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How to Reliably Combat Disease

and Achieve Optimal Health
through Nutrition and Lifestyle

Neil Nedley, M.D.

Edited by David DeRose, M.D.


eil Nedley, M.D.

1010 14rh t. W
Ardmore. OK 73401

Copyright 1998 by Neil Nedley, M.D.

AII rights reserved. No pan of chis book may be u 'ed or reproduced,
stored in a retrieval sysrem, or (l'ansmiued in any form or by any means
withour prior wriuen permission hom the publisher (Neil Nedley. M.D.,
1010 14rh Sr. NW, Ardmore, OK 73401).

lSBN 0-9661979-3-3

Caution: dus book does not estabJish a docror-patienr relationship with rhe reader.
Persons who are ill or on medication who wish to significamly change their lifeseyle
should do so under the direction of a physician familiar wirh the effects of Jjfesryle
change on health.

Library ofCongress Card Catalog Number: 97-92826

Publisher's Cataloging-in-Publication
(PrQvidul hy QlIllli~y Books. Ine)

Nedlcy. Neil.
Proofpositive: how 10 reliably combat disease and achieve
optimal heallh through nutrition and lifeslyle / Neil Nedlcy.
-- 1" ed.
p. cm.

Includes bibliographical references.

ISBN: 0-9661979-3-3
1. Health. 2. Self-care. Health.
1. tle.
RA 776.N43 1997


3. Health promolion.


To my father, A. LLoyd Nedley, Jr. (Eud).
My father is a mechanical engineer and not a heaIth professional by trade. He has spent
most of !lis working life designing automobiles for General Mowrs. lf it were not for the
personallifesryle changes my father made whell I wa growing up, this book would probably have never been wriuen. As a young ba)' I wirnessed lum make dramatic changes in
rhe areas of nmrition and exercise and turn his own failing health imo exceptionally good
health in a marter of mOll(hs. This sparked my interest in health, and by the time my
iruerest haei fully grown into adulthood, I was a ph)'sician and an Internal Mcdicine specialist. Dad, an aurhor of numerous scientil1c engincering papers, volunt.eered ro function
as the "lay editor" of this book. He has put in untold tireless hours in attempting ro make
lhis book UJ)derstanelable [Q the general public and in certain technical portions of the
book his work has been quire perplexing. Ye! he has wilJingly sacrificeel, stating tha! he
ma)' "do more for mank.ind in assisting in this book rhan 1 have done in ali of my engiIIccring years. ' If d)is book assisrs individuals ro change lifesr)'les for the beuer, thlls improving health. my father (ancl l) will be (fui)' gratified.


My gratitude and thanks to:
David DeRose, M.D., as an instructor in my Internal Medicine residency. who demonstrated rhe impoflance of diet in assisting in healing certain diseases. De. DeRose was
ilie fim person tO show me (rom modern scientific [jterature fhe superioriry of a dier thar
1describe and recommend in ilie book. He was instrumental in bringing abour changes in
my own diet and lifesryle for rhe berrer. It is fitting chat he be t!le editor for this work.
Uchee Pines Instirute, Seale, Alabama, who kindly loaned one of ies students ro assist
in referencing this book. Each chapter is extensively referenced, thanks Iargely ro the work
of Rodney Scale, who delayed the recum [O his home in Australia for over rwo years in
order to see rhe book completed. He spenr countless hours on MedHne (an online service),
obtained many full articIcs, and made maoy caJls ro individual authors of scudies ro cooflrm thac we were quoting the <lmhors correcdy. He is presently worlcing extensively on the
more exhaustive upcoming CD-ROM version.
Charles C1eveland, M.PH., who helped iuitiare che project by "rranslating" videotaped leccures inco book format and assiscing in initial referencing.
Shellie Hammack and ony Clifron who helped with the ftgure !ayouts and design.
Mcrcy Memorial Healili Center, Ardmore, Oklahoma, who not only "pllt up" with
rme periods that 1was absent writing the book, bur provided he1p through the use of their
medical library. Kim McClemore, ilie medical librariaJl, always cheerfully obtained fuU
arricles even ehough they were sometimes difficuJt ro hnd.
Velda Lewis, Ardmore Insticure of Health, who asked me ro give many health leccures
in several different settings aner we moved ro Oklahoma. She always insisred OI) professional-appearing visual aids. In the audience, occasionally, were those who lacer invired me
tO give additionaJ peesentations on a national and international scaJe. Had it not been for
the initiaJ heaJrh Iecmres, the material forthis book would never have been formed.
The board of direcrors of the Ardmore Institute of Healdl, owner and operator of clle
Lifesryle Center of America, who asked me ro be their initial medical director. They conInued to stimulare my thoughrs around nutricion and lifesryle lines. Their subsequem
medical direc[Qt, Dt. Zeno Charles-Marcd,also provided multiple weekends of medical
coverage for my medical practice ro aUow me ro finish the book.
Brian Shockcy, M.D., who has willingly provided muhiple weeks of medical coverage
for my practice ta permit rne (O author this book. This on-en meanr work days in excess of
16 hours so his medical partner could stay home and write withour interruption.
My pariems, who not only "put up" wirh my medical coverage while 1 was wriring the
book, but who were on my mind as I wrote many secroos of the book. Although rheit
names, for the mose part, do not appear in the book. they helped provide some of che
maJly true examples eiced in the book. Furthermore, chis book is written for any parjem ro

rcad, ro learn. and live a he.1lrhier way of1jfe.

My srudenrs :lnd lecwre audiences, who initially demande I rhe book so rhey \-vould
nor need ro rape lecrures aJld phorograph rhe visual aids ofinreresr ro them. The book was
conceived from rheir requests for written material ro rake home wirh rhem.
The late Ellen Wlure, whosc:: wriring conrinue ro srimulate thoughr discovery, and
research in healrh and medicine. Appendix X provides fu[[her acknowledgmenrs in rhis
My farher and morher, Lloyd and Orvetta Nedley, who provided me wirh as clase ro an
ideal upbringing as possible in rhe rurbulent 60s and 705. and who were m)' fim inslfucrors in hcalrh. The book's "Dedication" provides more derails conceming my farher.
My lovely wife Erica who nor only pariendy awaired the compleron of rhe project.
bur also made sure 1 remained focused during rhe rimes dedicared to the boole
AJso my three sons Joel, AJlen and Nathan, \Vho learned ro respect the rime rhat
Daddy was home bur was busy "working an rhe book.





FORE\X/ORD ............... "














































MJLK: Fnlr:~D OR











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About the Author

Nel Ned)ey, M.D., is a full-rime practicing physician in Interna) Medicine with ernphasis in Cardiology, Gasuoenrerology, Critical Care, and Preventive Medicine. He did
his undergraduate swdes ac Andrews Universiry in Michigan, majoring in Biochemjsrry.
FIe.graduaced from medical school in 1986 with a Doctor of Medjcine (M.D) degree from
Loma Linda Universit}' in California, ranking in the tap 10 percent of his class.
He completed his residency in Inrernal Medicine ar Keteering Medical Center at Wright
State Universiry in Ohio in 1989, and in the same year he became certiflee! by rhe American Board of [nrernal Medicine. He is a 111e1nber of the American Medical Associarion,
American College ofPhysicians, and Alpha-Omega-Alpha Honor Medical Sociery, as well
as a number of othcr health and med.ical associations. He is llighly skilled in numerous
careliology, gastroenterology. and critical care procedurc.5.
In 1989 he came ro Ardrnore, OklaJlOma, because of the uniquc opportuIliry to practice both acute care Inrernal Medicine wirh an emphasis in critica! care, and Lifestyle anei
Preventive Mcdicine with u)eArdmore Insritute of Hcalth, who operares rhe Lifestyle
Center of America, a Jive-in Prevenrive Medicine facility. Dr. Nedley served as MedicaJ
Direc(Or of rhe Ardmore Institute of Health and irs associated !ifesryle cemer rhrough
1996. He served as Chairman of rhe Medicine Deparrment ar Mercy Memorial HospiraI
and Healrh Cenrer, and President of the Medical Sraff He currendy is a hospital board
member ar Mercy Memorial Healrh Cenrcr, a regional referral medical center for sourhcrn
Oldahoma, and chajrs [he MedicII Education alld Medical Librar}' Commirrees.
Dr. Nedley has lecrured exrensively in rhe United Srates, Canada, Europe. and Russia
on nurrtion, lifesryle. and health. He has held numerous nlltririon seminars, cooking
schools (with his wife. Erica), srress semina.rs, and Stop smoking programs. He has produced a scries of health educarional videos an rhe ropics in rhis book, somc of which have
run on national sarellire relevision. He lives wirh his wife and rbree boys on a 90-acre
ranch in OkI<lhoma and cnjoys readillg, running. tennis, gardening, c1assicaJ rnusic, and
ridjng !lis rraCIOf.

This book is the most useful book for health promotion ever wriuen in rhis generarion
and willundoubredly emerge as rhe standard handbook for aU healrh educarors. It provides the faers in a sciemifie and bahnced manner thar shouJd be compeUing for any
rational being ro give reason for improving !lis/her lifesryle.
The book goes beyond the faers and dangers of our lifesryles ro give constructive rechniques in how eo change. It is well known thar rhe faers al1d dangers are noe enough [Q
change mosr people. However, rhis informarion alone ma)' well keep many horn developing soroe of rhese bad habits ta begin wirh as well as srop rhose in rheir rraeks who have
bad habirs, forcing rhem ro reeonsider whar ehey are doing. Bur rhis book conrinually
poinrs ro rhe only real Souree tlur will make change possibJe and urges ali ro avail rhemselves of rhar Power.
The major areas of lifesr)'le rhar need changing in rhe developing world are also addressed in rhe book. The World Healrh Organization~ srates:
"'On currenr projecrions. cardjovascular diseases (and cancer) will emcrge, or be esrablished,
. as subS[.1nria} heahh probJems in vinually every colJnrry in rhe world by [he year 2000." "Their
prevenrion or redllCrioJl is boch a social responsibiJiey and an economic necessiry."
"1 n developcd countries, diseases ee1al.ed ro life-slyle (including diel, alcohol consumption,
smoking, :LIld rhe level of physical activiry) ac.coum for mos[ morbidiry and morraliry."
The WHO sr'l(es rhar a program is needed of "primordi<ll" prevenrion; rhar is. do
somerhing ahour it before rhe epidemie oeeurs. Ir is possible ro reduce rhe coronary hean
disease risk by 90 percenr aod cancer risk by as much as 80 pereenr.
The moral brerkdown of socjety also has resulred in many of our problems, sueh as
AJDS. Srudies have demonstrarcd rhe lack of effeeriveness of the usual sex edueation
cITam whereas the spirirual influence of rwo parenrs in the hOlne has been effective.
Through rhe righr exercise of rhe will, an cnrire change may be made in rhe lifesryle.
This is ehe governing power in rhe nawre of man-rhe pO\ver of deeision, of ehoice.
Everyrhing depends an rhe righr aecion of (he will. Through rhe use of the informarion
ptesenred here in making proper choices. disease cannoc only be prevenred, bur many aJso
will be able ro regain rhe heaJ(h rhar rhey have Iose.

Nutrition Researcher and
Adjunct Prof ofNutrition
Loma Lindo Universit)'

"'\Yfl-IO Ie(h. Report Serit-, 797, 1990, pp. 28, 157, 38, 36.


Recent research has given us new rools [har help us scay healiliy and live life ro ilie
fullesr. Through aur choice of foods aJld by avoiding che pirfalls of smoking and other
chemical exposures, we have more power for health than we mighc have imagined. Even
seriOliS ilJnesses, such as hearr disease and cancer, are dramacicaJly influenced by rhe food
and lifestyle choices we make each day.
However, an optimal dicr is not the fOmine of skinless chicken breast, yogun, and
salad thar many people imagine it ro be. The powcr of foods goes mllch further. In ch.is
volume, Neil Nedley, M.D., takes [he latcs[ medical research and shows you how ro build
a rrul}' powerful menu for heaJ[h. He also shows how to break free of bad habits and
addiccions [har prevcnr sa many people from really living.
Of. Nedley's medical knowledge enriches readers with new insighrs, and his wa(lmh
a.lld compassion help LIS over any momenrs of reticence we may have as we embark on aur
journey ca health.

President, Physicians Committee

for Respo~lSib!e Medicittn


This book addresses the un.iversal problem of personal health and disease, and is wrirten for the generaJ public as well as rhe health professionaJ. le speaks to any person who
wishes ro auaill (or mainrain) good health and freedam from disease by natural means,
minimizing rhe use of prescriprioll drugs, food supplemems, and diet fads. It conrains
specific medica.l advice ro arrain rhese goaJs. The prevemioll of a disease as weB as the
rrearment, if it exisrs rhrough lifesryle measures, are both addressed.
It is designed to be readable and eas)' ro understand, wirh mally color illusuatiolls dlar
claJify the subjecr at hand. Each of the 20 chaprers covers a specific topic, and each "stands
alone," which permi.rs a frec choice to begin ar rhe topic of highest interest ro r.he reader.
The book is based on the latesr facrual, reliable medical principles rhar have been llsed
by Dr. Nedley for r.reaullg his par.ienrs for many years. Counrless sciemific srudies COIlducred arotlnd the world, combined widl rhe latesr medical knowledge of the effecrs of
lifesryle faccors, form the basis for the information and advice given. Many specific diseases and ailments are addressed, in addirioll ro stJess, problems of addicrions, common
myrhs a~olJ( nurririon, food supplements, substance abuse, and other health topics.


10 demonstrate che impact al nurrition and ocher lifesryle facrors an ovcrall health.
To show how cenain common (and sometimes unconilll0n) diseases can often be
completely prevemed ar helped by cenain lifesryle changes withour prescriprion drugs
and their accompanying side effeccs.
Ta enhance the readers' satisfacrion and enjoymcm of life by providing IDorivarion
and guidance for adopting rewarding lifestyle changcs thar are in agreemenc with cimeless
biblical principles and chose of modern science.
Ta present scielHific documelHacion of rhe chrust of dus book, raking it our of che
realm of opinion or fad and imo the realm ofsolid, reliable facr.
To provide a rdiable. well documemed saurce book for providing lIseful, IIp-ro-datc
information ca health professionaJs and assisrng them in educacing che public.
Ta make alI of me figures in chis book available in transparency, slide, or compurcr
presemation form ro beaJch educators and others for their use in preselHations ro omer
healrh professionals ar ro the general public rhrough {he soon-to-he-released CD-ROM





is situat ion was seriolls. 1 SlISpecred Harold had heaT[ disease. As parc ofm}" evalliacion,
1was now preparing bim for a
treadmill rest. While the llllfse and 1 were
hooking Haroid up ro the heaT[ monitor,
he. confided: "Oocror, J really don't rhink it
marter how J check out on the te t raday.
We each have a rime when \Ve are going tO
dic; thar rime is set and [here is nothing we
can do about it."
As 1 thought aboUT his sraremenr 1 reaJjzed how out of rouch Harold was ""ith aur
currenr knowledge of ehe relatiollship becwecl) lifesryle and health. An overwhclming amOllJlt of scienrific researeh eleady
demonsrrares rhat aur dai!y choices afFecr
our likeJihood of living a long ;md healchy
life. 1 decided lO ofFer Harold an extreme
cxample of how lifestyle choices can affect
Jongevicy. "Harold, ir may ar may nor bc
rrue [har God has already planned the besr
rime for you ta clic. Let us for a moment,
rhough, assume Hc did. What rhen would
happen if you committed suicide? Wouldn'r
you be dying sooner rhan the cime Gad
planned for you to dic?"
My point was obviolls. However, each
day mOsc aII of us make decisions tluc ultimarely have a bearing on life and healch.
Wc may nor commit suicide in a single de-

Iiberare acr, bur we may pllr harmfi.t1 sub"rances imo our bodies rhar will premarurely
cause dearh Or decrease our qualit)' of Jite.

Health Depends Largely on Lifestyle

Many erroneollsly believe thar inherred
rrairs (generic facrors) are rhe primary hlCtoL determining cheir quatiry of life and
how long [hey will Jive. For [Il vasr majority of us, aur health is primarily dependenr
on t\VO orher f.1crors: (1) whar we pur i ma
aur bodies, and (2) whar we do with our
bodies. A simple word rhar encapsulates
both of rhese concepts is "Iifesryle." The
good news is rhar even rhough we cannot
change aur genecics, \Ve Uln change our
lifesrylc. Those lifesryle choices can prevent
or foresrall che developmenr of diseases for
which we are genercally predisposcd. Regarding the most common diseases, OI'.
L1mom Murdoch of Lama Linda Universiry School of Medicine has put ic aptly:
"faulry genetics !oads the gun. fife.. ~yie pul/s

the triggcr."
1 have ofren wondered why people take
beteer care of theil' ears rhan their bodies. 1
have yer ta meet a person who said, "God
has a plan as to when my car should 'die.
and 1do nor need ro 'Vorry abour it. 1don'r
need ro check or change the oiI, ar perfol'm
any routine mailllenance. And 1don'r need


DEATH IN THE U..S.. (1990)

lofectious disclIses 90,000

1Toxic Agent.s 60,000

1..-_ _.....

*Firearms 35,000
*Sexual Bebavior 30,000
Motor Vebdes 25,000
*lIIicit Drugs 20,000









* Denotes lijestylefQcto~'
Figure 1

ro worry abollt the rype of gasoLi.ne ruse. n

We recognize the necessiry of proper care
ro get the Jongest life and best performance
aur of our auromobiles. When wiU we realize that proper care also gives our bodies
the Jongesr life and best performaJlce?
What are the root cau e.s of death?
When someone dies with a heart atrack,
srroke, or orher fatal condition, what really


Chronic luog djsease







1 0 . Kidney failure

Other 398,'000

Figure 2










eaused rhar f:Hal disease at thar rime in a

person's life? Researchers McGinnis and
Foege recendy analyzed ilie roor causes of
whar Americans die rrom and published
uleir findings in the Journal of rhe American Medical Associarion. The !line leading
causes of dcarh were largely relared ro
lifesryle choices: what wc put iota our bodies and what we do WiUl aur bodies. These
callses arc lisred for rhe year 1990 in Figurc 1.1
AII of rhe facrors widl asterisks are directly impacred by lifestyle. The total of
these facrors is abollr 1.25 miII ion, which is
over half of rhe roral mllnber of deaths in
America each year. We see dur rhe roor
causes of death are largely unhealrhfuJ
lifesryles. As surprisingly high as chis rotal
is, it may greatly underestimare [he roral
number of lifesryle-relarcd dcadls. Many
dearhs due ro infecrious disease.s are caused
by an immune system rhar is weakened by
a poor lifesryJe. Also, rhe researchers listed
onJy rhe deaths rhar could be amibuted ro
kllown lifesryle facrors. As we continue ro
learn more abolit lifesryle and health, we
likely will discover how orher lifesryle
choices could pl'evelH stiH more deaths.
Nonerheless, the figures demonstrare rhat
the nurnhel' of premature dearhs in our
counrry would be dramaricaLly decreased if
Americans wouJd be willing ro replace a11
of rheir harmfullifestyle factors with hclpfulones.
T!le.re would be benefits even beyond
rhe reduction in premarure dettths. Qutllil)'
of lift would improve, as diseases would
strike less frequently at any given age. YOl!
can help ro change rhese statisrics by joining the growing nllmber ofAmericalls who
are focllsing on healthy lifesryle choices ro
arraill t!le highesr qllalily of life a.nd optimallongeviry.

Prevention is the Key

Today, a wealth ofscienrific research has
confirmed that mOSt of the leading causes
of death are prevenrable. The mo.st COJl)mon aHlictions dur cause death in America
are lisred in Figure 2. 2
C. Evereu Koop, M.D., Sc.D, formel'
Surgeon General of the United Srarcs, pro-


duce-d rhe fim Surgeon General's Report an
Nurririon and Healrh in 1988. It \Vas based
on an exhausrive review of the scielHific literarure. He concluded that "dierary excess
and mhalance" colHribured significanrll' ro
cighr of the leading killer diseases in our
country. Excerprs from his rcpon are shown
in Figure 3. 3

Longevity Studies Related to Lifestyle

Just whar are these lifestyle factors thar
will help liS ro live a longer life? Drs. Nedl"a
Belloc and Lester Breslow were among rhe
first researchers ta presell( a convincing answet. In rheir classic smdl' of nearll' 7000
individuals living in Alameda COllnry, California, rhel' found dut there wcre seven
lifestyle factors that influenced how long
people \ived. These facrors are lisred in Figure 4. 4The number of these habits thar all
individual followed made a tremendous
impaCt on cheir longevity. Afret nine years,
the number ofhealthfullifesrylc practiccs a
person followed was directly related ro tlle
likeilllOod ofdying. The results are depierd
n Figure 5. 5 Norice t1m only abour 5 percem of men and women who followed all
seven health habits clied in the nine year
period, compared ta 12.3 to 20 percenr who
followed three habirs or less. .
Anorher way of lookng at rhe mpacr
of lifesryle an longeviry is by consideting
something referred to as "health age." As
an exaJup1e, a 50year.old who embraces
enough healrhfullifesryle facrors may havc
rhe samc health or physiologic age as che
average 35-yearold person. We could say
thar chis individual has a "heaJth age" of35.
On rhe orher hand, anorher 50-year-old
\vho had no regard for a heaJchfullfesryle
ma)' have a much older health age, perhaps
as high as 72. Ll ocher words, a person's
healrh age can be lower OI' higher tl\Jn che
actual chronological age, depending on rhe
numbcr of lifesryle facmrs adopted.
HeaJdl age rabIes have been crcatcd from
rhe AJameda Counry sratisrics. They cover
the chronological age range from 20 years
1:0 70, and are based on the same seven
health habirs lisrecl in Figure 4. One sllch
table is depcred in Figure 6. 6
You c..1n use this figure as a guicle ro get

1. Diet has a vital inOucncc on bcaltb.
2. Fi'lc of tbc tcn Icading causcs of iIlncss and dealh arc as!ociatcd
\'iith dicl (coronary hcart disCllSC, CjlDccr, slrokc, diabclcs,
and alhHoscierosis).
3. Anotherthrce ha'le been associalcd IVilh cxccssi'lC alcohol intakc
(cirrhosis of Ihe liver, accidenfs, and suicide).
4. These cight conditions accounled for nearly 1.5 million or the 2.1
mimon total deaths in 1987.
5. Dictary exccsscs or imbalanccs also contribuIe to
olhcr problelm such ilS hgh blood prCSSiJrc,
obesity, denl:!1 disel\ses, oslcollorosis, llnd
gastrointesfinal diseases.
6. It s now dear Iiull dicl conlribulcs in substantial
ways 10 the devclopmcot of thesc, discascs and that
modifical'ioD of dkt can contribuie 10 their
prc\'cniioll aud control.

Figure 3


]. Slcep 7 to 8 hours
2. No eating between meals
3. Eat brcakfast regularly
4. Maintain proper weight


5. Regular exercise

6. Moderate or

DO lIse

of alcohol

7. No smoking
Figure 4

Age-adj/lsted (le"l" rll1e

No, of bcaltb
h.:lbits practiced



in 9 Yf'ar~


of bcahb

habUi li"raC:1i.ud

"crcent dcad
lO 9 ~lt2t'!







Figure 5



//leiI alld WOl1lell




















-1 J.I































Figure 6

a feei for your own healrh age. For example,

assume rhar you are an average 40-year-old
Alameda county resident. If you are following only two of the seven Belloc and
Breslow's health habits, yOLlI' health age is
40 plus 19.4, OI' about 59, indicating a dramatic shortening of your Jlfe cxpectancy.
You would havc the saltle life expecrancy as
rhe average individual 19 yar older. Ifyou
conrinue the same lifesryle for 10 mare
yeaIs, when yOll are 50 your healr.h age will
be 50 plus 22, ar 72. Ar age 40. you had a
19-year health handicap, but a( age 50, the
handicap wilJ even be \Vorse by 3 years. In
10 years you wiU age 13 years!
an rhe otber hand, if yOll, ar 40, are
consistenrly following aII seven of Bel10c and
Breslow's health hahirs, your healrh age is
only 27 (40 minus 12.9). Furr.hennore. ar
age 50 youl' hcalth age wiU be onl)' 35. In
10 years you will only age 8 years! The
concepr. of health age iUusrrates how much
our lfesryle can eithet hasten 01' slow rhe
agmg process.

But What About Quality ofLift at

Some individua.!s believe u1at they are
able 10 exrend r.heir live-s, rer rhey fear rhe
resulrs ofliving longer. Tracy, a respirawry
rherapist, recenrly said lO me, "} don'r want
ta live ro be 70 years olel. People rhar age
seem ro have so man)' problems. [rhink I
wanr ro clie before ['m 70."

1 said in response, "Tracy, you 111ay sa}'

rhar now, bur wair until you'l'e. 69. Then
you will want ro live uneil70, and once you
ger to 70 you will likely want ro live ro 71
parricularly if )'OU havc good heahh. I know
mall)' individua.ls in theil' 70's and 80's that
are enjoying a goocl qualiry ofliCe. The socaUed 'golden ycars' are a realiry for them."
More recene research has funher he1ped
ro allswer Tracy's concern. Alrhough rhe
original AJameda Councy reports focused
primarily on the age at deat!? subseqllen(
work has looked ar quali~y of/~fe iSSllCS. For
example, rhe "Alameda sevel( have emerged
a powel'flll ways ro prevem probabl)' (he
mosr Feared complicarion of aging: dimbilit)!. A recene repore demonsrrared rhat those
who followed rhe greatest mtmber of (hese
health habirs expel'enced on.!)' ha!ftiu: risk
of disability as rhose wrh (he pool'est habirs. Those wirh an imermediare nllmber of
heahh habir.s also fared beuel' than rhose
\Vho spurned mosr of Belloc and Breslow's
seven. They expel'ienced ooly rwo rhirds
the risk of disability as the least hea.lr.h-consciolls grollp.7
Let llS look at some of the individuaJ
habits rhar BeHoc and Breslow idenrified
and sec how they have a bearing on life's
quaLry as well as Jongeviry.

Eat Breakfast Regularl)'

Many people reading rhe Alameda
Counry study are surpri cd tO finei "earjng
breakfasr' included in a lisr of seven of (he
most important longeviry facrors. Earing
breakfasr in and of itself increases longeviry. In some of r.he original dara ir W:lS found
rhat meo who ate breakfast and clid nor cat
berween meals had lcss than half the risk of
deaeh of men who skipped breakfasr anei
sl1acked. A more recent analysis of the
AJarneda Counry srudy dara focllsed particularly on individuals in the 60 to 94 year
old range. Those who did nor ear breakfast
regularly had a 50 perce)1( increased risk of
dea(h compared (Q the reguJar breakfast earers. 9 Rern:ukably, in chis group of older
Americans, long life \vas aS dependell[ on
earing a good b(eakfas( as it was on nor slHok
ing and getring regular phy. icaJ exercise.


Despjte rhese facrs (and whar rheir
morhers likely cold rhem), IUosr people give
a variecy of reasons for nor earing break.fasr.
A common reason is rhar they are nor 11lIngry in ilie morning, which is the usual resulr of earing a fuU meaJ in rhe evening. A
JiglHer evening meal will tend ta salve rhe
problem. Berter yet, if you have rhe re olve,
try caring no suppers for a week. By rhe
end of the week you will likel}' be hungry
for a good breakfast. You might also flnd
that }'ou are sleeping more soundly, even
though )'ou may go [O beci hungry for a few
nights uneil yom bod)' adjusts. With a litde
planning, brcakfasts are lIsually easier ro
prep:uc than Jllnch ar supper. Be creative
with )'our use of grains ancl be sun: co have
several servings of fresh Emir.

Eating Breakfast Helps to 7

Prevent Weight Cain
Another reason given for slcipping breakfast is to keep from gaining weighr. Some
rea an rhar becallse the)' were not hungry
in the morning, skipping breakf.,sr would
help them e<lr fewer calories during the c1ay
and wOlllC! thu favor weighr 1055. This is a
myrh. The rrurh is thar eariJlg a good breakfast should be parr of, ny weight loss program.
Years aga Dr. Charles Cllpp proposed
(har weighr gain is rhe result of inappropriare /iming of food intake in relaron (O the
evcning sleep rime. During a medical practice thar spanned a rell1<lrkable seven decade, Cupp insrrucred hllndreds of patienrs
on his novel approach ro weight COntrol.
Overweighr patients were insrrucred tO
change rheir meaJ patrern from a heavy meal
anei snacks in rhe evening ro a heav)' lUoming meaJ a moderare lunch, and a Iiglu supper. They were ro ear rheir lasr meaJ ideaUy
ar noon bur by no means larer rhan 3:00
p.m., and rhe)' were insrrucred nor ro go (O
sleep for at leasr eigh t and a hal f hours aher
[!le lasr inrake offood. Ofsignifica.nce, they
were 1I0t asked ro cha.nge rheir food choices
nor (he amOlllH of calories chey are. 1nrriglled researchers in rhe Depanmenr of
Nurririon ar Ti.Jlane Universicy's 5chool of
Public HeaJtn anaJyzed rhe records of 595

of CUPP's overweight pariems. The resulrs

of rheir srudy are shown in Figure 7 10 This
evidence and numerous orher srudies indicare rhar earing breakfasr regularly should
be parr ofany serious weight reducrion program. Nore rhar some additional bendlrs

All patiellts who fol/owed illstrucliolls 10S1 weigIJt

Those ",ho ate only break.fast a\'craged 10 Ib. weight
loss a month.
Thosc who ate brcak.fast, lunch, a,nd snacks averaged
5 to 6 Ib. a month.
Those who lost from 20 to 30 Ib. showed an
incrcase in hemoglobin levcl.
Blood sugar levels of diabctic paticnts who
lost 30 Ib. or more were normalized.
Hypothyroid patients showed a reductioll in
daily thyroid maintenance requirements.

Figure 7
accrlled from earing breakfasr: improved
blood hemoglobin level, reduced blood
sugar, and improved rhyroid funcrion.
The cypes of foods rypically earen ar
breakfasr ma}' al50 conrribure ro rhe imporranee of rhe morning meal for weighr control. III rhe U.5. eulrure the evening meal
tradirionally features a far-rich fare based an
animal producrs, and breakfasr is ofren eentered arollnd fruirs and grains wirh rheir
assoeiared complex carbohydratcs. This
becomes imponanr when we recognize rhar
weighr gain is ofren related ta gerring roo
many calories from fat rarher (han from
complex carbohydratt$. In rhe researdllab,
animals an a high fat djet gain more weight
than rheir pe r an a low-F.u regimen--evcn
whcn bod) grollpS ear rhe same number of
calories each day.ll

Breakfast and Heart Attacks

Eating breaJJ"ast has been found ro have
yer another benefic. Aduirs may be able ro
reduce their risk of hearr attacks by eating
breakfasr regularl}'. Plarelet$, the body's
blood cJorring cells, become "s(iclcier" in rhe
morning before breakfasr. This increases clle


''Wilboul bre.akfasl,
possible heart-allack
risk may be elevalcd
for 2-3 boun afler

potential 2

tendency for a blood c10r ro form during

the morning hours. If such a elOt occurs in
a heart blood vessel, a beaT( atrack can reSl1.Ir. As expected from this physiology, most
he;m anacks occur between 7 AM and 12
noon. Earing breakf.1sr can help the plarelets ro become less sticky and thus decrease
the risk of morning heart attacks. The impact of [hese eelarionships is illusrrated in
Figure 8. 12







Figure 8




more efficient problem solving

improved memory
increased verbal flucncy
improved attention span
better attitudes
better scholastic scores

Sleep) Exercise) and Smoking

Figure 9

Nine year follo ...-up for ages 30 1069




risk Bllo 2


Figure 10

There are addition:tl benetlts from eating a good breakfast beyond longevicy. In
August of 1995, the Pediarrics Depanment
at rhe University of California ar Davis
hosted a number of psychoJogisrs, neuroscienrisrs, nurririonists, and physiologisrs ro
review the sciemific srudies on breakfasr.
The researchers coneluded rhar rhe "eating
of breakfast is imponanr ro learning,
memory, and physical well-being in both
children and adl1.lts."13 Good breakfast habits are essential for maximum efficiency,
both menraJ and physical, parricularly during rhe late mOfJ1ing hours. Breakfast eaters demonstrate berrer attirudes and improved scholastic performance. A more
complete lisring of rhe benefits enjoyed by
breakfast-eating are listed in Figl.lre 9. 14

The AIameda Councy srudy showed rhat

our lifesryle habits regardingsleep, exercise,
and sllloking impacr rhe risk of dearh. ReSlllrS are presented in Figure 10,15.16 Six ro
nine hours of sleep per night appears tO be
ideal for most people. Ir is actual1y po sible
ro get roo much sleep as well as roo litde.
Those rhat slept significantly more or less
than this experienced a 60 tO 70 percem
increased risk of dying wirhin a nine year
period. For men, roo 111uch Or roo little
sleep carried a risk similar ro not exercising
reglilarly. Within the nine-year period, the
non-exercisers had a 50 percem increased
risk of dying compared ro those who made
a consistent effon ro keep fir. Women wirh
low physical activiry fared even worse. They
had over twice the risk of dying within (hat
nine year period.


Ir is never roo Iare ro begin an exercse
program. A separate study found rhat regardJess ofhow our ofshape a person is, r.he
risk of dearh from aH causes could be ceduced by lllerely becoming fir rhrough a
regular exercise progmm. The amount of
benefir is tabulated in Figure II Y
Notice rhat the death care ofphysically
fir men is only one-third ofIhe rare of those
,hat are unfir. For rhose that were uDnt and
then became fir, rhe dearh rare is abolit half
as much as for rhose who are unfit.

ner one's bones, the more likely rhey will

fracruce when subjected ro even minor
trauma. \'V'hen osreoporosis is nor dHeatening life, it is often decreasing irs qllaliry.
The disease can lead ro chronic pain as weti
as ta physical deformity.
These arc just a few examples of the
many dangers of smoking. More complere
informarion on chis subject is found in
Chapcer 16, cnriued "Dying for a Cigarette?
Kick d1C Habit and Live."

Dangers ofSmoking
The AJameda Counry data revealed that
if arnan smoked, he had double rhe risk of
dying wirhin a nine year period compared
{O a man who did nor smoke. If a womall
smoked, she had a 60 percenr increased risk
of dying. Anorher study found rhar meD
who smoked throughour rheir enrire adult
life had an average life expectancy of only
65 years. 18 This is 12 years shorcer (han the
expected 77-year life span for a lifelong nonsmoker. 19
AJrhough length of life is important,
quaLity Of life is also crirical ro ali of us.
Smokecs tend ro have a poorer qllality of
life. For example, peptic ulcer disease is
much more common among smokers.
Awakening ar 2;00 AM wirh burning abdominal pain cerrainly is nor qualiry living.
Evcn if a smoker does nor ger u1cers, o{her
digestive problems may arise relared ro rhe
smoking habir. For example, rohacco decreases rhe rone in [he band of mllscle berween {ile esophagus (swallowing tube) and
rhe sromach. This makes it easier for sromach acid ta flow inca rhe esophagus ,Uld
cause heartburn, anorher common robber
of life's quality.
Cigarette smoking also affecrs orher organ syscems. It contribures ro early skin
wrinkling and osccoporosi (rhinning of rhe
bones). Skin wrinkling is merely an undesicable condirion, bur osreoporosis c.an be
life threarening. Hip fractuces ace alllong
rbe leading c.auses of dearh in older Americans. (More complete infonnarion an osreoporosis is included in Chapter 7, "The
Grear Mea{ and Prorein Mym." The thin-

DeatJr rate per 10,000 lIlalt-years, lIIen ages 20 to 82.

Figure 11

Alcohol Use Shortens Lift

There are many voices roday advocaring moderate alcohol consumprion. This
is nor out of harmony with what the
AJameda Counry srudy in rhe early 1970s
revealed; namely, {hac moderate or no use
of alcohol enhanced longeviry. However,
research in the 25 years following Belloc and
Breslow's landmark publicacion demonstrates thar tolllL avoidllnce ofalcohol is Ule
best option from {ne perspective of disease
prevenrion. This issue is addcessed at lengrh
in Chapter 17, "Wanr a Drink?"

Social Relationships and Mortality

10 rhe surprise of mally skepeics, research aho suggesrs rhar rrusring Gad and
auending church on a reglllar hasis illcrease
longeviry. Having genuine friends, being a
member of a group, and even heing married have benefJcial effects on longeviry.
Most people inruirively lIndersrand that


Nille year follow-up of 7,000 adultI' ill lIorthern California for llges 30 to 49




rlsk ratio



Fe", rricndsl

Non cburch

Non ~roup

Figure 12

ehese e1emenrs enhance the moral and social quality of life, bm in addirion eheyalso
posieivdy affecr physiclli hellith imei longe-v;ty. When the Alameda COllllty data was
analyzed for ehese social and spirirual faetors, rhe I'esules were impressive. PanicuIarly srriking were ehe rcsuhs for rhose who
are 30 ro 49 years old. These are depicred
in Figme 12. 2oA growing body ofresearch
reseifies ro ehe value ofbdiefin God to one's
social and emOtional health. One such report from Duke Universiry fOllnd rhar individuals wirh strong religious faith reponed
higher levels of happiness ami s;'leisfaceion
in life. They 31so appeared ta handle craumarie evelHS better-wirh less menr31 and
social difflculries. 21 Chaprer 15, "AIDS and
HN- The Unrold Srory," and Chaprer 20,
'Beyond rhe Leading Causes of Death,"
provide addirional informarion on how [-urh
in God enhances healrh.

Many people in America in addirion to
my rreadrnill pariem, Harold, th.ink rhar
because of rheir generics or becallse ofsomt:
celesr.ial c1ock, the day and hour of deat.h
are hxed in srone. This faralisrie arritllde
forces rhem ro conci ude tiut they ca.n do
norhing ta prolong mei r Iives. The cvidence
presemed in rhis chaprcr dispds ali such
W. C. Willeu of rhe Harvard 5chool of
Public Healrh, Dcpanmenr of Nurrition

stares, "One clcar conc111sion from exisring

epidcmiologic evidence is dur man}' inclividuals in rhe United Srates have sllboprimal diets and that rhe porenrial for disca c
prcvemion by improved nllIrir.ion is subsIamial. "22 Betloc and Breslow summari1.ed
rheil' finelings in rhese words: "These data
are consistent wirh rhe idea... rhar a lifetirne
of good health pracrices produces good
healrh and exrends the period of relarively
good physical healrh sta rus by some 30
Indeed, Belloc and Breslow's seven
healrh principles are simple, yer rhey are
extremelyeffecuve. Furtherrnoee, rhey have
no adverse long-term side cffecrs and offer
profound bcnehts in the qualiry of life. If
any one of rhese seven healrh principles were
a medicarion ir would be classitled as a
"wonder drug." The originatar and rnanufacrurer would no doubr be rewarded with
fame and fonune. However, as an Inrernal
Medicine specialist, .1 can unequivocally say
thar no meelicarion even comes c10se ta a
single one of rhese healrh principles in irs
power ta improve and mainrain health.
The good ne\vs does nor scop [here. This
book will reveti a hosr of additional healrh
principles rhar careful researchers have discovercd in rhe 25 years following Bdloc and
BresJow's original srudies. These principles
offer additional benefirs for maintaining
health and erearing cerrain disease stares.
Yall will sec dut rhe healrh principles
brought co lighr in rhis book are dependable. They can be relied on with confidence
ro help yOll reaeh and m;linrain your health
Reaping healrh bendlts by following
sOI.U1d Iifesrrle principles is nor a new concept. Cenruries ago God made a promise
recorded in the Bible ro the newly formed
narion ofIsrael, , If ehou wilr diJigenrly hearken ro ehe vaice of rhe Lord d1Y Gad and
wilt do rhar which is righ[ in his sight, aud
wilr give ear ta his commandmenrs, and
keep aII his srarures, I will pur none of rhese
disease upon (hee, which I have brought
upon r.11C Egypri;ms: for] am [he Lord rhar
healetll [hee. "24
Yes, followng cerran principles thar resuit in good healrh is nOI a new concept.


Bur this very old concepr needs ro be resurrected in aur personallives, across America,
and rhroughotlt rhe world. As Egyprian
diseases could be avoided in ancienr times,
the ren leading causes of death in rhese
modern rimes can largely be avoided by fol-

lowing sound health prJlciples. In rhe chapters {hat foUow you will 1nd the information yOll need (Q successfully guide yOll ro
"do what is right" and thllS experience the
oprimal healrh promised.

References McGinnis JM. Foege W'H. ActlJaI callse,' of de;lth in the United St:l.tes.
JANf.A 1993 ov 10;270(18):2207-2212. F~'{IIl'eiltlLI!)tl'dJ1l1d J1djllSudfom
fiill,micfe. pper rang<-'S uscd for tobacco, ,,\Cohol, and diet/exercise ba "d
on additionJI intormation presellled in rhi, book.

Preliminary da!.1 on birlh and deaths-United Slare;, 1995. MMIllR

Morb MOrll11 Wkly Rep 1996 Ocr 25;45(42):914-9 J 9.

The Surgeon Gel/emIs Rtpon OII N/ltritioll alld Ht/1.lth. U.S. Dep!. ofHe:Jdl


Human Services (Public HeaJlh Service), 1988.

Belloc NB, Brcslow L. Rdarionship of physical heallh sratu and health

pr:\ctices. P,.,v M"d 1972 Aug; 1(3):409-421.

:; Breslo", L, Enslrom JE. Per. iSlence of heahh hahilS and their rel:uionship w mOrlaliry. Prrv Med 1980 Jul;9(4):469-483.
a ted from AJamcda Counry Sll.ldy data. For a similar table see T:\blc
X, page 79 In: BcHoe NB. Rclationship ofhealth pra liec and morraJiry.
?re-Il Merl1973 Mar;2(1):67-81.

13 Mathews R. Importanee of bl'eakfasr to cognirive performance ami

hcalth. Pm-pfCIive.f in Appli"d Nlltrilioll 1996;3(3):210.
14 Mathews R. lmportance of bl'eakfast ro cognitive perfonnance :H1d
hcalth. Perspectivt' in Applied Nurritioll 1996;3(3):204-212.

1; Wingard DL, Berkm'lI1 LE Monalir)' risk associ:\rcd Wilh sle.cping patterns among adults. Slup 1983;6(2): 102-107.
16 Wingard DL. Berkm:UJ. LE Brand, RJ. A mulriv:uialC analysis ofhca.lthrdalcd praerices: A ninc-year monaliry follo\\'-up of rhl' AI:uneda COllnty
studl'. Am J EpidellJio/1982 Nov; I 16(5):765-775.
17 Blair SN, Kohll-lW 3rd, el a.1. Clta.nges in physica.1 t1tnc_\-~ and all-causc
morraliry. A prospecuve s[Udr ofhcalthy and unhcalrhr men. JAMA 1995
Apr 12;273(14): 1093-1098.
18 Cigarene slOokin<>-:l1uiblitable morta.!iry :U1d rears ofp<>tcl1liallife )ostUnilcd States, 1990. MMWR MOI'h MOI'/J1/ Wkly Rep 1993 Alig

Bre;l"w L, BresJow N. Heahh praclices aJld Jisability: some 'vidence

frorn AJameda Counry. T'rNi Med 1993 J:\11;22(1 ):86-95.

l? Lew EA. G~rtlnkel L. Diflercnces in 1110rraliry and Jongeviry by sex,

smoking hca.lth hab.ils and health stalUs. Sacict} ofArtUitries TmmJ1ceionJ,
p. 39. 107-1.30.

Bclloc ND. Rdationship of h""lth prae.tices Jnd monality. !'reI.' Med

1973 Mar;2(1 ):67-81.

a /line-rear folJow-up srud}' of AJamcda COlllUy rc-sidems. Am j Epid(mio/



LE Syme SI..

Social nelM'ol'ks, hosl rcsistancc, aJld mortality:

1979 Feb; I 09(2): 186-204.

Kaplan GA, SttnUll TE, et al. Mortaliry among thc e1dcrJy ill ilie AJameda
Counry Sludy: behavioral and demographic risk faelOrs. Am j Public HCJ1hb
1987 Mar;77(3):307-312.

Soc &b(/II 1991 Mar:32( 1):80-99.

iO Carler JP, Browo J. Dr. Cupp's Simple Approaeh ro Weight Loss.

1IJ1loftIJe LOllisitJIIJ1 SttJlt .MedicJ11 Society 1985; 137(6);35-38.

22 Wilkll Wc. Diet and healrlt: wh:n ,hould



N,uion;)l R"'c:uch Col.lndl. C:Ilorics. In: Diet I1l1d HeJ1It1J. !mplicfltiollS

Washington, DC: National Academy
Pres., 1989 p. 151.

fo,. Rdullg C!JTOllic Disr.ase Risk,


Ellison CG. Religious involvemem and ubjcclive welJ-being.

\Ve cat~

f HCllltb

Scit!llu 1994 Apr

Belloc NB, Breslo", 1. ReI:l1ionship of physical hcalth s!alus and hcaJth

pracdces. Prel) Mcd 1972 Aug; 1(3):409-42 J.


24 Exodus 15:26.

The Holy Bibie. ;\urhori7.ed King James version.

RaJoff J. Breakf.1St may reduce momi ng heart atlack risk. Science New!
1991 April 20;139(l6):246-247.





It Can Be Prevented!

r was one of those appoinrmem tiut

we ali dread. June was back ar Or.
McAJesrer's office. A she sar fidgering in rhe wairing room, che thoughrs
were racing rhrough her mind. "Whar's raking him so long? 1 have ro find outwhar the
biopsy sH:owed. Maybe rhe news is bad and
he doesn't know how ro break it ro me."
5000, however, Juoe's name was calJed,
and she was broughr back ro one ofrhe exam
rooms. Aher what seemed like !loun larer,
Dr. McAlesrer sar facing her in rhe small
eX:lm rooro. He began r!le conversarion:
"1' m sorry, J
" N o sooner were rh ose
three words our of his mourh rhan June
sraned ctying. When she finally regajned
enollgh composure, she managed ta ger a
few words our: "Cancer-isn'r ir?" Or.
McAJesrer sadly oodded his head yes.
"Cancer." The word srrikes fear inca rhe
hearts of most Americans. Often in my years
of pracrice as a physician, 1 have had the
same lIncomforrable rask thar Dr. McAJester
haei. Many rimcs 1 have had ro rell individuals the frighrening news: "Yes, rhe biopsy is back and ir shows whar we aII
feared-you do have cancer."
A diagnosis of cancer is nor aJways a
death senrence. Somermes it can be rrcated
wirh chemorherapy, rad iar ion, surgety. or
other means. Unfortunate1y, far roo ofren

it advances beyond irs inirjaJ srage and the

disease js faraJ. Cancer is currendy rhe nllmber rwo killer in Americ.'l, rrailing onJy hearr
disease. Unless we as a narion make posirive lifesryle changes, soon afrer rhe year
2000 ir could be rhe number ooe cause of
dearh. 1 In America, rhe sr;trisrics indicare
rhar one in every nvo men and one in evety
rhree women wiU ar some time be diagnosed
wirh chis frighrfuj disease. 2 ClIrrenrly one
in every fOLU dearhs in rhis coufltry is from
cancer. 3 AH rold, over 500,000 Americans
die each year from rhis dreaded killer. This
alone is reason enollgh ro fear cancer. However, maoy people fear rhe ravages of cancer
even more rhan dearh irse1f.
Before a person dies from cancer, rhere
ofren are dramatic changes in physical appearance and inrelleccuaJ funcrioning. 511ch
changcs may include significanr weighr and
muscle los$, 10$s of hai r, severe episodes of
pain, memoty loss, near delirium, ,Uld even
profound personaliry changes. This is onJy
a parriallisrjng of rhe devast<lring effecrs of
cancer and irs rrearmcnr. Undollbredly, rhe
disease deserves to be feared for rhese reasons as well.
Unformnarely, mosr people feei rhar ali
[hey can do is hope rhcy never ger cancer.
They do nor realize rhar rhe degree of risk
of an individual ro develop cancer is Iargely


a marter of personallifesryle decisions. One
evidence of this lack of awareness is the filce
ehat, unJike some orher lifesryle-rdated diseases (such as hean disease), ehe total number of cancer deaths in America have been
sreadily increasing. 4 . S The rate of increase
is shown in Figure 1.





500,000 400,000









Figure 1


The rare of rise is dramaeic, doubling in

the last 30 years. Furrhermore, of the estimaeed 560,000 cancer victims who would
die in 1997,6 most ofrhem could have prevenred d\eir illness had ehey paid anemion
to some simple lifesryle facrors.
Akhough rhe number of cancer deaths
conrinues ro rise each year in rJ,e V.S., the
per capitl1 cancer morrality rate has jusr recently searced ro decline. 7 This celebrated
smaH decline was f1rst announced by (he
Nacional Cancer Institute in larc 1996, bUl
a ca refu I retrospective review of che daca
indicared ehat rhe per capiea cancer death
racc peaked in 1991 and has ever so sJowly
declined thereafter.RThe reason for rhis dec1ine~ Nor improved cancer rrearmems, bur
cancer preventioJl irselfemergcs as rhe cause
for rhis good news. 9 AJmough che auchors
of rhis repore readily admit rhar "rhe war
againsr cancer is far from over," they emphacic.llly srare rhar "A narional commirmene ro che prevention of cancer, largely replacing reliance on hopes for un iversal curef,

is now the way co go." This chapter is wrirten on che hopes of putting che reader on
tile cuning edge of rhis new commirmem
ro the prevenrion of cancer and cancer

, How Cel/s Become Cancerous

Lec us look ar whar cancer actually is.
Cancer involves rhe producrion of cells in
rhe body. Every minute 10 miJlion cells divide in ollr bodies. Complex internal control mechanisms usual!y eosure rhac every
one of these ceH divisions occurs in a precise way ar just che righr rime. 10 The process called cancer can begin when foreign
subsrances in the externttl environmene
(chemic.'lls, radiarion, virusc.s, etc.) ger inro
the body and somehow perturb these imernal control mechanisms. It can a1so begin
as a result of problems rhar originate with
rhe body's interna! environmenr (hormonal
imbaLulces, immune impairmenr. inherired
mucacions, erc.).ll Regardless of rhe corn
bination offaccors rhat start ilie process, che
resule is ehe same: a single cel! begins ro
mulriply in an unregulated manner. As this
ceH multiplies, ir passes irs characrerisric of
unregu!ared growth co its offspring. A caucerous rissue made up of many unregulared
cells is me result.
One of rhe ways thar environmental
agenrs appear co induce cancer is by inlliccing damage on [he cells' DNA. DNA conrain explicit nstfuceions for aU cell activiues and thus spells ouc exactly how each cell
in our body should function. For example,
rhe DNA [dIs our bodics what color (Q
make our hair and whether we should have
blue eyes or brown eyes. This same DNA
controls the rate of division ofcells. On cerrain criticaJ areas of a cell's DNA chere are
gene.s clut can stimulare che growrh of that
cel! and other genes char can suppress ies
growrh. One way tiUt cancer can occur is
chrough damage ro rhis DNA. II the d,1mage causcs ac(ivarion of areas (hat srimulare
growrh and/or the inaccivarion of areas thar
would keep growth in chcck, the resu1c cau
be unconrrolled growth of thar cel! aod its
offipring. This, as we have noced. signals
the beginning of a C~lI\cerolls growth. 12 We
refer ro that a1tered cdl as a cancer cell ifi[s


generics are ehanged in sLlch a way as [Q aJlow uneolltrollcd multiplication.
If rhe body derecrs abnormal cancerous
cdls at an carly stage, mase cells can be desrroyed before rhey have a chance ro signi(jcandy grow and multiply. In fact, many
sciencists belicve rhar evcry day-in evcry
pcrson-some normal celis are converted
inco cancerous cdls. Usually, rhe pcrson's
immune system desuoys rhese newly a1rered
cdls. Unforrunatdy. howevcr. sometimcs a
new eancerous ceU is nor derected and it
managcs ro divide and growwithot1t check.
These cells can rhen continue ta silencly
grow our of control. UJrimarely they can
fonn a mass ar "wmor." Commonly. cancer ceUs from larger (Umors will get into rhe
blood sueam aod/or Iymph sysrem and
rravel ro other vital organs. AI! of rhesc
changes may oeeur long before the cancer
is even djagnosed. Depending an rhe growrh
rate of the cancer, it may take 10 years or
longer before signs or symproms develop
that wtimate1y prompt rhe medical evaluarlon rhar results in rhe diagnosis ofcancer. 13
In rhis ehapter you will leam how ro
dctecr if you have cancer. and a1so how ta
reduce yur risk of getting it. We begin by
presencing means of detecting cancer.

Early Detection is Crucial

Early derecrion provides rhe besr chance
of rrearing cancer while it is stil! curable.
There arc rwo ways to do this: (1) prompr
recognition of cancer's symproms; and (2)
appropriare use of cancer screening tests.

Recognizing Cancer's Symptoms

Cancer is ofren curable if dcrccred catly
enough. Unforrunately. many pa[ienrs are
nor mindful of r!le importance ofearly dercetion. Time and rme again 1 have been
forcibly impressed wirh this sad real ity. In
addicion to my work in general internal
medici ne, I work in the fidd of gastroenterology. 1 have many paeienrs who come
ro my ofhee complaining of inrermirreo[
bleeding rrolll rhe rectulll for pcrhaps dyear
OI' more before seeing me ar any other physician. Somc pur atI that doctor's visit because of simple procrasrinarion, while orhcrs may have delayed because of ehe fcar of

cancer. Srill others may have dismissed [he

seriousness of this warning sign, thioking it
was due ro a minor condirion like a hemorrhoid. Only after they srart having pain or
orher symproms do rhey tJnally decide tO
have me evaluare rhe bleediog problem. By
rhis time. for many, it is aJready too late.
[n my eval1l3eion 1 use a colono;copea long, f1exible rube that is inserted nto the
rectum and passed up through rhe Iarge intestine, or colon. It has a light ar rhe end
rhat allows me ta direcdy look at the inside
of rhe inrestine. It also comes with special
rools for removing early cancers or non-cancemus polyps wirhout major surgery. As 1
look ehrough the scope J occasionally find
a cancerOlIs mass rhar is already [00 large
for me ro remove. Ar rhar poinr rhere may
be linIe chance of c urc:, but rhe person may
still need major surgery-ar Ie.ast ro avoid a
tOtal bowel blockage. Frequenrly. dearh is
rhe result. since by rhis time. the cancer has
often spread tO vital organs such as rhe Iiver.
T!le message rhar rhis and a rhousand
orher scenarios illustrate is tiut everyone
should pa)' artention ta canccr's warning
signs. It is onIy by heeding dlcse early warnings thar we have the best chance of detecting and treating t!le disease while it is stil!
curable. For years. the American Cancer 50ciery has encouragcd al! Amcricans tO be

1. A change in bowel or bladder habits
2. A sore that does not beai
3. Unusual bleeding OF discharge
4. Thickening or a lump in the !"
breast or elsewhere
5.1ndigestion or difficulty in
6. Obvi?US change in ,a wart ormole
7. N agglng cough or hoarseness

Figure 2


aware ofseven of the mosr imporranr ca.ncer
warning signs. These are [isred in Figure 2. 14
Mosr of these warning signs are self-explanatory. For example, "a change in bowel
habits" can refer ro persistent diarrhea ar
consriparioo as well as ta changes in color
or size of rhe sIOols. "Bleecling" ncludes
such rhings as recral or II nusllal vagi nal
bleeding. "Difflcul[y in swallowing" can


1. Digital reetal exam (yearly after age 40)
2. Stool sUde test, for microscopic blood (yearly after

age 50)
3. Sigmoidoscopy, preferably flexiblc (every 3 to 5
years after age 50)
4. Pelvic exam aud Pap smear (women: youIIger tita"
18 if sexually active; after 18 yearly for at least
three consecutive years, then frequeucy
determincd in conjunction with personal pbysician)
5. Blood PSA test (meu: yearly after age 50)
6. Selfibreast exam (women: monthly after age 20)
7. Breast physical exam (women: every three years
from 20-40, then annually)
8. Mammograro (women: begin by age 40, then
every other year, yearly after age 50)
Figure 3


occur when food secms ro remain in your

esophagus (swallowing rube) before ir goes
down. The imporram message is rhar any
of rhese seven signs indicares a need for a
prompt medical evall1<lrion. Paying ;tuenrion ta your body and recognizing when you
develop somerhing d1ar needs ro be evaluared ma)' provide a window of opporruniry
where cancer can be diagnosed-and
eureel-in irs early stages. Unfortunarely,
even prompr evalliarion of rhese signs does
nor gllaramee rhar we wiU diagnose a cancer at a rrearable stage.
Recently 1 had a patienr rhar came ro
me afrer onl y a single episode of recta I bleeding. When 1 checkeel dle stool microscopicaUy, blood was present. A few da)'s larer 1
diel a eolonoscopy exam anel found a rumor so large rhar r could nor remove ir using rhe scope. Grher lab resrs showed dur

[he cancer hac! ;llready spread ro rhe viral

organs. Yer for every pariem Jike this, l have
others who iniriated prompt evalllation of
reera! bleeeling and rumed our nor ta have
cancer-ar ro have it al an earlier srage so
rhar ir could be safely removed by using rhe

Yes, prompr evaluarion ofany of cancer's

warning sign is important ancl ShOllld never
be put offfor a convenienr rime. It can save
your life. However, there is an even hener
a1rernarive: raJ{e advanragc of any opporruniry [O derecr GUlCer before any signs or
symproms develop.

Eari)' Detection b)' Screening

Fonunace1y, in oreler to gain an lIpper
hand on cancer, rhere are ways ro derecr
cancer before we have symptoms. The
American Cancer Sociery recommends that
each person lmdergo eerrain rests designed
for chis purpose. These tesrs are generally
referred ro as "cancer screening tesrs." The
goal of rhe e evaluations is to derecr cancer
in irs early stages before symptoms occur.
The cllnem list of screening reconunendations is shown in Figme 3. l5
Further clescription ofsome of these resrs
may be helpful. A sigmoidoscopy exam i.s
performed lIsing a flexible rube ar scope.
The sigmoidoscope s virrllaHy idenrica! ro
the COIOI)OSCOpe wirh one exception: it LS
significanrly shoner. The six foor long
colonoscope can rravel the lengrh of {he
enrire colon. Ir is mos{ often lIsed for diagnosis when rhcre is a known problem such
as intestinal bleeding. On rhe orher hand,
rJ1e rwo tom long sigmoidoscope is more
ideal for screening purposes since it is simpler and less cosdy than the co10noscopy. lr
can visualize the lower one third of rhe colon where hisrorically mos{ colon canccrs
have occurred. Screening for colon cancer
is exrremely important-ir is the second
leading cause ofcancer dearh$ in A.mericland rhe Jeading Cause of cancer dearhs
among rhose who have never smokecl. Flll"rhermore, colon cancer is very prevemable
if ie is diagnosed in a precancerous stare.
A.lmos[ every colon cal1cer begins as a benign lump or finger-like projecrion known
as a polyp.lfdereercd in rhis stage, rhe polyp


C,U1 generaliy be removed witl1 the scape and
ir will never develop imo a cancer.
A pap smear can detect cancer of rhe
cervix (rhe opening of rhe t1terus or womb)
ar an early stage. Cervieal cancer is one of
rhe more common cancers in women. Ir is
also a preventable cancer ifit is detected early
enough by raurine screen ing.
Artention ro cancer's warning signs combined wirh proper lIse ofscreening rests has
alread}, saved literally thousands of lives in
our country. However, me American Cancer Society estimaees mat bereer use of diagnostic testS and more prompr attemion
ta cancer's warning signs could save another
115,000 lives each year. 16 This far exceeds
the nllmber of lives saved throllgh the acrual trearmenr of cancer. li
In spite of the chollsands of lives saved
by early detection of cancer, "early" decection is nor earl)' enollgh in many cases. The
CUlcer idemified by the screen ing test stili
ma}' kill some pacienrs. This sobering reality has left many wondering, "Is there hope
of prevenring cancer from starting in che
first place?" The answer is an lInequivocal
yes. The remainder of chis chapter reveals
che 'sreps' you can take tO prevem cancer
from ever beginning.

Two Primary Lines

OfDefinse Against Cancer
There are ewo basic strategies mat wiU
prevent most cancers from starting; even if
cancer has already begun, rhey may help che
body gain an upper hand. These strategies
are simple:
1. Avoid facrors that [avor cancer developmem.
2. T:tke advantage of facrors [hac help
rhe body ro ward off cancer.
These rwo srraregies are usually effecrive
because ofone or hod1 of the followiug reasons:
1. They help lIS avoid or mnimize contact with cancer-causing substances.
2. They help lIS strengthen aur body's
own mmune system for fighring

The remaillder of chis chapter is divided inca rwo sections. The ftrsr section
deals with minimizing contact with cancercausing subsrances. The second deals wim
rhe agenrs that will help aur immune system ta fight c.ancer, and other agenrs that
will reduce our risk of getting cancer.

SECTIONIAvoid Factors
That Favor Cancer
Ler us look ar the factors rhat F.lvor rhe
development of cancer and how we can
avoid rhem. As an exanlple, one (,\cror is
alcohol. We will see rhar rhe use of aleohol
favors the developmenr ofcancer and rherefore shollld be avoided. Furthermore, we
will find rhar avoiding alcohol helps us on
both of ehe froms menrioned. Alcohol a.nd
irs breakdown producrs have cancer-causing potential, and it al50 undermines t!le
immune system. COllsequent1y, a double
benefit will result from avoiding alcohol.
It is clear (har the besr way ro avoid cancer is by prevenring it before it has a chance
ro form in rhe first place; before it can even
be derected by screening resrs; before it has
a chance ro cause any symproms. Most can-

cers cari it/deed be pret/elUed before they ever

form. In 1988, the U. S. Surgeon General's
Report on NlItririon and Health carne off
che press. In irs comprehensive review of
cancer research, it st.ared, "In che course of
rhis research, it has become deal' mat many
cancers have [known] excernal causes and,
in principle, should therefore be preventable."18These findings concurred with oftcted research done a decade earlier by Drs.
Wynder and Gari. Their detailed comparisons of inrernational cancer rares lead rhem
co conci ude tine roughly 80 percenr of cancer was prevenrable by relativeIy simple
lifesryle choices. 19 Anorher decade prior to
Wynder and Gori's published work, Dr.
Higginson conduded that 90 perceLU of
cancerwas due ro "environmenral factors."2o
Thus, rhe Surgeon General's panel endorsed




research on rhe imporcance of lifeseyle w

cancer risk lhal had been prominently advocated since the 1960s.
What c1id they mean by "environmentaI f.1.cwrs?" They are referrillg (Q any factors apan from om imernaJ body processes
and inherited rcn<lencies thar affecr us.
These factors include the air we breathe, the
water we drink, rhe food choices we make,
our exercise habits (or Iack of chem), our
sexual praceices, our social relationships, etc.
So, when the expens tell us tiut 80 ro 90
percenr of cancer is 'envronmental" rhey
are saying tllat the vast majoriey of cancers
can be prevented if we pay arrenrion ro che
rhings we pur intO our bodies, che things
we allow Dur bodies (Q eome into comaer
with, and rhe rhings we do with Dur boclies.
Oespite 30 years of understanding rhe
linkage berween cancer and lifestyle, the
world's populaces for rhe most pan have not
integrated this knowledge intO praetjce. In
1996, Professor Michael Sporn reviewed 25
years ofhiscory since the U.S. ofticially dec1areel "war on cancer." Nthough he cited
area.5 ofsuccess, he also highligheed our very
slow progress in achieving significam cure
rate. for sorne of rhe leading cancers such
as breasr, lung, and prosrate. His remarks
brouglu us righr back to Higginsons insights
when he said: "We need to bolster educarionai efforts ro encourage challges in
Jifesryle, diet, and orher narura! facrors thar
might sllppress rhe process of carcinogenesis [causing cancer] ."21 Althollgh researchetS have been ralking abolit it for yea! , it is
obvious from devated cancer tares tllat we
stiU have nOt learned the lessons. Again, rhe
plea is for each one of us ro leam how aur
own lifesryle affects ollr risk of cancer and
make changes accordingly.
Jusr what are rhese experrs telling us
when it cornes ro Iifeseyle and "environmene" in rhe broadesr sense of the word?
They are communicatng a relarively simple
message d1<1t does not lend itself ro much
media hype. The environmemal concerns
anei the advoc:lred lifestyle changes are
si mple yet profound. They are talbng abOlit
things like sropping smoking, eatng bener,
gerring regular exercise, and losing weighr.
However. when rhe \'<Iall Srreet Journa1 Sllf-

veyed the rype of cancer news thar network

TV, news magaznes, and newspapers were
covering, rney taund rJ1ar cancer researchers feir the merua was misplacing irs emphasis. 22 Srories in rhe secuia.r media were
dominated by concems regarding fooel addirives, pollurion, radiarion, and pesricides.
These issues were much lower on cancer
expens' lists of imponance than our basic
habitual dierary choice .
Ne<1rly rwo clecades before the JoumaJ's
repon, Or. Ernsr Wynder already realized
what rhe problem was. "Individuals renel ro
ignore rheir own responsibiliey and blame
harmful occurrences, including exposure ro
carcinogens (cancer-causing agenrs), on
olltside forces. Therefore the genera! environmemal elemems [things tl1at we cannot
conerol well such as chemical pollurion of
air and water, or food addirives and COI1raminams] recei ve the mo t attention rather
than factors reslllting from personal
)ifesryles."23 M}' foens in chis chapter wiU
be solidly an rhe mosr important c.1ncer
prevenrive facrors-lifeseyle faclors rhar each
one of us can change.

Tobacco is the Number

One Culprit
Tobacco is rhe number one cancer culprit in rhe Urured Srares and in much of
the world. Increased cancer dearh rares accoum for a large share of robacco's bllrden,
and rhis bllrden is sraggering. In the U.S.
alone, approx.imarely 170,000 lives are losr
each year rrom cancer cal! ed by smoking, 4.
25 which is one-third of aII cancer dearhs.
(A conservarive estjmate of 400.000 Americam die [rom ali diseases callsed by smoking each year?' at an annual medical expense of $50 bllion.)27 Worldwidc, the annual dearh roll from smoking has reached a
mincl-boggling 3 million people. 28 This
equates ro one elearh every 10 seconds.
We have massive evidence demonsrraril1g eobacco's power ta callse cancer. Ova
4,000 diffirent chemicals have becn idenrifled in robacco smoke. 2':> A number of rhese
chemic.1.Js has rhe abilit), ro cause cancer aJI
by rhemselve . There are specific carcinogens in robacco thar cause lung cancer, orh-


ers that (duse kidney and bladder cancer,
some mat cause cancer of rhe esophagus,
and oehers (hat eause caneer of the pancreas.
AII rold, a [ong lisr of cancers have been
linked [O exposure ro robacco products.
They are Jisred in Figure 4. 30 . 31 2, 3.34
When you consider ehe veritable wirches'
brew of chemicals in robaceo smoke, it
should corne as no surprise rhar tobacco
causes more human cancers rhan any orher
known environmencal factor.
The porency of these chemicals is furrher artested ro by rhe fact dur it is nor onJy
{he individual who smokes or chews tobacco
who is ar risk. Those who brearhe second
hmul smoke aho increase their cancer risk.
Currenc estimares are thar cach year in the
U,$. 3000 non-smokers die from lung cancer due solely to second hand smoke exposure. 35 ln addirion, fathers who smoke
greater than 10 cigarettes a day ac ehe rime
rhey conceive rheir offsp.ring increase the
6sk ofa childhood malignanc)' in their new
son or daughrer by 31 perceut, Ifthey smoke
grearer ehan 20 cigarettts a day (he increased
risk goes up to 42 pereenc..36Tlus is rhoughc
ro be due ro rhe DNA damage in rhe sperm
caused by smoking.
The ohvious cancer preveneion message
ro each person is: "Avoid aU possible robaeco
exposure." That means we muse stop smoking. That means we have co stop chewing
eobacco. That means we need [O decrea e
even our passive smoking by choosing workplace.s and se[[ings for reereaton that are
Many Americans htlve heeded rhe tobaceo warnings rhar have been publicized
for years. Approximate1)' 46 miI/ion Arnericans have scopped smoking cigaretresY
Cigare[[e smoking among aduJts aged 18
and over declined from 42 percenc in 1965
ro 25 percenr in 1990. As a result, lung cancer is now finaJly scareing ro decline in
men. 8 However, since 1990, that sready
dedine in smoking has aJarmingly stopped.
The percentage of aur population ehae
smokes has remained unchanged for ehe lase
haJf decade. 9 Of perhaps even grearer concern is the face ehar more high $chool seniors are smoking roday ehan duee years
'\00 .


Mouth (oral cavity)
Throat (pharynx)
Voice box (larynx)
Trachea (wind pipe)

. Liver
Figure 4

II you are currendy struggling with nicotine addiction, do nOt despair. There are 46
million Americans who can eeseify thar ir
really is possible ro quic. Take advantage
roday of some of rhe effeceive strategies for
dealing wirh rhis addicrion as found e1sewhere in rhis book (see Chapter 16, "Oying For A Cigarene? Kick the Habie and
Live," and Chapter 18, "Overcoming Addiccions").

Alcohollncreases Cancer Risk

There is mueh evidenee that alcohol iner ases rhe risk of cancer on many froms, I
presenr some of the scienrific evidence linking alcohol with cancer in Chapeer 17,
"\X'ane a Drink?" Noneeheless, rhis copie is
so vieaJ roda)', tiut ie is wonh more than a
passing referenee in this ehapeer.
From population srudies it is weU estab
lished that drinking alcoholic beverages increases the risk of a varieey of cancers. The
list indudes cancers of rhe mourh, throat,
esophagus, liver, brease, and recrum. 41 ,42
AJehough the cancer association is primarily with heavy alcohol eonsumprion, moderate alcohol ttse may aho raise the risk of
some of these cancers. Breasr cancer is t11e
dassic example wirh the evidence suggesting ehae as Iittle aS three drinks per week increases a woman's risk. 43
Research has given 1I~ a goocl approx.i-





Figure 5

mation ofthe percenrage offatal cancers mar

a1cohol contriblltes ro. A parriallistingappears in Figure 5. 44
Compared ro non-drinkers, more rhan
rwo aJcoholic drinks per day doubles the risk
offorming benign rumors of the colon that
can larer become cancerous. 45 . 46 But if a
drinker's diet is low in folic acid and methionine. the risk of colon cancer rriples. 47

Akohol Jncreases Risk

OfBreast Cancer


AJcohol can affect hormone levels ehar

may in curn increase cancer risk. The greatest concern is with female hormanes aod
their re!arionship ro breasr cancer, which is
the second leading callse of cancer deadls
among American women (lung cancer is
first). Among nonsmoking women, breast
cancer is the number one cancer killer.
Many people are nor aware thar CI.
woman who drinks onl)' socially (:h~ little as
three drinks per week) significandy increases
her chance of gening breasr cancer. 48 49 Various studies have now shown rhar moderare
drinking may be associated with up ta 50
to 100 percenr elevated risk of breasr C<1ncer compared ro non-drinkers. 50 This increased risk exists wherhcr rhe alcohol comes
from beer, wine, or spirirs. 51 Of interesr (O
rhose who advocare wine ar meals as CI.

"health-eohancing habir," a French study

found an increased risk of breasr cancer in
subjects who consumed alcoholic drinks
wirh rheir meals. The associarion held rrue
for borh beer and wine. 52
Further supporr for rhe alcohol-breast
cancer relatiooship comes from the Nurses'
Heahh Scudy. Thcre, in a four-year study
of nearly 90,000 U.S. nurses aged 34 ro 59,
a significant relationship was found herween
aleohol consumpeion and breast cancer
risk. 5J Those who consumed ooly duee ro
nine drinks per week had a 60 percenr increased risk of breasr cancer. The more the
women drank the greater the iocreased risk.
This sreadily increasing risk of cancer wieh
increasing amounrs of aJcohol consumed is
called a "dose response" cffecI. This type of
relationship stroogly suggests rhar alcoholic
beverage consumption and nor somc other
factor is increasing the risk. For rhe younger
women below 55 ycars of age, rhe consumption of ooe drink per day illcreased their
risk 2.5 times.
Why does aleohol increase hreast cancer risk? AJrhoughall of me answers are nor
yer in, there is evidence [har alcohol increases estrogen levels. 54 . S5 Since rhis fcmale
hormone is known ro increase breast cancer risk, it is suspected chac alcohol's hormonal effecrs may be a damaging facror.
Furthermore, women with the most advanced forms of breast cancer rend ta be
drinkers of a1cohol, indicacing thar alcohol
mayacr primarily as a "tumor promotor or
growth enhancer"5 6 in those rhat are JUSt
beginning ro develop the disease. To date,
over 50 solid sciemific srudies have indicated
thar aleohol plays a definite role in rhe developmem of breast cancer. 57

What Percentage ofCancer Deaths

are Caused by Alcohol?
There are several mechanisms as ro why
aleohol use is associated with cancer: roxic
infiuences, immwle effeccs, dierary relationships. and hormonal associarions. Yet these
broad-ranging mechanisms teU us not.hing
abolit rhe total impact of alcohol on cancer.
Researchers previously rhoughr that only
ahour three percenr of ali U.S. cancer deaths


could be arcribured-even in parc-to alcohol. Sril! rhis figure is ignificant, accOlll1ting for 16 000 ro 19,000 dearhs per
ycar. 'sThe American Cancer Sociery quotes
a figure of 19,000 deaths, defining rhem as
being related ta 'excessive a1cohol use, frequencly in combination with robacco lIse."59
However, as we have seen, newer studies link
even relatively moderate aleohol consllmption-apan from smoking-with rwo major cancers: breast cancer and colon cancer.
Taking into aeeount chis additional evidenee some be1ieve that tOtal avoid,uKe of
alcohol could prevenr some 60,000 deaths
per year, which is 11 percenr of aii cancer
deaths. 60 The facr thar even relarively small
amounrs of a1cohol can increase one's risks
of common cancers leads to the following
conclusion: anyone who wants 10 keep ther
cancer risk as low as possible will romlly
avoid akoholic beverages. Indeed, e1iminating the use ofboth alcohol and robacco wil!
dectease your lifetjme cancer ri k by a signiflcant amounr.

Female Hormones and Cancer Risk

Esrrogens are CUlT .ndy at the crux ofone
of medi_ine's major COlltroversies. Many
health professionals ar encouraging ali poStmenopausal women ro use estrogenic replacement hormoncs. Commonly cited reasons are rhe pllrporred benefits for the hean
and bones. However, few wornen seem to
be full)' aware of the serious side eJjeets of
e.xcess esrrogens. Arnong r!le most sobering
is an increased risk of certain female cancers. For years rhere has been tecognition
that women who, fol1owing menopause.
take esrrogen alo ne (without a progesreronctype drug) experience a dramatical1y increa ed risk of CUlcer of the lining of the
womb. In an exrensive review of aii the research on the subject, Universiry of California ar San Francisco scienrists conclllded
rhar prolonged use of esrrogen after menopause could increase risk of cancer of r!le
womb by over 800 percent. 61 Because of
these well-known increased risks, physicians
have prescribed progesratjonal agenes in
combinarion wirh esrrogcns ro rry ro prevent th is cancer ri k. Although the data rcve..lls that rhe addjrjon of progesterone de-

crea es rile amoune of elevarion in risk, rhe

use ofthe combinarion stiU increases the risk
of womb cancer by 30 percent when compared with wornen who do nor take horJllones. 62 Potential bellefirs and risks of raking estrogen are included in Appendix 1,
enrided "Estfogen: Balancing Benefirs and
Cancer of t!le womb is an imponanr
cancer, bur it pales in significance compared
ro breasr cancer-the leading cancer kjller
among nonsmokjng women.lt is of utmOst
importance that we look at the relationship
of hormonal replacement and breasr cancer. Harvard Universiry has produced one
of the mose convincing repons on this subjecr, again from cheir urses' Healrh
Srudy.63 In their data covering 725,000 person-years of follow-up, women using esrrogen (alone) after menopause faced a 32 percene increased risk of breasr cancer. The
popular regimen of combining esuogen
with a progesterone hormone acmaUy increased the risk ro 41 percene Risk rended
ro increase ro 71 percem in women who
were over 60 and had llsed esrrogen for over
five years. 61 These reslIlts are similar ro a
smaller study done in the Seventh-day
Adventisr popu!ation. 65 There researchers
found that women taking hormonal replacement aEter menopallse experienced a 69
percenr illcrease in breasr cancer risk.
One obviollS message of these srudies s
that any women raking estrogen after menopause 'hollld be aware thar he is increasing
her breasr cancer risk. For a more complete
look at the benefits and risks of taking es
u'ogen a.her menopallse, see Chaprer 7, "The
Great Mear and Prorein Myth." Another recent smdy provjdes more evidence of r.he
breast cancer-estrogen reJariollshj( . It found
rhat women who yttl/urtlL(J' have hjgher estrogen levels al50 dramariclJly incre'J. e their
cancer risk. 66 Dr. Paolo Toniolo and associates ar Ne...v York Universit:y 5chool of Medjcine examined esrrogcn blood levels in 130
women wirh posrmenopallsal breast cancer
and 251 women the same age who were
cancer-free. An ullusual aspect of the srudy
was ehac the patienrs' esrrogen levels were
measured on blood thar had been drawn
frozen, and stored several years before their


cancers were diagnosed. This helped ro ensure rhat estrogen levels were nor influenced
by the cancer irself or by orher recent facrors, including estrogen replacemenr. The
women wrh the highesr naeural estrogen



in Japao



in Hawaii

in Hawaii



Figura 6

\evels experienced t\VO ro four rimes the

breast cancer risk.

The American Diet is Conducive

to Cancer
The impact of nurririon on cancer is
phenomenal. Some nutritional factors
elearly fvorcancer development while orhers help to ward off cancer. The dietaty
choces that increase rhe risk of cancer wiU
be dealt wirh in this seClion. Our unhealthfuI dier ranks as one of rhe mosr powerful
faccors increasing aur cancer risk. Estimates
are rhar 35 ro 60 percenr ofali cancer deaths
in our nation ma}' be anributahle ro poor
eating habits. 67 How do we know thar dier
has such powerful effecrs on cancer risk?
Perhaps more imporrantly, what dietary
challges can we make in order ro decrease
cancer risk? Ler us examine rhe scienrific
evidence that answers rhese important questioos.


Migration Demonstrates that Poor

Eating Habits lncrease Cancer Risk
A large number of research studies have
found thar lifesryle changes as a result of
migrarion are key facrors relating ro health
and disease. Migranrs generally assume the
risk of rhe indigenous populace in the country la which rhey move. Such sludies show
elearly mat the risk of cancer is gready influenced by diet. In Japan mosr cancer fates
are low (with rhe exception of sromach and
esophagus), bUL whcn people from Japan
emigrare ta Hawaii, death (ares of maoy
rypes of cancer become quite similar ro the
Caucasian Hawaiians. 68 The changes in
morraJity rates of various cancers due ro
migration are listed in Figure 6.
We see thar seven of clIe nine cancers
listed increase dramatically when the Japanese come ta live in Hawaii. For example,
cancer of the colon in Japan is low, wirh
only 78 cases per 100,000 people. After
emigrat ing ro the United States, rheir colon cancer rate rises to 371 cases per
100.000, nearl)' a fiveloM increase in risk.
Notice, coo, thar the new rate is similar la
r.hat of their Caucasian neighbors. Cancer
of clIe rectum is also 10w in the Japanese
who live in ]apan. After living in rhe U.S.'s
ftftietb state, however, recra! cancer strikes
rJ1em three rimes more frequcntly.
Many lifesryle Jactors change when
people emigrate ro rhe U.S. or ro any differem cuiture. The research scientisrs who
srudy these changes and the diseases associated wirh them are called epidemiologists.
Epidemiologisrs believe r.har changes in di
etary habits are one of rhe maio reasoos why
cancer risks change in r1lOse who immigrare. 69
The dietary practices of the Japanese
ll1ldergo a marked transformarion when
the}' move ro Hawaii.7' 71 Unfortunately,
mosc of (he chaoges are for the worse. The
Hawaii emigranrs cat rwice as much far and
subsraotially less carbohydrate than their
peers in ]apan. They car subsranrialiy more
bureer, margarine, and cheese, and slightly
more meaL Their consumprion of rice and
rafu (soybean curd) drops. It is, therefore,
no surprise thar the fars ealen by me Ha-


waiian group are 65 ro 70 percelU saturated
(ooly 40 percent of t11e fats eaten in Japan
are saturated). Among those in Hawaii, 35
percem of the carbohydrares they eat are in
the form ofsugar. This is comrasted by sugaJ
composing onl)' 20 percem of the carbohydrate inrake ofthose in Japan. Furthermore,
rhe changes toward an American diet become more complete over rime. The first
generation immigranrs retain more of rheir
japanese eating habits rhan their secondgeneratoll ofTspring. Compared ta theiI
parenrs, those born in Hawaii ear significaml)' more a.nimal protein, fat, satllrated
fat, and sugar. 72 These dietary changes conrribllte ro [he increased cancer rares ar such
diverse sires as tbe colon, rectum, prosrate,
breast, womb, and ovary. Other srudies confirm rhis conclusion as we will see.
The dietary changes mat rhe Japanese
made are nOt harmful in aII aspects. At leasr
two cancers-stomach and esophagusdecrease in incidence whcn they come ro
Hawaii, and th.is also likely has ro do with
changes in earing habits. Thc imake ofsalry
pick.led vegetables and dried, salred hsh decreascs dramaricall)' among dlose raised in
Ha}vaii. hese kinds offoods are tinked with
increased rares ofboth sromach and esophageal cancer. 73, 74
Similar associations have also been reportcd in srudies of Filipinos migrating ro
Hawaii.7 5 The immigration studies menrioned here provide only a glimpse of che
weahh of research published an this rapic.
They make an e\oquem point that in the
development of cancer, genetics are much
Iess important rhan environmemal condjtions, such as the way we live and eat.
Clearly, there is much more ro cancer rJlan
genetics. Diet plays a proftund
in causing or prevenring cancer.


Excessive Dietary Fat lncreases

Cancer Risk
Every American has heard the message:
"Cut the fat." Whether the subject is heart
disease, cancer, or a hosr of other problems,
dietar)' fat often seems ro emerge as the vi\lain. There are good reaSons for fat's bad
replltation. Studies involving the dietar)'

babits of many counrries provide slIbsrantiaJ evidence rhar excess fat in the diet increases the risk for cancer ofthe breast, prostate, skin, colon, rectum, ovaries, and
womb. 76

Breast Cancer lncreases

with Fat Comumption
One of rhe studies involving breast cancer was condllceed in 1970. It shows that
the rate of breast cancer faralities in any
given natiol1 corre!ares weB with bow much
fat its population eats, as illllstrated in Figure 7. 77




rate per



W. Germany
Hong Kong


100,000 15










Total dietllr)' fat inlake (g1day) 1944-66

Figure 7

Notice that the U.S. ranks among rhe

tOp counrries in both far intake and brease
cancer dearh rate. Canada, Australia, Sweden, and Germany share a similarly llnenviable status. This curve plot delllollserates
thar. those who eat the most animaJ far te ud
ca have the highest brcast cancer risk.i 8
A French stud)' found ehat women who
ate the mose total fac increased their risk
of breast cancer by 60 percenr. Risk was
greater wben the analysis foctlsed on saturated fat earen by post-menopausal
women-chey more tban rripled their risk
of breast cancer. 79
Berween 1964 and 1978, the japanese


doubled their fac cOllsumprion. As their far
inrake increased, so did rheir rare of bre.1sr
cancer. RO Unfonun.1rely, as illuscraced by Japan, [he rrend in many nariolls is ro emulare America with irs richer, faner diec. As a
result of living like Americans, rhey are begiJllling ro dic like Americans-from
chronic lifesryle-rclared diseases. Eating a
high far diet during pregnancy may also increase rhe risk ofdcvdoping breasr cancer. RI
A srlld)' based in Arhens, Grecce is .1150
noreworrh)' on rhe subjccr of breasr cancer.
Invesrigarors found-nor unexpecredlydur women rhere who ate marg.1rine expefienced more breasr cancer. Howevcf, rhc
Greek research ream nored rhar ar !casr onc
f.1r aceual1y seemed ta dccrease breasr cancer risk. Women who used more olive oii (a
predominantly monounsamrared far) had
a 25 percenr elecrease in breasr cancer risk. S2
Whar abour dlose who aL-eady have cancer? Does their clierary far consllmprion have
any effecr on rile success rare of their rrearment? Swedi h researchers found evidence
rhar dier does affecr breast (Umor growth



Prostate Cancer Increases

with Fat Const/mption


100,000 14


AII ages














Figurll 8


every one pereenr inerease in rotal calories

from far, ehey increased cheir risk of rrearmenr failure (breasr cancer re-currence) by
13 percene. In orher words. if a woman was
earing a 45 percent fat dier while her peers
were earing a 35 percenr clier, r!lose 10 percentage poinrs difference would translate
inra a 130 percene il1creased risk of her
breasr cancer recurring. The sraristics were
even worse for saturateel fat. For every one
perecnr rise in rhe porrion of toral calories
from saturated fat, risk rase 23 percenr. The
obvioLLs message from rhjs srudy is rhat resrriecing dierary far appears ro have a role in
treatment of mosr rypes of breasr cancer as
\\lell as in prevention.
Dr. Rose and eolleagues from rhe American HeaJth Foundation (AHF) shed furrher
light on ule breast cancer-dicrar}' far Jinkage in a srudy of 30 narions. 84 They also
found unt higher breasr cancer rates OCcurred in narions wirh higher levels of far
consumprion. However, they nored the
srrongesr relationship in posrll1enopausal
women-and they found no relarionship
wr.h lJegetabl.e fars.

rare. S3 The)' seudied 240 predominandy

posonenopausal women wha had been recently diagnosed as having breasr cancer.
Nearly rwo-tllirds of rhe women had hormonall}' responsive tumors. Among these
women, diet made a srriking difference over
rhe course of four years of follow-up. For

The leading faral canccr among nonsmoking men, prostare cancer, is also linked
widl a high far inrake. The pattern is similar ro breasr cancer in dus regard. In rhe
1950s Japan had a very low dearh rarc from
prosrate cancer. Norice tbeie dramatic death
rare inerease from this cancer shown in Figure 8. 85
The remarkable increase in prostate G..1.ncer dearh rate c10sely pa.rallels rhe rise in f.1t
inrake by the Japanese. As we have already
nored, the Japanese doubled rheir fat inrake
berween 1964 and 1978. 86
Similar f1ndings are apparenr when comparing 1950s prostarc cancer rares for me
Japanese living in both Hawaii ancl the
Unired States with rheir Caucasian COllmerparrs. Faral prosrare cancer occurred markedJy less frequendy in me Japanese, as it clid
for breasr cancer, wirh Caucasians having a
four fold increase in risk. 87 Broad internarional comparisons have consisrendy shown


an association between prosrare cancer and
fat inrake. 88.89 As poinred our by Rose and
associates in rhe mose recent of these studies, ilie incl'ease in prosrate cancer risk was
linked anly ro animal fat imakc; rhere was
110 relarionship ro vegetable far consumprion in rhe e cross-culrural comparisons.
Srudies wirhin mher population groups
reveal similar associations bet\'lcen fat inrake and prostate cancer. In one extensive
srud}' based in five U.S. and Canadian
locations, prostate cal1cer risk was analyzed
for duee eehnic groups: blacks, whiees, and
Asian Americans. 90 For aII ethnic groups
cllere was a sraristicaliy significane association betwecn roral far inrake and proseare
cancer. When rhe researchers looked ar specific faes, ehe increased risk was primarily
duc ro saturated fats, which come mainly
from animal produets. Mono-unsatllrared
fars seemed ro have onJy a weak effecr, while
(here was no relarion between polyunsaturared fat consumprion and prosrate cancer

Skin Cancer Risk Increases

wih Dietary Fat
Even skin cancer risk can be decreased

by foLiowing a low fae clieI. Animal srudies

have shown ehat a high fat diet increases
rhe risk of skjn cancer following sun exposure. 91 . 92 In 1994, Baylor University reseaJchers published data confirming ehese
relarionships in humans. They idcmified 76
parienrs who were willing ro parricipate in
rheir reseaJch. AH had prcviously been diagnosed wirh skin cancer and were generali)' folJowing a rypica1 high fat American
dier. They randomly enrolJed 38 of ehe paJricipanrs in an educational program rhat
helped rhem swiech ro a low-fae clicr where
far consejweed only 20 percent of their toraI calories. Over che coursc of rhe nexr rwo
years, che experimencal group followed the
program weB (rheir ave rage far incake was
21 percem ofcalories). Resulcs are illusrraced
in Figure 9. 9
Their adherence ro rhe diec paid off:
when compared (() rhose on an average fat
incake, rhey developed only ane-third as
many pre-cancerolls skin lesions.


Number ofLesiolls
00 low fat diet
(21 % or less calories from fat)

00 average diet
(approx. 39% calories from fat)
~ ,.'-






, 10

Figure 9

Ofher cancers linked ta a high consumpeion of saturaeed fat include colon cancer
and ovarian cancer.

u S. Fat Consumption is High

We have been looking in SOme deeail ar
problems relating to far imake. The amounc
of fat consumed by America ns over a 37 year
period is shown in Figure 10. 94 . 95
Although f.1r consumpeion has stayed
relarively stable since 1983, Americans are
stiU earing mllch more fac than they did a


Daily fat conslImptioll per perso"









_ _L




1940 1950




Figura 10


generation ago. Average far consumprion in
the 1980s was abouc 20 percenr higher rhan
thar in rhe 1950s. ar 165 grams per day compared to 140 grams per day. Before 1920,
far consumpeion was even lower, averaging
araund 120 grams per day. % Expressing
rhese exrremes il) tecms of percenrages, rhe
average American had a diet rhar was 32
percenr far in 1910. ThroughoLlr an 80 year



F oods with 10 gram'.\' ofsaturated fat:

2 cups of whole milk
1 double hamburger
213 serving of a Macand cheese
1 cup vaniUa ice cream
2 cups frozen soft serve yogurt
2 cups plain yogurt
2 slices of American processed cheese

Eating Meat lncreases Cancer Risk

In many people's minds. red meac epiromizes foods rhar are high in sarurared fat.
This associarion has nor been losr on some
n rhe mear and livestock industry; they have
been making concerred e/Torrs ro decrease
rhe sarurated far comem of meat products.
Even if they stlcceed, medical research indic.ares thar rhere is more wrong wiril red meac
than its saruraced fat conrenr. Regarding
cancer risks, flesh foods in generaJ-red
mear, pOLlttry, or even fish-have more
srrikes againsr chem rhan merely cheir far
contenc. The same is true ofdairy foods such
as checse, milk, and ice cream. Dairy foods
are nor derived from animal flesh, bllt chey
are animal products, and are listed wirh
otller irems rhar increasc cancer risk.
Ler LIS look ar SOme of the growing concerns wirh mear and animal prodLlcrs in
general from a cancer perspecrive. Several
studies have looked at rhe strong relationship berween eatng mese items and cancer
risk, and some of the theories as ro why such
relationships exist.

Meat lncreases Risk Of

Lymph Gland Cancer
figure 11

period, that figure has gradually increased

ro 40 percem in 1990,97
Based on evidence dealing wirh issues as
diverse as cancer prevenrion, weighr control, diabetes management, and hearr disease prevention, che expens are suggesting
mat we should try co eat bener than our
forefathers-not ~orse. Most aLlthorities
recommend char Eltshould comprise less
than 30 percellt of aur total calories, and
che far should be from planr and nor animal sources.
What foods arc we eating that sllpply
aJl of rhis fat-particuJarly sacurared fat? The
. sources are. shown JI1
. F'Igure 11 .-qs
Note thac rhese foods are aII animal
products. Planc foods are generally much
lower in sarurated fat. People wha are an a
pure vegetariall dier havc liule difflculty
keeping their saturaced fat intakc at a low


Some researchers such as Dr. James R.

Cerhan, assistanr professor at rhe University of Iowa College of Medicine, advise
decreasing both mear and fat in me same
breath: "Cur back on red meat, reduce saturated fat intake, and ear more vegetables."99
His commenrs were based an anorher Gl.1lcer (hat has been (inked ro meat earing, cancer of the Iymph glands. This important
cancer claims over 23,000 lives each year in
America. loo Chiu, Cerhan. and colleagues
studicd over 35,000 Iowa women and discovered rhat chose in che upper chird of red
rneac consumption had nearly double me
risk oflymphoma as those in r.he lower r.hird.
peeifically, eating hamburgers more rhan
four till1es per week more r.han doubled a
woman's risk of non-Hodgkin's Iymphoma.
FLlrthermore, women eould dccrease thcir
Iymphoma risk by 36 percenr by eatjllg rhree
ar more servings of fruit per day.


CoLon Cancer Connection

to aMeat Diet
Colon cancer is a1so srrongly relared (Q
mear earing. A srud)' of over 88,000 nurses
conducted by Harvard Universiry found
rhar rhose who regularly are red mear as a
main dish had a signlficant ulcrease in clle
risk of colon cancer. 101 The more ofcen chey
are it, rhe grearer rhe risk, as shown in Figure 12.
Note rhar eariJlg mear dai!)' caused a 149
pereem increase in risk. Expressed anorher
way, rhe dail)' mear earers had roughly two
tmd one halftimes me risk of ulOse who seldom or never ate red mear. Their dassiflcarion of "red mear" included a variery of
popular beef, pork, and Iamb irems. Exalllpies included roasts, sreaks, ham, mear
lasagnas, sandwiches, stews, casseroles, hamburgers, hor dogs, bacon, sausage. salami,
and other lun.cheon mears. Those \vho are
such red mear irems less frequently but sriU
olten (defined as five ro six times per week)
had an 84 percent increased risk of colon
cancer. Even rhose eating red mear as a main
dish jusr one te four rjmes per month had
39 percert more colon cancer than the lowesr risk group-rhose who never ate red
mear-or are it less than once per momh.
Regarding rhe cancer risk of eating fish
or chicken. ule srudy did not show rhal rhey
lowered cancer risk. They simply ma} not
mise the ris!? as much as orher meal. Ir is
important ta poine Out rhat mose eating rhe
mosr f1sh had relatively more cllses of colon
cancer rhan those eating fish rarely or never.
The data showed a grearcr colon cancer
risk from eating red meat SOUl'ces rhan was
e>:plained by an analysis of sarurared far
alone. This suggesrs (har [here are orher fac
tors in red mcat rhar furrher increase colon
cancer risk.
The findings in rhe Harvard-based
Nurses' Healrh 5rudy are not unique. A
1990 European srudy found similar relationships. When womn who ate mear frequenrly were compareel ro rhose rhar rarely
Of never ate mear, rhey had nearJy double
rhe ri k of colon cancer.'02 An Ausrralian
srudy found an association berween a hosr
of difrerent animal producrs and colon can-


Frequency ofeating
beef, pork, or Iamb

Colon cancer risk,

percent increase

Less than once per month

Once per month to once per
Two to four times per week
Five to six times per week
Daily or more




figure 12

cer U1 women. I03 104 Implicared foods included red mear and liver as weU as seafood
and dairy producrs. In rhis srudy, however,
rhe very worsr food group was eggs, wiu) rhe
heaviest consumers experienci ng .,i.'< times tht,
risk ofcolon cancer. Tbis Australian research
h.ll"rher emphasizes the condusion U):H. regarding mear eating and colon cancer, red
meat definirdy increases risk; chicken and
fish are associated wirh less risk, but are acmally not prorecri,'e. ThllS, Cllrrenr research
makes an e10quem poinr ro leave off alI red
meat-and ir does not provide a sound reason ro car more fish or chicken.
The colon cancer stlldies melltioned
thus far have been do ne on women. Srudies
in men have also linked mear inrake with
colon cancer. IOS , 106 For exaJnple, the same
Harvard research grollp lIsed similar medlodolog}' ro look ar colon cancer cases in rheir
male he.ahh professionals srudy.l07 They discovereel some srrkng dietary relarionships
b}' analyzing aII new cases of colon cancer
among rhe nearly 50,000 men in rhe sllId}'.
Those earing red mear as a main dish five
Of more rmes per week had a 3.5 rimes increilsed risk of colon cancer when compared
to rhose avoiding these foods (eating them
less rhan once per monrh). Remarkably.
despile rhis strong relarjonship, J10 relatioJ1ship emerged with silturated filt in/.ake. This
furrher srrengrhens rhe lkelihood rhar other


jctors besidefat contribute ro mear being a
high-risk food. This means rhat changing
animal-raising tcchniques and breeding
pracrices ta produce leaner live rock with
less sarurared far will not decrease many of
the most damaging aspects of these animal

Charcoal-Broiled Meat is
Even More Dangerous
A patent meat-related carcinogen, caUed
benzopyrene, is l'e1ated ta cooking. Benzopyrene is one of 4000 ehemicals found in
cigarette smoke. In srudies using rodenrs
as well as hllmaJl cells in culture, benzopyrene demonstrates carcinogenic activiry
affeeting many tissues, such as me liver,
stomach, colon, intestine, esophagus, lungs,
and breasr. lOS Charcoal-broiled mear prodllces this substance in large quantiries on
the surface of the mear, as illustrated in
Figure 13. 109

Beozopyrene in 2 Ib. }
charcoal-broiled steak

Benzopyrene in smoke
{ from 600 cigarettes

benzopyrene concenrrarion in rhe charcoalgriJled prodUCr. IIO

Too Much Iron in Meat?

One of the sllrprising discoveries in
modern nurririon is the growing concern
abour rhe large amounr of icon in rneat. A
readily available and abundanr.sollrce ofiron
was once routed as one of meat's bcnefirs.
However, problems wir.h iron in our diets
are now pllrring mear's liberal iron stores in
their uue liglu-as anorher of meat's LiabiLities rarher rhan a benefic A nllmber ofsrudies suggesr [har an iJlCreaSe in rhe srorage of
iron in the body or disrupriol1s in a person's
urilization ofiron increase rhe risk of colon
cancer. J 1 J A recent disserrarion from UCLA
suggesrs rhar tlle risk of colon polyps aud
rhus colon cancer is increased by eirher exeessively LoUl or excessively high levels of
iron. 112 Evidence like rhis furrher srrengthens (he case for a meatless dier rhar emphasizes plam sources of nurririon. Planr foods
provide icon in amOUllrs mar are generally
adequate-bur nor excesslve. A 1996 article
summarized some of the problems wirh exces ive aJuounrs of iron as it relares ta cancer risk: 1 13
1. It favors rhe formarion of compounds
called hydroxyl radicaJs which have
ehe porenrial (O damage DNA.
2. le sllppresses (he acriviry of host defense cells.
3. Ir promotes CaJKer cell mll!riplication.
Dr. E. D. Weinberg, rhe srudy's author
concluded: "P(Ocedllres associared wirh
lowering... iron inrake can assisr in prevention aud managemenr of neoplasric diseases

Eating Meat Increases

Breast Cancer Ri:Jk

Figure 13


About rwo pounds ofsteak produces an

amounr of benzopyrene on rhe mear surface equivalenr ro rhar fOUJld in 600 cigarettes. Thus, nonsll1okers can be exposed tO
a huge dose of one of cigarerte's powerful
carcinogens by simply earing grilled mears.
Furrhermore, in general, rhe higher rhe fat
comem of rhe mear. rhe grearer wili be the

A oumber of srudies demonstrare a

stfong association between meat eating and
breast cancer risk Some 20 years aga, Dr.
Takeshi Hirayama made a series ofsrarrling
observarions abour breast cancer in Japan
in a 10-year srudy of 140,000 women. Results are swnmarized in Figure 14. 114
Note rhe sharp difference in risk berween


rhe rwo groups. One parricularly illteresring aspecr of rhis research is rhac mear earing did not appear ro be rhe only facror of
imporrance. Ifyou (Ook ocioeconomic srarus our of rhe equarion, rJle risk of heav)'
meat consumers was reduced, but was srill
abolit four rimes rhar of rhe low mear consumers. This "uggesred [har orher dierary
and lifesryle facrors are also involved. Such
associarions are now well recognized.
Socioeconomic ami demographic facrors
are known (O have a role in breasr cancer
risk. Fewer pregnancies, a grearer age ar fir r
pregnancy, and less breast feeding alJ appear
ta increase brcasr cancer risk. 115.116.11/ Furrhermore, each of ehese facrors is likely ro
be more common among women who are
in professional and managerial roles. 1 hese
observaeons lcad ro twO imporranr observarions. Fim, diet--or mear eaeing per seis nor rhe only important factor in breasr
cancer. Many faccors have a cole in this devasraeing cancer, bur diet is one imporranr
modifiable faccor rhat aH shouJd address.
Second, dietary habits appear ro be mosr
importanr for rhose who already have other
risk facrors for brease cancer. Since Americam as avwhole are a high-risk populaeion,
dier would be expecred tO have a greater
Resules of ehe Japanese srudy are nor
unique. Other srudies have linked mear earin a wirh breasr cancer. One stlch example
is ~rovided by a Norwegian stlldy of over
14,000 women. 118 In rhis research, dlOse
earing meat five or more eimes per week were
compared ro rhose eating mear rwice ar less
weekJy. The heavier consumers had nearly
double rhe breasr cancer risk.

What is the Aetion ofMeat on the

Body Regarding Breast Cancer?
There arc a number of possible explanarions for rhe )inkage berween meat earing
aod breasr cancer ri.sk. These include many
of the f.1crors already presenred, such as isucs involving [ar and 5aeurared far intake
as well as concerns wirh toxins in meat and
hormonal effecrs.




Low socioeconomic
status - eating meat
occasiooally, rarely,
or Ilot at aU

High socioeconomic
status - eating meat


Figura 14

Toxins in Meat and

Breast Cancer Risk
le is wcll-recognized rhat many toxic oroanic compounds and heavy merals are
:tored in animal risslles. There is mounring
evidence rhat coxins have a role in breast
cancer. 119.. 120.121 .. 122

In rhe 1970's the level of the pesricide
DDT. a cornpound known ro be derrimenrai ro human healrh. (including possible
immllne sysrem sllppresslon
- was anaIyzed in rhe breast milk of morhers. Among
mea-t-eating morhers, 99 percenr had significam levels of DDI: Only eighr percent of
vegetarian morhers were found ro have significanr DDT levels. 124 DDE. a breakdown
producr of D DT, presents some serious concerns in rhe breasr cancer arena. Borh ir and
DDT have been c1assifjed by rhe U.S. Environmema1 Proreerion Agency as "proba bie
human carcinogens."125 Furchermore, researchers ar rhe Narional Insritute of Environmemal Health Sciences have poinred Out
mat rhere is a higher risk ofbrease cancer in
women wirh elevared blood levels of
DDE. 126 Orher international srudies demonstrare whar should be obvious by now: rhe
serong link berween rlle animal products
we eat and human exposure ro pesricides.


A srudl' from Spain amibured up [Q 85 percene of rheie popularion's exposure ro D DT
and relared substances ro livestock mear and
clairy produers. The Spani. h researchers
made rhis relling observarioo: "These pereentages are in accordance with rhe welldocumented fact rhar [DDT subsrances]
predominanrly accuJllulare in [animal] fat
[causingl animal fatty foods ro become a
major mure of exposure for humans. "127
Ir is imponanr to emphasize the conneetion berween Inear eating and high human roxin levels (as illusrrated by DDT anei
DDE). In researeh cired C<lrlier, vegetarian
morhers had the lowesr levels of D DTeven rhough rhe)' habiruaJly coosumed
fruirs and vegetables. Several pesrieides and
coxins arc srill being employed in our oarion (DDT is now banned). Alrhough u1ey
flnd rheir wa}' inro or onro fruirs and vegerables, the amounr rhat a person ears \vith
ilie planr producr is generally very small
compared to the amOUlH of pesrieides concained in animal f;H.
The reason dur pesticides and ocher roxins aecumulare in :lIlimalrissues is explained
by a process called biomagniflcarion. In rhis
process, animal rissues magnify rhe coocenrrarion of roxins over rhe course of rheir liferime as rhel' ear ocher animals or planrs thar
rhemselve have some level of concaminarion. The average animal ears at leasr ren
rimes its weiglu in food throughom rhe
course ofirs life span, bur cannor eflectively
ger rid of mose fat-soluble roxins and hea"l'
meraJs. Thus, mally of rhese roxins aceumulare in irs t:Ir srorcs. uch poisons are
poorly e1irninated from altimals and humans. As a resuit, over a period of weeks,
mondls, ar years, rhe chemicals thar rhese
animals have earen are compounded manl'fold in rheie fau)' rissues.

"Cleaning Up" Our Wters


Although rhere has becn progress in

"e1ean ing up" our warers in rhe V.S., significanr problems still remain. A recenr
California srudy illustrares the serious narute of pesticide conraminarion in tsh and
shelLfish. 1l8 The srate's Mussel Warch program has serialll' monirored shellflsh since
1977 for evidence of pesticidc conramina-

tion. Despire well-publicized resulrs of improved warer eeoJogy, approxirnarell' half of

rhe 47 monitoring stations showed ilO decrease in DDT levels, and fully rhree-quarters showed 110 PCB decrease. The conrinuing duear of PCB exposure is nor limired
ro rhe Unired Stares. Anall'sis of human
breasr milk specimens in Englal1d reveals ilO
decrease in P B levels since rhe Iare 1970s,
anorher indicatioo of cOHrinuing exposure. 129

Meat Eating lncreases

Prostate Cancer Risk
When individuals who consume animal
products begin ro see rhe wealdl of evidence
incriminari/lg such food , some may wonder wherher there is any hope for them.
"Afrer aII," a person may reason, "( have altead)' consumed huge amoums of animal
produCts-will ir make any difference ta
change now?" Research indicares rhar
changing dietary habirs ar any poinr tlocs
make a difference. Because of rhe varietl' of
ways rhar mear and omer animal producrs
affecr us many of our body processes can
be pur back inro a normal relarionship by
moving roward a vegeearian diee. Even ifyou
do nor make a complere change in l'our
habirs, parrial changes can mal<e some differenee.
This has been eloqueody illustrared by
research on prosrare cancer. [n rhe famolls
Advenc:isr Healrh srudl" deaths hom pres{are cancer wne srudied in relarion ro dieL
Ir wa observed rhar rhe more mear, milk
eggs. and cheese a man are, dle greater his
risk of dying of prosrare cancer. There was a
dose-response relarionship such rhar rhe
more of rhese producrs consumed ehe
greater rhe risk of faral prosrar.e cancer.
Those cOJlsuming rhe Iargesr quanrities of
animal producrs had 3.6 rimes the risk of
dl'i ng from prosrare cancer. 1 'o
The benefic of a dier low in mear regarding prosrare cancer risk is nor limired ro
Sevenrh-day Advemisrs. The large Harvardbased Health Pmressionals Follow-Up rudy
has come ro similar conelusions. Among
over 50,000 men srlldied, jr was observed
thar rhose earing red meat flve rimes per



week had 2 1/2 times rhe risk of a life-rhrearening form of prostate cancer when compared wirh rhose earing reel mear once a
week or less. 13l

Ovarian Cancer Risk

and Meat Eating
Ovarian cancer also is more frequene
<l1l10ng meat earers. Since it is usualIy detecred ar a very Iare srage, afrer ir has spread
ta orher viral organs, rhis cancer rends ro
be panicularly devasraring. The resllits of
an ovarian cancer study are shown in Figure 15. U2
In a Japanese Stllely, the daily consumption of meat anel/or fish \Vas also significantly associareel wirh an increaseel risk of
ovarian CJnCeL U3 ]n fact, rhi' srari rical
analysis suggested rhar neacly 20 percenr of
aiI ovarian GlJ\cers were relarecl [Q high mear
imake alone. Iralian researchers also looked
for connecrions berween elier anei ovarian
ancer. They came ta similar conc.lllsons.
Women who are mear seven ar more rimcs
per week had a 60 percenr increased ovarian cancer risk when compared ta rhose
wh6 had~ less than four porrions of mear
weekJy. The wou mear seemed ro be pork:
rhose earng ham four ar more times per
week had nearly double rhe amoul1t ofovarian cancer as rhose who are Iess rhar rwo
porrions of ham weekly.134
Mear may increase rhe risk of prosrare
and ovarian cancer rhrollgh similar mechanisms by which it exerrs irs breasr cancerdevating effecrs. Aher ali, each of these cancers is hormonally relared. However, as we
have seen, orher non-hormonally relared
cancers a1so bear a striking relarion ro mear
consllrnprion. Lung cancer, non- Hodgkin's
Iymphoma, colon cancer, and cancers ofrhe
pallcrea',135 Iiver,136 kidney,137 and womb
have been linked ro a more liberal incake
of mear specifically or animal producrs in

Cho!esterol is Linked to Cancer

A high intake of cholesterol, which is
presenr in mear, eggs and dairy ptoducrs.
ha' also been linked ro an increased incidencc of cancer in severa.l sruelies. 13s . lY)

Cancer sires demonsrraring rhis increa$ed

risk include ovary, lung, and laJYi1x.
Whether cholesrerol irself presenrs a problem or wherher it merely indicares a dier
[har is rich in mear and ocher animal proelucrs j nor clear. Further research linking
high blood levcls of cholesterol wirh colon


Age-(Idjusted III01tality per 100,000



Meat I to 3
times per

Figure 15

cancer and colon polyps has been published. 140 Women wid) rhe highesr cholesrerollevels are more [han three rimes likely
ta develop ovarian cancer as women wirh
low cholesterollcvds. \41
50 [,u in this chapter I have presented
rhe linkage of mear producrs wirll cancer.
When addressing cancer-prevenrive or
cancer-prorecrive factors, it shoulel be recognjzecl rhar mear, in addirion ro conrajning harmful subsrances, is ofccn sadly defient in some of rhese helpful compoundl". A
c1assic example is provided by dicrar)' fiber.
Tr is a f.1Cr rhar mear and animal producrs
generalI)' look baei in rhe cancer risk area
because of whar rhey lack in addirion ro
whar rbey cOn/ain. Even if aU of the reasons
rhar mear and animal producrs consistenrly
emerge in rhe medical lirerarure as having a
clase linkage wirh cancer arc nor complerely
understood. we shollld avoid rJ)cir lIse.
From rhis broad perspective on mear, it


is imeresring ro nore rhat over 100 years aga,
Ellen White wrote:
"Man)' die ofdiseases wholly due to mear
eating, when che real cause is scarce1y suspecred by themselves or oehers. Some do
noc imrnediately feei its effecrs, bur rhis is
no evidence thar r does nor hurt rhem. It
may be doing irs work surdy upon the s)'srem, yer for rhe rjme being rhe vicrim may
realize norhing of iL" 142
From a spiritual perspecrive, ir is equally
interesring rhat a diet devoid of meat ar
animal producrs is recordcd in rhe Bible as
God's original der for hurnankind. 143

Dairy Produets Linked to Cancer

A number ofsrudies have indiclted thar
rhere are plenry of grounds for concern regarding animal products such as milk, eggs,
and cheese. FataJ cancers ofborh me colon
and ovary have been linked ro egg consumption. 144 Orher research has suggesred rhar
eggs may also increase ova..rian cancer risk.
A Yale Universry srudy found rhar for each
addirional 100 mg of egg cholesrerol a
woman averaged per day, she had a 42 pcrcent increased riskof chis malignancy.l,j5Egg
consumpron is also posirively associatcd
with death from prostate cancer. 146 The
same study showed rhat milk consumption
aJso ncreased prostace cancer risk. The extensive international comparisons macle by
Rose, Boyar and Wynder ideJUified both
meat and milk as srrongly related ro breast
cancer riski milk inrake also showed a strong
relationship ro prosrare and ovarian cancer
in their analysis. 147

Coffee: Another Source of

Dietary Carcinogens?
Coffcc is another COIllIllon source of
carcinogens in rhe American dier. The experrs stiH debate whether cofI-ee presents a
significam cancer risk, but there is no ques(ion thar (rus popular beveragc conrains cancer-causing chemicals. Such chemicals include methylglyoxal,148. 149 catechol, cblorogenic acid, and neochlorogenic acid. 150
The pharmacologists aclulOwledge (hac


even caffeine irself "has potem muragenic

effecrs" in laboratory srudies of microbes.
le can also damage the chromosomes ofborh
planrs and animals in lab se((ings. ISI This
facr can suggest that a substance is carcinogenic in humans. However, (he same source
believes rhat a person could not obrain high
enough levels of caffeine with ordinary consumption of medicarions, foocis, and beverages ro increase cancer risk in this LUay.152
This argument fails ro rake imo aCCOllnt
me facr rha( coffee brings eogether a variety
ofcarcinogenic compounds. Caffeine is further superirnposed an other cancer risk factors thar we are aII exposed ro in varying
degrees. In this context, there is concern tha(
bod1 coffee and caffeine may significandy
increase cancer risk in che right setting. 5uch
a conclusion agrees with rhe epidemiologic
lirerarure that shows caffeine and coffee
sOll1etimes increasing risk, 3J\d orher tirnes
having no effec{ on certain cancers. The difference may have tO do wim rhe other carcinogens tIlat individuals in a population
may or may nor be exposed ro.
Dr. Winston Craig in his book, Nurririon for rhe Nineties, seems ro come ro a
similar conclusion, even though he rakes a
somewha{ differenr perspective. 1S3 Craig
sides with research suggesring tlur caffeine
is not a frank carcinogen irself, but is rat11er
a co-carcinogen. This means rhar it can increase rhe likelihood rhat cancer wil! occur
if it is in me presence of other carcinogens.
The cancer sites thar have been linked wirh
coffee include kjdney, breast, colon, pancreas, and ovary. 154 A look at a few of chese
epidemiologic srudies is i1hnninating.
Pancreas cancer has probab!)' received
the most attenrion regarding increased risk
from cofIee. This apparenrly derives in large
pal'( from a highly publicized Harvard study
in rhe early 1980s.)55 Other studie have not
found such a reJationship, bringing LIS back
ro my eartier poim about rhe likely interacrion berween coffee, caffeine, and other risk
factors. Coffee seems ro bear a more srriking relationship ro bladder C<1ncer. The first
smdy rhar drew rny atten{ion co (his was
[he large Advenrisr Hea.lth study. This epidemiological research involved some 24,000
California Sevenrh-day Adventisrs. The re-


sulrs of rJ1C smdy are depicted in Figure 16.'56
Norice rhat those who drank two ar
more cups of coffee per da)' had rwice rhe
risk of dearh from bladder cancer as those
rhar did nor drink coffee at alI. Orhcr research such as rhar condlleted at the Stare
Univcrsiey of New York ar Bllffalo has confil"rned the potemial of coITee drinking ro
double bladder cancer risk.'57 Significandy,
(he BuITalo researchers looked ar C/lSei of
bladder cancer, in contrast 10 rhe SDA inve5tigarors who compared bladder cancer


Mortality risk ratio for men

Non coffee users = 1

2+ cups/day = 2

Orhel" studies have a150 shown an increase in bladder cancer wirh coltee usage
or other cafleineated beverages. This has 1e.1.d
some ro speculare dur for bladder cancer,
caffeine irself may be rhe man culprit in
coflee. Faral colon cancer has aJso been
linked ro coffee consumprion. Those consurning two or more cups of coffce per day
increased rJleir risk ofdearh from colon cancer by 70 percetH when compared ro rhose
rhar consumed Jess than one cup a day. The
sUldy a1s0 revealed a dose-response relationshipi rhat is, rhe more coITee consumed the
higher rhe risk. 15

A Reltttive ofCaffeine in Chocolate

In anorher srudy of prostare cancer, mose
""ho averaged 20 mg ar more of rheobromil1e (a caffeine relarive rhar is especially
known ro be found in chocoJate) per day,
doubled [heir risk of prosrare cancer. Those
wirh inrermediare consumption had an inrennediare level of risk.'59 It does nor rake
much chocolare ro provide those 20 mg of
rheobromine. The amount of rheobromine
in some represenratve chocolate products
is Jisred in Figure 17. 160
Cbocolate also conrains the carcinogen
aJpha-merhylbenzyl alcohol. 16 !

Figure 16

rhough somc 750,000 squamous and basaJ

cell skin cancers are diagnosed each year in
rhe Unired Srarcs, only abOlit 2, I 00 faralirics result. 163 The faralities occur mostly in
rhose who failed ro get prompr and complete removal of the cancer.
Melanoma, another type ofskin cancer,
provides a markedly difterem siruarion. This
uSllally darkly pigmenred cancer has a fearsome rendency ro spread and kill rhe victim. Each year only abolit 34,000 cases of
melanoma are diagnosed in our counrry, and

Cadbory milk chocolate, 1 ounce

Theobromine content
44 mg

Chocolate sy'ru.p, 2 table.spoobs89 mg

(1 fii oz.)

Sun Exposure and Cancer

SlIlllighr in high doses increases skin
cancer I"isk. AbOlit 95 percenr of skin cancers are of two types: squamous cell and
basal cel 1. 162 Both of the e rypes of cancer
are increased by substantial cumularive liferime exposure to rhe sun. Forrunately, however, these skin cancers are slow growing and
usually remaln confined ro rhe skin. Even

Ohocolate tlavor mix in whole

milk (2 to 3 hea'ping teas'poons in
8 ounces of whole milk)

120 mg

Figure 17



su."__~,, . . .


Excess Fat
Saturated fat
Excessive iron
(from cookiog)


Eggs, milk, cheese:

Saturated fat
I Excess SUIl exposure
Wood dost
Excess sugar in the diet
Genitall powder and genital

7.200 dic <lnnllal1y from rhis dreadeci skin

cancer. 164 Melanoma is cllrrenrly on a rapid
rise worldwide; in Europe it is increasing
by rhree ro seven percem ever)' year. 165 Regarding this deadliesr of skin cancers, jt appears d1at the imporrant factor is nor so
much the totai am01/.nt of suniight you are
exposed ro, bur wherher ar nor you ger sunburned. Sllrprisingly, rhere is soroe evidence
rhar ourdoor work with chronic sun exposure ma)' actually be prorective (apparently
by increasing resi tance ro sunburn).166
The sunburns sllstained in childhood
seem ro be paniclllarly dangerolls. 167 168
One srlld)' showed rhar an execurive working indoors would be more likely ro devetop
me1anoma than a construction worker who
works outside aII day long. Although rhe
office-baseel executive is more likely to get
sunburned on a weekend excursion ro the
beach, the association with sunhurn and
melanoma appears (Q be more iJ11pOnanr
in childbood than in adulthood. Nonecheless, especially in a fair-skinned adult, avoiding excessive sun cxposure is prudent. This
does nor necessarily mean that fair-skinned
individuals should use more sunscreen. In
both humaJl and animal research rhere is a
worrisome lack of protection-or even increase in melanoma risk with sunscreen lIse.
As expressed by the U .S. Preventive Services

Task Force, "Ir is aho pas 'ible rbat sunscreens may increase skin cancer risk by
encouraging susceprible persons ro prolong
exposurc of greater skin surface areas ro solar rays rhar are not blocked by most currently used sunscreens."169 However, the
research does suagesr thar sunscreens may
help ta prevent squamous cell skin cancers. I70 Unlike melanomas, as already
pointed our, squamoLis cell cancers appear
relared ro substantial cUJnuJarive lifetime
sun exposure.
In Olu" byporherical example, given equal
skin rypes, (he construction worker would
be ar more risk of rhis type of cancer, assuming dut rhe executive avoids getting
sunburned. In one srudy, six or more severe
sunburns in a lifetime more rhan doubled
rhe risk of squamoLls cell carcinoma. 17I In
faer, the number of sunburns better predjcted risk of rhis cancer than a person's
natural complexion.
One other word of caurion: wearing a
T-shirt or polo shirc usually does nor provide full prorecrion from rhe sun's buming
rays. The Universir)' of California ar Berkeley Wellness Lener bas observed rhat such
lypical summer garb does nor block out aII
ultraviolet radiarion. These shins provide a
similar amount of sun blocking rhat a sunSCreen with a sun prorecrion factor of 6 or 7
Before the rair complexioned among llS
think rhe solLlrion is roral sunlight avoidance, 1 should haslen ro mention that suniigbt in moderate amounts is heaitl~ful. It is
necessary for rhe production of viramin O,
the viramin/hormone thar is involved in
calcium baIance, bone healrh, and perhaps
even cancer prelJention. Research now suggcsrs lhat judicious sun exposure and the
associaled production ofvirarnin O may also
help ro prevent cenain rypes of cancer.

Other Cancer-causing Agents

Other ca.ncer-callsing agems prevalent in
aur sociery include asbestos, which can cause
mesorhelioma, a cancer of rhe lining of the
lllng;l72 wood dust, whch can c:luse sinus
cancer; 173 excess sugar in the diet, which
may callse sma1J bowel cancer; 174 and genital powder and geniral deodoram sprays


which markedly increase rhe risk ofovarian
cancer. 175
A number of carcinogens and canccrcausing agencs havc bcen presemed in rhis
chaprer. For an oprimal cancer-prevemion
lifescyle, rhese can be and should be avoided.
A summary lisr of them is provided in
Figure 18.
The presence of robacco anei alcohol on
rhis lisc of cancer-causing agenrs is probably
nor une:xpected to many. Howcver, the pre eoce of rhe large nwnber of damaging factors in mear and dairy products rhar can
cause cancer, and ilie presence ofcoffee, may
be surprising ro many. As we sem rhis lisr,
we see thar every irem on ir can be avoided
by any individual whose gaal is co accomplish a maximum reducrion in che risk of
acqumng cancer.

we Can Limi! Our Personal

Risk ofGetting Cancer
The informacion presemed in (his seccion examined factors rhar favor cancer developmenc. Such information provides a
basis for each of us ro significanrly reduce
our personal risk of geuing cancer. I wiU
summarize the secrion wirh a guotarion
from Dr. Wynder, a world-renowned cancer prevenrion specialisr. "Wiili (he increasing number of news reporrs regarding hazardous componems, the average cirizen considers himself imll1ersed in an unconrrollable sea of carcinogens. Nrhough sociery
musr and can play an impowlIlt role in rhe
reducrion of those environmenral facrors
thar contribuce ro cancer incidence, we havc
shown rhar an individuaL can significan.tLy
/imit JJi-J own risk by appropriateLy aLtering

his LiftstyU."176


Agents That Act to

Reduce the Risk
In many of my original presemacjons an
cancer, 1 emitled chis secrion "lncrease Fac-

tors To Boost Your Immune Sysrem." However, excensive research on rhe subjecc of
cancer revealed chat lifesryle facrors chat prorect us from cancer involve Il\Ore chan cheir
important effeccs on rhe immune sysrem.
There i a variery of ways rhar healthful
choice help us ward offcancer. Even though
this chaprer rakes a broad approach ro cancer prevencive facrors, 1 scill marvel ac how
many of rhese f.1crors exerc rheir proteccjve
influence by screngchening aur immune
Our bodies are continuously under arcack from a variery of germs, roxins, and
pollutanrs. We brearhe air chat contajns dirr
parcides, smoke, fumes, carbon monoxide,
and chemjcals. We handle garbage in che
normal process of life. We ear food fuI! of
bacreria and drink warer wirh varyillg degree of conraminacion from a hosc of wells
and municipal wacer syscems. Nighr and
day, day aher day, we encoumer coundess
microbiologlc enemies who \VaD( ro dominace liS for cheir own purposes. Simply plIC,
rhere is no way ro go rhrollgh life complerely
avoiding aU rhrcars ro our healrh. And rhere
is no way ro avoid each altd every carcinogen. No mareer how hard we try, we \VilJ on
occasion brearhe in che roxins from someone e1se's cigarene smoke, ar facrory, ar incmeraror.
Because rhese dangers are ali around us,
many people throw up cheir hands and say,
"Forgec it. I will never be able ro avoid every carcinogen, sa why even cry?" This defearlsr 3rriCIJoe ignores r\Vo importanc facrs.
Firse, ir is noc an all-or-none phenomenon
regarding rhe dangers of carcinogens. Exposure ro a few carcinogens is not as harmfui as exposure ro many carcinogens. The
more we avoid carcinogens, rhe greater che
proreccion we will enjo)'- Second, the "why
rry" argument ignores rhe f.'lCC rhac our immllne syscems can help us deal effecrively
wich carcinogens. When we are exposed ro
a moderate level of carcinogens and aur
immune s}'srems are in cip-cap shape, we
can descroy cancer cdls before rhey have a
chance ro mulriply ro any significanr excem-and before rhey have a chance ro
C<"lUse sympcoms or even be derecced an an
x-ray ar a blood rese. This is, indeed, good


oews concerning tlle immune system.
The inUl1une sysrem has one mission:
ro idemify aod desrroy foreign invaders before signifJcam harm s dane ro our bodies.
Disease-causing organisms sllch as bacreria,
viruses, fungi, aod parasires, are detecred
llpon emry by a healrhy im.nlune sysrem,
and are ragged for eliminarion by hungry
immllne system cdls. Cancer cells should
be similarly detected as aboormal cells,
treated as unwelcome intrllders, and eliminated wirh a srrong immlloe system.
Our singular dllry ro the immune system is to develop a lifesryle that will SllppOft its constant defense work on our behalf. How we live day by day detennioes
whecher our immune system works ar peak
levels ar is inhibired by aur negleet and even
abuse. But is ir possible tO strengrhen our
immune system? Yes, there are a variery of
ways we can provide help ro aur immune
systems. Three of the mosr imporram are
diet, exereise, and srrcss control. Ler us Grst
look ar diet, both from rhe perspeerive of
its immune-enhancing potential and its
abiljry tO help LIS deal wirh cancerous duears
on orher levels.

Vitamin A and Related



Ir is widely known that vitamin A is required for the mainrenance of normal mucous membranes and for normal vision. 177
However, few realjze rhat, as oDe nutrition
text put ir, "Yiramin A is essemial, either
directly or indirectly, for the proper functioning of most organs of me body."178 Indeed, vitamin A is important for reproductive function in both males and females, and
ir also appears ro be critical for immune
Yitamin A is present in rhe dier as the
fully active form of rhe vitamin (cal led the
preformed vitamin) and as precursor compounds rhar the body can converr into vitamjn A. The mosr familiar precursor is beracaratene. Animal producrs can be rich
sources of preformed vi ramin A, but roxiciry can also occur from roo mllch of the viramin in rhis active state. Bera-caratene, a
planr subsrance, is safer: when viramin A

acriviry is needed, the body can rcadily converr ir into ule active vitamin. Unlikc viranun A irself, bera-carore-ne is virrually never
toxic regardless of the level of intake even il'
ir makes your skin yellow.
Animal products tich in preformed viramin A often have other strikes againsr
them. Some of me tichesr sources, like liver,
whole eggs, and whole milk are also best
avoided because rhey ,u'e loaded wirll cholesreral.
Borh humall epidemiology and animal
reseaIch suggest that viramin A is important for reducing aur risk of cancer. One
c1assic Norwegian study, published in 1975,
reported five years of research on over 8000
men. Dr. Bjelke found thar, for an)' given
level of smoking, low vramin A intake increased lung cancer risk. 179 For rhe (Otal
popularion, which includes smokers and
nonsmokers, mose who had low levels of
vitarnin A inrake had over double me risk
oflung cancer. More impressively, rhose wha
ever smoked had over four times rlle risk of
developing rhe mosr common smoking-reIared lung cancers jf their viramin A inrake
was low.
A more recem Japanese stUdy also fO!1nd
rhat [ow blood leve1s of vitamin A increased
thc risk of lung cancer. Those with serum
viramin A levels in the lowest third had
nearly six-times rhe risk of lung cancer as
rhose wirh levels in rhe upper third. I o Nor
ali lung cancers are developed in smokers.
Up ro 15 pereenr oflung cancers can occur
in those wllo do nor actjvely smoke, but may
be exposed ro varying levels ofsecond-hand
smoke. Those nonsmokcrs wirh a higher
bera C<lfOrene intake from fruirs and vegetables had only 70 percent of ehe risk of
lung cancer as rhose eating less bcra-carotene. 181
A hosr of other beta-carate-ne re!arives
occurs in planrs. These are caUed carorenoids
and can also be convened into vitamin A. 18Some ofrhese carorenoids include beta cryptoxant1un, lutein, and Iycopene. Lycopene
C<'luses rhe red color in strawberries and tomaroes. Foods thac are parricularly rieh in
lycopene have been associared wirh prostare
cancer prevenuon. Harvard's Hea1rh Professionals Follow-llp Srudy found rhat men


who ate tomara sauce as little as once per
week had prosrate cancer risks 23 percent
lower than those who never are ir .183 Those
men earing tomaro-based producrs ren or
more rimcs per week were LIp ro 35 percent
less likely ro develop pmsrate cancer. The
study's lead author, Dr. Edward Giovannucci, believes mat Iycopene may be the key
ingredient rhar causes rhis risk reducron.
Those wiril the lowest Iycopene blood
levels also have a significanrly increased risk
of developing pancrearic cancer. \84 Lycopene, like mOSt of the helpful beta carotene
relativcs, cannor be founel in pills but only
in frllts and vegerables.
To whar do rhe viramin A-related compOllnds owe rheir protecrive qualiries? Fim,
rhey act as anrioxidams. 185ln rhis mie, rhey
helI' rhe body dispose of chemicais callce!
free radicals dut can generically damage
normal cdls and sec ilie stage for cancer.
(Free raelicals are explained in ilie nexr section). Second, viramin A-related compoullds appear tO be <:''l.pable ofstimularing
rhe immune system. Mice given additional
viramin A have an improvemenr in rhe hlnction of their T Iymphocyres, which are a
variery ofwhite blood cells thac destroy <:'1ncer ceUs.186 Third. viramin A compounds
help body tissues to differenriare. that is,
develop in a normal, orderly fashion. Sincc
cancer is charaeterizecl by a Iack ofdifferenriation, some theorize {hat vitamin A may
help ro reverse carly cancerous changes by
helping rhose abnormal tissues ro move into
a more orderly stare of growrh. 187

Free Radicals and Antioxidants

1 have made menrion of free radicals already in rhis chaprer; d\ey are explained
more fuUy in connection wirh dle antioxidanr capaciries of me1awnin in Chapter 9,
"Melatonin: Agent for Rest and Rejuvenalion." However, in order ro undersrand the
importance ofanrioxidant acrion in preventing lung cancer, seme commems abolit free
radicals are in order.
Normally every molecule has elecrrons
rhar are in orbir arollod its nucleus. Those
eleclrons normally come in pairs, and render rhe molecule chemkally stable. How('veI', a free radical is a molecule that has an

unpaired e1ecrron. This leaves it extremely

unstable. lc has a powerful c1rive ro acquire
an electron to pair wirh rhe one ehar lacks a
partner. Often wirhin a fracuon of a second, a frec radi<:'1J wiU grab an e1ecrron from
a neighboring compound. Thar neighbor
who lost an e1ecrron is said ro have been
"oxielized." Furthcrmore, the oxidized COIllpound itself rypieally becomes a free radical. Since it now is missing an e!ecCJon. il'
has a srrong desire ro grab one from one of
ies neighbors-and it usually does so in
short order. The resuir is a chain reaetion,
where oxidation and damage can spread
from one molecule ro rhe next tlntil something stops rhe process. Molecules rhat can
top rhis chain reacrion are called antioxidancs, which restore the unstable molecules
ro a chc:mically srable conditioo.
While on the subject of free radicals. 1
should poim OUl' that radiation is yer anorher well known cause of free radicals. 188
This kind of free radical prodllCtion may
provide Oluch of the explanarion for the
increased cancer risk in acom bomb survivers. There are things we can do ro limit
our exposure ro frec radicals. However, becausc aJlliving creaeures produce them, we


Orange Yams, peeled after baking
Carrots, cooked*
Carrots, raw
Pumpkin, cooked
Sweet potato, pcelcd after baking
Sweet red beII peppcrs
Mixed vegetlbles, frozen
Spinacb, cooked
Kalc, cookcd
Turnip greens, cooked
Apricots, ",hole
Broccoli, cookcd
Watermclon, slicc hlO in.
Collard greens, cooked

Serving size
I cup
1 cup
1 cup
112 cup

1 med.

1 eacb
1 cup
'/2 cup
3 each

1 cup
1 servillg







.. 8)' cooll:ing canotJ: Ih(' Indigrillblll' nb4;:r mt'mbranci ari' brokl'll down ka\.'in2 mort \.'ifamin,\ ,*\'~i1ablt (f)r .'dHU)rpfion.
RccoOlm~nLlcd [)lIU,' AlIO'ft':.n('1t rQr Vif.,\ 01 CirOlf'nt~. (<null,' 800 RE. lUllIl{' 1000 RF. (1 Rdintll ~llth'Jolikn1 "" 10 rU)

Figure 19




canllor comp1erely avoid rhese high1y reaceivc compollnds. Ir is tor rhis reason rhar 1
encourage individuals ro srrengehen cheir
anuoxidanr defenses in addirion to avoiding tree radicals.
Where can we flnd foods that are rich
in the amioxidanr capacir)' provided by Viramin A-related compollnds? The quanriries of viramin A (as bera-carorene) in cerrain foods are lisrcd in Figure 19. 189
Note dur roor vegerables are specifically
high in bera-carorene. Therc is a whole hosr
of other Viramin A relatives (retinoids) in
planr foods rhae are nor induded in this lisr.
Since high beta-carorene inrake has been
associaecd wieh low rares ofcenain cancers,
many have concluded rhat they can protecr
themselves from rhese cancers by taking viramin A or beea carotene supplements. 50
far, medical research suggests thar these
suppfementJ do not providc ehe bencfits rhar
eating plam foods rich in bera carore.ne delivers. 190 However, tor rhose nor raking
supplemenrs, the higher the blood levels of
beca-carorene, rhe less rhe risk otboth cancer am! heart disease. 191
A Finnish srudy of ne.1r1y 30,000 male
smokers tound rhar raking bera-carotene
pills for lip ro eighr )'ears actually incretued
their risk of lung cancer by 18 percenr. In
Bera-carorene, like many anrioxidants, can
actualJ}/ become a tree radical or paradoxically increase free radical production when
consumed in 1arge amounts by itse.lf. \93
However, when bera carorene is combined
wich adcquate Viramin C, \fitamin E, and
other antioxidanrs such as is found in bera
carorene narucal foods, a porent antioxidanr
dfecr occurs. 194 Some are wonderiog itberacarocene ma}' be more important in che
bloodsrream as an indicator of a plant-rich
dier dut has man}' orher aJltic<lncer factors
going for it. We wiU look at a number of
those compounds larer in rhe chapter.
There is anorher d,Ulger ofbeta-carorene
supplemenrs. In both human and animal
srudies, raking beta-carorcne pills can lead
to ehe dep1etion of viramin E in rhe body.
Mice as well as hllmans have shown 40 percene drops in rheir viramin E levels while
an bera-carotene pills. '95 This is just one
example ofwhar are referred ro as "vitamin-

viramin inreraceions." There are dozens of

such inreractions, where ralci ng one viramin
increases OI' decreases your requiremem for
anorher. The safest pOlley is ro ear a variety
of planr foods rhae are loaded wich a balanced slIpply of vitamin as weU as other
cancer-prorcerive subsranees-some of
which have nor }'er been discovered.

Eat Foods Rich in Vitamin C

Viramin C is anorher cancer-proreerive
food. lrs main effecrs are also likely due to
its role as an amioxidant, similar to viramin
A, rhus decreasing exposure to toxic 'Tree
Viramin C a1so rends ro prevem ehe formarion ot carcinogenic nirrosamines rrom
nifrires in rhe dier.
It does more rhan prorecr rhe person
himself from cancer. Recenr research suggesrs ehar viramin C may help ro prorecr
sperm hom generic damage. There is evidence ehar genericaJI}' damaged sperm may
cause inherired diseases such as cancer in
rhe neXl gencrarion. Viramin C provides
prorecrion r1uough ies cole as an anrioltidanr.
Cerrain childhood maJignancies such as leukemia and cancer of the kidney and brain
have theirroors in fhe father's genericaJly
damaged speI'rn. l96 Such sperm abnormaliries may represenr a combinarion of factors
such as cigarerre smolcing l9i (which appears
able ro acwal!y ox.idizc rhe sperm and genetically damage ir), a poor diet (less rhan
250 mg of Viramin C a day)l?S and low
consumprion oforher antioxidams), and expOSIHe ro occuparonal toxins. Thll.s a man's
!ifesryle includillg eafing habirs, trom a few
weeks prior ro conceprjon up fO the rime of
conceprion is vitaliy importam in detcrmining rhe integriry of his oftspring's DNA.
The recornmended dietary imake tor
viramin C as published by rhe Naeional
Ac.ademy ofSciences is 60 mg per day. However, 1 beJievc every American shollld consume ar least 250 mg daily. My reasoning
is not only for [he benefirs ro men in procecring rheir sperm fOf fllwre generarions,
bur also because of rhe important ro!c rhat
viramil) C plays as an aneioxidant. Furrhermore, since viramin C is abundancly supplied in aur foods, obraini ng chis level


ofincake is nor difficulc. ome good sources
of rhis importanr vjramin are !isred in Figure 20. 19


Eat Foods Rich in Vitamin E

Viramin E appears [O help protecr
against cancer for similar reason that viramin does. Ir is an anrioxidanr and a freeradical scavenger. It also has a role in blocking rhe formation of carcinogenic 111trOsamines and nirrosamide from foods conraining nirrire.100.101. 202
fu an example of rhe power of alltioxidane viramins ro reduce cancer risk. consider rhe following srudy. Rcsearchers obrained a hairless strain
rabbirs thar were
prone ro skin cancer and exposed rhem ro
ultraviolet Iight ro accelerare rhe development of cancer. The resllies are shown in
Figurc 21.
Viramins e and E provided complete
prorecrion againsr skin cancer. The antox.danr acrion of these vitamjns apparenrly
decreased oxidizarion of the rissues where
skin cancer rends to develop.203
The rabbir skin cancer resrs are in agreemenr with a recent human srudy of Lung
Clmcer froln )apan. In chis srudy. ir was found
rhat rhose wirh low blood levels of vitamin
A (beta-carocene) had a six-fold grearer risk
of lung cancer compared ro rhose wirh
higher levels. The same srudy found an even
more ill)pressive prorecrive effect for Viranun E blood levels. Those with levels in the
lowest rhird had nearly 8.5 times rhe risk of
rhose with levels in {he upper rhird. 104
Ir is important to emphasize mar mosr
srudies thac have looked at cancer prorecrion from amioxidanrs like viramins A. C,
and E, have involved individuals who were
generally gerring rheir vitamins from nat71mi fOods, not viramins in a boule. Many
people :lrc undeI' rhe impression [har viramin A, e, and E supplemenrs will provide
adcquare srrengrh to rheu immune systcrn.
lowever, as we have seen, some of rhe research indicares thar vitmnin Jupplements do
Ilot furnisIJ tIJt' proteetion rhar food ources
of thesc viramins providc. Furrhcrmore,
foods conraining rhesc vitamins (fruirs and
vegerablesl conrain a hos! of narurally occurring protecrive subsrances in addition ro


Sweet red bell peppers,

Orange juice, fresb
Brussels sprouts, boiled
PinkJred grapefruit
Sweet green beII
peppers, raw
Broccoli, pieces, raw
Sweet potato, baked
Kale, boiled
Cab bage, raw
Baked potato

r~ommendcd daily


Serving size
1 med


1 cup
1 cup
1 eacb
1 cup
1 each
1 med
1 IOed


1/2 cup


1 cup
1 CU))
1 med

1 each
1 cup
1 med
1 med

aUowance for vitamin C


250 mg.
Figure 20


RaMii!> e.r:pllsed 10 lI1tral'io/ellig/II for 24 weeks
Regular diel

24% gol skin cancer

Regubr diel wilh extrll .'il. C & E



skin cancer
Figure 21





Serving size


(for male5.)

Wheat germ oii

1 tsp
Sunf10wer oil
1 tbs
Sunf10wer seeds,
1 tbs
oii roasted
Almond butt~1 tbs
Canola oil ........... 1 tbs
10 reach
Soybean oU
1 'bs
Margarine, tub
1 tbs
Safflower oil
1 tbs
Olive oiI
1 tbs
1 cup
Mustard greens
'/2 ClIp
Soybeans, grecn,
1/2 cup
Spinach, cooked
1/2 cup
Wheat germ
1 tbs


Rrrommc:nd~d DJilil~' All6wanc(' for ~'ifa_min E il: 8tllg: a:n:(;Ho('ophero' ~Iui,"al('nts)

(For JU. add onf,.....thi ...d 10 Ih~ aTF. ,a.lut... (".R- I tbl ()( illmontl buller JJaTE=-C.4IlJ)

Figure 22

(based 011 equal weigIJt proportiolls)




1. Garlic

2. Pilum
3. Orange

2. Kale
3. Spinach

4. Red grapes

4. Brussels sprouts

5. Alfalfa sprouts
5. Kiwi fruit
6. Grapefruit, pink 6. Broccoli
7. White grapes

8. Banana
9. Apple
10. Tomato
Figure 23


7. Beets
8. Red beII pepper
9. Onion
10. Corn

mese widely-hyped vitamins.

If you are looking for some good namraI sources of viramin E, a lisr offoods ehat
provide healthy doses of this anrioxidaJlt
viramill is shown in Figure 22.10~
One adclitionaJ considcrarion is in 01'der: as beneficia! as an tioKidams [ike vitamins A, C and E are, anrioxidants are noe
aii good. Exce sive amollllts can paradoKically ace as "pro-oxidanrs," compound
which acrually fiwrJ1' the formarion of free
radicals. This is rrue of vi ramin C and viramin E as well as orher anrioxidanrs such as
slIperoKide dismurase and glurarhione. 106
However, when bera carorene, Viramin C.
and Viramin E are presenr in abundanrbur nor superabunclanr-amoullrs (i.c.. in
whole plam foods) rhey aCIually work in
combinatjon ro e1icit a prorecuve anrioxidant effecr. This ef!-ecr is mllch more powerfui rhan just rhe aelditive effeees of these
rhree separate anrioxidants. 207 Funbennore,
suppiernenrs cOllsist aimo r enr.rely of one
parricular rype of vramin E, ealJed alpharocopherol. A recem srlldy has found rhar
anorher rype of viramin E gamma-rocopherol, may be a berrer antioxidam aud rhus
berter ar inhibiring DNA-damaging parrides in rhe bod)'. os Abour 75 percem of
vitamin E consllmed fi'om food is in ehe
gamrna-tocopherol form, whjle sllpplemtnrs comain either nont, or less dl<ln 10
percent gamma-rocopheroJ. The most effect.ive acrion is ro remper )'01.11" emhllsasm for
parronizing your local vitamin supptier and
illsread invesr in more fresh fruirs and vegerables.

Whole Plant Foods AlonePowerfid Antioxidants

Anorher illusrraeion of rhe power of
planr foods ro as isr in can el' pl'evemion
and possibly even to combar l'he effects of
aging v,ras pl'ovidtcl by rhe Unirecl Srares Deparrlllenr ofA.griclIJrure (USDA). They recendy arrempred ro rare foods accol'ding to
rlleir measured natural anrioxidanr pwperrjes, AJrhough rhey used onJy one group of
frec radicals (rhe pe.rQxyls) in rheir resring,
rhe Universiry of California ar Berkeley
championed rhe research an rhe headlines


of rheir March 1997 newslertcr. This research is the firsr rhat I am aware of thar
rated the power ofwllole plalH foods (as opposed ra just rhe SLlm of their viramin A, C,
and E content) ta provide antioxjdanr effeers. The rap ren fruit and vegerable SOLlfces
of aneioxidanrs from this USDA research
are Esteti in Figure 23. 209 . 210
Each of rhese foods has mLlch more anrioxidanc acciviry rhan rhe sum of rhe ~uHi
oxidanr contene of viramins A, C and E.
For example, ooe cup of cooked kale has as
mLlch aneiaxidanr acriviry as abour 800 mg
of Vitamin C ar 1100 IV of Vi ramin E.
However, rhe kaJe oniy conrains abOlit 50
mg ofVitamin C and 13 IV ofVit3.ll1in E.
Whar accouncs for ilie djJference? A whole
hosr of other twtioxidants in rhe kale thar
we ofreu do nor measure. It is well established rhar many frllirs and vegerables have
powerful anrioxidanr effecrs far beyond
what an assessment ofconventional vitamin
conrcnrs wOllld reveal.
These ranlcings should be viewed with
the realizarion rhar only a few dozen foods
were analyzed, wim some food groups nor
being represenred ar aJl-sueh as rhe legumes.

The natural chemicals rllaf are fOllnd in
planr foods are caJled phytochemicaLs. In one
sense of rhe word, vitamjns ar any other
consrituenr rhar is found in a planr producr
eould be given dus designarion. However,
rhe rerm js mosr Ohen used for food chemicais thal come ftom vegel/./ril1n sources dur
c.1JlJlOt be obrained from JnJnal prodllcrs.
There are literally rhousands of
phyrochemiC<11s, many of which appear ro
have a role in fighcing cancer. Many of rhese
ehenucals have JUSt recendy begun ro be
appreeiated. No doubt many orher
phycochemials are yer ro be discovered.
Even sa, wharever you find in a food
supplemenr pili represencs yesrerday's science. Regardless ofwhar be omes next year'
honesr selling phyrochemical in rhe healrh
food store, you can be reasonably cercain
rhat rhose wno ear an abundance of planr
foods have already been getting generous
doses of{har compound. On rhe orher hand,

rhase who skimp on fi'lIirs and vegerables

wiU be obliged ro waic for rhe vitamin companies ro firsr be convinced of the
compound's promise and salabiliry, and (hen
figure our how ro ger ir inra a pilI.
Study aher scudy cOllrlnlles ro reveal rhe
ca ncer-prorecri ve benefi tS of differenr
phyrochemicals. OI'. John D. Pouer of
Sea{eJe's Fred Hutchinson Cancer Research
CelHer has poilHed our ciur rhese phyrochemicals usually work in oile of rwo ways:
rhey eir.her function as blocking agenrs or
suppressing agenrs. 11 1 Blocking agen{s work
on the carcinogens-prevelHing them from
affecting rhe body's cells (rhis may occur by
desrroying rheir activicy or orher means).
Suppressing agellts work on rhe body's own
cells, combaring maJignanr changes tlur
ma)' have becll sr,med by carcinogens.
Many of rhe insighrs on che healch benefus of phyrochemicals came direcr1y from
r!le Iaborarory. A list of a few of (he
phyrochemicals (har have been shown ro
prevene ar even rreat cancer in rhe laboracory and rhe foods rhe)' are found in are
lisred in Figure 24. 212 13,214.21 J. 216
One group of foods rhar are loaded wrh
cancer-pror.ective factors are the cruciferous
vegerables. I hese Illcmbers of the Qlbbage
family include bmssels sproucs, cauliflower,


Allyl sulfides
Isot1avones, Saponins
Protease Inhibitors
Ellagic Acid
Caffeic Acid
Pbytic Acid


Brussels sprouts
Red grapes
Citrus fruits
Garlic, ouions, leeks
Soybeans, legumes
Soybeans, legumes


Figura 24




broccoL, bJe, wrnips, kohlrabi, bok chol"

collards and cabbage. One srudy showed
rnar dlOse who ate cabbage ar least once per
week had rwo-rhirds Icss colon cancer rhan
rhose who ate it once per momh ar Iess. lJ7
Indoles are arnong the cancer-protecrive
phyrochemicals in rhesc plams. These compounds work as blocking agenrs b)' increasing colon enzl'mes that can deacrivace carcinogens. ll8
Earing whole frujt dramarically reduces
the risk of cenain cancers. In rhe Advenrisc
Healtb Scudy involving 34,000 subjecrs.
Sevenrh-day Aelvenrisrs thac ear fruic rwice
a da)' decrease dleir risk of developing lung
cancer by a srarrling 74 percem compared
ro rhose rhac ear fmir le..ss rhan twice a week.
Sromach and olher cancers were also dramarically reduced. 219
Over 90 pcrcenr of rJle 34,000 subjecrs
were nonsmokers, which meanr rhar rhel'
were alI ar a low risk ofdeveloping lung cancer ar the outser. However nonsl11okers infrequendy do ger lung cancer. This srudy
shows that rheir risk can be sharply lowered
even more by includ ing an abundance of
fruir in rheir diets.
Soy is anolher food highly tomed for irs
cancer-protective properries. h is a verirable
gold mine of cancer-protecrive phytochemicals. Dr. Mark Messina summal'ized
over 30 difrerenr epidemiologic srudies on
soybcans and cancer in his book, The Simple
Soybean And Yom Health. 220 He poinrs our
rhar the results suggesr rhar those who consume the l'flOSt sOl JOods ha've the least cancer.
These srlldies sugge,st rhar sa)' decreases cancer risk ar mao)' sites including breasr. colon, recrum, lung, and sromach.
A large srudy from the 1erherlands involved over 120,000 men and women. Researchers dlere made a connecr.ion berween
anorher ph)'tOchemicaJ-rich food and cancer prevenrjon, rhe simple onion. The cancer ir prevenred was stOmach cancer. Those
earing rhe most onions (one or more onions every other day) had half rhe stomach
cancer risk of rhose who oevel' are onions. LI
Garlic has been shown ro prorecI againsr
developing cancer; in mice, it is effective in
trertting cancer. The amounr of 50 milligrams of garlic adminisrered in 3 ounce.~ of

drinking warer ro mice wirll bladder cancer

led ro signiftcanr shrinking of the rumors,
while 500 milligrams of garlic nor on]y reduced the cancer size but actually decrcased
rhe morraJiry rare from rhe cancer. 22 AlI of
chis occurred withour side effeers. The rcsearchers believe thar ilie garl.ic ma)' have
srimulared rhe mices immunc s)'stern , helping rhem ta combar rhe cancer.
The message from (hese few selecred ex<lmples is nor thar we sholild ear a soy, cabbage, aod ollion andwich every day. Rarher,
1 recite (hese studies only ro illllsrrate rne
wealth ofsciemif'ic informarion thal is coming out abour many fruirs, grains, and veget'lbles. In facr, some of rhe mosr exciung
research Jooks ar ali mese foods collecrivel)'.
For example, Harvard's Dr. Walrer \X/illetr
has observed rhat (here is abundanr and consisrent scienrific evidence which demonsrrares rhal "high intakes of fruits and vegerables" reduce rhe risks of "mose human
caocers."223 Willetr sees in this evidence support for "rhe concept (hal micronlluienrs
[such as vitamins minerals, and orher
ph)'tochemica]s] ma)' play important. 1'Oles
jn the prevention of human cancers."21.j
lndeed, rhe conslImptiofl of fruirs and vegerables is associared wirh 100",'er rares of cancers ofthe brea.n colon, rectum, IUllg, prostare, urinary bladder sromach. esophagus.
cervix, larynx (voice box) mourh, plurynx
(rhroat), and liver.21~ 126. 2-7
The National Research COllllci! has come
ro imilar conclusions as Or. Wlllerr: "There
is consistent evidence rhar fmit and vegerable
consumprion is prorective againsr severaJ amcer. ... Therefol'e, in considering appropl'lare
preventive measures, consumprion of rhe releva.nt foods (the foods themselves)-nor rhe
putarive prorecrive componenrs of rhose
foods-should be encollraged. "228 In orher
words, the Council is encouraging al!
Americans ro eat foods rhat conrain cancer-prorective compounds rarher rhan seeking supplemenrs rhar featllre thase compounds. Considel'ing rhe overwhelming
evidence as ro rhe imporrance of prorecrive
phytochemicals in fl'1I1rs grains, and vegetables, 1 could not agree more.
Even if Ihe prospecrs of making a dramaric dierary change seern daunring, rake


he.,If(. There are man)' natural food cook
books dur can make rhe rransirion much
casier. These books feature an abundance
of fruirs, grains, and vcgerable$ in a mulrilude of good rasring recipes. Appendix II
Iim several such books.

Fiber Reduces Cancer Risk

Anocher llmrien t class thac some wotlld
include among rhe phytOchemicals is rhar
of fiber. Fiber includes rhe pam of planr
n arerials thar resisr digesrion by rhe nOrmal human inresrina.! sysrem. Just as rhere
are maoy difftrenr cypes ofviram ins, so rhere
are many different types of flber. These
include celluloses, hemicelluloses I ignin,
pectins, gllms, mucilages, and algal polysaccharides. Major food sourees of flber are
fruirs, vegeeables, whole grain cereals, and
legumes. 229 There is virtually no liber in
meat, milk, eggs, cheese, OI' any other animal produce
A fiber-rch diet elearly reduces the risk
of developing colon cancer. Drs. Howe,
Beniro, and colleagues analyzed rne resu!rs
of 13 srudies thar looked ar the influence of
fiber intake on colon cancerYo They found
a t'rong "dose-response relationship when
ehe)' looked ar fiber incake: the more f1ber
earen, rhe lower rbe risk of colon cancer.
SpecificalJy, whel) tlle researchers divided
people inlO five groups based on rheir level
of fiber inrake, those wich rhe lowesr flber
intakes had rhe grearesr risk of colon cancer. Even rhose in rhe next lowesr group of
fiber consumpIion still had 21 percent le"ss
colon cancer when compared ro Ihe pooresr fiber earers. Those n rlle group with
ave rage fjber inrake had 31 percenr less,
those wirh somewhat above average intake
had 37 percenr less, and rhose with rhe besr
iiber inrake had nearly 50 percent less risk
of this major cancer.
The researchers concluded thar if rhe
average U.S. ciri7..en would merely increase
his or heI' fiber il)rake by 70 percenr (rhus
going from a current average of abolit 18
grams per day ro around 30 grams per day),
we would decrease our national rate of colon cancer by 31 percent and would save
some 50,000 cases of colon cancer ,mnu-


Eadier in this chaprer we looked ar dara

from Harvard Universir}"s Healrh Professionals Follow-Up Srudy. ReseaTchers rhere
srudied rhe relarionships of lifCsryle ro rhe
lesiolls rl1at precede colon cancer, known as
colorecral adenomas. Jn addition ro finding links wirh aleohol, the Harva~rd grollp
has documenred relarionship bet\vet:'n these
adenomas and both bigh sacurated fat COJlsumprion and low fiber inrake. Speciflcally,
rhose with high sawrared fat incake had
double rhe risk of these Iesions. Men wirh
r!le poorese fiber inra.!zc had almost duee
rime rhe risk ofcolorecral aclenomas \vhen
compared with those consuming flber liberali)'. When rhe)' ielentifed a group of rnen
earing liberal amounes of sarurared fat and
linIe fibct, rhe)' discoVCiTd rhar the)' experi
enced nearl}' faur rimes the risle of rhose on
a low sarurarcel far, high fi bel' diet. 2 '2
Dietar)' fiber has proteccjve bendlrs regarding other canecrs as well. For example,
a high fI.ber diet has been shown ro decrease
breasr ancer b)' more rhan 50 percenr. 233
Dr. David Rose of rhe American Healrh
FOliildarion believes that the evidence suggestS rhar fiber "ma)' favorably modify the
enhanced breast cancer risk associared wirh
the rypical AJllerican h igh-f:1t, low-IIber
dieL" Hc suggesrs rhar fiber ma)' "iork
through a varier)' of ways ro lower breasr
can er risk, but r!le primal)' effect is probabi)' through affecring eirher rhe acriviry OI"
the metabolism ofestrogen. Associated wirh
plant flbers are planr csrrogens ("fibehlssociared phytoestrogens") that may lower
breasr canccr risk. There is al$o evidence thar
flber can inrerfel"e with rhe intestinal re-absorprion of esrrogen-rhis wOldd aho be
expecred co lower breast cancer risk. 3';

Seleniull1 is a trace mineral found in
whole grains, such as wheat grown in North
and South Dakora in seJenilUn-rich soil. A
diel high in seknium (approximare!y 200
ro 400 micrograms a day) decreases rhe risk
of lung, colon, and prosrare cancer. 235 But
anorher word of camion for supplement
lIsers: too mllch se1erLiwn is toxic and causes
hair anei nailloss, baei brcarh, or other symproms.




Pre-menopause Post-mellopause









Figura 25

Maintain Proper Weight

Increased body weighr has been linked
an increased riskof several different rypes
of Cancer. The lisr includes cancers of rhe
breasr, kidney, endomerrium (inner lin ing
of rhe womb), and prosrare. 236 Ler us examine a few of [he man)' srudies [har have
explored chis rebrionship.
A c1assic Japan se study dane by Dr.
Hirayama found rhar rhin women had rhe
lowes[ ra[es of breasr cancer as porrrayed
in Figure 25. 237
In rhis figure, [he "overweighr" caregory



% of SO
risk of 40





Figure 26


was up to about 20 percent more (han (he

upper limit of nOftnal weiglu; obese was an)'
weigln above rhe "overweighr~ range. No[e

rhar obese WOmen had a r.hree-fold increased

risk for rhose who had not )'et gone rhrough
menopause, bur rhe risk climbed ta a rwelvefold level for rhose who were post-menopausal.
Anorher wa)' ta look ar facrors [hat predispose wamen ro breast cancer is ta srudy
rhose who developed more than one breast
cancer rJlar was not spread from rhe initial
cancer. Such seudies are imp0f(~lIn because
chey wauld be expecred ta idenrify a group
of women who have special flCwrs favaring rhe developmenc of breasr cancer. In
1985, other Japanese re earchers idenrified
such a group of over 60 patiems and compared them wir.h individuals who had just a
single breasr c..lncer. 238 A srrong rdarionship
emerged berween weighr and multiple
breast eancers. Those who were overweighr
had (fiple ilie risk ofhaving more rhan one
episade ofbreasr cancer, demonsrraring rhat
rhe overweiglu conditian in some wa)' predisposed rhem ro the developmenr of rhis
American research has also becn publisheel on rhe breasr cancer-overweight rda[onship. Dr. Kumar anei associates ar rhe
Universiry of South Florida found rhar
weighr gain from puberry ro early adulr.hood
was especially important in increasing breast
cancer risk They found rhar an exrra 10
pounds an a 30-year-old waffiall raised her
risk of breasr cancer by 23 pereenr, while
an exrra 20 pounds raised her risk 52 percenr. 239 Gaining weight aher rhe age of 18
has jusr recently been found ro be an "independenr risk facrar" (apan from aleohot
consumpron) use of hormones, physical
acrivity levels, age of firsr pregnancy, menarche. and menopause) for the devdop
menr of breast cancer. 240
Wamen are nor rhe only ones who experience an increased c.'tncer risk due ro
being overweight. In 1985, Dr. Garfinkel
reponed resulrs from one ofr.he largest srud
ies dur examined the relationship berween
body weighr anei c.1J1Cer risk of750,000 men
anei women. A 12 year follow-up srudy revealed ncreased cancer monaJity for rhose
who were overweighr. The flndings are tabuIared in Figure 26. 241
Nore rhar men who were 40 percenr


overweiglH haei a 33 pereel)( increased risk
of dying from cancer. \'V'omen who were
overweighr by the same percenrage increased
rlleir cancer dearh rares bl' 55 perccnr. In
men, chis relarionship \I,.as sr<]risrically significant for cancer of the colon, rcctum,
and prostare. For women. risk increased nor
onl)' for breasr cancer b\l( also cancer of the
uterus (cervix and endometrium), ovary, and
galJ bladder. 242
How do l'au Imow ifl'ou are overweight?
There are a varier)' of ways ro flnd DUC one
ofthe standard merhods is ro compare yourself ro tables such as rhose publjshed by rhe
Meeropoliran Life Insurance Company.
However, rhose rabIes do Hor work weB for
people rhar have signiFicandy grearer
amollnts of mllscle mass than average. By
such srandards mosr bodl' builders, for example, would be ovenveighr. Therefore,
some feel a more imponanr determinanr is
wherher l'au are "over-far." Me,asuremems
ofbody f.1r can be nude bl' a variety of rnerhods ranging from underwarer weighing
ro slun fald measuremenrs. ewee rnerhods usc an infrared beam or resistance ro a
weak e1ectrical currenr ro estim;lre bodl' fat
A simpler and yer very valuable method
for esti maring excess bodl' fat compares rhe
size of r.he waisr ta rhar of the hips.243 You
can do rhis l'ourself. Tal<e a measuring r:1pe
and measure araund l'our hips. then araund
your wa.isr. For women, rlle waisc size should
be 20 percem less than rhe hip size. For example, if the hips measllre 40 inches, rhe
waist ShOllld be 8 inches less, ar 32 inches
(0.2 rimes 40 = 8). If ir ' anl' b-ger rhan
32, you have excessive weighr.
For men. the waisr size should be 10
percem less rhan hip sze. For example, if
rhe hips meaSllre 40 inches, rhe wajst shouJd
be 4 i Dches less (40 rjmes 0.1 = 4), ar 36
inches. H1 lf it is larger, you are overweighr.
Those who are over-far bl' the waist/hip
mcrhod nor on-'y have a grearer risk of cancer bur aJso a greater risk of diabetes, hypertension, and coronary hearr disease.

Watch Out for Excess Protein

A clier low in prorein, parricularly in cerrain amino acids, will also srrengthen the

immune sl'srem agajnsr cancer. More informarion is provided in Chaprer 7 enrirled,

"The Great Mear and Protein Myrh."

Viruses in Animal Products

A pania1 1isring of viruse' known ta
callse human cancers indudes: the Hepatiris B virus, the Epstein-Barr virus, human
T-cell leukema viruses, and HfV, che human immunodeficiency viru ,.245 The human papilloma virus which also causes cancer, is dealt with in Chaprer 15, "AlDS and
H1V-The Untold Scory." In addirion to
viruses, parasites-which are comenon overseas-also find rhemse1ves an rhe Ist ofCo1ncer-causing infectious agenrs. Foryears, rwo
such parasires have been known to cause
cancer: they ale Schistosoma haematolJium
and Chlonorchis sinensis. The former is
Iinked ro bladder cancer, while rhe laner is
a known liver cancer risk factor. -16 Chronic
bacterial infecrions such as Helicobtlcter P)'lori Gtn callse cancer of the stomach and
have been linked ta lymphoma. 147 With a
renewed appreciarion for the dangers ofinfecriolls diseases, man)' arc wondering
wherher mear and orher animal prodllcts
mal' harbor infecrious agenrs mar could increase cancer risk. 1 deal wirh this concern
in Chapter 10, "Animal Diseases and Hllman Health Risk."

Regular Meals with Nothing Between

Meal frequency has been idemified as a
ri k faeror for colon. cancer. A number of
srudies in differenr pans of the world demonstrate thac eating meals more frequenrly
leads ro an increased risk ofcolon cancer. 218 .
219,250 Or. La Vecchia and colleagues in
Milan Italy have published an rhis subjecr,.
Their group faunei rhat rhe risk of borh
colon ancl rectal cancer coulel be nearll'
doubled by ea[ing more frequenrJy, as rabuIared in Figure 27. 251
Four meals per day almosr doubles rhe
risk of colon and reeral cancer compared ro
[wa meals per day. These impressive resuh
discovered by (he Milan researchers could
nor be explajned by a variery of djetary ar
orher lifesryle factors. The resulrs indjcated
thar meaJ frequency was indeed [he factor
thar impanecl increased risk.



M ea lsper d ay

2 or Jess

4 or more

Risk o f R i s k of
Rectal Cancer Colon Cancer




Figure 27


The resuhs concur with counsel given

years ago by Etlen White: "It should be
shown (hac to eoat two meaJs is far bener for
rhe hea.lth dun ro ear three. '252 She provided funher c1aloific<ltion: "Most people
enjoy bener health while earing rwo meals
a day (han three; od1ers, under their existing circllmsrances may reqllire somerhing
(O eat at supper time; bllt rllis meal should
be very light..."253
The medical research presemed rhroughour this book is mosr consisrent with such
an eaung sryle. We should eat a bean)' breakfast in rhe morning. his is an appropriate
rime to eat several servings of fruits and
grains, with nuts in moderation. These
foods alOC rich in viGunins, minerals, and fi
ber, wirh no cholestera!. The second meal
can be ar noon ar in the ea.rly afternoon.
This ITlay sound like an impossible ea(ing

sryle for many people-and it may nor be

permitted by your work schedule. However,
if you have the abiliry ro implement such a
program, 1 have found rl1ar mosr indjviduals nor only adjusr ro it, bur actuaJly thrive
on sllch a regimen. Oprimatly, if you do eat
in rhe evening, ir should be a liglu mea.!;
[he heavier rhe evening meal the greater
chance for weight gain, as itlustrared in
Chapter 1, "Principles for Optimal Hea/rh."
A good example ofa lighr supper woulcl be
a meal based on fruit.

E'(ercise-A Friend }Dur

Immune System Needs
Exercise and a healthy immune sysrem
go hand in hand. Can el' mana/ity rates are
signiflcanrly lower in regular exercisers. A
well-publicized swdy of Harvard Alumni
found thar rhose who burned only 500 calories ar less per week in exercise had 35 percem more cancer dearhs rhan rhose expending grearer rhan 2,000 calories per week. 25
Dearhs from aII causes, including hean discase, were increased by over 60 percenr in
rhe poorer exercisers.
Over 17,000 men ages 30 ro 79 were
c1assified according ro ilieir level of physical acrivity on rwo eparale occasions over a
25 year period. Those who \~'ere highly active (expending 2,500 OI' more ca/ories per
week in exercise) had 38 ro 61 percen( Iess
lung cancer (han rhose who were inactive
(ani)' 1,000 calories ar less of exercise per
week).255 Heavier individuals who were
highly active dropped rheir colon cancer risk
by 44 ro 81 percene. Expressed in orher
terms, their inactive peers had lip ro five
rimes the risk of colon cancer. Other srudies have a1so suggested that physical inacriviTJ' increases colon cancer risk. 256. 257
Stiti ocheI' stllrues have linked physical
acriviry to prorecrion from ocheI' cancers.
Researchers a( rhe Cooper Clinic in DaJlas
have found rhat rJlOse who exercse moderately have only abour rhree-quaners of tne
prostate cancer risk experienced by rheir
inactive peerS. The hig/' exerse group tared
by far rhe best; they had 011~Y I1bout 30 percent ofthe risk faced by rhase gerring linie
ar no regular exercise. 25


Exercise's protective effects extend ca
women as well. One recem swdy found rhar
women who exercise an ave rage of faur
hours per week during their childbearing
years decrease rheir risk of breast cancer by
nearly 60 percem. Even rhose \Vho ani)' had
one ro three hours per week of exercise cur
their risk by 30 percenr compared ro nonexercisers.259. 260
Why does exercise reduce cancer ri k?
There are several possible reasons-many
ofthem cenrer around the immune s)'stem.
For example, srrenuous, susrained exercise
srimllJares white blood cdls ro rdease a compound called inrerleukin 1. 261 We colild
expect an)' vigorous exercise ro accoll1plish
this dIecr, whether it is gardening, brisk
walking, or dozens of orher activities. This
is good news because inrerlellkin-l , in and
of icself, is a natural chemoeherapy agent.
Beyond rhis, inrerleukin- I. Stimlliates ehe
release ofinrerleukin-2, which also aids rhe
immune sysrem. These inrerlellkin chemicaIs from our white blood ceIls serve as
modularors of the whole immllne sysrem.
Anou1er wa)' ehar vigorous exercise helps
ule immune sysrem is b)' doubling the blood
plasma ibe.erferon levels. lG2 Inrerferon is a11orher chemorherapy agenr that aCL~ againsr
cerrain cypes of cancer such as hairy-ceUed
leukemia. It also fighrs chronic viral infecriollS such as heparitis B and hepatieis C.
Exercise also increases orJlcr critical irnIllLlne subsrances, the natural killer cells. 263
Natural bileI' cells arc cerrain wh ite blood
cells [har seern ro have a natural instinct ro
deeect abnormal cdls and desuoy [hem.
They stern to be especiaJly imporranr in
defending us from cancet.- 64 Finally, rhe
blood lymphocytes, which are a broad grollp
of whire blood cells that are very prominendy involved in rhe mmune system rself, are increased wirh exercise. 265
Exercise a1so has the abil-iry ro modulare
hormonal mechanisms. This ma)' be imporrant in borh sexes ar aII ages, but has been
parricularly nored in yOllng women who exercise vigorously. It is common kllowledge
rhat rhe hormonal changes from exercise in
rhar group can be so profound rhar mensrrual cycles can cease.
A1rhough no one really knows how

mllch exercise is oprimal regareling cancer

prevention, mosr expens agree rhar one of
tlle mosr imporranr facrors is consistency.
Indeed, exerci e should be a parr ofour daily
rautine if we are really serious abolit cancer

SunLight in Moderation
Mose. of {he media's ancmion has becn
on sunlight as a cause of cancer, as well it
is-in excess, a' menrioned earlier in rhe
chaprer. However, sunlight deprivlltioll inaClTSes the risk ofcancer of the breast, colon,
anei prosrare, possibly due ro less circlilating Vit;unin D-3 and irs derivatives. 2GG The
aurhors of rhis discovery conci ude {'rhar
rJ1ere should be no broad condemnation of
moderate sunlight exposure. "267
Sun expOSlire may actuali}' help prevent
colon cancer. Researchers ar rhe Universicy
ofWashingron srudied cancer rares in nine
areas of rhe United Stares. They discovere:d
rhat men from Sourhern srates haei much
less colon cancer than Norrherners. _68 When
cornpared ro New Me:xicans, men in Mich.i.gan, Connecticllt, and Washingron had colon cancer r,lfCS 50 ro 80 percenr higher.
The dTecr also seemed ro hold true for
women, althollgh it was not as marke:d. One
explanation for rhis decrease in colon cancer risk in sOllthem srates is ncreased sunlighr exposure with a resulting increase in
vitamin D leveJs. Vie.amin D appears able
to sllppress rhe growrh of cancerous cells.

Stress and the lmmune System

To optimall)' boosr yOllr immune system, adequare srress conrrol is a must. Srudies show rhat people who are not coping
adequae.ely wirh major stressors in rheir lives
have a mllch greater cha11ce of developing
cancer ar a life-threatening infection. A
number ofscudies have been performed on
people who already have a life-threarening
cancer. Although the specific biologic process of a person's cancer is rhe mosr consistent factor affecr.i.ng survival, social support
(such as given by a loving SpOll e) and a fairh
dimension (such as prayer) ale rwo relatively
consistem characrerisrics among 10ng-rerm
survivals of cancer.-69 Because stress control
is so illlporranr, 1 have wrirten aII emire



Proper diet


Regular mcails with

no snacks

Regular aerobic cxercise

Cereai grains
Maintain proper

Sun)jgM lin moderation

Stress control

to dramacical1y reduce our risk of cancet is

in order. And rhey are ali wr1Lin rhe scope
of pracricaliry. They are nor complicared'
rhey can bc implemented inco our lives \Virh
no addirjonal cost. For convenence, a summary lisr of the e1emenrs of a litestyle rhar
wiU vastly reduce our risk of gening cancer
is shown in Figure 28.
As we have seen, antioxidanr.s, seleniunl,
vitamin A, C, and E, and many phyrochemicals have been fotlnd ro have speciaJ
qllaJiries rhar prevelH cancer. Fruirs and vegerables rh:u comain one or more of rhese
subsrances in guod qtl:lnricy are lisced in
Figure 29.

A Personal Cancer-Protective Lifestyle

in a Nutshell
The information in rhis chaprer enables

Figure 28

ro oudine a personal cancer-procecrive

lifeslyle. Such a lifestyle would avoitl carcillogens. In chis chaprer we have seen (hat

citrus fruits
orange juice

kale, spinach
lettuce, collard grecns ~
brussel sprouts, cabbage
beans, peas, lentils
broccoli, caulinower
carrots, beets, I)otatoes
watercress, mustard greens
garlic, onions, leeks
turnip/turnip greens
yams, sweet potlltoes
mixed vegetables
cantaloupe, watermclon
beII peppers

Figure 29

chaprer, "Srress wirhollt Disrress" (Chapter

14). on how adequare srress control fan be
achieved even by rhose under vcry high

Summary ofAgents
That Prevent Cancer

To close Section II ofthis chaprer, a review of rhe mm}' acrions rhar we can rake

rhe leading and mosr common carcinogen

is robacco. Smokers need ro kick t!Je tobacco
!labil; efforts ShOllld continue ro have a
smoke-free. robacco-free society to eradicate
second hand smoke.
Regarding akohol, the data is ali in. We
need ro stop ltsing aLcohof. lndeed, even
moderare drinking increases cancer, and
when you consider rhar 56 percenr of rhe
American populatiol) drink aJcoholic beverages, this is no small ma((er. When we
rhink abour a1cohol's carcinogenic porentiai and whar it is doing in relation ro illcreasing accidems, homie.ides, and suicides
\Ve need ro choose ro abseain and encourage orhers ro do che same-it is ule only
oprion rhac ma.kes sense.
If we reali)' wam to maximize our personal cancer-procecrion eHort, we must

(hoose the fOods that wiLl UJork fOr our henef;'

and eliminate the foods t!JiU are working
agllin.st Iti, as (he man)' studies cired in rhis
chaprer have shown. We have seen ehar sociecies rhar regularly consume mear, high
fat dajl)' proelucrs, and sacurared fars associated wirh chem, have dle highesr rates of
cancer. Changing our c1icr does noe mea})
cU((ing down an reci meac anei eacing insread more chicken, (lIfkey, or IIsh, which
con.cain many roxins, viruses, anei other


pQ[enrially d;Ulgerolis subsrances. There is
no uet gain from thar approadr ir srill has
many of rhe origina.l haz.1.rds. Only by chang-

ing fi'om the 'Ypical American animal-based

JieI to il plant-bastd diei (such as in China
and many orher counuies in rJle world who
have rhe 10weSl cancer rares) \'.'ill we achieve
rhe resulrs we want. Eating freely offruits,

grains, 1Jegetables, and nuls in mod.eratiol1,

prepared in a variery of ways, offers us the
mOSl healthful dier in the world. It \Vas rhe
fim dier reeorded ill the history of man and
is still the besr rhar we know of roday. Ir nor
only e1iminares a host of cancer-causing
substanccs bur is aJso ideal for mainraining
proper weighr. Ir boosrs rhe immune sysrem by ma1<ing USe of viramins A. C, and E
and other very important proceerive
phyto hemicals and f1ber.
Coupling rhis dier wirh regular aerobic
exercise will boos[ the immune sysrem even
further. Rounding our rhe program wirh
adeqllare slress controL, moderate sunlight,

weight controL, aneideereasing snacks and meal

frequency will maximize rhe preventive porentiaL

Anyrhing wonh doing is worrh doing
righr. AlI of us are indeed capable of changing aur behavior for the good, espeeially
when we Imow whar benefics may resu1t.
The personal srakes are high-it is a life and
dearh marrer-my life, your life, and the
livcs of OUl' ehildren and loved ones. The
message is clear and ir caUs for aerian. The
rime ro act is now.

The Best Kept Secret for Preventing

a Catastrophic Disease
Think of whar would happen if romorrow-afrer ali the billions of dollars spent
on cancer rreatment research-a miracle
cancer pili was finally discovered. And ic's
promise was nor false: ir fllJly cured 90 percent ofaII cancers! No doubr rhe drug would
make headlines. The company that deve!oped ir could pur a huge priee rag an it.
Mter alI, rh.ink of aiI the money it would
S3ve on surgeries, radiarion rherapy, and
chemorherapy hospitalizations. o doubt
it would have irs share of side effects-all
drugs do. But who cares abOllr side effeers

when )'ou have cancer and me cure is just a

pili away!
The drug developer wOllld probably
receive rhe Nobel Prize for rheir work. It
would not be surprising jf (he President of
rhe Unired Srares invited the chief investigarors ro a special reception ar [he White
House. What a cause for rejoicing rhis truly
would be. AU the hoopla, rhe national fame,
and rhe honor bestowed upon the participanrs would be tremendous-as well ir
BUl stop for a minute. There is no sign
that any drug like rJlis is on rhe horizon.
Furthermore, whar is reali)' more important,
prevenrion or cure? We are alI aware of rJle
old saying, "An ounee ofprevention is worth
a pound of cure." But do we really live as
though we believe it? Even if mat imaginary cancer ellre piU reali)' were developed,
t hin k of ali [he problems tha t cancer
cause '-before it is even diagnosed: ali the
medic.ll bills, rime lost from work, and famil)' stress, nor ro menrion rhe pain and suffering caused b)' the disea.se. Even if chere
\'Iere a cllre for every single cancer, prevenrion would sriU be much cheaper and llluch
more desirable and ple.asanr. Bur in an era
when, despire ali rhe billions of dollars that
have already been spenr on hopes of rhat
e1usive wonder cancer drug, and we are stiU
nowhere clase to such a magic cancer
cure,2/0 how mueh more important is the

pre1Jmtion ofcancer?
As hard as ir may be ro beLieve, in a sense,
rhe magic cp.m.:erpillhas bem foul'Id Research
has revealed dur we now have lip ro a 90
percent effeelive "elite" for cancer in the.
form of a comprehensive cancer-preventive
lifestyl.e. Bur rhere have been 110 headlines,
no hoopla. no presidenrial invitatiolls, 110
Nobel prjzes. In fact, hardly anyone even
knows about rhis powerfullifesryle. Illdeed,
(here are many people wha know various
aspecrs of rhe program I have described in
dtis chaprcr. Many are aware of rhe importance of sropping smolcing, OI' exereising,
or earing more fruirs and vegerables. Ver,
regarding rhe whale package mat can give
such amazing resulrs, mosc of rJ1C general
public s rmally unaware. Unfonunately, dlis
includes heaJrh professionals. Alrhough


mOst ,ue aware of some of the e1emcnrs 1
have discllssed in this chapeer, feware aware
of [he power of the comprehensive lifesryle
approach ro cancer rhat has been preselHed.
This lack ofawareness is even more srriking in light of ehe "age of informaeion" in
which we live. We should be c1early broadcasring [his comprehensive approach tO cancer prevencion an every relevision and radio station; we should presenr ie graphically
and powerfully in every newspaper, magazine, and computer news service. Th.is
Iifestyle should be rhe sllbjecr of a massive
governmeru educationaJ program. lf such
happened ro morrow, and the American
public embraced rhe new way ofliving [hat
was championed, me number rwo hller in
America would soon be relegared to rhe
bottom ofthe 10 lea.ding cau.se~- ofdeatb. The
pain, suffering, productive work losr, family heartac11e, docror and hospieal visits, noe
ro menrion rheir associared eosts, would be
grearly diminished.
But for rhe mose parc, the media, researchers, healch educators, and Presidencs
have been dearhly silenc in promoting a

comprehensive lifeslyle program for cancer

prevention. They, like most of sociery, declare war on cancer b)' focusing energy on
e1usive ueatmencs and narrow preveneive
approaches, when a comprehensive prevenrive lifesryle is riglu al our finger tips. Is it
simply ignoraJlce? Or is it possible dut
many of aur leaders, scientises, and media
spokespcrsollS are not willing ro make bold
lifesryle c11anges themselves (sa long as rhe)'
are feeling well)-and mus wouJd be uncomfonable ill chaJlenging anyone else eo
adopt such a way of Jiving?
Is mere a rcar of back1ash from powerfuI cammereia! interesrs if the optimal cancer prevencive lifeseyle is advocated? (The
message of this chapter wiU nOI likely be
popular wieh the likes of the alcohol, meae
anei dairy industries, etc.) 1 hone-sely do nor
know whae aJl the impedimencs are, bur 1
do know ehat nolV is the eime ro get the word
our abolit rhis IOral lifesryle. Anei now is the
rime for eaeh one of us tO become a living
example of ilie power of such a lifestyle ro
combat America's fearful number lWO killer.


Can er Facrs & Figurcs-1997. Alluri.cl1Jl etmce,. 'oeiety, p. 1.


American Cancer Sociely, Ine. 1-800-ACS2345.

Cancer Fact5 & Figurcs-1997. American umur ~oely. p. 1.

Cancer Facls & Figures 1997. Am~ricl1Jl Crmcer Soci~,)'. p. 29 (proslatC

canCer gllidelines founel on p. 15).

Cancer Facts & Figures-1997. A1IIl'ricl111 Ctmcer Soeiery. p. 1.


Reftrenee.sMc)'skcns FL J r. Cot"t\ing of 'tge-tbc d\emoprcvcl1lion or canccr. N ElJgl

J Md 1990 Sep 20;323(12):825-827,

Davis Dt.., Dinse CE. Hod DG. Dccreasing cardiovascular disease and
increasing c.11lcer alTlong whiws in lhe Uniled $wcs from 1973 hrough
1987. Good news and bad news. JAMA 1994 Fcb 9;271(6):431--437.

Dcvesa SS, Blot WJ. et al. Recenr clIlcer lrcnds in ,he Uniled Sra[e.~. J
NIl!l Cl1llm Jml 1995 Fcb 1;87(3): 175-182.




& Figurcs-1997. Americl1l1 Call1'l'r Soeiely, p, 1.

Mcltlin CJ. New evidence of progress in Ibe nJlional Cancer progr:lln.

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Conquering the Number

One Killer
A WorlJwide Problem

ue never worried mllch abolit hean

disease. Sure, her dad had died ar
45 wich a heart acrack, but every
one knew that femaJe hormones
would procect her ftom hean problems ar
leasI umil she wene [hrollgh menopause.
Ovemighr, however, she was jolred back ro
re.aliry. Ar [he age of 40 hec younger sisrer
died wirh her fim hean anack-before she
weor rhrough rhe "cb:Ulge of life." Suddenly, Sue was confroneed wirh whar she
fcared deep inside ali along: she was ar risk
of a heare aaack.
Almosr every American knows someone
who has died of hearr disease. Like Sue,
you may have premawrely lost c10se relarives from rhis dreaded killer. Perhaps you
have had neighbors, friends, or coworkers
snacched away by hearr disease. As a resulr
of chis kilJer's predominance, most ofus have
ac leasr occasionally wondered, "Will 1 be
[he nexc one wirh a heart af(ack~" Such COI1cerns are warranred. Hean disease is rhe
num ber one killer in rhe induscrialized
coumries, as ourlined in Figure 1.1. 2
Contrary ro popular misconceprions,
heart di ease is nor only a disease of men.
In America, hean disease is rhe leading killer
of mcn and women aJike. Despire ali rhar
I\ledical science knows about how ro pre-

vent chis di ease, rhe latese stariscics show

thar over 954,000 people died of diseases
of rhe hcart and blood vessels (cardiovascllIar disease) in rhe Unired Srates alone in
1994, lip from 925,000 in 1992. 3 Every
33 seconds an American dies of cardiovascular disease. Since 1900 the nUlnber one
killer in rhe United Stares has been cardiovascular disease in every yeat bur one (918).
When an airline crashes in rhe U.5. and

Heart disease is tbe biggest killer in the entire world.

In developed nations, the proportion of total dca,ths riscs
to more than 50 percent.
It willlikely overtake
infectious diseases as
the main cause of
death in many
developing nations.
Worldwide, beart attacks and s'rokes account for 25
percent of deaths.
Figure 1


hllndreds of people die, the news is fiUed
with rhi foP tory for days. In-depth analysis is performed and broadcast regarding the
possible cause of the crash and how it miglu
have been preventcd. Consider dut approximately 2600 dearhs, many of them as
sudden as in an airline crash, OCCllr cach rlay
in the U.5. from cardiovascular diseas'e
alone. This is greater than 10 jumbo jet
crashesper day. Yet, these deaehs do not even
make rhe news broadcasrs except when a
farnous person dies from a hearr attack, and
then if rhe disease j menrioned ar aII, it 1S
only as al) aftenhought, as if it was inevirabie. The llumber one cause of death deserves more ehorough a((emion in America.
SadJy, dearhs only reU parr of rhe s(()ry
of rh.is dreadful disease. Of rhe currenr U .S.
poplllarion of abolit 258 million, more (han
57 miUion people have some form of (his
disC<1se. 4 The annual cost ro America for
diseases of the hearr and blood ve. sels is an
astounding 259.1 billion dollars, which includes not OI1J.y rhe medical and surgical
rreatment, bur also Iose producriviry in the
work force. 5 It you personally happen ro
survive a snoke, u)e average lifetime coSt in
medical bills and lost earnings will be
$103,576. 6 How much bener ro prevcnt:1
stl'oke OI' a hean ;ltrack rhan ro pay for one
and stiU sufler the diminshed qualiry oflife
that is aJmost cenain ro foUow! No wonder

Clyde Yancy, M.D., president of the American Hearr Associarion's Dallas divi ion and
researehing eardiologist al' the Universiry of
Texas SourJHvesrern Medical Ccntcr in Dallas said recenr1y, 'No matter where somcbody is in rheir marurity process, young,
middle-aged, Of old incorporaring a heanhealrhy lifesryle i5 rhe mosr cosr ef1eerive
rh ing (har can be dane righr now." Nor
only is it COSt ef1'ective, but even more important wiU likely be life saving, and cerrainJy will be life-enhancing!
How can rhe number of beaI'( anacks
be reduced? What can a person do ro reduce th risk of a hean atrack? Dt. Ivan
Gyarfas, Chief of tbe World Health
Organization's :udiovaseular Disease Prevenrjon Program, explains that prevenrion
measures could savc a significant number
of people from premature death: "AbOlit
twelve milIion people die [worldwide] evcry year ofhearr problems, but up to hll1fof
them couJ.d be saved if bena prevention
programs were in effeeL"!
Although betta prevenrion programs
could Cut dearhs due ro heart disease (especiaUy coronary hearr djsease) by abollt 50
percen.t. evidence suggests that optirnttL prevemion programs could CUt hean disease
deaths by as much as 90 percent. In shorr,
although hean disease is by far the number
one cause of deau) in America, it does nor
need to be. Nine out of ten hN/r' attacks

Diogram of OII Atlrerosclel'otic Plaq/le

Dcgeneraling ce Ils

Fibrou' cap
Smooth ll1uscle cel1s




be p reventabIe!

The Development ofHeart and Blood

Vessel Disease
Man}' peopJe who have hean disease are
not aware of it. This is because heart disease usually develops silenrly. Before any
d~unage ro the heart occurs, a process called
arherosclerosis (or "hardening ofthe aneries") has been taking place in u)e aneries of
the hearr for many years. The earl}' phase
of atherosclerosis is called a "fatry srreak."8
The process of atherosclerosis is not COI1fined ro rhe heart aneries (known as "coronaryaIteries"). The term "coronary aner)'
discase" refers pecifically ro [he gradual
nanowing of arherosclerosis as it afTeers rhe
hean anerie.s. Large and medium sized ar-

teries throughour tlle body can become narrowed by rhis bllildllp of farry marerial as a
plaque is formed, illllsrrared in Figllre 2.
Norice rhar rhere is more ro rhe process
of atherosclerosis man the buildllp of far.
When far accumlliares an rhe inside of rhe
coronary arreries (or any other acrery), rhe
body reacrs ro prevenr a blood c1or. Ir covers rhose farry deposirs wirh a tollgh. fibrollS
cap, as shown in the figure. This is an impoream response, because if f.rry material
is a1lowed ro carne imo direcr comacr wirh
lhe blood ir c.n stimulare the blood ro c1or.
The fibrous cap prorects againsr rhis deadly
dorring. In fact, this dual process gives arherosderosis ilS name. "Arhero" refer ro rhe
"mushy" or "gruel-like" fatry material ular
builds up inside rh aneries. "Sderosis"
describes me hard fibrous marerial made by
rhe body in response.
Unfoftunately, an atherosderoric plaqlle
can 1IIce.rare, causing a break in tlle prorective cap ;~s shown n dle ftgure. Wheo dus
happens, a combinarion offlbrous and farry
marerial is released ioro rhe blood srream.
A now smaller, eroded farty deposir, calted
an ulcerared plaque (somerimes called "Iesion"), remains attached (O r11e anery wall.
Borh the liberated farry marerial and the
u1cerared plaque irself can acrivare plarelers,
rhe body's doning cells. This often sers il1
mouoll a chain ofevenrs rhar can complere1y
obsrrllct any anery rhar is already significaody narrowed by arherosclerosis.? If rhis
or another process reslIlrs in complere obstrucron of a comnary anery, the hean
muscle rhar was dependent on [he blood
Aow in rhar anery will die. This dearh of
hearr tissue is calted a myocardial infarcrion
(MI), Of heart attack.
Atherosclerosis progresses at differenr
r:Hes in different people. The change over
rime in rhe arreries of a person who at rhe
age of 60 Of 70 wiU sllffer from hean disease is shown in Figure 3.1
Note mar cady atherosderosis is presenr
ar age 20, as shown ar rhe bonom of rhe
figure. This is commo!} in Wesrern narions.
1; f.Kt, it may be presenr arage 10 or 15.
By [he rime a person reaches 20, Farry stfeaks
can be so prominenr rhar rhe}' are elearly
visible when the coronary artery is cur open.

If rhe unhealrhy lifesr}'le continues, by age

30 the plaques progress ro become even
more pronoullced. By age 40, ir is noe unllSUal tO have significanc coronary anery
blockages rhar reduce the diamerer of the
anery by more rhan hali: Even ar rhis point,
rhe eflects of 30 years worrh of aeherosdef()sis will likely srill be "si lent. " Mosr individuals will have 110 sympeoms ar ali, as
nored on rhe figllre by the area labeled "a5ymptomaric."
Ifsymptoms do arist, rhey may be vague
or "arypical," or they may be c1assic "angina
peecoris," which is shown ill the figure as
rhe first symprom in rhe progTession roward
a hean arrack (shown as MI in rhe figure).
Angna pectoris refers ro chesr pail1 an exereion ar severe emorional srress rhar is USllally described as a heaviness, pressure, or
tighrness cenrered in rhe middle ar lefr side
of rhe chest. The pain can rravelup ro rhe
ncck Of jaw or down eirher arm. Occasionally there is also back ar sromach area pain.
A large meal ar cald wearher may also precipitate this paiu. l1 The symprom of pain
is GlllSed by an inslifficient blood slIpply ro
rhe hearr mllsc1e, reterred ro as "c(}ronary
illSufficiency" in the figure.
Currenr1y, approximare1y 6,750,000
people in rhe Unired $rares suffer from angina pecroris. 12 Unfortunare1y. mally have

Insuf.6ciency Ischemie

% of Artery Remaining Open



No Symptoms



o o


Congesti...e Hean Failure /



Figure 3


no such symproms umil they have their fim
hean attaek. Even llnder siruarions of significanr exertion, a hean aner)' musr have
at leasr 50 ro 60 percenr of its diameter
blocked before the hean musde suJfers from
lack of blood sllpply, which is the eause of
the pain. 13 Many individuals \Virh nanowing even in rhe 70 pereenr range ar greater
have no recognizable symproms.
As a result of ilie lack ofsympeoms, hearc
disease is often not derected in its earlier
srages. A person may feel grear, be working
full rime, and yet be on the verge of a major
hean anack aJld perhaps even sudden dearh.
Approximately 60 percenr of hearc aeraek
dearhs occur suddenly or ourside of a hospital before treatmenr can be adminisrered. 11
Over half of ali sudden dearhs (almosr (WOrhirds ofsudden deadl cascs in women) oecur in individuals who were nOt previously
diagnosed \Vith coronary artery disease. It
is a sobering realicy for many iliar r-!leir firsr
hean arrack is their ouly heart anack. Sudden death offers no second chances.
Even when people survive a heart anack,
over rwo-rmrds do nof make a complete rtcovery, leaving rhem with some form of disabilicy and a permanencly decreased qualiry of life. ' S Following a heact attack, rhe
hearc is weaker because of losr musde rissue.
This weakness can be signifieanc, particularly if rhe heaer atrack \Vas large. In
such a case, rhe hean may be unable ro adequare!y per[orm even ramine pumping
functions. This s an example of what is
callcd ischemie ctlrdiomyopflt/~y rcferred ro in
Figure 3. The rerm refers (Q a hean muscle
("cardio-myo") disease or parhology
("parhy") thar was caused by lack of blood
supply ("ischemia"). When such a diseased
hean is nor ahle ta keep rhe bod)' funcrions
going, physicians use ilie rerm "congestive
hean faiIure." In rhis situarion, an affected
individual may ger shorc of breath easily,
experience feer or ank1e swelling, or be generally farigued.
Ta prevenc these progressive steps from
leading ta a fatal or crippling hean anack,
it is unwise ro pur offhean evaluarions untiI symptoms develop. A variery of rem io5
availabJe ro diagnose hean disease before a


faral evenr, such as an elecrroeardiogram

(EKG) wirh or withollt a stress (rreadmill)
rest. A resting EKG can rcveal evidence of
previous hearr attacks, but ir is a poor cool
for detecti..ng blockages rhar have not yet
resulred in the loss of hean muscle. One
signilcant exceprion is rhe occurrence of
chesr pain. In rhjs siru3rjon, if a hearc problern is causing rhe discomfort, rhe EKG,
when performed while rhe pain is OCCllfriJ)g, wiU ofren idenri/)r a porential coronary
fn a person wirhom syrnproms, an EKG
srress re t is far superior for derccting coronary anery narrowing (ha.1l the plain EKG.
Even a 50 pereenc blockage of a single artery will sornerimes sllow up an a good scress
rest. Unforrunare!y, ho\Vever, even a streso5
test can miss a considerable number of diseased individuals. As many as 35 percellt
of chose \Virh signiflcanr hean vessel blockages will have a normal srreo5s EKG.1G The
number offalsely reassured individuals can
be reduced significan ly by che use of a radioaetive rracer ca1led Thallium or by doing the stress rest in conjuncrion wirh
emocardiography (an ultrasound resr of rhe
hean perforrned imrnediately befare and
after the steess re r). Giving an injeetion of
ThaHium at rhe maximum Ievel of exercion
on r!le srress rest ""iIl identi/)r ali bur abOlIT
eighr percene of individuals wid) hearc arrery blockages and aJI bur abour four percent if the echocardioaram is ur il izedY
Since coronary arter)' disease and c!lesr pain
are so common, as a practicing physici'lJl I
perform one ar more of dlese resrs an a dail)'
The mose conclusive tesr rhar can be
performed is a dye srudy of the hean and
its blood vessels. Ir is very good for idemifying bJackages thar are likely ro cause problems. Such dye srudies are sometime referred ro as "cardiac carheterizations" or
"coronaryangiograms." Unlike r!le previous tests menrioned, a cal'c!iac catheterizarion is an iJwasive rest (meaning we go inside the body wirh a cathercr). Once a
blockage narrows t!le diameter of the blood
vessel by 40 ro 50 percenr or more such a
dye srudy usuaily idemiiles the problem.


The Different Kinds ofHettrt and

Blood Vessel Disease
As the rerm cardiovascular disease imattacks are nor rhe onl)' mani,
fesration of rhis disease. Strokes are 31so
ofrcn camed b)' athcrosclerosis. Complete
blockage ofa bran anery resuhs in rhe dearh
of any brain rissue that depeoded an rhe
blood flow in that artery. It is r11e deaeh of
brain riSSlle thar is called a srroke. Although
mosI people know tiut srrokes commonly
paralyze half of rlle bod~" fhel' can (ause
alher serious diHiculries. For example, rhe)'
can cause blindness, inabilry 1O speak or
hear, aod severe personal it), or memory
prablems. The actual problcms rhat accur
depeod on whar part of rne brain is damaged.
Arherosclerosis, as we have aJ readl'
nored, rends ro a/Tect aii of the large anei
medium sized bJood vessels throughout the
bodv. Some of rhe more common sires
\Vhe're atherosderosis tends ta accur are depicred in Figurc 4, along wirh rhe resulting
Most of these affiictions can cause death;
such. dearJls would be classified as cardiovascuJar monality. The bodl"s largest aHery,
rhe aona, is commonl)' affeeeed by atherosderosis. This huge vessel (hal carries blood
direcrJy from the heart and is auached ta it
is especially prone ro problems called "ancurysms." Aonic aneurysms rypcally result
when the lning of ehe aona is weakened by
Jrherosclerosis. Because of the h.igh presSlll'es n this grear anely, rJle weakened wall
can baUoon aur like a bad spot on a rirc. If
rhis balJooned area gels large cnough, the
rissues will be roo thin ro conrain rhe high
prc8sure and the artery will burst. A ruptllfcd
aonic aneurysm is usuaJly a deam senrenee.
Massive internal bleeding oecurs literalJy
wirhin il mareer ofseconds or minures.
Two arreries dut branch off (he aorta in
rhc abdomcn are also prone ro arherosclerade narrowing. These are rhe renaJ aneries, the blood vesseLs thar supply rhe kidneys. rf one of these aneries becomcs significantly narrowed, a person can develop
high blood pres-sure, or-even wo[se~lose
rhe funcrion of that kidney enrirely.
pljcare~, he'lrr

Othet atherosclerosis-re1ated conditions

mally nOt cJ.use deam but will rob me gualiw oflife, allowing the amicted jndividuaJs
r~ live wirh varying degrees of misery. For
example, male impotence, leg pain when
waHcing (called "intennrrelH claudjcation"),
I imping, and gangrcnc can rcsult from atherosclerosis in (he femoraJ arteries in rhe
thigh, shown in the ftgure, Jnd posrerior
ribiaJ arreries in (he lower leg and ankle.
When atherosclerosis affect. he~u-t and brain
aneries, peripheral arreres supplying (he
legs and atms are often also narrowed. Gan-



Cerebral arteries



Hcart attack


Angina pectoris

Aorta .

Renal Arteries


Femoral arteries



Figure 4

grene can result in blood poisoning and

dearh if ampurarion is nor carried Out
Cardiovascular diseases c1aim ehe [ives
ofabolit one om of rwo people il) ollr COUJlrr)'. Bur rJlcre is good news. The major
factor in a.lmosr ali of rhese deaths is atherosclerosis-and arherosclerosis is a condjtion dut medical science has now demonsrrated ro bc preventable, tTeatable, anei
evm reversible. Let us now look ac the compelling evidence tiut will give you t!le keys
to a lifesryle program ro combar atherosderosis. aur focus will be primarily on hean
diseasc prevenrion, bur be aware rhar rhe
preventive factors \Ve iUuminat.e wiU help
addre s arherosclerosis in ali its varicries aod
loca(ions in the bodl"





In Finland, 14,257 men and 14, 786 wOlllen:

lowered thelr cholcsterol' intake
lowered their blood pressure
stopped smoking


Focusing on ChoLesteroL

55% decreased dea,th rate in men

68% decreased death rat'e in women
Figure 5








tOMOO 300








Mean scrunl cholesierol (mgldl)

Figure 6


ing. high blood pressure, and hjgh choleste ro 1.

Addressing aII rhree can make a consielerable impact, as was illusrrated by a srudy
of some 29,000 Finnish men and wamen
over a 20-year period (1972 ro 1992).
When these individuals lowered rhe cho)esterol in t!leir diets, lowered rheir blood
pressure, <mei sropped [heir tobacco llse, they
recluced theu hearr attack risk by more than
half, as shown in Figure 5. 18

Keys to Preventing Heart Disease

There are some factors [har inf1uence aur
risk of heart disease tbar we can do nothing
about. For example, age and sex cannor be
ch:wged, )'er rhey have a significanr bearing
an cardiovascular risk. The older we are.
rhe grearer aur risk. Similarly, men are ar
higher risk rhan women of [he same ageparricularly in [he years before menopause.
FOfruna[e1y. however. medical research dernonsrrares thar we can ChaJlge a number of
factors dut influence our risk of hean disease. The duee mosr imponanr modifiable
heart disease risk faerors are cigarette smok-

Smoking and high blood pressure are

each related ro so many differenr healrh isstles that rhe}' warrant individual chapters.
We wiU examine lhem more closely iarer in
the book. Cho)esrerol, an rhe alher hand,
is of primar)' irueresr becatlse of irs specific
role in heart disease; eonsequendy, we wiU
fOCllS on it here. However, before leaving
rhe impression mat eholesrerol is only aJl
isstlc as il relares to increasing hearr djsease
risk, J must emphasize rhar eholeslerol is 3n
imporraJH and essenrial natural compound.
This white, waxy f.-H is manufacmred in aur
bodies and is used LO builel cell walls and
make certain hormones. However, roD
much cho[eslero) in the blood srream (callee!
"serum cholesterol") can conrribure ro a[herosclerosis. For this reason, high blood
choleslerollevel as a single factor correlates
wel! with eoronary hearr disease dealh rare.
Ir is recommended rhar aII Americans over
[he age of 20 know wha[ their LOcal blood
cholesterol and HDL are. 19 The higher [he
choleslerol level d1e greater [he death rate,
as demonsrr;)red in Figure 6.
This graph shows lhat [he average serum eholesrerol level in 19 coumries is a
predicror of [he risk of hean disease among
men in those narions. 20 Note dur Finland
tOpS rhe seale, wirh a very high average choleseerol and a very high death rate. The
Unired Srares is also relarively high an both
seales. Ireland and England are higher than
Poland, Yugoslavia. and Japan.


Lowering Cholesterol Protects against

Heart Disease
How ean we ehange rhese high levds of
cholesterol rhal are liJ)ked to hundreds of
thollsands of needless deaths every year? We
gain some insighls iIlto an allswer by s(lJdying the example of ilie Japanese. In rhe figurc, Japan s at the bouom of rlle sca.le for
heart disease aldlOugh rheir smoking rate is
much highcr rhan here in the Unreei Srat~s.
Japan is ranked number 10 in the worIeI in
s'l'loking, wirh 59 perecn( of ]apancsc men
and 14 pereent of Japanese womell smoking. On the olher hand, the Unired St3res
ranks 78rh wirh 28 percenr of American
men and 23 percenl of American womer,
smoking. 21 Why, rhen, is eheir hearr disease rate lower tl1an ours? le appears ro be
due tO their signifieanrly lower average eholesrerollevels. The Japanese staliseics provide one piece of evidence suggesring dur
on a worldwide sC<lle, cheleslerol is the mose
importam risk faCtor for hean disease.
A man wirh a serum ehelestera! over 240
mg/dl (or 6.2 mmol/L) has more [han (hree
rimes rhe risk of dl'ing from a hean attaek
rhan a. maT\. wirh less rhan 200 mg/dJ,22 as
illustrated in Figute 7.
Nore rhar the inerease in risk is mosr
pronoullced when cholesrerol levels climb
over (he 240 mg/dl mark.
We have aJready observed ehar hean discase and atherosclerosis bcgin earl)' in life
il) \'\Iestern nations. Individuals 30 l'ears of
age and younger have comrnonly been
found ro have deposi(s of a(herosc!erorie
fmy srreaks an rl'e nner waUs of their arrerie!;. The size of the wal! area rhar is cavered is grealer in individuals in chis age range
\Virh high blood choJestcrollevels, as shown
in Figure 8. 23
Note that those with a cholesterollevel
of230 have over 50 percenr of (heir blood
vessels' surface area covered with earIy arherosclerorie fatry s(reaks. This amounrs ro
roughly five times ehe amounr of fauy
buildup (han thar of a person wirh a more
ideal cholesrerol level of 11 O. T!le evidence
is elear: high blood cholesterol does damage ro (he ane.ries even in people undtr 30.
Some people misrakeoly J.Ssume rhar heart











Cholesterol Levcl

Figure 7
discase is reserved for rhe e1derly, bur 5 percerU of ali hearl attacks occur in people
under rhe age of 40, :Ind 45 percen( of aII
hearr ae.tacks occur in people under (he age
of 65. 2,1

What is the Ideal Cholesterol Lellel?

Somc experts have fOf years asscrred (hat
andeal cholesterol is 100 plus l'om age,ZS
Suppofr for this value cornes from a number



Pcrecut Covcrcd 30






Serum Cholestcroi

Figure 8






per J,OOO










Serum Choleslerol

Figura 9







lOO . -

. Beart











HDL Cholesterol (mg/dl)










IIDL Cholesterol (mg/dl)

Figura 10





of perspecrives. Two examples may prove

helpflll. Fim, when inrernational comparisons are made, cOllnuies with e)(tremely low
risks of hearr disease (end to have average
cholesrcrollevels rhar run 100 plus (heir age.
Second, extcnsive dara an rhe U.S. popuLa(ion was garhered in rhe course of the Multiple Risk Factor Intervenrion Triaj
(MRFIT). Among rhe more rhan 300,000
men studied. rhe risk of death frorn hearr
disease beg'ln to increase \Vhen total choLesrerol exceeded ) 50 mg/dl, as shcwiI1 in Figure 9. 6.27
A cholesrerol level of I 50 is fU' below
rhe 200 level whieh m,llly people misrakenly think is ideal for rhe U.S. Furrhermore, rhe 150 levelrepresems a value of 100
plu aoe for an average 50 year old-a firring guideline for an age group rhat is ofren
more aware of cheir hean disease risk factors rhan younger individuals.
Much confusion has eorne from che initial repon ofThe National Cholesterol Eduearion Program rhat provided a public
heal(h goal when rhey recommended eholesterol va.lues ro be tess than 200 mg/dJ.28
This level is an excellenr number for public
healrh workers and policy pLlIlners to ser as
a goal for every American, considering fhat
97.2 million Amcricans (52 percent of
adlllrs) have serum cholesrerols in excess of
200 mg/dl. 29 In fact, if cvery U.S. citizen
reduced his ar heI' cholestero! ro {har level,
counrless rhousands oflives wOllld besaved.
However, if you, personally, wanr ta have
rhe lowesr risk of hean disease, you would
be much wiser to adopt as a personal goal
100 plus your age. There is a vast difference bet\'v'een a goal for the popula(ion ar
large and a personal gaal for an optimal
chole rerol.
Allother problern wirh rranslating u)e
panel's original public healrh gaal inro indjvidual reeomrnendarjons was rhe faer (har
rhe guidelines clici not address rhe all-importa.nr subrypes of cholesrerol. (This subjecr was fonunare1y reerined in rhe second
repon issued by rhe National Cholesterol
Education Program Expert Panel.).lO Le( us
e.xamine rhese sllbtypes.


Chalesterol's Subtypes: HDL and LDL

Choleseerol nevec tcavels alone in ouc
arreries and veins. Ir alway rravels in differene carriers ar vehicles. Each rype of vehicIe has a differenr weighe ar dcnsity. Ouc
ro rhis faer, we can put blood cholestcrol in
adevice called an u!cracenrrifllge ancl divide
it imo fmerions according ro the density of
ies vehides. The heaviesr carriers of cholesterol are caUed HOL ar high dcnsiry lipoprotein. Some ligheer weight carriers are
named low densiry lipoprorein (LDL), whilc
a scilllighter vehicle is caUed very low clensit)' lipoprotein (VLOL).
Today we are able ro llse rhese cholesterol fracrions as bener indicarors of hcart
disease risk rhan [Oeat cholesterol levels
alone. For example, HOL acrually proeeces
liS [rom heart disease. The reason for chis is
rhat HOL accually removes cholesecrol from
the areeries. 31 The HDL vehide then carries that choleste.rol ro rhe livcr, whcre ehe
bod)' disposes of the fauy material ehrough
the bile. The benefirs of a high HOL cholesterol levei in both men and women are
illustrared in Figure 10,31 .
The upper part of ehe figllre shows male
heare auack vicrims, anei ehe lower part
shows female hean aerac1<s. Noeice duc in
chis scudy there was nor a single hearr <1[eack among men with H D Ls greater than
75 mg/dl, but when ehe HDL was less than
25 mg/dI, the risk ofa hearc attack was ve!"y
high. Women wirh an HDL cholesrerol
greaeer [han 75 mg/dl ..1lso had low risk of
hean dise.ase. Those wieh HOLs less ehan
35 mg/dl bad a dramatic rise in theiJ coJ'onary hearc disease risk.
LOL (Iow densiry lipopcotcin), an ehe
orher hand, is the so-called ('bad choleseerol"
ehat is linked ro an incretJJed risk of hearc
disease. f[ is probably a cercain rype ofcholesterol wiehin LDL ehae is rhe bad acror,
n..1me1y, ox.idized choJesterol. brer in ehe
chapter we will explore this tox.ic compound
in detail. For now, lce me affirrn che wellknown face ehae ehe level of LDL in ilie
blood s an imporcam determinant of rhe
rate at which cholesterol is dtjJOfited in the
arter)' waLIs.
Now tlue we sec ehe effeces of che cholesterol subrypes HDL and LOL, let llS review

leEP initially recommended that for individuals wjth a

total cholesterol of 200 or less, there is no oeed to test
for the Icvel of choJesterol subtypes HDL aod LDL.

A person with 160 LDL Of 35 HDL would be in the bigh risk

category for a heart attack, but could bave a false seose of
security if he knew onJy his total cholesterollevel.
Amoog individuals with total cholesterol
below 200, 21 % have high LDLs aod
66% have low HDLs.

Figure 11
the practice of using the coral choleseerolleveJ
as an indicator of risk of heart disease. The

problem with simply focusingon the National

CholesteroJ Eeluc;lrion Panel's (NCEP'S) initial 200 mg/dl gllideline for roral cholesterol
is explained in Figure 11.33
Individuals wieh high risk HOL and
LDL levels but with a eoeallevelunder 200
would be misseel if they imply haei a roral
cholesterol reading; iliey woulel receive a par
an rhe back beclUse rhey were below (he
200 cucoff poinr.

Mean Ratio
... - ~--

Total Vegetarians


Boston marathon
runners (pbysicians)


Average risk (women)


A verage risk (men)


Average CHn victim (male)

5.5 - 6.1


cun victim (female)

4.6 - 6.4
Figure 12


In shon, ifwe merei)' followeel rhe Educarion Program's original recommene!atiOlls,
we would only pick lip 59 percenr of rhe
. people who are ar high risk of a heart art:1ck. YOIJ can beuer une!ersrand )lOW why
ir is importanr ro look ar rhe total blood far
picrurc with HDL aneI LDL as well as tot:11
cholesrerol. Unfortunarely, ll1:1ny lay people
aneI healrh professionals still seem ro holel
the concept rhar if total cholesterol is under

Cholesterol is found

Fruits, vegetables,

only in animal foods.

grains, and nuts con 'ain



Figure 13

Items (3 Oz.)
MiiI<. nOD-fat, 1 t
MiiI<. 2% JOW-fllt, It
MiII<. wbole, le

Egg while
Ite cream, 1/2 C
Buttcr, 1 Tbs
Egg, (Iargc

DrumSlick & skin

Drumslicl<. DO skin

Figure 14


Cltol. (mg) 1tems (3 Oz.)

_CJw/. (mg)



Cbieken b,-cast, DO skin
Beer, sirloin
Chicken breast & skin
Beef kidncy
Beef liver









200 rhere is no neeel for concern.

One \Vay oflooking ar borh HDL and
(Oral cholesreral \Vid1 a ing1e value s ro look
ar the rario of rhe rwo. This provides a betrer indicarion of hean disease rsk rhan by
looking ar eirher value alane. You cao appreciare the valuc of rhi rario b)' looking ar
some example.s listeel in Figure 12.
Nore dur vcgerarians have an average
toral cholesrerol to HDL rario rhar is 10\V,
ar 2.8. 34 Veg rarians generali)' have a very
low rsk of hean di case, a f.1C( we will furrher explore Jater in rhis chaprer. Boston
Mararhon runners are aiso ar low risk for
hearr disease; d1eir ratia is 3.4. These desirable low levels can be compared wirh (he
average AmeriGU1 woman who has a rario
of 4.4, or rhe average mall who come in ar
5.0. Although many peaple would feel secure ro be 'average," average is nor reali)'
desirable in a counrry whcrc more peop1c
clie from heart disea e (han any other c~use.
Thi, is emphasized b)' rhe t:1Cr rhar rJ1e average hearr auack vicrim has a total cholesrerol ro HDL ratio rllar is very dose ro average for d1e whole popuJarion. The r)'pical l11an wllo has a hearc anack has a rato
grearer (han 5.5. 3nd rhe average female
coronary hean disease vicrim has a ratio
grearer rhan 4.6. In orher words, if you arc
a woman and your roral cholesterol ro HDL
rario is greater rhan 4.6, or ifyau axe a man
wirh a ratio above 5.5, you are right where
rhe avcrage hearr arrack vicrim is. The mcssagc is thar before a hearc arrack srrike
adapr a bettcr Ijfesryle program. Tly ro ger
yOllr total cholesterollHDL raria inro d1e
ideal range-3.4 or Jess.





How to Achieve the Best

Cholesterol Levels
How can we improve aur cholesreral
levels? Specific:'llly, how can we decrease
toral cholesrerol and LDL and at rhe same
rime raisc HDL? The answcr ro rhis question i. exrreme!y important. To fully appreciarc rhe 3l1swers, however, we musr
rnake sure we undersrand where cholesrerol
comes ham.
Ir is of primary imporr:mce rhar we recognize rhat our livers manufacrure more

lhan cnough cholesterol for aII aur body
fllllclons. For Ihis (eason, we do nor need
ro ear an)' cholesterol wharsoever. In orher
words cholesterol is total61 unnecessa'y in the
JJUmllJ1 diel. However, many of us get signiflcanr amOllnl of cholesterol from our
foods. rn faer, rhe average American ears
about 300rng of cholesterol every da)'.35
\'<fhere does alI this chole 'terol come from?
Figure 13 gives us rhe answer in simple
Nor.e that aII lhe cholesterol we eat comes
rrom animaJ producrs. It is critica1 d1ar we
ullderstand rhat frujcs, vegerables, grains,
and even nuts comai n no cholcsrcrol. Tf
[he food COll1,es exclusively from planr products, rhen it has no cholescerol in it. On
lhe ocher hand, if the food producr cornes
[rom an animal, ir almost always has cholesrcrol in it. (A few exceprions exisr where
the cholesrerol-coruaining porrion of me
animal product has been removed. Egg
whires wOllld be rhe main example of rhis.)
Funher information regarding dielar)'
sources of cholesterol is rabuialed in Figure 14,36
AII would be wise ro pa)' eareful attenlion'ro tnese examples in the figllre. AJThough most people rnay be aware mat organ meats such as liver and kidney are
among rhe mosI' intense sources of cholesterol as rhe figure shows, many sTill do nor
undersTand the basic prevalence of cholesterol in an.imal foods. They rhink that if
rhey eat chicken, rurkey, OI' fish they are nor
getting cholesterol. On the contrar)', we see
(haT every animal produc( conrains cholesleroI. AJso, Take note rhar chicken cO\1rains
abOlit rlle same amount as pork and beer
This bad news abour "white mear" has nor
received much press. Funhermore. many
kinds of f1sh have a high cholesterol con-



(mg/day) 800






Change in serum cholcsterol (mgldl)

Figure 15

lf aur inrake is gre.1ter rhan 900 mg, nor

mueh funher increase in serum cholesterol
oecurs. Forrunarely, OUl' bodie have protecrive mechanisms ro keep blood cholesterol from going sky high a~ter consllJlljng
extremely large amounts of cholesterol.
The curve in (he figure also shows mar
we can dramarically drop aur cholesrerol
level by decreasing ehoIes(erol inlake subslanrially below dur 900 mg dail)' level. For
exarnple rhe f1gurc shows mar dropping tbe

Cooking fats 6.0%

Other 8.0%


To \Vhat extenr does our jmake of cholesterol affect our blood cholesrerol level?
The more cholesrerol we ear, me higher Dur
blood cholesrcrol lends ro bej as shown in
Figllre 15,37
Noticc rhat as our inrake of cholesrcrol
increases, it is reflecled as an increase in senun cholesterol. An in crease of 75 pointJ
can occur if we consume 900 mg per day.

Milk products


Egg yolk 35.:,0%

Figura 16



L1Blood cbolesterol, mg/dl

= 1.26 (2.L1S - L1P) + 1.5L1[4C]

S = Saturated Fat (% Calories)

P = Polyunsaturated Fat (% Calories)
C = mg Cholesterol (Per 1000 Calories),

= change in intake

Figure 17
cholesrerol in your diet from 900 mg ro 200
mg daily may lower l'oul" cholesrerol 50 or
60 poinrs. Norice (har you get even more
benefit when you elrop )'our cholesterol below 200. GOillg from an inrake of200 mg
per dal' dOV.rtl ro no cbolesterol in your dier
ma)' drop your blood levels anorher 20
poims. The imporr.an[ message is rhat l'ou
can dramarica1ll' lower your cholesterol by
removing aII cholesrerol (ali animal preduers) from l'our dier.

TypicalSources ofDietary Cholesterol


Ame6cans get mOSt of their cholesterol from meat and eggs, as shown in
Figure ] 6. 8
Note rJ\ar 35 percenr of the cholesrerol
conSllmed in Anlerica each da)' comes from
meat, fowl, and fish, and anather 35 percenr comes from eggs. The cooking [1.rs and
oils rhar contain cholesterol are ani_mal in
origin, sllch as buneI', lard, anei orher fat.
Conunercial baked goods rend ro use lard,
which accounrs for eight percenr of the cholesterol consumed per day.
This figure show that we can lower our
cholesterol inrake by 70 percenr just by
e1iminating eggs, red mcar, pou1rry, and 6sh.
Of course we can lower it even funher JUSt
by e1iminaring more of ilie an.imal producrs.
lfwe realll' want ro eliminate ali the cholesrerol in ou r d ier, essen [ia L1y ali animalproducts must go.

Animal Fats Contribution to

Cholesterol Levels
50 hlr we have seen rhar e!ev:ued blood
cholesrerollevels are closely associated wirh
faral hean disease. We have also nored thar
cholesrerol in rbe diet wiU rase blood cholesrerollevels. There are a number of orher
facrors, however, rhar contribure ro elevarcd
cholesrerollevcls. Some ofthese facrors were
c1arified by one of the grear cholesrerol pioncers, Dr. Ancel Keys. In the 1960s, Dr.
Keys demollstl'ared hs abilir}' ro predcr
with asrounding acclIracy rhe average blood
cholesterollevels of population groups. AlJ
he lIsed was il knowledge of rheir habitual
diers in order tO make lus srartling preclicrjons. Unforcunare!y, rhere was tOo much
genetic variabiliry from person ro person ro
do rhis on an individual basis. However.
when looking ar large groups of people, rhe
ave rage generic rendencies rended ro be
similar from one popularion ro rhe neXL
Thus, Kel's could make his cholesrcrol predictions baseel on habirual food choices
alone-withollt deaJing with genetics. He
devised il marhematical formula rhar fir rhe
dara. This equacion is ofren referred to as
the "Keys Equarion" and is illusrrated in
Figu re 17. 39 Those with a marh backgrolmd
will find the equarion illuminacing. Wirh.
out goi ng [h rough rhe ca1cu1arions, OI'. Keys
preves with rhis eqllation thar, apan from
geneucs, aur blood cholesrerol level is derermined by our dier, and essen.[ially only
duee val'iables in the diet: saturated fat (5),
polyunsarumed fat (P), and cholesrerol (C).
Many people do nor lInderstand the difference berween rhe rwo [1.rs. Imagine thar
you are sitting in from of two 1O-galion glass
f1sh ranks. Each rank is filled with fat. One
is filled emirell' wir11 saturareel far, and the
orher wirh polyunsatllrated. Ir would be
easy ro rell rhe difference ben....een the rwo.
The satllrated f.1.t would be solid at room
temperatllre and the polyunsaturated far
woulcl be liquid. Generally, rhe more solid
tJle fat, the more saturated it is. Mosr fars
from animal products are predominately
sarurared, while most planr prodllets are
high in po!yunsaruratcd fats. We willlook
ar specific examples sbortly.

With a basic undersranding of rhe three
rerms uscd in the Keys eqllarion, ler me now
explain whar the equarion rdls LIS. Firsr, it
asserrs thar borh satllrated fat and cholesrerol in rhe dier rend ro raise blood cholesrerollevels. Second, it rnakes rhe poinr (har
sarurared far is mllch more porent ar raising your blood cholesrerol rhan even dierary
d1olesrcrol irself. Third, polyunsatllrared fat
rends ro Jower cholesterol in rhe blood.
However, sarurated far has rwice rhe power
ro raise your eholesrerol as polyunsarurated
far has ro lower it. Expressed anorher way,
ro caneel out rhe eholesrerol-raising effeets
of a given amoulH of saturared fat, yOll
would have ro ear lWiee as much polyunsalUl"ared far. This faer can be u cd tO judge
whether rhe far contenr of a given food will
raise or lawer your blood cholesrerollevel.
Since alI naturally oceurring foods have a
combination of fars in them (both polyunsatufared and satll'dred), you ean divide rhe
3mounr of pol)'llnsalurared fat in the faod
by the arnounr of saturared fat in ir, and
cnd lip wirh whar is called a "{l ro S rario"
(abbreviared "P/S ratia"). rf rhis P/S rario
is greater rhan 2.0, the fat in the food \ViII
rend ta lawer one's blood eholesrerol leve!.
Be aware rhat th is ratio rdls us nothing
about mher factors in rhe foad (Iike cholesterol irself, for cxample) rhar ma)' affect a
person's cholesrerollevel.
Since a high P/S ratia in aur diet will
tend ro lower rhe blood cholesterol. we need
ro be awal"e of the ris ratia of eommon
foocis. This raria is [isred in Fgure 18 for a
variet)' of foods. 40
Nore thar many of rhe animal producrs
such as beef. venison (deer), Iamb, and bacon have extremely low rIs rarios. These
foods, based on rheir far courenc, will rend
ro dramatically raise an individuaJ's serum
dlOlesrero!. Thus, red meats are undesirable nor anly because [hey conrain cholesterol, bur rheir harmfulness is compounded
because rhey conrain 50 much S<1rurated fat,
and so !.irue polyunsaturated far. The same is
rruc ofmilk, burter, and cheese. Chicken aod
rurke)' have lcss sarurarcd fat
red meats,
but their P/S rarios are stilllower rhan rwa
ro one, so rhey, roo. will r;lise eholesrerol
levels. One of rhe greare t mYlhs is rhar


chicken, {Urkey, and fish lower a pcrson's

cholesrerolleveL These foods actuali}' raise
a person's cholesterol, but rhey raise it less
than red meac does. As a resulr, a person's
cholesterol may go down when leaving off
red meat and subsrituring fish and faw!. But
ule drop in cholesterol level occurs because
chicken, rurkey, and fish raise one's cholesrerolleve11ess than red mear, nor because rhey
have a cholesterol-Iowering effecr.
1 have had people came inco m)' office
and tell me, "1 JUSt can'{ understand what is
happening. r have been eating mostly
chicken and rurkey but my cholesterol stiU
has nor carne down that much!" When you
understand the rIs ratio, it tdls where parc
of the problem lies. Furrhermore, as 1 menrioned earlier, chicken and mrkey have as
much cholesterol in r11em as do the red
mears. We will sec /ater thar some of rhe
cholesterol in fowl is undoubtedly oxidized.
Switehing from one kind of meat ro another
is simply not the uleimate solucion for cholesterol COntrol.

Ave. selected fish
Beef, lunch mcats
Bacon, decr, Iamb

PIS rlltio

0.17 - 0.50

Walnut, black
Walnut, English
Rickory nut
Brazii Nut
Palm oii

PIS ratio



Figure 18
The Story is simjlar wirh fish. Some fish
have favorable {lIS ratios (grearer than 2.0),
bur many orhel"s do nor. Furchcl"more, ali
fish eomain cholesrerol. In shon, flsh, like
fowl, if sllbsriwred for red me;:lt, will tend
ro lower eholesterol levels, possibly even
more rhan fowl. However, yOUl' eholesterol





Nonfatal MI




Risk of 06
Heart .


Frcquency of Eating Nuts
Figure 19

levels would be Iowa yet ifl'O\! lefr chicken,

rurkey, and fish completc/y out ofyour diet.

Vegetable Fats Effeet on Cholesterol

In conrrasr ro animal faes, vegerable fars
have no cholesrerol ar aiI. There are differeor kinds of vegetable f.us, and aiI bur a few
are highJy polyunsaturared. In figure J 8,
notce that coconut has a P/S ratio of 0.01.
This s a highly saturated far and will tend
ro raise cholesrerol levcls. Although coconur has no cholcsrcro\' irs s;lrurared fat coo-

"With nuts may be combined grains, fruits, and some

roots, to make foods that are healthful and
nourishing. Care should be taken, bowever, not to
use too large a proportion of nuts.
...some nuts are not so wbolesome as otbers.
Almonds are preferable to peanuts, but peanuts in
limitcd quantities, used in connection with grains, are
nourishing and digestible."

Figure 20


eent dramarically inerC<lses blood chole terol. On rhe orher end of the specrrum,
walnurs can have a rarher dramaric effen in
lowering an individual's choleseeroL
Mosr nuts, in view of eheir fat conrenr,
are "hean healthy" foods, as shown in rhe
figure. Nurs in general have been stlldied
extensively and have been found nor only
ro lower blood cholesterol levels, bur also
ro proviele a corresponding decrease in rhe
risk of hearr disease, as shown n Figure
19.11. 42
This stllcly on Ilm consumprion was
conducted at Loma Linda Universiry and
has received nrernationaJ arteruioll. The
inirial srudy focused on rhe ;Jmount of nuts
eaten by rhe panicipams in rhe Adveruisr
Health Study. They found rhar {hose con
suming nllts less mall once per week hael
the highesr risk of hearr arrack. 1 hose who
consumed nllts one tO four rimes per week
lowered their risk abollt 25 percent as ShOWI1
in rhe figure. Those who consumed nurs
more rhan five rmes a week Cllt their risk
in haH: The s[lJdy was cOJ1rwlled for other
lifestyle variables so rhar the researchers
could be more certain rhar che nuts were
che onl}' t:lCror involved. Many health professionals were surprised by the findngs of
chis srudy. Previously, healrh professionals
eommonll' t:l1couraged pacients ta avoid
nurs because of rheir high far Gomene. Now
we know that nuts in small ta moderare
amOllntS are parc of a healrhfl.ll elier because
dley supply some fac nurriems mac are beneficial for preveming hearr disease.
Regarding peanurs, dle fae in peanurs has
a specific chemisrrl' and triglyceride srructure (apan from rhe sarurared anel polyunsaturared comem) thar makes rhem surpl'isingly harder an your arrcl'ies rhan ocheI' vegerable fars. 43 Thus, a person who wanrs !O
proteet his arteries would be wise ro choose
ocher nurs such as almonds walnurs, or
pecans in place of peanurs. AJmonds have
another advamage. They are unique among
rhe fim food group in thar rhey conrain far
moreviramio E rhan orher oucs; in t3.ct, they
exceed just abolit aiI omer foods n rhis regard. We will sec larcr rhar vitamin E redllces the risk of hean discase. The realization ofsome of peanur fat's negarive aspects

leaves me impressed widl a sraremenr 1 read
about I1lItS thar was wrinen nearly 100 years
ago in rJle c1assic book on rhe principles of
healrh, 77u Ministry ofHi?t1/ing, wrineo by
Ellen W11re and quored in Figure 20. 44
Why did she wam against excmive nut
consumption? One likely reason is thar a
high fat dier (even jffrom ugood fats") rends
to promore weighr gain. For manl' people.
a Iarge a proporrion of nuLS in their dier may
contribure (Q obesiry. The overweighr conditon iLSeif can raise cholesterol levds and
increase rhe risk of hean disease and orher
healrh problems.

The \!ery Low Fat Theory

The research on nurs has helped tO lal'
to resr a popuJar bur ficririolls approach ro
hean disease prevenrion somerimes called
"(he verl' low fat r11eory." For years, many
have advocared that ro ma.ximalll' reduce rhe
heart aHack rare we musr cur rhe far in large
amouncs, (O abour 10 percenr of caIorie.).
Some people have become f,UllOUS by advocating such a verl' low fat diec. Unfortunarell', very low far diers are oh:en not palatable and are nor necessariJy the arlswer to
reducing heaf( disease risk. lfthe far is coming from monouJlsarurated and polyunsarurarcd sourees, a higher far dier ean aCluaJly
be as good for rhe heart as rhe vcrl' low far
fare. The Commirree an Diet and Healrh
of me National Research Council said this
in so m:tny words when rhel' posed ule gllestion, "Is d1e very low far rheory correcr?"
From a review of ilie currenr [jrerarure, rhey
concluded, "No." Thel' went an ro state,
"L1rake of (Otal fat per se, independenr of
the relarive comem of rlle djfferenr types of
f.my acids, is nor associated wirh high blood
cholesterol and coronarl' hearc disease. "45
We now know rhat we can have a healthful
dier thar incIudes moderare levels of fat if
we are using (he besr types of fat.
After (he 1992 srudl' of nurs and cholesterol, Dr. Sabare rook (he nur research a
srep funher. Insread of using Sevcnrh-day
Advenrists again, who are already an a berter overall dier than mosr Americans, he now
studied inruviduals an an average American dieL One haJf of rhe rora.! group was
placed on an average diee The o(her half

were feel an identical-looking diet W1(h one

major difference. WaJnurs were blended lip
and added to various food tems. Orher
sourees of fat were decreased ro keep rhe
calorie and roral far levels the same in the
rwo groups. The effects an cholesrerolleve1s are shown in Figure 21. 46
Earing walnurs daily hac! some amazing
results. LDL cholesterol, the "bad cholesrerol " dropped by 18 point". This represel1ts a remarkable lowering oChean attack
risk. For each percenrage poinr drop in rhe
bad cholesterol, (here is a rwo ro duee pereenr clrop in rhe hearr arracl< rareY An 18
poinr drop in LDL translate~ inro a 36 ro
54 percenr elrop in hearr eli ease risk. The
benetts of walnurs ma)' nor simply be due
ro rheir excellenr P/S rario. These nurs are
also high in so-caIled omega-3 fatty acids,
which have some special benefirs. Chaprer
5, "Tile 1rurh About Fish," has more informarion on rhis subject.

Other Fat Factors

Although P/S ratios offoods are importanr, rhey do nor necessaril)' provide the final word an wherher a fat is good ar bad.
They do give liS an excellenr idea of where a
food srands in relation ro its fat content.
However, rhings are JHOre complex rhan

The study group ,ale 1% cup (84

grams) of walnuts daily for
4 weeks.
A verage LDL (bad chol.esterol),
was reduced by 18 (mg/dl).

Figura 21


Keys originaUy elwisioned. Some satLIrated
fats are extremely bad while orhers are not
very difficllir for rhe body to dcal wirh.
Si~ilarly, not al! foods thar ;re high in polyllnsarurarcd fars provide equaJ heart benefic. Margarine is an example ofsuch a food.

Margarines were fim thought tO be beneficia] because they had a higher polyunsarurated far con tem than buner. Some tub
margarines hoast a P/S rario grearcr rhan
4.0. Most margarines, however, are !lOt
narural products. Thesc POPUlal' sprcads are
rypicaJly nude rTom vegeeahle oiI, such as
corn oii, which is heated under pressllre ro
paniaIly hydrogenare (saturate) il sa rhar ie
becomes a spreadable, soljd (lt ac room remperature.
The hydrogenation process alrers some
of the fat in rhe vegetable oii by changing
rhe microscopic shape of rhe fat molecules.
Normali)' fatry acids (the building blocks
offar) are found in nature in what is called
rhe cis form, which refers ro rhe molccnles'
rhree dimensional appearancc. The hydrogenarjon process changes somc of rhese
molecules inro the tram form. Ti-arts fany
acids, unlike cheiI' cis counr.erpans, significandy raise rheserum cholesterol and LDL,
even thollgh rhey are poJyullsaturaeed. 48

Womc.n who eat 4 or more teaspoonfuls of margarine a

day have a 66 per."centgreater risk of hear,t disease than
women ",ho have margarine less than once a month.
The trans~fatty ada J.ev,els in margarine s,eem to be the
"Vege,table oils should be used in their natural state,"
said the lead researcher.

Figure 22


This risc in choJcsrcrol corre1arcs with rhe

cffen of margarine an heart disease risk
measured in an eiglu year Harvard University study. The findings are summarized in
Figure 22.,19
Trans fatiy acids have also been implicated in callsi ng cancer. 50
AJI of ehese facrs suggesr that i( wOllld
be bener ro sprcael a little nut burrer, llcb
as alrnond burrcr (a favorite of mine) an om
breacl (han margarine ar buner. Anothcr
op(ion would be (O I'eplace margarne ou
aur breael with canola (rapeseeel) oii ar 01ive oiI. Ei(her ofIhcse oils could he brushed
on (he breael. In a srudy of margarine llsers
who consen(ec! ro re place margarine an ilicir
bread by rape-secel ar oJive oiI, (here was a
distinct rise in HDL levels anei also a favorable slight decrease in LDL,5I

Fat Substitutes
People are always rrying ro finei ways to
avoid changing (heir eating habirs. Foad
manutlCHlrers are well aware of this element
of human Ila(ure and are reaei)' ro profit
from it. Currendy; food companies are testillg various far subsriwtes. Some have slIggested that rhe Food and Drug Adminisaation (FDA) seems verywUing ro approve
fat substitutes rhat may 1Iitimately provc
harmful. A case in poille is (he FDA-approved fat subs(jrllte called Olesrra. Not
ani)' can Olesua cause diarrhea anei soileel
unelerwear, but evcn more cOncern ing are
studies demons(ra(ing [hac earing Olesera
decreases one's absorption of fat-solllbie vitamins. Thm, less vitamin A, D, E anei K
will be absorbed. Furrhermore, prolonged
use of O[estra appears able ro deplcee the
body's stores of vitamin E. It can also disasrrollsly inreract wiili medjcations such as
COllrnaelin. Other far subsritlltcs are being
stlldied. Nor ooe dtar I am aware of has a
completely safe ([ack record. Fat-fl-ee subsrl(U[.es are not the arlswer for a nul} healthconsciOliS individual who does not wam ro
(rade the rsk of one bealdl pl'Oblem for
a.nother. 52


Beyond Ancel Keys and His Equation

for Blood Cholesterol Levels
For nearly 20 years, convenrional health
educat ion in America clici nor go beyond
Dr. Keys' amazing insights inro the effect
of diet:.1ry cholesterol ancl f.,tS on blood eholesrerollevels. Dietit ans would rightly tall<
about cholesteroJ and saturared filt in the
dier \.vhile negJecting a number of orher
importanr dietary f.,crors. Forrunarely, however, we are now seeing a growing appreeiatiou among healm professionals for orher
dietary facror that can inf1uence beaI( disease risk. Some of the horrcst areas are fiber, oxidized eholesterol, and anrioxidanr
viramins. We will look ;tt each of mese areas in dc(ail.

Fiber's Cholesterol-Lowering Abilities

Fiber in aur food will help lowcr cholesterol. Mosr Americans eat far less rhan the
recommended 25 ro 30 grams per day. Evidence now sugges( tllat a low fat, high fiber, high earbohydrate dicr offcrs a number
ofadV:lntages. Eating at least 30 ta 40 grams
offiber eer day from a \Iariery of planr food,~
ean'low;r your risk of heart disease, cancer,
intestinal disordcrs, and other diseases. 5.3 A
!is( ofdiseases associated with a t)'pica! American low-fiber diet appe:lIs in Figllre 23. 54
Many are sllrprised ro Jeam thar [here
are different rypes of fiber. Yer .111 fibers have
one rhing in com(l)on-r.he)' cannor be digested by d1e normal human inrcsrinaJ s)'stem. One definition for fiber is "jndigesrible carbohyd.rate," ll1eaning thar fiber is nor
absorbed but is rather excrered. Differem
caregories offib rs include celluloses, hell1icelluloses, lignin, pecrins, gUll1S, ll1ucilages,
and algaJ polysaecharides.
A si I11pler c1assificarion of fiber divides
flber types simply inro water solubJe and
insoluble flbers. It is rhe warer-soluble 6bers that are particularly valuabJe for lowering cholestcrol. Fruits, vegetables, nuts,
grains, and legumes, all in (heir natural,
unrefincd stare, are rhe five main food
[hat CQmain rhis cholesrerol-Iower~
ing liber. Examples of such warer-soJuble
liber. are oar bnu1 aJ1d frui( pec(in. These

compounds work by bind.ing ro cholesrerol

and biJe aciels (exereted by t!le liver) in the
small intestine, mus preveming their absorption. Fortunarely, neirher bile nor choles(eroi is absorbeel high in (he intestinal tracr,
bur rather in rJ1e distal ileum (rhe last pan
of the small bowel). This a!lows rhe fiber
plenry of rime ro bind up mese compounds.
lf, however, adequate fiber is lacking, bath
bile and cholesteraJ are reabsorbed imo the
blood stream, raising blood cholesrcrol

. Diverticular disease

Colon polyps

Hiatus heroia

Heart disease

Varicose veins


. Hemorrhoids

Diabetes mellitus

Bowel cancer

Gallbladder disease
Figure 23





Figure 24



A high fiber diet CdlI

lower serum chokterol ,by
J5 pereent

levels. Bile acids are actually made from

cholesterol by the liver. As a reslllt, dle more
bile yOll Iose in (he stool, the more cholesterol the body must urilize ro make new bile
acids thar arc necessary for fat digestiol1.
The medical lireratllrc is replete wirh
examples of fiber's health-giving benefirs.
One stlldy, published in 1992, found rhar
adding 15 grams of fiber per day ro r!le djer
lowered serum cholesterol by 15 percenr. 55
The effec( of fiber in lowering cholesrerol correlates wirh rhe decrease in heaT[
disease risk in people \vho consume high
amounrs of it. Those [hat consume a high
fiber diet have a 65 percem less risk ofhean
disease, as shown in Figurc 24. 56 In another
srudy, seven groups were fed differing

Serl'ing is l Clip or l piece IIl1less intiiul/eri olherwise



Wbole wbeal bread

Bagel, wbole whe.at
Pita bread, wbole wheat


Popcoro (4 c)r->~.JN'f'"il

Fiber (g)


,. ~
Spaghetti, wbole wbeat


Shrcdded wheat, biscuits



Apple" with skin

Orangc, fresh
Blackberries, raw
Pears, canned



Brussels sprouts
Swcet potato, without skin
Pinto beans
Navy beans


Fiber (,g)



Figure 25


amounts of either oatmeal, oar bran, or farina. At (he end of six weeks there were
significam improvemellts in rotal and LOL
cholesterol for rhose daily consllming either
oile ounee offarina, (WO ounces of oar bran,
(2/3 of a CUI' dry), or three Ollnces of
oatmeal (one Clip of dry rolled oats).57 Beeallse some skeprics were stiH nor willing ro
believe that oars can lower cholesterol, a
computer assessmcnr (mera-analysis) of 20
carefully performed oat srudies was comp!ered in 1992. The resulrs demonsrrared
rhar oar prodllcrs in rhe diet signitlcanrly

reduce eholesterol levels. S8 Anorher grain

rhar has been found ro have beneficial effeets on blood cholesrerol levels is buckwheat. 59 A study from mainland China
founel buck:wheat [O lower borh ro rai cholesterol and LOL cholesterol; at t!le salIle
rime it lowered rhe ratio of roral cholesterol
ro HOL.
Animal producrs (meat, milk, eggs, and
cheese) have absolmely no fiber. Many
wonder why, sinee animals often consume
large quancires of fiber. For exarnple, t.!le
cow, a total vegerarian, ears fiber ali da)' long.
You would think that eating [he cow would
furnish plenry of fiber, bur ir does nor. The
reason is thar when a cow ears, it extracrs
anei absorbs many nurrienrs, but the fiber
in its foocl has a differenr fate. Some of this
fiber can acruaHy be digested by the cow
(even though it is indigesrible by humans).
The re.st of rhe fiber passes rhrough c.!le cow's
intestina! traer anei is excretecl onco the pasrure. In eicher case, che cow's meat OI' milk
ineorporates none of the beneficial fiber. ln
effect, when people eat eows or ocher animals, rhey are eatillg llutrienrs second hand.
Unfornmarely, they get no fiber, since the
animal has "refined" rhe food through its
process of digestion. If we wam an abundant supply of 6ber, we will choose to eat
grains, fruirs, vegerables, or nuts dircctly.
Foods that al'e gooel sourccs offiber are lisred
n Figure 25. 60
As we observed earlier, umil very recenrly, mosr cholestcrol education programs
never wenr beyond t!le Keys equarion. They
rold panicipams abolit the imporcance of
cholesterol in rhe dier as well as the dangers
of satllrared fat wim mosr of tne emphasis
being on saturated fat, bur this is where disclIssions endeel. More recently, dle copic of
fiber has found irs way inro lay eelueational
effofts, bur ir ofren cloes nOt ger the full attemion rhat it deserves. Other information
rhar is sadly lacki.ng in mOSI educational efforrs is the topie of protein anei oxidized

Animal Protein Raises Cholesterol

The relatonships benveen cholesrerol
and protein have been published in the
medicallirerature for some 20 years, but for

rhe mosr parr have been sadJy ncglectcd. An
exrensive bod)' of research now has est~b
lished rhat serllm cholesterol is extremely
dependelH on ehe eype of prorein conSlill1ed. 6 1. 62. 63 Animal protein alone (even
skim miJk protcin) will increase blood cholesterol levels wh iJc pLant proteins will decrease cholese.eroJ. [n face) man}' peoplc who
are an orherwise hean-healthy diets will be
uuable ro lower cheir choleseerol sufficiently
uJlless rhey cornpleteo' eliminate animalproleln rrom cheir diers. Research has shown
rhar swirching from a 10w sarurated fat, low
cholesterol dict using skim milk prorein ro
a 10w sarurared fat, Iow choJesrerol diet using soy procein as a milk substirute Can drop
cholesrerollevels by as much as 60 ro 80mg/
dt in as linie as three weeks. 1 have seen this
happen in many of my patienrs who have
nied a roral vegerari:m dier (no animal protein). lf a dramatic reducrion does nor occur in such a diee., 1 ehoroughly review what
rhe patiem is actually eating, and often find
thae animal protein has b en unwi((ingly
consumed in rhe form of casein in a milk
subsrirme or a choles[erol-free cgg product
such as Egg Bearers. Once the animal protcin
is completely excluded, rhe expecred dramatic
result usually occurs. More complere informarion on rhe subjecr of prorein sources and
serum cholesrerol is found in Chaprer 7,
"The Gtear Mear :lIld Proeein Myrll."

Stored foods that cootain chol1esterol can
combine with oxygeo in the air.
An cstimated 32 oxidation products have been
found in such foods.
Some of these products, even in small amounts,
have a lethal damaging effect on arterial walls.

sclerosis. On rhe orher hand, chickens [har

were given hormones ro raise rheir choleseerol ro similar levels haei virtuali)' no fate)'
bllildllp in [heir arreries. 64 Des. Peng anei
Taylor in Albany, New York carried an fureher experimenrs looking for something in
dierary cholesrerol thar was panicularly
damaging ro blood vessels. Their discovcries are stared in Figure 26. 65 . 66
Some of rhe chemiClls, called 'oxidation
products," were sa toxic rhae dley desrro)'ecl
cells ehar line ehe arreries in less rhan 24

The Problem with Oxidized

Cholesrcrol exposed ro the atmosphere
for a period of rime rends ro combine wirh
oxygen in rhe air, producing whac is called
"oxidized cholesterol." Oxidizeel cholesrerol
is anorher importanr dieeary factor rhar the
Keys equarion did nor address. In facr, chis
compound may turn out ro be ehe mosr
imporc<lnr dieeary factor dur influences
heart disease risk.
As early as ehe 19405 ir was discovered
rhar nor aII cholesrerol was the same in irs
Iikelihood of C1using arherosclel'Osis. Dr.
Chaikoff :md associares found that chickens rhat were fed large amoull(s of cholesterol developed high blood cholesrerolleve1s and a considerable amounr of athero-

Sources oftlle most IwrmfuJ c1IOJestero/ to mOJlkey lIortlls "re:


,0::-. :.,~ ..

1. Custard mixes
2. Pancakes mixes
3. Parmesan Cbeese
4. Lard
Figure 27


hours. Furthermore, it took on.!)' a smalL
amollnt of these toxic chemicals ro cause
irrel)crsible damage. In Peng and Taylor's
work rhe deadl)' efTeces an blood vessels
oecurred when as linJe as one half of one
pereene of rhe blood cholesterol was oKidiud. 6i Their researeh is panicularly imporranr because deseruerion ofareery-lining
ceUs is oue of d1e main factors rhar begins
or acceJerates rhe buildup of choleseerol .in

Especially harmful are the custards

and puddings in which millk, eggs,
and sugar are the chief
ingredients. The free use of
mUk and sugar taken
together sbould
be avoided.
Figure 28

Oxidized cholesterol fed to rabbits and

mODkeys produced dramatic vascular
damag,e within 24 hours.
Pure, non-oxidized cholesterol
produced DO vascular
Figure 29


Peng and Taylor al50 made ehemiGll

measuremems of specific fooels ro see how
much oxidized dlOlesterol ehey conrained.
The researchers ehen tested the harmful
cornpounds on blood vessel cdls of monkeys to determine how dangerous d1ey were.
Foods that conrained oxidized cholesterol
products and produced damage ro blood
vessel ceUs are listed in Figure 27. 68
The mose harmful combinacion of cholesterol oxidat.ion products \Vas found in
custare! mi>:. where sugar, milk, and eggs were
combined. The dried mix was apparenrly
exposed to air for a considerable period of
rime due ro irs long shelf life.
Over 100 years ago che dangers of custards and puddings was recognized by
Ellen White. Her warning is quoted in Figure 28. 69
Some have obselved that ce cream is the
most common form of custard in America
roday. Pancake mixes conraining eggs and
dried powdered milk were equally as hannfui as cusrard. The chird mase hannful item
was Parmesan cheese; it tumed out ro be as
damaging as lard.
Funhennore, earing oxidized cholesterol
may raise blood cholesrcrollevels more dUJl
pure eholesterol alone. 70 However, even if
your blood cholesterol level remains normal, animal research demonstrates thar cating oxidized cholesterol can have adverse
consequences, as summarized in Figure 29. 71
The rabbits were fed a moderate amOUlH
of pure, non-oxidized cholesteral for 45 days.
Their blood cholesrcrols stayed in rhe normal range and ehey suffered no damage ro
their blood vessels. Those rabbirs rhar were
given rhe same amount of oxidized cholesrerol also mainrained normal blood cholesrerol values. However, rhey susrained significaJ1t darnag" ro their blood vessels. Research on humans ..1lso supporcs the fact iliat
oxidized cholesrerol in rhe dier can increase
your risk ofheart disease even f your blood
cholesterollevd stay normal. For e:xarnple,
we have known for years that-regardless
of your blood cholesrerol level-rhe more
cholesterol you eat, the greater your risk of
hean disease. Cholestero! in the. diet is ""har
is called an "independent risk factor" for ilie
developmellt of hean disease.7 2

Let me try to make this c1earer Wdl an
example. Assume dur rwin sisrers are identical in every faccor that reiates ro hearr discase. They have identica! blood pressures,
they both have never smoked, they have
idencical genes, etc. Let us a!so assllme rhat
rhe)' have identical blood cholesterollevels.
Buc suppose there is one difference: one of
the sisters ears much more cholesrerol rhan
(he omer. What the research tdls us is thar
the liberal cholesterol eater is much more
likcly ro suffer a he-arc ateack. Simply put,
we know rhat cholesrerol in your diet is
harrnful for more reasons than its tendency
ro mise blood cholesrero!. I believe that a
large amount of this added danger is explajned by the presence of oxidjzed cholesterol. Even rllOugh as of chis dare, detailed
measuremencs of oxidized cholesrerol have
nor been made on every food, it is logical
to assume rl)ar every food that con tai ns cholesterol has some oxidation producrs in il.
The important message is rhar even individuals with normal blood eholesrerols
should be careful to limit cholesterol in their
diets. If )'ou are not an sueh a low chole 'teroJ dier,rhen you are Likely at increased
risk of h'earr altack ar stroke, regardless of
what your cholesterol numbers are.
Atherosclerosis often begins early in life.
The oxidized cholesrerol srudie.s may also
he1p ro explain why some individuals develop arherosclerosis earlier rhan orhers.
One importanr earl)' factor may be rhe rype
of milk mar infants drink. When a baby
cOllsumes hllman breast milk direcu)' [rom
the human nipple, ir does get cholesrerol in
that milk. However, me cholesrerol dur
comes from mom is pure, nor oxjdized like
that presenr in cow's milk-based formulas
dl,H have been extensively processed in the
presence of alr. Peng and Taylor idemifled
toxic oxidized eholesterol prodllcts in powdered infaJ\t milk formula.7 3 One theory is
[har babies that are fed on cow's milk formula are predisposed tO fatey srreaks early
in infancy. However, you should not conclude from this thar rlle best way for adults
ro ger their milk is ro go down ro the bam
and ger ir suaight from rhe eow ro mnmize exposure to aid Thar meehod might
decrease your cOfLSumption ofoxidized cho-

lesterol, but. it wOlJd a1so grearly inerease

your exposure ro a host of infectious disedSes as listeel in Chapter 11, "Milk-Friend
or Foe?"
Our growing understanding ofoxidized
cholesterol has Jead me ro conci ude mat any
program that does not address rhis subject
is neglecting one of (he mosr important f:1.CtOrs in decreasing hean disease risk. 1 tllink
rJlat t11e increased research anention 00 oxdation prodllcrs of cholesterol will illumioare some orher relatiollships. For instance,
ir is very possible that foods with high sugar
comem are more susceptible ro oxidarion. 74
This would help further explain r!le abundant oxidation producrs thar are found in
rhings like Cllsrard and pancakes-foods
wim a souree ofcholesrerol (milk and eggs)
and sugar. It would also explain why dierary sugar has repe~Hedly been linked ro

Probfems with lro12 and Oxidation

In 1992, Scandinavian researchers surprised many in rhe med.ical commuHiry wim
rhe discovery that higher amounts of iron
stored in the body increased a person's risk
of hean disease. These researchers highlighted al) important fact: in addition to
cholesrerol being oxidized in our food, it
may also become oxidized wichin our bodies. Higher blood icon levels (measured by
a blood compolJnd calJed "ferritin") may
increase the conversion of normal cholesrerol inco dle dangerous oxidized varierywithin our own bodies. In fact, iron is a
well-recognized stimulanr (eatalysr) of oxidarion. Oxidized compounds like oxidized
cholesrerol can then damage rhe lin ing of
blood vessels and prolnotc atlleroselerosis.
Iron a1so promotes higher hemoglobin
levels. Ahhough high hemoglobins were
once rhought to be desirable, roo high a
hemoglobin level can presenr problems.
More hemoglobin means more oxygen in
rhe blood. Oxygen-carrying hemoglobin
can, in rurn, provide fuel for rhe oxidation
thar iron stimulares. Thcrefore excessive
icon ma)' be adversely working in t\vo ways
in OUl' blood: fiJst, it means more oxygen is
presem, and second, ir srimulares rhe oxygen ro combine with cholesterol ro form


oxidized cholesrerol. A rhird adverse resulr
ofhigher hemoglobin levels is that it makes
rhe blood thicker and more likely ro c10r
and initiare a heart attack.7 5
It is imponallt to undersrand rhar we
do need iron, but excess iron appears ro be a
problem. Forrunarely, a person can maintain sufficiellt iron levels wicllollC having
excess iron by adopring a rotai vegerarian
diee. Research from Harvard Universiry
proves rhese relarionships.7 6 Harvard researchers analyzed rhe dierary habirs of
nearly 45,000 men and rhen kepr in rouch
wirh rhem for four years. They found rhar
rhe men who are rhe largesr amOlln[ of animal sources ofiron (caJled "heme' iron) had
higher rares ofhearc attacks. This relationship could nor be explained by differences
in rhe :unOlllH offar or cholesreroI rhey were
earing. Those same men wirh liberal inrakes of iron from animal sources aJso had
higher serum ferririn levels, meaning rhar
rhey had more iron srored in rheit bodies.

Vitamins Benefit Cho/estero! Levels

An increased
consumption offruits
and vegetabfes high
in Bela Carotene
decreases cardiovascuLar disease dealhs.


We have seen char iron appears ro increase rhe likelihood rhac normaJ cholesterol
wiU become oxidlzed in our bodies. However, rhere are a llumber of subsrances in
foods mar appear ro prevenr oxidarion from
raking place inside of u . These subsrances
are called anrioxidams. Three of rhe mose
well-researched compounds in this r gard
are the anrioxidanr viramins E, C, and beracarorene.
Vira-min E inrake has been found ro reduce one's risk of hearr disease. A total of
40,000 men were cacegorized as ro rhe
amounr of their daily vitamin E intake.
Those who consumed 60 IU per day decreased cheir risk of hearr disease by 34 ro
50 percenr, regardless of orher food chey
consumed. 77
How can we ger enollgh viramin E in
aur diee an a daily basis? Since animal producrs are.low in viramin E, rhis leaves us wirh
a choice of taking sllpplelllenrs or making
substanrially more vegerarian food choices.
AldlOugh rllere are no known roxic effecrs,
rhere is also no medical jllsriflcarion for rhe
use oflarge dose.~ ofviramin E supplemenrs
ca prevenr heare disease, panieularly since

ie is widely disrriburcd in common foocls.?

Good sources ofViramin E are whear germ
vegerable oils, legumes, l111rs (particularly
aJmonds), whole grains, and green, leafy
v gerables.i? As we have already nored, rlle
prorecrion againsr hean disease provided by
viramin E is rllOught ro be due ro rhe prevenrion of rhe oxidarion of cholesrerol
wirhin rhe bod)'.

Beta-carotene Foods Benefit

Cho!estero! Levels
A Harvard Universiry srudy found thar
rhe consllmption ofbera-carorene foods reduced card:iac dearhs. Over a period of
nearly f1ve years, some 1300 individllals
participared in chis research. The resulrs
showed dur an jncreased consumprion of
fruirs and vegerables high in bera-carorene
decreased subseqllenr ca rdiovascu.lar diseasc
dca[hs. 80 Inrerestingly, taking ~'upplements
of beta-carorene does noi lower [he ri 'k of
hearr disease. I Thus other anrioxidanr
llll[rienrs in rhe fruirs and vegerabies ma)'
be adding a prorecrive effecr ro the blood
Bera-carorene is plenriflll in ca.lTors, tOmaroes, broccoli, strawberries, and rhe leafy
green vegetables such as kaJe, collards, and
musrard greens. It is aJso found in warel'melan, pineapples. and the yeUow rypes of
squash. In the srudy, when rJlese faods were
consllmed, no mattcr whar rhe cholesrcrol
level was in (he pareicipams, rhere was an
independent rda[ion,ship in lowering rhe
hean arrack risk.

Other Dietary Factors Affecting Heart

Disease: Homocysteine
Homocysrcine is one of more rhan 20
different amino acids thar rhe body uses ro
cOllsrrucr proreins and carry Out chemical
processes in che cells. AJrhough genes play
a parc in e1evated levels of homocysreine,
djcr aJso has a signifiGlIlt mie. Researchers
have now found thar individuals wirh high
levels ofhomacysreine in [heir blood rream
are t:\vice as Iikely ca have c10gged arreries. 2.
83. 84 One researcher srared thar because
many Americans have devated homocys-

rcine levels, it "ma)' aCCOlint for a substanrial proportion of va cular disease in the
Unired Srates."8 For every 10 percenr rise
in blood homocysreine levels, hearr disease
risk goes lip roughly 10 percent as well. 86
Alrhough rhis is nor quire as significanr a
risk factor as serum cholesrerol (for every
10 percenr risk in dlOlesterol [here i a 20
ro 30 percelH rise in hean disease risk), homocysreine levels are anorher "independent
risk facror" for dle disease.87 The good
news, as li ual, is rhar a hea.lrhful lifesryle
can hclp salve rhe problem by beneficia II)'
decreasing blood homocysreinc Icvcls.
Coffee drinkers have high blood levels
of rhe subsrance. If rhey smoke it is higher,
:lceording ro a study of 16,000 aellllrs in
Norway.88 The srudy is slImmaJized in Figure 30.
Abmtining from coffee and tobacco wilI
go a long \Vay in freeing a person from rhis
J"isk of hean disease.
Folare anei viramins B6 and B l2 in [he
e1ier ger rid of homoc)' [cine, convening it
ro aI)orher amino acid calle.d merhioninc.
These B vitamins are founel in fonified soy
milks and cenain break.fasr cereals as \-vell
a animal. producrs. Obraining ar teasc 400
mcg/day of folate in fJ"ujts and vegerables
solely may reduce rhe risk of hean arrack
and srroke by lip ro 40 percenr by lowering
hOlllocysreine leve!s,89.9ll while reslllring in
an esrimared 13,000 fewer dearhs per year
from coronary hean disease. \'Vomen (especially rhose who may ger pregnant) should
consume rhis amount of folic acjd each day
fa prevenr fetal malformarions of the cen[raI nervous sys[em. Rich sources offolate91
and B6 92 are listed in Figures 31 anei 32.
Adequare supplies of methionine (an
essemiaJ amino acid) are imponant anei can
be ea ily obrained from a toral vegerarian
dier. However, exeessive amollnts of merhionine may be dange.rous. One of [he
reasons for this is rhar merhionne is also
convened in the bod)' ro homocys[eine. 93
Avoiding foods wim excessive levels of merh.ionine, such as eggs, cheese, beef, fowl.
and fish eems prudent. 94

HOlllocystei/'e in f/te blood is raised by:

Drinking more than Dine eups of eoffee pcr day.
Heavy smoking eombined with
high eoffee eonsumption.
The biggest coffce drinkers had
almost 60% more homocysteine
than abstainers.
Figure 30


A "'mIII(

FO/Q(e (mcg)

Sirloin sleak, broiled. trilUJIlcd


'/2 cup

Parsnips. raw sliee$


1 Clip

Pineapple juicc. canl)ed


1 Clip

Frcsb oral)gc juicc

II. Clip


panish peanu!S, ra\\'


I Clip

Mustard grecI) ,ra\\'

1 cup

Spinllcb. rll\\'


1 cup
1 Clip

Na"y beans
Okra pod~. frozel)


1 Clip
1 cup

Black-eyed cowpeas


Figure 31



86 (IIIg)

1'/2 ounccs

Becfrump roaS!


1 Clip

ReU peppers, chopped


1 eaeh

SmaU swc,et potato. bakcd


'h cup

Enl:lish walnlll


1 Clip

Brussels sprolllS. frozen


1 cach



1 cup

Garbanzo beansJchickpeas


1 cup

SlInf10wer secds


Sesame secds, wholc


Ricc bran


1 cup
'/2 cup


Figure 32



E'<ercise Benefits HDL

CholeJterol Levels
When rhe HOL cholesterol is high, it
extracts the bad choles(erol from (he arte(ies and helps protect the arteries from damage. High levels of HOL may even help
reverse coronary arrery disease. How can
we get our HOL leveJs LIp? Exercise has
been shown to rajse HDL.95 The exercise
rhar rases HOL is nor rhe weigJ)[-lifting


Other Factors That Raise HDL


Running, jogging, brisk walking,

biking, cross-country skiing,
swimming, cardiac rehabilitation

Fibrate drugs, niacin, estrogen, dilantin,
gemfibroziJ, alcohol

Lecithin, ginseng, garlic, onions, brewer's
yeast, chromium, vitamins C and E

'. Cessation ofsmoking

Chlorinated pesticides
Figure 33







Serum cholestcrol




Serum triglyceridc




LDL + VLDL (% of totall)




HDL (% of total)




Figure 34

rype, bur rarher the more active or aerobic

sOrt ehat gees dle hean rare up and requires
rhyrhmic body movemems aod deep breaming. The more aerobic exercise obeained the
grearer rhe rise in HOL.% Because of rhe
role of exercise in raising HDL and dms
lowering ehe risk of arherosclerosis, low
physicttl fitruss should be ehoughr of as an
independent riskfactor for rhe developmenr
of heal"( disease,97 A list of HDL-raising
factOrs is shown in Figure 33. The besr news
is rhar if you are unot now, and yOll get on
a regular excrcise program, research indicares
(hat you can decrease your risk ofheart discase by 50 percenr. 98

Taking any of the drllgs lisred in Figme

33 rhat raise HOL is nor rhe preferred
merhod due to possible side effecrs. 99 . 100
High doses of the B vitamin, niacin, can
boost HDL levels; however, in rhese do es
(he niacin is acring as a drug rather than a
viramin. 101 Consequenrly, ifyou are (aking
high doses of niacin yOll should be under a
docror's care. Careful medical monitoring
for side effects is srrongly recommended.
Particular arrcnrion should be pajd ro rhe
liver as high doses of niacin can be toxic ro
[har organ on occasion.
Esrrogen in women raises HOL. This
ma)' be one of rhe primary reasons why rhe
average woman does nor experience heart
disease unril 10 years larer rhan the average
man. Afrer menopallse, when e rrogen production drops, women quickly carch lip
with men with regard ro hean disease risk.
Thus, 52 percent of ali coronary hean disease deaths occur in women. 102
Alcohol drinking has been assocjared
wirh higher HDL leveIs. However, 1
stfongly discouragc a1cohoI use because of
rhe significanr hidden dangers rhar ir carries. These dangers are covered more COI11plerely in Chaptcr 17, enritled "Wanr a
Orjnk?" Furmermorc, alcohoI may nor raise
yom HOL if you are already on an excellent program. Hartung and colleagues
found dlar moderate alcohol consumpuon
provided no HOL benefir for men ehat were

running regularly.103 In addjrion to aleohol, rhere are orher toxins rhar raise HOL
levels, such as chlorinated pestieides. Again,
[ would obviously nor recommelld such
agems as HOL enhaneers.
There ;He safer ways ro raise HOL.
When individuaJs srop smokillg, cheir HDL
u uaJly rises signjfieantly as a resulr. Weighr
loss can aJso help raise your HOL. 104 Foods
conraining leeirhin, ginseng, garlie, onions,
brewer's yease, (he rrace mineral chromium,
vitamin C, and viramin E ali ean help raise
HOL. An example of a food wirh HOLboosring ef1eccs is garljc. One gaJ"lic smdy
had individuals with coronary heart disease
lIse lip ro four doves of garlie each day for
eighr monrhs. The resulrs are impressive
and are shown in Figure 34. 10S
Ar r.he srare of rhe srudy, HOL levels were
dismaJly low, ar onl)' 17 percent of rhe roral
cholesrerol. They were solidly in rhe danger zone. However, at rhe end of eighr
monrhs rheir absolute levels ofHOLs were
a fult 65 percent higher, at 28 percenr of
rhe rorat. Moreover, garlie not only raised
the desi rabie HOL, ic aJso lowered rotal and
LOL cholesreral as welt as rriglycerides. In
othar words, alt cholesterol values moved
in rhe right direction. The only signifieanr
variable in this study was the consulllptioll
ofgarlie. From many difTerent perspeerives,
garlic is nor only a food enhancer, but is
pare of a healrhful dier.

One step is to Iose weighe. Many people

wirh high triglycerides are overweighr. Getting down ro your ideal weight may bring
yaul' rriglycerides inca ilie ideal range (Iess
than 150mg/dl). Anorher. cep is ro exercise. Exercise, as we have already nored, also
raises HDt. The third item lisred is ro ear
less far. As we have aJready seen, mosr of
the Lpids in our diet are rriglycerides by
narure. In addition, dccreasing your Stress
level and sropping smoking can lower che
Many people have high triglyceride levels just because of akohol use. When rhey
become abscainers their uiglyceride levds
come down ro normal. Las tl y, use sugar
sparingly. Sugar raises triglycerides. lf you
wam [Q bl'ing your rriglycerides inco line,
especially avoid refined sugars like whire
sugar, hone)', molasses, and sofr drinks, des~
sens, candjes, etc. rhar mil.ize rhose sweereners. Sweereners in combination wirh cho~
lesreroJ and sarurared [ars as in custards and
iee cream are especially to be avoided.

Genetics and Cholesterol

Somc individuals generically have a tendency roward low blood cholesrerol levels.
However, if rhey follow a poor Iifesryle, ehey
ean stiU have a hearr auack. Other indi-

"Triglyceride" refers ro a compound that
is rnade up of rhree f:u (rechnicalty, 'farry
acid") ehains. These eompounds are d1e
main transpore form of F.u in rhe bloodsrreaJll. Furrhermore, the far in foods is usually in rhe form of rriglycerides. Elevared
ilJUOllnts of triglycerides are a1so a risk facrar for heare disease.
For years it has been recognized dut the
higher one's rriglycerides, rhe lower his HOL
remis ro be. It is not e1ear wherher rriglycerides depress HDL, bur rhis may be the
case. In any evenr, bringing down a high
triglyceride level will invariably boost HOL.
How do we ger the triglycerides down?
An overview ofsome of rhe key life.sryle recommendarions is shown in Figure 35.

Lose weight
Eat less fat
Decrease stress
Stop smoking
Abstain rrom alcohol
Avoid sugar
Figure 35


viduals have "bad genes rhat predispose
rhem ro high cholesteroJ levels. However,
if cheir overalilifesryle is good rhey can definirei)' posrpone-if nor complerely avoida hearr att3ck. There are people who genetiealJ)' cend ro run high toral cholesterol
levels but may nor be at risk for hean arracks beeause (hey are living a healrh)'
Ijfesryle and have high HOL levels.
The important messageis chis: we need
ro look beyond whar our cholesrerol levels
are, beyond whar our HDL levels are, and
be)'ond whar our trigl)'eerides are. The
nllmber ooe line of defense is to live a
healrhfullifesryle. This includes special atremioo ca a food imal<.e rhat is based largely
on rhe eholesrerol-free, high-fiber plam
foods dlat we have been looking ar in this
chaprer. We have a150 identified other aspeets of a heart disease preventive regimen
including regular e,xercise, not smoking, and
conrrolling blood presslIre. However, rhere
are stiH orher factors in a heart-healdw
lifesryle dur we must address ifwe wam r~
maximize rhe preventive porential of hearr

The study iDvolved the use of Cholestyramille, a

moderately priced medication.
Tbe cost va.ried from $36,000 to $1,000,000 per year
of Iife sav,ed.
Cost effectiveness was best with youllger
patieots, smokers, aud hypertensives.

Figure 36


Risk Factors Beyond Cholesterol:

''Normal'' Weight
In 1990, rhe U.S. Go"ernmenr revised
women's weigh( guidelines. This appeared
ro suppon rhe idea rhat a modest weiglu
gain in middle age was aceeptable. However a subseqllenr srudy analyzed weight
dara an over I 10 000 female regisrered
nllrses over a 14-year period. The Harvard
researchers found rhar any tveight gain afrer
18 years old incretued rne risk of hean djsea e. Even among those who were wimin
the new guidclines for normal weight, {he
more weight rhey gained, the more they
increased their heaT[ disease risk. There \Vas
abour a 20 percem increase in risk for rhe
smallest weight gain bur nearly four times
the ehance of hean attack for rhe largesr
weighr gainers who were still/.oithin the nor-

mal weight guidelines.

The researeh arricle concluded (hat a
weighr gain aher 18 years of age s a srrong
predictor ofhean djsease.. It expressed eoneerns thar Cllrrenr U.S. weight guidclines
""ere falsely reassuring a large proporrion of
people who are within d1e currem gllidelines bUl have avoidable risk [acrars for hean
disease. Although we have known for years
rhar obesir)' aJone is a risk for hean disease,
rhis study shows thar eveo "nieely fliled our"
people may have a sgniftcarn risk for hearr
disease compared wirh theit rhinner nonsmoking eOllIlterparrs. I06 However, obese
women are free from increased risk if rhey do
not have high blood pressure, e1evared lipds,
or diabetes. OnIy ooe-third of women ~aJI in
rh is caregory.

Use ofDrugs to Reduce

Cholesterol Levels
In rodays America it is popular ra lower
high cholesrerollevels wim drugs. We have
very porenr medicarons dur can ineleed
help lower cholcsteroL bur rhey ali have rhe
potential for adverse side effeet.'>. On the
other hand, many who adopt a healrhful
lifesryle find that (hey can lower their cholestero] levels as much or more rhan rhey
could wirh drugs-and they avoid rhe porenciaJly harmful side effecrs. There are no

adverse side efTecrs when following a jlldicious regula.r exercise program and consuming a dier low in sarurared (.1r, low in cholesrerol, and high jn fiber. There are only
good side effecrs rhar resuh from such a
lifesryle. Examples include a bener energy
Jevel, sounder sleep, more anracrive appearance, and Jess minor iJlnesses.
When physicims prescribe medications,
we musr always weigh the benefits against
the risks. It is rrue rhat a small minoriry of
the popularion, because of genetic defects,
may need medicarion in addirion ro a
healrhfullifesryle (O prcven( ar reverse hean
disease. However, (he vasr majoriry would
nor need such medicarion if rhey developed
a healrhfullifesrylc ro irs fullese potential.
The cost of medicariol1 is anoeher factor ehat for many is a burden, panicularly if
they do not have insurance coverage for such
medici ne. Whcn someone comes (O n1y
office that has high cholesterol and needs
to be followed very c1osely, even when the
benefir of the medication seems ro outweigh
the risks, cost is a seriolls concef\l. A srudy
published in rheJournal ofAmerican Medical A~ociation suggested t.hat a mcdic:!tion's
possible benefit.s should be weighed againsr
irs risks, not only in rhe arca of sidc effects,
but also in the COSt deparement. 107 The
3uthors' cosr estimares are summarized in
Figure 36.
For people wirh high cholesterol and an
additional problem such as high blood pressure or smoking, t.he COSt per yeal" of life
saved is relatively less.
Medicarion is nor reaIly the bes[ answer
ro America's number one kilIer, heart discase. Prescription drllgs have eheir place, but
in ehe overall prevenrion of hearr disease,
rhe besr, mosr inexpensive, and most effective way is stiH a healehy life.style. A heaJrhfuI dier is nor expensive and rhe bendits are
far reaching. Even the drug manllti1Crurers
who wrire the Physician's Desk Reference
of prescripeion drugs always menron rhar
dier is rhe ftrst and cornersrone step of cholesterol-Iowering therapy. Even for those on
medications, a good dict is stiU necessary.
That person wilI ger a grearer cholesterollowering effecr if rhey make lifesryle changes
in addition ro taking a pili.

Lift Stresses Can Cause a

Heart Attack
Stress is yet another factor thar increases
hean anack risk. Deadlines, d.isagreemenrs
with r!le boss, and orher such puIse-raising
situatiollS aH significanrly increase hean
attack risk. A tOral of 129 heart attack survivors were questioned abOlit everyrhing
[hat happened ro (hem in the 26 hours before rJ)e arrack. Serious Stress was experienced by 51 percent. The o/pes of evenrs
rhar they experienced are (isred in Figure
37. 108
In comparison, a large number of people
rhac clid not have a hean anack were asked
aboLlr their stresses. Only 12 percenr of
rhose experienced any seriom stress J) rhe
same rime frame.

Anger Can be Dangerous

Stressful situarions rhat provoke anger
are especiaIly rrying for thase wirh hean
disease. Individuals wirh pre-e:cisting hearr
disease more rhan double rheir risk of myocardia) infarc(ion when they get angry.l09
This increased risk continues for twO hours
afrer the anger episode.
It is clear from these and orher studies
rhar stressful experiences can significamly
raise om hcan ;}uack risk. One reason may

Deadlines, fights with the boss, other pulse-raising

Important meetings, givin~ presentatioDs, being
laid off
Emotionally meaningful il1teractions
with spouses, kids
Deaths in the family
Financial problems -- pay bills,
bounced checks, comil1g into
a financial \VindfaU

Figure 37


be rhat suess can cause hean aneries ro go
inro spasm. As a resulr, when the body's
c10uing cells, rhe p1ate1ets, rry (Q pass
through that aner)' rhey are resrrained aod
clar more easily.

The Importance ofEmotiona! Support

Srudies have shown rhar emotional support provides a way co buffer srres .
Whedler we recognize it or nor, it is a factor thar is desirable for aII of us. However,
it is especaJly important for rhose wieh he,lf(
disease. Elderly people who have suffered
hearr arracks and have oile or rwo sources
of emotional support are twice as hkely ro
live ar least a year afrer rhe arrack rhan rhose
wirhour sllpport. The author of one srudy
conclllded, "With rhis srudy we have a
much more specific idea dlae (he aspect of
emotional supporr ma)' be the crirical di-


Qveloge cllOlesterollevels for ",CII und women dec1illed

7% between 1960 -1991. This COllltl redllce CHD hy 12-32%.


Total 100
Level (mg) 190


Should Drug. Ee Used to Control

N1<my individuals rry ro control (heir
stress by using drllgs. This s no( oprind.
Psychiarric drugs can actually increaJe rhe
risk of a hearr attaek. A study was dane
with women who were taking anti-anxiety
drugs (such as Valiurn Ariv,ln, Libri1l111, and
Xanax) and/or anrdepressaIHs (such as
Elavil, Tofranil, and Pamelor). The study
found that rile drugs mlly greatly increcue the
risk for a hearr arraek. Women using the
drugs had nearl)' ] 7 (imes [he rsk for a heart
attack, and (hase who had at some rime in
meir life used the e drugs werc ar (h ree times
the r1sk. III AII of rhe increased risk may
nor be due simply ro being 011 the medica(ion. Some may weB be due to the s(ress
nnderlying rher problems. Nonerheless, even
beyond the stress f.Kror, ehe rnediemion itself
poses a signi/lcam hearr disease risk.
The imponam message from these lines
of research is thar a hean disease prevemve
lifesryle includes an emphasis an dea.!in o
wirh srress-ideally withouc medicarions.
Ways to achieve oprimum stress control are
preserued in Chaprer 14, "Stress withou!

How Much Difference Can Lifestyle


Figure 38


pon GlO be a tremendous help in preventing a second hean Grrack. This is uot somerhing ro be taken lighrly. A second heart
arrack i ofren more dead.!y rhan the f1rst

mension relared ro survival af(cr rhe onser

oflife-threatening artacks. "110 Relatives and
rriends provide a unique Sa uree ofemOliona.!
suppon; however, spiritual facrors also play
a cole. Alrhough you may be living alo ne.
you can have a sense of spiritual supporr
rhat comes from knowing Cod personally.
The imporrance of emotional supporr
also reminds lIS of aur obligations ro our
rriends and neighbors. Tfan individual clase
ro us has a hearr arrack, aur emotional sup-

Therc is mllch good news in Americ<l
regarding hean disease. Alrhough i( is stil!
the number one killer, hean arrack rares h<lve
decreased. In face, rhe hearr disease dearh
rate dropped some 22 percenr berween 1984
aJld 1994 a.!one. 112 One of [!le main reasons for rhc general improvemenr is rhar
Americans are paying more attention ro
rheir food choices. l13 arion<ll HeaJrh and
NlIrririon Surveys demonstrare thar cholesrerol leve\s in America have bcen c1ecreasing aver rhe ]ast tiu-ee decades, as spelled
aur in Figllre 38.

Norice {har in 1960, an average cholesrerol for a Olan was abour 215 mg/dJ. In
1991, rhar averagc chole terol came down
ro 205mg/dl. In women, rheir average chole (eroi in ) 960 was 222. In 1991, rhar
average value had fallen ro 205, rhe same as
for men.
These rrends are encouraging, bur cholesrerol levels are stiH bigher than rhey
hould be. Hean disease does nor need ro
be the number one !<iller in America. We
bave seen from the variery of srudies reviewed rhus far thar hearr disease is largely
prevenrable. We can be encouraged by rhese
choles{erol deereases over the lasr 30 years
and the decrease in rhe hearr dearh rate rhat
ir conrributed ro. Thousands of lives have
been saved. But rhis should be looked ar .15
only rhe beginning, because fuU)' 42 percent of dearhs in America are sriH due to
diseases of che hean and blood vesseIs. 111
elearly, dramatic changes srill need ro be
How mum can we aeruall)' reduce aur
hean a((ack risk? Information from The
Harvard Healrh Lener helps provide rhe
an wer, which is documenred in Figure
39. IJ

orice {he jmponance of rhese five

lifesryle facrors. By sropping s/lloking aIone,
we can reduce OUl' hearr attack risk by onehalf ar more wirhin five years. Aerobic exercise lowers aur heart attack risk by almosr
as much. By mainraining aur ideal weight,
our risk is 35 ro 55 perccnr lower ifwe were
20 pereenr ar more above rhar ideal weighr.
The greater che decline in the s)'srolic blood
pressure and blood cholesrerol, rhe more rhc
ri k is reduced. A 10 point reduction in
blood pressure would reduce rhe risk 20 ro
30 percenr. A reducrion in cholesterol of
30 pcrcenr (which is quite possible ro do
rhrough diet) reduces the risk of a hearr arlack 60 ta 90 percellt by rhis means aIone.
It is weU known thar among rho e who have
high serum eholesrerol, significantly reducing thar cholesrerol will definirely produce
rhe beneflr in risk reduerion. One recent
tudy showed rhar 3/ll0ng rhose rhar already
have had a hearr aw\ck, but happen ro have
a "Iow" cholesterol of less than 200 mg/dI,
dropping their cholesrerol will htIther lower

Preventive Measure

Risk Reduction

Stop smoking
Reduce blood cholesterol
Exercise regularly
Maintain ideal weight
Reduce blood pressure

c::> 50 to 75% in 5 years

c::> 2 to 3% with cach 1%
c::> 45%
c::> 35 ta 55% lower risk 'if overweight b)' 20% or more
c::> 2 to 3% for cach llmm


reduction in diastolic

even cheir risk of a subsequenr life-ending

addirional hearr arrack by up ro 45 percenr. 116
Let us look at a compelling srudy dur
helps us ro see d1e impacr of dier a10ne in
decreasing heart disease risk. Maoy honestly wonder, "How much can 1 expecr ro
reduce my hea.rt auack risk by adopring a
uuly ideal dier?"
First, what is rhe ideal dier? By now it
should be clear from rhe medical researeh
thar the ideal dict consists of plenry of fruirs,
vegerables, whole grains, and nucs (rhe lacter in Inoderation). TE we use foods thar
come exclusively from d1ese food group ,
we can make the mosr dramaric changes in
lowering cholesrerol and hean disease rares.
This is the ideal dier 1 recommend ro rny
parienrs wim high cholesterol or orher risk
facrors for hean disease, and is also the besr
diet for my hean disease patienrs. Most of
my patienrs with high cholesrerol will drop
rheir serum cholesterols 60-80 mg/dl an such
a JieI. Now baek ro rhe primary quesrion:
how much can you expecr ro lower your
risk? This seudy looked ar the impact of
duce diers an hearr disea e risk: COtal vegerarian (ilie diet 1 recommend for my high
cholesrerol and hean diseasc patienrs),
lacra-ovo vegerarian, and non-vegerarian.
The popularion that was srudied were Seventh-day Adventist men over 35 years ofage
living in California. The U.S. governmenr

Figure 39



Males age 35 QI,d over as percelJt ofexpected, in

comparison with genera/population

Total Vegetariaos

Lacto-Ovo Vegetarians
Figure 40

Zero cholesteroJ
Low saturated fat
High fiber
Zero animal pro1tein
Zero "heme" iron
Rich in antioxidants
Rich in folic acid and B 6
Promotes weight control
More nutrients for the dollar

Figure 41

has spent more than fourreen rnillion dollars tunding research on Seventh-day
Advencists and their lifestyle. 117 Ths tascinaton with Advclltists probably derives
largely from their markedly increased 1.00gevity and decreased disease rares. They
found a signific.ant decrease in hean disease
deaths among vegetarian Advcmists, as
shown in Figure40. 11 >
The rese.uch revealed that abolit half of
the Adventists were nor vegerarialls; nanerheless, th is non-vegctarian grollp had onl)'
56 percellt of rhe average he.arr disease death
rare compared ro the general population.


The researchers felt this was due largely to

their being nonsmokers; they aha avoided
alcohol and possibly had a somewhar
health.ier diet ehan rJ1C general poplIIation.
Most of the other Advemsts were lacto-ovovegerarians; fhar is, they lIsed eggs and diary produClS bur no mear ofany kind. Their
hearr disease death (ate was down to 39
pereenr of expecred-apparendy due simply ta eJiminating mear from their diers.
The rotal vegetarians had fhe most asrounding results. Thcy only experienced 14 percent of rJ1e expectec! death rare.
The low risk ofhean disease among rotaI vegerarian Seventh-Day Advemjsrs is not
surprising in lighr of rhe beneftrs of such a
c1ict as ourlilled in rhis chapter. These benefirs are summarized in Figure 41.
As we have seen, any one of these fea(llres alone redllces rhe risk ofhean disease.
When taken in ror;ll, rhey have a great impact in prorecring againsr the number one
killer in the nation. The first two features
on the lisr are probably the mose commonJy
known ro reduce heart disease risk. The
rhird one, high fiber, is cOlTImonly denrifled as protecrjon againse cancer, but we have
seen rhar ir also prorec.rs againsr hearr Jisease. Lesser known are [he benefirs of irem
numbers four throllgh eight in fighring
hearr disease.
The Advenrist Healrh Srudy provides
solid evidence that we can significamly reduce our risk of hearr disease dearh by following a roral vegetarian djet. IJ1 ('lct, (he
research wc havc presenred in rhis chapter
suggests rhar fully nine aur of ten hearr ar
rack dearhs eould be prevenced wirh a proper
lifesryle program. We now know enough
abolit rhe cause ofhean disease to virtually
eliminate chis disease as a major cause of
death in the world. If [he elimination of
hearr disea e was accomplished in rhe U.5.,
rhe American Hean Association srae(::s chat
our average life expecranc)' wOllld increase
by almosr 10 years. 119
In realty, however life ex:pec[ancy wouJd
increase significancly more [han rJle nearly
ten years sllggested br rhe American Hearr
Association. An ideal program ro prevellt
hean disease would also, ro a large extent
prevenr cancer, chronic Obstructive pul mo-

nar)' disease, pneumonia and many orher
Icading causes of dearh. Preveming rhesc
maladies wOllld no doubt exrend OUl life
span aod qualiry of life even furrher.

Heart Attacks Can be Prevented

Denis Diderot, an eighreenth cemury
French philosopher, gave LIS :t proverb rhar
1 believe is applicable roday. srared in Figure 42.
Ir is rime we do somerhiog abour rhis
crisis in America's kirchens. Our cooks can
prepare delicious meals wirhollt using ingredienrs mar damage our healrh. I and my
LuniI)' personaJly follow a [Dtal vegeral"ian
dier and Olake no sacrifices in the deparrmem of taste. My food 1S de1ieious, sarisfying, and varied. Besides, ir impans a sen e
of healrh and viraliry mar an inferior dier
would nor provide.
Ler Ole illusuare olY pOnt wirh I"WO example.s. One favorite in our house is a nondairy (no cholestera!) "iee cream." We make
it by purring frozen bananas and other se
leered ffO'.l.en fwits rllrough a Champion
juieer. Ir comes our smoorh and cold aod
creamy. and sweer (Q the tasre. However, ir
is law in far, high in fiber, and has no animaJ prorein and no cholesterol. Another
example is provided by rofu (soy bean curd),
an incredibly versarile (ood. By lIsng a varicry of seasonings, it makes a rasry subsritute in our home for somc dairy products,
eggs, and even some mear dishes. I could
give hundreels of other examples, but, of
course, rhis is nor a cookbook. The Appendix II listS a few of the mally exeeUe.nt vegeraran cookbooks rhar fearure recipes (har
are cholesrerol-free, low in saturdred far, and
high in fiber. Bceause of my own experienee, 1 firmly believe rhat we can re-educare aur cooks ro prepare Ilew varieries of
foods chat both caste good and hdp ro furrher decre;:tse hearc disease risk.

Does High Tech Treatment ofHeart

Disease Make Lifestyle Changes
Some people may feei rhar our advaneed
rechnology for treating hearc dsease gives
rhem more liberty ro do as chey please. They

reason rhac rhere s 110 need for a concrolled

lifestyle if rhey live near a srare-of-rhe-;}rr
hospiral. Indeed, "high reeh" has made ti
significanr differellee n dle hearr disease
scene. When a person has a hean anack,
cardjologisrs can open up rhe blocked arreries wirh potent drugs or angioplasry baJ100ns. As a resulr, if rhe tim-rime hean arrack patient livcs ro reach rhe hospiral rhey
have only about a LO percenr risk of dying
from rhe hearr a((ack. Twenty-five years ago
r,he risk was almosr 30 percenr. Judging
from cheir own practces, even cardiologists
scem prcdisposed ro fali inro thinking thar
lifesryle is nor very important. (Sad.!)', hean
specialiscs have 110 berrer blood cholesrerol
levels as a group than do rhe general popula cion). 120
By failing ro emphasize the imponance
of lifestyle, cardiologisrs and oehers seern ro
neglecr rhe important faer ehar heart a((ack
survvors ofren live on wirh a marked decrease in ql<.ttLity o/Lift. Of COlll"se, cardiologisrs are well aware of rhe resulrs of hean
Jrraeks. The main cardiology associarion
in our nation, the American Hean Associa-

"Doctors are always worklng to

preserve our healtl1 and cooks to
destroy it. But the latter are
often tlle more

Figure 42
don, recently arracked rhe common lay
myrh rhar hean arrack victims who survive
will "recover and be fine." The)' explained
(hat (hose who do survive a bean a((ack have
a risk ofillness and death rwo ro nine times
higher ehan rhe general popularion. 121


One COIl1mon problem thar xesulrs from
heart aeracks is congestive hearr failure. As
previously srared, rhis is a condirion in
which rhe hearr is weakened by a hean attack (or ocher cause) and can no longer perform aJl rhe work it sbould be c\oing. As a
resuIt, fluid typically backs lip inco rhe lungs,
legs, and feet. Conges[ive hean fajJure hospiralizarions more than doubled from 1979
ro 1992. Tn 1979,377,000 were hosptalized due ro this very borhersome disease.
In 1994,874.000 had ro be admitted ro ule
hospital. Congestive hean failure is now
the mos[ common cause of hospitalization
for people over 65. 122 We e1earl)' need ro
ger ro the root of the problem. It is nor
sllfficiem ro trade an epidemic ofheart disease deaths for an epidemic ofhean disabiIiries. Ooly by prellcnting or rC/lersing arhero e1erosis by lifestyle improvemenrs will
we see an)' grear srrides roward bom decre;~s
ing hean disease dearhs and hean-related

The evidence is indeed deal'. We can
dramatcaHy decrease our risk of heat[ disease by following an oprimal Jifesryle. We
need ro make rhese changes sa [hat a known
prevenrable disease no longer leads the list
of America's killers. 1 am aware that you
probably will nor change your lifeseyle to
merely aJrer general statisrics abour rhe lerhal impacr of heart disease in America.
However, 1 am concerned abour individuals, hundreds of thou. ands of who will un-

Refertmces Gyar[\s 1. Chief of rhe World He.ahh Org'Uliz~riorl Cardiovascular Dis

(ase. Prevenlion Program: World Hcalth Day, Apr. 1992.

Murray CJ, Lopez AD. Monaliry by cause for eight rcgions of tbe world:
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American Hearr ;\ssoci,\tion. Hmrr and Srroke Filet: 1996stllfistirlt/ wppkmmt. 1996 p. 2.
Amcrican Hean A.ssocialion. 1997 HeilTtlllld SI7'Oke StIlIsli,n/ Upthee.
American Heart Associalion, 1997 p. 2.


American HC'.1rl Associalion. 1997 Hearl ilnd Sh'ak,' StaliJliml Updal<'.

American Hean Associaeon, 1997 p. 28.

necessaril)' go ro rheir graves-rhis year

alone-becallse [hey did not take the proper
lifestyle steps in rime. And I know tiUt yOll
are ar leas[ somewhar concerned abollt yourself.
A[ rhe risk ofsounding trire or affeered,
1 musr honesd)' sa)' 1 feei a deep sense of
responsibiliry for ea h one of you wha are
reading rhis chaprer. I waIU ro do ever)'rhing I can ro help prevem me rragedy of
hearr disease from rouching your life. I havc
sem roo man)' [har have been hurt, killed,
and crippled b)' rhis murderer ro be llnimpassioned an the subject. From. eha[ perspective, Je[ me make a dosing request: jf
rhis chapter has convinced you of areas rhar
you need ro change in yOUl' life, do nOt clelay. Now is rhe ver)' besr rime ra improve
your die[ anei other lifest)'le habirs. Do nor
wait for warning signs or a first hean attack
before gerrillg serious abolit lifesryle changes.
By rhen you ma)' have already developed irreversible disease. Worse, yer, hean djsease ma)'
dam your life before you are ever aware dur
you had a hean problem.
For your own sake and rhe sake of your
loved ones, why nor embark on ar Icasr ome
elemems of a new lifesry[e raday? Tf you
stick wirh such change , [ am convinced you
will regard chem as among )'our life's wisesr
invesrments. Afrer aiI, the inves[mem will
pay dividends in providing longer life, disability prevemion, and an enhanced qualiry of tife. Do not procrastinare-starr ro
get more of rhe fuJI benefits of a hean disease prevemive lifestylc roday.

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Clean Them Out

he ~aJdiologisr ~lHered.d1e examinanon room wlth a grlm look on

his face. Aher exchanging a few
formaliries, he came ro rhe main
reason for rhe consulrarion. "Jim, I've reviewed your angiograms again, :llld r.here is
1l0.opriQn. You will need ro have bypass
Jim was dearly shaken. "Bur doctor, are
)'OU sure? J nearly died on the operarng
rabIe rhe lasr rime 1 had surgery. Are mere
ilO orher oprions? What abour that balJoon
procedure-or new medications?"
Jim, J really am sorry. J know how
much you drcad ilie rhought ofsurgery. but
rhere is simply no orher oprion."


Drawbacks ofHeart Surgery

DiaJogues like chis take place thollsands
of rimes each year in America. In spire of
al1 of oul' advancemelHs in rechnology, we
stiU perform some 500,000 hean bypasses
each year. l The darling of hearr specialisrs
roday, however, appears ro be coronary
angioplasty. Fully 404,000 angioplasries are
performed each year in the 0.5. 2 Often
referred (Q as the "balloon procedure" in lay
circles, rhis rechnique opens Lip bJocked
hearr arreries by forcibly opening a sturdy
baUoon inside the c10gged vessel. The balloon flauens our rhe obsrructng farry de-

posirs, and rhus allows more blood ca pass

through the previously narrowed area. If
the cardiologisr believes rhere is a high likelihood of repear elosure of rhe artery, a stainless steel wire O1esh circular wbe, called a
"srem," will be placed where (he angioplasry
was performed ro decrease tlle possibiliry of
short-renn repeated c1ogging.
Many lay people roday have become so
familiar wirh borh bypass surgery and
angioplasty rhar chey mighr rhink thar Jim
is a bit childish to fear slIch weU-honed
rherapies. Ver, expcrrs who recognize ilie
resulrs of these common procedures would
likely share Jim's senrimellts. One of che
grearcsr concerns wieh rhese memods is rhar
rhey do not address the underlying disease
process. Th:l.( disease is arheroselerosis, a
condirion rhar silendy affects blood vessels
throughollt rhe body. The disease causes a
slow but steadily il1creasing blockage of
major arreries. Bypass surgery and
angioplasry do nodLing {Q change rhis
gradual accumularion of farry deposirs
throughollt the body. These high-rech procedures only "buy time" by addressing what
are ofren rhe most life-d1fearening areas of
blockage-the blood vesseIs nourishing d1e
hean. If rhe process of acheroselerosis is nor
addressed, the arreries rhar have been bypassed wiIl again c10g up; rhe vessels mat



Provides a temporary fix.
Does not corr,ect tbe
underlying cause.
Permanent side

effect.s can occUJl".

High cost.

Figure 1


have been angiopl~~tied OI' steIHed will again

be obsrrucred wirb fatry marerial.
Furrhermore, surgiGlI merhoels are expensive anei fraught with some very real
risks. The ave rage cosr of a hospiralizarion
for coronary anery bypass surgery is
$35,000 to $62.000 (national average of
$44,200) depeneling on the operaring surgeons anei in what hospitaJs rhey perform
rhe surgery,5 AJthough rhe risk of operarive
dearh is 1l0W down ta about tluee percenr
or less in some cenrers,4 most people are
completely unaware of the potentially permanent siele ejJect. rhar can occur from dus
surgery. For insrance, tv"o percenr of bypass parienrs have a stroke anei up ro 57
pereenr suffer some kind of neurological
complicarion, often so subrle that [he
inelividual's family may have simply written it off as 'Dad is just getting older."S. 6. 7
MIU evaluarions have shown thar rhe brain
swells v,;ithin an hour ofbypass sllrgery; rhe
reason may be panly ex.plaineel by microscopic blood c10ts rhat arc COllllllon duting
hean surgery. 8
On (he orher hand, coronary angioplasry
COStS abolit $22,000, elepending on rhe
physiciao who eloes rhe procedure and
where ie is performed. 9 The failure rare of
angioplasties done 00 a single heart blood
vessel in rhe firsr six months is 35 to 45 percene, and for mul(i-vessel angioplasries is 50
ro 60 pereene within the same length of
time. Such F.!.ilures rhen require an omer

angioplast)', stent placement, Of even bypass

Thus, performing surgery on a person
with hearr disease has three drawbaeks, as
summarized in Figure 1.

Alternatives to Conventional Tretltments for Heart Disease

Fonunaeely, rhere are alternatives ta bypass surgery, angioplasty, and medications.
However, many pariems-and even phy icians-ar nor aware of rhese options. Prevenrive medicine experrs have now proven
(har blockages in hem blood vessel can be
rel)ersedby changing one's lifesryle. Perhaps
what is more important, when li ed properly, lifesryle agenrs such as stress control,
smoking cessation, diet, and exercise have
no harmfuL siele effiCiJ. The only side effects
are desirable ones-coneriburing ro a betrcr
qllaliry of life anei a decreased risk of diseases of many rypes in addirion ta heart elisease.
Those incljviduals with hcan disease who
become aware of rhe faers as outlined in rhis
book are confroneed with a vital quesrion:
"Am J willing ro make the eommon sense
Lifescyle changes necessary ro reverse Ill)' disease?" II' rhe answer is "no" it is likely that
either angioplasry 01' bypass surgery will be
llnavoidable ar sOllle poine.

The Standard Heart Disease Diet

Some hospjeals in variou l'am of rhe
worlel otfer nutririon classes for indviduals
who are trying ro deal wirh hearr disease.
This dicr instrucrion focllses mosuy an rwo
main issues: deereasing saturatcd fat and ro
a lesser exrem decreasing cholesterol in [he
diel. Comprehensive programs also tailor
rhe dictary advice ro help overweight pariems Iose weighr. In 1992 rhe National
lnstitlltes of Healrh's "Expert Panel" spelled
Out rhese goaJs wirh specific guidelines.
Their guidelines were similar ro mose enuncated by other presrigioLls inelivieluals OI'
groups such as rhe Surgeon General I
American Hea.rt Associatjon 13 and Naronal
Aeadem)' of Sciences. '4 The guielelines are
somewhar effective, but fali shorr of yielding u1e desired rcsulrs.

In this ehapter you will see a diel mar is
fu superior ro rhe diets suggested by rhese
in~tirtHions. Howcver, rheir recommcnded
dier is wonh examinjng because of rhe widespread populariry it and similar diers cnjoy.
lr is called rhe Narional Cholesrerol Educarion Program (NCEP).
The NCEP diet reeommends Jimjring
daily cholesterol inrake ra 300 mg per day
in rhe Srep r elier, anei ro 200 mg in rheir
mosr restricrive ar Srep II diee. In both diers, far is ro be kepr ar ar below 30 percenr
of rhe raral calories. Sarurated fu is ro make
up only eighr ra ren percelH n rhe $rep 1
dier, and less than seven percenr in rhe $rep
II diee.
How do rhese levels of cholesrerol inrake compare [O ehar of rhe average American? Approx.imations indicare rhar men consume 270 ro 400 mg per day and women
consume 200 ro 260 rog per day.l;
Therefore, mosr women and many men
are already below rhe NCEP cholesrero!
goals of 200 or 300 - but have we seen a
large decrease in hearr disease? Hardly. We
c.m be glad ehar Americans overall have lowered rheir cholesrerollevels, bur we cannor
be sarisfred ro only begin the race. We wanr
ro win it. A dierary cholesrerol of even 220
mg is srill higher rhan the oprimum ,unOLlIH,
as we shall funher illustrare. In addirion,
Americans also consume significant
amounts of far in rheir dier, including sacurared far, which of irself has a blood cholesrerol-raising effece.

Failures ofThe Standard Heal't

Disease Diet
Let us see whar The National Choie rerol Education Program Dier, by jrself, has
dane for people. In a srudy called rhe Cholesterol Lowecing Atherosderosis Srudy
(CLAS) , individuals with corona!'y arrery
disease were r[eared wirh diet ar diee plus
medicarions. The djer used was one that
rhe researchers apparendy thought was
miC(: no more rhan 250 mg ofdietary cholesterol per day, and less thaD 26 percenr of
calories from far. 16 Norice rhar dle CLAS
dier was actuali)' quite simila.r ro rhe National Cholesterol Edllcation Prograll1's rec-

ommendations and was more fat-restrictive

tha.n the average American diee. Mrer faur
ye.:us on rJ1IS program, rbe panicipanrs' heart
arc ries were re-evaluated by coronary
angiograms. Those on the special diet wirhOUt medicarion had a meager decrease in
dler rotal and LDL (bad) cholesrcrolleve1s. The resulrs of rhe angiography (special xray picrures of rhe bearr aneries) before and

Standard heart disease diet

After 4 years:
6 0/0 decrease in total cholesterol
6 0/0 decrease in LDL cholesterol

Angiography results:
6 0/0 regression
150/0 no cbange
79 % progression


Figure 2

afrer (he four year period, along \Vlrh the choIesrerollevels, are shown in Figure 2.
These are very discouraging reslllrs.
Noriee dur rhe vasr majoriry, almosr four
out of five, had lUorse blockages rhan rbey
did before rhey went an the dieL Only six
perce n t expedenced an im provemen r.
Cleariy, rhese dienry change and rhe resulring six pereent drop in coral cholesterol
and LDL is not mouglJ for (he average person wi[h comnar)' anery disease. The resulrs are nor unique. Similar studies have
been perfoIllled in differenr settings and rhe
resulrs are always similar and equally disappOlnClng.
Another srudy rhar illu trales chis pojD(
was called rhe "Program an the Surgical
Concrot of rhe Hyperlipidemias."l7 1'h1s
srudy examined rhe resulrs of an inresrinal
surgery rhar iruerruprs rhe rec)'cling ofcho(es[erol through rhe digestive rraer. They
demonstrared rhar rhis surgery, caUed a "partial ileal bypass," could reduce cholesrerol
leve\s. This procedure carne on rhe scene
over 20 years aga; now, however we recognize [here are much beuer ways ro deal with


elevaeed blood fars. Consequently, my inrerese is not in the group that was sllrgically
rreared. It is rarher in anorher group rhat
was smdied ar the same time, tllOse thac
served as (he "conrrols." Ac me beginning
of the program (hey randomly assigned enrollees ro one of rhe t\vo grollps. The controls did noc have rhe imes(in.al. surgery but
were placed on a special diec instead. Spcci fi cally, they were given a diet chat was as
restrictive, if not more restrictive [han rhe
study shown in Figure 2. It conrained 25
percene fat and 200 ro 250 mg of dietary
The subjects were ob erved for a perod
of ten years. Those on rhe die( program
low red their total cholesrerol and LDL. In
one year their average LDL choleseerol wene
down slightly, from 178 ro 174. By flve
years on the program mac average was down
even more, ro 167, and by 7 years ir was
159. Even ar 10 years, parricipams stiH
maintained a lower average cholesterollevel
rhan when they started, alrhough the LDL
value had risen back to 167. Despite the
modest improvemene in cholescerol nUIl1bers, blockages in cheir hea.rc arteries became
progressively worse. as shown in I;igure 3.
Norice tllar ehey sceadily became worse
ehroughollt the 10-year perjod. Ar che 10-

After 3 years
41 % had progression

After 7 years
77% had progression

After 5 years
65% had progression

Figure 3


After 10 years
85% had progression

year pOilH, fuJ!y 85 percenr showecl disease

progresslOll .
Is it an)' wonder that so Illany bypass
pariem must undergo a repeat surgery 10
years lacer? Although a few individuals improve on a dier like that recommellded by
t.he National Cholestero! Education Program, most do not improve. Sporadic success sCOl'ies are simply not good enough.
Imagine yom disappoinnnenr and frusuacion if you had hearc disease and pt:rfecrJy
Followed your docror's dier instructions for
years only ro find ehat your hean blood vessels became significantly wor e. Your frus{[ation wOllld likely further in crease if you
men learned t.hal almosr everyone e1se who
perfecdy followed me same diec also became
worse. Frustration woulcl become complere
when you learned that rhe dicr had already
been rested and found ro be inadeqllate.
It is obviou.s thllt something better is

A Proven Diet for Heart

Disease Revemtl
De. Dean Ornish and colleagues conducced a srudy called 'The Lifeseyle Hearr
Trial" in the San Francisco Bay area. 18 Like
the rwo previolls examples, me focus was
noe on bypass surgery or angioplasry. In
chis trial, rhere was a remarkably different
dieralJ' approach: insrcad of allowing 200250 mg of dietary cholesteroI, as did rhe
t\vo previolls srlldies, che Lifesryle Hean
Trial allowed a mere 5 mg of cholesrerol per
day. Insread of 25 ro 26 perceJlt of calories
from fat, this study allowed only a 10 percent far dieL Total calories. howevcr, were
noe restricted. Basically, rhe dier was nearly
total vegecarian (fruirs, vegetables, grain ,
and a small amOlJlH of Illlrs) wirh no animal products excepr egg whites and up ro
one cup pet day of skim milk or non-far
yogurt. (The skim milk Of non-fat yogllrt
comains 5 mg of cholesterol.) The resllirs
of the Lifestyle Hean Tria! are rablliated in
Figure 4. This diet is remarkab!)' bener on
aII counts. Notice rhe very large decre:,l. e
in both (Ota! cholesterol and LDL "bad"
cholescerol. These decreases are much
greater ehan rhose rhar occurred in rhe pre-

vious (\VO srudies. Especiall)' norewonhy is
(he face tbat these individuals were aJready
on a program ver)' c10se ro chac advocar.ed
by r.he Nacional Cbolesrerol Educacion Program b~(rJre this srud)' began. Before working wirh Or. Ornish and his col1eaglles, ilie
parricipanrs on rhe average were anI)' consull1ing 3] .5 percenr of rheir calories from
far and 213 mg/day of cholesterol.
O)'e srudies of ilie hearr blood vessels,
called caronar)' angiogr<UllS, were ll1ade before (he program scarted and tben 12
mOIl{h later. Special campucerized 3ssessments of these angiograms allowed very precise calcu1acion of whecher na.rrowing had
worsen d, s(3)'ed ehe same, ar improved. Ta
rhe atnazemenc of mall)' physicialls, che
compucer comparisons revea.led thar 82 percent of (he patienrs experienced a reversal
of their arherosclerosis. anI)' 14 percenc
had no change, and jllsr 4 percene worsened.
This is che fim scudy where any significanc
rcgression occurred by lifesryle changes
;llone, and it happened ro 82 percent ofparticipant.' wich i n rhe shon per iod of J2

"Regression" \Vas rhe rerm applied ro the
reversa!s in bloc.kages char occlIrred in becler rJlall 8 in 10 of rhese parricipants. Overali, there \Vas a 2.2 percem diamerer regression ofalliesions, which rranslates to a bJood
Ilow increase of9 percem. Norce char chose
who began rhe srudywim the greatestscenosis OI' bloc.kages, and rhus had che greatesr
need for regression, reaped rhe greatest bentors. Of rhe coronaries rhac were more rhan
SO percent blocked rhere was a 5.3 percenr
iJllprovemem, uans!aring co a 23 percenr
increase n blood flow. This is a significam
amount of regression afccr ani}' one yea.r.
Be.fOre this study was conducted, most physiciam diei not beliel/e regre.iSion bJI lifestyle
c!Jange WI1S possible in an'y length oftimelee alone within twell/e months.
Note rhac a small percentag change in
di:.unecer steJloss provides a much greacer
percenrage increase of blood flow. This is
because che blood Haw rare is malhemaricll1y proportional ta che fouCth power of
the c.hange in diamerer (rhe diamerer change
mulriplied by icself 3 rimes). 10



IArter ODe year:

24% decrease in total cbolcsterol
37% decrease in LDL cholestcrol

82 % regrcssion
14% DO change
4 % progrcssion

2.2% diameter ovcrall regressioD
of atbcrosclerosis (alllesions)
9% increase in blood fIol"
LetioDl grellter than !4).;' bl~kage:
5.3% regressioD of atberosclerotic
lesioDS greater tbao 50% blockage
23% iocrease in blood fIow

Figure .4

No animal products except egg
whites aod nonfat dairy
7510 complex carbohydrate
Al (east 15% protein
Lcss than 5 mg of ehulesterol
No caffeine
Calories not restricted
Figure 5

Diet ofSubjects in the Lifestyle

Heart Trial
Even Wilh Il1cdications, not a single
scudy before the Lifesryle Hearr Tria! demonsrrared regression in such a shorr period
of rime. Th.is study not onl)' showed dur
regression is possible in a shorr rime, but ir
can occur witbout the use ofmedications, furnishing an example of\Vhat Ca.tl happen with
che acceprance of a simple Jjfestyle program
mat includes an excellenr diet among ocher



Low fat vregetarian diet
Stress management training
Smoking cessation
Moderate exercise
Social and emotional
figure 6






"Fa,miliar tbings happen and

mankind does not bother aJbout
them. It requires a very unusual
mind to undertake the
aoalysis of the obvious."
figura 7


facrors. Ler us rake a c10ser look ar the dier;

it is outlined in Figure 5.

Factors Other Than Diet in the

Lifestyle Heart Trial
A10ng with changes in diet, rhe subjects
made several omer lifeseyle changes. The complete list of changes is shown in Figure 6.
Recently, Ornish's patients completed a
nve year follow-up eva1uarion. Measurement ofhean blood flow continued ro show
signiflcant improvements when compared
ro rheir evaluatjons before the five year program, and when compared wirh rhe COIltrol group who received rhe N CEP-rype dier
and other aspecLS of usual Gue. 20
Alfred Whirehead, a philosopher, Wl'Ote
a stacemenr thar apples ro this problem of
heart disease and rhe srudies chat show ies reversaJ. The staremellr is quored in ,Figure 7.
Or. Ornish's work provides a good e.xample ofwhat an unuslla1 mind can do witb
the obviollS. Hean disease is the nllmber
one killer in Americ.1. Every U.S. physician is very familiar with it, yer it seems mat
mosr of LIS merely rrear the dise~se's symptoms rather rhan rhe roor cause. Lifeseyle is
c1early ule roor cause in the vast majoriry of
cases. Many medical professionals spend
so much rime and efrort mopping up rhe
Ooor that we do not norice dut an overrunning fallcet is the lInderlying GIUSe of
rhe problem, as illustrared in Figure 8.
Now mat t!le obviolls has been demonsrrated, it is time for people wirh hearr disease ro rake notice and begin ro change (heir
lifesryle accordingly-before it is roo late.

Ca.ffeine May Work Against the Heart


Note rhar beyond dle near zero cholesterol intake and a very low fat intake, rhe
Lifesryle Hean Ti-ial alJowed no caffeinc.
Why prohibit caffeine, when it is an integral ingredient in some of Americ.1'S f.worire foods and drinks? First, there are concerns that caffeine may have a relatively
small bur signific.1nt effecc in elevating cholesterol ,md blood pressure levels,2l It a150
may raise the blood homocysteine level
which may bring about atherosclerosis. 22
What is more important, Ornish and his

eolleagues excluded caffeine becallse of irs
abiliry ro /lJorscn siTess in many people. 23
Srress control appears [O be extreme1y important in reversing coronary artery disease.
If you wam ro sray cool, collecred, and
sready, ir will often reqllire a c1ean break wirh

E'Cercise with Elevated Heart Rate

The Lifesryle Hearr Trial also inclllded
a regular exerei e program as oudined in
Figure 9. The goal was to rake a daily walk
rhal is brisk enough ro ralse r.he hearr fate
in beats per minure ro 50 ro 80 percem of
each ;ndividual's m,Lximum heart rate.
The maximum heart rare and the Guger
rare for exercise is calculared aceording ro
age. To illllstrare rhis simple calculation.
derermine your own maximum rarc and
rarger rare a explaioed in Figure 10.
An emry-level srre s test was adminisrered ro each participam before rhe exercise program began. If a person had an abnormal EKG rhat indiated a shonage of
blood supply ro the hearr dming rhe resr.
rhe hearr rate ar rhe moment of rhe shortagc was nored. The targer bear rare for rhar
person's exercise session would be 50 ro 80
percelU of rhar hearc rate. l4

Total Blood Cholesterol Reductions in

the Lifestyle Heart Trial
There were two groups ofsuhjecrs in the
Lifesryle Hean Trial. The results presel\{ed
rhus far are for the grollp callee! rhe "Ex_
perimental Group." The other group was
called rhe "Control Group." The control
group followed a diet similar to [he National
Cholesterol Eduearion Program dier as previously spelled out. A eomparison of rhe
tora1 eholesterol of rhe rwo groups is hown
in Figure II.
This graph vividly illu rrares rhe superiority of rhe vegetarian diet of rhe experimental group over rhe mear-earing dier of
rhe control group. The vegerarian group
had a 56 poinr reducrion in cholesterol, or
24 pereenr. after one year; rhe mear-earing
group haci only a 13 poinr reduction, or six
percenr. This is whar we would expeer for
rhe mear-earing group, in keeping wirh rhe



3 hours per week,
at least 30 minutes
per session
Heart rate at 50-80%
of maximum heart rate
Figure 9

Step 1 Figure your maximum heart rate by
subtracting your age from 220.
Example: ifyou are 40 years old, your
predicted lIul.;'Cimum would be 180 beats
per minute.

Step 2 Multiply that number by 0.5 to give the

lower end of your range and 0.8 for the
upper end. Example: ifyou are 40
years old, tIris wouJd be 90 to 144 beats
per minute.
Figure 10


Total ellolesterol











One year
Figure 11


rypical six percenr decrease attained on the
National Cholesterol Edllcarion Program
Oier. Can we be sarsfied wrh so small a
reducrion when we know now rhar a ve.getaran diet like [he Lifesryle Hearr Trial djer
can provide such siglliflcam positive resll1rs?

LDL c/lOleSlerol



Impact ofLow LDL






Baseline (pre)
Figure 12

One year (post)

ReduCng LDL in heart disease patients with
Ihigh LDL was more effective than conventional
therapy as follows:
Reduced progression
frequency by half
Increased regression
frequency by 200%
Reduced cardiac
occurrences by 750/0
Figure 13

LDL Reduetions in the Lifesty!e

Heart Trial

ages the aneries, and produces coronaly arrery disease? Comparison of dle rwo groups
is depicted in Figure 12.
After one year on ehe vegerarian dier and
ocher lifesryle illtervenriolls, rhe LOL of the
experimental group droppcd 37 percen(.
The conrrol group rJ1ar was on a National
Cholesrerol Educarion Program-rype dier
onlyexperienced a drop offive percent. This
certainly helps w e.xplain why d1ere was such
significanr reversal of coronary anery disease in the vegetarian pariems.

What abolit rhe "bad" cholesrerol, rhe

LOL cholesrerol iliat so easily oxidizes. dam-

Numerous srudies have demonsrratcd

thar f rhe LOL cholesrerol s subsralHiaJly
brought dOW{l, reversal of coronary anery
dsease will likely occur. ome high LOL
subjeees with coronaJ)' hean disea e were
rreared by lowering rheir LOL and others
wirh conventional hean disease rherapy.
The resulrs are compared in Figure 13. 25
Abolit one in hve patiems thar has a
hean attack has a rotal cholesrerol below
200. A1rhough (hese pariems willlikely havc
other risk facrors such as smoking or a low
HOL, physcans have convenuonalIy not
paid aerenrion ro rheir rotal or LOL cholesrerol. However, a recent srudy has shown
thar he.arr arrack patienrs mar already have
"desirabie" cholesrerol levels will gain further benefit from a program rhar brings rheir
cholesterol down even furrher. 26

Vegetarian Diet Reduces Cardiac

FlIrrher SllppOrt for rhe dia wirh reduced cholesrerol and roral lifesryle approach is provided by the Sr. Thomas' Atherosclerosis Regresson 5tudy (STARS).27
This British srudy moved closer ro the dic[
program rhat Ornish lIsed and, as expected,
prodllced resllits rlUt were between thosc
achieved on rhe NCEP cliee and [hose Olt
rhe Ljfesryle Heart Trial regimen. The
STARS researchers wenr beyond rhe CEi>
Srcp II dier in a number of ways. They: (1)
added a sgniftcam amount of planr fiber
ro rhe dier (lip ro 6 grams per J 000 calories); (2) furtber decreased cholesrerol inrake amollnring ro only 100 ro 120 mg per

day for mally of the panicipanes; and (3)
inercased polYllnsaturared f.1t in the eliet. AJI
of ehese changes made ehe diee closet ta a
vegerarian dler than rhe NCEP diet. They
aJso counseled parienrs againsr smoking and
"advised a suirable level of daily exercise."
However. me descriprion of rhese componenes in cheit repare slIggests rhar relatively
liale atten(ion was given to these areas COlllpared ro Ornish's strllcrured foclIs on exercise. When angiograms dane ar the beginning of rhe STARS were compared with
lhose dane an average of abOlit 3 years bter,
the results were as expecred. That is, rhe
results were becween rhase aehieved by
Ornish and those seen wirh rhe NCEP diee.
SpecificaJly, regressionocclIrred in 38 percem, while 15 percent progressecl; about haJf
clici nor show any significanr change.
However. lh is dietary approach decrcased clle number ofcardiac evenrs. When
ehey looked ar rhe toraJ of aU the serokes,
hean attacks, deaths, comnary bypass sllrgeries. and angioplasries. rhey realized they
made a remarkable impace. Whereas ten
percenr of control patierns had one of mese
evems, only mree percenr ofthe dier-rreared
patlents had one.

HDL Did Not Rise In the Lifestyle

Hetlrt Triaj
Whar abollr HOL cholesterol? As we
saw in me previolls chapter, the higher rhe
HOL cholesrerol the berrcr as far as heart
disease is concerned. The HOL valucs for
r.he (wo groups are compared in Figllre 14.
Borh groups had a slight decrease in
HOL, which is so small as ro be scatisticaJly
insignificanr. However, rhe experimenraJ
group stiH experienced reversal of coronary
hearc disease despite rheir low HOL. 1 believe mis makes an important. sr.acemenr: if
you have coronary anery di case, Jowering
your LOL is more important (han raising
your HOt. The control group had a higher
HOL, whidl is considered to be heaJrhy,
but cheir earonary arrery disease sriH gat
worse. which suggesrs again rhat lowering
LOL may be more imporram in regression
of amerosclerosis. However. do not chink
[har me rale of HOL is of 110 imporrance.

HDL c1wlesterol








Baseline (pre)

One year (post)

Figure 14

We willlook ar HOL concerns more c10sely

later in the chapler.

Triglycerides IncretlJed in the Lifestyle

Heart Triaf
For average Amerieans, [he higher rheir
rriglyceridcs, the worse ehey fare as far as
coronary anery dlscase is cOllcerned. 2 Ir
was rherefore slIrprising rhat [he inelivieluals who reversed cheir hean disease on [he
Lifesrylc Hean Trial experienced a rise in
rheir rriglycerides, as secn in Figure 15.









One year
Figure 15


The vegetadan group haei a 46-point
increase in rriglycerides. On the other hand,
{he cOlluol group [owercd (heu triglycerides over r.he samc time pcriod by 17 point.s.
This rise in triglycerides is nor rypical for
vcgerarians in orher srudies. Some studies
have idenrified groups of vcgcrarians wirh
lower triglyceride levels ehan average. 29, 30
Whar, tl1cn, was happcning in tl1e Lifesryle
Hcarr Trial? Individua.ls an a jat-restricted
vcgcrarian diet may rcnd ro run a higher
rriglyceride Icvel because d1CY are consuming higher amounts of complex carbohydrares. Carbohydrares made lip fully 70 ro
75 percenr of thc Lifesryle Hearc Trial eliee
However, these carbohydrate-rich foods
usually look like good guys regarding hean
disease risk as wel! as cancer risk. Ir seems
difficult ro comprehend rhar rhey wcre getting "roo much of a good thing."
Alrhough rhe rise in rriglyceridcs did nor
appear ro interfetewith the ovemll success
of rhe Lifesryle Hean Trial ir leaves a nagging question: cOll.ld the teslllts have been
stiH berrer if far consumprion had not been
so rigorously reduced? Could Ornish's severe fat restricrions COme back ro haune the
parricipanrs in rhe long run? The quesrion
is more rhan academic. As we have a[ready
seen, vegerarians who havc not made pains
ro drop their f:l.t intake, do rend ta consume
less fat than average but nowhere near as
litde as Ornish anel his colleagues required.
lnterestingly, in Resnicow's own research,
as well as in nine o[her srudies rhar he anaIyzed, toral vegctarians generally had lower
cholesrerol, lowcr LOL levels, and lower
triglyceride levels-all wirh equally good
HDL levels. 31 This evidence cam sLlspicion
on the exrremel)' low far inrake and rhe corresponding higl~ carbohydrare inrake of the
Ornish dier being the cause of the risc in
Another report documeming vcgerarians' lower [riglyceride levels provides further insighrs. Specifically, vegcrarians who
decrease {heir far consump{ion within more
moderate range5 (down tO 23 percent of
cheir calories) have been found to lower {heir
triglycerides. 3- Other teseareh has shown
that a vegetarian dier that doe. not excessively restricr fat consumprion 01n Jower


cholesterol levels, yet nuintain HOL va!

ucs. 33 These srudies cast nlfther sLlspicion
on dle very low-fat diet. The concern is
rhar lowering fat con.sumption w the profound levels of (lte Ornish diet w111 result ill
a tiSf oftrig/ycetides and a dcprcssion o/HDL,
as we have seeI). in. the Lifesryle Hean Tria!.
A laSt bit of information m<ly help ro
put the pcrcent fat issue inta stiU berter COIltext. When Dr. Ornish analyzed his da[:I
ro find rhe mOSI imporcant parc of his diet
in reversing hearr disca e, he found ir \Vas
irs low cholesrcrol COlltcnt rarher than irs
lo\v far conrenr .34 Ir implies thar U1e absence
of animal prodllctS in the dier (which ensures that a dier will have no chokstcrol) s
more imporranr rhan dramatic l'edllCrions
in far contenr. This line of thinking is in
harmony wirh rhe !arest srudies rhar demonstrate the preventive benehtS ofsome high
far, no-cholesrcrol foods like nllrs. Srlldies
an dle beneficia.! effects of nllrs are pre.seIited
in the prcviolls chaprcr.
Stil! furrher support ro this perspective
comes from Sranford University. Researchers there a[so demonsrrated dur lifesryle
changes cOllJd be used ro significanrly impace rhe progression of coronary artery disease. 35 Based on {heit research and orher
published srudies, rhey concluded: "In general, it appears (har bener angiographic ourcomes are achieved wirh greater reduceions
[i n LO L cholcsrerol] beca use stud ies reponing regr ssion of diseae in rlleir rreatmellt
groups 31so produced reduc(ions in LDLof
35 percent 01' more." As we have seen in
rhe previous chapter, a very lo\\' far elicr is
nor necessary ro achieve a reduction of either tOtal ar LDL cholesrerol.
Considering ali of [he evidence regarding the besr level for far in the diet, we Conclude dur five ro ten percem is too low, and
30 percen{ is probably too high. AbOlit 25
percenr fat scems ro be oprimum.

Chest Plfins R~duce Rttpidly With a

Vegetarran Dtet
When an individual experiences frequent chesr pain rypica.l of coronary arrery
dlsease, rhey \ViII ofren undergo a coronary
angiogram. An angiogram derermi nes if rhe
pariem does indeed have signiHc..1.nt coro

nary anerl' disease. Ifblockages are present,
the tesr measures exactly where and how
.-evcre rne blocbges are. Partially blocked
arreries reduce blood flow ro hearr muscles,
causing pain in the mllscle.
In several studies preselHed in rhis chapter, rhe parricipants were individuals who
haei heart-related chest pain. or angina, on
a frequenr hasis. lr was rhis pain rhar rr.iggered rhe examination of rlleir coronar)' arreries in rhe fi rsr place. We have seen thar
rhe vegerarian group in rhe Lifesryle Hearr
Trial had significanr improvemenr in their
overall cholesrerol levels and reductions n
lheir areerial blockages. What happened ro
their chesr pa.ins~ When ilie studl' slaned
lhe average rnember of rhe experimenlaJ
group experienced chesr pain approximarely
five limes per week. Chesr pain comparisons of the lifesryle group and rhe onrrol
group in {Ile Lifesryle Hean lrial are shown
in Figure 16.
(hest pains in ilie experimenral group
(vegerarian dier) decreased 91 percelH, [O
less than once per week. On rhe orher hand,
in the control group (mear diet recommended bl' CEP) rhel' worsened hy 165
percenr over rhe course of a year. These resulrs are as expected, and in agreemenr with
the reduced blockages in the hean aneries
of the fim group and increased blockages
in the !aner rhar were shown in Figure 4.
One resulr of this srudy was largely unexpected. The dramatic 91 percem reduclion in chest pain of rhe experimentaJ group
occurred in tiu! first ihree weeks-Iong betore we could reasonably expecl an)' signiflcallt physical reversal of rheir blockages.
Such quick reductions in chest pains were
starrling ro mally in rhe medical communil}'. However, orhers of LIS were well aware
of the dramatic shorr-term changes ('har
could take place wirll lifesryle changes. 1
personally have seen mally patiellrs who.
initially. would merely wa1k across rhe room
and develop crushing anginal chese pain.
After twa ar three weeks an a vegerarian diet
and exercise program. maol' of rhose same
parienrs would be waJkingfive mi/es il dl1)1without chest pain and using less hearr rnedicalion rhan before. The rcsults are ofren so
amazing rhar you wOllld have ro sec it firsc

hand (O flllll' appreciare the dramaric improvement.

High Blood Cholesterol Preverzts Blood

Vessel Relaxation
Alrhough some people think of blood
vessels as wbes or pipes dur pass rhrough
OUl' badies, such a characrerization is misleading. Actuali)', healehl' arreries are muscular organs rhat have rhe abiliry ro control
how much blood f10ws rhrollgh them bl'
changing thei r diamerer. Thel' can relax and

A IIgill a freqllency/week






Baseline (pre)

Ooe year (post)

Figure 16

allow more blood ro pass rhrough, ar rhel'

can consrricc and permir less blood f1ow.
Blood v ssel re1axarion is eXlremel)' imporranr ror rhe work of rJle hean. Relaxarion
of tlle caronary arreries a110ws grearer blood
/low ro rhe hean muscle. Relaxarion of
blood vessels elsewhere reduces th hearr's
workJoad bl' decreasing che resisrance thac
rhe hearr pumps againsr.
1f reducrions in rhe amoulH ofblockage
could not explain rheir improvemenr in
chesr pain, what could? The reasons for rhis
impressive reduclion in angina on rhe vegerarian dier are only recenrly becoming elear.
The answer probably relares-ar le~lSt in
pan-ro how a vegerarian dier can help relax blood vessels.





Arg (g)

American cheese
Egg ~
Nonfat skim milk
Beef sirloiD steak
Firm tofu
English walnuts
Brazii nuts
Black walnuts
Baby Uma beans
Red kidney beans
Garbanzo beans/
Roasted pUlmpkin

1 piece
1 c.
1J2 c.
112 c.
112 c.
1/2 c.
112 c.


1 c.



Figure 17



1 c.~.., 2.6
1 c.
1 c.
1 c.
1/2 c.


The Role ofNitric Oxide in Preventing Chest Pain

A chemical in rhe blood called nirric
oJLide i essential ro the abiliry ofblood vessels ta relax. Nor ro be confused wieh ninous oxide ("[aughlng gas"), ninie oxide is
a critical relaxing factor dur is made by rhe
endoehelial ceUs lining our blood vcssels.
However, when cholesterol Icvels rise, rhe
blood vessels do nor relax sufficiently in response ro )linic oxide. Changes in blood
cholesterol levels can make a significant differcnce in the amounr of reiaxaeion in a
shorr period of rime. Recentiy, researchers
caused pacients' cholesrerollevels ro rise by
stopping their cholesterol-Iowering drugs.
Wirhin [Wo weeks there was a signific.1llr
drop in responsiveness ta the effects of nirric oxide. reducing relaxation. 36

Why wou[d high cho[esterol levels inrerfere wirh rhe effects of nirric oxjde? Recent lab work provides one reason for this
associarion. Researchers have now documenced ehat high blood cholesterol [evels
cause the destruction of nirric oxideY The
endorhelial cdls try ro compensate for this
[OS5 by making more nitric oxide. 38 Ho\\'ever, due ro rhe rapid destfllction of nit.rie
oxide, ehose cells generally run Out ofL-arginine, a crucial raw material thar is essenrial
for making ninic oxide. A recent study
demonstraeed ehat a significant cholesrerol
drop will improve suess EKG test scores
(showing improved blood flow to the hean)
in four weeks. 39 In harmony wirh rhese relationships, scienrists have found mat giving addieional L-arginine helps resrore normal anery relaxation even if someone has
high cholesterol levels. 4o L-arginine JUSt
happens ro be found in abundance in a vegetarian djet, but is sparse in mcat and dairy
products. Tabularion of the arginine content of foods is shown in Figure 17.
Note that meat and dairy proclucrs fali
far shon ofargininc in comp:uison ro beans,
nurs, and seeds, which have 3 ro 35 times
as much.
Consequcnrly; me rapid angina improvemenc in the Ufesryle Hean Trial may be due
ro ac leasr twO separare effecrs. First, reduced choleseerol levels may help ro resrore
normal blood vessel re1axation mechanisms.
Second, an increase in dietary arginine provided by me vegetarian diet will furmef-help
to relax areeries from dle outscr, likely even
before blood cholesrerollevels have d ropped
sign ificanr1y.

Reduction ofRed Blood Cell ''Stickiness" Reduces Chest Pain

There is a third cxplanation for the rather
d.ramatic shorr-rerrn angina reducrion occurring wirh cholestcrol-lowering diets. A
reduction in rhe rendency for red blood cells
ro srick rogerher, or blood "fluidity," was
observed in a slUdy by German researchers.
This is anorher study of (he impact of
lifesryle changes an hearr disease progression. Dr. Gerhard Schuler and his associaees made some of the mose detaiJed mea-

suremelHs of any of ilie stlldies regarding
rhe regression of areery blockages. 41 Using
regulat physica1 exereise and a diet ehat averaged 26 pereent f.u and 135 mg of cho1eseero!, (beeeer than ehe bese "narional eholesterol education diet") rhey helped 30 percent of 56 smdy parricipants :main regression. Only four percent of a second group
achieved regression withollt the lifeslyle
Of interese ro the angina quesrion, ehe
researchers measured ehe ecndcncy for red
blood cells co stick together (caUee! ehe
"eryrluocyte aggregation rate"). Stickier red
blood cells eend ro c1ump and interfere \Virh
optimal blood flow ro the hean lllusc!e,
which can increase angina. Even an thjs
Iess-than-optimaJ lifesryle program, dle red
blood cells' tendency ro stick togerher decreased by a highly sigll.i.ficam percentage.
This evidence thus provides anodlcr reason
why we would expect angina to decrease on
a bcerer lifeseyle program. One only wonders how profound the changes would havc
bem if a zero choleseerol, roral vegeearian
dier had been adopted.
A summary of rhe three possible reasons
for rapid angina reductions mat occur wirh
cholesterol-lowering diers is shown in Figure 18.

Afler a Heart Attack - Change YOur

Diet to Reduce Death Risk
Orher research has prodllced hndings
(hat are relevam in showing the power of
dier in reversing coronary anery disease. A
1992 repon did nor measllre regression but
examined an imponallt issue: subseqllem
hearr probJems in hean anack survivors. 42
Parienrs in the experimental group were
given a specific intervention dier that moved
[hem strongly in the direction of vegerarianism. Meat and eggs were not allowed.
Their descriprion of the dietary protocol
sOllnds essenrially vegetarian, being described as "conraning fruits, vegerables, cereals, and nllts," although some flsh was
apparendyallowed. Among rhe (over 400)
hearr attack vicdms in rhe study. those an
rlle inrcrvencion dict experienced a dramatic
decrease Ul total cardj~lC events. Wirhin just

six weeks, rhe near-vegetarians showed a significanr 35 perccnr decrease in toral cardiac
OCCllrrences rJlar included fatal and non-fatal heart attacks as well as sudden cardiac
The repon suggesrs that diet changes are
superior to 17ledication for someone who has
had a recent hean anack. which is asronishing ro rhe medical communiry. One of
the most widely tOuted groups of medic."lrions in rhis regard :lre bera blockers and
ACE inhbitors. They demonstrate onJy
half of the effecriveness of the vegetarian
diet, \Vith an average redllcrion in toral
morrality of onJy abour 20 percent. 43 . 44

1. Relaxation of blood vessels caused by
reduced serum cholesterol increases
the amount and effectiveness of nitric
oxide in the blood.
2. Further relaxation of arteries due to an
increase in arginine in vegetables occurs
before blood cholesterollevels have lowered.
3. Reduction in red blood ceH stickiness,
increasing blood flow to the heart muscle.
Figure 18

Drawbacks ofDrug Medications fOr

High Cholesterol or Triglycerides
There are numerolls medicarions now
<wailable to assist in lowering LOL cholesterol and in some cases lowering criglycer'des or raising HOL cholesterol. One of
the mOSI popular grollps of drugs is knawn
as the "statins" and include prescription
medications such as 20cor, Pravachol,
Mevacor, and Lescol. These medicarions
can significantly lawer LOL cholesterol
while slighrly raising HOL choleseerol but
onl}' when L1sed in conjllncton with a good
low cholesrerol, low saturated fat dieL


Srarins can infreqllenrly callse severe liver
inf1ammarion and desulicrion as well as
dearh of volunrary muscles of me body.
Anorher popular agenr used ro lower
borh cholesrerol and rriglycerides is a very
high dosage of the B vitamin, niacin. When
used in rhe high doses necessary ro achieve
significanr1y Jower cholesterol and rriglycericles. niacin should be considered a drug
because it can illfreqllently callse life-rhrearening side effects. These side effecrs include
destrucrion of the [iver and internal bleeding from severe inf1ammation of the stomach; omer cOl11l11on annoying side dfects
are hot flashes and flushing of the skin.
1 prefer ro reserve rhese meelications for
rhe approximarely 1 in 400 people wirh a
heredirary disorder that callses rhe Jiver ro
greatly overproduce cho[esrerol or rriglycerides. 1 also use them in heart patienrs who
have failed ro achieve rhe desired serum lev-

Risk of

cardiovascula'r 3

umbcr of fitness tcsts passcd

Figure 19


e1s of cholesrerol wirh elier alone and who

are willing ro pa}' ilie high cam. The costS
conssr of medications (a year's supply of a
popular cholcsrerol-Iowering drug costs
$1308),45 frequent doctor visits, and lab
work necessary ro monitor for and possibly
prevenr serious side effecrs. The good news
is rhar t!le majority of people wirh high cholesterol can bring i[ elown ro an ideal level

with an ideal eliet and lifesryle program rhat

includes regular exercise IVithout the llse of
drug meelicarions.

Beyond Diet-Physical Fitness

In chis chapter we have se n rhar an excellent lifesryle is essemial for anyone ehat
wishes ro reverse coronar)' areer)' dise.ase.
More than dur, it is the basis fOf preventing
hearr disease from occllrring in rhe fim
place. This lifesryle must include a cliet rhar
has negligible amounts ofclierary cholesterol
,uld is low in sarurared far. Besides being
on a good diet, one neeels ro have a regubr
program of moderate exercise.
The imporrance of regular exercise in
prevenring and reversing hearr elisease needs
ro be emphasized. Regular exercise alone
has been shown ro help the hean in many
srudies. I wiU cite JUSt one. A 19-year srudy
of abour 10,000 men addressed the impact
of regular aerobic exercise on the risk of
deam duc ro card iovascu Iar disease. 16 They
were categoriz.ed neo three groups as determinecl by each pareicipant raking (wO I1t
ness rests 011 a treadmjll at an ave rage offive
years aparr. ThllS, physical fimcss was assessed for each parricip,lnt at [he start and
again afrer five years. Those who enjoyed
sustained physical fitness (passed bod} tesrs)
comprised the firsr grollp. Those who had
shorr-lived fitne.ss (p,L~sed only one of rhe
rwo tests) made up rhe second grollp. The
rhird group consisted of r!lose who were
llnfit (failed both teSIs). The reslllrs are
shown in Figure 19.
Note thar rhase wha were physically fir
and maintained their fitness had the lowest
risk. The risk \Vas rwice as mllch for rhose
who faileel ta mainrain a lasting fimess program, and was over four rimes as much for
ilie non-exercisers. Another significant resuIt is rhar in addition ro [he benefir for rhe
hearr, those ehat mainr;lined their firness also
had rhe LOUJest risk ofdeath fi"om nIL cal/ses.
It is sobering ro recognize ehar non-exercisers increase rheir risk of dearh from
hean disease by abotlt rhe same amOUIH as
smokers. In other worcls, from the srandpoinr of hearr disease, you probably have
Jiule right ro pat yoursclf on the back for
nor smoking lInless you exercise regularly.

Exercise is eleady a major paH of any program ro prevent or reverse heart disease.

Healthier Lifestyle-Better Sense of

The Lifesryle Hean Trial also looked at
(he "before and after" results of how well
panicipams fared as far as their general sense
ofwell-being was concemed. Each participant was asked ro fiU out a questionnaire
before and after the study regarding his or
her psychological diseresses. They were
asked ro rare theit degree of anxiery, depression, illSomnia, and rheir inabiliry to experience pleasure (anhedonia). These four
distresses were totaled ro yidd a distress ndex level for each participanr. The average
levels are shown in Figure 20.
It carne as a surprise to many that aFrer
one yeaI it was rhe vegcrarian grollp rhat
nor only felr better ph)'sicaJly, but memally
as well. The)' had a decrease in depression
and anxiery. fewer problems wth srress, and
improved irnerpersonal reiarionshipsY
Many mistakenly believe rhat their overali enjoymem of life wiJl deteriorare if they
change ro a he.a1thy liJestyle, especially if
they become vegerarians. What will 1 rell
my friends when 1 go out to eat? Will 1
have to sacrifice attending cerrain social
evellts becallse of my new diet? What about
my relatives coming home for the holidays?
Will my taste buds suffer? Will my hllnger
be satisfied? Despite ali of rhese new "problems," the vegetarian group enjoyed Lift more,
and even had a better social lift than before.

Alfxiety, depressiolf, ilfsomllia, & alfhedolfia index








Baseline (pre)

One year (post)

Figura 20

blood vessel improved over four percenr on

the average. 48 Those (hat were moderarely
adherem ro rhe program experienced a 2.5
percenr regression ofcoronary arrery disease.
Those rhat were the leasc adherent had minimal improvemenr, measuring less than one
The issue of adhel'ence makes three
poinrs. Firsr. the closer one gers ro ilie optimal lifestyle, the bener. Obviously, rhe
closer we follow a vegerarian diet, a regular

Angiographic results

Sticking with the Program

Did it make a difference how elosely dle
participanrs stuck ro the program in (he
Lifesryle Heart Trial? Were there an)' <ldverse affeets from "chearing"? This quesrion was looked at very carefully in rhe ini
tial report rhar fcarure<! 12 momhs of follow-up. The allswer was a resoundingyes.
as illusrrated in Figure 21.
These resulrs are not surprising. Within
the vegetarian grollp, rhose rhar were the
mosr adherenr ro [he program had ilie greatest amollnt of regression; that is, [hey xperieneed rhe mose reversa!. Each diseased


regrc5son 4
blockage 3

Most adbcrcQce

Medium adberence Leul adberence

Figura 21


exercise program, and stress conrrol measures-rhe bener off our arreries are going
ta be. The second point is that le ser degrees of adherence can srill produce some
benefic, alchough the resulrs are not as dramarie. The third i rhat ilie lifesryle changes
in the Lifesryle Hea.rr Trial were of grearer
benefit ilian the data shows beeause ofweak
adherence ro che program by some participanrs.

Doctors' Recommerzddtions-Who
Follows Them?
lf you have heart disease. there is much
you C<1n do with simple lifesryle changes.
But mosr people [aii ta grasI' ilie full 1'0renrial of lifesryle changes upon ilieir overali health. Many wim hean disease do not
do l.nuch more than see their doctor and
take medications. An American Hearr Associarion srudy was made to determine how
many individuals who have been diagnosed

About Jh of heart disease patients follow
their physicians' advice in dealing with:
high cholesterol
high blood pressure
lack of exercise

Figure 22


wirh hearr disease complied with rhe correcrive measures prescribed by rheir physicians. The astaunding results are shown in
Figure 22Y)
We see rhat abOlit {Wo-th.irds of hean
disease parients neglecr ta make rhe basic
changes in habits prescribed by mosr doc-

rors (Iower salt, less red meat intake, daily

waJking, no tobaeco. etc.). Thi is a surprisingly Iarge nurnber, since the disease will
take the life of80 percent of tho e patiel1rs.
lf rhey are unwilling ro make ule simple
changes in lifesryle, how can we expeet [hem
ro make major ehanges such as oudined in
dlis chapter? Ase these changes more restrictive than most people cOlild tolerate;

ls Lifestyle Change for Everyone?

It is one ch i ng {Q prcseIH overwhelming
evidenee thar a veoerariall dier is of signifi.
cam advamage in reverslllg heart disease, bUl
is ir a clier that rhe average person C<1n rollow for life? It may seem resrricrive ar fim
becallse most of LIS grew lip earing whalever we liked-an abundance of meat, milk
eggs, checse., ice cream srore-boughr cOJ]venience foocls, erc.-you name ir, we are
it. But loolc how sick many have become
on dur lifesryle. Americans, instead ofbeing an example of fir r c1ass hcaleh, are
among che world's Inosr obese, and conrinue
ro have high rares ofhean disease.We have
ilie largesr and most advancecl hospital in
rhe world-and \ve need rhem for people
who are on the rich, rehl1ed, cholesceroI, farbden elice.
lf yOLl begin to make [he change ro a
vegetarian elier, you wiJl be surprised rhal
what may stan offlooking lilce a "sacrifice"
eloes nor have ro end rhar way. This book i
ded.icared nor only (Q inform yOll of a berreI' way ro live, bur ro also encourage you ro
make ch,Ulges and expericnce rhe benefir,.
They say "Rome wasn'( builr in a day," bUl
when ir comes ro OUl' earing habits, we real'
dle "building" process. Perhaps ir would
be more accurate ro say we mosr fear the
"remodeling" process, rhe c1eaning out of
freeurs and clIpboards of foods thar arc
dangerous ta OUl' hcalth. But 011 rhe posirive side, joining a vegerariaJl ar narural
foods cookiJlg clas can help you get a jumpsrarr imo a new worle! ofbrand new dishes
and foods rhar are borh healchful and rrul)'
sacisfying. lf you do nor havc a cooking
class available in yom arca, obtain several
vegerarian cookbooks and set aside some
qualiry rime ro experimenr. A list of good
vegerarian cookbooks is provided in

Appendix II. Sriek wirh ir, and soon you
will be surprised by how quiekly you have a
wi le varier)' of new recipes that you ean look
f01WaJd ro-and in addition, you wiU Iikely
feei rnuch ben r in a number ofways, borh
ph}'sieally and menrally.

The Vegetarian Bandwagon Rolls

Vegerarianism is beginning ro sweep the
counrry. Millions ofAmericans have raken
srep roward a more healrhful lifesryle in
var}'ing degrees. Many have gone aJl rhe
wa}' 10 dle rotal vegerarian dier and rhe orher
aspeers of a healrhful lifesr)'Je. Vegerarian
rcstauranrs and healrh food srores are proliferating. Ali major airlines now offer roral
vegerarian meals an reqllesL The Ilumber
of brands of non-dair)' foocls such as miJk
and cheese made from wholesome grains is
multiplying. Medical insuranee companies
are bcginning (Q cover costs of vegerarian
lifesryle inStIllet10n and eOllnseling for heare
patient,'. Communiry vegerarian cooking
schools are increasing in populariry. Vegelarian periodicals and eookbooks are being published in increasing numbers. The

vegetarian bandwllgon is rol/ing and this is


one you wiLL 110t W/lnt to

tvledieal insuranee companies are recognizing rhar the vegetarian approaeh is mllch
more cosr-effective tllan rhe alternative of
surgery. MueuaJ of Omaha's expe.nses per
hearc parient is cur by over half by covering
rhe cosr of lifestyle insrruerion for hean
patients. They repon rhar rheir healrh care
subscribers with chesr pains rhar are 0.11 the
program have a 65 percenr decrease in rhe
l1umber e.xperienei ng chesr pain. For rhe
remainder who riU have ir the frequel\cy
and ,everir)' de-crease < often dramaricall)'."
They ;llso repon a signiflcant drop in blood
cholesterol widl no medicarion; !lean seans
sho\\' {hat many pariems experience cessa{ion Of rcversal ofhean disease progression,
and exereise toleranee measured on a ueadmiII "improved 22 percenr." This program
is reducing Mlltual's bealth care COSIS while
producing bener health ofirs subscribers ar
the same time.

"Lifestyle Center/'
Some may feei that ilie)' would like formal insrruerion ro help rhem in making rhe
rransirion ro rlle idealliIestyle. There are
instirutions known as "Lifesryle Cemers"
thar are dediaued ro perform.ing sucll a service. These cenrers accommodare guesrs
wirh various aspeers and severiry of hean
disease and other ailmenrs who sray for a
number ofdays or weeks. Eaeh guesr i pur
on a dail)' exercise raurine railored ro ilie
individual's need, fed a vegetarian diel, given
insrruction in nurririon and orher aspecrs
of healrhfulliving, and raughr how ro prepare healrhful and rasry dishes ro maintatn
rhe dier aner rerurning home. A lisr of
names and locations ofsueh cen rers is found
in the Appendix III.

"It's a very paternalistic attitude

to say, 'We know you won 't even do
it because it's too bard.'" "The
program is not for everyone, but
there is a larger percentage of people
interested in foUowing a
program like this tban
many doctors might
Figure 23

Health Professionab'-Get the Facts

Out-Let the Patimt Decide
Or. Omish is convineed ehar we should
get the faet.s out ta everyone as ta how to
prevenr hearr disease, and inform [hose who
already have it how to reverse iL His staeemenr is quored in Figure 23. 50
Is lifestyle dlange for everyone? Yes, for
everyone wbo has a deep desire for a full
and happy Iife rhac is stronger [han rhe desire for shon-eerrn rasre blid graei ficat ion.
The taste buds wiU adjuse in a few weeks


and will then respond wit.h grea tel' gratitlcaeion rhan eveI before.
Gone by the wayside is (he obsolete CllSrom of healeb professionals who "compassionately withhold" (he oprimal life ryle
counsel-so as noI' [Q "blll'den" patienrs.
Such an approach is nor uue compassion.
Today's health professionals need ro more
fuUy presenr aII of rhe beneflcial lifesryle
options, regardless of how difficult they
think r may be for a pacient (Q implement.
Health professionaJs have no right tO withhold any informa(ion that could lead a parient ro atrain the highest level ofhealth thar
is possible for rhar person. Mv messaoe
the he.1l(h professional is "Transmit the potential benefirs of a healchy lifeseyle c1eaxly.
Then IeI' each patiem decide for himself"
By analogy, if (here was an ideal bul' expensive medicarion available ro ueaI a condition, most physiciallS, including myself,
would inform [he parient of the ideal drug,
and advise the pariem of rhe expense. le
would (hen be up ro the patient ro decide
wherher to take rJle drug.

"Good" Diet "Better" Diet "Best" Diet

Cholesterol (mg)
Fat (% of calories)
P/S Ratio of fat
Animal' protein
Vegetable protein
Caffein.e (mg/day)
Fibet (grams)
Figure 24

>1.5: 1


>2:1/0 rr


Thl'ee Diet Choices-Good, Better,

and Best
We conci ude this chapter by looking al
the approach 1 use when discussing lifeseylc
d1a.nges with my hean patients. 1 call it the
'Cood, Better, Besr Approach." Firsr, thc
"be.~e" approach is the lifesryle program tim
has bcen clearlv shown ro be (he mosI'
heal(hful: a wral' vegetarian diet-the ideal
dic(-in addirion ro smoking cessa(ion, caf
[eine avoidance, regular ex.ercise, emotjonal
supporr, and stress COntrol.
There will be some people ehat for one
reason OI' anorher feel (har iliey cannor~or
choose noI' to--gee on ehe best program.
For chem we can offer the "bcrrer" approach.
The better approaeh would be somewhcre
beeween the j ational Chole.secrol Education Program Diet and tlle best appraach.
For rhose who eleeI' not ro follO'oN eieher
approach, there is the "good approach,"
which is ro follow the National Choleseerol
Educaeion Program ar a similar diet. The
conr.enr of these (h ree diets is shown in Figure 24.
The patients are informed of the level
ofexpececd resulrs from following each opeion. Those who only sllcceed in meeting
[he "good" dier, which is rhe NCEP's srrictesr reeommendaeions: 200 mg cholesrerol
incake per da)', :lnd 30 percent OI' less calories of coral fat (with noe more ehan sevcu
percenc sarura(ed fat), willlikely experiencc
progrt!ssion of hean disease racher ehan regrcssion, especially if iliey are nor on chranie
choleseerol-lowering medication. However,
if (heir previous diet was Tl111ch worse rhan
rhis, (hey may slow ehe ratc of progression.
But the odds are good (hat rhe futuce evenma.lly holds sl1l'gery 01' angioplasry, if noe a
heal'( anack. Whcn one nceds ro jump
across a chasm, a half jllmp just does noI'
do the job.
The goot! news is that throllgh proper
lifeseyle change.s withour use of medications
01' other sophisricared teehnologies such as
angioplastics OI' bypass surgeries, you can
noI' only pret-'m! heare disease. Vim can reIJtrs(!



Ornish 1). an l'ou prcvenr-and rever.e-CAD? I'atiml Care. 1991
15;25:25-4 J.

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9 Andrews Te. Rab)' K et al. Effec! of cholcslerol reduCI ion on myocMdial ischemja in pa!ielllS Wilh coron"r}' discase. Circulalion 1997 Jan
21 ;95(2):324-328.

4; WabJII/l"l PIHJrl7/PC)' "ell1i!pricc. Ardlllore, OklahOIJl;l oblained Fcbruary

9, 1997 for Zocor (20 mg daily).


Slroes ES. Koom:ms HA, el al. Vascular hmction in dle [orearm of

bypercholcslcrolaemic parjcllcs offand on lipid-lowering medicllion. LIII/cel
1995 Aug 19:346(8973):467-471.

Schuler G, Hambrechr R. el al. Regular physic11 exercise and low-fal

dieL EfTecls 011 progression of coronar)' anery ruscase, Cireu/ot/oll 1992

Singh RE, !U.<rogi SS. e! al. An Indian experimeUl wid} nUlrilional

mOduJalion in aCUle myocardial infarclion. Am j Cordiol 1992 Apr

YusufS, PelO R, el al. Bela blockadc during and af!el myocardial inh.rcrion: an ovcrview of lhe ralldomized rrials. Prog Dl1y!iO"l/OSe Dis 1985 MarApr;27(5):335-371.


Bhir SN, Kohl HW 3'~, er al. Ch:Ulges in ph)'sical firness and aii-caus,'
mort;lJir)', A prospecrive lUd)' ofhc.aJrhy and ul\healrhy Ine". }AMA 1995
Apr 12;273(4): I093-1 098.


Ornish. D., BroWl\, S. ., cr :lI. 1990. Call LifcsryJe Challges Reverse

Coronary Hean Disease?The Lifesr}'1c HcarrTrial. umal Jul21 ;336(8708)


< Ornish D. Browll SE, el al. Ca.n IiI" ryle changes reverse corOlur}' hean
disc~se? Tlle Litcsryle Hearr'frial. LiI1lCCf. 1990 Jul21 ;336(8708): 129-133,


Jr, B1air S ,el"!. Prcvenring hcarr allack and dealh in pariems Wilh coronar)' disease. Cirrull/lio71 1995 Jul I:92( 1):2-4.



Ornish D. Fim AJlIlIIo! COllft1'C71ct ()l1lhe Eiimilltltioll ofCoro71t11)' A1'11'1)'

Disl'osf, 7iICf07J, Ari.2IJ7m. Ol'lobn, 1991.





r. Richardson was seartled. What

could possibly have gone wrong?
After years of Sllccess in controlling her cholesterol wirh diet,
Jane's choleseerol was now again an ehe rise.
In lace, in roughly ehree months her LDL
Jevel had soared 50 poinrs. Like any good
doctor, Richardson cried ro find ehe explanation for ehis perplexing rise. Nothing
major seemed ta have changed. Jane's
weight was not a problem; in fact, she had
Iose ftve pOllnds since her last visit. Furthermore, there was no change in the glands
Of oeher organs that can affect cholesrerol
Jcvels, such as the rhyroid or liver. Fi nalIy,
an fllfther queseioning, the source of che
problem surfaced. Jane !lad heard about the
hearr benefits of fish and had added a liberal amOllllt offish ro her nearly-vegetarian
diet. Dr. Richardson discovered it was rhis
addition of fish that had boosted her choleseerollevels. I
If sllch a scenario sounds perplexing to
you, I am sure it did ro many of the physicians who read that actual case history il)
1987. le was inc111ded in a special physician newsletter ehar was paft of a cholesrerol education program co-sponsored by
Columbia Universiry aod ehe American
Heart Associaeion. AJ.though we were noe
raId rhe doctoc's or patienr's acrual name,

the accounr was there in print-a woman

who had moved from a vegetarian-sryle diet
ro a fish-based dier and had experienced a
marked rise in her cholesrerollevels. What
could be ehe explanarioJl fOf chis delctcrious effecr from a [ood we have heard so
IDllCh good about?
For weB over a decade ehe media has
championed fish consllmption. They have
tollted ics abil it)' ro lower cholesterol and
decrease heart disease risk. In 1985, three
high profile studies carne Out on the same
day in the prestigiolls New EnglaJld Journal of Medjcine. In one of (hose reportS,
rcsearchers studicd 20 years worch of coronary hean disease deaths among men in
HoBand. They found [hat ehose who consumed loz. of fish daily reduced cheir eisk
of heart dearh by 50 perccnr. 2 A second
repon dcscribed rhe effecrs of fish oiI on
the lowering of cholesrerol and rriglyceridcs. 3 The rhird srudy dealr wirh fish oil's
effect on whiee blood cell function. 4 As a
resulr of these and ocher stlldies, rnany
Americans switched from red m~u ro fish,
hoping ro improve cheir fat imake, lower
cheir cholesterol levels, and dccrease cheir
risk of heaT{ disease. In rnany cases, the
strategy seems to have worked. A switch
from heavy red meat usc to heavy fish consumption does (end ro lower cholesrerol

1I 1

levels and bring wirh it health beneflrs ro
rhe hean. Howevel', medical research aIso
contains ample UJf1-rnings abour rhe use of
hsh and fish oiI.
Before we look ar some of rhe porenrial
drawbacks of fi, h consumprion, (er us look
at rhe advanrages of earing flsh compared
ro orhel' animal products. fu already stated,
many have lowered rheir blood cholesterol
levels by abandoning cheir "sreak and bacon" ways n favor of a tlsh-rich fare. The
physiology of fish helping ro lower chole.srerol is sound. Compared ro mher aJ1ima.l
prodllCtS, hsh has a generally more [worable P/S ratia. You wiJl recall from Chaprer
3, "Heart Disease-Conquering rhe Leading KilJer," rhat a high P/S ratio meaos
hjgher in polyul1s:lturared tu. An increase
in this rype of fat wilJ lower cholesrerol. Fish
aJso bas less sarurared far. Sarurared fat is
high in sLlch proelllces as meat, whole milk,
eggs, cheese. and coconut and palrn oils.







IS g

IS g

15 g

J5 g

Figura 1

Two Sides to the Fish Story

Wirh aII of these things seeming ta faUle Llse of tlsh, how do we explain the
perplexing illusrr:.uion at the opening of ehis
chapter? The aurhors of Jane's srory k.new
the explanation and stated ir elearly:
"... compared \"'irh a dier rhar is essenrially
vegerarian, rhe consumption offish wiJJ increase dieta1Y cholesterol and often rhe inrake


of sarurateel farry acid as weU. The net resuIt may be, as in this parienr, a rise in LDL
levels."s Olhe.r more recent stuelies have
contlrmed rhar fish oiJ consllmption wiU
very Jjkely illcrease the LDL cholesterol in
mosr people. 6 .7 As e.xplained in Chaprer 3
on heal"( disease, LDL is the "bad" cholesrerol rhar can produce clogged arrcric,
t1uoughour rhe body.
Ler us look ar rhe rwo poinrs madc in
dus disringuished publicarion and see why
fish presenrs a problem. Firsr, fish is an
animal produce, and ie therefore contains
cholesterol. In faer, rhere is nor much difference berween tlle cholesrerol conrel)( of
fish and orher ;:Inimal producrs such as
chicken, turke)', ar even pork and beef.
These cholesteraJ Jevels aJe also rabulared
in Figure 14 in Chaprcr 3 on hearr djsease.
The facr rhar f1sh conrains cholesrerol
purs it in a complerely elifferenr c1ass than
aII planr produces. You will recall rhar aII
plaur sources of nutririon have absolutely
zero cholesrerol. A comparison of rhe cholesterol con tem of various fish and .fish oils
is found in Figure 1. 8
orice rhar rhe cholesrerol levels are
srared for rhe amounr of 15 grams of fish
oiI, which is a standarei supplemenrarion
dosage for cardiovasclilar disease. 9 We see
mat rhese amoums ofcholesrerol in fish oii
are eqllal ro ar grearer than ehe cholesrerol
in a generous serving of T bone srcak, as
shown in the bar on the lefr side of Figure
1. It is ilO woneler thar fish oii can raise the
serum choleseerol. The American Hean
Associarion is known for being soft on dielary guidelines; neverrheless, cven eheir
mosr liberal diet for heaI( disease sriH forbids more rhan 300 mg of choleseerol per
da)'. SlIpplemenra.l use of flsh oii GlJ1 go a
long wa)' ro exce ding even rhis recommendarion.
The second poinr raised by rhe aurhors
of Jane's srory has lO do wirh rhe iSSlle of
sarurared far. Compared ta ot!Jermeats, flsh
has a favorabJe polyllnsatllrared ro saturatcd
far rario (P/S ratio). However, ir does nor
have as favorable a rario as mosr plam-derivedfrati. Again, wh.ile i( is true rhar rhose
who have been earing red mear can bring rheir
cholesreroJ down somewhar b)' s\Virching 10


a hsh-based dier, a vcgerarian dict is much
more dTecrlve. The poim is mar fish raises
blood cholesrerol levels less rhan red mear
ar even poultry. Compared ro planr proclucrs, however, fis/' mises cholesrerollevels.
Although many la} people have been
drawn ro flsh because of ir adveni ed cholesrerol- [owering effecrs, ir is imeresring ro
rcvisir rhe Holland smdy rhar hclped ro srir
up so ll1uch inrereSL 10 When rhe aurhors
published rheir dara showing a 50 percenr
dmp in hean disease deaths, rhey incllldcd
an irnporram facr t.har has been o[ren overlooked: rhe fish earers and heavy red mear
earer had virtual!;, identica! cholesterol levels. The facr rhar flsh may Ilor lower cholesterol bcgs a quesrion: whar is rhere abour
hsh rhar mighr reduce hearr disease risk even
rhough choleslerollevels may nor be alrered?
The answer may [ie wirh anorher compound, ealled omega-3 fars.

Omega-3 Fatty Ads Reduce Heart

Disease Risk
Cerrain fish are rieh sources ofamega-3
fan)' acids. 511Ch flsh include sah110n sardines, mckerel, and some orher fany fish. II
The omega-3 fars in rhese hsh are long-chain
pO[Yllnsamrared farry acids which include
eicosapemacnoic acid (EPA), a far wirh some
unique hearc advamages. For e-xample EPA
helps ro decrease rhe srlckiness of plarelers.
lhe body's c10ering cdls. ll This is imporranr: anyrhing lhal helps ro prevem platelers c1umpi ng cogether decreases rheir rendcncy ro plug up blood vessels. This in rurn
ean help ro decrease ehe ri k of a blood elOt
forming in a hean blood vessel aud causing
a hearr arrac1<.
Omega-3 far can aJso help ro mildl)' decrease blood peessure. 13 Many experience
an aClual decrease in rhe serum rrigl)'cerides from consuffi.ng rhis dass of far .14 For
mese re.lsons and omers, l s likely ehar rhe e
omega-3 fars al leasr have some rendency
ta decrease rhe rate of al.herosderosis. 1;
Bc)'ond tJ)ese reasans, animal lnodels suggesll.har ifa hearr arl.ack does occur, omega3 fany acids may decrea e rhe amOllnr of
muscular damage occllrring horn lhe artack. 16 These unique fars 31so appear ro

decrease rhe likelihood of blood vessels

blocking up again afrer angioplasry ("rhe
baJloon procedure" used ro open up blocked
hearr arreries), 17 ;:md can a[so decrease lhe
rare of c10gged bypass grafrs following bypass surgcry.18 A ummary of rhese omega3 benefirs is sho\vn in Figure 2.


They help to decrease stick.iness of platelets, tbe
blood's c10tting cells.
They tend to decrease blood pressure.
They tend to decrease serum
If a heart attack does occur, they may
decrease muscular damage resulting
from the attack.
Tbey appear to decrease the Iikelihood
of blood vessels block.ing up again after
angioplasty or bypass surgery.
COllsidering (he evidence, should we eal.
flsh to help decrease hearr disease risk? A
furrJ)er look ar orher popularion studies may
help ro provide rJ)e answcr. We have alread}' looked ar the DUICb srudy thar demonsrrared a 50 percenr decrcase in coronary
aner)' discase dearh. among dajJy fish earers. 19 Wh.ile a 50 perccl1t reducrian is signiflcanr, a ll1uch grearer re,ducrion occurs
among total vegetarians. A sludy ofSevenrhday Advenrisr men on a toral vegerarian diet
showed [har cheie risk was lowered bv 86
perceI1t. ,,0 The resulrs in borh srudie~ are
noe unexpecred: rhose on a poor diee may
benefir from adding fi h in place of other
more harmful foods. Adding hsh may lower
rheir hearr disease ri k; ir mighr even Jower
[heir cholesrero[ levels. However, t.hey cannor get lhe magnilLlde of benefit rhar ehe
optimal dier provides. As we have seen in
[he rwo previous chaplers, 111311Y lines of
evidence demonserare rhar lhe oprimal dier
for hearr disease preveneion is (he (Oral vegerarian diee.

Figure 2


Anomer popularion stlldy is of parricuIar noee. This published repore from
Harvard Universiey represents probably che
mose sIarisrically powerful research ever condueted ro examine che fish-hearr relarionship. Where che Ducch srudy looked ac only
852 men, Ihe Harvard researchers srudied a
phenomenal44,895 male healrh professionals. 21 The researchers' findings were asronishing: men who ace fish several cimes a week
were jusc as likely ro have hean disease as
rhose who are ie only once a moneh. If anything, there was a suggestion ehae [he men
who consumed six or more servillgs of fish
per week had a somewhac grealer risk of
coronary hearc disease ehan those who con-


rheumatoid atthritis


primary Raynaudl's


GI ul'cers
uJcerative colitis
Croho 's disease

possible prevention
of breast aod
colon carcooma
possible prevention of
chronic obstructive
puLmonary disease

Figure 3

The better the diet, the less

benefit rkrived from adding fish. On an excellent
diet, fish wilL increase
rather than decrease heart
disrase risk.


sllmed one serving per month ar less. The

explanaeion mOSI likely has ro do with whac
foods other than fish were inclllded in the
dieL The beuer ehe dice, (he less benefir
derived from adding fish. On an exeellem
dier, fish will lncrease racher rhan decrease
hearc disease risk.

Smoking Negates Benefits of

a Highjish Diet
Inrake of omega-3 farey acids in a highftsh dier by ehose who smoke does nor pfOrect against coronary dearh. In (acr, it might
have ehe opposite effect. A six year srudy

spearheaded by Dr. Pirjo Pieeinen of Helsinki, Finland, involved 22,000 middle-age

srnoking men for c<udiovascular disease risk
and intake of fauy acids. Those who had
t!le highest inrake (eating more fish) had a
30 percenc incrett.ccd risk of dying of COfOnary disease compaced ro mose who had rhe
lowese imake. 22
In summary, regacding ehe hean. rhere
is srrong evidence ehar fish only worsens an
excellenr diee and thar in smokers a high
fish dier is also deerimenra1. However, could
there be orher benefirs beyond hearc disease
from earing hsh and eheir accompanying
omega-3 faley acids? Should we eal ar least
some f1sh co reap ehose benefits? Let us look
ac furcher information on omega-3.

Other Omega-3 Benefits

Tlle advantages of a dier high in omega3 do noe Stop wim the heare. The various
known non-cardiac benefiIs of following a
dier high in omega-3 fatIy acids are \isred
in Figure 3. 23
Omega-3 farey acids are of benefir to
[hose with rheumaroid archriris and other
infhmm.arory anhriric condirions. 24 . 25.26.
27 Rheumaroid archrili is a crippling eype
of arrhrieis. Often Ihe hands and orher
joilHs become seriously deformed. In addi(ion, ir rends eo affect the whole body and
nor juse ehe joinrs. It can affecr blood vessels, ehe spleen, heare, lungs, and skin. 28
Funhermore, rhis disease can be notoriously
difficuh ro treae. Often ehe drllgs employed
have serious side cffecrs. Thus, when rhe
news earne ouc thar a dierary change could
help chis devaseaeing disease, rhousands of
sufTerers 110 doube rejoiced.
The omega-3 fars are also help/td in psoriasis. 29 . 30 Psoriasis is a skin condirion rhar
can range from mild irehiness and scaI ing
ro distlguring and painful rashes ehae ma)'
ooze and bIeed. Omega-3 fars along wirh
orher polyunsacuraeed fars can also help wirh
[he healing of skin and sromach 1I1cers. 31
These fars can prevem the mulciplicarion
of or even kiU Helicobacterpylori, bacreria
[har are weli known to cause seomach and
duodenal ulcers. 1'his provides furrher good
news for armrieis pariems; many of mem
suffer from sromach ulcers duc ro common


arr1lfiris medicarions, especialJy if chey harbor the harmfuJ bacteria in their stomach
linings. The omega-3 fars may also have a
role in cancer prevenrion. The risk ofbom
colon cancer and breasr cancer seems ro
decrea e when rhese fars are inc1uded in the
clieL 32,3 ,34
One of my special interesrs is in gasrrointesrnal diseases. One problem rhar 1
crear in my office on a daily basis is a disease caUed u1cerarve coliris. Ulcerative coliris is an auroimmune disease wherein rhe
body atracks rhe colon, causing ulcers, in~ammarion, fevers, bJeeding, diarrhea, and
abdominal pain. It tenels ro relapse frequently; that is, it will subside for awhile
and then fiare lip agaiJl. A four-monrh long
stlldy included 23 patienrs wieh chronic
acrive ulcerarive colitis. 35 About onc-half
of rJle parienrs were given duee grams daily
of eicosapemaenoic acid (EPA), an omega3 fatty acid. The omer group received lookalike pills rhar had no medicinal cffeces
(called a placebo). Afeer four monchs, rJle
rwo groups were switched ro the opposite
trearmenL The results of ehe scudy are summarized in Figure 4.
Norice chac only rhree Out of ten who
took rhe placebo had remission, and aII duce
lacer relapsed. The stOry was rernarkably
differenr for rJlOse raking ornega-3: 10 aur
of 13 experienced a remission of their discase. Even rhough sJighdy morc rhan 50
percenr of chose wirh a remission later relapsed some remained disease-free.
Unfortunate!y, cow's milk anei many infam formulas lack cerrain ol11ega-3 fars rhar
are necessary for o~){imaJ brain and eye developmen(. Human breasr milk, however,
has abllndanr omega-3 fars and may be one
reason why infanrs raised on hllman milk
do berter on inreliigence tescs rhan rheir
formuJa-drinking counrerparrs. 36 . 37. 38 An
omega-3 farry acid deficicncy can also cause
depression or even over-aggressiveness in
adlllrs. 39
Wirh ali the wealth ofinformation demonstraring ilie bcnefirs of omega-3 fars, it
ll1ighr seern thar we should ar leasr pur a
[itde /lsh on our din ner plates. Bur before
final recommendarions are issued regareling
our personal eating habirs, we need ro ex-

plore more flllly ilie "down side" of fish consumptlon.

Fish and Fish Oif's Bad Side

Fish oii capsules anei other fish oiI
sllpplemenrs may nor olter che benefies of
flsh oii in its fresh, naruraJ stare. Alrhough
rhe fresh omega-3 polYlll1sarurated acids
tend ro help plarelers anei decrease heart
disease risk. oxidized omega-3 fatry aciels
may do rhe opposice. 40 While on the shelf,
natural fish oil can become oxidized,4f and
therefore very damaging ro arreries due ro
the oxielizeel cholesrerol. Furthermore, EPA
(the omega-3 fatty acid present in flSh)
re:adily ox.idizes ro form peroxides, which
are powerflli (ree radicals. For anyone who


Dose = 3 g/day
First Test

EPA Placebo
otal subjects



No. Improved


No. Uncbanged

No. Worsened

Figure .4

is concerned aboLIt avoiding free radicals,

giving up fish wOllld be a logical fim srep.
Fish oiI supplemencs may nor offer me hearr
and blood vessel benefits consumers aoricipare. The Nllerition Commirree of the
American He:trt Association has recenr.ly
gone on record staring, "fish oiI capsules
cannor be recommended at this rime ... tO
prevenr disease of rhe coronary aneries. "42
There are several important potenrial
problems wirh eacing fish aud fish oiI. These
problems have nor been well publicized.
They are ljsted in Figure 5.




Can worsen blood sugar levels in diabetics.
Large amounts can dangerously prolong the
blood clotting time.
Fish oii is expensive.
Large amounts cause vitam'in overloading Olr
vitamin deficiency.
Can lead to an increase in body weigbt.
Sea food is a large reservoir for infeetious
Toxins acquired from contaminated waters
concentrate in the fatty tissues of fish.
Figure 5


The irems in Figure 5 deserve funher

1. Fish oiI can raise blood sugar in adulronser diaberics. A Universiry of California
smdy found rhar chese so-called Type II diaberics experienced a nearly 20 percem rise
in their f.1.Sting blood sugar levels after raking fish oiI for a mere four weeks. 43 The
reason for the diaberic worsening appears
ro be EPA; rhis omega-3 fac may reduce insu1in produccion in diabecics.
2. A dier very high in fish or fish oii can
dangerollsly increase rhe blood clorring
rime. 44 Eskimos, alrhough rhey have [ess
heart disease. have more hemorrhagic
(bleeding) srrokes ehan Americans do.'oS
Apparenrly, rheir fish-rich dier causes such
an impairmem of plateler fllnccion thar rhey
bleed more easily.
3. Fisb oii is expensive, especially in capsuIes. Researchers used [5 capsules of fish
oii daily for six momhs in arder ta decrease
re-acclImularion of arherosderosis folJowin.g angioplasty.46 Remit prices are about
$9.00 for 100 capsules. This rranslares imo
over $245 for rhe six month course of
rherapy. Continuing on rhe regimen wouJd
cosr around $500 per year.
4. Large amounrs of fish oiI used as 3
supplemem may upscc your viramin baIanceY Or. Jack Yetiv has poimed out rhar

high doses of fish oiI may cause ve,.y high

levels of Vitamins A and O-so hjgh thar
rhey could be toxic. BOth of rhese vir3mins
are fac-soluble nurrenr rhar are necessary
for life and healrh in appropriate amoums.
However, either can cause poisoning-and
in some cases-death, iflevels buiJd up roo
high n the bJood. On rhe ocher hand, a
diet rich in fish oiI can cause Viramin E r!e-


5. The large amOllnrs of fish oii rhar

have been lIsed in many studies can Iead ta
a signiflcanr increase in body weiglu. These
prepararions are exuemely high in far and
calories. 49 Yeriv estimaced a person could
gain up ro 24 pounds in a year ifhe rook as
mllch fish oii eacb day as some srudies wcre
llsing. so
6. Seafood is a reservoir for infectioU5
diseases. There are abolit 113,000 reporred
cases offood poisoning from comaminared
seafood each year in rhe U.S.51 This is clearl}'
an underestimare, since many iJlCidents are
nor reported. Seafood concribures ro ;t disproporrionaeely high amounr of food poisoning otltbreaks. Staristics suggese rhar
reporr.ed outbreaks (episodes of food-relared
iJIness where more rhan (\Vo people are affccted by a commons source) 1nighr be as
much as 15 ar more rimes likely ro occur
wirh seafood than with beef, poultry, or
pork. 52 Raw shellfish in particular (such as
oysters. clams, and mussels) have a dismal
record. Abotlt 20 miII ion Americ.1ns ear raw
shellfish, which account for more rhan 90
percenr ofseafood poisoning cases. S3 When
raw sheUfish s earen, rhe whole living crearure is consumed complete wieh irs gasrroinresrinal uact. Thac would be equivalent to plllcking a [ive chjcken and eating il
whole, guts and alI. Whar's more, shellfish
feed by filtering (\VO ro rhree gallons of water an hour. That means rhe)' ral<e in wharever is floaring by-not only plankron and
orller food, but viruses, bacreria, mercur)',
and who knows whar else~
Unfoftunace1y, sheUfish are commollly
harvesred from coasral w<trers [har have becn
conraminared with human sewage. Infecrion wirh salmonella, campylobacter, t11e
Norwalk virus Vibrio vulniflcus (which
alone kilis 10 ro 15 people each year), and


orher infecriolls diseases can reslIir. Even
well-cooked shellfish can infrequendy cause
serious or life-rluearening illness. Two such
maladies include paralytic shelJfish poisoning and neurocoxic shellfish poisoning. 54
hellfish are nor the only seafood ehar
presene causes for concern. For example,
over 400 different species of reef fish carry
rhe risk of rransmitting ciguarera poisoning, which is rhe most common fin fish
poisoning in rhe Unired Srares. 55 Some
8000 Americans a year are made il! by rhe
ciguarera roxin. Altecred fish, such as red
snapper, amberjack, barraclIda, and grouper, look and Tasre normal but C<ln produce
a disease thar causes digestive symptoms
such as nausea, abdominal cramps, and diarrhea. Later a "pins and needles" sensation occurs around and inside the mourh
and in rhe hands aud feet. Vierims often
experience "remperatllre reversals" where
hor rhings feel cold and more likely, cold
rhings feei hot. While the effects of
ciguarera usually last aboUf twO weeks, as
mal\Y a 20 percem of aH victims will srill
have some symptoms at six momhs and five
percenr ar rwo years. 56 Nerve and vision
invoJvemenr, heart and joinr problems, and
somerimes even dearh can occur. 57
Scombroid poisoning is less common
and less serious rhan cigU:Hera. SYll1ptoms
include a rillglillg and burning sensation
around the mourh as well as diarrhea,
ccamping, and an ieching rash. Most cases
in the U.S. occur from mahimahi or fresh
luna. 58 Sushi, raw fish Japanese-sryle, a1so
presenrs unique risks. Roundworms, flarworms, tapeworms and flukes can aII be
rransmirred by rhese sea food items. 59
What about rJ1C~ redllcrion in warer pollurion~ Has it now made it safe ro ear fish?
Do not be misJed by impressions thar warer pollution is f:1sr becoming a rhing of rhe
past. AJehough regularory bodies may be
keeping a closer eye on roxins released by
indusrries, rhere are even more imporram
non-industrial concerns regarding infecrious
disease agems. For example, in some locations l:lrge numbers of sepric tanks have
been consrrucred in unsllirable soi! near
\Varer sources. The resuiring overElow has
been known ro callse such severe pollurion

rhar shell fish beds have been officially

c1osed. 60 Other sources of microbi;ll water
comamination include animal wastes from
agriculture and municipal wastewarer discharged by publidy owned trearmem facilities. 61
7. Perhaps mosr imponandy, fish concentrare roxins in rheir fatry ti sues. These
roxins include pesricides, chlorinated hydrocarbons, diox.in chlordane, and mercury. As
of 1996, 47 srates had fish consllmption
advisories thar wam againsr eating cenain
species. They cover 1,740 rivers and lakes
(including alI of the Creat Lakes) and large
chunks of coastal areas. 62 The mosr COl11mon reason for consumprion advisories is
mereury. which can callse brain and nerve
damage, especiaJly ro feruses and young
children. Large fish fike fresh tuna, swordfish, and shark have rhe highesr levels of
mercury.63 Despire rhe popular belief rbar
fruits and vegerables have rhe greatesr risk
of pesticide contam.inarion, rhe FDA's resC<1rch reveals rhat domestic fish producrs
conrain significamly more pesticide residues
ehan domesric fruits, grains, or vegerables. 64
Bluefish, along wirh lake reout and orher
freshwarer fish caughr in inland lakes, are
most likely ro be conraminated wieh carcinogens like dioxin or PCBs (poJychlorinated biphenyls).6"

Contaminated Fish from Contaminated W0ters

Pesricides are an extremely important
issue. Worldwide, there are more than 900
differenr active pe,sricides in some 40,000
difTcrem chemical formularions. 66 In the
U.S., abolit 600 pesricide ingrediems are
used, accouming for some 800 million to 1
billion pOllncls per yearY Huff and
Hascman reviewed some 200 radene studies; they concluded rJ)iH "rhere is considerable evidence that exposure ro cerrain pesricides may prcsem real carcinogenic hazards ro hunlalls. "68
How do fish become exposed t() pesticides? fu previously memioned, one big
cause is agricultural runoff. When a farmer
sprays !lis fields, a ponion of rhe chemicaJs
will be washed ofT into neighboring creeks


and srreams, and ulcimarely imo eivers and
oceans. Sewage overflows, falllry sepric sysrems, boarjng wastes, and poisonous eunoff Erom city streets have a1so coJ1tribllced
ro the poUurion of warers. These watees are
sometime-s considered so dangerous rhar
signs like (he one shown in Figllre 6 are
erecred ar some swimming beaches.

Figure (,





Figure 7





rf swimming in the warer is haz:lrdolls

for humans, it i~ ironic that peaple Stil! go
fishing n these areas. The sign are nOt "calJing wolf." IlInesses sucit as gasrroenreriris,
dysentery, hepariris, and orhers can result
from swimming in conraminared wareI.
The risk of spending rime in the warers
an aur globe is highlighred bya disrurbing
tTend among fish. Fish have more cancer
now rJlan 50 years ago. 69 A Canadian biologisr, Ron Sonsregard, has examined borrom-dwelling fish in the Grear Lakes aIld
rhe rivers rhar feed rhem. In every fish spccies he has found [Umors-ofren maIignanr
ones. 70 For example, 30 percene of rhe buliheads in Lake Ete had liver cancer. The
Ph.D. nurririonisr and amhor, Dr. Winsron
Craig, in commenting an these findings,
added duee more sobering facrs: (1) the
Grear b.kes sruarion is not unique: problems wirh cancerous ftsh have [Umed up
from Pugct Sound ro rhe Culfof CaJifornia
and from the Hudson River ro rhe F10rida
Keys; (2) National Cancer lnsrittlte dara
show an increased death rarc from cancer
among people living in areas wherc fish have
exceptionally large amounrs of tlImors; (3)
tne toxic nature ofwhat s found in some of
our watcrways is astOnishiIlg: whe-n seelimenrs [rom the bottom of L1ke Erie were
painred an cl1e skin of mice, rJ1e mice developed skin cancers. 71 A1though Craig's
insights may not necessaril)' prove human
risk, clIey surdy raise serious concerns abour
the hllman healrh hazards from rhe "epidemie" of cancers in fish.
Rarher large amounrs of fish die in
droves every year throughour our counrry
simply due ro pollurion itse1f. The Environmemal Protection Agenc)' (EPA) of the
D.S. governmenr has arrempred ro rraee rhe
amount offish kills duc ro pollmon as well
as orher causes. Figure 7 reports rJ1e nuOlber of fish kills proven ro be due ro pollution by state in 1993. 2 Each fish kjllllSllally represents lireralIy thou 'ands of fish.
The EPA admjts tiut rhese figllres
grearIy ullderesrimare rhe aCtual number of
fish kills, since 15 stJtes did nor repon oe
keep track of cheir fish kiJls. Also, man}'
addirional fish kiJls oceur bur cannor be
definireiy proven ro be duc ta pollution.


Pesricides were rJ1e mo 1 freqllenrly identifiee! wxc pol/mam callsing hsh kills, followed by oiI and gasoline prodllcrs, chlorine, ammonia heavy mecals, and orher
toxic subsrance5.1 3 Unforrunarely, many
fish rhar are ill and suffering from rhese
pollulanrs bur have nor yel died are c<lllghr
by flsherman, taken to marker, and COJ1sumed by humans rhar rhink rhe)' ale ea(ing healthy food.

No Mandatory Inspectiol1 ofFish

OI'. Craig has poilHed our another serious concern wirh fish safee}'. There is no
governmem mandatar)' inspection program
for fish ar fish producrs ar rhis wriring.
Craig srares (har only "bom 1O percem of
flSh undergo any rype of inspecrion, and rhis
is through a voluntary program.74 Obviously, there is need for a well-ordcred inspection sysrem for fish rhar has just noe
laken place. If we could find I~on-fish
sources of rhe beneficial omega-3 fats,
wouldn'[ it be more sensible, from aU rhar
\Ve bave learned, ro JUSl ser fish aside? Such
Coods would not provide a porential reservoir for cancer, infecrjolls diseases, ~U1d oeher
ailmenrs. Foods of rhis kind do exisr, as we
shall sec later.

Mildly-polluted wtlter Produces

Super-polluled Fish
\'{firh cancer being ehe greatesr concern
regarding exposure ro pesricides and orher
ro>ns, we musr recognize which roxins pose
the grearese risk during long [enn exposure.
Poisolls thar present rhe greatest long-renn
rhrears ro hllmans have rwo narural characterisrics: a tendency toward "bioaccumubrion" and a rendency wwarel "biomagniflcation." 80rh of these processes cause
fish from mildly poLiuceel warers ro have
lalge concenrrations of rox.ins in f1sh tissues.
Bioaccumularion is rhe process by which
IOxins gradually build lip in cenan organs
of hllmans 01' ocheI' rargec organisms.
Biomagniflcation refers ro a process where
poisons become progressively more concentrared as rhey move lip rhe food chain,75
A c1assic example of biomagnification
was discovered in Cle<lr Lake, California,

abOli! 90 miles norrh of San Francisco.76

The Iake had been sprayed several rimes with
an insecticide called 000 ta control rhe
insece popularion. (000, a less pOleIH
cousin of ebe infamolls ODT, is eechnicaIly
referreel ro as a halogenared hydrocarbon,)



parts per million (ppm) in Clear Lake, CA

Figure 8

The re5l1lrs of spraying rhis insecticide are

shown in Figure 8.
Norice ehat the lake warer revealed bardv
derectable levels of rhis pescicide. at .02 PPI~
(2 drops of 000 in every 100 million drops
oflake water). Biomagnificarion. however,
callsed a dramatic increase in rhe lisslle leve1s of organisms thar lived in rhe lake. The
concenmHion ofDOO in rhe phytoplankcon in the lake measured 5 ppm, which is
500 rimes rhe concenrrarion in the Jake
warer. furthermore, in progressing up rhe
food chain, rhe conccnrration ofDOO approached 2500 pplll-a whopping 125.000
rimes rhe warer concenrrarion.
Such examples of biomagnificarion are
not rhe exceprion; rlley are lhe rule. The
EPA has gone an record ebat: "Aquatic organisms may bioaccllmulare environmental contaminanrs tO more rhan 1,000,000
rimes rhe concenrrarions dereeted in the
warer. .. "7 Evidence is mounrng rhar rhere
may be a relationship berween IOxns a.nd
chronic hllman diseases sllch as cancer




and hean disease rhar altecr rhe developed

narions in epidemic proportions. An example is provided by rhe halogenared hydrocarbons, which is one cIass of compounds, as we have seen, known ro be
biomagnified through rhe food chain.
They also bioaccumulare in humans.
Elevared levels of these compounds have
been found in d)e rissue of breasr cancer
parienrs. 78 The researchers who idemified
rhis breast cancer 1inkage conduded:
"These resulrs, alrhough preliminar)', suggesr a role for environmenrally-derived suspecr carcinogens in the genesis [origin] of
mammary [breast] carcinoma." But the
problems do not srop wirh cancer. One
invesrigaror, in rus review of rhe lirerature,
found a "correIarion berween DDT plus
ODE [rwo orher halogenared hydrocarbons] in the blood and subjecrs who reported hyperrensiol), arreriosderosis, and
diabetes during subsequem years ..." 79
Fish present some of rhe grearesr concerns
rhe standpoinr of
biomagnificarion and bioaccumularion.
They have nor only bee)) found ro be conraminared wirh PCBs and various heavy
merals such as mercllry, bur also wirh perroleum hydrocarbons and the halogenared
organic compollnds. 80 . Rl In a prominem
medical rexrbook an environmenral medical issues, Dr. Kennerh Rosenman ofMichigan Srate Ulliversry srared: "The major
ongoing source of PCB exposure for rhe
general popularion is rhe consumprion of
6sh."82 Along with concerns about causing
cancer, rhere is preliminary evidence linking borh PCBs and dioxins with e1evated
blood cholesreral and uiglycerides. 83 Orher
data indicate rhar PCBs may affect male
sperm cou nts and fertil i()'. 84
Research suggesting rhar d)ese contaminams can harm the developing ferus has
increased rhe srake.s in rhe PCB issue even
furrher. Dt. Theo Colborn has poinred our
that ilie research lirerarute suggests that PCB
presem in the womb can "affect rhe developing nervous sysrem of rhe embryo, ferus,
and newborn."85 RecentIy, the New England Journal of Medicine grabbed headlines when Drs. Joseph and Sandra Jacobsen
further quanrified the developmemal risks

of PCB e.xposure. 8G Even ar 11 rears of age,

children wirh higher exposures to PCBs brftre birth showed impaired inrellecrual development. AJrhough rhe children were nor
rerarded, dwse with the highesr PCB exposures were rhree rimes more like1y ro have
low IQs and f\vice as likely to be at least
rwo years dela)'ed in rheir readij)g comprehension.
Accllmulation of toxic merals in fish has
become of particular concern recenti)' in
light of the problems wirh acid rain. Acid
rain Ieads ro acidified waters. This chemically-a1rered warer can then leach a1uminum, manganese, lead, zinc, cadmiuln, aaci
mercury our of bonom sedimenrs or soil
ineo the warer. Once rhese toxic merals are
liberared, rhe)' find rheir wa)' imo the food
chain and rend ro bioaccumulare in fish rissues. Even i Il seenie Maine, women ofehiJdbearing age and children under eighr are
being urged not to ear fish from any pond
or lake in Maine. Orhers are advised ro resrricr rheir consumprion ro no more than
six large fish ar 22 small ones annllaHy, aU
due ro rile mercur)' comene of the fish. 87
Mercury ingestion in high levels ean harm
the deve10pmenr ofhuman fetuses and children, and callse nervous sysrem disorders
and kidl)ey damage in children and adults.
Michigan is rhe only orher srare ta issue
such a sratewide warning. However, aceording ro Martha Kearing, an EPA sraff scienrist, the U .S. national average of orher lakes
and srreams are jusr as hazardous as Maine's.
The Boswn-based Clean Water Aetian
grollp has even gone on record stating that
90 percenr of freshwater fish callghr in New
England warers have conraminarion levels
of mercur)', lead, PCBs, or dioxin rhat are
ullsafe when consumed more thar once a
week. Alrhough the group had collecred
significanrly less data an salrwarer fish and
thus could not make such a sweeping srJremenr, rhey did warn rhar rhe salf'.'Iater fish
rested had high levels ofPCB and mercur)'.
Probably the most widely publicized case
of hsh-l'e1ared heavy metal poisoning had
nothing ro do wirh acid rain. It involved
the tragic human methyl mercury poisoning thar resulted from eating fish from
Japan's Minamata Bay. Japanese facrory dis-


charges of merhylmercury into rhe bay Iaid
rhe foundacion for rhe problem. The
biomagni/lcation rhat occurred through rhe
food chain exposed humans who are ilie fish
ro dangerous organic mercury levels. 88

Health Problems/rom
Contaminated Fish
Perhaps rhe grearesr dangers from fish
are rhose faced by Illirsing infams. One
srudy found rhar those who consllmed conraminared Grear Lakes fish experienced reproductive complicarions. These incLllded
alrerarions in birrh size, gesraronal age,
changes in neonaral health sratus, an.d effeers rhar persisred inro early infancy.8? As
a resulr of rhese risks, some have sllggested
tim infanrs should .nor be breasr-fed becallse
of rhe cancer risk. A1rhollgh rhis may secm
ro make sense in aur roxin-conraminared
world, a berrer alternarive may be avoiding
rhe major sourees of (hose roxins. Orher
researeh suggesrs rhar the borrle-feeding
srraregy may back.fire. There is evidence rhar
breasr feeding in alld ofirself tkcreases breasr
cancer risk. A 1994 srudy found (har daughrers who 'were breasr fed by (heir motl1ers
had 2S percenr less breasr cancer. 90
For convenience, a SllJnmary of previously menrioned conraminarion compounds fOllnd in fish is shown in Figure 9.
Possible links ro cancer from conraminared fish are slImmarized in Figllre 10.
PCB con ramil-lar ion of fish has been weU
docllmenred. The evidence of the delereriDUS efTecrs of PCB on rIIe human reproducrive sysrem is sunuuarized in Figllre Il.

Fish Farmingfor Safer Fish?

In fairness ro the fishing indllsrry, it
shouJd be menrioned rhat aquaculrure (fishfarming) may circumvenr some of rhe concerns regarding roxins. Such fish are grown
in conrrolled bodies of warer (har are isoIared from open srreams. Ifauenrion is paid
(O warer qualiry in (hese commercial fish
fanns, some of rhe problems assoeiated with
pollution can be avoided.
However, if financial inreresrs continue
ro prevail, lax warer qualiry standards may
also render these fish po(entially dangerous.

Fish from mildly polluted water concentrate
toxins up to more than 1,000,000 times more
than detected in water.
Toxins in their fatty tissues include
pesticides, chlorinated hydrocarbons,
mercury, and dioxin.
. . Fish can also be contaminatcd with peRs,
various heavy mctals, petroleum
hydrocarbons, halogenated
organic compounds, and Icad.
Figure 9


Elevated levels of pcsticide compounds bave been
found in tbe tissue of breast cancer patients.
ational Cancer Institute data ShOlV an increased
death rate from cancer among people Iiving in
areas wbere fisb have exceptionally Jarge
amounts of tumors.
Fish have more cancer now
than 50 years ago. Example:
30 percent of the bullheads
in Lake Erie were found
wth Iiver cancer.
Figure 10


The major ongoing source of PCR exposure for
the general population is the consumption
of fish.
peR may affect male sperm counts and fertility.
PCB-contaminated fish eaten by pregnant
mothers are Iioked to alterations in
birth size, gestational age, and
changes in neonatal heaith status.
Children at tI years of age with hgher
exposures to peR before birth show impared
intellectual development.
Figure 11


Of. Mchael Jacobson of rhe Cenrer for Science in rhe Public lnreresr indicarcs rhar
farm-raised hsh are nor free from concern.?1
Based on rus research, he has highlighted
several issues: (J) food coloring has iliegaHy
been added ro feed ro make farmed ush look
more arrractve ro consumers; (2) anribiories are romine1y used in the ush farming
indLJsrry; (3) pesticides have also been applied by aqua-cu1rurisrs; (4) fann-raised fish
may have lower omega-3 levels due ro differences in their feed.



Food Item
Fla.xseedlLinseed oiI
Walouts, Englisb
Canola oU
Walnuts, black
Wbeat germ oii
SoybclIn oU (Crisco/Wesson)
Green soybeans
Spin8ch, canned
California avocado
Samower oii
Swcct pot,atocs
Medium apple w/pccl
Roasted potato, medium size
Cucumber slices w/pecl
Whole wbeat bread

1 Tbs.
1 Tbs.
1/4 cup
1 Tbs.
1 Tbs.
1 cup
1 cup
1/4 cup
1/2 cup
1 cup
J Tbs.
1 piece
1 each
1 cach
J each
10 picces
1 piece




Figure 12

Get the Omega-3 Benefits Without the

Risks ofEating Fish


There is a way ro have rhe benefirs of

rhe omega-3 fatry acids without having to
ear fish, fish oii, or expensive capsules. There
is a way ro bypass rhe cholesterol and toxins rhar come w,irh rhe animal-derived
omcga-3. The way is so simple, bur it is
nor gening rhe publieiry it deserves. We
can obrain rhe benefits of omega-3 fatry
acids /Tom a planr far caUed linolenic acid.

The human body can acrually make rhe

well-srudied eicosapenraenoic acid (EPA)
from linolenie acid. Linolenic acid is itself
an omega-3 farry acid and is an essential
componenr of rhe human dier.
Linolenic acid is differenr from linoleic
acid. The cririeal difference is in the letrer
"n" rhar is rhree lerrers from the end. StIldenrs of biochemistry may remember che
difference berween rhese very difFerem fats
by noting rhar rhe one with rhe "n" rhrec
lerrers from rhe end is an "n-3" t1r (another
redmical nallle for an omega-3 far). an
rhe orher hand, rhe far wirhour rhar crirical
"n" is linoleic acid, called omega-6 fatry acid,
and is round in corn oii and safflower oiI.
Mally comOlon planr foods are rich in
linolenic acid. Some of rhem are lisred in
Figure 12. 92
Nore rhar rhe highesr source oflino!enic
acid is flaxseed oii (a1so c;ll1ed linseed oii).
Onc rablespoon has over 7500 mg of linolenic acid. One-quaner cup ofEnglish walnurs conrains 1700 mg of rhe omega-3 linolenie acid. One tablespoon of soybean
oii has more rhan 900 mg. Even one cup of
canned spinach comaios abolit 350 mg. We
do nor normally rhink ofspinach as having
much far, bur it is an excellent source of
omega-3. Today's generarion of morhers can
now rell rhei( children ro ear rheir healrhful
spinach wirh added force. Even common
foods we ear every day, Wee a banana, an
apple, bre-ad, or poraroes, aII make rlleir
conrriburion ro our linolenic acid imake.
As we can now bener undersrand the
benefirs of omega-3 fatt)' acids, we can also
appreciare rhar it can make a difference
where we ger rhem. When adopring a balanced dier of plaJH foods, we reap the benefits of omega-3 wirhour rhe roxins, pesticides, aod cancer risk inherenr in rodav's
fish. Besides enjoying ilie foods lisred abo~'e,
if you are in need of eoncentrated amOUl1TS
of omega-3 fan}' acids, rry grinding equal
proponions of flaxseed and walnuts. We
caII it "flax-nm burrer." It has a te..xture similar tO peanllt butter and is quire tasry. Patienrs suffering from significanr coronary
arrery disease, rheumaroid anhritis, psoriasis, or hyperrriglyceridemia may benefir
from rhe higher doses of omega-3 rhar flax-


nut blltter Cln provide.
It is import:tm ro poinr out [hat mosr
stlldies tegarding the benefits of omega-3
f.my acids have focused on rhe oile farry acid
Ibar has been considered in this chapterEPA. Many researchers seem to ignore rhar
EPA is not an essential farry acid. We have
already identified why it is not essential: our
bodies manufacrure EPA from rhe linolenic
acid char is found abunclantly in rhe planr
foods listed above. The sreps by which EPA,
eicosapenraen.oic acid, is derived from linolenic acid are omlined in Appendix IV.
Studies clearly show that whcn a person
increases his consumprion of plam sources
of alpha-linolenic acid, blood levels ofEPA
a1so significanrly increase as expected. 93
Anorher study demonsrrarjng conversion of
a1pha-linolenic acid imo EPA in humans
prornpred an inreresring observauon. This
seudy shows mar linolenic acid may have
llnique benefirs in irself in addirion ro rhe
benefits ir provides in being converted ro
EPA.9 4 Thus, ic may be berrer to ear foocls
conr.aining linolenic acid rarhcr than rhose
wirh EPA. In this way, rhe body can use
however much ir needs for conversion ta
EPA while reserving the excess for orher
beneficial llses. Thjs would also avoid rhe
dangers of an excess of EPA in the bloodSlream, whkh Cln trigger a stroke due ta
One study of a diet enriched in alphalinolenic acid has already suggesred rhar rhis
fal has a role in preveming hearr disease. 9S
A cousin of alpha-Iinolenic acid, known as
gamma-linolenic acid. appears effecrive in
dealing with arthritic conditions.%

Vegetables and Pesticides

Regarding conlaminarion wilh pesricides, man)' American consumers are mostl)'
concerned abOlit conraminared fruit.s and
vegerables. le is truc thar acute roxicities
rrom pesricides have been rraced ro conramioared plant producrs. A 1991 repon reviewed some of the classic examplesY7 In a
1962 episode in Turkey 333 died and as
many as 3000 were poisoned due ro consllmprion of seed grains treated wirh
hexachlorobenzene. In 1968. severe poisonings and dearhs were documented when

individuals are bakery producrs that had

been contaminated wim paratbion. Man)'
also died in a 1972 Irag incidem when rhey
ingested grains treared with an organomercuriaJ fungicide. More recendy in 1987,
fifreen Peruvians died and 260 became il!
when rhey are bread made from aldrin-contaminated flour.
Acute roxiciries like rhese, although serious and frightening, are relatively easy ro
prevenr in developed nations. Because of
ule acute narure of Ihese tox:icities, rhey have
been well srudied. Legislarion bas been enacted thal guarcls consumers againsr exposures ro roxin levels bigh enough ro Cluse
acute hllman healrh risks.
Long rerm or chronic effecrs, however,
are not as easy ro prevenr. wherher the contaminarion is (rom vegerables or fish. The
reasons for this include: (1) it may take
lllaJly years for long-term effecrs ro become
apparent; (2) even when the effea occurs,
it may be difficulr ta pinpoinr the toxin
causing rhe effecr; (3) even if an association
is made, ir is difficult ro derermine how
much exposure is required to produce [he
Chronic effecrs, particularly cancer rislc,
tend ro take cemer slage regarding Americam' concerns for pesricides. As 1 talk with
(he average person 011 the street abOlit pesticides, it seems tbat the greatest concern is
cancer. Usually, rhe food groups they fear
ro be rhe mOSt comarninared are frllirs and
vegetables rather rhan animal producrs.
However, the f..1Cts tell a different srory.
When you look ar fmit and vegerable
cOllsllmprion, rhe more of rhese plam foods
we eal, rhe smaller our risk of Gl11Cer. This
fact was highlighted by one of America's
foremost nutririon researchers, Of. Gladys
Block of rhe Universiry ofCalifornia ar Berkeley. Dr. Block and her colleaglles reviewed
170 stlldies rhar ser our ro derermine if fruir
and vegetable consumprion affected cancer
risk. 98 Results showed rhar 132 of rhose
srudies showed a dear Cflnt:er-protective benefit rrom rhese planr foods. Only 4 studies
our of 170 suggested a sratistically signiflcam increased risk of cancer. The other 34
studies were indeterminate.
Let lIS consider a simple law that applies


w statisrical srudies. Jf there is a true relationship between nvo things, and you do
nearly 200 srudies, you would expecr rhe
vast majority of them ta disc/ase rhat re1ationship. BecaLlse of rhe narure of statisries, however, you wouid expect SOll1e scuc\ies ro be indererrninate, and a few srudiesjuSt by chance-will suggesr a relarlonship
in rhe opposire direction of rl'uth. Such is
rhe case wirh Block's analysis. In summary,
fruirs and vegetables emerge solidly as cancer-pwrective foocis.
Perhaps rhe most imponant point of
Block's repon s that she was not looking
exclusively ar vegetables grown organically.
These nearly 200 srudies simply looked
ar rhe foods rhat the average person is accustomeel ta eating. Likely, most of rhe
fruits and vegetables lud been spraycd with
pesticides anei grown wirh fenilizers. le is
deal' rhat, far from plltring us ar cancer I'isk,
fruirs aud vegetab1es-even if grown wirh
fenilizers and pe ,ticide -help us prewnt


Jnspiration lnsights
Because I quore inspired sources rourinely ancl believe in rhe accuracy of the
Bible, I am ot1en asked Biblica! quesrions
about fish. A common query is: if fish is
nor an ideal food, why elid Jesus eat it? (ln
faet, dus is ilie only animal product the Bible
explicitly records being eaten by Jesus),
First, the fish that Christ consumeel in His
day were lIneloubtedly much healrhier than
the marine life available ro llS currently,
IndusrriaJly pollured \-"arers as we have today did not exisr in the rime of Christ and
chemica.! pesticides were unknown. Second,
alrhough the Bible presents Jesus as aur example, it does so from the perspecrive of
His characrer-not from r.I1e minute derails
of His life. JUSt as "being like Jeslls' doe.s
not mean moving ro Palestine ro live, oeirher does it imply thar we will ear fish as He
clici. However, Gad did record in the Scriprures His original intenrion for rhe e1ict of
mankind: a total IJegetarian diet. 99
Mear and fish are not included in this


original diet, but c1ean mear wirhollt rlle

fat were not (Otally prohibited in Chrisr's
day. Christ's ex:unple. in t":lcr, does show
(har Goel cliel nor rigidly enforce His original diet, bur m:lele aJlowances for rime and
circull1srances. However, rhe book of Genesis also indicares rhar rhose \Vho consumed
:l vegetarian eliet lived substantially longer
than (heir offspring who began ro incorporate mear into rheil' dieL This can be een
by comparing rhe long life span of the generarions that lived before "Noah's" flood
with a s(eady decline for (hose who followed
iL 100 Chapter 7 on protein, Figure 27,
documems rhis life span decline. Of note.
ilie Bible records (har ir was aher rlle fload
that God gave bumankind permjssion ro ea[
animal f1esh. 101

As a physician I find deep satisfacrion
in helping sick f01ks regain their health and
"igor. But there is somerhing eqllally and
perhaps even more sa(isfying and rhat is
helping indivieluals understand bow to prevenI illness. ham aII rhe research we now
have an rhe causes ofhe<lrt disease, rhe conclllsion is e1ear: hean disease is largely prcvenrable. Meelications have theit place, bur
regarding the prevenrion of hean disease,
rlle very best srrategy is a commonsense vegetariall elier using a variery of fruits, grains,
nurs, seeels, and vegetables. Adei to rhis dicr
a consistent exercise program a program for
srress managemenr, and the other pracric.al
lifesryle recommendations in rhi and rl1C
chaprcrs ro carne. Such a cOlnbination will
give you the Hnesr program for prevenring
hearr disease ar addressing a problem that
has alread}' begun.
Remember: anythil'g worrhwhile i.n life
takes time. Many people have given (heir
ali ro make a fortune, bur in rhe process have
lost what is mosr deal' and priceless: rheir
hea.lth. My wish for you can be besr. expressed from rhe Bible, 'Beloveel, l wish
above aII things thar thou maresc prosper
and be in health, even a thy saul
prospereth. '102


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LJ, Boyce G. Zuricr RI3. TrealmelH of rhcumaroiJ arthril-is

\Virh gamrnali!lolcnic acid. Ann Intern Med 1993 Nov 1; 119(9):867-873.

% Levemhal

7 19bedioh 50. Effecls ofagricultura.1 pt'Slicide.s on humans, animals. and

higher pbnrs in devcloping collntries. Arc/' Environ Hcalt!J 1991 JulAug;46(4):218-224.

Block G, Panerson R, Subar A. Fruit vegclablcs, and cancer prevenlion: a review of the epidemiological evidence. NulT CrlTlcer J992; 18(1): 129.



Gene~is 5:1-22, 11:10-32.

Tbe Holy Bibk. AUlhorized King James




Gencsi 1:29. Tht Holy Eib!". Authoriud King ):uncs "<:rsion.


Genesis 9:3. 17Je Ho~y Eib!r. Authorized KingJamcs version.


3 Jolul 1:2.

Tiu Hol;' Siblt. Authori7.Cd King James version.

Mail1e issucs mcrcury warning reponcd Junc 29. 1994.







aU seemed 50 hard (O believe. Jolul

had been [he picture of healrh. Now,
a( 62 years old, he had gone from eEO
of a Fortune 500 compa.ny to a nursing home residem. It had been six months
since hjs devastatng suoke and rhe docrors
heJd linIe hope of any significam recovery.
Whar John had anen referred ro as "just a
lirde high blood pressure" now took on new
significance. Hs physicians said [hat rhe
srroke was undoubtedly due ro his poorly
cOlllrolled blood pressure.
Although John did not die from the ravages of high blood pressure, his situation
iUustra(es why the condi(ion is oft:en referred
(O as "(he silent kiIler."
High blood pressure (a1so called hypertension in rhe medical lileratlJre) often does irs damage wi(hout warning. Indeed, the disease has lifelong and life-shorrening implicuions. In
lhis chapter we wiIl explain whar high blood
pressure is, what causes ir, whar damage jt
does, and how Il can be colltrolled without

Measurement ofBiood Pressure

Each time the heart beats, i[ sends a
blood pressure pulse down [he arm. The
force of this pulse generates rhe sysrolic
blood pressurc. The systolic measuremenr
s the "top llumber" of the blood pressure

reading. After each heart beat, rJle hearr

rests for a fraction of a second. The pressure in the blood vessel during rrus resring
phase drops, and is called the "diastolic pressure." It is measured by the "bonom number" of the blood pressure reading.
Blood pressure is relatively simple ro
determine. You can measure it yourselfwith
a device called a sphygmomanome{er
("sphyg" for short, pronounced "sfig"). The
sphyg is made up of a heavy dury baJloon
ar aiI' chamber thar lies inside a band ofdo{h
called the "cuff." The cuff is wrapped
amund the upper arm and the baHoon is
filled wirh air. The increasing pressure in
(he balloon eompresses the artery un tii
blood flow to rhe lower arm is eompletely
shur off You then graduaJly decrease the
cuff pressure. During rhis time you are listening over {he anery with a stcrhoscope
and warching a scale that records (he
amOUJlt of pressure in the balloon. As you
decrease {he cuffpressure ro the sysrolic pressure level, you will begin ro hear the pulsil1g sound of tlle heart beac. This indicates
the rerum ofblood flow in {he artery. The
number an (he measurement gauge at that
installt is recorded as the sysrolic blood pressure. As you continue ro slowly reduce the
pressure in {he cufT, {he plllsing sound conullues ulltil it suddenly cannor be heard.



How High is High?

Blood pressure is measured in millimeters (mm) of mercury. This dares back ro


High blood pressure

(greater risk
of disease)

above 140 or abovc 90



Blood pressure
that iocreases the
risk of disease
Optimal blood

130 to 139 or 8S lo 89




120 to 129 or 80 to 84

below 120 and below 80

Numbers opply 10 /IIJulrs who are noI laking Jmgs 10 Jower Illeir
blood pressure.
.lIyour sysloJic and Jias(o/ic pressures loJI inlo differenl calcgories
_J'!}.l!..r ~i1k depends on Ihe higher calegory.

Figure 1

The pressure at which chese soullds disappear is recorded as rhe diasrolic pressure.

Some Causes OfHigh Blood Pressure

Arteries are muscular organs [har can
borh contracr aud expand. Excessive contraerion or sti ffen ing ofthe artery walls raises
blood pressure. Hormones can also raise
blood pressure. Some organs such as rhe
kidneys and adrenal glands are espeially
important ro ilie hormonal regulation ofour
pressure. However, the major cause ofhigh
blood prcssure is a lcss rhan optimallifesryle.
Most people have some rendency ro high
blood prcssurc; wherher chey develop the
problem anei how soon rhey do, is large!)' a
function of rheir everyday decisions.
Ofcourse, there are rJ10se unusual people
who seem to be generically immllne ta bypercension. You may know of someone who
does everyrhing wrong-but stiH has a normal blood pressure reading. Even if rhac
person is a close relarive, do not assume mat
you can bear [he odds. There appears ro be
many genetic factors thac have eidler a direct OI' indirect bearing on blood presslIre.
lr is unlikely tlur your generic makeup is
idenrical ro any relative in aII of those respects.


me days when aII sphygmomanometcrs

used a column of mercur}' to record rhe
pressure. The medical world eoday divides
blood pressure readings imo faur levels of
. k as s hown In
. p''Jgure I .'1 1
Norice dur rhe safest blood pressure
range i characterized by an average sysrolic
pressme of 120 mm of mercury ar lower,
and an average diasrolic presSllre of80 mrn
ar lower, ac rest. Every person should srrve
ro get his ar her resri ng blood pressure inro
chis "120/80 mm or less" range. Highrr
pressu re , carry increased risks of disease and
premature deach. J However, rhe most carefuJ research suggests ehat lowering ehe diastolic blood pressure below 80 furrJ1er lowers one's risk of heart arrack ,mei seroke. In
fact, there is Ha ehreshold ar which fllfther
lowering of diastolic blood pres ure (DBP)
does not give further lowering of risk ofborh
he:lrt disease and stroke. 4 For example, a
DEP of 70 is benel" rhan 80. A diastolic
reading of 60 is bener stiH.
Control of blood pressure begin with
knowing whar your blood pressure is. Do
not aSSllme dut just because you feei fine
you are free of a blood pressure peoblem.
I-ligh blood pressure is indeed G11lcd "rhe
silent killer." It has this name because serious disabiliry or dearh is ofte.n rhe ver)' fim
sympCOm of hypertension. Many people
wiJl never reaJize rhat their blood pre,~sure
is high unless [hey ger it checked bya docror, go ro il screcning program, ar get a blood
pressure instrument and check il rhell1selves.
In faer, it is common for people ro feeI tine
with blood pressures of 200/ 100 or e.vcn
higher. Indeed, you may feel grear \vhile
being uuwiningly on [he verge of a disasrer
such as a sudden scroke or heart arrack, or
gradual kidney damage wich resulring renal
failure down the road.

Prevalence ofHigh Btood Pressure

As man" as 50 mllion Americans h;wc
eJevared bl~od pressure. 5 This is ddined in
Figure 1 as a systolic blood pressure of 140
mrn or more and/or a dia8rolic prcssure of
90 mm or more. Despice improvemenrs in


awareness and treatmenr, as maoy as 35
percent ofAmericans wirh dcvared pressures
still are nor even a\v;u'e r.har r.hey have a probIem. 6 Even among rhose rhar knO\'". rhey
have a blood pressure problem and are an
medication, onll' about half of them reaUy
appear tO have rheir pressure undeI' conrroI.7
Even iJl'ou recendy had yom blood presstire checked and do nOt have high blood
pressure now, do nor assllme dur yOll never
wil!. As il person ages, blood pressure tcnds
ro rise. In [he U.S. the average person's systalie pressure rises by 15 poinrs between me
ages of 25 and 55. About 60 percenr of
Amerjcans aged 65 ro 74 have high blood
pre sure. 8

Dangers OfHigh Blood Pressure



Congestive heart

Kidney disease
Disease of the retina

Hcart attack

("hardening of
the arteries")

Blood vessel rupture

Weakened memory
and mental ability

What damage can high blood pressure

Figure 2

do ro your body? There are many diseases

assoejated with bigh blood pressure. The
major ones are shown in Figure 2. 9 10
Stroke, the fi est maladl', is caused bl'
hypcrrension through at least rwo differenr
lllecharlisms. Firsr., bigh blood pressure predisposes individuals ro arherosc1erosis (often ca/Ied "hardening of the atteries"). In
,his process, large and medium sized arteries u1roughout me body become narrowed
bya buildup of f~my materia!. Arherosclerosis commonly strikes the vessels in [he
head and ncck that carry blood tO the brain.
Evidence testifies mar high blood pressure
Gln darnage the cdls rhar line these blood
vessels. This damage appears ro be one of
[he ways rhat me process of atherosderosis
is initiated or perperuJred. \ I
The bodl' does nor sir idly by as its vessels accumulatc far. It responds by covering the fatr.y deposits wirh a rough fibrous
cap. This is an important response. Iffatry
material comes inw direct contact with
blood it can stimulate rhe blood tO dot. The
/lbrous cap helps ro ensure thar such an
cvent will not OCCUf. It is acruaJly tlus du;u
process whjch gives atherosclerosis it.s name.
"Amero" refers ta the "mush}/' or "gruellke" fatr.y material and "sclerosis," meaning "hard," designates the bod)"s fihrous
walling off of this materia!.
Unfortunarell', areas of <lrhcrosclcrosis,
called plaques, can uleerate. When t.his hap-

pens, the fibrous cap is lost OI' damaged. A

combination of flbrous aod farty material
is relcascd into the blood seream. A now
smaJler, eroded fauy deposit is left on the
ancry wall; this is called an ulcerated plaque.
If a plaque in a blood vessel sllpplying the
brain breah down in this way, the resuII
can be a "mini srroke" or TIA (rransiem ischemc attack). These episodes are very
similar ro srrokes, but chel' resolve completdy. Full recovery occurs withill nunutes to hours.
Worse l'et, however, ulcerated plaqlles
Gtn activate platdets, (he c10rting cells of
thc body. This often sers in motion a chain
of evclHs thar can complctely obsrruct an)'
aftcry that is alrcady narrowed by arhcrosclerosis. If complde obstruction occurs in
all artety supplying blood to paft of the
brain, rhe brain risslle [har \Vas dependent
on dur anery will die. This deam of brain
tissue is caJled a stroke.
A second \vay that high blood pressure
causes sHokes is by causng more severe
damage ta brain blood vessels. In this scenaria, cumularive damage ro the artery is
so severe that [he vessel ruprures and bleeds.
These so-called hcmorrhagic srrokes :lfe
particularll' dangerous. The bleeding ofren
continues for sOlIle rime. Since the brain is
encased in a rigid shcll c-aJlcd Ihc skull, iI
has no place ta go when an acculllularon


of blood comperes wirh it for roOO1. Thc
more blood rhar accumulares. rhe more [!le
pressure rises inside rhe brain. If rhe bleeding does nor stop, pan of r!le brain can actuaUy be pushed down duough rhe small
opening for the spinal cord. Thisis calJed
"herniarion of rhe brain" and generally
causes elead, rapidJy.






140 or more




SystoLic Blood Pressure

Figure 3

6-22 times


Risk 8
kidlley 6






140/90 to

Blood p"ressure
Figure 4


ovcr 159/99

Hozo Much Stroke Risk Does High

Blood Pressure Cause?
Studies have shown rhar the risk of developing arherosclerosis (mainly ischemie
hean elisease anei cerebrovascuJar elisease) is
five rimes grearer for rhose whose blood
presslIre is 160/95 than rhose wirh normal
blood pressure. Il Blood pressure's effecr in
increasing rhe rsk ofhean ;}rtack and stroke
is illllsrra red in Fi gll re 3. 13
As we have alread)' nored, rsk begins ro
rise ar rhe 120 ro 129 level even though rhis
range s frequendy called "normal." Risk
rises even more Sh<Hply ar highcr pressure
levels. StilI ro minimize l'isk, blood pressure should be below 120 systOlic. In orher
words, do not be satisf1ed when someone
tells you dUH yOLlr blood pressure is ('normaL' Make sure thar il is below rhar 120
Ievel. This suicter guideune means mall)'
Americans musr get more serious aboLIt their
Iifestyle. Nearly haJf of aur male popularion
has a sysrolic pressure of 130 or greater. 14

Kidney Failure Caused by High Blood

Kidney f'lilure is anorher disease callsed
by high blood pressure, and rhe higher the
pressure rhe grearcr rhe risk. In facr, in rhe
Unired Stares hgh blood pressure is the second leading c<luse of kidney failure. (The
first is diaberes). Kidney failure and its relarionship ro high blood pressure were smdied in mOfe ulan 300,000 men over a 16
year pel'iod. 1S The resulrs are shown in Figure 4.
The srudy also showed dIar. a ver}' mild
increase iIl blood pressure ro 127 systolic
increased rhe risk of kidney failul'e larer in
Iife by 50 percenr. How does high blood
pressure harm the kidneys? It acrually deStroys nephrons, dlOse riny microscopic fii
rcring cells rhar make rhe kidney function.
By gl'adually desrroying one nephron afrer
anorhel', r!te kidney's abiliry 10 c1ea.nse rhe
blood becomes progressively compromised.
\Y./e lIse tlle rerm kidney (01' renaJ) fuilure
when this purif'lcarion funcdon becomes sa
impaired that roxin levels build lip in rhe
body. With early kidl1ey failure there ma)'


bc no symproms. As rhe disease progresses,
a pcrson reods [O dcvelop nausea and fatigue. Ultimare!y. when kidney funcrion
bccomcs markedly impai red, dearh occu rs-unlcss dramatic steps are raken. Such
steps mar include dialysis ar kidney trans
planr. Wrhour dialysis machi nes many
pcople would die soooer from rhe consequences ofrheir high blood pressure. However, even wirh diaJysis, many experience a
shon exrension oftife accompanied by a signiHc.'mr decrease in their quality oflife. For
this reason, some people have even chosen
10 die rarher rhan ro begin ar continue with

High Blood Pressure and Decreased

Mental Ability
Numerous scudies have documenred
rh;H high blood pressure rhar is nor con
rrolled by lifesryle frequently causes gradual
menral decline. One recenrly published
srudy showed rhar for every 10 mm of mercllry increase in systolic blood pressure ar
midlife, rhere was a 9 percent increased risk
of poor inrellectual ability 25 years later. 16

egor}'. This figure confirms rhar a desirable

sysrolic blood pressure is less rhan 120.
Since rhere are benettts ro having sy.srolic blood pressures of 120 or lower, why
do physicians rend ro avoid prescribing
meclicarions thar help parienrs drop rheir
blood pressures from, sa)', 138 systoLic ta
118 sysrolic? The reason js rhar ali high
blood pressure drugs have side efficts. When
prcssurcs are only mildly e1evtcd above rhe
ideal; the risk of rak.ing a drug is generaJly
greater than the benefit of funher lowering
rhe blood pressure.
;-\1so, when deal1ng wirh rhe lower enel
of rhe spectrum ofclear cut high blood pressure, rhere is nO consensuS on rhe benefirs
of long r.erm drug rrearmen[" One recent
srudy dealr with "mild hypertensives," rhose
wir.h sysroLic blood pressures in the 140 ro
1S9 range ami diastOlic~ in the 90 ro 99
range. Tbe researchers observed: "concerns
have been raiseel regarding rhe appropriareness of long term drug rberapy for mild
hyperrensives and rhere is interesr in ilie
possibiliry of trearing rhese parienrs wirh
nonpharmaco'logic therapy .... "18 Thus,
rhere are growing misconceprions-even in

Quality OfLift Reduced by High

Blood Pressure
The roll that high blood pressure ralees
an rhe kidneys reminds us rhar high blood
pressure does more than lull. Ir robs uS of
qualiry of life. "Morbidiry level" is a measure of rhe illnesses thar cause suffering and
decracr frorn life's qualiry. A study relaring
morbidity level ro blood pressure is shown
in Figure 5. 17
This figure demonsrraecs how rapidly
m.orbidiry increases once a person's blood
pressure creeps over duc 120 level. It ma)'
nor be surprising ro sec rhar rhose wirh a
ystolic blood pressure greare r rhan 160 have
tour ril1le~~ the risk ofmorbidry as rhose wirh
a systolic blood pressure of Icss rhan 120.
The risk doubles evcn when you move frorn
less than 120 inco rhe 120 ro 139 range.
When one exceeds 140 sysrolic, rhe risk of
morbidiry is even greater. Over the 160
level, rhe risk dramarically rises and srays
abolit the same in rhe grearer rhan 180 car-




120-139 140-159 160-179


Systolie blood pressure

Figure 5
the medic~11 communiry-abollt rhe wisdom of lIsing drug rherapy ro trear "nlild"
high blood pressure. More are looking ro
rhe non-drug or lifesryle approaches.


Funher cOll1plicaeing dle picture are ehe
subrle side effeets of high blood pressure
drugs on qualir)' oflife. 111 one study, phyicians and patienes cOllsistenrly felt d1<lt
qllality of life had improved or scayed the
same while on high blood pressure drllgs.
However, the c10sest l'e1atives of the medication-ereatecl patienes had a differel)( perspective: 99 percel)( of ehem were aware of
imponant changes in eheir loved ones. Specifically ehey reponed such pl'oblems as
memory loss (33 percenr) irrjtabilir)' (45
percent), depression (46 percene), and dccreased sexual interest (64 percellt). 19

E./fie! ofLowering Blood Pressure on

Cardiovascular Disease
There is direct evidence dlat jf you reduce blood pressure, you decrease ehe risk
of cardiovasClllar disease. This is illustrated
in Figure 6. 20

For the general population, a 3mm decrease
in systolic blond pressure would yield:
11 percent fewer strokes
7 percent fewer coronary events
5 percent fewer deaths

Figure 6


We see ehat a relativd)' small reduction

in blood pressure has a significanr impact
on disease of the hean imei blood vessels. Jr
is as[Ounding [O consider the implications
if aU Americans with high blood pressure
wOlUel lower rheir blood pressures by juSt 3
mm. Ae least 27,500 lves would be saved
each year, noe ro mcmion ehe Olany more

people whose lives would noe be markedJy

worseneel as a resule of living through a
srroke Of hean auack. These facts, combined with rhe ocher inforrnation (har \Ve
have examined 50 far, sbollld motivate us
ro do everything we can in OUl' own lives ta
prevent ar cOITece high blood pressure.

How Can

we Lower Dur Blood

aur approach ro blood pressure control

depends on the rype of hypertension chae a
perSOll has. There are ('\\'O main rypes of
high blood pressure:
Secondary hypertension is callsed by
orher diseases. There are many examples of
dlis. For insrance diseased adrenal glands,
the small hormolle-producing gJands 10cated JUSt above che kidneys, can produce
excess hormones cilat c<luse high blood pressure. Overproelucrion of hormones by e!le
gland in the neck, caIJed the thyroid, can
cause high blood pressure.
We have al ready Jearned that high blood
preS5ure can damage rhe kidneys. an che
ocher hand, kidnc)' disease (from problems
other ehan hyperrension) can actuaJll' cause
high blood pressure in and of itself There
are sr.ill omer callses ofsecondat)' high blood
pressure. For rhest reasons, 311yone who has
high blood pressure should be checked bya
physician; ie may nor be rhe "garden variery" high blood pressure chat grandma had,
bur secondaty hypertension.
For chose wirh secondary hypertension,
treaement is lIsually srraighrforward. We
search for rhe lInelerlying disease that is cauS'ing ehe high blood pressure aod then treat
thac disease. ClIring the d.isease solves the
blooel presslll'C problem. Unfortunate1y, ereatroent is nor thar easl' for mosr hl'perrensives.
Ninery percenr ofchose with high blood pressure have primary hypertension. 21
Whar can we offer in eerms of rreaeJ1}ent
when their condition is (aused by a lessrhan-desirable lifesryle along wirh an in.herited sllscepeibiliry? Whae sreps shouJd thel'
r.ake ro bring (heir blood pressure down ro
normal? A common allswer would be eo
rake medicarion prescribed bya doctor. Noe
l11al1)' years ago, rJlis seemed to be che only



answer. We now know that this is usuallv

not the best answer. There are several re;sons for thk
1. Every drug has muJdple potential side
effects-including cffecrs an quaJiry
oflife thar ofeen go unnoriced by rhe
medicaeion user. 22
2. High blood pressurc, cven if controlled by medicine (and nor
Jifesryle), causes a slow deecrioration
of brain maner whidl wealeells rhe
parienr's ability and inrelligence. 23
Unconrrolled high blood pressure
causes rhe same problem.
3. Less than halfof rhose who take drugs
lower rheir presSUre below 140/90. 24
4. The cost of drugs.
5. Lowering blood pressure with medication is not equivalent to lowering
blood pressure natllrally.
People takjng antihypereensive drugs
have higher rates ofhean disease than people
who have identicaJ blood pressures wiehour
drugs. 25
It is obvious rhar rhe preferred method
of conuolling blood pressure is ro adopt
lifesryle changes ro bring ehe blood pressure
down in a natural way. Since lifesryle caused
rhe high blood pressure in the fim place,
why nor lower it with lifesryle changes? Is
it possible ro reduce blood pressure with
lifesryle changes? The good news is thar
medical srudies demonstrate that rhis approach does indeed work. Moreover, 1 have
scen ie rourinely work in my practice.
A logical quesrion is, "How much of a
reduction in blood pressure can 1expect ifI
am willing ro make lifesryle changes?" Thc
answer depends on how much change you
are willing (Q embrace. Approximatdy 80
percem of hypenensives wiU be able ro reduce meiI blood pressure co a sah levdwithollt medjcation-if chey accept ali the
changes oudined in this chapccr. The remain ing 20 percen t will also be able to lower
their pressure to a safe level by combining
rhose lifcscyle changes with some am,ount
of drug cherapy. What \cind of challges in
lifCSlyle will result in lowering blood pressure? We will cire rhree srudies ta answer
lhis important question.

Specific Lifestyle Changes for Lowering Blood Pressure

The Nationallnscituce of Heahh sponsored a swdy thar demonsrrared rhe power
oflifesryle changes co lower blood pressure.
Over 900 subjects (men and womeu, black
and whice) wich mild hypertension were
enrolled in a Iifesryle change program. SpecificalJy, program parricipams initially had
diasrolic blood pressures in the 85-99 range
(average 90.5). Sysrolic blood pressures averaged 140.4. 26 Some of (he subjecrs were
pur on a lifesryle change regimen, while rhe
remaitting ones were ueared wim a single
blood pressure medicarion. The reductions
in blood pressure for (he group rreaced wirh
lifesryle challge alone are shown in Figure 7.
As impressive as rhis daca is, lifescyle
changes of a greacer magniwde than thase
in rhis srudy can yield even more impressive reduccions in pressur ".We will explore
thar evidence later.
Anorher stlJdy derermined rhe efreC[ of
just twO lifestyle factors on blood pressure. 17
le involved over 30,000 men, ages 40 to 75,
who were categorized as (O rhe amounr of
fiber they are and rheir degree of obesiry.
The tesulrs shown in Figure 8 illustrare ehat
obesiry was rhe largest sillgle factor affeering


Four simultaneous lifestyle changes reduced
blood pressure:

Weight loss
Low salt diet
Alcohol reduction
Increased pbysicall activity
Afler one year:
Average reductian in systolic pressure = 10.6 mm.
Average reduction in diastolic pressurc = 8.1 mm.
Figure 7


bleod pressure.
Obesiry appears ro be one of the most
importanr high blood pressure facrors in
America. ln rlle famolls Frarningh,un smc!y,
fuUy 70 percent ofhyperrension in /nen and
61 percent in women was direerly anribured to inereased body fa(,28
A thirel study involved 73 men anei
women with high blood pressure who atteoded a rhree week live-in program ar
Weimar Institute in California. Their aver-


Thin men eating
ltigh liber
Men eatulg
low fiber

Obese men

Rjsk of high blood pressure

Figure 8


Lifestyle challges:
Abstinence from alcohol,
tobacco, coffee
Total vegetarian diet
Aerobic exercise
Length oftest -- 3 weeks
Average blood rpressure a,t the start
Average blood Ipressure at the end
Percent off of blood pressure medicine
= 80%
after three weeks
Figure 9


age age was 65. They adopred a series of

lifest)'le changes during dtis supervised program anei reapeel large redllCtions in blood
pressure. The resu1rs are shown in Figllre 9. 2 '1
These blood pressure redlletions arc
greater rhan tlle reducrions in the fim study'
rhe reason is thar more lifesryle facwrs were
changed. Over 90 percent of the partieipants were on ar leasr one medication 10
control their blood pressure when they enrolled in rhe program. Thar figure dropped
to 20 pereenr afrer rhree weeks; even rhose
remaining on medjcine were able ro significantly reduce rheir dosage.
The averagc efrecr oflifesryle changes in
this study is grearer rh3n indicared in Figure 9. Two sers of changes were nude sil1111ltaneously: ehanges in lifesryle al\d reducrions in blood pressure medjcine. However. redllcing the medicine would oormally
produce an average increase in blood pressure, bur the eXl1.ct opposite occurred. Why?
Because rhe lifestyle changes had such a
powerful effecr rhat rhey more than offser
rhe blood pre Sllre increase rhar would be
callsed by r.he reducrion in medici ne.
Anorher inreresring resulr is tlur over
half of rhe cimp in blood pressure occurred
in tlle fim week. Blood pressure levels rcspond quicldy ro I ifesryle changes.
The above studies ,ue in harmony wirh
maoy orhers. Collecrively they firmly demonstrate rhat lifestyle change is a porenr defense againsr high blood pressure bringing
quick and positive reslllts. Fatalisrs [ah
nore: rhe my[h thar yaur genes enrirely dicrare yOllr blood pressure level has bem com
plerely discredjred.
So far, we have seen rhe efrecrs ofseveral
lifesrylc facror in combinarion. Are rhere
an)' swdies thar show rhe effect of a single
lifesryle factor on blood pressure? The an
swer is yes. The rcmainder of the chaprer
looks ar research on individual lifestyle factors.

Dietary Factors That Reduce Blood

The firsr lifesryle f:1CtOf \Ve wilJ fOCllS on
is diet. Whar 1 advocare is called dietary
rherapy, a self-irnposed rrearmenr. Dierary


rherapy obvously involves what you put
inra yOllT body in rhe form of food. There
are mally foods in the average dier rhar affecr blood p ressu re. Some are helpful and
some ~ue harmful. If you want (O lower your
blood pre.ssure, you will need ro know which
foods (O cat more of and which ones ro
Oiet, however, is not reaJJy a single facror. \'{fe ear many differenr foods, each of
which are made up of combinations of nurririona[ componenrs. We willlook ar each
of severaJ eomponents rhat affecr blood presSUIe.

S,tlt-A Major Culprit

Sah is rhc first componem of r!le diet
rhar we wanr ro explore. because [here is
Illuch evidence rhat it significanrly raises
blood pressLlre. Thc relarionship berween
salt in rhe diet and blood pressure is lisred
in Figure 10. 30
Ir is no exaggerarion ro say rhar salr is a
major culprir in causing high blood presSUTe. For hyperrensivc patients, r!le greater
rhc reducrion in dietary salr, rhe greater the
rcduction in blood prcssure. One hasic
caLlse of hyperrension appears ro be an inability of the kidney [O eliminare an increased sah load. To excrete rhis excess salt,
rhe body makes adjusrments rhat boost the
blood pressure, which then enables (he kidne}' ro eliminare rhe salr. J1
Salt consisrs of twO elemenrs-sodium
and cWoride; it is 40 percent sodium. It is
founei in a majoriry of foods in the supermarker, and the amount per serving is lisred
(as sodium) on the concainer or package by
law. Surprisingly, research suggest$ thac c
is actuall)' the comhinarion of sodium with
chloride thar does the damage. 32 In animaJ
srudies on high blood pressure, neither excess sodium alone nor excess chloride alone
causes high blooel pressure. 33 However, rhe
labei ing of sodium cOlltenr usually provides
rhe necessary informacion: sodium and chloride rypically are found in rougWy equal
JlTlounrs in foods. Thus by [imiring rhe
sodium intake, we generaJly limit (he chloride inrake as well.
A srudy involved 20 high blood pressure paliencs who were taking no medica-


1. Societies that ingest Httle or


salt have


2. When diets very low in salt, such as the rice

aud ,frut diet, are given to hypertensive patients,
blood pressure often Calls toward normal.
3. Chaoging to a cliet that is on'ly maderatdy
low in salt produces only smal)
reductions in blood pressure.
4. Salt-induced hypertension bas been Iproduced in
both mao and experimental aoimals.
Figure 10

tion, bur reduced their previollsly high sodiurn intake ro less rhan 3000 mg a day.34
The resulring reducton in average blood
pressure is ourlined in Figure 11.
This i, a dl'amatic demonstration of the
effect ofchanging juSt one item in tlle elietsalt. The average reducrion was 19 mm systoljc pressure and 14 mm dia rolie aftcr one
yeaT. We wOllld expect furrher blood presstire reducrion if rhe salt imake was further
I have tre:ued many people in my practice

1. 20 patients with average blood pressures of

161/101 rom reduced their salt inta1kc for
one year.

2. After one year, tbeir average systolic pressure

was lowered by 19 points and diastolic was
lowered by 14 points.
3. Blood pressure of 16 of the 20
patients was well controlled by
simply restricting their salt intake.
Figure 11





Corn flak!?s, 1 c.

Peaouh, 1/4 c.


Tomato soup, 1 can

Sauerkraul,l/1 c.





1 c.


Inst.anl mashed pOlatoes, 1 c.

Ham, cured, :) oz-


Rlce, Chinese stylc. I c.

Freuch Frles, 1 servo


Ice cream, soft serve,

Bou11loD, [Il c.


Oill pick1c, 1 large


Peas canned, III c.

POlato cbips,

Peas, froz!?n


!mall bag


Bacon. 2 slices
8ultermilk, 1 c.


Oallish pastry, I piece


Cottage cheese, I c.


Figure 12




mg sodium

Corn chip!, I c.


Corn flakes. 1 e-


Pellnuls,l/4 c.


Tomato soup, 1 can



Egg Mcmuffin



Inslaut mashed polaloes. 1 c.




Polato chips, 1 small bag

Ham, cured, 3 OZ.


Rice, Chiuese style, I c.


Frencb {ric!, I servo


Ice cream, sofl sen'e,l c.

Bouillon, J/2 c.


Dill pick1e, I large



Peas callned, lh c.


Pe.as, frozen

112 C.

Bacou, 2 slices


Danlsb pastry, 1 piece


ButtermiJk, I c.


Cottage cheese, 1 C.


Figure 13



Average American diet

4000 mglday

Those witb normali blood


2400 mg/day

Tbose with high blood prcssure

2000 mg/day

Those with ihigh blood pressure

and congestive beart failure
or liver disease

1000 mg/day

Minimum necessary level

Figure 14


250 mg/day

Ulat say, "1 :l.In already on a low salc dier,"

and eher firmly believe it because rhey do
not add salr ar the meal rabIe. Since rhe salr
shaker sic5 unused on rhe rabie (01' is removed complerely), :lnd they do nor use a
huge amount in cooking, rhey are confident
rhac ehey are on a low salc dier.
Ar this poin.r, 1 ask my high blood pressure parients ro go duough a liale quiz rhar
you mighr like ro rake regarding rhe sah
comem of some COJlllllon foods. Do you
know whar foods are high in sodium con(em and what foods are low? The foods in
Figure 12 arc shown in pairs for compari50n. 35
1 ask rhe reader ro make choices before
reading fu rrher. Which has more sodium,
a cup of corn chips ar a cup of corn flakes?
How about 1/4 cup of peanurs ar a call of
comaro soup? Or a bag ofpoearo chips vcrsus a cup ofinstant mashed poratoes? When
you finish scanning rhe list, look ac Figmc
13 which Iim rhe same foods along wirh
(he amoullts of sodium.
Notice (har rhe foods wirh the highesr
sodiuJn conccnr are on t!le righr. You may
be surprised ro see thar a cup of tomaro soup
colltains six rimes as much sodium as 1/4
cup of peanurs. Sauerkraur is nor considered ro be a low sodium food, bur Egg
McMuffin is rwice as high. Cured ham is a
high sodium food, but Chinese style rice
has almosc duee rimes as much. Frozen peas
have ver)' low sodium, but canned peas are
ftve times as high because sale is added in
(he processing.
The purpose of (his litr!c exercise is ro
encourage you ro rcad labels when you shop
for groceries. lf you (fuse ro guess work,
you wiLllikely often be wrong. We alI need
ro be aware thar rhere is a high amounr of
hidden sodium in cerrain foods.
What is (he maximum safe inrake of
sodium? le depends an your circumstance,
as shown in Figure 14Y;
Notice rhar (he average American consumes 4000 mg per day, which is 16 times
che minimum necessary levcl 01'250 mg. It
is colllOlonly believed rhat onIy rhose wha
have hypertension, hearr disease, or liver
disease shollld limi[ eheir sodium intake, but
rhar is nor rhe case. A recent srudy showed


rhat rhe higher the sodium intake the higher
rhe risk ofhaving a hean arrack, whemer or
not rhe person had hypenensiol).37 The
lowering of sodium ro (he recommended
levels could reduce the monaliry rate of
srroke by 39 percenr and hearr arrack by 30
percenr accordiog ro a panel ofblood pressure expens recenrly convened by the Columbia School of Public Healrh in New
In addirion, a low sodium dier reduces
rhe risk of som.e cancers, osteoporosis, and
kidney srones as listed in Figure 15.38
For example, earing more rhan 3 reaspoons (6.6 grams) of salt per day ar eating
pickJed vegetables more rhan rwice a monrh
significantly increases rhe risk of .'colllach
cancer. 39 .40 In addirion, a recent large inrernational study showed rhat if you have normal blood pressure you wiU reduce yOU( risk
of ever developing hyperrension if you are
already 00 a low sodium diet.~1
If your dier is such thar rhe daily incake
of sodium roeals up ro less than ehe ma.ximum safe amount, you may use some sale
rrom rhe shaker. How mucb an you use?
Actually very linIe. One reaspoon of sah
comajns roughly 2300 mg of sodium 42
(compared tO a limir of2400 mg for a persoo witb normal blood pressure). Therefore. even if ehesodium camel\( ofyour food
is lower man rhe maximum for your condition, you could use very linie additional salt
from tbe shaker in cooking or ac rhe eable
and stiH be sa fe.
Ir is obvious ehar these limits can bc
uHwittinglyexceeded. In our office we provide descripeions of diees coneaining Ofle
gram of sodium per da)' rhar can be easily
followed. They are inclllded for yom use
in Appendix V, entirled, "One Gram $0diurn Diet". Sodillm conrenr of some addirional foods is provided in Figure 16 3 as
addJtionaI help in controlling yom sodiulll
Notice rhar soy sauce is bigh in sodium,
and dill pickJe are even higher. Pickles in
general are very high. Sauerkraur ha rhe
highesr amounr ofsodium on the charr. You
wil! find v<lriaeions according ro rhe brand,
but aII sauerkraur is high. On the other
hand, salad dressings are llsual1y low in so-



Hypertension and its complications

Myocardial infarction
Complications of congestive heart failure,
cirrhosis of the liver, and kidney failure
Stomach and nasopharyngeal cancer
Kidney stones
Figure 15

dium when lISed sparingly. Hor dogs and

bologna are high, in the same range as dairy
produces. Canned SOllpS and canned spaghetti sauce rend ro be very high ,u1d shoulel
be lIseel sp:tringly if ar ali. Some soups may
be higher or lower than those seaeed. The
poinr is that labels should be read before
you buy. Approximate1y 80 percent of our
salt intake comes from proc ssed foods. 44

Food Item


Diil PickJes
Olives, Mission
Thousaod Island Drcssing
French Dressiog
Italian Dres.sing
Blue Cbeese Dressing ....
Canned Ham
Hot Dogs
Corned Beef
Sausagc Link
Saucrkraut ~
Canned Soup:
Cream of Mushroom
Vegelarian Vegefable
Spaghetti Sauce
Cbeddar Cheese
Cottage Cheese
Tomato Juicc

1 Tbs.
1 largI'

10 med.
I Tbs.
I tsp.
1 Tbs.
1 Tbs.
1 Tbs.
1 Tbs.
1 Tbs.
1 slice

2 sllce~


1 cup
10 tbin
I cup
I cup
1 cup

II: cup
1 cup
1 cup



Figure 16


What abouc resrauram food? There is
much hidden sodium in food served byearing establishmems. Resrauranrs compcrc
wirh each orher, and because Americans
demand it, saIt-flavored food appears ro be
esscnrial w remaining comperirive. Some
resrauralHS, however, specialize in offering
oprional low salr meals ro arrracr healrh
minded cuswmers. Prepared foods, whecher
chey are found in rhe supermarker ar rhe
restauram, are often dangeroLlsly high in
sodillm. The only prorcccion we have is ro
read tlJe labels (ar ger specific nurricional
informa(ion, in d)e case of resr.allranrs) so
we can be aware of where hidden sodium
Some people become discouraged ac chis
poinr and wonder if rhere are any eommon
faods rhar are very low in sodium. The answer is a resoundingyes. Figure 17, rhe final chan on sodium comene, lists food
grollps [har are extremely low in sodium. 45
The.se foods have 50 Linie sodium chat
you can eat as mueh of them as you like
wirhouc being concerned abour exceeding
che daily limir. Unsalced lllltS are safe [Q
eac; rhe added salt found in some processed
nUC5 makes rhem high in sodium. Thus,
we see rhar rhere are many foods ehar can
be freely earen wi(hout concern abOllt cheir
sodillm conrene. Fruits provide a dOllble
benefit in rhar rhey are a1so high in potas-


Ave. Sodium Content

per Serving, mg

Fresb fruit

Grains & cereals

Nuts (unsalted)

Shredded wheat (loz.)
Figure 17



sium, which tends ta reduce blood pressure

even further. This is panially wh}' a natLlral
diet high in fruics. vegerables, .'Ind grains is
rhe answer ro the blood pressure problem.
Any food rhar is low in soelium can be
nude high, of eOllrse. b)' holding rhe sah
shaker over it. Any person wid) hjgh blood
pressure sholild keep cbe salt shaker where
it belongs-resring on ehe cable, or berrer
yer, hielelen .in rhe cupboard. Of eourse, if
rhe prepared foods in )'our elicr concain less
sodium rhan rhe chart previoLlsll' shown,
)'ou mal' add a linie sale aeeording (Q rhe
formula previously given. rn our house we
kee.p ehe sah shaker in tlle cupboarcl, reserved for guesrs, even mough no one in
OLlr famil)' has a blood pressure problem.
A eornrnon reaerion ro the idea of reducjng salt in rhe diee is, "1 eannor ear food
wirhollt [he Ievel of salr thar r am accustomed to. There wiU be no tasee ro [he [ood..
I am hooked on salc." YOtl m;ly be surprised.
as ro rhe ehanges ehar can occur in your [asre
buds wirh a Litrle efron and parienee.
My grandfather Ned1ey was told by his
ph)'sician ehar he shouJd reduce his sah incake because of hjgh blood pressure. He
was ;1 heavy salr shaker lIser, anei said rhat i(
was impossiblc for him ro CUt down. He
arglled rhar wirholll his cllscomary use of
salt his fooel haei no taste, and r.har he ma}'
as weU ear salt and dic, because life was nor
wonh )iving ifhe could not enjo)' his food.
AfLer he haei a slighr stroke, he immediarely
changed his stanee-he took (.!le sah OUt of
his elice. My gcandmother sropped cooking with salt, avoided prepareel fooels COl)taining salt, and removed rhe salt shaker
hom che table. Grandpa complained bicrerll' thar the taste of food had elisappeared.
with che salt. Afrer a few weeks, howcver,
his complaining faded away. One day
Granelma miseakenly pur a litrle sale in his
mashed pocacoes. He tOok one bite. pllshed
rhem away, and said, "1 can't ear it. AJI 1
call taste is alt." His salt addicrjon was
gone. The faod aelelitive rhat he OJ1ce was
addieted to he J10W loathed. Masr of Illy'
patiems that have undergone a similar experience with a cenajn food (Iaathing whar
was once enjoyed) start rhat ir mal' rake lip
ro faur months afrer {he decided dietary


change is strietly adhered ro before this advanrageous change in taste oecurs.
\'\Ihar about salr subsrjrures? The earll'
versions had an llnpleasam biuer, merallic
raste rhat few couJd toJerare. Cardia Sah is
one brand name rhat correcrs rhe flavor
problem. It conrains rorassllm, magnesium, and only half the sodium of regular
rabie salt. Prdiminary srudies of 40 men
and women sbow dur replacing regular
rabIe. salr wirh Cardia Salr lowered blood
pressure an average of 13 mm diastolic pressure and 8 mm sysrolic pressure in six
monrhs. Otber studies bave shown similar
resul ($. 46
Salt subsrrures bave rhree drawbacks.
The main one is rhar the)' onl)' conecr parr
of (he sodium problem-rbe amount of
sodium adeled wirh rhe sah shaker. Processed foods sucb as soups, dairy producrs,
and omers lisred in rhe preceding charts will
remain as bigh sources ofsodium in rhe dieL
Tbe second drawback s thar some people
with renal fajlure ar on cerrain blood pressure medicine (such as C~lporen and orher
ACE inhibirors) will dangerollsll' elevare
rheir serum porassillm by consumjng salr
subs(imtes and risk sudden cardiac deatb.
The thirel drawback is rhat they increase the
desire for the "real rhing," and the vicrory
(har ml' grandfarher obtained becomes duSlve.

Monosodium Glutamate Not a

What ahout anorher source of sodium.
monosodium gllltamaee~ This chemical has
been labeled as a hidelen subsrance ehar is
unclermining aur health. It is commonll'
found in food served in Chinese resraurams,
and is an addieive presene ill some foods thar
we buy in d1C supermarker. Ir has been
blamed for c.'l.llsing sweating anei mall)' orher
biLane symptoms in some people.
Be aware of an important and basic facr
regarding monosodilll1l glutamate
(MSG)-ir is not a substance that is foreign ro rhe bod)'- It is a comhination of
rwo narural subsrances: odillm anei
glutamic acid. Gluramic acid is one of 20
amino acids naturally presenr in the bod)',
and is necessary for normal body funcrions.

As a resulr of the many complaints

again t MSG, it has been the subjecr of
manl' srudies, with surprising results. The
srudies have ali been consisrent in proving
rhar MSG s nOt a problem. The resulrs of
one of rhe stlldies are shown in Figure 18. 47
lf there is a "Chjnese Restauram 5)'0drome," it does not appear to be re1ated ta
monosodium glllramate. le may be re1ated
ro some(hing else thac is in the food. Since
sodillm apan from chloride is not as harmfuI as sadium chloride wirh respeCt to blood
pressure, MSG would nor be expecred to
raise one's pressure. In fact, studies show
thar blood pressure is actually lowered somewhat by consuming MSG.48

71 subjects we,re randomly ~ed MSG or a pllacebo

in their food for five days.
Result -15 % of those consumblg
MSG had symptoms.
- 14% of those conslJmIng
a placebo haEI

Figure 18

What abollr se-a alr? Is ir Iess damaging

ehan "regular" salt? No, it has the same sodiurn and ehe Sal11e chloride. Sea sale will
tend ta misc your blood pressure jllsf as
much as regular sale. Granred, d1ere mal'
be some trace amounrs of addirional nutrienrs in sea salt thar could be helpful ro other
body fUllctons; noncrheless, it wiU do as
mllch dalllage tO your blood prcssure as
regular sale.



Losing Weight
For individuals who are overweight, iniriaring a weight los5 program can ignificantly lower tlle blood pressure. The blood
pressure will usually dmp as much as a low
salt diet will dmp ir,49 The hyperecnsive
parienr does nor neeel ca rcach optjmuln
weight for a drop in blood pressure ro oecur. Jusr iniriating a weight 105s program
and shedding about 5 pounds will bring rhe
blood pressure down substaruiaJly in mose
ca es. In order for the cHeer to be mainrained, however, rhe individual needs to sra)'
011 ehe weighr loss program umil ideal
weight s achieved. A simple four-step plan
is prescribed for mosr of my overweight
pariell[s ro achieve rheir desired weiglu.
o SIlacks. Drink onl)' warer bef\veen meals.
2. Ear a good breaki'lSf :lJld a moderate
lunch. Eliminate the evening mea!.
If somerhing "must" be eaten in the
cvening, whole fruir is ali rhat is allowable.
3. Eliminate OI' ar teast greatly reduce
refined sug;u and free fars or fatty
foods in the e1iee, wbile emphasizilw
foods high in fi bel'.
4. Dail)' moderate eJ<ercise for approximately 45 minures a da)'-

Foods Hig!? in Catcium are Beneficial

weight loss.

Foods wirh a high calcium conrent can

also significanrly lower blood pressure. Over
6000 men and women wilh high blood
pressure were dassifled as ro ther calcium
inrake. The resuh was rhar each gram of
calcium consumed per day seems ro lower
rhe risk ofhigh blood pressure by about 12
percent. Professor Jamcs Dwyer, who reporteei on rhe research ar rhe American
Hean Associaeion annual meering in November 1992, warns against raking Iarge
amounts of calcium supplemems, however.
"Inslead," he saiel, "people shou1d ger ca1cium rhrough rheir diers ... green leat}> vegerable.. are good sources of calcium."

CafJeine and Alcohol

Oatmeal Helps

Studies show [har caffeine affecrs blood

pressure. One cup of coffee per day (OI' rhe
equvalenr in cola drinks) may raise rhe diastolic and systolic blood pressure ftve to
six points. 50 It follows that e1iminating
caffeinared drinks has dle potential ro lower
blood pressure by rhe same amounr, Caffeine nor only rajses resring blood pressure,
bur if consumed before Of during exercise,
ir can raise blood pressure anei hearr rare
collsiderably above rhe levels achieved during exercise alone. 51 This could turn a
healthy activiry into an unhealrhy one by
increasing [he risk of il sign.ificam ardiovascular evenr during exercise.
Whar is the effecr of alcohol on blood

A common bremlsr food, oarmeal, has

been founel ta reduce blood pressure. In
one s[lldy, 850 people were caregorized for
the amounr of oatmeal they cOllsumed.
One-bowl-per-day users had lower blood
pressure and lower cholesterol..53 The effeer was independent of age, weighr, and
inrake of sodiurn, potassium, and alcohol.
The conc1usion is rhat people who are
trying ro control their blood pressure narurall)' may ger an unexpecred benefir hom
eaeing a bowl of oatmeal each day. Thus
oatmeal offers a double beneflr for our
hearrs. Most of us have known for some
rime rhar oaemeal helps ro lower blood cholesterol levels bccause ic is rich in warer-

Virtually aII of my patients thar srick

ta chis simple program achieve lasting


pressure? Many people are unaware rhat

alcohol raises blood pressure. Jusr an mmce
ar two per day is ali rhat is necessary ro cause
signiflcam hyperrension. 52 This is one of
the reasons why cven moderare users of alcohol have a signiflcanrly increased risk of
suoke. 1 have had some people come imo
my office, follow our low sodiU1l1 eliet, ger
on an exerci e program, anei do aH tlle right
rhings. They have come back and said,
"Dac, rny blood pressure is srillup." Ofren
when 1 raise rhe alcohol qucstion, they silently leave. However, if they are bold
enough ro rake my advice, cheiI' blood presslIfe is usuaJJy undeI' control when rhey rerurn. Eliminacing alcohol is a necessary pan
of reelucing blood pressure rhe narural \Vay.


soluble liber. The informacion an blood
pressure provides an addirional cndorsemcm
for rhis versatile grain.

Smoking Increases Blood Pressure

Smolcing is anorher lifesryle factor that
raises blood pressure. S4 After smokil1g just
one cigarerre, borh systolic and diasrolic
blood pressures can remain e1evated for as
long as 30 minure .55 In fact, blood pressure C4n rise by 10 rom of mercury. AIrhough a single cigarerre does not seem to
eause a iasrjng increase in blood pressure,
many smokers have enough eigarenes in e.he
day rhar [hey are conrinually raising r.heir
pressure. Dr. Norman Kaplan, oue of rhe
world's forem05t aurhorities on high blood
pressure, poims aur e.har a (ypieal pack-perday smoker is e1evaring his blood pressure
for most of [he day.5 6

Life's Stresses and Blood Pressure

Along wich dietary factors, life's stresses
ean raise blood pressureY' 58 Stress does not
seern ta afTecr rhe diascolic blood pressure
much, but tends ro act more on the sysc.olic
blood pressure, the rap number. Stress is a
broad subjecri in facr, 1 have devored an
en[ire chapeer ta ir. To rOllch on rhe subjecr here, I will poim out [hat rhe exrernal
pressures thac confram us (called srressors)
are very differem from aur imernal reacrions
(Q chose srressors. Wirh inadequare coping
mechanisms, stressors cake a toU on our
physical and mental well being. Boch aspecrs are addressed jn Chapcer 14, "$eress
Wi[houe. Disrress."

Aerobic exercise--exercise rhar calls inro
play [he hearc and lungs- igniflcanr!y lowers blood pressure in hyperrensive pauenc.s.
In one srudy, eighreen sedenrary indjvidual, wirb high blood pressllre eompleted a
16 \Veek exercise progr,un. During che program, [hey rode an exercise bicycle rl1Tee
days a week for abolit 45 minures per day.
They exercised ar a moderare inrensicy (60
ro 80 percenc of their predicred maximum
hean race). N[er e.he four monrh program,
(he average sysrolic blood pressure fell 7 nun
;:1I1c1 che average diascolic pressure. 5 mm.

The exercise program also helped to prevent cheir blood pressure from rising as high
during exercise. Their average systolic blood
pressure when exerdsing was 19 mm lower
anei diasrolic 10 rnrn lower than before che
program. 59

Low Blood Pressure

Many people with low blood pressllre,
around 90/50, ask jf ir is tOO low. The answer is no, noc if the)' are feeling well. In
fact, che lower che blood pressure the less
rhe risk of the many diseases and complications mencioned ac the beginning of the
chapter, as long as che individual is feeling
weU. However, if the individual fee1s
"washeel OUt," lightheaded, or generalI)' ilI,
or if the blood pressllre drops signi.ficandy
when sranding up (normally r:he blood pressure is consranc. or rises slighdy lIpOO seanding), then the blood pressure ma) be toO low.
lf your blood pressure drops more man 10
points diasc.olically when you quickJy go
from a lying down posirion ro scanding lip,
you have significant postural hypotension.
This condition is srrongly associated wirh
tlle chronic facigue syndrome. Finding rhe
reason for rhe postural hypotension and
rreae.ing ic wiU ofcen help rlle chronie fatigue syndrome. 60

In this chaprer an hyperrensiof), we have
looked ar a number of key f:las. Some of
che mose im.porc.anc poincs are lisred below:
1. High blood pressure is dangerous c.o
your healch; it is rhe cause of mally
debilitatillg and facal diseases.
2. An opcimal blood pressure will noe.
exceed 120/80 ac rest.
3. The majority of those with high
blood pressure can bring ie. under control by nacural means, rhar is, by
lifeseyle changes.
4. Making changes in lifesryle is che besc
and safesc approach c.o reducing blood
pressure, as opposed ro raking drugs.
lf you wane ro use lifeseyle ro lower your
blood pressure, you will wanr ro make che
foJlowing c.hanges:


1. Ear plenry of fruits, vegetables, grains,
aod unsalted nllts il) moelerarion, anei
orher low sodium foods.
2. Avoid fooels such as dill pickJes, cured
ham, Chinese riee, bouillon, anei
orher high sodium foods. Read rhe
3. Avoid low fiber foods such as mear
aJ1d d:'liry produets.
4. Eliminare eoffee, eola drilJks> and alcohal from rhe diee.
5. Stop smoking.
6. Keep the sah shaker ar fese
7. Bring your weighr down ro the recommended level for your height and
8. Aelopr an aerobic exercise ratiune,
such as brisk waJking.
9. Learn ro cope wirh srreS$.
Wirb rhe above changes in lifesryle, you
have a very good chance of reducing your
blood pre sure ro a normal level and keep-

ing ir rhere wrhour rhe need for medicanon.

Take rhe rime now ro make sure your
blood pressure s in rhe ideal range. Il' r is
nor, do nor pur off rhose simple lifesryle
changes. None of LIS like ta change aur
lifesryle at fmr, bur an)' one can develop
new enjoymclHs for new ways of living.
Be)'onel thar, [he lifesryle changes we have
eliscllssed are smalt compared ro rhe Ijfes[yle
change yOll may have ro make as a '[roke
ar hearr arrack vcrim. And rhe cliet dur a
kdney filure pariem is an is much more
difficuh ro adjust ro [han a pure vegeraria.n
djer. Jt also lacks rhe rich variety of the vegcrarian die[ ancl is much less sarisfYing.
Yes, you may be one of rhe ltlcky ones
who, [ike tn)' grandfather, received a "wake
up call" before it was coo late ro change.
But yotl may nor be sa fortunare. The nursing homes and cemeteries of our nation are
filled with many people who JUSt had "a litde
hgh blood pres .lIre. "

Refermces -

PA.: JP. Lippcou COlllpanr. 19n p. 2%-237.

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1993 Jan 25; 1')3(_): 154-183.

The fifth report of lhe Joilll arion,,1 Com'uirrcc on DClection, Ev"lualion. and Trc31mem of l-ligh 13I00d Prcssure UN V). Arci} !lItern j'-"etl
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II Hancock WE. Coronary Arter)' Discase: Epidemiology And Prcve"rion. 1991. In 5ciwrijic J1mericf1ll Mcdilll' (eD ROM), 1995.

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14 K:lplan
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G The


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The Jihb repon of tlle Joinr National ComJ)~ilree on Dcrecrion, Ev:tluation, and Treatmenr of l-ligh Blood Pressure (JNC V). A,.d; !fJ/cm Mcd
1993 Jan 25; 153(2): 154-183.

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It, Launer LJ. Masaki K. e' al. The assoc.iatioll berwcen midlifc blood
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1 ElliOI P, Slamler]. er al. Il1Iersalr r('vi irecl: furrhl'r anal}"es 01'24 houl
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21 Weinberger MH. Systcmic Hypencnsion. In Kellcy \'V'N. DcVila

editors, et al. Trxtbookoflll1{'mnl Ml'liiciTl1\ Phih,delphia, pi\: J.r. LipI'
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Jachuck SJ , Bricrley H . er al. The efrecr of hypolensivc drug: on rhe

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van Swieten Jc, Gc)'skcs GG, er al. Hypencnsion in lhe elderll' is

as OCial(d wirh w!lire mauer lesion and cognilive decline. AmI Nt'1Irol
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Thc fiflh repon of the Joim National Commincc on DClecrion, Evahlalion, and Trearmem of High Blood Pressure ONC V). Arr/' Intern Med
1993 Jan 25: J53(2): J 54-183.

Hl'penension in rhe Population al Largt. In: C/iuir(r/

HyperumioIJ-G" rE/iiion. Baltimorc, M D: Williams :uld Wilkins, ) 994 p.

25 Kaplan N}"t.

Elmer PJ. Grimm R Jr. et al. Life lyle imervemion: restlhs of tlw Tre;lrmenr of Mild Hypertension Study (TOMHS). ['rtl) Mu/ 1995

Ascherio A. Rimlll Efi. er.L A prospeclivc sludl' of nuuitiol13.1 faCtor>

ami h}'penen ion among US mCl1. Cirr:ulillion 1992 Nov;86(5): 1475-1484.


Kanncl WB, Garrison RJ. Dannenberg AL Secular blood pressurc lfl'l1ds

in Jlorl11otensivc persons: rhe F,,,mingham Study. Am Hrtll'/ J 1993
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The Food Processor for Windows: NUllition }\mlysis & fimcss Soft
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Tarasoff L, Kelly MF. Monosodiun, I~gllt(:lm:lte: a oouble-blind stlJdr

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4~ Corr"ea I:M, Saavedra JM. Chemic11 lesion of (he cir Lunvelllricuiar

organs witll monosodium gluramale reduces rhe blood pressure ofsp0nlaneollsll' hypertensive bur not olone kidney-one clip h)'pcrtCl1sve rat_,. BrtlZ
J Med Biol Rtf 1992;2S(5):515-519.

Etrects of weight Joss and sodiulll reduction intervention on blood pressurc and hypenension incidence in ovcrweighr rcople wirh high-normal
blood pressur~. The Trials ofHypenension Prt'vt'ntion, pll, e J1. Thc Tri"I,
of Hrpcnension Prevent ion ollaboralive Research Group. Anb II/lem
Mtd 1997 Mar 24;157(6):657-667.

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singl~ ora.! close of caffeine in milclly hypC'rtcnsiw men. Am J Hypenm.t
1994 Aug;7(8):755-758.
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Freis ED. The role ofsa.!r in hypcnension. Blood Pm.s J 992 Dce: 1(4):1 96200.


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H MacGregor GA, Marl"'1.ndu ND, Ct al. DOllblc-blind .nldl' of three
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Slcight I~ Smoking :Ind hl'penension.


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HypmtJlJion 1995 J1In:25(6): J 144-1152.


38 Anronios TE MacGregor GA. Sah imake: potential dclelerioLls e!Tens

exdlle!ing bJoou prc:-s ure. J Hum Hypertt:ll.f 1995 JlIn;9(6):511- -1-.

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infeclion and gastritis amOllg l'oung adu.hs iJ1 China. /:.;tr J Cllnrf}' !'reu
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SI ud}'

57 Boone JL. Strcss ami h}'peftcn ion. Prim Cuc 1991



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Ob'S behaviorwas highly unllsual.

However, he did nOt feel he had
any choice in rhe marter. Each
day he came ro rhe college cafeteriawirh a container ofhigh prorein food.
One day it was peanucs, rhe nexr day roasred
soybeans. the nex( day sllnflower seeds OI
walnuts. Rob wOllld ear r!lese high protein
foods Iiberally. His morivation: he had recenrty become a vegetarian and was worried thar he wouJd nor get enough protein
on his new dieI.
A year or sa iarer when Rob took a good
college nurririon class, he was astonished.
He leamed that he was gerring (Wo ar rhree
rimes rhe amollnc of protein he needed in
his diet. Worse (han rhat, he djscovered rhat
c:lting (00 much protein posed health risks.
But rhen rhere was even worse news: when
Rob analyzed his djet. he was hard pressed
ro {jnd a way [Q lower his prorein in(ake
sufficiendy ro be ,u an oprimallevel. Even
on a vegerarian dier, he was having a hard
rime avoiding his incalce of too muc); protn.'
Rob's rruc srory need never have happened ifhe had bcen aware of research rhar
was done ar Harvard and Lama Linda Universiries in the 1950s and 60s. There. researchers Drs. Hardinge and Stare had discovered mar individuals on a [Ota) vegetar-

ian diet ger sufficient amouncs of al) the

proper rypes ofprorcins needed by rhe human body.l
However, long before Hardinge and
Stare arrived on rhe scene, other eminent
sciencisrs were quescioning rhe long-held
dogma of the imporrance oflarge amounrs
of prorein in rhe die(. The renowned nurritional researcher, Dt. T. Colin Campbell,
recendy described SOme of our cultural biases toward high prorein diers aud mearbased meals. 2 Dr. Campbell, Professor of
Nuuieional Biochemistry ar Cornell Universiry. srands in a unique position to evaluare this subject. He is rhe director of rhe
massive Cornell-Oxford-China Diec aI,d
Healrh Project, and bas seen rhe healch advantages of a lower protein diet such as is
common in Mainland China. In rhe July
1996 issue of his New Cemury Nurrition
healrh leuer. Campbell shared the experience and research of rhe famous Yale Universiry Professor, Russell Chirrenden. 3
Chinenden was among the firsr in clIe modern era ro challenge che nurrirional dogma
chac had persisced for centuries. He had
heard rhe standard line chac rhe high prorein animal-based foods promored screngrh
and energy along with mental and physical
fitness. BlI( he wondered, was this realJy
rhe case? In ilie carly 1900s Chirrenden


conducred at least rhree sllIdies rhat examined rhe qucsrion ofwherher mear and high
proren were reali)' necessary for oprimal
performance. The capsronc of his research
was a srudl' of well-rrained arhleres. Ar ilie
beginni ng of his stlIcll', these athletes were
aII on a rypicalmeat dier. Chinenden haei
rhem {hen swirch ta a planr-based dicr for
hve momhs. Ar rhe end of rhe swdy period when rheir fimess levels were rcanaIyzed. the atllJeres had improl)ed a- .()'iking
35 percent. As Campbell commenred, "only
ilie dierary change could have accounred for
rhese remarkable resulrs."4
Whar Chinenden suggesred years ago is
now bei ng re-ccha ci by hundreds of vaices.
Earing animal flesh and animal prorein is
nor necessary in order ro obrain oprimal
prorein intake for proelucrivit)' and performance. So where did this grear meat aod
prorein myth come from?

History OfMan's Knowledge ofProtein


Prorein was discovered as a nutrienr class

in 1838. 5 By then, ir was also recognized
rhar proteins were associateel with ali forms
ofLife from rhe simplesr single-ceUed organisms ro man. No wonder rhere has been
such fascination with prorein-anyrhing
rhat is necessary for aII forms of life is rruly
awe inspiring. In f;lCr, Webster suggests thar
rhe verl' word "prorein" is derived from rhe
Greek roor "prows" which means "hrsc"6
Our appreciation for protein has grown over
rhe years; we now know rhat ir is viral for
such diverse roles as musc1e function, hormone synrhesis, and the producrion of enzymes.7 Furthermore, aur need for protein
is increased during our growth years, during rhe repair of rissues (afrer an injllry ar
surgery, for example), anei during musclebuilding exercise. 8
Thus rhere is no myth regarding rhe
importance of protein in aur diet. However> rhe confusion about rh so-called superioriry of a-nimal protein sOllfces emerges
when we look a linie closer ar the natllre of
proteins. Proreins are complex molecules
that are nude up of molecular builcling
blocks called "amino aciels." There are 20
amina aciels rhat the human body uses w
build the proreins it needs for life and

healrh. 9 In adulr humans eight of these

amina acids are called essentiaJ, because rhey
must come from the dier. The names of
rhese amina acids are isoleucine, leucine,
lysine, methionine, phen}'laJanine, ducanine. tryprophan. and vaii ne. 10 The remaining 12 amino acids CUl be made by the human body. If we compare a protein molecule ro a train, the amino ;\cids are like (!le
individual cars of rhe train. Just as a nain
cannot be built out of al! box cars or ali cabooses, so rhe body needs amina acicls in
rhe right proporrions w constfLlCt funcrioual
prorein molecules. At rhis point animal
protein bias begins ro creep in. It is obvious rhar animals are physiologically more
like humans rhan planrs are. Therefore, it
shouJd come as no surprise rhat n comparing meat rrom a singLe animal species (Iike
beeD widl food from a single plam species
(like oatmeal), the mixture of amina acids
in ilie animal product will reml ro be closer
ro the proporrions n which humans ueeel
rhem. Because of chis. manl' have incorr ctll' reasoned rhat a eliet based on animal
protein sources like mear is superior ro a
eliet based on plam products in providing
adequate amounts of rhe cssenrial amina
aciels in the right proportions.

Plant \!ersus Animal Sources of

This brings LIS back ro rhe basic quesrion: do animal sOllrces of nutrition provide berrer "quality" protein rhan planr
sources? If you look ar the cliet as a whole,
the answer is no. This is exactly wh:lt
Hardinge and Stare faund in their dassic
research in rhe 1960s. Il They lookeel ar the
complere diets of duee groups: meat-eatng
Americans, pure vegerarians (rhose who exclllded alI animal producrs from (heir dier),
and lacro-ovo vegerarians (rhose \Vho exduded aII animaJ proelucrs excepr for dairy
products anei eggs). The researchers measured the actual amotlnt of each amino acid
consumed by each of rhese groupsj7mn their
whole diets. They then compared rhar inrake wirh the ideal balance of amino acids
needed by man according ro twO standarels:
(1) rhe srandarel determineel bl' Dr. Rose in


rhe 19405 and 505 and sriU llsed by rhe
World Healrh Organization ro rhis day, and
(2) hllman breasr miLk. The only food specifically designed ro mCCl aII ilie amino acid
needs of a human is human breast milk.
Amazingly, rhe best qllaljty prorein among
rhe rhree complete dier was rhe pure vegerarian diet. The mix of amina acids in rhe
total vegetarian dier mosr closely resembled
rhe mix in Rose's recommendarions antL in
human breasr milk, as illustrared in Figure 1.
The message from this classic research
is simple. lfyou look ar a single food, 31\imal prodllcrs have r!le upper hand in providing prorcin qllaJiry. However, when yOll
look ar rhe emire dier, rhen the pure vegerarian dicr cmerges as superior in prorein
quaJity. The non-vegetarian diet departs
from bom srandards alrnosr ("\vice as far as
rhe pure vegerarian diet.

Comparisons ofProtein in MiLk of

Different Species
The protein conrenr of milk is an indicarion of rhe protein requirement of a newborn. wherher rhar new-born is human or
animal. Ler us exallline rhe differences in
amounr of prorcin in milk in the differenr
mammaJian species. The)' are tablliated in
Figure 2. 12
This comparison demonsuates that humans actuali)' need less protein rhan rhe
ani maJs an the lise. Notice that the relative
growrh rare is grearer in rhose rhat have
greater alllOlllltS of protein in t!le rnilk, as
wOllld be expecred, because of the grearer
protei n requirement to bllild body rissue.
lf a human con umed a rat's milk [rom
birth, would rhat baby be able ro dOllble irs
birrh weight in days insread of monms? The
answer is obviously no, since the rare of
growth is !argely genetically determined.
The excess protein wOllld not be utiJjzed
and, as we williarer see. cOllld actually harm
rhe developing child.

Is the "CompLementary" Theory VaLid?

Ar rhis poiO[ Oll,1e may cOllnrer: "what
Hardinge and Srare did was unfair-yoll
musr ear a perfecr balance ofamino acids ar



Percent variallce /1'0111

Rose's standard

pure- egetariaD



Percellt variallce /1'0111
''''mall hreast lIIi1k





Figure 1


Mean values for

Jlrotein content,

Time required
to double birtb
weight (days)









. -,... ..Cat



Figure 2

a given meal ro uriJize rhem properly." This

argument is based on an old theory thar argued yOll mllst "complement" plant proreins
at a given meal ro get the proper protein
balance. Tbis would require an impractical
rask of weighing each serving rhar makes
IIp a meal, calculating the amino acid content of each, and rhen adding them lip.
Elaborate charts were drawn up thar listed
whar foods vegetarians needed ro combine
at a given meal ro get rhe same "quality"
prorein that a mear-eater was gerting. This


dogma went by rhe wayside long ago. Historically, rhe American Dicreric Association
(ehe professionaJ associaeion for dietirians
in the Unieed Srates) has nor been known
for adVOc.1ting a vegerarian diee However,
in 1988, ehey came out solidly in sllpporr
of vegerarian diers. They stated: "It is the
position of dle American Dieectic Association rhat vegctarian diets are health/i.Ii and
nurrirjonaJly adeqllare when appropriately
planned."13 They addressed rhe issue of
complementing proteins in rheir paper.
. it is not necessary that complememarion
of amino acid proflles bc.precise and at exacrly dle same mc.al, as the recently popular
'combined proteins rheory' suggested." The
reaJiry is rhac a vegerarian dier rhat conrajns
fruits, graillS, nurs, and vegerables is fully
adequate in protein.







Tomatocs Pumpkin









- Trp.



--i Val.






Asparagus Broccoli RECOM-



M'ENDED '~:.:..~nl"+

Figure 3

Whether you are a roraJ vcgerarian or

mear earer, you should "appropriately plan"
your diet beyond the llartOw scope of alnino
acids. Other nurrienrs need ro be included
in the planning.
o one withour some
rhought inro his regular earing praccices can
simpJy expect to be gening a nurritionally
balanced diet-regardJess ofwhether or nor
meae is induded in me fa re. There is no
evidence that vegeearians musr be more
knowledgeable man meat eaters in order to
be an a healrhful dier. In face, (he cvidence


Jeans solidly in the opposire direcrion. lf

you know llorhing about nutrit ion, you wU
likely be heahhier by leaving meat out of
your dier rather (han including it. The information in rhis chapter establishes (hat
you can ger aU the essenrial amino acids evcn
wth what may look like a very "lInbalanced"
vegerar:ian dict, as we will sec.

Can Plant Proteins Furnish Ali ofthe

Essential Amino Acids?
Let liS rake some examples of the lIJtimate in "unbalanced" vegetarian c1iersnamely, single planr foods-and see how
they measure up ro the amina acid requiremenrs. We have aJready made reference ro
Dr. Rose's work in derermining amino acid
requiremenes in hllmans. A number of
other researchers have each offered rheir own
version ofamino acid requiremems nor only
for adult men, but aJso for adult women,
and for infants and children. 14 MlILHO and
Crim have pllbtished a comparison ofRose's
requiremenrs wirh rbose of rwo orher experrs. 15 For rhe sake of assessing how planr
produers fare in rheir protein conrem I have
chosen to compare rhem ro the highesl
(most stricr) adulr daily requiremem for
each of rhe essenrial amino acids as compilecl by MUlHO and Crim. 16 Since we arc
looking at the wildly hypotherical example
of a person earing only a single food aJI day
Jong, rhe comparisons must be based on a
sufflcient (Ocal dajly caJoric imake. 1 have
chosen tO use a level of2,500 caJorcs, which
is the basis of tlle Percem Dajly Values (as
seen on rJ1e food labei) for many Americ.1n
men anei active women. J chose e1even foods
commonly eaten by non-vegetarians and
vegetarians alike. The quanriry of each of
the eighr essenrial amino acids for these
e1even foods is tabulaeed in Figure 3.
The essentiaJ amino acid color codes are
shown on the extreme right of (he f1gure.
The recommended daily amollnts of rhese
amino acids are represenred by the clllster
of shorr bars on the lower righe. The contem of dle amino acids in each of 11 plant
foods is represemed by ehe raHer bars in rhe
main body of rhe figure. Note rhar these
bars are much eaHer for aJl 11 foods (han


ehe bars represeming rhe recommended
amolllltS, signifying mar planc foods supply much more proeein than is needed. This
is rrue for every amino acid of everyfood. In
facr, if you chose virrually tmy vegerable or
whole grain you would find mat rhey have
more rhan adequare quanrities of ali eight
essential amino acids. The recommended
daily quantieies are the srriceesr requirements
ofMunco and Crim, (highcr recommended
qualHities rhan others recommend) which
are similar ro rhose of rhe World HeaIrh
Organ izario o.
Thus, rhere is no shorrage qf proreio
here. Any ooe ofrhem alone fumishes more
rban sufficient amounrs ofeach ofehe cighe
essenrial amino acids. It follows [hat a diet
eonsisting o/a variny o/plan! foods wilf have
a greater content ofali essential amino acids

rhan is needed..
Norce thar rhere is no fruit on this list.
Frwr concains a lower amount of pcoreill,
aod some varieries may nor comajn an adequare amounr of each individual essential
amino acid when earen alone. There may
be omer planr foods thar are similar ro fmir.
However, when you rh..nk abolit ir, mllch
of rhe world's popularion for centuries has
survived primarily on plant proreins. They
havc been ablc ro do rhjs simply because
vcgcrable protein provides alI ehe amino
acids needed for good heaJch.
Once when I was lecruring on ehe subjece of prorein, a woman raised her hand
and said, "Por rhe firsr rime 1 undersrand
why our family survived the Grear Depression." 1asked whar she meant. She replied,
"Our family was very poor ar the rime of
rhe Grear Depression. My parents had
many chjJdren and rhe only thing we had
availablc ro ear during rhase years were potaroes. Thllt WI1S ali. 1 never could undersrand how ali of us not only survived on
such a diet, bur also grew up healthy. Now
1undersrand how we did so wdl." She went
an ro say, "However, afrer rhe Depression,
I was so rired of potatoes that 1 did nor have
another one for 15 years." It may have been
a monotonous dier, bur it was nurritionally
sound in ali rhe essential amino acids.
1 do not recommend rhar yotl eat only
one vegeeable ehroughour rhe day and nom-

ing else. Such a cliet would lack a balance

of vitamins, minerals, aud phyrochemicals,
even though the protein intake would be
adequate. Such a balance does come easily,
however, by eating a variety of vegetables,
grains, nuts, and fruits.
We see dut we do nor need a college
degree in nmrirjon ro get "qualicy pcorein"
an a vegetarian dier. Remember, Drs.
Hardinge and Stare found mat even pure
vegerarians living in ilie 1960s wirhout aII
rhe benenrs of knowledge mar we have today were doing jusr fine regarding their intake of essential amino acids. The daea on
amino acid contene of foods helps llS ro
appreciare why this was the case.
Perhaps one of rhe bese summary sratements on this whole topic is provjded by a
respecred nutrition scienrisr, DI. Mark
Messina. Dr. Messina holds a Ph.D. in
Nutririon Science from Michigan State
University and has worked in the National
Cancer Insrirute's DieI and Cancer Branch.
Afrer speaking in derai) about the balance
of amino acids in plam producrs, he made
t he following sum mary srarement:
" ... when people ear several servings of
graillS, beans, and vegerables rhroughour the
day, and get enough calories, ir is virrually
impossible to be deficiem in protein."17

Can W'e Get Too Much Protein?

Mosr Americans are weU aware ehar ie is
possible ro gee too rnuch fa! in rheir diet.
They also know rhar eating too much sugllr
can be harmful. However, mauy do nor
realize thar rhere is much evidence ehat
shows ehe serious consequ.ences from earing

too much protein.

Osteoporosis and Protein

Osreoporosis-a condition thar refers ro
a loss ofbone densicy or mass-has become
a household word in America. Among the
mOSI feared complicarions of this bone-rh..nning process are hip fractures. Fracrures of
ehe backbones (vertebrae) and wrisrs are also
commonly related to osreoporosis. One in
rhree women over 50 years of age worldwide have oseeoporosis. 18 A1iliough rhe disease hies white women aftcr menopallse the
most, it affecrs ali races and both sexcs.


Some 70 percenr of aII fracrures rh:u
occur in Ameri ans over 45 have been reIared ro osteoporosis.l 9 Furrhennore, the
srarisrics indicare rhar over h,tIf of alI posrmenopausal women will suffer a fracrure
due ro osreoporosis ar sorne rime in rheil"
lives. 20 AbOlit 1.3 miLlion osreoporosis-I"eIared rracwres occur each year in me Unired
Statcs. The annllal medic.,] costs for 05reoporosis fracwres among adults ages 65
and lip wtaled 13.8 bilLion dolJars in 1995. 21
These fracrures can signiflcandy decrease rhe
quaJity oflife, and can also ser rhe srage for
premature death as a result ofcomplicarions
like pneumonia. For example, in rhe year
f(>l\owing a hip fracrure, risk of death increases 15 ro 20 percenr. 22


Ate 48 gms.

Ate 95 gms.

Ate 142 gros.







U Loss



Figure 4

A growing bod)' of research evidence

indicares rhat e;<cessive prorein in {he die.tespeciaLly animal protein-increases rhe risk
of osreoporosis. Srudy afrer srudy indicares
rhat earing mear can cause a IOJS ofcalcium
from me body. Research done ar rhe Universiry ofWisconsin illusrrared panicularly
weIl rhe hannfuJ effeers of excess prorein. 13
Healrh)' young adult men were given
carefully eonrrolled diers for nearly four
monrhs. During this eIHire rime rh.ey were
consuming 1400 mg of calcillm daily-an
aJnollnr abolit as high as anyone is recoJnmending wday. and signifiGUltiy above rhe

U.5. recommended daily aJlowance (RDA)

of 1000 mg per day for women. During
rhe srud)', rhe invesrigawrs also conrrolled
rhe subjecrs' protein int/lkes ar two levels,
namely, 48g per day anei 141 g per da)'.
These two levels of prorein are below and
above rhe currenr average inrake in rhe U.S.
of 105 g per day, according ro rhe btesr St3risrics from the U.5. Deparrment of Agriculture. 24 The amollnr of calcium gain Of
loss in each subject was measured ar {he twa
Resulrs showed dl,l[ when on rhe 1lJW
protein diet. rhe yOllng men g/1ined 10 mg
of calcium ro rheir body srores each clay. On
rhe high protein dier rhe very same men lost
an average of84 mg each day. The amhors
concluded, "The calcillm loss of 84 rng
dail)'. which oecurred when rhe high prarein dier was fed, was substantial and ifconrinued ()ver a period of rime woulcl resuir in
eonsiderable loss of body calcillm."
A follow-up stlldy was conducred by
Linkswilcr and associares in 1981. 25 The
srudy was similar ro rhe srudy cired abovc,
excepr rhar ir added a rhird level of protein
intake of95 grams per day, which was close
ro rhe average D.S. intake ar rhar rime
(99 g). They divided their sllbjecrs into
duee groups, each wirh a differenr level of
prorein inrake. AlI three grollps were consllming 1400 mg of calcium per day in rheir
diers, which is identical ro rhe previous
srudy. The researchers looked ar caJcium
gain or loss of each grollp by measuring rhe
amollnr of calcium excrered in each
parricipam's uril1e and srool. The results of
rhis srudy are shown in Figure 4.
Notice that rhe grollp eating 142 grams
of prorein per day actllally losr 70 mg of
caJcium daily. Where clid mar calcillm come
from? It carne from rheir bone reserves.
This is an obvioLls conclLlsion since 99 percent of rJ1e caJcilltn in our bodje.s is in our
bones. The high prorein inrake group was
losing calciu-m el}e~y doy silnply because of
rheir high proteil1 cOrJSumption. The excessive prorein was leeching calcium from rheir
bones even though theywere gerring plem)'
of calci li m in their diel.
he group rhar con umed rhe amounr
of prorein close ro rhe dail)' U.5. ave rage


a150 lost calcium. Their 105s was Iess. as expected, because rhey consumed less protein.
The group on che so-called low prorein dier
was rhe only graup dlat had a ner calcium
gain. The gain of 20 mg per day would
help maintain thicker and stronger bones.
It is one thing ro look at data from a
llurrieion lab, buc ie is even more compelling tO see evidence of chese same relationships in people '""ho are living normallives
da~' in and dayour. Internaeional comparisons ofoseeoporosis lead ro some of rhe same
conclusions. The esteemed researcher. Dr.
D.M. Hegsred, has poinred out thar osreoporosis is lugher in coumries th;H consume higher amounts of caLcium. l6 He
looked ar {he average calcium inrake and
number of hip fracrures in 16 coumrie.s.
The resulrs are tabulated in Figure 5.
The councries are listed in ascending
oreler ofcalcium intake. Noeice char in general, those wieh {he higher imakes of calcium tend to have the highest rates of osreoporosis. 27 The first seven countries.
which consume an average ca1cium below
900 mg per day, have less than 100 hip fracrures per 100,000 people. Seven of t.he nine
other countries, a11 ofwhich consume more
than 900 mg, have 100 or more hip fracwres per 100,000.
An exceHem case in poinr is provided
by the Alaskan Eskimos. By direct measuremem ofbone densiry. twO orher Universicy
of Wiscoosin researchers Richard Mazess
anei Warren Marher found thar Eskimos
over the age of 40 had 10 ro 15 percem more
bone 1055 tban white Americans in dle sam.e
age range. These losses were true of borh
sexes. 28 lnreresringly, when these rescarchcrs reviewed the medicallirerature on Eskimos' detary iIHake, they found (hat they
consumed a high LeveL 0/2500 mg ofcaLcium ddiLy.29 Where did t.hey get 50 much
calcium? Apparently they were eating large
quanti ties of fish, inci uding rhe bones.
However. (hey a1so had a high protein intake, in che range of 250 to 400 grams per
day, probably becausc of rheir high consumption offish, walrus, and whale. 30 The
aurhors concluded: "The most obvious f:.lClOr in rhe ... higher rate ofbone loss in middlc;lged Eskimos would be r.heir mear diee:'3]

These stlldies anei orhers like rhem indic<1te thar osteoporosis, contrar)' ro popular opiniol1, is nor reLued ro a Lack of caLum in the Jiei. The bigger problem seems
ro be excessive calciurn losses as a result of
conmming 100 much protein. \Y/e would nor
expecr the American dair)' industr)' ro advenise rhis. Afrer aU rhey have worked for
years ro convince liS rhar drink.ing more milk
and eating more cheese and yogure wou1d
heJp us prevcm osreoporosis. The fact is
chis: if your diet is high in pwrein, you can
car ali (he calcium tha( the dairy association has ro offer and you are stiH likely incre.asing yom risk of rhinning your bones
and pcrhaps facing a hip fracrure latcr in

Eskimos comuming over

2000 m-g ofcaLcium dai!),
have the highest raW ofosteoporosis in the world


Hip-fractllre Rate
(per 100,000 people)





Unifrd Stah'5


. . .

nited KinKdom







N,... Z..land






N'ew Goinea








CalciwlI llllake
(nrgldaJ' approx.)

Figure 5

life. E'lCcess protein Leads to il decrease ofcalcitim storn even when (aLrium intake is Lib-


Why Does Meat in the Diet CaUJe

Bone Loss?
What is ir about meat eating and dicrs
high in proeein (har causes bone los5 and an
increase in oseeoporosis risk? Onc explanarion is t.hat meat rcnds ro be rich in amino
acids rhat contaln sllifur, such as merhionine. When consllmed in excess, dlese amina
acids Icad ro a buildup ofsul fur ions. Some



Vrea is produced in the

metabolism ofprotein and
in excess acts IlS a di uretic

believe that th.is inerease il\ sulfate alone may

eause [he kidlleyS to excrete more calcium
in the urule. 32 Others provide a more complicated explanation for [he relationship.
They argue mat the excess sulfur makes the
blood more acidic. The body [hen uses bone
eonstiruents ta neutralize this acid load, rhlls
causing a loss ofbone tissue. Increased ealcillm in the mille then provides a teHtaJe
sign of this bone loss.33
Another explanation is stiH more complicated. It hinges an a well-known physi-

Factors SignificantIYJ!1cr~asin Risk

---Rl!l#ve Risk

Current use of anticonvulsive drugs

Current smoking
History of maternal hip fracture
Resting pulse rate> 80 beats/min.
Current use of long-acting benzodiazepines
Current caffeine intake'
(equal to 11/2 cups per day)



Factors Not Affecting Risk

Current estrogen use
Daily calcium intake


Factors Significantl Decreasing Risk

Walking for exercise
On feet more than 4 hrs per day


Figure 6


ologie fact: essential amina acids are needed

in faidy precise amollnts. When intake of
these essential amino acids exceeds the
body's needs, liver emymes are tumed an
[Q break down rJlese amino acids. Some of
the c1assic experimems in this regard vere
done by Elwyn. 34 He fed dogs excessive
amounts of mcat and traced [he path rrave1ed by rhe amino acids. The protein was
broken down in the sromach and inrestine
aod [hen rhe amino acids were raken up inra
the blood vessels surrounding the intestine.
From rhere, they were carried ro [he liver.
At this point, beeause of the exeessive
amounts, a large portion of the amina acids was immediately broken down when

rhey passed through rhe liver. Over half of

them were converred ro a breakdown produet ealled urea, whiJe anly 23 percenr of the
amina acids passed from the liver inco [he
general circulation where they could be used
by other body tissues.
What happens ro rhis excessive urea~ [t
acrs as a diuretic. 35 A diuretic causes e1imination of water, bur in the process it elinlinates not only water, but a1so lIseful mincrak A similar effect occurs when ;~ person
rakes dillretic mediatiolls. That individual
often must take potassium becallse cerrain
diuretics can eliminate potassiuJn a10ng with
water. Excess urea eallses calcium loss \Virh
rhe water loss.
AlI of rhese mechanisms may be panial
explanacions. Whatever the case, it is well
established dur a meat and h igh protein fare
incrCdses the risk of osreoporosis.
This line of evidence may prove very
disconcerring ta mally readers. What are
we ro do wirh rhe revered mineral, calcium?
One of rhe most comprehetlsive srudie" on
osteopowsis helps ro put [he mie ofcakiulll
in perspective. This srudy was nor restricred
ro the lone effect of Gllcium intake, bUl
looked ar man)' additional lifestyle facrors
in relation to hip fractures. Faur major [esearch cenrers worked rogether to analyzc
the risk of hip fracrure ll nearly 10,000
white women over 65. 36 The)' found [har a
low calcium imake-even below 400 mg
per day - did nor cause hip fractures in chis
exrensive srud)'. This result agrees with t!le
smdy shown previously in Figllre 5. Beyond calcium, chey [ollnd many orller factors thar were damaging. They are listed in
Fgure 6.
Notice thar mose whose mothers had
had hip fracmres experienced double rhe risk
afhip fracrure. Those wha did not exercse
regularly were at higher risk. Caffeine consumprion equivalenr to ]1/2 cups of coffce
per day was aha dearly assoeared wirh an
increased risk, as was taking anri-anxiery
(benzodiazepines) 01' anri-seizure medications. Numerous addirional smdies have
shown rhat the higher rhe animal protein
inrake, the lower rhe densiry of rhe bod)"s
bones and rhe greater the risk for hip fracrure.37 Interesringly, higher consumptjon


of vegerable prorein does nor appear ro be
relared ro osteoporosis or bone fracrures. 38
AlrJlOugh cakium intake and hip fracrures
are unrelated in many studies, some swdies
have shown that an increase in caJciuffi intake. can prevenr osreoporosis, parricularly
when rhe CaJCiUffi consumption is adequate
and the prorein inrake is relativel)' low before rhe age of30.3~) Omer known risk tac[Ors rhar addirional studies have identfied
for osteoporosis include inadequare sl.lnlighr
(ar low Vitamin D levels), alcohol consumprion, caffeine consumption, and lack of
regular physical exercise. 40 Many srudies
have shown rhar thin posr-menopausal
women who are nor taking eserogen supplemenes are also ar risk. 11
A diet plenriful in cakiuffi comained in
plant foods is srill recommended. Calciuffi
is not only essential for strong bones; it is
beneficia] in orher important body functiOM. For ex.ample, it may help to prevem
high blood pressure. Tr :uso appears ro "assisr ehe heare in beaeing wieh greater viraJiry.42
A number of foods rhat have goodly
amounrs of calcium are listed in Figure 7. 43
Sa)' beans and greens are a good natural
source of calcium. Some green leafY vegerables-like coLlards and Jamb's-quarrershave even more calcium per serving rhan
soybeans. Greens also have propenies rhar
help prevent cancer. rnd ed, we C<1n obrain
adequare C<1kium from planr sources. Fllrrhermore, rhese foods are lower in prorein
and merefore should noe extracr calcium
from our bones. If we avoid an excess levei
of prorein inrake and ear a good \Iariery of
plam foods, our body ca1cium swres wiU
likely be more rhan adequare.
Tables like rhar above fail ta reveal one
orhcr important fact abOli( cakium ba.lance.
Namel)', it is nor on.!)' rhe quantity of calcium in a given food that is important, but
how well that cakiulll .is absorbecl. And calcium absorption is dependent ro some degree on the composirion of the whoLe diel,
nor merely an [he nurririonaJ characterislies of a given calcium-rich food.



Amount Calc (mg)

Quinoa grain
Dandelion greens
Mustard greens . - .
Baked beans
.., le.
2 Tbs.
Sesame seeds (dried)
Blaekstrap eane molasses 1 Tbs.
Turnilp greens
Filberts/Hazelnuts (dried) le.
Green s o y b e a n s l c.
Figs (dried)
Whole milk
Amaranth grain
Nonfat sitim milk
CoUard greens
Carob flour
.1 c.


357 ~


Absorption ofCalcium from Plant

Foods vs. Milk
Although milk has a high calcium contem, 60 to 80 percmt of it is nof absorbed
through rhe human intestine. 44 Of. C.M.
Weaver and associares ar Purdue Universiry
have observed rhar, in general, hllmans ab
sorb a.r much or more ofrhe calcium in plam
products rhan rhe)' do from mi.fk:l5 46 (The
main exceprions are planr foods rhat conrain high concentrations ofcompounds thar
bJock calciull1 absorption. Examples include spinach with irs oxa.lic acid and wheat
bran cerea] wirh irs liberal amounrs of phyric
acid). Since r is now recognized thar calcium can be assimilated as well or better
from vegetarian sOllfces rhan from milk, we
musr simply become aware of the rich


sources ofcalcium in the vegerarian diet and
ehoose ro regularly consume these items.
One possible reason for the very favorable absorption ofcalciull1 from plam producrs like green leafY vegetables is uleir low
phosphorus comem. Dark green leaf vegetables can have rhree ro Ave rimes as much
calcium as phosphorus. By way of COIllparison, (he rypical U.S. dier is reversed: i(
has more rhan twiee as much phosphorus
as calciulll. And diets with a phosphorusro-ealeiull1 ratio over two have been linked


Food Item:

Calcium ('!!1:) PllOspllOrliS (mg)

Diel Pepsi (12 /1. oz.)

Lcan T-bone steak (3 07_)
Cund bam (3.5 Ol.)
Atlantic salmon (3 Ol.)
Polaloes (3 oz.)
Calush (3.5 oz.)
T.ofu, raw (lh c.) ~ 258
Skim milk (1 c.)~- \
Whole milk (1 c.)
Scsame seeds (1 Tbs.)
Human miJk (1 c.)
SpiDacb (1/2 c.)
Mustard greens (1 c.)
Turnip grccns (1/2 c.)
Kale (1 c.)
[,amhsquarlers (1 c.)
Collards (1 c.)

CIP Ratio




< 0.1
< 0.1
< 0.1











44 :"""-=:=...0_ 4.4

Figure 8


to inereased bone Joss in animalsY High

levels of dietar)' phosphorus lead ro inereased losses of calcium in rhe Stool. It is
recolnmended rhat ar Ie..ast as mueh caleium
as phosphorus is consumed in rhe dict if
you want ro oprimize calcium absorption. 48
The balance of calcium and phosphorus in
a variery of foods is 'hown in Figure 8. 49
There is a problem with looking ar rarios: they can be misleading. For example,
some may conclude thar carfish is equaJ ro
poraroes because rheir rarios are equaJ. Nor
so-rhe rario ll1ul the cotaJ phosphorus arc
imporranr. To keep your phosphorus load
down, you wOllld favor the poraro, which
bas onJ}' rvvo-ehirds as much as G.1.dish; and
neilher of them eomribure much in the way
of calcium.
Thus, in addition ro looking at calciumto-phosphorus ratios, we need tO consider
ehe phosphorus cOnteOf itself in common
food groups. The average American dier
has been eva1u<lred regarding (he percelHage of phosphorus in each of eighr major
food groups thar provide aur total phosphorus intake. Two food groups stand aur Wilh
a high phosphorus conrem and rhey account
for rhe major percenrage ofour total imake.
The percenrage in each of the eight groups
is shown in Figure 9.
Note rhac two groups, meat and dair)'
products, aecounr for 60 pereenr of aur
phosphorus imake. To lower ehe inrake, the
besr srrategy would be ro lirnit ar stop our
consumprion of foods in these two food

Catcium in the Urine Causes

Kidney Stones

Grain products

Figure 9




Iluts &

soy 5%


We havc seen tiut losing calcium in the

uril1e increases rhe risk of osteoporosis. It
also presenes ocher problems. One of these
is an increased risk of kidney stones. A
Harvard stud)' of abour 45,000 heaJth professionals found rhat rhere was a 33 percenr
increase in kidlley srones in (hase eaeing the
largesc amounrs of animal protein. The resulrs suggested that inrakes of more tllan
61 grams of prorein daily inereases kidney
srone risk. Anotller result suggests rhar a
50 percene decreased risk is produced by


eating high potassium foods from frllirs and
vegerables. S' As expected, me researchers
also found dut drinking plenry of water
decreased kidney Stone risk.
Another scudy done in Brirain reache<\
similar conclusions; namely. rhar a high
animal protein diet increased calcium in the
urine and rhe risk of caJcium srone formarion.)2 rf you have already had a kidney
srone. you are mucll more likely ro form a
recurrem kidney stone if you have a dic[
high in animal prorein. It is obvious lhar
rlle besr way ro reduce rhe risk of kidney
seones is simply ro ear an abllndance ofplant
foods rhar are naturally lower in prorcin.

Cancer is Linked to Eating Ey:cess

Animal Protein
Cancer is anorher problem linked to
excess animaJ prorein. International comparisons suggest that coumries where more
animal prorein is eaten have more Iymphoma,S3 a deadly cancer of rhe lymph
glands. Some rypes are parricularly devasraring becausc rhey strike younger adulrs.
ForruoareJy. modern advances have rendered many Iymphomas rrearable with chemorherapy and/or radiarion. Nonetheless,
lymphoma sriJl c1aims over 23.000 lives per
year in rhe Unired Srates. The link berween
animal prorein consumprion and Jymphoma appears solid. An even stronger relarionship is fouod wirh one parricular rype
of animal protein; namely, bovine (cow)
prorein. The New York rese.archer, Allan
Cunningham, found rhar r11e suongest internarional relationship exists between dairy
and beef protein and Iymph gland cancer.
This re1arjonship is iIJusrrared in Fig1.lre 10.
Nore rhac the U.S. has [he unenviable
distincrion. of sraoding in the rop tier of
counrries regarding the inrake of dairy aod
beef procein and Iymphoma risk.
Grher popllla.tion srudies have found an
association berween animal protein consumprion and increased incidence of cancers mher than lymphoma. 54 Armstrong
and Doll found mat increased animal protein consumption increased rhe risk ofcancers of the breasr, colon, prostace, kidney,
and womb (endomerrium).5S With a.U of

rhese associations, the quesrion could be

asked wherher i[ is animal protein that is so
bad, or wherher rhe bigger problem is lack
of certain nurrienrs fOllnd abwldalltly in a
planr-based dier. ActuaIIy, there is some
truth in borh assllmprions. Animal protein
irself does increase cancer risk when compared to vegerable protein. In addition,
nutrielHs inund in many planr products
appear ro prelJent cancer. Thus, rhose who
consume large amounrs of animal protein
are likdy shortchanging rhemselves regarding an adequare inrake of healrhful plan[
The soybean provides an example ofhow
difficulr it may be ro confirm the reason(s)
planr protein may help decrease cancer. Dr.


USA New uRlind

F"m laod
Unlted Kingdom
Swed en




Per capita bovine protein consumption (g/day)
Figure 10

Mark Messina, a noted soy bean researcher,

has listed a number ofsoy proten products
rhar have a cancer-fighting role. These include soy protein isolare, soy flour, and textured vegerable protein. 56 Furrhermore,
human popularion studies suggesr that soy
has a role in preventing a variety of cancers
incllJding colon. rectum, prosrate, sromach,
lung, and breasr. 57 Messina explains ehar
the primar)' reasoo for the anricancer beneflts of rhese producrs probably resides
largely in their liberal supply ofanriox:idants,


which are chemicals ular can block cancer
formarion. Thus, rhe example of soy illusrrares rhat it may be difficulr ro reU how
much benefir comes from rhe plalH protein
irself (and rhus avoidance ofanimal prorcin)
and ha\'{ much arises from other compound.s faund in liberal amoulHs in proreinrich planc foods. The evidence is char plam
producrs often have a hosr of Cll1cer-prorecrive properries rhar may be of even more
benefir rhan thcir superior rype of prorein.
Chapte.r 2 on cancer addresses {!.lese properries more fully.
Specific cancer research, however, identifies animal protein i{self as a cancer-promot ing factor. Researdlers ar Cornell University in ew York have provided striking
evidence of a relarionship berween animal
prorein intake and liver cancer. In humans,
tWO of rlle main causes of liver cancer are
generic changes caused by che hepariris B
virus sS aJld exposure ro a carcinogen called
aflatoxin B 1. 59 (Ailaroxins are a graup of
chemica1s produced by certaln molds rhar
are capable ofcontaminaring ordinar)' foodsrufTs, such as moIdy peanurs.) The Cornell
group has now shown rhar in anima1s these
twO patent causes of liver cancer can be
rhwarred b)' following a dier with reduced
animal prorein. When Illice are given a.flaroxin or have Heparitis B-related generic
changes ro increase rhe cancer risk, a lowcred animal protein dier can elramarically
reduce rheir liver cancer risk.
One recent srudy involved rwo groups
of m.ice prone ro liver cancer mac had Hepatiris B-altereel genetics. Dr. Cheng and colleagues fed one gratiI' of rhese mice a srand:ud 22 percenc milk procein (casein) diec.
They feei rhe ocher group a dier wirh casein
reeluced by abouc 75 I'ercenc. The difference in cancer developmenr was suibngly
proportional (Q the casein in rhe diec. 60
Whereas 64 percenr of rhe mice an rhe srandard eliet contracred liver cancer, onI)' 16
percenc of chose on rhe low animal prorein
dier did (a reduc(ion of75 percenc).
Similar results have been found in rheir
tab with aflaroxill rarher rhan Hepatitis Baltercd genetics. Increasing the procei n COIl(em ro the same 20 percem range by usi tlg
soy ar orher planr proteins insread of miile


I'rotejl) did nor increase che cancer risk. T!lis

makes a $rIo11g case tJlat ir is the animal prorein itself, not protei Il in general, rhac is the
These cancer-promoring effects of a
higher animal protein-based e1ier also appear ro occur in hUll1ans. For example, afla(oxin exposure in China does not seem ro
increase liver cancer risk becausc of their low
prorein dier. 61
Why eloes a high animal procein diet
increase cancer risk? Oile explanarion may
be rhac animal proteins lead to increased
levels of cerrain growrh hormones thar
srimulare cancer growth. One such growrh
factor is called insulin-like growth factor II
(lGF2). T!lis facror is needed for rhe normal growth of the human embryo, and
cencls ro decrease as we get older. 62 . 63 Howevcr, IGF2 is often found in high amOUlHS
in tlImors. 64 . 65 Some researdletS belicvc
rhar rhis growrh f:Kcor helps ro give the cancer cells a growth. advamage. Of particular
importance, fGF2 levels were over four
rimes higher in mice with the hepatitis B
generic chaJlges that were given fhe 22 percent casein diet compared to those with rhe
same genetic changes for mice thar were an
rhe 6 percent casein diet. 66
There lllay be orher rea ons for the Sllperiority of plant protein regarding cancer.
Immune sysrem effects may a1so be pan of
rhe explanation. Although rhe reseacch is
far from conclu ive, we are srarting ro learn
abollt some iJlteresting relariollships berwecn diet and a grollp of cells called natural killer cells.
Nanual kiUer cells are a special type of
whire blood cell. These ceUs have rhe ability ro destroy foreign cells such as cancer
cells. 67 There is now sorue evidence demonsrrating that the consulllptioll of larger
amollnts of proteill, especaJly from animal
sources, can decrease rhe number of narurai killer cells. The higher pwrein illrake
may al50 adversely affecr rwo orher rypes of
whire blood ceUs; rhe T helper cdls and the
T cytoroxic cells. For example, oile scudy
determined dlar resrriction of rwo amino
acids, phenylalanine and ryrosine, could
mprove [he immune sysrems of healrhy
human voluntcers. 68 For 28 da)'s, rhe elice


of rhe panicipams was changed ro restrin
the rwo amina acids, aher which rheir diers
were swirched back ro rhe eypical American
dieI with higher amoul1ts of tbe amina acids. The effecrs of {hese dier changes are
rraced in Figure Il.
Notice rhar the nacural killer cells
doubled. from 3 ro 6. Two orher importalH cancer-prevenring ceUs, the T helper
ceUs and rhe T eytoroxic cells, also increased.
In rhe last 2 weeks of rhe srudy rhe individuals were given back their eypical American lJleac diet rhar is naturally high in phenylalanine and eyrosine. As a resulr, their
healthy high immune cell levels dropped,
excepc for the T-killer cells, which had a
more delayed drop.
Whar kinds of foods have t!le amino
acids phenylalanine and ryrosine? A lisr of
such foods is shown in Figure 12. 69
Notice that various meats have a high
cantene of rhese amina acids, a10ng wirh
lentils. Fruits are among rhe besr foads for
avoiding eyrosine and phe.nylalanine. Fasring, of course, would reduce the intake of
{he amina acids to zero. Ir i5 inreresring in
liglu of rhesc observations ro {ake nore of
{he advice writtcn by E1len Whire as quoted
in Figure 13. 70
There is IlOW evidence rhat resericting
cerrain essential amino acids such as phenylalanine and eyrosioe may help co creac
certain deadly cancers that have already
sprcad ar merasrasized. Several srudies were
done in mice rhat had rhe deadly skin cancer, called melanoma, which had already
sprcad ro the liver and IWlg. However, when
[he mice were placed an a diet 10w in rhese
[WO amina acids, the tumors stopped growing. Me:u1\vhilc., the mice an rhe "normal"
dier died quickly from rapid melanoma [Umor growth.
This research raises some serious concerns. Many would consider rhe amounr
of amino acid resericrion in these srudies as
extreme. Even an a eypical vegerarian dier,
such lowcring would call for specific vegetarian food resrricrions. Thus, one queseion rhar emerges is: can a1rering even a vege[arian die( in cenain ways (such as a very
low phenylalanine dic[) acrually assisr metastatic cancer human pariem' longeviry? The



Cell 25




iiiiii_--==:;~~~:: 9

5 3.O

Natur I killers
Day 28

Day O


Diet 10'" in ]; Dmino acid.\'

Day 42
American diel

Figure 11


Food Item:


Plren (mg)

Applesauce (Ill c.)

Mediulll Apple (2 uch)
Cabbage (1 c.)
CoUard Grccns (1 c.. )
Muslard Greeos (J c.)
Dried Figs (10 ellch)
Lentils(l c.)



Tyro (mg)


Egg (1 each)
Whole milk (1 c.)
Crab (3 oz.)
Tuna (3 oz.)
BeefSirloin Sleak (3 OI.)
Chicken Breasl (1 eacb)








Figure 12

"10 many e-ases of sickness, lhe very best remedy i5 for
the patient 10 fast for a meal OI' two, that the overworked
organs of digestion may have an opportunity to rest. A
fruit diel for a few days has often brought great reliefto
brain workers. Many times a sbort period of entire
abstinence from food, followed by simple, moderate
eating, bas led to recovery through
nature's own recuperati ve effort. An
abstemious [self-restraining] diet
for a month or two would convince
many sufferers that the path of selfdenial is the path ta bealth."
Figure 13









One year
after diet

_ Normal American _ _ Ouc )'car of low

protein diet
Figura 14






One year
after diet


One Year
Figure 15

answer ro rhis quesrion has nor yer bcen


A High Protein Diet Deteriorates

Kidney Function


We have known for years rhar diseases

like high blood pressure and djabcres can
destroy the kidney's microscopic ftltering
units called nephrons. For examplc, among
diabecics, kidney disease is one of rhe leading causes of death and medical disabiliry.

One OUl of duee diaberics who are dependenr an insulin evcmually develop kidney
failure requiring cither dialysis or uansplanrarion.?l More rhar 20 million Americans
suffer diseases of rhe kidney and urinary
rracr and more than 90,000 dic cach year.
A high protein imake can progressively destroy kidney nephrons, which weakens the
kidney filtering abiJilY. Such damaged kidneys normali}' continue ro dereriorate. AlthOligh tightly conrrolling [he blood sugars
and blood pressures of diaberics can help.
rhe disease will srill progress and worsen
wirh rime.
A dassic study was done on chronjc kidne)' failure parients who had already Iose signjficam kidney funceion.l- These paeienrs
had protein in the urine, which is rhe resllir
of weakened kidney flltering. Normal kidneyl> do not produce urine thar colltains
protein. Doctors had measured their kidney filtering ability. In normal individllals
ehis value is around 125 milliliters per
minute (ml/min). However, rhese kidneyimpaired individllals had values rhar averaged only 50 ml/min.. which mea1lS tiut
their kidney fi.lIlcrion had already deteriorared by more t.han 50 perCel)L
The researchers placed these patiems 011
a low protein diet of 40 grams per dar Thc
purpose of rhe srudy was ro derermine it"
kidney dererioration could be arresred by
redllcing prorein in the dieL The resulrs
are shown in Figure 14.
Note rhat one year laeer, rheir kidney
funcrion remaned Slable, srill with a fileering ability of 50 mI per minute. This landmark seudy demonstrated whar sOlUe had
rhollghr was unrhinkable; namely, rhat signit-lcant diaberjc kidney disease could actually be held ar bay. But the nexe questioll
was, will ehe reduce ion in dietll1y?rottin
cause a.n undesirable reducrion in proteil1 in
the Mooel? Blood albumin measuremenrs,
which are an indicator of the level of protein in rhe blood, were done ae rhe beginning and end of rhe rese The resulrs are
shown in Figllre 15.
Note [.har tllOse in the study saw rheir
blood protein leveJs rise significantly, even
though they were an a low prorein elieL This
was rrul)' surprising: man)' docrors had


raughr for years thar diaberics wha were losing prorein in rheir urine musr eat a higher
prorein eliel. A high prorein eliet was
dlOughr neeessary tO make up for mine protein losses. This sruely c1early clemonsrrared
dtar a IOUJcrprotein diel was realI>, what was
called for.
Haw is ir possible rhar rhe levels of prorein in the blooel inereased while the prorein inr~tke was lowereel? he answer is
found by looking Olt the measurem(~ntS of
protein lost in rhe urine ar the begiillling
anei enel of rhe test. Thcse measuremenrs
are shown in Figure 16.
AfteI" a year on rhe low protein elicr, rhe
parienrs' urinary prorein losses elropped signiflcandy. The effeer of rhe lower prorcin
intal,e was more rhan o.ffser by the sharp
reduction in protein IOHCS rhrough [he urine,
resulring in an actuaJ increase in protein in
the blood.
Blooel pressures aJso seerned ro benefi r
from rhe low prorein elier since both rhe
sysrolic anei diastolic came elown slighdy.
Although conrrolling a kielney failure
pariem's blood pressure can help prevenr the
worsening ofrhe disease, rhe aurhors' clcafly
St:lre rhar rhe milel reeluction in blooel pre sure could nor, by irself~ have dramatieally
prevenred the worsening of the elisease seen
in this srudy. Thus, rhe prorein resrricrion
irselfwas the imponanr element in prevenring worsening kidney funcrjon.
To summarize this srudy, rhe resulrs of a
low prorein clicr in pariems with signifieanr
kidney f1ltering clamage proeluced four posirive eftecrs: arrcsred kidney failure, increaseel
blood protein, sharply reducecl mine protein, anei lowered blood pressure. This study
and numerous adelicionaJ subsequenr sruelies
add kidnev failure ro [!le lise of diseases tiut
are besr tr~ateel by protein resrrcron.73. 74

Weight L055 Inhibited by Milk Protein

A Stuely indieares rhar ir is more difficulr for an individual to Iose weighr if rhe
diel conrains a high amollnt of milk prorein. OI'. Cheng anei his associares ac Cornell
have found rhar mice feei a elice higher in
milk prorein (casein) gain more weighr man
mice feei a elier coneaining less casein. To

Urioe 2400



One year
after diet

Diet changed


Ooe Year

Figure 16
gain e!le same amoum of weighr, rhe mice
had ro ear 25 percenr mor of a dier conr,lining 6 pereem casein than wirh one containing 22 pereenr easein.7 5 Cheng auributed this elifference ro che fact rhar rhe body
generares more he-ar {thus consumjng more
ealories} when it is funerioning on a elier
thar is lower in animal profein, ehus maJ(ing it easier ro Iose weighr on rhe same
amoum of food. le is important ro nore
[hat wirh the lower <1mount of casei Il, the



change, -20

Crosso\'cr poinr

-120 L -



3 wecks

3 weeks

figure 17


dicr was sciH fOllnd ro be consisccnc wich
good growth and long term healrh.

Vegetable versus Anima! Protein for

Heart Disetlse
In controlling blood cholesterol, rhere
are a nllmber of srudies ehar now show rhe
advantages ofplant or vegerable protein over
animal protein. One classic six-week studl'
was conducred by Or. Sirtori, who puc two
grollps of patients with high blood cholesterol levels on diets ehat, on thc surface,
appcared equalll' good. 76 Borh wcre low in
cholestcrol and saturaccd fac, but high in
fiber, which sholild help (Q control blood
cholcsterol. There was, however, one significam difference: onc dicc was based on
skim milk procein, while [he oehcr diee was
based on sol' protein. The cffccts of [hese
two diets on e!le blood cholesrerollcvels are
shown in Figure 17.
We see rhat during the firsr duce weeks,
rhe milk protein grollp lowcred rheir blood
cholesterol by 20 points. The soy-based
group did significanrll' berrer, however, wirh
a 60-point drop in cholestcrol. Afrer [hree
wceks, [he two groups were rhen reversed
([his s called a "cross-over study"). Those
who had been on rhe skim milk-based dier
changed ro the soy-based menu and cxperienced a furmer and much sharper choles-





rerol reduction of80 points in rhe Ilcxt duce

wecks. Those who wcre srarted on ilie vcgerable protcin (sol') die[ now swilched to
rhe skim milk-based regimen. They saw
cheir cltolestcrol risc neaely 40 mg/dl.
Sirtori's research is not alone n demonscraring rhe imponance of eating vegerable
protein inscead of animal procein ro lower
che risk ofcoronary hearr disease. Researchers ar the Universiry of Kencucky used advanced statisticaJ computer methods ro anaIl'ze 38 separate stlldies in rhe medical lircrature that have looked ac rhe use of so)'
protein ro lower cholesrerol. Their :lnaJysis
showed rJlat when compared to animal pro[cin, soy protcin signiflcantly decreascs
blood levels of toral cholesrcrol, LOL cholesrerol (rhe "bad" cholesrerol), and rriglycerides. 77

Why the Type ofProtein Matters for

Animal foods are generaHy high in rhe
amino acid lysine and low in argininc.
Conversely, the average ptanr or vcgerable
food is much higher in arginine than Iysine.
The proporlioJls of rhese two viral amino
acds appear ro play a role in how our body
responds hormonaHy (O a meal. Proteins
rhar are low in arginine like rhose found in
animal producrs have been observed tO rai e
human cholesrerol levels, apparenrly
chrough scimularing inslllin producrion.78

Anima! Proteins Increase

eho/estero! Levels
Two renowned cholesrerol researchers,

K.K. Carroll and M.W Huff, have do ne


mgldl 100


Figure 18



Rabbits 00 plaotbased proteio

Rabbits 00 aoimalbased prote.io

cxtensive rese-arch on how differenr planr

and animal proteins affccr cholesrerollevels. In eheir research, rhey lJsed a "laboratorl' chow" diet thac was low in fat and had
absolutely 120 choLesteroL. The onll' item that
was varied from ooe subjcct ro the next was
rhe source of procein in cite chow, which
was from bodl animal and plant sources.
The animal protein was isolated from the
animal product aud added [O rhe chow, such
[hat rhe chow remained free of cholesrcrol.
r imagine alI the fare was indisringuislt-


able and looked nondescripr-probably
similar ro dog food. No one could reasonably expecr humans ro accepr such a dier
for the fuI! four weeks of rhe srudy. The
researchers (Umed ro rhe New ZeaJand
whire laborarory rabbit an animal rhar has
dier and cholesreroJ re/arionships rhat are
similar ro humans. Each of I I specific arumal proteins and 10 specific planc protcins
were evaluared on 21 groups of five ro six
rabbits in each group for rhe emire four
week period.
The drecr on rhe blood cholcsrerollevels of rhese 100-plus rabbirs was remarkable, given rhar the diers had no cholesrcrol
and differed only in ther source ofpcorein.19
Figure 18 conrrasrs rhe average cholesrerol
Jevel for rabbirs on planr-derived proreins
wirh rhe cholesrerol Ievel of rhose on proreins from animal sources.
Note rhar on rhe planc prorein-based
chow their average blood cholesterol was
low, averaging 67 poims; however, on rhe
animal protein-based menu rheir cholesrerol
valllCS raJl markedJy higher ar 175. Remember, however, in rheir research rhere wcre
21 groups of rabbirs, wirh each group earing a protein from a differenr source. Figurc 19 delineares how blood cholesrerol values were affecred by differenr rypes of planc
prorein sou(ccs.
The average cholesrerollevel for rabbirs
earing animal protein (J 75) is shown for
Figure 20 provide a similar breakdown
for [hose an animal protein-based diers, wirh
ilie ave rage of rhe animals on rhe plant prorein diets shown for reference.
Note rhar rhe rabbits on animal proreins
had a range of cholesrerol leve/s of 101 tO
270, whereas the range of [hose an planc
proreins was 43 ro 96. The ranges did nor
overlap. C1early, subsrituring planc proeein
for animal prorein in the diee, regardLess of
which specific plant or animal loura is used,
would reduce elle risk of ali disease.s relaeed
ro high blood cholesterol.

Other Advantages o/Plant Protein

Orher advafleages of earing planc prorein are just now surfacing in nucrieional
resea.rch srudies. A recent seudy of women


Ave. Animal Protein 175
Rapeseed Flour . . . . . . 96
Wheat Gluten


Peanut Protein


Dat Protein


Coltonseed Protein


Sesame Protein


Soy Protein holate


Sunflon'er Proteill
Pea Protein


Faba Bean Protein








Blood Cholesterol Level, mg/dl

Figure 19


Egg Yoke Proteill
Skim Milk Protein
Turkey Protein

lIiiiiiiiiiii~iii-ii-iiii i 270



Casei II



Whole Egg Prolein

Fish Protein
Beef Protei.D
Chicken Protein
Pork Protein
Raw Egg White

Ave. Plant Protein













Blood Cholesterol Levcl, mg/dl

Figure 20

suffering from severe hor flashes was conducred. These uncomfortable episodes of
intense heae sensarion freqllcntly accompany rlle dropping esrrogen levels in menopausal women. le was demonseraeed iliar
eating 20 grams ofsoy proeein a day (eqllivalene ro a half-cup or 4.5 ounces of rofu) significancly rcdueed the severi'y of thei,. hot
flashes. 80 Thc stlldy's (ead researcher, Or.
Gregory Burke from Wake Foresr Universiry
and ehe Bowman Gray School of Medicine
in Nord) Carolina, believes the improvemem




American Basic Four
FruilS and Vegetables
Cereai GraillS

Chincsc Basic Four

Green Leafy Vegetables


Soybean Products
Sweet Potatoes

Figure 21

is due ro plaot estrogens in rhe so)' protein

which "may have the same beneficia! dTects
of e~rrogen, but may not have some of tlte
downside." These plam esrrogens do nor
seern ta increase che risk of uterine cancer
like cheiI' human and piU form counrerparrs.
Ali ohhe women eating the soy protein aho
experienced a beneficial "side efTect" of tl

significant drop in tlle totltl tind LDL dJOlesterol (l0 and Il percenr respeGive1y) wirh
no drop in their good HDL cholesterol during ilie six week sttldy.



Recommended daily
amollnt (g)

supplied (g)

Green leafy vegetables


Soybean producls





Sweet potatoes


Figure 22


71 grams

Protein in Growth and Development

The average age of menarche, rhe age
rhar gir1s begin ro have mensrruaJ periods,
seems ro be connecred wirh rhe amotlllt or
rype of protein thar is conStlmed in ch.ild
hood. For illsrance. severaJ years aga when
rhe Japanese were consuming a very low
me:lr and animal producr dier, rhe average
age of menarche wasl . 81 This cOlllpares
wirh the average age of menaI'che in rhe U.S.
ofless rhan 12.8 years ofage. 82. 83 Many
experrs believe rhar an early age of menarche
is a significanr risk facrar for the later developmeru of breasr and uterine cancer84
and may hdp expbjn why American women
have ovcr faur rimes the I'isk ofbreast cancer compared [O japanese women. 8 The
only srudy 1know of dur has compared ule
growrh of vegeearian ehildren with meatconsum ing children in the same geograph ic
arca showed rhar rhe meat-earing children
were slighcly raller than che vegerarians unt.il age ten. However, when both groups had
reached rhe age of 18. the vegerarians had
caughr up wirh and rhen smpassed (heir
meat eatng counrerparrs. being ar lea 'r an
inch raJler as aduJts. 86

USDA Basic Four Food Groups For

Proper Nutrition
The U. S. Departrnenr of AgricuJrure
published dierary recommendarions for
good lluuirion that srood for 40 years. They
divided rhe foods imo faur food groups
caUed rhe "Basic Four. " As a rhird grader, J
learned whac r "must eat" every day ta have
good healrh based an these food groups.
Contrary ro rhe USDA recommendatiolls,
che Chinese Medical Association recoOlmends four food groups rhat are in sharp
contrast. The Chinese approach ro nurririon is especiaJly imerestjng because China
has a very low illcidence of cancer, heart
djsease, diaberes, and many of the odler
degenerative diseases common in Western
socieries. The American and Chinese "basic faur" djets are compared in Figure 2).
Nore thar rhe Chinese ear rhree vegerable
caregories plus cereaJ grains. Animal producrs are conspicuous by cheir absence. In
clle U.S. basic faur lisr, rwo of the faur irems


are animal products, while fruirs aod vegetables are dowoplayed by combin.ing r11em
11HO one [[em.
As we have seen in this chaprer, a vegerarian-based diet like the Chinese dier can
easily provide aH rhe prorein oeeded wirhout the use of animal products. lf we look
at rhe daily amoum of each food caregory
in rlle Chioese basic four recommenda(ions
we see fhat rhe protein comem is ample.
These daily amountS, along WirIl rIle prorein comem, are tabu Iared in Figure 22.
The 7I-gram total prorein exceeds r1le
U.S. recommended daily aJlowance of 56

us. Government Switches to Lower

Protein Recommendatioll
Why clid rhe American faur food groups
differ sa much from (hose of rhe Chinese?
The USDA recommendarions were nor
based on health 50 much as an American
cultural eating habits. It was nor umil very
recently that our governmellt undenook the
fask of producng new recommendarions
rhar shifted emphasis from nutrient deficiencies ro chronic diseases. Their new recommendarions reduced meat and diary consumptJon.
As expecred, rhe daicy and mear industries were disrurbed abolit rhis change and
pressured the governmem so heavily rhar rhe
new food gujde was wirhdrawn for monrhs
while the speciaJ interesr batcle raged. In
rile end, the mear and dairy indusrries succeeded in having rile wording changed from
"decrcase consumprion of meat" ro "have
rwo or three (daily) servings [of meat]."87
Excepr for rh is unforrunare alreratiol1, rhe
new (ood guide, which is in rhe form of a
pyramid, is an improvemenr over clle older
four-food groups. The chan is reprodllced
for Y0l! in Figure 23.
The foods shown ar rhe base of the pyeamid are ro be earen witil rhe great st fi'equency. This is based on healrh reasons,
not cultural reasons. Grains are abundant
in natural fooru. Mosr Western cOllnrries
have adopre<:! rhe pracrice of refining man)'
of rheir grains. However, we need ro car
Ulholl' f?:'tlin foods ro receive the maximum

beneflrs of fiber, viramins, and minerals.

Frurs and vegerables are rhe nexr carcgory.
Today rhere are numerous stlldies, O1any of
which arc: presenred in Ihis book, rhar clearl)'
indicat.e the procective benetlts of rhese
faods. Those who ear rhe mosr frllirs and
vegerables have the leasr amounr of cancer
and hearr disease. Unfonunarely, rhe average American has failed ro follow rhese pracrical recommendarions. L'uesr sllrveys indicate rhat mosr Americans ear an average


Fats, oils, and sweets
Use sparingly


Meat, nuts, eggs

2-3 Svgs.

2-3 Svgs.

2-4 Svgs.

6-11 Svgs.

Figura 23
of onl)' 3.4 servings of fruirs and vegcrables
per day, far from the 5 ro 9 rhe pyran:tid
recommends. 88
Meat.s, l1UtS, and eggs are now dassified
rogcther in the prorein group. However,
\Ve have seen (hat vegerable proreins (including legllmes) are by far rhe safest [orms of
prorein to consume. Dairy is also represen red probably because ofdai ry association
pressure. Bur soy milk, which 1S a substiture for cows milk, is now commonly available, and is cholcsreroI-free :lod low in far;
rhere are many flavors and varieries (Q
choose from. Ac the rop of rhe pyramid,
fars, ous, and sweers are lisred. We agree
",;irh rhe message of llsing [hese sparingJy.
In facr, rhe 1e.ss rhe benCf.
What would be the re.sulr if Americans
followed rhe full recommendations of the
bonom half of rhe food guide pyramid by




Plant Source
Baked potato
Brown riee
Corn, frozen
Whole wheat
Pinto bea ilS

~ro.t~.in(g) Animal SOllrce




Whole miJk
American cheese




Nonfat skim milk


Whole egg



Pink salmon, calloed



Chicken breast


Tuna, canned


Figure 24

ommenda[ions? It wOllld drop dramarically

lO a sa fer level, becallse animal prodllCls
would have a smaller parc in our dier. Ta
consume a given amOllllt of calories each
day by using a large amoum ofanimal foods.
a person would have a high inlake of pro[ein. This is simply because the nllmber of
grams of protein in anjmal foods is high in
relaljon lO fhe calories they comain. Conversely, consuming ehe same number of
calories by eating a Iarge amOllnt of planr
foods wOllld result in a lower prolein inlake, becallse plant foods comain less grams
of prolein for a given number of calories.
A comparison of planr and animal foods in
lhis regard is tablliared iJ1 Figure 24. 89
We see rhar plam sOllrces of food are
generally mllch 10we1' in prolein for a given
calorie comene than animal SOllfces.
For those rcaelers who desire to know
the percent of calories from protein in [he
foocls listeel, mllltiply the vaJues by four.

Basic Four Diet Based on lnformation

/rom this Chapter
If we were ro COnSr.Illct aur own recommended food groups baseel on the informa(ion shared in d1S chaprer, we could serve
lhe callse of health well WiUl a simple four
fooel grollp plan. This basic faur plan is
shown in Figure 25.
[fwe were ro subssr wholly on lhese faur
food groups, we could prevent a whole host
of diseases, improve both our quafity arid
quantity oflife, anei make a hllge difference
n [he hcalrh of lhe emire Wesrern \Vorld.

lnspired lnsights

Figure 25


earing Il servings of grains, 5 servings of

vegelables, 4 servings of fruit, and 3 servings of lllHS each day? Obviollsly, there
would not b much room left for the undesirable items listed at lhe rop pOliion of dle
pyramid. And that is precisely rhe point.
Whar wOllld happen ro rhe level of pro[ein imake if we followed [he pyramid rec-

If you believe in the Bible as Ido, you

will bc fascinated as you read lhe seclions
in the book of Genesi [har have a bearing
on elier anei longevicy. [n the days of our
earliese ancestofs, the eliel \Vas wholl)' vegcrarian, no dOllbr including a wide variecy
of fruirs, vegetables, grains, and I1U[s.90 In
Genesis, chaprer njne, lhe elier changed
ralher dramarically. Meal and animal produers were aeldeel. Forrunatdy, the Bible also
records rhe life span of inelivieluals represeming ten generatjons before meat earing
anei ule nexr len generarions after mear was


ilHroduced. A human longeviry Cl1rve plot
ofBible charaeters is shown in Figure 26.
We see thar rhose living in the first ten
generations on a vegetarian diet lived an
average of about 900 years. After meat and
animal produces carne inro the diet, a life
span of 600 years is recorded, ehen several
ar abom 450 years. The steady decline conrinued uncil reaching ehe "ehree score and
ren" (70) level stated in Psalms.
The essence of ehis biblical account was
reiterated in the 1800s by Ellen White.
Over 100 years ago, White wrate: "the liability to take disease is increased ten-fold
by meat eating."91 In the 1800s vegetarianism had noe gained (he populariey thac it
has roday. Toclay, however, we know with
eereainty th;u meat eating does increase rhe
risk of a nost of degeneracive diseases.

Te is high timewesee aside tlte greac mear
and proeein myth. Preoccupation wim meat
and ies proeein raeher chan improving
healrh, has comributed (Q mally degeneracive diseases such as hearr disease, cancer,




'JU 'Il !NS 910 ii.

. ,'"

(Genesis 5 and 11)







1000 B.C.

Figure 26
osteoporosis, kidney failure, and kidney
seones. Plant sources of nutrieion are generally modese in protein and reasonable in fat
coocentj furchermore, ehey never contajn
any cltolesterol. Wirh our growiJlg underst:lnding of protein physiology, a planrbased diee has emerged as the optimal way
to ear for chose interested in maximizing
longevity and the quality ofliving.

PhiJade.lpnia, PA: Lea and Fehiger, 1988 p. 29.


Am Din Assoc 1966 Jan;48(I):25-28.

11 J-1ardillge MG, Cmok> H, Stare FJ. Nurririona1 seud.ies of vegerarians. )

Am Diel Assoc 1966 Jan;48( 1):25-28.

Campbcll TC Mliscling Out rhe meat myrh. New Ci:mury Nutrilioll

1996 Jul;2U):1-2.

12 BeJl G. lb:lbook ofl'byrio!ogy and Bioclmnistry--4iJ' l,dilion. Baltimore.

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) Campbell Te. Musclillg OUl lhe. mear Ill)'lh. New Century N/IIrition
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I PositiOIl of t!le American Dieleric Associatioll: vcgctari,\11 diet.~-rechlli

cal suPPOrt paper. J Am Din Assoc 1988 Mar;88(3):3S2-3S5.

, Campbdl Te. Musding Olll rhe meal m)'lh. New Cmmry Nlllririoll
1996 Jul;2(7): 1-2.

I~ Munro H , Crim Me. The proteins and :lIniIlO acids. In: Shils ME,
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Philadelphia, I>A: tea and Febiger, 1988 p. 30.

15 Munro J-11 , Crim Me. The proteins :\I\d amino acid. In: Shils ME,
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l'biladelphia, PA: Lea and Febiger, 1988 p. 30.

1 Hardinge MG, Crooks H, St:uc FJ. NlIrritional sllldies of vegerarians.


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Ph.iladelphia. PA: Lea and Febiger. 1988 p. l.

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The Sugar
and Diabetes Story

he called the Lifescyle Cencer of

America desperately for help.
Thirty years of diaheces had caken a
cremendous roll an her healeh. The
high blood sugars hd done their work silenrly for years, but now the biner harvesr
was undelliably obvious. Jenoy had kidney
failure and resulting fluid accumularion. Of
more concern to her, however, was rhac she
was going blind. Her vision had been gecring progressively worse, and dle docrors had
given her no hope. Wirh those discouraging prospcctS ahead she became excired as
she heard about a lifescyle approach toward
reversing the effects of diabeces.
The Lifescyle Cemcr ofAmerica, a place
in Oklahoma thac provides a three week
rherapy live-in program, is nor unique in
offering a program to reverse the ravages of
diaberes. J have been giving my patienrs
similar information for years and have seen
some of rhe same dramatic resulrs thar the
live-in centers achieve: people decreasiog or
gening ofTinsulin and oral medications with
a lifesryle approach ro chis killer disease.
Sadly, however, there are many people like
Jenoy who come to me wirh advanced diaberes. In many of dl.Ose cases we are not
able [Q "cum back rhe clock" and resrore
rheir vision or their kidney function. Yes,
we may be able ro provide some help in

rhose areas, but onen the severe damage rhat

has already been done is beyond the point
of complere reversal.
Whar is tragic is rllac ic ofcen rakes irreversible complications before people really
ger serious abOLit doing ali they can ro control their diabcres. By rhen it is roo late ro
accomplish aH we could have if rhey had
goncn seriolls years earlier. The cases of a
thollsand Jennys eloquently proclaim: diaberes needs to be prompcly recognized and
treated. MaJly newly diagnosed diabericsas well as those srruggling wirh the disease
for longer periods of rime-----ea.n control rheir
diaberes wirhollf drugs by following an exceHem lifescyle. Do nor wait umil a heafr
auack, ar ampuracion, or blindness serves
as a wakc lip cali. Thc wake up c~1I should
be mar first "borderline blood sugar"-the
slighresI slIggestion of diabcrcs.
In rhis chapter we will look ar important information about diagnosing and dealing wirh diabetes. Even if you do not have
diabetes, you wiJl want ro give special acrenrion ro the closing secrions of rhis chaprer; rhere 1 focLiS on ilie dangers of earing
sugar even for rhose who have no problem
wich diaberes. You will learn abolit rhe effecrs ofsugar on the immune syscem, its rale
in weghr gain, and omer fascinating areas.
Also in dus chaprer I comrast sugar wirh its



-THEFACTS Approximately 16,000,000 Americans are diabetic
(50% are unaware).
About 625,000 new cases are diagnosed per year.
Over 6% of tbose 45 - 64 years old and as many
as 20% of those over 65 have diabetes.
Total costs may be as high
as 90 to 130 billion
dollars per year.
Figure 1

Life expectancy is sbortened by 5 to 10 years or more
It contributes to 160,000 deaths eacb year
Two to twelve times the risk for heart disease
Two to four times the risk of stroke
Number one cause of blind ness in adults
with 12,000 to 24,000 new cases annually
A factor in half of aII foot and leg amputations
Over 60,000 amputations yearly in diabetics
In any given year, over 50,000 diabetics are either
on dialysis, or have had a kidney transplant (due
to diabetic nepbropathy)
Cause of peripheral neuropathy
Increased risk of breast and uterine cancers
Figure 2

two carbobydrare cousins: complex carbohydrares and fiber. We willlook ar some of

rhe exciting bcnehrs of these more healrhfui carbohydrares.

What Exactly is Diabetes?


Diaberes mellirus or "sugar diabetes" is

a condition where an abnormal response ro
insulin and/or inadequare insulin producrion causes high blood sugar levels. This is

lIsual1y deflned by a fasting b100d sugar of

greater rhan 125 on two occasions,) or a
positive glucose rolerance rest (rhe individual drinks a specified amOunt of glucose,
usually 75 grams and rheir blood sugars are
evaluated over a rwo hour period). Over
rime, these high blood sugar levels and rhe
orher metabolic chal1ges thar go aJong with
diabetes are exrremely taxing on rhe body.
Consequemly, diaberes dramatically increases one's risk of dearh and disability.
Current staristics are sobering. In
America [here arc now duee rimes as many
diabeties as there were .in 1958. 2 Estimates
are that some 16 million Americans now
have this condirion, up from Il million as
recenr as 1983. DepeJ1ding on rheir type
of diabetes and orher characrerisrics, rhey
run aJlywhere from 2 ro J 2 times rhe risk of
death when compared ro theil' non-diabetic
peers. 3 Diabetes increases the risk of hean
disease and other diseases l'e1ated ro amerosclerosis such as srroke ar rhe loss of an arm
01' leg from blood vessel blockage. Diaberes also dramaric.1l1y iocreases one's chance
of infeetions, kidney failure, and an eye disease called retinopad1Y, which can resuh in
blindness. The number of people in the
U.S. rhat are affiictcd bv diaberes is shown
in Figure 1. 4
The rnyriad ofaffiiccion . rhat result from
diabetes is lisred in Figure 2. ),
Although hearr disease is the leading
cause ofdearh among diabetics, 10 somerimes
rhe debjliraring efTecrs ofblndness and kidney disease are more frightetting. Wirhin
onIy seven yeaJ's of diagnosis, as man)' as 50
percenr of children with daberes have developed diaberic retiJlopathy, a disease of the
e)'es rhar can result in blind ness. 1I Diabeties Jleed ro ger checked by eye docrors regularly. Diabetic eye disease is prevenrable,
nor only thl'Ough Iifesryle, bur also byearl)'
rreatmenr. Furthermore, diaberics run a
significanc risk ofdeveloping kidney disease.
In any given yeal' some 55,000 Americans
are suffering wth what is caJled "end-srage
renal disease" due ro their diaberes. 1. 13
These ndividuals have such poor kidney
funcrion rhar they al'e alive only by vrrue
ofa transplant or regular dialysis treaunenrs.
End-srage renal disease arnong diabetics is


increasing dramaricaUy in the Unired Stares.
Whereas 5.000 new cases were being diagnosed per year in rhe early 1980s, a decade
!ater the ftgure had jumped co 18,000 new
cases per year. 14 In f.'Ier. over 35 percenr of
aII patients with elld-stage kidney disease
are diabetic. 15 Diabetic women arc also
more prone co develop breast and uterine
cancer. 16
No doi Iar amount can eclipse the thousands of personal tragedies duc ro diaberic
everrheless, in a llarion
where health care costs are skyrocketing, the
flnancial impact ofdiabete5 is rruly relevant.
The direct and indirect cost ro sociery for
diabetes is esrimared ro be berween 90 and
130 billion dollars per year in America
alone. 17

Al! Diabetics Are Not the Same

Diaberics are ofren divided inro four
c.1regories. Of rhese four caregories, rhere
are actually rwo main types of diabetes: inslllin-dependem diabetes mellirus (IDDM).
often refened ro as Type 1, and non-insulin-dependent diabetes me1lirus (NIDDM).
otl:en designated Type ll.18 A1though some
diabetcs purisrs will rake pains ro usc the
terms IDDM and NIDDM, in rhis chapter I will use rhe rerms Type I and Type II.
A r!lird rype ofdiabetes OCCllrs in pregnancy
and is called gestational diaberes mellirus.
Tbe fourrb cacegory of diabeces takes in a
hosr of rarer callses of rhe disorder such as
those duc ro hormonal abnormalities ar
ocher medical condirions.
Typc 1 diaberes is rhe most severe form
of rhe disease. It rypiC.111y occurs in childhood (bur can develop at any age) and for
rhis reason was previously caJJed "juveniJe
diabetes." The most common c.1use of Type
I eliabetes is destrucrion of che insuJin-making cells in the pancreas by the person's own
immune sysrem. This is referred ro as "auroimmllne destrucrion." The specific facrors rhar rrigger this auroimmune process
have proved e1usive. AJtbough some cases
have been linked ro viruse.s or chemical roxins, much is sriH unknown abollr the beginnings of rhe Type 1 diabetes process. 19
There does seem ro be a generic suscepribiliry ro the disease, plus an envllonmental

factor thar rriggers the disease process. Sorne

of rhe most imeresring recent research links
some cases ofType 1 diabete.s ro an abnormal immune reaction ro milk procein. We
now know dl;1t children who are breasr feci
[ar a shoner rime or who are sr.<lrted on cow's
milk earlier have an increased risk for rbis rype
of diabercs. 20 In fact, the drinking of cow's
milk may be the rrigger dut iniriares rhe
disease in over half of aII Type I diabetics. 21
Regardless of rhe cause of rheir Type I
diabetes, ,tffected individuals Iose their abiliry ro make adequate amOllnrs ofinslllin and
are lefc with an absolute life-and-death need
for inslliin shors. Wirhout those shor$, rhey
go iota a conditian called diaberic keroacidosis, which is faral ifnor promptly ncared.
Bec.111se of their absolure need for illSulin.
individuals wirll Type 1 diabetes are lIsually
diagnosed early in the disease process. Typically rhey have symproms like excessive uri
nation (polyuria), excessive rhirsr (polydipsia), excessive hllnger. al1d excessive earing
(polyphagia). They ohen are also bothered
by farigue anei weight loss.
Why does ehe T}'Pe 1 diabetic develop
these symproms? The answer is best arrived
ar rhrough a brief revie\.... ofsome of ilie main
facrs about blood sugar and how it is conrrollcd. The main fuel for our bodies is a
simple sugar called glucose. There is a poreorial problem, however, wirh rhis fuel
source. It can on.!y get inro each cell of the
body if inslllin is presenr. Some have compared insulin ro a key ehat opens "rhe doors"
in body cells so rhar rhe vital fuel, glucose,
can get inro rhe ceL!. However. il tllere is an
nsufficient amOl1m of insulin (as in Type I
diaberes) or if rhe locks on che doors are
"gulluned up" sa thar the insulin key has
difficulty opening rhem (as Glt1 occur wirh
(he insulin resistance ofType rr diabetes),
then blood sugar levels can rise. When
blood sugar leve\s rise sllfficienrly. rhe ability ofthe kidney ro comain rhe sugar is overwhelmed, and sugar comes our in rhe uri ne.
The sugar takes water with it, thus leading
ro rhe excessive urinaeion so familiar in uncolltrolled diabetes. The loss of water reSlJts in anorher diabetes symprom: increased
rhirsr. Ar rhe same rime, sugar is not moving into the body's celIs adequately. In a



sense, che body's cells are srarving for energy. This can cause fatigue, weight los5,
and excessive hunger.
Forrunately, only abolit 5 ro 10 percenr
of diaberics in America fali under rhe 'fype
1 diabetes category.22 The remainder are
Type II diabetics. These individuals eirher
have a problcm called "insulin resistance"
or a less severe underproducrion of insulin
than rhose with the Type 1 varicry. In actualiry, mosr fully developed Type II diabcrics
have boch of these problems. 23 There appear ro be many differenr causes ofType II
diabercs; rnost seern lO have a generic basis.
The majoriry of individuals wirh chis rype
of diaberes have a family member that had
also been diagnosed with rhe disease. For
cxample, many NativeAmericans have rllis
genetic rendency; howevcr, it appears rhey
did nor have diabetes umil rhey adopred a
Western dier wirh an overabundance of
sugar and far. Simply pur, ir usually t;\kes a
combination of MO facrors (O develop adult
onset diabetes. One is genetics, and rhe
orher is a poor dier-like rhar consumed
by rhe average American.
Many individuaIs wirh Type II diaberes
generate plenry of insulin but their body is
resisranr ro ir. This cond it ion of illsulin
resistance can be addressed by lifestyle
changes. By maintaining an exceiient diet,
achieving an ideal weight, and embarking
on an exercise program, many Type Il diabetics can control their blood sugars with
rhese lifesryle changcs alone. Some may
need diet changes plus a pili ta help control
cheir blood sugar.
Because of the more subrle narure of
Type Il diabetes compared ro Type 1, it often goes undiagnosed. A person with Type
II diabetes may not have any of the classic
diabetes signs like excessive urinat ion, cxcessive thirst, excessive hunger. farigue, or
weight loss. Ar any poinr in rime, it is estimared thar fully 50 percenc ofType Il diabetics have not yer been diagnosed. 24 Of
course, unrecogrlized diabetes still does irs
damage steadily and slenrly. Abolit 20 percenr of newly diagnosed Type II diaberics
already had damage to rheir eyes (retinopathy).25 Sometimes an unsuspecring person
will be told rhey have diabetes when a rou-

tine blood screen ing reveaIs Iligh blood

sugar. If the blood sugar is above 125 after
an overnighr fast, it indicates diaberes. 1ndividuaIs caJ) have diabetes, however, wirh
fasring blood sugars below rhar leveI. If a
doctor suspecrs diabetes in a person with a
relarively low fasting sugar, further testing
can be dane. The oral glucose tolerance test
checks for diabetes by measuring a person's
blood sugar response tO a sugary beverage.
Pregnanr women routinely have such a test
ro make sure chey are not diabetic. Some
doccors recommend that orhers in the general popularion should have a glucose (01erance test. Depending on rhe physician,
some will recommend the test for those wirh
significanc obesity and/or genetics. Others
advise the g1ucose colerance test in anyone
with fasting sugars higher than a certain
level. Sorne will check ali those Wir11 fasting sugars over 105; some very conservative
docrors will advise the test ro ali their patiems who have fasting sugars consisrenrly
over 95, since th.is usually indicates dur at
least the individual has rhe gene for Type II
diabetes. A glycosylated hemoglobin level
(discussed later in rhe chapter) may be able
ro substirute for che glucose rolerance test
in derecring diabetics wirh fasring blood
sugars less man 125. 26
AJrhough Type fI diabetes can be picked
up by suell blood tem for e1evated sugar,
mauy Americans do nor seek out health
professionals for sucb preventive services.
They wait umil rhey are sick. This is unforrunare. As a resule, many Type II diaberics only become aware of their disease
when r11ey experience potenrially irrevcrsible problems like eye ar kidney disease,
nerve problcms, or a heart attack.
Regarding gesrationaI diabercs, two to
five percenr of ali pregnanr American
women are affecredY This rranslares into
abour 200,000 children being born ro
mothers with gestational diabetes each
year. 28 , 29 Th.is is signific<lnt, because rhose
children experience an increased risk of
healrh disorders such as birth rrauma.lower
blood sugars ar birth (neonaraJ hypoglycemia), and even premature death in infancy
(peri natal morraIiry).30 The message is clear:
ifyou are a diabecic who becomes pregnant.


or if you develop gestational diabetes, you
should have yom blood sugar monitored
closely. Your diet and lifestyle need ta be
well regulated. Furrhermore, any woman
who develops gestationa1 diabetes has a genetic rendency for diabetes. She is at high
risk ro develop fuB blown diabetes later in
life. 31 Pracricin&..healthy habits rhroughout her life span mus becomes critica1.

Control/ing Diabetes: Can the Ravages ofDiabetes be Prevented?

Recently, a landmark Diabetes Control
and ComplicadonsTriaI (DCCT) was completed. Thjs six-year study looked at 1441
Type 1 juvenile diabetics. Those diabetics
who strove ro keep their blood sugars as clase
to normal as possible (using insulin and
lifesryle ch:mges) had 76 pereenc less chanee
of developing diabetie retinopathy, a serious eye diseaseY They also experienced 54
percent fewer cases of significant kidney
disease and 60 percenr fewer cases of nerve
problems involving the hands and/or feet
(peripheral neuropathy).33 The participancs
also significandy lowered ther blood ehoIesrerollevels, suggesting rhat right control
could decrease heart disease risk by up ta
35 perccnr. 34 These improvemencs are summarized in Figure 3.
Diabetics in this smdy who keep their
sugars as c10se co normal as possible are said
ro be praericing "intensive therapy" or "tight
control." Trus begs a question: in the rese.arch JUSt referred ro, exaerly how intensive was "jncensive" (or how tight was "tight
COnt ro]")? The DCCT had very clear blood
sugar goals. Fasting blood sugars in the
morning as weU as blood sugars before each
meal were ro be between 70 to 120. Aftermeal levels were to sray below 180. Furthermore, a middJe-of-rhe-night sugar at 3
AM was ro stay above 65. To find out how
weB the participants were adhering to rhese
goals, an addirional blood rest called
glycosylated hemoglobi.ll was taken regularly. This test measures rhe amount ofsugar
that becomes attached to a person's red
blood eells. The amount of attached sugar
in turn is directly related ro the average
amouor of sugar in the blood throughout

the life span of the red blood ceUs. SiJlce

red blood cells rypicaHy live for 90 ta 100
days, the glycosylated hemoglobin value
gives an approximation as to the average
blood sugar level over a three-month period.
In tbe DCCT smdy, levels were aboUI 6.05
percem. This compares favorably with a
value of 7.5 percenr, which is considered
the upper limit of normal in a non-diabetic
population. 35
How does intensive therapy differ from
the standard or conventional way of treating diabetes~ First, intensive therapy always
refers ro r.reatment using insu.lin. Second,


760/0 reduction in diabetic retinopathy
54 % reduction in significant kidney disease


Ireduction in peripheral neuropathy

350/0 decrease in cardiovascular risk

Figure 3

with intensive therapy there are no flxed

doses of insu.lin. For example, a diabctic
on this rype of program does not take a fl.Xed
amount of insulin every morning. The
amount of insulin is adjusted according ro
the level of blood sugar at ehe time tlte insulin is given. This differs from the old way
of giving insulin (hat is stiH called a "conventional fixed dose program. "36 That approach assumed rhat insulin requirements
would be the same each day. In fact, we
now know t.hat insu.lin needs can vary tremendously from day ro day. This knowledge ofcbanging insulin needs provides the
rationale for intensive eherapy.
Intensive insulin therapy attempts [Q
artificially simulare how aur bodies' insulin-




producing organ, the pancreas, works: rbe

pancreas consrantly secrere.~ insulin inra {he
blood so thar mere is always some insulin
presenr. This is whar is called the basa.! insuJin Ievel. The pancreas aho secretes exua
insllJjn in response ro rhe food we earY To
reproduce rhis effea of basaJ insuJill some
diabeties \viJluse a 10ng-acring insulin shor,
while orhers willuse an insulin pllmp (har
works continllollsly ro deliver rhis basal nsulin level. To reproduce rhe food-relared
insulin surge, wherher on shots or on rhe
pump, addirional regular inslllin or a new
shon-acring insulin (Humalog) is given. If
the shor method is used, ar leasr rhree shots
per elay are given on rhe intensive insuun
program. To evaluare rhe body's needs for
insulin, frequenr blood sugar monitoring is
necessary. Blond is obtained for this purpose by prick.ing d1e f1nger wirh a smaJl
needle-like insrrumenr caUed a lancer. Then
this blood is anaJyzed by a home sugarmoniroring device. The diaberic who is on
an intensve schedule lIsua.!l)' pricks his or
her finger a minimum of four times and an
ideal of seven rimes per day: before each
mea.! and ar bedrime, plus ideallyan hour
afrer each meaP8
Alrhough tighr conrrol makes a profoune! difference for rhe Type 1 diaberic, it
is a much more cumbersome and expensive
process in the shorr run. Many have felt
thar rhe DCCT resulrs could be extended
ro apply (Q Type II diabe:rics; rhis inrerprerarian is nor based 011 any facrs obrained
from dlar seudy.
In my opinion, we should noe be roo
qllick ro try ro rigorously control dle blood
sllgars of a Type II diaberic wrh an inrensive insulin program. In addition ro the
time, expense, aod discomforr involved in
finger pricks and mllhjple injeetions, rhere
are even lllore pressing coneerns. Before we
look ac those concerns, some words of exphHlation are in order. Although Type 11
diabetics are called "non-iJlslIlin dependent," remember, this simply means that
rhey do not have a life or deadl need for
insulin shots. Man)' docrors nonerheless put
these individuals on insulin to bener conuol rheir bloodsllgars. In faCt, rhe National
lnscirutes of Health indicate thar 50 per-

cent ofknown Type II diabeucs in America

are eirher using insulin alone OI' insulin in
combination with oral medjcarions. 39 This
grearly confuses many in lay cirdes. They
erroneoLlsly think rhar jusr because someone is on insLllin, the)' are a Type I diaberic.
More ofren rhan nor, a diabetic who is on
illslliin has the Type II variery. Afeer aU,
esrimares are char rhere al'e over 3.5 miII ion
inslILin-usng Type II diaberies in aur narion. This compares wirh only 800,000
ype I diabeues in rotaJ:1O Now rhar we have
paused ro recognize rhat many Type II diaberics L1se insulin, we need ro look ar one of
rhe most worrisome problems wirh rhis
practice. It is whar I caB "rhe vicious cycle
of insulin use." The cyele begins with a 50bering face: usjng nsuJin aggressively srimulares weighr gain. In the DCCT, rhe average participanr 01.1 rhe inrensive program
weghed 10 pounds more rhan the control
subjects after 5 years.'lI This is ('speciali,.
ominolls for rhe Type II diaberic. Type I
diaberies are oftel) rhinner and more resistanc ro weiglu gain relative ro the Type Ils.
However, some rend ro gain weighr afree rhe
onser. of rhe disease. Type Ils ofren have
overweight problems ar. rhe onser of diabefes, and experience further weight gain as
the disease progresses.
In my medical experience when 1 am
asked ro see a Type II diabcric who has been
placed on insulin ro rry ro improve blood
sugar control, T generalIy expect rhem ro
have gained a signiflcanr amollnt of weghr.
Thjs inrroduces rhe nexr part of that vicious
cycle. Weight gain conrribures ro the Type
II diabetic's resisrance ro the effects of insulin; t1ms, as weighr increases so do nsulin
necds. The cycle comes full circle when
insulin dosages are furmer increased, only
to srimulare funller weiglu gajn. The significance of this dilemma has been appreciared by the Narional lnsrirures of Healrh.
Because of rhe tendency of intensive inslllin therapy ro promote weighr gain, rhcy
have srared, "Intensive rreatmem may not
be appropriate for dlaberies who are 'overweighr,"42 which includes mosr Type II diabetcs.
The tighr control of diaberes with insulin also introduces orher problems. The


DCCT srudy parricipants ran a much
higher risk of low blood sugar (hypoglycemic) reactions rhan those who were nor
pracricing imensive eherapy. Alrhough hypoglycemia is usually no more ehan a physically uncomforcable inconvenience, severe
re~1.ctioJls can actually be life threarening.
At chis poim, someone may poun out:
yes, rhere are problems wich insulin therapy
for the Type II diabetic, but is ic possible
for these individuals ro keep cheir blood
sugars in an ideaJ range by using oral medication-wthollr ali the ftnger sccks and
insulin? It is true rhac early in the COUfse of
ilie disease it is often possible for a Type II
diaberjc ro use medicarion ro oprimaJly control their sugars. However, over rime, ilie
oral medicatioJls ofcen become insufficiem
ro keep blood sllgars in c.he righr control
range demanded by imensive rreaemen.L
Even if blood sllgars can be cOlurolled
with pills by mouth, this does nor prove rhe
wisdom of using rhem. Although 1 do lIse
oral medicarions in some of m)' diabetc
patiems, rhe practice is parr of one of the
longest sranding controversies in medici ne.
The main drugs that continue ro be used
for blood sugar comrol belong ro a class
called the slilfonylureas. Common drugs
in this family include DiaBet,;t, Micronase,
Glucocrol, Glynase, Amaryl and Diabinese.
Today, if you look up any of rhese drugs in
the Physician's Desk Reference, you will (ind
a warning in bold prim encided "Specia]
warning on increased risk of cardiovascular
mortaliry."43 Thac warning goes on ro explain the findings of a study published back
in 1970 by whar. was called the Universiry
Group Diabetes Program (UGDP). Researehers found chat diaberics who rook
tolburamide, an oral pili used in ehe seudy,
had more than dOlJble the risk ofdying from
heart disease as iliose who treaced their diaberes with diee aJone. Today, some urge thar
the drugs in this family are vastly differenr
now than the tolbllramide of the 1960s.
However, ilie FDA still requires [hac even
ilie newest drugs in rhis class carry a bold
prillr warning ehae reads, "A1though only
one drug in rhe slllfonylurea c1ass (rolburamide) was included in chis [UGDP] sClldy,
ie is prudent from a safery standpoint ro

consider thar dus warning may also apply

ro orher oral hypoglycemic drugs in this
class, in view of rheir c10se similaricies in
mode of acrion and chemical srrucUlre."
Some of the newer medications for diabetes such as Precose, Glucophage, and
Rezulin are not in rhe same c1ass and have
differing mechanisms of aerion. Thus they
may be less likely ta increase tlle risk ofheart
disease, although [hey have not been on the
markec long enough ro make afirm derermination in this regard.
My concllJsion, based an published
medical research and my personal experience, is that careful blood sugaf conrrol is
important in Type II diaberics. However,
rhe use of inslilin and ora.! agents in rhese
individuals carries che potential ro do more
harm ehan good. Thus, {he mose important quesrion iJl my mind always is: how
can I help myType II diabetic patients concroi their sugars withour drllgs? Slich an
approach scands co reduce the eomplicacions
of high blood sligars whiLe decreasing the
risk of problellls from rrearmenr.

Non-Drug Approach Brings

Startling Results
Man)' seem to think rhat using a nondrug approach would increase the risk of
diabetic complicarions and decrease the likelihood ofanaining optimal blood sugar control. Ironically [he evidence suggesrs ehar
rhe opposite is tfue: an optimaJ Lifesryle program seems ro help maJly diabetics more
than an)' drugs available. One recene example of rhe power of a comprehensive
lifesryle program comes [rom Weimar [nsecuee in California. Researchers there scudied the benefits of a live-in 25 day comprehensive lifesryle program on Type II diabetic
parienrs. A frequent complicarion of diabeces is peripheral neuroparhy, a conditon
rhat often manifesrs tse1fas burning ar aching sensations in the feer and legs and may
aJso involve rhe hands and arms. The pain
is ofcen described as excruciating and sharp.
The disease can larer progress ro Ilumbness,
as heat, cold, and pain can no longer be felr
in rhe affecred areas. Although medicariolls
may somerimes help che condjrion, they


ofren make no significant impact. Thc
smdr's lead researcher was Dr. Milron CTane
(an cndocrinologisr who speciahzes in reversing [he effecrs of diabetes throllgh
lifestyle changes). He showed mat a mearless diet, free from ali animal prodllcts and
high in llnrefined (Oral vegetarian foods, will
bring complere relief ro painflll neUfOpathy in over 80 percent of diaberics with rhis
condition in juSt 4 to 16 days.14 Other clemenrs of rhe program. included: regular exercise, hydrorherapy rreatmenrs, cooking
c1asses, grollp lectures, exclusion of a variety of beverages (coffee, rea, and alcohol)
exclllsion of tobacco, and for rhose who
desired ir, religiolls cOllnseling. Previously,
diabetic neuropathy was thought (Q be inCllrable. This srudy shows rhat rhe condition can actually be reversed cluollgh a C0111prehensive lifesrylc program thar includes
diet and exercise. Blood sugars and cholesrerol a1so dramatically improved on this dieL
The benefits of complere relief of djaberic
painful neuropathy conrinued according ro
a ot)e ro four year follow-up programY
Keeping blood sugars as clase ro normal
as possible 1S one of rhe keys {Q kjdney health
in the diabetic. A comprehensive lifestyle
approach will gready assisr this process.

Decrease risk ofdeveloping diabetes by 50% in those
with high risk defined by:
High blood pressure
Family history
Relative risk of
developiog diabetes



Figure 4


Kcal of Exerclse per week


Furrhermore, a11 optirnal d.iet, \Vbich is torai vegerarian, generaHy has much less protein in it rhan t-he srandard American farc.
Such a lower protein diet rends ta put less
srress on th kidneys, again providing a boon
ro kidney heaJrh 46 (see Chaprer 7, "The
Creat Meat and Procein Myth," for more
information). Not only can a cornprehensive lifcsryle program help accomplish these
goals, but such a broad-based lifesryle approach will a1so likely diminish ocher risk
facrors rbar could in rime furrher warsen
kid.ney function.
Examples of some of rhe ot-her facwrs
dlat can worsen diabetic kidney problems
include high blood pressure, cigareue smoking, and e1evared blood fars (LDL chobrerol and rriglycerides),47 One little-recognized factor that also seems ro increase rhe
risk of kidney problems in diaberics is the
use ofTylenol OI' other brands of aceraminophen. Srudies show rhar using as lirde as
rwo pills oncC' a week doubled the risk of
severe kidney disease in diaberic parienrs. 48
Controlling diaberes pain with an approach
Like mar used at Weimar would be expected
ro result in a decrease OI' e1iminarion of rhe
need ofsuch drugs among afTected diabetics.

Exercise - First Element Needed in a

Comprehensive Diabetes Lifestyle
Exercise pl.ays a powerjiti rol.e in lowering
blood sugar levels. Evidence suggests rhar
musdes in morion reduce resisrancc ro insulin; dut is, insuljn sCllsitiv1ty 1S improved
by regular physical exercise. 49 More simply
put, exercise-in a sense-works like nsulin in a diabetic: it helps sugar go out of the
blood and imo the musde tissue. In fact,
the prestigiolls Joslin's Diabetes Medical
textbook lldicates rhat lack of exercise is "a
key factor" in the development of insulin
resistance as people ger 0lder. 50 Since diaberics need insulin on a daily basis (eirher
their own body's insulin or injccted insulin) sa do diabeties need daiLy exercise ro
optimally control their blood sugars and
tlleir disease.
Exercise not onJy helps diabeties control rheir blood sugars, it aJso help non-


diaberics decrease [heir risk of ever developing diaberes in rhe fim place. Oile srudy
showed rhar cxercisc dramaricaLly decreased
rhe risk ofdeveloping diabetes among rhose
who were ar high risk for the diseaseY As
rhe amounc of energy expended in exercise
increased frorn 500 calories per week [Q
3500 caJories per week, rhe risk of devdoping diabctes dropped by 48 percenr. In
other words, regular exercise nearly cuc the
risk ofdeveloping diabetcs in h,tlf, as shown
in Figure 4. Interesringly, those who were
ar che highest risk of developing c1iabetes
benefited rhe mOSt from regular exercise.
Individuals c1assified as high risk in rhis
srudy induded those who were overweight,
had a Family hi rory of c1iabetes, or haei high
blood prcssure. The bonom line is thar'exercise is important for eVeJ)'one. However. ir is
especially cririca1 for the diabetic and for
rhose at high risk of developing cbe disease.

Proper Diet-Second Eltment in a

Comprehensive Diabetes Lifestyle
Umil recenrly, diabctics wcre rold rhat
n order ro control rheir blood sugars they
had ta e1imi mue most of rhe carbohydratcs
from their diet. They were cold co avoid
sugar, bur rhe message did nor srop rhere.
Planr food.s-narurally rich in complex caIbohydrate.s-werc also an the "hir lisr. ' The
resulr leh diaberics gravitarllg ro a heavy
mear dier. S2 The medical communiry did
nor realize ar rhar rime whar we have already
nored; namely, a high protein diet promotes
kidney destrt/etion. \'V'ith hea")' mear consumprion also carne increased ingesrioll of
cholesterol and saturated fat. Galloping
<}rherosderosis men foJlowed dose behind.
"Missing the forest for the tred' was cerrainly truc in rhis case. The trees were rhe
high blood sugars, rhe forest was the whole
pariem. Yes, earing a low carbohydrare (rugh
mear) diet can control the blood sugars, but
rhe number one cause of dearh atnong eii.\betics is heart and blood vcssel disease. In
faer, the American Hearr Associarion has
gone on record rhar fully 80 percellt of diabetics die of some form of hearr ar blood
vessel disease. S:l The roor cause ofhearr and

blood vessel disease is arherosclerosi . This

process is, of course, accelerared by meat
wirh its high content ofdlolesterol anei saturared fu. Ironically, rhen, by rrearing his ar
her blood sugar wirh a high mear dicr) a
diaberic may likely rrade the coneml of
blood sugar for an early dearh from he~m
disease. Since ir is rhe complicarions and
afflictions of diaberes rhat need ta be particularly avoided (nor jmt rhe control of
blood sugars) rhe dier needs ro be tailored
ro avoid 01' creat rhese complicarions as well
as control rhe blood sugar.
Obesiry is often oue of the main dererminanrs of insulin rcsisrance (the primary
cause ofType Il diabercs). Thus ir is imperative for an obese diabetic ro Iose weighr
if conrrol of the disease is ro be obrained by
lifesryle changes alone. Mear is a1so dens~
in calories and makes weighr 10ss more djfficulr. On the orher hand, whole fruits
vegerables, and grains (without fany roppings) are l11uch les$ dense in calories, rhus
faciliraring an exccUeor weighr loss program.

Meat and Death from Diabetes

Norwi(hsranding rne faer thar mear Gll1
help control blood sllgars n diaberjcs, a large
Southern California srudy dane among Seventh-day Advenrisrs showed rhar rhose rhar


Risk ratio in Seventh-day Adventist men



Less than 1 day per week


6 or more days p'er wee'k

Figure 5



Foods high in solubLe alld insolublefiber
II1 cacll
1 cup
1 cup
1 cup
1 cup
I cup
I cup

Food Item

Soluble Fiber (g)

Dried figs
Garbanzo bCllns/cblckpea
Large lima bcaos
Red kidncy bean~"
Corn grils
Carob Oour

Insoluble Fiber (g)




F oods high in insoluble fiher

lh cup
I Clip
1 Clip
1 cup
1 cUJ!)
1 Clip

Food Item

Insoluble Fibcr (g)

Wheal br:1Il
Oricd c.oconul
Pislachio nuis
Blackc)'cd cowl'cas
Corn bran



Figure 6

are mear six or more rimes per week were ar

3.8 ames grearer risk of dying from diaberes rhan rhose who are mear less (han once
per week, as illustrared in Figure 5. 54 Other
research indicares an addirional benefit ro
diaberics whe avoid meat and animaJ produce.. These anmal-derived irems have no
fiber in them wharsoever. And fiber is
emergjng as a critical ingredienr in the con-


Reduees levels of serum cholesterol and triglycerides
Reduces blood pressure in those with hypertension
Promotes discontinuation of insulin therapy for
1I0n-insulin dependent diabetics
Reduces r,isk of death from beart disease
lmp1roves gastrointestinal fUDetion

Reduces body wdgJht in the obese

Reduces risk of kidney damage
Reduccs insu1n requilfements
Improves glycemic control
Figure 7


trol of blood sugar. In fact, some are suggesring rhar an abundant supply of fibee is
one of the main reaSOllS dur a vegerarian
dier bcnefits diabetics.

Fiber Facts
Fiber is a (errn (hat refers ro plant consriruenrs rhat are resisranr ro human digestive enzyrnes. 55 AJmost aII of rhe diHe;enr
r)'pes of fiber are acruaJly indigesrible carbohydrares (rhe only cxceprion is a fiber
called lignin).56 Some of the other fiber
rypes include cdlulose, hemice1ll1lose, prerins, and gums. 57 Fiber is generally c1assifled as either solllbie (disselves in warer) or
insoluble. As we will sec shortly, rhese two
types of f1bers have different benefirs. One
of the bonuses of eating a balanced diet of
naruraJ planr foods is thar we rend ro ger
liberal amounrs ofborh rhe soluble and insolllbie flbers.
There are man)' foods rich in fiber. A
high content of insoluble fiber is found in
wheat (especially the bran) and bananas.
Foods s(rong n soIuble flber include m05r
fruirs, vegerables, legumes (fresh or dried),
oars, brown rice, and barley. Mosr foods
rhat are strong n soluble fiber are also srrong
in insoluble fiber. Examples of foods high
in fiber are shown in Figure 6. 58

Fibel; Jnsufin, and Blood Sugar

Rcsearch makes evident rhar foods (har
are high in fiber lead ro a slower rise in blood
sugar, and as a reslllr, reqllire less insulin ro
handle (he meaJ.S9 Fiber, especially soluble
fiber like rhe pecrins and gurns, slows rhe
emptying of food from the stomach60 and
helps ro slow rhe absorption of simple sugars in the small intesrine. 61 This should be
conrrasted wirh high far meals thar can resuit in high blood glucose levels for up ro 5
hours after [he mea!. 62
Addition of these rypes of fibers ro tlle
diet has been demonsrrated ro improve diabetes COntrol. 63 Indeed, eatjng a low far.
high fiber, vegetarian dier keeps blood sugars low even wben frurs are eaten. Dr. James
Anderson and colleagues at rhe Universit)'
ofKenrucky found rhar by lIsing a high carbohydrare and high fiber diet, rJle need for
inslliin was grearly reduced. Blood sugar


control was better and fasring Jevels of cholesterol and (figlycerides feLl. These and
od1er benefl(s ofilie high carbohydrare, high
fiber diet are listed in Figllre
Many nlltririon experrs recommend
that aur diers should contain benveen 20
and 35 grams of fiber per day when i[ comes
ta issues I.ike cancer prevention. 67 1owever,
even higher amoums offiber seem oprimaJ
for diaberes conrrol. Stlldies thar demonstrare consisrenr deereases in insulin requiremelHs by improving fasung and post-meaJ
blood sugar levels have lISeel berween 25 and
35 grams of fiber for every 1000 calories
ea[en. 68 This ean easily bring daily fiber
consumption inro rhe range of 50 ro 100
grams per day.
Consumption of solllbie fiber a1so appears ro be imporram in non-diabetics. As
we have already nored, wherher or not a
person has diaberes, rhese fibers prevellt (he
rapid rise in blood sugar, with a resulting
lower peak level. Therefore, insulin reqlliremenrs are aCll1ally deereased when rhese fibers are added ro rhe diet. 69 ll,-is is no smaJi
111atrer. As imporranr as inslliin is in COI1trolling aur blood sugar, ongoing reseaJch
demonstrates rhar higher blood inSlllin levels increase the speed at which the blockagcs of arherosderosis devdop.70. l ThllS,
we ShOllld help our bodies by placing fewer
demands for high insulin OlltpUr. One wa)'
we can do rhis is by e<uing less sugar and
choosing more fiber-rich foods.
One group of Ilon-diabeties rhat may
especiall)' benefir from the in 1Ilin-sparing
effeers of a high~fiber vegetarian diet consisrs of rhose wirh high blood pressure. Individllals wirh elevared blood pressurc (sa
calied "essential hyperrension"), even if d1ey
are not overweighr and nor diaberic, rend
ro have tissues rhar are less sensitve ro iJ1SUlin. n The bod)' responds ro this lack of tissuc senstiviry by making more nsu/in ro
ger rhe job dane. Therefore, ifhypenensives
adopr a bener diet, their blood vesse/ waUs
wiU be exposed to a reduced amounr ofinsulin.

srances and carcinogens found in our food

supply. Fiber helps prevent colon cancer,
and may help against several orher cancers
as well.7 3 A e1ier rich in fiber helps in healing peptic ulcer disease?4 Fiber is effeetve
in curing al1d preveluing chronic constipa[ion. It can also be effecrive in curing
ehronic diarrhea.
We have come a long way since fiber
gained worldwide attention in 1970. It was
then tlur Dr. Denis Burkirr, a renowned
Brirish physieian, published a repon rhar
ver)' effeerively sounded the aJarm. He ob-


Diabetes mellitus



Bowel cancer


Bowel polyps

Varicose veins

Heart disease

Hiatus herna


Divcrticular disease

Gallbladder disease
Figure 8

served thar in counrries where diers include

large :lmOUlHS of fiber, rhere were few cases
of rhe many degenerative diseases common
in rhe Wesrern world roday. These diseases
are lisred in Figure 8. 75
Remember, fiber is found on1y in piant
foods such as fruirs, vegetables, grains, anei
nurs. Fiber is nor presell( in an] ani.mal
produc[s. There is no Aber in meat, milk,
eggs, ar cheese. Yes, a eow eats plel1ty of
fiber and is a vegetarian by namte, bur ir
rerains n-o fiber in its jleJh or its milk.

Other Benefits ftom Fiber

Fiber from plant foods helps dilure,
bind, inacrivJte, and remove toxic sub-



More on Proper Diet:Meal Timing

on an Optimal Lifestyle Program
Most people do nor rea.lize dMr rheir glucase lOlerance decreases as the da)'
progresses. This means rhar tDward evening,
your body's abilif)' ro hand1e sugar decreases.
In a srudy ofsubjecrs with Type II diabcrcs,
absolure blood sugar leveLs were 10 ro 15
percenr higher when eati~1g six rimcs a da}'
(rhree meals and rhree snacks) compared to
just duee meals a day.76 Years ago, before
veI')' precise insulin rypes were avaiJable, a
snack at bedrime was recommended for djabetics because the insulin Ievels peaked in
the middle of the sleep period. The bedtime snack helped prevenr hypoglycemia.
ar low blood sugar. Today, wirh r.he rypes
of insulin available, this is not only unnecessary, but counrerproducrive. aur hcaviesr me."11 shouJd be in the morning, emphasizing frurs and grains. This prcpares liS
for the most active paft of rhe day. A subsrantial meal for lunch, including several
servings ofvegerables, is also imponanr. As
rhe day progresses, our abiliry ro hand le
blood sugar decreases, so a lighrer mcal in
the evening (ideali)', for obese Type II djaberics, no evening meal) wirh no reflned
sugar is the besr rule ta foHow. Asking your
doctor ro cailor yOllf insulin injecrions so
rhar dus progran; can be followed can produce gre~lt beneflrs.

1s Sugar OKfor the Diabetic?

Many docrors who uear diabetes seem
ro have grown more lenienr about sugar
consumpeion. Therefore, it is not llncommon for diaberic patients ro w,tlk away wirh
rhe idea rhat earing sugar "in moderation"
is OK.
This seemed ro be the attmde ofLois, a
75 year old Type II eliaheric. Alrhough she
was raking abour 50 llnits ofinsulin per day
she saw no problem wirh an occasional ice
cream. There was a major wrinkle, however; Lois hael whar I would caJ) an addictive relationship wirh ice cream. She could
nor control her consumprion of rhat high
fat, high sugar "treat." When she adopted
a healthful program, she left OUt heI' ice
cream and made orher heahhful changes in


her lifesryle. Consequenrly, she losr weighe

:lnd saw her insulin needs drop by ovel' 60
pacent in less than three weeks. Parc of Lois'
uccess was due ro tlle face that she flnally
faced rhe realization thar high sugar foods
were a real problem for her and her diaberes.

What Other Problems Does Sugar

It is imporranr eo recognize rhar wllen
eaten aparr [rom flber, simple sugars are asociateel wieh demal cavities, obesiry, high
malnutrition, and decreased
t> ,
resistance ro disease. This is true whether
(he simple sugar is in rhe form of wluee
sugar, brown sugar, honey, molasses, corn
syrllp, maple syrup, milk, or [ruit juice.
Furthermore, rhere is concern thar higher
amOUlHS of sugar in the blood can combine
wirh LOL cholestcrol ro produce a compound rhar is damaging tO che lining of
blood vessel walls, rhus srimlliaeing aeherosderosis. This "glycared LDL" (LOL cornbineel with sugar) ma)' become oxidized
LOL rhar increases rhe risk ofhearr diseaseF
See Chapter 3, "Hearr Disease-Conqucring rhe Leading Killer," for informarion on
the problems wirh oxjdized cholesrerol.
Retlned sugar has effects rhar also impacr our qualiry of life. A high s'}gar diel
and rhe consllming of fruir juices and sodas
inerease the severit)' of premenseruaJ syndrome symproms in college girls.7 8 Sugar
also may decrease cognitive or inreUecruaJ
funetion, especially in children. 79 Soroe
hypothesize mat rhe reason for chis mental
dererioration is a result of fhe body overreacrlng ro refmed sugar consumption. A load
of sugar srimulaees rhe pancreas ta release
excessive amouJlts ofinsulin, which ln turn
leads in a few hours ro a blooel sugar rhae is
lower than normal. 80 Therefore, children
ma)' ger poor grades on thei r reSIS alehough
they are weU prepared. Eating natura! but
nOt rdlned, ugar, such as is found in apples,
oranges, pears, etc., should be encouraged
because these foods are packed wirh nutrienrs, including fiber, along \Virh rhe lInreflned sugar. Ar the risk ofbeing redundant,
let me reirerate: flber slows rhe rare ofslmple


sugar absorption, allowiog utilizaeion of ilie
energy from rhe food we ear ac a steadier
One classic srudy examined rlle effects
of earing apples in one of ehree differenr
physical forms: as whole apples, as
applesauce, or as apple juice. Even though
rhe same number of calories was consumed
from each prepararion, eaeing the apples
kepe blood sugars sreadier rhan drinking
> 80
apple juice or llsing applesauce alone. The
change of blood sugar levels rhrough a pe~
~ 75 .~
riod cime after earing apples in rhe rhree
forms is shown in Figure 9. 81
'&l 70
Nore rhar ilie blood sugar levels peaked
for aU eheee ar the same level 30 minutes
afler eating. Then aII levels decreased as
sharplyas ehey rose, but each ro a different
low poinr. The level for rhe apple juice consumer feU the lowese, ro 50. The level for
Apple Juice
(he apple sauce earer went down ro 61, while
rhe whole apple eater had a high 66 level as
his lowesr point. The raw applc eater's level
srayed constant ar (he high level for che re'-'--'--.L-l-.L---'--'-_LI J __LJ-L
maining rwo hours, while {he level for (he
120 150 180
ocher rwo stayed ar lower values. AJehough
rhis scudy was do ne in non-diabeeics, rhe
blood sugar peaks arc more pronouncedFigure 9
(higher) in diaberics consum ing rhe juicc
Sugar and the Jmmune System
or sauce in comparison wirh rhe whole
Researchers performed a series of srudapple. ehus indica,ing thar the natural whole
examined how sugar consumprion
apple will produce a steadier blood glucose
(he abiLiry of white blood cdls ro
tim rhe body can more easily handle. This
seudy demonsrrares that eating food in iu
naturalstate is ehe safesc and-ultima(elyehe mase satisfying way ro enjoy sugar.

More on Sugar and Diabetes

Anoeher concern wirh sugar for rJle diabetic is rhar sugar itself provides plenty of
calories, bue very liede in rhe way of rrace
minerals and orher nutrienrs. There are
growing concerns rhar cenain minerals may
help wich diaberes conrrol. Two examples
are zinc and vanadillm. 82 Ocher minerals
and viramins suggesced [Q have an important role in diaberes include magnesium,
manganese, chromillm, potassium, and pyridoxine (vitamin B().83 The more you fiII
lip on sugar, ilie less capaciry you will generally have for che nurrienc-rich foods like
fruits, grains, and vegerables.



Teaspoons ofsugar

No. bacteria destroyed








Figure 10





Colon cancer
Rectal cancer
Breast cancer
Ovarilan cancer
Uterine cancer
Prostate cancer
Kidney cancer
Cancers of the nervous system

Figure 11


desnoy bacreria. The srudies showed tlur

rhe capacicy for whire blood cells ro desrroy
bacreria is weakened as sugar consumprion
rises. Rcsu!rs of rhe whire blood cell smdy
are rabuJared in Figure 10. 84
Note rhat if a person consumed no sugar
for 12 hours, each whire blood cell could
dcsuoy an avcrage of fourrecn baneria. If
rhar samc individual are r11c cquivalenr of
six reaspoons of sugar (such as found in a
half-cup of pudding or a mere (\vO ounces
ofcand y85), each whire blood eell cOllld only
eliminate tcn bacteria-a 25 percenr decrease in killing power. Progressive dereriorarion in the white cells' baereria fighting capaciries beyond 25 percenr occurred
when J 2 r.easpoons and rhen 18 reaspoons
were ingesred. When 24 re<lspoons ofsugar
were conslImed (rhe amount in a medillm
piece of cheesecake or a rnilk shak(86 ), rhe
whire blood cdls were so compromised thar
they could onll' destroy an average of O1U
bacterium each. Thar represenrs a 92 percent reducrion. This effecc s silnilar ro whar
happens in a diabetic who !las uIlcontrolled
high blood sllgars. This provides one explanarioll why diabetics frequendy ger foor
infecrions and orher rypes of infecrions.
Keeping a heaIthy immune sysrem is simply a personaj choice rhat each one of us s
frec to make.
The above smdy provides furrher insight

inco why rhe immune sysrcm is weakened

when blood sugar levels rise in diaberics.
The researchers funher demonstrated dut
sugar's impairing efTeers on whire blood cclls
are not shon-lived. The impainneIlt lasred
a full five hours in normal subjecrs. S7 This
means thar during rhar five-hour period rhe
whire blood cdls coule! nor perform optimally.When you considet how ofren
rhroughom the day some people consume
sugar, ir becomes apparent rhar their whire
cells are nor funcrioning very effecrively for
many hours of each da)'. These researchers
also discovered an illteresting sidelighr: a 36
hom fast seemed ro signincandy il1creast' rhe
abilit}' of the whire blooe! eells ro kill off
bacreria. When you are sick anei nor hungry, it may rhus be ro your advanrage !O
avoid earing. or ac least ro car very sparingly
for a dal' OI' nvo.
One orher sobering linkage involves
sugar and cancer. 88 A nllmber of different
cancers have been sfarisrically linked ro sugar
consumprion in scienrific seudies. A listing
of rhese cancers is shown in Figme 11.
There are a number of rheories why mese
linkages exisr; however, a fiiII explanarion
for them is nor l'ec clear. However, rhe dara
rhar is available provides 'ln. addirional reason ro chink seriousll' abour being aware of
l'our imake of sugar, and making adjusIlllenrs as indicartd.
In lighr of ali rhis research ir is imeresring ro nore che caurions of Ellen Whire.
Over a hundred l'ears ago she wrore:
" ... sugar, when largely useel, is more injurious rhan mear."89 Predacing Whire bl' man)'
cemuries, the Holy Scriptures aJso recorded
reservarons abolit simple sugars. Alrhough
honey was melltjoned, the principle seems
ro apply wirh equal force ro any simple
sugar: "It is nor good ro eat much hOlley.'
Proverbs 25:27.
Americans are beginJling (O beed rhe
\varnings regarding meat, bur somehow we
have failed ta make ir clear rhar sugar ar rhe
levels con umed bl' rh average American
lnay be, in some respecrs, even more harmfuI rhan consllming mear. The emerging
dara on sugar suggesrs [har we should nor
rake Lghtly che counsel of modern day scienrisrs tlur coneur wirh rhe reservarions


voiced by dle Scriprures and Ellen White
about the dangers of excessive sugar intake.
Sugar. indeed, eems ro be a probJem for
mosr Americans, whether diabetie ar noc.

ls Sugar Comumption Really a

Probtem for Me?
lf you are Jike most Americans, you are
e:uing large amounts ofsugar withour even
realizing ic. The average U.S. eitizen eats
over 147 pounds of sugar each year. 90 Thi
rrans!ates Ulto a whopping 46 tetlSpoons per
day. The trends are even more disturbing.
Americans IOday are eating nenrly 70 percent more sugar than their grandparenrs did
in 1909. 91 Despite aII the emphasis an
healrhier Jiving and healrhier eating, since
1970 rhe average American yearly ugar
consumprion has cominued tO increase by
25 pounds. 91 One reason for this is rhar
even whiJe we may speak more abolit health,
Americans are consllrning more candy and
soft drinks per person roday than ever before. 93
These foocis seern to be replacing rhe
heaJrhful cereaI grains. While rhe average
U.S. eitizen in 1909 are 300 pounds of Aour
and cereai products, caday we average only
199 pounds annually.94 Ali cald, 38 percent of the rotaJ carbohydrates in the AJnerican diet now come from rehned sugars. This
compares to 40 percent of aur total carbohydrares coming from grain. 95 Therc is
callse for serious concern in view of the
problems associated with sa much sugar in
the diec.
Virtually no one ears 46 rcaspoons per
day from rhe sugar bowl. How is it possible, then, ca consume this much sugar?
Mos[ of rhe sugar in our dier is "hidden."
lrs presenee in [he foods we ear often goe
unnoriced. Some of rhese hidden sources
are hsted in Figure 12. 96
Notice that one of the main sources of
hidden sugar is soft drinks or sada pop. Soft
drinks were unknown umil modern times.
However, in 1994 rhe average American
consumed 52.2 gallons of soft drinks, with
40 gaHom of it in rhe form of regular (nondtet) beverages. 97 This amounrs ro the
equivalent of 427 rwelve ounce cans per

year, or more rhan one per day for every

mall, woman, and child. Since a rypica1
non-diet soft drink packs 150 calories,98
each year the average American consumes
over 64,000 calories of sugar from soft
drinks alone. This is no small rl1auer when
you recognize rhar i[ rakes only 3,500 excess calories in aur diet ro gaiu one pound.
What nutritional qualities do soft drinks
comain? Very little. They are the souree of
a liberal amount of simple carbohydrates
rhat must be classitied as (empty calories."
In faer, rhey aptly illustrate whar an empt)'
calorie food is: ir eolltains many calories but
is largely devoid of vieamins and minerals.
Whar, then, makes soda pop so popular? It
is rasry and cheap well advertised. and available almost everywhere. Furrhermore,
many soft drinks are eaffeinated, making
(hem part of an adJictive process.


Malted milk




Soft drinks

12 02


Canned fruit
(Iight syrup)

1 serving

Chocolate cake C!Q!!) t




Chocolate candy


Fruit pie

1 sUce

Ice cream

1 scoop

Donut, glazed

1 each


1 Tbs

Figure 12

Complex Carbohydrates: A Better

Choice than Sugar
The rnain sources of food energy originare Eram d1ree catcgories of Illltriencs:
carbohydrate, fat, and protein. The body can
most casily eonvert G.'l.fbohydrate inro energy


for our everyday acrivities. Sweer. empty
calorie foods give rhe blood sugar a quick
boost, bur this rise is not sU5tained. To rhe
conrrary, we have learned thar the boost may
he followed by a sharp drop in blood sugar.
We would do well to make carbohydrates
the largesc percemage of our diet, bur nor
the empry calorie ones. Gur energy should
come from quaIiry carbohydrates (called
"complex" carbohydrates) like natural fruits.
grains. and vegerables. We have already
looked in derail ar many of the ben.efirs of
foods with rhese kinds of carbohydraresone of rhe mosr important being thar rhey
tend ro be packed with liberal amounrs of
fiber along wirh orher nurrienrs.
The conc1usion is rhar for diabetics and
non-diaberics alike, complex carbohydrates
should make up the major part of a healrhfuI dier. Most Americans consume 10 to
15 percent of meir ca10ries from prorein.
(eight percenr would be more hcalthful).
and planr sources of protein are the best.
An ideal amount of fat consumption is approximately 25 percem of calories with an
emphasis an the unsamrated and omega-3
[ars. One recent study from Australia has
shown that a diet high in monounsaturated
far (such as is found in olive oii) using 38
percenr total fat and 21 percent monollnsaturated fat can adequately control blood
sugars in diabetics withour adversely affect-

Hazetnut oU
Olive oiI
Pumpkin kernels
Sesame lleeds
Figure 13









ing the cholesterol and trglycerides. as long

as the roca 1 calorie inrake remains controlled. 99 Figure 13lists foods rhac are high
in monounsatllrated fat. 1oo
Carbohydrates should makc up the bulk
of rhe diet at approximate1y 55 to 70 percent. They provide rhe most efficient aud
readily available source of energy for our
bodies. The brain and nervous system r1ssues use carhohydrares almost exclusively for
energy. Carbohydrates will act ro detoxify
harmful substances that are manufaccured
by Of raken ioto Dur bodies. Complex carbohydrates are abundant in vegeeables as
well as in whole grains such as rice, wbole
grain pasta, and potaroes.
Adier rich in complex carbohydrates and
fiber is also [he best way to address the problem of obesiry. which, as previously mentioned, is ooe of the major reasons for the
insensitiviry ro nsulin ehar characterizes
diabetes. In fact, the Joslin Diabetes
Center's textbook srates: "the mosr COOlmon and important cause of insulin resistance is obesity."lOl That may be why, as
important as exercise is in an overweiglu
individual, weight /{lSS seems ro be even mOTe
important, at least in prevenring heart disease, improving HDLcholesterol (the good
cholesterol), and in reducing blood pressure
and blood sugars. 102 There is. however. an
old myth in America mat says [hat if you
eat starchy foods you will gain weight. The
fact is. starchy foods in moderate amounts
should be paft of a weight ioss diee. The
extra fars and c.-uories rhat we add to the
starchy foods make them fattening.
For example. it would take 60 potatoes
ro equal the amount offat in one tablespoon
of butter. One medium sized potaro has
onIy 145 calories and a mere trace of fat,
2/10 of a gram. If we add JUSt one tablespoon of buner. rhat one potato jumps up
ro 247 calories wirh 12 grams offat. I03
&ting a liberal supply of complex carbohydrate and fiber-rich fruits, whole
grains. and vegetables will go a long way to
provide benefirs beyond improving blood
sugars. As we have seen, these foods have a
desirable short-term effecr in decreasi.ng insulin needs. But they aIso have long-term
benefits. in ehar rhey form che optimal diet


for weight loss. When combined wirh reguIar exercise and oprind meaJ riming (people
Iose more weight if rhey ear lightly-or nor
at aH-in rhe evening), such a diet can help
rhe overweight diabetic tO shed a significam
number of pounds. As the weighr comes
down, sa do the insulin needs.

What about artificial $wcctcncrs? Today many believe anificial sweeceners are a
good alternarive ta sugar in everyrhing from
soft drinks ca cakes and candies because rhey
conl<lin fewer caJories. NmraSweet, for example, is the brand name of a synrhelic
amino acid called aspaname. In small
anlounrs it can mimic che tasce of sugar.
Do rhe low calorie soft drinks really
work? Currenr research says "110." In f.1.cr,
lhose who drink the lllosr diec drinks have
che mosr problems widl c1leir weight. And
ir seems ro be more rh:U1 juSt a situation
where heavier people are choosing lower
calorie irems. One srudy of over 75,000
women ages 50 ro 69 found rhat users of
arrificial sweeteners were sign ificanc.ly more
Jikely than non-users tO gain weight over
cime. 104 In anorher swdy, 30 volunreers
drank faur dier sodas daily for rwo weeks.
Surprisingly, rhese diet soda users are more
food and gained more weighr rJlan when
Ihey were free ro drink regular sugar-sweetened sofr drinks. Researcher Michael
TordofT reporrcd [har artificial sweeteners
increase the appetite. "We found rhar Imnger increases aher drink.ing just a liter of
asparrame sweercned soda," he said. 'o ) Simply pUI, arcificial sweeceners jusc seem tO
ncrellSe the desire for the real sUJeeteners. This
is a problem ofobvious significance. In our
councry, an average of over 20 pounds of
arciflciaI sweeteners are consumed per person per year, 106 bur despire rhis increase in
consumplion of arciflcial sweereners, actuaI
sugar consumpnon connoues ro riSC.

A Betier Alternative
Research scudies as well as my personal
experience as a physician make an eloquenr
poinc: if we adopt new and betTer ways of
eacing and living-and srick wich chemwe will likdy devewp an enjoymem for (har

new lifestyle-. In other words, inscead of

concinuing ro car foods that are characrerizcd by excessive sweerness, regardless of
wherher rhe sweet raste comes [rom sugar
ar from arcificial sweeteners, why not ler
your raste. develop for foods rhar are naturalIy sweec.? Try ro fUld more enjoymellt in
a crisp apple, a ripe banana, ar perhaps even
a home grown carcor ar a garden-fresh
squash. Our rasce buds are rrainable.
AJrhough I can rhink of many examples
among my parienrs of"rrainable tasre buds,"
[here is one example from someone who is
nor my pariem dlat is especially "close (O
home"-my f.1ther. When 1 was growing
up in Michigan, my father, although not a
diaberc, was suffering from a number of
minor healrh problems. As a mechanical
engineer, he was nor acquainred wirh medical or healrh subjecrs. He happened across
a book caJJed "Sugar Blues" and bec.'1mc
convinced [har his overweighr condirion and
healrh problems were rel:ued ro his high
sugar inrake. He had always been an avid
milkshake drinker, and an ardem consumer
of Reese's peanut bUlter cups and chocolate
covered cherries, among mher sugary foods.
One evening he inrriglled the family by
announcing he had decided la give up refined sugar emirely. My morher, however,
conrinued ro cook for our family [he way
she always did. When ir carne time for rhe
dessen, my father would leave and go work
in rhe garden. When he carne bome from
work and choeolate-chip cook.ies were baking he wOllld go ourside and do some chore
ta avoid rhe aroma and accompanying
temprarioll. We aII quierly wondercd how
long he could COntiIlue with his decisioIl.
After abour four monrhs, Jlly farher
carne home and anorher sweet dessere was
baking, buc rhe appeal and desire were no
Jonger present. In fact, he described rhe
odor as a "sickening sweet." He now enjoyed apple pies made withouc sugar (my
morher finally broke down and would make
him desserrs wirh no refined sugar) as much
as he had enjoycd his former dessercs. My
unele, who would frequendy visit liS from
lexas, commenred on how ir was worrh {he
ctip just ro sec how "Bud" obviously relished
and delighred in plain simple. foods. My


f.uher's weighr came down and bjs healrh
probJems disappeared, but his enjoyrnellt
for food and life, ifanyrhing. improved. As
a youllg boy, this obvious "before and after" difference thar 1 had observed in my
own farher launched my interese in lifestyle
and heald). Althollgh ir reqllired disciplined
sacrificc for a few monrhs, the resulrs demonstraee rhat tasre bllds Crin be rrained for
the bener.

Putting It AII Together: Principles of

Diabetic Nutrition
Mall)' of my diabetic patiems requese
that l give rhem a very specific menu thar
will help conrrol rheir diabetes. However,
for mose diabetics, menlls are nOt as imporram as knowing (and practicing) the dietary
principles of diabetic control. This is especially truc for rhe non-illSulin dependent
lype II diabetic. The principles are really
very basic-we have 100ked at aH of them
in this chapter. The more natural fruirs,
vegerables, and whole grajns the bener (Ilms
aJe also good in moderation). The less mear
and dairy prodllcts rhe bener. The less refined sugar ehe bcner. The more fiber rhe
bener. Eat a good breaHm and linie ifany
supper. If you are overweighr ir is of lltmosr imponance dur you reduce your
weight ro yOUI" ideal weighe (thus, rhe less
far in the dier the bener) and follow an earing sryle ehar allows you to attajn and mainrain rhis reasonable weight. Aerobic exercise, ar leasr 30 mjnures in durarion, should
be parc of the daily diabetic ramine.
1 am happy ro provide my patieors wich
de1icious recipes incorporaring rhe balanced
low far, low sugar, high fiber vcgcrarian diee
rhat is besr for diaberes. l avoid giving them
a menll, however. Once rhey understand
rhe principles, 1 le( rhem thoughtfully plan


rheir own meals. l would give the same

advice tO each rcader. Do nor feel bound ro
some restrictive way of eaeing. Take rhe
principles ro hean. Experiment with ditTerenc options. You will be surprised ar how
enjoyable a hcalrhy lifestylc c~n really be.

The Surprising Truth-Even for NonDiabetics.

Some people find ir hard to believe this
simple rrurh: rhe diabetic Iifesryle 1 have
been describing is also the best lifesryle for
Ilon-diaberics. Whether you are concerned
about preventing diabetes or merely trying
to oprinuze your healrh, rhis program will
also pay you rich dividends. And you will
not have ro sacrifice pleasl1rc eirher.
Almosr every day at rhe Lifestyle Center
of America in Oklahoma you will find diabetics enrolled n OUl' live-in prograrns for
the purpose of reversing rheil' djsease process. YOl! will also find some oehers-individuaJs fram the surrollnding communities
who come ro cnjo}' a meal in our dining
mom. They are ofren earing rhe very Same
fare mar the diabetic across (he room is en)oymg.
Ofren our fear ofcbange is large1y driven
by ignorance. Pick up a good cookbook or
find a fTiend who can make some tasty mearless entrees, and embal'k roday on a more
vegetarian-type ofearing program. A lisr of
cookbooks (har specialize in healrhfi.ll menus
can be found in Appendix Il. You wiU find
what our neighbors around rhe Lifestyle
Cenrer of America havc found: food can
tasee good, your life can have enjoymenr,
and you can sriH be on rhe finesr dier and
lifesryle ro reverse, control" or prevent diaberes, in additjon ro reducing )'our risk of
mally ocher diseases.


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