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GM: Before we discuss specific clinical evidence, let’s talk about the fact that people are understandably confused by studies. You hear on the news that vitamin E is good for the heart and then you hear that vitamin E isn’t good for the heart. Or you hear that fish oil lowers cholesterol and heart attacks and then you hear that it doesn’t. Why do we get contradictory results? Can we believe any of these studies?
PP: The first thing that I tell everybody when I’m giving public lectures, or when they join The Wellness Forum, is that you should always look at every study with some skepticism. No study by itself is really important; it’s a study taken into consideration with the preponderance of the evidence that either adds weight to its importance or completely discounts it altogether. For example, the dairy industry put out a study—yes, it actually did commission such a study—that showed that dairy helps people lose weight. So you read the headlines and you think, “Gosh, I’d better go get some ice cream and cheese to slim down.” But if you look at all of the studies that have been done on the topic, and there are a couple dozen of them, only a couple show that dairy helps you lose weight. And, oh, by the way, they were done by the same guy at the University of Tennessee who was paid $1.7 million by the dairy industry for those studies. On top of which, it’s patently illogical that calorie-rich, dense, fatty foods should help anyone lose weight.
And so when we take a look at all of the rest of what’s out there, the preponderance of the evidence says these two studies are irrelevant. Then let’s take an opposite example. Dr. Caldwell Esselstyn’s study shows that you can reverse heart disease, stop its progression, and actually reverse it with diet. That alone is provocative, but then you add in the China Study, you look at all the population studies that show that people who eat more of a plant-centered diet have less heart disease, and you add in the rest of what we know, suddenly that one study with eighteen patients starts to seem significantly more important. I tell people not to get carried away with the latest study or the latest headline, but to take a deeper look and use their brains when they read something that sounds too good to be true.
There are also ways, which we expound upon in one of the classes we offer from time to time, to sort through nutritional confusion with research. We show people how to evaluate research and go through why they don’t need to be concerned with short-term changes and biomarkers that may not be significant for their long-term health. Remember, we live in a country where people are dying with excellent blood work, so we need to weigh more heavily studies of health practices that produce improved quality of life and longevity than studies of health practices or drugs that produce better biomarkers. There are some guidelines that you can use to look at research even as a layperson and make some pretty good decisions about what’s reliable and what’s not reliable evidence.
GM: How did the researcher manage to devise two studies that showed dairy helps you lose weight? How did he rig the results?
PP: Well, you can do a lot of things. You can do some things with selection criteria. For example, if you wanted to skew a study to show that people eating a plant-based diet don’t fare better than people eating meat, just make the selection criteria the answer to the question “Do you eat meat and dairy?” No other criteria involved. So you could choose to enroll in the study a 475-pound person (like Del used to be) who would say, “I’m vegan; no meat, no dairy, no fish.” Obviously, he’s doing something wrong or he wouldn’t weight 475 pounds, so he’s probably going to be worse off than the meat eaters. You then publish a study that states a plant-based diet isn’t very helpful.
One thing that the drug companies do is recruit what we call “perfect patients.” Let’s say they need to find 1,700 people out of the more than three hundred million in our population to do a study on a new cholesterol-lowering drug. Since they want to minimize the side effects, they find 1,700 people who have high cholesterol diagnosed for the first time recently and have absolutely nothing else wrong with them. The researchers put these perfect patients on the drug; their cholesterol goes down with minimal side effects. Once the drug gets approved, that’s not how the general public will use it. The drug gets used by many people who are taking four or five other drugs and have lots of other things wrong with them, including side effects that are significantly more severe.
Another problem with studies is that the research can just be plain sloppy. I hate to say that, but in this day and age, particularly if there’s industry funding, the study design is not carefully scrutinized. And universities, in my opinion, are simply happy to see money coming in. A lot of these researchers have to fund their own departments or offices, so the lure of money to produce a study that shows a certain result can really lead to some sloppy study design. They can also skew the interpretation of the results; the study may not actually isolate dairy as a causative factor in weight loss, or the results can be so vague or insignificant as to not make any difference, but it can be reported in relative terms as if it’s significant.
And then the study may only see a two-pound difference in weight loss between two groups but it is reported as people who eat dairy products lost 50 percent more weight than the other group. Well, the first group lost four pounds and the second group lost six pounds, which is 50 percent more, but it’s a pretty meaningless number. There are all kinds of things that researchers can do, ranging from selection criteria for the subjects to how they define and measure the outcome and at what intervals to measure it, to how they report the findings, whether they are framed in absolute or in relative terms.
Sometimes, too, you can portray an apparently positive outcome without taking the negative consequences into consideration. The obvious example in the diet business is the Atkins Diet. People lose weight on the Atkins Diet, but they also get sick. I’ve always said if the only thing we’re considering is that “it works,” then let’s throw in everything that works. Cocaine addiction works for weight loss. I’ve had lots of cocaine addicts in this office over the years and they were all skinny people. Now, we can all agree that cocaine addiction would be a ridiculous approach to weight loss. Well, so is the Atkins Diet in terms of adverse health effects.
GM: There’s also the matter, when an isolated food or diet is being studied, of what kind of diet it’s being compared to. Very rarely are studies, let’s say of dairy or fish consumption, compared to a low-fat, plant-based diet; it’s always compared to the standard American diet.
PP: Yeah, that’s a big issue. And even when they do use a control group that is eating a plant-based diet, or they consider that the intervention diet, it’s not a well-structured diet. Our chef ate his way to 475 pounds on a plant-based diet. Just giving up meat doesn’t make you a healthy eater at all; it has to go beyond that. That’s where the comparison group can make all the difference in the world in terms of showing a result.
Take Loren Cordain, the guy who promotes the Paleo Diet. One of the reasons his diet looks so good when he tells stories (and he doesn’t use a lot of research—he tells a lot of stories) is that he takes people who are eating the standard American diet, which includes fast food and cheese and pizza and toaster pastries and all this stuff you shouldn’t eat, and puts them on the Paleo Diet, which is heavy on meat, vegetables, and fruit. And they generally get better, since they’ve cut out dairy, refined sugars, and a lot of processed foods. So you conclude, “My gosh, the Paleo Diet is spectacular.” Well, the Paleo Diet is spectacular compared to where people were before, but in terms of comparing it to people eating the diet that I recommend, it’s not spectacular at all. What the comparison group is doing helps determine the value of these studies.
GM: I once called the lead researcher of a study that had led the national news; the study was that high profile. This was a 2002 study published in the Journal of the American Medical Association that found that dairy consumption reduces insulin resistance syndrome.1 I found that very remarkable news, the idea that dairy could reduce insulin resistance and therefore reduce diabetes. Here’s how the lead scientist designed the study: it was a self-reporting study; he divided foods people ate into three categories: dairy, non-dairy, and mixed. He didn’t include data from the mixed group in his study because, well, I guess he found mixed foods inherently ambiguous. It turns out that cheeseburgers were considered mixed. Macaroni and cheese was mixed, and so were double-cheese pizzas; none of that was considered dairy. I mean, if a double-cheese pizza was mixed, I wondered, then what was considered pure dairy?
PP: Maybe deep-fried butter on a stick?
GM: Yeah, maybe deep-fried butter on a stick, although the sugary glaze could make it a mixed dish. You know, these are the kind of questions that only a highly trained scientist can answer. There are clearly some nuanced distinctions here that are over my head. But I’m pretty sure that if you suckled directly from the teat of a bovine, it was considered dairy.
I called the man up and said, “Look, you’re claiming with evidence that excludes pizza and many other cheesy foods that insulin resistance can be reduced with dairy. Since you want to isolate the effect of dairy on insulin resistance, why don’t you actually do a study that compares people who eat dairy in all its forms, including pizza, with people who eat no dairy at all and look at the results there?” And he said, “Hmm, that’s an interesting idea.” Like it took remarkable insight to come up with that. But I don’t believe he’s ever done that study.
PP: Because it’s something that the dairy industry would never fund.
GM: In fact, I believe his study had been funded in part by General Mills. Okay, let’s talk about some studies that you feel do have value.
PP: Well, let’s start with the work of Dr. Esselstyn that I alluded to earlier. I want to start with him because his work has rightly garnered so much attention, leading Bill Clinton to essentially adopt the diet we recommend. What I like about Dr. Esselstyn’s results is that they’re based on clinical practice; they’re clear, impossible to dispute, and really unimpeachable.
Back in the mid-1980s, Dr. Esselstyn took twenty-four cardiac patients and asked them to follow a low-fat vegan diet. The rules of his diet were simple: no animal foods, no oil, no refined grains, and no nuts. He did not ask his patients to eliminate alcohol. About 9 to 12 percent of the calories in the diet were from fat. It turned out that eighteen of the twenty-four patients were compliant with the diet. Those eighteen very sick individuals, some of whom had been all but given up for dead by standard medical practitioners, had collectively experienced forty-nine cardiovascular events in the eight years before they adopted Dr. Esselstyn’s diet regimen. There had been four heart attacks, three strokes, seven bypass surgeries, and nine of the patients suffered from increasing angina attacks.
After dietary intervention, the blood cholesterol of the compliant patients had dropped from an average of 246 mg/dl to an average of 137 mg/dl.2 Follow-up angiograms determined that not only had the progression of disease been reversed in all patients but at least eight had actually reversed their disease, meaning that there was a significant opening of their coronary arteries. With the exception of one participant who stopped being compliant with the diet six years into the program, there were no new cardiac events in any of the patients during the first twelve years of the program.
Now consider the odds. What are the chances that Dr. Esselstyn just got lucky and his eighteen patients by random chance happened to get healthy and avoid cardiac events for the twelve years on his diet after they had collectively suffered forty-nine of them in the prior eight years? For any single individual who had had several cardiac events in the prior eight years, you might estimate his chances as being one in ten that he’d manage to survive the next twelve years without another such event. For that to happen to all eighteen individuals based on random chance, you’d be looking at odds of one in 10 to the 18th power.
The efficacy of the diet becomes clearer still when you compare the results of those eighteen compliant patients with the six who dropped out of the study in the first year or so and went back to their old ways of eating. What happened to them was just what you’d expect. Reviewed by Dr. Esselstyn in 1998, their cases of heart disease all progressed, and they had four more bypass operations, increasing angina, heart failure, and one death. So it’s just not possible to make the case that it could have been anything other than diet that was responsible for the remarkable results that Dr. Esselstyn achieved. It’s also worth noting that Dr. Dean Ornish has conducted similar studies, with a slightly different but similarly low-fat diet, and more emphasis on lifestyle, and achieved comparable results. As Dr. Ornish once said about the question of evaluating studies, “The more significant the degree of change, the more likely it is that the change is not due to chance.”3 Well, the degrees of change in health outcomes that both Dr. Esselstyn and Dr. Ornish have achieved in clinical studies have been highly significant and parallel.
GM: So the efficacy of diet has been proven, but do we have studies to determine how important a role genes play?
PP: Yes. Many studies have demonstrated that genes are less important than diet. This is an important idea to communicate because many people have a very defeatist attitude about their health that gets reinforced by their very learned cardiologists and other medical doctors who say, “Well, it’s certainly not surprising that you’ve developed diabetes. I’ve been treating your mother for diabetes for the last fifteen years and your grandfather died of it. Of course this was destined to happen to you, and because you’re a helpless victim of this relentless disease, we have to put you on these medications.”
It’s often one of the reasons why people won’t seek care from somebody else or get a second opinion; they just think they’re stuck with it. I see this when people come to dinners here at The Wellness Forum. They’ll come as a guest with somebody else; they really don’t know much about what we do and they’re just flabbergasted to find out. They’ll raise their hands and say, “I have high cholesterol and I’ve done the diet thing; I’ve tried everything and I just can’t get my numbers down. I’ve been taking statin drugs and my doctor says that’s just the way it’s going to be. Now you’re telling me that you can get rid of that problem?” When I estimate a 95 percent chance that proper diet will rid them of that problem, they almost cannot believe it. It’s breathtaking to them.
It’s very important that people understand the difference between having a gene and genetic expression, and the effect that your behavior has on the expression of certain genes, including those that predispose you to developing diseases. We have lots of evidence.
First, we have migration studies that have shown that when people move from one area to another and start eating the typical diet of their new home, they soon have the same disease risk of the area to which they moved.4 For example, Japanese women in the United States are significantly more likely to develop breast cancer than Japanese women living in Japan and other Asian countries.5 One of the reasons is that the traditional Japanese diet is lower in fat, particularly saturated animal fat, than the typical Western diet. In the 1940s, breast cancer was relatively rare in Japan; at that time, the Japanese diet was comprised of less than 10 percent of calories from fat.6 But within a short time after moving to the United States, Japanese women have the same risk of breast cancer as American women.
Their genetic makeup does not change as they fly across the ocean to their new homes; the main cause is the increase in consumption of fat, particularly fat in animal foods. Their behavior changes when they get here—that’s the cause of their health deterioration. One of the first such studies was published in the Journal of the National Cancer Institute in 1968; it demonstrated that when people migrate from one area to another and adopt the typical diet in their new home, they acquire the disease risk of the area to which they migrated.7
There are some interesting population comparisons that have been done. One of them involves the Pima Indians, who are essentially divided into two groups: one leads a mostly Westernized lifestyle in Arizona, consuming a diet high in animal protein and fat; the other eats a more traditional Indian diet in Mexico: a grain and starch-based diet, with potatoes, corn, rice, beans, and locally grown vegetables and fruit—a diet with more than fifty grams of fiber per day. So they have the same ethnicity, essentially the same genetic makeup, and are close geographically, yet we find a huge difference in the diabetes rates between one group and the other. Naturally, the far worse outcomes are with the Western diet and lifestyle habits.
GM: How big is the difference?
PP: Diabetes rates are about 38 percent in the Arizona Pima and 6.9 percent in the Mexican Pima, according to the 2006 study published in Diabetes Care.8 That’s a big difference for people who are essentially ethnically identical.
We have to educate people quite a bit to get this point across. I’ll tell you an area where it affects public policy. This way of thinking is going to take a long time to shift, but controversy arises when insurance companies and other companies seek to reward people for improving their health and losing weight. There are always those who object that companies are discriminating when they reward people for improving their health, since they see people as helpless victims of their genetic history. If we assume that people have no control over their own health, it seems unfair to reward those who lose weight. How then do we compensate the people that can’t possibly lose weight because everybody in their family’s overweight? Well, this is the defeatist prevailing wisdom out there. We need to tell employers that for the very tiny percentage of employees who actually can’t change their health status, then we agree—they shouldn’t be penalized. But for the rest of the group who can do something about it, they should be rewarded for doing it and penalized if they don’t. That’s an area where this misconception about genetic predisposition really influences what can be done in the public arena.
GM: Let’s move on to supplements, since a lot of studies are designed to demonstrate whether or not they provide a benefit.
PP: What we find is that the weight of the evidence shows over and over again that supplements fail to prevent, stop, or reverse any disease. Sometimes they’re even harmful. The advocates of the supplements are not usually the conventional doctors, but rather complementary and alternative and integrative practitioners, who I refer to as “holistic pharmacists.” They are gaining more traction every day because of dissatisfaction with the traditional medical community. That dissatisfaction is widespread, and I firmly understand its roots. But the holistic pharmacists say to treat your health problems with health supplements instead of drugs because they’re natural and don’t have the same toxic side effects.
The reality remains that treating symptoms instead of the underlying cause is a bad idea. You could argue that some of the supplements are less toxic than the drugs, but they still don’t solve the problem. You’ve just got a different method of symptom control. Second, it’s premised on the same defeatism toward diet that conventional medicine offers: people won’t eat the right diet, so we have to give them supplements. I totally disagree with that whole line of thinking. And if you look at the studies, they clearly show that you cannot make up for your dietary indiscretions by popping a couple of vitamin pills in the morning. Much of the public has bought into the attitude toward supplements that they’re harmless. Even if they don’t help you, they believe, supplements aren’t toxic; the worst-case scenario is that you end up with expensive urine. I still hear a lot of comments like that.
In fact, there was a huge study reported in the British Medical Journal in 2006 that looked at tens of thousands of participants and addressed the issue of whether or not omega-3 supplementation actually helps. That’s a hot issue right now. Lots of doctors are promoting the idea that omega-3 deficiency has to be made up for with supplements. The study demonstrated that supplementation resulted in no benefits, found no reduced risk of total mortality or cardiovascular events in participants, and couldn’t rule out an increased risk of cancer.9 That’s a powerful study that supports my premise: you can’t make up for your dietary indiscretions with supplements.
Then we have The Cochrane Collaboration. I like studies done by Cochrane because, again, it’s one of the more independent groups out there. They do meta-analyses of previously published studies. It’s hard to find people and groups that aren’t corrupted by industry influence in some form or another. This is a huge study: sixty-seven randomized trials, with close to a quarter of a million participants. And the researchers concluded as follows:
[N]o evidence to support antioxidant supplements for primary or secondary prevention. Vitamin A, beta-carotene, and vitamin E may increase mortality…. Antioxidant supplements need to be considered medicinal products and should undergo sufficient evaluation before marketing.10
And people are just flabbergasted at this kind of stuff. You mean vitamin C and vitamin E might have medicinal properties, and I should be careful about taking them? Well, yes, a quarter of a million people in sixty-seven randomized, controlled trials is a pretty good sample. I don’t think we can fault them for not having a large enough cohort here.
Then there’s the Folate After Coronary Intervention Trial,11 a study published in the New England Journal of Medicine in 2004. This study took patients who already had stents implanted and randomized them into two groups: one got folic acid; the other received a placebo. After six months, the results were clear: those getting the folic acid had their arteries clogging again faster than the others. The big take-home point here is that supplements should be treated like medicine. In that regard, they can be useful for specific and targeted purposes. But if you’re self-medicating by buying this stuff over the Internet, through your neighbor in a multilevel marketing business, or at a health food store, and you’re thinking that the worst-case scenario is ending up with expensive urine, you’re wrong. People really need to rethink the money they spend on supplements and the potential damage to their health the supplements can cause.
GM: When you talk about expensive urine, I’ve often wondered how much of these supplements are just excreted?
PP: Well, a lot of it is excreted. But excreting substances not needed by the body can cause health issues, ranging from kidney stress to increasing risk of disease. The Folate After Intervention Trial showed that patients taking folic acid after angioplasty were developing arterial thickening faster than patients taking a placebo. The study was ended early as a result.
And there really is no such thing as a “natural” vitamin. In whole foods, nutrients are all bundled up in packages with coenzymes, conutrients, and that sort of thing. We purify these nutrients and take them in pill form, but the first thing the body starts doing is drawing cofactors out of the cell’s tissues to try to create a complex that looks familiar. We’ve seen people develop what I call compensatory deficiencies. A person will take highly purified isolated nutrients and in the body’s attempts to find something to do with these nutrients, it will actually deplete stores of other nutrients.
GM: So you’re saying the body doesn’t really know what to do with a dose of isolated vitamin E or isolated ascorbic acid?
PP: Right. The other problem you encounter is flooding the receptors. For example, there are about six hundred different carotenoids in foods. So you take in a massive dose of beta-carotene, for example, and that’s one out of the six hundred. Well, you only have one carotenoid receptor in every cell, so you overwhelm the cells with this massive amount of beta-carotene you’re taking in every day. Then you start eating actual food and your body can’t use the other carotenoids you’re taking in from the foods that you’re eating.
GM: How about someone who takes the attitude, “Well, I’ll pop a multivitamin once a day or once a week just in case I’m missing some nutrients somewhere that I don’t know about.” Still a bad idea?
PP: Well, the first thing I would do is laugh because nobody comes to The Wellness Forum with deficiency conditions. What, I wonder, do you think you’re missing? And to my colleagues whom I meet at “alternative conferences,” who tell me that they supplement their patients, I ask, “Why? When’s the last time you had somebody in your office with scurvy? How many people in our line of work are treating beriberi these days?” All the people who are coming to us with health problems have diseases of excess. We’re way too worried about deficiency in a place where deficiency is just not an issue. The second thing I ask people is, “Do you own stock in a vitamin company that you buy this stuff from?” I can’t think of any other reason to take it. In other words, we don’t have any evidence showing that this helps people in any way in the long term, so unless you own stock in the company and it’s your way of supporting its efforts, I don’t know why you’d want to waste your money.
GM: The one exception you make is with vitamin B12, right?
PP: Yes, but it’s very misunderstood because most people assume that as soon as you adopt a plant-based or vegan diet, B12 deficiency is an imminent risk. We see B12 deficiencies, and I do here, much more in meat eaters than we do in plant eaters. And the reason is, while they’re taking in a lot of B12 in the animal foods that they’re eating, they are notorious for having gastrointestinal problems, which range from simple constipation to serious inflammatory bowel diseases. A lot of times these people are deficient in intrinsic factor, which is a protein manufactured in the stomach that helps with the absorption and use of B12. So you can be taking in plenty of B12 and not using it well at all. Having said that, most people who eat a plant-based or vegan diet are eating some fortified foods. We’re consuming plant milks that are fortified with B12, for example, and B12 requirements are really low. It’s not very likely for somebody to develop a deficiency. The people most at risk are the rare individuals who eat no animal foods and no fortified foods. They can develop a B12 deficiency; supplements are probably a good idea for people like that.
Before I wrote my last book, I did some research looking for toxic effects of B12 and I couldn’t find any. I don’t discourage people who take a B12 supplement the way I discourage taking other supplements because you’re not going to hurt yourself with it. So I’m fine with people saying that supplemental B12 is an insurance policy and they feel better for taking it.
GM: If the body doesn’t know what to do with a massive dose of ascorbic acid or vitamin E, does it know how to process a sudden massive dose of B12? Does the same problem present itself?
PP: Well, we don’t really have any studies showing what happens when you take a massive dose of it.
GM: I don’t mean a dose beyond what you would recommend, but five hundred micrograms is what my bottle says. It’s five hundred micrograms of B12 that’s been isolated, not integrated in food. Does the body know how to handle that?
PP: Yes, and here’s kind of an interesting thing about B12 that’s different from other supplements. B12 is bound to the protein in food and has to be separated from the protein by enzymes in the stomach; intrinsic factor helps a little bit with that. And when you take it in its supplement forms, it’s already in what we call its free form, so it’s actually pretty immediately useable. It’s one situation where a supplement is actually easier to contend with than B12 in its natural form.
GM: What do clinical studies tell us about oils?
PP: They tell us that they’re not health foods. This goes heavily against the grain of popular wisdom. There’s a myth that it’s not the amount of fat we’re eating, but it’s the type of fat; that olive oil is heart healthy and fish oil particularly heart healthy. Unfortunately, the evidence just doesn’t take us there. In fact, oils can be successfully used to treat autoimmune conditions because they suppress immune function.12 I don’t think it’s the right way to treat autoimmune conditions, but the fact they suppress immune function should tell a healthy person you don’t want to be taking in a lot of this stuff.
I particularly like a study that Dr. David Blankenhorn did; he was looking at people consuming a “normal” diet versus those eating more of their fat as monounsaturated fat, which is what comes from olive oil, supposedly the healthy oil that we all want to include more of in our diet. It basically showed that the disease progressed just as much in those who consumed olive oil, high in the supposedly healthier monounsaturated fat, as it did in those who were consuming more saturated fat.13 The study proves that people have got to ratchet the fat consumption down; they won’t see any benefit by consuming olive oil instead of saturated fat in chicken or beef.
And we know that if people make dramatic, sweeping changes, they’re more likely to stay compliant; that’s been proven in clinical studies.
GM: Tell me about those studies.
PP: They’re crucial studies. I can’t tell you how many times over the years I’ve had people (many of them in health care) say to me, “Okay, let’s assume you’re right about how healthy this diet is. Nobody’s going to do this. Even if you can get them to do it, they’re not going to stick with it.”
Dr. Neal Barnard did some early studies on Dr. Ornish’s patients and found out their compliance levels were much higher than expected and they were much happier with their diets than the people eating the more moderate diet. He’s also surveyed patients in his own studies to assess satisfaction and compliance on what we would think is a pretty strict diet and found the same thing. They’re happier eating the stricter diet; they’re happier with the results and they stay with it longer.
He did two of these studies, actually. One study showed that Dr. Ornish’s patients were compliant on his diet to treat heart disease,14 and another on diabetic patients.15
GM: More compliant than … ?
PP: More compliant than patients following dietary guidelines set by the American Heart Association or the American Diabetes Association. You see, if you’re in the business of helping people change their diets, the specificity of the advice that you give becomes very important. Part of the problem with the diets recommended by our colleagues who stress moderation is that not only do they not work but their health status doesn’t change. Our colleagues don’t know what the heck they’re talking about. Vague instructions about eating a little less of this or a little more of that are unclear and unworkable because “a little less” can mean something completely different to two different people. However, when people come here or they go to one of Barnard’s programs or they’re with Dr. Ornish or they’re with Dr. McDougall, the directions are really specific. Now, you can choose to not follow them, but all of us are very clear in what we’re saying to people, so they have a much easier time with implementation.
I can tell you from personal experience that people will stick with dietary instructions if they’re presented with the right evidence, which is partly a matter of understanding the futility of what they’re currently doing. We can get them to make the change, but, contrary to the conventional wisdom, if we get them to make the big sweeping change, they’re much more likely to stick with the diet they’ve adopted. The reason is that big changes in diet bring about big changes in health; the changes are highly motivating. There’s a clear discernible difference in their health and in their weight. Doctors are telling me all the time, “I tell people to alter their diet this way or that way; they try, but they don’t stick with it.” Well, that’s because it seems like a whole lot of effort for not much return. But if you take a type 2 diabetic and put him on a diet that reverses his diabetes in two weeks, or if you take somebody with erectile dysfunction and you solve the problem in a matter of a month, those people aren’t going to be as interested in cheeseburgers anymore. They see the results of the dietary changes they’ve made and it motivates them to stay compliant. And diet always brings results quicker than drugs.
GM: As studies prove?
PP: Absolutely. Diet changes work incredibly fast, as was initially demonstrated in a study done by Dr. James Anderson at the University of Kentucky. He did studies on diabetic patients using a low-fat, high-fiber, plant-based diet in the 1980s. He showed that in three weeks, type 1 diabetics could reduce insulin by 40 percent, cholesterol dropped by 30 percent, and twenty-four out of twenty-five type 2 diabetics were able to completely discontinue their insulin medication.16 If you talk to endocrinologists who are using metformin or insulin or whatever combination of drugs they’re using to treat diabetics, they can’t get the treatment right in a three-week time period, let alone reverse the type 2 diabetes or reduce insulin needs in a type 1 inside three weeks. These are nothing short of miraculous results that cannot be duplicated with drugs. We’ve seen people have their cholesterol drop by eighty points in five days. You can’t do that with a statin drug. And so not only is this diet better than the drugs from a health perspective but it’s more effective than the drugs and works faster.
GM: Well, what do we know from studies about the effectiveness of drugs and surgical interventions for cardiovascular disease?
PP: There were three major studies that showed that surgical intervention was no better than drug therapy: the 1984 Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group;17 the European Coronary Surgery Study Group of 1988;18 and the Coronary Artery Surgery Study of 1990.19 All three studies showed that the outcomes for patients who have bypass surgery versus patients who only take drugs are the same, with the exception of an advantage to the surgery group for those with damage to the left ventricle. There was also the AVERT study that showed that patients who did not receive angioplasty but took Lipitor experienced fewer heart attacks, less chest pain, and made fewer visits to the hospital.20
Angioplasty involves risk: often the inflating of the balloon releases plaque and causes heart attacks. And very often the arteries are blocked again within a few months of the procedure. Yet we spend billions of dollars a year on angioplasty.
The research shows that bypass surgery is really only warranted about 3 percent of the time—in those cases when doctors can get to somebody during or right after a myocardial infarction, or when there’s extensive damage to the left ventricle. Other than that, it’s a totally voluntary and useless surgery that costs about $100,000 over a five-year period for the surgery and follow-up care.
When we consider how useless these surgical interventions generally are, we need to factor in that about twenty thousand people per year die as a result of angioplasty21 and another ten thousand die as a result of bypass surgery.22 It’s unconscionable that this practice continues. So the question comes up, and I’ve asked it of Dr. Esselstyn, “Why do we keep doing this?” He says, “Well, Pam, somebody’s got to pay for these cardiac cathedrals that they build.” The average hospital, after all, thrives on bypass and angioplasty. So it’s the unwitting patients and their insurance companies who wind up paying.
GM: We’ve talked about studies that show that surgical intervention for cardiovascular disease is generally no more effective than drug therapy. But exactly how effective is drug therapy?
PP: Not much at all. We have many studies that show that cholesterol-lowering drugs don’t significantly reduce the risk of heart attack, stroke, or death. So why would someone take a useless drug unless he has stock in Merck and feels like he ought to support the cause? No one should want to take these drugs. In fact, the package inserts on the drugs pretty much say that in small print; Crestor is one. The prescribing information states that Crestor reduces the risk of major cardiovascular events by 1.2 percent.23 That’s not much of a risk reduction, particularly when factoring in the side effects. So it will lower cholesterol levels, but it’s not very effective for actually solving the problem. What it will do is help a person die with good blood work.
GM: It seems to me such a powerful, provocative statement to say that cholesterol-lowering medication doesn’t reduce the risk of death. How does that affect a nation of doctors who are prescribing such drugs? Do they realize it’s not reducing the risk of death or serious events? Do they accept that?
PP: A lot of them do. But so many doctors get their information from drug reps and through continuing medical education programs sponsored by drug companies. This, combined with the fact that many don’t read medical journals regularly and don’t know how to interpret the results of the articles they do read, is why so many patients get bad advice from doctors.
GM: When my mother was about seventy years old, my parents moved to Florida. She had suffered from angina since her mid-fifties and after seeing her, my mother’s new cardiologist immediately recommended she have an angioplasty. Luckily, my father, who was always skeptical of the medical profession, was in the office with her and said, “Well, you could do that, honey; it’s your heart, after all. Just keep in mind that if you do it, I’m going to leave you.” So there was a big fight in the doctor’s office with the doctor saying, “Who are you going to listen to, him or me? What does he know about medicine? If you’re going to listen to him, then you’re fired. I don’t want you as a patient!” Well, my parents had been happily married for more than forty years. My mother obviously didn’t want to get divorced, so she refused the intervention, the doctor fired my mother, and she never went back to him. She’s ninety-three years old today and has never had a heart attack or any cardiac event. I’ve got her on a low-fat, plant-based diet; she’ll probably outlive that cardiologist.
PP: I always find it interesting when doctors fire patients. It’s despicable. Basically, what the doctor is saying is, “You’ll do as you’re told. I’m not interested in having you as a patient if you decide to have an original thought or become proactive on your own behalf.” They don’t say it in those words, but that’s the essence of what they’re communicating.