The China Study (21 page)

BROKEN HEARTS                                131
of health professionals at eight diverse sites have been trained to treat
heart disease patients with Dr. Omish's lifestyle intervention program.
Patients eligible to participate are those who have documented heart
disease severe enough to warrant surgery. Instead of surgery, they may
enroll in a one-year lifestyle program. This program was started in 1993,
and by 1998 there were forty insurance programs that covered the costs
for selected patients. 32
As of 1998, almost 200 people had taken part in the Lifestyle Project,
and the results are phenomenal. After one year of treatment, 65% of
patients had eliminated their chest pain. The effect was long lasting, as
well. After three years, over 60% of the patients continued reporting no
chest pain. 32
The health benefits are equaled by the economic benefits. Over one
million heart disease surgeries are undertaken every year.32 In 2002,
physician services and hospital care for heart disease patients cost $78.1
billion (that does not include drug costs, home health care or nursing
home care) .2 The angioplasty procedure alone costs $31 ,000, and by-
pass surgery costs $46,000.32 In marked contrast, the year-long lifestyle
intervention program only costs $7,000. By comparing the patients who
underwent the lifestyle program with those patients who underwent
the traditional route of surgery, Dr. Omish and his colleagues demon-
s t r a t e d that the lifestyle intervention program cut costs by an average of
$30,000 per patient. 32
Much work remains to be done. The health care establishment is
structured to profit from chemical and surgical intervention. Diet still
takes the back seat to drugs and surgery. One criticism that is constantly
leveled at the dietary argument is that patients will not make such funda-
m e n t a l changes. One doctor charges that Dr. Esselstyn's patients change
their eating habits simply because of Esselstyn's "zealous belief. "47 This
criticism is not only wrong and insulting to patients; it is also self-fulfill-
ing. If doctors do not believe that patients will change their diets, they
will neglect to talk about diet, or will do it in an off-handed, disparaging
way. There is no greater disrespect a doctor can show patients than that
of withholding potentially lifesaving information based on the assump-
t i o n that patients do not want to change their lifestyle.
Well-meaning institutions are not exempt from such closed-mind-
edness. The American Heart Association recommends a diet for heart
disease that favors moderation, rather than scientific truth. The National
Cholesterol Education Program does the same thing. These organizations

THE CHINA STUDY
132
pitch moderate diets with trivial changes as being healthy lifestyle "goals."
If you are at high risk for heart disease, or if you already have the disease,
they recommend that you adopt a diet containing 30% of total calories
as fat (7% of total calories as saturated fat) and less than 200 mg/day of
dietary cholesterol. 48,49 According to them, we should also keep our total
blood cholesterol level under the "desirable" level of 200 mg/dL,49
These venerable organizations are not giving the American public the
most up-to-date scientific information. While we are told that a total
blood cholesterol level of 200 mg/dL is "desirable," we know that 35%
of heart attacks strike Americans who have cholesterol levels between 150
and 200 mg/dPo (a truly safe cholesterol level is under 150 mg/dL). We
also know that the most aggressive reversal of heart disease ever dem-
o n s t r a t e d occurred when fat was about lO% of total calorie intake. Stud-
ies have clearly demonstrated that many patients who follow the more
moderate government recommended diets see a progression of heart
disease. 51 The innocent victims are health-conscious Americans who
follow these recommendations, keeping their total cholesterol around
180 or 190 mg/dL, only to be rewarded with a heart attack leading to a
premature death.
To top it off, the National Cholesterol Education Program danger-
ously writes, "Lifestyle changes are the most cost-effective means to re-
duce risk for CHD[coronary heart disease]. Even so, to achieve maximal
benefit, many persons will require LDL [cholesteroll-Iowering drugs."49
No wonder America's health is failing. The dietary recommendations
for the most diseased hearts among us, given by supposedly reputable
institutions, are severely watered down and followed by the caveat that
we'll probably need a lifetime of drugs anyway.
Our leading organizations fear that if they advocate more than mod-
est changes, no one will listen to them. But the establishment-recom-
m e n d e d diets are not nearly as healthy as the diets espoused by Drs.
Esselstyn and Omish. The fact is that a blood cholesterol level of 200
mg/dL is not safe, a 30% fat diet is not "low-fat," and eating foods con-
taining any cholesterol above 0 mg is unhealthy. Our health institutions
are intentionally misleading the public about heart disease, all in the
name of "moderation."
Whether scientists, doctors and policy makers think the public will
change or not, the layperson must be aware that a whole foods, plant-
based diet is far and away the healthiest diet. In the seminal paper re-
garding the landmark Lifestyle Heart Trial, the authors, Dr. Omish and

BROKEN HEARTS                          133
his scientific colleagues, write, "The point of our study was to determine
what is true, not what is practicable [myemphasisl."46
We now know what is true: a whole foods, plant-based diet can pre-
vent and treat heart disease, saving hundreds of thousands of Americans
every year.
Dr. William Castelli, the long-time director of the Framingham Heart
Study, a cornerstone of heart disease research, espouses a whole foods,
plant-based diet.
Dr. Esselstyn, who has demonstrated the most significant reversal of
heart disease in all of medical history, espouses a whole foods , plant-
based diet.
Dr. Ornish, who has pioneered reversal of heart disease without
drugs or surgery and proved widespread economic benefit for patients
and insurance providers, espouses a whole foods, plant-based diet.
Now is a time of great hope and challenge, a time when people can
control their health. One of the best and most caring doctors I have ever
met puts it best:
The collective conscience and will of our profession
is being tested as never before. Now is the time
for us to have the courage for legendary work.
Dr. Caldwell B. Esselstyn,Jr.8
-

...._.___..........________....__...______. 6_ ..___..._.._.._ __........
__ . __. .._.___ ._
____           ............
Obesity
PERHAPS YOU'VE HEARD THE NEWS.
Perhaps you've caught a glimpse of the staggering statistics on obe-
sity among Americans.
Perhaps you've simply noticed that, compared to a few years ago,
more people at the grocery store are overweight.
Perhaps you've been in classrooms, on playgrounds or at day care
centers and noticed how many kids are already Crippled with a weight
problem and can't run twenty feet without getting winded.
Our struggle with weight is hard to miss these days. Open a newspa-
p e r or a magazine, or turn on the radio or TV-you know that America
has a weight problem. In fact, two out of three adult Americans are
overweight, and one-third of the adult population is obese. Not only
are these numbers high, but the rate at which they have been rising is
ominous (Chart l.2, page 13).1
But what do the terms "overweight" and "obese" mean? The standard
expression of body size is the body mass index (BMI). It represents body
weight (in kilograms, kg) relative to body height (in meters squared,
m 2 ) . By most official standards, being overweight is having a BMI above
twenty-five, and being obese is having a BMI over thirty. The same scale
is used for both men and women. You can determine your own BMI
using Chart 6.1, which lists the necessary information in pounds and
inches for your convenience.
135

THE (HINA STUDY
136
CHART 6.1: BODY MASS INDEX TABLE
Normal                              Overweight                    Obese
8MI
19           21          23    24                    27             29    30     35     40
20                             25      26                28
22
(kg/m)
Height
Weight (lb.)
(in .)
143    167    191
91    96    100   105   110   115   119    124      129   134      138
58
198
143   148   173
59        94    99    104   109   114   119   124    128      133   138
153   179     204
102    107   112   118   123   128    133      138   143      148
97
60
111   116   122   127          137      143   148      153   158   185     211
61       100   106                            132
191     218
62       104   109    115   120   126   131   136    142      147   153      158   164
141                   158      163   169   197     225
63       107   113    118   124   130   135          146      152
122   128   134   140   145    151      157   163      169   174   204     232
110   116
64
132   138   144   150    156      162            174   180   210     240
65       114   120    126                                           168
130   136   142   148          161      167   173      179   186   216     247
124                            155
66       118
121   127    134   140   146   153   159    166      172   178      185   191   223     255
67
144         158          171      177   184      190   197   230     262
68       125   131    138         151         164
69       128   135    142   149   155   162   169    176      182   189      196   203   236     270
278
132   139    146   153   160   167   174    181      188   195      202   209   243
70
71       136   143    150   157   165   172   179    186      193   200      208   215   250     286
191      199            213   221   258     294
169
72       140   147    154   162         177   184                   206
197      204            219   227   265     302
189                   212
73       144   151    159   166   174   182
179         194             210            225   233   272     311
186          202            218
74       148   155    163   171
224            240   279     319
75       152   160    168   176   184   192   200    208      216            232
246   287     328
156   164    172   180   189   197   205    213      221   230      238
76
THE CHILDREN
Perhaps the most depressing element of our supersize mess is the grow-
ing number of overweight and obese children. About 15% of America's
youth Cages six to nineteen) are overweight. Another 15% are at risk of
becoming overweight. 2
Overweight children face a wide range of psychological and social
challenges. As you know, children have a knack for being open and

OBESITY                                137
blunt; sometimes the playground can be a merciless place. Overweight
children find it more difficult to make friends and are often thought of
as lazy and sloppy. They are more likely to have behavioral and learning
difficulties, and the low self-esteem likely to be formed during adoles-
cence can last forever.3
Young people who are overweight also are highly likely to face a host
of medical problems. They often have elevated cholesterol levels, which
can be a predictor for any number of deadly diseases. They are more
likely to have problems with glucose intolerance, and, consequently,
diabetes. Type 2 diabetes, formerly seen only in adults, is skyrocketing
among adolescents. (See chapters seven and nine for a more thorough
discussion of childhood diabetes.) Elevated blood pressure is nine times
more likely to occur among obese kids. Sleep apnea, which can cause
neuro-cognitive problems, is found in one in ten obese children. A wide
variety of bone problems is more common in obese kids. Most impor-
t a n t l y, an obese young person is much more likely to be an obese adult,3
greatly increasing the likelihood of lifelong health problems.
CONSEQUENCES FOR THE ADULT
If you 'are obese, you may not be able to do many things that could make
your life more enjoyable. You may find that you cannot play vigorously
with your grandchildren (or your children), walk long distances, par-
ticipate in sports, find a comfortable seat in a movie theatre or airplane
or have an active sex life. In fact, even sitting still in a chair may be im-
possible without experienCing back or jOint pain. For many, standing is
hard on the knees. Carrying around too much weight can dramatically
affect physical mobility, work, mental health, self-perception and social
life. So you see, this isn't about death; it really is about missing many of
the more enjoyable things in life. 4
Clearly no one desires to be overweight. So why is it that two out of
three adult Americans are overweight? Why is one-third of the popula-
t i o n obese?
The problem is not a lack of money. In 1999, medical care costs relat-
i n g to obesity alone were estimated to be $70 billion.5 In 2002, a mere
three years later, the American Obesity Association listed these costs at
$100 billion. 6 This is not all. Add another $30-40 billion out-of-pocket
money that we spend trying to keep off the weight in the first place. 5
Going on special weight-loss diet plans and popping pills to cut our ap-
p e t i t e s or rearrange our metabolism have become a national pastime.

THE CHINA STUDY
138
This is an economic black hole that sucks our money away without
offering anything in return. Imagine paying $40 to a service man to
fix your leaky kitchen sink, and then two weeks later, the sink pipes
explode and flood the kitchen and it costs $500 to repair. I bet you
wouldn't ask that guy to fix your sink again! So then why do we end-
lessly try those weight-loss plans, books, drinks, energy bars and as-
s o r t e d gimmicks when they don't deliver as promised?
I applaud people for trying to achieve a healthy weight. I don't ques-
t i o n the worthiness or dignity of overweight people any more than I
question cancer victims. My criticism is of a societal system that allows
and even encourages this problem. I believe, for example, that we are
drowning in an ocean of very bad information, too much of it intended
to put money into someone else's pockets. What we really need, then, is
a new solution comprised of good information for individual people to
use at a price that they can afford.
THE SOLUTION
The solution to losing Weight is a whole foods, plant-based diet, cou-
p l e d with a reasonable amount of exercise. It is a long-term lifestyle
change, rather than a quick-fix fad, and it can provide sustained Weight
loss while minimizing risk of chronic disease.
Have you ever known anyone who regularly consumes fresh fruits,
vegetables and whole grain foods-and rarely, if ever, consumes meats
or junk foods like chips, French fries and candy bars? What is his or her
weight like? If you know many people like this, you have probably no-
ticed that they tend to have a healthy weight. Now think of traditional
cultures around the world. Think of traditional Asian cultures (Chinese,
Japanese, Indian), where a couple of billion people have been eating a
mostly plant-based diet for thousands of years. It's hard to imagine these
people-at least until recently-as anything other than slender.
Now imagine a guy buying two hot dogs and ordering his second beer
at a baseball game, or a woman ordering a cheeseburger and fries at your
local fast food joint. The people in these images look different, don't they?
Unfortunately, the guy munching his hot dogs and sipping his beer is rap-
idly becoming the "all-American" image. I have had visitors from other
countries tell me that one of the first things they notice when they arrive
in our good land is the exceptional number of fat people.
Solving this problem does not require magic tricks or complex
equations involving blood types or carbohydrate counting or soul