All In or Slow Change?

There are different ways to approach healthy eating. The simplest is more veggies and fruits, less animal products, sweets and processed foods. More ambitious seekers of health aim at gradual improvement where hopefully they reach an optimal diet. The completely committed choose between Pritikin, Barnard, Esselstyn, McDougall, Fuhrman, Ornish or similar whole food plant based diets and eat this way immediately.

Any of these dietary changes is good for you. If you're only willing to eat a few more veggies then do it, but greater commitment is much better. There aren't good studies showing how much better total dietary change is. Food intake surveys show better health results for more vegetables and fruit daily up to 8 portions; after that results level off. All physicians reporting on their patients' change to whole food plant based eating have many remarkable success stories for heart disease, diabetes, hypertension, auto-immune disease and, less often, cancer.

Careful, accurate analysis of cigarette smoking may provide help in assessing likelihood of dietary change effectiveness. Those who cut back 50% have only modestly less cancer and lung disease, not nearly 50% less. To have major impact total abstinence is necessary.

The other big reason for going all in from the start is that cravings for fat, salt and sugar are almost wiped out after a few weeks without them. The brain's control centers can be quickly reprogramed, something that does not happen with gradual change.

                           Temptation

A recent NY Times article (Tim Herrera, Smarter Living newsletter, June 10, 2018) discussed research on will power. What does it take to do what you know is best for you, especially in regard to food choice? There remains a modest number who ignore scientific evidence and advocate a high protein and high fat diet, but most know and admit that whole plant foods are good for health with caloric needs filled by minimally processed starches, legumes, seeds and nuts. But we were raised on rich, high fat, high sugar foods which we enjoy, indeed are often addicted to.

Research shows that resisting temptation is exhausting. End result is that we have less energy for other important tasks and that we often eventually give in and eat unhealthy food. Resisting temptation does not strengthen, it weakens. The solution is to minimize temptation: keep unhealthy foods out of sight, out of home cupboards and refrigerators. Meals or drinks with friends at places that offer only unhealthy choices are rejected. You might be surprised- most friends, especially good ones, will honor your request and go to a place with healthy options, and they'll respect you for taking charge of your health. Some will join you in dietary change creating a strong bond.

Should you splurge and buy unhealthy food for home, throw the the rest away after eating some. You don't want it there for tomorrow when you'll resume your good habits. Many of us have a strong sweet tooth. Have healthy options on hand- oranges and dates are sweet, tasty and filling plus healthy. Keep home, office desk and travel bag well stocked with these these and similar choices. You can promise yourself an ice cream cone or candy bar after you eat some healthy sweets. You may decide you don't want the ice cream after your orange; almost for sure you'll eat less.

                    The Cancer Paradox

Modern medicine has decreed aggressive screening and treatment for cancer. In spite of shaky grounds for screening and the futility of many treatment plans most patients meekly agree to whatever a physician recommends about cancer. Most treatment programs including surgery, radiation and drugs are very expensive. With newer drugs cost is often astronomical, perhaps leading to poverty for patient and family. In spite of this most agree to whatever is ordered by their doctor not even pursuing a second expert opinion which I think is crucial for any major medical decision.

Contrast this to best treatment for more common, life threatening conditions like diabetes and heart disease. Physician recommendations of procedures and drugs are often followed. The by far best treatment of lifestyle change is either not offered or rejected even though results are better than standard cancer treatments and the cost is negligible, often negative. This I call "the Cancer Paradox."

Why this illogical, expensive disparity? Most of the fault is with our medical system, starting with miseducation of physicians which is then compounded by strong financial incentives to over diagnose and over treat. Advice to take expensive drugs which offer little chance of success and likelihood of serious side effects is presented to the patient as an absolute. Advice to change diet or other lifestyle is an option to be considered if it is mentioned at all. Furthermore, lifestyle change requires an excellent support system with education, cooking classes, social and psychological professionals for the patient and family, but these are mainly non-existent. There's no profit in such systems and money drives medical center and physician resource allocation.

What's the answer? Unfortunately, it's to find or create such a support system for yourself, family and friends. The internet has many possibilities as long as you're careful to avoid the charlatans promoting fad diets, supplements and foods. Good luck!

                         Extreme Variety

Over 30 years ago Larry Smarr, professor of computer science at UCSD, first proposed the idea of super computer centers based at universities and convinced the National Science Foundation to fund these centers. He also developed systems allowing the internet to be created, but more recently his work has focused on another of his brainstorms, Calit 2, which explores advanced digital technology for medical practice. The structure and work of Calit 2 has been so successful that top level computer scientists have left much better paying jobs to join Smarr in his work.

In addition to computer applications Smarr has studied medical research, concluding that lifestyle was the critical variable for good health and longevity. Optimally, this is patient controlled as he demonstrated in the management of his own Crohn's disease. Exercise, sleep and relaxation are all important features of best lifestyle but diet is the most critical. Smarr has concluded that the gut microbiota are key to many aspects of health including his own Crohn's. Maintaining a wide variety of "good" gut microbes requires the right food. Smarr attempts to eat 32 varieties of whole plant food regularly, often incorporating them into smoothies. He comments- "Although I am not a vegetarian, I am a follower of what Thomas Jefferson once said: "I eat meat only as a condiment to the vegetables which constitute my principal diet."" Smarr cites Michael Pollan's classic book,  In Defense of Food, as an excellent analysis of the best approach to diet. He limits animal products to a maximum of 10% of his diet.

https://www.theatlantic.com/magazine/archive/2018/03/larry-smarr-the.../550883/

https://en.wikipedia.org/wiki/Larry_Smarr

                           Starchivore

Dr. John McDougall has coined the term "starchivore" to describe his diet regime which is based on the observation that populations that eat little animal products and refined oils rarely suffer from heart disease, diabetes, cancer or auto-immune disease. Many excellent epidemiological studies have confirmed this. McDougall advocates a low protein, low fat diet which includes some fruit and vegetables but is mainly "comfort foods": potatoes, yams, rice, pasta, whole grains and other starches. Small amounts of salt and sugar are okay to increase palatability. Initially he taught that a few lower fat animal products were acceptable but in recent years he advocates staying vegan.

McDougall designed his medical practice around this diet which he created based on work of Pritikin, Kempner and Burkitt. He has successfully treated many thousands over the last 40+ years, first in private practice in Honolulu and later through clinics; 10, 5 and 3 day programs in Santa Rosa, CA; many books and an active free internet site which has access to many talks given at his "Advanced Study Weekends" plus patient interviews describing dietary success treating various chronic diseases and obesity. Deb and I  attended his 10 day program and found it a powerful, instructive and pleasant experience. We've also attended many of his weekend and travel programs, befriending many "McDougallers." The seed for many of my blogs was from his programs.

McDougall just announced his retirement from active practice; his Advanced Study Weekends and travel programs ended last year, but 3, 5 and 10 day treatment programs under the supervision of his colleague, Dr. Anthony Lim, continue as does his excellent educational website( link is on right side of this blog's home page.)

                         Nutritarian

Much writing and study of diet revolves around what not to eat: too many calories, fats, carbs, protein, refined oils, or some combination of these. Some research and advice centers more on what to eat. One of the most prominent of this group is Joel Fuhrman, a New Jersey family practice physician who has devoted his career to promoting diet as the principal way of maintaining health and treating many diseases.

Fuhrman has had a family practice for decades where he has treated thousands using his dietary approach, "nutritarianism," which is to eat a large variety of vegetables, fruits, legumes, nuts and seeds- the more variety the better. Sharing meals with him is fun since he eats huge quantities of very low calorie foods which includes a few starches but emphasizes salads and smoothies. His salad building technique is amazing: after filling his large plate with a variety of greens he takes another plate, puts it on top of his greens, presses down crushing them into a smaller volume and then adds another layer of greens. His comment is that otherwise he can't get enough on his plate.

I've known Joel for more than ten years, visited his practice in Flemington, NJ, and attended multiple conferences where he was the only presenter. He is a remarkably energetic, enthusiastic scholar who knows as much about nutrition literature and research as anyone I've met on my odyssey searching for dietary truth. Initially, when I first met him he indicated that a small amount of animal products, especially eggs, were a reasonable part of a good diet but over the years he's evolved to a diet which does not include any animal products. Fuhrman has many books to his credit plus DVD's and very successful PBS shows. He's an engaging, enthusiastic speaker. Concepts he espoused years ago have become more mainstream and accepted over the years (eg intermittent fasting.) He maintains an active website which includes a good way of linking with others about dietary issues and questions. Unfortunately this requires dues to participate. He also sells many products, various supplements and foods, in addition to his books and DVD's. These products all seem to be highest quality but I have an issue with too much supplementation which is well shown to be wasteful and occasionally harmful. 

                                M and M

In medicine we have M and M conferences. Often we'd have preferred that this meant we sat around and ate M and M's, since the subject matter was morbidity (serious illness) and mortality (death) in patients under our or our colleagues' care. The purpose was to understand what went wrong and what we could have done to prevent it.

Much of medical science revolves around the same theme: cause and prevention of death and disease. Eleven years ago, around the time of my 66th birthday, reading and study made it obvious to me that much M and M was due to changeable lifestyle and that modern medical practice paid little heed to this while emphasizing drugs and procedures for patient care. My wife Deb and I changed our own diets since this was by far the major cause of M and M. We had no health problems at the time but felt that we wanted to share this information and couldn't preach what we didn't practice. If you've read many of my prior blogs you know that the dietary change was to cut out or minimize animal products, refined oils, refined carbohydrates and added salt, effectively eliminating most processed foods.

I've recently swapped emails with a high school classmate whose wife has dementia. His observation  that many older people in his retirement community have poor quality of life in their "golden years" led him to muse that perhaps early death was a better option. But what if you can have both low M(ortality) and low M(orbidity)? Several excellent large epidemiological studies make it clear that this is so. Not only do you live longer with good diet but the quality of your last years is much better. It is very reasonable to dread final years with dementia or taking drug after drug for cancer, advanced heart disease, diabetes. Life in a hospital, extended care facility or making regular rounds of doctors' offices is no one's choice for the golden years, but that is the path made very likely by ignoring sound dietary guidelines. Another friend of mine died earlier this year after several miserable years of chasing health from doctor to doctor. A few months before he died he said, "Jack, I sure wished I had taken your advice about diet years ago."