The China Study 5 – Heart Disease

I’m continuing with my discussion of Dr. Campbell’s book, The China Study.  Remember, I’m a reader, not a doctor.  It occurred to me after I wrote last time saying he doesn’t seem to have a vegan agenda that perhaps I might be said to.  But when I read this book, a different part of my brain is working from when I think about the ethics of veganism.  When I read this book, I’m thinking about science and the suffering of people in homes, hospitals and nursing homes across the country.  I’m not taking the time here to describe the more important points of this book in order to save farm animals.  My compassion extends to people, too – I’m concerned about your health.

26% of Americans die of cardiovascular disease (CVD), our number-one killer.  Every day, 2,400 people die of CVD.   Women sometimes think CVD is not their problem.  Think again:  Since 1984, more women than men die of heart disease.  “In the United States in 2005, all cardiovascular diseases combined claimed the lives of 454,613 females while all forms of cancer combined to kill 268,890 females. Breast cancer claimed the lives of 41,116 females; lung cancer claimed 69,105” *.

CVD is also not just a problem that happens in middle age.  In 1953, military medical investigators examined the hearts of 300 male soldiers killed in action in Korea.  77.3% had large evidence of heart disease.  One in 20 had 90% blockage in an artery.  I find this amazing.  These soldiers would have been in peak physical fitness, and their average age was 22 years old.  Heart disease is not a disease of the elderly – we just don’t notice it until then.  If our kids are eating poorly now, not only are they developing bad habits, but also their heart disease has already begun.

In 1948, the most well-known heart study ever done was begun in Framingham, Mass., and it continues to this day, with over a thousand scientific papers having been published from it.  At the time, most doctors believed heart disease was an inevitable “wearing-down” of the body, but in 1961 the study showed a strong correlation between high cholesterol and high blood pressure, and heart disease.  Suddenly the idea of preventing heart disease took hold (pp.114-5).

Throughout this posting, remember the known factors that lead to high blood cholesterol I mentioned in my previous posting.   Here they are again from strongest correlation on down:

• Consuming more animal protein
• Consuming less plant protein
• Consuming more cholesterol (only present in animal fat)
• Consuming more saturated animal fat

The point, again, is that reducing your animal protein intake and increasing your plant protein intake is more important for reducing your blood cholesterol than the other two, the ones we always hear about.  Of course, unless you’re adding lard to your food, decreasing animal protein will automatically reduce dietary cholesterol and saturated animal fat.  In the end, this means that beyond reducing calories, low-fat animal products are not doing your body any favors when it comes to cancer and heart disease.

Many other studies were being done comparing U.S. CVD death rates with those of other countries.  It was found that the more plant-based the diet, the lower the CVD death rate, strikingly.  Japan was particularly compared to the U.S.; a chart showing death rates for men ages 55 to 59 shows the U.S. rate about seven times higher than Japan’s.  Researchers also looked at genetically Japanese men who lived in the U.S., and found that their rate was much higher than in Japan, even though Japanese men in Japan tended to smoke more than Japanese-Americans!

Dr. Lester Morrison began a study in 1946 in which he counseled 50 heart attack survivors to continue their current diet and another 50 to reduce their consumption of fat and cholesterol.  This was a modest diet, allowing 4 ounces of lean meat per day but prohibiting fatty meats, whole milk, cream, egg yolks, etc.  After 12 years, every single patient in the control group was dead.  In the special diet group, 19 were still alive.  Clearly even this modest diet had a big impact on their survival.

A group of doctors in Northern California about the same time put a larger group of patients on a low-fat, low-cholesterol diet and found that their death rate was four times lower than the control group.  This was all good news, but the focus was all on fat and cholesterol.  Dr. Campbell says, “The possibility that no one wanted to consider was that fat and cholesterol were merely indicators of animal food intake” [p.119].  Dr. Campbell talks here about how much resistance there was to the very notion that diet could have ANY impact on heart disease, despite all the evidence supporting this, and that for the most part the status-quo has continued to this day, with most doctors focusing on surgery, drugs, and electronic devices.  He makes the point that while our death rate from CVD has dropped, the incidence rate is about the same.  We have “gotten slightly better at postponing death from heart disease, but we have done nothing to stop the rate at which our hearts become diseased” [p.123].

As an aside, I asked my brother, a pulmonologist, about why doctors don’t counsel their patients on diet more, and he gave a very reasonable response.  He said that if you look at success rates with diet/exercise and with pills/surgery, lifestyle loses.  This is because these rates take into account failure of the patient to follow the regimen.  Diet and exercise may very well be the better option, but if the patient won’t follow it, it won’t work.  Pills and surgery require less initiative from the patient.  So if my brother has a certain amount of time to counsel his patient, he is going to spend the time recommending the option with the best success rate, rather than spend the time talking about diet and exercise.  My father and I pointed out that this was a doctor-oriented statistic, and that perhaps it did not serve individual patients, who might choose to change their lives if they knew their real chances with a diet change.  We thought patients should also be told what they could expect if they stuck to the diet, not only the rates including people who did not follow the diet.

Dr. Esselstyn, of the Cleveland Clinic, also believing that medical science was treating symptoms of disease instead of preventing it, decided to test the effects of a whole-foods, plant-based diet on people who had heart disease.  In 1985, he instructed his 23 heart patients to follow a diet free of all added fat and almost all animal products except skim milk and lowfat yogurt.   After five years he recommend to his patients to eliminate the milk and yogurt as well.  Patients used minimal cholesterol-lowering medication.  He met with these patients every two weeks for counseling and blood tests.  He called home that night to report the blood tests and discuss the diet more if needed.  Patients met together a few times a year to talk about the program.  In other words, Dr. Esselstyn was involved and supportive of this lifestyle change.

Five patients dropped out within two years, leaving 18.   Within the 8 years leading up to the study, these 18 people had had 49 coronary events, including angina, bypass surgery, heart attacks, strokes, and angioplasty.  Their starting cholesterol was 246 mg/dl.  During the study, their average dropped to 132 mg/dl.  “Bad” cholesterol dropped just as much.  In the following eleven years, these eighteen people had a total of one coronary event, and that was in a person who dropped the diet for two years.  The patient developed angina and returned to the diet, at which time the angina went away.  70% of them had their clogged arteries open up.  Blockages were reduced by 7% over the first 5 years, increasing blood flow by 30%.  As of 2003, all but one patient was still alive, heading into their 70’s and 80’s.  The five patients who dropped out of the program had ten new coronary events by 1995.

One doctor, 44 and having just had his first heart attack, heard about these results and came to Dr. Esselstyn.  He began the program with no other medication and reversed his heart disease within 32 months, lowering his cholesterol to 89 mg/dl.  There is a dramatic before-after image of one of his blood vessels, shriveled up and then nice and broad.

One point I don’t think Dr. Campbell makes in his book is to compare the results of this study with the Morrison study, above.  Better results are achieved with a move from four ounces of meat to none, though I can’t say for sure that it wasn’t some other part of Dr. Esselstyn’s program.

Dr. Dean Ornish began a study, the Lifestyle Heart Trial, in which he put 28 heart disease patients in a hotel for a week to begin their year-long low-fat (10% of calories) plant-based diet.  They could eat all they wanted from the approved list of fruits, vegetables, and grains.  The only animal products allowed were egg white and 1 cup per day non-fat milk or yogurt.  There was also one hour per day of stress management, and three hours per week of exercise.  The group met twice a week for four hours for support.  No drugs, surgery, or other technology was used.  There was a control of 20 other patients put on standard treatment.  Those on the experimental treatment dropped their cholesterol from 227 to 172, their “bad” cholesterol dropping from 152 to 95.  Their chest pain dropped 91%, and it was clear that those patients who adhered most closely to the program saw the best results, 4% reduction in blockages in one year.  82% of the patients saw regression of their heart disease in the year.

The control group, receiving standard care, had their chest pain worsen 165%, cholesterol was worse than the experimental group, and blockages increased 8%.

Dr. Ornish has now expanded this study.  Patients eligible for surgery can instead elect to enroll in a one-year lifestyle program.  As of 1998, 200 people had participated, with 65% eliminating their chest pain, with 60% reporting no chest pain even after three years.  This program costs $7,000, instead of $46,000 for bypass surgery or $31,000 for angioplasty.  By 1998, 40 insurance companies were covering Dr. Ornish’s program.

For some reason I find I hesitate to assert that this diet is a “cure” for heart disease.  I’ve been programmed to believe that cures come in a bottle of pills or at the end of a scalpel.  A good diet is a cure for heart disease like stopping banging your head against the wall is a cure for headaches.

Next – Osteoporosis.