In the past 30 years there have been many articles written about coffee – initially stating it was associated with higher risks of pancreatic and other cancers.  Cardiologists for years have been telling patients to cut down or eliminate coffee from their diets. But more studies have come out to refute that early data, and coffee appears to be be ok.

The New England Journal of Medicine reported, “the National Cancer Institute researchers turned to data on 402,260 adults who were between the ages of 50 and 71 when they joined the NIH-AARP Diet and Health Study in 1995 and 1996. The volunteers were followed through December 2008 or until they died — whichever came first.” The researchers found that, “compared with men who didn’t drink any coffee at all, those who drank just one cup per day had a 6% lower risk of death during the course of the study; those who drank two to three cups per day had a 10% lower risk, and those who had four to five cups had a 12% lower risk.”

Neal D. Freedman, a National Cancer Institute researcher and the study’s lead author, said, “It offers some reassurance for coffee drinkers,” but “we shouldn’t say coffee is a fountain of youth or anything like that. The biggest concern for a long time has been that drinking coffee is a risky thing to do. Our results, and some of those of more recent studies, provide reassurance for coffee drinkers that this isn’t the case.” Individuals “who are regularly drinking coffee have a similar risk of death as nondrinkers, and there might be a modest benefit.”

Coffee drinkers also were a little less likely to die from specific causes: heart disease, respiratory problems, strokes, injuries and accidents, diabetes and infections. About two-thirds of study participants drank regular coffee, and the rest, decaf. The type of coffee made no difference in the results.

Early on the results indicated that coffee drinkers were at a higher risk, until they removed those patients who smoked. Once that factor was taken care of it appeared that people who drink 4-6 cups of coffee per day had longer lifespan than those who didn’t drink coffee.

As with all population studies correlation does not equal causation – that is, what we know is that coffee consumption doesn’t adversely effect longevity, but it may not improve it either. Nor do we know if there is a single, or multiple factors in the coffee that are responsible for those having less incidence of heart disease, lung disease, infections, or cancer.

Coffee isn't all bad

Forks over Knives, a movie whose theme is in the title: food will replace surgical scalpels for cancer, heart disease, obesity, type 2 diabetes, and others.  Their answer is a “plant based” diet (Vegan).  The movie provides three live anecdotes to prove this, and star T. Colin Campbell and  Caldwell Esselstyn, Jr whose careers intersected with both having come to the same conclusion that a vegan lifestyle would eliminate heart disease, perhaps cancer, obesity, and other chronic illness.

The two stars of the movie, answering questions at its opening

The movie started with lots of video of obese people, and the movie ended with most of the people in the movie sitting down having a friendly, plant-based meal: great cinematic contrast as this small band of people fighting diseases by eating plants.

Some consider this movie  a documentary, especially those who advocate the whole plant (Vegan) lifestyle. It is not a documentary, a documentary is non-fiction, this is a movie, it is a hope, it is an unproven hypothesis.  As much as we (physicians) would love food to solve medical problems, and there is no doubt food can cause problems, but food, as medicine is another matter.

We are introduced to the narrator, Lee Fulkerson, who presents himself to a clinic while smoking a cigarette and having left behind two empty cans of an energy drink, and stating he earlier drank  a large cup of coffee.  The clinic is a family owned clinic  where the physicians, Drs. Matthew Lederman and Alona Pulde, promote a vegan lifestyle and will shop with the patients, cook with the patients, and watch their laboratory values improve. By the end of the film the narrator has lost weight, improved cholesterol, and improved his cardiac risk factors (they don’t tell you that the main reason for that improvement is he stopped smoking).

Lee Fulkerson looking over his lab results with Dr. Lederman

Much like the narrator doesn’t tell you that removing cigarettes, and weight loss were the primary improvement, the entire movie has a tendency to gloss over points, data, and misrepresent biology.

The good points of the movie are:

(1)  The doctors

It is great to see the physicians who take time with patients to change and impact their lives. Drs. Esselstyn, Matthew Lederman, and Alona Pulde whose fundamental belief in prevention is to impact what a patient eats. If you believe that food makes that fundamental impact on health, these physicians make a tremendous investment in their time to helping these patients. Many of us are teaching patients how to cook, and what to cook and more physicians are taking the course at Culinary Institute/Harvard to learn to these skills.  Changing lifestyle, spending time with patients, and having a positive impact is the ideal of primary care medicine.

Dr. Lederman and Pulde are a great team in this movie

(2)  Eating Healthier

Eating healthier is better than eating junk. No doubt the lady who ate her share of donuts into a heart attack helped herself by avoiding donuts. Whether she would have done just as well following a paleolithic diet as a vegan diet is debatable

Told she had to go to a rocker, Ms. Oswick found Dr. Esselstyn, and now lives without her donuts and chocolate

(3)   Feel Good Story

Watching a heartfelt good story: seeing people’s health improves, feeling better, and being more fit is a great story. Seeing physicians working to that end, as well as advocates of that position

The Incomplete Data
Cholesterol: The notions of cholesterol were not only out of date, but incorrect.  Early on the narrator states that cholesterol is what forms the plaques in the arteries of the body. To quote, “But when we consume dietary cholesterol, which is only found in animal foods like meat, eggs, and dairy products, it tends to stay in the bloodstream. This so-called plaque is what collects on the inside of our blood vessels and is the major cause of coronary artery disease.” This is not how plaque forms, and dietary cholesterol is far less important.  It may be that both T. Colin Campbell and Esselstyn were both trained in the era when cholesterol was thought to be the cause of the arterial plaques.  It isn’t and there are more discussions about this here.  Some people,  who have minor elevations of lipids,  can lower their lipid level (I avoid saying cholesterol because that is just not what we need to be talking about here)  through diet, exercise, and weight loss alone, but before throwing away medications and eating plants they should be  carefully monitored by their physician.

This is not a “minor slip up” in the movie- this is the first tenant of a plant based diet. It is also dangerously incorrect. Dietary cholesterol is avoided in a plant based diet, but a plant based diet does not avoid plaque in arteries.

The now clean arterial plaque:
One of Dr. Esselstyn associates had a heart attack- and they show the angiogram of his coronary arteries after the heart attack. You see the smooth arteries around this and then the ragged artery that caused the heart attack. After time on the plant based diet another angiogram was taken- and behold the artery is now clean.

Left is a clot, the artery on the right is free of clot - it is NOT reversed disease

This is misdirection to the viewers.  What they are seeing in that ragged artery is the remains of the clot in the artery that caused the heart attack. If a person survives, within a few days on aspirin that clot will disappear.  The associate credits Dr. Esselstyn with saving his life, by putting him on the plant based diet. But the misdirection is egregious, planned, and is often replicated on many websites that advocate a plant based diet — they will either show an artery of someone who had a heart attack with remaining clot, and then show a clean artery- or they will give you a slightly different two dimensional view of the artery that is more favorable.

The Norway Data
Dr. Esselstyn then shows the data of mortality from heart attacks and strokes of World War 2 Norway, which drops dramatically after the Nazi take over, and confiscate the meat supply.

The death rate dropped before the Nazi's took the Norwegians meats

The first question one would ask — if this is true, if by removing meat you immediately see a drop in strokes and heart attacks?  That is the implication. The problem is that Dr. Esselstyn’s conclusion about the data is missing a few points that might clarify the data:

The decrease in wartime heart disease and strokes was replaced with an increase in mortality from infectious disease, trauma (in war people tend to fire more bullets) – and in particular outbreaks of TB. The meats from the livestock were not taken by the Nazis until after this graph showed the dramatic decline (hence the drop was not because of less meat being consumed, in fact during this drop Norwegians consumed more meat  because the Nazis had told the Norwegians they were going to confiscate their livestock, so many Norwegians simply slaughtered their animals and didn’t raise new ones the following year. Meat consumption during this “fall in the graph” was almost double what it was during normal times.

The fish consumption during these times doubled. Not that eating more fish will decrease coronary disease (except in large population series this is a trend).

While others have pointed out that sugar consumption decreased, wheat consumption decreased and thus they became a paleo society with an emphasis on fish (thought Norwegians were Lutherans and turned out they were Pescatarians) – it is a long stretch that any single change in a diet would cause a single year dramatic decrease in cardiac mortality and strokes (but would be great if it did). It fits the theme of the movie that the change to a Vegan diet will, within a year, dramatically alter years of coronary artery accumulation of plaque – it won’t.

Dr. Campbell’s cancer study:
Rats given more milk protein have more “foci” of cancer than rats fed less milk protein. Several issues with this study, and those conclusions.  First, it wasn’t that the rats lived longer- they didn’t.  The rats died from being a part of an experiment, and some rats died before they were suppose to– those rats all were the rats getting less of “mothers milk protein.”

Campbell takes the one milk protein  and generalizes it to all animal proteins. Why? Proteins are chains of amino acids, and there is some magic about how a plant puts the amino acids together than an animal?  Casein is a bio-active group of proteins found in milk- it stimulates tissues to grow, which is what you want mother’s milk to do- it is not just a source of nutrition but is a “bioactive protein” meaning it helps to turn on certain proteins.  Take a rat liver, put it with a super high concentration of a protein that turns on proteins, and then add a cancer causing agent –well, it makes sense. But remember, these rats had better looking livers than the low protein rats (who died faster). Also  whey protein, another milk protein, has been demonstrated to have some opposite effect with tumor.  Some proteins are bio-active, and have effects when given in super concentrated form and isolated from their natural counter parts – like whey, they behave in not natural ways. Then to use this to make global conclusions about animal proteins is not science, it is prejudice. I discussed Dr. Campbell’s assumptions here.

Dr. Esselstyn’s patients:
Dr. Esselstyn took a bunch of patients with heart disease, convinced them to go on a Vegan diet (initially the group was allowed to have dairy til he met Dr Campbell then no dairy). Of this small group, six people dropped out. You can see more about his works on my previous post regarding him and this study.

While the study seems great, and they bring out two individuals who were a part of the original study (I think- they don’t really say that, and since the movie tends to gloss over details quite a bit one cannot make assumptions).

What is remarkable is that Dr. Esselstyn met with these patients every couple of weeks in his home. One sweet lady who had two heart attacks before 59 while eating a diet of chocolate and “every donut I could get my hands on and lots of gravy.” She also noted that Dr. Esselstyn, in spite of his “kind eyes” was quite strict “there’s the door.” That may explain why 6 of the original 24 dropped out.  Of the remaining 18 the math gets a bit fuzzy. 6 had “evidence of regression of disease” 11 stabilized.  But it turns out that Dr. Esselstyn’s math as presented was off, and not surprising, the data in this movie is driven by making a point, and not by precise details.

Esselstyn’s publication states he started with 22 patients, five dropped out, and six stayed on the diet but never came back for data collection—leaving Esselstyn with only 11 people in the study. The data from the  11 had  stabilization of their heart disease, but four people  had lesions that slightly progressed. The paper then looks at the method of regression of plaque, and these methods are now considered out-dated and of no use.

The high drop out rate could mean people either could not tolerate the diet, or died, or were asked to leave. The other issue is these patients had other interventions, such as statin agents that really do reduce arterial plaque formation. Esselstyn’s paper that does not rise to the evidence based medicine for major research. It is quite small, highly selective of the patients, not controlled for other interventions with heart disease (some patients had angioplasties, heart surgeries, and etc) – thus we cannot determine which intervention for this small group of individuals worked, if any. Why Esselstyn didn’t keep the other drop-outs on to serve as a control is deeply flawed.  Throughout the years on this diet variables changed – such as removing dairy products, and even if there was a dietary answer to heart disease, it would be lost in the details.

As a personal anecdote, my father had a heart attack in 1979, was forced to retire at age 55, did not have angioplasty (not available then) and loves sugar, ice cream, peanut butter, meat,  cheese, but he stopped smoking, retired, and 33 years later (and a few stents and an implantable defibrillator later). Looking at his previous angiograms- his disease has regressed (in spite of not being on a plant based diet, not being on a paleo diet, and not probably eating things that most diet zealots would shun). That is a series of 1, not 11 – but has as much validity as Esselstyn’s work.  The question is, was it diet that did this for these 11 people? What happened to the others? What does this mean? The answer is that this is as much of an anecdote as my dad is.

The China Project
T. Collin Campbell, a physiologist, calls this massive study the highlight of his career.  With his Chinese counterpart, Dr. Chen,  they took the simple hypothesis: diet effects disease rate.  By choosing rural villages with stable diets, and known health and mortality statistics assumptions could be made about how diet effects health.

Campbell and Chen with their monograph

The film shows the proud researchers, with reams of data, and the NY Times Jane Brody column (Brody is not an authority figure but the implication that the NY Times said this was a good study is another logical fallacy called “appeal to authority.”).

There are major problems with the China Study – the blood samples of all individuals was pooled and studied – avoiding individual variation. The statistics for heart disease in rural villages in the 1970′s (they used this data for their study) was imperfect at best, and if you ask Chinese cardiologists today the current statistics – 30 years later – are poor.  Heart disease is underestimated now, and even more 30 years ago. The same with cancer statistics, and most rural Chinese statistics.

The China Study has been uniquely reviewed and dissected by  Denise Menger of rawfoodsos.com.  She points out how the data sometimes shows the opposite of what is stated (much like this movie).  For example, the meat eaters of one village had lower levels of the diseases.

OVERALL
This is a movie, and not a documentary. This is a movie that advocates a plant based (Vegan) diet will solve heart disease, cancer, and other ailments- and presents inadequate and skewed data to that end. To be clear, there is no substantial data that proves their point, and the data they use is skewed if not outright incorrect.  It is a warm, feel good movie with some great people.

IF you wish to have a whole plant diet – then do so..  If you think you can throw your medicine away and just eat plants, do not do this without medical supervision – and by that I mean the MD or DO who prescribed the medication for you, or a physician that will monitor your blood levels of lipids, glucose, etc.

Offit's lead editorial in the May issue of JAMA - profound

Paul Offit’s editorial in The Journal of the American Medical Association (JAMA. 2012;307(17):1803-1804.)  goes through the history of the National Center for Complementary and Alternative Medicine(NCCAM) and nicely points out that studies funded by NCCAM have failed to prove that complementary or alternative therapies have any more benefit than placebos.

Offit points out how NCCAM spent $374,000 proving lemon and lavender scents do not promote wound healing, $750,000 to prove that prayer does not cure AIDS, or improve recovery from breast reconstruction; $390,000 to find that ancient Indian remedies do not control type 2 diabetes, $700,000 to find that magnets to not treat arthritis or even carpal tunnel syndrome; and $406,000 to show that coffee enemas do not cure pancreatic cancer.

As much as we would love to find the new treatment that is available in your grocery store, or Ace Hardware, or Starbucks – it just has not been found.

Still, proponents of acupuncture, homeopathy, naturopathy, and even HCG diets, insist they have proof it is always in their own journals, with less than rigorous studies, and never reproduced in major medical journals. But clearly, science is less important to those who take these “treatments” than the potential of placebo effect.

This Month's art is called "Circus Side show" Appropriate for NCCAM

Offit points out that while many drugs today were originally derived from plants (aspirin, quinine, digitalis, and artemisinin ) – the funding from NCCAM is not about finding the next great herb, isolating the ingredient, and then working out the chemistry. Instead NCCAM seems to be spending money on studies that reasonable people would laugh at, and know that they will lead to no improvement in the health and well being of our citizens.

Projects that funded programs are recruiting for include:
So I went to NCCAM website to see what sorts of programs they are funding and would they be, on the simple sniff test, something that would make sense in an era when we have a limited number of research dollars. Here is what I found:

A Pilot Study of Acupuncture Treatment for Dysphagia:
No study to date has found a use for acupuncture, why they keep looking is beyond me.

Antioxidant Therapy to Reduce Inflammation in Sickle Cell Disease:
Science is clear that most antioxidants are inactive when they leave the stomach, basic chemistry 101, and antioxidants have never been proven beneficial in any disease yet so why we continue to put money into this is proof that Snake Oil Salesmen abound.

Hypnosis for Hot Flashes Among Postmenopausal Women in a Randomized Clinical Trial:
How you randomize for this, do you have non-hypnotized women?
Patient Response to Spinal Manipulation – Pilot Study:
Spinal manipulation again, while massage has proven worth, spinal manipulation never has and it is an embarrassment that we allow chiropractors to be anything more than a historical footnote.
Probiotic Lactobacillus GG (LGG) in Patients with Minimal Hepatic Encephalopathy:
So you get a bunch of bad liver patients together, give them a dose of bacteria that won’t reach the colon and think you have a study. Amazing how probiotics have caught the attention of the public and marketers when we know  they are essentially useless unless done through a fecal transplant via colonoscopy.

Quantification of Outcome Measures for Mind-body Interventions:
How do you quantify the mind? What is mind over matter – and how come it doesn’t work when you have a real issue like an automobile accident or traumatic stab wound to the heart

Sauna Detoxification Study: Pilot Feasibility:
Ok, my ancestors from Norway love Saunas, but they detoxify nothing. Sweat glands in saunas cool people by simple sweat that is sodium chloride- there have never proven to be toxins in any sweat, in spite of what “ancient Chinese medicine” might think

We need regulation for supplements and Alternative Medicines

Better yet, if NCCAM would develop a registry where various herbal supplements that are sold would be noted, and tested to see if there is actually the ingredients that they state are. Then serve as a registry for adverse events, something the FDA is prohibited from doing. Because of the Dietary Supplement Health and Education Act of 1994 the FDA has no role in regulation of these items. But having a registry where reports of adverse events could be noted would be helpful. Manufacturers are not required to submit safety information before marketing “dietary supplements,” so only after multiple adverse events can the FDA act. Since the FDA is prohibited from monitoring and regulating Alternative medicine products, the public is virtually unprotected against supplements and herbs that are unsafe.

The article goes on to show that clear evidence that there is no efficacy or therapeutic value to these supplements does not stop people from buying them. This is further need that those individuals will consume anything with a label of “natural” or “organic” or perhaps endorsed by their guru, be it Mercola, or Dr. Oz, or Dr. Weil.  Regulation to allow these supplements to be tested, standards of manufacturing to avoid contamination, and a registry where health problems from the supplements occur may help protect these individuals from their worst enemy – themselves.

We as physicians, however, have a duty to our patients- a strong ethical duty of beneficence. Some mistake our ethic as “do no harm,” but it is not that. Treatments (medications, surgery) have known side effects and a risk-benefit ratio. Having a side effect does not violate beneficence as they are expected. However, if we prescribe a treatment that we know has no beneficial effect, we violate one of the basic tenants of a physician’s ethics. While government agencies do not have  ethics- physicians do, and I hope the physicians who sit on NCCAM take their ethics seriously.

I hate going to funerals, especially to funerals for a teen-ager.  What made this funeral worse, was I had to pronounce her. I didn’t even recognize her when I did. The daughter of good friends, came into my trauma service, dead on arrival- not a thing we could do- and only an hour later when I heard that my good friends daughter had died in a car accident did it hit home—that was the little girl I had known for years, now 19 years old, killed in a wreck.

Allie died 15 years ago and it all came back to me when my brother-in-laws son, Austin, was in an accident – he walked away, and so did everyone else. But the feelings of a senseless life lost, well, they never go away.

So here is the message: You are going to buy your teen a car, and you think- “I’ll buy them an old beater.” –DON’T.  Instead, buy them the car that has the most advanced collision avoidance technology you can get.  It won’t be the car they want, it will be a car more expensive than yours, but its your kid.

My son is almost 2, and in 14 years he will be getting a car.  When my brother-in-laws son, Austin, got in a wreck I could only imagine what Bob felt.  Thankfully all walked away but the truck.  As I leaned details of the wreck it was clear, a collision avoidance system would have avoided the wreck entirely.

Some people say “The old cars were made of steel, that’s what you need, an old truck would not have been totaled.” That is true- but the energy of impact if it is not absorbed by the truck Austin was driving, would have been absorbed by his body.  So having a new truck saved him.

As a trauma surgeon I saw too many teenagers die in automobile accidents – some as little as 25 miles per hour.  I also saw teenagers come in who walked away from major collisions – and they walked away because they were in the right automobile.

Here are the new features that are put in the collision avoidance technology:

Radar sensors that trigger the brakes if you are getting to close to the car in front of you—had Austin’s truck had this he would not have had the impact he did. These features also trigger an alert that tightens seat-belts, adjusts headrests, and close windows.

Lane alerts – that tell you not to change lanes because someone is in your blind spot.

Adaptive cruise control that sensors the traffic ahead of you to keep you at a safe following distance.

Teenagers do not react as adults do, they don’t drive as safely as adults do, and their brains are not yet developed. In some ways they over-react to collision systems.  Having a smart car that does this for you is helpful.

So, if you have a son or daughter that needs a new car – don’t get the old beater- get the one that has the most collision avoidance systems you can obtain. These are starting to appear in some cars like the Ford Taurus, but have been available in the Volvo series for a while.

So yes, your son or daughter might not get the car they want, but they will get the car they need – and if they do get into an accident, they will be much better protected.

A doctor of Chinese medicine, diagnosing me

Today if you get a degree in Traditional Chinese Medicine (TCM) in Beijing you will read from the original text of Li Shi Chen who first categorized the pharmacy of TCM 500 years ago. He put together various herbs and portions that are used by the Traditional Chinese Medicine (TCM) physicians even today. Using the “argument to antiquity” TCM will state that these have been used for 5000 years, and are still  of value for treating a variety of ailments.
Many of the medications prescribed in the United States today were not available when I graduated medical school in 1986. Cleaning out my desk I found samples of Viox, now off the market, a once highly touted pain medication. Vioxx came to the market in 1999, and was one of the most widely prescribed pain medicines until a few cases of cardiac deaths convinced the FDA to pull it from the market in 2004. Medications change in the modern world of medicine, we get more effective, better and less toxic alternatives. If a physician today only used medicine from 500 years ago  they would lose their medical license:

Mercury:
In China and Tibet it was thought to prolong life, help heal fractures. Mercury was so revered that the tomb of the first Emperor of China, Qin, has “rivers of mercury” so he would have a good after life. In the west it was used as a treatment for infections including syphilis.

Arsenic
Hippocrates (460-377 BCE) used arsenic as medicine. Galen (130-200 ACE) recommended arsenic to treat ulcers. In the 19th century arsenicals were used to treat acne. In the early 1900’s physicians were using arsenicals to treat pellagra and malaria, and was the mainstay treatment for syphilis until penicillin.

Morphine
A potent pain reliever was once bottled as Mrs. Winslow’s Soothing Syrup, used to keep babies quiet, and for teething. While it kept the children quiet during the Victorian Era, when children were to be seen and not heard, it may have led to  addiction at the least and some children died from overdosing.

Snake Oil
A liniment used for arthritis – and sold widely by “snake oil salesmen.” Once it was discovered that it didn’t work very well (has a bad odor also).

Old in medicine does not translate to effective, or tested, or non-toxic. Still people get the impression that TCM is not harmful, and can be used since it has been used for over 5000 years. But TCM is harmful in several ways:
Two British women who took a Chinese herbal remedy called Mu Tong have renal failure and need kidney transplants. They remedies were found to contain aristolochic acid, toxic to kidneys. Dr. Graham Lord, a consultant kidney specialist from the Hammersmith and Charing Cross Hospitals NHS Trust last year stated, “We have no idea how many people consumed this herb, but there are hundreds of Chinese herbal medicine clinics in Britain, so the number is probably substantial.”
A DNA analysis of some traditional Chinese medicines found that they contained DNA of endangered animal species. Researchers at Murdoch University in Australia found samples contained DNA from animals listed as “trade-restricted” according to the Convention on International Trade in Endangered Species Legislation. Animals clearly died for their use in TCM.

Many things are used in Chinese medicine, some endangered

The rhinoceros is nearly extinct because its horn, used in Traditional Chinese medicine, is highly prized. When the rhino horn is ground into a powder, the 16th century Chinese pharmacist Li Shi Chen said it could cure snakebites, typhoid, headaches, vomiting, and food poisoning.  Contrary to popular belief it is not prescribed as an aphrodisiac. Tested, high doses can lower fevers in rats, however, Tylenol is cheaper, works better, and does not endanger a species. The last rhinoceros of one species in South Africa was slaughtered – bled to death by removing the horn with a chain saw. There is still, in South Africa an abundance of white rhinoceros, although they are still killed for their horn.
The dose of the medication is unknown. Different plants, herbs, and species have different levels of active ingredients in them. Some ingredients, even if they have an effective dose, that dose cannot be determined without chemical analysis. You could get a dose that is ineffective, a dose that is effective, or a dose that is toxic.

TCM represents a group of medicines that have been classified in the 16th century, and have not been updated since that time. The argument to antiquity would not work with modern medicine here, as the Food and Drug Administration is keeping America safe.

A contrast TCM with modern medicine is seen in the Yew Tree. The Yew Tree is highly poisonous and was found to have an anti-cancer agent, now called Taxol, which is used to treat ovarian Cancer. Taxol was purified from the Yew tree initially and now is chemically synthesized without using the now endangered species of Yew Trees. However, TCM still uses extracts of Yew Trees for their medicines. From the synthesized taxol, and number of chemical modifications have been done to provide more effective anti-cancer agents, with lower toxicity to humans. Practitioners of TCM might point to this as a win, however, ground bark from the Yew tree to treat ovarian cancer would have only two results: either ineffective or toxic.

To diagnose a patient needing medications western medicine uses comprehensive physical examinations in combination with laboratory tests, perhaps x-ray tests such as the CAT scan. TCM physicians will look at the palms of your hands, as they prescribe herbs from Tibet, without having the foggiest notion of what the herbs/dried rhino horns/ bear gallbladders, or whatever potions, come from.

They diagnose based on the palm

Finally, the older something is does not mean that it is better. When it comes to medicine it often means it is worse. TCM fails with a part of their argument to antiquity when they cannot even substantiate how long the medicines have been used, nor can they point to any good trials of the medicines. If your doctor used a western medical text that is over 10 years old it would be considered out of date, as would the doctor. It is time that the world realize that TCM is out-of-date, ineffective, possibly toxic, and a threat to endangered plants and animals.

I look forward to the People’s Republic of China taking control of this group and forcing them to comply with standards of safety for their people and the people of the world.

The Huffington Post is at it again- by promoting a nutrition quiz from the Physicians Committee for Responsible Medicine (PCRM).  One would think that a group like PCRM would be a responsible group, with a website that would have credible information. However, PCRM is a vegan organization that promotes an anti-dairy, anti-meat, anti-seafood, anti-egg diet, and the purpose of their quiz was to help evoke those ideas.  They have also sent out news releases that are bias to  a vegetarian diet and argues for it with half-truths that do little to advance their position, and a lot to reduce their credibility.

Recent breaking news quoted a paper in that indicated that fish oil did not prevent recurrence of heart problems and “evidence fails to support their use.”  PCRM did not include the conclusion:

“However, a diet high in fatty fish (≥2 servings of marine fish per week) should continue to be recommended for the general population and for patients with existing CVD because fish not only provides omega-3 fatty acids but also may replace less healthy protein sources, such as red meat.”

PCRM is anti-fish, as well as anti-dairy, and they fail to note that the American Heart Association recommendations for two meals a day being replaced by fish.

Recently PCRM released another study showing E. Coli was in 48% of chicken bought in 10 cities by their group. What they failed to state was that the E.Coli was not the type that causes humans illness.  Further, the major outbreaks of food-borne illness have recently come from produce and peanuts – as they are grown in soil that contains E. Coli. and can be contaminated with salmonella.  There are many types of bacteria in the soil, and E. coli is a common soil bacteria, but it is not the same type as that which comes from feces.

If you were a Vegan this might be your view of food

Here is their quiz with Science and Evidence based medicine rebuttal:

(1) Skim milk has the same amount of calories as cola

Yes, they are anti-dairy, and this is suppose to scare people into thinking that dairy is bad. For those who can tolerate milk, those who are not lactose intolerant, milk is a great source of nutrients.  Cola, not so much. They say all you need is water, nothing else – and we agree, however,  milk can have plenty of nutrients in them and should not be over looked.

(2) Cheese and steak have the same amount of cholesterol.

The first question you should ask is- so what? Dietary cholesterol has a minimal effect on the blood level of  the body’s cholesterol, we have known this since I was in medical school ( 1980’s). You can see my last post about fats to see more. That different amounts of cheese as well as a porterhouse steak have the same amount of cholesterol means nothing.  Very few physicians look simply at the cholesterol level, unless it is either very high >250 – and then we look at the underlying lipid profiles.

(3) Cheese is 70% fat.

Some cheese is, but again, cheese in moderation is not a bad thing. Some cheese is not  70% fat. By the way, most nuts, which this group advocates, are also 70% fat. They go on to say that Americans are eating three times the cheese we did in the 1970′s – probably not the case for some. Cheese is something that should be used in moderation – as it is dense with calories

(4) Frequent consumption of hot dogs and bacon makes it more likely you will get colon cancer.

In the one study, that has many flaws, if you eat a diet rich in processed meats your risk of cancer is higher- by a small amount. But that is a correlation, and not necessarily a causation, and when you work out the statistics, your chance of eating that much (a lot ) is not much, and your chance of getting cancer from it is – well, we don’t know. We don’t advocate eating a lot of processed any food. They state that the recommended amount of processed meats would be “none” – we would disagree, as do bacon lovers everywhere.  The correlation is so small with this as to be stretched.

(5) Women who regularly eat soy have a lower cancer risk.

This is not necessarily so.   Comparison studies have been mixed- so the answer is, we don’t know.  PCRM based their information about population studies from Asia- but other factors these women have include (a) less obesity (b) more physically active (c) drink less alcohol (d) eat more fruits and vegetables. Until the issue becomes clearer, many doctors recommend that women who take hormonal therapy or who have estrogen-receptor-positive breast cancer avoid soy supplements because they contain high concentrations of isoflavones. But in general, it’s fine to eat moderate amounts of soy foods as part of a balanced diet. One to 3 servings of soy a day (a serving is about a half cup) is similar to an average Japanese woman’s daily soy intake. If you are taking hormonal therapy to fight off a hormone-receptor-positive breast cancer, and you are concerned about any phytoestrogen effects, ask your doctor or registered dietitian about how much soy you can eat.

(6) Salmon has cholesterol and fat

Ah yes it does, and to repeat- consuming cholesterol is not the issue. Salmon fat is high in omega-3 fatty acids and quite healthy. Eskimos and maritime Native Americans had a diet rich in salmon and the lowest rate of heart disease on earth.  There is not convincing evidence to advocate taking fish-oil capsules, there is still evidence that replacing two meals a week with fish is protective for the heart.

(7) An egg has more cholesterol than a Big Mac

Cholesterol is not an issue in diet but the 540 calories in a Big Mac compared to the 90 calories in a large egg is. The calories in a Big Mac come from 29 grams of fat, while only 5 grams of fat from an egg. While PCRM has an issue with dairy, as do some from the Paleo diet, eggs are a healthy source of protein.  If you get rid of the yolk you can get rid of a lot of the calories also. The amount of cholesterol is less important than the lower calories- and you could always use egg whites which have less fat, much less cholesterol, but a great source of protein.

(8) Milk, Beans, and broccoli are all high in calcium

This is true, and for those who need a good source of calcium but do not drink milk, there are some good alternatives. They point out that the calcium in the beans and broccoli is absorbed at a rate of  50-60%, while milk is just  32%. What they fail to point out is that 1/2 cup of broccoli contains 21 mg of calcium while 8 oz of nonfat milk contains 300 mg. That means from broccoli you get 11 mg of Calcium which is about 1 percent of the daily requirement. If you get non-calcium enriched milk you are still getting 100 mg of calcium or ten times the amount you would with broccoli.

Vegetarians may absorb less calcium than omnivores because they consume more plant products containing oxalic and phytic acids . Lacto-ovo vegetarians (who consume eggs and dairy) and non-vegetarians have similar calcium intakes. However, vegans, who eat no animal products and ovo-vegetarians (who eat eggs but no dairy products), might not obtain sufficient calcium because of their avoidance of dairy foods.

In the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition, bone fracture risk was similar in meat eaters, fish eaters and vegetarians, but higher in vegans, likely due to their lower mean calcium intake.  It is difficult to assess the impact of vegetarian diets on calcium status because of the wide variety of eating practices and thus should be considered on a case by case basis.

(9) Fish and Beef have no fiber

Quite true- there is no fiber in meats. This is why a balanced diet contains fruits and vegetables. However, fish and beef contain better sources of fat absorbable vitamins, calcium, B12, protein, and other nutrients than vegetables do.

(10)  A skinless roasted chicken breast has more calories per ounce than soda or white rice

This is quite true- and mainly because of the fat content of the chicken. But chicken has more nutrients than white rice and more than soda.

PCRM also was responsible for the comments that E. Coli was found in many of the chicken products.  What they didn’t say was that the E. Coli they found were not the same as responsible for food borne illness.  In fact, the E. Coli they found was the kind commonly found in the soil, where the very plants grow that they advocate consuming. The pro-Vegan group also neglected to mention that the majority of Salmonella infections that have caused major outbreaks have come from agricultural products, including peanuts, that they advocate for a healthy diet.

It appears that PCRM is more propaganda than science. If you are going to advocate for a position, your position is diminished when you don’t tell the full story. If cornered in press conferences they avoid the answers to the questions. This is not a place to get information at all.

In the case of diet and lifestyle, there is a lot we do not know- but PCRM as a source of nutritional information is less than adequate, in that often it does not tell the whole story.  As a website for health and information it is more like a political party than a resource for those looking for evidence based medicine or science based medicine.

One of the misleading advertisements from PCRM

A doctor of Chinese medicine, diagnosing me

Underneath the white coat, however, was nothing more than a practice of “Chinese medicine.” A hoax, a fraud, and designed to extract about $300 from me to fix me using Kung Fu to rid my liver of toxins, then purchase a larger quantity of herbs to keep me from having an issue, help me lose weight, and open up the arteries going to my brain (which, if I bought this nonsense might be proof that they were closed).

With this special medicine from Tibet, my life would be saved. Only $309

I was hijacked to the Ancient Chinese Medicine Institute, not because I was looking or feeling ill.  My day had been planned around a tour of the Great Wall of China. Once on the bus, the tour guide, Sally, told us that when we were finished with the Great Wall we were going for a free “foot massage” and lecture about “longevity”  at the Institute.

During this attempted wallet extraction, my wife was having a hard time keeping a straight face. Her husband, a physician & surgeon, the ultimate skeptic, somehow got trapped into this, and she was waiting for me to begin an inquisition.  Later she told me she was surprised I had kept my mouth shut with a respectful smile and lots of nodding.

There is something compelling about “ancient Chinese medicine,” especially when they tell you it has been around for 5000 years.  It hasn’t of course, but the older something is, the more it appeals to the logical fallacy of antiquity.  The “appeal to antiquity” is an argument that states if “it” has been around long enough it must have stood the test of time, and therefore be legitimate.

Still, it would be nice to believe someone could look at you and both tell you for certain you have something wrong with you, and fix you at the same time. As a surgeon I have to do this. The difference is, we operate based on science based medicine, and hope our principles are backed with good science, and not anecdotes. The field of medicine we ascribe to has been continually modified and challenged for years, and is set to continue to evolve.

But this part of China, this “Institute” has not evolved since Sun Simiao cataloged a number of herbs a few hundred years ago.

Back to the Great Wall of China – looking at the brochure for the tour there was nothing on it about this stop.  For my wife, a free foot massage piqued her interest, although massage for me is about as enticing as tooth extraction (although a tooth extraction at least has some virtue).  But we were “on the bus” in a foreign land, and were now held captive by the tour guide, Sally.

Started out as a pleasant day on the Great Wall of China

Earlier that week we visited a Daoist temple in Xi’an where the father of Chinese medicine, Sun Simiao, is enshrined.  I thought this would be my extent of enduring a hoax of medical treatment, but alas, it was just a precursor of things to come.  Simiao produced two textbooks, one of which, 1500 years later, is still used for study of medicine.  This of course is unlike Western medicine, where our monthly journals change our idea of medicine.  Imagine if our medicine stopped 1500 years ago, and all we knew about herbs was that if we didn’t extract the active ingredients, we didn’t get to the point where we could say “you need this much of the medicine, not more, not less” but instead had to rely on a text of someone from 1500 years ago.

The much venerated Sun Simiao

We used to do that in the West. We relied on ancient manuscripts, and even made it criminal if someone were to challenge that.  Today we challenge assumptions all the time.  A medicine we think is a good one day, we discover a few years later isn’t.  What if some of the herbs were not good, or were toxic at a higher level, or didn’t work at a lower level?  No further work would be done, we would just grind up the plant, of course, you’d want to sell plants to Westerners that are from Tibet…after all, isn’t that where Shangri-la is located?

As the bus turned into the lot, Sally told us that this institute had been the private province of the Emperors of China, their staff, and only the highest ranking government officials.  Then in 1949, with the liberation, the institute was opened to the public.  Nothing like using an “appeal to authority” to attempt validation of a scam.  Since authority figures used it (they probably didn’t) then it must have been good.

She looked like a nurse, but carried a credit card machine

Entering the building, there are rows of apothecary drawers, as well as large mason jars filled with dried starfish, sea horses, and other creatures and plant parts. Next to them is a women dressed in a pink nurses outfit, complete with nurse’s cap.  We are escorted past chairs that are roped off, as they are chairs where presidents and others sat during the Olympics.  The wall is filled with pictures of world leaders meeting Chinese ambassadors, Mao, and others – I suspected to provide more “appeal to authority,” but I knew that Obama had not set foot in this place.

Lots of herbs from Tibet- we all know Tibet is where they have the best

We were escorted into a classroom where rows of lazy-boy style chairs were set up with small stools in front of them.  A young woman introduced herself and told us that we were going to get a massage and talk about medicine, but first we had to take our shoes and socks off and have our feet washed.

A group of young boys, all appearing no older than 18, came in, each bringing a bowl with plastic lining and water.  We were warned the water was hot – and it was. Floating in the water was a large “teabag” filled with some herbs from Tibet.  Apparently, herbs from Tibet are magic.  The water was indeed hot, so hot none of us could immediately put our feet in the water.

Footwashing begins, to be followed by wallet extraction

She told us to slowly place our feet inside the bowls (not that any of us could do otherwise). She told us this was good for our circulation. My wife looked at me and asked, “Is this true?”

No dear, circulation is dependent on the arteries going to the feet. If arteries had blockages secondary to atherosclerosis, there would be a fixed rate of blood flow. You could not increase that flow by placing feet into hot water.  However, with heat, the capillaries of the heated area expand to attempt to cool the feet, thus with healthy arteries there would be more flow, but that has no useful benefit whatsoever. Nerdy response, but accurate. Such a killjoy.

Finally the water cooled, enough to put our feet in – and after a long walk up and down the Great Wall, it felt good to relax in a chair and soak.  Then the young men marched back in, behind them the young woman in the pink nurse’s outfit, carrying a credit card machine and some boxes that had pictures of herbs on them.

Entice you with a foot massage and get you to buy the herbs

The young men proceeded to give a massage of the feet and legs. As they massaged the calf I wondered if they ever massaged a deep venous blood clot forcing it to break free, traveling to the lungs and causing death.  Then I coughed… and in my mind I could see it now; the 7000 miles of travel had no doubt caused the clot which now broke free and my death would happen in the Chinese Medicine Institute, and my fellow surgeons and skeptics would just wonder what I was thinking.

My wife asked the young men if they were studying, and indeed they were in the curriculum for the next six months. My wife looked at me and said, “Wow, how many years did you study to be a doctor and surgeon, and these guys get to do it in six months?” The lady overheard her and corrected her, stating that to become a “traditional” Chinese medicine doctor was a five year curriculum. Still, four years of college, four years of medical school, five years of surgical residency – my wife’s point was well taken.

Then we were told we could have a free evaluation by the distinguished faculty of the institute.  In came several “doctors” and she asked we applaud the “President” of the institute as he arrived (must be a sign of respect).  She told us that the palms reveal everything about a person. “This is not palm reading,” she said, “that isn’t science.”  Just loud enough for my wife to hear I said,  “Yes, that has only 6,000 years behind it.” Two can play the appeal to antiquity argument.

We were asked to applaud the President of the Institute as his able assistant set up the credit card machine

She then proceeded to explain that if someone had problems of the liver the palm would be yellow – if they had “low blood” and red spots indicated, “too much blood, that leads to circulation problems.”

Jaundice could be manifested in the palms, but would be manifested through the entire skin, not just the palms.  The whiteness of the palms may be a sign of anemia, but there are better signs, and too much blood is not the cause of atherosclerosis and circulatory problems.  Some grain of truth, however,  most scams have a grain of truth.

They diagnose based on the palm

My wife raised her hand for the free “assessment.” The doctor in the white coat came over with his interpreter.  Looking at my wife’s palms he asked if she had cold feet and hands sometimes, and then asked about her menstrual cycle. The doctor deduced that she has kidney problems, and of course, with the right kinds of herbs, not only will her menstrual cycles improve (they are, as she told them, like clockwork, regular and not an issue),  but she would feel better immediately. He took out a prescription pad and began to write.  My wife asked if the herbs were a tea form, or a pill.  They brought her a box and showed her a sample of the pills.  She said she didn’t want them- he kept his prescription.

I asked for an assessment.  He immediately went from my palms to my belly, announcing that I had toxins in my liver. He asked if I had pain in the back of my neck – I said that I did, when I had a long day of surgery.  The surgery part didn’t register.  Through the interpreter he told me that the toxins in the liver were affecting the arteries to my brain, laying down clogs, and that is why the back of my neck hurt. Of course the main arteries to the brain, the carotid arteries are in the side of the neck, not the back, and where he was pointing to was below where the vertebral arteries went to the brain, but that wasn’t the point.

Which doctor was diagnosing witch doctor

Whatever was I to do? He told me that he could fix me immediately.  He would use Kung Fu to remove the toxins from my liver. “Kung Fu?” I asked.  The interpreter said, “Yes, like Bruce Lee.  The doctor will use his energy to remove the toxins from your liver, then you can take some herbs that will keep the liver free of toxins and help you lose weight.”  And how much would this Kung Fu Panda inspired technique cost?  Just over 4,000 RMB (a little over $300).

I declined, of course.  Then looking over our group I saw the president of the institute using his Kung Fu on a lady by her forehead.  It reminded me of Benny Hinn curing someone in his church. I almost expected the “doctor” to yell “Fresh” as his kung fu energy was zapping out the toxins from that woman’s brain.

Next to us was a man who was told his pulses were low.  Using acupuncture, several needles were placed into his wrist, and as the needles were taken out, the doctor who spoke English  very well, said, “See, already the circulation is better.”

There was more conversation with the fellow tourist’s wife and I heard the doctor say, “Oh, you don’t need surgery. That’s Western medicine, you need Chinese medicine.” He explained with herbs he could shrink her uterus to the size of a bean (since they don’t use x-rays, CAT Scans, ultrasounds, or even do autopsies on their patients I am not certain how he knows or could confirm this).  Next thing we knew, she and her husband were off with the doctor for a “private consultation.”

The entire tour group was waiting for this couple to come back.  It took them a good hour and when they came back they had a large grocery sack filled with herbs. This woman will make her way merrily back to the Philippines, secure in the knowledge that she will not need surgery for her uterus that has a benign tumor.  Of course, I thought to myself, there is absolutely no liability if the Chinese doctor was wrong.

So here are a few facts when you hear things like “ancient Chinese medicine” and it being thousands of years old. It isn’t.  The herbs they use were mostly described 1500 years ago.  Since then science has taken herbs, plants, fish, trees, and other assorted products in nature – purified the active components, or tested and found out some were just not active.  For example: Digitalis, a drug we use to use a lot for heart failure, can be found in about 20 different plants. The dose of digitalis is important – use too much and the person goes into heart block and dies, use to little and you have no effect.  It is quite dose dependent – something you don’t want to rely on a plant alone, but want it purified and quantitated. Most recently from the Yew tree, Taxol was found– one of the first potent agents against Ovarian Cancer – again, scientists found the active ingredient in the bark (saving forests of Yew trees), purified it and it is also dose dependent.  Eat too much Yew bark and you won’t cure ovarian cancer, you will die.  Eat too little and it will just slowly poison you.  When you talk to these “doctors” they will tell you they use the original writings from 1500 years ago — really? If a doctor quotes an article from a journal ten years ago, other than to show for historical purposes – they are considered not being up to date.

What about acupuncture? There has NEVER been a study showing that acupuncture has more than placebo effect.  Meaning, when you compare acupuncture with random placed needles, or pressure, there is no difference.  Hence, there is no Chi, or field that the needle person can do anything with. Did you hear about the story where someone didn’t need anesthesia, just surgery — all bogus, didn’t happen.  And acupuncture is first seen about 2000 years ago, although much more used 150 years ago (the stuff from 2000 years ago is speculation, we have good data from 150 years ago). The Journal of Chinese Medicine says the earliest they have indication of it is 2000 years ago .

Using Kung Fu to take out poisons or toxins? Don’t know where this came from — since they were hijacking tour buses, they probably either were appealing to Westerners who watch Bruce Lee movies, or they had seen the “healing” done in evangelical churches.

Many things are used in Chinese medicine, they like sea creatures most of all

As I was in the parking lot of the “institute” I quietly let out a loud flatus.  My wife was horrified but I told her, “I’m passing toxins.” You are what you eat- and I was just fed a lot of what I just passed- pure and utter BS.

The "Institute"

Campbell didn’t start out as a vegetarian, he grew up on a farm, and spent the first few years of his career thinking that the farm diet was the healthy way for a person to live.  On the basis of his early work with some proteins and cancer, and some statistical work he did from rural China villages he wrote The China Study. In it he formed the conclusion that an animal based diet is the promoter for cancer, and that if people converted to a whole plant diet (not processed flours, pastas, or processed, white, rice ) they would lose weight, have less cancer, less heart disease, and less obesity.

To be fair, let me quote him:
“In fact, dietary protein proved to be so powerful in its effect that we could turn on and turn off cancer growth simply by changing the level consumed.” (page 6-7)

The premise for much of this comes from a Campbell’s work with aflatoxin – a potent carcinogen that is found in peanuts. Campbell’s work noted that with adding a milk protein casein – there was a direct relationship to the extent that rats appeared to get foci of cancer.  Campbell then extrapolates that data from a milk bio-active protein to all animal proteins.

“..People who ate the most animal-based foods got the most chronic disease.  Even relatively small intakes of animal-based food were associated with adverse effects. People who ate the most plant-based foods were the healthiest and tended to avoid chronic disease.”

His first declaration came from his lab studies where he examined the biologic influence of a milk protein (casein, which is a bio-active protein) on rats who were fed a potent carcinogen. The rats that were given more of this milk protein developed more foci of liver cancers.

Casein makes up 20-45% of the protein in human milk.  Does this mean that mother’s should not breast feed their children? That we should not be drinking milk at all? Does this mean that all animal based proteins are cancer causing, and the reason we develop cancers?

The answer to all the above questions are NO.  Simple experiments done with rats do not form universal answers to major health questions, nor do they provide us with scientific insight into the health of human beings.

First, let’s look at proteins. Proteins are called the building blocks of tissues.  They are complex molecules that contain a number of amino-acids.  Amino acids are divided into two types: essential and non-essential amino acids.  Essential amino acids are those amino acids that humans cannot make, and thus we must get them from our diet.  When you eat protein, the digestive process breaks down the proteins into the various amino acids which are then carted away by the blood stream and used to build or rebuild cells in your body.  That is the simple stuff. Proteins are found in animals and plants.  Once the protein is digested, and the amino acids are freed, your body has no idea if that amino acid came from a bean or a T-bone steak. The lysine (an essential amino acid) your body gets from a T-bone steak looks no different than the lysine your body gets from a soy bean or a walnut.

Proteins can have more of an effect than just being used as a source for amino acids. The way proteins are put together they look less like pearls on a string (amino acids being the pearls) and more like rather complex geometric shapes.  Some of those shapes can unlock powerful changes in a person. Allergies, for example, come from proteins that turn on an overwhelming inflammatory response in people who are sensitive to them.  Take that same protein and alter its structure so that the 3D structure of the protein is altered (this can be done by changing a single amino acid, or heating a protein, or putting the protein in a acid environment) – and that protein won’t cause the same reaction.

Proteins are quite complex – just to give you an example, here is a representation of what some people think the protein ovalbumin looks like (this is the protein found in egg whites):

A 3-D look at ovalbumin, the protein found in egg whites

One of my favorite proteins because almost 30 years ago we used some genetic modification of this protein expression in a virus, but that is another story.

Proteins are complicated 3-D structures, and like keys into locks, if you change a bit of their structure they no longer unlock the reaction.  Some proteins cause other reactions in people besides the allergic reaction — but anyone can be allergic to almost any protein, except most people are not allergic to proteins their own body makes – except in some severe auto-immune disorders (arthritis, Lupus).

Other keys that proteins unlock can be hormonal.  Insulin is a protein – it is made up of a chain of amino acids and looks like this:

The primary structure of insulin - each amino acid in sequence

Insulin’s is a protein, that if given in the blood stream will unlock cells and force glucose into cells. Without insulin blood sugar rises, people can go into coma, and long standing low insulin levels can cause all the complications of diabetes. But insulin is a bio-active protein.

But if you eat insulin, when the insulin is in the stomach, the acid of the stomach will quickly change the structure of the insulin, it will break down, and ultimately not be a bio-active protein, but instead become just a source of amino acids for the body to use.

Back to Casein- which isn’t a single protein, but a group of proteins found  in milk.  In Campbell’s work he gave rats that had been subjected to a cancer causing agent high doses of casein. He then examined their liver for foci of pre-cancer lesions, and noted they were higher with the higher levels of the milk protein.  From that he determined that depending on the level of protein, its possible to turn cancer genes on or off. This becomes a later theme of the book. Increased levels of animal proteins cause human disease from heart to cancer, and here is some experimental evidence to prove it.

Casein is a bio-active protein- which is not surprising. If you want mammals to grow you want to give them proteins that will not only break down to supply nutrition, but will also serve to promote growth of those cells. One could conclude that if you have a cell that has been treated with a carcinogen that adding something that makes it grow will increase its growth.

A non-casein example is hormones and prostate cancer, for which Charles B Huggins received the Nobel prize in 1966. Huggins found a number of cancer cells were turned on and off by hormones.  Estrogens are not proteins, they are another class of chemical compounds – but the idea that a chemical compound could signal and cause growth in cancer cells was well established with Campbell did his work with rats.

Back to the questions: Casein does not appear to have a role in any human carcinogensis. In fact, those milk proteins do appear to have a protective effect against cancer in humans. Campbell’s work with rats has not been reproduced to find the reason he saw what he saw at that time.  Whether the test he used to predict cancer, and the proteins he fed those rats exposed to that carcinogen apply to humans in any way is more than any speculation.

Milk is more than casein proteins, there are also whey proteins- which have also been found to have an effect with cancer, a protective effect.

It is not the first time that someone doing bench research takes their ideas from the laboratory bench and applies them globally.  It is what we are supposed to do.  We are supposed to see the large picture. In this case, Campbell’s conclusion was that animal protein induced cancer, which did not happen with plant protein.

For part one of The China Study- while he reports years of his research as a basis for his beliefs, it does not hold up for all animal proteins. Animal proteins for the most part are broken down and serve as sources of amino acids and nutrition. Milk is an essential part of all mammal diets for their young . The world of research has gone beyond Dr. Campbell’s bench days, and is now looking at pathways of cell cycles within pathways, and nowhere to be found is the broad picture that plants are better than animals.

Many of the hypothesis that were generated in the laboratory I worked in no longer apply either. Some have, but research has become more and more focused on other pathways, with new pictures.

Bernard Roizman, my science mentor- where I spent many wonderful years in his lab

Still, for those who read The China Study, and wonder if milk is bad for you, or your baby, or if this is the simple model for cancer and turning off cancer genes — it is not.

In a future article on the China Study, we will focus on how they conducted the epidemiological research in China.  We will take a unique perspective on it, we’ll take it from China itself, to see the pros and cons of how the rural village research and death statistics worked.

Do you think you know which of these is best for you?

What do we really know about fat?  About how fats react in the human body when they are eaten?  Government agencies make a lot of assumptions about fat, and they base that on the popular opinions of physicians and scientists who serve on their advisory committees.  Those recommendations are published, and then are used by many physicians, dieticians, nurses, and other health care professionals as a basis of what to recommend to patients.

But what if those experts got it wrong? When the latest data about fats is examined critically we find out that the recommendations made by those government agencies has no basis in the literature.  However, you will find those recommendations repeated as gospel in almost every website about what to eat and what is healthy for you, even the highly respected websites such as WebMD.com

In the March issue of Nutrition, a highly respected, peer-reviewed, academic publication,  Robert Hoenselaar outlines how the advisory committees not only got their advice wrong, but how they cherry-picked the data (Nutrition 28 (2012) 118-123, Saturated fat and cardiovascular disease: The discrepancy between the scientific literature and dietary advice).

Recommendations from the United States Department of Agriculture (USDA) and European Food Safety Authority (EFSA) regarding consumption of fat are similar

(a) Consume less than 10% of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids

(b) Keep the intake of saturated fatty acids as low as possible while consuming a nutritionally adequate diet

(c)  Saturated fat intake should be as low as possible

In 2003, a meta-analysis of over 50 trials was published examining the relationship of dietary fat to serum cholesterol levels (Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serumlipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003;77:1146–55.).  The conclusion was that saturated fat increases the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) but without changing the ratio of total to the HDL cholesterol.   They concluded that using cholesterol alone as a marker of risk was unreliable. This was because if you replace the saturated fat with carbohydrates or tropical oils if you examine the effects on HDL and apolipoprotein B. They concluded that “… we can never be sure what such fats and oils do to coronary artery disease risk.” To translate that from doctor-scientist language: we can improve some laboratory markers, but really not by any mechanism that makes a difference from what we know.

While a systematic review of randomized trials showed that when saturated fats are replaced by polyunsaturated fats there is a reduction in the laboratory marker for risk of heart disease, there was no association with mortality from heart disease.  To emphasize this: the laboratory values of the patients studied improved, but their mortality didn’t. The review also showed that monounsaturated fat intake significantly increased cardiac events, but no effect from the intake of saturated or polyunsaturated fat. Let me emphasize that: Monounsaturated fats, by at least one study, not only didn’t improve issues with the heart- the patients in that study did worse.

When examining other prospective studies about the risk of saturated fat and cardiovascular disease, there has been a consistent lack of an association between fat intake and heart disease, stroke, or total cardiac events.

Cohort studies show that by replacement of saturated fats with unsaturated fats, or carbohydrates – and examining the hazard ratios for heart attacks and deaths from heart disease were as follows: 0.87 for polyunsaturated fat, 1.19 for monounsaturated fat, and 1.07 for carbohydrates.  For those not familiar with statistics, these are essentially no difference, and if these small statistical numbers are accepted than polyunsaturated fat shows an alarming trend. So here is a study that indicates (with as much precision as most studies these days) that polyunsaturated fats are worse for you than saturated fats.

There is a difference between protection against what we define as risk of heart disease and death from heart disease.  Risk reduction means that we lower the laboratory values of factors we associate with risk – but the end point is death.  In a meta-analysis published in 2010 (Ramsden CE, Hibbeln JR, Majchrzak SF, Davis JM. N-6 fatty acid-specific and mixed polyunsaturated dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. Br J Nutr 2010;104:1586–600.) examined seven different trials, they found that there was a risk reduction but no change in mortality.  Another study (Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomized controlled trials. Ann Nutr Metab 2009;55:173–201.  ) had eight trials found “There is probably no direct relation between total fat intake and risk of CHD (heart disease).”
The advise of the USDA is reflected in places like WebMD, recounted in public service commercials, and recited as gospel by health care workers everywhere.  Giving false impressions about what an appropriate diet is.

Many of us constantly look for the right things to eat, the right food to feed ourselves and our families.  For that information we choose what we consider informed sources about risk reduction. What we discover is that there is not a clear answer, at least not yet. The differences between these ingredients are not large enough in the studies performed for a reasonable person to make blanket statements.

The only statements about fat that can be made are that trans-fats are bad for a person.  Trans-fats are the fats found in stick margarine, most pastries, and fast foods – but rapidly being eliminated because of their clearly demonstrated bad effects.

Here is what we do know: eating too many calories, be it of fat, carbohydrates, protein, or alcohol will lead to excess weight, and excess weight is a contributor to heart disease, diabetes, and joint problems.

Eat healthy, fresh, delicious food — all in moderation.