Whole (6 page)

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. Esselstyn
⁶
and Dean Ornish
⁷
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.

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

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?

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.

When we live in a system, we absorb a system and think in a system.

—
JAMES W. DOUGLASS

W
hen I began my research career in nutritional science, I was naïve to a fault. My childhood environment of hay fields and milking barns did not prepare me for the dark side of “science” as it is currently done: the greed, the small-mindedness, and the outright dishonesty and cynicism of some of its practitioners. Not to mention the shocking examples of how public officials closed their eyes to important findings that got in the way of their reelection.

I entered the academy eager to participate in my idealized version of scientific inquiry. I couldn’t imagine anything better: learning new things, choosing which questions to research, then sharing and debating ideas with students and colleagues. I loved the transparency and integrity of the scientific method—how personal opinions and biases faded away before the majesty of real evidence. How a well-conceived experiment was like setting the table beautifully and inviting Truth to dinner. How honest questioning could banish ignorance and create a better world.

What I discovered is that science was, is, and can be just like that—as long as the researcher is careful not to pursue politically incorrect ideas outside the boundaries of “normal” science. You can wonder and ask and research anything you like, until you cross the line defined by prejudice and reinforced by the moneyed interests that fund almost all science.

Normal science. That’s a strange phrase, isn’t it? Normal science means anything that doesn’t challenge the prevailing paradigm—the agreed-upon story of how the world is. “Normal” doesn’t mean “good” or “better” in any way; it just means that the researcher has refrained from asking questions whose answers are considered already known and no longer subject to debate. For much of my career I’ve found myself bumping up against the invisible boundaries of the scientific paradigm. In the last few decades, I finally decided to blast through them altogether. That’s how I know so much about those boundaries: sometimes you have to cross the line to find out where it is.

One of the most devilish things about paradigms is that they’re almost impossible to perceive from the inside. A paradigm can be so all-encompassing that it simply looks like all there is. For example, let’s look at an obsolete paradigm that reigned for hundreds of years: the idea that the sun revolved around the earth, and not the other way around. You can’t blame people for believing that the earth was the center of the universe; when you go outside, you see the earth standing still while the sun, moon, planets, and stars move across the sky. When Copernicus published
De Revolutionibus
in 1543, asserting that the earth rotated around the sun, he was challenging common sense, a millennium of scientific agreement, and an outraged religious community. The fact that he had evidence—that his theory in fact explained phenomena that were unexplainable under the prevailing earth-centric theory—didn’t matter one bit. As philosopher-songwriter Paul Simon put it, “A man hears what he wants to hear and disregards the rest.”

I’m not trying to compare myself to Copernicus. His story is just a well-known example of an obsolete paradigm standing in the way of progress and the discovery of truth. In a perfect world (the one I believed in when I began my research career), the scientific method would simply compost inadequate paradigms when the evidence showed their limitations. But people who have built their careers upon these paradigms can act like threatened dictators; they cling to power at all costs, and the more they are
challenged, the nastier and more dangerous they become. (This is doubly true when the paradigm supports powerful moneyed interests—but we’ll get to that shortly.)