In my work as a radiologist, every day I see a whole lot of poop, well, actually images of poop. One of the most common emergency room patient complaints is abdominal pain and, too often, particularly in children, the cause is simply constipation. This is evident on imaging studies, and I believe this is a symptom of a much larger problem, our Standard American Diet, which is generally very high in animal-based foods and processed foods, and quite low in plant-based whole foods (e.g., fruits, leafy vegetables, and whole grains).
Unfortunately, constipation is just the beginning for many of these youngsters. Here are just a few of the problems they are likely to encounter later in life without significant dietary changes:
Hemorrhoids. These are vascular structures in the anal canal that help with stool control. They become pathological when swollen. They are composed of arterio-venous channels and connective tissue. Internal hemorrhoids usually present with painless rectal bleeding, whereas external hemorrhoids may be asymptomatic or, if thrombosed, may cause significant pain and swelling related to the anus region. Factors that increase intra-abdominal pressure (e.g., chronic constipation) contribute to hemorrhoids.
Diverticulosis/Diverticulitis. Diverticulosis refers to diverticula in the colon, which are outpocketings of the colonic mucosa and submucosal, through weaknesses of muscle layers in the colon wall. These are more common in the sigmoid colon, which is a common place for increased pressure (e.g., chronic constipation) and are uncommon before the age of 40. Diverticulosis often results in painless rectal bleeding. Diverticulitis results when one of these diverticula becomes inflamed, may cause pain and fever, and can be complicated by abscesses, which occasionally require drainage procedures or surgery.
Colorectal Cancer. Cancer is an uncontrolled cell growth, which in this case occurs in the colon or rectum. Symptoms of colorectal cancer typically include rectal bleeding and anemia, which are sometimes associated with weight loss, pain, and changes in bowel habits. Results of The China Study showed that high fiber intake (e.g., plant-based whole foods) was consistently associated with lower rates of cancers of the rectum and colon.1,2
Constipation and hemorrhoids used to be personal issues for me. However, since adopting a whole food, plant-based diet, neither has been a problem and I sincerely doubt they ever will be. I consider myself fortunate that I did not progress to diverticulitis or colorectal cancer before making my dietary changes.
It is noteworthy that recent studies seem to suggest that the environment within our colon may be a predictor of our risk of many chronic diseases. A chronic failure to expeditiously eliminate waste/toxins through our bowel seems to have reverberating consequences throughout our body. Furthermore, it has been my anecdotal observation over the last 15 years as a practicing radiologist that adults in whom I diagnose constipation on imaging studies are much more likely to have cancers (e.g., breast, prostate, and colorectal) and visible atherosclerotic disease.
Yet, relatively few dollars are spent on research and education related to the benefits of a plant-based diet to promote colon health. Instead, like other cancers—including breast and prostate—most expenditure in the United States is toward screenings for early detection and implementing treatment regimens following diagnosis. Why do we not place more value on nutritional prevention in our US health system? Why do we generally prefer only to diagnose/screen and to treat?
As health care professionals, we can and should educate our patients and encourage them with regard to plant-based foods as the most comprehensive and effective way to prevent the diseases that result in most American deaths. By starting with our children, we can give them each an opportunity for a healthier, longer, and more productive life, free of many chronic diseases.
References
1. Li JY, Liu BQ, Li GY, et al. Atlas of cancer mortality in the People’s Republic of China. An aid for cancer control and research. Int J Epidemiol. 1981 Jun;10(2):127-33.
2. Junshi C, Campbell TC, Junyao L, Peto R, eds. Diet, Life-style and Mortality in China: A Study of the Characteristics of 65 Chinese Counties. Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press; Cornell University Press; Peoples’s Medical Publishing House; 1990.
When Americans think of breast cancer, most consider it to be like a game of craps. If a woman is lucky she will avoid breast cancer during her lifetime, but if she is unlucky, then she may be diagnosed with this dreadful disease. This philosophy on breast cancer is unfortunately perpetuated in the United States health care system.
We doctors, nurses, and other health professionals learn early in our educations that breast cancer is virtually inevitable for many women. Currently, the lifetime risk of breast cancer in an American woman is about 12%. In other words, a female born in the United States has about a 1 in 8 chance of developing breast cancer during her lifetime.1 This is one of the highest breast cancer rates in the entire world. It is well known that rates of breast cancer are substantially lower in many developing countries where diets consist of more plant-based whole foods (and less animal-based foods) and where lifestyles are generally less sedentary. For example, compared with a 12% lifetime breast cancer risk in the US, there is only a 3% lifetime risk in East Asia, Central and sub-Saharan Africa, and Western sub-Saharan Africa.
In the United States, our approach to breast cancer is tailored around its inevitability. As a result, instead of investing substantial research into dietary and lifestyle prevention of this disease, we prefer to focus instead upon early diagnosis and treatment. Techniques used for diagnosis most often include physical examination, mammography, ultrasound, and biopsy procedures. Such screening simply identifies cancers that have been around long enough that they have grown to where they can be detected. Breast cancer treatments often include surgery (e.g., mastectomy or lumpectomy), radiation, and chemotherapeutic agents. These approaches to breast cancer are unfortunately reactive, similar to how we typically approach many other diseases in our country, including heart disease, stroke, and hypertension.
“Wait until the disease is diagnosed. Then prescribe drugs and perform surgery.”
This approach ignores the root causes of these diseases, which is principally our diet and lifestyle.
Key risk factors for breast cancer include early age of menarche, late age of menopause, high levels of female hormones in blood, and high blood cholesterol. These were confirmed in the China Study and have been documented in many other research studies.2 With the exception of the blood cholesterol, these risk factors are all related to exposure to excess female hormones, such as estrogen and progesterone, which increases breast cancer risk. Women who consume diets rich in animal-based foods and relatively low in plant-based whole foods have menarche earlier and menopause later, resulting in greater lifetime exposures to estrogen. This explains why research has shown that lifetime exposure to estrogen is 2.5-3 times higher among Western women when compared with rural Chinese women.2 Estrogen is a direct participant in the breast cancer process.3 Its levels are a key determinant of breast cancer risk. High levels of estrogen and other female hormones result from consuming typical Western diets, high in fat and animal protein, but low in dietary fiber.4 This research strongly suggests that the risk of breast cancer can be markedly reduced simply by eating foods that keep estrogen levels at lower levels than is typical with the Standard American Diet (SAD).
Instead of addressing preventable dietary causes of breast cancer, we prefer to discuss other risk factors, including genes, hormone replacement, and environmental toxins. While it is true that genes play a role in breast cancer, it is wrong for women to feel that if they have a family history of breast cancer, there is nothing they can do to decrease their risk. This is simply untrue and it removes personal responsibility from the equation. In truth, most breast cancer is much more strongly tied to diet and lifestyle than to genes. Even in women who have so-called “breast cancer genes,” those genes would need to be expressed in order for breast cancer to manifest. Whether such genes are expressed is closely related to one’s diet and lifestyle.5 Hormone replacement therapy is considered a risk factor for breast cancer. As discussed previously, exposure to female reproductive hormones during the course of a woman’s life increases her breast cancer risk. Therefore, it is no surprise that administering these hormones as therapy in postmenopausal women would also increase breast cancer risk. The good news is that consuming a plant-based diet (as opposed to the typical American animal-based diet) reduces the abrupt hormone changes that typically cause menopausal symptoms and may make such hormonal therapy unnecessary in many women.5 Environmental chemicals such as dioxins, Polychlorinated Biphenyls (PCBs), and Polycyclic Aromatic Hydrocarbons (PAHs) have also been discussed as increasing a woman’s breast cancer risk. While such chemical exposures may contribute to carcinogenesis, it is important to realize that with similar chemical exposures, a plant-based diet has been shown to be protective against cancers, while an animal-based diet is more conducive to cancer cell growth.5
A review of more than sixty research studies suggests that premenopausal and postmenopausal women who exercise regularly may reduce their incidence of breast cancer by 20-40%.6 Also, a study of nearly 3,000 nurses with stages 1, 2, or 3 breast cancer published in The Journal of the American Medical Association indicated that simply walking three to five hours per week reduced the risk of breast cancer by 26 to 40%.7
Stress also seems to play a role in breast cancer. A study following nearly 60,000 African American women for six years found that women who reported feelings of racial discrimination were more likely to develop breast cancer than their peers.8
In summary, based on much research to date, there is reason to believe that the following may significantly reduce your risk of breast cancer … and that of your patients:
Depart from the SAD, which is high in animal-based and processed foods, and instead adopt a plant-based, whole-food diet that is high in nutrients and fiber.
Engage in regular exercise.
Reduce your stress levels through prayer, yoga, meditation, and mutually supportive relationships.
Don’t sit back and let breast cancer find you. Be proactive and reduce your risk of this terrible disease in the first place. As health care providers, we can do more than merely suggest mammograms for our patients. We must educate them on dietary and lifestyle changes to prevent this terrible disease from happening in the first place.
References
Forouzanfar MH, Foreman KJ, Delossantos AM, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: A systematic analysis. Lancet. 2011 Oct 22;378(9801):1461-84.
Junshi C, Campbell TC, Junyao L, Peto R, eds. Diet, Life-style and Mortality in China: A Study of the Characteristics of 65 Chinese Counties. Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press; Cornell University Press; People’s Medical Publishing House; 1990.
Bocchinfuso WP, Lindzey JK, Hewitt SC, et al. Induction of mammary gland development in estrogen receptor-alpha knockout mice. Endocrinology. 2000 Aug;141(8):2982-94.
Adlecreutz H. Western diet and Western diseases: some hormonal and biochemical mechanisms and associations. Scand J Clin Lab Invest Suppl. 1990;201:3-23.
Campbell TC, Campbell TM II. The China Study. BenBella Books; 2006.
Exercise and malignancy: Can you walk away from cancer? Harv Mens Health Watch. 2006 Nov;11(4):4-6.
Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005 May 25;293(20):2479-86.
Taylor TR, Williams CD, Makambi KH, et al. Racial discrimination and breast cancer incidence in U. S. black women: The Black Women’s Health Study. Am J Epidemiol. 2007;166(1):46-54.
As a child, more than four decades ago, I once heard older relatives talking about their health troubles related to diabetes, which they often simply called “sugar.” This sounded more to me like a tasty treat than a disease. I soon learned that diabetes could have dreadful health consequences, often resulting in much suffering and early death. Sadly, more than 20 million Americans have diabetes, which is a nutritionally related disease that is preventable, reversible, and often curable (in cases of Type 2) by dietary changes.1
Type 1 vs. Type 2
Diabetes mellitus is a group of metabolic diseases that result in a person having abnormally high blood sugar, either because the pancreas does not produce enough insulin or cells do not respond to the insulin produced. Nearly all cases of diabetes mellitus are either Type 1 or Type 2. Type 1, which accounts for about 5 to 10% of diabetes cases, typically develops in early childhood and adolescence and is sometimes called juvenile diabetes. Type 2 accounts for about 90 to 95% of diabetes cases and used to be referred to as adult-onset diabetes, but now up to 45% of new cases are actually in children.2-3
A Physiological System Gone Haywire
After we eat, the carbohydrates in food are broken down into simple sugars that enter the bloodstream. In response, the pancreas normally produces insulin, which helps the glucose enter cells for both short and long-term energy. However, in diabetes, this process breaks down. Type 1 diabetics cannot make enough insulin since certain cells in the pancreas have been destroyed, whereas Type 2 diabetics do produce insulin, but it is not effective. Both types lead to dangerously high levels of blood sugar, which has detrimental health consequences, both short and long-term. Complications of diabetes include increased risk of heart disease, stroke, high blood pressure, blindness, kidney disease, Alzheimer’s disease, and limb amputations. More than 80% of adults who have diabetes die from heart attacks or strokes.1
Genes and Destiny
Doctors and nurses recognize the importance of recording detailed family histories from patients, and diabetes in a family is always considered noteworthy. Unfortunately, in my experience, too many patients leave their doctors’ offices believing that a strong family history of a certain disease, such as diabetes, is essentially a crystal ball sealing their fates.
As mentioned in my last column, I strongly believe that Type 2 diabetes (and most other common chronic diseases that impact Americans) has more to do with families eating the same fatty, salty, sugary, high calorie, processed, animal-based, low-nutrient foods and sharing the same couch than having the same DNA.
Research Support for Plant-Based Diet
The results of many research studies strongly suggest that the clinical course of both Type 1 and Type 2 diabetes can be dramatically improved simply by making dietary changes. For example, Dr. James Anderson studied the effects of 25 Type 1 diabetics and 25 Type 2 diabetics in a hospital setting, all of whom were taking insulin. His experimental “veggie” diet consisted of mostly whole-plant foods. After only 3 weeks, the Type 1 diabetic patients were able to lower their insulin medication by an average of 40%. Their blood sugars improved greatly and their cholesterol levels decreased by 30%. For the Type 2 diabetics in his study, all but one were able to discontinue their insulin medication after only a few weeks.4
It is also worth noting that in the early 20th century, H.P. Himsworth compiled research comparing diets and diabetes rates in six countries. He found that some countries were eating diets high in fat and animal-based foods while other countries had diets high in plant-based foods that were low in fat. Diabetes related death rates dropped from 20.4 to 2.9 per 100,000 people, as plant-based carbohydrate (low-fat) intake increased and animal-based (high-fat) intake decreased.5
On a Personal Note
I was obese and pre-diabetic until only a few years ago. Now, I am now cured of prediabetes and no longer obese, simply because of significant dietary and lifestyle changes. Fortunately, my doctor suggested diet and lifestyle to me as a cure rather than a lifetime reliance on prescription medications, which may delay the onset of diabetes-related complications and death, but will not prevent, reverse, or cure diabetes. As health professionals, we are most effective when we are able to address root-cause in order to prevent, reverse, or cure any disease for our patients—and for ourselves.
Also, remember that overcoming obesity is essential for beating diabetes. Losing weight by adopting a plant-based, whole-food, healthful diet and lifestyle, including regular exercise, is the best diabetes “medicine” and offers many other health benefits, as well. As we health professionals personally begin to embrace healthier lifestyles, we can often cure ourselves and will be in a much better position to advise our patients, families, and friends, so we can all be
American Diabetes Association: Diabetes Statistics. http://www.diabetes.org/diabetes-basics/diabetes-statistics. Accessed January 14, 2013.
Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.
3. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care. 2000;23(3):381-389.
Anderson JW. Dietary fiber in nutrition management of diabetes. In: Vahouny GV, Kritchevsky D, eds. Dietary Fiber: Basic and Clinical Aspects. New York, NY: Plenum Press; 1986:343-360.
Himsworth HP. Diet and the incidence of diabetes mellitus. Clin. Sci. 1935;2:117-148.
Suggested Media
Books
Eat to Live, by Joel Furhman, MD
The China Study, by T. Colin Campbell, PhD, and Thomas M. Campbell II
Heart disease is the leading cause of death in the United States both for men and women, killing 25% of Americans, and heart disease deaths are most often due to ischemic heart disease (e.g., heart attack).1 These facts are well known among doctors, nurses, and other health professionals. However, did you know that virtually all “heart attacks” are preventable by diet and lifestyle? If you have never heard this, you are not alone. In my opinion, our education as health professionals tends to focus on the treatment of disease, using drugs, surgery, and other technological advances, and unfortunately, generally underemphasizes relatively inexpensive preventive techniques, including healthy dietary and lifestyle changes. Furthermore, doctors and nurses are trained to pay close attention to disease trends within families and to remind patients of their family histories. As a result, patients often leave doctors’ offices and hospitals with a misconception that if certain diseases, such as heart attacks, are common in their family, they will also likely die from the same disease. I have encountered many people who feel that their fate with regard to disease is sealed in their genes. In actuality, I strongly believe that heart attacks (and most other common chronic diseases that impact Americans) have more to do with families eating the same fatty, salty, sugary, high calorie, processed, animal based, low nutrient foods and sharing the same couch than having similar DNA.As deliverers of health care, we have the opportunity to empower ourselves and our patients as we become more familiar with the current research on preventive health, and as we personally embrace healthier diets and lifestyles.
Let’s consider heart attacks in more detail. Plaques develop as a consequence of damage to the endothelial cells that line our coronary arteries. Only about 12% of heart attacks are actually related to coronary arteries closing off due to large old plaques. The remaining 88% of heart attacks are due to rupture of relatively young, fatty coronary artery plaques.2 Subsequently, clot forms in an attempt to heal this injury, but often occludes the vessel, so that not enough oxygen rich blood reaches the heart muscle. This death of heart muscle (myocardial infarction) is often referred to as a heart attack. There is credible and comprehensive research that this cascade of events, which is often fatal, is directly related to a typically Western diet.3
Nearly all heart attacks are preventable based upon my review of the current research. For example, beginning in 1985, Dr. Caldwell Esselstyn studied a group of patients who had severe coronary artery disease.4,5 The 18 patients that remained in the study (5 patients dropped out) had suffered 49 coronary events in the eight years leading up to the study, including angina, bypass surgery, heart attacks, strokes, and angioplasty. During the study, they were to eat a plant based, whole food diet, avoiding oils, meat, fish, fowl, and dairy products, except for skim milk and non-fat yogurt. Only a very low dose of a cholesterol lowering statin drug was used. During the course of the study, the average cholesterol dropped from 246 mg/dL to 132 mg/dL. LDL levels also dropped dramatically. In the following 11 years, there was only 1 coronary event, which occurred in a patient who strayed from the diet. Seventy percent of Dr. Esselstyn’s patients experienced opening of their clogged arteries. Furthermore, it is compelling that Dr. Esselstyn and two other prominent heart researchers, Dr. Bill Castelli (longtime director of the Framington Heart Study) and Dr. Bill Roberts (longtime editor of the prestigious medical journal, Cardiology), each indicated that they had never seen a heart disease fatality among their patients who had blood cholesterol levels below 150 mg/dL.6
It is also noteworthy that the rate of heart attack deaths in the United States is among the highest in the world, with rates over the years typically 10-15 times greater than some other countries.7 In fact, there are some countries where heart disease is rare.8 Please note that Japanese men who live in Hawaii or California have a much higher total cholesterol and incidence of coronary artery disease than Japanese men living in Japan.9,10 These data are not explainable by genes, but rather by diet and lifestyle.
We know that 35% of heart attacks strike Americans with cholesterol levels between 150 and 200 mg/dL.11 Why then do we set our goals for a total cholesterol of under 200, when, actually, a truly safe cholesterol has been shown to be under 150 mg/dL? I believe that cultural bias plays a role here, impacting governmental legislation and medical education. After learning this valuable information about heart attack prevention, several years ago, I decided to personally strive for a total cholesterol of below 150 mg/dL. By adopting a whole food, plant based diet, I was able to achieve a sub 150 cholesterol within a few months and have maintained it. In the words of Dr. Esselstyn, I have now been “heart attack proof” for 4 years. I have no intention of returning to the Standard American Diet (SAD), because since adopting this healthy diet and lifestyle, I have also “cured” my pre-diabetes without meds and lost more than 50 pounds, which is a typical response to a plant based, whole foods diet and regular exercise. My dietary caloric intake is about 95% plant food and 5% animal based food (generally fish). I virtually never eat red meat and only occasionally eat skinless grilled chicken (typically on a salad).
It is most important that we seek the truth. The truth is that heart attacks are preventable in nearly all cases, and once informed, we all have the option of protecting ourselves (through our diet and lifestyle) from coronary artery disease. In my opinion, we also have an obligation to pass this information along to our families, patients, and friends. It is my experience that many people will make healthy dietary and lifestyle changes, when they fully understand the benefits of doing so, as well as the potential consequences of not making such changes. As doctors and nurses, let’s take the lead by personally embracing healthier diets and lifestyles to prevent and reverse chronic disease, becoming role models whose behavior our patients can emulate. In doing so, we can also rest assured that we will not succumb to “the big one“!
References
Kochanek K, Xu J, Murphy SL, Minino AM, Kung HC. Deaths: Final Data for 2009. National Vital Statistics Reports. Centers for Disease Control and Prevention. 2011; 60(3):5,8,37,70. http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf.
Esselstyn CB Jr. Prevent and Reverse Heart Disease. 2007;16.
Campbell TC, Parpia B, Chen J. Diet, lifestyle, and the etiology of coronary artery disease: The Cornell China Study. Am. J. Cardiol. 1998 Nov 26;82(10B):18T-21T.
Esselstyn CB Jr, Ellis SG, Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease: a 5 year longitudinal study of a single physician’s practice. J Fam Pract. 1995 Dec;41(6):560-8.
Esselstyn CB Jr. Introduction: more than coronary artery disease. Am J. Cardiol. 1998 Nov 26;82(10B):5T-9T.
Campbell TC, Campbell TM II. The China Study. 2006;79.
Jolliffe N, Archer M. Statistical associations between international coronary heart disease death rates and certain environmental factors. J. Chronic Dis. 1959 Jun;9(6):636-52.
Scrimgeour EM, McCall MG, Smith DE, Masarei JR. Levels of serum cholesterol, triglyceride, HDL, cholesterol, apolipoproteins, A-1 and B, and plasma glucose, and prevalence of diastolic hypertension and cigarette smoking in Papua New Guinea Highlanders. Pathology. 1989 Jan;21(1):46-50.
Kagan A, Harris BR, Winkelstein W Jr, et al. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: demographic, physical, dietary and biochemical characteristics. J. Chronic Dis. 1974 Sep;27(7-8):345-64.
Kato H, Tillotson J, Nichaman MZ, Rhoads GG, Hamilton HB. Epidemiologic Studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: serum lipids and diet. Am. J. Epidemiol. 1973;97(6):372-385.
Castelli W. Take this letter to your doctor. Prevention. 1966;48:61-64.
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