The China Study (4 page)

THE CHINA STUDY
12
wooden barn floor in front of us and then opened a box containing fine
black powder. The powder, he explained, was bacteria that would help
the alfalfa grow. They would attach themselves to the seeds and become
part of the roots of the growing plant throughout its life. Having had
only two years of formal education, my father was proud of knowing
that the bacteria helped the alfalfa convert nitrogen from the air into
protein. The protein, he explained, was good for the cows that would
eventually eat it. So our work that morning was to mix the bacteria and
the alfalfa seeds before planting. Always curious, 1 asked my dad why
it worked and how. He was glad to explain it, and 1 was glad to hear it.
This was important knowledge for a farm boy.
Seventeen years later, in 1963, my father had his first heart attack. He
was sixty-one. At age seventy, he died from a second massive coronary.
1 was devastated. My father, who had stood with my siblings and me for
so many days in the quiet countrySide, teaching us the things that 1 still
hold dear in life, was gone.
Now, after decades of doing experimental research on diet and health,
1 know that the very disease that killed my father, heart disease, can be
prevented, even reversed. Vascular (arteries and heart) health is possible
without life-threatening surgery and without potentially lethal drugs. 1
have learned that it can be achieved simply by eating the right food .
This is the story of how food can change our lives. 1 have spent my
career in research and teaching unraveling the complex mystery of why
health eludes some and embraces others, and 1 now know that food
primarily determines the outcome. This information could not come
at a better time. Our health care system costs too much, it excludes far
too many people and it does not promote health and prevent disease.
Volumes have been written on how the problem might be solved, but
progress has been painfully slow.
SICKNESS, ANYONE?
If you are male in this country, the American Cancer Society says that
you have a 47% chance of getting cancer. If you are female, you fare
a little better, but you still have a whopping 38% lifetime chance of
getting cancer.1 The rates at which we die from cancer are among the
highest in the world, and it has been getting worse (Chart 1.1). Despite
thirty years of the maSSively funded War on Cancer, we have made little
progress.
Contrary to what many believe, cancer is not a natural event. Adopting

13
PROBLEMS WE FACE, SOLUTIONS WE NEED
CHART 1.1: CANCER DEATH RATES (PER 100,000 PEOPLE)1
250
200
150
DMaie
100                                                  •    Female
50
O~--L--
1972-1974            1992-1994
a healthy diet and lifestyle can prevent the majority of cancers in the
United States. Old age can and should be graceful and peaceful.
But cancer is only part of a larger picture of disease and death in
America. Looking elsewhere, we see that there is an overall pattern of
poor health. For example, we are rapidly becoming the heaviest people
on earth. Overweight Americans now significantly outnumber those
who maintain a healthy weight. As shown in Chart l.2, our rates of
obesity have been skyrocketing over the past several decades.2
According to the National Center for Health Statistics, almost a third
of the adults twenty years of age and over in this country are obese! 3
One is considered obese if he or she is carrying more than a third of a
CHART 1.2: PERCENT OBESE POPULATION2
35
30
25
20
15
10
5
0
1976-1980           1988-1994          1999-2000

14                          THE CHINA STUDY
person above and beyond a healthy weight. Similarly frightening trends
have been occurring in children as young as two years of age.3
CHART 1.3: WHAT IS OBESE (BOTH SEXES)?
5'0"                                  153
5'2"                                  164
5'4"                                  174
5'6"                                  185
5'8"                                  197
5'10"                                209
6'0"                                 221
6'2"                                 233
But cancer and obesity are not the only epidemics casting a large
shadow over American health. Diabetes has also increased in unprec-
e d e n t e d proportions. One out of thirteen Americans now has diabetes,
and that ratio continues to rise. If we don't heed the importance of diet,
millions of additional Americans will unknowingly develop diabetes
and suffer its consequences, including blindness, limb amputation,
cardiovascular disease, kidney disease and premature death. Despite
this, fast food restaurants that serve nutritionally defunct foods are now
fixtures in almost every town. We eat out more than ever 4 and speed
has taken precedence over quality. As we spend more time watching
TV, playing video games and using the computer, we are less physically
active.
Both diabetes and obesity are merely symptoms of poor health in gen-
eral. They rarely exist in isolation of other diseases and often forecast
deeper, more serious health problems, such as heart disease, cancer and
stroke. Two of the most frightening statistics show that diabetes among
people in their thirties has increased 70% in less than ten years and the
percentage of obese people has nearly doubled in the past thirty years.
Such an incredibly fast increase in these "signal" diseases in America's
young to middle-age population forecasts a health care catastrophe in
the coming decades. It may become an unbearable burden on a health
system that is already strained in countless ways.

PROBLEMS WE FACE, SOLUTIONS WE NEED                       15
DIABETES STATISTICS
Percent Increase in Incidence from 1990 to 19985 :
•                      •
Age 30-39 (70%)         Age 40-49 (40%)        Age 50-59 (31 %)
Percent of Diabetics Who Aren't Aware of their IIIness5 : 34%
Diabetes Oukomes6 : Heart Disease and Stroke; Blindness; Kidney Disease;
Nervous System Disorders; Dental Disease; limb Amputation
Annual Economic Cost of Diabetes7 : $98 Billion
But the most pervasive killer in our culture is not obesity, diabetes
or cancer. It is heart disease. Heart disease will kill one out of every
three Americans. According to the American Heart Association, over 60
million Americans currently suffer from some form of cardiovascular
disease, including high blood pressure, stroke and heart disease. s Like
me, you undoubtedly have known someone who died of heart disease.
But since my own father died from a heart attack over thirty years ago,
a great amount of knowledge has been uncovered in understanding this
disease. The most dramatic recent finding is that heart disease can be
prevented and even reversed by a healthy diet. 9 , 10 People who cannot
perform the most basic physical activity because of severe angina can
find a new life simply by changing their diets, By embracing this revo-
l u t i o n a r y information, we could collectively defeat the most dangerous
disease in this country.
OOPS ••• WE DIDN'T MEAN TO HAVE THAT HAPPENl
As increasing numbers of Americans fall victim to chronic diseases, we
hope that our hospitals and doctors will do all that they can to help us.
Unfortunately, both the newspapers and the courts are filled with stories
and cases that tell us that inadequate care has become the norm.
One of the most well regarded voices representing the medical
community, the Journal of the American Medical Association QAMA) ,
included a recent article by Barbara Starfield, M,D. , stating that physi-
cian error, medication error and adverse events from drugs or surgery
kill 225,400 people per year (Chart 1.5),u That makes our health care
system the third leading cause of death in the United States, behind only
cancer and heart disease (Chart 1.4) .12

THE (HINA STUDY
16
CHART 1.4: LEADING CAUSES OF DEATH12
of the Heart                              710,760
Diseases
553,091
Cancer (Malignant
225,400
Medical Corell
167,661
Stroke (Cerebrovascular Diseases)
122,009
Chronic Lower Respiratory Diseases
97,900
Accidents
69,301
Diabetes Mellitus
65,313
Influenza and Pneumonia
49,558
Alzheimer's Disease
CHART 1.5: DEATH BY HEALTH CAREl I
7,400
Medication Errors 13
12,000
Unnecessary Surgeryl4
20,000
Other Preventable Errors in Hospitals 11
80,000
Hospital Borne Infections 11
106,000
Adverse Drug Effects 15
The last and largest category of deaths in this group are the hospital-
ized patients who die from the "noxious, unintended and undesired ef-
fect of a drug,"15 which occurs at normal doses.1 6 Even with the use of
approved medicines and correct medication procedures, over one hun-
dred thousand people die every year from unintended reactions to the
"medicine" that is supposed to be reviving their health. 15 Incidentally, this
same report, which summarized and analyzed thirty-nine separate stud-
ies, found that almost 7% (one out of fifteen) of all hospitalized patients
have experienced a serious adverse drug reaction, one that "requires hos-
pitalization, prolongs hospitalization, is permanently disabling or results
in death."15 These are people who took their medicine as directed. This
number does not include the tens of thousands of people who suffer from
the incorrect administration and use of these drugs. Nor does it include
adverse drug events that are labeled "possible" effects, or drugs that do

PROBLEMS WE FACE, SOLUTIONS WE NEED                       17
not accomplish their intended goal. In other words, one of fifteen is a
conservative number.1   5
If nutrition were better understood, and prevention and natural treat-
m e n t s were more accepted in the medical community, we would not be
pouring so many toxic, potentially lethal drugs into our bodies at the
last stage of disease. We would not be frantically searching for the new
medicine that alleviates the symptoms but often does nothing to address
the fundamental causes of our illnesses. We would not be spending our
money developing, patenting and commercializing "magic bullet" drugs
that often cause additional health problems. The current system has not
lived up to its promise. It is time to shift our thinking toward a broader
perspective on health, one that includes a proper understanding and
use of good nutrition.
As I look back on what I've learned, I am appalled that the circum-
stances surrounding the way in which Americans die are often unneces-
sarily early, painful and costly.
AN EXPENSIVE GRAVE
We pay more for our health care than any other country in the world
(Chart 1.6) .
We spent over a trillion dollars on health care in 1997.17 In fact, the
cost of our "health" is spiraling so far out of control that the Health
Care Financing Administration predicted that our system would cost 16
trillion dollars by 2030.17 Costs have so conSistently outpaced inflation
that we now spend one out of every seven dollars the economy pro-
duces on health care (Chart 1.7). We have seen almost a 300% increase
in expenditures, as a percentage of GDp, in less than forty years! What is
all the extra financing buying? Is it creating health? I say no, and many
serious commentators agree.
Recently the health status of twelve countries including the U.S.,
Canada, Australia and several Western European countries was com-
pared on the basis of sixteen different indicators of health care efficacy. 19
Other countries spend, on average, only about one-half of what the U.S.
spends per capita on health care. Isn't it reasonable, therefore, for us to
expect our system to rank above theirs? Unfortunately, among these
twelve countries, the u.s. system is consistently among the worst per-
formers.lI In a separate analysis, the World Health Organization ranked
the United States thirty-seventh best in the world according to health
care system performance. 20 Our health care system is clearly not the best

THE CHINA STUDY
18
CHART 1.6: HEALTH CARE EXPENDITURES PER PERSON, 1997 $USI7
3912
4000        r-
3000
..
2364           2175   2047
~
..
1760
2000                                     ~
1391
•         870
1000
r
o
ro
c
ro
>-                    ~
Vl      c                     u          ro                     ~
"0
c
ro            ro                 0.
::)                                               ::)           0
c                  ro
~
E                               ....,               ~
ro      L.L
(jj          U
19
CHART 1.7: PERCENT OF U.S. GOP SPENT ON HEALTH CAREI7, 18
14
12
10
8
6
4
2
0
1990          1997
1960           1970          1980
in the world, even though we spend, far and away, the most money on
it.
Too often in the United States, a doctor's treatment decisions are
made on the basis of money, not health. The consequences of not hav-
ing health insurance, I suspect, have never been more terrifying, and
close to 44 million Americans are uninsured. 21 It's unacceptable to me

19
PROBLEMS WE FACE, SOLUTIONS WE NEED
that we spend more money on health care than any other country on
this planet, and we still have tens of millions of people without access
to basic care .
From three perspectives-disease prevalence, medical care efficacy
and economics-we have a deeply troubled medical system. But I do
not do justice to this topic simply by recounting figures and statistics.
Many of us have spent awful times in hospitals or in nursing homes
watching a loved one succumb to disease. Perhaps you've been a patient
yourself and you know firsthand how poorly the system sometimes
functions. Isn't it paradoxical that the system that is supposed to heal us
too often hurts us?
WORKING TO LESSEN CONFUSION
The American people need to know the truth. They need to know what
we have uncovered in our research. People need to know why we are
unnecessarily sick, why too many of us die early despite the billions
spent on research. The irony is that the solution is simple and inexpen-
sive . The answer to the American health crisis is the food that each of us
chooses to put in our mouths each day. It's as simple as that.
Although many of us think we're well informed on nutrition, we're
not. We tend to follow one faddish diet after another. We disdain satu-
rated fats, butter or carbohydrates, and then embrace vitamin E, calcium
supplements, aspirin or zinc and focus our energy and effort on extreme-
ly specific food components, as if this will unlock the secrets of health.
All too often, fancy outweighs fact. Perhaps you remember the protein
diet fad that gripped the country in the late 1970s. The promise was that
you could lose weight by replacing real food with a protein shake. In a
very short while, almost sixty women died from the diet. More recently
millions have adopted high-protein, high-fat diets based on books such
as Dr. Atkins' New Diet Revolution, Protein Power and The South Beach
Diet. There is increasing evidence that these modem protein fads contin-
ue to inflict a great variety of dangerous health disorders. What we don't
know-what we don't understand-about nutrition can hurt us.
I've been wrestling with this public confusion for more than two de-
cades. In 1988, I was invited before the U.5. Senate Governmental Affairs
Committee, chaired by Senator John Glenn, to give my views on why the
public is so confused about diet and nutrition. After examining this issue
both before and since that testimony, I can confidently state that one of
the major sources of confusion is this: far too often, we scientists focus on