Food Over Medicine (23 page)

Furthermore, the U.S. Preventive Services Task Force has now said that PSA tests are useless and men should not have them. The task force’s conclusions were based on five clinical trials that showed PSA testing does not save lives and that having the test leads to more tests and treatments that cause impotence, incontinence, and other side effects.
¹³

The lead researcher, Dr. Virginia Moyer, stated, “Unfortunately, the evidence now shows that this test does not save lives. This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does.”

GM:
And the Dexa scan for osteoporosis is worthless?

PP:
Completely.

GM:
How about genetic testing to find out if you have the genes for breast cancer or something?

PP:
Harmful, terrible. It labels people as patients. It turns them into victims.

GM:
The case for genetic testing is that it simply makes people aware of their risk profile.

PP:
Yeah, and then you have to live with that information.

I had a member who recovered from an autoimmune disease who’s doing quite well, actually. She has been practicing dietary excellence. Her sister died of ovarian cancer, so her family and her doctor pressured her to undergo genetic testing. They found that she had the gene mutation that predisposed her to have ovarian cancer, so the doctor removed her ovaries. While taking them out, they found out that she had some diverticular pouches, so they recommended a colonoscopy.

She asked me for my opinion. I said, “I want you to think about what’s happened in the last thirty days. You were happy, living your life with two ovaries; now you’ve had two ovaries removed and the doctor wants to do a colonoscopy. When are you going to stop this? How much more are you going to let them do to you? You have two well-formed bowel movements every day; you have no bowel problems. Those diverticular pouches are probably left from the days when you were a cheese eater.”

If these interventions just stopped with notifying someone she is carrying the gene mutation and she could put it in the back of her head and forget about it, that would be great. But
nobody
puts it in the back of her head and forgets about it. We think we have to do something about it. Human beings are designed and engineered to solve problems; generally speaking, that’s a pretty good idea. If I have a flat tire, I need to get a new tire; we’ve got to solve that problem. But when you get into a lot of these tests with their dubious results about genetic predispositions, all you’re doing is putting terrible stress on people who are not medically knowledgeable. You may be solving a problem you don’t have.

GM:
What about Pap tests?

PP:
While I don’t oppose the Pap test as much as the others, its importance has been overstated, and the test too often results in overtreatment. According to Dr. Welch in
Overdiagnosed
, a fifteen-year-old girl who has annual Pap tests has a 75 percent chance of eventually having a colposcopy
¹⁴
(the procedure to biopsy abnormal cells). There is no watchful waiting or dietary change recommended in response to an abnormal Pap, and the treatments range from simple freezing with local anesthesia in the doctor’s office to hysterectomy. The American College of Obstetrics and Gynecology now recommends that screenings start much later and be performed less frequently.
¹⁵

GM:
I wonder if the tide is turning. Nine medical societies, taking part in an initiative of a group called Choosing Wisely, have come up with a list of forty-five dubious medical services, most involving testing.
^16
,
17

PP:
That’s a long overdue first step.

GM:
Let’s turn to mental health. Can diet be related to the condition of depression?

PP:
It can be. First, there are a lot of people being diagnosed with depression who are eating a terrible diet; they’re dehydrated, sedentary, out of shape, tired, have no energy, have low sex drives, sleep poorly, and suffer other related symptoms. These are also common symptoms of depression. I think some doctors are quick to label patients as depressed when there are other things going on. Sometimes an optimal diet, drinking adequate water every day, and exercise will cause the person to feel better, to have more energy, feel more clearheaded, sleep better, have an improved sex drive, and other noticeable improvements.

Then we have people who are depressed for visible reasons, such as the loss of a loved one or a job. We are labeling everyday stress and disappointment as depression and medicating people for it, when what they really need is just time to process their emotions.

Even for those who are truly clinically depressed, diet is important; they will feel better and think better, which will help them to get more out of therapy and to resolve their problems. Of course, nobody is saying that diet is the whole remedy; a truly depressed person won’t overcome his issues with broccoli.

For the clinically depressed, therapy can be helpful if it is the right type of therapy. I recommend Cognitive Behavioral Therapy (CBT), which has been shown to be very effective for treating conditions like depression, anxiety, ADHD, and other mental and emotional disorders. It works quickly—usually fourteen sessions or so—there’s a very low recidivism rate, and drugs are rarely used. The therapists who practice CBT are to the mind and emotions what Dr. Caldwell Esselstyn and Dr. McDougall are to the cardiovascular system and the endocrine system.

If you seek help for depression, I think the first thing you should say to your doctor is that you’re not interested in a pharmaceutical solution to your problem. You’re interested in talking and working your way through it. Psychotropic drugs are being dispensed like candy in this country and their side effects, including addiction, can be highly destructive. You want to avoid them at all costs.

GM:
What do you think underlies the overprescription of antidepressants?

PP:
There’s a real arrogance today to the practice of psychiatry. Right now, we know that taking antidepressant and antianxiety drugs not only increases your risk of suicide but they ultimately make people more depressed.
¹⁸
That’s why people have to take multiple drugs, which have to be constantly switched out to be effective. Forty percent of the time, there’s absolutely no response to the drugs at all,
¹⁹
other than the depression getting worse. However, it doesn’t stop psychiatrists from prescribing them. The trend in the psychiatric profession is to do less and less talk therapy, so the profession is now attracting people who don’t like people. They have no interest in relating to people; they don’t want to talk to them, and they don’t have to talk to them; they just prescribe drugs.

Doctors are very smart people, but I think many times we’re admitting the wrong people to medical school. We’re bringing people into the profession who are very bright and technically very proficient, but they don’t have the right idea about what medical practice should be about: preventing, stopping, and reversing disease. So they go to work every day and get used to the idea that everybody gets worse, everybody has to have more drugs, everybody has to have more procedures. Most of them are still making a lot of money and don’t really have much interest in changing anything. I suspect that many of them like remaining ignorant. When confronted with evidence, they’ll get upset about being confronted, but many will just continue to do what they’re doing.

GM:
You know, you’re remarkably antidrug and antisupplement for a woman named “Popper.”

PP:
Maybe I overcompensate.

GM:
Out of curiosity, when was the last time you went to a medical doctor, Pam?

PP:
That was in 1994, about nineteen years ago. A cat bit me, and I got an infection. I went to a doctor, told him I needed an antibiotic and which one I wanted, and got out of there in ten minutes.

I want to make it clear that I have nothing against doctors. I’ll go back promptly the next time I need one.

....................................

GM:
Before we discuss specific clinical evidence, let’s talk about the fact that people are understandably confused by studies. You hear on the news that vitamin E is good for the heart and then you hear that vitamin E isn’t good for the heart. Or you hear that fish oil lowers cholesterol and heart attacks and then you hear that it doesn’t. Why do we get contradictory results? Can we believe any of these studies?

PP:
The first thing that I tell everybody when I’m giving public lectures, or when they join The Wellness Forum, is that you should always look at every study with some skepticism. No study by itself is really important; it’s a study taken into consideration with the preponderance of the evidence that either adds weight to its importance or completely discounts it altogether. For example, the dairy industry put out a study—yes, it actually did commission such a study—that showed that dairy helps people lose weight. So you read the headlines and you think, “Gosh, I’d better go get some ice cream and cheese to slim down.” But if you look at all of the studies that have been done on the topic, and there are a couple dozen of them, only a couple show that dairy helps you lose weight. And, oh, by the way, they were done by the same guy at the University of Tennessee who was paid $1.7 million by the dairy industry for those studies. On top of which, it’s patently illogical that calorie-rich, dense, fatty foods should help anyone lose weight.

And so when we take a look at all of the rest of what’s out there, the preponderance of the evidence says these two studies are irrelevant. Then let’s take an opposite example. Dr. Caldwell Esselstyn’s study shows that you can reverse heart disease, stop its progression, and actually reverse it with diet. That alone is provocative, but then you add in the China Study, you look at all the population studies that show that people who eat more of a plant-centered diet have less heart disease, and you add in the rest of what we know, suddenly that one study with eighteen patients starts to seem significantly more important. I tell people not to get carried away with the latest study or the latest headline, but to take a deeper look and use their brains when they read something that sounds too good to be true.

There are also ways, which we expound upon in one of the classes we offer from time to time, to sort through nutritional confusion with research. We show people how to evaluate research and go through why they don’t need to be concerned with short-term changes and biomarkers that may not be significant for their long-term health. Remember, we live in a country where people are dying with excellent blood work, so we need to weigh more heavily studies of health practices that produce improved quality of life and longevity than studies of health practices or drugs that produce better biomarkers. There are some guidelines that you can use to look at research even as a layperson and make some pretty good decisions about what’s reliable and what’s not reliable evidence.

GM:
How did the researcher manage to devise two studies that showed dairy helps you lose weight? How did he rig the results?

PP:
Well, you can do a lot of things. You can do some things with selection criteria. For example, if you wanted to skew a study to show that people eating a plant-based diet don’t fare better than people eating meat, just make the selection criteria the answer to the question “Do you eat meat and dairy?” No other criteria involved. So you could choose to enroll in the study a 475-pound person (like Del used to be) who would say, “I’m vegan; no meat, no dairy, no fish.” Obviously, he’s doing something wrong or he wouldn’t weight 475 pounds, so he’s probably going to be worse off than the meat eaters. You then publish a study that states a plant-based diet isn’t very helpful.

One thing that the drug companies do is recruit what we call “perfect patients.” Let’s say they need to find 1,700 people out of the more than three hundred million in our population to do a study on a new cholesterol-lowering drug. Since they want to minimize the side effects, they find 1,700 people who have high cholesterol diagnosed for the first time recently and have absolutely nothing else wrong with them. The researchers put these perfect patients on the drug; their cholesterol goes down with minimal side effects. Once the drug gets approved, that’s not how the general public will use it. The drug gets used by many people who are taking four or five other drugs and have lots of other things wrong with them, including side effects that are significantly more severe.

Another problem with studies is that the research can just be plain sloppy. I hate to say that, but in this day and age, particularly if there’s industry funding, the study design is not carefully scrutinized. And universities, in my opinion, are simply happy to see money coming in. A lot of these researchers have to fund their own departments or offices, so the lure of money to produce a study that shows a certain result can really lead to some sloppy study design. They can also skew the interpretation of the results; the study may not actually isolate dairy as a causative factor in weight loss, or the results can be so vague or insignificant as to not make any difference, but it can be reported in relative terms as if it’s significant.

And then the study may only see a two-pound difference in weight loss between two groups but it is reported as people who eat dairy products lost 50 percent more weight than the other group. Well, the first group lost four pounds and the second group lost six pounds, which is 50 percent more, but it’s a pretty meaningless number. There are all kinds of things that researchers can do, ranging from selection criteria for the subjects to how they define and measure the outcome and at what intervals to measure it, to how they report the findings, whether they are framed in absolute or in relative terms.

Sometimes, too, you can portray an apparently positive outcome without taking the negative consequences into consideration. The obvious example in the diet business is the Atkins Diet. People lose weight on the Atkins Diet, but they also get sick. I’ve always said if the only thing we’re considering is that “it works,” then let’s throw in everything that works. Cocaine addiction works for weight loss. I’ve had lots of cocaine addicts in this office over the years and they were all skinny people. Now, we can all agree that cocaine addiction would be a ridiculous approach to weight loss. Well, so is the Atkins Diet in terms of adverse health effects.

GM:
There’s also the matter, when an isolated food or diet is being studied, of what kind of diet it’s being compared to. Very rarely are studies, let’s say of dairy or fish consumption, compared to a low-fat, plant-based diet; it’s always compared to the standard American diet.

PP:
Yeah, that’s a big issue. And even when they do use a control group that is eating a plant-based diet, or they consider that the intervention diet, it’s not a well-structured diet. Our chef ate his way to 475 pounds on a plant-based diet. Just giving up meat doesn’t make you a healthy eater at all; it has to go beyond that. That’s where the comparison group can make all the difference in the world in terms of showing a result.

Take Loren Cordain, the guy who promotes the Paleo Diet. One of the reasons his diet looks so good when he tells stories (and he doesn’t use a lot of research—he tells a lot of stories) is that he takes people who are eating the standard American diet, which includes fast food and cheese and pizza and toaster pastries and all this stuff you shouldn’t eat, and puts them on the Paleo Diet, which is heavy on meat, vegetables, and fruit. And they generally get better, since they’ve cut out dairy, refined sugars, and a lot of processed foods. So you conclude, “My gosh, the Paleo Diet is spectacular.” Well, the Paleo Diet is spectacular compared to where people were before, but in terms of comparing it to people eating the diet that I recommend, it’s not spectacular at all. What the comparison group is doing helps determine the value of these studies.

GM:
I once called the lead researcher of a study that had led the national news; the study was that high profile. This was a 2002 study published in the
Journal of the American Medical Association
that found that dairy consumption reduces insulin resistance syndrome.
¹
I found that very remarkable news, the idea that dairy could reduce insulin resistance and therefore reduce diabetes. Here’s how the lead scientist designed the study: it was a self-reporting study; he divided foods people ate into three categories: dairy, non-dairy, and mixed. He didn’t include data from the mixed group in his study because, well, I guess he found mixed foods inherently ambiguous. It turns out that cheeseburgers were considered mixed. Macaroni and cheese was mixed, and so were double-cheese pizzas; none of that was considered dairy. I mean, if a double-cheese pizza was mixed, I wondered, then what was considered pure dairy?

PP:
Maybe deep-fried butter on a stick?

GM:
Yeah, maybe deep-fried butter on a stick, although the sugary glaze could make it a mixed dish. You know, these are the kind of questions that only a highly trained scientist can answer. There are clearly some nuanced distinctions here that are over my head. But I’m pretty sure that if you suckled directly from the teat of a bovine, it was considered dairy.

I called the man up and said, “Look, you’re claiming with evidence that excludes pizza and many other cheesy foods that insulin resistance can be reduced with dairy. Since you want to isolate the effect of dairy on insulin resistance, why don’t you actually do a study that compares people who eat dairy in all its forms, including pizza, with people who eat no dairy at all and look at the results there?” And he said, “Hmm, that’s an interesting idea.” Like it took remarkable insight to come up with that. But I don’t believe he’s ever done that study.

PP:
Because it’s something that the dairy industry would never fund.

GM:
In fact, I believe his study had been funded in part by General Mills. Okay, let’s talk about some studies that you feel do have value.

PP:
Well, let’s start with the work of Dr. Esselstyn that I alluded to earlier. I want to start with him because his work has rightly garnered so much attention, leading Bill Clinton to essentially adopt the diet we recommend. What I like about Dr. Esselstyn’s results is that they’re based on clinical practice; they’re clear, impossible to dispute, and really unimpeachable.

Back in the mid-1980s, Dr. Esselstyn took twenty-four cardiac patients and asked them to follow a low-fat vegan diet. The rules of his diet were simple: no animal foods, no oil, no refined grains, and no nuts. He did not ask his patients to eliminate alcohol. About 9 to 12 percent of the calories in the diet were from fat. It turned out that eighteen of the twenty-four patients were compliant with the diet. Those eighteen very sick individuals, some of whom had been all but given up for dead by standard medical practitioners, had collectively experienced forty-nine cardiovascular events in the eight years before they adopted Dr. Esselstyn’s diet regimen. There had been four heart attacks, three strokes, seven bypass surgeries, and nine of the patients suffered from increasing angina attacks.

After dietary intervention, the blood cholesterol of the compliant patients had dropped from an average of 246 mg/dl to an average of 137 mg/dl.
²
Follow-up angiograms determined that not only had the progression of disease been reversed in all patients but at least eight had actually reversed their disease, meaning that there was a significant opening of their coronary arteries. With the exception of one participant who stopped being compliant with the diet six years into the program, there were no new cardiac events in any of the patients during the first twelve years of the program.

Now consider the odds. What are the chances that Dr. Esselstyn just got lucky and his eighteen patients by random chance happened to get healthy and avoid cardiac events for the twelve years on his diet after they had collectively suffered forty-nine of them in the prior eight years? For any single individual who had had several cardiac events in the prior eight years, you might estimate his chances as being one in ten that he’d manage to survive the next twelve years without another such event. For that to happen to all eighteen individuals based on random chance, you’d be looking at odds of one in 10 to the 18th power.

The efficacy of the diet becomes clearer still when you compare the results of those eighteen compliant patients with the six who dropped out of the study in the first year or so and went back to their old ways of eating. What happened to them was just what you’d expect. Reviewed by Dr. Esselstyn in 1998, their cases of heart disease all progressed, and they had four more bypass operations, increasing angina, heart failure, and one death. So it’s just not possible to make the case that it could have been anything other than diet that was responsible for the remarkable results that Dr. Esselstyn achieved. It’s also worth noting that Dr. Dean Ornish has conducted similar studies, with a slightly different but similarly low-fat diet, and more emphasis on lifestyle, and achieved comparable results. As Dr. Ornish once said about the question of evaluating studies, “The more significant the degree of change, the more likely it is that the change is not due to chance.”
³
Well, the degrees of change in health outcomes that both Dr. Esselstyn and Dr. Ornish have achieved in clinical studies have been highly significant and parallel.

GM:
So the efficacy of diet has been proven, but do we have studies to determine how important a role genes play?

PP:
Yes. Many studies have demonstrated that genes are less important than diet. This is an important idea to communicate because many people have a very defeatist attitude about their health that gets reinforced by their very learned cardiologists and other medical doctors who say, “Well, it’s certainly not surprising that you’ve developed diabetes. I’ve been treating your mother for diabetes for the last fifteen years and your grandfather died of it. Of course this was destined to happen to you, and because you’re a helpless victim of this relentless disease, we have to put you on these medications.”