-fat, high-fiber diet supplemented with healthy doses of aerobic exercise.
Because Pritikin did not have a degree in medicine, his research was never fully accepted by the medical community. Even so, he never backed down, and ably defended his viewpoint against his critics. Proof that he had been on the right course all along came after his death in 1985, at the age of sixty-nine, of complications from experimental treatment for leukemia. The New England Journal of Medicine published the results of his autopsy, noting an “absolutely remarkable” absence of calcification and fatty deposits in Pritikin’s coronary arteries. Those blood vessels, the medical examiner declared, were like those of a teenager.1
Hans Diehl, who studied with Nathan Pritikin, has made healthier lifestyles his own lifelong cause. His Coronary Health Improvement Program—CHIP—trains entire communities in how to change their bad nutrition habits. I have been one of CHIP’s guest speakers on numerous occasions and have experienced firsthand the magical influence its founder can have in mobilizing large groups of people to take control of their own health.2
Yet another pioneer in the field is a physician named John McDougall, who for more than thirty years has been teaching about the critical importance of diet to health. I read his book The McDougall Plan in 1983, and it helped convince me that I was on the right track in my own growing belief in plant-based nutrition. Dr. McDougall became interested in the subject when he lived in Hawaii, on a sugar plantation. As he tells the story, “I met first-, second-, third-, and fourth-generation Filipinos, Japanese, Chinese, and Koreans.” He noticed that his patients from the first generation of immigrants, who ate the “worst diet,” according to traditional nutritional principles—virtually no dairy products or meat—always seemed trim and fit. “They avoided heart disease, diabetes, breast cancer, prostate cancer, and arthritis, by and large, and they also lived to work and function fully into their eighties and sometimes nineties on a diet primarily of rice and vegetables.” But as the succeeding generations became more Westernized and learned to eat what the experts considered a “well-balanced diet,” they became fatter and sicker. “This caused me to reevaluate everything I was taught previously about ‘good nutrition,’” says Dr. McDougall. Ever since, he has been writing and teaching about the benefits of a primarily vegetarian, “starch-based” diet.
Of all the low-fat nutritional programs that have emerged over the past twenty years, perhaps the most similar to mine is that of Dean Ornish. I have known Dr. Ornish for twenty years, and I have the greatest respect for his work. At my invitation, he has spoken at the Cleveland Clinic and at national conferences on preventive cardiology. Among the wide variety of programs promoting cardiovascular health, his and mine are the only ones I am aware of that are based on peer-reviewed research that demonstrates arrest and reversal of heart disease.
As you have read, my own twelve-year study started in 1985. I set a clear goal: achieving total cholesterol in my patients of less than 150 mg/dL using a plant-based diet and cholesterol-lowering medication. The emphasis was on absolute adherence to my nutritional program, which I reinforced through my interviews with patients and my reviews of their diet diaries every two weeks for the first five years, every four weeks for the second five years, and every twelve weeks for the last two years of the study. All of the participants in my research were severely ill, with disease in all three-coronary arteries. Most had undergone a previous heart bypass operation or an angioplasty that eventually had failed. Several had failed these procedures twice. And several had been told by their cardiologists that there was nothing further to be done—that they must prepare for the inevitable progression of their disease.
Dr. Ornish started his study in 1986. Like mine, his aimed to reverse coronary artery disease through plant-based nutrition. But he did not specify cholesterol targets for his patients, and he did not use cholesterol-reducing medication. Like mine, Dr. Ornish’s patients had three-vessel coronary artery disease. And Dr. Ornish insisted that in addition to adopting a plant-based diet, his patients must use relaxation and meditation techniques and participate in a structured exercise program. Finally, Dr. Ornish had a control group of patients who had similar disease severity, but who followed a traditional program of cardiac care.
My own research had convinced me that it was plant-based nutrition, rather than meditation or exercise, that protected people in certain cultures from developing coronary artery disease, so I did not require anything of my patients apart from an absolute commitment to eat according to the plan. I wanted them to focus absolutely on proper nutrition, and I worried that asking them to make too many changes in their lifestyle would interfere with that focus. Since the health benefits of relaxation and exercise are well documented, they were free, of course, to meditate if they chose to (none did) and I encouraged them to exercise (most chose walking—although there was an occasional jogger or swimmer). It is worth noting that two of my patients, who had had moderately disabling strokes before the study began, did no exercise at all—yet like the others, they had excellent results that have lasted more than twenty years since the start of the study. Patients with coronary artery disease who cannot exercise must not despair. Full adherence to the nutrition program will protect them from progression of their disease.
Just one year into his study, Dr. Ornish published his findings to date. During those first twelve months, his experimental patients had suffered less severe and less frequent attacks of angina than the members of the control group. Follow-up angiograms had showed reversal of coronary artery disease among the experimental group, and that benefit continued at the five-year follow-up study. Additional PET-scan imaging of his experimental patients at five years confirmed that 99 percent were able to halt or reverse disease. There was a direct correlation between adherence to the program after one year and after five years.
Dr. Ornish reported twenty-five new coronary events in his experimental patients at five years, which were 2.5 times fewer events than were identified in his control patients receiving traditional cardiac care. I have personally met some of Dr. Ornish’s original patients, who like mine were doing well nineteen years later. The Ornish program has been expanded to multiple sites throughout the nation.
I waited five years before publishing my first report on our results. Angina was diminished in all patients, and had completely disappeared in several more. Follow-up angiograms had shown some stunning reversals of disease. Average total cholesterol was 137 mg/dL, and average LDL was 77 mg/dL. After twelve years, the end of the formal study, I could report that seventeen of the eighteen original patients had experienced no subsequent coronary events since the start of the research. (One noncompliant patient had required bypass surgery.) And more than twenty years later, as I noted in Chapter 6, these patients continue to flourish.
To the best of my knowledge, the twelve-year report on my patients represents the longest follow-up study in the medical literature of arrest and reversal of coronary heart disease.
The key, as both Dean Ornish’s research and mine clearly show, is in persuading patients to grasp the total message and to comply fully with the programs. Our approaches differ in some significant ways, but the goal is the same: stopping heart disease in its tracks and even eradicating its effects.
And what of future generations? There has been some significant progress on that front, as well.
It started with the publication, in 1995, of Dr. Attwood’s Low-Fat Prescription for Kids: A Pediatrician’s Program of Preventive Nutrition.3
This wonderfully comprehensive book observed that by the age of twelve, 70 percent of American children have fatty deposits in their arteries, the precursors of heart disease. In his book, Dr. Charles Attwood, who died in 1998, destroyed many of the common myths about the harmful effects of plant-based eating for children and adolescents. Among them: the notions that a child on a plant-based diet won’t attain full growth or have enough energy, that he or she won’t consume enough calcium, protein, and iron, that controlling obesity and cholesterol can wait until the child is older. Not one of these premises is true.
A longtime pediatrician with an extremely busy practice, Dr. Attwood felt an obligation to eliminate the barriers that prevent children from exposure to healthy low-fat eating. Most significant, he took a very courageous step in recommending the elimination of dairy products, meat, fish, fowl, and oil from the pediatric diet—recommendations accepted and endorsed by the late Benjamin Spock, who wrote the foreword for Attwood’s book. Since the book was published, similar advice has proliferated in bookstores and on the Internet, and today it does not seem so revolutionary to suggest that providing children with low-fat, plant-based nutrition will protect them from the ravages of heart disease and the common cancers in their adult years.
But will children develop a taste for healthy eating?
Antonia Demas answers that question with a resounding yes. During the 1990s, while pursuing her doctorate in nutrition at Cornell, Demas performed a controlled experiment in Trumansburg, New York. Her subjects were children from kindergarten through fourth grade who prepared, cooked, and consumed a plant-based diet. She was able to show that when introduced to the subject of nutrition in a hands-on learning process, children not only adopted healthy, low-fat diets—they did so with enormous enthusiasm. Her doctoral thesis based on that research, Food Education in the Elementary Classroom, won numerous awards and international attention.
Demas now heads the Food Studies Institute, a nonprofit organization, based in Trumansburg, which is devoted to the long-term health and education of children. In 2001, she published Food Is Elementary, an elementary-school curriculum that uses a multidisciplinary approach to teach children about food, nutrition, culture, and the arts. In addition, Demas’s institute works with schools across the country to incorporate low-fat, high-fiber choices into school meal programs and to get parents involved in what their children are learning about nutrition.
I take great pleasure in all these developments. And yet, with all the research that demonstrates the wisdom and benefits of plant-based nutrition, its growing ranks of proponents still face a formidable array of opponents, from the titans of the animal food industry to the medical establishment itself. My colleague Dean Ornish succinctly sums up the dilemma faced by those of us who believe in this healthy way of eating: “I don’t understand why asking people to eat a well-balanced vegetarian diet is considered drastic, while it is medically conservative to cut people open.”
Well said.