1. I KNOW LOTS OF PEOPLE WHO EAT FAST FOOD AND JUNK FOOD ALL THE TIME, AND THEY ARE PERFECTLY HEALTHY AND PLENTY SMART. WHAT ABOUT THAT?
We all have different genetic weaknesses and tendencies. Some people are more sensitive to nutritional insults than others. Some of us can resist apparent signs of early life damage even when eating suboptimally. However, damage still accumulates over the years, and it almost always catches up with us, resulting in serious disease in midlife or later. Nobody escapes the cumulative damage from a diet heavy in fast foods, even if the damage can’t be seen when we’re younger.
The United States has the most overweight and diabetic population ever recorded in the history of the world. The amount of suffering experienced today by so many people with serious medical conditions that can be avoided is simply heartbreaking. We have to expect that those people who are eating the unhealthiest and are the most addicted to food will be the ones who most resist change. They often propose irrational excuses why they should not change their bad habits. Lots of people still smoke cigarettes; everyone is not going to quit, despite the overwhelming evidence of danger. All we can hope for is that everyone is properly informed and educated. My hope and goal are to make the tools available for those who want to protect their health and the health of their loved ones, and that those who want to, can get professional help to change when they need it.
Age of Death: SAD vs. Nutritarian Diet
LIFE SPAN PROBABILITIES: A BELL-SHAPED CURVE
Let’s look at age of death. If you plot age of death among people on a similar diet, you get a bell-shaped curve of possibilities, where the center of the curve represents the average age of death for a particular population. If there is a great difference between the ages at which people die, the width of the curve is greater. If there is less difference, the width is narrower. For people eating the SAD, the curve is wide, meaning that people eating this diet die at a wide variety of ages. Some live much longer, which is balanced with others who die very young.
If we look at populations eating heavily from natural plants and avoiding processed foods (the “Nutritarian diet” on the figure), such as in the Blue Zones around the world, the curve not only shifts to the right by ten to fifteen years (that is, people live longer generally), but it also narrows considerably. Without poor nutrition, people are much less likely to die prematurely (except for accidents). My experience as a physician over the past twenty-five years caring for thousands of people adhering to my nutritional guidance (Nutritarians) has indicated that thriving well into one’s 90s is not just possible, but most probable.
The vast majority of adults older than 65 in the United States take medications for their heart and high blood pressure. Many also take diabetes medications and antidepressants. Almost all Americans die of diseases related to nutritional ignorance. But premature death is not the only problem; all the morbidity, suffering, and physical, emotional, and intellectual deficits that occur as people age make their lives very difficult and even tragic. The fast food eaters don’t just die fifteen to twenty years prematurely; they suffer greatly (and needlessly) during the last two decades of their lives.
I believe that many millions of people would be willing to make more substantial dietary improvements if they knew about and understood the true risks involved with taking medications for high blood pressure, high cholesterol, and high blood sugar levels. Medications are not very effective at mitigating the morbidity and mortality associated with these chronic diseases of dietary folly. Dramatic protection against heart disease, stroke, dementia, and cancer cannot and does not occur from access to medical care; it can only happen when people eat very healthfully—and when they have the information they need to take charge of their health destiny. The problem is that too many millions of people do not have this information. Nor do many of them have access to healthy foods, as we have seen. They are not given the opportunity to even make the choice to live healthfully.
But with that information and available healthy food, and with effort and time spent learning new recipes, we can all find that a healthy diet becomes more and more enjoyable as our taste and food preferences change the more we eat healthy food. Healthy food can taste great! You don’t enjoy living more when you eat dangerously.
“I heard the food doesn’t taste so good once you’re in the coffin.”
2. WHY CAN’T A MULTIVITAMIN MAKE UP FOR WHAT PROCESSED FOODS LACK?
Real food contains too many important factors that have never seen the inside of a vitamin pill. An important message of this book is that we need to eat real food to be healthy: We cannot expect supplements to do the job for us.
Many delicate, valuable phytonutrients are lost through processing and cooking food. These nutrients number in the thousands, and eating a variety of plants is the only way to get them. Important phytochemicals form during chewing, as plant enzymes are released and activated. Some of these enzymes are heat-sensitive, so the more the plant food is cooked, the more nutrients are lost.
For example, eating a salad every day made up of mostly raw vegetables is a critical centerpiece of a health-supporting, life span–enhancing diet. The reason is because heat inactivates the enzyme myrosinase, which is needed for the production of cell-supporting and cancer-fighting nutrients. Many of these phytonutrients are not as available in cooked vegetables. The same thing is true regarding the health benefits of raw scallions, onions, and shallots, to maintain function of the enzyme called alliinase. Hundreds of other delicate, supportive compounds are found in colorful plants that interact with each other to improve and safeguard our health, and these compounds and enzymes cannot be found in supplements.
I want to add an important but much more radical and universally unappreciated point here. The fortification and supplementation of foods with petroleum-derived folic acid may actually increase the risk of disease, and even more tragic, increase the risk of cancer and a premature death.
Many studies have evaluated whether taking a standard multivitamin-mineral supplement wards off heart disease, cancer, and dementia or extends life span. Overall, the results of the majority of such studies show very little benefit, if any. A meta-analysis conducted for the U.S. Preventive Services Task Force assessed the evidence from twenty-seven studies on vitamin and mineral supplementation that included more than 450,000 people and found no evidence of benefit for preventing heart disease and only a minimal benefit for reducing cancer risk.1 A significant number of studies also show that the commonly included nutrients in multivitamins can cause harm. These data are a bit complicated and need to be explained and understood further.
Any study looking at the risks and benefits of long-term multivitamin use is by its nature poor science. That’s because multivitamins have too many variables and mix together some potentially useful elements with other potentially harmful ones. Studying multivitamin use is as illogical as studying the Mediterranean diet: Is it the fish that is good or bad for you? Or the tomato sauce, walnuts, and olive oil? Or did the oil cause more weight gain and death? Does the white pasta and cheese in the Mediterranean diet promote a longer life span, or the pizza crust? You can see the point: Too many variables are lumped together to be able to get any useful information about which elements are good or bad when they are included all together in one study.
We need to evaluate one intervention at a time to really learn which are the most favorable or unfavorable components of a diet. When we do that with the Mediterranean diet, we invariably find out that the white flour pasta and the pizza crust are unfavorable. Clearly, a Mediterranean diet is far from an ideal diet, and just because it is better than the SAD, it is not scientific to position it as such.
Likewise, a study evaluating the benefits of a multivitamin lumps together elements such as vitamin D, vitamin B12, and zinc supplementation, which may have benefits in certain populations, with other elements such as beta-carotene, folic acid, vitamin A, and copper, which most likely have overall harmful effects.
These studies are examples of poor science and wasted resources; they tell us almost nothing. Therefore, the inconsistent and marginal benefits shown by these studies on whole multivitamins do not offer us any insights on which elements, if any, aid health or are effective in reducing cancer or extending life span. We have to study each micronutrient individually to ascertain its risks and value. I explain this in more detail below and offer suggestions.
FOLIC ACID IS NOT FOLATE
Let’s consider the practice of supplementing flours and foods with folic acid and vitamin A and look at the benefits and risks. If you understand the complexity of this issue, you will be able to better understand why supplements cannot take the place of eating right.
Folate is a B vitamin that is universally present in plants. A synthetic form of folate called folic acid is used in dietary supplements and fortified foods. Folic acid is derived from petroleum and is not the same compound as the real folate that is found in fruits, vegetables, and beans.
Synthetic folic acid is highly absorbable, but then the body has to modify it so it can behave like real folate. The body can convert only a limited amount of folic acid into folate, so most people ingesting folic acid have unmodified folic acid circulating in their bloodstream and in the tissues of their body. Remember: Folic acid is a manufactured chemical substitute for folate, and throughout human history, folate has been the protective vitamin ingested from eating real food. Only in our recent fast food era have people been encouraged to supplement with folic acid because they no longer eat sufficient vegetation, which is naturally high in folate.
The problem begins with folic acid competing for absorption into the body, thus decreasing the absorption of the folate in fruits, beans, and vegetables. Once inside our body’s cells, the real competition begins where folic acid binds to folate-dependent enzymes, creating potential hazards in their function. DNA synthesis is affected, leading to more DNA errors in dividing and replicating cells, which potentially can increase the risk of developing cancer.
Almost every obstetrician today prescribes a folic acid–containing supplement to pregnant women to protect the growing fetus from neural tube defects. The neural tube is the embryo’s precursor to the central nervous system, which comprises the brain and spinal cord. Neural tube defects occur during early fetal development because modern women are not eating vegetables—not because they require a petroleum-derived chemical to have a normal child. Modern health authorities repeatedly try to solve health issues with pills instead of fixing the real problem, in this case, the lack of green vegetables in the diet.
Instead of encouraging women to eat more vegetables and beans to give birth to normal children, we give them folic acid pills. Instead of encouraging people to eat more vegetables and lose weight to reverse type 2 diabetes, we give them pills. Instead of encouraging people to eat more vegetables so they can lower their cholesterol and prevent heart disease, we give them statin drugs. The problem with these “pill solutions” is that they have unintended side effects. It is more effective and safer to lower your blood pressure and reverse your diabetes through an excellent diet and exercise, not medication. It is more effective and safer to maintain a normal level of folate in your body by eating properly, not by taking a supplement containing folic acid.
When people ingest folic acid routinely in multivitamins and fortified foods, their bodies get overloaded with the stuff, and unintended consequences result. For instance, we know from animal studies that the presence of artificial folic acid promotes the progression of precancerous lesions to cancer and the spread of cancer, including breast cancer.2 In addition, taking folic acid during pregnancy to prevent neural tube defects may actually damage the child. Let’s look at some of the evidence, but remember, it can take thirty to fifty years to see increases in cancer occurrence from ingesting folic acid.
• A study compared breast cancer death rates between women who took folic acid during their pregnancies and those who did not. Thirty years later, those women who took a hefty dose of folic acid were twice as likely to have died from breast cancer.3
• A ten-year study on more than thirty-five thousand women taking multivitamins showed that women who took a multivitamin containing folic acid had a 20 percent increased occurrence of breast cancer compared with women not supplementing with folic acid.4 (Note that ten years would underestimate the increased cancers that could have been created.)
• Researchers looking to find a benefit from using folic acid to prevent breast cancer followed more than twenty-five thousand women and were shocked to find the opposite—folic acid supplement use was associated with a higher incidence of breast cancer.5
• A 2011 meta-analysis of folic acid supplementation and colon cancer found people taking the supplement for three years or longer increased their risk of developing advanced adenoma by 50 percent. A 2012 meta-analysis of folic acid supplementation found a 21 percent increase incidence of cancers at all sites.6
• One randomized controlled trial of folic acid supplementation reported that men who took folic acid had triple the prostate cancer risk compared with men who took a placebo.7
Some studies looking at this issue have not shown an increase in breast cancer incidence in women supplementing with folic acid. This is most likely because the studies are not well-controlled and do not follow the study populations long enough. When atomic bombs exploded in Hiroshima and Nagasaki in Japan to end World War II, cancer deaths began to appear about ten years later, and the rates were still climbing after forty years. We cannot look at studies performed for fewer than ten years to ascertain the potential cancer-promoting effects of an intervention.
Today, even people who do not take a supplement containing folic acid still have a large exposure to supplemental folic acid in fortified foods, so this is a difficult subject to study when our entire population is exposed to folic acid from multiple sources every day. A systematic review and meta-analysis of nineteen studies discussing this issue was published in 2012 and showed an increase in prostate cancer in men taking folic acid in supplements and a borderline increase in overall cancer.8 Remember, even a negative study does not mean folic acid is safe; it just means that the study could not detect the harm. Given that our modern population ingests multiple carcinogenic substances, it is nearly impossible to isolate every contributor to determine individual effects.
When people eat commercial baked goods, they don’t just ingest cancer-causing additives, such as bromate and sodium phosphate, and bleaching and softening agents, such as benzoyl peroxide and azodicarbonamide; they also consume a load of folic acid because all of these things are added to the fortified white flour used in commercial baking. Add the underlying risks of the high-glycemic flour as well as the synthetic folic acid in a multivitamin, and you have a witches’ brew for cancer promotion.
Unlike supplemental folic acid, we know that eating real food with real folate offers significant protection against cancer. Folate is abundant in all green vegetables, and folate-containing foods include hundreds of protective nutrients. We do not need synthetic folic acid supplements to meet our daily folate requirements. Here are a few examples of folaterich foods (as a reference point, the U.S. recommended daily allowance for folate is 400 micrograms).
| MICROGRAMS OF FOLATE | |
| Asparagus (1.5 cups cooked) | 402 |
| Edamame (1 cup cooked) | 358 |
| Lentils (1 cup cooked) | 358 |
| Broccoli (2 cups cooked) | 337 |
| Chickpeas (1 cup cooked) | 282 |
| Adzuki beans (1 cup cooked) | 278 |
| Romaine lettuce (3 cups raw) | 192 |
| Brussels sprouts (2 cups cooked) | 187 |
| Spinach (3 cups raw) | 175 |
When you eat produce to get your folate, you radically improve your nutritional status in many ways, as these are all micronutrient-rich foods in general, containing many antioxidants and phytochemicals.
However, it is not healthy to be deficient in folate, and certainly for people who can’t or won’t eat vegetables, taking some folic acid is better than nothing. But everyone should be informed that ingesting an excessive amount of folic acid from a combination of fortified foods and supplements can be dangerous. Too much exposure to folic acid during pregnancy may increase respiratory problems in children such as asthma and pneumonia.9 There is even evidence that excessive blood levels of folate (which likely is from excessive exposure to folic acid) at childbirth is associated with doubling the risk of autism in children.10
One thing we know for sure: If women ate more green vegetables and beans throughout their lives, they would get plenty of folate, and their offspring not only would be protected against neural tube defects but also would get hundreds of other beneficial compounds that offer protection against childhood cancers. It has been known for years that a lack of green vegetables in mothers’ diets increases the risk of childhood cancers in their offspring.11 The diet before conception also affects these risks. If the public were fully informed on all these issues, maybe more people would eat right and we would have many fewer children with autism, brain tumors, and leukemia. Now is the time for public health authorities to promote a diet with adequate folate from plant foods.
Future studies may indicate that some people metabolize folic acid and vitamin B12 differently and are at higher risk than others from excesses. However, this would not be an issue if women got their needed folate from a healthy diet. We can’t stop the folic acid recommendations across the board yet, because so many women still don’t eat healthfully, but at least we can start to reeducate our population about the necessity of getting these nutrients from their natural sources, and the profound benefits from doing so.
This is a complicated issue, and most people are in the dark about it. But it has important implications because excluding accidents, cancer is the leading cause of death in children younger than 15. This missed opportunity to educate young women about the critical importance of a healthy diet that contains adequate folate to have a normal and healthy child leads to many subtle medical issues in children that can affect them throughout their lives—including allergies and autoimmune diseases. Advocating folic acid supplements, instead of sufficient vegetables and beans to obtain folate, likely harms and even kills thousands of children every year.
SUPPLEMENTS AND FORTIFICATION OF FOODS IS PART OF THE PROBLEM, NOT THE SOLUTION
When you eat a healthy diet, you are exposed to a huge amount of carotenoids, such as beta-carotene, a precursor to vitamin A in the body. The body converts beta-carotene (as well as alpha-carotene and beta-cryptoxanthin) into vitamin A, so if people eat enough colorful vegetables, there would be no need for vitamin A supplementation. People are exposed to preformed vitamin A in supplements and in fortified foods, and it has been shown that even in ranges not normally considered toxic, it can be harmful. A review of sixty-eight randomized trials of vitamin A supplementation, with a mean dose of 20,000 IU, showed an average 16 percent increased mortality over an average of three years.12 Since this analysis was not over decades, it likely underestimates the damage from excess vitamin A intake.
The amount of vitamin A in typical multivitamins has been shown to increase the risk of osteoporosis and hip fractures, and excess vitamin A in fortified foods makes these effects even worse. One study showed a doubling of the hip fracture rate with more vitamin A, comparing an intake of 1,500 IU vitamin A with 4,500 IU, the latter being the typical amount found in vitamin supplements.13 High doses of vitamin A during pregnancy have also been linked to birth defects.14
A more recent evaluation of all relevant trials carried out around the world showed that taking vitamin A, beta-carotene, and vitamin E supplements increased mortality—that is, the risk of sudden death was higher for those who took such supplements. Some skeptics doubted these findings, claiming that people taking supplements likely had worse diets because they believed that the supplements would improve their health. These doubts were rejected in later randomized trials, which means that study participants were randomly assigned to take the supplements or a placebo. The results showed the same dangers from the supplements as the earlier studies had shown. This new study carried out in 2011 was based on eleven new trials and used ordinary dosages typically found in vitamin pills that were linked to the increased death rate.15 The researchers tested both single vitamins and multivitamins, and they found increased mortality in both cases.
The full spectrum of natural vitamin forms that is found in natural foods, such as eight separate vitamin E fragments or hundreds of carotenoids, behaves much differently from the vitamins we take as supplements or get from fortified foods in our diet. As the saying goes, “You can’t fool Mother Nature.”
Supplements cannot take the place of a healthy diet and should be avoided—especially the widely available inexpensive varieties. This does not mean that the judicious use of supplements to cover nutritional gaps in a person’s diet is not important; it just means we have to review the data carefully regarding each ingredient and the precise form of supplement being used, and assure that the dosage used is not excessive.
3. WHAT ABOUT THOSE WHO DON’T EAT RIGHT? AND, DO PEOPLE WHO EAT HEALTHFULLY NEED ANY SUPPLEMENTS AT ALL?
Unquestionably, people who eat fast food, commercial baked goods, processed meats, fried foods, and soft drinks are dangerously deficient in micronutrients, especially antioxidants and phytochemicals. We have to recognize that despite the potential dangers of certain supplemental ingredients, this group is more likely to be better off with a carefully chosen assortment of supplements, including powdered whole food extracts, phytochemical isolates, and a full spectrum of low-dose antioxidants.
Of course, supplementation will not grant them optimal health, but it is better than being severely deficient in micronutrients. However, it is important to remember that individual nutrients and isolated nutrient extracts and synthetics can still be potentially harmful. Take care not to overdose on any micronutrient that could have negative effects, especially in excess amounts.
A large number of Americans eat what they consider a “healthy” diet, but so often that diet still does not include sufficient vegetables, beans, onions, mushrooms, berries, and seeds and still is too close to the SAD (meaning they eat too many processed foods and animal products). These people are not exposed to enough micronutrients and phytochemicals. For these people, a supplement with a dehydrated vegetable-based formula with dozens of phytochemical extracts from superfoods is likely beneficial, though not as valuable as eating an excellent diet. There are other groups of people who may benefit from supplementing their diets with certain vitamins and minerals:
1. The elderly: Vitamin B12 absorption decreases with age, and elderly people may also need higher amounts of calcium and vitamin D. Zinc is also important for the elderly, as the body’s ability to absorb zinc can decrease and immunity wanes in later life, increasing the risk of a person developing influenza and pneumonia. A significant amount of research indicates that such supplementation is particularly important in the aging population to decrease the risk of infections, especially life-threatening pneumonia.16
Calcium can also be an issue for the elderly, as bones age and grow brittle. Green vegetables, beans, and seeds are generally rich in calcium, and a diet including these foods is healthful for the bones. Taking too much supplemental calcium in a concentrated form can lead to increased blood vessel calcification and may increase heart disease risk.17 So even in postmenopausal women, the right diet and the moderate use of food-derived calcium in small amounts (such as 150–250 milligrams) with meals is a better choice than a high dose (500–1000 milligrams) of calcium taken at once, which may have detrimental health effects.18
2. Vegans and vegetarians: Vitamin B12 is found only in animal foods. Depending on food choices and the care taken to cover insufficiencies, vegans and vegetarians may also have suboptimal levels of vitamin K2, zinc, iron, vitamin D, and omega-3 fatty acids (see Omega-3 Index in Vegans chart).
3. Children who are picky eaters: Children who do not eat a varied diet may benefit from the regular use of a carefully designed supplement that contains a variety of powdered superfood extracts and micronutrients. Children’s developing brains also benefit from a DHA-EPA supplement, since reliance on seafood in today’s world can expose children to too much mercury and petrochemicals, both of which are found in fish.
Others who may benefit from taking multivitamins include people who have had weight-loss surgery, people who are on very low-calorie diets, people who have a poor appetite, and people who don’t get enough nutrients from food alone because of a medical or genetic reason.
Many people think that a healthy diet should supply all the nutrients we need for optimal health; this is pretty close to being true, but there are exceptions. The first exception is vitamin D, known as the “sunshine vitamin,” because the only way to obtain enough vitamin D naturally is from the rays of the sun. These days, however, most people work indoors, and many live in more northern climates with less daily sunshine. Also, with our mixed backgrounds, our skin has differing abilities to produce vitamin D from the sun—not only because of skin pigmentation but also because of genetic factors.
Sure, if we lived most of our lives outdoors, with not much clothing on—aging and wrinkling our skin in the process and in some cases creating a higher risk of developing skin cancer—then we wouldn’t need vitamin D supplements. The bottom line is that supplementing with vitamin D3 is important for many people to maintain an optimally healthy level in their bodies. Being severely deficient in any nutrient, even when arising from a desire to stay “natural,” is not healthful for anyone and gets many individuals into trouble, as I’ve frequently seen in my medical practice. A vitamin D deficiency does not just increase one’s risk of getting osteoporosis; it also can increase the risk of cancer.19
On the other hand, too high a dose of supplemental vitamin D can also have untoward effects.20 A 25-hydroxy vitamin D blood test can assure that people are not taking too much or too little, aiming for blood levels between 30 and 50 ng/dL. For most people who do not get enough sun exposure, a daily dose of 2,000 IU vitamin D3 (the preferred form) assures they will reach a favorable blood level without the risk of taking too much. Occasionally, people need more or less.
There is another important concept to grasp here: A growing segment of our health-seeking population restricts or omits animal products in order to protect against chronic diseases. As animal product consumption becomes more infrequent, the risk of vitamin B12 deficiency looms larger. So as we strive for more healthy produce and fewer animal products, we need to have a reliable source of B12. If you are elderly or completely vegan, your need for B12 can be significantly higher than the recommended daily intake because only a small percentage of a B12 supplement is absorbed at one time, and the supplements are generally taken only once a day.
Zinc, vitamin K2, and iodine are also nutrients that could be suboptimal depending on your choice of foods, and many very healthy eaters can still be low in one of these nutrients if they don’t consume animal products for zinc or seaweeds, seafood, or iodinated salt for iodine. Plant foods do contain adequate zinc, but because of the binding of zinc to plant phytates, the bioavailability is lower.21 This means that despite adequate zinc in the diet, many vegans may require a bit more for optimal immune function. Zinc needs can vary, and zinc absorption can decrease with aging.22
Just because some supplements are potentially dangerous doesn’t mean that all supplemental ingredients are harmful or not beneficial. In fact, when extensively studied, many have been shown to be life span favorable in general populations.
| YOUR SUPPLEMENT SHOULD NOT CONTAIN | YOUR SUPPLEMENT SHOULD CONTAIN |
| Folic acid | Vitamin B12 |
| Vitamin A | Vitamin D |
| Beta-carotene | Iodine |
| Vitamin E | Zinc |
| Copper | Vitamin K2 |
Vitamin K2 is another example of a supplement that may benefit the general population as well as those people eating an excellent diet. There are two natural forms of vitamin K: the K1 found in plants, especially green vegetables, and the lesser-known K2, which is more difficult to obtain from modern diets. Several studies have found that vitamin K2 reduces the risk of hip and spine fractures and reduces bone loss with aging.23 Vitamin K2 is found in some animal products, such as fish eggs and organ meats or natto, a fermented soy product, so supplemental K2 likely has significant benefits.
Supplements of the omega-3 fatty acids EPA and DHA can also have important health benefits for those people who don’t eat seafood regularly. As discussed in Chapter 2, EPA and DHA are important for brain development and health, affecting intelligence and even emotional stability. Omega-3 fatty acids are also important nutrients for protection against depression, dementia, and neurological disorders.
The study results diagramed below tested fatty acid levels in 167 vegans of various ages who were eating a natural diet and avoided processed foods. Results showed that 64 percent had insufficiencies and that 27 percent had more severe deficiencies. These deficiencies were easily corrected with a low-dose vegan DHA/EPA supplement. There was no correlation with DHA insufficiency and ALA levels, the short-chain omega-3 fat found in leafy greens, walnuts, and flaxseeds from which the body can make EPA and DHA. There was also no correlation with the amount of omega-6 oil consumption. This means that the differences were largely due to a wide genetic variability in the conversion of ALA to DHA, since the problem was not solved by higher ALA intake and lower omega-6 intake. The important learning point here is that vegans and people who don’t eat fish may be placing themselves at needless risk of later life memory loss and dementia if they don’t take supplements. If a person is uncertain regarding their needs, thankfully, blood tests are easily available to check for adequacy.
Omega-3 Index in Vegans24
Omega-3 index measures levels of EPA and DHA in red blood cell membranes and represents long-term exposure to these beneficial fatty acids. Levels less than 3.5 percent are particularly alarming, because once your brain shrinks, no supplemental regimen can enlarge it again.
More than a dozen epidemiological studies have reported that reduced levels of omega-3 fatty acids were associated with an increased risk for age-related cognitive decline or dementia, such as Alzheimer’s disease. In the Women’s Health Initiative Memory Study of more than eleven hundred postmenopausal women, a higher omega-3 index was correlated with larger total normal brain volume and hippocampal volume measured eight years later.25 The hippocampus is critically important for memory and orientation.
4. WHAT ABOUT IRON SUPPLEMENTATION DURING PREGNANCY? ISN’T THAT UNIVERSALLY ACCEPTED AS IMPORTANT FOR OFFSPRING INTELLIGENCE?
Iron is essential for a baby’s developing brain and future intelligence, but excess iron promotes oxidative stress and is associated with elevated blood pressure in pregnancy and low birth weight.26 It’s important to understand that some additional nutrients from supplements may be useful during pregnancy and breastfeeding, but others (like vitamin A) can cause birth defects. Levels of DHA and vitamin D and iron status are important, but the amount needed may be different from person to person. Iron is particularly critical because both too much and too little can cause problems for the unborn child.
For a subset of women with adequate iron stores, taking supplemental iron can harm their child. It is wise for pregnant women to learn their iron status via a ferritin blood test, starting early in pregnancy, and then use this information to decide the appropriate level of supplementation (if any) to complement a health-promoting diet because absorption of iron varies so much among people.
During pregnancy, a woman’s iron needs increase, and it is estimated that 18 percent of pregnant women are iron deficient.27 Each woman needs to be evaluated to determine her own iron needs. Adequate iron stores are essential for early infant brain development and are needed to support the large increase in blood volume that occurs during pregnancy. Iron adequacy is also important for the mother-child bonding during infancy.28 Most importantly, iron deficiency in the mother can lead to iron deficiency in her breast-fed infant, which may impair health and future intelligence.29
Iron is more readily absorbed from animal than from plant food sources. For this reason, it is important for pregnant women (and those planning to becoming pregnant), especially those eating a vegan, vegetarian, or flexitarian diet, to maintain adequate iron stores.30 In recent years, researchers have begun to support the idea of making individualized iron supplementation recommendations, rather than providing blanket guidelines for all pregnant women. Research scientists studying this issue have concluded that recommending a fixed dose of iron to avert deficiencies in all women does not result in optimal outcomes. It is safest to use the minimum effective dose. Substantial evidence shows that those women who have plenty of iron stores (documented by blood tests) to support a healthy pregnancy should not take any supplemental iron.
To be consistent with the current science, and to make the best decision to maximize the health of both mother and child, my iron recommendations for pregnant women are more intricate than standard recommendations. The goal of iron supplementation should be to achieve the “sweet spot” of adequacy for the baby’s development without excess.
I recommend that when a pregnant woman’s iron stores are low, with a ferritin level less than 30 ng/mL or hemoglobin less than 11 g/dL she should supplement with a low dose (such as 15–30 milligrams) of iron two to three times daily. When the ferritin level is in the middle range of 31–80 ng/mL and hemoglobin greater than 11 g/dL, supplementation with the standard dose of 9–27 milligrams iron (once daily) is reasonable, depending on the test results within that range. However, with ferritin levels greater than 80 ng/mL and hemoglobin greater than 12.5 g/dL, I do not recommend any iron supplements. Of course, women should discuss these recommendations with their personal physicians.
5. HOW BAD FOR YOU ARE ALCOHOLIC BEVERAGES?
Most people believe what they want to hear, and this is particularly true with how alcohol intake is related to health. We latch onto information which tells us that red wine is good for the heart or that drinking alcohol is okay in moderation. However, scientific evidence on this subject says otherwise. After declaring alcohol a carcinogen in 1988, the International Agency for Research on Cancer went further in 2014 and concluded that there is no safe amount of alcohol when it comes to cancer risk.31 In its “14th Report on Carcinogens,” the National Toxicology Program of the U.S. Department of Health and Human Services lists “alcoholic beverage consumption” as a known human carcinogen.32 The research evidence indicates that the more alcohol a person drinks—particularly the more alcohol a person drinks regularly over time—the higher his or her risk of developing an alcohol-associated cancer. Based on data from 2009, an estimated 3.5 percent of all cancer deaths in the United States each year can be attributed to alcohol intake.33
The risks of drinking a small amount of alcohol, such as a few drinks a week, is certainly minimal, but health authorities should not encourage it because even light drinking is somewhat risky. Most people are under the impression that “social drinking” is harmless. But in a meta-analysis of 222 studies comprising ninety-two thousand light drinkers and sixty thousand nondrinkers with cancer, it was estimated that light drinking could have contributed to five thousand deaths each from oropharyngeal cancer and breast cancer, and twenty-four thousand from esophageal squamous cell carcinoma yearly.34
Alcohol consumption also elevates your risk of developing other cancers. A 2016 review article noted strong evidence that alcohol causes cancer at seven sites: the mouth/pharynx, larynx, esophagus, colon, rectum, breast, and liver.35 Links have also been found between alcohol consumption and leukemia; multiple myeloma; and cancers of the head and neck, stomach, cervix, vulva, vagina, and skin.36 The evidence suggests that the relationship between alcohol consumption and cancer is dose-dependent; that is, light drinking increases cancer risk lightly, and heavy drinking escalates that risk into danger zones.
More than one hundred epidemiological studies have looked at the association between alcohol consumption and the risk of breast cancer in women. These studies have consistently found an increased risk of breast cancer associated with increasing alcohol intake. A meta-analysis of fifty-three of these studies (which included a total of fifty-eight thousand women with breast cancer) showed that women who drank more than 45 grams of alcohol per day (approximately three drinks) had 1.5 times the risk of developing breast cancer as nondrinkers. The risk of breast cancer was higher across all levels of alcohol intake: For every 10 grams of alcohol consumed per day (slightly less than one drink), researchers observed a small (7 percent) increase in the risk of breast cancer. The Million Women Study in the United Kingdom (which included more than twenty-eight thousand women with breast cancer) provided a more recent, and slightly higher, estimate of breast cancer risk at low to moderate levels of alcohol consumption: Every 10 grams of alcohol consumed per day was associated with a 12 percent increase in the risk of breast cancer.37 If you want to live as long as possible, the safest choice is to not drink alcohol at all.
Scientists think that acetaldehyde, a compound formed during the digestion of alcohol, may be responsible for the development of these types of cancers. In addition, alcoholic beverages also contain other carcinogenic substances, such as arsenic, benzene, cadmium, formaldehyde, lead, ethyl carbamate, acrylamide, and aflatoxins.38
Some people say that red wine is good for the heart. The link between alcohol and a reduced risk for coronary heart disease is thought to primarily be due to the fact that alcohol interferes with blood clotting. But this effect is valuable only in a person who consumes a dangerous, heart-disease–promoting diet, which increases the propensity of clot formation to abnormal levels. For someone who eats a healthful diet rich in unrefined plant foods, a high level of protection against heart disease will already exist, and then one would not want to abnormally thin the blood with alcohol because it could cause bleeding, increasing the risk of hemorrhagic stroke.39
An added risk of light drinking is that it can lead to occasional binge drinking or heavy drinking—consuming three or more drinks a day—which is dangerous and associated with cardiomyopathy, hypertension, and potentially life-threatening arrhythmias.40 Younger people who have higher rates of excessive or binge drinking more frequently suffer the adverse consequences of acute intoxication (accidents, violence, and social problems). In fact, among males 15–59 years of age in the United States, alcohol abuse is the leading risk factor for premature death.41
Red wine contains a widely studied beneficial compound from grape skins called resveratrol. This compound has been shown to have several anti-inflammatory and antioxidant effects that may contribute to cardiovascular protection.42 However, at this point, we don’t know whether resveratrol in red wine contributes additional protection beyond the blood-thinning effects of alcohol, and it is unlikely that the resveratrol benefit would outweigh the carcinogenic risk of the alcohol.
Regardless of those possible benefits, it doesn’t make sense to consume a carcinogenic substance just to get resveratrol, because resveratrol can also be found in grapes, raisins, blueberries, cranberries, peanuts, and other plant foods.
6. HOW DO YOU GET YOUR KIDS TO EAT HEALTHFULLY, ONCE THEY HAVE BECOME PICKY EATERS AND WON’T EAT FRUITS AND VEGETABLES AND ONLY WANT JUNK FOOD?
There are two important approaches to the secret of getting children to eat healthfully. The first one is relatively simple: Only keep healthy food in the house. Children’s environments should not expose them to dangerous choices, such as drug use, alcohol, cigarettes, and junk food, and they should understand the reasons why. The second approach is to model the behavior and eating you want your children to follow. Children will frequently copy their parents’ behavior, especially when that behavior makes logical sense and can be explained to them.
Once children have been exposed to highly sweetened, artificial foods, it becomes more difficult to change their behavior because they frequently no longer desire healthy fruits and vegetables. Family meetings can be important—to discuss the problem of unhealthy food consumption and changes that the family agrees are important. In a family meeting, every person has input and can make suggestions. Children can help motivate parents to eat better, and parents can help motivate children to eat better.
One great way to start this conversation with your children is to enlist their help in your efforts to eat better. Explain why you are no longer eating sweets and white flour and processed foods, and how they can help you stick to a healthy diet. Kids love their parents and want them to live a long life. Focusing on you gets the focus off the children so they don’t feel criticized for their eating choices. They will also want to learn this information. When they learn how much food can affect life span and health, they will easily grasp why it is important not to be tempted with unhealthy foods around the house. Then, as a consequence, they will understand that family members can all help and support each other in retraining the taste buds, learning to cook healthier, and removing unhealthful temptations from the home.
My mission is to help people recognize that learning about optimal nutrition for a better life is essential, basic knowledge—like reading and writing. It should be a part of our education from early in life.
In today’s unhealthy world with fast food and junk food all over the place, we need regularly scheduled family meetings to plan the week’s shopping and menus, enlist everybody in helping out, and discuss and share why it is so important for everyone to eat healthfully. And in family meetings, you can “show them the evidence.” This doesn’t have to be all or nothing, especially at the beginning. By working as a family unit, and properly supporting each other, you all can improve your health habits. Use this as an opportunity to bring your family together with a common goal. Your children can understand the concept of Frankenfoods being designed by the fake food industry to make people like them better than real food made by nature.
They can also understand that it takes time to develop a liking for natural foods, but the more they eat them, the more they will like them. The only way to remove food addiction to junk food is to abstain from eating junk food. Fortunately, your family can have fun together trying the great-tasting, healthful recipes and desserts in this book, and in my cookbooks; making these tasty and healthy alternatives to what the family is eating now is a great family project. Achieving better health, fitness, and intellectual accomplishment via excellent nutrition is exciting, and having this as a family goal is a form of love. I have occasionally asked my children, “What would you do if you were the father and you loved your child as much as I love you?” They get it.
7. IF A PERSON ALREADY IS SUFFERING FROM CHRONIC DIETARY-INDUCED ILLNESS, SUCH AS DEPRESSION, AGITATION, POOR SLEEP, FATIGUE, OBESITY, DIABETES, OR HIGH BLOOD PRESSURE, WHAT CAN HE OR SHE DO TO GET WELL WITHOUT DRUGS?
The most rewarding part of my career as a physician has been enabling the transformation of people’s lives and watching them recover their health. My experience and the experience of many other physicians specializing in lifestyle medicine is that nutritional excellence is far more powerful than drugs. This story is not merely about prevention; it is about the fact that targeted nutrition has amazing therapeutic potential to revolutionize health care, to help people, and to save our economy from the staggering costs of caring for such a sickly society. It not only enables people to normalize their weight, blood pressure, and cholesterol and reverse diabetes, but also enables complete recoveries from asthma, depression, and autoimmune diseases such as psoriasis, lupus, and rheumatoid arthritis. People suffering from severe chronic ailments can return to normal, healthy lives. I have a unique perspective among primary care physicians because I have used nutritional excellence therapeutically for more than twenty-five years and have observed the miraculous healing power of the well-nourished body, which in most cases can heal itself.
In 2016, I published a study in the American Journal of Lifestyle Medicine documenting an average drop in systolic blood pressure of 26 mm/Hg in 443 people following a Nutritarian diet.43 I included numerous cases of advanced obstructive coronary artery disease that resolved. I am not the only physician who has observed, and published studies regarding dramatic reversal of even advanced heart disease as a result of excellent nutrition. This is already well-established in the scientific literature. In 2012, I published a study in the Open Journal of Preventive Medicine which demonstrated that 90 percent of patients with type 2 diabetes following a high-nutrient, low-glycemic diet were able to stop taking all of their medications for diabetes; their mean HbA1c after one year was 5.8 percent, which is within the normal, nondiabetic range.44
Nutrition is powerful medicine, and most conventional physicians in the United States today underuse it. I remember that first pharmacology lecture in medical school when the professor told us to never forget that all drugs are toxic and should be used only as a last resort. The problem was, we never learned about other options, such as changing a person’s diet sufficiently. I am proud to say that my life’s work is a testament to the effectiveness of nutritional and lifestyle medicine for most chronic diseases. Tens of thousands of people have recovered from chronic illnesses for which conventional medicine has no cure. There will always be some advanced and severe illnesses that are beyond the help of nutritional and lifestyle modifications, but even in such cases, excellent nutrition can reduce the need for medications and thereby medication side effects.
8. HOW MUCH SALT IS ACCEPTABLE IN ONE’S DIET?
Salt is sodium chloride, and sodium is an important mineral that is essential for proper functioning of the human body. However, the SAD contains dangerously high amounts of sodium, almost 80 percent of which comes from processed foods and foods we get at restaurants and fast food joints. For millions of years the human diet didn’t contain any added salt—only the sodium present in natural foods, which usually adds up to less than 1,000 milligrams of sodium per day. The dietary intake of sodium in the United States today is about 3,500 milligrams per day.
Numerous observational studies and randomized controlled trials document the fact that high sodium intake increases blood pressure.45 The evidence implicating excess sodium intake as a major cause of high blood pressure levels has been called “overwhelming.”46 A recently published large long-term lifestyle intervention study showed that a 25–35 percent reduction in dietary sodium over ten to fifteen years results in a 25–30 percent lower risk of cardiovascular disease outcomes.47 It is estimated that a 50 percent decrease in sodium consumption in the United States could prevent at least 150,000 deaths annually.48 According to a meta-analysis of sixty-one studies, the lower an individual’s blood pressure, at least down to 1 15/75 mm Hg, the lower the risk of stroke or heart attack.49 There was no “threshold” below which the risk did not decrease; of course, that is assuming the lower blood pressure is “earned” through healthy eating, exercise, and salt avoidance and is not just medicated downward.
But the effects of salt intake are not all about blood pressure. The interesting finding from many different studies is that high salt intake is linked to increases in all-cause mortality and that its death-hastening effects occur in those people who are not “salt sensitive” to its blood pressure effects.50 In other words, significant amounts of sodium in the diet predicts overall mortality and risk of coronary heart disease, independent of other cardiovascular risk factors, including blood pressure.51
The most compelling evidence is from long-term trials following individuals over decades. A 2016 study followed the lives and deaths of participants over many years, clarifying and giving substance to the undeniable reality that higher salt intake kills. The study included multiple twenty-four-hour urine samples collected from adults between the ages of 30 and 54 who were then followed for an average of twenty-four years. The results showed a direct linear association between average sodium intake and total mortality (death from all causes). The more sodium consumed, the higher the death rate. And just the opposite was found as well—fewer deaths occurred in people with the lowest intake of sodium.52
Natural foods such as fruits and vegetables all contain sodium. The amount of sodium humans and other animals need is contained in the natural foods we eat. If we just ate natural foods without added salt, we would most likely consume about 500–750 milligrams of sodium a day. Real food supplies the perfect amount of minerals people need to maximize their health. The human body was designed to function on food, and early humans did not consume extra salt. Our Stone Age ancestors consumed a diet consisting of mainly fruits, vegetables, nuts, seeds, fish, insects, and wild game and obtained all the sodium they required, as well as the other minerals. This eat-what-you-can-find diet continued for approximately one hundred thousand generations, during which time salt was not added to food.
Today, people in most areas of the world consume ten times as much sodium as is found in a natural “unsalted” diet. Our species developed agriculture around three hundred generations ago, and the Industrial Age again changed our diet over a span of five to ten generations until now. As we have already seen, the “Processed Food Era” started after World War I, two to three generations ago. This means we live with “thrifty genes” that were selected over a long period during which our ancestors had to deal with low salt intake, periods of starvation, and caloric inadequacy.53 These genes were selected to conserve sodium in the body, not get rid of it.
Since almost all Americans and modern industrialized societies consume so much salt, we have to look at isolated or primitive populations to really see the long-term result of low salt intake. It is still possible to find pockets of people living on mostly natural food diets, without added salt. Tribes in New Guinea, the Amazon Basin, the highlands of Malaysia, and rural Uganda all eat very little salt. Hypertension is unheard of in these regions, and blood pressure does not rise steadily with age as it does in the United States and other countries with high salt intakes. The most elderly members of these populations have blood pressure readings like those we see in children. When salt is introduced into these salt-free cultures, however, blood pressure climbs.54 In all human populations studied by medical anthropologists, it is known that people in all salt-free cultures (that is, those cultures not using salt as a condiment) experience almost no increase in blood pressure even into old age. By contrast, blood pressure rises significantly over many years in all human populations in which salt is added to food in significant quantities, resulting in most people sooner or later ending up with high blood pressure.
High-sodium diets ultimately lead to high blood pressure, which causes an estimated two-thirds of strokes and almost half of all heart attacks. According to the NIH, consuming less sodium is one of the single most important ways to prevent cardiovascular disease.55 Certainly, not smoking, maintaining a healthy body weight, eating a nutrient-dense diet rich in vegetables and fruits, and limiting the intake of trans and saturated fats are critical; but too much sodium in our diets ranks right up there as a primary killer in our modern toxic food environment, and most people overlook this until it is too late.
Salt is also the strongest factor related to stomach cancer. Sodium intake data from twenty-four countries were significantly correlated to stomach cancer mortality rates. Additional studies have found positive correlations between salt consumption and the incidence of gastric cancer.56 A high salt diet also increases growth of the ulcer-promoting bacteria H. pylori in the stomach, which is also a risk factor for gastric cancer.57
Reducing dietary salt is not only important for people who already have elevated blood pressure, but limiting added salt is essential for all of us to remain in good health. Since natural foods supply us with 600–800 milligrams of sodium a day, it is wise to limit any additional sodium, over and above what is in natural food, to just a few hundred milligrams. Even the CDC reports that salt kills far more Americans than tobacco (or anything else) and that almost 90 percent of all Americans, including everyone over the age of 40, should cut their salt intake by nearly two-thirds, to 1,500 milligrams per day.58 Medications cannot do nearly what diet improvement and salt reduction can do, and more and more physicians and scientists recognize this. Just cutting out excess salt from the diet can return blood pressure to normal, which can reduce the risk of heart disease by at least 70 percent.
It is also important to note that expensive and exotic sea salts are still just salt. All salt originates from the sea—and sea salts are still more than 98 percent sodium chloride and therefore contribute to your diet the same amount of sodium per teaspoon as regular salt. Sea salts may contain small amounts of trace minerals, but the amounts are insignificant compared with those in natural plant foods, and the excess sodium doesn’t magically become less harmful.
Salt also deadens taste buds, meaning that when you avoid highly salted and processed foods, you will regain your ability to detect and enjoy the subtle flavors in natural foods and experience heightened pleasure from natural, unsalted foods. Your taste buds will get stronger when you stay away from highly salted foods. Of course, this takes time to occur.
9. IF I’VE EATEN ALL THE WRONG FOODS MOST OF MY LIFE, IS IT TOO LATE FOR ME TO CHANGE NOW? HOW MUCH IS MY GOOSE COOKED?
Your goose is never fully cooked. Heart attacks and strokes are the leading cause of death in the modern world, and cardiovascular disease kills more individuals than all cancers added together. But, you can make a decision right now to never have a heart attack or stroke and make the necessary changes in your eating habits to almost guarantee this never happens.
For instance, you can always reduce your risk of developing lung cancer by quitting smoking at any point before cancer begins. Likewise, you can reduce your risk of a variety of cancers with nutritional excellence, even if it is too late to maximally protect yourself against cancer at an advanced age. Even people who have cancer have been shown to live longer eating the healthful, anticancer dietary suggestions discussed in this book. Many studies have already been referenced here on G-BOMBS demonstrating this fact.
Nutritional excellence can do what drugs can’t do; drugs lower risk maybe 10–15 percent, while superior nutrition has the potential to lower risk 100 times that. In my twenty-five years of medical practice offering nutritional advice, I have not heard of anyone who has followed my program strictly for years who has ever had a heart attack or died from heart disease. I have cared for thousands of individuals with heart disease, many of them with very advanced heart disease, and I have seen miraculous healing happen, including improvement of ejection fraction and resolution of atrial fibrillation. It has been exciting and rewarding to see people earn back excellent health and celebrate their health recoveries.
I don’t know about you, but it’s not enough for me to lower my risk of experiencing sudden cardiac death by a mere 30–40 percent. I want that risk to be zero, if possible. With the dietary advice in this book, and my other books on these subjects, I present the medical evidence which shows that you can achieve dramatic reduction in weight, cholesterol levels, triglyceride levels, and cardiac risk that simply cannot be accomplished through medication. In other words, nutrition trumps standard pharmacology.
Cancer is a bit different because the years that you eat an unhealthful diet, including fast food and commercial meats, take their toll on the body and can cumulatively damage DNA. After sixty years of very poor eating habits, the change to an excellent diet cannot reduce risk by 99 percent, like it can with heart disease. My guess is that it will reduce risk of cancer by 50–75 percent. I base that estimate on studies that show reductions in cancer deaths after nutritional interventions. For example, one study followed for ten years women already diagnosed with breast cancer and found the death rate from breast cancer was 71 percent lower over those ten years for women who ate higher amounts of lignans (found particularly in flaxseed and chia seeds).59 But, we are not talking just about flaxseeds here. When we put together a synergistic portfolio of foods, fresh herbs, and spices that have anticancer benefits and avoid unhealthy foods, we can restore immune system functioning and enhance the ability of the body to fight the initiation, development, and spread of cancer. It may not have the extreme benefits we see for heart disease, but the benefits are still remarkable.
Of course, the anticancer benefits are more profound the earlier in life one adopts a healthy diet, and the more advanced the cancer, the less likelihood we will observe such positive effects. Still, one never knows what benefits will accrue and what the body can accomplish when fed right. It is never too late to try to protect your health.
You can slow the aging process now, maintain a healthy weight, lower your blood pressure, prevent or reverse diabetes, protect yourself against a stroke and the so-common mental decline seen with aging, and overall live a better-quality, healthier, and longer life from making these improvements in your eating habits.
Too many people suffer and die needlessly, and I’m sure millions of people of all ages would adopt a healthier diet style if they learned about the profound benefits they would receive. I hope you join me on this quest to inform and motivate others to take better care of their health and to protect all of our children, enabling them to reach their full potentials for health and happiness. Let’s bond together in our mutual desire to spread kindness and goodwill and to value every person’s human potential for health and happiness. I wish you and your family a rewarding and pleasurable experience in your quest for excellent health.