Heart	disease	wasn’t	the	inevitable
result	of	old	age,	and	even	when	a	person	had	advanced	disease,	a	low-fat,
low-cholesterol	diet	could	significantly	prolong	his	or	her	life. This	was	a
remarkable	advance	in	our	understanding	of	the	number	one	killer	in
America. Furthermore,	this	new	understanding	made	diet	and	other
environmental	factors	the	centerpieces	of	heart	disease. Any	discussion	of
diet,	however,	was	narrowly	focused	on	fat	and	cholesterol. These	two
isolated	food	components	became	the	bad	guys.We	now	know	that	the	attention	paid	to	fat	and	cholesterol	was	misguided. The	possibility	that	no	one	wanted	to	consider	was	that	fat	and	cholesterol
were	merely	indicators	of	animal	food	intake. For	example,	look	at	the
relationship	between	animal	protein	consumption	and	heart	disease	death	in
men	aged	fifty-five	to	fifty-nine	across	twenty	different	countries	in	
Chart
5.3
. 16
This	study	suggests	that	the	more	animal	protein	you	eat,	the	more	heart
disease	you	have. In	addition,	dozens	of	experimental	studies	show	that
feeding	rats,	rabbits	and	pigs	animal	protein	(e.g.,	casein)	dramatically	raises
cholesterol	levels,	whereas	plant	protein	(e.g.,	soy	protein)	dramatically
lowers	cholesterol	levels. 24
	Studies	in	humans	not	only	mirror	these	findings,
but	show	that	eating	plant	protein	has	even	greater	power	to	lower	cholesterol
levels	than	reducing	fat	or	cholesterol	intake. 25
While	some	of	these	studies	implicating	animal	protein	were	conducted	in
the	past	thirty	years,	others	were	published	well	over	fifty	years	ago	when	the
health	world	was	first	beginning	to	discuss	diet	and	heart	disease. Yet
somehow	animal	protein	has	remained	in	the	shadows	while	saturated	fat	and
cholesterol	have	taken	the	brunt	of	the	criticism. These	three	nutrients	(fat,
animal	protein	and	cholesterol)	characterize	
animal-based	food	in	general. So
isn’t	it	perfectly	reasonable	to	wonder	whether	animal-based	food,	and	not
just	these	isolated	nutrients,	causes	heart	disease? CHART	5.3:	HEART	DISEASE	DEATH	RATES	FOR	MEN	AGED	55
TO	59	YEARS	AND	ANIMAL	PROTEIN	CONSUMPTION	ACROSS	20
COUNTRIES
16
Of	course,	no	one	pointed	a	finger	at	animal-based	foods	in	general. It
would	have	led	immediately	to	professional	isolation	and	ridicule	(for	reasons
discussed	in	
Part	IV
). These	were	contentious	times	in	the	nutritional	world.A	conceptual	revolution	was	taking	place,	and	a	lot	of	people	didn’t	like	it. Even	talking	about	diet	was	too	much	for	many	scientists. Preventing	heart
disease	by	diet	was	a	threatening	idea	because	it	implied	that	something	about
the	good	old	meaty	American	diet	was	so	bad	for	us	that	it	was	destroying	our
hearts. The	status	quo	boys	didn’t	like	it. One	status	quo	scientist	had	a	good	time	making	fun	of	people	who
appeared	to	have	a	low	risk	of	heart	disease. In	1960,	he	wrote	the	following
piece	of	“humor”	to	mock	the	then-recent	findings
26
:Thumbnail	Sketch	of	the	Man	Least	Likely	to	Have
Coronary	Heart	Disease:
An	effeminate	municipal	worker	or	embalmer,	completely	lacking	in
physical	and	mental	alertness	and	without	drive,	ambition	or
competitive	spirit	who	has	never	attempted	to	meet	a	deadline	of	any
kind. A	man	with	poor	appetite,	subsisting	on	fruit	and	vegetables	laced
with	corn	and	whale	oils,	detesting	tobacco,	spurning	
ownership	of
radio,	TV	or	motor	car,	with	full	head	of	hair	and	scrawny	and	un-
athletic	in	appearance,	yet	constantly	straining	his	puny	muscles	by
exercise;	low	in	income,	B.P. (blood	pressure),	blood	sugar,	uric	acid
and	cholesterol,	who	has	been	taking	nicotinic	acid,	pyridoxine	and
long	term	anticoagulant	therapy	ever	since	his	prophylactic	castration. The	author	of	this	passage	might	just	as	well	have	said,	“Only	REAL	men
have	heart	disease.”	Also	notice	how	a	diet	of	fruits	and	vegetables	is
described	as	“poor”	even	though	the	author	suggests	that	this	diet	is	eaten	by
those	people	who	are	least	likely	to	have	heart	disease. The	unfortunate
association	of	meat	with	physical	ability,	general	manliness,	sexual	identity
and	economic	wealth	all	cloud	how	the	status	quo	scientists	viewed	food,
regardless	of	the	health	evidence. This	view	had	been	passed	down	from	the
early	protein	pioneers	described	in	chapter	two. Perhaps	this	author	should	have	met	a	friend	of	mine,	Chris	Campbell	(no
relation). Chris	is	a	two-time	NCAA	Division	1	wrestling	champion,	three-
time	U.S.	Senior	wrestling	champion,	two-time	Olympic	wrestler	and	Cornell
Law	School	graduate. At	the	age	of	thirty-seven	he	became	the	oldest
American	ever	to	win	an	Olympic	medal	in	wrestling,	weighing	in	at	198
pounds. Chris	Campbell	is	a	vegetarian. As	a	man	not	likely	to	have	heart
disease,	I	think	he	might	disagree	with	the	characterization	above. The	battle	between	the	status	quo	and	the	dietary	prevention	camp	was
intense. I	remember	attending	a	lecture	at	Cornell	University	during	the	late
1950s	when	a	famous	researcher,	Ancel	Keys,	came	to	talk	about	preventing
heart	disease	by	diet. Some	scientists	in	the	audience	just	shook	their	heads	in
disbelief,	saying	diet	can’t	possibly	affect	heart	disease. In	those	first	decades
of	heart	disease	research,	a	heated,	personal	battle	flared,	and	open-
mindedness	was	the	first	casualty.RECENT	HISTORY
Today,	this	epic	battle	between	defenders	of	the	status	quo	and	advocates	of
diet	is	as	strong	as	ever. But	there	have	been	significant	changes	in	the
landscape	of	heart	disease. How	far	have	we	come,	and	how	have	we
proceeded	to	fight	this	disease? Mostly,	the	status	quo	has	been	protected. Despite	the	potential	of	diet	and	disease	prevention,	most	of	the	attention
given	to	heart	disease	has	been	on	mechanical	and	chemical	intervention	for
those	people	who	have	advanced	disease. Diet	has	been	
pushed	aside. Surgery,	drugs,	electronic	devices	and	new	diagnostic	tools	have	stolen	the
spotlight. We	now	have	coronary	bypass	surgery,	where	a	healthy	artery	is	“pasted”
over	a	diseased	artery,	thereby	bypassing	the	most	dangerous	plaque	on	the
artery. The	ultimate	surgery,	of	course,	is	the	heart	transplant,	which	even
utilizes	an	artificial	heart	on	occasion. We	also	have	a	procedure	that	doesn’t
require	cracking	the	chest	plate	open,	called	coronary	angioplasty,	where	a
small	balloon	is	inflated	in	a	narrowed,	diseased	artery,	squishing	the	plaque
back	against	the	wall,	opening	up	the	passage	for	increased	blood	flow. We
have	defibrillators	to	revive	hearts,	pacemakers	and	precise	imaging
techniques	so	that	we	can	observe	individual	arteries	without	having	to
expose	the	heart. The	past	fifty	years	have	truly	been	a	celebration	of	chemicals	and
technology	(as	opposed	to	diet	and	prevention). In	summarizing	the	initial
widespread	research	on	heart	disease,	one	doctor	recently	highlighted	the
mechanical:
It	was	hoped	that	the	strength	of	science	and	engineering	developed
after	World	War	II	could	be	applied	to	this	battle	[against	heart	disease]
…. The	enormous	advances	in	mechanical	engineering	and	electronics
that	had	been	stimulated	by	the	war	seemed	to	lend	themselves
particularly	well	to	the	study	of	the	cardiovascular	system…. 4
Some	great	advances	have	been	made,	to	be	sure,	which	may	account	for
the	fact	that	our	death	rate	from	heart	disease	is	a	full	58%	lower	than	what	it
was	in	1950. 2
	A	58%	reduction	in	the	death	rate	seems	a	great	victory	for
chemicals	and	technology. One	of	the	greatest	strides	has	come	from	better
emergency	room	treatment	of	heart	attack	victims. In	1970,	if	you	were	older
than	sixty-five	years,	had	a	heart	attack	and	were	lucky	enough	to	make	it	to
the	hospital	alive,	you	had	a	38%	chance	of	dying. Today,	if	you	make	it	to
the	hospital	alive,	you	only	have	a	15%	chance	of	dying. The	hospital’semergency	response	is	much	better,	and	consequently	huge	numbers	of	lives
are	being	spared. 2
In	addition,	the	number	of	people	smoking	has	steadily	been	decreasing,
27,
28
	which	in	turn	lowers	our	death	rate	from	heart	disease. Between	hospital
advances,	mechanical	devices,	drug	discoveries,	lower	smoking	rates	and
more	surgical	options,	there	clearly	seems	to	be	much	to	cheer	about. We’ve
made	progress,	so	it	seems. Or	have	we? After	all,	heart	disease	is	still	our	number	one	cause	of	death. Every
twenty-four	hours,	almost	2,000	Americans	will	die	from	this	disease. 2
	For	all
the	advances,	there	are	a	huge	number	of	people	still	succumbing	to	broken
hearts. In	fact,	the	incidence	rate	(not	death	rate)	for	heart	disease
29
	is	about	the
same	as	it	was	in	the	early	1970s. 2
	In	other	words,	while	we	don’t	die	as	much
from	heart	disease,	we	still	get	it	as	often	as	we	used	to. It	seems	that	we
simply	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.SURGERY:	THE	PHANTOM	SAVIOR
The	mechanical	interventions	that	we	use	in	this	country	are	much	less
effective	than	most	people	realize. Bypass	surgery	has	become	particularly
popular. As	many	as	380,000	bypass	operations	were	performed	in	1990,
30
meaning	that	about	1	out	of	750	Americans	underwent	this	extreme	surgery. During	the	operation,	the	patient’s	chest	is	split	open,	blood	flow	is	rerouted
by	a	series	of	clamps,	pumps	and	machines,	and	a	leg	vein	or	chest	artery	is
cut	out	and	sewn	over	a	diseased	part	of	the	heart,	thereby	allowing	blood	to
bypass	the	most	clogged	arteries. The	costs	are	enormous. More	than	one	of	every	fifty	elective	patients	will
die	because	of	complications
31
	during	the	$46,000	procedure. 32
	Other	side
effects	include	heart	attack,	respiratory	complications,	bleeding
complications,	infection,	high	blood	pressure	and	stroke. When	the	vessels
around	the	heart	are	clamped	shut	during	the	operation,	plaque	breaks	off	of
the	inner	walls. Blood	then	carries	this	debris	to	the	brain,	where	it	causes
numerous	“mini”	strokes. Researchers	have	compared	the	intellectual
capabilities	of	patients	before	and	after	the	operation,	and	found	that	a
stunning	79%	of	patients	“showed	impairment	in	some	aspect	of	cognitive
function”	seven	days	after	the	operation. 33
Why	do	we	put	ourselves	through	this? The	most	pronounced	benefit	of
this	procedure	is	relief	of	angina,	or	chest	pain. About	70-80%	of	patients
who	undergo	bypass	surgery	remain	free	of	this	crippling	chest	pain	for	one
year. 34
	
But	this	benefit	doesn’t	last. Within	three	years	of	the	operation,	up	to
one-third	of	patients	will	suffer	from	chest	pain	again. 33
	Within	ten	years	half
of	the	bypass	patients	will	have	died,	had	a	heart	attack	or	had	their	chest	pain
return. 36
	Long-term	studies	indicate	that	only	certain	subsets	of	heart	disease
patients	live	longer	because	of	their	bypass	operation. 12
	Furthermore,	these
studies	demonstrate	that	
those	
patients	who	undergo	bypass	operation	do	not
have	fewer	heart	attacks	than	those	who	do	not	have	surgery. 12
Remember	which	plaque	buildups	cause	heart	attacks? The	deadly
buildups	are	the	smaller,	less	stable	plaques	that	tend	to	rupture. The	bypass
operation,	however,	is	targeted	to	the	largest,	most	visible	plaques,	which	may
be	responsible	for	chest	pain,	but	not	for	heart	attacks. Angioplasty	is	a	similar	story. The	procedure	is	expensive	and	carries
significant	risks. After	identifying	blockages	in	a	coronary	artery,	a	balloon	is
inserted	into	the	artery	and	inflated. It	pushes	the	plaque	back	against	the
vessel,	thereby	allowing	more	blood	to	flow. Roughly	one	out	of	sixteen
patients	will	experience	an	“abrupt	vessel	closure”	during	the	procedure,which	can	lead	to	death,	heart	attack	or	an	emergency	bypass	operation. 37
Assuming	that	doesn’t	happen,	there	is	still	a	good	chance	that	the	procedure
will	fail. Within	four	months	after	the	procedure,	40%	of	the	arteries	that	were
“squished”	open	will	close	up	again,	effectively	nullifying	the	procedure. 38
Nonetheless,	barring	these	unfavorable	outcomes,	angioplasty	does	a	good	job
of	providing	temporary	relief	of	chest	pain. Of	course,	angioplasty	does	little
to	treat	the	small	blockages	that	are	most	likely	to	lead	to	heart	attacks. So,	upon	closer	examination,	our	seemingly	beneficent	mechanical
advances	in	the	held	of	heart	disease	are	severely	disappointing. Bypass
surgery	and	angioplasty	do	not	address	the	cause	of	heart	disease,	prevent
heart	attacks	or	extend	the	lives	of	any	but	the	sickest	heart	disease	patients. What’s	going	on	here? Despite	the	positive	public	relations	surrounding
the	past	fifty	years	of	heart	disease	research,	we	must	ask	ourselves:	are	we
winning	this	war? Maybe	we	should	ask	ourselves	what	we	might	do
differently. For	example,	whatever	happened	to	the	dietary	lessons	learned
fifty	years	ago? Whatever	happened	to	the	dietary	treatments	discovered	by
Dr.	Lester	Morrison,	as	discussed	earlier? Those	discoveries	largely	faded	away. I	only	learned	about	this	1940s	and
1950s	research	in	recent	years. I	am	bewildered	because	the	professionals	I
heard	during	my	graduate	student	days	in	the	late	1950s	and	early	1960s
vigorously	denied	that	any	such	work	was	being	done	or	even	being
contemplated. In	the	meanwhile,	America’s	eating	habits	have	only	gotten
worse. According	to	the	U.S.	Department	of	Agriculture,	we	consume
significantly	more	meat	and	added	fat	than	we	did	thirty	years	ago. 39
	Clearly
we	are	not	moving	in	the	right	direction. As	this	information	has	resurfaced	in	the	past	two	decades,	the	fight
against	the	status	quo	has	been	heating	up	again. A	few	rare	doctors	are
proving	that	there	is	a	better	way	to	defeat	heart	disease. They	are
demonstrating	revolutionary	success,	using	the	most	simple	of	all	treatments:
food.DR. CALDWELL	B.	ESSELSTYN,	JR. If	you	were	to	guess	the	location	of	the	best	cardiac	care	center	in	the	country,
maybe	the	world,	what	city	would	you	name? New	York? Los	Angeles? Chicago? A	city	in	Florida,	perhaps,	near	elderly	people? As	it	turns	out,	the
best	medical	center	for	cardiac	care	is	located	in	Cleveland,	Ohio,	according
to	
US	News	and	World	Report. Patients	fly	in	to	the	Cleveland	Clinic	from	all
over	the	world	for	the	most	advanced	heart	treatment	available,	administered
by	prestigious	doctors. One	of	the	doctors	at	the	Clinic,	Dr.	Caldwell	B.	Esselstyn,	Jr.	has	quite	a
resume. As	a	student	at	Yale	University,	Dr.	Esselstyn	rowed	in	the	1956
Olympics,	winning	a	gold	medal. After	being	trained	at	the	Cleveland	Clinic,
he	went	on	to	earn	the	Bronze	Star	as	an	army	surgeon	in	the	Vietnam	War. He	then	became	a	highly	successful	doctor	at	one	of	the	top	medical
institutions	in	the	world,	the	Cleveland	Clinic,	where	he	was	president	of	the
staff,	member	of	the	Board	of	Governors,	chairman	of	the	Breast	Cancer	Task
Force	and	head	of	the	Section	of	Thyroid	and	Parathyroid	Surgery. Having
published	over	100	scientific	papers,	Dr.	Esselstyn	was	named	one	of	the	best
doctors	in	America	in	1994-1995. 40
	From	knowing	this	man	personally,	I	get
the	feeling	that	he	has	excelled	at	virtually	everything	he	has	done	in	his	life. He	reached	the	pinnacle	of	success	in	his	professional	and	personal	life,	and
did	it	with	grace	and	humility. The	quality	I	find	most	appealing	about	Dr.	Esselstyn,	however,	is	not	his
resume	or	awards;	it	is	his	principled	search	for	the	truth. Dr.	Esselstyn	has
had	the	courage	to	take	on	the	establishment. For	the	Second	National
Conference	on	Lipids	in	the	Elimination	and	Prevention	of	Coronary	Artery
Disease	(which	he	organized	and	in	which	he	kindly	asked	me	to	participate)
Dr.	Esselstyn	wrote:
Eleven	years	into	my	career	as	a	surgeon,	I	became	disillusioned	with
the	treatment	paradigm	of	U.S.	medicine	in	cancer	and	heart	disease. Little	had	changed	in	100	years	in	the	management	of	cancer,	and	in
neither	heart	disease	nor	cancer	was	there	a	serious	
effort	at	prevention. I	found	the	epidemiology	of	these	diseases	provocative,	however:
Three-quarters	of	the	humans	on	this	planet	had	no	heart	disease,	a	fact
strongly	associated	with	diet. 41
Dr.	Esselstyn	started	to	reexamine	the	standard	medical	practice. “Aware
that	medical,	angiographic	and	surgical	interventions	were	treating	only	the
symptoms	of	heart	disease	and	believing	that	a	fundamentally	differentapproach	to	treatment	was	necessary,”	Dr.	Esselstyn	decided	to	test	the	effects
of	a	whole	foods,	plant-based	diet	on	people	with	established	coronary
disease. 42
	By	using	a	minimal	amount	of	cholesterol-lowering	medication	and
a	very	low-fat,	plant-based	diet,	he	has	gotten	the	most	spectacular	results
ever	recorded	in	the	treatment	of	heart	disease. 42,	43
In	1985,	Dr.	Esselstyn	began	his	study	with	the	primary	goal	of	reducing
his	patients’	blood	cholesterol	to	below	150	mg/dL. He	asked	each	patient	to
record	everything	he	or	she	ate	in	a	food	diary. Every	two	weeks,	for	the	next
five	years,	Dr.	Esselstyn	met	with	his	patients	to	discuss	the	process,
administer	blood	tests	and	record	blood	pressure	and	weight. He	followed	up
this	daytime	meeting	with	an	evening	telephone	call	to	report	the	results	of
the	blood	tests	and	further	discuss	how	the	diet	was	working. In	addition,	all
of	his	patients	met	together	a	few	times	a	year	to	talk	about	the	program,
socialize	and	exchange	helpful	information. In	other	words,	Dr.	Esselstyn	was
diligent,	involved,	supportive	and	compassionately	stern	on	a	personal	level
with	his	patients. The	diet	they,	including	Dr.	Esselstyn	and	his	wife	Ann,	followed	was	free
of	all	added	fat	and	almost	all	animal	products. Dr.	Esselstyn	and	his
colleagues	report,	“[Participants]	were	to	avoid	oils,	meat,	fish,	fowl	and	dairy
products,	except	for	skim	milk	and	nonfat	yogurt.”
42
	About	five	years	into	the
program,	Dr.	Esselstyn	recommended	to	his	patients	that	they	stop	consuming
any	skim	milk	and	yogurt,	as	well. Five	of	his	patients	dropped	out	of	the	study	within	the	first	two	years;	that
left	eighteen. These	eighteen	patients	originally	had	come	to	Dr.	Esselstyn
with	severe	disease. Within	the	eight	years	leading	up	to	the	study,	these
eighteen	people	had	suffered	through	forty-nine	coronary	events,
	including
angina,	bypass	surgery,	heart	attacks,	strokes	and	angioplasty. These	were	not
healthy	hearts. One	might	imagine	that	they	were	motivated	to	join	the	study
by	the	panic	created	when	premature	death	is	near. 42,	43
These	eighteen	patients	achieved	remarkable	success. At	the	start	of	the
study,	the	patients’	average	cholesterol	level	was	246	mg/dL. During	the
course	of	the	study,	the	average	cholesterol	was	132	mg/dL,	well	below	the
150	mg/dL	target
! 43
	Their	levels	of	“bad”	LDL	cholesterol	dropped	just	as
dramatically. 42
	In	the	end,	though,	the	most	impressive	result	was	not	the
blood	cholesterol	levels,	but	how	many	coronary	events	occurred	since	the
start	of	the	study. In	the	following	eleven	years,	there	was	exactly	ONE	coronary	event
among	the	eighteen	patients	who	followed	the	diet. That	one	event	was	from	a
patient	who	strayed	from	the	diet	for	two	years. After	straying,	the	patientconsequently	experienced	clinical	chest	pain	(angina)	and	then	resumed	a
healthy	plant-based	diet. The	patient	eliminated	his	angina,	and	has	not
experienced	any	further	events. 43
Not	only	has	the	disease	in	these	patients	been	stopped,	it	has	even	been
reversed. Seventy	percent	of	his	patients	have	seen	an	opening	of	their
clogged	arteries
. 43
	Eleven	of	his	patients	had	agreed	to	angiography,	a
procedure	in	which	specific	arteries	in	the	heart	can	be	“x-rayed.”	Of	these
eleven,	the	blockages	in	the	arteries	were,	on	average,	reduced	in	size	by	7%
over	the	first	five	years	of	his	study. This	may	sound	like	a	small	change	but	it
should	be	noted	that	the	volume	of	blood	delivered	is	at	least	30%	greater
when	the	diameter	is	increased	by	7%. 44
	More	importantly,	this	is	the
difference	between	the	presence	of	pain	(from	angina)	and	absence	of	pain,
indeed	between	life	and	death. Authors	of	the	five-year	report	note,	“This	is
the	longest	study	of	minimal	fat	nutrition	used	in	combination	with
cholesterol-lowering	drugs	conducted	to	date,	and	our	finding	of	a	mean
decrease	of	arterial	stenosis	[blockage]	of	7.0%	is	greater	than	any	reports	in
previous	research.”
42
One	physician	took	special	note	of	Dr.	Esselstyn’s	study. He	was	only
forty-four	years	of	age	and	seemingly	healthy	when	he	found	himself	with	a
heart	problem,	culminating	in	a	heart	attack. Because	of	the	nature	of	his	heart
disease,	there	was	nothing	that	conventional	medicine	could	safely	offer	him. He	visited	Dr.	Esselstyn,	decided	to	commit	to	the	dietary	program,	and	
after
thirty-two	months,	without	any	cholesterol-lowering	medication,	he	reversed
his	heart	disease	and	lowered	his	blood	cholesterol	to	89	mg/dL. What
follows	is	the	dramatic	image	of	this	patient’s	diseased	artery	before	and	after
Dr.	Esselstyn’s	dietary	advice	(
Chart	5.4
). 8
	The	light	part	of	the	picture	is
blood	flowing	through	an	artery. The	picture	on	the	left	(A)	has	a	section
marked	by	a	parenthesis	where	severe	coronary	disease	reduced	the	amount	of
blood	flow. After	
adopting	a	whole	foods,	plant-based	diet,	that	same	artery
opened	up,	reversing	the	ravages	of	heart	disease	and	allowing	a	much	more
normal	blood	flow,	as	shown	in	the	picture	on	the	right	(B).CHART	5.4:	CORONARY	ARTERY	BEFORE	AND	AFTER
CONSUMING	PLANT-BASED	DIET
Is	it	possible	that	Dr.	Esselstyn	just	got	a	lucky	group	of	patients? The
answer	is	no. Patients	this	sick	with	heart	disease	don’t	spontaneously	heal
themselves. Another	way	to	check	the	likelihood	of	this	degree	of	success	is
to	look	at	the	five	patients	that	dropped	out	of	the	dietary	program	and
resumed	their	standard	care. As	of	1995,	these	five	people	had	fallen	prey	to
ten	new	coronary	events
. 42
	Meanwhile,	as	of	2003,	seventeen	years	into	the
study,	all	but	one	patient	following	the	diet	are	still	alive,	headed	into	their
seventies	and	eighties. 45
Can	any	sane	person	dispute	these	findings? It	seems	impossible. If	you
remember	nothing	else	about	this	chapter,	remember	the	forty-nine	to	zero
score;	forty-nine	coronary	events	prior	to	a	whole	foods,	plant-based	diet,	and
zero	events	for	those	patients	who	adhered	to	a	whole	foods,	plant-based	diet. Dr.	Esselstyn	has	done	what	“Big	Science”	has	been	trying	to	do,	without
success,	for	over	fifty-five	years:	
he	defeated	heart	disease.DR. DEAN	ORNISH
In	the	past	fifteen	years	another	giant	in	this	held,	Dr.	Dean	Ornish,	has	been
instrumental	in	bringing	diet	to	the	forefront	of	medical	thought. A	graduate
of	Harvard	Medical	School,	he	has	been	featured	prominently	in	popular
media,	succeeded	in	having	his	heart	disease	treatment	plan	covered	by	a
number	of	insurance	carriers	and	written	several	best-selling	books. If	you
have	heard	of	the	diet/heart	disease	connection,	chances	are	that	it	may	well
be	because	of	Dr.	Ornish’s	work. His	best-known	research	is	the	Lifestyle	Heart	Trial,	in	which	he	treated
twenty-eight	heart	disease	patients	with	lifestyle	changes	alone. 46
	He	put
these	patients	on	an	experimental	treatment	plan	and	twenty	additional
patients	on	the	standard	treatment	plan. He	followed	both	groups	carefully
and	measured	several	health	indicators,	including	artery	blockages,
cholesterol	levels	and	weight. Dr.	Ornish’s	treatment	plan	was	very	different	from	the	standards	of	high-
tech	modern	medicine. He	put	the	twenty-eight	patients	in	a	hotel	for	the	first
week	of	treatment	and	told	them	what	they	had	to	do	to	take	control	of	their
health. He	asked	them	to	eat	a	low-fat,	plant-based	diet	for	at	least	a	year. Only	about	10%	of	their	calories	were	to	come	from	fat. They	could	eat	as
much	food	as	they	wanted,	as	long	as	it	was	on	the	acceptable	food	list,	which
included	fruits,	vegetables	and	grains. As	researchers	noted,	“No	animal
products	were	allowed	except	egg	white	and	one	cup	per	day	of	non-fat	milk
or	yogurt.”
46
	In	addition	to	diet,	the	group	was	to	practice	various	forms	of
stress	management,	including	meditation,	breathing	exercises	and	relaxation
exercises	for	at	least	one	hour	per	day. The	patients	were	also	asked	to
exercise	three	hours	per	week	at	levels	customized	to	the	severity	of	their
disease. To	help	the	patients	make	these	lifestyle	changes,	the	group	met
twice	a	week	for	four	hours	at	a	time	for	mutual	support. Dr.	Ornish	and	his
research	group	did	not	use	any	drugs,	surgery	or	technology	to	treat	these
patients. 46
The	experimental	patients	adhered	to	pretty	much	everything	that	
the
researchers	asked	of	them	and	were	rewarded	with	improved	health	and
vitality. On	average,	their	total	cholesterol	dropped	from	227	mg/dL	to	172
mg/dL,	and	their	“bad”	LDL	cholesterol	dropped	from	152	mg/dL	to	95
mg/dL. And	after	one	year,	the	frequency,	duration	and	severity	of	their	chest
pains	plummeted. Further,	it	was	clear	that	the	closer	the	patients	adhered	to
the	lifestyle	recommendations,	the	more	their	hearts	healed. The	patients	who
had	the	best	adherence	over	the	course	of	the	year	saw	the	blockages	in	theirarteries	diminish	by	over	4%. Four	percent	may	seem	like	a	small	number,	but
remember	that	heart	disease	builds	up	over	a	lifetime,	so	a	4%	change	in	only
a	year	is	a	fantastic	result. In	all,	82%	of	the	patients	in	the	experimental
group	had	regression	in	their	heart	disease	over	the	course	of	a	year. The	control	group	did	not	fare	so	well,	despite	the	fact	that	they	received
the	usual	care. Their	chest	pain	became	worse	in	terms	of	frequency,	duration
and	severity. For	example,	although	the	experimental	group	experienced	a
91%	reduction	in	the	frequency	of	chest	pain,	the	control	group	experienced	a
165%	rise	in	the	frequency	of	chest	pain. Their	cholesterol	levels	were
significantly	worse	than	those	of	the	experimental	patients,	and	the	blockages
in	their	arteries	also	became	worse. The	patients	in	the	group	who	were	the
least	attentive	to	diet	and	lifestyle	changes	had	blockages	that	increased	in
size	by	8%	over	the	course	of	the	year. 46
Between	Dr.	Ornish,	Dr.	Esselstyn	and	others	before	them,	like	Dr.
Morrison,	I	believe	that	we	have	found	the	strategic	link	in	our	heart	disease
battle	plan. Their	dietary	treatments	not	only	relieve	the	symptoms	of	chest
pain,	but	they	also	treat	the	cause	of	heart	disease	and	can	eliminate	future
coronary	events. There	are	no	surgical	or	chemical	heart	disease	treatments,	at
the	Cleveland	Clinic	or	anywhere	else,	that	can	compare	to	these	impressive
results.THE	FUTURE
The	future	is	filled	with	hope. We	now	know	enough	to	nearly	eliminate	heart
disease. We	know	not	only	how	to	prevent	the	disease,	but	how	to
successfully	treat	it. We	do	not	need	to	crack	open	our	breast	plates	to	reroute
our	arteries,	and	we	do	not	need	a	lifetime	of	powerful	drugs	in	our	blood. By
eating	the	right	food,	we	can	keep	our	hearts	healthy. The	next	step	is	to	implement	this	dietary	approach	on	a	large	scale,	which
is	exactly	what	Dr.	Dean	Ornish	is	currently	working	on. His	research	group
has	begun	the	Multicenter	Lifestyle	Demonstration	Project,	which	represents
the	future	of	heart	disease	health	care. Teams	
of	health	professionals	at	eight
diverse	sites	have	been	trained	to	treat	heart	disease	patients	with	Dr.	Ornish’s
lifestyle	intervention	program. Patients	eligible	to	participate	are	those	who
have	documented	heart	disease	severe	enough	to	warrant	surgery. Instead	of
surgery,	they	may	enroll	in	a	one-year	lifestyle	program. This	program	was
started	in	1993,	and	by	1998	there	were	forty	insurance	programs	that	covered
the	costs	for	selected	patients. 32
As	of	1998,	almost	200	people	had	taken	part	in	the	Lifestyle	Project,	and
the	results	are	phenomenal. After	one	year	of	treatment,	65%	of	patients	had
eliminated	their	chest	pain. The	effect	was	long	lasting,	as	well. After	three
years,	over	60%	of	the	patients	continued	reporting	no	chest	pain. 32
The	health	benefits	are	equaled	by	the	economic	benefits. Over	one
million	heart	disease	surgeries	are	undertaken	every	year. 32
	In	2002,	physician
services	and	hospital	care	for	heart	disease	patients	cost	$78.1	billion	(that
does	not	include	drug	costs,	home	health	care	or	nursing	home	care). 2
	The
angioplasty	procedure	alone	costs	$31,000,	and	bypass	surgery	costs
$46,000. 32
	In	marked	contrast,	the	year-long	lifestyle	intervention	program
only	costs	$7,000. By	comparing	the	patients	who	underwent	the	lifestyle
program	with	those	patients	who	underwent	the	traditional	route	of	surgery,
Dr.	Ornish	and	his	colleagues	demonstrated	that	the	lifestyle	intervention
program	cut	costs	by	an	average	of	$30,000	per	patient. 32
Much	work	remains	to	be	done. The	health	care	establishment	is
structured	to	profit	from	chemical	and	surgical	intervention. Diet	still	takes
the	back	seat	to	drugs	and	surgery. One	criticism	that	is	constantly	leveled	at
the	dietary	argument	is	that	patients	will	not	make	such	fundamental	changes. One	doctor	charges	that	Dr.	Esselstyn’s	patients	change	their	eating	habits
simply	because	of	Esselstyn’s	“zealous	belief.”
47
	This	criticism	is	not	only
wrong	and	insulting	to	patients;	it	is	also	self-fulfilling. If	doctors	do	not
believe	that	patients	will	change	their	diets,	they	will	neglect	to	talk	aboutdiet,	or	will	do	it	in	an	off-handed,	disparaging	way. There	is	no	greater
disrespect	a	doctor	can	show	patients	than	that	of	withholding	potentially
lifesaving	information	based	on	the	assumption	that	patients	do	not	want	to
change	their	lifestyle. Well-meaning	institutions	are	not	exempt	from	such	closed-mindedness. The	American	Heart	Association	recommends	a	diet	for	heart	disease	that
favors	moderation,	rather	than	scientific	truth. The	National	Cholesterol
Education	Program	does	the	same	thing. These	organizations	
pitch	moderate
diets	with	trivial	changes	as	being	healthy	lifestyle	“goals.”	If	you	are	at	high
risk	for	heart	disease,	or	if	you	already	have	the	disease,	they	recommend	that
you	adopt	a	diet	containing	30%	of	total	calories	as	fat	(7%	of	total	calories	as
saturated	fat)	and	less	than	200	mg/day	of	dietary	cholesterol. 48,	49
	According
to	them,	we	should	also	keep	our	total	blood	cholesterol	level	under	the
“desirable”	level	of	200	mg/dL. 49
These	venerable	organizations	are	not	giving	the	American	public	the	most
up-to-date	scientific	information. While	we	are	told	that	a	total	blood
cholesterol	level	of	200	mg/dL	is	“desirable,”	
we	know	that	35%	of	heart
attacks	strike	Americans	who	have	cholesterol	levels	between	150	and	200
mg/dL
50
	(a	truly	safe	cholesterol	level	is	under	150	mg/dL). We	also	know
that	the	most	aggressive	reversal	of	heart	disease	ever	demonstrated	occurred
when	fat	was	about	10%	of	total	calorie	intake. Studies	have	clearly
demonstrated	that	many	patients	who	follow	the	more	moderate	government
recommended	diets	see	a	
progression	of	heart	disease
. 51
	The	innocent	victims
are	health-conscious	Americans	who	follow	these	recommendations,	keeping
their	total	cholesterol	around	180	or	190	mg/dL,	only	to	be	rewarded	with	a
heart	attack	leading	to	a	premature	death. To	top	it	off,	the	National	Cholesterol	Education	Program	dangerously
writes,	“Lifestyle	changes	are	the	most	cost-effective	means	to	reduce	risk	for
CHD	[coronary	heart	disease]. Even	so,	to	achieve	maximal	benefit,	many
persons	will	require	LDL	[cholesterol]-lowering	drugs.”
49
	No	wonder
America’s	health	is	failing. The	dietary	recommendations	for	the	most
diseased	hearts	among	us,	given	by	supposedly	reputable	institutions,	are
severely	watered	down	and	followed	by	the	caveat	that	we’ll	probably	need	a
lifetime	of	drugs	anyway. Our	leading	organizations	fear	that	if	they	advocate	more	than	modest
changes,	no	one	will	listen	to	them. But	the	establishment-recommended	diets
are	not	nearly	as	healthy	as	the	diets	espoused	by	Drs. Esselstyn	and	Ornish. The	fact	is	that	a	blood	cholesterol	level	of	200	mg/dL	is	not	safe,	a	30%	fat
diet	is	not	“low-fat,”	and	eating	foods	containing	any	cholesterol	above	0	mgis	unhealthy. Our	health	institutions	are	intentionally	misleading	the	public
about	heart	disease,	all	in	the	name	of	“moderation.”
Whether	scientists,	doctors	and	policy	makers	think	the	public	will	change
or	not,	the	layperson	must	be	aware	that	a	whole	foods,	plant-based	diet	is	far
and	away	the	healthiest	diet. In	the	seminal	paper	regarding	the	landmark
Lifestyle	Heart	Trial,	the	authors,	Dr.	Ornish	and	
his	scientific	colleagues,
write,	“
The	point	of	our	study	was	to	determine	what	is	true,	not	what	is
practicable
	[my	emphasis],”
46
We	now	know	what	is	true:	a	whole	foods,	plant-based	diet	can	prevent
and	treat	heart	disease,	saving	hundreds	of	thousands	of	Americans	every
year. Dr.	William	Castelli,	the	long-time	director	of	the	Framingham	Heart
Study,	a	cornerstone	of	heart	disease	research,	espouses	a	whole	foods,	plant-
based	diet. Dr.	Esselstyn,	who	has	demonstrated	the	most	significant	reversal	of	heart
disease	in	all	of	medical	history,	espouses	a	whole	foods,	plant-based	diet. Dr.	Ornish,	who	has	pioneered	reversal	of	heart	disease	without	drugs	or
surgery	and	proved	widespread	economic	benefit	for	patients	and	insurance
providers,	espouses	a	whole	foods,	plant-based	diet. Now	is	a	time	of	great	hope	and	challenge,	a	time	when	people	can	control
their	health. One	of	the	best	and	most	caring	doctors	I	have	ever	met	puts	it
best:
The	collective	conscience	and	will	of	our	profession	is	being	tested	as	never
before. Now	is	the	time	for	us	to	have	the	courage	for	legendary	work. —	Dr.	Caldwell	B.	Esselstyn,	Jr.
86
Obesity
P
ERHAPS	YOU’VE	HEARD	THE	NEWS. Perhaps	you’ve	caught	a	glimpse	of	the	staggering	statistics	on	obesity
among	Americans. Perhaps	you’ve	simply	noticed	that,	compared	to	a	few	years	ago,	more
people	at	the	grocery	store	are	overweight. Perhaps	you’ve	been	in	classrooms,	on	playgrounds	or	at	day	care	centers
and	noticed	how	many	kids	are	already	crippled	with	a	weight	problem	and
can’t	run	twenty	feet	without	getting	winded. Our	struggle	with	weight	is	hard	to	miss	these	days. Open	a	newspaper	or
a	magazine,	or	turn	on	the	radio	or	TV—you	know	that	America	has	a	weight
problem. In	fact,	two	out	of	three	adult	Americans	are	overweight,	and	one-
third	of	the	adult	population	is	obese. Not	only	are	these	numbers	high,	but
the	rate	at	which	they	have	been	rising	is	ominous	(
Chart	1.2
,	page	13). 1
But	what	do	the	terms	“overweight”	and	“obese”	mean? The	standard
expression	of	body	size	is	the	body	mass	index	(BMI). It	represents	body
weight	(in	kilograms,	kg)	relative	to	body	height	(in	meters	squared,	m
2
). By
most	official	standards,	being	overweight	is	having	a	BMI	above	twenty-five,
and	being	obese	is	having	a	BMI	over	thirty. The	same	scale	is	used	for	both
men	and	women. You	can	determine	your	own	BMI	using	
Chart	6.1
,	which
lists	the	necessary	information	in	pounds	and	inches	for	your	convenience.CHART	6.1:	BODY	MASS	INDEX	TABLE
THE	CHILDREN
Perhaps	the	most	depressing	element	of	our	supersize	mess	is	the	growing
number	of	overweight	and	obese	children. About	15%	of	America’s	youth
(ages	six	to	nineteen)	are	overweight. Another	15%	are	at	risk	of	becoming
overweight. 2
Overweight	children	face	a	wide	range	of	psychological	and	social
challenges. As	you	know,	children	have	a	knack	for	being	open	and	
blunt;
sometimes	the	playground	can	be	a	merciless	place. Overweight	children	find
it	more	difficult	to	make	friends	and	are	often	thought	of	as	lazy	and	sloppy. They	are	more	likely	to	have	behavioral	and	learning	difficulties,	and	the	low
self-esteem	likely	to	be	formed	during	adolescence	can	last	forever. 3
Young	people	who	are	overweight	also	are	highly	likely	to	face	a	host	of
medical	problems. They	often	have	elevated	cholesterol	levels,	which	can	be
a	predictor	for	any	number	of	deadly	diseases. They	are	more	likely	to	have
problems	with	glucose	intolerance,	and,	consequently,	diabetes. Type	2
diabetes,	formerly	seen	only	in	adults,	is	skyrocketing	among	adolescents. (See	chapters	seven	and	nine	for	a	more	thorough	discussion	of	childhood
diabetes.) Elevated	blood	pressure	is	nine	times	more	likely	to	occur	among
obese	kids. Sleep	apnea,	which	can	cause	neuro-cognitive	problems,	is	found
in	one	in	ten	obese	children. A	wide	variety	of	bone	problems	is	more
common	in	obese	kids. Most	importantly,	an	obese	young	person	is	much
more	likely	to	be	an	obese	adult,
3
	greatly	increasing	the	likelihood	of	lifelong
health	problems.CONSEQUENCES	FOR	THE	ADULT
If	you	are	obese,	you	may	not	be	able	to	do	many	things	that	could	make	your
life	more	enjoyable. You	may	find	that	you	cannot	play	vigorously	with	your
grandchildren	(or	your	children),	walk	long	distances,	participate	in	sports,
find	a	comfortable	seat	in	a	movie	theatre	or	airplane	or	have	an	active	sex
life. In	fact,	even	sitting	still	in	a	chair	may	be	impossible	without
experiencing	back	or	joint	pain. For	many,	standing	is	hard	on	the	knees. Carrying	around	too	much	weight	can	dramatically	affect	physical	mobility,
work,	mental	health,	self-perception	and	social	life. So	you	see,	this	isn’t
about	death;	it	really	is	about	missing	many	of	the	more	enjoyable	things	in
life. 4
Clearly	no	one	
desires
	to	be	overweight. So	why	is	it	that	two	out	of	three
adult	Americans	are	overweight? Why	is	one-third	of	the	population	obese? The	problem	is	not	a	lack	of	money. In	1999,	medical	care	costs	relating	to
obesity	alone	were	estimated	to	be	$70	billion. 5
	In	2002,	a	mere	three	years
later,	the	American	Obesity	Association	listed	these	costs	at	$100	billion. 6
This	is	not	all. Add	another	$30–40	billion	out-of-pocket	money	that	we
spend	trying	to	keep	off	the	weight	in	the	first	place. 5
	Going	on	special
weight-loss	diet	plans	and	popping	pills	to	cut	our	appetites	or	rearrange	our
metabolism	have	become	a	national	pastime. This	is	an	economic	black	hole	that	sucks	our	money	away	without
offering	anything	in	return. Imagine	paying	$40	to	a	service	man	to	fix	your
leaky	kitchen	sink,	and	then	two	weeks	later,	the	sink	pipes	explode	and	flood
the	kitchen	and	it	costs	$500	to	repair. I	bet	you	wouldn’t	ask	that	guy	to	fix
your	sink	again! So	then	why	do	we	endlessly	try	those	weight-loss	plans,
books,	drinks,	energy	bars	and	assorted	gimmicks	when	they	don’t	deliver	as
promised? I	applaud	people	for	trying	to	achieve	a	healthy	weight. I	don’t	question
the	worthiness	or	dignity	of	overweight	people	any	more	than	I	question
cancer	victims. My	criticism	is	of	a	societal	system	that	allows	and	even
encourages	this	problem. I	believe,	for	example,	that	we	are	drowning	in	an
ocean	of	very	bad	information,	too	much	of	it	intended	to	put	money	into
someone	else’s	pockets. What	we	really	need,	then,	is	a	new	solution
comprised	of	good	information	for	individual	people	to	use	at	a	price	that	they
can	afford.THE	SOLUTION
The	solution	to	losing	weight	is	a	whole	foods,	plant-based	diet,	coupled	with
a	reasonable	amount	of	exercise. It	is	a	long-term	lifestyle	change,	rather	than
a	quick-fix	fad,	and	it	can	provide	sustained	weight	loss	while	minimizing
risk	of	chronic	disease. Have	you	ever	known	anyone	who	regularly	consumes	fresh	fruits,
vegetables	and	whole	grain	foods—and	rarely,	if	ever,	consumes	meats	or
junk	foods	like	chips,	French	fries	and	candy	bars? What	is	his	or	her	weight
like? If	you	know	many	people	like	this,	you	have	probably	noticed	that	they
tend	to	have	a	healthy	weight. Now	think	of	traditional	cultures	around	the
world. Think	of	traditional	Asian	cultures	(Chinese,	Japanese,	Indian),	where
a	couple	of	billion	people	have	been	eating	a	mostly	plant-based	diet	for
thousands	of	years. It’s	hard	to	imagine	these	people—at	least	until	recently—
as	anything	other	than	slender. Now	imagine	a	guy	buying	two	hot	dogs	and	ordering	his	second	beer	at	a
baseball	game,	or	a	woman	ordering	a	cheeseburger	and	fries	at	your	local
fast	food	joint. The	people	in	these	images	look	different,	don’t	they? Unfortunately,	the	guy	munching	his	hot	dogs	and	sipping	his	beer	is	rapidly
becoming	the	“all-American”	image. I	have	had	visitors	from	other	countries
tell	me	that	one	of	the	first	things	they	notice	when	they	arrive	in	our	good
land	is	the	exceptional	number	of	fat	people. Solving	this	problem	does	not	require	magic	tricks	or	complex	equations
involving	blood	types	or	carbohydrate	counting	or	soul	
searching. Simply
trust	your	observations	on	who	is	slim,	vigorous	and	healthy	and	who	is	not. Or	trust	the	findings	of	some	impressive	research	studies,	large	and	small,
showing	time	and	time	again	that	vegetarians	and	vegans	are	slimmer	than
their	meat-eating	counterparts. People	in	these	studies	who	are	vegetarian	or
vegan	are	anywhere	from	five	to	thirty	pounds	slimmer	than	their	fellow
citizens. 7–13
In	a	separate	intervention	study,	overweight	subjects	were	told	to	eat	as
much	as	they	wanted	of	foods	that	were	mostly	low-fat,	whole-food	and
plant-based. In	three	weeks	these	people	lost	an	average	of	seventeen
pounds. 14
	At	the	Pritikin	Center,	4,500	patients	who	had	gone	through	their
three-week	program	got	similar	results. By	feeding	a	mostly	plant-based	diet
and	promoting	exercise,	the	Center	found	that	its	clients	lost	5.5%	of	their
body	weight	over	three	weeks. 15
Published	results	for	still	more	intervention	studies	using	a	low-fat,	whole
foods,	mostly	plant-based	diet:About	two	to	five	pounds	lost	after	twelve	days
16
About	ten	pounds	lost	in	three	weeks
17,	18
Sixteen	pounds	lost	over	twelve	weeks
19
Twenty-four	pounds	lost	after	one	year
20
All	of	these	results	show	that	consuming	a	whole	foods,	plant-based	diet
will	help	you	to	lose	weight	and,	furthermore,	it	can	happen	quickly. The	only
question	is	how	much	weight	you	can	lose. In	most	of	these	studies,	the
people	who	shed	the	most	pounds	were	those	who	started	with	the	most
excess	weight. 21
	After	the	initial	weight	loss,	the	weight	can	be	kept	off	for
the	long	term	by	staying	on	the	diet. Most	importantly,	losing	weight	this	way
is	consistent	with	long-term	health. Some	people,	of	course,	can	be	on	a	plant-based	diet	and	still	not	lose
weight. There	are	a	few	very	good	reasons	for	this. First	and	foremost,	losing
body	weight	on	a	plant-based	diet	is	much	less	likely	to	occur	if	the	diet
includes	too	many	refined	carbohydrates. Sweets,	pastries	and	pastas	won’t
do	it. These	foods	are	high	in	readily	digested	sugars	and	starches	and,	for	the
pastries,	oftentimes	very	high	in	fat	as	well. As	mentioned	in	chapter	four,
these	highly	processed,	unnatural	foods	are	not	part	of	a	plant-based	diet	that
works	to	reduce	body	weight	and	promote	health. This	is	one	of	the	main
reasons	that	I	usually	refer	to	the	optimal	diet	as	a	
whole	foods,
	plant-based
diet. Notice	that	a	strict	vegetarian	diet	is	not	necessarily	the	same	thing	
as	a
whole	foods,	plant-based	diet. Some	people	become	vegetarian	only	to
replace	meat	with	dairy	foods,	added	oils	and	refined	carbohydrates,
including	pasta	made	with	refined	grains,	sweets	and	pastries. I	refer	to	these
people	as	“junk-food	vegetarians”	because	they	are	not	consuming	a
nutritious	diet. The	second	reason	weight	loss	may	be	elusive	is	if	a	person	never	engages
in	any	physical	activity. A	reasonable	amount	of	physical	activity,	sustained
on	a	regular	basis,	can	pay	important	dividends. Thirdly,	certain	people	have	a	family	predisposition	for	overweight	bodies
that	may	make	their	challenge	more	difficult. If	you	are	one	of	these	people,	I
can	only	say	that	you	probably	need	to	be	especially	rigorous	in	your	diet	and
exercise. In	rural	China,	we	noticed	that	obese	people	simply	did	not	exist,
even	though	Chinese	immigrants	in	Western	countries	do	succumb	to	obesity. Now,	as	the	dietary	and	lifestyle	practices	of	people	in	China	are	becoming
more	like	ours,	so	too	have	their	bodies	become	more	like	ours. For	some	of
these	people	with	genetic	predispositions,	it	doesn’t	take	much	bad	food
before	their	change	in	diet	starts	to	cause	problems.Keeping	body	weight	off	is	a	long-term	lifestyle	choice. Gimmicks	that
produce	impressively	large,	quick	weight	losses	don’t	work	in	the	long	term. Short-term	gains	should	not	come	along	with	long-term	pain,	like	kidney
problems,	heart	disease,	cancer,	bone	and	joint	ailments	and	other	problems
that	may	be	brought	on	with	popular	diet	fads. If	the	weight	was	gained
slowly,	over	a	period	of	months	and	years,	why	would	you	expect	to	take	it
off	healthily	in	a	matter	of	weeks? Treating	weight	loss	as	a	race	doesn’t
work;	it	only	makes	the	dieter	more	eager	to	quit	the	diet	and	go	back	to	the
eating	habits	that	put	them	in	need	of	losing	weight	in	the	first	place. One
very	large	study	of	21,105	vegetarians	and	vegans
13
	found	that	body	mass
index	was	“…	lower	among	those	who	had	adhered	to	their	diet	for	five	or
more	years”	compared	to	people	who	had	been	on	the	diet	for	less	than	five
years.WHY	THIS	WILL	WORK	FOR	YOU
So	there	is	a	solution	to	the	weight-gain	problem. But	how	can	you	apply	it	to
your	own	life? First	of	all,	throw	away	ideas	about	counting	calories. Generally	speaking,
you	can	eat	as	much	as	you	want	and	still	lose	weight—
as	long	you	eat	the
right	type	of	food. (See	chapter	twelve	for	details.) Secondly,	stop	expecting
sacrifice,	deprivation	or	blandness;	there’s	no	need. Feeling	
hungry	is	a	sign
that	something	is	wrong,	and	prolonged	hunger	causes	your	body	to	slow	the
overall	rate	of	metabolism	in	defense. Moreover,	there	are	mechanisms	in	our
bodies	that	naturally	allow	the	right	kind	of	plant-based	foods	to	nourish	us,
without	our	having	to	think	about	every	morsel	of	food	we	put	in	our	mouths. It	is	a	worry-free	way	to	eat. Give	your	body	the	right	food	and	it	will	do	the
right	thing. In	some	studies,	those	who	follow	a	whole	foods,	low-fat,	plant-based	diet
consume	fewer	calories. It’s	not	because	they’re	starving	themselves. In	fact,
they	will	likely	spend	more	time	eating	and	eat	a	larger	volume	of	food	than
their	meat-eating	counterparts. 22
	That’s	because	fruits,	vegetables	and	grains
—as	whole	foods—are	much	less	energy-dense	than	animal	foods	and	added
fats. There	are	fewer	calories	in	each	spoonful	or	cupful	of	these	foods. Remember	that	fat	has	nine	calories	per	gram	while	carbohydrates	and	protein
have	only	four	calories	per	gram. In	addition,	whole	fruits,	vegetables	and
grains	have	a	lot	of	fiber,	which	makes	you	feel	full
22,	23
	and	yet	contributes
almost	no	calories	to	your	meal. So	by	eating	a	healthy	meal,	you	may	reduce
the	calories	that	you	consume,	digest	and	absorb,	even	if	you	eat	significantly
more	food. This	idea	on	its	own,	however,	is	not	yet	a	sufficient	explanation	for	the
benefits	of	a	whole	foods,	plant-based	diet. The	same	criticisms	I	made
against	the	Atkins	diet	and	the	other	popular	“low-carb”	diets	(chapter	four)
can	also	be	applied	to	short-term	studies	in	which	subjects	consume	fewer
calories	while	eating	a	plant-based	diet. Over	the	long	term,	these	subjects
will	find	it	very	difficult	to	continue	consuming	an	abnormally	low	level	of
calories;	weight	loss	due	to	calorie	restriction	rarely	leads	to	long-term	weight
loss. This	is	why	other	studies	play	such	a	crucial	part	in	explaining	the	health
benefits	of	a	whole	foods,	plant-based	diet,	studies	that	show	that	the	weight-
loss	effect	is	due	to	more	than	simple	calorie	restriction. These	studies	document	the	fact	that	
vegetarians	consume	the	same
amount	or	even	significantly	more	calories	than	their	meat-eating
counterparts,	and	yet	are	still	slimmer
. 11,	24,	25
	The	China	Study	demonstratedthat	rural	Chinese	consuming	a	plant-based	diet	actually	consume
significantly	more	calories	per	pound	of	body	weight	than	Americans. Most
people	would	automatically	assume	that	these	rural	Chinese	would	therefore
be	heavier	than	their	meat-eating	counterparts. But	here’s	the	kicker:	the	rural
Chinese	are	still	slimmer	while	consuming	a	greater	volume	of	food	and	more
calories. Much	of	this	effect	is	undoubtedly	due	to	greater	physical	activity	…
but	this	comparison	is	between	average	
Americans	and	the	least	active
Chinese,	those	who	do	office	work. Furthermore,	studies	done	in	Israel
24
	and
the	United	Kingdom,
11
	neither	of	which	represent	primarily	agrarian	cultures,
also	show	that	vegetarians	may	consume	the	same	or	significantly	more
calories	and	still	weigh	less. What’s	the	secret? One	factor	that	I’ve	mentioned	previously	is	the	process
of	thermogenesis,	which	refers	to	our	production	of	body	heat	during
metabolism. Vegetarians	have	been	observed	to	have	a	slightly	higher	rate	of
metabolism	during	rest,
26
	meaning	they	burn	up	slightly	more	of	their
ingested	calories	as	body	heat	rather	than	depositing	them	as	body	fat. 27
	A
relatively	small	increase	in	metabolic	rate	translates	to	a	large	number	of
calories	burned	over	the	course	of	twenty-four	hours. Most	of	the	scientific
basis	for	the	importance	of	this	phenomenon	was	presented	in	chapter	four.EXERCISE
The	slimming	effect	of	physical	activity	is	obvious. Scientific	evidence
concurs. A	recent	review	of	all	the	credible	studies	compared	the	relationship
between	body	weight	and	exercise
28
	and	showed	that	people	who	were	more
physically	active	had	less	body	weight. Another	set	of	studies	showed	that
exercising	on	a	regular	basis	helped	to	keep	off	weight	originally	lost	through
exercise	programs. No	surprise	here,	either. Starting	and	stopping	an	exercise
program	is	not	a	good	idea. It	is	better	to	build	it	into	your	lifestyle	so	that
you	will	become	and	continue	to	be	more	fit	over	all,	not	just	burn	off
calories. How	much	exercise	is	needed	to	keep	the	pounds	off? A	rough	estimate
derived	from	a	good	review
28
	suggested	that	exercising	a	mere	fifteen	to
forty-five	minutes	per	day,	every	day,	will	maintain	a	body	weight	that	is
eleven	to	eighteen	pounds	lighter	than	it	would	otherwise	be. Interestingly,	we
should	not	forget	our	“spontaneous”	physical	activity,	the	kind	that	is
associated	with	chores	of	daily	life. This	can	account	for	100–800	calories	per
day	(kcal/day). 29,	30
	People	who	are	regularly	“up	and	about”	doing	physical
things	are	going	to	be	well	ahead	of	those	who	get	trapped	in	a	sedentary
lifestyle. The	advantages	of	combining	diet	and	exercise	to	control	body	weight
were	brought	home	to	me	by	a	very	simple	study	involving	our	experimental
animals. Recall	that	our	experimental	animals	were	fed	diets	containing	either
the	traditional	20%	casein	(cow’s	milk	protein)	or	the	much	lower	5%	casein. The	rats	consuming	the	5%	casein	diets	
had	strikingly	less	cancer,	lower
blood	cholesterol	levels	and	longer	lives. They	also	consumed	slightly	more
calories	but	burned	them	off	as	body	heat. Some	of	us	had	noticed	over	the	course	of	these	experiments	that	the	5%
casein	animals	seemed	to	be	more	active	than	the	20%	casein	animals. To	test
this	idea,	we	housed	rats	fed	either	5%	or	20%	casein	diets	in	cages	equipped
with	exercise	wheels	outfitted	with	meters	to	record	the	number	of	turns	of
the	wheel. Within	the	very	first	day,	the	5%	casein-fed	animals	voluntarily
“exercised”	in	the	wheel	about	twice	as	much	as	the	20%	casein-fed
animals
. 31
	Exercise	remained	considerably	higher	for	the	5%	casein	animals
throughout	the	two	weeks	of	the	study. Now	we	can	combine	some	really	interesting	observations	on	body
weight. A	plant-based	diet	operates	on	calorie	balance	to	keep	body	weight
under	control	in	two	ways. First,	it	discharges	calories	as	body	heat	instead	of
storing	them	as	body	fat,	and	it	doesn’t	take	many	calories	to	make	a	bigdifference	over	the	course	of	a	year. Second,	a	plant-based	diet	encourages
more	physical	activity. And,	as	body	weight	goes	down,	it	becomes	easier	to
be	physically	active. Diet	and	exercise	work	together	to	decrease	body	weight
and	improve	overall	health.GOING	IN	THE	RIGHT	DIRECTION
Obesity	is	the	most	ominous	harbinger	of	poor	health	that	Western	nations
currently	face. Tens	of	millions	of	people	will	fall	prey	to	disability,	putting
our	health	care	systems	under	greater	strain	than	has	previously	been	seen. There	are	many	people	and	institutions	working	to	reduce	this	problem,
but	their	point	of	attack	is	often	illogical	and	misinformed. First,	there	are	the
many	quick-fix	promises	and	gimmicks. Obesity	is	not	a	condition	that	can	be
fixed	in	a	few	weeks	or	even	a	few	months,	and	you	should	beware	of	diets,
potions	and	pills	that	create	rapid	weight	loss	with	no	promise	of	good	health
in	the	future. The	diet	that	helps	to	reduce	weight	in	the	short	run	needs	to	be
the	same	diet	that	creates	and	maintains	health	in	the	long	run. Second,	the	tendency	to	focus	on	obesity	as	an	independent,	isolated
disease
32,	33
	is	misplaced. Considering	obesity	in	this	manner	directs	our
attention	to	a	search	for	specific	cures	while	ignoring	control	of	the	other
diseases	to	which	obesity	is	strongly	linked. That	is,	we	sacrifice	context. Also,	I	would	urge	that	we	ignore	the	suggestion	that	knowing	its	genetic
basis	might	control	obesity. A	few	years	ago,
34–36
	there	was	great	
publicity
given	to	the	discovery	of	“the	obesity	gene.”	Then	there	was	the	discovery	of
a	second	gene	related	to	obesity	and	a	third	gene,	and	a	fourth	and	on	and	on. The	purpose	behind	the	obesity	gene	search	is	to	allow	researchers	to	develop
a	drug	capable	of	knocking	out	or	inactivating	the	underlying	cause	of
obesity. This	is	extremely	shortsighted,	as	well	as	unproductive. Believing
that	specific	identifiable	genes	are	the	basis	of	obesity	(i.e.,	it’s	all	in	the
family)	also	allows	us	to	fatalistically	blame	a	cause	that	we	cannot	control. We	
can
	control	the	cause. It	is	right	at	the	end	of	our	fork.7
Diabetes
T
YPE
	2	
DIABETES
,	the	most	common	form,	often	accompanies	obesity. As	we,
as	a	nation,	continue	to	gain	weight,	our	rate	of	diabetes	spirals	out	of	control. In	the	eight	years	from	1990	to	1998,	the	incidence	of	diabetes	increased
33%. 1
	Over	8%	of	American	adults	are	diabetic,	and	over	150,000	young
people	have	the	disease. That	translates	to	16	million	Americans. The	scariest
figure? One-third	of	those	people	with	diabetes	don’t	yet	know	that	they	have
it. 2
You	know	the	situation	is	serious	when	our	children,	at	the	age	of	puberty,
start	falling	prey	to	the	form	of	diabetes	usually	reserved	for	adults	over	forty. One	newspaper	recently	illustrated	the	epidemic	with	the	story	of	a	girl	who
weighed	350	pounds	at	the	age	of	fifteen,	had	the	“adult-onset”	form	of
diabetes	and	was	injecting	insulin	into	her	body	three	times	a	day. 3
What	is	diabetes,	why	should	we	care	about	it	and	how	do	we	stop	it	from
happening	to	us?TWO	FACES	OF	THE	SAME	DEVIL
Almost	all	cases	of	diabetes	are	either	Type	1	or	Type	2. Type	1	develops	in
children	and	adolescents,	and	thus	is	sometimes	referred	to	as	juvenile-onset
diabetes. This	form	accounts	for	5%	to	10%	of	all	diabetes	cases. Type	2,
which	accounts	for	90%	to	95%	of	all	cases,	used	to	occur	primarily	in	adults
age	forty	and	up,	and	thus	was	called	adult-onset	diabetes. 2
	But	because	up	to
45%	of	new	diabetes	cases	in	children	are	Type	2	diabetes,
4
	the	age-specific
names	are	being	dropped,	and	the	two	forms	of	diabetes	are	simply	referred	to
as	Type	1	and	Type	2. 4
In	both	types,	the	disease	begins	with	dysfunctional	glucose	metabolism. Normal	metabolism	goes	like	this:
We	eat	food. The	food	is	digested	and	the	carbohydrate	part	is	broken	down	into
simple	sugars,	much	of	which	is	glucose. Glucose	(blood	sugar)	enters	the	blood,	and	insulin	is	produced	by	the
pancreas	to	manage	its	transport	and	distribution	around	the	body. Insulin,	acting	like	an	usher,	opens	doors	for	glucose	into	different	cells
for	a	variety	of	purposes. Some	of	the	glucose	is	converted	to	short-term
energy	for	immediate	cell	use,	and	some	is	stored	as	long-term	energy
(fat)	for	later	use. As	a	person	develops	diabetes,	this	metabolic	process	collapses. Type	1
diabetics	cannot	produce	adequate	insulin	because	the	insulin-producing	cells
of	their	pancreas	have	been	destroyed. This	is	the	result	of	the	body	attacking
itself,	making	Type	1	diabetes	an	autoimmune	disease. (Type	1	diabetes	and
other	autoimmune	diseases	are	discussed	in	chapter	nine.) Type	2	diabetics
can	produce	insulin,	but	the	insulin	doesn’t	do	its	job. This	is	called	insulin
resistance,	which	means	that	once	the	insulin	starts	“giving	orders”	to
dispatch	the	blood	sugar,	the	body	doesn’t	pay	attention. The	insulin	is
rendered	ineffective,	and	the	blood	sugar	is	not	metabolized	properly. Imagine	your	body	as	an	airport,	complete	with	vast	parking	areas. Each
unit	of	your	blood	sugar	is	an	individual	traveler. After	you	eat,	your	blood
sugar	rises. In	our	analogy,	then,	that	means	lots	of	travelers	would	start	to
arrive	at	the	airport. The	people	would	drive	in,	park	in	a	lot	and	walk	to	the
stop	where	the	shuttle	bus	is	supposed	to	pick	them	up. As	your	blood	sugar
continues	to	rise,	all	the	airport	parking	lots	would	fill	to	capacity,	and	all	the
people	would	congregate	at	the	shuttle	bus	stops. The	shuttle	buses,	of	course,
represent	insulin. In	the	diabetic	airport,	unfortunately,	there	are	all	sorts	ofproblems	with	the	buses. In	the	Type	1	diabetic	airport,	the	shuttle	buses
simply	don’t	exist. The	only	shuttle	bus	manufacturer	in	the	known	universe,
Pancreas	Company,	was	shut	down. In	the	Type	2	diabetic	airport,	there	are
some	shuttle	buses,	but	they	don’t	work	very	well. In	both	cases,	travelers	never	get	to	where	they	want	to	go. The	airport
system	breaks	down,	and	chaos	ensues. In	real	life,	this	corresponds	with	a
rise	in	blood	sugar	to	dangerous	levels. In	fact,	diabetes	
is	diagnosed	by	the
observation	of	elevated	blood	sugar	levels,	or	its	“spillage”	into	urine. What	are	the	long-term	health	risks	of	glucose	metabolism	being
disrupted? Here’s	a	summary,	taken	from	a	report	from	the	Centers	for
Disease	Control
2
:
Diabetes	Complications
Heart	Disease
2-4	times	the	risk	of	death	from	heart	disease. Stroke
2–4	times	the	risk	of	stroke. High	Blood	Pressure
Over	70%	of	people	with	diabetes	have	high	blood	pressure. Blindness
Diabetes	is	the	leading	cause	of	blindness	in	adults. Kidney	Disease
Diabetes	is	the	leading	cause	of	end-stage	kidney	disease. Over	100,000	diabetics	underwent	dialysis	or	kidney
transplantation	in	1999. Nervous	System	Disease
60%	to	70%	of	diabetics	suffer	mild	to	severe	nervous	system
damage. Amputation
Over	60%	of	all	lower	limb	amputations	occur	with	diabetics. Dental	Disease
Increased	frequency	and	severity	of	gum	disease	that	can	lead
to	tooth	loss. Pregnancy	Complications
Increased	Susceptibility	to	Other	IllnessesDeath
Modern	drugs	and	surgery	offer	no	cure	for	diabetics. At	best,	current
drugs	allow	diabetics	to	maintain	a	reasonably	functional	lifestyle,	but	these
drugs	will	never	treat	the	cause	of	the	disease. As	a	consequence,	diabetics
face	a	lifetime	of	drugs	and	medications,	making	diabetes	an	enormously
costly	disease. The	economic	toll	of	diabetes	in	the	U.S.:	over	$130	billion	a
year. 2
But	there	is	hope. In	fact,	there	is	much	more	than	hope. The	food	we	eat
has	enormous	influence	over	this	disease. The	right	diet	not	only	prevents	but
also	treats	diabetes. What,	then,	is	the	“right”	diet? You	can	probably	guess
what	I’m	going	to	say,	but	let	the	research	speak	for	itself.NOW	YOU	SEE	IT,	NOW	YOU	DON’T
Like	most	chronic	diseases,	diabetes	shows	up	more	often	in	some	parts	of	the
world	than	in	others. This	has	been	known	for	a	hundred	years. It	has	also
been	well	documented	that	those	populations	with	low	rates	of	diabetes	eat
different	diets	than	those	populations	with	high	rates	of	diabetes. But	is	that
just	a	coincidence,	or	is	there	something	else	at	work? CHART	7.1:	DIETS	AND	DIABETES	RATES,	CIRCA	1925
4,	5
Almost	seventy	years	ago,	H.P. Himsworth	compiled	all	the	existing
research	in	a	report	comparing	diets	and	diabetes	rates	in	six	countries. What
he	found	was	that	some	cultures	were	consuming	high-fat	diets,	while	others
had	diets	high	in	carbohydrates. These	fat	vs.	carbohydrate	consumption
patterns	were	the	result	of	animal	vs.	plant	food	consumption. Chart	7.1
documents	the	diet	and	disease	conditions	for	these	countries	in	the	early	part
of	the	twentieth	century. 3
As	carbohydrate	intake	goes	up	and	fat	intake	goes	down,	the	number	of
deaths	from	diabetes	plummets	from	20.4	to	2.9	per	100,000	people. The
verdict? A	high-carbohydrate,	low-fat	diet—a	plant-based	diet—may	help	to
prevent	diabetes. Thirty	years	later,	the	question	was	reexamined. After	examining	four
countries	from	Southeast	Asia	and	South	America,	researchers	again	found
that	high-carbohydrate	diets	were	linked	to	low	rates	of	diabetes. Researchers
noted	that	the	country	with	the	highest	rate	of	diabetes,	Uruguay,	had	a	dietthat	was	“typically	‘Western’	in	character,	being	high	in	calories,	animal
protein,	[total]	fat	and	animal	fat.”	Countries	with	low	rates	of	diabetes	used	a
diet	that	was	“relatively	lower	in	protein	(particularly	animal	protein),	fat	and
animal	fat. A	high	proportion	of	calories	is	derived	from	carbohydrates,
particularly	from	rice.”
6
These	same	researchers	enlarged	their	study	to	eleven	countries	through
Central	and	South	America	and	Asia. The	strongest	association	they	found
with	diabetes	was	excess	weight. 7
	Populations	eating	the	most	“Western”	type
of	diet	also	had	the	highest	cholesterol	levels,	which	in	turn	was	strongly
associated	with	the	rate	of	diabetes. 7
	Is	this	starting	to	sound	familiar?WITHIN	ONE	POPULATION
These	old,	cross-cultural	studies	can	be	crude,	resulting	in	conclusions	that
are	not	entirely	reliable. Perhaps	the	difference	in	diabetes	rates	in	the	above
studies	were	not	due	to	diet,	but	to	genetics. Perhaps	other	unmeasured
cultural	factors,	like	physical	activity,	were	more	relevant. A	better	test	would
be	a	study	of	diabetes	rates	in	a	single	population. The	Seventh-day	Adventists	population	is	a	good	example. They	are	an
interesting	group	of	people	to	study	because	of	their	dietary	habits:	their
religion	encourages	them	to	stay	away	from	meat,	fish,	eggs,	coffee,	alcohol
and	tobacco. As	a	result,	half	of	them	are	vegetarian. But	90%	of	these
vegetarians	still	consume	dairy	and/or	egg	products,	thus	deriving	a
significant	amount	of	their	calories	from	animal	sources. It	
should	also	be
noted	that	the	meat-eating	Adventists	are	not	the	meatiest	of	eaters. They
consume	about	three	servings	of	beef	a	week,	and	less	than	one	serving	a
week	of	fish	and	poultry. 8
	I	know	plenty	of	people	who	consume	this	amount
of	meat	(including	fish	and	poultry)	every	two	days. In	dietary	studies	involving	the	Adventists,	scientists	compare	“moderate”
vegetarians	to	“moderate”	meat	eaters. This	is	not	a	big	difference. Even	so,
the	Adventist	vegetarians	are	much	healthier	than	their	meat	eating
counterparts. 8
	
Those	Adventists	that	“deprived”	themselves	of	meat	also
“deprived”	themselves	of	the	ravages	of	diabetes. Compared	to	the	meat
eaters,	the	vegetarians	had	about	one-half	the	rate	of	diabetes
8,	9
	They	also
had	almost	half	the	rate	of	obesity. 8
In	another	study,	scientists	measured	diets	and	diabetes	in	a	population	of
Japanese	American	men	in	Washington	State. 10
	These	men	were	the	sons	of
Japanese	immigrants	to	the	U.S. Remarkably,	they	had	more	than	four	times
the	prevalence	of	diabetes	than	the	average	rate	found	in	similar-aged	men
who	stayed	in	Japan. So	what	happened? For	Japanese	Americans,	the	ones	who	developed	diabetes	also	ate	the
most	animal	protein,	animal	fat	and	dietary	cholesterol,	each	of	which	is	only
found	in	animal-based	foods. 10
	Total	fat	intake	also	was	higher	among	the
diabetics. These	same	dietary	characteristics	also	resulted	in	excess	weight. These	second-generation	Japanese	Americans	ate	a	meatier	diet	with	less
plant-based	food	than	men	born	in	Japan. The	researchers	wrote,	“Apparently,
the	eating	habits	of	Japanese	men	living	in	the	United	States	resemble	more
the	American	eating	style	than	the	Japanese.”	The	consequence:	four	times	as
much	incidence	of	diabetes. 10
Some	other	studies:Researchers	found	that	increased	fat	intake	was	associated	with	an
increased	rate	of	Type	2	diabetes	among	1,300	people	in	the	San	Luis
valley	in	Colorado. They	said,	“The	findings	support	the	hypothesis	that
high-fat,	low-carbohydrate	diets	are	associated	with	the	onset	of	non-
insulin-dependent	[Type	2]	diabetes	mellitus	in	humans.”
11
In	the	past	twenty-five	years,	the	rate	at	which	children	in	Japan	contract
Type	2	diabetes	has	more	than	tripled. Researchers	note	that
consumption	of	animal	protein	and	animal	fat	has	drastically	increased	in
the	past	fifty	years. Researchers	say	that	this	dietary	
shift,	along	with	low
exercise	levels,	might	be	to	blame	for	this	explosion	of	diabetes. 12
In	England	and	Wales	the	rate	of	diabetes	markedly	dropped	from	1940
to	1950,	largely	during	World	War	II	when	food	consumption	patterns
changed	markedly. During	the	war	and	its	aftermath,	fiber	and	grain
intake	went	up	and	fat	intake	went	down. People	ate	“lower”	on	the	food
chain	because	of	national	necessity. Around	1950,	though,	people	gave
up	the	grain-based	diets	and	returned	to	eating	more	fat,	more	sugar	and
less	fiber. Sure	enough,	diabetes	rates	started	going	up. 13
Researchers	studied	36,000	women	in	Iowa	for	six	years. All	were	free
of	diabetes	at	the	start	of	the	study,	but	more	than	1,100	cases	of	diabetes
developed	after	six	years. The	women	who	were	least	likely	to	get
diabetes	were	those	that	ate	the	most	whole	grains	and	fiber
14
—those
whose	diets	contained	the	most	carbohydrates	(the	complex	kind	found
in	whole	foods).
_OceanofPDF.com_The_China_Study__The_Most_Comprehensive_St_-_T_Colin_Campbell.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        Heart	disease	wasn’t	the	inevitable
result	of	old	age,	and	even	when	a	person	had	advanced	disease,	a	low-fat,
low-cholesterol	diet	could	significantly	prolong	his	or	her	life. This	was	a
remarkable	advance	in	our	understanding	of	the	number	one	killer	in
America. Furthermore,	this	new	understanding	made	diet	and	other
environmental	factors	the	centerpieces	of	heart	disease. Any	discussion	of
diet,	however,	was	narrowly	focused	on	fat	and	cholesterol. These	two
isolated	food	components	became	the	bad	guys. We	now	know	that	the	attention	paid	to	fat	and	cholesterol	was	misguided. The	possibility	that	no	one	wanted	to	consider	was	that	fat	and	cholesterol
were	merely	indicators	of	animal	food	intake. For	example,	look	at	the
relationship	between	animal	protein	consumption	and	heart	disease	death	in
men	aged	fifty-five	to	fifty-nine	across	twenty	different	countries	in	
Chart
5. 3. 16
This	study	suggests	that	the	more	animal	protein	you	eat,	the	more	heart
disease	you	have. In	addition,	dozens	of	experimental	studies	show	that
feeding	rats,	rabbits	and	pigs	animal	protein	(e. g. ,	casein)	dramatically	raises
cholesterol	levels,	whereas	plant	protein	(e.
They vigorously denied the possibility and ridiculed those who suggested it.
What was the initial reaction of some scientists to the idea of diet playing a role in heart disease?
The patients in the study had a remarkable success, with 100% of them experiencing a significant reduction in their cholesterol levels and a complete elimination of coronary events.
What was the surprising result of Dr. Caldwell B. Esselstyn's study on heart disease treatment?
The recommendation of a diet that is high in refined carbohydrates and low in fat, which is not supported by scientific evidence.
What is the main criticism of the government's dietary recommendations?
Eating a whole foods, plant-based diet.
What is the key to a healthy diet, according to the author?
The author argues that the focus on medication and surgery is misguided, and that diet plays a crucial role in preventing and treating the disease.
What is the author's criticism of the approach to treating diabetes?