NutritionFacts.org: Preventing, Arresting, and Reversing Leading Killers PDF

 Begin Reading Table of Contents About the Authors Copyright Page Thank you for buying this Flatiron Books ebook. To receive special o ers, bonus content, and info on new releases and other great reads, sign...

 Begin Reading Table of Contents About the Authors Copyright Page Thank you for buying this Flatiron Books ebook. To receive special o ers, bonus content, and info on new releases and other great reads, sign up for our newsletters.  Or visit us online at us.macmillan.com/newslettersignup For email updates on Michael Greger, M.D., click here. For email updates on Gene Stone, click here. The author and publisher have provided this e-book to you for your personal use only. You may not make this e-book publicly available in any way. Copyright infringement is against the law. If you believe the copy of this e-book you are reading infringes on the author’s copyright, please notify the publisher at: us.macmillanusa.com/piracy. To my grandma Frances Greger  Preface It all started with my grandmother. I was only a kid when the doctors sent her home in a wheelchair to die. Diagnosed with end-stage heart disease, she had already had so many bypass operations that the surgeons essentially ran out of plumbing—the scarring from each open-heart surgery had made the next more di cult until they nally ran out of options. Con ned to a wheelchair with crushing chest pain, her doctors told her there was nothing else they could do. Her life was over at age sixty- ve. I think what sparks many kids to want to become doctors when they grow up is watching a beloved relative become ill or even die. But for me, it was watching my grandma get better. Soon after she was discharged from the hospital to spend her last days at home, a segment aired on 60 Minutes about Nathan Pritikin, an early lifestyle medicine pioneer who had been gaining a reputation for reversing terminal heart disease. He had just opened a new center in California, and my grandmother, in desperation, somehow made the cross-country trek to become one of its rst patients. This was a live-in program where everyone was placed on a plant-based diet and then started on a graded exercise regimen. They wheeled my grandmother in, and she walked out. I’ll never forget that. She was even featured in Pritikin’s biography Pritikin: The Man Who Healed America’s Heart. My grandma was described as one of the “death’s door people”:  Frances Greger, from North Miami, Florida, arrived in Santa Barbara at one of Pritikin’s early sessions in a wheelchair. Mrs. Greger had heart disease, angina, and claudication; her condition was so bad she could no longer walk without great pain in her chest and legs. Within three weeks, though, she was not only out of her wheelchair but was walking ten miles a day.1 When I was a kid, that was all that mattered: I got to play with Grandma again. But over the years, I grew to understand the signi cance of what had happened. At that time, the medical profession didn’t even think it was possible to reverse heart disease. Drugs were given to try to slow the progression, and surgery was performed to circumvent clogged arteries to try to relieve symptoms, but the disease was expected to get worse and worse until you died. Now, however, we know that as soon as we stop eating an artery- clogging diet, our bodies can start healing themselves, in many cases opening up arteries without drugs or surgery. My grandma was given her medical death sentence at age sixty- ve. Thanks to a healthy diet and lifestyle, she was able to enjoy another thirty-one years on this earth with her six grandchildren. The woman who was once told by doctors she only had weeks to live didn’t die until she was ninety-six years old. Her near-miraculous recovery not only inspired one of those grandkids to pursue a career in medicine but granted her enough healthy years to see him graduate from medical school. By the time I became a doctor, giants like Dean Ornish, M.D., president and founder of the nonpro t Preventive Medicine Research Institute, had already proven beyond a shadow of a doubt what Pritikin had shown to be true. Using the latest high-tech advances—cardiac PET scans,2 quantitative coronary arteriography,3 and radionuclide ventriculography4—Dr. Ornish and his colleagues showed that the lowest-tech approach—diet and lifestyle—can undeniably reverse heart disease, our leading killer. Dr. Ornish and his colleagues’ studies were published in some of the most prestigious medical journals in the world. Yet medical practice hardly changed. Why? Why were doctors still prescribing drugs and using Roto- Rooter-type procedures to just treat the symptoms of heart disease and to try to forestall what they chose to believe was the inevitable—an early death? This was my wake-up call. I opened my eyes to the depressing fact that there are other forces at work in medicine besides science. The U.S. health care system runs on a fee-for-service model in which doctors get paid for the pills and procedures they prescribe, rewarding quantity over quality. We don’t get reimbursed for time spent counseling our patients about the bene ts of healthy eating. If doctors were instead paid for performance, there would be a nancial incentive to treat the lifestyle causes of disease. Until the model of reimbursement changes, I don’t expect great changes in medical care or medical education.5 Only a quarter of medical schools appear to o er a single dedicated course on nutrition.6 During my rst interview for medical school, at Cornell University, I remember the interviewer emphatically stating, “Nutrition is super uous to human health.” And he was a pediatrician! I knew I was in for a long road ahead. Come to think of it, I think the only medical professional who ever asked me about a family member’s diet was our veterinarian. I was honored to be accepted by nineteen medical schools. I chose Tufts because they boasted the most nutrition training—twenty-one hours’ worth, although this was still less than 1 percent of the curriculum. During my medical training, I was o ered countless steak dinners and fancy perks by Big Pharma representatives, but not once did I get a call from Big Broccoli. There is a reason you hear about the latest drugs on television: Huge corporate budgets drive their promotion. The same reason you’ll probably never see a commercial for sweet potatoes is the same reason breakthroughs on the power of foods to a ect your health and longevity may never make it to the public: There’s little pro t motive. In medical school, even with our paltry twenty-one hours of nutrition training, there was no mention of using diet to treat chronic disease, let alone reverse it. I was only aware of this body of work because of my family’s personal story.  The question that haunted me during training was this: If the cure to our number-one killer could get lost down the rabbit hole, what else might be buried in the medical literature? I made it my life’s mission to nd out. Most of my years in Boston were spent scouring the dusty stacks in the basement of Harvard’s Countway Library of Medicine. I started practicing medicine, but no matter how many patients I saw in the clinic every day, even when I was able to change the lives of entire families at a time, I knew it was just a drop in the bucket, so I went on the road. With the help of the American Medical Student Association, my goal was to speak at every medical school in the country every two years to in uence an entire generation of new doctors. I didn’t want another doctor to graduate without this tool—the power of food—in her or his toolbox. If my grandma didn’t have to die from heart disease, perhaps no one’s grandparent did. There were periods where I was giving forty talks a month. I’d roll into town to give a breakfast talk at a Rotary Club, give a presentation at the medical school over lunch, and then speak to a community group in the evening. I was living out of my car, one key on my keychain. I ended up giving more than a thousand presentations around the world. Not surprisingly, life on the road was not sustainable. I lost a marriage over it. With more speaking requests than I could accept, I started putting all my annual research ndings into a DVD series, Latest in Clinical Nutrition. It’s hard to believe I’m almost up to volume 30. Every penny I receive from those DVDs, then and now, goes directly to charity, as does the money from my speaking engagements and book sales, including the book you’re reading now. As corrupting an in uence as money is in medicine, it appears to me even worse in the eld of nutrition, where it seems everyone has his or her own brand of snake-oil supplement or wonder gadget. Dogmas are entrenched and data too often cherry-picked to support preconceived notions. True, I have biases of my own to rein in. Although my original motivation was health, over the years, I’ve grown into quite the animal lover. Three cats and a dog run our household, and I’ve spent much of my professional life proudly serving the Humane Society of the United States as the charity’s public health director. So, like many people, I care about the welfare of the animals we eat, but rst and foremost, I am a physician. My primary duty has always been to care for my patients, to accurately provide the best available balance of evidence. In the clinic, I could reach hundreds; on the road, thousands. But this life- or-death information needed to reach millions. Enter Jesse Rasch, a Canadian philanthropist who shared my vision of making evidence-based nutrition freely accessible and available to all. The foundation he and his wife, Julie, set up put all my work online—thus, NutritionFacts.org was born. I can now reach more people while working from home in my pajamas than I ever could when I was traveling the world. Now a self-sustaining nonpro t organization itself, NutritionFacts.org has more than a thousand bite-sized videos on nearly every conceivable nutrition topic, and I post new videos and articles every day. Everything on the website is free for all, for all time. There are no ads, no corporate sponsorships. It’s just a labor of love. * * * When I started this work more than a decade ago, I thought the answer was to train the trainers, educate the profession. But with the democratization of information, doctors no longer hold a monopoly as gatekeepers of knowledge about health. When it comes to safe, simple lifestyle prescriptions, I’m realizing it may be more e ective to empower individuals directly. In a recent national survey of doctor o ce visits, only about one in ve smokers were told to quit.7 Just as you don’t have to wait for your physician to tell you to stop smoking, you don’t have to wait to start eating healthier. Then together we can show my medical colleagues the true power of healthy living. Today, I live within biking distance of the National Library of Medicine, the largest medical library in the world. Last year alone, there were more than twenty-four thousand papers published in the medical literature on nutrition, and I now have a team of researchers, a wonderful sta , and an army of volunteers who help me dig through the mountains of new information. This book is not just another platform through which I can share my ndings but a long-awaited opportunity to share practical advice about how to put this life-changing, life-saving science into practice in our daily lives. I think my grandma would be proud.  Introduction PREVENTING, ARRESTING, AND REVERSING OUR LEADING KILLERS There may be no such thing as dying from old age. From a study of more than forty-two thousand consecutive autopsies, centenarians—those who live past one hundred—were found to have succumbed to diseases in 100 percent of the cases examined. Though most were perceived, even by their physicians, to have been healthy just prior to death, not one “died of old age.”1 Until recently, advanced age had been considered to be a disease itself,2 but people don’t die as a consequence of maturing. They die from disease, most commonly heart attacks.3 Most deaths in the United States are preventable, and they are related to what we eat.4 Our diet is the number-one cause of premature death and the number-one cause of disability.5 Surely, diet must also be the number-one thing taught in medical schools, right? Sadly, it’s not. According to the most recent national survey, only a quarter of medical schools o er a single course in nutrition, down from 37 percent thirty years ago.6 While most of the public evidently considers doctors to be “very credible” sources of nutrition information,7 six out of seven graduating doctors surveyed felt physicians were inadequately trained to counsel patients about their diets.8 One study found that people o the street sometimes know more about basic nutrition than their doctors, concluding “physicians should be more knowledgeable about nutrition than their patients, but these results suggest that this is not necessarily true.”9  To remedy this situation, a bill was introduced in the California State Legislature to mandate physicians get at least twelve hours of nutrition training any time over the next four years. It might surprise you to learn that the California Medical Association came out strongly opposed to the bill, as did other mainstream medical groups, including the California Academy of Family Physicians.10 The bill was amended from a mandatory minimum of twelve hours over four years down to seven hours and then doctored, one might say, down to zero. The California medical board does have one subject requirement: twelve hours on pain management and end-of-life care for the terminally ill.11 This disparity between prevention and mere mitigation of su ering could be a metaphor for modern medicine. A doctor a day may keep the apples away. Back in 1903, Thomas Edison predicted that the “doctor of the future will give no medicine, but will instruct his patient in the care of [the] human frame in diet and in the cause and prevention of diseases.”12 Sadly, all it takes is a few minutes watching pharmaceutical ads on television imploring viewers to “ask your doctor” about this or that drug to know that Edison’s prediction hasn’t come true. A study of thousands of patient visits found that the average length of time primary-care doctors spend talking about nutrition is about ten seconds.13 But hey, this is the twenty- rst century! Can’t we eat whatever we want and simply take meds when we begin having health problems? For too many patients and even my physician colleagues, this seems to be the prevailing mind-set. Global spending for prescription drugs is surpassing $1 trillion annually, with the United States accounting for about one-third of this market.14 Why do we spend so much on pills? Many people assume that our manner of death is preprogrammed into our genes. High blood pressure by fty- ve, heart attacks at sixty, maybe cancer at seventy, and so on.… But for most of the leading causes of death, the science shows that our genes often account for only 10–20 percent of risk at most.15 For instance, as you’ll see in this book, the rates of killers like heart disease and major cancers di er up to a hundredfold among various populations around the globe. But when people move from low- to high-risk countries, their disease rates almost always change to those of the new environment.16 New diet, new diseases. So, while a sixty-year-old American man living in San Francisco has about a 5 percent chance of having a heart attack within ve years, should he move to Japan and start eating and living like the Japanese, his ve-year risk would drop to only 1 percent. Japanese Americans in their forties can have the same heart attack risk as Japanese in their sixties. Switching to an American lifestyle in e ect aged their hearts a full twenty years.17 The Mayo Clinic estimates that nearly 70 percent of Americans take at least one prescription drug.18 Yet despite the fact that more people in this country are on medication than aren’t, not to mention the steady in ux of ever newer and more expensive drugs on the market, we aren’t living much longer than others. In terms of life expectancy, the United States is down around twenty-seven or twenty-eight out of the thirty-four top free-market democracies. People in Slovenia live longer than we do.19 And the extra years we are living aren’t necessarily healthy or vibrant. Back in 2011, a disturbing analysis of mortality and morbidity was published in the Journal of Gerontology. Are Americans living longer now compared to about a generation ago? Yes, technically. But are those extra years necessarily healthy ones? No. And it’s worse than that: We’re actually living fewer healthy years now than we once did.20 Here’s what I mean: A twenty-year-old in 1998 could expect to live about fty-eight more years, while a twenty-year-old in 2006 could look forward to fty-nine more years. However, the twenty-year-old from the 1990s might live ten of those years with chronic disease, whereas now it’s more like thirteen years with heart disease, cancer, diabetes, or a stroke. So it feels like one step forward, three steps back. The researchers also noted that we’re living two fewer functional years—that is, for two years, we’re no longer able to perform basic life activities, such as walking a quarter of a mile, standing or sitting for two hours without having to lie down, or standing without special equipment.21 In other words, we’re living longer, but we’re living sicker. With these rising disease rates, our children may even die sooner. A special report published in the New England Journal of Medicine entitled “A Potential Decline in Life Expectancy in the United States in the 21st Century” concluded that “the steady rise in life expectancy observed in the modern era may soon come to an end and the youth of today may, on average, live less healthy and possibly even shorter lives than their parents.”22 In public health school, students learn that there are three levels of preventive medicine. The rst is primary prevention, as in trying to prevent people at risk for heart disease from su ering their rst heart attack. An example of this level of preventive medicine would be your doctor prescribing you a statin drug for high cholesterol. Secondary prevention takes place when you already have the disease and are trying to prevent it from becoming worse, like having a second heart attack. To do this, your doctor may add an aspirin or other drugs to your regimen. At the third level of preventive medicine, the focus is on helping people manage long-term health problems, so your doctor, for example, might prescribe a cardiac rehabilitation program that aims to prevent further physical deterioration and pain.23 In 2000, a fourth level was proposed. What could this new “quaternary” prevention be? Reduce the complications from all the drugs and surgery from the rst three levels.24 But people seem to forget about a fth concept, termed primordial prevention, that was rst introduced by the World Health Organization back in 1978. Decades later, it’s nally being embraced by the American Heart Association. 25 Primordial prevention was conceived as a strategy to prevent whole societies from experiencing epidemics of chronic-disease risk factors. This means not just preventing chronic disease but preventing the risk factors that lead to chronic disease.26 For example, instead of trying to prevent someone with high cholesterol from su ering a heart attack, why not help prevent him or her from getting high cholesterol (which leads to the heart attack) in the rst place? With this in mind, the American Heart Association came up with “The Simple 7” factors that can lead to a healthier life: not smoking, not being overweight, being “very active” (de ned as the equivalent of walking at least twenty-two minutes a day), eating healthier (for example, lots of fruits and vegetables), having below-average cholesterol, having normal blood pressure, and having normal blood sugar levels.27 The American Heart Association’s goal is to reduce heart-disease deaths by 20 percent by 2020.28 If more than 90 percent of heart attacks may be avoided with lifestyle changes,29 why so modest an aim? Even 25 percent was “deemed unrealistic.”30 The AHA’s pessimism may have something to do with the frightening reality of the average American diet. An analysis of the health behaviors of thirty- ve thousand adults across the United States was published in the American Heart Association journal. Most of the participants didn’t smoke, about half reached their weekly exercise goals, and about a third of the population got a pass in each of the other categories—except diet. Their diets were scored on a scale from zero to ve to see if they met a bare minimum of healthy eating behaviors, such as meeting recommended targets for fruit, vegetable, and whole-grain consumption or drinking fewer than three cans of soda a week. How many even reached four out of ve on their Healthy Eating Score? About 1 percent. 31 Maybe if the American Heart Association achieves its goal of an “aggressive”32 20 percent improvement by 2020, we’ll get up to 1.2 percent. * * * Medical anthropologists have identi ed several major eras of human disease, starting with the Age of Pestilence and Famine, which largely ended with the Industrial Revolution, or the stage we’re in now, the Age of Degenerative and Man-Made Diseases.33 This shift is re ected in the changing causes of death over the last century. In 1900 in the United States, the top-three killers were infectious diseases: pneumonia, tuberculosis, and diarrheal disease.34 Now, the killers are largely lifestyle diseases: heart disease, cancer, and chronic lung disease.35 Is this simply because antibiotics have enabled us to live long enough to su er from degenerative diseases? No. The emergence of these epidemics of chronic disease was accompanied by dramatic shifts in dietary patterns. This is best exempli ed by what’s been happening to disease rates among people in the developing world over the last few decades as they’ve rapidly Westernized their diets. In 1990 around the world, most years of healthy life were lost to undernutrition, such as diarrheal diseases in malnourished children, but now the greatest disease burden is attributed to high blood pressure, a disease of overnutrition.36 The pandemic of chronic disease has been ascribed in part to the near-universal shift toward a diet dominated by animal-sourced and processed foods—in other words, more meat, dairy, eggs, oils, soda, sugar, and re ned grains.37 China is perhaps the best-studied example. There, a transition away from the country’s traditional, plant-based diet was accompanied by a sharp rise in diet-related chronic diseases, such as obesity, diabetes, cardiovascular diseases, and cancer.38 Why do we suspect these changes in diet and disease are related? After all, rapidly industrializing societies undergo multitudes of changes. How are scientists able to parse out the e ects of speci c foods? To isolate the e ects of di erent dietary components, researchers can follow the diets and diseases of large groups of de ned individuals over time. Take meat, for example. To see what e ect an increase in meat consumption might have on disease rates, researchers studied lapsed vegetarians. People who once ate vegetarian diets but then started to eat meat at least once a week experienced a 146 percent increase in odds of heart disease, a 152 percent increase in stroke, a 166 percent increase in diabetes, and a 231 percent increase in odds for weight gain. During the twelve years after the transition from vegetarian to omnivore, meat-eating was associated with a 3.6 year decrease in life expectancy.39 Even vegetarians can su er high rates of chronic disease, though, if they eat a lot of processed foods. Take India, for example. This country’s rates of diabetes, heart disease, obesity, and stroke have increased far faster than might have been expected given its relatively small increase in per capita meat consumption. This has been blamed on the decreasing “whole plant food content of their diet,” including a shift from brown rice to white and the substitution of other re ned carbohydrates, packaged snacks, and fast-food products for India’s traditional staples of lentils, fruits, vegetables, whole grains, nuts, and seeds.40 In general, the dividing line between health- promoting and disease-promoting foods may be less plant- versus animal- sourced foods and more whole plant foods versus most everything else. To this end, a dietary quality index was developed that simply re ects the percentage of calories people derive from nutrient-rich, unprocessed plant foods41 on a scale of zero to one hundred. The higher people score, the more body fat they may lose over time42 and the lower their risk may be of abdominal obesity,43 high blood pressure,44 high cholesterol, and high triglycerides.45 Comparing the diets of 100 women with breast cancer to 175 healthy women, researchers concluded that scoring higher on the whole plant food diet index (greater than about thirty compared to less than about eighteen) may reduce the odds of breast cancer more than 90 percent.46 Sadly, most Americans hardly make it past a score of ten. The standard American diet rates eleven out of one hundred. According to estimates from the U.S. Department of Agriculture, 32 percent of our calories comes from animal foods, 57 percent comes from processed plant foods, and only 11 percent comes from whole grains, beans, fruits, vegetables, and nuts.47 That means on a scale of one to ten, the American diet would rate about a one. We eat almost as if the future doesn’t matter. And, indeed, there are actually data to back that up. A study entitled “Death Row Nutrition: Curious Conclusions of Last Meals” analyzed the last meal requests of hundreds of individuals executed in the United States during a ve-year period. It turns out that the nutritional content didn’t di er much from what Americans normally eat.48 If we continue to eat as though we’re having our last meals, eventually they will be. What percentage of Americans hit all the American Heart Association’s “Simple 7” recommendations? Of 1,933 men and women surveyed, most met two or three, but hardly any managed to meet all seven simple health components. In fact, just a single individual could boast hitting all seven recommendations.49 One person out of nearly two thousand. As a recent past president of the American Heart Association responded, “That should give all of us pause.”50  The truth is that adhering to just four simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases: not smoking, not being obese, getting a half hour of exercise a day, and eating healthier— de ned as consuming more fruits, veggies, and whole grains and less meat. Those four factors alone were found to account for 78 percent of chronic disease risk. If you start from scratch and manage to tick o all four, you may be able to wipe out more than 90 percent of your risk of developing diabetes, more than 80 percent of your risk of having a heart attack, cut by half your risk of having a stroke, and reduce your overall cancer risk by more than one- third.51 For some cancers, like our number-two cancer killer, colon cancer, up to 71 percent of cases appear to be preventable through a similar portfolio of simple diet and lifestyle changes.52 Maybe it’s time we stop blaming genetics and focus on the more than 70 percent that is directly under our control.53 We have the power. * * * Does all this healthy living translate into a longer life as well? The Centers for Disease Control and Prevention (CDC) followed approximately eight thousand Americans aged twenty years or older for about six years. They found that three cardinal lifestyle behaviors exerted an enormous impact on mortality: People can substantially reduce their risk for early death by not smoking, consuming a healthier diet, and engaging in su cient physical activity. And the CDC’s de nitions were pretty laid-back: By not smoking, the CDC just meant not currently smoking. A “healthy diet” was de ned merely as being in the top 40 percent in terms of complying with the wimpy federal dietary guidelines, and “physically active” meant averaging about twenty-one minutes or more a day of at least moderate exercise. People who managed at least one of the three had a 40 percent lower risk of dying within that six-year period. Those who hit two out of three cut their chances of dying by more than half, and those who scored all three behaviors reduced their chances of dying in that time by 82 percent.54 Of course, people sometimes b about how well they eat. How accurate can these ndings really be if they’re based on people’s self-reporting? A similar study on health behaviors and survival didn’t just take people’s own word for how healthy they were eating; the researchers measured how much vitamin C participants had in their bloodstreams. The level of vitamin C in the blood was considered a “good biomarker of plant food intake” and hence was used as a proxy for a healthy diet. The conclusions held up. The drop in mortality risk among those with healthier habits was equivalent to being fourteen years younger.55 It’s like turning back the clock fourteen years—not with a drug or a DeLorean but just by eating and living healthier. Let’s talk a little more about aging. In each of your cells, you have forty-six strands of DNA coiled into chromosomes. At the tip of each chromosome, there’s a tiny cap called a telomere, which keeps your DNA from unraveling and fraying. Think of it as the plastic tips on the end of your shoelaces. Every time your cells divide, however, a bit of that cap is lost. And when the telomere is completely gone, your cells can die.56 Though this is an oversimpli cation,57 telomeres have been thought of as your life “fuse”: They can start shortening as soon as you’re born, and when they’re gone, you’re gone. In fact, forensic scientists can take DNA from a bloodstain and roughly estimate how old the person was based on how long their telomeres are.58 Sounds like fodder for a great scene in CSI, but is there anything you can do to slow the rate at which your fuses burn? The thought is that if you can slow down this ticking cellular clock, you may be able to slow down the aging process and live longer.59 So what would you have to do if you wanted to prevent this telomere cap from burning away? Well, smoking cigarettes is associated with triple the rate of telomere loss,60 so the rst step is simple: Stop smoking. But the food you eat every day may also have an impact on how fast you lose your telomeres. The consumption of fruits,61 vegetables,62 and other antioxidant-rich foods63 has been associated with longer protective telomeres. In contrast, the consumption of re ned grains,64 soda,65 meat (including sh), 66 and dairy67 has been linked to shortened telomeres. What if you ate a diet composed of whole plant foods and stayed away from processed foods and animal foods? Could cellular aging be slowed?  The answer lies in an enzyme found in Methuselah. That’s the name given to a bristlecone pine tree growing in the White Mountains of California, which, at the time, happened to be the oldest recorded living being and is now nearing its 4,800th birthday. It was already hundreds of years old before construction of the pyramids in Egypt began. There’s an enzyme in the roots of bristlecone pines that appears to peak a few thousand years into their life span, and it actually rebuilds telomeres.68 Scientists named it telomerase. Once they knew what to look for, researchers discovered the enzyme was present in human cells too. The question then became, how can we boost the activity of this age-defying enzyme? Seeking answers, the pioneering researcher Dr. Dean Ornish teamed up with Dr. Elizabeth Blackburn, who was awarded the 2009 Nobel Prize in Medicine for her discovery of telomerase. In a study funded in part by the U.S. Department of Defense, they found that three months of whole-food, plant-based nutrition and other healthy changes could signi cantly boost telomerase activity, the only intervention ever shown to do so.69 The study was published in one of the most prestigious medical journals in the world. The accompanying editorial concluded that this landmark study “should encourage people to adopt a healthy lifestyle in order to avoid or combat cancer and age-related diseases.”70 So were Dr. Ornish and Dr. Blackburn able to successfully slow down aging with a healthy diet and lifestyle? A ve-year follow-up study was recently published in which the lengths of the study subjects’ telomeres were measured. In the control group (the group of participants who did not change their lifestyles), their telomeres predictably shrank with age. But for the healthy-living group, not only did their telomeres shrink less, they grew. Five years later, their telomeres were even longer on average than when they started, suggesting a healthy lifestyle can boost telomerase enzyme activity and reverse cellular aging.71 Subsequent research has shown that the telomere lengthening wasn’t just because the healthy-living group was exercising more or losing weight. Weight loss through calorie restriction and an even more vigorous exercise program  failed to improve telomere length, so it appears that the active ingredient is the quality, not quantity, of the food eaten. As long as people were eating the same diet, it didn’t appear to matter how small their portions were, how much weight they lost, or even how hard they exercised; after a year, they saw no bene t.72 In contrast, individuals on the plant-based diet exercised only half as much, enjoyed the same amount of weight loss after just three months, 73 and achieved signi cant telomere protection.74 In other words, it wasn’t the weight loss and it wasn’t the exercise that reversed cell aging—it was the food. Some people have expressed concern that boosting telomerase activity could theoretically increase cancer risk, since tumors have been known to hijack the telomerase enzyme and use it to ensure their own immortality.75 But as we’ll see in chapter 13, Dr. Ornish and his colleagues have used the same diet and lifestyle changes to halt and apparently reverse the progression of cancer in certain circumstances. We will also see how the same diet can reverse heart disease too. What about our other leading killers? It turns out a more plant-based diet may help prevent, treat, or reverse every single one of our fteen leading causes of death. In this book, I’ll go through this list, with a chapter on each: MORTALITY IN THE UNITED STATES Annual Deaths 1. Coronary heart disease 76 375,000 2. Lung diseases (lung cancer,77 COPD, and asthma78) 296,000 3. You’ll be surprised! (see chapter 15) 225,000 4. Brain diseases (stroke and Alzheimer’s ) 79 80 214,000 5. Digestive cancers (colorectal, pancreatic, and esophageal)81 106,000 6. Infections (respiratory and blood) 82 95,000 7. Diabetes 83 76,000 8. High blood pressure 84 65,000  9. Liver disease (cirrhosis and cancer)85 60,000 10. Blood cancers (leukemia, lymphoma, and myeloma)86 56,000 11. Kidney disease87 47,000 12. Breast cancer88 41,000 13. Suicide89 41,000 14. Prostate cancer90 28,000 15. Parkinson’s disease91 25,000 Certainly there are prescription medications that can help with some of these conditions. For example, you can take statin drugs for your cholesterol to lower risk of heart attacks, pop di erent pills and inject insulin for diabetes, and take a slew of diuretics and other blood pressure medications for hypertension. But there is only one unifying diet that may help prevent, arrest, or even reverse each of these killers. Unlike with medications, there isn’t one kind of diet for optimal liver function and a di erent diet to improve our kidneys. A heart-healthy diet is a brain-healthy diet is a lung-healthy diet. The same diet that helps prevent cancer just so happens to be the same diet that may help prevent type 2 diabetes and every other cause of death on the top- fteen list. Unlike drugs—which only target speci c functions, can have dangerous side e ects, and may only treat the symptoms of disease—a healthy diet can bene t all organ systems at once, has good side e ects, and may treat the underlying cause of illness. That one unifying diet found to best prevent and treat many of these chronic diseases is a whole-food, plant-based diet, de ned as an eating pattern that encourages the consumption of unre ned plant foods and discourages meats, dairy products, eggs, and processed foods.92 In this book, I don’t advocate for a vegetarian diet or a vegan diet. I advocate for an evidence-based diet, and the best available balance of science suggests that the more whole plant foods we eat, the better—both to reap their nutritional bene ts and to displace less healthful options.  Most doctor visits are for lifestyle-based diseases, which means they’re preventable diseases.93 As physicians, my colleagues and I were trained not to treat the root cause but rather the consequences by giving a lifetime’s worth of medications to treat risk factors like high blood pressure, blood sugar, and cholesterol. This approach has been compared to mopping up the oor around an over owing sink instead of simply turning o the faucet.94 Drug companies are more than happy to sell you a new roll of paper towels every day for the rest of your life while the water continues to gush. As Dr. Walter Willett, the chair of nutrition at Harvard University’s School of Public Health, put it: “The inherent problem is that most pharmacologic strategies do not address the underlying causes of ill health in Western countries, which are not drug de ciencies.”95 Treating the cause is not only safer and cheaper but it can work better. So why don’t more of my medical colleagues do it? Not only were they not trained how, doctors don’t get paid for it. No one pro ts from lifestyle medicine (other than the patient!), so it’s not a major part of medical training or practice.96 That’s just how the current system works. The medical system is set up to nancially reward prescribing pills and procedures, not produce. After Dr. Ornish proved that heart disease could be reversed without drugs or surgery, he thought that his studies would have a meaningful e ect on the practice of mainstream medicine. After all, he e ectively found a cure for our number-one killer! But he was mistaken—not about his critically important ndings regarding diet and disease reversal but about how much in uence the business of medicine has on the practice of medicine. In his words, Dr. Ornish “realized reimbursement is a much more powerful determinant of medical practice than research.”97 Though there are vested interests, such as the processed food and pharmaceutical industries, which ght hard to maintain the status quo, there is one corporate sector that actually bene ts from keeping people healthy— namely, the insurance industry. Kaiser Permanente, the largest managed-care organization in the country, published a nutritional update for physicians in their o cial medical journal, informing their nearly fteen thousand physicians that healthy eating may be “best achieved with a plant-based diet, which we de ne as a regimen that encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all re ned and processed foods.”98 “Too often, physicians ignore the potential bene ts of good nutrition and quickly prescribe medications instead of giving patients a chance to correct their disease through healthy eating and active living.… Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.”99 Physicians should give their patients a chance to rst correct their disease themselves with plant-based nutrition. The major downside Kaiser Permanente’s nutritional update describes is that this diet may work a little too well. If people begin eating plant-based diets while still taking medications, their blood pressure or blood sugar could actually drop so low that physicians may need to adjust medications or eliminate them altogether. Ironically, the “side e ect” of the diet may be not having to take drugs anymore. The article ends with a familiar refrain: Further research is needed. In this case, though, “Further research is needed to nd ways to make plant-based diets the new normal.…”100 * * * We’re a long way o from Thomas Edison’s 1903 prediction, but it is my hope that this book can help you understand that most of our leading causes of death and disability are more preventable than inevitable. The primary reason diseases tend to run in families may be that diets tend to run in families. For most of our leading killers, nongenetic factors like diet can account for at least 80 or 90 percent of cases. As I noted before, this is based on the fact that the rates of cardiovascular disease and major cancers di er vefold to a hundredfold around the world. Migration studies show this is not just genetics. When people move from low- to high-risk areas, their disease risk nearly always shoots up to match the new setting.101 As well, dramatic changes in disease rates within a single generation highlight the primacy of external factors. Colon cancer mortality in Japan in the 1950s was less than one- fth that of the United States (including Americans of Japanese ancestry).102 But now colon cancer rates in Japan are as bad as they are in the United States, a rise that has been attributed in part to the vefold increase in meat consumption.103 Research has shown us that identical twins separated at birth will get di erent diseases based on how they live their lives. A recent American Heart Association–funded study compared the lifestyles and arteries of nearly ve hundred twins. It found that diet and lifestyle factors clearly trumped genes.104 You share 50 percent of your genes with each of your parents, so if one parent dies of a heart attack, you know you’ve inherited some of that susceptibility. But even among identical twins who have the exact same genes, one could die early of a heart attack and the other could live a long, healthy life with clean arteries depending on what she ate and how she lived. Even if both your parents died with heart disease, you should be able to eat your way to a healthy heart. Your family history does not have to become your personal destiny. Just because you’re born with bad genes doesn’t mean you can’t e ectively turn them o. As you’ll see in the breast cancer and Alzheimer’s disease chapters, even if you’re born with high-risk genes, you have tremendous control over your medical destiny. Epigenetics is the hot new eld of study that deals with this control of gene activity. Skin cells look and function a lot di erently from bone cells, brain cells, or heart cells, but each of our cells has the same complement of DNA. What makes them act di erently is that they each have di erent genes turned on or o. That’s the power of epigenetics. Same DNA, but di erent results. Let me give you an example of how striking this e ect can be. Consider the humble honeybee. Queen bees and worker bees are genetically identical, yet queen bees lay up to two thousand eggs a day, while worker bees are functionally sterile. Queens live up to three years; workers may live only three weeks.105 The di erence between the two is diet. When the hive’s queen is dying, a larva is picked by nurse bees to be fed a secreted substance called royal jelly. When the larva eats this jelly, the enzyme that had been silencing the expression of royal genes is turned o , and a new queen is born.106 The queen has the exact same genes as any of the workers, but because of what she ate, di erent genes are expressed, and her life and life span are dramatically altered as a result. Cancer cells can use epigenetics against us by silencing tumor-suppressor genes that could otherwise stop the cancer in its tracks. So even if you’re born with good genes, cancer can sometimes nd a way to turn them o. A number of chemotherapy drugs have been developed to restore our bodies’ natural defenses, but their use has been limited due to their high toxicity.107 There are, however, a number of compounds distributed widely throughout the plant kingdom—including beans, greens, and berries—that appear to have the same e ect naturally.108 For example, dripping green tea on colon, esophageal, or prostate cancer cells has been shown to reactivate genes silenced by the cancer.109 This hasn’t just been demonstrated in a petri dish, though. Three hours after eating a cup of broccoli sprouts, the enzyme that cancers use to help silence our defenses is suppressed in your bloodstream110 to an extent equal to or greater than the chemotherapy agent speci cally designed for that purpose,111 without the toxic side e ects.112 What if we ate a diet chock-full of plant foods? In the Gene Expression Modulation by Intervention with Nutrition and Lifestyle (GEMINAL) study, Dr. Ornish and colleagues took biopsies from men with prostate cancer before and after three months of intensive lifestyle changes that included a whole-food, plant-based diet. Without any chemotherapy or radiation, bene cial changes in gene expression for ve hundred di erent genes were noted. Within just a few months, the expression of disease-preventing genes was boosted, and oncogenes that promote breast and prostate cancer were suppressed.113 Whatever genes we may have inherited from our parents, what we eat can a ect how those genes a ect our health. The power is mainly in our hands and on our plates.  * * * This book is divided into two parts: the “why” and the “how.” In part 1—the “why” to eat healthfully section—I will explore the role diet can play in the prevention, treatment, and reversal of the fteen leading causes of death in the United States. I’ll then take a closer look at more practical aspects of healthy eating in the “how” to eat healthfully section presented in part 2. For example, we’ll see in part 1 why beans and greens are among the healthiest foods on earth. Then, in part 2, we’ll take a look at how best to eat them—we’ll explore such issues as how many greens to eat every day and whether they’re best cooked, canned, fresh, or frozen. We’ll see in part 1 why it’s important to eat at least nine servings of fruits and vegetables daily, and then part 2 will help you decide whether to buy organic or conventional produce. I’ll try to answer all the common questions I receive daily and then o er real-world tips for grocery shopping and meal planning to make it as easy as possible to best feed yourself and your family. * * * Besides writing more books, I intend to keep lecturing at medical schools and speaking at hospitals and conferences for as long as I can. I’m going to keep trying to ignite the spark that led my colleagues into the healing profession in the rst place: to help people get better. There are tools missing from too many doctors’ medical toolboxes, powerful interventions that can make many of our patients well again instead of merely slowing their decline. I’ll keep working on trying to change the system, but you, the reader, don’t have to wait. You can start now by following the recommendations within the following chapters. Eating healthier is easier than you think, it’s inexpensive, and it might just save your life. PART 1  CHAPTER 1 How Not to Die from Heart Disease Imagine if terrorists created a bioagent that spread mercilessly, claiming the lives of nearly four hundred thousand Americans every year. That is the equivalent of one person every eighty-three seconds, every hour, around the clock, year after year. The pandemic would be front-page news all day, every day. We’d marshal the army and march our nest medical minds into a room to gure out a cure for this bioterror plague. In short, we’d stop at nothing until the terrorists were stopped. Fortunately, we’re not actually losing hundreds of thousands of people each year to a preventable threat … are we? Actually, we are. This particular biological weapon may not be a germ released by terrorists, but it kills more Americans every few years than have all our past wars combined. It can be stopped not in a laboratory but right in our grocery stores, kitchens, and dining rooms. As far as weapons go, we don’t need vaccines or antibiotics. A simple fork will do. So what’s going on here? If this epidemic is present on such a massive scale, yet so preventable, why aren’t we doing more about it? The killer I’m talking about is coronary heart disease, and it’s a ecting nearly everyone raised on the standard American diet. Our Top Killer America’s number-one killer is a di erent kind of terrorist: fatty deposits in the walls of your arteries called atherosclerotic plaque. For most Americans raised on a conventional diet, plaque accumulates inside the coronary arteries —the blood vessels that crown the heart (hence “coronary”) and supply it with oxygen-rich blood. This buildup of plaque, known as atherosclerosis, from the Greek words athere (gruel) and sklerosis (hardening), is the hardening of the arteries by pockets of cholesterol-rich gunk that builds up within the inner linings of the blood vessels. This process occurs over decades, slowly bulging into the space inside the arteries, narrowing the path for blood to ow. The restriction of blood circulation to the heart muscle can lead to chest pain and pressure, known as angina, when people try to exert themselves. If the plaque ruptures, a blood clot can form within the artery. This sudden blockage of blood ow can cause a heart attack, damaging or even killing part of the heart. When you think about heart disease, you may think of friends or loved ones who su ered for years with chest pain and shortness of breath before they nally succumbed. However, for the majority of Americans who die suddenly from heart disease, the very rst symptom may be their last.1 It’s called “sudden cardiac death.” This is when death occurs within an hour of symptom onset. In other words, you may not even realize you’re at risk until it’s too late. You could be feeling perfectly ne one moment, and then an hour later, you’re gone forever. That’s why it’s critical to prevent heart disease in the rst place, before you even necessarily know you have it. My patients often asked me, “Isn’t heart disease just a consequence of getting old?” I can see why this is a common misconception. After all, your heart pumps literally billions of times during the average life span. Does your ticker just conk out after a while? No. A large body of evidence shows there were once enormous swaths of the world where the epidemic of coronary heart disease simply didn’t exist. For instance, in the famous China-Cornell-Oxford Project (known as the China Study), researchers investigated the eating habits and incidence of chronic disease among hundreds of thousands of rural Chinese. In Guizhou province, for example, a region comprising half a million people, over the course of three years, not a single death could be attributed to coronary artery disease among men under sixty- ve.2 During the 1930s and 1940s, Western-trained doctors working throughout an extensive network of missionary hospitals in sub-Saharan Africa noticed that many of the chronic diseases laying waste to populations in the so-called developed world were largely absent across most of the continent. In Uganda, a country of millions in eastern Africa, coronary heart disease was described as “almost non-existent.”3 But were the people of these nations simply dying early of other diseases, never living long enough to come down with heart disease? No. The doctors compared autopsies of Ugandans to autopsies of Americans who had died at the same age. The researchers found that out of 632 people autopsied in Saint Louis, Missouri, there had been 136 heart attacks. But in 632 age-matched Ugandans? A single heart attack. The Ugandans experienced more than one hundred times fewer heart attacks than the Americans. The doctors were so blown away that they examined another 800 deaths in Uganda. Out of more than 1,400 Ugandans autopsied, researchers found just one body with a small, healed lesion of the heart, meaning the attack wasn’t even fatal. Then and now, in the industrialized world, heart disease is a leading killer. In central Africa, heart disease was so rare it killed fewer than one in a thousand.4 Immigration studies show that this resistance to heart disease is not just something in the Africans’ genes. When people move from low-risk to high- risk areas, their disease rates skyrocket as they adopt the diet and lifestyle habits of their new homes.5 The extraordinarily low rates of heart disease in rural China and Africa have been attributed to the extraordinarily low cholesterol levels among these populations. Though Chinese and African diets are very di erent, they share commonalities: They are both centered on plant-derived foods, such as grains and vegetables. By eating so much ber and so little animal fat, their total cholesterol levels averaged under 150 mg/ dL,6,7 similar to people who eat contemporary plant-based diets.8 So what does all of this mean? It means heart disease may be a choice. If you looked at the teeth of people who lived more than ten thousand years before the invention of the toothbrush, you’d notice they had almost no cavities.9 They never ossed a day in their lives, yet no cavities. That’s because candy bars hadn’t been invented yet. The reason people get cavities now is that the pleasure they derive from sugary treats may outweigh the cost and discomfort of the dentist’s chair. I certainly enjoy the occasional indulgence— I’ve got a good dental plan! But what if instead of the dental plaque on our teeth, we’re talking about the atherosclerotic plaque building up in our arteries? We’re not just talking about scraping tartar anymore. We’re talking about life and death. Heart disease is the number-one reason we and most of our loved ones will die. Of course, it’s up to each of us to make our own decisions as to what to eat and how to live, but shouldn’t we try to make these choices consciously by educating ourselves about the predictable consequences of our actions? Just as we could avoid sugary foods that rot our teeth, we can avoid the trans fat, saturated fat, and cholesterol-laden foods that clog up our arteries. Let’s take a look at the progression of coronary heart disease throughout life and learn how simple dietary choices at any stage may prevent, stop, and even reverse heart disease before it’s too late. Is Fish Oil Just Snake Oil? Thanks in part to the American Heart Association’s recommendation that individuals at high risk for heart disease should ask their physicians about omega-3 sh oil supplementation,10 sh oil pills have grown into a multibillion-dollar industry. We now consume more than one hundred thousand tons of sh oil every year.11 But what does the science say? Are the purported bene ts of sh oil supplementation for the prevention and treatment of heart disease just a sh tale? A systematic review and meta-analysis published in the Journal of the American Medical Association looked at all the best randomized clinical trials evaluating the e ects of omega-3 fats on life span, cardiac death, sudden death, heart attack, and stroke. These included studies not only on sh oil supplements but also studies on the e ects of advising people to eat more oily  sh. What did they nd? Overall, the researchers found no protective bene t for overall mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke.12 What about for someone who had already had a heart attack and is trying to prevent another? Still no bene t was found.13 Where did we even get this idea that the omega-3 fats in sh and sh oil supplements are good for you? There was a notion that Eskimos were protected from heart disease, but that appears to be a complete myth.14 Some early studies, however, looked promising. For example, the famous DART trial from the 1980s involving two thousand men found that those advised to eat fatty sh had a 29 percent reduction in mortality.15 That’s impressive, so it’s no wonder the study got a lot of attention. But people seem to have forgotten about the sequel, the DART-2 trial, which found the exact opposite. Run by the same group of researchers, the DART-2 trial was an even bigger study—three thousand men—but this time, participants advised to eat oily sh and particularly those who were supplied with sh oil capsules had a higher risk of cardiac death.16,17 After putting all the studies together, researchers concluded that there was no longer justi cation for the use of omega-3s in everyday clinical practice.18 What should doctors do when their patients follow the American Heart Association’s advice and inquire about sh oil supplements? As the director of Lipids and Metabolism at Mount Sinai’s cardiovascular institute put it: “Given this and other negative meta-analyses, our job [as doctors] should be to stop highly marketed sh oil supplementation to all our patients…”19 Heart Disease Starts in Childhood In 1953, a study published in the Journal of the American Medical Association radically changed our understanding of the development of heart disease. Researchers conducted a series of three hundred autopsies on American casualties of the Korean War, with an average age of around twenty-two. Shockingly, 77 percent of soldiers already had visible evidence of coronary atherosclerosis. Some even had arteries that were blocked o 90 percent or more.20 The study “dramatically showed that atherosclerotic changes appear in the coronary arteries years and decades before the age at which coronary heart disease (CHD) becomes a clinically recognized problem.”21 Later studies of accidental death victims between the ages of three and twenty-six found that fatty streaks—the rst stage of atherosclerosis—were found in nearly all American children by age ten.22 By the time we reach our twenties and thirties, these fatty streaks can turn into full-blown plaques like those seen in the young American GIs of the Korean War. And by the time we’re forty or fty, they can start killing us o. If there’s anyone reading this over the age of ten, the question isn’t whether or not you want to eat healthier to prevent heart disease but whether or not you want to reverse the heart disease you very likely already have. Just how early do these fatty streaks start to appear? Atherosclerosis may start even before birth. Italian researchers looked inside arteries taken from miscarriages and premature newborns who died shortly after birth. It turns out that the arteries of fetuses whose mothers had high LDL cholesterol levels were more likely to contain arterial lesions.23 This nding suggests that atherosclerosis may not just start as a nutritional disease of childhood but one during pregnancy. It’s become commonplace for pregnant women to avoid smoking and drinking alcohol. It’s also never too early to start eating healthier for the next generation. According to William C. Roberts, the editor in chief of the American Journal of Cardiology, the only critical risk factor for atherosclerotic plaque buildup is cholesterol, speci cally elevated LDL cholesterol in your blood.24 Indeed, LDL is called “bad” cholesterol, because it’s the vehicle by which cholesterol is deposited into your arteries. Autopsies of thousands of young accident victims have shown that the level of cholesterol in the blood was closely correlated with the amount of atherosclerosis in their arteries.25 To drastically reduce LDL cholesterol levels, you need to drastically reduce your intake of three things: trans fat, which comes from processed foods and naturally from meat and dairy; saturated fat, found mainly in animal products and junk foods; and to a lesser extent dietary cholesterol, found exclusively in animal-derived foods, especially eggs.26 Notice a pattern here? The three boosters of bad cholesterol—the number-one risk factor for our number-one killer—all stem from eating animal products and processed junk. This likely explains why populations living on traditional diets revolving around whole plant foods have largely remained free from the epidemic of heart disease. It’s the Cholesterol, Stupid! Dr. Roberts hasn’t only been editor in chief of the American Journal of Cardiology for more than thirty years; he’s the executive director of the Baylor Heart and Vascular Institute and has authored more than a thousand scienti c publications and written more than a dozen textbooks on cardiology. He knows his stu. In his editorial “It’s the Cholesterol, Stupid!,” Dr. Roberts argued (as noted earlier) that there is only one true risk factor for coronary heart disease: cholesterol.27 You could be an obese, diabetic, smoking couch potato and still not develop atherosclerosis, he argues, as long as the cholesterol level in your blood is low enough. The optimal LDL cholesterol level is probably 50 or 70 mg/dL, and apparently, the lower, the better. That’s where you start out at birth, that’s the level seen in populations largely free of heart disease, and that’s the level at which the progression of atherosclerosis appears to stop in cholesterol- lowering trials.28 An LDL around 70 mg/dL corresponds to a total cholesterol reading of about 150, the level below which no deaths from coronary heart disease were reported in the famous Framingham Heart Study, a generations- long project to identify risk factors for heart disease.29 The population target should therefore be a total cholesterol level under 150 mg/dL. “If such a goal was created,” Dr. Roberts wrote, “the great scourge of the Western world would be essentially eliminated.”30 The average cholesterol for people living in the United States is much higher than 150 mg/dL; it hovers around 200 mg/dL. If your blood test results came back with a total cholesterol of 200 mg/dL, your physician might reassure you that your cholesterol is normal. But in a society where it’s normal to die of heart disease, having a “normal” cholesterol level is probably not a good thing. To become virtually heart-attack proof, you need to get your LDL cholesterol at least under 70 mg/dL. Dr. Roberts noted that there are only two ways to achieve this for our population: to put more than a hundred million Americans on a lifetime of medications or to recommend they all eat a diet centered around whole plant foods.31 So: drugs or diet. All health plans cover cholesterol-lowering statin drugs, so why change your diet if you can simply pop a pill every day for the rest of your life? Unfortunately, as we’ll see in chapter 15, these drugs don’t work nearly as well as people think, and they may cause undesirable side e ects to boot. Want Fries with That Lipitor? The cholesterol-lowering statin drug Lipitor has become the best-selling drug of all time, generating more than $140 billion in global sales.32 This class of drugs garnered so much enthusiasm in the medical community that some U.S. health authorities reportedly advocated they be added to the public water supply like uoride is.33 One cardiology journal even o ered the tongue-in- cheek suggestion for fast-food restaurants to o er “McStatin” condiments along with ketchup packets to help neutralize the e ects of unhealthy dietary choices.34 For those at high risk for heart disease who are unwilling or unable to bring down their cholesterol levels naturally with dietary changes, the bene ts of statins generally outweigh the risks. These drugs do have side e ects, though, such as the potential for liver or muscle damage. The reason some doctors routinely order regular blood tests for patients on these drugs is to monitor for liver toxicity. We can also test the blood for the presence of muscle breakdown products, but biopsies reveal that people on statins can show evidence of muscle damage even if their blood work is normal and they exhibit no symptoms of muscle soreness or weakness.35 The decline in muscular strength and performance sometimes associated with these drugs may not be such a big deal for younger individuals, but they can place our seniors at increased risk for falls and injury.36 More recently, other concerns have been raised. In 2012, the U.S. Food and Drug Administration announced newly mandated safety labeling on statin drugs to warn doctors and patients about their potential for brain- related side e ects, such as memory loss and confusion. Statin drugs also appeared to increase the risk of developing diabetes.37 In 2013, a study of several thousand breast cancer patients reported that long-term use of statins may as much as double a woman’s risk of invasive breast cancer.38 The primary killer of women is heart disease, not cancer, so the bene ts of statins may still outweigh the risks, but why accept any risk at all if you can lower your cholesterol naturally? Plant-based diets have been shown to lower cholesterol just as e ectively as rst-line statin drugs, but without the risks.39 In fact, the “side e ects” of healthy eating tend to be good—less cancer and diabetes risk and protection of the liver and brain, as we’ll explore throughout the rest of this book. Heart Disease Is Reversible It’s never too early to start eating healthfully, but is it ever too late? Such lifestyle medicine pioneers as Nathan Pritikin, Dean Ornish, and Caldwell Esselstyn Jr. took patients with advanced heart disease and put them on the kind of plant-based diet followed by Asian and African populations who didn’t su er from heart disease. Their hope was that a healthy enough diet would stop the disease process and keep it from progressing further. But instead, something miraculous happened.  Their patients’ heart disease started to reverse. These patients were getting better. As soon as they stopped eating an artery-clogging diet, their bodies were able to start dissolving away some of the plaque that had built up. Arteries opened up without drugs or surgery, even in some cases of patients with severe triple-vessel heart disease. This suggests their bodies wanted to heal all along but were just never given the chance.40 Let me share with you what has been called the “best kept secret in medicine”:41 Given the right conditions, the body heals itself. If you whack your shin really hard on a co ee table, it can get red, swollen, and painful. But your shin will heal naturally if you just stand back and let your body work its magic. But what if you kept whacking it in the same place three times a day— say, at breakfast, lunch, and dinner? It would never heal. You could go to your doctor and complain that your shin hurts. “No problem,” he or she might say, whipping out a pad to write you a prescription for painkillers. You’d go back home, still whacking your shin three times a day, but the pain pills would make it feel so much better. Thank heavens for modern medicine! That’s what happens when people take nitroglycerin for chest pain. Medicine can o er tremendous relief, but it’s not doing anything to treat the underlying cause. Your body wants to regain its health if you let it. But if you keep reinjuring yourself three times a day, you interrupt the healing process. Consider smoking and lung cancer risk: One of the most amazing things I learned in medical school was that within about fteen years of stopping smoking, your lung-cancer risk approaches that of a lifelong nonsmoker.42 Your lungs can clear out all that tar buildup and, eventually, it’s almost as if you never smoked at all. Your body wants to be healthy. And every night of your smoking life, as you fall asleep, that healing process is restarted until … bam!—you light up your rst cigarette the next morning. Just as you can reinjure your lungs with every pu , you can reinjure your arteries with every bite. You can choose moderation and hit yourself with a smaller hammer, but why beat yourself up at all? You can choose to stop damaging yourself, get out of your own way, and let your body’s natural healing process bring you back toward health. Endotoxins Crippling Your Arteries Unhealthy diets don’t just a ect the structure of your arteries; an unhealthy diet can also a ect their functioning. Your arteries are not merely inert pipes through which blood ows. They are dynamic, living organs. We’ve known for nearly two decades that a single fast-food meal—Sausage and Egg McMu ns were used in the original study—can sti en your arteries within hours, cutting in half their ability to relax normally.43 And just as this in ammatory state starts to calm down ve or six hours later—lunchtime! You may once again whack your arteries with another load of harmful food, leaving many Americans stuck in a danger zone of chronic, low-grade in ammation. Unhealthy meals don’t just cause internal damage decades down the road but right here and now, within hours of going into your mouth. Originally, researchers blamed the animal fat or animal protein, but attention has recently shifted to bacterial toxins known as “endotoxins.” Certain foods, such as meats, appear to harbor bacteria that can trigger in ammation dead or alive, even when the food is fully cooked. Endotoxins are not destroyed by cooking temperatures, stomach acid, or digestive enzymes, so after a meal of animal products, these endotoxins may end up in your intestines. They are then thought to be ferried by saturated fat across the gut wall into your bloodstream, where they can trigger the in ammatory reaction in your arteries.44 This may help explain the remarkable speed at which cardiac patients can experience relief when placed on a diet composed primarily of plant foods, including fruits, vegetables, whole grains, and beans. Dr. Ornish reported a 91 percent reduction in angina attacks within just a few weeks in patients placed on a plant-based diet both with45 or without46 exercise. This rapid resolution in chest pain occurred well before their bodies could have cleared the plaque from their arteries, suggesting plant-based diets don’t just help clean out arteries but also improve their day-to-day function. In contrast, control-group patients who were instead told to follow the advice of their doctors had a 186 percent increase in angina attacks.47 It’s no surprise their conditions worsened, given that they continued to eat the same diet that crippled their arteries in the rst place. We’ve known about the dramatic power of dietary changes for decades. For example, there was a paper entitled “Angina and Vegan Diet” published in the American Heart Journal back in 1977. Vegan diets are exclusively plant based, avoiding meat, dairy, and eggs. Doctors described cases like that of Mr. F. W. (initials are often used to protect patient con dentiality), a sixty- ve- year-old man with angina so severe he had to stop every nine or ten steps. He couldn’t even make it to the mailbox. He was started on a vegan diet, and his pain improved within days. Within months, he was reportedly climbing mountains with no pain at all.48 Not ready to start eating healthier? Well, there is a new class of antiangina drugs, such as ranolazine (sold as Ranexa). A drug company executive suggested its product be used for people not “able to comply with the substantial dietary changes required to achieve a vegan diet.”49 The medication costs more than $2,000 a year, but the side e ects are relatively minor, and it does work … technically speaking. At the highest dose, Ranexa was able to prolong exercise duration by 33.5 seconds.50 More than half a minute! It doesn’t look like those choosing the drug route will be climbing mountains anytime soon. Brazil Nuts for Cholesterol Control? Can a single serving of Brazil nuts bring down your cholesterol levels faster than statin drugs and keep them down even a month after that single meal? It was one of the craziest ndings I’d ever seen. Researchers from—where else?—Brazil gave ten men and women a single meal containing between one and eight Brazil nuts. Amazingly, compared to the control group who ate no nuts at all, just a single serving of four Brazil nuts almost immediately improved cholesterol levels. LDL—the “bad”—cholesterol levels were a staggering twenty points lower just nine hours after eating the Brazil nuts.51 Even drugs don’t work nearly that fast.52 Here’s the truly insane part: The researchers went back and measured the study participants’ cholesterol thirty days later. Even a month after ingesting a single serving of Brazil nuts, their cholesterol levels stayed down. Normally, when a study comes out in the medical literature showing some too-good-to-be-true result like this, doctors wait to see the results replicated before they change their clinical practice and begin recommending something new to their patients, particularly when the study is done on only ten subjects, and especially when the ndings seem too incredible to believe. But when the intervention is cheap, easy, harmless, and healthy—we’re talking just four Brazil nuts per month—then in my opinion, the burden of proof is somewhat reversed. I think the reasonable default position is to do it until proven otherwise. More is not better, however. Brazil nuts are so high in the mineral selenium that eating four every day may actually bump you up against the tolerable daily limit for selenium. Nevertheless, this is not something you have to worry about if you’re only eating four Brazil nuts a month. Follow the Money Research showing that coronary heart disease can be reversed with a plant- based diet—with or without other healthy lifestyle changes—has been published for decades in some of the most prestigious medical journals in the world. Why hasn’t this news translated into public policy yet? In 1977, the U.S. Senate Committee on Nutrition and Human Needs tried to do just that. Known as the McGovern Committee, they released Dietary Goals for the United States, a report advising Americans to cut down on animal-based foods and increase their consumption of plant-based foods. As a founding member of Harvard University’s nutrition department recalls, “The meat, milk and egg producers were very upset.”53 That’s an understatement. Under industry pressure, not only was the goal to “decrease meat consumption” removed from the report but the entire Senate nutrition committee was disbanded. Several prominent senators reputedly lost their election bids as a result of supporting the report.54 In more recent years, it was uncovered that many members of the U.S. Dietary Guidelines Advisory Committee had nancial ties to everything from candy bar companies to entities like McDonald’s Council on Healthy Lifestyles and Coca-Cola’s Beverage Institute for Health and Wellness. One committee member even served as “brand girl” for cake-mix maker Duncan Hines and then as the o cial Crisco “brand girl” before going on to help write the o cial Dietary Guidelines for Americans.55 As one commentator noted in the Food and Drug Law Journal, historically, the Dietary Guidelines Advisory Committee reports contained: No discussion at all of the scientific research on the health consequences of eating meat. If the Committee actually discussed this research, it would be unable to justify its recommendation to eat meat, as the research would show that meat increases the risks of chronic diseases, contrary to the purposes of the Guidelines. Thus, by simply ignoring that research, the Committee is able to reach a conclusion that would otherwise look improper.56 What about the medical profession, though? Why haven’t my colleagues fully embraced this research demonstrating the power of good nutrition? Sadly, the history of medicine holds many examples of the medical establishment rejecting sound science when it goes against the prevailing conventional wisdom. There’s even a name for it: the “Tomato E ect.” The term was coined in the Journal of the American Medical Association in reference to the fact that tomatoes were once considered poisonous and were shunned for centuries in North America, despite overwhelming evidence to the contrary.57  It’s bad enough that most medical schools don’t even require a single course on nutrition,58 but it’s even worse when mainstream medical organizations actively lobby against increased nutrition education for physicians.59 When the American Academy of Family Physicians (AAFP) was called out on their proud new corporate relationship with Coca-Cola to support patient education on healthy eating, an executive vice president of the academy tried to quell protests by explaining that this alliance was not without precedent. After all, they’d had relationships with PepsiCo and McDonald’s for some time.60 Even before that, they had nancial ties to cigarette maker Philip Morris.61 This argument didn’t seem to placate the critics, so the AAFP executive quoted them the American Dietetic Association’s policy statement that “[t]here are no good or bad foods, just good or bad diets.” No bad foods? Really? The tobacco industry used to broadcast a similar theme: Smoking per se wasn’t bad, only “excess” smoking.62 Sound familiar? Everything in moderation. The American Dietetic Association (ADA), which produces a series of nutrition fact sheets with guidelines on maintaining a healthy diet, also has its own corporate ties. Who writes these fact sheets? Food industry sources pay the ADA $20,000 per fact sheet to explicitly take part in the drafting process. So we can learn about eggs from the American Egg Board and about the bene ts of chewing gum from the Wrigley Science Institute.63 In 2012, the American Dietetic Association changed its name to the Academy of Nutrition and Dietetics but didn’t appear to change its policies. It continues to take millions of dollars every year from processed junk food, meat, dairy, soda, and candy bar companies. In return, the academy lets them o er o cial educational seminars to teach dietitians what to say to their clients.64 When you hear the title “registered dietitian,” this is the group they are registered through. Thankfully, a movement within the dietitian community, exempli ed by the formation of the organization Dietitians for Professional Integrity, has started to buck this trend. What about individual doctors, though? Why aren’t all my colleagues telling their patients to lay o the Chick- l-A? Insu cient time during o ce visits is a common excuse physicians cite, but the top reason doctors give for not counseling patients with high cholesterol to eat healthier is that they think patients may “fear privations related to dietary advice.”65 In other words, doctors perceive that patients would feel deprived of all the junk they’re eating. Can you imagine a doctor saying, “Yeah, I’d like to tell my patients to stop smoking, but I know how much they love it”? Neal Barnard, M.D., president of the Physicians Committee for Responsible Medicine, recently wrote a compelling editorial in the American Medical Association’s journal of ethics, describing how doctors went from being bystanders—or even enablers—of smoking to leading the ght against tobacco. Doctors realized they were more e ective at counseling patients to quit smoking if they no longer had tobacco stains on their own ngers. Today, Dr. Barnard says, “Plant-based diets are the nutritional equivalent of quitting smoking.”66  CHAPTER 2 How Not to Die from Lung Diseases The worst death I ever witnessed was that of a man dying of lung cancer. I was interning at a public health hospital in Boston. Evidently, people dying behind bars looked bad for prison statistics, so terminally ill prisoners were shipped to my hospital for their nal days, even if there was little we could do for them. It was summer, and the prisoners’ ward had no air-conditioning, at least for the inmates. We doctors could retreat to the chilled con nes of the nursing station, but the inmates, handcu ed to their beds, just lay prostrate in the heat on that top oor of the tall, brick building. When they were shu ed down the hall in front of us, ankles chained together, they left a trail of sweat. The night the man died, I was on one of my thirty-six-hour shifts. We worked 117-hour workweeks back then. It’s amazing we didn’t kill more people ourselves. Overnight, there were only two of us—myself and a moonlighting doctor who preferred to sleep for his $1,000 paycheck. So most of the time I was on my own to cover the hundreds of patients there, some of the sickest of the sick. It was on one of those nights that, staggering through a sleep-deprived haze, I got the call. Up until then, all the deaths I had seen were those in which the patient was either dead on arrival or had died during cardiac “codes,” when we try desperately, and nearly always unsuccessfully, to resuscitate. This man was di erent. He was wide-eyed, gasping for air, his cu ed hands clawing at the bed. The cancer was lling up his lungs with uid. He was being drowned by lung cancer. While he thrashed desperately, pleading, my mind was in medical mode, all protocols and procedures, but nothing much could be done. The man needed morphine, but that was held on the other side of the ward, and I’d never get to it in time, let alone back to him. I was not popular on the prison oor. I had once reported a guard for beating a sick inmate and was rewarded with death threats. There was no way they’d let me through the gates fast enough. I begged the nurse to try to get some, but she didn’t make it back in time. The man’s coughing turned to gurgling. “Everything’s going to be okay,” I said. Immediately, I thought, What a stupid thing to say to someone choking to death. Just another lie in probably a long line of condescension from other authority gures throughout his life. Helpless, I turned from doctor back to human being. I took his hand in my own, which he then gripped with all his might, tugging me toward his tear-streaked, panic-stricken face. “I’m here,” I said. “I’m right here.” Our gaze remained locked as he su ocated right in front of me. It felt like watching someone being tortured to death. Take a deep breath. Now imagine what it would feel like not to be able to breathe. We all need to take care of our lungs. * * * America’s number-two killer, lung disease, claims the lives of about 300,000 people each year. And like our number-one domestic killer, heart disease, it’s largely preventable. Lung disease can come in many forms, but the three types that kill the most people are lung cancer, chronic obstructive pulmonary disease (COPD), and asthma. Lung cancer is our number-one cancer killer. Most of the 160,000 lung cancer deaths every year are the direct result of smoking. However, a healthy diet may help mitigate the DNA-damaging e ects of tobacco smoke, as well as perhaps help prevent lung cancer from spreading. COPD kills approximately 140,000 people annually, from either damage to the walls of tiny air sacs in the lungs (emphysema) or from in amed and thickened airways plugged with thick mucus (chronic bronchitis). Although there is no cure for the permanent lung scarring that COPD causes, a diet rich in fruits and vegetables may help slow the progression of the disease and improve lung function for its thirteen million su erers. Finally, asthma, which claims 3,000 lives each year, is one of the most common chronic diseases among children, yet it may be largely preventable with a healthier diet. Research suggests a few extra daily servings of fruits and vegetables can reduce both the number of cases of asthma during childhood and the number of asthma attacks among people with the disease. LUNG CANCER Lung cancer is diagnosed about 220,000 times each year in the United States and causes more deaths annually than the next three cancers combined— those of the colon, breast, and pancreas.1 At any given moment, nearly 400,000 Americans are living under lung cancer’s dark shadow.2 Unlike with heart disease, which has yet to be fully acknowledged as the direct result of an artery-clogging diet, there is widespread recognition that tobacco is by far the most common cause of lung cancer. According to the American Lung Association, smoking tobacco contributes to up to 90 percent of all lung cancer deaths. Men who smoke are twenty-three times more likely and women thirteen times more likely to develop lung cancer than nonsmokers. And smokers aren’t just harming themselves; thousands of deaths each year have been attributed to secondhand smoke. Nonsmokers have a 20–30 percent higher risk of developing lung cancer if they’re regularly exposed to cigarette smoke.3 Those warning labels on cigarette packs are everywhere now, but for a long time, the link between smoking and lung cancer was suppressed by powerful interest groups—much as the relationship between certain foods and other leading killers is suppressed today. For example, in the 1980s, Philip Morris, the nation’s leading cigarette manufacturer, launched the notorious Whitecoat Project. The corporation hired doctors to publish ghostwritten studies purporting to negate links between secondhand smoke and lung disease. These papers cherry-picked various scienti c reports to conceal and distort the damning evidence of the dangers of secondhand smoke. This whitewashing, coupled with the tobacco industry’s clever marketing campaigns, including cartoonlike ads, helped hook generations of Americans onto their products.4 If, despite all the evidence and warnings, you’re currently a smoker, the most important step you can take is to stop. Now. Please. The bene ts of quitting are immediate. According to the American Cancer Society, just twenty minutes after quitting, your heart rate and blood pressure drop. Within a few weeks, your blood circulation and lung function improve. Within a few months, the sweeper cells that help clean the lungs, remove mucus, and reduce the risk of infection start to regrow. And within a year of quitting, your smoking-related risk of coronary heart disease becomes half that of current smokers.5 As we saw in chapter 1, the human body possesses a miraculous ability to heal itself as long as we don’t keep reinjuring it. Simple dietary changes may help to roll back the damage wrought by the carcinogens in tobacco smoke. Load Up on Broccoli First, it’s important to understand the toxic e ects of cigarettes on the lungs. Tobacco smoke contains chemicals that weaken the body’s immune system, making it more susceptible to disease and handicapping its ability to destroy cancer cells. At the same time, tobacco smoke can damage cell DNA, increasing the chance for cancer cells to form and ourish in the rst place.6 To test the power of dietary interventions to prevent DNA damage, scientists often study chronic smokers. Researchers rounded up a group of longtime smokers and asked them to consume twenty- ve times more broccoli than the average American—in other words, a single stalk a day. Compared to broccoli-avoiding smokers, the broccoli-eating smokers su ered 41 percent fewer DNA mutations in their bloodstream over ten days. Is that just because the broccoli boosted the activity of the detoxifying enzymes in their livers, which helped clear carcinogens before they even made it to the smokers’ cells? No, even when DNA was extracted from the subjects’ bodies and exposed to a known DNA-damaging chemical, the genetic material from the broccoli eaters showed signi cantly less damage, suggesting that eating vegetables like broccoli may make you more resilient at a subcellular level.7 Now, don’t think this means that eating a stalk of broccoli before smoking a pack of Marlboro Reds is going to completely erase the cancer-causing e ects of cigarette smoke. It won’t. But as you’re trying to quit, such vegetables as broccoli, cabbage, and cauli ower may help prevent further damage. The bene ts of broccoli-family (cruciferous) vegetables may not stop there. While breast cancer is the most common internal cancer among American women, lung cancer is actually their number-one killer. About 85 percent of women with breast cancer are still alive ve years after diagnosis, but the numbers are reversed when it comes to lung cancer: 85 percent of women die within ve years of a lung cancer diagnosis. Ninety percent of those deaths are due to metastasis, the spread of the cancer to other parts of the body.8 Certain compounds in broccoli may have the potential to suppress this metastatic spread. In a 2010 study, scientists laid down a layer of human lung cancer cells in a petri dish and cleared a swath down the middle. Within twenty-four hours, the cancer cells had crept back together, and within thirty hours, the gap had closed completely. But when the scientists dripped some cruciferous-vegetable compounds onto the cancer cells, the cancer creep was stunted.9 Whether or not eating broccoli will help prolong survival in cancer patients has yet to be tested in clinical trials, but the nice thing about healthy dietary interventions is that since they have no downsides, they can be added to whatever other treatments one chooses. Smoking Versus Kale Researchers have found that kale—that dark-green, leafy vegetable dubbed the “queen of greens”—might help control cholesterol levels. Researchers took thirty men with high cholesterol and had them consume three to four shots of kale juice a day for three months. That’s like eating thirty pounds’ worth of kale, or the amount the average American consumes in about a century. So what happened? Did they turn green and start to photosynthesize? No. What the kale did do was substantially lower their bad (LDL) cholesterol and boost their good (HDL) cholesterol10 as much as running three hundred miles.11 By the end of the study, the antioxidant activity in the blood of most participants had shot up. But curiously, the antioxidant activity in a minority remained at. Sure enough, these were the smokers. The free radicals created by the cigarettes were thought to have actively depleted the body of antioxidants. When your smoking habit erases the antioxidant- boosting e ects of eight hundred cups of kale, you know it’s time to quit. Carcinogen-Blocking E ects of Turmeric The Indian spice turmeric, which gives curry powder its characteristic golden color, may also help prevent some of the DNA damage caused by smoking. Since 1987, the National Cancer Institute has tested more than a thousand di erent compounds for “chemopreventive” (cancer-preventing) activity. Only a few dozen have made it to clinical trials, but among the most promising is curcumin, the bright-yellow pigment in turmeric.12 Chemopreventive agents can be classi ed into di erent subgroups based on which stage of cancer development they help to ght: Carcinogen blockers and antioxidants help prevent the initial triggering DNA mutation, and antiproliferatives work by keeping tumors from growing and spreading. Curcumin is special in that it appears to belong to all three groups, meaning it may potentially help prevent and/or arrest cancer cell growth.13 Researchers have investigated the e ects of curcumin on the DNA- mutating ability of various carcinogens and found that curcumin was indeed an e ective antimutagen against several common cancer-causing substances.14 But these experiments were done in vitro, meaning e ectively in a laboratory test tube. After all, it wouldn’t be ethical to expose humans to nasty carcinogens to observe whether they got cancer. However, someone got the bright idea of nding a group of people who already, of their own accord, had carcinogens coursing through their veins. Smokers! One way to measure the level of DNA-mutating chemicals in peoples’ bodies is dripping their urine on bacteria growing in a petri dish. Bacteria, like all life on Earth, share DNA as a common genetic language. Unsurprisingly, scientists who tried this experiment found that the urine from nonsmokers caused far fewer DNA mutations—after all, they had a lot fewer carcinogens owing through their systems. But when the smokers were given turmeric, the DNA-mutation rate dropped by up to 38 percent.15 They weren’t given curcumin pills; they merely got less than a teaspoon a day of just the regular turmeric spice you’d nd at the grocery store. Of course, turmeric can’t completely mitigate the e ects of smoking. Even after the participants ate turmeric for a month, the DNA-damaging ability of the smokers’ urine still exceeded that of the nonsmokers’. But smokers who make turmeric a staple of their diets may help lessen some of the damage. The anticancer e ects of curcumin extend beyond its ability to potentially prevent DNA mutations. It also appears to help regulate programmed cell death. Your cells are preprogrammed to die naturally to make way for fresh cells through a process known as apoptosis (from the Greek ptosis, falling, and apo, away from). In a sense, your body is rebuilding itself every few months16 with the building materials you provide it through your diet. Some cells, however, overstay their welcome—namely, cancer cells. By somehow disabling their own suicide mechanism, they don’t die when they’re supposed to. Because they continue to thrive and divide, cancer cells can eventually form tumors and potentially spread throughout the body. So how does curcumin a ect this process? It appears to have the ability to reprogram the self-destruct mechanism back into cancer cells. All cells contain so-called death receptors that trigger the self-destruction sequence, but cancer cells can disable their own death receptors. Curcumin, however, appears able to reactivate them.17 Curcumin can also kill cancer cells directly by activating “execution enzymes” called caspases inside cancer cells that destroy them from within by chopping up their proteins.18 Unlike most chemotherapy drugs, against which cancer cells can develop resistance over time, curcumin a ects several mechanisms of cell death simultaneously, making it potentially harder for cancer cells to avoid destruction.19 Curcumin has been found to be e ective against a variety of other cancer cells in vitro, including those of the breast, brain, blood, colon, kidney, liver, lungs, and skin. For reasons not fully understood, curcumin seems to leave noncancerous cells alone.20 Unfortunately, turmeric has yet to be tested in clinical trials for the prevention or treatment of lung cancer, but with no downsides at culinary doses, I’d suggest trying to nd ways to incorporate the spice into your diet. I o er a number of suggestions in part 2. Dietary Secondhand Smoke Though the majority of lung cancer is attributed to smoking, approximately a quarter of all cases occur in people who’ve never smoked.21 Although some of these cases are due to secondhand smoke, another contributing cause may be another potentially carcinogenic plume: fumes from frying. When fat is heated to frying temperatures, whether it be animal fat, such as lard, or plant fat, such as vegetable oil, toxic volatile chemicals with mutagenic properties (those able to cause genetic mutations) are released into the air.22 This happens even before the “smoke point” temperature is reached. 23 If you do fry at home, good ventilation in the kitchen may reduce lung cancer risk.24 Cancer risk may also depend on what’s being fried. A study of women in China found that smokers who stir-fried meat every day had nearly three times the odds of lung cancer compared to smokers who stir-fried foods other than meat on a daily basis.25 This is thought to be because of a group of carcinogens called heterocyclic amines that are formed when muscle tissue is subjected to high temperatures. (We’ll talk more about these in chapter 11.) The e ects of meat fumes can be hard to separate from the e ects of eating the meat itself, but a recent study on pregnant women and barbecuing attempted to tease them out. When meat is grilled, polycyclic aromatic hydrocarbons (PAHs) are also produced, one of the probable carcinogens in cigarette smoke. The researchers discovered that not only was the ingestion of grilled meat in the third trimester associated with smaller birth weights, mothers merely exposed to the fumes tended to give birth to babies with a birth weight de cit. Exposure to the fumes was also associated with a smaller head size, an indicator of b