Two Men With Heart Disease

I tabled with RAVS at a health fair today.  We talked to about 25 people.  I’m really impressed with PCRM‘s handout nutrition booklet “Vegetarian Starter Kit.”  It is very appealing with nice graphics, and made it easy to discuss a lot of issues and send people home with something easy to understand.

This morning I thought up the idea for “Two men with heart disease,” composed a poster, printed it out and had it on the table with the handouts.  The other staffer laughed at my photo of Cheney; I could have been much more cruel, but I had held back.  All the photos I saw of Clinton were calm and happy, but at least half the photos of Cheney he was angry with his mouth open.  So I figure my poster was just reflecting the truth.  Anyway, as little as I like Dick Cheney, I’m not blaming him for his condition, just asking people to reflect on why one treatment is considered normal and the other is not.

The idea was based on a Compassionate Cooks podcast where Colleen first described open heart surgery and then compared that with the alternative by reading a recipe for split pea soup.

Boiling my Garbage

My husband once told me that he and his friends used to make fun of one of their moms who would freeze her garbage.  This sounded ridiculous until he explained that she was freezing food scraps in a bag so they wouldn’t stink up the trash can, and then would throw them away on trash day.

But I can’t help thinking of this story since I have begun boiling my garbage.  The short story is that I’m making never-ending soup stock.  I’ve just started keeping my smallest pot in the fridge, lid on, and any vegetable trimmings that aren’t spoiled go into it right off the cutting board.  It gets peelings, ends, and even the pulpy centers of peppers, and don’t forget the onion skins.  I typically fill this little pot every day.  When it’s filled, I cover the trimmings with water, simmer an hour, and then let it cool.  I drain it into a plastic container with whatever stock I already had.  The soggy trimmings then complete their detour into the compost bin.  If you’re going to keep adding stock to an existing container, of course you’ll want to make sure to use it all up frequently so you don’t have a mix that’s getting older and older.

The long story: I’m not only doing this to reduce waste and save on purchasing stock, since after all the cooking gas isn’t free.  I’m also doing it to try to cut down on salt.  The bouillon paste I use, Better Than Bouillon, is awfully salty.  Despite my pretty healthy lifestyle, my blood pressure has been climbing for a few years, and I’m consistently in prehypertension now, in the 120’s over whatever.  The word prehypertension sounds like something you don’t need to worry about yet, but a Dummies book I read said it would be better called “lower risk hypertension.”  It’s still hypertension, it still does damage, it still increases risk of heart attack and stroke, just not as much.

After reading the book, I bought an automatic blood pressure monitor and have started tracking some things I think might affect my bp: sleep (snoring husband), exercise, meditation, alcohol/caffeine, and salt.  Too little data to comment yet.  I read that vitamin D deficiency may affect bp, so after several years of failing to bring my D up with vegan D2, I did a 45-day trial with some vegetarian D3.  It certainly brought up my D3 levels, but it didn’t make any difference in my bp, so I’ve returned to the D2.  There are other things that affect bp, such as obesity or lack of fruits/vegetables, but they don’t apply to my situation.

I eliminated most prepared foods, a huge source of sodium, from my diet years ago.  This past few weeks I’ve been able to cut way back on the salt I use in cooking, and while my family often adds salt at the table, I don’t miss it.  I made Lentil Soup last night without salt; I used my stock instead of water and some diced tomatoes instead of tomato sauce; I thought it was great.  I’m not planning on being an anti-salt fanatic, especially if it doesn’t turn out to affect my bp readings; but why not adjust my taste buds to a healthier habit?

Why I care what other people eat

I was commenting at a blog the other day in favor of recent proposed legislation meant to nudge people into making better food choices.  A reply to my reply asked me why I care what other people eat.  I had to think this over a bit, but I have an answer, and prefer to give it its own space here on my own blog.

I care what other people eat because of compassion, the food environment my family faces, and concerns about costs and sustainability.

First the background.  People are not making food choices in a vacuum.  They are making those decisions in an environment which is slanted in such a way that they are encouraged to make unhealthy choices.  Unhealthy food is subsidized by the government (through grain which is converted into meat, sugar, and fat) and is more profitable for food companies and retailers.  Unhealthy quantities are pushed on us through ubiquitous placement and marketing by a food system that needs us to buy more, more, more, in order to remain competitive.  The fact that we can only eat so much has been ignored and, actually, disproved; turns out we can eat more calories than we used to, and than we should.

What this means is that the status quo, expecting people to suddenly make better choices, regardless of whether they are children, whether they can afford it, whether it is available in their neighborhood, and whether they are relentlessly marketed unhealthy food, is unrealistic, as has been proven by decades of rising obesity.  Thirty-four percent of the U.S. population is now obese, and an additional 34% are overweight.  Yes, that’s 68% of adults over a healthy weight.   Almost 17% of U.S. children ages 2-19 are obese.  How is a two-year-old responsible for being obese?  How will blaming the child’s parents help the child?  Scroll down at this page from the CDC to see an amazing map showing the population relentlessly getting heavier, state by state, through the years.  Blaming individuals hasn’t worked for the past 30 years, as obesity rates have risen, so what makes us think that it’s going to work in the future?

The U.S. Center for Disease Control introduces their entire obesity section not with an urge to “put down the fries, fatty,” but with this:

American society has become ‘obesogenic,’ characterized by environments that promote increased food intake, nonhealthful foods, and physical inactivity. Policy and environmental change initiatives that make healthy choices in nutrition and physical activity available, affordable, and easy will likely prove most effective in combating obesity.

But to return to the question, so what?  I provide good food for my family and we are healthy.  Why don’t I mind my own business?  Why should I care what my proverbial neighbor eats?

I care because I have compassion.  The same compassion that leads me to forgo eating animal products leads me to support legislation that tries to undo the unfair food environment in which we are immersed, an environment I have been lucky to resist not because I’m a superior human being with stronger character (I’m not) but probably because of a combination of good genes, good socioeconomic status, a mother who ate well during pregnancy and nursing and cared about nutrition and family suppers, and a leaflet someone handed me that led me to become vegan.  I have compassion for the 68% of overweight adults and the real suffering that ensues; the risks for these diseases increases:

• Coronary heart disease
• Type 2 diabetes
• Cancers (endometrial, breast, and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Stroke
• Liver and Gallbladder disease
• Sleep apnea and respiratory problems
• Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
• Gynecological problems (abnormal menses, infertility)

People who are overweight also suffer social stigma, employment bias, and low self-esteem, often along with a continual struggle with the unhealthy food that surrounds them.  Overweight people often report that they never stop thinking about food – it controls their lives much like an addictive drug.  For this I have compassion, and if I can speak up to encourage laws to prevent overweight and obesity, I will.  I care.

I have compassion for the 925 million hungry of this world who would like to eat the grain wasted when it is fed to animals.  Thirty-six million people died of malnutrition in 2006.  Of course this is not all our fault, and this is a complex issue, but our country’s food policies, including subsidies which not only encourage our inefficient consumption but also unfair trade, absolutely play a strong role.  I support domestic and international policies and encouragement of personal diets that take world malnutrition into account.  I care.

I also have compassion for the animals suffering in this food system under government-skewed economics that encourage us to eat more of them because their feed is subsidized and their negative environmental and health impacts are not paid for at the checkout counter.  If I can encourage legislation that brings the price of meat in line with the real costs, I will.  If I can lift the veil of secrecy that hides the horrible things done to farm animals in our name, I will.  I care.

My children eat well at home, and I pack lunches for them because the school lunches are not healthy.  Did you know there is currently no limit to the amount of sugar that can be in a USDA-approved school lunch?  And yet there are minimum calorie requirements, and insufficient funding.  Hmm, how can schools put in enough calories with hardly any money?  Sugar and fat are the cheapest calories (remember corn oil and high fructose corn syrup are subsidized by the government?), but the fat actually is restricted to 35% of calories (still a lot), so now you know why school lunches are loaded with fat and sugar.  So I support legislation to improve school lunch standards for other kids, even though I side-step them myself.  Here are some other ways I mentioned in an earlier blog about how the food environment impacts my kids despite my best efforts.  We seldom eat out or watch TV, but my kids have personally encountered these:

Restaurant kids meals are always horrible, commercials on TV encourage kids to eat unhealthy food, teachers have kids visit web sites from candy companies in school, unhealthy snacks are often given to kids in preschool programs, lollypops are handed out on the way out of restaurants, fast food restaurants line the streets near schools, candy and sugary drinks are sold at gas stations and drug stores on the way home from school, schools have vending machines selling sports drinks and candy, weekly birthday or holiday parties include cupcakes with 4″ of icing, classes that behave well earn pizza or doughnut parties; chips, cookies, ice cream, and Little Debbie snack bars are sold daily in the lunchrooms, and on the first day of school my son’s teacher handed out taffy to kids who raised their hands.  Every one of these situations makes parents’ job, to raise healthy kids, harder.

Someday soon my kids will be on their own.  I hope that I, like my mother, can inoculate them against the toxic food environment they will face 24/7.  But if I can speak out to help improve that environment to make healthy decisions easier, I will.  I care.

I’m concerned about our nation’s diet’s effect on health care costs.  The Physician’s Committee for Responsible Medicine makes the connection between this issue and our hair-tearing about the high costs of medical care:

“Even if the steak and cheese produced on American farms foster health problems, our government rallies behind agribusiness all the way to the emergency room.  Sadly, every administration in recent decades has been caught up in a system that not only tolerates ill health, but encourages it.” – Barnard

Almost 10% of total U.S. medical expenditures are attributed to overweight and obesity.  The Congressional Budget Office calculates that if obesity rates continue to rise from 2007’s 28% to 37% in 2020, health care spending will be 7% higher than it would be if obesity rates were to be reversed and drop to 20%.  I support legislation that will lead to a reversal in obesity rates because I care about health care costs that our family pays through insurance premiums and taxes.

I’m very concerned about the environmental unsustainability of Americans’ current eating patterns, and trends in the developing world.  We eat more meat per capita than any other country except Uruguay, so we can hardly ask others to cut back, but the planet cannot, cannot support even the current worldwide population eating like Americans do.  I’m not talking about causing some pollution somewhere, maybe a few frogs die, I mean it’s physically impossible, but on the way to the impossible we will irreparably harm our planet.  Our choice of diet is having an enormous and unsustainable impact on water usage and pollution, acid rain, soil erosion and pollution, air pollution, global warming, wildlife, oceans, antibiotics, and non-renewable energy.  I don’t mean that our unavoidable need to eat causes these problems, I mean we make them magnitudes worse than they need to be because of the discretionary foods we choose to put in our mouths.  The example we set, the culture we export, and our inability to ask others to do what we cannot is setting the stage for a disaster.  The U.N. knows this and is urging the world to adopt a plant-based diet.  One of the suggestions to reduce energy use from a University of Wisconsin researcher who calculated energy use of foods is to “decrease consumption of beef, sugar, and highly processed foods.”  But right now our government is subsidizing exactly these foods through grain subsidies, making them cheaper and therefore increasing sales.  I support ending those subsidies, or if that is politically impractical, counterbalancing them with taxes on unhealthy foods or subsidies on healthy foods.  I care what people eat because our diet is ruining our planet.

All legislation is not equal.  We can debate the merits of particular bills, their costs and effectiveness.  But first we need to care.

The Standard American Diet’s Effect on our Environment and our Health

Leo Horrigan

I read this accessible paper, “How Sustainable Agriculture Can Address the Environmental and Human
Health Harms of Industrial Agriculture” (by Leo Horrigan, Robert S. Lawrence, and Polly Walker
Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore), which delivers a crushingly broad indictment of the effects of our industrial diet.

Robert S. Lawrence, M.D.

It concisely discusses the unsustainable and often irreversible effects on the environment of intensive use of water, energy, pesticides, fertilizers, antibiotics, hormones, and genetic manipulations, and modern agriculture’s astonishing increases in topsoil loss, water pollution, animal waste, and greenhouse gas emissions.  The paper also makes the point very clearly that eating meat intensifies all these industrial uses and effects by its inefficiencies.  Ruining the environment doesn’t just mean messing up our nest, it also means messing up our food supply – if we don’t take care of the land and water, inevitably there will come a day when we can’t grow enough food – in the past farmers just moved on to new land, but what happens when even the marginal land is useless?

Then the paper moves on to the effect of all these chemicals and the foods themselves on our bodies.

They sum up:

These phenomena are due, in part, to production and processing methods that emphasize economic efficiency but do not give sufficient priority to public health or the environment.

Some things that surprised me:

The average U.S. farm uses 3 kcal of fossil energy in producing 1 kcal of food energy (in feedlot beef  production, this ratio is 35:1), and this does not include the energy used to process and transport the food.

Thirty-five calories of fossil fuel to make one calorie of food energy!

Barnard et al. estimated that meat consumption costs the United States roughly $30–60 billion a year in medical costs. The authors made this calculation (which they considered a conservative one) on the basis of the estimated contribution that eating meat makes to the diseases discussed above, plus other chronic diseases common in affluent countries and foodborne illnesses linked to meat consumption.

The United Nations has estimated that about 2 million poisonings and 10,000 deaths occur each year from pesticides.

One meta-analysis found that in nine comparison studies, vegans had an average cholesterol level of 158 mg/dL, vegetarians 182 mg/dL, and omnivores 193 mg/dL….  Whereas the average cholesterol level among heart attack victims is 244 mg/dL of blood serum, heart attack risk falls to virtually zero when the cholesterol level is less than 150 mg/dL.

The authors make the point that unsustainable farming is nothing new – many civilizations have collapsed because of their farming methods.  Sustainable methods will consider long-term effects on topsoil, biodiversity, and rural communities, instead of just short-term profit.  Sustainable agriculture will change from place to place and over time.  Sustainable methods might include crop rotation and soil conservation, among others.

So why don’t we do this?  Because farm input required by modern agriculture methods (think fertilizer, pesticides, and the kind of seeds farmers can’t save and replant)  is a huge, powerful business that influences government subsidization of large-scale unsustainable farming.

One thing that would help, they say, is to convince farmers that sustainable farming can be just as profitable, and they give a large-scale example in Gallo Wine.  Urban agriculture is good, and this is about the fourth paper I’ve read that says that farm markets and CSAs are a really important way consumers can make an impact.

They conclude:

Coupled with energy- and resource intensive food production methods, rising population and rising per capita consumption are bringing us closer to the limits of the planet’s ability to produce food and fiber for everyone.

These problems are complex and have no single solution, which leaves many people feeling powerless to affect them.  One personal act that can have a profound impact on these issues is reducing meat consumption.

The Center’s book “Putting Meat on the Table” is available for free download.  Lawrence and Walker offered a course, “Food Production, Public Health, and the Environment” through John’s Hopkins which sounds similar to the Yale course I’m auditing (and from the same semester).  Although JH’s course is less user-friendly (you have to synchronize MP3 audio lectures with PDF slides), it does have a list links of readings which seemed different than those required by Yale.

Forks Over Knives

Movie coming Summer 2010

Cardiovascular Disease and the Vegan Diet

This posting will be my on-going catch-all for articles and studies I find relating vegan or nearly-vegan diets with heart disease.  This is a companion to my cardiovascular posting on The China Study.

Studies:

• Lifestyle Heart Trial
• Multicenter Lifestyle Demonstration Project
• The Vegetarian Site has a list of diet-related studies

Articles:

• Dr. Dean Ornish criticizes the American Heart Association’s position on very low-fat diets

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.