Introduction:
More Than Coronary artery Disease (continued)
Medicine must focus, as never before, on how to support personal behavior modification. Exercise, smoking cessation, and moderation in alcohol consumption are integral parts of this strategy, but space permits me to focus only on diet.
With its lack of fiber and antioxidants, and its emphasis on animal protein, fat, and extreme free- radical production, the US diet is largely responsible for the bitter harvest of diseases mentioned above. Dr. Robert Kradjian has said that our single most important interface with our environment is the cell membrane, which is 1 one-thousandth of 1 micrometer (10--8 m) thin.'0 This delicate interface is subjected to irreversible metabolic injury with each and every Western meal. We define this summation of injury as a disease, whether it be cancer, vascular disease, diabetes, or some other condition.
How will we get this message to the public? In the case of smoking cessation, physician behaviors have been admirable, and as a group, we have contributed greatly to the reduction of tobacco consumption. Whether we can achieve these same inroads with plant-based nutrition remains to be seen.
One great stumbling block has been the government and national health organizations that support the target of 30% dietary fat and a cholesterol level <200 mg/dL. The First National Conference on the Elimination and Prevention of Coronary Artery Disease concluded that these guidelines did not offer the best chances to arrest and reverse coronary artery disease, essentially corroborating what the government' s own scientists had said in the 1989 epic Diet and Health. Namely, greater health benefits would be derived from even less fat than the 30% recommendation. The reason given for not advocating lower levels was that it might frustrate the public, who would have difficulty maintaining a lower level. It seems to me that the public's greatest frustration would come from not being informed of the optimal diet for health.
Now, at this second conference 6 years later, there is additional support for the need for further lipid reduction. It is time for these organizations to re evaluate their recommendations of a cholesterol level <200 mg/dL and a diet composed of <30% fat. It is time for a concerted and consistent effort to inform the public and the medical profession of what the existing data show will be most optimal.
In many cultures, coronary disease is practically unheard of when total serum cholesterol levels are 90--150 mg/dL. We cannot continue to have public and private organizations on the forefront of health leadership recommend to the public a dietary plan that
guarantees that millions will perish from the very disease the guidelines were supposed to prevent. If we are to truly shift the paradigm from only technologic intervention to prevention, then significant lifestyle changes are needed and justified.
I am acutely aware of the castigation that accompanies recommending a plant-based diet--namely that the recommendation will be met with skepticism and hostility on the part of the general public. This attitude is peculiar, because many cultures sustain themselves with such a diet, enjoying its taste, texture, and vanity, as well as its health-promoting qualities. How ever, diet preference is deeply personal, and one can easily be offended. Nevertheless, the public has a right to know the truth as understood by experts in nutritive biology about what constitutes the safest and healthiest diet.
Some criticize this exclusively plant-based diet as extreme or draconian. Webster's dictionary defines draconian as "inhumanly cruel." A closer look reveals that "extreme~~ or "inhumanly cruel" describes not plant- based nutrition, but the consequences of our present Western diet. Having a sternum divided for bypass surgery or a stroke that renders one an aphasic invalid can be construed as extreme, and having a breast, prostate, colon, or rectum removed to treat cancer may seem inhumanly cruel. These diseases are rarely seen in populations consuming a plant-based diet.
We are presently witnessing a meltdown of the tobacco industry. Science and the public are aware that using addictive tobacco products exactly as advertised often leads to irreversible illness and death. The data of Drs. Berenson and McGill, defining the ravages of atherosclerosis in the young, tempt one to place cheeseburgers, steak, and cold cuts under similar scrutiny, since these and similar foods' composition destroy the vascular health of the young, as well as of adults.
The next step toward rectangularization of the survival curve involves personal lifestyle changes--par amount being a plant-based diet. This is not vegetarianism. Vegetarians often consume oils, margarine, and animal products such as milk, cream, butter, cheese, ice cream, and eggs. This new paradigm is exclusively plant-based nutrition.
Technology will have little place in this new preventive paradigm. It will be people--physicians and allied health personnel with the knowledge, patience, powers of persuasion, and communications skills--who will en able this transition. Assistance in this endeavor from government agencies, national health organizations, insurance companies, and culinary institutes is welcome and needed. The very foundation of the healing arts, a bastion of integrity, mandates that we define for our patients and the public this opportunity to avoid these common chronic and killer diseases through practical, achievable personal choices.