Liver Disease

Liver Disease, Hepatitis, and Liver Failure

Standard Practice:

The function of the liver is to detoxify and excrete a variety of substances consumed in the diet and waste products of our body’s metabolism. The liver also produces proteins necessary for the clotting of the blood and a protein called albumin that serves to keep fluid in the blood vessels. A failing liver results in the accumulation of breakdown products of metabolism, edema, and finally coma and death.

There are many causes of liver disease; the most common are infections with viruses and alcohol. Continuous injury with either of these agents results in permanent loss of liver tissue. One of the changes in the liver that occurs during injury is the accumulation of fat within the liver cells. This condition known as fatty infiltration commonly occurs in alcoholism, diabetes and obesity, and is in part due to a high-fat diet. With severe liver damage, liver cells are replaced by extensive scar tissue–the condition is known as cirrhosis of the liver.

Current Treatment:

Liver damage is first treated, whenever possible, by stopping drinking alcohol, especially when alcohol is the primary cause. The recommended diet for anyone suffering from liver disease is high in carbohydrate, low in protein, low in fat diet, and low in sodium.

Drugs are used to help control some of the complications of the ailing liver. Diuretics are often given to help relieve the edema and partially compensate for the patient’s poor compliance to a low-salt diet. Drugs, such as lactulose, decrease the absorption of protein from the intestine, and thereby further reduce the protein load to be handled by the liver. Steroids are sometimes used to decrease inflammation.

Drawbacks:

Medications deal primarily with symptoms and fail to prolong the patient’s life in most cases. Survival is not improved with the use of steroids and other antiinflammatory drugs. Unfortunately, strict adherence to a healthy diet is rarely encouraged by the physician until liver disease is far advanced. By this time there is too little liver left to make much of a difference.

The McDougall Program:

The McDougall Program: (Dietary and Lifestyle Implications):

The treatment of liver disease is primarily with a low-fat, low-protein, high-complex carbohydrate starch-based diet started early–long before liver failure is advanced. A healthier diet will relieve much of the burden on the diseased liver, since a large part of the liver’s function is to metabolize excess proteins, cholesterol, fats and additives from the diet. The low-fat quality of the McDougall diet helps relieve the fatty infiltration stage of the liver disease; there is a gradual disappearance of fat from the liver in four to eight weeks along with the improvement in diabetes and weight loss following the introduction of the diet. Progress can often be measured by reduction in the liver enzymes, SGOT and SGPT, seen by blood tests.

Current Therapy:

A person with liver failure must be as kind to his or her body as possible primarily by avoiding toxic substances and making food choices that are not excessive in fats and proteins. Low-sodium may be important in advanced liver failure to reduce fluid accumulation. Because all foods are naturally plentiful in protein it is often necessary to make-up as much as half the diet from “empty calories” foods in the form of simple sugars such as white sugar or corn syrup in order to dilute the protein content of the starches, vegetables and fruits to a tolerable level.

Cancer Prevention PCRM

NEWS RELEASE June 9, 2014

Researchers Unveil Six Dietary Guidelines for Cancer Prevention

WASHINGTON—Six dietary guidelines – more aggressive than previous cancer prevention advice will be unveiled in the June 30 issue of the Journal of the American College of Nutrition.

The cancer prevention guidelines, emphasizing a diet rich in plant-based foods, such as soy beans and cruciferous, allium, and carotenoid vegetables, are based on the principle that diet changes are justified, even when evidence on certain issues are up for debate. The recommendations urge the same kind of precautionary approach health experts took against tobacco decades earlier, before smoking bans were enforced, and warn about the association between cancer and alcohol, red and processed meats, dairy products, and carcinogens in well-cooked meats, including beef, poultry, and fish.

“The key recommendation is to build meals around fruits, vegetables, and legumes,” says study author Neal Barnard, M.D., president of the nonprofit Physicians Committee and an adjunct associate professor of medicine at the George Washington University School of Medicine and Health Sciences. “Plant-based foods provide an antioxidant boost and help promote a healthy weight, reducing the risk for all types of cancer in the long run.”

The six dietary recommendations to reduce risk of several types of cancer are:
1. Limit or avoid dairy products to reduce the risk of prostate cancer.
Findings: Consuming thirty-five grams of dairy protein each day, the equivalent of one large cup of cottage cheese, increases risk of prostate cancer by 32 percent. Drinking two glasses of milk each day increases risk of prostate cancer by 60 percent.

Note: Calcium supplements appear to have the same effect as milk intake. Men who supplement with more than 400 milligrams of calcium per day increase risk for fatal prostate cancer by 51 percent.

2. Limit or avoid alcohol to reduce the risk of cancers of the mouth, pharynx, larynx, esophagus, colon, rectum, and breast.
Findings: One drink per week increases risk of mouth, pharynx, and larynx cancers by 24 percent. Two to three drinks per day increase risk of colorectal cancer by 21 percent.

Note: The alcohol itself (rather than additives) appears to be the cause of cancer, and all types of alcoholic beverages (wine, beer, and spirits) are problematic.

3. Avoid red and processed meats to reduce the risk of cancers of the colon and rectum.
Findings: Each 50-gram daily serving of processed meat, equivalent to two slices of bacon or one sausage link, increases risk of colorectal cancer by 21 percent. Each 120-gram daily serving of red meat, equivalent to a small steak, increases risk of colorectal cancer by 28 percent.

Note: The heme iron, nitrites, heterocyclic amines, and overabundance of essential amino acids in red and processed meats are all believed to contribute to cancerous cell growth in the body.

4. Avoid grilled, fried, and broiled meats to reduce the risk of cancers of the colon, rectum, breast, prostate, kidney, and pancreas.
Findings: Four types of heterocyclic amines (HCAs) are associated with cancer of the colon and rectum. HCAs form from creatine and amino acids in cooked skeletal muscle, increasing with higher cooking times and higher temperatures. When ingested, HCAs can disrupt DNA synthesis.

Note: In addition to the cancers listed above, HCAs are also associated, to a weaker extent, with cancers of the breast, prostate, kidney, and pancreas.

5. Consume soy products to reduce risk of breast cancer and to reduce the risk of recurrence and mortality for women previously treated for breast cancer
Findings: Evidence from Asian and Western countries shows that soy products are associated with reduced cancer risk. Chinese women who consume more than 11.3 grams of soy protein, equivalent to half a cup of cooked soybeans, each day during adolescence have a 43 percent reduced risk of premenopausal breast cancer, compared with women who consume 1.7 grams.

Research in Shanghai shows that women with breast cancer who consume 11 grams of soy protein each day can reduce mortality and risk of recurrence by about 30 percent. U.S. populations show similar findings: the higher the isoflavone intake from soy products, the less risk of mortality and recurrence in women with breast cancer.

Note: When choosing soy products, opt for natural forms, such as edamame, tempeh, or organic tofu, as opposed to soy protein concentrates and isolates, common in powders and pills.

6. Emphasize fruits and vegetables to reduce risk of several common forms of cancer.
Findings: Fruits and vegetables, especially leafy greens, help reduce overall cancer risk. A high intake of cruciferous vegetables, such as broccoli, kale, and cabbage, is associated with an 18 percent reduced risk of colorectal cancer and reduced risk of lung and stomach cancers.

Women who consume the most carotenoid-rich vegetables, such as carrots and sweet potatoes, lower their risk of breast cancer by 19 percent. Overall, women who consume the highest quantities of any kind of fruit or vegetable reduce breast cancer risk by 11 percent. A high intake of tomato products has been shown to reduce risk of gastric cancer by 27 percent. Garlic and other allium vegetables, such as onions, significantly reduce risk for gastric cancer, while a Western diet (high amounts of meat and fat with minimal amounts of fruits and vegetables) doubles the risk.

Note: Some components in soybeans, green tea, turmeric, grapes, tomatoes, and other plant foods have the ability to regulate apoptosis (a natural process for destroying unhealthy cells), an important pathway for cancer prevention.

Dietary Guidelines for Cancer Prevention (PDF)

“There’s considerable benefit–and no harm—in loading up with plant-based foods,” notes study author Susan Levin, M.S., R.D., C.S.S.D., director of nutrition education for the Physicians Committee. “Large bodies of research show fruits, vegetables, and legumes offer a variety of protective properties, so why not move these foods to the center of our plates?”

When Friends Ask: Where Do You Get Your Protein?

April 2007

Vol. 6, No. 4

When Friends Ask:
Where Do You Get Your Protein?

If you don’t know where you get your protein while following a plant-food-based diet, you’re in good company. The Nutrition Committee of the American Heart Association, scientists from the Human Nutrition Research Center and Medical School at Tufts University, and registered dietitians, research nutritionists and physicians of Northwestern University, and the Harvard School of Public Health are just a few examples of “experts” you look to for advice who have the protein story wrong.^1-4 Consequences of their shortfall are as grave as a lifetime of sickness and obesity, and premature death, for innocent people. These professionals must be held accountable.

Wrong Statements from the Experts ^1-4

Although plant proteins form a large part of the human diet,most are deficient in 1 or more essential amino acids and aretherefore regarded as incomplete proteins. (American Heart Association)

Plant protein sources, although good for certain essential amino acids, do not always offer all nine essential amino acids in a single given food. For example, legumes lack methionine, while grains lack lysine. (Tufts Human Nutrition Research Center)

Single plant protein foods usually are lower in protein quality than most animal proteins because they lack significant amounts of various essential amino acids. (Tufts University Medical School)

Other protein sources lack one or more amino acids that the body can’t make from scratch or create by modifying another amino acid. Called incomplete proteins, these usually come from fruits, vegetables, grains, and nuts. (Harvard School of Public Health)

Plant sources of protein (grains, legumes, nuts, and seeds) generally do not contain sufficient amounts of one or more of the essential amino acids. Thus protein synthesis can occur only to the extent that the limiting amino acids are available. (Feinberg School of Medicine, Northwestern University)

Ignorance Sickens and Kills People

Don’t think it matters little if our public policy makers and educators remain ignorant about our nutritional needs. Misinformation leads to disastrous outcomes. People have serious health problems like heart disease, type-2 diabetes, multiple sclerosis, and inflammatory arthritis that can be easily resolved by a diet based solely on plant foods. However, advice to make this dietary change may be withheld from you or a family member because of the erroneous fear that such a diet will result in a greater catastrophe, like a nutritional collapse from protein deficiency.

Consider this scenario: Your loving husband of 35 years has a massive heart attack. He recovers and both of you pledge you will do anything—even eat cardboard—in order to avoid a repeat experience. On your first follow-up visit you tell your doctor that your family is going to follow a low-fat, vegan diet (all plant foods) from here on out. Your doctor says, “You can’t do that; you will become protein deficient—plant foods are missing essential amino acids—you must eat meat and other high quality animal foods.” Even though you vigorously explain meat, dairy, and eggs are the reasons you almost lost your husband, your doctor insists that you would be foolish to embark on such a course and defends that position with the writings of the Nutrition Committee of the American Heart Association.

The Nutrition Committee of the American Heart Association Has It Wrong

In an October 2001 research paper published in the Heart Association’s journal, Circulation, the Healthcare Professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism wrote, “Although plant proteins form a large part of the human diet,most are deficient in 1 or more essential amino acids and aretherefore regarded as incomplete proteins.”¹ My letter to the editor correcting this often quoted, but incorrect information, about the adequacy of amino acids found in plants was published in the June 2002 issue of Circulation.⁵ Another letter from me in the November 2002 issue of Circulation demanded a correction.⁶ But, the head of the nutrition committee, Barbara Howard, PhD, would not admit she was wrong and used research from the world’s leading expert on protein, Professor Joe Millward, to defend her position.⁶

Joe Millward, PhD, Professor of Human Nutrition, University of Surrey (England), reviewed the published letters of disagreement between the American Heart Association (AHA) and myself, and wrote the following to me on July 10, 2003, “I thought I had made my position quite clear in my published papers. In an article I wrote for Encyclopedia of Nutrition (Millward DJ. 1998 Protein requirements. Encyclopedia of Nutrition. Academic Press pp 1661-1668) I said ‘Contrary to general opinion, the distinction between dietary protein sources in terms of the nutritional superiority of animal over plant proteins is much more difficult to demonstrate and less relevant in human nutrition.’ This is quite distinct from the AHA position which in my view is wrong.”⁷

I informed the American Heart Association about Dr. Millward’s position, but so far they have chosen to remain silent—and annually, 1.25 million people in the USA alone suffer with heart attacks—an often fatal condition entirely preventable by following a low-fat diet based solely on plant foods—all of which contain all of the essential amino acids in ideal amounts for humans.

Plants–the Original Sources of Protein and Amino Acids

Proteins are made from chains of 20 different amino acids that connect together in varying sequences—similar to how all the words in a dictionary are made from the same 26 letters. Plants (and microorganisms) can synthesize all of the individual amino acids that are used to build proteins, but animals cannot. There are 8 amino acids that people cannot make and thus, these must be obtained from our diets—they are referred to as “essential.”

After we eat our foods, stomach acids and intestinal enzymes digest the proteins into individual amino acids. These components are then absorbed through the intestinal walls into the bloodstream. After entering the body’s cells, these amino acids are reassembled into proteins. Proteins function as structural materials which build the scaffoldings that maintain cell shapes, enzymes which catalyze biochemical reactions, and hormones which signal messages between cells—to name only a few of their vital roles.

Since plants are made up of structurally sound cells with enzymes and hormones, they are by nature rich sources of proteins. In fact, so rich are plants that they can meet the protein needs of the earth’s largest animals: elephants, hippopotamuses, giraffes, and cows. You would be correct to deduce that the protein needs of relatively small humans can easily be met by plants.

People Require Very Little Protein

The World Health Organization (WHO) recommends that men and women obtain 5% of their calories as protein. This would mean 38 grams of protein for a man burning 3000 calories a day and 29 grams for a woman using 2300 calories a day. This quantity of protein is impossible to avoid when daily calorie needs are met by unrefined starches and vegetables. For example, rice alone would provide 71 grams of highly useable protein and white potatoes would provide 64 grams of protein.⁸

Our greatest time of growth—thus, the time of our greatest need for protein—is during our first 2 years of life—we double in size. At this vigorous developmental stage our ideal food is human milk, which is 5% protein. Compare this need to food choices that should be made as adults—when we are not growing. Rice is 8% protein, corn 11%, oatmeal 15%, and beans 27%.⁸ Thus protein deficiency is impossible when calorie needs are met by eating unprocessed starches and vegetables.

The healthy active lives of hundreds of millions of people laboring in Asia, Africa, and Central and South America on diets with less than half the amount of protein eaten by Americans and Europeans prove that the popular understanding of our protein needs is seriously flawed.

WHO Recommendations: (With a wide safety margin)

Men:	5%
Women:	5%
Pregnant:	6%

Percent of Calories of Proteins¹⁶ (Selected Foods)
Food	% Protein

Grains & Flours:
Cornmeal	9
Brown Rice	9
Oatmeal	15
White Rice	7
Whole Wheat Flour	16
White Flour	11

Starchy Vegetables
Black Beans	27
Cassava	10
Corn	11
Kidney Beans	27
Peas	28
Potato	8
Sweet Potato	7

Green Vegetables
Asparagus	42
Broccoli	42
Carrots	10
Lettuce	40
Onions	32
Mushrooms	12
Spinach	51

Animal Foods
Beef	53
Chicken	46
Pork	29
Salmon	43
Whole Milk	21
Skim Milk	39
Human Milk	5
Cheddar Cheese	25
Cottage Cheese	68
Egg	32

Faulty Observations Lead to High Protein Recommendations

People commonly believe: the more protein consumed the better. This faulty thinking dates back to the late 1800s, and was established without any real scientific research. An assumption was made that people who could afford to do so would instinctively select a diet containing the right amount of protein. After observing the diets of laborers, soldiers, and workers in Western Europe and the USA, recommendations of 100 and 189 grams of protein a day were established.⁹ People’s innate ability to select a proper diet is disproved by the present day popularity of burger joints, donut shops, and pizza parlors.

Further confusion about our protein needs came from studies of the nutritional needs of animals. For example, Mendel and Osborne in 1913 reported rats grew better on animal, than on vegetable, sources of protein. A direct consequence of their studies resulted in meat, eggs, and dairy foods being classified as superior, or “Class A” protein sources and vegetable proteins designated as inferior, or “Class B” proteins.⁹ Seems no one considered that rats are not people. One obvious difference in their nutritional needs is rat milk is 11 times more concentrated in protein than is human breast milk. The extra protein supports this animal’s rapid growth to adult size in 5 months; while humans take 17 years to fully mature.

The recent popularity of high protein diets has further popularized the fallacy that “more protein is good for you.” True, high protein diets, like Atkins, will make you sick enough to lose your appetite and temporarily lose weight, but this fact should not be extrapolated to mean high protein is healthy—in fact, the opposite is true.

The Truth Has Been Known for More than a Century

In 1903, the head of Yale’s department of biochemistry, Professor Russell Henry Chittenden, reported profound health benefits gained by cutting popular recommendations for protein held at his time by half to two-thirds (from 150 grams to 50 grams daily). His research included detailed dietary histories and laboratory studies of his subjects.⁹

In the 1940s, William Rose performed experiments on people which found daily minimum protein needs to be about 20 grams a day. Further research on men found single plant foods consumed in an amount sufficient to meet daily needs easily met these human requirements for all 8 essential amino acids.⁹ (A more detailed discussion of the history of protein recommendations is found in my December 2003 newsletter article: A Brief History of Protein: Passion, Social Bigotry, and Enlightenment.)

The results of Dr. Rose’s studies are summarized in the following chart, under “minimum requirements”. From the chart, it is clear that vegetable foods contain more than enough of all the amino acids essential for humans.¹⁰

(grams per day) Amino Acids	*Rose’s Minimum Requirement*	*Rose’s Recommend Requirement*	*Corn*	Brown rice	Oatmeal flakes	Wheat flour	White beans	Potatoes	Sweet potatoes
Tryptophan	.25	.50	.66	.71	1.4	1.4	1.8	.8	.8
Phenylalaline	.28	.56	6.13	3.1	5.8	5.9	10.9	3.6	2.5
Leucine	1.10	2.20	12.0	5.5	8.1	8.0	17.0	4.1	2.6
Isoleucine	.7	1.4	4.1	3.0	5.6	5.2	11.3	3.6	2.2
Lysine	.8	1.6	4.1	2.5	4.0	3.2	14.7	4.4	2.1
Vailine	.8	1.6	6.8	4.5	6.4	5.5	12.1	4.4	3.4
Methionine	.11	.22	2.1	1.1	1.6	1.8	2.0	1.0	.8
Threonine	.5	1.0	4.5	2.5	3.6	3.5	8.5	3.4	2.1
Total Protein	20	37 (WHO)	109	64	108	120	198	82	45

(grams per day) Amino Acids	*Taro*	*Asparagus*	*Broccoli*	*Tomatoes*	*Pumpkin*	*Beef Club Steak*	*Egg*	*Milk*
Tryptophan	1.0	3.9	3.8	1.4	1.5	3.1	3.8	2.3
Phenylalaline	3.0	10.2	12.2	4.3	3.0	11.2	13.9	7.7
Leucine	5.2	14.6	16.5	6.1	6.0	22.4	21.	15.9
Isoleucine	3.0	11.9	12.8	4.4	4.3	14.3	15.7	10.3
Lysine	3.4	15.5	14.8	6.3	5.5	23.9	15.3	12.5
Vailine	3.5	16.0	17.3	4.2	4.3	15.1	17.7	11.7
Methionine	.6	5.0	5.1	1.1	1.0	6.8	7.4	3.9
Threonine	2.7	9.9	12.5	4.9	2.7	12.1	12.	7.4
Total Protein	58	330	338	150	115	276	238	160

You Don’t Need Beans or to “Combine” Your Foods

Many investigators have measured the capacity of plant foods to satisfy protein needs. Their findings show that children and adults thrive on diets based on single or combined starches, and grow healthy and strong.¹⁰Furthermore, no improvement has been found from mixing plant foods or supplementing them with amino acid mixtures to make the combined amino acid pattern look more like that of flesh, milk, or eggs. In fact, supplementing a food with an amino acid in order to conform to a contrived reference standard can create amino acid imbalances. For example, young children fed diets based on wheat or corn and supplemented with the amino acids tryptophan and methionine in order to conform to the standard requirements set by the Food and Agriculture Organization of the United Nations (FAO) developed negative responses in terms of nitrogen balance (the body’s utilization of protein).¹⁰

People who are worried about getting sufficient protein will sometimes ask me if they can still follow the McDougall Diet if they do not like beans. From the chart above, you will notice that any single starch or vegetable will provide in excess of our needs for total protein and essential amino acids—thus there is no reason to rely on beans or make any efforts to food combine different plant foods to improve on Nature’s own marvelous creations.

Potatoes Alone Suffice

Many populations, for example people in rural Poland and Russia at the turn of the 19^th century, have lived in very good health doing extremely hard work with the white potato serving as their primary source of nutrition. One landmark experiment carried out in 1925 on two healthy adults, a man 25 years old and a woman 28 years old had them live on a diet primarily of white potatoes for 6 months. (A few additional items of little nutritional value except for empty calories—pure fats, a few fruits, coffee, and tea—were added to their diet.)¹¹ The report stated, “They did not tire of the uniform potato diet and there was no craving for change.” Even though they were both physically active (especially the man) they were described as, “…in good health on a diet in which the nitrogen (protein) was practically solely derived from the potato.”

The potato is such a great source of nutrition that it can supply all of the essential protein and amino acids for young children in times of food shortage. Eleven Peruvian children, ages 8 months to 35 months, recovering from malnutrition, were fed diets where all of the protein and 75% of the calories came from potatoes. (Soybean-cottonseed oils and pure simple sugars, neither of which contains protein, vitamins, or minerals, provided some of the extra calories.)¹² Researchers found that this simple potato diet provided all the protein and essential amino acids to meet the needs of growing and small children.

Excess Protein Causes Diseases of Over-nutrition

Unlike fat, protein cannot be stored. When it is consumed in excess of our needs, protein is broken down mostly by the liver, and partly by the kidneys and muscles. Consumption in excess of our needs overworks the liver and kidneys, and can cause accumulation of toxic protein byproducts.

Proteins are made of amino acids, and are, therefore, acidic by nature. Animal proteins are abundant in sulfur-containing amino acids which break down into very powerful sulfuric acid. These kinds of amino acids are abundant in hard cheese, red meat, poultry, seafood, and eggs, and their acids must be neutralized by buffers found in the bones. The bones dissolve to release the buffering materials; eventually resulting in a condition of weakened bones, known as osteoporosis. Released bone materials often settle and coalesce in the kidney system, causing kidney stones. Fruits and vegetables are largely alkaline, preserving bone health and preventing kidney stones.¹³(A more detailed discussion of the health consequences from excess protein is found in my January 2004 newsletter article: Protein Overload.)

Diseases of over-nutrition are directly connected to planet health, too. Recommendations to eat animal foods for protein have resulted in an environmental catastrophe. Livestock produces 18% of the greenhouse gases; these food-animals occupy 26 percent of the ice-free surface of the Earth and 33 percent of the total arable land is used to produce their food. One telling tragedy is they account for the deforestation of 70 percent of Amazon rainforests, which act as the “lungs of the Earth.”¹⁴ (A more detailed discussion of the environmental damage from livestock is found in my December 2006 newsletter article: An Inconvenient Truth: We Are Eating Our Planet To Death.)

Protein Deficiency Is Really Food Deficiency

How many cases of the so-called “protein deficiency state,” kwashiorkor, have you seen? I have never seen a case, even though I have known thousands of people on a plant-food based diet. How about those starving children in Africa? The picture one often sees of stick-thin children with swollen bellies in famine areas of Asia or Africa is actually one of starvation and is more accurately described as “calorie deficiency.”¹⁰ When these children come under medical supervision, they are nourished back to health with their local diets of corn, wheat, rice, and/or beans. Children recovering from starvation grow up to l8 times faster than usual and require a higher protein content to provide for their catch-up in development—and plant foods easily provide this extra amount of protein.¹⁰ Even very-low protein starchy root crops, such as cassava root, are sufficient enough in nutrients, including protein, to keep people healthy.¹⁵

Starving People Die of Fat, Not Protein, Deficiency

In 1981, 10 Irish prisoners from the Republican Army (IRA) went on a hunger strike. Nine out of 10 of these men died between 57 and 73 days (mean of 61.6 days) of starvation after losing about 40% of their body weights (the remaining striker died of complications of a gunshot wound).^16,17 This experience gave doctors a chance to observe first hand the metabolic changes that occur during starvation. Protein stores were generally protected during starvation, with most of the energy to stay alive being derived from the men’s fat stores. It was estimated that the hunger strikers had lost up to 94% of their body-fat levels, but only 19% of their body-protein levels at the time of death.¹⁶ They died when they ran out of fat. Since fat is more critical than protein, people should be asking, “Where do you get your fat (on any diet)?

Since Nature designed her plant foods complete, with abundant amounts of fat, protein, carbohydrates, vitamins and minerals, “Where you get a specific nutrient?” is almost never a relevant question, as long as there is enough to eat. So, why have scientists, dietitians, medical doctors, diet-book authors, and the lay public become fixated on a non-existent problem? Protein is synonymous with eating meat, poultry, fish, dairy, and eggs—the foods traditionally consumed by the wealthier people in a society—thus, protein-eating means higher social status. High-protein foods are also high-profit foods. Therefore, propagating the protein myth is motivated by egos and money—and the usual consequences of pain and suffering follow closely behind these two human frailties.

References:

1) St Jeor S, Howard B, Prewitt E. Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 2001; 104: 1869–1874.

2) Tufts University: http://www.thedoctorwillseeyounow.com/articles/nutrition/protein_2/
http://www.quackwatch.org/03HealthPromotion/vegetarian.html

3) Harvard School of Public Health: http://www.hsph.harvard.edu/nutritionsource/protein.html

4) Northwestern University: http://www.feinberg.northwestern.edu/nutrition/factsheets/protein.html

5) McDougall J. Plant foods have a complete amino acid composition. Circulation. 2002 Jun 25;105(25):e197; author reply e197.

6) McDougall J. Misinformation on plant proteins. Circulation. 2002 Nov 12;106(20):e148; author reply e148.

7) Personal Communication with John McDougall, MD on July 10, 2003.

8) J Pennington. Bowes & Church’s Food Values of Portions Commonly Used. 17^th Ed. Lippincott. Philadelphia- New York. 1998.

9) The December 2003 McDougall Newsletter: A Brief History of Protein: Passion, Social Bigotry, and Enlightenment.

10) McDougall J. The McDougall Plan. New Win Publ. 1983; pages 95-109.

11) Kon S. XXXV. The value of whole potato in human nutrition. Biochemical J. 1928; 22:258-260

12) Lopez de Romana G. Fasting and postprandial plasma free amino acids of infants and children consuming exclusively potato protein. J Nutr. 1981 Oct;111(10):1766-71.

13) The January 2004 McDougall Newsletter: Protein Overload.

14) The December 2006 McDougall Newsletter: An Inconvenient Truth: We Are Eating Our Planet To Death.

15) Millward DJ. The nutritional value of plant-based diets in relation to human amino acid and protein requirements. Proc Nutr Soc. 1999 May;58(2):249-60.

16) Leiter LA, Marliss EB. Survival during fasting may depend on fat as well as protein stores. JAMA 1982;248:2306

17) Zimmerman MD, Appadurai K, Scott JG, Jellett LB, Garlick FH. Survival. Ann Intern Med. 1997 Sep 1;127(5):405-9.

How Plant-Based Diets May Extend Our Lives

News

July 10, 2014 by Michael Greger M.D. in News with 5 Comments

A recent review suggested that plant-based diets may prove to be a useful nutritional strategy for lifespan extension in part because they tend to be naturally low in the amino acid methionine (see my video Starving Cancer with Methionine Restriction). Apparently, the less methionine there is in body tissues, the longer different animals tend to live. But what are the possible implications for humans? See my video Methionine Restriction as a Life Extension Strategy.

I’ve talked before about the free radical theory of aging, the concept that aging can be thought of as the oxidation of our bodies just like rust is the oxidation of metal (seeMitochondrial Theory of Aging). Methionine is thought to have a pro-oxidant effect. The thinking is that lowering methionine intake leads to less free radical production, thereby slowing aging. Fewer free radicals would decrease the rate of DNA damage, which would curtail the rate of DNA mutation, slowing the rate of aging and disease and potentially increasing our lifespan.

There are three ways to lower methionine intake: The first is caloric restriction. By decreasing our overall intake of food, we would reduce our intake of methionine. Or, because methionine is found protein, we could practice protein restriction, eating a relatively protein deficient diet. The third option is eat enough food, eat enough protein, but just stick to proteins that are relatively low in methionine, which tends to mean plant proteins.

Caloric restriction is hard, because we walk around starving all the time. Something like every-other-day eating is described as “never likely to gain much popularity as a pro-longevity strategy for humans, so it may be more feasible to achieve moderate methionine restriction by eating a plant-based diet.” On a population-wide level, folks could benefit from just lowering their protein intake, period. Researchers noted that “the mean intake of proteins [and thus methionine] of Western human populations is much higher than needed. Therefore, decreasing such levels has a great potential to lower tissue oxidative stress and to increase healthy life span in humans while avoiding the possible undesirable effects of caloric restriction.”

We’re eating around double the protein we need, so the first thing doctors can recommend is to decrease the intake of protein, but we can also get our methionine even lower by eating a plant-based diet.

The fact that beans have comparably low methionine has been classically considered a disadvantage. But, given the capacity of methionine restriction to decrease the rate of free radical generation in internal organs, to lower markers of chronic disease, and to increase maximum longevity, this “disadvantage” may actually be a strong advantage. This fits well with the important role of beans in healthy diets like the traditional Mediterranean diet. Interestingly, soy protein is also especially poor in methionine, which may help explain the healthy effects iof soyfoods. Watch my video Increased Lifespan from Beans.

The reason why plant-based diets are so protective is not known. Yes, vegetables contain thousands of phytochemicals, but separately investigating their possible protective roles would be an impossible task. The idea that the protective effect is not due to any of the individual plant food components, but to a synergic “combined effect” is gaining acceptance. However, based on the relationship of excess dietary methionine to vital organ toxicity, as well as its likely mechanism of action through increases in free radical generation, the possibility exists that the protective effects of plant-based diets can be due, at least in part, to their lower methionine content. As one paper concluded, “The low-methionine content of vegan diets may make methionine restriction feasible as a life extension strategy.”

Plant-based diets can also mimic other benefits of caloric restriction, such as improving levels of the “fountain of youth” hormone DHEA. See The Benefits of Caloric Restriction Without the Actual Restricting.

Americans are living longer but sicker lives. That’s why we need a diet and lifestyle that supports health and longevity. I have a whole presentation on the role diet can play in preventing, arresting, and even reversing many of our top 15 killers: Uprooting the Leading Causes of Death.

I’ve touched previously on the irony that animal protein may be detrimental for the same reasons it’s touted as superior in Higher Quality May Mean Higher Risk.

-Michael Greger, M.D.

Rice Diet Founder Dr. Walter Kempner

The War On Cancer

This article is part of the Center for Media & Democracy’s spotlight onglobal corporations.

In 1971, many sponsors of the War on Cancer predicted a cure by 1976. Instead, this multibillion dollar research program has proven to be a failure.

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Overview

The age adjusted total cancer mortality rate climbed steadily for decades until the early 1990s, when the rate started to fall slowly, due largely to reduced smoking. To encourage continued support for cancer research, now exceeding two billion dollars annually in the U.S. alone; researchers and administrators have misled the public. In 1987, the U.S. General Accounting Office (GAO) found that the statistics from the National Cancer Institute (NCI) “artificially inflate the amount of ‘true’ progress”, concluding that even simple five-year survival statistics were manipulated. The NCI termed five-year survival a “cure” even if the patient died of the cancer after the five-year period. Also, by ignoring well known statistical biases, the NCI falsely suggested advances had been made in certain cancer therapies. ^[1]

Failure of toxic “therapies”

In 1971 when the U.S. declared war on cancer, scientists still hadn’t identified the immune defense system. Doctors and scientists, along with the American Cancer Society, continue to refer to a non-contagious condition with no incubation period or identifiable foreign invader as a “disease”. Scientists have requested and received billions in grants from the federal government, non-profit organizations, corporate and private donors. However, according to critics, like the New England Journal of Medicine, the “war on cancer” is a failure. According to John C. Bailar III, M.D., Ph.D., Chairman of the Dept. of Epidemiology & Biostatistics at McGill University:

“Despite $30 billion spent on research since 1970, cancer remains undefeated, with a death rate not lower but actually higher than when they started. The effect of new treatments for cancer has been largely disappointing. The failure of chemotherapy to control cancer has become apparent even to the oncology establishment.” ^[2]

The late Professor of Medical Physics, H.B. Jones, was a leading U.S. cancer statistician. In a 1969 speech to the American Cancer Society, he stated that studies had not proved that chances of survival were improved by early intervention. In fact, according to his studies, untreated persons with cancer lived up to four times longer and with a better quality of life than treated ones. He was not invited back. According to the prestigious British medical journal, The Lancet:

“If one were to believe all the media hype, the triumphalism of the medical profession in published research, and the almost weekly miracle breakthroughs trumpeted by the cancer charities, one might be surprised that women are dying at all from breast cancer.” ^[3]

Cancer for profit

According to the oncologist, Glen Warner, M.D.:

“We have a multi-billion dollar industry that is killing people, right and left, just for financial gain. Their idea of research is to see whether two doses of this poison is better than three doses of that poison.” ^[4]

NCI & clinical trials for hydrazine sulfate

According to “The $200 Billion Scam”, published in Penthouse in 1997:

“In the 25 years since the federal government declared War on Cancer, an estimated $200 billion has been spent by U.S. taxpayers and private investors on research that has produced so little bang for the buck that it makes the Pentagon’s $600 toilet seats look like bargains for every American home. The cancer industry has become a huge jobs program for brilliant, even highly motivated, doctors and other scientists, whose efforts are misguided by the economic forces behind the industry. Directly put, it’s in the interests of all the fat cats in government and private enterprise who earn their living and status from what is largely a failed enterprise, to stick with it. That is why a drug like hydrazine sulfate is dumped on by the cancer establishment, instead of given legitimate support and honest evaluation.”

The General Accounting Office (GAO) defied logic, reason, and science to give its blessing to the NCI’s deliberately biased testing of hydrazine sulfate which produced false results to make it appear ineffective. NCI higher administrators who wrote the report also and ignored evidence pointing to rigged clinical trials. ^[5]

American Cancer Society

The American Cancer Society ACS is largest non-religious charity in the world. As of the fiscal year ending in August of 2007, the ACS had a net revenue 1.17 billion dollars. ^[6] ACS’s daily expenditures exceed one million dollars with only approximately 16% going into patient cancer programs. The rest is funneled into expensive research and bureaucratic overhead. Meager prevention programs are designed not to offend the industry. The average American diagnosed with cancer spend upwards of $25,000 of their savings on cures to save or lengthen their lives. However, claims of ‘progress’ include many people with benign diseases. Those in remission for longer than 5 years are declared cured, although many of those will die from either cancer or treatment after five years. ^[7] Corporate donors include processed food industryand pharmaceutical industry giants like Pfizer, Sanofi-Aventis, AstraZeneca, Novartis and Walmart as well as Metropolitan Life Insurance. ^[8]

Memorial Sloan-Kettering Cancer Center

A look at financial relationships between large facilities such as the Memorial Sloan-Kettering Cancer Center (MSKCC) and corporations making billions in profits from chemotherapy drugs, is extremely telling as to its continued use in the face of such failure. Furthermore, expensive laboratories and diagnostic equipment have already been paid for by large corporations.

Craig B. Thompson, MD President and CEO of MSKCC, is also on the Board of Directors for Merck Corporation.^[9]

James D. Robinson III Honorary Chairman, is also former Chairman of Bristol-Myers Squibb, the world’s largest producer of chemo drugs. Paul Marks, MD, MSKCC’s former President and CEO, is the former Director of Pfizer. Another board member, Richard Furlaud, recently retired as Bristol Myers’ president. ^[10]

The late Richard Gelb was Vice-Chairman of the MSKCC board as well as CEO of Bristol-Myers. ^[11], ^[12]

The National Institutes of Health (NIH) is the primary agency in the U.S. government conducting and funding medical research. MSKCC Director Thomas Kelly, M.D., Ph.D. serves on the both the NIH Advisory Committee and Scientific Management Review Board. ^[13]

Cancer United

Cancer United is a pharmaceutical industry front group established by the Weber Shandwick public relations firm. It is funded entirely by Roche. ^[14]

Cancer & animal testing

More is spent on cancer than any other medical problem. There are more people living off of cancer than cancer sufferers.Millions of laboratory animals, including rats, mice, monkeys, guinea pigs, cats and dogs have been injected with cancerous material or implanted with malignancies.^[15], ^[16] Why hasn’t progress been commensurate with the effort and money invested? One explanation is the unwarranted preoccupation with animal testing. Crucial genetic, molecular, immunologic and cellular differences have disqualify animal models as an effective means to a cure. Mice are most commonly used, although “Mice are actually poor models of the majority of human cancers”; according to the industry’s own laboratory animal publication. According to leading cancer researcher, Robert Weinberg:

“The preclinical (animal) models of human cancer, in large part, stink… Hundreds of millions of dollars are being wasted every year by drug companies using these models.” ^[17]

A widely discussed 2004 article in Fortune magazine entitled “Why We’re Losing the War on Cancer” ^[18] laid the blame on animal research. The basic approach in the 1970s was to grow human cancer cells in a lab dish, transplant them into a mouse whose immune system had been tweaked to not reject them and throw experimental drugs at them to see what happened. However, few successes in mice are relevant to people. According to Fran Visco, who founded the National Breast Cancer Coalition four years after being diagnosed with cancer in 1987, “Animals don’t reflect the reality of cancer in humans. We cure cancer in animals all the time, but not in people.”

Newsweek combed through three decades of high-profile successes in mice for clues to why the mice lived and the people died. According to oncologist Paul Bunn, who leads the International Society for the Study of Lung Cancer:

“Animal models have not been very predictive of how well drugs would do in people. We put a human tumor under the mouse’s skin, and that micro-environment doesn’t reflect a person’s—the blood vessels, inflammatory cells or cells of the immune system.”

Human tumors that scientists transplant into mice and then attack with their weapon du jour, almost never metastasize. For decades, scientists ignored metastatic cells (which are responsible for 90% of all cancer deaths) because metastasis didn’t occur in animal models. Throughout the 1980’s and 90’s, researchers focused on increasingly detailed molecular mechanisms, instead of looking into the real problem. ^[19] See also animal testing.

Cancer & diet

Food Additives & adulteration

Today, over 6,000 synthetic chemicals are officially condoned for use in the processed food industry. These include some that are known carcinogens. Processed foods contain high levels of the debilitating, denatured ingredients such as white sugar, refined starch, pasteurized cow’s milk, land mined salt and hydrogenated vegetable oils. The human immune system correctly recognizes chemical food additives as toxic foreign agents and attempts to rid the body of them; thus causing severe biochemical reactions and stress on the immune system.

After years of daily exposure to inorganic chemicals, the immune system breaks down and burns out, leaving the body vulnerable to microbes, toxins and cancerous cells. The food industry has duped the public and government health agencies into believing that their products are safe for human consumption; even in the face of abundant scientific evidence to the contrary. In fact, such information is in the public domain and openly available to anyone who seeks it.^[20] See also processed food industry.

Animal products & health issues

The China Study culminated a 20-year partnership of Cornell University, Oxford University, and the Chinese Academy of Preventive Medicine. The survey of diseases and lifestyle factors in rural China and Taiwan is widely thought to be the most comprehensive study on nutrition and related diseases to date. The project produced over 8,000 statistically significant associations between diet and disease. The findings indicated that the consumers of the most animal-based foods suffered the most chronic diseases while those with the most plant based diets avoided these diseases and were the healthiest. Chronic diseases included heart disease, diabetes and cancer. Also studied were the effects of diet in reducing or reversing the risks of chronic disease. The study also examines the source of nutritional confusion produced by powerful lobbies, government entities and irresponsible scientists. ^[21] According to Dr. T. Colin Campbell of Cornell, “we’re basically a vegetarian species, should be eating a wide variety of plant foods and minimizing animal foods.” ^[22], ^[23]

The focus of published reports on dairy consumption are infections, colic, intestinal bleeding, anemia, allergies and more serious issues of diabetes and viral infections of bovine leukemia, an AIDS like virus. Common childrens issues include ear infections, tonsil infections, bed wetting and asthma. Adult issues include heart disease, arthritis, respiratory distress, osteoporosis, leukemia, lymphoma and cancer. Overall health issues include milk contamination by pus cells and chemicals such as pesticides. ^[24] Most cows’ milk contains toxins such as herbicides, pesticides and dioxins and up to 52 powerful antibiotics; blood, pus, feces, bacteria and viruses. Both organic and non-organic milk contain fat, cholesteral and various allergens as well as 59 active hormones. This includes the powerful Growth Factor One (IGF-1) which has been identified in the rapid growth cancer. ^[25] It has been positively documented and affirmed that dairy consumption leads to clogged arteries, heart attacks and strokes and exposure to contaminants. ^[26], ^[27] Research has demonstrated a calcium wash or a loss of calcium and other critical minerals like potassium, magnesium and iron from the blood stream as a direct result of dairy consumption starting at 24 ounces per day. ^[28] Low animal protein diets create a positive calcium balance, whereas high animal protein diets create a negative balance resulting in bone density loss. While many have turned to low fat dairy products, these products contain higher concentrations of protein. Low fat and particularly non-fat dairy products have actually been shown to increase osteoporosis, kidney problems and some cancers. ^[29]

See also meat & dairy industry, sections 4 & 5 & section 6 on animal products & health issues.

The prostate cancer predicament

For many men diagnosed with prostate cancer, the treatment may be worse than the disease

To screen or not to screen? For prostate cancer—the second leading cause of cancer deaths in men, after lung cancer—that is the bedeviling question.

The dilemma springs the wide variation in the potential of prostate cancers to spread to the rest of the body. The vast majority of these malignancies, especially those discovered with the extensively used prostate-specific antigen, or PSA, test, are slow-growing tumors that are unlikely to cause a man any harm during his lifetime. Yet in 10 to 15 percent of cases, the cancer is aggressive and advances beyond the prostate, sometimes turning lethal.

Murky diagnoses

The dilemma has become more urgent in recent years as widespread screening with PSA in the U.S. and around the world has led to a sharp increase in the number of detected prostate cancers. Currently, there is no way to accurately determine at the time of diagnosis which cancers are likely to threaten a man’s health and which are not. As a result, almost all men with PSA-detected cancer opt for treatment, which can leave long-lasting physical and emotional scars.

“One of the biggest challenges in oncology is to distinguish men who have a potentially lethal form of prostate cancer from those with a more slow-growing disease.”
—Lorelei Mucci, ScD ’03, associate professor of epidemiology

Put simply: with prostate cancer, the cure may be worse than the disease. The dilemma was underscored in May 2012, when the U.S. Preventive Services Task Force (USPSTF) issued a strongly worded final recommendation against PSA-based screening for prostate cancer. According to the task force, “[M]any men are harmed as a result of prostate cancer screening and few, if any, benefit.” In a study of U.S. men who were randomly screened, the screening did not reduce prostate cancer death (though a similar study among European men did find a lower risk of cancer death). In any case, experts agree that prostate cancer has been vastly overdiagnosed as a result of screening.

So what should patients and doctors do? At Harvard School of Public Health, the prostate cancer epidemiology team—which includes more than 25 faculty, postdoctoral fellows, and student researchers—is developing the science to answer that question, identifying both the risk factors behind the deadliest variations of prostate cancer and the lifestyle changes that may lower the risk of aggressive disease.

“One of the biggest challenges in oncology is to distinguish men who have a potentially lethal form of prostate cancer from those with a more slow-growing disease,” says Lorelei Mucci, associate professor of epidemiology at HSPH. “Our research aims to directly address that question, as well as to find opportunities to reduce risk of dying from cancer after diagnosis.”

Aggressive or slow-growing?

When it became widely available in the late 1980s, the PSA screening test was hailed as a simple way to uncover possible malignancy. But PSA screening, which was adopted without evidence of its usefulness, turned out to be a poor indicator of cancer, in two ways. First, it creates false positives in men who may simply have elevated antigen levels from other conditions, such as benign enlargement of the prostate gland. These patients often endure subsequent invasive biopsies but never go on to develop prostate cancer. Second, even when the test correctly identifies prostate cancer, many of the diagnosed patients never develop the deadly form of the disease.

“PSA screening has been a disaster,” says Hans-Olov Adami, former chair and now adjunct professor of HSPH’s Department of Epidemiology, who has opposed the test for 20 years. “We overdiagnose many men who would die of other causes.” In fact, a multinational study of cancer registries published by Adami, Mucci, and other HSPH colleagues in July 2012 found that the most common causes of death among prostate cancer patients—65 percent of patients in Sweden and 84 percent in the U.S.—are heart disease, diabetes, stroke, or other cancers.

What may protect against advanced prostate cancer?

PHYSICAL ACTIVITY
AVOIDING SMOKING
AVOIDING OBESITY
CONSUMING TOMATO SAUCE
CONSUMING COFFEE
VITAMIN D

Yet these patients frequently underwent radical treatments for their prostate cancer—interventions such as radiation, surgery, and chemotherapy, which can produce severe side effects such as incontinence and erectile dysfunction. “While we are uncertain about the number of deaths that screening prevents,” says Adami, “we are certain that the price for any reduction in deaths from prostate cancer is very high.”

A study published in August 2012 in the New England Journal of Medicine found no difference in survival between men who had surgery for prostate cancer and those under “watchful waiting,” in which the doctor withholds treatment while carefully monitoring the progress of the cancer. “This is a very perplexing observation,” Adami says, “because screening reduces mortality only if treatment makes a difference in outcomes. This indicates there are still big question marks in how doctors and patients should respond to this diagnosis.” As the USPSTF noted last May, “[R]esearch is urgently needed to identify new screening methods that can distinguish nonprogressive or slowly progressive disease from disease that is likely to affect quality or length of life.”

“ Men with at least three hours of vigorous physical activity a week had at least a 60 percent lower risk of prostate cancer death.”
—Edward Giovannucci, professor of nutrition and epidemiology

Clues in diet and lifestyle

To clarify the prognosis for a tumor, HSPH researchers are homing in on other factors that might affect susceptibility to prostate cancer, especially the aggressive form of the disease.Edward Giovannucci, professor of nutrition and epidemiology, recently looked at nine diet and lifestyle factors. He found that smoking, obesity, and lack of physical activity raise the risk of developing a more virulent cancer. According to Giovannucci, “The question is whether there are two types of prostate cancer–an aggressive and nonaggressive form–or whether certain factors cause a nonaggressive form to become more aggressive.” Evidence provided by HSPH researchers suggests that an increase in insulin in the bloodstream, caused by obesity and physical inactivity, may encourage tumor growth.

Other investigations have linked dietary factors to the disease. A 2011 study by HSPH research associate Kathryn Wilson, together with Mucci and Giovannucci, professor of nutrition and epidemiology Meir Stampfer, and other colleagues, found that men who drank coffee had a notably lower risk of aggressive prostate cancer. Those who consumed six cups or more a day were 20 percent less likely to develop any form of the disease, and 60 percent less likely to develop a lethal disease; those who consumed one to three cups a day showed no difference in developing any form of the disease, but had a 30 percent lower risk of developing a lethal form.

Jennifer Rider, instructor in epidemiology at HSPH, has studied parasitic infection and prostate cancer.

Another, more surprising, study revealed that consuming tomato sauce was associated with a markedly lower risk of prostate cancer. In fact, men who had two or more servings of tomato sauce a week were about 20 percent less likely to develop prostate cancer, and about 35 percent less likely to die from the disease. A separate report in 2009 by Mucci and Giovannucci found that the overgrowth of blood vessels might be one of the most reliable indicators of whether a tumor will spread. After sifting through genetic and lifestyle factors that might lead to the growth of these vessels, they found that the antioxidant lycopene was the item most strongly associated with lower blood vessel formation.

Another factor that might determine the difference between a harmless and a lethal form of prostate cancer is the sexually transmitted parasitic infection Trichomonas vaginalis. By itself, the infection rarely produces symptoms in men (who are often treated only after their female partners show signs of infection). In a 2009 study, led by HSPH instructor in epidemiology Jennifer Rider, infected men had a much higher incidence of prostate cancer spreading to the bone or death from prostate cancer. “The good news is that if the association between the infection and lethal prostate cancer is confirmed, there is an effective antibiotic treatment,” Rider says.

To treat or not to treat?

“Up until now, with a few notable exceptions, doctors have myopically focused on treating prostate cancer,” says Adami. “They are willing to spend tens of thousands of dollars on chemotherapy that has minimal effects on cancer mortality, often with substantial side effects. But we ignore entirely the fact that large groups of prostate cancer patients die from other causes that actually are preventable.”

By focusing on lifestyle changes, he adds, men can achieve three goals simultaneously: diminishing the risk of dying from common conditions such as heart disease and diabetes, improving quality of life overall, and perhaps also improving the prognosis for prostate cancer. In particular, stopping smoking and increasing physical activity after diagnosis can substantially cut the risk of developing aggressive prostate cancer. “Men with at least three hours of vigorous physical activity a week had at least a 60 percent lower risk of prostate cancer death,” says Giovannucci. “It’s a strong association.”

Among older patients especially, that activity can take the form of vigorous walking. Recently, Mucci has spearheaded an intervention with Adami and other colleagues in Sweden, Iceland, and Ireland in which men walk in groups with a nurse three times a week. In a pilot study, researchers found improvements in just 12 weeks in body weight, blood pressure, sleep, urinary function, and mental health.

Scientists at HSPH are also searching for genetic and lifestyle markers that help predict how aggressive a patient’s prostate cancer will be. For example, an ongoing project led by Mucci and Adami draws on detailed cancer registries in Nordic countries, including an analysis of 300,000 twins, to tease out the relative contribution of different genes to prostate cancer incidence and survival.

Until all these associations come to light, doctors and patients will be confronted with weighty decisions about treatment. Surgery, radiation, or chemo might still be the wisest course of action in instances where the cancer has clearly already advanced, or when a patient is young and otherwise in good health. In situations where men are older or face a higher risk for other diseases, improvements in diet and lifestyle may be more effective not only in subduing the cancer but also in boosting general well-being. As Mucci puts it, “Our hope is that clinicians will use the prostate cancer diagnosis as a teachable moment to reflect on the global health of the patient.”

Michael Blanding is a Boston-based journalist and author of The Coke Machine: The Dirty Truth Behind the World’s Favorite Soft Drink.

Reducing the harm caused by screening mammography

By Charles Wright

Women have a right to be confused about whether they should have screening mammography or not. They have been told for two generations that it is life-saving.

They have been bombarded by messages from healthcare professionals and public health programs urging them to comply: “If you don’t go for regular mammograms you need more than your breasts examined”; “Give your mother the gift of life for mother’s day — give her a mammogram”; “Mammograms can detect breast cancer when it is still curable.” Health agencies and ministries have enthusiastically supported breast screening as a demonstration of their commitment to women’s health.

When first introduced in the 1970s there was good reason for the hope that mammography would be a major tool in dealing with the scourge of breast cancer and that early diagnosis and treatment would translate into many lives saved.

A huge industry to support the demand was built involving doctors, radiologists, technicians and equipment manufacturers. The many adverse consequences of breast screening have been well known since the beginning but they were generally deemed acceptable at first with the prospect of saving women’s lives. With hindsight this was a mistake.

What has only more recently been recognized, quantified and publicized, is just how serious the negative effects are in relation to how very small the potential benefits.

The facts have now been clearly presented by many independent expert groups, including the Canadian Task Force on Preventive Health Care, the U.S. Agency for Health Care and Quality and the Cochrane International Collaboration. Public understanding is not helped by debates about relative and absolute death rate results. But the easy way to grasp the results is to consider what happens to a large group of women, say 2,000, who are screened regularly for 10 years.

One woman will have her life prolonged while 700 will have at least one false-positive mammogram with all the resultant anxiety and further investigations, 70-80 will have unnecessary biopsies and at least 10 women will be diagnosed and treated for a ‘cancer’ that would never have developed in any case.

In addition, several women will have a false-negative mammogram that failed to show a real cancer that shows up soon after.

Cancer of the breast can be a devastating disease and almost every woman knows of a friend or relative who had breast cancer successfully treated after a screening mammogram. The cruel reality is that the screening so rarely brings any change to the eventual result.

For the one in 2,000 who benefits, more than 800 are harmed.

What can be done about the current confusion and conflicting advice on the subject? Concerning the support of screening programs we have to decide whether to heed the consistent findings of independent experts, or the advice of those with a large vested interest in the screening industry. John Maynard Keynes, the famous economist, famously responded to a challenge that he had changed his opinion on a disputed topic, saying, “When the facts change, I change my mind. What do you do, sir?”

It may take a long time to dispel the false hope that has been given to women, but public education dealing with the current evidence will have to be planned and presented. There is a more immediate need to replace current advocacy with honesty and balance in how the facts are presented.

In every medical test or procedure the potential benefit and harm must be considered, and it is now clear that in the case of screening mammography the harms tip the scale heavily.

At the very least a consent form summarizing the facts clearly and in plain language should have to be signed by women presenting for screening while plans for gradual re-allocation of resources are developed.

Some women may wish to continue with regular screening in spite of this information but unfortunately we now know that mammography does not pass the test for any acceptable screening program designed for the general population: namely, that it must cause significant benefit with insignificant harm.

Dr. Charles Wright is an expert advisor with EvidenceNetwork.ca. He is also councillor with the Health Council of Canada.

This Commentary is from Commentaries, More Care is Not Always Better.

Public health takes aim at sugar and salt

HSPH FEATURES

The war on obesity and other lifestyle ills has opened a new battlefront: the fight against sugar and salt.

It may be a fight for our lives.

In the last few years, evidence has mounted that too much of these appealing ingredients—often invisibly insinuated into beverages, processed foods, and restaurant fare—harms health.

Research at the Harvard School of Public Health and elsewhere, for example, has tied sugary drinks to an epidemic of obesity in the United States. The average 12-ounce can of soda contains 10 teaspoons of sugar, and the average teenage boy consumes nearly three cans of sugary drinks a day. Is it any wonder that about two-thirds of Americans are now overweight or obese?

Obesity, in turn, raises the risk of type 2 diabetes, heart disease, arthritis, and certain cancers. Meanwhile, studies have linked salty diets to high blood pressure, which increases the risk of heart attacks and strokes, the first and third leading causes of death in the United States.

At HSPH, the Department of Nutrition is helping to lead the charge for healthier consumer fare. In April, at a widely covered press conference, the department’s faculty publicly challenged beverage makers to create a class of drinks with 70 percent less sugar—a partial reduction that could lower obesity and diabetes rates within a year, they believe. On the salt side, experts estimate that cutting average sodium consumption by one-half could prevent at least 150,000 deaths annually in the United States.

Bolstering this two-pronged public health campaign has been a shift in national political philosophy. “The previous administration believed that market forces solved everything and that regulation was off the table. But market forces, left alone, damaged the economy,” says Walter Willett, Chair of the Department of Nutrition and Fredrick John Stare Professor of Epidemiology and Nutrition. “That also applies to the food supply and health. Market forces don’t promote a healthy diet—in fact, they do exactly the opposite. We made a lot of progress on trans fat. Now the biggest issue, outside of too many calories, is the huge amount of sugar and salt.”

As in many recent public health campaigns, New York City has been ahead of the pack. Its “Healthy Heart-Cut the Salt” program, now a nationwide effort by a coalition of health organizations and public agencies, works with food industry leaders on a voluntary framework to cut salt in their products. “New York City created a market for trans-fat-free foods, and it will create a market for lower-sodium foods,” Willett predicts. In May, President Barack Obama picked Thomas R. Frieden, New York City’s health commissioner, to direct the U.S. Centers for Disease Control and Prevention (CDC), installing a fierce advocate for lowering salt and taxing sugary beverages in a position to bring about change.

SPOONFULS OF SUGAR

In the School’s current battle plan, the prime target is sugar in sodas, fruit juices and other cloying drinks. Here’s why:

Downing just one 12-ounce can of a typical sweetened beverage daily can add 15 pounds in a year.
In children, one sweetened beverage a day fuels a 60 percent increase in the risk of obesity—and American teenaged boys drink almost three times that much.
This April, an HSPH study linked sugary drinks to increased risk of heart disease in adults. Scientists have long known that sugar reduces the “good” HDL cholesterol in the blood. Consistent with this effect, the April study showed that it wasn’t just weight gain that raised heart disease risk, but sugar itself—eating an otherwise healthy diet or being at a healthy weight only slightly diminished the risk.
In 2004, the Nurses’ Health Study found that women who had one or more servings a day of a sugar-sweetened soft drink or fruit punch were nearly twice as likely to develop type 2 diabetes as those who rarely imbibed these beverages.

As a dietary enemy, sugar is cleverly camouflaged, because it is dissolved in liquid. A typical 20-ounce soda contains 17 teaspoons of sugar. “If people thought about eating 17 teaspoons of sugar, they’d become nauseated,” Willett says. “But they are able to drink it right down and go for another.” While we normally balance a big meal by taking in fewer calories later, that compensation doesn’t seem to occur after guzzling soft drinks—possibly because fluids are not as satiating as solid foods, or because sweet-tasting soft drinks whet the appetite for high-carbohydrate foods.

Willett and Lilian Cheung, lecturer in the Department of Nutrition and editorial director of The Nutrition Source, urge people to choose drinks far lower in sugar and calories: options such as water, tea, seltzer with a splash of juice, coffee with one lump of sugar.

“If we can shift the present American norm back to a lower expectation of sweetness, people will adjust their palates, particularly the younger population,” says Cheung.

PASS (UP) THE SALT

Almost 80 percent of the salt in the American diet comes not from the salt shaker, but from processed or restaurant foods. According to the U.S. Department of Agriculture, in 2005 and 2006, the average American on a 2,000-calorie-per-day diet devoured more than 3,400 mg of salt per day (mg/d). That’s substantially more than current dietary guidelines, which recommend that adults in general consume no more than 2,300 mg/d—about a teaspoon.

Several years ago, the National Institutes of Health’s Dietary Approaches to Stop Hypertension-Sodium clinical trial (DASH-Sodium), led by HSPH’s Frank Sacks, professor of cardiovascular disease prevention, found that the biggest blood-pressure-lowering benefits came to those eating at the lowest sodium level tested, 1,500 mg/d. For those prone to high blood pressure, people over 40 and African Americans—groups that together represent nearly 70 percent of the population—the CDC likewise advises no more than 1,500 mg/d.

That 1,500 mg/d threshold would require cutting sodium in processed and restaurant foods by about 80 percent. Though it may sound drastic, the goal is more urgent than ever. In 1982, the U.S. Food and Drug Administration (FDA) called on the food industry to voluntarily reduce sodium levels in processed foods—yet sodium consumption has steadily drifted upward. By 2000, men were eating 48 percent more salt than they did in the early 1970s, and women 69 percent more.

REFINING THE AMERICAN PALATE

To wean ourselves from excess sugar, the Department of Nutrition’s challenge uses a benchmark of one gram of sugar per ounce, which equates to a 12-ounce soda that contains three teaspoons of sugar and 50 calories. “We’ve suggested that manufacturers provide an option in between high-sugar and sugar-free drinks,” Willett says, “to help people step down if they can’t go cold turkey from full sugar to no sugar.” The department is currently discussing the challenge with Obama administration officials. While Willett and others are not directly in contact with manufacturers, the challenge’s press coverage has stirred debate within the beverage industry, and several small start-ups are introducing low-sugar drinks.

The HSPH challenge further proposes that the FDA require manufacturers to label the fronts of their cans and bottles with information on total contents rather than per-serving quantities. Currently, most consumers assume that a single package of chips or bottle of soda is a single serving. Only upon close inspection do they discover that there are two or more “servings” in the package. Willett has called for an initial reduction of salt in processed foods of up to 20 percent—a change that studies show does not perceptibly affect taste.

LAUNCHING A NATIONAL CAMPAIGN

In its forceful call to action, HSPH joins a growing chorus of health experts demanding change. “New Horizons for a Healthy America: Recommendations to the New Administration,” a report issued in April by the Commission on U.S. Federal Leadership in Health and Medicine: Charting Future Directions, describes sugary beverages and salty processed foods as “serious concerns” for the Obama administration. The Washington, D.C.-based Center for Science in the Public Interest (CSPI) has also pressed Congress and the administration to act.

Looking to economic levers to cut consumption, Willett proposes a national sales or excise tax of up to 18 percent on sodas and candy. Along with CSPI, the Department of Nutrition submitted a letter to Congress in June supporting a tax on full-sugar beverages; Willett has also testified before the Massachusetts Legislature in support of such a bill. Some of this tax could be used to subsidize healthy but relatively expensive alternatives, such as fresh fruits and vegetables. Willett would also rewrite government procurement policies to help set new industry standards. In his view, food services at military facilities, hospitals, government organizations, and schools should all phase out highly sweetened beverages in favor of low-sugar options.

And Willett has called for a ban on child-focused marketing for sweetened drinks—since children and teens drink most of their sugary calories at home. “There should be strong regulations, with real teeth in them, against advertising to children. It’s immoral—criminal, even—to have children’s health undermined for the sake of profit,” he says. To this end, Willett has also contemplated lawsuits on behalf of children: “If a child is encouraged to consume these beverages by a fast-food chain, without being warned of the consequences, and they develop diabetes, is there not some liability?

“We will use all levers possible, as we have done for trans fat elimination,” he adds. “Public education is central to this effort, and talking to journalists is a great multiplier of information.” A Reuters news service story on the department’s industry challenge was picked up from Canada to China, and in JuneUSA Today ran a major story on the topic. Nutrition department investigators are also preparing a scientific review article for a leading medical journal about the deleterious consequences of high-sugar drinks.

The HSPH Department of Nutrition is raising funds to set up a research and information center that would conduct, compile, and disseminate studies on the health implications of sugar-sweetened beverages. The center’s mission: to educate policy makers and the public.

So far, food manufacturers have not widely reformulated their products, for fear of losing customers and getting ahead of taste trends. But other nations, such as Finland, have proven not only that palates can grow more refined when governments embark on full-scale efforts steering people toward more wholesome fare, but that population health dramatically improves when they do. (See: What Other Countries Have Done)

For now, Willett intends to point public health’s artillery toward sodas and other sweetened drinks. “Going for the low-hanging fruit is the first step, and the sugared beverage area is the place,” he says. “These products are in a class with tobacco. There’s only harm, no benefit.”

Photograph: Kent Dayton/HSPH

Larry Hand is associate editor of the Review.
Madeline Drexler is guest editor of this issue of the Review.

Parkinson’s Disease

Neurology

Parkinson’s Disease

BY: PHYSICIANS COMMITTEE FOR RESPONSIBLE MEDICINE

Parkinson’s Disease: Overview and Symptoms

Parkinson’s disease (also known as idiopathic paralysis agitans) is a chronic and progressive movement disorder that affects as many as 1 million Americans. It occurs when groups of neurons in specific areas of the brain (known as the substantia nigra and locus ceruleus) malfunction and die.

As a result, the brain does not produce enough dopamine, a chemical messenger that is important for movement and coordination. Without enough dopamine, Parkinson’s disease patients have difficulty with movements and activities of daily life, and may have mood and memory problems.

The cause is unknown, but researchers think that both genetic and environmental factors are involved. However, Parkinson’s-like symptoms can occur in individuals who are exposed to several toxins (such as pesticides; MPTP, which is a contaminant of opioid narcotics; and high levels of the mineral manganese), infections of the brain and spinal cord, head trauma, or certain medications that affect dopamine receptors (such as antinausea medications, antipsychotic medications, and reserpine).

Parkinson’s disease affects approximately 1 percent of Americans over age 50. The typical age of onset is the late 50s, although 10 percent of cases occur in people under 40.

Symptoms

The symptoms of Parkinson’s disease usually appear gradually and increase in severity over the course of years. Patients tend to have slowed movements (called bradykinesia) and appear stiff or rigid. They may have a tremor at rest, usually in the hand or thumb.

As the disease progresses, patients have more and more difficulty maintaining balance, walking, talking, and completing daily activities (such as eating, writing, dressing, and combing their hair).

Patients with Parkinson’s disease often experience some degree of depression, and may have other psychologic symptoms, including hallucinations. This may occur due to the disease itself or as a side effect of medications. Also, dementia is common in people with Parkinson’s disease, occurring in about one-third of cases.

Diagnosis

Parkinson’s disease is usually diagnosed clinically when an experienced neurologist observes the characteristic physical and neurologic symptoms. There are no tests to definitively confirm the disease but testing, such as a CT scan, MRI, or spinal tap, may be useful to rule out other diseases.

If the diagnosis is in doubt, a doctor may begin a trial of a Parkinson’s medication to see if it improves symptoms. If so, Parkinson’s disease is diagnosed.

Treatment

There is no known cure for Parkinson’s, but medical and nutritional therapies can decrease the symptoms and may slow the course of the disease.

The first step is to eliminate any drugs or medications that may be causing symptoms of Parkinson’s disease. These include antinausea medications, antipsychotic medications, reserpine, and others.

The most common medical drugs used to treat Parkinson’s disease are medications that mimic the effects of dopamine in the brain, most commonly levodopa (Sinemet). Other medications may also be useful, including bromocriptine, pergolide, entacapone, tolcapone, and selegeline.

Medications are also available to treat some of the specific symptoms of Parkinson’s disease. For example, benztropine may be effective to treat tremors. Clozapine or quetiapine may decrease hallucinations.

Physical, occupational, and speech therapies are usually very helpful for patients to improve activities of daily living, achieve or maintain independence, and interact better with their environment. Outside of therapy sessions, patients should try to maintain as active a lifestyle as possible.

There has been some coverage in the media of surgical treatments for Parkinson’s disease. While these may be helpful in treating advanced disease or in patients with specific symptoms (such as severe tremor or rigidity), they are not considered useful for most patients.

Parkinson’s Disease: Nutritional Considerations

Nutritional Considerations for Reducing Risk

Although there is no known cure for Parkinson’s disease, research studies are investigating whether dietary changes decrease the risk of disease. The following steps are under consideration:

Avoiding animal fat: Some studies have shown that Parkinson’s disease is more common in people who eat high levels of animal fat and saturated fat. Avoiding animal fat brings other benefits, of course, such as lower cholesterol and reduced risk of heart disease.
Avoiding dairy products: A large study (called the Health Professionals Follow-Up Study) found a higher risk for Parkinson’s disease in men who had high intake of dairy products. Researchers think this may be due to chemicals found in dairy products called tetrahydroisoquinolines. Further, dopamine neurons may be damaged by other chemicals in dairy products, including beta-carbolines, pesticides, and polychlorinated biphenyls.
Drinking caffeinated beverages: Some studies have found that people who drink several cups of coffee or tea daily have a lowered risk of developing Parkinson’s disease. This may be related to the high levels of antioxidants in both tea and coffee.

Nutritional Considerations for More Effective Treatment

Dietary changes may also improve the effectiveness of medical treatment. In some patients, the standard levodopa medication may not successfully improve symptoms. If so, there are several nutritional changes that may help.

Eating a low-protein diet during the daytime can be helpful because protein may decrease the availability of levodopa to the brain.
In addition, vitamin supplements and foods high in vitamin B₆ (such as fortified cereals and grains, beans, meat, poultry, potatoes, and sweet potatoes) may also decrease the availability of levodopa to the brain. Therefore, limiting these foods and supplements may be useful.
Parkinson’s disease often causes weight loss. Patients should try to maintain a healthy body weight by eating regular meals and between-meal snacks that have sufficient calories from whole grains (100 percent whole oats, oat bran, bulgur, barley, brown rice), fruits, 100 percent fruit juices, and vegetables.
Patients may want to consult with a nutritionist for help in making healthy food choices.

Liver Disease, Hepatitis, and Liver Failure

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Contents

Overview

Failure of toxic “therapies”

Cancer for profit

NCI & clinical trials for hydrazine sulfate

American Cancer Society

Memorial Sloan-Kettering Cancer Center

Cancer United

Cancer & animal testing

Cancer & diet

Food Additives & adulteration

Animal products & health issues

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For many men diagnosed with prostate cancer, the treatment may be worse than the disease

“One of the biggest challenges in oncology is to distinguish men who have a potentially lethal form of prostate cancer from those with a more slow-growing disease.” —Lorelei Mucci, ScD ’03, associate professor of epidemiology

What may protect against advanced prostate cancer?

HSPH FEATURES

Parkinson’s Disease

Symptoms

Diagnosis

Treatment

Parkinson’s Disease: Nutritional Considerations

Nutritional Considerations for Reducing Risk

Nutritional Considerations for More Effective Treatment

“One of the biggest challenges in oncology is to distinguish men who have a potentially lethal form of prostate cancer from those with a more slow-growing disease.”
—Lorelei Mucci, ScD ’03, associate professor of epidemiology