Comfortably Unaware
Let’s get it right: it’s not drought or climate change that is wreaking havoc on water supplies in California or anywhere else in the southwest U.S. … it’s what we are eating.
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60 Minutes, Leslie Stahl, and the real issue at hand
On November 16, CBS aired a 60 Minutes episode called “Water,” where Leslie Stahl reported to over 12 million viewers “new evidence” that our planet’s groundwater is being pumped out much faster than it can be replenished. The story focused primarily on the scarce water conditions in California. While Ms. Stahl’s findings were important to emphasize, they were nothing new. Whether in California or globally, audiences will eventually need to hear the truth about freshwater scarcity as it relates to our current and projected water-management trends: where all of our freshwater supplies are going and what we can do about it.
Those living in California and the Southwest U.S find themselves embedded in a significant four-year drought and have turned to strategies such as rationing water, educating the public about conventional conservation tactics (such as shortening shower times), and even approving $500 fines for overwatering lawns.
On average 2 to 3 gallons of water can be saved by reducing your time in the shower by one minute or by turning the water off while brushing your teeth. However, you can save more than 1,000 gallons per day by eliminating meat and dairy from your diet. That’s the average amount of water required to produce the nine ounces of meat that every American consumes per day, on average.
Raising livestock plunders global resources and devastates our water supply
In some areas of the southwest U.S., including California, it requires over 4,000 gallons of water to produce just one pound of beef and over 1,000 gallons to produce just one gallon of milk–as compared to, on average, 6 to 30 gallons to produce a pound of vegetables, such as carrots or various greens.
Using land and water to raise livestock and to grow crops to feed them is a tremendously inefficient way to produce food. It wastes energy, resources, and lives. With a burgeoning global human population expected to reach 9.6 billion by the year 2050 (2.5 billion more than we have now), there will come a time where growing plants for direct human consumption will be the only socially (and perhaps legally) acceptable way to deploy our finite resources for food production, whether in California or anywhere else in the world.
The state of California raises over 6 million cattle and 2 million dairy cows. Each animal drinks between 20 gallons (grazing beef cattle) and 40 gallons (dairy cow) of water daily. An additional 2 million annual gallons of virtual water (the amount of water used in the entire production process of an agricultural product) are tied up in grain and pasture to feed just one cow. Annually, this is over 100 times more water than one human drinks and is 130 times more than what is used to produce food for one person each year if eating a purely plant based diet.
Pastured livestock: far from sustainable
Many people consider raising livestock on pasture to be a more “sustainable” way to produce meat and dairy. But if we examine the water that just one of the two billion grass-fed cattle in the world drinks (not accounting for the significant additional water required for feed, slaughtering, or processing), it would still require 20,000-22,000 gallons over a 24-month period to raise just one grass-fed cow. That amount of water is the equivalent of a person taking a five-minute shower each and every day for 6.7 years. Indeed, when accounting for land and water use inefficiencies, net greenhouse gas emissions, effect on biodiversity, and ratios of end product consumed per resources required, pastured animal agricultural systems are LESS sustainable than factory farming.
Loss of the Colorado River via alfalfa
Every year, California devotes 900,000 acres of its land to growing alfalfa, ninety-five percent of which is eaten by cattle (the other five percent by horses). Each one of these 900,000 alfalfa acres receives irrigation to the tune of 1 to 2 million gallons per year (50-80 acre inches per acre per year). Therefore, total freshwater used in California for just one year of hay production is 1.8 trillion gallons.
Each year, California uses 1.8 TRILLION gallons of freshwater to produce hay for livestock.
In California’s Imperial Valley, one-fifth of all the water from the Colorado River is diverted through the Imperial Canal, and 70 percent is used in one way or another for livestock. The average yearly rainfall in the Imperial Valley is less than 3 inches, and water is sparse in other areas in California where alfalfa hay is grown.
Knowing this, it is shocking that the largest importer of California hay for the past few years has been the United Arab Emirates (UAE), which is importing hay because it is concerned about the scarce water supply for its own citizens. Saudi Arabia will soon follow, essentially importing water from California via hay for its animals, which are then consumed by Saudi citizens. This virtual water trading loss will be a growing trend—certain countries depleting the natural resources of other, more unaware countries, such as the U.S., Brazil, and others, so they may “prosper” with importation of animals and animal products.
These animals are produced in countries where true environmental costs of production continue to be externalized, and a proper economic metric has yet to be affixed to the raising and slaughtering of livestock and fish, the largest contributors to global depletion. Opportunistic countries with dwindling natural resources will continue to take an approach similar to that of the UAE by utilizing their limited water supply more for human consumption than for crop or animal production, while taking advantage of countries such as the U.S., which doesn’t know any better or is letting economics dictate ecological reasoning.
Historically, the U.S. has heavily subsidized use of aquifer water for livestock and feed crops, such that farmers in the Ogallala and San Joaquin regions of the western U.S. (home of two of the largest aquifers on Earth) pay only 5 to 10 percent as much for their water as do residents in those areas. This has encouraged continued alfalfa and feed crop production and freshwater depletion.
“Subsidence”: ground craters where water once lived …
Typically, most areas of the world predominantly use either surface water (lakes, streams, rivers) or groundwater (aquifers). California uses a combination of both, in an approximately 60/40 ratio, blending the surface waters of the Sacramento-San Joaquin River Delta and the diverted Colorado River with underground water from the San Joaquin aquifer and others. In times of drought, California places restrictions on surface water and relies heavily on withdrawals from aquifer systems.
Visual indicators of these water withdrawals can be seen in many areas, most notably, perhaps, near Mendota, California, where a 1977 study showed land elevation having dropped as much as 28 feet in some areas. Known assubsidence, this phenomenon occurs when ground cratering results after excessive amounts of groundwater have been withdrawn from an aquifer. Once water has been removed from the sediment and subsidence has taken place, it cannot be replaced.
Subsidence can also be readily seen in many Texas counties and elsewhere in the world. It is occurring in the state of Guanajuato, Mexico, where the water table is falling by 2 meters or more per year, due to the withdrawals required to support the growing livestock and feed crop industry there.
Worldwide, there are many examples of rapid groundwater depletion. India is witnessing losses due to the irrigation of rice fields, and the North China Plain is quickly depleting its two aquifer systems because of expansion of animal agriculture. In the U.S., there is depletion of aquifers due to livestock and feed crop operations in North Carolina, Arkansas, the Columbia River Basin, and especially in California’s Central Valley, the focus of Ms. Stahl’s report.
“The single largest human alteration of land”
The San Joaquin Valley forms the backbone of California’s agricultural industry, the nucleus of the Central Valley area, which produces 25 percent of the nation’s food on less than 1 percent of the country’s farmland. Land subsidence in excess of 1 foot has affected more than 5,200 square miles of irrigable land—one-half the entire San Joaquin Valley. The USGS has called this “the single largest human alteration of land.” It, along with depletion of the Ogallala, will likely be the single largest human alteration of water, as both the San Joaquin and Ogallala aquifers are expected to be completely drained in coming decades (within sixty years for the former and as soon as 2030 for the latter).
Abuse of the Ogallala
At an average depth of 200 feet, the Ogallala is the most heavily depleted aquifer in the U.S. and the world’s fastest-disappearing freshwater source, having lost 150 feet of depth in the past twenty years. It contains water formed from glaciers 12 million years ago, has a recharge rate of less than a half-inch per year, and is being drawn down at a rate of 3 to 10 feet per year.
Since the 1960s, farmers have irrigated this land, receiving subsidies to use this water to grow crops to feed cattle. Almost half of all cattle raised in the U.S. come from just four states in this area—Nebraska, Iowa, Kansas, and Texas, which accounted for 49 percent of the United States commercial red meat production in 2010.
The vast majority of the Ogallala abuse and depletion has occurred in support of the largest cattle herds in the U.S. and the corn that feeds them–a vivid example of just how much power various influences exert over our decisions about food. When confronted with the very real potential of running the Ogallala aquifer dry, a movement in the late 1980s supported creating a pipeline to pump water from Lake Michigan, one of the great lakes, back to all the livestock operations. This brings us front and center to the real problem—water management and food choice.
We need to find another solution. We could, for instance, eat all plant-based foods, which are far less water intensive. We do not need to eat cattle from the High Plains states or anywhere else to live thriving, healthy lives. We do, however, need water.
Water by the numbers, globally and in the U.S.
Worldwide, alfalfa is grown on approximately 79 million acres. The majority of it is irrigated, and 70 percent of it comes from the United States, Russia, and Argentina—countries suffering now from frequent periods of heat, drought, and water stress. Wherever water scarcity is found in the world, particularly with irreversible overdrawing of aquifers, livestock is typically involved, leaving the indelible mark of our insatiable demand to eat them.
Between 50 and 75 percent of all water withdrawal from the largest aquifers in the world—the Ogallala, North China Plain, San Joaquin, and Columbia River Basin—can be attributed to livestock and the alfalfa, corn, sorghum, and other crops they eat, the water they drink, and the water used to generally service and slaughter them, as well as to the processing and packaging of animal products.
In the U.S., livestock consume 34 trillion gallons of water per year, accounting for nearly 50 percent of all freshwater-consumptive withdrawals.
Each year, the U.S. livestock industry uses 34 TRILLION gallons of freshwater.
Globally, agriculture is responsible for 92 percent of all freshwater use, 30 percent of which goes to livestock and crops or pasture to feed them.
The China connection
Most of China’s arable land and freshwater supplies are polluted and dwindling, so they are turning elsewhere to help supply their growing demand for pork, dairy, and other meat products. China’s demand for meat has quadrupled since 1980, and it now consumes over 50 percent of the world’s production of pork and 60 percent of the world’s soybeans. Feed crops such as corn and even wheat grown in drought-ridden areas of the U.S., such as the southwest and middle corn belt, are irrigated with water from rapidly depleted ancient aquifers to feed livestock grown in China and elsewhere, while U.S. policy makers are scratching their heads to find solutions to a growing freshwater scarcity issue.
Robert Glennon, a water policy expert at the University of Arizona, calculated that approximately 100 billion gallons of western U.S. water—enough to supply the annual household needs of one million families—were being exported to China in the form of alfalfa crops grown with irrigation water from the Colorado River and dwindling aquifers in California and Arizona.
Refocusing of issues—animal agriculture, climate change, and global depletion
Regarding sustainability issues, most of the world’s attention recently has been focused on climate change and greenhouse gas emissions—energy and fossil fuel use. But climate change is only one component of the much larger, more insidious concern of global depletion. It is an exacerbator, taking these pressing issues and making them worse.
Climate change is not the sole cause of various aspects of global depletion, such as agricultural land use inefficiencies, oceanic ecosystem devastation, rainforest deforestation and degradation, food insecurity, accelerated extinctions and loss of biodiversity, and freshwater scarcity. All of these phenomena are occurring with or without the effects of climate change … with or without the use of fossil fuels. The primary driver of all of these combined issues worldwide is the raising, harvesting, slaughtering, and consumption of animals.
Regarding our state of sustainability, make no mistake that we are in overshoot mode. According to the Global Footprint Network, it would require more than 1.5 Earths to sustain what we are currently taking from and doing to our planet, and no other single factor contributes to our unsustainability as significantly as our demand for meat, dairy, fish, and eggs and the agricultural systems that support these products.
Timelines of irreversibility
All aspects of global depletion are marked by timelines—the number of years before tipping points may be reached and thus cause irreversibility. To wit:
- Global warming: Most researchers agree that our planet will display irreversible effects if we have not drastically reduced greenhouse gas emissions by 2017.
- Oceans: With massive loss of sea life (90 percent of all large fish species are gone) due to commercial fishing, warming waters, and 30 percent acidification, irreversibility has already occurred in our oceans. It has been 300 million years since the last time our oceans have been this warm and acidic, and at that time, it took over 30 million years to recover.
- Tropical rainforests: Since 1978 over 300,000 square miles of tropical rainforest in the Amazon have been destroyed. Ninety percent of the destruction in Brazil and between 70 and 80 percent of rainforest destruction in the other seven Amazonian countries has been due to grazing livestock and growing feed crops. The diverse wildlife lost will never be seen again in our lifetime.
- Species extinction: Similarly, with the massive number of species extinctions (occurring at up to 10,000 times the annual background rate) and loss of biodiversity, we are already witnessing irreversibility. For some species with whom we share this planet, time has already run out. Cause of extinction: humans.
… And so it is with the availability of freshwater.
One of our most critical concerns regarding sustaining current and future life on Earth is our supply of freshwater. From 1941 to 2011 the world’s population tripled, but freshwater consumption quadrupled. The gap between worldwide demand for water and what is really available is growing at such a rate that a 40% shortage in water supply is expected in just 15 years.
Water and geopolitics
Although the amount of water on earth remains constant, the consumptive form it happens to be in does not. Four out of five people now live within 30 miles of a water-damaged area (meaning soon to run out, or polluted), and there are nearly 300 transboundary river and waterways on Earth where multiple countries share vital running water supply. As we see water shortages over the next fifteen years, we will surely see droughts, famine, and human sickness. And then we’ll see conflicts, social unrest, and even wars. Indeed, those living downstream will be fiercely battling those living upstream for water rights.
Climate change will make these matters worse, but it will not cause them. Food choice and virtual water trading through food, especially with animal products, will play much larger roles than energy and fossil fuel use.
As we continue irreversibly damaging the environs that support us and all other life on Earth (lithosphere, hydrosphere, and atmosphere) and begin running out of freshwater, topsoil, arable land, fish in our oceans, and tropical rainforests–creating extinctions of other species and loss of biodiversity–we will come to accept that sustainability of our own species is contingent upon the choices we make. While scientists and policy makers are concerned about advancing technologies, we should be first concerned about our decisions, particularly those decisions that have the most profound effects on the health of our planet and our own health, such as food choice specifically related to animal agriculture.
The easiest solution to any area of global depletion can be found by adopting a more optimal level of relative sustainability—and to do so today, as the timelines of irreversibility are imminent and the clock is ticking.
A plea for equal time
As usual, 60 Minutes and Ms. Stahl’s “Water” segment presented an entertaining story to over 12 million viewers with a report of a real-life problem, consisting of selected interviews, a possible solution, and even a sprinkling of space technology (GRACE satellite information). But instead of resorting to “toilet-to-tap” recycling of waste water as perhaps the last resort to solving our problem of freshwater scarcity as indicated in the report, we need to hear where the overwhelming majority of our water is going and how this relates to the profound issue of agricultural system inefficiencies. We need to hear about the most sensible manner in which we can produce food … and why it needs to be donetoday.
Let’s move the critical mass in the right direction and do so now. Let’s all contact Ms. Stahl, asking her to seriously consider reporting on how animal agriculture is the sector most responsible for global depletion. Ask her to clearly spell out to her massive audience that the timelines necessary for action are upon us and that immediate and complete replacement of animal products by organically grown, whole-plant-based food alternatives is necessary to ensure the highest level of relative sustainability for our species. Remind her that this topic should not be considered political, nor should her reporting of it be constrained by cultural or economic bias, because it is a topic of our survival and that of future generations.
It’s a story about health, peace, truth, and social justice. It is a story about saving resources, saving lives, saving species, saving humanity. As such, it should be considered the most important topic we have in front of us today—the most worthy of conveying. This is the report we all need to hear.
Dr. Richard Oppenlander
Protein
Answer to a Reader’s Question:
Many people are rightfully confused about the various ways that protein recommendations are established, and fail to know the main factors that have caused the confusion. Understanding the protein recommendations requires an understanding of the history of protein research and the serious bias that crept into the science over the years. From the beginning, there was a very strong bias that has emphasized the health importance of protein and this almost always meant animal-based protein. This bias arose even though the research results clearly showed in many cases that it SHOULD NOT be emphasized. Nonetheless nutrition researchers still emphasized higher consumption of protein because it was the “sign of civilization itself” as was said in the early 1900s and, further, that those who did not consume these generous amounts of protein (i.e., meat) were “of an effeminate nature”!
Researchers continually pushed the protein idea and continually found ways to develop methodologies and algorithms to ‘show’ that higher levels of protein were advisable. The whole concept of protein “quality” was devised so that it could be said that animal protein was high quality and plant proteins were low quality when, in fact, the concept of quality only indicated a biological efficiency of utilization per unit protein consumed. Naturally, animal-based proteins more nearly mimic our needs because they are composed of the right ratio of amino acids, thus are used more efficiently. But these studies were mostly based on animal production research that served the farm community (also served for my PhD thesis!) far more than it served the interests of human health. More efficiently used “high quality” proteins also efficiently grow cancer cells as well!
However, it’s important not to miss the really bizarre point that the current US dietary guidelines advocate an upper limit of 35% of calories as protein that is supposedly consistent with minimizing chronic diseases. The only way that one can go this high is to be a virtual carnivore. The correct recommended intake is around 8-10% protein (not 35%!) which can be easily supplied by a good whole foods plant based diet. Even potatoes will do the job alone.
So, it’s back to the question of how and why and who is recommending these ridiculous numbers. The first time that these new high limits appeared was when a top consultant to the dairy industry, was chairing the Food and Nutrition Board that was responsible for the report. That report was funded by the dairy industry-based Dannon Institute, among other corporate benefactors who, accidentally I suppose, rather liked these high protein recommendations.
This is where Dr. Caldwell Esselstyn’s research that was focused on low fat intake and my research that was initially focused on lower protein intake converged, pointing to the elimination of animal based food consumption that was so highly correlated in international studies with Western diseases.
Why China Holds the Key to Your Health
I have been a researcher, lecturer, and policy advisor in the field of diet and cancer for nearly 45 years.
Since 1963, primarily from an academic position, I have seen the many faces of establishment science and have been both rewarded and distressed by what I have witnessed. I have seen a vast increase in consumer nutrition information and, regrettably, an almost equal increase in consumer confusion. One week we hear that eating meat increases our risk of colon cancer, the next week the exact opposite. One news report states that dietary fat is not related to breast cancer, another says it is. It seems to me that public confusion has grown far beyond acceptable limits.
In the 1980s, I was invited by Senator John Glenn’s U.S. Senate Committee on Governmental Affairs to offer an opinion about why there is so much confusion. My opinion then and now is that we tend to think so specifically about ideas and products that we fail to comprehend the main message. We stare fixedly at the trees and miss the forest. Specific ideas and products provide immediate money for the entrepreneur, grant money for the scientific researcher, and some degree of presumed “certainty” for the educator and publicist. They do not necessarily promote good health. Despite all our products and proclamations, more people are overweight in the U.S. than ever before. By the latest count one out of every three adults is overweight, an increase from one in four in the late 1970s.
The real aim of science is to advance knowledge about what makes you healthy, reduce your confusion, and alleviate human suffering. When I look at these problems strictly from the science point of view, I know there can be no quick intellectual fix. But I also know that the present confusion is beyond reasonable limits and something new is required. Thus, my colleagues and I felt that a newsletter of a different kind could provide a starting point. From this was born the idea of Nutrition Advocate, a newsletter advocating a diet based on a variety of quality plant foods and providing simple explanations so you can make reasonable decisions at your own pace.
As practicing scientists and researchers, we believe that we have done our homework. The science presented in these pages is the best that we can provide. Much of our research is based on the Cornell-Oxford-China Study (“China Project”), the most comprehensive survey of the connection between diet and disease in world medical history. The New York Times hailed this investigation, directed from Cornell University, as the “Grand Prix of all epidemiological studies.” These discoveries have vigorously challenged and altered existing conceptions about nutrition and health. We are now prepared to share more of these findings so you might join us in our excitement.
Why We Went To China
Previous studies relating nutrition to degenerative disease have mostly been limited to consideration of single factors and single diseases. Yet even when large surveys have been taken, they have generally produced mixed results. This is because these studies have largely been conducted in the developed world, where everybody eats more or less the same thing.
The China Project offers a rare opportunity to study disease in a precise manner because of the unique conditions that exist in rural China. Approximately 90% of the people in rural China live their entire lives in the vicinity of their birth. Because of deeply held local traditions and the absence of viable food distribution, people consume diets composed primarily of locally produced foods. In addition, there are dramatic differences in the prevalence of disease from region to region. Various cardiovascular disease rates vary by a factor of about 20-fold from one place to another, while certain cancer rates may vary by several hundredfold.
These factors make rural China a “living laboratory” for the study of the complex relationship between nutrition and other lifestyle factors and degenerative diseases. As a result, the China Project is the first major research study to examine diseases as they really are, multiple outcomes of many interrelated factors.
These factors make rural China a “living laboratory” for the study of the complex relationship between nutrition and other lifestyle factors and degenerative diseases.
When Is an Illness Normal?
The data from the China Project suggest that what we have come to consider as “normal” illnesses of aging are really not normal. In fact, these findings indicate that the vast majority perhaps 80 to 90%of all cancers, cardiovascular diseases, and other forms of degenerative illness can be prevented, at least until very old age, simply by adopting a plant-based diet.
In China, we found people whose diets ranged from being very low in fat (6% of calories) and almost entirely made up of foods of plant origin, to diets that contained significant amounts of animal products and even much higher amounts of fat (24% of calories). Dietary protein also varies across China. When we compare people on diets that are virtually nil in animal protein with those for whom animal protein is upwards of 20 to 30% of the total protein intake, the cholesterol levels go, on average, from around 90 mg per 100 ml to about 170 mg per 100 ml (see chart, below). Such an increase in cholesterol is associated with the emergence of the cancers and heart disease that increasingly plague the world’s developed nations.
Protein Key to the Cholesterol Dilemma
Earlier studies have provided impressive evidence that when a reduction in fat is compared to a reduction in protein, the protein effect on blood cholesterol is more significant than the effect of saturated fat. Blood cholesterol levels can be reduced by reducing dietary animal protein and exchanging it for dietary plant protein. Some of the plant proteins, particularly soy, have an impressive ability to reduce blood cholesterol. I really believe that dietary protein both the kind and the amount is more significant as far as cholesterol levels are concerned than is saturated fat. Certainly it is more significant than dietary cholesterol. While we don’t know how animal proteins have this effect, we do know that animal protein has a quick and major impact on enzymes involved in the metabolism of cholesterol.
I can understand why some of you may not want to consider that animal protein creates the same problems as excess fat intake, but it turns out that animal protein has many undesirable health effects. Whether it is the immune system, various enzyme systems, the uptake of carcinogens into the cells, or hormonal activities, animal protein generally only causes mischief. If you are switching from beef to skinless chicken breast and other animal-based food simply to reduce your intake of fat, it is my opinion that this may be a start, but it is not a solution. Even lean cuts of meat still contain around 20-40% of total calories as fat, or sometimes even more. You may get your fat intake down a bit, but your protein intake is not going to change.
Change is the Name of the Game
Personally, since coming upon these findings, my family and I have managed to change our diets substantially. I know what it’s like to eat meat. I was raised on a dairy farm and I milked cows from the time I was 5 until I was 21. When I went away to school, I eventually got my Ph.D. in animal nutrition at Cornell, where I worked on a project to produce animal protein more efficiently. So both my personal life and my professional life were entirely on the other end of the research findings that we’ve been getting.
Blood cholesterol levels can be reduced by reducing dietary animal protein and exchanging it for dietary plant protein. Some of the plant proteins, particularly soy, have an impressive ability to reduce blood cholesterol.
We started changing our diet when our children came along, and we have been changing ever since. In the short run, people who are accustomed to a high-salt, high-fat diet are not going to like healthier foods at first. But if you have a little patience, you will find that after two or three months, perhaps longer, you will pick up new tastes. Tastes do change. You will then discover that you are happier and more fit than ever before. In Nutrition Advocate we will provide the science to help you make the right decisions.
Nutritional Simplicity
In our next issue, I will begin to share with you some of the consequences of eating a typical American diet, along with a few provocative ideas about what’s missing in much of current gene research. The news reports telling you the way your genes determine your chances for getting cancer or other ailments are only telling you half the story. I’ll be filling in some of the “missing ingredients” in our next issue and give you some nutritional clues for ways you can help beat the odds, no matter what kind of genes you have.
East/West Cholesterol Report: China’s high is almost equal to the U.S. low!
With interest in diet and nutrition increasing at an unprecedented pace, I find that I’m asked to travel much more than in earlier days. I recently returned from England and Russia, where I was heartened to see the burgeoning interest in good nutrition. In England, where I serve as Senior Science Advisor to the World Cancer Research Fund (WCRF), I joined a group of senior researchers to comb through research grant applications from the very best scientists. WCRF, in my view, has taken the lead role in the world today to promote education and research on diet and cancer. After meeting in England, I flew on to Russia, where I joined several colleagues who are actively helping to restructure Russia’s biomedical science organizations. How very heartening to see so many at work in this troubled country making the link between diet and disease. It is my hope that more of the well-established scientific research institutions will take notice of this turn in events, so that all of us can more effectively chart a clearer path to wellness.
The message of the China Project is one of simplicity. You might say we are primarily interested in the symphony, secondarily interested in the individual musical notes
The message of the China Project is one of simplicity. You might say we are primarily interested in the symphony, secondarily interested in the individual musical notes. We believe the notes are most meaningful when perceived within the larger composition, especially when the symphony represents the very essence of our planetary well being. We must take more seriously the comprehensive effects of whole diets, rather than randomly tracking the misleading effects of individual nutrients and other odd chemicals. The time for making these linkages is now. The China Project data rigorously challenge many of our long-held nutritional assumptions and offer immense opportunities for improving our dietary habits on a global scale.
T. Colin Campbell is the Director of the Cornell-Oxford-China Diet and Health Project. He was trained at Cornell (M.S., Ph.D.) and MIT (Research Associate) in nutrition, biochemistry and toxicology. He presently holds the endowed chair of Jacob Gould Schurman Professor of Nutritional Biochemistry at Cornell University.
References
Brody, Jane, “Huge Study of Diet Indicts Fat and Meat,” The New York Times, May 8, 1990.
Chen, J., Campbell, T. C., Li, J., Peto, R. Diet, Life-Style and Mortality in China. A Study of the Characteristics of 65 Chinese Counties. Oxford, UK; Ithaca, NY; Beijing, PRC; Oxford University Press; Cornell University Press; People’s Medical Publishing House, 1990. 894 pp.
How Sweet is a Sweet Potato? Pretty Sweet!
Sweet potatoes are a super food that I have only recently come to appreciate. When preparing my lecture on heart disease epidemiology for ournew eCornell course, I found reports of several traditional cultures known for avoiding heart disease that subsist largely on this delicious tuber. In fact, a 1978 paper[1] cited a dietary survey finding that sweet potatoes supplied about 90% of total calorie intake in the traditional subsistence culture of the Papua New Guinea highlanders. 90%! Sinnett and Whyte write, “Indeed, non-tuberous vegetables accounted for less than 5% of the food consumed, while the intake of meat was negligible.” There was no evidence of malnutrition from this diet and no evidence for hypertensive heart disease.
Here are some facts to chew on. If HALF of your diet was solely baked sweet potatoes with no salt, you would get all the nutrients in the table. To top it off: you get all this in a package with a lower glycemic index than white potatoes and many grains[2].
Nutrients in 1000 calories of sweet potatoes (about 10)[3]
Percentage of daily requirements (2000kcal diet)*
* Nutrient amounts calculated from USDA, reference 3, using the average daily requirements listed onhttp://www.dsld.nlm.nih.gov/dsld/dailyvalue.jsp
http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2667/2
References
- Sinnett P, Whyte M. Lifestyle, health and disease: a comparison between Papua New Guinea and Australia. Med J Aust 1978;1:1-5.
- Willcox DC, Willcox BJ, Todoriki H, Suzuki M. The Okinawan diet: health implications of a low-calorie, nutrient-dense, antioxidant-rich dietary pattern low in glycemic load. Journal of the American College of Nutrition 2009;28 Suppl:500S-16S.
- USDA National Nutrient Database for Standard Reference, Release 26. In: U.S. Department of Agriculture, Agricultural Research Service; 2014.
A Health Disaster in the Making
In 2002, the Food and Nutrition Board (FNB) of the National Academy of Sciences (NAS) released their most recent recommended nutrient intakes.
Since 1943, the FNB has been telling us how much of each nutrient to consume, in the form of the Recommended Daily Allowances (RDAs). This Board, and its companion Dietary Guidelines Committee of the United States Department of Agriculture (USDA) that translates the FNB recommendations into practical food guides, create what is generally known as national nutrition policy. The influence and responsibility of these two panels is omnipotent and awesome. Numerous government-supported programs use these recommendations, including the school lunch program, the Women, Infants and Children (WIC) program, and Medicare-reimbursed meals for hospitals and nursing homes.
Having been a member of several diet and health policy-making expert panels over a 20-year period, until 1997, I harbored the naïve view that these panels were dedicated to the promotion of consumer health. I no longer believe this.
This report makes clear that the food and health practices that have brought us so much illness in recent decades will remain intact, perhaps even made worse. Two of three Americans are overweight and ‘adult-onset’ diabetes is now attacking our children. The long-time high rates of various cancers and cardiovascular diseases remain mostly impervious to change. We’re paying increasing amounts of money – lot’s more – and getting less. An even faster food nation awaits us, to paraphrase Eric Schlosser’s book.
In this most recent FNB report, we see some brand new recommendations, especially for the macronutrients (protein, carbohydrates, fat) that supply our calories. Instead of recommending nutrient intakes that are based on single RDA numbers as in past reports, this new report allows for ranges of intake that are said to “meet the body’s daily nutritional needs while minimizing the risk for chronic disease”. The main conclusions are highlighted in the executive summary and news release. “Adults should consume 45 to 65 percent of their total calories from carbohydrates, 20 to 35 percent from fat [up to 40% for children], and 10 to 35 percent from protein.” The report also says that we can consume up to 25% of our energy from added sugars found in sweets, pastries and soft drinks. Expressing optimal nutrient intakes as ranges is certainly more informative and realistic than were the single-number RDAs of past reports. But defining and setting these boundaries must be based on a careful and complete review of the evidence.
Let’s consider the case for protein, which symbolizes our preferences for food more than any other single nutrient group. The lower limit of 10% dietary protein is equivalent to the RDA of previous reports, first published in 1943. Indeed, this quantity is already above the theoretical requirements of almost all people. Professor Henry Sherman of Columbia University was largely instrumental in establishing this recommendation, based on a 1920 summary of about 100 subjects. He suggested that about 8% of dietary calories was enough but offered that for those “whose temperaments lean toward a higher protein intake”, a range of 10-15% might be in order.
However, because we practically worship protein-rich foods, the vast majority of us have decided to ‘pig out’ within the range of 11-22% dietary protein, with most of this extra protein coming from animal based foods. But we do so at considerable health risk, partly due to the excess protein itself and partly due to the kinds of foods that mainly provide such a high protein intake. Only a very few of us consume diets as high as 22% protein, generally for ‘pumping iron’.
Now, we are to understand the astounding conclusion that consuming diets as high as 35% protein(!) lies within a range of “minimizing the risk for chronic disease”. The disease-promoting implications of this new recommendation are staggering. There is voluminous evidence showing that consuming diets ‘only’ as high as 20-22% protein increases the risk of many serious diseases. But the FNB committee says that we can go to an even higher level of 35%, without ill effect.
Increasing animal-based protein consumption up to dietary levels well below 35% associates with higher blood cholesterol levels and more atherosclerotic plaque (even more than saturated fat), greater risk of cancer (caused by multiple mechanisms), greater bone loss of calcium and higher risk of osteoporosis, greater risk of Alzheimer’s disease, and greater formation of kidney stones, to name just a few chronic diseases that the FNB committee mysteriously ignores or claims to remain unaffected by this high protein intake. These ignored findings are not the results of a few isolated experiments. In most cases, they represent a summary of multiple studies, some of which are even many decades old.
This report makes other macronutrient recommendations that are equally troublesome. It is said, for example, that we can safely consume up to 25% of our daily energy as added sugars, meaning candies, soft drinks, sweetened food products and pastries, some products of which are also loaded with added fat. The committee acknowledges that obesity has become a health problem of great concern but then disingenuously blames ‘high carbohydrate’ diets for the problem. Like certain popular diet book authors, they err in this view because they fail to distinguish between the health benefits of complex carbohydrates (e.g., whole grain products), which were previously recommended, and the health problems of refined sugars and starches (e.g., sweets, pastries and refined flour pastas), which were never recommended by previous reports.
The FNB report also lifts the lid on dietary fat. Previous reports recommended keeping dietary fat under 30% but this recent report now says that we can go up to 35%, even up to 40% for children.
Groups who use this report will be encouraged to consume the same diet of sugar and starch type carbohydrates and high fat and animal-based protein foods now making us fat and fertilizing the growth of our chronic diseases. Admittedly, past recommendations have not stemmed the rising tide of chronic degenerative diseases during the past few decades. But these recommendations, themselves, were lukewarm, partly because of a perception of insufficient evidence and partly because of a timidity of confronting a growing food industry offering up a buffet of protein-rich, fat-rich, processed foods. We now have overwhelming evidence to show that a plant-based diet of whole foods, low in fat and protein and high in complex carbohydrates (but not in refined carbohydrates!), is associated with substantially lower rates of these diseases. Furthermore, we also now have substantial information on how these foods produce their biological benefits.
This report represents a backlash against emerging but convincing evidence that now terrifies the food and drug industry. However, it does its best to remedy this problem by cooking up a bunch of sweets for these industries. Corporate health will undoubtedly be enhanced but consumer health will undoubtedly be set back, perhaps for decades.
I take no comfort in discovering a very troubling corporate influence in the making of this report. For example, the Chair of the sub-committee responsible for setting the upper limits for these macronutrients departed the panel before its conclusion for an executive position with the world’s largest food company who will find these goodies especially tasty for their bottom line. His replacement was someone who openly acknowledges that he knows very little about nutrition, as this has not been his field. The FNB Chairman, who helped select panel members, is a well-known associate of the dairy industry. During his chairmanship of the companion Dietary Guidelines Committee, his industry ties regrettably became known only through court-enforced legal action. I also find it troubling that this report received funding from food and drug companies who will find its contents especially tasty.
I do not recall such egregious conflicts of interest during my tenure with such advisory panels. It is time that advisory panels and their parent organizations who develop diet and health policy take more responsibility of fully revealing all potential conflicts of interest. Further, I would urge that they consider disallowing researchers with serious conflicts from holding leadership positions on these panels. The public deserves far more than they are getting from this very important report.
RDA’s: Time to Peel Back the Labels
RDA’s: Time to Peel Back the Labels
Every once in a while, when strolling through the grocery store with my wife, Karen, I get up the nerve to look at those nutrient profiles on the side of the package.
Even though I was recently on a National Academy of Sciences committee on food labeling, responsible for redesigning this information, I still wonder what all this really means. The Recommended Daily Allowances (RDAs) are the nutrient levels considered by governments and industry throughout the world to be desirable for good health. But how desirable are they really? Let’s see what’s beneath the label.
To begin with, the RDA is just what it says it is. It’s a recommended allowance; it’s not a minimum requirement. The underlying assumption is that if you consume exactly the RDA level for a specific nutrient, there is a very high (97-98%) probability that you will exceed your actual minimum requirement. In other words, to play it safe, the RDA represents a substantially higher intake than what you need.
Why then do so many people believe that they must consume an intake at least equal to or even higher than the RDA? This is because the food and vitamin supplement companies carefully coach us to believe in RDAs. For them, this idea makes money, and lots of it. It’s an easier “sell” to say that the nutrient content per serving of a company’s particular product comes closer to the RDA than that of their competitors.
The idea of RDAs started reasonably enough when a few folks began asking about the nutrient value of military rations during World War II. The decision was handed over to the Food and Nutrition Board of the National Academy of Sciences. Ever since, this authoritative body has stood at the helm of so-called “good health” by issuing their revised listings every five years. But let’s look at what these reports are actually saying. First, there is an RDA given for each nutrient, broken down according to age and sex. Each RDA represents the minimum intake for a “single” nutrient, along with an upward adjustment thrown in for good measure. While this presumably provides us with a “safety check,” no range is given with high and low numbers. This single bottom number, already higher than the minimum requirement, suggests to many, “the more, the better.”
Making Money from RDAs
Folks, it just ain’t so. Witness the recent beta carotene revelations. You may recall that this study was halted when scientists reported the death rate from lung cancer was 28% higher among the participants who had taken the massive doses of beta carotene and vitamin A than those who had taken a placebo, and the death rate from heart disease was l7% higher. At least in countries like the U.S., where gorging is often the norm and vitamin supplements are treated as medicine, we ought to be thinking more about nutrient excesses than deficiencies. Note especially vitamin labels boasting such claims as “high potency” or “super-stress” formula. This problem is compounded when we forget about good wholesome diets (of plant-based foods) where nature works wonders in her own way.
Another serious problem goes something like this. In the absence of adequate scientific information, scientists establish RDAs which tend to be biased in favor of conventional levels of intake. But what are these “conventional” intakes? It’s this: they are those intakes which characterize diets that are high in fat, low in fiber, and high in animal proteinthe very kind of diet which causes us so many problems. Thus, a tendency exists to keep RDAs for plant-based nutrients low, while keeping animal-based nutrients high.
Even when we know it’s questionable, we find a very strong tendency to maintain the status quo. Vitamin C, for example (only available in plants), is given an RDA of 60 mg/day even though considerable information suggests that levels around 200-300 mg/day are more beneficial. And beta carotene, obtained almost entirely from plants, doesn’t even have an RDA. Generally, beta carotene is viewed as only a part of the “real” vitamin A, called retinol, which is found only
in animal-based foods. Dietary fiber, another plant-based nutrient, is relegated to the same non-category as beta carotene, and is similarly deprived of an RDA status. When it comes time to hand out RDAs, plant-based nutrients are either not assigned one or are given an RDA biased toward the low side. To register the higher, more appropriate intakes would suggest eating considerably more fruits and vegetablesa tough thing to do for meat and potatoes folks.
Standing on Shaky Foundations
By contrast, RDAs for animal-based nutrients are characteristically biased upwards. To take but one example, the RDA for calcium (at 800-1200 mg/day) is considerably in excess of the much lower intakes that are adequate for those on a plant-based diet. Probably a more accurate figure, based on our China Project surveys, would be closer to 400-600 mg/day. Especially in the case of calcium, the amount of the nutrient needed is influenced by the type of diet consumed. That is, a high-dairy diet brings along baggage in the form of extra protein. And this extra protein causes calcium to be lost; thus more is needed. Why not try cutting down on dairy products so you require less calcium? In this country, about 60-70% (on average) of total calcium intake is provided by dairy products.
RDAs have for a long time provided the so-called bedrock for dietary recommendations, such as the Basic Four Food Group guide, despite their shaky foundations. Used for so many years as a “good” general nutrition message by the United States Department of Agriculture (USDA), the Basic Four Food Group guide was devised to ensure adequate intakes of certain nutrients, especially those which supported high intakes of animal-based foods. As a result, scientists were inclined to “discover” that vegetarian diets were deficient in some nutrientscalcium, “good quality” protein, “good quality” iron, riboflavinwhen they were actually being judged against the biased RDA standards.
Heeding Mother’s Advice
Even though I believe that RDAs have mostly been an albatross around the neck of sound nutrition education, they may possess some value in defining nutritional profiles of large populations. That is, nutrient reference standards, such as the RDAs, can give a rough idea of a nation’s comparative nutritional health. But even so, I still wonder what useful purpose is served when nutrient intakes of a population are judged by reference standards prejudiced in favor of a low-fiber, high animal protein and fat diet.
Of all the dietary recommendations, RDAs are the oldest. In my view, they have been problematic from the start. Fortunately, the USDA’s Basic Four Food Group guide, with its emphasis on RDA standards, is now virtually dead. Still more fortunate is that we are now getting the U.S. Dietary Guidelines and the USDA Diet Pyramid, which pay less heed to the RDAs and which give somewhat more emphasis to plant-based foods, although this emphasis is still preciously limited. And then there are the newer Mediterranean and Asian Diet Pyramids, produced by a prominent well-heeled consumer based agency, which give considerably more emphasis to plant-based foods. I’ll comment on these newer nutrition guidelineswhere they succeed and where they failin an upcoming issue.
Progress is painfully slow in this arena where Big Science, Big Politics, and Big Business tell us what to eat. I rather still like that old advice of our mothers and grandmothers: eat your vegetables!
References
Campbell, T.C., “More Is Not Necessarily Better.” Natural History, 90:12-16, 1981.
Kolata, Gina, Studies Find Beta Carotene, Taken by Millions, Can’t Forestall Cancer or Heart Disease, New York Times, Jan. 19, 1996.
T. Colin Campbell is the Director of the Cornell-Oxford-China Diet and Health Project. He was trained at Cornell (M.S., Ph.D.) and MIT (Research Associate) in nutrition, biochemistry, and toxicology. He presently holds the endowed chair of Jacob Gould Schurman Professor of Nutritional Bio-chemistry at Cornell University.
Coconuts are for nuts only.
I Should Use Coconut Oil, Right?
By Anne Ledbetter, EdD November 21st, 2014 News21 Comments
A quick Internet search reveals that coconut oil must be a super healthy food. The health benefit claims include: increased endurance, reversing Alzheimer’s, stress relief, weight loss, bone strength, skin care and more. Of course coconut oil belongs on my healthful food shopping list, right? Not so fast.
Beyond what folks selling products want us to consider, some vegans and even plant-based foodies believe that using coconut oil has got to be healthy because after all, a coconut is a plant. In their natural unprocessed state coconuts, corn and olives are all plants. However, a serving of highly refined plant (even organic) oil is quite different than taking a bite of fleshy coconut meat, eating niblets of corn, or popping an olive in my mouth.
This explains why many science based, optimal health advocates such as Dr.’s T. Colin and Thomas M. Campbell, authors of The China Study use a more specific term a whole food, plant-based (WFPB) diet. WF takes the level of food processing into consideration. Dr. Caldwell Esselstyn Jr., author of Prevent and Reverse Heart Disease, advocates a no oil WFPB diet and lifestyle.
Dr. Esselstyn’s mantra is “NO OIL!” How can he be so emphatic? Could it be that vegetable oils have absolutely no: fiber, carbohydrates, protein, vitamins, minerals, or essential fats? Is it possible that a lot of calories and an abundance of saturated fat lurk in the fatty “healing elixir?” Maybe it’s because oil injures the endothelium, the innermost lining of the artery, the ‘gateway to vascular disease.’ Matthew Lederman MD, co-author of Keep It Simple Keep It Whole, strongly supports the no oil WFPB diet as well.
If interested in learning more about coconut oil, be sure to check out Dr. Ledermans’s article from our Plant Based Nutrition Certificate Program. Dr. Lederman describes medium chain fatty acids (MCFA’s) and “why vegetable oils are better used for lubricating vehicles and skin than consuming as food”.
Dr.’s Campbell, Esselstyn and Lederman are T. Colin Campbell Center for Nutrition Studies faculty.
Image Credit: Alex Masters / Flickr
No Whey! Man
No Whey, Man. I’ll Pass on the Protein Powder
By Guest Author November 7th, 2014 The Wheys of Dairy & Casein123 Comments
For the past fifteen years, I have been closely involved with the bodybuilding industry. I have an intimate understanding of how the industry operates. In a nutshell, it is sustained by the supplement companies that sponsor the athletes who represent them. This in turn inspires fans who admire the athletes to purchase the products they represent, thus creating a cycle that drives record sales and profits, all the while potentially harming the health of many involved in the industry later on down the line.
Two of my favorite professional bodybuilders, Nasser El Sonbaty and Mike Matarazzo, recently died in their forties, likely from diet-related health issues. In all probability, their deaths were a result of too much protein consumption, coupled with the use of performance enhancing substances day after day until their organs failed. Now they’re gone. This is not a rare occurrence in bodybuilding. Though bodybuilders exercise more than the average person, the rate of bodybuilders suffering from diet-related health problems is often more common than the general American public falling ill to diet-related diseases. Clearly, there is a problem that needs to be addressed.
If there is one thing in the sport of bodybuilding that is as common as weight training, it is the use of supplements. No supplement is more widely consumed than protein powder. The powders of choice among mainstream bodybuilders are whey and casein, which are proteins derived from cow’s milk. In fact, these are the substances of choice for most protein powder consumers worldwide.
Athletes from all walks of life embrace the consumption of excess protein under the assumption that more is better. Many companies (and entire industries) have gone to great lengths to convince the public that they need to seek out high protein foods and consume as much protein as possible, without any consideration of the health consequences that accompany excess consumption. The focus on consuming large amounts of protein is so engrained in our culture, there are often warnings given out by friends and relatives of those following a plant-based diet that protein will be hard to come by without consuming animal products. That is another way protein supplements squeeze their way into the diets of citizens everywhere, through the unwarranted fear that we won’t get enough of this specific nutrient, suggesting whey and casein as plausible aids in this quest.
Years ago, I learned from Dr. T. Colin Campbell’s book, written with his son, Dr. Thomas Campbell, The China Study, that casein has the ability to turn on and turn off cancer growth simply by adjusting the level of intake of that protein. This was determined through years of clinical trials, experiments, and tests, which yielded these results, and are outlined in detail in Dr. Campbell’s research. His findings show that when casein is consumed in large quantities, cancer cells increase in size, and when there is a cessation in consumption of casein, cancer tumor cells recede.[1] I later learned that elevated levels of protein can also cause kidney damage, liver problems, kidney stones, excess fat gain, contribute to the damaging of the lining of artery walls, lead to plaque build up in arteries, result in lethargy, diminish bone density, and cause a host of other health problems. If this is truly the case, as it has been revealed by Dr. Campbell and numerous other world renowned experts who came to the same conclusions through experimentation, observation, and scientific research, why are these products consumed at such high levels? With their direct correlations to increased risk of disease, why is casein, which has been linked to illnesses such as prostate cancer, more than any other protein, allowed to be sold in stores? Why are these products even produced? After all, who needs them, besides calves?
If we have special protein powders created from cow’s milk for human consumption, it would only make sense that it must be because our society sees a very high rate of protein deficiency. But, that isn’t the case at all. In fact, a protein deficiency is almost unheard of in America and only exists in someone who does not consume adequate calories. The reason this is so, is because of the macronutrient make-up of food. Food is only made up of proteins, fats, carbohydrates, and water (and sometimes alcohol). Some level of protein is present in all foods, and in significant quantities in specific types of foods such as beans and other legumes, nuts, seeds, leafy green vegetables, other vegetables and grains. The amount of protein required by the human body (5-10% of total calories per day) is relatively low in comparison to the other macronutrients. It is therefore impossible to be protein deficient when sufficient calories are consumed. This is how nature works. In reality, most people in developed countries, including those following a plant-based diet, eat too much protein, not the other way around.[2] We clearly don’t have a health or nutritional need for whey or casein protein powders, so why are they here, why are they so popular, so common, and why is their use so infrequently questioned?
Part of the answer lies in the world of bodybuilding and the magazines, books, websites, athletes, and other individuals that feed the industry. The community that I have been part of for so long is a key factor in keeping these antiquated ideas about protein alive. It is therefore my (and others’) mission to effectively dispel these myths by showing a healthier way to support fitness goals without the use of any substances that came from a cow’s udder. As a semi-retired bodybuilder and current health and wellness advocate and multi-sport athlete, I endorse a whole-food, plant-based diet for optimal results, even when bodybuilding. I aim to put the desire for elevated levels of protein to rest by showing how a relatively low protein, whole-food, plant-based diet can support all athletic endeavors effectively and efficiently. I have achieved great results as a plant-based athlete for the past two decades, and have sought to lead by example.
If health is your goal, clearly, your answer to cow-based protein powders should be, “No whey, man.” Let’s put this into perspective. If you had to buy a clearly labeled animal-derived fat powder and carbohydrate powder at the same time of purchase as a whey or casein protein powder, would you proceed with the purchase? Or would it seem so silly to get your required macronutrients from canisters of animal by-products, the cashier at the store would raise an eyebrow and question your sanity? Consider these questions the next time you think about buying powders made from cow secretions for proper nutrition. How about eating something from a garden instead? Not only is it a much healthier choice, but fresh produce is a lot more appetizing, too.
References
Campbell, T.C., Campbell, T.M. (2006). The China Study. Dallas, Texas: BenBella.
Do Vegetarians Get Enough Protein? (2014). Retrieved from (link).
Guest Author Robert Cheeke
Robert Cheeke, bestselling author of Vegan Bodybuilding & Fitness, and author of the new book, Shred It!, available on http://www.veganbodybuilding.com.
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The Collapse of Cardiology
By Caldwell B. Esselstyn, Jr., M.D.
January 17, 20007 — Recent weeks have witnessed a collapse of the drugs and technology which form the present back bone of cardiology’s assault on the coronary artery disease epidemic. Is this a dark shadow over our cardiac health or could it be a time to rejoice?
Pfizer, in late December 2006 announced its long hoped for block- buster new drug Torcetrapib was killing more people in its test run than were dying in the control group. Pfizer had spent 800 million in developing this drug to raise HDL, “good” cholesterol and had openly forecast it would reap billions for the company once it came into production. But the research trial was clear and unequivocal with its results. Among 15,000 patients, 82 died taking Torcetrapib and 51 died taking a standard drug to lower cholesterol Additionally the Torcetrapib group experienced a greater number of cardiac events such as angina, heart failure, and a need for angioplasty. The independent monitoring group advised Pfizer to halt the trial and they complied. The unfathomable mysteries of human metabolism could not tolerate the assault of this drug. It was making vascular disease worse not better.
The double whammy for cardiology also developed in the second half of 2006. Reports from Europe in September 2006 indicated that patients utilizing the new drug eluting stents were suddenly having heart attacks and some were dying. While the number was small (0.5%), it was disturbing to cardiologists and remains frightening for patients.
When an artery to the heart is severely narrowed and causing symptoms cardiologists insert a balloon tipped catheter to the area of blockage and expand the balloon to widen the constriction. The benefit of this angioplasty is lost in 50% of patients because of recurrent constriction in 6 months. Placing a metal scaffold or stent improves the results to only 10% to 20% recurrent narrowing. Starting in 2003, stents were coated with a drug which diminished the rate of recurrent blockage after angioplasty. However, it is essential to maintain patients on an anti clotting drug for 6-12 months to prevent the stent from developing a clot or thrombosis. It now appears that after stopping the anti-clotting drug 1 in 200 or 0.5%or 5,000 nationwide and 10,000 persons worldwide will have a heart attack and 50% of these will die when the stent fails. These results have so upset cardiologists and the Federal Drug Administration that a national conference was called in December 2006 to review this disturbing news. Watching intently and participating were the stent manufacturers Johnson and Johnson and Boston Scientific. Billions of dollars are at stake.
Following testimony, experts contend that for patients with uncomplicated disease the benefits of the drug-coated stents outweighs the risks. For patients with more advanced or complicated disease patterns the outlook is less clear and more research data is required. What is clear is that everyone feels it may be necessary to prolong the period requiring the anti-clotting drug: Plavix from months to years or indefinitely. However Plavix is not without complications. It promotes bleeding, which may mean a gastrointestinal hemorrhage as well as easy bruising. The most desperate situations occur when a patient taking Plavix must stop it for dental work, hip or other major surgery and colonoscopy. Will they have a heart attack or die from a stent clot when Plavix is stopped? This scenario has occurred and is continuously encountered. It is as if a therapy for one disease now is painting patients into a corner from which they can not escape when other illnesses require surgical therapy.
This Gordian knot has lead leading cardiologists to question stent therapy.
Dr. Eric Topol, a member of the conference panel stated, “There’s a much more liberal use of angioplasty and stenting than there needs to be.”
The head cardiologist at Kaiser Permanente, Dr. Calvin L. Weisberger added, “A large pool of angioplasties and by pass surgery are being done with out scientific evidence.”
The hard science, which seems not to be prominent in all these discussions is that it is not the major blockages which are treated by angioplasty and stents which account for heart attacks. The small unstable juvenile arterial plaques are prone to rupture and cause over 85% of heart attacks, and they are not treated by angioplasty or by-pass surgery. Then why do cardiologists treat the blockages unlikely to cause the heart attacks? There is a lingering belief that somehow the patient will be improved by widening the opening, and there is the unspoken force of money – huge guaranteed money from doing these procedures.
Then there is the harshest critic of all- scientific research. Study after study indicates for most patients undergoing angioplasties and stents, there is no increase in survival and no decrease in heart attacks.
Why might this be a time to rejoice? The morbidity, mortality, expense and transient benefits of a high technology approach toward the coronary disease epidemic, has failed. It is time to realize that the answer to a faulty lifestyle epidemic is not drugs and technology – it is lifestyle. The epidemiologic evidence that coronary artery disease does not exist in cultures consuming plant-based nutrition is robust and overwhelming. There is clear evidence that cultures which switch from a plant based culture to a western diet develop an epidemic of coronary heart disease. Lewis Kuller, Professor of Medicine at the University of Pittsburg School of Public Health, based on his 10 year cardiovascular health study states “all males 65 years of age or older who have been exposed to the traditional western diet have cardiovascular disease and should be treated as such.
This toxic diet with its burden of animal protein, dairy, processed oils, white flour, sugar, and excess saturated and trans fats and free radicals marinates in our bodies injuring our delicate cellular matrix with every bite at every meal. Science shows us how this occurs. We depend mightily on the capacity of our endothelial cells, which comprise the single cell layer lining our arteries, to manufacture nitric oxide. Nitric oxide is the strongest vasodilator in the body. It causes blood vessels to enlarge, prevents blood flow from being sticky or sluggish, and inhibits arterial plaque formation.
The brachial artery tourniquet test quantifies the endothelial responses. The test requires an ultrasound measure of the diameter of the brachial artery below the elbow before and after an upper arm tourniquet stops blood flow to the forearm for 5 minutes. Normally when the cuff is released and the brachial artery ultrasound measurement is repeated the artery dilates or widens. This occurs from a healthy out pouring of nitric oxide from the endothelium. When volunteers consume cornflakes their brachial artery tourniquet test is normal. If they consume sausage, olive oil, or saturated fat they fail the test. The ingested fat so injures the endothelium that it cannot produce nitric oxide. Regular consumption of the toxic western menu is a cardiovascular disaster. The time is long overdue to challenge the failure of drugs and technology to stop the coronary disease epidemic.
The natural next question is can patients who have severe coronary artery disease arrest and reverse this disease by consuming a totally plant based diet?
Dr. Dean Ornish and this author have investigated this question through scientific peer reviewed study. Dr. Ornish reported his results at one year and again at 5 years. This author reported results at 5 years, 12 years and most recently at 21 years in a book for the public, Prevent and Reverse Heart Disease, Avery /Penguin, February 2007. These studies indicate that fully compliant patients decrease the episodes of angina or eliminate them, decrease their cholesterol, decrease their weight, increase their exercise capacity, and arrest and selectively reverse their disease on follow up x-rays of the coronary arteries. Seeing these patients thrive beyond 20 years of initiating their plant-base therapy is the most powerful reason for wanting the cardiology community to embrace and utilize plant- based nutrition. There is no morbidity, mortality or added expense with plant-based nutrition and benefits endure and improve with the passage of time. Cardiologists say they doubt that patients will follow such a nutritional change. My experience in counseling hundreds of these patients indicates this concern is flatly not true. As a matter of fact, patients rejoice in the knowledge that they have become the locus of control over the disease that was destroying them and are distraught they were never told of this option by their cardiologist.
In summary, the dark shadow cast over cardiology, through failure of its miracle drug and the melt down of drug eluting stents with unforeseen clotting resulting in heart attacks and death should motivate us to look more closely at a proven therapy which is effective and endures and has the potential to eliminate the coronary heart disease epidemic, as well as other chronic western illness such as strokes, hypertension, adult onset diabetes, obesity, impotence and dementia.
Caldwell Esseltyn MD is a preventive cardiology consultant in the Department of General Surgery Cleveland Clinic Foundation, Cleveland, Ohio, and the author of the forthcoming, “Prevent and Reverse Heart Disease” due out February 1, 2007.
The Way To Eat 