Wednesday, December 28, 2011

How Greens and Grains Can Change Your Life: The Relationship Between Diet and Chronic Disease

I never liked vegetables. I was one of those adults who never outgrew their childhood distaste for all things green. At mealtime, I turned to meat: flavorful and filling; savory, salty, tasty meat. I chose meat for lunch, meat for dinner, and sometimes meat for breakfast too, with a side of dairy each time for good measure. Why not? I needed protein and calcium. It never occurred to me that meat and dairy may be responsible for my chronic daily fatigue (and subsequent coffee addiction);
for my slow, steady weight gain with each year of my 20s;or for my heartburn after meals. After almost 30 years of being a carnivore, and a complete western medical education which fully supported my eating habits, I watched a documentary that turned on its head everything I thought I knew about nutrition and chronic disease. The film, “Forks Over Knives” featured a Cornell University professor of nutrition and a Cleveland Clinic Cardiac Surgeon who both claimed that the tsunami of chronic diseases sweeping the West could not only be stopped but reversed by simply subscribing to a whole grain, plant-based diet (Fulkerson, 2011).

Meat and dairy, Doctors Campbell and Esselstyn assert, are not our exclusive sources of protein. In fact, the amount of protein found in a serving of meat may be significantly more than we need in one meal, leading to a form of “poisoning,” as occurs when we ingest too much of any vitamin, mineral, or nutrient. The American diet can be described as excessive, in a word. The majority of America’s poor do not starve, but instead are easy targets for industries selling inexpensive processed “fast” foods. If we look instead to legumes and grains for all the essential amino acids we need to build protein, we may bring our dietary protein back into balance. By further eliminating processed foods, which are extremely high in calories for a given unit volume of food, we can reign in the fat, carbohydrates and total calories in our diet. By making the right choices at the grocery store, we can safely curb our diet of excess, and eliminate obesity, diabetes, and hypercholesterolemia.

Compelled by some of the arguments in the film, I picked up a copy of “The China Study,” published in January 2005 by Dr. T. Colin Campbell (Campbell, 1998). It detailed an epidemiologic study conducted over 20 years by Cornell University, Oxford University, and The Chinese Academy of Preventative Medicine. Dr. Campbell, who was born and raised on a cattle farm, began his career in nutritional research by trying to prove hypotheses about the benefits of protein in meat and dairy. Frustrated with his early findings, he took a new approach and designed and conducted several studies about the potential harmful effects of animal-based protein. On such study found a relationship between peanut contaminant Aflatoxin AF and the high prevalence of liver cancer in the children of affluent families (Campbell, 1974). The affluent children developed cancer far more frequently when exposed to Aflatoxin and also had a much higher percentage of protein in their diet. Spurred by further findings that the milk protein casein promotes tumor development and growth in rats (Dunaif, 1987), Campbell became involved in “The China Study.” The study’s conclusions were radical: that high consumption of animal based foods was associated with a high prevalence of chronic disease, while a predominantly plant-based diet was associated with significantly better health. The strength of “The China Study” was in the huge population of China included in the study which is largely genetically homogenous - at least as compared to most other countries in the world - but which has a diet that varies significantly by region. Although Dr. Campbell acknowledges “we have no data to show that 100% plant based eating is better than 95%,” he advocates for total abstinence from meat and dairy because he believes they are unnecessary for good health, and that our tastes change when we eliminate these foods and break our widespread addiction to animal-based fats and flavors.

Inspired by the preliminary findings of “The China Study,” Dr. Caldwell Esselstyn, a renowned cardiac surgeon of The Cleveland Clinic, began a 12 year clinical trial involving only patients with known advanced coronary artery disease demonstrated on angiography (Esselstyn, 1999). 5 of the 17 patients included in the study were given a life expectancy of 1 year at the beginning of the 12 year period. Of the 17 patients who adhered to a plant-based diet, all 17 demonstrated a significant decrease in serum cholesterol levels, no further cardiac events, and a widening of the coronary arteries on angiography, indicating a reversal of disease (Esselstyn, 2001). These findings were a shock to the medical community who are yet to find a pharmaceutical with the power to undo damage to coronary arteries.

Not all are believers, however. A recent Harvard study performed and published in the US in May 2010 found no increased risk of heart disease among meat eaters in general. The study also found that eating only one serving of bacon, sausage or deli meat a day is associated with a 42% increased risk of heart disease and a 19% increased risk of diabetes (Micha, 2010). Still meat itself has not been linked to chronic disease in any major study in the US. Many argue that while meat and dairy industry insiders may well have circulated a biased perspective on our need for animal products, for personal gain, Dr. Campbell himself has every reason to present a biased perspective on nutrition. After a lifetime of research dedicated to proving a single point: that animal products in our diet cause chronic disease and cancer, he has yet to prove it definitively. Because there are certainly a multitude of factors that cause disease and many confounding variables, we may never have a clear answer.

Dr. Campbell’s critics point out that his demonstration of casein causing cancer in rats should not be used to make a blanket accusation about all animal protein. What powdered, isolated casein does to rats, may tell us very little about what milk does to humans, and nothing that can be generalized to animal protein. However, no further studies were done before his overarching proclamation in “The China Study” that animal based foods increase tumor development, while nutrients from plant based foods decrease tumor development. Critics also attack Dr. Esselstyn’s study on diet and heart disease for including a small number of subjects. Both the doctors do seem to jump from limited data to emphatic, life-changing advice on nutrition.
As for “The China Study” itself, some claim it tells only half the story. The nutritional benefits of animal proteins are totally ignored and Campbell is cautious not to generalize from casein to plant proteins, but has no issue in generalizing from casein to animal protein. He ignores the well-described role of wheat gluten in autoimmune disease, but emphasizes the role of milk protein.

Although doctors Campbell and Esselstyn seem to select and interpret evidence with the intention of making a case for a whole grain, plant-based diet, they do present basic science and clinical data which is quite overwhelming. We may not yet have all the answers, but all evidence seems to support the idea that a diet devoid of animal products and processed refined items will help any person to feel healthier, manage their weight and consequently stave off weight-related diseases such as hypertension, diabetes, and coronary artery disease. The possibility that a whole grains, plant-based diet may also stunt the development and growth of cancer may simply be a bonus.

On the internet, patient testimonials are abundant in support of the dietary advice of two medical pioneers, and I am happy to add one more. Since adopting a whole grains, plant-based diet, I have more energy and a healthier digestive system. As a primary care provider I cannot ignore an intervention with no side effects that can outperform any combination of medications designed to treat chronic disease. My patients deserve to know that a specific change in their diet may be an effective treatment. Since the answers are not and will likely never be simple, it follows that neither can the recommendations be. Perhaps, as our mothers taught us, moderation is the key. But then maybe the question is: “what is moderation?” Certainly it is not processed meat and a side of dairy for breakfast, lunch and dinner. My conclusions? Eat fewer processed foods and fewer animal products. Eat more greens and grains. Eat to feel healthy and be healthy. That is what I teach my patients to do. I don’t believe it is an all-or-nothing situation, and it may be difficult for some to transition to a meat, dairy and oil free lifestyle. I do encourage any patient suffering from a chronic ailment, and certainly any physician, to try it. You never know, you may just love it.

Shirin Peters earned a B.S. in Biology from UNC-Chapel Hill, where she graduated with Honors. She went on to earn an M.D. from New York Medical College and completed her residency training at St. Vincent’s Hospital in Manhattan, and Wyckoff Heights Hospital in Brooklyn, New York. She worked as a Primary Care Provider at Bethany Medical Center in High Point, North Carolina as well as a Physician Investigator at Peters Medical Research, a clinical research company. She now lives in New York City and is owner of Urban Orchid Medical, a medical practice with a focus on nutrition, weight loss, physical health and skin care.

Works Cited
Campbell. (1998). Diet, lifestyle and the etiology of coronary artery disease: the Cornell China Study. The American journal of cardiology .

Campbell. (1974). Hepatocarcinogenic material in urine specimens from humans consuming aflatoxin. Journal of the National Cancer Institute .

Dunaif. (1987). Dietary protein level and aflatoxin B1-induced preneoplastic hepatic lesions in the rat. The Journal of nutrition .

Esselstyn. (2001). Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition. Preventive cardiology .

Esselstyn. (1999). Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). The American journal of cardiology .

Fulkerson, L. (Director). (2011). Forks Over Knives [Motion Picture].

Micha. (2010). Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation .

This article is free for republishing


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