Food Over Medicine (25 page)

PP:
Well, we don’t really have any studies showing what happens when you take a massive dose of it.

GM:
I don’t mean a dose beyond what you would recommend, but five hundred micrograms is what my bottle says. It’s five hundred micrograms of B
₁₂
that’s been isolated, not integrated in food. Does the body know how to handle that?

PP:
Yes, and here’s kind of an interesting thing about B
₁₂
that’s different from other supplements. B
₁₂
is bound to the protein in food and has to be separated from the protein by enzymes in the stomach; intrinsic factor helps a little bit with that. And when you take it in its supplement forms, it’s already in what we call its free form, so it’s actually pretty immediately useable. It’s one situation where a supplement is actually easier to contend with than B
₁₂
in its natural form.

GM:
What do clinical studies tell us about oils?

PP:
They tell us that they’re not health foods. This goes heavily against the grain of popular wisdom. There’s a myth that it’s not the amount of fat we’re eating, but it’s the type of fat; that olive oil is heart healthy and fish oil particularly heart healthy. Unfortunately, the evidence just doesn’t take us there. In fact, oils can be successfully used to treat autoimmune conditions because they suppress immune function.
¹²
I don’t think it’s the right way to treat autoimmune conditions, but the fact they suppress immune function should tell a healthy person you don’t want to be taking in a lot of this stuff.

I particularly like a study that Dr. David Blankenhorn did; he was looking at people consuming a “normal” diet versus those eating more of their fat as monounsaturated fat, which is what comes from olive oil, supposedly the healthy oil that we all want to include more of in our diet. It basically showed that the disease progressed just as much in those who consumed olive oil, high in the supposedly healthier monounsaturated fat, as it did in those who were consuming more saturated fat.
¹³
The study proves that people have got to ratchet the fat consumption down; they won’t see any benefit by consuming olive oil instead of saturated fat in chicken or beef.

And we know that if people make dramatic, sweeping changes, they’re more likely to stay compliant; that’s been proven in clinical studies.

GM:
Tell me about those studies.

PP:
They’re crucial studies. I can’t tell you how many times over the years I’ve had people (many of them in health care) say to me, “Okay, let’s assume you’re right about how healthy this diet is. Nobody’s going to do this. Even if you can get them to do it, they’re not going to stick with it.”

Dr. Neal Barnard did some early studies on Dr. Ornish’s patients and found out their compliance levels were much higher than expected and they were much happier with their diets than the people eating the more moderate diet. He’s also surveyed patients in his own studies to assess satisfaction and compliance on what we would think is a pretty strict diet and found the same thing. They’re happier eating the stricter diet; they’re happier with the results and they stay with it longer.

He did two of these studies, actually. One study showed that Dr. Ornish’s patients were compliant on his diet to treat heart disease,
¹⁴
and another on diabetic patients.
¹⁵

GM:
More compliant than … ?

PP:
More compliant than patients following dietary guidelines set by the American Heart Association or the American Diabetes Association. You see, if you’re in the business of helping people change their diets, the specificity of the advice that you give becomes very important. Part of the problem with the diets recommended by our colleagues who stress moderation is that not only do they not work but their health status doesn’t change. Our colleagues don’t know what the heck they’re talking about. Vague instructions about eating a little less of this or a little more of that are unclear and unworkable because “a little less” can mean something completely different to two different people. However, when people come here or they go to one of Barnard’s programs or they’re with Dr. Ornish or they’re with Dr. McDougall, the directions are really specific. Now, you can choose to not follow them, but all of us are very clear in what we’re saying to people, so they have a much easier time with implementation.

I can tell you from personal experience that people will stick with dietary instructions if they’re presented with the right evidence, which is partly a matter of understanding the futility of what they’re currently doing. We can get them to make the change, but, contrary to the conventional wisdom, if we get them to make the big sweeping change, they’re much more likely to stick with the diet they’ve adopted. The reason is that big changes in diet bring about big changes in health; the changes are highly motivating. There’s a clear discernible difference in their health and in their weight. Doctors are telling me all the time, “I tell people to alter their diet this way or that way; they try, but they don’t stick with it.” Well, that’s because it seems like a whole lot of effort for not much return. But if you take a type 2 diabetic and put him on a diet that reverses his diabetes in two weeks, or if you take somebody with erectile dysfunction and you solve the problem in a matter of a month, those people aren’t going to be as interested in cheeseburgers anymore. They see the results of the dietary changes they’ve made and it motivates them to stay compliant. And diet always brings results quicker than drugs.

GM:
As studies prove?

PP:
Absolutely. Diet changes work incredibly fast, as was initially demonstrated in a study done by Dr. James Anderson at the University of Kentucky. He did studies on diabetic patients using a low-fat, high-fiber, plant-based diet in the 1980s. He showed that in three weeks, type 1 diabetics could reduce insulin by 40 percent, cholesterol dropped by 30 percent, and twenty-four out of twenty-five type 2 diabetics were able to completely discontinue their insulin medication.
¹⁶
If you talk to endocrinologists who are using metformin or insulin or whatever combination of drugs they’re using to treat diabetics, they can’t get the treatment right in a three-week time period, let alone reverse the type 2 diabetes or reduce insulin needs in a type 1 inside three weeks. These are nothing short of miraculous results that cannot be duplicated with drugs. We’ve seen people have their cholesterol drop by eighty points in five days. You can’t do that with a statin drug. And so not only is this diet better than the drugs from a health perspective but it’s more effective than the drugs and works faster.

GM:
Well, what do we know from studies about the effectiveness of drugs and surgical interventions for cardiovascular disease?

PP:
There were three major studies that showed that surgical intervention was no better than drug therapy: the 1984 Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group;
¹⁷
the European Coronary Surgery Study Group of 1988;
¹⁸
and the Coronary Artery Surgery Study of 1990.
¹⁹
All three studies showed that the outcomes for patients who have bypass surgery versus patients who only take drugs are the same, with the exception of an advantage to the surgery group for those with damage to the left ventricle. There was also the AVERT study that showed that patients who did not receive angioplasty but took Lipitor experienced fewer heart attacks, less chest pain, and made fewer visits to the hospital.
²⁰

Angioplasty involves risk: often the inflating of the balloon releases plaque and causes heart attacks. And very often the arteries are blocked again within a few months of the procedure. Yet we spend billions of dollars a year on angioplasty.

The research shows that bypass surgery is really only warranted about 3 percent of the time—in those cases when doctors can get to somebody during or right after a myocardial infarction, or when there’s extensive damage to the left ventricle. Other than that, it’s a totally voluntary and useless surgery that costs about $100,000 over a five-year period for the surgery and follow-up care.

When we consider how useless these surgical interventions generally are, we need to factor in that about twenty thousand people per year die as a result of angioplasty
²¹
and another ten thousand die as a result of bypass surgery.
²²
It’s unconscionable that this practice continues. So the question comes up, and I’ve asked it of Dr. Esselstyn, “Why do we keep doing this?” He says, “Well, Pam, somebody’s got to pay for these cardiac cathedrals that they build.” The average hospital, after all, thrives on bypass and angioplasty. So it’s the unwitting patients and their insurance companies who wind up paying.

GM:
We’ve talked about studies that show that surgical intervention for cardiovascular disease is generally no more effective than drug therapy. But exactly how effective is drug therapy?

PP:
Not much at all. We have many studies that show that cholesterol-lowering drugs don’t significantly reduce the risk of heart attack, stroke, or death. So why would someone take a useless drug unless he has stock in Merck and feels like he ought to support the cause? No one should want to take these drugs. In fact, the package inserts on the drugs pretty much say that in small print; Crestor is one. The prescribing information states that Crestor reduces the risk of major cardiovascular events by 1.2 percent.
²³
That’s not much of a risk reduction, particularly when factoring in the side effects. So it will lower cholesterol levels, but it’s not very effective for actually solving the problem. What it will do is help a person die with good blood work.

GM:
It seems to me such a powerful, provocative statement to say that cholesterol-lowering medication doesn’t reduce the risk of death. How does that affect a nation of doctors who are prescribing such drugs? Do they realize it’s not reducing the risk of death or serious events? Do they accept that?

PP:
A lot of them do. But so many doctors get their information from drug reps and through continuing medical education programs sponsored by drug companies. This, combined with the fact that many don’t read medical journals regularly and don’t know how to interpret the results of the articles they do read, is why so many patients get bad advice from doctors.

GM:
When my mother was about seventy years old, my parents moved to Florida. She had suffered from angina since her mid-fifties and after seeing her, my mother’s new cardiologist immediately recommended she have an angioplasty. Luckily, my father, who was always skeptical of the medical profession, was in the office with her and said, “Well, you could do that, honey; it’s your heart, after all. Just keep in mind that if you do it, I’m going to leave you.” So there was a big fight in the doctor’s office with the doctor saying, “Who are you going to listen to, him or me? What does he know about medicine? If you’re going to listen to him, then you’re fired. I don’t want you as a patient!” Well, my parents had been happily married for more than forty years. My mother obviously didn’t want to get divorced, so she refused the intervention, the doctor fired my mother, and she never went back to him. She’s ninety-three years old today and has never had a heart attack or any cardiac event. I’ve got her on a low-fat, plant-based diet; she’ll probably outlive that cardiologist.

PP:
I always find it interesting when doctors fire patients. It’s despicable. Basically, what the doctor is saying is, “You’ll do as you’re told. I’m not interested in having you as a patient if you decide to have an original thought or become proactive on your own behalf.” They don’t say it in those words, but that’s the essence of what they’re communicating.

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

GM:
Pam, we’ve talked a lot about individual dietary choices and their effect on human health. But there are also collective choices we make as a society that influence health in all kinds of ways, not least by directing, or misdirecting, the citizenry in making their individual choices. So let’s discuss public policy and propose some changes to the status quo.

PP:
Well, public policy has to change because we simply cannot afford to keep spending as much as we spend on health care and expect to have either a vibrant economy or a balanced budget. It’s simply impossible. We spent $8,000 per person on health care services in 2009, the most of any country in the world by a long shot. Poor Norway limped along in second place at $5,000 per person. So we’re spending 60 percent more than the second most expensive health care system in the world.
¹
That’s insane, particularly for a country that ranks thirty-sixth in the world in longevity. If a company made laptops and it was spending 60 percent more for microprocessors and other parts than its competitors, and yet its laptops came in thirty-sixth in a test for durability, I don’t think that company would be in business very long.

GM:
When I think of our health care system, I’m reminded of what my doctor said to me once. As I mentioned, he’s got a humble approach to his practice, which is why I return to him annually. He said, “I’m not interested in the practice of health care. I’m interested in the practice of medicine.” I asked him what the difference was. He told me that he sees health care as the system that doctors get caught up in: he has to see so many patients per hour, deal with the insurance companies, diagnose and treat according to guidelines, etc. He’s dismissive, to put it mildly, of the health care system. He’s passionate about the practice of medicine; medicine to him means a lot of talking and listening, getting to know his patients, and treating them as individual human beings. He happens to believe in colonoscopy screening, but when I turn it down annually, he hears me out and he’s fine with that.

PP:
The problem is medical education. There are plenty of doctors who have the best of intentions, but they’ve never been schooled in nutrition. If they’re seeing patients with degenerative diseases and they’re not practicing nutrition, they’re not practicing medicine, period.

Doctors are taught to mitigate and treat symptoms. We need to set the bar higher in training health care professionals. Health care has to become outcome-oriented. We have to teach doctors that stopping the progression of diseases, and even reversing diseases, is an option.

GM:
How do we do that?

PP:
Be the first one to show up in your doctor’s office reversing disease with diet. Doctors were never taught in school that you can eat your way out of disease. However, be your doctor’s first patient who does, and maybe your doctor will take a fresh look at diet as an intervention tool. Until medical schools give doctors a proper education, patients may have to do it.

GM:
And then there’s the education of the rest of us. The schools are key to getting children off to a healthy start in life, yet school nutrition guidelines are effectively written by agribusinesses through their shills in the U.S. Department of Agriculture (USDA). What can be done to help kids eat healthy lunches in schools?

PP:
Well, first, of course, if you can pack a healthy lunch for your child that’s generally best, but that’s not an option for everyone. We need to concern ourselves with what’s offered in the cafeteria. The federal nutrition guidelines allow for meals that are 30 percent fat, which is a good way to promote obesity, and it’s been quite effective at doing just that.

GM:
In fact, the problem is even worse than those obscene guidelines, because in 2005 only 30 percent of schools met the guidelines for maximum saturated fat allowed in school lunches.
²
So first they set preposterously unhealthy guidelines and then find even those lax guidelines too onerous to meet, so they violate them with impunity. They’re making children obese and diabetic and sick in countless ways, and we know that obese children and adolescents often become obese adults. So the degree of failure here, both moral and nutritional, is stunning.

Representative Jared Polis of Colorado, a rare congressman who’s aware of these issues, introduced The Healthy School Meals Act of 2010, for which the Physicians Committee for Responsible Medicine (PCRM) is fighting the good fight. This would be only a first step, but a terrific first step, toward improving school nutrition. It would increase the availability of plant-based foods in schools, incentivize schools to provide plant-based options, such as plant milks, and remove the restrictions currently in place for non-dairy milks. Children would no longer have to bring in a note from their doctor explaining why they don’t choose to drink bovine lactation fluid. Unfortunately, the bill may not have a chance to be voted on until the Child Nutrition Act next comes up for renewal in 2015. But in the meantime, before the government acts, parents and even children have to take matters into their own hands.

PP:
Right. One of the reasons why our own foundation’s focus is at the local level is that a great deal of authority has been taken away from the local school or school system, but not so much that a group of concerned parents, teachers, or students can’t make substantive changes in their local schools. If you want better lunches for your kid, you can start gathering a group of interested people who can begin to put pressure on the school system to set up a committee to get this done. You don’t want to focus on getting all the unhealthy foods, like cow’s milk, out of the school because that’s not likely to happen any time soon; instead, you want to focus on insisting that healthy alternatives be made available. A salad bar, at least one low-fat vegan option, and a plant milk should be offered every day. This would make life easier for the nutritionally aware parent who now won’t be forced to prepare a lunch every day, and it would expose all the children, whether their parents have a consciousness around these issues or not, to some healthy choices. People shouldn’t feel hopeless and powerless at the local level; that’s where the most immediate solutions are available.

GM:
Let’s say there’s a high school kid who’s on the diet we recommend, and he would like to have new kinds of food choices in the cafeteria. What should he do?

PP:
Let me tell you the story of a very exclusive private school here in Columbus. A group of students got together and sent a letter to the headmaster. They wrote something like this: “We get a great education here. We have unparalleled opportunities and we appreciate that. Our facilities are second to none.” And they went on with praise. And then they said, “But there’s one area in which we feel that the school has not paid much attention to—it’s not up to par with the rest of what goes on here—and that is the food that’s served in the cafeteria. We think that an educational institution that strives for excellence everywhere should pay as much attention to this issue as to academics.” It was a very well-crafted, polite letter; I was astounded that it came from high school students. After it stimulated some parents to get active on the issue, changes were made in the cafeteria. Now, that was in a private school. You can imagine that with tuition bills being as high as they are, private school administrators are likely to show responsiveness to the concerns of parents and students.

I have another example from a public school situation. I met a young woman whose mother had converted to a plant-based diet for health reasons. She got into it after her mom and discovered that there was nothing for her to eat at school. She started asking why. She spoke to the people who were running the cafeteria and was told, essentially, “That’s just the way things are.” She refused to accept that, so, as a sophomore in high school, she started a campaign that actually resulted in changes in the cafeteria. I think that kids can make a big difference because when kids initiate a campaign for healthy food, that immediately overcomes the argument that the advocates for the status quo constantly bring up, which is that kids won’t eat healthy food. Well, present a letter signed by two hundred kids saying, “We want healthy food,” and they can’t use that easy, thoughtless excuse anymore.

Let’s keep in mind, too, that high school is supposed to be about getting kids to think critically. So why not get them to think critically about something that’s critically important, like their health? We ought to be assigning kids comparative research on health issues. For example, give them the assignment to research the question, “Is cow’s milk good for you or bad for you?” Give them a dozen websites to visit, equally divided between those that do and do not advocate consumption of cow’s milk, and let the kids prepare their findings and offer their own opinions. They can weigh the opinions expressed by PCRM against those offered by the American Diabetes Association. I don’t think you’d find too much pushback on that idea. I don’t think a lot of parents are going to protest, “Forcing my kid to do research is a bad idea.” We can be considerably more adventurous in a high school classroom than in a grade school classroom, and we should be.

GM:
So we should invite kids to actually think about their health?

PP:
Absolutely. That’s going to pay dividends in untold ways. I have every confidence that high school students who research these issues will wind up, more often than not, making better choices for their health. I bet they will also wind up knowing more about nutrition than their doctors.

GM:
Hospitals, like schools, are sometimes public and sometimes private institutions, but it seems to be the case that hospital food is almost universally atrocious.

PP:
Hospitals are run by health care professionals; we have to train health care professionals about diet. If you or I walked down the halls of a hospital, we’d be appalled at the food served: meatloaf, eggs and bacon, greasy pancakes and butter, chicken and turkey, and macaroni and cheese served to people who’ve had heart attacks and strokes. Now, if someone came to the hospital for emphysema, they wouldn’t be offered cigarettes. However, if they come in for any number of medical conditions, they’re served the very foods that caused them. Yet doctor after doctor, nurse after nurse, and dietitian after dietitian walk down the halls of a hospital and see patients eating these meals that are counterproductive to their recovery. By doing nothing about it, they are essentially saying, “This is okay with me!”

GM:
What would happen if doctors, nurses, and dietitians told hospital administrators, “We can’t feed people like this.”

PP:
If enough of them spoke up, I believe that it would change overnight. In the meantime, patients need to complain and bring in healthy food from the outside. And if you’re bringing in food from the outside, I suggest you negotiate with the hospital to reduce the bill, since there’s no reason you should pay for food that, for your own good, you refuse to eat.

GM:
I read an article recently about film director Duncan Roy, who was wrongly imprisoned in the Los Angeles Men’s Central Jail for a period of months, in which he said, “People in that jail are hungry, and nobody gives a damn.”
³
I don’t think prison food is something the general population cares a lot about, but it’s not hard to imagine that the facts, if reported, would be Dickensian. What could or should be done about prison food?

PP:
Dr. Antonia Demas is a friend of mine who did a remarkably low-cost project in Miami at the Bay Point School, a residential school for violent male juvenile offenders. She recruited a group of kids and asked them to eat a plant-based diet, to participate in the preparation of the food, and to keep a journal while they were engaged in the project. And the kids started getting better grades, their health improved, their athleticism improved, and their behavior improved.
⁴
She brought to one of our conferences excerpts from their journals with their names redacted. In the beginning of one of the journals, the writing was so bad you could hardly read or understand it. And then, thirty-five pages in, the kid’s writing is completely legible, the grammar has changed, the sentences are finished, the thoughts are clear, and the statements were amazing.

GM:
Is the implication that the diet itself is improving clarity of mind?

PP:
Oh, absolutely. This is explainable from a medical perspective because we know that the brain is a huge user of water, oxygen, and glucose. When you don’t eat well, it’s not just that you’re not fueling your body—you’re not fueling your brain. When people eat the food that their bodies are designed to eat, they think more clearly, they are able to participate in life better, and they make better decisions. I remember one kid wrote in his journal about how one of the benefits of this experience was that he would one day be able to make healthy food for his wife and his family. Now, for a juvenile offender to have positive thoughts like that toward women and family because he’s been exposed, in a caring way, to a diet that helps people care for themselves, speaks volumes.

I think a lot of people would perceive feeding prisoners a good diet as providing them with an undeserved luxury. Actually, I think the people who would benefit most would be society at large. The guards and the wardens would certainly have an easier time and we would return prisoners back to society as more productive people.