2

The Whole Truth

History is a race between education and catastrophe.

—H. G. WELLS

In the previous chapter I inferred that what we eat can have a bigger impact on our health than just about anything else. The evidence that I and others have amassed over the years points to WFPB as the optimal human diet. I refer you to my last book, The China Study, for an in-depth look at the evidence supporting these assertions.

Of course, not everyone in the world believes that a plant-based diet is the best way to eat for our health and for the planet, despite all the evidence. The media is awash with pundits who contradict what I say, often in quite articulate and entertaining ways. The fact is, it’s pathetically easy for critics to take individual data points out of context and misapply them to support opposite conclusions from mine. The question is, how can they evaluate the evidence without becoming experts in biochemistry, cardiology, epidemiology, and the dozen other disciplines that would provide the necessary context?

Before we discuss the barriers to more widespread adoption of the WFPB diet, I want to address those critics and those criticisms by sharing with you my model for evaluating diet and health research. My hope is that it will help you make sense of the barrage of nonsense and half-truths that passes not just for legitimate criticism of the WFPB diet, but also for health coverage in the media. Once you’re inoculated against “fad of the week” reporting, you’ll navigate health claims in general with much more savvy and confidence—and be even better equipped to judge the evidence in favor of the WFPB diet, and criticisms of it, for yourself.

EVALUATING HEALTH RESEARCH

If you watch TV news, you’ll see lots of stories each week about promising new drugs, new gene therapies, new high-tech machines, and new health claims about foods, vitamins, enzymes, and other micronutrients. None of these “breakthrough discoveries” come close to the benefits of the WFPB diet, although you wouldn’t know it from the hyped-up and ill-informed reporting of the studies upon which these claims are based.

Before I stack up my evidence against theirs, let’s talk about how to evaluate research in general. Otherwise we’ll be trapped in a “he said, she said” shouting match in which the loudest (or in this case, best-funded) voice wins. When you hear a health claim, ask yourself three questions: Is it true? Is it the whole truth, or just a part of it? Does it matter?

Is it true? The first step in evaluating a health claim is determining whether or not the studies supporting that claim were properly done—in other words, whether they were well-constructed, professionally conducted, and accurately reported enough to uncover some facet of the truth. Unfortunately, some studies are constructed and conducted so poorly that their conclusions are pure nonsense. The likelihood of such a result increases dramatically when the organization funding the research stands to make money from a particular result. Reliable study results are those that, ideally, have been replicated in multiple experiments, preferably by different researchers, and definitely underwritten by different funders.

Is it the whole truth? It’s also important to look at what “they” aren’t telling you about potential side effects and other unintended consequences of a particular course of action. In nature (and our bodies ideally are products of nature), pretty much everything is connected to everything else. If you have a headache and take a pill, you can be certain that the pill is doing a lot more in your body than just relieving your headache. Likewise, if you’re on a WFPB diet to prevent heart disease, that way of eating will have effects that reach far beyond your arteries. When you hear about a wonder pill that lowers blood pressure, always get curious about the additional (“side”) effects of the pill. In reality, there are no side effects, just effects. What is this health intervention doing beyond its stated goal?

Does it matter? As we’ll see throughout this book, a lot of so-called health breakthroughs are not nearly as impressive as their marketing makes them appear. While it may be good business to spin the numbers to increase sales, it isn’t good science. One of the ways to do this (without outright lying) is to cherry-pick details, report them out of context, and imply a much greater significance than they actually possess. For example, a drug may be shown to reduce cholesterol, but to have absolutely no effect on the rate of heart attacks and strokes. Given that the public assumes that lower cholesterol leads to better heart health, the ads for this drug may make a big deal about the drop in cholesterol, and even state accurately that lower cholesterol is typically associated with lower risk of cardiovascular disease. They just conveniently leave out the fact that this particular drug doesn’t seem to lead to that same lower risk. The drug’s ability to reduce cholesterol doesn’t really matter, at least when it comes to its users’ length and quality of life.

Realistically, you need to have a working knowledge of the scientific method to assess a health claim according to the first two tests (is it true and is it the whole truth?), along with access to the details of how the study was constructed. If you’re not a scientist, however, don’t despair. If you’re looking at a drug ad in a magazine, you can just turn the page to read the voluminous fine print about its side effects and warnings. Or you can consult peer-reviewed journals. Peer review is a process in which research findings are reviewed and critiqued by qualified professionals before publication. This strategy affords the scientific community an opportunity to challenge study results in a way that is open to professional and public scrutiny—it is a chance to replicate and verify research observations or to demonstrate that the findings are false. This may not be a perfect system, but I know of nothing better. At a minimum, it encourages objectivity and integrity. And it provides readers of peer-reviewed journals with a level of confidence about the findings published in its pages.

However, when it comes to the third question—whether a new health claim’s implications matter—that’s something just about everyone can evaluate for themselves. It just requires a little common sense.

HOW TO TELL IF A HEALTH INTERVENTION MATTERS

When I think about whether a health intervention matters—in other words, whether it is worth pursuing for an individual, business, or researcher—I use three basic criteria, listed here in reverse order of importance:

     How quickly does it work? (Rapidity)

     How many health problems does it help solve? (Breadth)

     How much will my health improve due to the intervention? (Depth)

Let’s look at each of these in turn.

Rapidity

How long does it take for a nutrient, drug, genetic modification, or whatever to actually function within the body? I’m not talking about how long it takes for a substance to be absorbed in the bloodstream and transported to tissue cells. Instead, I’m asking, “How long before there’s a meaningful effect, like an energy boost or reduction of disease symptoms?”

The speed at which most nutritional benefits appear when switching to a WFPB diet is jaw-dropping. Diabetics must be monitored from the very first day they adopt the diet, so their meds can be reduced as the diet takes effect. Otherwise, they’re in real danger of having their blood sugar drop low enough to send them into hypoglycemic shock.

Nonnutritious food also works really quickly, but in the opposite direction. Within one to four hours of consuming, for example, a high-fat McDonald’s meal (Egg McMuffin®, Sausage McMuffin®, two hash brown patties, non-caffeinated beverage), serum triglycerides shoot up (increasing the risk of heart disease and diabetes, as well as many other conditions) and arteries stiffen (raising blood pressure). Recovery to normal fluidity takes several hours. None of this occurs following a low-fat meal consisting of cereal and fruit.1

When my friend and colleague, Caldwell Esselstyn, Jr., MD, used a mostly WFPB diet to reverse advanced heart disease in a study that began in 1985, he found that chronic chest pain (also known as angina) typically disappeared within one to two weeks. Compare that to an angina drug such as ranolazine (marketed under the trade name Ranexa), which was approved by the Food and Drug Administration (FDA) in 2006.2 One clinical trial undertaken to establish its effectiveness randomly assigned 565 patients to a Ranexa group or a placebo group. The Ranexa group experienced a “statistically significant reduction” in angina episodes over six weeks. Sounds great, right? What it means is that the Ranexa group went from 4.5 to 3.5 angina episodes per week. Not exactly the speedy solution anyone really wants, is it? Add to that the common side effects reported by the manufacturer, including “dizziness, headache, constipation, and nausea” (the study didn’t say how rapidly those showed up), and you have Western medicine’s best answer to a WFPB diet: expensive interventions with limited positive effect and a host of potential side effects.

Some may think it’s unfair to compare pharmaceuticals to WFPB, since the drugs are meant to treat symptoms rather than root causes of disease. But if there is one thing these prescription meds should have going for them, it is rapidity of effect. Indeed, the one useful function they can perform is “buying time” for a patient for whom a lifestyle and dietary intervention otherwise might be too late. When someone is wheeled into the ER after suffering a heart attack or stroke, it’s a better idea to administer a thrombolytic drug to dissolve the blood clot than to give them an intravenous kale smoothie. But aside from true emergencies, the rapidity of response of WFPB is superior to any drug—without the negative side effects.

Breadth

How widespread are the intervention’s effects throughout the body? Does the intervention improve a wide range of functions, or just one specific measure of biological functioning, like blood pressure or lipid profile? You might think that a one-size-fits-all approach, where one strategy could resolve a wide variety of medical conditions, would be exactly what the doctor ordered. But medical science is deeply suspicious of anything claiming to be a panacea (from the Greek words pan, meaning “all,” and akos, meaning “remedy”).

In contrast, the most highly prized Chinese medicines are the ones that treat the widest variety of ailments. In the early 1980s, senior medical people in China introduced me to their centuries-old tradition of using herbs medicinally. Often, these herbs are used in their whole form, typically steeped in water and often as one of several ingredients. The “king” of these Chinese herbs, the one most prescribed and consumed, is ginseng. Carl Linnaeus, who pioneered the scientific system for naming plants and animals, dubbed ginseng “Panax” based on his awareness of the plant’s multiple uses in traditional Chinese medicine.

Remember Daniel Boone, that famed American frontiersman? Do you know what he was doing out there in the wilderness with his coonskin cap and rifle? Hunting and trapping, right? Sure, Boone did his share of harvesting animal parts. But when he faced financial ruin because of some bad real estate deals in the 1780s, he went where the money was: American ginseng (scientific name Panax quinquefolius). Boone paid Native Americans to harvest the roots, which he shipped to China for a fortune. He wasn’t the only one making money on the herb; we know that John Jacob Astor earned $55,000 for his first shipment of ginseng to China, equivalent to more than $1 million today.

The reason the Chinese were willing to pay so much for ginseng, and why the Native Americans knew exactly where to harvest it, is because the plant works to promote health in so many different ways. The Cherokee used ginseng to ease colic, convulsions, dysentery, and headaches. Other Native American tribes found the roots helpful in treating indigestion, weak appetite, exhaustion, croup, menstrual cramps, and shock.3 Now that’s breadth!

The WFPB diet deals with so many diseases and conditions that you begin to wonder if there isn’t just one basic disease cause—poor nutrition—that manifests through thousands of different symptoms. Rather than focus on the underlying cause, Western medicine has decided to focus on the individual symptoms and call each of them a disease. And admittedly, it’s good business to identify thousands of different diseases, then make and sell treatments for each of them, rather than to look at the big picture and prescribe one simple intervention that helps them all. But it’s not good medicine.

If you’re impressed with the range of effects of the ginseng root alone, you’ll be blown away by the breadth of results from a WFPB diet. While ginseng can relieve a wide variety of symptoms, good nutrition deals with the root causes of disease—including those as different as cancer, cardiovascular disease (e.g., cardiac arrest, stroke, and atherosclerosis), obesity, neurological disorders, diabetes, a wide variety of autoimmune diseases, and bone diseases. Since The China Study’s publication, I have heard from readers about other illnesses, mostly nonfatal, that have also been alleviated or resolved by a WFPB diet—illnesses like headaches (including migraines), intestinal distresses, eye and ear disorders, stress disorders, colds and flu, acne, erectile dysfunction, and chronic pain. This is an exceptionally broad scope of nutritionally controlled diseases, although for each of these diseases or disease groups, more professional research would be helpful to document mechanisms for these effects. My impressions of the impact of this diet on a few of these illnesses (e.g., colds and flu, headaches, various aches and chronic pain conditions) are based more on anecdotal evidence than on empirical, peer-reviewed, and published evidence. Still, the number of times I’ve heard individuals and physicians say that adopting a WFPB diet simultaneously resolves these health problems has begun to convince me that it works for the vast majority of people most of the time. In earlier years I had my own problem with migraine headaches and arthritic-type pain. These problems disappeared when I fully adopted the WFPB diet.

Let’s try a thought experiment. Someone you care about tells you they have a chronic disease (take your pick from the list above) and their doctor gave them a choice of two treatments. Treatment #1 would slightly reduce the severity of a single symptom of that disease, but would not improve their chances of being cured of it (or even living longer), and would threaten a wide array of nasty side effects. (Of course, their doctor would prescribe additional meds to deal with those side effects, and then still more meds to deal with the side effects of all the interactions of the other meds, and so on.)

Treatment #2 would typically resolve the root cause of the disease fairly quickly, thus ending all symptoms and increasing their life expectancy and the quality of that life. Side effects would include achieving their ideal weight, having more energy, looking and feeling better, and even helping to preserve the environment and slow global warming.

Which treatment would you suggest to them?

To the medical establishment this thought experiment is totally nonsensical. The vast majority of medical research looks only at the very specific effects of one element (whether a drug, vitamin, mineral, or procedure such as an operation) on a single symptom or system. Anything else—such as looking at macro differences like lifestyle and diet—is just considered too messy to be reliable.

Depth

Okay, so far we’ve looked at how quickly nutrition affects bodily functioning (rapidity) and how many systems it influences (breadth). There’s one last crucial factor in evaluating the power of a health intervention: the size, or significance, of the effect. Another word for this is profundity. All things being equal, would you rather undergo a therapy that made a slight improvement to your well-being, or an enormous one?

Plant-based nutrition tends to elicit enormous effect sizes. I first saw this in a set of experiments in India that I read about and then replicated with my graduate students at Cornell, in which researchers exposed laboratory animals (rats) to a powerful carcinogen (cancer-causing agent), then fed one group a diet of 20 percent animal protein and the other a diet of 5 percent animal protein. Every single animal in the 20 percent group developed cancer or cancer precursor lesions, while not one of the 5 percenters did. One hundred percent to zero percent. That kind of result is rarely seen in biological studies that have so many confounding variables. Yet that’s what we found. We repeated this experiment in several different ways because it was hard to believe at first, but that result held, experiment after experiment. You don’t get more profound than that.

Maybe you’re thinking, Hold on. Just because diet has this kind of effect on rat cancer doesn’t mean it can improve human health on the same scale. Animal studies are one thing. What about a study that looked at really sick people and changed their diet drastically? Could a nutritional intervention produce as profound an effect?

Two cardiologists, Lester Morrison and John Gofman, undertook studies in the 1940s and 1950s (almost 70 years ago!) to determine the effect of diet on heart disease in people who had already had a heart attack.4 The doctors put these patients on a diet with less fat, cholesterol, and animal-based foods—a regimen that dramatically reduced subsequent recurrence of heart disease. Nathan Pritikin did the same thing in the 1960s and 1970s.5 Then Drs. Esselstyn6 and Dean Ornish7 set out to learn more in the 1980s and 1990s. Working separately, they both showed that a plant-based, high-carbohydrate diet controlled and even reversed advanced heart disease. We touched on Esselstyn’s remarkable study in the section on rapidity above, and you can read more about his and all these researchers’ work in The China Study. But let’s talk a little more now about Esselstyn’s findings in terms of depth of effect.

ESSELSTYN’S HEART DISEASE REVERSAL STUDY

In 1985, Esselstyn recruited patients with advanced but not immediately life-threatening heart disease for a clinical trial to explore whether heart disease might be reversed using diet.8 He confirmed the severity of the coronary artery disease with angiograms to be sure that their disease progression was advanced. The only other requirement for admission into the study was a willingness to attempt the dietary changes he proposed: effectively, a WFPB diet.

Dr. Esselstyn formally reported his findings at five and twelve years.9 In the eight years prior to the study, his eighteen subjects had had forty-nine coronary episodes (e.g., heart attacks, angioplasty, bypass surgery), but during the twelve years after adopting a WFPB diet, there was only one event, involving a patient who strayed from his diet. He has casually followed his subjects since then, and all but five are still alive today, twenty-six years later. The five who passed away did not die of cardiac failure, but from other causes. (The average age of his subjects in 1985 was 56; someone who was 56 in 1985 would be 83 in 2012, so that’s really not unexpected.) And the ones who are still alive are cardiac symptom free. The subjects had forty-nine cardiovascular events in the ninety-six months prior to the intervention, and zero cardiovascular events in the roughly 312 months since the intervention began. This life-and-death finding is about as profound as any health benefit I have ever known. Nothing else in medicine comes close.

Compare these findings to the drug Ranexa, which we looked at earlier in this chapter, in terms of reducing deaths from heart disease and other causes. A giant follow-up study of 6,500 Ranexa patients found a few trivial improvements in certain numbers, but the overall verdict, as reported in the Journal of the American Medical Association, was: “No difference in total mortality was observed with ranolazine compared with placebo.”10

STATISTICAL SIGNIFICANCE VERSUS MEANINGFUL SIGNIFICANCE

The depth of an effect is important not just to the person who experiences that effect. The depth of effect you expect to see in an experimental study determines the number of subjects you need for that study in order to assess with any degree of confidence whether the results are real or just a meaningless blip. In other words, the smaller the difference between two conditions (say, experiment and control group, or Treatment A and Treatment B), the more experimental subjects you need in order to show that the difference is real, and not simply due to chance. In a case like Ranexa, where episodes of angina were reduced from 4.5 to 3.5 per week, you’d need several hundred study participants to show that the result is unlikely to have occurred randomly—or, in scientific jargon, to be “statistically significant.”

You may be wondering about the size of Esselstyn’s study, since his experimental group was so small. Is eighteen a large enough sample size to prove statistical significance? To answer that question, let’s imagine a different outcome to the experiment above. Let’s say Group B, the control group, still gets four to five attacks per week on average. Group A, the group getting the new treatment, gets no more attacks at all. None. Zero. Hundreds of data points are no longer required when the effect is so large. The likelihood that such profound, consistent results are the result of chance is nearly zero.11

When you spend time poring through scientific research, you come across the concept of statistical significance a lot. The concept is very useful; it prevents people from drawing conclusions based on not enough data. If you flip a coin once and it lands heads, for example, you can’t announce that it’s a fixed coin that will always land on heads. You can’t distinguish a pattern from the noise of randomness inherent in coin tosses from a single toss, or even five or six. The problem is, many researchers worship statistical significance at the expense of something equally important: actual significance, as in, “Who cares? Why does this result matter?” Are we really that excited about reducing angina attacks from 4.5 to 3.5 per week? Not to minimize the suffering of patients with heart disease, but shouldn’t we spend our time and money seeking and evaluating treatments that significantly improve lives, as opposed to just maintaining and managing a disease state?

TOWARD A BETTER HEALTH SOLUTION

Given the evidence I’ve shared with you in this chapter, you would think that the top med schools in the country would make plant-based nutrition the premier “medical” science of the future. The majority of medical school training and NIH funding should be for training and research in nutrition to discover the best ways to counsel patients to improve their diets and create environments where eating well is easier than eating poorly. Nothing of the sort is happening.

Sure, healthy eating (a purposefully vague term that means nothing in the public discussion) is given lip service by the medical establishment. But that establishment doesn’t really take diet seriously as the first and primary means of treating and preventing disease. The importance of eating a diet of whole, plant-based foods (especially high-antioxidant, high-fiber vegetables) has really only been accepted by the alternative, preventive medicine community, while within the medical establishment, the idea that nutrition might impact diseases as serious as cancer is considered just plain “wacko”—despite the fact that almost none of those professionals who systematically reject nutrition’s potential have any training in this field.

Research shows this way of eating is actually our best means of treating disease. Better than prescription drugs. Better than surgery. Better than anything the current medical establishment has in its arsenal in the various “wars” on cancer, stroke, heart disease, MS, and so forth. Perhaps it’s time to stop declaring war on ourselves through toxic drugs and dangerous surgeries, and instead treat ourselves with kindness by feeding ourselves the sorts of foods shown to grow and sustain healthy, vibrant people and cultures.

We need a new way of relating to words like health and medicine. Health is more than a few superficial expressions like “eat a good diet” or “use alcohol in moderation” or “use the stairs, not the elevator.” Of course, there is merit in these statements, but for the most part they dismiss the possibility of real change. They are politically correct statements lacking specificity and substance.

Instead of feel-good pabulum that accomplishes nothing, we need to make nutrition the central element of our health-care system. Furthermore, we must get away from the “diet” mentality that promotes heroic and unsustainable spurts of healthy eating. Instead of “dieting,” we must change our lifestyle to include a diet that promotes health. People who adopt a WFPB diet find that most of their health problems were caused or significantly worsened by their old diets and resolve naturally and quickly once the body starts getting the proper fuel. It’s like someone who hits their head with a hammer three times a day and finds that nothing cures their headaches. It just makes sense to put down the hammer!

I naïvely believed that everyone in the research and medical communities would be able to see the common sense wisdom in this approach once they saw the findings I had. But when I began to state my conviction that nutrition should be the centerpiece of our medical system, I saw how wrong I was. One of the most eye-opening phenomena has been the ferocity with which I’ve been attacked for sharing my research findings and their implications—sometimes even by fellow medical practice and research professionals.

As foolish as it appears to me now, I had no idea when I started on this path that the ideas in this chapter would brand me as a heretic and threaten my funding and career. Fortunately for me, those effects have proved to be far more unsuccessful than successful. But before we jump into the big issues driving those attacks, I’d like to share my heretical path with you. After all, I’ve had a fifty-year head start on some of these ideas. Let’s bring you up to date before we jump into the fray.

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