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“FoodOverMedicine is an excellent book that reveals the truth that health ismore about dietary choices and plant-based nutrition than about doctors,diagnostic tests, surgeries, procedures, and medications. The book is easy-to-read,entertaining,andhumorous.But,aboveallelse,itisincrediblyinformative,enlightening, inspiring, and self-empowering. It will open your eyes. It willencourageyoutotakechargeofyourlife.”

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FOODOVER

MEDICINE

FOODOVER

MEDICINE......................................................

THECONVERSATIONTHATCOULDSAVEYOURLIFE

PAMELAA.POPPERPH.D.,N.D.andGLENMERZER

All rights reserved. No part of this book may be used or reproduced in anymanner whatsoever without written permission except in the case of briefquotationsembodiedincriticalarticlesorreviews.

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pagescmIncludesbibliographicalreferencesandindex. ISBN978-1-937856-80-9 (tradecloth : alk.paper) -- ISBN978-1-937856-57-1 (e-book) 1. Nutritionally induced diseases--Popular works. 2. Diet indisease--Popular works. 3. Food habits--Popular works. 4. Health behavior--Popularworks.I.Merzer,Glen.II.Title.RA645.N87P6632013616.3’9--dc232013004503

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This book has been written and published strictly for informational purposesonly.All of the facts and opinions expressed in this book come frommedicalfiles,clinicaljournals,scientificpublications,personalinterviews,publishedtradebooks, magazine articles, the personal practice experience of the authoritiesquoted or the sources cited, the personal experiences of both authors, and theprofessional experiences of Dr. Pamela Popper. You should not consider theeducationalmaterialhereintobethepracticeofmedicine.Norshoulditreplaceconsultationwithaphysicianorotherpractitioner.Theauthorsandpublisherofthis information areproviding youwith this information so that you canhaveknowledge.Youcanchoose,atyourownrisk,toactonthatknowledge.Innoway should the information in this book be used as a substitute forrecommendationsfromyourownhealthcarepractitioner.

Youmayalsoconsiderthepossibilitythatyourhealthcarepractitionermaynotbefullyinformedaboutsomeofthesubjectscoveredherein.

Allthedecisionsaboutyourhealthareultimatelyyourowntomake, includingthedecisionaboutwherebesttoseekoutinformationandwhichinformationtobelieveandtoactupon.

Thisbookisdedicatedtoallofthepeoplewhohavelistenedtomylectures, read my books, joined the Wellness Forum, improvedtheirhealth,andsharedtheirstoriesduringthelastsixteenyears.You have all inspiredme to continue to tell the truth about diet,health,andmedicine.

Andalsotothegreatpioneerswhohaveinfluencedmywork—Dr.JohnMcDougall,Dr.T.ColinCampbell,Dr.CaldwellEsselstyn,Dr. Neal Barnard, Dr. AlanGoldhamer, Dr. Doug Lisle, Dr. PeterBreggin, William Lessler, Dr. Ralph Moss, and many othercolleaguesfromwhomIcontinuetolearneveryday.

Lastbutnotleast,tomyparentswhotaughtmethatanythingispossiblewithhardworkandpersistence.

—PamelaA.Popper

CONTENTS....................................

CopyrightAcknowledgmentsIntroduction

1Deep-FriedButteronaStickandOtherAtrocities

2TheProgram

3DiseasesandtheFoodsThatBringThemOn

4SuccessStories

5TheDietaryEstablishment

6ManagingYourDoctor

7ProvingtheCase

8

It’stheFood,Stupid

Notes

AbouttheAuthors

W

ACKNOWLEDGMENTS....................................

ewould like toexpressourgratitude toAmandaCrichton,whohelped inmorewaysthatwecancount,toJillHiller,forherassistancewithgraphics,

andtoNicoleSwartz forherassistance inarchivingtheresearchfor thisbook.ThanksalsotoKellySherman,GaryMorse,DelSroufe,andCindyBeebe,whohelptorunTheWellnessForum,oftenwithoutPam,whichallowsforprojectslikethisbook.

ThankyoutoChefDelforcontributingmanyofhisdeliciousrecipes.ThankyoualsotoRobertMerrillandRobertMetzgerforthephotography,

andtoNicoleSchlosserandErinKelleyfortheirsuperbeditorialassistance.Weappreciate aswell the input of JanaGermano,DavidNemtzow, JohnTanner,andDr.PamelaRusso.

And ourmost heartfelt thanks go to themanyWellness Forummembers:“Darcy,”MaureenYatwa,JillCollett,BarryandElisabethSmall,PattyYeager,“Martin,” Ellen Seigel, Cat Timmons, Janet Triner, Larry Nicol, and, onceagain,theincomparableWellnessForumChefDelSroufeforsharingtheirverypersonalstoriessothatotherscanlearnfromthemandregaintheirhealth.

N

INTRODUCTION....................................

utritionmust ranknear the topof subjects thatarevitally important to thehuman experience, and yet are still poorly understood. Textbooks on the

subjecttendtobedry,intendedtobereadonlybyprofessionalsinthefield,suchasnutritionists anddietitians.Popularbooks that address the subject generallytake the form of diet books, designed to hawk the latest weight-loss fad andskewallresearchinfavorofthedietbeingsold.Thenewsoffersusonlysnippetsofnutritionalinformation,devoidofcontextandmisinterpreted,leavingmillionsofAmericans believing that fish oilwill protect them fromheart attacks, thatchocolateholdsthekeytolongevity,orthatlow-faticecreamisahealthfood.Andsotheycontinuetoeatthemselvesintoanearlygrave.

Furthermore,eventhosewhoeatasounddietmaystillendupexperiencingpoor health as a result of interaction with themedical system. There is littleevidence to support the use of many of the tests, drugs, supplements, andprocedures commonly recommendedbyamajorityofhealthcarepractitioners.Mostmedical professionals donotmake full andhonest disclosures about theminimal(ornonexistent)benefitsofthesemedical interventions,orabouttheirrisksandsideeffects.

Sorting out the confusion perpetuated by the barrage of conflictinginformationonthetopictakesmoretimeandexpertisethantheaveragepersonhas.Wemaynotallbeupforreadingascientifictextbook,butonamatterasimportantasourownhealth,we’reallup foragoodtalk.Sowethoughtwe’dtakeashotatbringingthesesubjectstolifethroughconversation.

Wehopeyou’lllikeit,andwehopeyou’llwalkawaywithanunderstandingthatwillimproveyourhealth.

PamPopper

GlenMerzer

1

DEEP-FRIEDBUTTERONASTICKANDOTHERATROCITIES....................................

GLENMERZER: Pam, how would you characterize the overall state of thehealthofAmericansasapopulation?Howsickarewe?

PAMPOPPER:Verysickandveryoverweight.It’sfarworsethanmostpeoplebelieve.

GM:Butaren’twelivinglongerthanbefore?

PP:We’renotlivinglongeringoodhealth;we’relivingfractionallylongerwithdiseases that compromise our quality of life and that cost us a fortune.We’relivinglongerwithdiseaseslikediabetesandAlzheimer’s,whicharebothseeingexplosivegrowthinthenumberofdiagnoses.And,infact,we’renotlivingthatlongatall;we’rearoundthirty-sixthamongnationsonthelongevitycharts,tiedwith our very poor neighbor Cuba.We’re in a health crisis.We spendmoremoney by far than any other nation on health yet we have miserable healthoutcomes. Some people don’t perceive it that way. We have to change theirminds.

GM:What’smakingAmericanssosick?

PP:Ourfood.AndIsaythatfortworeasons:One,wehaveexcellentdataonpopulationswithlowerdiseaseratesandweknowthattheireatingpatternsaredifferentthanours.Two,wehaveexcellentdataontherarephysicianswhousedietasaninterventiontool,showingthatwhenpeopleadopttherightdiet,theyofteneattheirwayoutoftheirdiseases.Dietisclearlytheproblem.

GM:HasanationeverexistedthatisfatterthanAmericatoday?

PP:Neverinrecordedhistoryhaveweseensuchobesity.We’vesettherecord.Andit’sgoingtobetoughtobeat.

GM: There’s been a lot of attention paid to obesity recently.Do you see anysignsofimprovement?

PP:It’sgettingworse,unfortunately.WhenIwasdoingresearchforForksOverKnives, Iwas looking at obesity statistics; the statementwasmade in the filmthat40percentofAmericansareobese.IfyoutakealookatthewebsiteoftheCentersforDiseaseControl,thepartylineisthatathirdofthecountryisobese.Well,ifyoutakealookathowwecategorizeobesityandoverweightconditionsinourcountrybasedonbodymassindexcharts,we’rebasicallysaying21to24percentisnormal,25to29percentisoverweight,30percentandhigherisobese,and40percentandhighermeansyou’remorbidlyobese.WellinIndia,21to24is overweight, not normal.1 This is also the approach in Canada2 andmanyothercountries.Ifyoupickupthepopulationof theUnitedStatesandplop itdown in the middle of India and other countries with higher standards thanours,ourobesityratewouldapproach60percent.

GM:Sothere’sapotentialwayoutofthecrisis.Justlowerourstandardsalittlemore.Define“overweight”as“twiceasfatasanobeseIndian.”

PP: It’salmostunbelievable.Nootherpopulationhaseverhadsuchunlimitedaccesstosomanybadfoodstobecomethisoverweight.Andnopopulationhasever been as misled as ours by a perverse system of incentives in foodmanufacturing, the advertising industry, and themedical field. Sowe’ve eatenourselvesintothedubiousdistinctionofbeingthefattestpopulationinrecordedhistory;nowwe’vegot to figureouthowwe’regoingtoteachmorethanthreehundredmillionpeopletoeattheirwayoutofthisterriblestate.

GM:IheardareportonNPRaboutthehealthiest, fittest,andleaneststate inAmerica:Colorado.3Thereporterwentonaboutallthejoggers,thebikepathsin Boulder, and the skiing in Aspen. Then he actually said, “In fitness-crazyColorado,theobesityrateisonly21percent.”4

PP:Sothat’sonlyaboutamillionpeople.

GM:Yup.That’sourskinniestpopulation.That’sasgoodasitgets.And,creditwherecreditisdue,onlyoneinfourchildreninColoradoisoverweightorobese.

I’venoticedthatpeoplejustassumethatit’snormaltogainweightasyouage.Friendswhowere160poundsincollegehitmiddleageandthey’re200pounds.Isthereanyreasonwhyafifty-year-oldshouldweighmorethanhedidwhenhewastwentyortwenty-five?

PP:Theonlyreasonwhyafifty-year-oldwouldweighmorethanhedidwhenhewastwentyortwenty-fiveisthathisdietandlifestylefinallycaughtupwithhim.Youthwill overcome a great number of indiscretions.That’swhy peopletendtogetcanceralittlelaterinlife;ittakesthatlongforthedietaryhabitstocatchup. It’s simplydietand lifestylehabitscatchingup,with themajorhabitbeing exercise, or lack thereof. I’m fifty-six years old and the vastmajority ofpeoplemyagearenotdoingtherightamountofexercise;someof themdon’texercise at all. Gaining weight is not a normal function of aging. There’s noreasonwhy you can’t stay lean and physically active into your nineties and behealthy.

GM:Whatwould you say are the leading causes of our unmatched record ofobesity?

PP:First,thereisanoverallconfusionaboutfoodandthewaythatpeoplearetaught to eat from a very early age.Wehave strange ideas about food in thiscountry.Oneistheideathatmoderationisthekeytosuccess,thatyoucaneatalmostanythingyouwantaslongasyoueatitinmoderation.

GM:Ihearthatalot,thoughnooneeversaysitabouthemlock.

PP:Iattendedaweddinglastnightandfoodwasthetopicofthetable.Iwasn’teating90percentofwhattheyserved,andtheguynexttomesaid,“Everything

inmoderationisokay,soI’mjustgoingtohavealittlebitofthisstuff.”Well,itwas a little bit of a bunch of horrible things that added up to probably 2,500calories,2,000ofthemfromfat.Youknow,that’snotmoderation—that’sadietthatkillspeople.Wehavealotofmisbegottenideasaboutfood,manyofwhichcome fromthegovernment,nationalhealthorganizations like theAcademyofNutritionandDietetics,andotherprofessionalgroups.

Anotherpartofitistheavailabilityofrich,inexpensivefood.Ifyougobackseveral hundred years, you used to have the wealthy and poor eating vastlydifferent diets.Thewealthy ate rich foodwith lots of calories,with the resultoftenbeinghealthandweightproblems.Thepoorpeasantscouldn’taffordrichfoodsotheylivedonpotatoesandvegetablesformostoftheyear.Afewtimesayearthey’dhaveafestivalandroastapig,butthenitwasbacktovegetablesandpotatoes.Thefactthattheydidn’thavetheeconomicwherewithaltoeatasthewealthyatewasprotectiveforthem;itkeptthemleanerandhealthierthanthewealthy. Today, most Americans can afford to eat meat and animal foods—thingsthatusedtobereservedforthewealthy.They’reeatingallofthiscalorie-denseanimalfoodandprocessedandpackagedfood,dayinanddayout.Andit’softenaloteasierandsometimescheaperintheinnercitytofindKentuckyFriedChicken orMcDonald’s than fresh produce, so many people find themselvesalmost trapped intoobesity.The cost ofmany animal foods is effectively keptlowbyfederalfarmsubsidies,soourtaxdollarsarebeingusedtoskewourdietinthedirectionoftheveryfoodsthatmakeussickandobese.

Whenyoueatthiscalorie-densefood,asDougLislesaysinthemovieForksOverKnives,“Peoplehavetoovereatjusttobesatisfied.”IfI’mgoingtotrytofillmybellywithcheeseandpotatochips,I’vegottoeatfourthousandcaloriesof it to accomplish that goal. You can’t eat those foods without becomingoverweight because you’re forced to overconsume from a caloric standpoint.That’swhywehaveanobesityepidemicinthiscountry.Thenyouaddtoitthesedentarylifestyleofmostpeople,andit’snowonderwe’regainingweightatanalarmingrate.

GM:Areyouforcedtoovereatthosefoodstofeelfullbecausethey’redeficientinfiber?

PP:Yes.Thereare twomechanismsbywhichpeopleexperiencewhatwecallsatiety:stretchreceptorsandnutrientreceptors.Stretchreceptorsinthestomachtellyouthatthebulkofthefoodthatyouateissufficient,andthat’swherefiber

isreallyhelpful;ifyoueatabowloflentilsandricewithfourteengramsoffiber,you’regoingtofeelfull.Infact,youcouldn’tovereatitbecauseifyoutriedtoeatfourbowlsof it,you’dexplode.Ontheotherhand, ifI’meatingcalorie-dense,fiber-deficient food (such as a turkey sandwich and potato chips), in order toactivatethosestretchreceptors,I’vegottoeatanenormousamountofcalories.Weonlyfeelsatietywhenthestretchreceptorsandthenutrientreceptorsinourstomachtellusthatwe’vehadenoughbulkoffoodandcalorieconcentration.Sowiththesecalorie-dense,nutrient-deficient,andfiber-deficientfoods,inordertoactivate those stretch receptors, you’ve got to eat a gargantuan quantity ofcalories to accomplish that goal, sometimes thousands of calories in a singlemeal.Whenyoutakeintoconsiderationthatanaverageadultmayneedonlytwothousandcaloriesperday,youcanseetheproblem.It’seasytoconsumehalfofthisinonemeal.

GM:Tellmeaboutthenutrientreceptors.Howdotheywork?

PP:Theytellyou if thecaloriedensityof thefood isadequate.Thatbecomesimportantbecausejustasyoucanovereatfromacaloricstandpointbyeatingthestandard American diet with animal foods and processed foods, you can alsoundereatbystructuringaplant-baseddietthewrongway.Iseethisoftenwithpeople coming into our classes, people who have seen variousmovies or readarticlesanddecided,“I’mgoingtoeatalotoffruitsandvegetables.Infact,I’mgoingtostructuremyentiredietaroundfruitsandvegetables.”Sotheyeatfruitforbreakfast,haveabigsaladforlunch,andabigsaladfordinner.Afteraboutthreedaysofthat,they’rereadytochewtheirdeskupattheofficeandcan’tsleepat night from the rumbling stomach. They’re uncomfortable all the time andhaveanagginghunger.Evenwhentheirstomachsarefullofapoundandahalfofvegetables,theyhavethisnaggingfeelingofneedingmorefood.Why?IfIeata pound and a half of vegetables,my stomach is going to be full from a bulkstandpoint, but my nutrient receptors are going to say, “One hundred fiftycalories?Gosh, Idon’tknow ifwecankeep thishumanoperating for anotherfourhourson150calories!” Imaybe full froma fiber standpoint,butI’mnotdoingwellbasedonmybody’sperceptionofthecaloriedensityofthefood.Soweadvisepeopletoincludealotofgrainsandlegumesandpotatoesintheirdietbecausetheyaddcaloriedensitytothemealswithoutaddinglotsoffatandtoomanycalories.Nature’sperfectplanforhumans.

GM:Sothat’stheargumentforhavingstarchasastapleofthediet?

PP:Well,youhaveto.Ifyoudon’t,here’swhathappenstopeoplewhotrytolive on fruits and vegetables. They go through what I call the “honeymoonperiod,” when they benefit from what they take out of the diet. When theyremoveanimalandjunkfoodsfromtheirdiet,theyfeelgreat.Theyloseweight,their skin clears up, their headaches go away, and they say, “Boy, this is thegreatestthingsincerightturnonaredlight.”However,withinafewweekstheystarttofeelfatiguedbecausetheeffectofthecaloriedeficiencysetsin.

Whatalotofpeoplewilldothenistostartaddingdriedfruits,nuts,oroilstotheirdiet.Therearealotofunhealthfulplant-basedoptionspeoplechoosetoincrease the calorie count.Over time, those peoplewill develop health issues,generally speaking, asmuch as themeat eaters will.A plant-based diet won’tworkeffectivelyifyoudon’tdoitright.Andjusteatingfruitsandvegetablesisoneof theways thatpeople canmess it up for themselves andamajor reasonwhypeople revert to their old eating patterns.Then they say, “Well, this dietmustnotwork.IhavetogobacktowhatIwasdoingbefore.ItmaynothavebeenthebestthingbasedonwhatIreadinso-and-so’sbook,butatleastIwasabletostayawakealldayandIwasabletosleepatnightbecausemystomachwasn’trumbling.”

GM:Theword“starch”seemstohavealousypublicrelationsguy.Peoplealwayshaveterrible thingstosayaboutstarch.Dieterssaythat they’re tryingtoavoidstarchy foods and that they gainweightwhenever they eat starch.What’s thedealhere?Howcanthetypeoffoodthatactuallyhelpspeopleloseweightandstayhealthyhavesuchabadreputation?

PP:That’sbecausetherearedifferentsortsoffoodsthatgetlabeledas“starch,”andbecausestarchoftentravelsinbadcompany.Inotherwords,peopleslathersourcreamontheirbakedpotatooroliveoilontheirpastaorpestoontheirrice.YouwalkintoaMexicanrestaurantandinsteadofhavingthehealthystarchofbeansandrice,youorderrefriedbeanswithlardinsideaburritowithcheeseinit—a1,500-calorie,fat-ladenMexicandish.

Let’s posit a hierarchy of starch. The healthiest starch comes fromwhole,unprocessed foods, such aswhole grains, potatoes, sweet potatoes, yams, corn,and so forth. The next healthiest but suboptimal starch comes from brokengrains, also known as flours.Whole wheat bread, for example, is denser and

more caloric than wheat berries in their original form, but whole wheat flouritselfisnotinherentlyfattyorunhealthy.Ifyou’retryingtoloseweight,stayingawayfrombrokengrainsisprobablyagoodideabecausebrokengrainsaremoreconcentratedincaloriesandgenerallydon’thaveasmuchfiberaswholegrains,so they’re absorbed quickly in the system. The worst starch comes in refinedfoodsand is combinedwith fats and sugars inproducts likemuffins andcake.These starchy foodswillputweightonyou fast,but it’s largelybecauseof theaddedfatsandsugars.Peoplearemisunderstandingthenatureandimportanceof starch if the word conjures in their minds the image of donuts. It shouldconjuretheimageofyamsandcornandrice.

GM:Soit’ssimplisticandmisleadingtosaythatcarbsarefattening?

PP:Whenpeopletellmecarbohydratesarefattening,Itellthem,“Youknow,twobillionAsiansnevergotthatmemo.”

GM:Whatarethefoodsyourecommendthathavesufficientcaloriedensitythatmakeyoufeelfull?Whatarethebestfoodstomakethestaplesofyourdiet?

PP:Wholegrains,legumes,andstarchyvegetables.Morebroadly,Itellpeopletomakethestaplesof theirdiet the four foodgroups,whicharewholegrains,legumes,fruits,andvegetables.WehaveourownlittlepyramidthatweusehereatTheWellnessForum.Beans,rice,corn,andpotatoesareatthebottomofthepyramid.Thensteamedandrawvegetablesandbigsaladscomenext,withfruitsafterthat.Wholegrains,orpremadewholegrainfoodslikecerealsandbreads,areallrighttoeat.Everythingelseiseitheroptionaloracondiment.

As for high-fat plant foods—nuts, seeds, avocados, olives—use themoccasionallyorwhenthey’repartofarecipe,butdon’toverdoit;thesefoodsarecalorie-dense and full of fat. No oils, get rid of the dairy, and then, veryimportantly,youneedtodifferentiatebetweenfoodandatreat.Idon’tthinkyoucanget through topeopleby tellinga twenty-five-year-old that shecan’thaveanother cookie or a piece of cake for the rest of her life.Where you can gainsome traction is to say, “Look, birthday parties are a good time for cake,Christmasmorning is a good time for cookies, andValentine’sDay is a goodtime for chocolate, but you don’t need to be eating that stuff all the time.”People endup inmyoffice because they’re treating themselves several times aday.

GM:Ihadobeserelativeswhoaregonenow,myauntanduncle.WhenItoldthem at the age of seventeen that I had gone vegetarian, they became terriblyconcernedthatIwouldn’tgetenoughprotein.Theyweren’ttallandmusthaveweighedmorethantwohundredpoundseach.Theirkidswereoverweight,buttheywereworriedaboutme.Usuallytheywereononedietoranother,buttheywouldmakeanexceptionforcakeandicecreamonspecialoccasions.Andthespecial occasionswere theirbirthdays, their kids’ birthdays, their kids’ spouses’birthdays,anniversaries,holidays,EarthDay,NationalOrganDonorAwarenessWeek…thelistwentonandon.

PP: Right. You really have to put some common sense into this. My sisterturnedfiftyacoupleofyearsago,whichisaprettybigdeal.Wehadcakeandchampagne,buttherewasnocakeandchampagnethenextdayorthenextdayorthenextday.Thesehavetobeoccasionaltreats;Itellpeopletomakethemsituational.Inotherwords,don’tkeepthisstuffaroundthehousebecausethey’llcallyournamefromthekitchen.Ihavenotroublestayingawayfromcheeseandanimalfood.Butsweets,that’sadifferentstory;they’renotaseasytoresist.Nothavinganyaroundistheeasiestwaytoavoidthem.IfIwantsomethingsweettoeat after I get offwork at ten o’clock, I’ve got bananas, plums, oranges, someapples,andsomestrawberriesinmyhouse.That’s it.IfIwantanythingelse,Ihavetogetinthecarandgooutandgetit,somethingI’mnotgoingtodoatteno’clock at night. It’s a much better plan than standing in the kitchen saying,“Huh,IcouldhavesoyicecreamorIcouldhavesomecookiesorIcouldhaveabananaor anapple.”That’s a choice thatputsme inaposition tohave tousewillpower.

GM: Iused tohavea sweet tooth.Fromthe timeIwasakid, Iwouldalwayshave cookies and cake and ice cream in the evening. Even when I becameconcerned about health as a teenager and became first a vegetarian and then,closetotwentyyearslater,avegan,Iwouldstillhaveafewvegancookiesintheevening.Inthesummer,Iwouldfollowthatupwithsomesoyicecream.AndthenitturnedoutthatmycholesterolkeptcreepinguponwhatIthoughtwasan excellent diet. Itwas embarrassing. I had already coauthoredwithHowardLymantwobooksondiet,andyetmycholesterolwas212andmytriglycerideswere203.MydoctorrecommendedthatIconsidertakingastatindrugtolowermy cholesterol, whichwould have been really embarrassing.Now, I have badgenes.Therehavebeenalotofheartattacksinmyfamily,whichiswhatledme

tovegetarianismatseventeen;myrelativesweredropping likeflieswhileIwasgrowingup.

I ran into Dr. John McDougall (www.drmcdougall.com) at an event andaskedhimwhymycholesterolhadgoneashighas212andifitwasjustmybadgenes.Afterall,Iwasonabasicallylow-fat,vegandiet.Andhesaid,“Fructose.”I said, “Well, my blood sugar is fine; it’s just my cholesterol …” And Dr.McDougallsaid,“Fructose.”He’saveryefficientguy—hegavemeaone-worddiagnosis. It was like the “plastics” scene fromTheGraduate. I don’t know ifthere’s another doctor in America who would have instructed me that myproblemwas fructose, and certainly there isn’t anotherwho couldhavehelpedme in just one second. Other doctors would have put me on drugs and runcountless testsonmeand increasedmystress level.Hemetmeatapartyandsaid“fructose.”Arguably,Iowehimmylife.

I went home and Googled “fructose and cholesterol” and discovered thatindeed there was a theory that there was a direct relationship.5 So Iexperimented. For the next several weeks, instead of having for breakfastcommercial,organicfruit-flavoredsoyyogurt,whichcomessweetenedwithcanesugar,intowhichIhadtypicallyaddedfruitsandraisins,Ihadoatmealwithoatbran,cutoutthecookiesandthesoyicecream,andcutoutdriedfruit.Imadeabsolutely no other changes. Seven weeks later my cholesterol was 146 and mytriglyceridesdroppedfrom203to81.ButthereasonImentionthisisthatafterIwentcoldturkeyonthesweets foracouplemonths,nowifI trytoeatoneofthosecookiesthatIusedtoeat,ittastestoosweettome.Itdoesn’ttastegood.

PP:Well,youbringupareallygoodpoint,whichistheneuro-adaptationofthetaste buds over time. I’m the sameway. I went to a wedding of a very goodfriendofmine.Wemadethecake—WellnessForumFoodsmadethecake,soitwasavegancake.Ihadatinybitofthefrosting,anditwasunpleasantlysweet.Iateacoupleofbitesofthecakewithoutthefrostinganddidn’tfinishit.Itwasn’tbecausewedon’tmakegoodcakes.Imean,everybodyelsewaslickingtheplateandlookingaroundformore,soIknowthecakewasreallygood.

Ireallyamalothappierwithfruit,eventhoughIfindIstillhaveabitofasweet tooth.Theevenings inparticulararewhenI feel like Iwant something,but I’m just as happy with a nice crisp apple or a bowl of pineapple orstrawberries. A bowl of strawberries makes me perfectly happy; I really don’tmiss the other stuff. And speaking of Dr. McDougall, he often says in hislecturesthathumansdohaveasweettoothandnaturebuildsinagreatwayto

satisfyit;it’scalledfruit.Gohavesomeandyouwillfindthatyoudon’thavetohaveallthisothergarbage.

GM:Now,inmycase,Pam,Imoreorlesscutsweetscoldturkey.Whenpeoplehaveveryunhealthydiets,doyoufindthatit’smoreeffectiveforthemtomakemajordietarychangesrightaway,juststopwhattheyweredoingbeforeanddosomething radically different, or is it more effective for people to changegradually?Ordoesthatdependontheindividual?

PP:Ithinkthebestthingtodoismakeagreatbigleapintothelandofwhatwecalldietaryexcellence.Thereareacoupleofreasonsforit.Thefirstoneisthat,ifyouwanttogetpeopletostickwiththis—andthat’smygoal;Iwantpeopletodoitandkeepwithitfortherestoftheirlives—they’vegottoseeresults.Youknow,peoplereadPreventionmagazineandgototheircardiologist,whowilltellthemtoeatmorefishandeat lesschicken.Sotheyworkatthis,makingsmallchangesto includea littlemoreofthisfood,a little lessofthatfood.Theytryhard,butattheendoftheday,they’reinworseshapefromaweightandhealthperspective than theywerebefore they started.That’snotmuchmotivation tokeeppayingattentiontodiet.

GM:Whichcouldbewhythemedicalestablishmentoftendownplaystheroleofdiet.

PP: Yes, because they don’t see results from the minimal, half-assed dietarychanges they typically recommend. So I found that when wemake great bigchanges,weseegreatbigresults,andthemotivation lasts.Yougivesomebodysomephenomenalresultsandyoudon’tseethemgoingback.They’llexperimentwithsome junk food—Icall itgoingoff the reservation—andthen they’ll findouthowpoorlytheyfeeleatingsomeofthisstuff.They’reprettycompliantafterthat. Ifwewantpeople tobecompliant,we’vegot toshowthemgreat results.Thatonlyhappenswhentheydothewholediet.

Iwasexplainingthistosomebodyrecently.EverywhereIgo,foodbecomesthesubjectofconversation.Iwasatmyfriend’swedding,sittingatthistablefullofpeople—noneofwhomeatlikeIdo—andtheywereallcuriousaboutthewaythatIeat.Theyweresayingthingslike,“IcutoutthisandthatandIhaven’tlosta pound.” “My cholesterol is still high.” “I still have to take blood pressuremedication.”Andsoon.Iexplainedtothemthatdietislikeacombinationlock.

Ifyouhavetodialfournumberstoopenacombinationlockandyoudialthreecorrectly,youdon’tget75percentoftheresults.Yougetnothinguntilyougetthatfourthnumberright.Wehaveasocietyfilledwithpeoplewhoaredoing75percentofwhat theyneed todoor50percentofwhat theyneed todo.Theydon’tget50percentor75percentoftheresults;nothinghappensuntiltheygetthewholethingright.

GM:Aswithme. Iwas doingmost everything right, but Iwas taking in toomuchsugar.

PP:That’swhyweteachdietarypattern.Wereallyworktomakepeopleleavetheiroldlifebehindandembracedietaryexcellence.Ifweproducethechangesforthemthatthey’relookingfor,they’llstickwithit.There’sanotherissue,too,anditgoesbacktothesebadfoodscallingtheirnamesfromthekitchen.Aslongas the stuff is around, as long as they’re teasing themselveswith it every day,they’regoingtoreverttotheiroldways.It’s justgoingtogoonforever.Sowetellthem,“Look,ifyou’regoingdothis,thenlet’sdoit.Getridofthestuff.”

GM: What would you say are the most outrageous and self-destructivenutritionalhabitsofAmericans?

PP:Milk drinking would be right up there. All cow’smilk products: cheese,butter,yogurt,cottagecheese,skimmilk,allthatstuff.Callmecrazy,butIfindtheideaofconsuminganothermammal’ssecretionskindofgross.Here’showIrecommendthinkingaboutit:allcow’smilkhasestrogenmetabolitesbecauseitcomesfromlactatingcows.6Sothenexttimeyou’regettingreadytoputasliceofcheeseonasandwich,justthink,“I’mreallylookingforwardtoabigsliceofestrogenbetweenmyslicesofbread.”Nexttimeyou’regettingreadytoputskimmilkonyourcereal,say,“I’dreallylovetohaveestrogenwithmyCheeriosthismorning.”Doesn’tthatsounddelightful?

GM:Sohowdoestheestrogenincow’smilkaffectwomenwhoconsumedairyproducts?

PP:Mostbreastcancersareestrogenreceptorpositive,soelevatedbloodlevelsofestrogenincreasetheriskofbreastcancer.There’salsoanother issue.Cow’smilk isdesigned tohelp a calf grow to severalhundredpoundswithin a short

periodoftime,socow’smilkincreasesproductionofahormonecalledinsulin-like growth factor, or IGF-1, which helps to fuel this growth.7 But dairyproductsalsoincreaseIGF-1levelsinhumans;thedairyindustry’sownstudiesshow this.8 The problem is that IGF-1 is a powerful cancer promoter inhumans;thereareclearlinksbetweenIGF-1levelsandbreast,lung,colon,andprostatecancers.Infact,thelinkbetweenlow-fatcow’smilkandprostatecancerisstrongerthanthelinkbetweensmokingandlungcancer.9

Estrogen levels inmilk increaseduring thecow’spregnancy.Farmersaren’tsupposed to milk their cows during the last twomonths of pregnancy, whenestrogen levels are highest, butmilk products still contain lots of estrogen.Sothat’s why I’d say that consuming dairy is right up there as one of the mostperniciousanddangerousdietarypractices.

GM:Whataresomeoftheotherworstpractices?

PP:Drinkingcaloriesisanotherterribledietarypractice.Ispokeatalargelocalschool about improving foods in the school system.They’ve alreadymadeoneveryimportantadvance:thekidscanbuyonlywatertodrink.Wateristheonlydrinkavailabletothemotherthanthemilkthat’sunfortunatelyservedwiththelunch. Themilk, of course, is a disaster, but at least if the kids want to buysomethinginthevendingmachines,it’swaterornothing.Andthereasonthat’simportantisthatonethingallnutritionistsprettymuchagreeuponisthatliquidcaloriesdon’t reduce thecaloriesconsumed in food.Thereare somanypeopleconsuming soft drinks, sports drinks, flavored milk, and juices—we’re talkingbetween500 and700 calories a day thatdon’t reduceby a single caloriewhatthey’reconsuminginsolidfoods.That’scertainlyonereasonwhypeopledevelopweightproblems;drinkingcaloriesisamajorcontributortoobesity.

The other major dietary nightmares in the United States are too muchprotein,toomuchfat,andtoolittlefiber,withanimalfoodsaleadingcauseofallthreeproblems.Inthefatcategory,oilisaclosesecondwiththehavocitcausesonthebody.

I’ll add one more thing that’s become an issue in recent years: takingsupplements instead of eating well. The justification for that approach is, “IknowIdon’teatwell,butI’lljusttakesomepills.That’llmakeupformydietaryindiscretions.” Unfortunately, the pills people take depend on whichpractitionerstheygotoandwhichmagazinestheyread;they’reallfairlyuseless

mostofthetime,butsomeofthemcanbedangerous.I’d say that not understanding the importance of dietary pattern is the

overarching issue. People think that they’re going to improve their diets byeatingsoytwiceaweek.Ortheyreadanarticlesayingblueberriescanreducetherisk of cancer, so they eat blueberries every day for sixmonths. They end upgaining four pounds, and their health deteriorates because it turns out thatneitherblueberriesnoranyothersinglefoodcanfixwhat’swrongwiththem.It’sonlybychangingthefundamentaldietarypatternthattheycanfixwhat’swrong.ThosearesomeofthewaysinwhichAmericanshavegoneastray,whythey’resoconfusedandfrustrated.

GM:Doyouseesupplementsasanattempttogetbywithminimalchanges?

PP:Yes.ItgoesalongwithAmericans’unendingquesttoeatahealthierversionoftheirbaddiets.“I’meatingchickenandfishinsteadofbeef.I’mdrinkingskimmilk insteadofwholemilk. Iuseonlyorganic,cold-pressedoliveoil.”Well, itdoesn’t matter what kind of oil. Again, you need to understand the dietarypattern that promotes health. It’s the entire diet that the average person eats,including many of my very well-educated friends who believe they’re eatinghealthfully. It’s their entire diet that’s appalling from the standpoint of bothmacronutrients (protein, carbohydrate, and fat) and micronutrients (vitamins,minerals,andphytochemicals).

GM:Ireadaboutastudyshowingthat90percentofAmericansbelievetheyeatahealthydiet.

PP: Yeah. Isn’t that amazing? Then it must be just the other 10 percentresponsibleforthe40percentobesityrate.

GM:Don’tyouhateitwhenasmallminorityruinsitforeveryoneelse?

PP:Peoplehavetheideathattheycaneatwhatevertheywantbecauseittastesgood;theyhavenoconceptoftherelationshipbetweendietandhumanhealth.Youseethis inyoungpeople, too.Youngpeopleespeciallyassumethat they’reinvincible.

Theythinktheycaneat,drink,andbemerry,withnopricetopay.Andthenone day, there is. They go to the doctor and realize they’ve gained twenty or

thirtyorfiftypounds,andtheircholesterolisoutofcontrol.There’sacompletedisregard,eveninthemedicalcommunity,fortheideathatwhatgoesintoyourmouthinfluencesyourhealth.That’stherootoftheproblem.

GM: I’vegotacandidate for theworst foodout there. I sawthisonaSundaymorningnewsshow.AttheIowaStateFair,thebighitthisyearwasdeep-friedbutter.

PP:Deep-friedbutter?

GM:Onastick.Fourouncesofbutterdeep-fried,dippedinhoney,andtoppedwithasugaryglaze.

PP:Doesitcomewithanangioplasty?

GM:Thereporter,JakeTapper,who’sanintelligentguy,tookabiteoutofitontelevision,as ifhe thought itwasamusing.Hewas showingushewasagoodsport,amanofthepeople.I’llbethehasagreatlifeasamajormediafigureinWashington, and I’msurehe’d like toattendhis children’sweddingsoneday,buttherehewas,eatingdeep-fried,sugar-glazedbutter.Now,ifhewasdoingastoryoncrystalmethbeingalltherageinIowa,Idon’tthinkhe’dsampleit.

PP:That’swhatI’msaying.It’sthiseat,drink,andbemerryapproachtofoodsthatarepoisonsthatistrulydeadly.

GM: I’m curiouswhat first step you ask people to take to begin their dietarytransformations.WhenpeoplejoinTheWellnessForumandtheyareobeseandoncholesterolmedication,havingakitchenloadedwithmeat,cheese,sodapop,cookies,andchips,doyoutellthemtojustgohomeandthroweverythingout?

PP: I tell themto take it toachurchor foodbank.Therearepeoplewhoarehungryandareworriednotaboutcardiovasculardiseaseanddiabetesbutaboutfeedingtheirkids.Sothebestgiftyoucanmakeistotakethatfoodthatdoesn’tserve you anymore and give it to people who desperately need food tonight.Then go buy the right stuff.Wehave to get over some of themental imagesassociatedwiththis:Ispentall thismoneyonfoodanddon’twanttothrowitoutorgiveitaway!Well,ifyouenduphavingaheartattacktomorrow,areyou

goingtosay,“Hey,I’msogladIatethatbaconandgotmymoney’sworth.Sure,Ihadaheartattack,butIdidn’twasteanickel!”Nobodyeversitsinmyofficeasaresultofmakingbadchoicesandendingupinabadhealthsituationandsays,“Yeah,IknowI’vegotthisbreastcancer, lupus,ordiabetesnow,but itwassoworthitbecauseallthatanimalfoodandprocessedfoodwasdelicious.”Getthestuffoutofyourhouse.Leaveitbehind.Leaveyouroldlifebehindandjoinme.Letmetakeyourhandandtakeagiant leapover towhere thehealthypeoplelive.

If I could find away tomake people understand this quickly and easily, IknowI’dbeabillionaire.IfIcoulddevelopapillwherepeoplecouldliveinsidemybodyforjusttwenty-fourhoursandthengobacktotheirown,we’dhavenotroubleconvincingpeopletoeatlikethisbecausetheywouldfeelhowgreatitistofeelaliveandenergeticandtobeabletorunaroundeighteenhoursaday.Iwantthemtoexperiencethat.That’stheonlywaywe’regoingtogetcompliance.That’stheonlywaypeoplearegoingtogetwiththeprogram.

2

THEPROGRAM....................................

GM:Let’stalkabouttheoptimaldiet.There’satheoryouttherethatwe’realldifferent and we should choose our diet according to our blood type or ourgenetic makeup or our personality type or our astrological sign, and that theoptimaldietisonethingforonepersonandavastlydifferentthingforanotherperson.Isthereanytruthtotheideathatdifferentpeopleneedwildlydifferentdiets,orarewemostlyalikeinwhatweoughttobeeating?

PP:We’reshockinglyalike.Theonlythingthatdifferentiatesussignificantlyisfoodallergies.Myattorney,whodiedacoupleyearsagoatsixty-one,wasinhisfiftieswhenImethim.Hehadbeenallergic tocherries,peaches,andapricotssince he was five. Well, he could eat a plant-based diet, but since cherries,peaches,andapricotssenthimintoanaphylacticshock,wekepthimawayfromthose foods.Thatwouldbe an example of a genetic situation; stay away fromthreespecificfoods.

GM:Waitaminute.Heateaplant-baseddiet,butdiedatsixty-one?

PP:Well,hecheatedalot.Hediedofnoncompliance.Hewouldsayhewasonaplant-baseddiet,buthenevergaveupcheesesandsalmon,andheateoliveoilandsweets.Oneday itcaughtupwithhimandhehadamassiveheartattack.Hewasasuccessfulmanandhelikedtolivelarge;asaconsequence,hediedin

aninstant.Itwasatragicexampleofhowyouhavetogetthewholedietright,notjustgethalfoftheequationright.

Butwithreferencetothis ideathatpeoplearedifferentandthereforesomepeopleshouldeatdifferenttypesofdietsbecauseoftheirethnicityortheirbloodtype, there’sno solid evidence. I come to allmyconclusionsbasedonmedicalevidence. If you wonder whether there’s anything to the blood-type diet, doPubMed searches. Anybody can do it. You’ll find absolutely no publishedevidence indicating that blood type makes a difference in long-term healthoutcomes.Igetveryfrustratedbecausethepromotersofthesebloodtypedietsand metabolic diets and caveman diets have made millions and millions ofdollarspromotingtheseprogramstopatientsandthegeneralpublic.Andtheyspendnoneof thatmoneyonproving theirhypotheses. I love thewayDr.T.ColinCampbell,theauthorofTheChinaStudy,putitwhenhewasgoinghead-to-headontheInternetwithsomeonewhowascriticizinghim:“Putyourtheoryto the test because what you’re essentially saying by refusing to do so is thatresearchisaluxurytobeenjoyedbysomebutnotrequiredbyall.”Andthat’sarather insulting attitude to those of us who are serious because I, for one,rigorouslyadhere towhat thesciencesaysaboutall aspectsofnutrition.Theresimply isn’t a shredof evidence that the cavemandiet or these other faddietshelpachieveormaintainoptimalhealthinpopulationstoday.Thesepeoplearewritingstorybooks.Theymaybeveryinteresting,butthey’renottobeconfusedwith science. They cite a lot of studies, but a close look shows that theymisinterpretthemtopromotetheirdiet,andtheyneverconductasinglestudyoftheirowntoprovetheircase.

Letmegiveyouanexampleofhowstorytellingcanconfusetheissue.WhenI conduct lectures, invariably I’ll have somebody raise his hand and say, “Myuncleatebacon,eggs,andcheesethreetimesadayandhelivedtobeninety-fouranddiedinhissleep.Howdoyouexplainthat?”AndIwillsay,“Ibelieveyou.Ibelievethathappened.Butifyoudelveintothepublishedscientificinformationthatwehave,itclearlyshowsthatisnotthelikelyoutcomeforotherpeoplewhoengage in that behavior.” So that’s a story. It’s probably a true story. It hasnothingtodowiththeadvicethatweshouldgivetothegeneralpopulation.

GM:You’vegottolovethepremiseofthecavemandietbooks,thatweshould,for some reason, eat the diet of our primitive ancestors.Maybe to prove thatcivilizationhasnotcomethatfar.Iactuallyhaveatheorythatthefirstveganwasacavemanwhodiscoveredthatit’seasiertosneakuponaplant.

Anyway, sincewe’re shockingly alike as humans,what should our diet be?Let’sbeginwithfat.Whatpercentageofcaloriesfromfatshouldwehaveinourdiet?Therearethosewhorecommendaplant-baseddietandemphasizethatitshould be low-fat, roughly 10 percent of calories as fat.And there are others,even some who recommend the vegan diet, who say no, we need a healthyamountofnutsandseedsandavocados,ahigherpercentageoffat.Andthen,ofcourse, thereare thedietbookhucksters, likeDr.BarrySearsandthe lateDr.RobertAtkins,whopromoteadietthat’s30percentfatormore.

PP: Let’s disregard the hucksters because they’re not worth our time. Butbetween the serious scientists advocating a low-fat, plant-based diet and theseriousscientistsadvocatingaplant-baseddiet that’s somewhathigher in fat, Ithink the answer is in themiddle. I don’t like to restrict peoplemore than isnecessary;mygeneralrecommendationtopeopleisanupperlimitof15percent,whichisstillprettylow.It’sveryachievableifwegetoilsoutofthedietandusenutsandseedsandolivesandavocadosaspartsofdishesthatweeat,butdon’tgo out of our way to eat a bunch of fatty plant foods all the time.Now, forsomebody who has coronary artery disease, or who needs to lose a hundredpounds,wewanttogethimdowntothe9to11percentrangeintermsoffat,whichmeans he’s not going to be consuming avocados and nuts and olives. Irecommendanupperlimitof15percentandalowerlimitof9to11percentforpeoplewhohavecertainkindsofdiseases.

GM:Allowmetociteamainstreamnutritionist:WalterWillettoftheHarvardSchoolofPublicHealth.Hearguesthatlow-fatdietsshownoimprovementinhealthoutcomescomparedwithhigher-fatdiets;theimportantthingistohavegood fats—polyunsaturated andmonounsaturated fat.He cites a Journal of theAmericanMedical Association study published in 2006,1 an eight-year study ofmore than 49,000 women that he says demonstrated no improvement inoutcomesfromalow-fatdiet.

PP:Willettisnottheonlypersonwhofindsthatalow-fatdietdoesnotprovidebenefit. The problem is his definition of a low-fat diet, and definitions aresomething that plague nutritional research. In Willett’s Nurse’s Study, forexample(Ithinkthegovernmenthasinvestedroughlyahundredmilliondollarsinthiswholeproject),thelowestamountoffatthesewomeneverconsumedwasinthevicinityof29or30percent!Idon’tthinkanyofuswhoadvocateaplant-

baseddiethasevertoldanybodythatadietthatcontains30percentofcaloriesasfat isprotectiveagainstanything.TheotherthingI’llpointoutaboutWillett’sresearch and the Nurse’s Study is that one of the ways in which peopleaccomplish a “low-fat” diet is often to eat fat-free dairy products. Thedetrimental effect of the concentrated protein in those dairy products oftenovercomes the benefit of any fat reduction, even if itwere to reach the targetlevel.

GM:Okay, so let’s say I’m convinced that I should aim for roughly 10 to 15percentofmycaloriesasfat.HowdoIexecutethat?Icouldn’ttellyouwithanyaccuracy thepercentageof calories I ingest is fat.Areyou recommending thatpeoplesomehowcount theircaloriesandcalculate thepercentagederivedfromfat?

PP:Itellpeople,ifyou’reeatingaccordingtoourpyramid,you’llbejustfine.Ican’t teach people to be either calorie counters or nutrient counters because itcan’tbedone.AndIusemyself as anexample.Today for lunch Ihada saladwithoneofWellnessForumChefDelSroufe’sfat-freedressingsandariceandvegetablecasserole.SoIhadanicebigportionofthiscasseroleandabigplateofsaladwithdressing.InorderformetotellyouhowmanycaloriesIate,I’dhaveto come back here to my office with a database and feed in fairly accurateinformationabouthowmanypiecesofbroccoliIate,howmuchricewasontheplate,andhowmuchdressingIputonthesalad.OfcourseIwouldhavenoclue.So if somebody likeme, withmy background in nutrition andmy resources,can’tfigureoutwhatIhadforlunchfromacalorieandnutrientstandpoint,howdowetakeabusyCPAwho’spreparingsomebody’staxreturnandteachhertodoitonalunchbreak?It’sobviouslynotdoable.

Whatyouhave todo is teachtherightdietarypattern. Just stayattunedtotheprinciplesofthediet.Theonlywayyou’regoingtomessitupisifyoustarttreatingyourselfallthetime,ortheoilsstartcreepingintothedietandyoustarteatingthoseitemsatthetopofthepyramidwithagreatdealofliberalism.Butifyoustickwiththebasicfoodgroupsthatwe’retalkingabout,you’llgetfull,youwon’tdevelopaweightproblem,andyou’llloseweightifyouneedto.Youjustcan’tovereat.Icouldn’thavepossiblyeatenanotherplateoffoodtoday;itwouldhavebeentoomuchbulk.

THEWELLNESSFORUM’SEatingPlan

GM:We’vediscussedfat.Howaboutprotein?Ifindthatwhenpeopletalkaboutnutrition,theirconcernstendtobetheirweightandtheirproteinintake.Doyoufindthat’swhatpeoplearemostconcernedabout?

PP:Thosearetwomajoranxieties,butpeoplehavelotsofmisdirectedconcerns.Ihavepeoplecoming intomyofficewith serioushealthandweightproblems,and they’re worried about the plastic in water bottles and about all kinds ofthingsthatmaybeconcerningbutthey’rehardlythemainissue.Americansareverydistractedbyinformationthatisn’tpertinentattheexpenseofgettingtotheinformationthatispertinent.

People are concerned about their weight, but not enough of them, in myopinion.There’saninterestingphenomenongoingoninourcountryandit’stheway that we’ve simply accepted our increasing weight. When I was in highschool, there weremore than seven hundred kids in our graduating class andonlyahandfulofthemwereoverweight.Nowmostofthestudentsingraduating

classes are overweight. People who are overweight look around and everyonelookslikethem;theydon’tfeelparticularlybadaboutitorfeelcompelledtodosomething about it right away. And that’s an insidious trend because beingoverweightputsyouatadditionalriskforeverydiseaseyoudon’twanttogetandfordyingfromthosediseases.

Regarding protein: it’s all but impossible to design a diet that has enoughcalorieseverydaythatdoesn’tcontainenoughproteinbecauseproteinneedsaresolow.Excretionstudieshaveshownthatproteinneedsfornormaladultsmaybeaslowas2.5percentofcalories.2Humanbreastmilk,whichfuelsmostrapidgrowthofhumansduringourentiretimeontheplanet,containsonly6percentprotein.3Sothere’snotmuchchanceofproteindeficiencyinanydietofcaloricsufficiency. I’ve told people, just go to the USDA food database and startenteringanycombinationoffoodsthataddupto1,500or2,000caloriesaday;you’re going to see that it’s impossible to become protein deficient eating anycombination of food.Our problem, by contrast, is that we eat way toomuchprotein.

GM:What’stheriskthere?

PP:We now know that animal protein consumed in excess of what humansneedbecomesapowerful cancerpromoter,basedonDr.Campbell’s studiesasreported in The China Study.4 Even if you consumed a really high-protein,plant-baseddiet,thefactremainsthatthebody’sneedforproteinisactuallyverylow.Soifyouconsumetoomuchprotein,evenplantprotein,yousimplyhavetoget rid of the excess; we can’t storemuch protein.What the body will do isconvertsomeofthesurplusproteintocarbohydratebecausethat’sreadilyusableforenergy.Intheprocessofdoingthis,thebodyhastogetridofnitrogenfromtheaminoacidchains,ascarbohydratedoesnotincludenitrogen.5Asthebodyreleases nitrogen from the amino acid chains, the nitrogen throws off a lot oftoxic by-products like urea and ammonia,which are detoxified by the kidneysandliver,causingalotofstressonthoseorgans.

GM: Sowe basically have thisword—protein—that enjoys a great reputation.Wehavewhole industries that are set up to provide uswith an abundance ofprotein,whetherit’sintheformofasnackbarorahighlyconcentratedproteinsupplement.Andyou’resayingthatit’sreallyjustamyththatallthisproteinis

goodforyou?Thatifproteinhadthelousypublicrelationsguythatstarchhas,wemightnothavealltheseproteinbarsinhealthfoodstores?

PP:Yes,andwewouldbehealthier.Themythgoesback,asIlearnedfromDr.Campbell, to protein’s origin as one of the first nutrients discovered.A lot ofbenefit was attributed to it because if youwithheld protein from lab animals,theydied.Itwasaround1839whenproteinwasdiscovered,andresearchersatthe timeattributedall thismagicalquality to it.Mygosh,without it peoplewilldie!Andthat’strue—it’sanecessarynutrient—buttheyexaggeratedthebenefit,especiallybyassumingthatsincealittleisindispensable,alotmustbesalutary.The belief never got corrected, even when evidence began to show that theirinferences were wrong. Russell Chittenden did some experiments back in theearly1900son students eatinga low-proteindiet and found that they thrived;even the athletes performed better on it.6 But once an idea takes hold andbecomespartof theconventionalwisdomin thehealth field, it isveryhard toundo.It’sveryfrustrating.Peopleinthehealthfieldarenoteasilypersuadedbyfacts.

GM:Ihaveafriendwhotoldmethatheeatsmeatforproteintobuildmuscle.Ipointedoutthatelephantsmanagetogrowprettystrongonadietofplants.Thisgavehimpause.Heponderedforalongwhileandthensaid,“Yeah,butIdon’twanttogetfat.”

Musclebuilderswillgenerallyeatahigh-proteindiet.They’llhaveeggwhitesandfortifiedproteinfoodsbecausetheybelieveithelpsthembulkup.Aretheyrightaboutthat,thatithelpsthemdevelopmuscle?

PP:Well,ifproteinbuiltmuscle,ifyoucouldbuildmuscleinthekitchen,we’dlive in a land full ofArnold Schwarzeneggers. The issuewith bodybuilders issomething I call error of attribution. In otherwords, bodybuilders needmorefood and more calories, but it doesn’t necessarily mean that they need moreprotein.However, when they start doing aggressive bodybuilding and athleticactivities, their coaches and advisors tell them to increase their protein intake;theydoandtheyfeelbetterasaresult.Butwhatthey’rereallydoingisaddingtheextracaloriesthattheyneedtotheirdiets;theywouldfeelequallywelliftheyateadietliketheonethatyouandIeat.

GM:Sotheirmusclescouldgetjustasbigonourdiet?

PP: Yes, because the way muscles get big is resistance training, which issomewhat limited to gender and genetic predisposition.There is nothing thatmostmencando to look like anNFL linebacker.They’ll justneverhave thatbodytype,nomatterhowmuchtheyexercise,nomatterhowmuchtheyeat.Wedohavegeneticlimitations,butitispossibleforsomebodywiththerightgenestobecomejustasbigorstrongbyeatingaplant-centereddiet.(Interestedpartiescancheckoutwww.veganbodybuilding.com.)

Athletes may be the key to turning popular opinion around because whattheydo ishighprofileand they’realways looking foranedge.Thereare someprettyhigh-profileathleteswhohaveconverted toaplant-baseddietand theirperformances improved.ThetriathleteDaveScottwasveganwhenhewonsixIronmanTriathlons in the 1980s.Carl Lewiswas veganwhen hewas settingtrack records, andheattributeshis success to thevegandiet.And then there’sTonyGonzalez,oneoftheolderplayersintheNFL,whoadoptedaplant-baseddiet.

GM:Therearemoreandmoreveganathletesallthetime.NFLrunningbacksArian Foster and Montell Owens, boxer Timothy Bradley, former NBAbasketball players John Salley and Salim Stoudamire, tennis champion VenusWilliams, ultimate fighters Mac Danzig and Jake Shields, and “the world’stoughestwoman,”JulianaSproles,winnerofthe“ToughMudder”competition.

PP:ToughMudderbillsitselfasthetoughestobstaclecourseontheplanet,andit’s now clear, for anywhomayhavehaddoubts, that you canwin itwithoutingestinganyanimalprotein.

GM:Okay,soanincreaseinanimalproteindoesn’tresultinanincreaseinthesize of your muscles or in improved athletic performance. What are thedifferencesbetweenanimalproteinandplantprotein?

PP:Well,TheChinaStudyshowsthatthecancer-promotingeffectwaslimitedtoanimalprotein.Wedidn’tseethiseffectwhenitcametoplantprotein,butthatdoesn’tmeanthathighamountsofplantproteindon’tbecomeproblematic.That’swhypeopleneed to consume ahigh-carbohydrate, low-protein, low-fatdiet.

GM:Sowehaveanupperlimitof15percentofcaloriesfromfat,andanupper

limitof10percentfromprotein.Bymymath,I’dsaywe’retalkingalowerlimitof75percentfromcarbohydrate?

PP: Yes, from whole, unprocessed foods. Legumes, vegetables (including thestarchyvegetables),fruit,andwholegrains.Fiber-richfoodsarethebasisofthediet.Notthecarbohydratesfoundinprocessedfoods,fruitjuices,andsugar.Thelabel “carb” gets applied in common usage to both unhealthy processed foodsandhealthywholegrainfoodsandvegetables;that’swhyit’simportanttofocusoneatingwholeplantfoodsandforgetabouttheuselesslabel“carbs.”

GM:Let’sgetmore specific aboutyourdietaryplan.Whatdoyouadvise thatpeopleeatfortheirthreemealsaday?

PP:Well,firstofall,Idon’tadviseeatingjustthreemealsaday.Wehavethemeatfourorfiveorevensixmealsaday.Iwantthemtodothatforacoupleofreasons.ThefirstisthatIdon’twantpeoplegettingravenousbecauseitleadstoovereating.Ifyoueatbreakfastat6:30inthemorninganddon’teatlunchuntil12:30, you’re likely tobe so ravenousby the time you sit down for lunch thatyou’re going to overeat.While it’s not that you want to eat when you’re nothungry,youwant toeatwhenyou’rebeginningtogetmildlyhungry; formostpeople,that’severythreeorfourhoursorso.Thesecondthingisthatwhenyourbloodsugarlevelsgetlowenough,ifyoureallywaituntilyou’reoutoffuel,youwon’tfeelorthinkwell.Iliketogetupinthemorningandoperatewithhigh-speedcognitiveabilityandenergyalldaylong;that’sreallyhardtodowhenyoursystem’s completely empty.Sowe like four, five, sixmeals aday,with smalleramountsoffoodateachmealthanonewouldconsumeonathree-meal-per-dayplan.

Andweliketoofferpeoplespecificsuggestionsforwhattoeatforbreakfast.Oatmealisalwaysgoodandit’sreallysimple.Oatmealandraisins,forexample,and a sliced banana. Or I make a fruit smoothie in the morning that hasvegetablepowders,almondmilk,abanana,frozenberries,someflaxseeds,food-gradegreentea,andbrewer’syeast.Youmightwonderwhat’supwithbrewer’syeastandvegetablepowders.I’mallaboutmaximizingmyintakeofsuperfoods—choppingupkaleandaddingittosoup,usingromainelettucetomakewrapsinstead of tortillas, for example. So I had Wellness Forum Foods develop asmoothie mix with simple ingredients—dehydrated vegetable powders in themorningisagoodthing—brewer’syeastbecauseitissuchaconcentratedsource

of several vitamins and minerals; food-grade green tea, which is a powerfulsource of antioxidants; and flax seeds.Mix in a blender with almondmilk, abanana, and some frozen fruit, and you have a nice twenty-ounce drink withfourteengramsoffiber.Ittasteskindoflikeamilkshakewithfrozenfruitinit.Ilookforwardtoiteverymorning.

Iknowpeoplewholikericeandvegetablesforbreakfast,soItellthemtogofor it. You don’t have to wait until noon or six o’clock to have rice andvegetables.Ifyouwantabakedpotatoforbreakfast,that’sfine.Wehavesomestrangebiasesinthiscountryaboutwhichfoodscanbeeatenatwhichtimesoftheday.On a typical day forme, I startwithmy smoothie and then I’ll havesomecerealmidmorning.TodayIhadbroccolicasseroleandsaladforlunch.IfIgethungrymidafternoon,I’llhavesomeleftoverbroccolicasserole.Fordinner,I’llhaveagreatbigsaladandbakedpotatoesor riceandvegetables.Mysweettoothsetsinduringtheevening,soI’mmostlikelytoeatfruitforasnack.

That’sthebasicplan.Itdoesn’thavetobefancy.Istilllovetogooutonceinawhileandeatelegantfood,butonceyourtastebudsgetdown-regulated,youfindthatyou’reperfectlysatisfiedwithsimplefare.It’snotthatyoudon’tfocuson flavor—the food I eat is really delicious—but I’m happywith baked sweetpotatoes and a salad.Steamedvegetables and rice and a salad.Bakedpotatoesandblackbeansoup.Alotofsimplefarethat’sreally,reallygood.

GM:Let’slistthegrainsthatcouldbethebasisofadiet.

PP:Rice,quinoa,wheat,corn,barley,buckwheat,anyofthem.

GM:Now,wheatissomethingpeoplegenerallyeatintheformofbread,pasta,andcouscous—

PP:Right,butwheatberriesarealsoswell.IwishIatemoreofthem,actually,becausethey’rereallygood.They’reveryfillingandpeoplegenerally likethem;they’rekindofchewyandhaveagreattexture.

GM:Youmakeitlikeyoumakerice.Youjustboilwheatberries?

PP:Yes,andthat’sanimportantpoint.Peoplegenerallyknowwhattodowithrice,butthey’relessfamiliarwithothergrains.Peoplesay,“Iknowhowtocookrice,butwhatdoIdowithbarleyorquinoa?”Andtheansweris,substitute it.

Youknowhowtomake riceandvegetables, riceandbeans,youknowhowtoput a cupof rice in soup—do the same thingwithbarley, quinoa, buckwheat,wheatberries,anygrain.Boil it justasyouwouldboilriceanduseitthesamewayinthemeal.Thatgetspeopleexperimentingwithdifferentgrains.Andit’sthesimplesubstitutionforricethatgetsthemtostepoutsidetheirusualeatingpattern a little bit. Later they take it a step further; there’s an abundance ofcookingclassesandhealthy-eatingcookbooksusingplant-basedfood.You justhavetogettotheplacewhereyouunderstandwhatitisyouwanttolearnhowtodo.Itisn’teatingchickenandfishinsteadofbeef;it’seatingplantsinsteadofanimals.Andonceyougetthatdistinctioninyourmindandunderstandthatby“plants”wedon’tmeantofuhotdogsandfruit juice–sweetenedcookies,you’reonyourway.We’retalkingaboutwhole,unprocessedplantfoods.It’stheneasytosourceoutinformationwiththatdistinctionmade.

GM:Speakingoftofu,forpeoplewhoareusedtohavingchickenorfishormeat—high-proteindeceasedanimals—asa centerpieceof theirmeals,howdoyoufeel about replacing animal protein with tofu, tempeh, seitan, or some otherhigh-proteinplantfood?

PP:They’refine.Overtimewewanttobegettingclosertothebeans,rice,corn,potatoes,steamedvegetables,rawvegetables,andfruitdiet,ratherthansomuchhigh-protein meat substitutes. It’s also important to differentiate betweenminimallyprocessedmeatsubstitutes,liketofuandtempeh,versusthetofuhotdogs,fakepepperoni,andotherhighlyprocessedmeatsubstitutesthatarereallyjust vegan-friendly junk food. These junk foods are okay while you’re firsttransitioningtoaplant-baseddiet,orwhenyou’regoingtoaholidaypicnic,buttheyshouldnotbepartofthedailyfare.

GM:Isgivingupthetraditionalmeat,chicken,orfishthehardestpartforfolks?

PP:Well, sometimes they give it up for something evenmoredeadly.At theweddingItalkedaboutearlier,whileIwaseatingaplateofbroccoli,everybodyelseateveggielasagna.Now,veggielasagna,youthink,“Hey,thatsoundsprettyhealthy, right?That’sgot tobebetter foryou thanmeat.”Thisveggie lasagnahad four kinds of cheese in it andwas toppedwith a cream sauce.And reallythere isn’t any redmeat they could’ve served at this place thatwouldbemoredeadlythantheveggielasagnathattheyservedasthecenterpieceofthemeal.

GM:Fourkindsofcheeseandcream?That’snotreallyawholelotbetterthandeep-friedbutteronastick.

PP: Exactly. At best we’re talking only a difference of degree between whathealth-conscious, sophisticatedpeople at anurbanwedding are eating and thecrap thatwe thinkonlyunsophisticated rubeswouldeat.So thecenterpieceofthemealcanbesomethingthatappearstobehealthyandoftenisn’t.I’vebeenatpeople’s houses when they’ve said, “Oh, we know you’re a vegetarian, so wemadeavegetarianmealforyou.”Andtheyservepastaandvegetables.Ifigure,okay,that’snotbad,howcanyoumessthatup,right?Well,ifItakepastaandvegetablesanddouseitinoliveoil,I’vejustconsumedenoughfatfortheweekinonemeal.Soevenpeopletryingtoaccommodatemeonaveganplanmessitup,despitethebestofintentions.

GM:Wouldyousaythat,inadditiontoasurfeitofunhealthyingredients, likedairy products andmeats and oil and sugar, Americans suffer from a lack ofnutrientsthattheyneed?

PP:Yes,andthathappensinacoupleofdifferentways,actually.Forexample,people take in gargantuan amounts of salt on the standardAmericandiet andvirtuallynopotassium.And it’snot just the excess salt that’s theproblem; thelackofpotassiumisaproblem,too.Sotheyadaptaplant-baseddiet,potassiumlevels go up, salt consumption goes down, and the body is much healthier.Peopleoverconsumesomenutrientsandunderconsumeothers.A lotofpeopleinthiscountryareoverfed,butarestillmalnourished.Also,peoplewhoeatthestandardAmerican diet generally have prettymessed-up gastrointestinal tractsduetoconstipationandinflammation.Thatmakesitdifficultforthemtoabsorbthe nutrients that they’re taking in. So the nutrient deficiencies happen twoways:what they’re putting (or not putting, actually) in theirmouths and howmuchofitactuallygetsintothesystem.

GM:Let’stalkaboutinflammation.Inflammationcanbesystemic,isthatright?Ifyourbodygetsinflamed,it’sthroughoutthetissuesofthebody?

PP:Yes.Youcouldhavelocalizedinflammation.Youhavesurgeryandthesiteoftheincisionbecomesinflamed;therearesomethingsyoucandoaboutthat,andweallunderstandthat.Inflammationcanalsobegeneralized,whichwecan

measurewithsomethingcalledaCRPtest,forC-reactiveprotein.Itdoesn’ttellyou where the inflammation is, but themost likely place is the lining of thebloodvessels,theendothelialcellsthatproducenitricoxideandkeepthebloodvesselsopen.That’susuallywheretheinflammationresides,whichiswhyCRPisconsideredaprettygoodmarkerforariskofcoronaryarterydisease.

GM:What’scausingthisinflammation?

PP:Animalfoodscontainsomethingcalledarachidonicacid.Insmallamounts,it’s really not so bad for you. However when you consume a lot of it, it’s aprecursor to somethingcalled series-2prostaglandins,whichare inflammatory.Again,it’sgoodtoproducesomeseries-2prostaglandins;toomuch,though,andyougetsomeinflammation.Sothat’sonewaysomeinflammationhappens.

Another cause of inflammation is obesity itself. We used to think thatadipose cells and tissueswere just sortofbenignanddidn’tdomuch;nowweknow that these cells are busy all day long pumping out substances likehormonesandinflammatorycytokines.Sothefatcellsofoverweightpeoplearepumping out inflammatory chemicals all day long, leading to generalizedinflammation.That’swhyit’sso importanttoaddresstheweight issue.Evenapersoneatingaplant-basedorvegandietcanbemaintainingextraweightandisthereforestillathighriskforlotsofhealthissues.

GM: How does CRP rank as a marker of heart disease compared withcholesterolandhomocysteine?

PP:They’reallgoodmarkersandtheyallshouldbelownumbers.Cholesterolshould be under 150 mg/dl, CRP should be 1.5 mg/L or lower, andhomocysteine under 6 micro mol/L. So you want low numbers all the wayaround. But here’s the big problem: we’ve gotten to the place nowwhere wefocusonthosenumbersanddon’tnecessarilycarehowwegetthere.Peoplegotothedoctorandthey’rediagnosedwithhighbiomarkers.Thedoctorputsthemon drugs to bring those numbers down without actually changing the healthstatus of the individual. And what’s the result? A new phenomenon in thiscountry,asDr.McDougallpointsout:peopledyingofsuddenheartattackswithgreatbloodwork.

GM:Theclassicgoodnews,badnewskindofthing.

PP: It’s sad but true. Instead of curing the individual, we’re curing hisbiomarkers. Here’s an example to illustrate how terrible our system is. TimRussert,NBCNews’ political guru, died a few years ago.Hehad a great job,great insurance,andmoney.Hewent to thebestdoctorsandhadall the righttestsdone.Hewasdiagnosedearly,whichissupposedtobeagoodthing,right?Hewas treated for all his problems: he took a drug for blood pressure, statindrugs,adrugtotreathispre-diabeticcondition,andadailyaspirin.Andhestilldiedatfifty-eightofaheartattackbecausenoneofthosedrugsaddressedwhatwas wrong with him: the amount of unstable plaques throughout his arteriesfromtheanimalfoodandfatthathewaseating.HetrustedhisdoctorsandtheyofferedwhatWesternmedicine traditionallyoffers,whichdidhimnogoodatall.

On the other hand, you get the critics of the Western pharmaceuticalapproach, theadvocatesofamoreholisticapproach topharmacology,whosaythatRussertshouldn’thavebeentakingthosedrugs.Instead,theysayheshouldhavebeen takinghigh-dose cinnamon forhis diabetes, hawthornberry forhisbloodpressure,andhigh-doseniacinorredriceyeastextractforhischolesterol.And you knowwhat?He’d still be a dead guywith great bloodwork becausenoneofthosethingsaddresswhatkilledhim.So,we’vegottenverycarriedawaywithbiomarkers.Whileweneedtolookatthem,wealsoneedtorecognizethatallmethodstobringthemdownaren’tequal.Theonlythingthatbringsthosenumbersdowninawaythatmattersisdiet.Theotherthingschangeyourbloodwork,butdon’tchangeyourhealthoutcome.

GM:IrememberwhenTimRussertdied;allhiscolleaguestalkedaboutwhatagreatguyhewasandhowtheylovedgoingtotheballgamewithhimandhavinghot dogs together.Of course, they didn’t seem aware of the irony that itwasthoseveryhotdogsthathelpedcausehisdeath.

PP: Right, and unfortunately, he just dropped dead. Other people survive aheartattackandendupgoingto theaveragedieticianorcardiologist,whotellthemtoeatfishandleanmeatsandpoultry.Theircholesterolkeepsgoingup,sothedoctorssay,“Well,youknow,it’sageneticissue.”Thedoctorsputthemonapharmaceuticaldrugbecausethat’sreallyalltheyknowtodo.

If people really understood, in clear terms, what food did to them, they’dhave a whole different attitude about it. I know when people come to mylectures, they leave with a whole different attitude. They don’t all change

overnight,buttheyleavewithadifferentattitudeaboutthewholething.

GM:What’s theirattitudeaboutgivinguptheanimalfoodsthattheygrewupeatingandhavebeenencouragedtoeatalltheirlives?

PP:Well, firstofall, atTheWellnessForum,wedon’taskpeople togiveupanimal foods entirely. TheWellness Forum is not an explicitly or exclusivelyveganprogram.

GM:Okay.Whynot?

PP:BecauseI’veyettoseetheevidencethatpeoplewhoeata low-fat,starch-centered,plant-baseddiet,whileincludinguptothreeservingsaweekofanimalfoods,haveworsehealthoutcomes thanpeopleona similar,butpurelyvegan,diet. There just is no such evidence. I believe, and my experience with TheWellnessForumconfirmsmybelief,thatwewillhelpmorepeopleconverttoahealthy diet ifwe espouse amoremoderatemessage, ifwe don’t scare peopleawaybyinsistingthattheyabstainfromanimalfoodsentirely.

NowwhenIsay“moderate,”I’mnotrepeatingtheshibboleththateverythinginmoderationisokay,likecheeseburgersandicecreamsundaes;I’msayingthatit’snotadealbreakertohavetwoorthreesmallservings—threetofiveounces—per week of wild-caught salmon or organically raised beef. There’s no wiggleroomonthediet;whenwesaytwoorthreeservings,thatdoesn’tmeanfourorfiveorsix,anddairyisabsolutelyout.Andit’simportantthat,ifyouchoosetoinclude two or three portions of animal foods per week, that they be fromorganicallyraisedanimalsorwild-caughtfish,whichinalmostallcasesisgoingtomeanthatyou’regoingtohavetopreparethesemealsathome.

Let’snotforgetthatwehavethisphenomenonoftheunhealthyvegan.Therearealotofpeoplewho’verenouncedanimalfoodsforethicalreasons.Irespecttheir decision; that’s an admirable reason to give up animal foods. I have noquarrelwiththeirreasoning,butmanyofthesepeoplearenohealthierthantheirmeat-eatingcounterparts.They’relivingonveggiecheeses,fakemeats,oliveoil,margarine, potato chips, and French fries. You’ll be much better off from ahealthstandpointifyoueataccordingtoTheWellnessForumprogram,evenifyouchoosetoincludetwoorthreeportionsoforganicallyraisedmeatperweek,thanifyoueatafat-laden,nutrient-poorvegandiet.

GM: I’ll accept that yoursmaywell be themost effective approach to gettingpeopletoconverttoahealthydiet;I justwon’tgosofarastoactuallyendorseeatinganyanimalfoods,sinceIbelievethattheoptimalintakeofsuchfoodsiszero.

People make their dietary decisions based on lots of factors, includingconvenience, taste, and habit. And to the extent that for any or all of thesereasons, people decide to continue to consume some animal products inaccordancewithTheWellnessForumguidelines,Ihavenoissuewiththat.Butfor those who are making their dietary decisions strictly based on healthconcerns,here’swhatIwouldsay:thereisnodirectscientificevidencethatsmallamountsoffleshfoodsinthedietwillhaveadetrimentaleffectonyourhealthoryour longevity. Indeed, some of the longest-lived populations, like theOkinawans,eatfish.Butsinceweknowthatallfleshfoods,includingfish,haveno fiber, are high in fat and cholesterol, are high in sulfuric animal protein,containnoantioxidants,andhavenocarbohydrateforthefuelingofourcells,wemight want to deduce that if you consume a little of it, to the extent that itaffects your health at all, it might be in a negative way. At least, that’s myreasoning.

PP:Glen,you’vemadeapersonalchoice.Whatyou’resayingis,“It’sbetterformetohavenoanimalfoodsatall.”I’vemadethesamechoice.Ijustdon’twantto say that’s the only choice available, or that one has tomake that choice inordertoachieveandmaintainoptimalhealth.

GM:Doyoucomeacrosspeoplewhosay,“IcantrythisWellnessForumdiet,butonlybecauseIcanstillhavemychickenorfishacoupleoftimesaweek”?Andthenayearortwolatertheygovegan?

PP:Yes,lotsofthem.Wecallthemtheaccidentalvegans.Wecanalmosttellinadvancewhothey’regoingtobe.It’saninterestingthing;it’sthepeoplewhoaremostlikelytodrawthelineinthesandandsay,“Idon’twanttobeavegan!”Wetell them that we’re not asking them to be vegan. And then they make thatdecisionontheirownlateronandannounceitproudly.I’manaccidentalveganmyself,bytheway.

GM:Areyou?

PP:Yeah.WhenIfirstconvertedtothisdiet,Istillallowedmyselftohavefishacoupleof timesamonth.Idid that forawhileandthenmoreor less forgotaboutthefish.OnedayIwokeupandsaid,“Huh,Idon’tthinkI’vehadfishforsixorsevenmonths.”AndthenIthought,“Well,apparentlyIdon’tmissit,soIdon’tthinkI’mgoingtohaveitanymore.”

GM:Let’sstipulatethatpeoplearedrawntothevegandietnotjustforreasonsof health but also out of concern for the treatment of animals and for theenvironment.HalfoftheUnitedStatesrightnowissufferingaseveredrought;the grazing of animals contributes to drought by reducing vegetation, fromwhichwater transpires.7Animal agriculture has been determined by aUnitedNationsreporttobetheworld’sleadingsourceofgreenhousegases,8andit’saleadingcauseofwaterpollution;incountlessways,it’screatinganenvironmentalnightmare. But I thinkwe can also agree that the animal agriculture industrywouldworrymoreabout30or40or50percentofthepopulationscalingbacktojustacoupleofservingsofmeatperweekthanitwouldworryabout1or2or3percentofthepopulationgoingstrictlyvegan.

PP: Ifhalfof thecountryateanimal foodonlya coupleof timesaweek,andonly organic animal food, the factory farmswould be gone. You’d have somehumane,smalloperationsoutthere,butfactoryfarmingwouldnotberemotelysustainablewith such reduceddemand.And ifwe could encouragemillionsofAmericans to eat this way, the improvement in their health will encouragemillionsmore, and a tipping point would be reached.And from that pool ofenlightened people, there’s no telling how many accidental vegans might becreated.

GM: And we do know for a fact that when people eat this way, others areinspiredtojointhefoldbecausetheeffectsaredramatic.

PP:Absolutely.PeoplewhohavegonethroughTheWellnessForumprogramhave improved the quality of their lives enormously, extended their lives, andbroughtnewlifeintotheworldagainsttheodds.

GM:Againsttheodds?

PP:ManyofthemembersofTheWellnessForumhavebeenwomenwhowere

unable toconceiveuntil theygotonourprogram.We’vehadaboutahundredbabiesdeliveredtowomenwhohadn’tbeenabletoconceiveorwhohadhadoneormoremiscarriagesuntiltheyfoundus.

GM:That’ssomethingIdidn’tknow.Thisdietcanhelpawomanconceive?

PP:Absolutely.Isaythatfortworeasons:alotofanecdotalevidencethatI’veseenhereatTheWellnessForum,andclinicalstudiesthatdemonstratethattheproperdietcanhelpawomanconceive.9,10,11

GM:Andbringmoreplanteatersintotheworld?

PP:Icertainlyhopeso.

3

DISEASESANDTHEFOODSTHATBRINGTHEMON....................................

GM:Pam,here’smynearlyall-inclusivelistofthevariouscausesofdiseases:dietand lifestyle, the environment, genes, stress, psychological factors, andpathogens.Let’sreviewthemanymaladiesplaguingourpopulationandexaminethecauseforeach.Let’sstartwithheartdisease.

PP:Definitelydietandlifestyle.

GM:Doesgeneticsplayanyrole?

PP:Withveryfewpeople.Icansaythesamewithregardtoanyconditionthatwewould label chronic anddegenerative.Youhavegeneticpredisposition,butthosegenesareswitchedonbydietandlifestylechoices.You’regoingtohave,inanypracticesetting,2to3percentofthepopulationwhosecholesterollevels,nomatterhowmuchtheycleanuptheirdietandlifestyle,won’tgetdowntoideallevels. Or perhaps they’re salt-sensitive and an adjustment in salt intake isneededtogettheirbloodpressuredown,andsometimeseventhatdoesn’twork.We see a very tiny percentage of people who honestly have been dealt a badhand.Butthegoodnewsisthatyoucansaytothenewpersoncominginthatthechancesareoutrageouslyhighthatyourbodyisgoingtorespondpositively

to thisdiet and lifestyle thatwe’re going to showyou and that it’swellworthdoing.

GM: I’msomeonewithheartdiseaseandhypercholesterolemia rampant inmyfamily,andyetIloweredmycholesterollevelswhenIfinallygotthedietexactlyright.

PP:Yeah,mostpeoplehavehaditdrilledintothemthatit’sfamilial;Itellthemthat there’s no question that you have genetic predisposition. As I think I’vementionedtoyou,womeninmyfamilyhaverheumatoidarthritisandthey’refat.I’mpositivethatitwouldnottakeme,atmyage,butayearortwotoeatmywayintorheumatoidarthritisandobesity,ifIchoosetodoso.ButI’mnotgoingtoswitchonthosebadgeneswithmydiet.

GM:Howaboutstrokes?

PP: Definitely diet and lifestyle. There are times when there is a structuralabnormalitythatwillcausesomebodytodevelopabloodclot.That’sfairlyrare;again, it’s diet and lifestyle that’s going to cause your risk of stroke to go up.Strokeisanoutcomeofatherosclerosis,justlikeheartdisease.

GM:Highbloodpressure?

PP:Dietandlifestylemostofthetime.Thecausesaresimilartoheartdiseaseandstroke.

GM:Cancer?

PP:Dietandlifestyle,aboveall.Twolifestylefactorsaresignificant:obviously,cigarettesprofoundlyincreasetheriskofmanycancers,notjustlungcancer,andalcohol increases the risk ofmany cancers, not just liver cancer.There’s a rolethatstressplays,butitmaynotbewhatpeoplethink.Idon’tthinkstresscausescancer,justasIdon’tthinkitcausesheartdisease.Ithinkthatstressoftencausespeopletobecomeevenlessdiligentabouttakingcareofthemselves;that’sitsrolein disease-promotion.As your stress levels increase, youmay exercise less, eatmorejunkfood,orturntoalcohol,andthat’showyouendupwithcancer.

GM:Whatabouttheenvironmentalfactorforcancer?

PP:Theenvironment isoftenresponsibleforcancer initiation,butnotusuallypromotion; it’sdiet thatpromotes the cancer.Thereare some types of cancer,however,thatarepurelyenvironmental.Forexample,Ihadagoodfrienddieoflungcancerwhoneversmoked.However,heownedaplasticsfactory.Heusedtospendalotoftimeonthefactoryfloor,ofcourse,andthiswasatatimewhenenvironmentalregulationswerealotmorelax.That’sprobablywhatcausedhislungcancer.Thatwouldbeacaseofanenvironmentalcause,butit’sanatypicalcase.Andyoualsohavetoconsiderthedegreeofexposure.Myfriend’sexposurewasmassiveanddaily,asopposedtoourexposuretochemicalcarcinogensandairpollution,whichisnotasmassiveaspeoplemightbelieve.Ithinkthatthat’saminorfactorformostpeople.

Thereisanareawhereenvironmentanddietoverlapconcerningcarcinogens—pesticides and toxins inour food.Themost important thing toknowabouttoxins is that they are concentrated in the fatty tissues of animals andbecomemore concentrated as youmove up the food chain. Fish have levels of heavymetals, pesticides, and other toxins that are often off the charts.As a generalrule,you’llfindfarlesspesticideexposureinplantfoodsandyoucanwashsomeofitoff,oravoiditaltogetherifyoueatplantsgrownorganically.ButeventheEnvironmental Working Group, one of the most active in trying to changefarming practices, states on its website that the benefits of eating fruits andvegetablesfaroutweighanyexposuretopesticidesinthosefoods.

GM:Type1andtype2diabetes?

PP:Type 2 diabetes is definitely brought on by diet and lifestyle. For type 1diabetes,thereareanumberofcauses,butamajoroneisdairyproductsthroughthemechanismknownasmolecularmimicry.1,2,3Someother causes canbevirusesandinfections,andgeneticsisdefinitelyafactoraswell.Inotherwords,weknowthatnotallchildrenwhoconsumecow’smilkdevelopjuvenilediabetes,so there has to be some genetic predisposition that actually causes that tohappen. Of course, we don’t know which kids are genetically susceptible, sowhenwe feedalmosteverychild in thecountrycow’smilk, someof themwillget juvenile diabetes. The better optionwould be to never give cow’smilk toinfantsandtoddlers.

GM:SoItakeityou’reanadvocateforbreast-feeding.

PP:Iam.Dr.JohnMcDougallsaysthatifheweresurgeongeneral,hewouldmakeformulaavailableonlybyprescription.I’mnotsureI’dgothatfar,butIdothinkweneedtoeducateallmoms-to-bethatinfantsdobestwithbreastmilk,and there are many negative consequences of formula feeding, includingcompromised immunity and increased risk formanydiseases, such as asthma4

andCrohn’sdisease.5

GM: If somebody has the genetic predisposition to type 1 and he neverconsumesdairy,mightthegenestillexpressitself?

PP:Itcould,ifexposedtotherightvirusorsometypesofinfection.

GM:WhatdoweknowaboutthecauseofAlzheimer’s?

PP: Alzheimer’s is a cardiovascular disease, very much related to diet andlifestyle.6

GM:Nowthat’snotgenerallyacceptedwisdom,isit?

PP:No,it’snot.Ithinkthegeneralwisdomabouttheetiologyofmostdiseasescomesdowntogenes,badluck,andwedon’tknow.

GM: Most mainstream doctors would concede that diet and lifestyle play amajorroleinheartdisease,buttheywouldn’tsaythataboutAlzheimer’s.

PP:True.Buttheirownmedical journals, if theywouldtakethetimetoreadthem,haveshownthattakingstatindrugscanimprovesymptomsinearly-stageAlzheimer’spatients.7Thattellsmethatthere’saconnection.Theotherthingisthatthebrainisthebiggestuserofglucose,oxygen,andwater,soitonlymakessense that if you narrow blood vessels to the brain, you’re going to impair itssupplyofthoseessentialsubstances.

GM:WhataboutthefactthatwithAlzheimer’s,there’sanamyloidplaquethatforms that resembles the plaque found in people who haveCreutzfeldt-Jakob

disease(CJD),thehumanformofmadcowdisease?

PP: Yes, and there’s a theory, which Howard Lyman has talked about, thatsomepeoplebeingdiagnosedwithAlzheimer’sactuallyhaveCJD.8Alzheimer’sis rarelypresent inplant-eatingpopulations; it’s adiseaseof theWesterndiet.It’savasculardiseasethatismostprevalentinthepopulations,likeours,thateatthemostmeat.9

GM:What’sthecauseofosteoporosis?

PP:Well,firstofall,osteoporosisisamythicaldiseasemuchofthetime.

GM:It’smythical?

PP: To the extent that it actually exists, it’s principally a diet and lifestyledisease,orit’sdrug-induced.Forexample,takingsteroidscancauseosteoporosis.Another thing that happens is people with celiac disease and gastrointestinaldisordersoftenhaveosteoporosisbecausetheyarenotabsorbingnutrientsfromfoods,includingcalciumandothernutrients,neededtobuildbones.Butthevastmajorityofthetime,thediagnosisofosteoporosisisfictitious.

GM:Well, could you explain that?We havemillions of Americans believingtheyhaveosteoporosis and takingdrugs for it.Have they imagined it?What’sgoingon?

PP:No,theyhaven’timaginedit;theirdoctorshavehelpedthemarriveatthisconclusion.Yearsandyearsago,osteoporosiswouldbediagnosed if somebodywould have a fracture or broken bone for no apparent reason; maybe theywouldn’tevenknowtheyhadafracture—theywouldjustexperiencepain.SometypeofX-rayorimagingwouldshowthatthecauseofthepainwasafracture.Withouttheevidenceofanyimpactormemoryoffallingdownoranythingelse,theywould consider adiagnosisofosteoporosis.Theyused toput youon thisscanningdevicethatwasveryexpensiveandverylarge.Theywoulddoawhole-bodyscanthatwouldshowporousbones intheskeletonandwouldgiveyouafirmdiagnosis.Youactuallysawbonesthatwouldbeporousandpoorlyformed.

ThischangedafterMerckdevelopedaterribledrugcalledFosamaxtotreatosteoporosis. It doesn’t really work and has been linked to all kinds of side

effects, including fractures to the thighbone10—the very sort of thing you’dthinkitwouldhelpprevent—andosteonecrosis(bonedeath)ofthe jaw.11Butin the beginning, the problem was that there weren’t enough people beingdiagnosedwithosteoporosis.SoMerckhiredamarketingexperttochangethat.A conference was convened in Rome in 1992, sponsored by drug companies,duringwhichmedical experts, if youwant to call them that, got together andredefinedthediagnosticcriteriaforosteoporosis.Itwouldhenceforthbethelossofbonemineraldensitythatwouldbethediagnosticcriteria.12

Theproblemwith that is that all people lose bonemineral density as theyage,particularlywomen.Womenhaveverystrongskeletonsbecause theyneedstrongbones for childbearing;whenwe’re past our childbearing years,we losebonedensity.I’mnotplanningoncarryinganymorechildren,somybonesdon’thavetobeasstrongastheywerewhenIwastwenty-eight.Mercksucceededindeveloping diagnostic criteria that would eventually include everybody. In aprocesscalleddisease-mongering,thedefinitionofadiseaseisexpandedsothatmore and more people will qualify and get treatment. The other thing thathappened at this meeting was that they picked an arbitrary amount of bonemineraldensity loss thatwasnotbasedonanyscience.Thequestioncameup:Whataboutpeopleontheothersideofthearbitrarylinewhoaren’tyetqualifiedfor osteoporosis but are getting close? So they made up the mythical diseasecalled osteopenia. Merck, being the ever-accommodating company, actuallydevelopedalowerdoseofFosamaxtotreatthosepeoplewhohadthemythicalconditionthatwasconsideredaprecursortotheevenworsemythicalcondition.

GM:Soosteopeniaissimplylesslossofbonemineraldensitythanosteoporosis?

PP: Yes. Osteopenia is a stepping-stone. You’re told, once you’re diagnosedwiththismythicaldisease,thatifyoudon’tdosomethingaboutit,you’regoingtoprogresstothenextlevelofmythicaldisease.

GM: So there are no symptoms? Osteopenia is merely a way station, likepurgatory?

PP:ExceptthatIthinkthere’sprobablymorescientificproofofpurgatory.

GM:Butdon’tweliveinanationofelderlypeoplefallingdownandfracturing

themselves?Isthatjustnaturalorissomethingwrong?

PP: Well, first of all, let me make what sounds like an obvious, asininestatement:thenumber-onecauseoffracturesisfalling.Butwhydopeoplefall?Theyfallbecausethey’refrail,ondrugs,orhavepoorbalanceandcoordination.People who haven’t exercised become frail.Mymother hasn’t exercised since1956, so it’s not surprising that she’s terribly frail. Of course, we’re furtherfrightenedbytheideathatoncethesefallshappenandbonesarebroken,thesepeopleoftenbecomebedriddenandthendie;we’retoldit’sthehipfracturethatkilledthem.Well,itisn’tthefracturethatkilledthem;it’sthepoorhealthandthe drugs they were taking that caused the fall in the first place. They’refracturingbonesbecauseofthetrajectoryofthefall inmanyinstances.I’mnotsayingthatnobodyhasosteoporosis;weseepeopleinherewhohaveit,butI’msaying the vastmajority of peoplewho think they have it, don’t. TheseDexascans to determine bone density are very unreliable.13 Many, many healthagencies inothercountrieshave said that there’sno relationshipbetweenbonemineraldensityandfractureriskandthattheDexascantellsusnothing.

GM: But you do acknowledge that some people have osteoporosis, meaningsomepeoplehaveverylowbonedensity?

PP:Right.

GM:Andisthecauserelatedtodiet,orisitjustgenetics?

PP:First,it’slifestyleasitrelatestoexercise,orthelackthereof.Itcanalsobedietrelatedas itpertainstodevelopingaGIdisorder, like inflammatoryboweldiseases,where you’re not absorbing nutrients.The other cause is a conditioncalledmetabolicacidosis,inwhichyoueatanimalfoods,highlyprocessedfoods,orfoodswithahighsulfurcontent—animalproteinishighlysulfuric—andthesesulfur compounds increase the acid load in the body, necessitating thewithdrawalofcalciumfromthebonesinorderforthebodytomaintainproperpH.

GM:Andthecalciumiseliminatedthroughtheprocessofurination?

PP: Yes, you literally pee out your calcium. People drink milk because it

allegedly builds strong bones due to its calcium, but in fact the high sulfuricprotein content of milk winds up costing the body calcium; that’s why thehighestratesofosteoporosisareincountrieswiththehighestdairyintake.14

GM:Have therebeen any studies thathaveproved this dynamicofmetabolicacidosis?

PP:Yes,absolutely.15,16,17,18Ameta-analysisofeighteenseparatestudiespublished on bone health found that fourteen of them, or about 78 percent,supported the idea that low-acid eating improves bone health.19 So thepreponderanceoftheevidenceshowsthateatinganimalfoodscausesthebodytouse calciumdrawn from the bones to buffer the acid in order for the body tomaintain blood pH within a very narrow range.We can measure howmuchcalciumsomebodytakesin;it’squantifiable.Wecanalsomeasurehowmuchyouurinate;that’salsoquantifiable.Ifyou’reexcretingmorethanyou’retakingin,it’scomingfromsomewhere.

GM:Whatbringsonacidreflux?

PP: Diet and lifestyle. It’s related to several things, but one is weight.Overweight people tend to have acid reflux because the sheer force of theirweightsometimesweakenstheesophagealsphincter,particularlywhentheyarelying down. Overeating is another cause. Eating large meals that expand thestomachwaybeyonditscapacitycontributestoit.Constipationalsocontributestoitbecauseallthatstrainingpushesthediaphragmupandputspressureontheesophagealsphincter.Certainfoods,whichwouldincludealcohol,caffeine,andfoodshighinfat,tendtoaggravateacidreflux.What’samazingisthatwithinafairly short period of time, there’s generally relief from acid reflux as soon aspeoplestopeatingaterriblediet.

GM:Let’smoveontomultiplesclerosis(MS).Genesordietorsomethingelse?

PP:MS is definitely diet, particularly saturated fat and dairy intake.Lifestylecanalsobeafactorintermsofstress,whichcanexacerbateMS,butdietistheprimaryculprit.

GM:MScanactuallybecausedbydiet?

PP:Yes,absolutely.

GM:Whereistheevidenceforthat?

PP:Evenasfarbackasthe1940s,therewasevidencethatdietplayedarole.Forexample,inareasoftheworldwherefatconsumptionwashigher(morethanonehundredgramsperday), the incidenceofmultiplesclerosiswashigher, too.Inareaswherefatconsumptionwaslessthanfiftygramsperday,theincidenceofmultiplesclerosiswaslower.20StudiesinNorwayconfirmedthis:inareasofthecountrywherefatconsumptionwashigher,theincidenceofMSwashigher,andsaturatedfatwasthemostharmful.21ButIthinkthemostcompellingevidencewe have comes fromDr.Roy Swank,who developed a theory sixty years agostatingthattherewerecertaincausesofmultiplesclerosis,oneofwhichwaspoordiet that eventually compromised the blood/brain barrier and the intestinalbarrier. Itwould takea long time toexplain themechanismofaction,but thebottom line forhimwas to testhis theorybyplacing thirty-fourpatientsonalow-fatdiet,verylowsaturatedfat.Theresultswereastounding.22

Some of Dr. Swank’s patients were compliant and others were not. Hecategorized his patients based on their fat consumption—“good dieters”consumed less than twenty grams per day of saturated fat; “bad dieters”consumedmorethantwentygramsperday.Patientsinthegroupconsuminglessthan twenty grams of saturated fat per day fared significantly better than thegroup eating more saturated fat. For those who ate a low-saturated fat diet,“about 95% […] remained only mildly disabled for approximately 30 years.”EightypercentofthepatientswhoconsumedmoresaturatedfatdiedofMS.23Dr. Swank published several articles in medical journals documenting hisresults.24,25,26Heduplicatedthoseresultsonthousandsofadditionalpatientsand showed that patients on a low-fat dietwith aminimal amount of animalfoods basically remained asymptomatic. The exacerbation rate—exacerbationsarewhat they call these flare-ups thatMSpatients experience—wentdownby95percentandstayedthatwayincompliantpatients.

GM:Dr.McDougallisdoingasimilarstudynow.

PP:Heis.Hisdiet—andIlearnedaboutdietandMSfromDr.McDougall—isalittlebitdifferentfromDr.Swank’s:noanimalfoods,nolow-fatdairy,nooils.

AccordingtoDr.McDougall,Dr.Swankacknowledgedbeforehediedthattheinclusion of oils had no therapeutic value.He thought it might make peoplemorecompliantonthediet,buthedidn’tattributehissuccesstotheinclusionofoil.SoDr.McDougall’sdietislowerinfat.Andtheresultsareevenbetter.It’samazing, andwe see that here, too. It’s complete regression of the disease, somuchsothatIwouldcallitareversalofthedisease,especiallyinpatientswhoadoptthedietintheearlystagesofthedisease.Peoplesay,“Howcanyoumakethat claim?”Well, there are two things that are common toMS patients: anintolerance of heat and a lack of stamina or endurance. We have WellnessForummembers withMSwho are doing bike rides for three hundredmiles,taking hot yoga classes in a 105 degree room.They don’t take any drugs andhaveabsolutelynosymptoms.AtthispointintimewewouldpronouncethemformerMSpatients.

GM:Sotheyhavenosymptoms?

PP:None.

GM:Isthereanymarkerforthediseaseotherthanitssymptoms?

PP: In theearly stages,no.That’swhatmakesdiagnosis reallydifficult.Mostpatients start with what we call “relapsing-remitting MS,” which means thatthey get symptoms and then they go away. Then a few weeks later they getsymptomsand then theygoawayand the symptomschange.Thedoctorswillsay, “I can’t find anything wrong with you,” and sometimes send them to apsychiatrist. They’ll even take spinal taps; nothing shows anything so “maybeyou’vegotamentalproblem,”theyaretold.Doctorssendthemtoapsychiatristinsteadoftellingthemtoimprovetheirdiet.Theycangoforareallylongtimewithoutafirmdiagnosis.Eventuallyyoucansee,throughproperimaging,whatlooks like plaques or lesions in different areas of the central nervous system.Therearesometests,aflickerfusionvisiontest,andsomevarioustestsyoucando to test reflexes that sometimesgiveyouaprettydefinitivediagnosis,but intheearlystages,thereisnodefinitivediagnosis.

GM:Whataboutinfluenza?Doesithaveanycauseotherthancontagion?

PP:Well, it iscontagious,butwhetherornotyouget it,andhowsevereit is,

dependsuponyourhealthstatus.Aboutfiveyearsago,oneofthemostvirulentstrainsof flu ran throughColumbus,Ohio, that I can remember inmy entirelife.Itwasheinous.Ibelongtoalotofgroups,andpeopleweremissingworkforthreeweeksat a time;wewerehavingmeetingswithhalfof thepeople there.Oneschoolclosedforacoupledaysbecausethereweresomanykidssick.Itwasbad.Andatfirst,noneofusgotsickhereatTheWellnessForum,eventhoughwe’re exposed to sickpeople everyday in thisoffice.Thenoneday Iwokeuparoundfourinthemorning(I’manearlyriser),andIwasassickasadog.Iwassick formaybe fouror fivehours,and then itwentaway. Iwas just tired, so Itookanicenapandcameintotheofficearoundoneortwoandmadeitashortday.Bythenextday,Iwasbacktonormal.

Well, sure enough, thenextdayGary, ourgeneralmanager,wokeupwiththeflu.Hehaditforaboutfourorfivehours,cameinlaterintheafternoon,andwasfineafterward.Onebyone,itcycledthroughtheoffice.Weallactuallygotit,butnobodymissedmorethanahalfadayofworkbecauseofit.Ithinkmanytimes I don’t get what’s going around because I’m a very uninviting host fordisease.AndifIdogetit,orsomebodyaroundheregetssomething,it’susuallyanonevent.Nobodyheremissesworkmuch for anything, andwe’re exposed tomoresicknessthanmostpeople.

GM:MyoldmandiedofParkinson’s.Isitgenetic?

PP:Eveniftherearesomegeneticpredispositionstoit,andtheremaywellbe,Ithinkthatdefinitelydietandlifestyleplayasignificantrole.Chemicalexposuremaybe involved aswell;we justdon’t know.The sadpart is thatby the timesomebody has full-blown Parkinson’s, we don’t usually see diet and lifestylereversingit.Whatwedoseeisthatit’llstoporslowitsprogression,whichcanbe a blessing for the personwho has Parkinson’s and anybody caring for thatperson,butwedon’tnormallyseetheregressionthatyouseeinMSandsomeoftheseotherconditions.

GM:Haveyoubeenabletosloworstopitsprogression?

PP:Both,dependingonhowbadour clients arewhen theybecomemembersandstarteatingaplant-baseddiet.Sometimeswegetpeopleinsuchlatestagesthatallwecandoisslowit.Again,it’snotthewayIwishitwere,butit’sbetterthannothing.Asthesepeopledegenerate,theylosetheirabilitytocommunicate,

or to do anything for themselves; they become tremendous burdens on theirfamilies,soevenaminorreductionintherateofitsprogressioncanmakeabigdifference.

GM:Rheumatoidarthritis?

PP:It’salmostalwaysdietandlifestylerelated,andisparticularlyrelatedtotheconsumptionofanimalfoods.

GM:Andthat’snotcommonlyacceptedwisdom,either?

PP:Oh,no.Theconventionalwisdomiswrong,butas I said, it’snoteasy tochange the conventional wisdom of people in this country, including healthprofessionals.

GM:Doesgeneticsplayaroleinrheumatoidarthritis?

PP:Yes.Geneticscanmakeyoupredisposed.IampositiveIampredisposed.IampositiveIcouldmakemyselfhaveitinaveryshorttime,particularlyatmycurrent age. But I don’t eat like my mother, my grandmother, or the othermembersofmyfamilywhohavethisdreadfuldisease.

GM:Whatarethecausesofasthma?

PP: Well, there are a lot of things that can cause asthma. There areenvironmentaltriggersanddietarytriggersforsure,dairybeingoneofthemostcommon.27,28Dehydrationisafactor;29alotofkidsarenotverygoodwaterdrinkers, so that has an impact. PoorGI health contributes; peoplewhohavescrewed-up GI tracts often have respiratory disorders, including allergies andasthma.We see a lot of asthma in children,which is related tomany factors,includingpoorgutecologyduetoconstipation;treatmentwithantibiotics;and,insomesituations,evenvaccinations.Theirgutsarenotveryhealthyandtheirimmune systems are overstimulated.The overuse of antibiotics due to chronicinfectioncompromisesthehealthoftheirGItractsandcontributestoitaswell.Respiratorytoxinsaggravatethesituation.

Asthmatendstogetbetterinkidsifyoutakethedairyoutofthediet,getthekiddrinkingenoughwater,puthimorheronaprogramofdietaryexcellence(a

wholefoods,plant-baseddiet),andaddsomeprobioticsupplements.Generallyspeaking, it improves to thepointwhere theyoftendon’t evenhave touse aninhalerforexercise.Inolderpeoplewho’vehaditforalongtime,ittakeslongertogetbetter,buttheyfollowthesameprotocolwiththeadditionofsupplementslike quercetin. I recommend sea salt as a natural antihistamine. I don’trecommend against salt consumption for most people, as you know, so werecommendseasaltasanantihistamine,moresoinadultsthankids.

GM:Sohowdoesthesaltwork—howmuchdopeoplehavetoconsume?

PP:Weuseittherapeutically;howitisusedandthedosedependontheageoftheindividual.

Eveninthosecaseswhereasthmaorenvironmentalallergiesdon’tentirelygoaway, with a change in diet, people can become a lot more comfortable andreducetheirdependenceonantihistaminesandmedications.

GM:Itisn’tveryintuitivethattheGItractwouldhavesomethingtodowitharespiratorydisease.

PP: There are a number of connections between asthma and GI function,including reflux and beneficial bacteria in the GI tract. Reflux contributes toasthma, because the acid is inhaled through the back of the throat, burns thebronchialtubes,andcausessymptomsofasthma.30,31

Beneficialbacteria in theGI tractarevery important in regulating immunefunction. It is compromisedby takingantibiotics, steroids, andotherdrugs, aswell as by constipation and inflammatory bowel diseases. When enoughbeneficial bacteria are destroyed, leaky gut can result, allowing whole-foodparticles to enter the bloodstream, leading to compromised or overactiveimmunity,allergicresponsestofoods,andsystemicinflammation.Anoveractiveimmunesystemandsystemicinflammationcancontributetothedevelopmentofasthma.

GM:Whatcausesgallstones?

PP: It’sdefinitelydiet related.Gallstones aremadeof cholesterol innearly allcases.Peopleendupwithgallstonesfromeatingahigh-fat,animal-proteindiet.Unfortunately,oneproblemwehaveinmedicinetodayistheoverridingviewby

a lotofdoctors thatbodypartsaredisposable. “Oh, if it’sbotheringyou,we’lljusttakeitout.”

GM:Sothegallbladdergoes.

PP:Thegallbladdergoes,ormaybethespleenortheappendixgo.Ihappentothinkwehavethesebodypartsforareasonandweshouldworkhardtopreservethem.Unless the disease has progressed to the place where it’s horrific,mostpeoplewhochangetothedietwe’repromotingwouldexperiencerelieffromthepain associated with gallstones and gallbladder disease. As long as they’recompliant,they’refine.I’vehadmemberswhosay,“Ieatonehigh-fatmealandI’mmiserable,” and I tell them, “Good, that’s a goodway to keep you on thestraight and narrow.Wedon’t have toworry somuch about you because youhaveaninstantadverseeffectfromstraying.”

It’s not unusual, of course, for people to have their gallbladder removed.Then they continue their dietary habits and find out they’re still just asuncomfortablebecauseallofthefatandanimalproteinthatthey’reeatingissodetrimentaltotheirhealth.They’reusuallyfairlydistressedtofindoutthatsomeoftheirdiscomfortiscomingfrombileacidsdrippingrightintothecolon,whichiswhy they still feel nauseous and sick.And the presence of bile acids in thecolon increases their risk of colon cancer substantially. They were promisedinstantaneousrelieffromtheirdiscomfort;however,theyendupwithlong-termincreasedriskofcoloncancerandnorelieffromtheirsymptoms.32Iwouldsaythat that probablyhappens 35 or 40percent of the time following gallbladderremoval.

GM:Sohavingyourgallbladderremovedincreasesyourriskofcoloncancer?

PP:Yes.Andweallacknowledgethattherearesituationswherethegallbladderis just so diseased that you have to take it out, but doctors tend to be reallycavalier about removing body parts. I think it’s always worthwhile to see if achangeindiet,ifsomebody’swillingtodoit,affectsthesituation.Sometimesithappenssoquickly—I’mtalkingaboutamatterofdays—thatsomeonecallshisdoctorandsays,“ThatsurgeryIhadscheduledfornextFriday?Idon’tneedtodoitnowbecauseI’mfeelingmuchbetter.”

GM:HaveyouhadWellnessForummemberswhodidthat?

PP:Yes.I’vealsohadmemberswhohavehadtheirgallbladdertakenout.Theunfortunaterealityisthatwhatwewantashumanbeings,fromboththedoctor’sperspective and the patient’s perspective, is resolution. The doctor and thepatientwantitresolved,andthere’ssomethingsatisfyingaboutjusttakingitout.Thediseaseisgone.It’soverwith,andwecanjustputitbehindus.That’snotreally thecase,but that’s theperceptiona lotofpeoplehavethat leadthemtoengagein,orconsentto,riskymedicalpractices.

GM:Soifsomebodyhasadiseasedgallbladder,riddledwithgallstones,andthenheadoptsthecorrectdiet,willthosegallstonesjustdissolve?

PP: Sometimes they will, but usually they just stop causing problems. If thegallstones get caught in the duct, that’s when youmay have to do somethingsurgically,butnotalways.

GM:Andwhataboutkidneystones?

PP: Well, that’s the result of several factors. The first is increased calciumconcentration,whichcomesabout fromthehighcalciumintake thatpeople inthis countryhavebeen convinced isnecessary.Wehave a lot of people takingcalciumsupplementsand,ofcourse,consumingcow’smilk.Theothercauseofhighcalciumlevelsisthereleaseofcalciumfromthebonestobufferacidity,themetabolic acidosis that results from consuming a lot of protein, fat, refinedfoods,caffeine,alcohol,etc.Combinethehighcalciumlevelswithdehydration,andourpoorlittlekidneysareforcedtoconcentratemoreandmorewastewithlessandlessfluid.Youcanendupwithsomekidneystones.Theycanbecomeathing of the past, even for people who have a lot of them, if they just startdrinking enough filtered water every day and eating a healthy, whole foods,plant-baseddiet.

GM:Howmanyglassesoffilteredwater?

PP:Ilikeforpeopletodrinksixty-fourouncesofwateradayasabase.That’sforadults.Childrenshoulddrinkhalftheirweightinounces.Andthenyouhavetocompensateforactivities.YesterdayIran,wenttothegym,taughtahotyogaclass, and then took a hot sweatbox class, so I probably had three gallons ofwatertocompensate.

I’veheardpeopleinsistthatifyoueattherightdiet,youdon’tneedtodrinkwater.Idisagree.Weneedtorememberthatthirstisnotanadequateorreliableindicatorof theneed forwater.Thereare a coupleof reasons for that.One isthatwesalivatewhenweeat,whichdisguisesthethirstresponse.Thesecondisthat our bodies adapt to dehydration.Eventually, just as if you don’t eat longenough, you don’t feel hungry anymore, if you don’t drink water for a longenoughtime,youlearntolivewithdehydrationandnotnecessarilyfeelthirsty.As evidence, consider the number of people who end up hospitalized fordehydration every year, in perfectly ordinary circumstances, when they couldeasilyhavereachedforadrinkofwater.

OneofthesmartestpeopleIknowrunsamultimillion-dollarcompanyhereinColumbus.Acoupleofyearsago,atameetinginNewYork,hepassedoutonthefloor.Theytookhimtothehospital;hewasjustdehydrated.Now,I’msurethat if this very smart, educated, wealthy guy thought that he was thirsty, hewouldhavereachedforsomethingtodrink.Toinsistthatallofthiswouldjustberemediedifwewoulddrinkjustwhenwe’rethirstyandnotworryaboutittherest of the time is to miss the lesson in incidences like this, which are notuncommon.

GM:Foodpoisoning is obviously adietary issue, but is there one typeof dietthatmakesyoulesslikelytogetfoodpoisoningthananother?

PP:Onewayyoucanavoidfoodpoisoningistoavoidchicken,fish,pork,beef,andtheotherfoodsthataremorelikelytogiveyoufoodpoisoning.Thesecondthing is thathealthypeople, evenexposed toapathogen,oftendon’thaveanyresponse to it. So if you’ve got really well-established colonies of beneficialbacteria in your system, even exposure to a pathogen may not make anydifference.Generally,foodpoisoningresultsfromconsuminganimalfoods,withsomerareexceptions liketheonethathappeneda fewyearsagowhenspinachwascontaminatedbyanimalsnear the farm.Thespinachwasnot thecauseofthefoodpoisoning;itwasthenearbyenvironmentalabusers,likecattleranches,causingthefoodpoisoning.

GM:Yeah,italwaysbugsmewhenthenewsmediareportssomescare,likeE.coliinlettuce,withoutnotinganimalagricultureasalikelycause.Theymakeitsound like it’s normal, like some lettuce from a bad seed just grows intopathologicallettuce.

PP: I have no idea what they’re thinking, but our best defense in any caseremainsmaintainingcoloniesofbeneficialbacteria,whilelimitingoreliminatingtheanimalfoodsthatgenerallyexposeustotheharmfulbacteria.

GM:Doeseatingsoyyogurthelpapersongetthosehealthybacteria?Howdoyougetthehealthybacteria?

PP: Well, first of all, you’re born with it. You acquire it during vaginaldelivery.33OneproblemwehaveistheoveruseofCaesareandeliveries,mostofthemunnecessary.Thebaby’snormalwayofacquiringbeneficialbacteria,whichismovingthroughthebirthcanal, isn’thappeningasfrequently,sothebabyisacquiringbacteriafromthehospitalenvironment,whichimpairsthechild.

Another way that the baby develops beneficial bacteria is through breast-feeding.34SoaCaesarean-born,bottle-fedbabyhasanautomaticdisadvantage.That child is at adisadvantage for the rest ofher life.Thatdoesn’tmeanbadthingsaregoingtohappen;itmeanstheyaremorelikelytohappen.Butlet’sjustsay that a baby is vaginally born, is breast-fed, and has healthy bacteria.Thatchildwillbefineunlessshedoessomethingtodestroyit,liketakeantibioticsorbirth controlpills,develop constipation, irritablebowelor inflammatorybowelconditions, or celiac disease. Those kinds of conditions impact the beneficialbacteria intheGItract.Ifyou’vehadanyofthosethingshappen,youneedtotakestrong,pharmaceutical-gradeprobioticsinordertofixit.

GM:Well,mostAmericanshavetakenanantibioticnowandthen.

PP:Right,andthisissomethingIgetangryabout.Onehundredpercentofalldoctors surveyed will tell you that taking an antibiotic destroys beneficialbacteria.Yetinanymetropolitanarea,youcancountononehandthenumberofdoctorswhoputtheirpatientsonprobioticstocompensateforthedestructionoftheantibioticregimen.Wehavealotoffolksouttherewhohavetakennotjustone antibiotic regimen but twenty-five or thirty of them in their lifetime andnever fixed the damage. They need good pharmaceutical-grade probiotics.You’renotgoing to replenishadestroyedcolonybyeatingyogurtof any type.Therearen’tenoughofthecrittersintheyogurttoestablishthecolonies.Eatingsoy yogurtmay help a little; people claim benefits from consuming probiotic-laced products, but they don’t really grow colonies. You get some temporary

relieffromthesymptoms,butyoudon’tresolvetheunderlyingissue.Having a healthy colony of beneficial bacteria is crucial for your immune

function,yourabilitytoabsorbnutrientsfromfood,andyourabilitytokeeptheintestinalbarrierhealthysothatpartiallydigestedfoodandotherpathogensandbacteriadon’tgetintothebloodstream.

GM: And these pharmaceutical-grade probiotics, can you get them in healthfoodstores?

PP: You can get better ones from a doctor or another knowledgeablepractitioner.Alotofthebestcompaniesdon’tselltheirproductsinhealthfoodstoresforacoupleofreasons.Firstofall,somepeoplecanhurtthemselveswiththeseproducts.Forexample,ifapersonwithactiveCrohn’sdiseasewalkedintoastore,boughtareallystrongproduct,andtookithome,hemightendupinthehospitalasaresultoftakingit.Itcouldincreasetheirdiarrheaconsiderably,andaCrohn’s patient definitely doesn’t needmore diarrhea. I found that the bestprobiotics manufacturers sell their products through practitioners rather thanthroughhealthfoodstores.

GM:Let’sdiscussthecausesofirritablebowelsyndrome,ulcerativecolitis,andCrohn’sdisease.

PP:Absolutelydietand lifestyle.Forsomepeople, there’salsoapsychologicalcomponent in the case of irritable bowel; while the syndrome is biological innature, there is some evidence that it can be brought about by psychologicalfactors.35

There are two ways in which our thoughts and emotions can impact GIhealth.ThefirstisthatweactuallyhaveanervoussysteminourGItractcalledthe enteric nervous system that operates independent of our autonomic andcentral nervous systems.This iswhat causes you tohave a “gut feeling” aboutsomething. This is what causes you to have diarrhea or a stomach ache inresponse to stress or somethingof thatnature.Butterflies in your stomach areyourentericnervoussystemactingupabit.Also,therearecertainpsychologicalprofilesofpeoplewhoaremoreinclinedtodevelopandmaintainirritablebowel,even when you do all the right things to fix it. They continue to have it,sometimes because they get secondary gain from hanging on to the disease.Some of these people had trauma or were rewarded for sickness as children.

Theygotexcusedfromgoingtoschooliftheyhadatummyache.Ortheygotexcused from dinner and were given ice cream instead. So some people learnsecondarygainfromusinggastrointestinaldisordersofanundefinednatureandthose people grow up sometimes to have irritable bowel syndrome. There’s alittle bit more of a complex causation with irritable bowel than with otherailments. On the other hand, I can say with a great deal of confidence thatinflammatoryboweldiseasesareatbasetheresultofdietandlifestylechoices.

GM:Isdairyoneofthemainculprits?

PP:Dairy is a big culprit.Animal foods are also a culprit, as are high-glutenfoods:barley,rye,oats,andwheat.

GM: Now you’re talking about good, healthy, vegan foods that could causetrouble.

PP:Nutsaregoodfoods,too,but ifyougointoanaphylacticshockwhenyoueatthem,youwouldn’tsaythey’reparticularlygoodforyou.High-glutenfoodsare really deadly for these people.They have tomaintain complete abstinencefrombarley, rye, oats, andwheat in order tomaintain the complete remissionfrom their disease. The good news is that people with inflammatory boweldiseases who follow the dietary recommendations we give them—a low-fat,plant-baseddiet,whichisphasedinovertime—achieveexcellentresults.36

GM:Andthat’sthenextmaladyIwasgoingtoaskyouabout:celiacdisease.

PP:Celiacdiseasehasageneticpredisposition.Idon’tthinksomebodyeatsherway into celiac disease. There is some evidence that a virus or precipitatingevents can contribute to it.Youhave todoa coupleof things to recover fromceliacdisease.Oneistostopconsuminganygluten;youeliminateanyexposuretoglutenatall, including tinyamountsofglutenasan ingredient in soy sauceand thingsof thatnature.Youhave tobeverydiligentabout it.Youalso takeprobiotics to restore thebeneficialbacteria that’sbeendestroyed.Manypeoplehavebeenundiagnosed foryears, so theypresentwithconsiderabledestructiontotheGItract.Iftheyspendalongtimetakingahigh-gradeprobioticproduct,theycanrestoretheirhealthiftheyeattherightdietandabstainfromallglutenproducts.

GM:Doyouadvocatebloodteststodetermineifsomeonehasceliacdisease?

PP:Thebloodtestisnotalwaysdefinitive.Themostdefinitivetestistotakeabiopsyandlookatthetissue;ifallthelittlevilliaredestroyed,thenthepersonisaceliacpatient.ButIdon’tthinkwehavetogothatfar.Ifsomeonehasafamilyhistory of celiac disease and has gotten better since giving up gluten, that’senoughevidenceinmanycases.Somebodyaskedmeduringaclasswhydoctorssubjectthesepatientstoalotofthesetests.Isaid,“Well,somepeopleshowupwithaverybigdisadvantagewhentheyarriveinadoctor’sofficeorahospital;it’scalled“goodinsurance.”Oneoftheworstthingsyoucanhaveifyou’reatafacilitywheretheyliketodotestingisgoodinsurance.Iftheyknowit’sgoingtobepaidfor,they’llsubjectyoutoasmuchofitascanpossiblybearranged.

GM:Wehaven’t talked about one of the leading causes of death inAmerica,whichisiatrogenicdeath,ordeathcausedbymedicaltreatment.

PP:Thenumbersareastounding.

GM:AndwhenIresearchit,Iseewildlyvaryingestimates.Wikipediacomesupwithafigureof225,000deathsperyear;criticsoftheAmericanmedicalsystemwillestimatemorelike800,000or900,000deathsperyear.

PP:Dr.T.ColinCampbellandDr.McDougallareamongthosecritics.

GM: It’s obviously hard to know exactlywhat the correct figure is because somany people, especially older people, whose death may be brought on by amedication,neverhavethatfactdeterminedincourt,andtheirdeathcertificatesdon’treflectthatcause.

PP:Well,Ithinktheproblem’sgettingworse.Icanjusttellyoufrommyownexperience,peoplewhojoinTheWellnessForumareoftenassickfrommedicalcareastheyarefromwhateverwasailingthemwhentheyfirststartedreceivingmedical care. Or they were perfectly healthy people who were treated formythicaldiseaseslikeosteoporosisorcarcinomainsituandbecomesickpatientsas theresultofbeingtreated fordiseases theyneverhad.In termsofwhat theactualnumbersare,themostreliablenumbersI’veseencomefromsourceslikeShannonBrownlee’sbook,Overtreated,37awell-referencedbookon the topic.

Even the Journal of the American Medical Association has published articlesshowingthatbetween230,000and284,000deathsperyearresultfrommedicaltreatment.Thisdoesnot includeadverseeffects frommedicationthat result insicknessordisability,whichareestimatedtoresultin116millionextraphysicianvisits,77millionextraprescriptions,17millionemergencydepartmentvisits,8million hospitalizations, 3 million long-term admissions, 199,000 additionaldeaths,and$77billioninextracosts(equivalenttothetotalcostoftakingcareof patients with diabetes).38 It’s generally accepted that dying from medicaltreatmentisthethird-orfourth-leadingcauseofdeathinthiscountry;atleastafew hundred thousand or potentially more people die every year directly as aresultofthetreatmentthattheyreceive.

Now, I’llmitigate that frightening statistic somewhat. Some of the peoplewhodiefrommedicaltreatmentwerereallysickanddecrepitwhentheyenteredthehospital;whiletheyreceivedtreatmentthatmayhavebeenuselessandmayhavespeduptheirdeath,theyweregoingtodieanyway.Thatsaid,there’sstillanatrociousamountofdeathfrommedicaltreatmentarisingfromthetreatmentof conditions that patients don’t really have. From overmedication orunnecessary surgery. From suicides brought on by useless antidepressant andantianxietydrugs.Overall,it’scertainlyoneoftheleadingcausesofdeathinthecountry.That’swhyDr.McDougall says, “Stay away fromdoctors; they’ll killyou.”

GM:Pam,havingreviewednowasignificantlistofdiseasesandailments,what’srevealed tome is the sweeping and I’d say revolutionary nature of yourwork.Under standardmedical care, a very sickpatientpresentingwithheartdisease,diabetes, highbloodpressure, acid reflux, and irritable bowel syndromewouldspend his days shuttling between his cardiologist, gastroenterologist, andotolaryngologist, getting different medications or interventions for eachcondition. Then he’d have to hope that his medications don’t interact in adangerousway.He’d findhimself on a slippery slope to doom.And there aremillions ofAmericanswho live thatway, if you could call it living.Now, youwould argue that all these conditions are essentially expressions of the samedisease that is theWestern diet, and that the remedy for all the conditions isessentiallythesame:alow-fat,plant-baseddiet.Withthisdiet,it’squitepossiblenomedicationswouldbeneededatall,foralmostanycondition.

PP:That’sexactlyright.

GM:Unfortunately, there areonly a fewplaces inAmerica that take this verysimple and comprehensive approach todisease,mostnotablyDr.McDougall’spractice in Santa Rosa, California, and your own Wellness Forum based inColumbus,Ohio.

PP:That’swhyweneedtogetthewordout.

GM:Sincefoodisactuallytheleadingcauseofdisease,let’sgetveryspecificnowaboutdifferenttypesoffood.What’swrong,forexample,withfish?

PP:There’samisperceptionthatfishisahealthierformofanimalfoodwhen,infact,it’sactuallyhigherinfatthanmanyanimalfoods.Themisperceptioncausespeople to replace red meat with fish and feel that they have improved theirhealthwhentheyreallyhaven’t.Iftheyeattoomuchfish,theymayhaveactuallymadethingsworsebecauseofthehighfatcontent.

GM:Butwe’veheardsooftenthatit’shealthyfat;it’sfullofomegafattyacids.

PP: I think that there isn’t any such thing as healthy fat beyond a certainpercentage in thediet.The idea is toeatavery low-fatdiet:15percentat theupperendand9 to11percentat the lowerend forpeoplewhohavecoronaryartery disease, obesity, and certain other conditions. So when more than 50percentofthecalories insalmonarefromfat,youcan’teatawhole lotofthatandkeepyourselfwithinthatrange.

GM:Isthefatfromfishbetterthanthefatfrombeef?

PP:Ifyou’recrossingthat15percentline,Idon’tthinkitmakesanydifferenceatall.Andwhilemanyclaim that fish is somehowprotective, therehavebeensomeinterestingstudiesonJapanesementhatshowthatthemorefishtheyeat,thehighertheincidenceofprostatecancer.39Atacertainpoint,youcrossthatthreshold in terms of the allowable amounts of animal protein and fat; fishbecomesjustanotherfleshfood,andbadthingsstarttohappen.Therearealsothedangerspresentedbymercuryandothertoxinsinfish.Attheendoftheday,the source of that animal fat and protein doesn’t make much difference; itdoesn’t matter if you’re getting it from eggs, fish, chicken, turkey, pork—it’sreallyallthesamething.

GM:We’veallheardstudiesreportedinthenewsthatfishallegedlyprotectstheheart.Mytheoryisthatwhentheydothesestudiesandtheycomparefisheaterstobeefeaters,it’spossiblethatsalmonismarginallylessbadfortheheartthanbeef. People have better outcomes in terms of sudden cardiac deathwith fishthanbeef,butthey’veneverdoneastudycomparingfisheaterstovegans.

PP:Right.But there’s anothercomplication, too.Thereare somestudies thatshow that eating fish andor taking fishoil capsuleswill raiseHDL,or “goodcholesterol,” levels,whichisonereasonit’stoutedasbeingprotective.Butthatdoesn’tmakeanydifference.Inotherwords,wedon’t reallyhaveanyevidenceshowingthathigherHDLlevelsarethekeytobettercardiovascularhealth.And,in fact, two drugs nevermade it tomarket, very promising drugs, not bymydefinition,butbythedefinitionofdrugcompaniesandthetraditionalcardiologyprofession.These two drugs, dalcetrapib,whichwas developed byRoche, andtorcetrapib, which was developed by Pfizer, were designed to elevate HDLcholesterol;bothdidthatquitewell.Theonelittleproblemwasthatthepeoplewith the higherHDL levelswere dying off faster than the peoplewith lowerHDLlevels,sothosedrugsnevercametomarket.TheconcernwiththeratioofHDLtoLDLiscompletelymisplaced.40

GM:SohavedoctorsacrossAmericamisunderstoodthis,orhavetheyallbeenmisled?Howdidthishappen?

PP: It’s a fundamentalmisunderstanding about the role ofHDL,which is tohelp to clear the bad cholesterol from the bloodstream. As your LDL levelsratchetdown,whichtheydoonalow-fat,plant-baseddiet,theneedforHDLwill also ratchet down. If you look at populations like the Tarahumara ofnorthwesternMexico,who typicallyhavevery, very lowcholesterol levels, theyalso have low HDL levels. I love Dr. Caldwell Esselstyn’s line; he says “theHDLlevelsoftheTarahumaraIndianswouldmaketheaveragecardiologistintheUnitedStatesapoplectic.”Why?Becausetheywouldbecertainthatitwouldbedeadly.We’retalkingaboutHDLlevelsintherangeoffourteentotwenty-fourmilligramsperdeciliters,whichisvery,verylow.41TheTarahumaraeataplant-baseddietcenteredaroundcornandhavealowincidenceofheartdisease.

GM:We’vetalkedaboutfish.Whatdoyouthinkaboutchicken?

PP:IsometimesrefertothestrategyofreplacingonebadfoodwithanotherasrearrangingthedeckchairsontheTitanic.Chickenisjustanotheranimalfood,and a particularly filthy one at that. It’s another food that has a face and amother,whichishowwedefineanimalfoodaroundhere.Thesamedetrimentaleffect thatwewould expect to experienceby consuming toomuchbeef inourdiets,we’llseewithtoomuchchickeninthediet.We’vegottostopimaginingthatthere’ssomeanimalouttherethat’sreallyhealthytoconsume.We’vegottounderstandthatifanimalfoodsareconsumedmorethantwotothreetimesperweek, and even that may be too much for some people, we’re going to haveproblems; it really doesn’t much matter what animal we pick. Chicken, evenwhitemeat chicken, ishigh in fat.Again, it’s extraordinarilydifficult if this isgoingtobepartofthedailyfaretokeepfatconsumptioninline.

Andit’snotjusttheexcessivefatthat’saproblem.There’snofiber.Therearenophytochemicalsandantioxidants.Whenpeopledevelopcancer,whatreallyisgoing on, on a certain level, is that cancer promoters have outnumbered theanticanceragents in thediet.Wehave toconsider theanticancerpropertiesoffood, the phytochemicals like indole-3-carbinol that we see in, for example,cruciferous vegetables. Well, chicken doesn’t contain those, or any otherantioxidants. It offers absolutely no protection, and that’s why I say if it risesabovethelevelofcondimentinthediet,it’sdeadly.Thereareno“better”animalfoods.Whenwestarttalkingaboutgrass-fedbeefandorganicbeefandorganicchickenandthosesortsofthings,we’restilltalkingaboutaproductthathasnofiber,nophytochemicals,noantioxidants,andishighinfat.Yes,weavoidsomeofthehormones,steroids,andantibioticsthataregiventoconventionallyraisedanimals,buttheaminoacidchainsthatmakeupthoseanimalfoodsareexactlythesame,andthey’rejustascancerpromotingatacertainconcentrationinthediet. All the evidence points in the same direction: you should not consumemuchofthisstuff,oranyofitatall.Mypreferenceisnoneatall.

GM:Iliketolookatitthisway:carbohydrateisthemostefficientfuelforthehumanbody.

PP:Right.Andwhenthebodyisforcedtousefatorproteinforfuel,it’lldoit,butit’saverycumbersomeprocess;it’sverystressfulandquitetoxictothebodytodothat.

GM:Soweknowthatcarbohydrateisthenaturalfuelforthehumanbodyand

weknowthat fiber isnecessaryandhealthpromotingto thehumanbody.Yetwe look at these flesh foods and they have no fiber and no carbohydrates. Itstrikesmeasacluethatthey’renothumanfoods.

PP:Right.Thesearenotthefoodsweweredesignedtoliveon.Ourintestinaltractsarelong.Weneedalotoffibertopushfoodthroughthesystem,andtheprimaryenzymethat’ssecretedinyoursalivaisamylase,whichisanenzymethatbreaks down starch. We could anatomically take a little tour through thedigestivesystem,startingwithwhathappenswhenfoodenters themouth,andmakeastrongcaseforourdesignbeinggearedtowardconsumingplantfood.

GM: Which brings us to another high-fat, high-protein, zero-fiber, low-carbohydrateanimalfood:dairy.

PP:Ithinkthat’sthemosttoxicofall.WhenIgivelectures,Igetasked,“IfIweregoingtodoonethingandonethingonly,whatwouldyousuggestIdo?”Well,onechangealonewon’tdothetrickifyou’reeatingthestandardAmericandiet.Butifyou’regoingtomakeanimportantfirststepthatwouldimproveyourhealth, get the dairy out of the diet. Dairy products have no upside. On thedownside, dairy proteins have been linked to asthma, allergies, chronicconstipation, chronic ear infections in children,42, 43 multiple sclerosis,44

autoimmunediseases,breastcancer,prostatecancer,45andosteoporosis.46Thelikelihood that a genetically susceptible child consuming dairy products willdevelop juvenile diabetes is actually greater than the likelihood of a smokerdevelopinglungcancer.47,48,49That’skindofhardtowrapyourarmsaroundwhenyouthinkaboutit,particularlysinceourgovernmentactuallypromotestheconsumptionofdairyproductsbychildren.

GM: People who follow the federal dietary guidelines, the ever-changingpyramidsandplatesthattheUnitedStatesDepartmentofAgriculture(USDA)spendsuntoldmillionsrevising,believethey’reeatingabalanceddiet.Aretheysowronginbelievingthattheirdietoffruitandvegetablesandgrainsontheonehand,anddairyandeggsandmeatontheotherhand,isatleastbalanced?

PP:Only in the sense that it can lead to abalancedneed for various typesofmedical interventions.Here’s something I’ve observed: a family of four people

sitsdowntoeatdinnerinarestaurantandthere’sabsolutelynothingonthetablethey’re eating that I would put in my mouth. You have one person eating acheeseburgerand fries.Thenext iseatingchickenandcheesequesadillas.Andthe next one is having a spinach quiche. The last one is having a turkeysandwich.They’re alldrinking sodas and lemonade.This is thewhole family’sdinner.ItwouldprobablybeheartilyendorsedbytheUSDAandthere’snotasingleworthwhile,nutritiousthingonthetable.Theyjusthavenoideathatthemealtheyjustspentfiftyorsixtybucksonisworthnothingnutritionally.“Oh,cheeseisgoodforyourbones,thechickenislowerinfatthanthebeef,andthefriesmustbebetterbecausethey’rehousemade.Oh,andit’sDietCoke.”Theyuseallthisridiculouscriteriatojustifythechoiceofthesefoodsandbelievethatthey’redoingreasonablywell,butit’salljusthorrible.

GM:Beyondanimalfoods,thereareothersinsinthestandardAmericandiet.

PP:There’sthefatcontentingeneral,butwhatmakesitreallyhorrendousarethe oils; people cook with oils, packaged foods and baked goods contain oil,salad dressings are full of oil, and restaurants overuse it. So people consumeenormous amountsofoil and fat in thediet.Andenormous amountsofplainjunkfoods.

GM:Whataboutsugarandsweets?

PP:Well,Ialwaystellpeoplethatwecan’tvilifyindividualconstituentsbecauseit’sthepatternthatmakesthedifference,butsugarisjustemptycaloriesandisalsoaddictive.Idon’tknowverymanypeople—Icanthinkofahandful—whocanbearoundsweetswithouteatingthem.Ipersonallydon’tlikethosepeople.I’mveryenviousofthembecauseifit’sinfrontofme,Iwanttoeatit.Dr.NealBarnard, in his bookBreaking the Food Seduction, writes that there are studiesthathaveshownthattheeffectofsugaronthedopaminereceptorsofthebrainisverysimilartotheeffectofdrugslikeheroinandcocaineonthosedopaminereceptors.Most people don’t understandwhen they buy this stuff at the storethat it has a highly addictive quality and that they’re going towantmore andmoreofit.

Notonlydosweetsnotprovideanynutritivevalue,andonecouldarguethatthey’re destructive to health in terms of elevating blood sugar levels andsuppressing immune function, but they displace healthy foods in the diet. If

someone eats eight hundred calories’worth of cookies and brownies in a day,that’seighthundredcaloriesthataren’tgoingintosweetpotatoesandvegetablesandriceandotherfoodsthatwouldactuallyhavesomeprotectivevalue.

The other thing to remember is that these refined sugary foods elevatetriglycerides. And triglycerides are blood fats waiting to cause mischief.Triglyceridesandcholesterolwillgodownwhenyouget ridofall that refinedandprocessedsugar-filledstuff.

GM:Now, is thereanythingwrongwithbuyingaboxofcrackers,whether it’ssomething likeRitz crackers, or even crackers youmight see in a health foodstoremadewithwholewheatflourandorganicsesameseedsandsoforth?

PP: There’s definitely something wrong with the Ritz crackers. The topingredients for your regular, store-bought cracker brands, the ones that mostpeoplewouldknowabout,aresugar,whiteflour,andsometypeoffat.This isjustabsolutelyjunkfood.There’snonutritivevaluetoit;youdon’twanttobuyit.Whenitcomestocrackersinahealthfoodstore,youcanfindafewthatdon’tcontainoil.However,anytypeofprocessedfoodlikethatisgoingtobecalorie-dense.Youreallydon’twanttobefillingyourdietwithcalorie-densefood.

Idon’tcompletelyabstainfromeatingcrackers,butthey’renotastapleofmydiet.Ilikefat-freehummus;Iuseitforvegetablewraps,butIalsoliketoeatitasadip.Nowmostpeoplewoulddipcrackersinit;Idipmushroomslices,slicedcucumbers,carrots,andthingslikethatinthehummus.They’remuchbetterforyou than crackers. If I were having a party this weekend, Imight have somecrackers,butI’mworkingalonethisweekend,soI’llbedippingmymushroomslicesinthehummus.

GM:Okay, let’s talk about fatty plant foods. Let’s assume you’re eating thesefoodsintheirwholestate.Avocado—anythingwrongwiththat?

PP:Well,there’snothingwrongwithanyofthesefoodsforarelativelyhealthyperson.Avocados, nuts, seeds, olives—I love them.What I tell people is thattheydon’twanttobegoingoutoftheirwaytoconsumethem,though,becausetheycanendupeatingadietthat’squitehighinfatwiththosefoods.OurChefDelisagoodexample.Onatotallyvegandiet,heatehimselfto475pounds.

GM:Whattheheckwasheeating?

PP:High-fat plant foods, fried food, baked goods…Del used to eat lots ofavocadosandalmondsbythehandful.Nowhe’s losthalfofhimself.Iwanttomakethatclear;he’sdoneagreatjobsincehe’sbeenhere.SomyruleisthatIeatthesefattyplantfoodswhentheyoccur inadish,butIdon’tgooutofmyway toeat them.Arestaurantnearmyhousemakesblackbeanwrapsand thechef puts slices of avocado in them; I eat that. We have a dish here calledvegetablebyrianithathasalmondsinit;Ieatthat.ButIdon’tbuyavocadosatthestoreandputthemonallofmysalads.NordoIhaveabagofalmondsatmyhousetonoshonbecausethesearedenselycaloric,high-protein,high-fatfoods.ItelleverybodyIcouldeasilybeathree-hundred-poundvegan.I’matahealthyweightbecauseIminimizethiskindofstuffinthediet.

GM:Whataboutcoconut?I’llgo intoahealthfoodstoreandtherewillbealltheserawdesserts,thesesupposedlyhealthyalternativedesserts.However,theyhavesomuchcoconutinthemthatthey’llhaveeighteengramsofsaturatedfat.Iscoconutasunhealthyasitappearstobe?

PP:Absolutely.It’sfullofsaturatedfat.Now,havingsaidthat,Iloveit.IfyoutoldmeIcouldneverhavecoconutagain,Imighthavetoendmylife.SoIdon’twanttogiveitup,butI’mveryclearthatit’satreat.Rawfooddessertsandrawfooddishes ingeneralareveryhigh in fat.Theyoftenaccomplish the texturestheydesirebyusingreallyhigh-fatfoods.

Thisissueoffood-versus-treatissomethingwejusthavetodrivehome.Ontheonehand,wecertainlydon’twantpeopletothinkthey’remakingasixty-yearcommitmenttoneverhavingdessert,birthdaycake,orweddingcake,etc.;that’snot going to fly.Nordowewant people stressing out thinking they blew thediet.That’sabad idea.Ontheotherhand, this stuffcan’tbepartof thedailyfare. We need to make the whole foods our daily fare and make the treatsoccasional.Andthisissomethingthatpeoplegetintoallthetime:“Well,whatdo youmean by occasional?”And I tell them it should be situational.Dowehave a reason for having this item that is not part of the daily fare? If yougraduatefirst inyourclass,aglassofchampagne isokay.Buttoday’sTuesday,it’saprettynormalday,we’renotcelebratinganythingaroundhere,soI thinkweoughttojusteatourbeansandriceandvegetables.

GM:Onthesubjectofplantfoodsthatyouhavetowatchyourintakeof,whataboutdriedfruit?

PP:Therearetwoissueswithdriedfruit:First,it’shighincalories.Youcansitdown and eat half a bag of dried apricots pretty easily. Just think about howmany calories you consumed. It’s like eating three dozen apricots, which youwouldnever do.Second, youhave tomake sure thedried fruits you’re buyingaren’tadulterated.Therearelotsofsulfites,coloringagents,andsugarinmanydried fruitproducts.Any timeyoubuycranberries that tastegoodrightoutofthepackage,youknowthatthey’vehadsugaraddedtothembecausecranberriesare actually sour. Be careful when you buy dried fruits; you don’t want to beeatingalotofthatstuff.Again,I’lleatitwhenit’sinadish.Delmakesagreatsaladherethathasraisinsinit,orI’llputraisinsonmyoatmealeverysooften.ButI’mnoteatinghandfulsofdriedbananas,driedapples,driedpineapples,thatkindofstuff.

GM:Howaboutfruitjuice?

PP:Never.

GM:Okay,what’swrongwithfruitjuice?

PP: It’s concentrated calories and sugar. Instead of drinking apple juice, eatapples;insteadoforangejuice,eatoranges.

GM:Whataboutsalt?

PP:Well,nowweget intoacontentious issue.Salt restriction isoneof thosethings that became part of the conventional wisdom; we’ve been told it’snecessaryforpeopletorestrictsaltinordertohavenormalbloodpressure.

Earlyinmycareer,IheardDr.McDougallbucktheestablishmentbysayingthatsaltrestrictionisnotonlyinadvisablebutmaybedetrimental.Igotcuriousabout it, so I reviewed the studies that had shown that salt restriction wasbeneficial; the difficulty was that salt restriction is usually accompanied withother dietary changes. The famous DASH (Dietary Approaches to StopHypertension)diet,promotedbytheUSDAtolowerhypertension,isprobablythebestexampleofthis.TheparticipantsoftheDASHstudywereeatingmorefruitsandvegetables,lessanimalfoods,higherfiber,andlesssalt.50Idon’tthinkwe can attribute the improvement in their health to the salt restriction alone,whenpeopleweremakingsomanyotherchangestotheirdietatthesametime.

I just really could not find a lot of clear evidence that salt restriction wasimportant. On the other hand, according to the 2007 National Health andNutrition Examination Survey, which included almost one hundred millionadults,peoplewhoeatmoresalthavealowerriskofdeathfromheartattackandstroke.51Therearemanypopulationsontheplanetthateatalotmoresaltthanwedothatenjoygreatcardiovascularhealth.

GM:IsJapanoneofthose?

PP:Japanisoneofthose,yes.AndpartsofChina.We’ve used salt to cure and flavor food for centuries. I don’t thinkwe can

attributeourcurrentepidemicofhypertension to salt.Thebottom line is this:whenyouadoptthedietthatwerecommend,yourconsumptionofsaltisgoingtoratchetdownquiteabitbecauseyou’renotgoingtobeeatingprocessedmeatsand asmuch packaged foods as youwere before.And another very importantthing is going to happen, too—your consumption of other minerals andnutrientslikepotassiumwillgoup.Ithinkthatoneoftheissuesistheratioofsalt to other nutrients, particularly potassium, in the diet, so you’re going toexperiencesaltreduction.Also,ifyousaltyourfoodatthetableinsteadofinthecookingprocess,you’regoingtouselesssalt,andIthinkthat’sagoodidea.Inany given year,we endupwithhalf a dozenpeopleherewhohave to restrictbecausetheyreallyhavesomesaltsensitivity;theirbloodpressuregoesupwhentheyeatsalt,anditgoesdownwhentheydon’t.

GM:Soyou’renotdenyingthatthatrelationshipcouldexist?

PP: Oh, it does exist. But as public policy, what we’re doing is restrictingmillionsofpeopletotrytohelpahandfulwhoneedtherestriction.

GM: Aren’t we salt-restricting millions of people primarily because of theirbloodpressure?

PP:Well,yes,buttheydon’tneedtoberestricted.52Inotherwords,iftheylostweight and they ate a plant-based diet without salt restriction, their bloodpressurewouldcomedownnaturally,withoutrestrictingitovertly.Ifyoulookatthemechanismofactionforhighbloodpressure,alotofitisrelatedtodamagetotheendothelialtissue.Iftheendothelialcellscan’tproducenitricoxide,which

isavasodilator,thevesselsstarttoclosealittlebit.Addinalittlearterialplaqueandthelumeninthevesselsstarttonarrowevenmore;essentially,you’retryingtoforcemorebloodthroughnarrowerarteries.That’stherecipeforhighbloodpressure.Well,whenyouputpeopleona low-fat,plant-baseddiet, theplaquedepositsstopformingandthenarrowingofthelumenofthebloodvesselsisn’thappening anymore.We stop assaulting the endothelial tissue and it starts toregenerate;itbeginstoproducenitricoxideandopensupthosebloodvessels.It’samazing,overaperiodoftime,howmanypeoplewillhavetheirbloodpressurereturn to normal. Add in some exercise and take off a few pounds andmostpeoplewillbeabletogettheirbloodpressuredownwithoutsaltrestriction.

Iwanttomentiononething.Thisisnotmyidea—it’saDr.McDougallideathat’s worth sharing, and there’s a considerable amount of evidence in themedical journals to support it.53 Remember that our object is to encouragepeople to eat starchy foods and vegetables. And if salting the broccoli makesthemeatalotofitthen,bygosh,let’sputsomesaltonit.Idon’twantthevastmajorityofpeoplewhoaren’tsaltsensitivetothinkthey’recheatingbecausetheyputsaltontheirbroccoliandrice.

GM:What about themeat analogs: the tofuhotdogs and theGardeinmeatsandsoforth?

PP:Well,someofthemareprettyclean.Usingtempehtogivespaghettisaucethetextureofsomethingwithgroundmeatinit,ifit’sacleantempehproduct,liketheoneswemakeatWellnessForumFoods,Idon’thaveanyproblemwiththat.Idoit;wedoithere.WhatIhaveaproblemwithisthesehighlyprocessedmeat analogs that are just garbage food, like the tofu hot dogs and the fakepepperoni. Once in a while, it’s not a problem. People invite me, say, to aMemorial Day picnic and they say, “Pam, we’ve got veggie burgers for you.”Theymaybeoverlyprocessedveggieburgers,butit’sMemorialDayandpeoplearebeingnice.I’mnotgoingtodiefromeatingaveggieburgerthatisn’tclean.It’sonlywhenthiskindofgarbageinfiltratesthedailydietthatyoudon’treallyendupwiththehealthimprovementthatyou’re lookingfor.Thesefakemeatsare transitional foods and treats. If you’vegot to feedyourkids some tofuhotdogstogetthemthroughthetransitionalperiod,that’sfine.However,ifyou’restilldoingittwoyearslater,you’rejustpostponingmakingsomeserioushealthimprovements.

GM:Howdoyoufeelabouttherawfooddiet?

PP:That’sacomplicatedquestion.Whattypicallyhappenstopeoplewhoadoptarawfooddietisthattheydoreallywellforawhilebecauseofallofthethingsthat they eliminate.Manypeoplewho start a raw fooddiet come fromeatingsomeversionofaterriblediet,sotheyfeelreallygreat.Butthen,evenwiththemeatandthedairyoutoftheirdiet,theystarttofeelbadly.Thebiggestreasontheyfeelbadlyisthattheycan’tgetenoughcaloriesfromeatingonlyrawfoods,or they have difficulty doing so. When they begin to feel the impact of thecaloriedeficiency,theystarttoincreasetheircaloriecountbyeatingnutsandoilsandthingsofthatnature.Thentheystarttogetsick.

Thereare somepeoplewhoare able tomaintaina raw fooddietwell.Noteverybodygetsitwrong,butmostpeopledon’tdoitwellandendupworseoffasa result. I think thebigger issue is thatwe reallydon’thave any evidence thatshowsthatarawfooddietisbetterthanadietthatincludescookedfood.Oneofmyphilosophicalissuesaroundrawfoodisthatwhatwe’reaskingpeopletodoisabigenoughchangeallbyitself,withoutaddinglayersofdifficultytoitthatareunnecessary. Often I find that these added layers of difficulty attract a lot ofattention at the expense of things that aremuchmore important. I think it’smuchmoreimportanttodealwithfatinthediet,forexample,thantoeatallrawfood. It requiresan involveddiscussionabout theeffort that it takes todo therawdiet right and to teachpeoplehow todehydrate foodsandall that sortofthing;Idon’tseethatit’sworthit.

GM:Ilookatitthisway:therearetwoimportantgoalsinnutrition.Oneistoobtain nutrients and the other is to avoid poisons or deleterious substances.Now, if you eat a lot of raw greens, vegetables, and salads, you get a lot ofnutrients,which is a positive.Youwant tohave ahealthy complementof rawfoodsinyourdiet.Thenifweaddtothesesomerice,potato,orotherplantfoodthatrequirescooking,there’snodownside.We’renotgettinganypoisons.We’renotgettingsomethingthat’shighinfatorfulloftoxinsorhasanimalproteinoranythingelse.Ijustcan’tseethecaseforabstainingfromhealthy,cookedfoodsthat satisfy our appetites, as long as we’re getting our full complement ofnutrient-denserawfoods.

PP:Iagreewiththat.Wewantpeopletoeatlotsofsaladsandrawfoods.Buttheextremeideathatyoutrytoliveononlyrawfoodsdoesn’tplayoutreallywell

in real life.Weneed those cooked foods, those cooked starchy foods, becauseotherwiseit’sdifficultforthediettobecaloricallyadequate.

OnefundiningadventurethatIenjoyinmanycities istosamplerawfoodrestaurants.TherearemanyinLosAngeles,andI’vehadthepleasureofdininginsomeofthem.Thefoodisjustphenomenalatsomeoftheseplacesbut—andthisisabigbutthatcouldleadtoabigbutt—it’salsoveryhighinfat.IfIateatthoserestaurantseveryday,I’dbeathree-hundred-poundvegan.

The whole idea of adopting a health-promoting diet is not to separateyourself fromthe restofhumanityandmake it impossible to interactwith therest of theworld.That’s a terrible outcome, inmy opinion.The emphasis oneating only raw food, and food combining, and a lot of other ideas that arecirculating,makeitharderandharderforapersontobeoutamongtherestoftheworld.Idon’twanttostopgoingtofamilygatheringsandbookclub,oranyof the other things that I do that involve interactions and meals with otherpeople.Idon’twanttoadoptsomeeatingstylethat’sincompatiblewiththewaytherestoftheworldlives.Icaneattheplant-baseddietwe’vediscussedhere;IcanpracticedietaryexcellenceanywhereIgo.Ican’tpracticerawfood-ismandfoodcombiningandalotoftheseotherextremethingseveryplaceIgo.

GM:Howdoyoufeelaboutthemacrobioticdiet?

PP:Well,that’sinteresting.There’ssomeevidencethatthemacrobioticdietishelpful for resolvingcancer.Wedon’t reallyhavea lotof studies thatpoint inthat direction, but we have a lot of stories, enough that I think if somebodywantedtodoastudyonmacrobioticdietsandcancer,itcouldbejustifiedfromafundingstandpoint.It’llneverhappenbecausethedrugcompanieswillneverletithappen,butI’vereadenoughaboutittobelievethere’ssomethingtoit.

Onethingthat’smisunderstoodisthatthemacrobioticdietisn’t justadiet;it’salifestyle,too.Thepeoplewhohavesucceededwithithavenotonlyadheredto the dietary principles but they’ve done a lot of the other things that arerecommendedintermsofthewaytheylivetheirlives.Ithinkifyou’regoingtodomacrobiotics,you’regoing tohave to incorporate thewholeprogramtogetthebenefit.

Themacrobioticdietcanbedifficultintermsoffoodpreparation;ittakesalotoftime.Whatwedon’tknowisifit’sthespecificcombinationoffoodsthatareincludedthat’scausingthepositiveeffect,orifit’ssimplytheeliminationofsomeof thebadfoodsthat’scausingthepositiveeffect.Inotherwords,dowe

really have to do all of this, or canwe get the same results from just eating aplant-based diet? I’d love to see a study with leukemia patients comparing amacrobioticdiettoourWellnessForumplantoseeiftheretrulyisadifferencebetweenthetwo.Willthateverhappen?No,notinthiscountry.

GM:IlivedinBostonin1983inavegetariangrouphousenearoneofMichioKushi’smacrobioticschools(KushifoundedtheKushiInstitute).Wheneverweadvertisedforanewroommate,alotofhisstudentswouldcomeandinterviewwithus to see if theywanted to live inourhouse.Theywould always ask thesamequestion:“Doyoueatvegetablesthatgrowatnight?”Iwouldsay,“Idon’tknow.Inevergetuptowatch.”

Is there anything to this “nightshadevegetable” thing?Apparentlypotatoesand eggplants and I’mnot surewhat else grow at night; is there anybasis forconcernaboutthat?

PP:No,notgenerally.Therearesomepatientswitharthritis—it’saverysmallminority—who seem to do better without nightshade vegetables. I think youbring up a great example of what I was just talking about. That’s a layer ofdifficultyaddedtoeatingamacrobioticdiet,andwejustdon’thaveanyresearchto show that added level of restriction and difficulty is necessarymost of thetime.I’dlovetoseeitstudiedsomeday;maybeIwilllivelongenoughtoseetherighttypesofstudiesdoneaboutdietinthiscountry,butrightnowwejustdon’thavetheevidenceforit.

GM: Speaking of potatoes, what’s the best way to prepare a potato? Bakedpotato,boiledpotato?Doyoueattheskin,doyounoteattheskin?

PP:Ialwayseattheskin.Ilovepotatoskins.Boiled,baked,steamed—thosearethewaysIusuallyhavethem.Butit’snotnecessarytoeattheskinifyoudon’twantto.

GM:Nowwhataboutaglassofwineintheevening?Anythingwrongwiththat?

PP:Everyeveningisabigdeal.Alcoholisnotbeneficialforhealth.Theseveralstudies that have shown that occasional drinkers are healthier than abstainershave not, I think, accounted for the fact that many abstainers are abstainersbecause of health conditions. I don’t see a benefit from drinking, but I don’t

want to take theenjoymentoutof life. Iknowsomerealpurists,andthey’reapaininthebutttobearound.Idon’twanttobeoneofthem.Itdoesn’tattractpeople toourwayof life. Ienjoyanoccasionalcocktail andIdon’tdiscourageour members from doing so unless they have a condition like pancreatitis orhepatitisC.Ithinktheaveragepersoncancertainlydrinksomealcohol,butnoteveryday.

GM:Whatdoyousaytothosewhobelievethatadailyglassofredwineexplainsthe so-called French Paradox? Theymanage to eat a fatty, animal-based dietwithlessheartdiseasethanAmericans.

PP: First of all, the incidence of heart disease and cancer in France is veryhigh.54It’s lower thantheUnitedStates,but it’s stillveryhigh.Iwouldn’tbeattracted to that type of risk profile. Second, the French, as well as otherpopulations in Europe that eat similar diets, eat an enormous amount oflegumes,freshvegetables,wholegrains,andfruit.Thepeoplewhotrulyabidebythisdietarenotoverweight.Andwhiletheyeatplentyofanimalfoods,theyeatmuchsmallerportionsthanwedoinAmerica.I’vespentalotoftimeinEurope;I’veeatentheMediterraneandietinEurope,soIknowwhatI’mspeakingabout.

Having said that, their disease rates are still high.To the extent that theirhealthisbetterthanours,it’snotbecauseoftheredwineoroliveoil;it’sbecauseof the entire way they live their life, which includes more walking andmorephysical activity. It’s their pattern of diet and lifestyle that is somewhatprotective,notredwineandoliveoil,andinanycasethey’renotashealthyasissometimesreported.Whathappenshereisthatpeoplelookatvariousdietsandthey readabout theMediterraneandietandsay, “I like the redwineandoliveoil,”andtheyextractthatandaddthattotheAmericandiet,onlytomakethingsworse.

GM: Chocolate has been in the news lately because of studies that allegedlyshowthatit’sverygoodfortheheart.Thatseemstobetoogoodtobetrue.

PP:Anditis.ThedangerwouldbepeoplethinkingtheycancontinuetoeatthefattyWestern diet and then protect themselveswith fatty chocolate bars.Thestudy thatwas in thenews recentlywasameta-analysisof sevenstudies.Onlyfive of the seven showed some benefit. Even the researchers issued a cautionabouthowto interprettheresultsbecausechocolate ishighinfatandcalories;

even they did not interpret their own study as a mandate to begin eatingchocolateasapreventivetool.55Ifthere’ssomelegitimategoodnewshere, it’sthatifyou’reingoodhealthandpracticingalow-fat,plant-baseddiet,youcantreatyourselfoccasionallytosomechocolatewithoutworry.

GM:Whataboutcoffee?

PP:Coffeehasbeenalittlevilified.There’snoquestionthatcaffeineisadrug.Aswithalcohol, ifyouabuse it, you’regoing tohaveproblems. Iused tobeacaffeineabuser,soIcanspeaktothatfromextremepersonalexperience.Itusedtotakethreepotsofcoffeeadaytokeepmegoing.Idon’tthinktheoccasionalcupofcoffeeisadealbreaker.Whenpeoplewhoarecompletelycompliantwiththediet say thatacupofcoffee in themorning is somethingtheywant todo,I’mnotgoingtomakeanissueoutofit.Todosowouldbechoosingthewrongbattle. But when I see people drinking coffee all day long to stay awake andmasking symptoms of fatigue, which should signal to them that they’reoverworking themselves and that their body is exhausted, I’llmake an issueofthat.

GM:I’mpleasedtosaythatI’vehadonlyonecupofcoffeeinmylife.

PP:How’dyoumanagethat?

GM: Well, I was a seventeen-year-old high school student and visited thecollegeIwouldultimatelyattend,NewCollegeinSarasota,Florida.Somebodytold me that there would be a coffee klatch in the evening at the home ofProfessorPeggyBates,soIwenttheretomeetthestudentsandsomeprofessors.Dr.Batessaidtome,infrontofeveryone,“Glen,doyoudrinkcoffee?”Well,Ineverdrankcoffeegrowingup;ithadneveroccurredtometotryit.ButnowIwasgoingtocollege,joiningthegrown-ups,andIdidn’twanttomakeafoolofmyself,soIhadtothinkonmyfeet.

Isaid,“Idon’tknow.”Shesaid,“Well,Glen,wouldyouliketotryacup?”Isaid,“Sure.”Soshegavememyfirstcupofcoffee.AndIdrankafewsips.Ittastedlike

mud.ItwastheworsttastingdrinkI’deverexperienced.Icouldn’timaginethatpeopleactuallydrankthiscrap.SoIneverhadcoffeeagain.

Cuttotwentyyearslater.Myoldliteratureprofessorwasretiring,andIflewback to Sarasota to speak at his retirement dinner. I’m hanging around thecampus and Imeet a youngwoman fromChinawho is a new student at thecollege.Shetellsmeshe’sstudyinginternationalrelationswithDr.Bates.Isay,“Oh,isshestillhere?How’sshedoing?”

Shesays, “Great.She’s just thegreatestprofessor.But shemakes theworstfriggin’coffee.”

4

SUCCESSSTORIES....................................

GM: Pam, let’s discuss how the dietary program that you recommend hasworkedinpractice,withspecificindividuals.Iknowthat,intheviewofscience,everyindividualisjustananecdote,butafterawhiletheanecdotesbegintoaddup.

PP:Okay,let’sstartwithayoungladybythenameofDarcy(hernamehasbeenchanged),whocametousafterherconditioncausedhertodropoutofcollege.She had started hermenstrual period at about the average time forAmericangirls, sometime aroundelevenor twelve, but from the verybeginning thiswasjust a torturous experience for her. Her periods were irregular and heavy,sometimesbleedingthreeweeksoutoffour.Thenshedevelopedsevereacneandthebeginningsofpolycysticovarysyndrome,whichisahorrificconditionforateenager tohave.Shegraduated fromhighschoolandwentoff tocollege,buttheconditionworsenedsomuchthatshehadtodropoutofcollegeandcomebackhome.

HerparentsfoundTheWellnessForum.Theycalledandsaidtheirdaughterwasnineteenyearsoldandeffectivelycan’tdoanything—can’tleavethehouse,gotoschool,getajob.Thisisquiteayoungagetoessentiallyhaveyourlifebeprettymuchoverwith,sowestartedteachingherthediet.Wecutthedairyoutandgotheronalow-fat,plant-basednutritionalprogram.Withinsixweeks,hermenstrual periods started to become regular, the horrible bleeding and the

cramping started to go away, her skin cleared up, and she returned to school.She’sbackinnursingschoolnowandhashadacompleteandtotalrecovery.Shetakesnomedication.So,justdiet—completeandtotalrecoveryusingourdiet.

GM:Didsheexperienceanyotherchanges?Didsheloseweight?

PP: Yes. She lost fifteen or twenty pounds. It’s hard to know if her originalweightgainhadbeencausedbythefactthatherlifehadcometoahaltandshecouldn’tdoanything,butnowsheruns,sheexercises,andherskin’sclearedup.She’sanormalcollegestudent.

GM:Now,doyoususpectthatdairyhadbeenthemainculprit,ordoyouthinkitwas just somehowtheoveralldiet,all the fatandeverything in thestandardAmericandiet?

PP: I think it’s both. First of all, dairy foods are the worst for women withmenstrualproblemsbecausedairyproductsbytheirverynaturecontainestrogen.Mostwomenwhohaveproblemswithhormonesrangingfromirregularperiodstoinfertilityarehavingthoseproblemsbecausetheirestrogenlevelsaretoohigh.Takinginmoreestrogenmetabolites inaglassofmilkorasliceofcheese justmakes the problem worse. In the case of this young lady, her entire dietarypatternwashorrific.Shelivedonthetypicalcollegekidfareand,beforethat,thetypical high school kid fare. The whole family, by the way, was in a similarcondition.Hermotherhasalsohadamiraculoushealth recovery.After seeingwhathappenedwithherdaughter, themotheradoptedthedietandherhealthhasturnedaroundalso.Thewholefamilynoweatsthisway.Soawholefamilyofsickpeoplebecameawholefamilyofactivepeopleeatingahealth-promotingdietallbecausetheirdaughterhadreachedacrisispoint.

GM:AndwasDarcyresistantatall,ordidsheimmediatelytaketothediet?

PP:Shewassoanxioustohavethisbehindherthatifwehadtoldhertograzeongrassinthesideyardofherhouse,shewouldhavegoneanddoneit.Whenpeople are really sick, they’re really compliant because they want to heal.Somehowwe’vegottoreachpeoplewhoaren’tsosickandgetthemtotake itjustas seriously. Ifyoucanmakethemsee theirchoice, they’dmuchratherbewellthanbecomesickandhavetorecover.

DARCYINHEROWNWORDS......................

MystorystartedatageelevenwhenIstartedmyperiod.BythetimeIwasthirteenyearsold,Istartedhavingseverepain.Ithoughtitwasnormal, but then it kept getting worse and worse every month. Ibegan to have cramps before, during, and aftermy period. Somemonthsmymenstrualperiodwouldlastfortwo-and-a-halfweeks.

Iwenttoagynecologist,andhegavemepainmedicine,butitdidnothelpverymuch.Ihadalaparoscopy,duringwhichthesurgeonfound a cyst in my left tube and the beginning stages ofendometriosis.Thedoctorsgavemebirthcontrolpills,butIdecidedtostoptakingthemaftertwoyearsbecauseIwasconcernedaboutthehealthrisks.Allofmysymptomsreturned.

I began seeing a holistic health specialist, who prescribedcompoundedprogesterone.Itseemedtohelpforaboutsixmonths,and then the symptoms returned. I tried lots of different holistichealthalternatives,becauseIrefusedtogobacktothedoctorswhonever seemed tohavea clear answerandalwayswanted to treatmy symptoms instead of the actual cause. But the holisticprofessionals just ran tests and gave me pills and creams.Sometimestheyworkedforaperiodoftime,butIusuallyendedupworsethanwhenIstarted.

As ifallof thiswasnotbadenough, Istartedbreakingoutwithacneallovermybody.Myfacewaspurered.Ifeltawfulandtired,andatthispoint,theonlytimeIgotoutofbedwastoeatandvisitdoctors. I was sleeping about fourteen hours per day. I gainedtwentypoundsandevenwhenItriedeatingonlylettuce,Icouldnotlosetheweight.Mymoodswingsbecamemoresevere,mytemperwas out of control, and I began to develop sugar and thyroidproblems.ItseemedlikeIwasveryyoungtohaveallofthesehealthissues.

Forced to go back to medical doctors, I was diagnosed withpolycysticovarysyndrome;Ihadcystsallovermyovaries.Thistimethe doctors put me back on birth control and added anantidepressantandmetforminforthesugarproblem.

Iwasabsolutelydesperateat thispointand I continued toprayand pray, until one day amiracle came. A wonderful lady sharedwithmeherpersonalrecoverystorywithDr.PamPopperandTheWellnessForum.IdecidedtogetintouchwithDr.Popperandseewhatmighthappen.Bythispoint, Iwasaboutsevenyearsintomyjourney and Iwould have probably tried anything.Amazingly,withDr.Popper’sdietand theexercisesheaskedme todo, in just sixweeksmy period returned——the first one in sixmonths! I think Ihad thebiggest smileonmy face that I hadhad in thepast threeyears. Iwassothankfuland joyfulandI feltsomuchbetter. I trulyfeltrelieved.Mybodywasstartingtoworkandfixitself,and,littlebylittle,thingsstartedadjusting.

IhavebeenonthisdietforabouttwoyearsandIamalmostfullyrecoveredfromeverything.Mostofmypimplesaregone,I lostthetwentypoundsIhadgained,andIhavealotmoreenergy.Iamabletofunctionlikeanormalperson.IwillcontinuetosticktothisdietfortherestofmylifeandIamsogratefulforthetransformationithascausedinmyhealth.Whenthingsweretheworst,IneverthoughtI’dhavearegularmenstrualcycleorbeabletogetoutofbedagain.Itisanamazingfeelingtohavemyhealthrestored.

GM:Now,mostpeoplecometoTheWellnessForumonlywhenthey’resick.

PP: Yes. Maureen Yatwa actually came to me through my work with RipEsselstyn andWholeFoodsMarket.She showedup at oneof the Immersionprogramslastfall.

GM: That’s the program thatWhole Foods funds for employeeswithweightproblemsorhealthchallenges,right?

PP: Right.Maureen, from Jacksonville, Florida, is in her forties and she hadCrohn’s disease—that’s past tense. She qualified for the program because shealsohadhighcholesterolandwasoverweight.

AtthefirstnightofImmersion,duringtheintroductions,shestoodupandsaid, “I’moverweight, Ihavehighcholesterol,andIalsohaveCrohn’sdisease.

Mydaughter,who’sateenager,alsohasCrohn’sdisease,andIwantbothofustogetbetter.”So Iwentup toher after theopening-nightdinner, introducedmyself,andsaid,“InordertofixtheCrohn’sdisease,you’llhavetoacceptalittlebitmoredietaryrestrictionthantheothersbecausegluteniscontraindicativeforCrohn’s.Sotheoatsandsomeoftheotherthingswehavehere,you’renotgoingto be able to eat. But there’s plenty of food here; you’re not going to starve.Therearejustsomethingsyoucan’thave.”EverybodyattheImmersionisonawhole food, low-fat,plant-baseddiet,butshewouldhave justa littlebitmorerestriction.

ThereareallkindsofactivitiesplannedattheImmersion,canoeingandfieldtrips and so forth. Maureen didn’t sign up for any of it because if you’re aCrohn’s patient, your disease is not under control. You can’t go anywherebecauseyouhave tobeby thebathroom. It’s adebilitatingdisease.The forty-five-minutebusrideintotown—youcan’tdothat.Youcan’tbeoutonacanoe.Liferevolvesaroundlocatingthenearestbathroom.

Bythetimethemidweekcame,shewaswellenoughtodothosethings.Sheshowedsignificantimprovementwithininamatterofdays.Today,shenotonlydoesn’thaveCrohn’sdiseasebutshedoesn’ttakemedicationforit,she’slosttheweight,andhercholesterolisdown.Andherdaughter,whowasonherwaytoduplicatingmomattheageofseventeenoreighteen,alsonolongerhasCrohn’sdisease.

GM:SoinjustafewdaystheCrohn’swasgone?Crohn’softenstayswithpeopleforhowlong?

PP:Theirwholelives.ThetrajectoryofCrohn’sandulcerativecolitisandtheseinflammatory bowel diseases is discouraging. There may be periods of someremission,whereitgetsalittlebitbetter,butitalwaysprogresses,andthedrugsget stronger. It’s not unusual to use Remicade infusions, which areimmunosuppressants, very strongdrugs.Andwhen that fails, they start takingportions of the bowel out; they remove the inflamed portion. And obviously,there’s anendpoint to that; there’sonly somuchyoucan takeoutbeforeyoudon’thaveaGItractorintestinesanymore.That’swhereMaureenwasheaded,and her situation was obviously pretty acute. If you’re afraid of a forty-five-minutebusridebecauseyou’renotgoingtobenearabathroom,you’reprettyfardown the road.So she totally recovered.She talksabout it veryopenly, as sheshouldsinceshecanbearealinspirationtootherswhohavethiscondition.

MAUREENYATWAINHEROWNWORDS......................

ImetDr.PamPopperwhileparticipatinginaprogramsponsoredbymy employer. There were several reasons why I wanted toparticipateinthisprogram,andoneofthemwasthatIhadCrohn’sdisease for nineteen years.During that time Iwasmedicatedwithsteroids, antibiotics, and other medications; would have flare-ups;andwasevenhospitalizedafewtimes.In1993Ihadmygallbladderremoved.MyCrohn’shadadvancedsomuchthatIwashospitalizedwith toxic shocksyndromeandhad twelve inchesofmy intestinesremovedinanemergencysurgery.Theinfectionwassoseverethatthewoundwasleftopentoheal;Iwasleftwithahorriblescar.Fromthat point, I routinely had visited the bathroom between six andfourteen times per day, and my stomach was always sore andbloated; I just accepted that thiswasmy fate. I had to always benear a restroom. The anxiety I experienced would cause me toshake, sweat, and feel guilty because I was always making myfamilywaitwhile I foundabathroom.Aclass tripwithmychildrenwasaheinousexperience.

Dr.PamtoldmetheveryfirsttimewemetthatIcouldgetbetterandthatshewouldhelpmefigureoutwhat toeatandwhatnot toeat.TheprogramIattendedlastedfor fivedays;bytheendof thistime,myCrohn’sdiseasewasbetter.Imaintainedaplant-strongdietaftertheprogramandmyCrohn’sdiseasecompletelywentaway!

For the first time in nineteen years, I am not running for thebathroomandIhavethefreedomtodoanythingIwanttodo.Icanwatch my daughter’s whole soccer game without running to arestroom.Thishastotallychangedmylife.

GettingridoftheCrohn’sdiseaseisnottheonlypositivechange:I’ve lost nineteen pounds and my blood pressure and cholesteroldroppedtoideallevels.

IwishI’dknownaboutthisearlier,butI’mgratefultohavemylifeback.

GM:ItakeitthatTheWellnessForumattractsalotofpeoplewithdigestiveorboweldisorders?

PP:Wedo.JillCollettisayogateacheratourstudiowhohadulcerativecolitis.She’dbeenonandoffmedicationforit.Herulcerativecolitishadprogressedtotheplacewheretheinflammationinthebowelstartedtoaffectotherpartsofthebody;shedevelopedsomeinflammationinhereyesandhervisionbecameabitimpaired,somethingthatcan’tbefixed.Jillhadbeenastudentatouryogastudiofora longtime,butIdidn’tknow,untilshestartedouryoga-trainingprogramandspokewithmeabout it, that shehadbeen suffering for twentyyearswithulcerativecolitis.

Jilldidn’teataterriblediet,butitwasn’tperfect.Rememberthecombinationlocktheory;youknow,you’vegottogetallfournumbersright.Youcan’tdo75percent.Wehelpedhermakethatadditional25percentofdietaryimprovement;it took only three weeks for her stools to become solid and for her to stopsuffering fromulcerativecolitis—off themedsandeverything’s fine.Andshe’sbeenfineeversince.Sheactuallymadethecommentthatherenergylevelwassohigh that shewas starting to scare her husband.This had been a twenty-yearproblemforher;afteronlytwenty-onedaysonthediet,shewasingreatshape.Youcouldreallyseethedifference,too.Herface,hercomplexionchangedalotafterthisperiodoftime;nowshejustlooksphenomenallygreat.

JILLCOLLETTINHEROWNWORDS......................

WhenItalkedwithPamPopperregardingmygutissuesforthefirsttime,IthoughtIwasfaringwellwithmyulcerativecolitis.IthoughtIfeltasgoodaspossiblegivenmycondition.Fornearlytwentyyears,Ihadacceptedstomachcramps,bloating,andoccasionalsprintstothetoiletaspartofwhoIwas.Ilearnedtobreathethroughcramps,dressforthebloat,andIcouldtellyouwherethenearestrestroomwas in anypublic venue, including theRomanColosseum (acrossthe street in the train station). I also accepted the fact that onceeveryfewyears,Iwouldwakeupinthemorningandabitmoreofmy eyesight would be gone. All these symptomswere due to the

diseasediagnosedinmytwentiesasulcerativeproctitisandthentheprogressiontoulcerativecolitisastheyearspassed.

When I firstmentionedsomething toPamaboutmycondition, IwastakingamaintenancemedicationthatIhadbeenonforseveralyearsfollowingmylastvisionloss.Itookittostaveoffanysystemicinflammation and to preserve my remaining eyesight. I had beenthroughallsortsofdrugsbeginning inmy twentieswith thesulfas,usingsuppositoriesforflaresandmusclerelaxantsforcramps.Ihadhadcolonoscopies,MRIs,spinal taps, tonsofbloodwork, flown tosee top doctors, all with the same outcome: use themaintenancedrugs, try tominimizestressandknown triggers,andhope for thebest.Iatefairlywell,didn’tdrinkcaffeine,hadtheoccasionalglassofwine,andexercisedregularly.SowhydidIstillwakewithcramps,dealwiththe“foodbaby,”andhaveirregularBMs?

Through Pam and TheWellness Forum, I learned that I couldsootheandevencuremyinflamedsystemwithjustafewchanges.Shesaid,“Youcangetridofthis.”Thosewerethegame-changingwords;well,thoseand,“Youcanneverletdairyorglutenpassyourlips again.” I hadminimizedmydirect dairy intake in thepast, butneverhadIbeentoldsobluntlythatwhatIatehadsuchaprofoundeffect. Itwasn’t justminimizeortrytoavoid——itwasanabsolute.Nogluten,nohiddendairy,nothingbakedin,melted,sprinkled,etc.Itmakesperfectsensenow.Stopannoyingthe intestinesandtheywillstopannoyingme.WhileIhadalwayseatenwhatIthoughtwasa“healthy”diet, Icleaneditupevenfurthertobecomemoreplant-centered.

Since that first meeting, I have been careful to stick with theabsolutes, andmy system is functioning amazingly well. Nomorecramps,nomorerunstothenearestbathroom,and,bestofall,myenergy level is throughtheroof. I find iteasy tostickwith theplansinceIfeelsomuchbetterasaresult.Idonotmissgreasycheese,icecream,or theaftermathof indulging.Notworth itatall.Feelinggoodisanamazingmotivator.

GM:Sothesehavebeenexamplesofpeoplewholookbetterandfeelbetterand

get their livesback.Anotherbraggingpointyoumake for thediet is clarityofmind…

PP:Okay,I’vegotastoryonthesubject.I lovethisstory.Theman’snameisBarrySmall,andI’vebeenfriendswithhiswife,Elisabeth,fortwenty-twoyears.ImetBarrybecauseoneofmybestfriendsmarriedhim.IwasattheirweddingandI’mafrequentguestattheirhouse.Soovertheyears,theirdiethaschangedsomeasaresultofmyinfluence;theyneverwereMcDonald’s-eatingpeopleoranythinglikethat,buttheyalsoneverateoptimally;Ithinktheyalwayslookedatme as an extremist.They took themoremoderate road tohealth andwereable to do pretty well. They never were very sick or obese or anything. Theyneverconsultedwithmemuchabouthealthissues.WhenIwasintheirhouse,wealwaysatethelow-fatveganfood,butIknewfromwhatwasinthefreezerthattheyweren’treallyonourdiet.Andthesepeople,bytheway,adoptedaboyandagirlfromRussia.Barrybecameaparentagainattheageofsixty,whichisakeenmotivationtostayhealthy.

OnedayIgotacallfromBarryandElisabeth;they’rereallyworried.Barry’sconcernwasthatacoupleoftimeshewasonaconferencecallforworkandhismindwent blank.He said, “I completely skipped out and I couldn’t even getwordsoutofmymouth. It tookacoupleminutes forme tocomeback to thepresent and I’m very concerned because I felt like an idiot.” It also happenedoncewhenhewastalkinginfrontofagroup.Hetoldmehehadbeengoingtothe Cleveland Clinic; Barry has good insurance and boy, will these high-endhospitals use it up. He explained that he’s got high cholesterol and bloodpressure,soimmediatelyit’sclearthisisacardiovascularissue.Heovernightsmehisfiles;theyweresoextensivethattheyhadtocomeinabox.IsatdownonenightandIreadthroughthepatientfiles; itwastestaftertestandimageafterimage.Theyspent$10,000to$20,000onallthisimagingandtestinganditallsaid the same thing: he hadhigh cholesterol andhigh blood pressure, he hadgainedweight over the years, andhehad cardiovascular disease that hadbeenprogressingfordecades.

IgotBarryandElisabethonthephoneandtoldthemwhatIthought.Isaid,“What’swrongwithyouisverysimple:youhavehighcholesterolandhighbloodpressure—it’s a marker for coronary artery disease. You’re having impairedoxygenationtothebrain.Thesemomentswhenyoucheckoutandittakesyoutwominutestocomeback,Ithinkit’sallvascular.”

Wewentthroughthelow-fatvegandiet,andhelistenedhardbecausehewas

scared.Hesaid,“I’vegotkids,I’vegottogetmyselfsquaredaway.”Fearcanbeareallygoodmotivator.Hesaid,“IpromiseIwilldoeverythingstartingwiththenextmorselIputintomymouth.You’llgetmycompletecooperation;I’mgoingtodothisthing.”Itdidn’ttakeverylong.Hewentbacktohisdoctorafteraboutthreemonths.Hehadlosttwenty-fivepounds.Hesaidhehadtogooutandbuyallnewclothes.Allofthosethoughtandspeechsymptomshewashavingtotallydisappeared.Withinthreemonths,hewentbacktothedoctorattheClevelandClinic andwent off all his blood pressure and cholesterol-loweringmeds.Hischolesterol dropped like a rock and his blood pressure was healthfully low tonormal. The doctor did the brachial artery tourniquet test on him and toldBarry,“Ithinkthere’samistake.Lasttimeyouwereinhereyouhadadvancingcoronary artery disease andnow,myGod, it’s like youhave the arteries of aneighteen-year-old.”Andso theydid the testagainand itwasexactly the sameresult.Barrycompletelyreversedhiscoronaryarterydisease.

Andhetellsmethateverytimepeopleseehimnow,theysay,“OhmyGod,whatdid youdo?Whathappened to you?You look fabulous!”AndElisabethwasnever reallyoverweight,butbecause the familyconvertedto thediet, she’salsodroppedafewpounds.TheylooklikeaHollywoodcouplenow.They’rejustinphenomenalshapeand,ofcourse,they’vegotkidsinhighschoolandwanttostayyoungandhealthyandseetheirkidsgraduatefromhighschoolandcollegeandgetmarriedandallofthatgoodstuff.Infact,they’rethinkingofadoptingsomemorechildrennowbecausethey’refeelingsogreat.Andhischolesterolissolowthathegetstheusualresponsefromthepeopleinthemedicalfield,“Ohmygosh,Barry, that cholesterol is so low it’sprobablydangerous.”He laughs.HereadRipEsselstyn’sbookandhe trustsme.Sohe laughs.Hesays, “Yeah,yeah,fourmonthsagomycholesterolwashighlikeyouthinkitoughttobe.Iwas a candidate for bypass surgery.Nowyou’re tellingme youwantme to gobackthere?”

GM:Hesoundslikeagoodcaseofsomeonewho’sseentoomanydoctors.

PP:Yeah.WhileIdon’tdiscouragepeoplefromseeingdoctors,manyjustneedtobe taught thediet.WhatBarryneededwasnotmoredoctors;heneededtogetthesalmonandtheoliveoiloutofthehouseandtostopfoolinghimself.Hejustneededtostopallthatstuff;it’samazinghowfastpeoplegetbetteriftheydo.Oneof the reasonswhy that’s a favorite story is because everybody in ourfieldwantstohelpthepeopleclosetothem,butitcanbeveryfrustratingwhen

peoplewhoarecompletestrangerslistentoyouandheal,whilethepeoplewhoareclosesttoyouarehardertoreach.You’dliketosaysomething,butyoudon’twant to lecture themevery timeyousee them.I love thesepeople. I’veknownElisabethfortwenty-somethingyearsandI’veknownBarryforhalfthattime;itwouldbedevastating tome if somethinghappened to eitherof them.So, youknow, these are close, close friends.Nowhe’s better, and thatmakesme veryhappy.Butsometimesyouhavetowaituntilthetimeisright.

BARRYSMALLINHISOWNWORDS......................

Iamsixty-threeyearsold.Ihavehadhighcholesterol,hypertension,andweight problems for several years and they had been gettingworse. InAugust2010,my totalcholesterolwas264,myLDLwas186,andmytriglycerideswere147.Iwasbeingmedicatedfortheseconditions,butmyhealthwascontinuingtodeteriorate.

InSeptember2010,IwastoldthatIwasgettingclosetoneedingbypasssurgery.ThiswasnotsomethingIwaswillingtodo;Ihaveagreatwifeand twogreat kidswhoneed their dad.Myhealth riskshadtobeaddressed,soIdecidedtolookintootheroptions.

Mywife,Elisabeth,andIhaveknownDr.PamPopperformanyyears; Pam’s a close family friend. She had influenced our eatinghabitsovertheyears.Wetalkedoftenabouthowpowerfuldietcouldbeinpreventingandtreatingdisease.Butwehadneverreallymadethe great leap to being vegan or near-vegan. Now, though, facedwiththeprospectofworseninghealthandasurgeryIdidnotwanttohave,Idecidedtotalktoheraboutmyhealth.

I senthermyblood testsandothermedical informationandonDecember2,2010,shecalledmetogiveherrecommendations.I’llneverforgetwhatPamsaidtome:“Areyoureadytodowhatittakestogetbetter?”Irespectedheropinion,sowhenshesaid,“Neverletanother bite of animal food, processed food, or oil pass your lipsagain,”thatwaswhenIimmediatelybecameanoil-freevegan.

Onlyninetydayslater,Iwenttomyfamilyphysiciantogetalipidprofile blood test. A few days later, he calledme to come in and

review the results. In his office, the first thing he said was,“Hippocrateswasright!Foodisyourmedicine.”Mycholesterolwentfrom 197 (onmedication) to 157. He also did an arterial elasticitytest,anditshowedthatIonceagainhadflexiblearteries.Hesaiditwascompletelydifferentfrommytestafewmonthsearlier.

The weight loss was also impressive. After ninety days, I hadtrimmeddownfromasize38-inchwaisttoa33-inchwaist.Iamnowthe weight I was in college forty-five years ago. I now take nomedications, and people constantly tell me I look twenty yearsyoungerthanIusedto.

ItwasamazingtomethataproblemthatIhadbeendealingwithfortwentyyearsvanishedinonlyninetydaysonaplant-baseddiet.

PP:ImetPattyYeagerinLasVegasafewyearsago;whenwefirstmet,shewasvery overweight. After my visit, she became a Wellness Forum member andlearnedoureatingplan.IwasinLasVegasthefollowingyearforaForksOverKnivesscreening,andPattywasthere.Shehadlostsomuchweightandchangedso much I walked right by her and did not recognize her. Patty was alwaysattractive, even when she was overweight, but when she lost the weight, shebecamedrop-deadgorgeous.

PATTYYEAGERINHEROWNWORDS......................

ItooktheWellness101classaboutayearandahalfago,andmyeating habits started changing as soon as I started taking theclasses.Oneof thefirst thingsIdidwastogetridofallprocessedfoods in my pantry. I had already stopped eating most meat, butafteronlytwoweeks,Idecidedtoeliminatefish,too.ThelastthingIgave up was dairy. I was a frozen yogurt addict, but was reallysurprised when I decided to treat myself to it a few months aftergivingitup—ittastedawful!Itwasthesameforsomanythingsthatwereapartofmy regulardiet, likesodapop, cheese, yogurt, and

otherfoods.Ihadheardoverandoverthatyourtastebudschange,but I really didn’t believe it until it happened tome. I am now soattuned tomy body that when I have that occasional treat, like acandy bar, I can immediately feel my body turning into a sugar-cravingmachineforthenextfewdays.Infact,IusedtofeelthatwayALL the time and I’m so glad I no longer live feeling that way!Usually after the sugar craving, a feeling of sluggishness wouldfollow,andIfoundmyselfnotwantingtodomuchofanything.IamSOhappynottobeinthatcycleanymore!

ProbablythemostsurprisingthingIlearnedintheWellness101classwas that Icouldeatasignificantly largerquantityof the rightfoodsandstillloseweight.BylearningtheRIGHTthingstoeat,youneverreallyoverindulgeandyoufeelsatisfied.Infact,IfeellikeIeatallthetimeandI’veneverlookedbetterorfelthealthier.

Iwas fortunate that I didnothaveanypending “medical healthproblems”andthatIwasdoingthisforpreventionpurposesformykidsand formyself, but Iwasconcernedaboutextraweight I hadputon.Idefinitelyhavelostweight,Iamnevertired,andIfeelgoodall thetime.It is interestingthatwhenyoufeelthisway,younoticeeven more how many people around you are always tired,complaining, have a negative attitude, and are always running totheirdoctortohaveprescriptionsfilledforeverylittleacheandpain.IKNOWthatachangeinnutritionwouldturnALLofthataround.Mymindfeelsclearerandmybodyfeelshealthy.IamneversickandIamneverever tired. Iwanteveryonetofeel thewayIdo,which iswhyIamheadeddownthepathtosharethislifestylewithasmanypeopleasIcan!IfeelveryblessedtohavelearnedthisinformationbeforeIwas in thesickcaresystemandI feeldoublyblessedthatmychildrenwilllivetheirwholeliveswiththesehealthyhabits!

When I was asked what is my favorite dish or food, I candefinitely say it’s a tie between my morning smoothies and a bigbrown rice bowl, both of which are amazing and SO filling! Did Imention——I’mneverhungry!

Beingasinglemomwithfourchildren,IdomakeanefforttogetatleastsevenhoursofsleepandIworkoutatleastfivetosixtimesaweek.Ihike,bike,run(wellmorelikeaslowjog,butatleastItry),attendyogaclasses,andliftweights.Thebetteryoustarttofeel,the

MOREyouwanttodophysicalactivityandyouactuallyseeandfeelthedifferenceinyourmindandbodywhenyoudon’tgettheworkoutin.

Whenaskedhowmy family and friends have responded tomynew habits, I can honestly say, “Some have and some have not.”Sometimes,asweknow,thepeoplewhoneedthehelpthemostarethemostresistant. Ihave learnedthatstrong-armingsomeone intothislifestyle,iftheyarenotreadytoheartheinformation,willneverwork.Ihavechoseninsteadtolivebyexample.I thinkpeoplewhomeetmeandfeeltheenergyandhappinessthatIexude——largelybecauseofthisplant-stronglifestyle——willgetpeoplewhowantachangetoaskforthehelpandgeteducatedandmakethechange.IknowforsurethatifICANDOIT,anyonecan!

Finally,whenIwasaskedwhatadvicedoIhaveforotherpeoplewhoareconsideringbecomingWellnessForummembers,Icansaywithouthesitation there is nothing to lose.Get theeducation, thendecide,makesmallchanges,makebigchanges,DOsomething. Ifyoucontinuetodowhatyouhavealwaysdoneyouwillcontinuetogetthesameresults.WhynottrysomethingthatWORKS?

Iamvery fortunate tohavecome in contactwithTheWellnessForum and Dr. Popper. Everyone should take advantage of theopportunity and make a life-altering decision to not only “look”healthybutBEhealthy!

PP:Martin (hisnamehasbeenchanged) is a restaurantmanager inhis fiftieswho lives in California. He has hepatitis C and was advised to undertakeinterferontherapybecausehisviralloadwasvery,veryhighandescalating.Hisliverenzymeswereup.IfyoulookatthetrackrecordforinterferontherapyforhepatitisC, it’s effective about40percentof the time, and the sideeffects arehorrible.Soyou’vegot a60percent failure rate andyou’re stuckwith the sideeffects.Martindecidedthathedidn’twanttodoitandcalledme.

We put him on a low-fat vegan diet, to which he has been faithfullycompliant.Martin’s reallygoodabout it.Longstory short, evenhis traditionaldocs leave him alone now because nothing’s changed; his disease hasn’tprogressedatall.Thisisaninstructivestorynotonlybecausethedietworkedso

well but also because it reminds you that the disease can kill you only if itprogresses.Evenifyourenzymesarestillelevatedandyourviral loadisa littlehigh, it’s not going anywhere; you’ll probably live to ninety-five and die ofsomethingelse.Martinwillnotdiefromliverfailure.

GM:Ididn’tknowthathepatitisCisn’tasmuchofathreatifyou’reonthisdietbecause—PP:Becauseitdoesn’tprogress.Amajorprobleminthehealthcarebusiness is the tendency to want to get rid of disease at almost any cost.Sometimesintheprocessofgettingridofitwekillthepatient;thisisoftenthecasewithcancer.Manytimesit’sbettertojustkeepthediseaseatbaybecauseifitdoesn’tprogress,itcan’tkillyou.

GM:Andthat’salessonthatmanyarelearningwithprostatecancer.

PP:Yeah. I’ve seen a lot of peoplewho are not cured, but they’re not dying,either. Martin’s a good example of that. His HCV RNA, a measure of hishepatitisviralload,actuallydeclinedbetween2006and2011,from6.74to6.21,respectively.HisALT (alanine transaminase), a liver enzymewhose increasedlevelsmirror worsening disease, similarly declined from 87 to 75 in the sameperiod. As aggressive as his hepatitis was, he could have been either oninterferontherapyordeadbynow,andhe’sneitherofthosethings.Thefailureratefortheusualdrugtreatmentisquitehigh,around60percent,andthereareserious side effects; there are good reasons to avoid this treatment. Instead offighting that losing battle, he’s out surfing and living life—and loving it.Hisdoctorsusedtonaghimtotrynewmedications,buthestuckwiththeprogram.Sinceit’snowclearthattheconditionisnotworsening,hisdoctorshavelearnedtoleavehimalone.

MARTININHISOWNWORDS......................

IcontractedhepatitisCmanyyearsagofromintravenousdruguse.Ihavebeencleanformanyyears,but,ofcourse,Iamstillconcernedabout this illness.My traditional doctors recommended a one-yeartreatment program with interferon, but I was reluctant to do this

becauseof thesideeffectsand the fact that the treatment isoftennotveryeffective.

Idecidedtolookforalternativesand,shortlyafter,ImetDr.PamPopper at a health conference. After listening to her speak, I wasconvinced that diet was a big influence on health and decided toconsultwithher.Afterdoingso,Iadoptedtheplant-baseddietsherecommended with a few additional suggestions to address thehepatitis C. The results have been amazing. The hepatitis C hasbeen arrested (my viral load decreased and then has remainedconstanteversince),mycholesterolwentfrom182to151,andmyhomocysteine was lowered to 8. At the age of sixty-five, I amhealthierthanIwasattwenty-five.IalsofollowedDr.Pam’sadviceabout exercise——I do aerobic exercise, lift weights, and practiceyogaforflexibility.

I’mgladIdidnotsubjectmyselftodrugtreatment——theresultsfromthedietaremuchbetter,andtherewerenorisksinvolved.

PP:EllenSeigelisaninterestingstory.TherearetworeasonsIwantedtotalkabouther.Thefirstisthat,unlikemostmembersofTheWellnessForumwhojoinbecausetheyhavehealthissues,Ellenreallyhadnodiseasesorconditions.Shedidwanttolosesomeweight,butmainlyshejustdecidedshewantedtostayhealthy.Herstoryisalsointerestingbecauseherhusband,bycontrast,didhavesomehealthissuesandheinitiallychosenottoadoptthediet.Ithinkthisisasituation many people face; they are ready for change, but their spouse orsignificantotherisnot,whichcanmakelifemoredifficult.

ImetEllenwhen shemoved toColumbus fromNewYork. Somemutualfriendssuggestedthatshecometomyyogastudioandgettoknowme.Shedid,webecamefriends,andasaresult,shejoinedTheWellnessForum.Sheadoptedtheplant-baseddiet,startedworkingoutwithmeatourgym,andcontinuedtocometoyoga.

Her husband, however, was not ready to change his eating habits or toexercise.

Overaperiodofaboutayear,Ellen’sphysicalappearancechangedalot—shelostalotofweightanddevelopedthatbright-eyed,energetic“I’maplanteater”lookwe’veallseen.Herhusbandcontinuedtoeatanimalfoodsandstayonhis

meds.Ellenisatherapistandhasbeenmarriedforfortyyears,sosheknewbetter

than to try to tell Gary what to do. Eventually, her patience paid off. Garystarted eatingmore plant food, he lost weight, and his cholesterol and bloodpressurewentdown;nowtheplant-baseddietisonemorethingtheyshare.

ELLENSEIGELINHEROWNWORDS......................

Ihadbeenpracticingyogaoffandonforayearorso.Whenmysonwentawaytocollege,IsearchedforstudiosinColumbussoIcouldtake a class when visiting. I discovered TheWellness Forum hotyoga; those classes are what eventually led me to meeting Dr.Popper.

Myprevioushealth/fitnessbackgroundcanbesummedupinoneword: inconsistency. I had been a vegetarian on and off for yearsand I never exercised regularly. I joinedTheWellnessForumandtook theWellness101classwith the tenderattitudeof, “I’ll let thisinformation wash through me and I’ll see what sticks.” I hadschooledmyselfon“so-called”nutritionovertheyearsandnowwasreadytotakeinnewinformation.Iwaspleasantlysurprised;Ifeltthenewideaswereregistering.Iwasmakingchangesgradually.Allofasudden,theideahitmethatIcouldn’tgoonweighing165pounds.Gradualwasnolongerenough.IretooktheWellness101classandstartedtostrictlyfollowtheprogram.IalsobegantotrainwithPam.Iparticipated inyogaregularlyand lost twenty to twenty-fivepoundswithinashorttime.Ineverinmylifefelt“athletic,”soIwasdelightedandsurprisedwhenIwasawardedwith“yogastudentofthemonth”!

I worked hard during yoga to see and embrace the benefits ofworking withmy body while relaxingmymind. It’s alwayswise tokeep your spirits up and look for ways to turn challenges you’veundertaken (changing to dietary excellence and exercise) into fun,enjoyment,andgratification.

WhileIcontinuetoremainconsistentwiththisdietaryexcellence,Istilleatalittletoomuch——italltastessogood.Iamcontinuingto

improvebothmyeatingandyogapractice.Myfamilyisamazedandimpressed with the consistency ofmy eating right and exercising.The key to this, I believe, is keeping my active connection with“everything”WellnessForum.

Myhusband,Gary,wasnotonetobeavegetarianortoexercise.Gary had three stents put in fifteen years ago and never felt theneed to drastically modify his eating or his relaxed, sedentarylifestyle.Atmyinvitation,heagreedtotaketheWellness101classwithme.Iwashappilysurprisedthatheagreed.HealsoheardPamtalkatafewof theWFdinnersandthen,afterwesawForksOverKnives, I witnessed the most amazing transformation in him. Hestartedtotakebriskwalksforanhourdaily,significantlyreducedhisconsumption of animal foods, lost fifteen pounds, and reducedhismedicationssignificantly.Heevenorderspizzawithout thecheese…andfindsitsatisfactory.I’mimpressed!

WhileGary had good reasons to change, I never thought he’deverchange.So Iworkedonmyself.Oneof the things that ticklesmethemostisGarysaying,“I’mfixingsalad.CanIcutsomeupforyou?” I haveanewclosenesswithmyhusband inanarea I leastexpected. Sharing the food preparation and dietary excellence isamazingandwonderful.

Myadvicetoanyonewhoisconsideringthistypeofchangeistotake yourself seriously and get moving on it——the sooner thebetter.Ahealthyandhappylifeawaitsyou.Iwasfortunateenoughto changemywayswhenmy only problemwas being overweight——I did not have other serious diseases. And don’t make yourplans based on others, even those close to you. In my case, myhusbandwasnotinterestedatallandeventuallyjoinedmebecausehesawthewisdominitforhimself.Sometimessomeonehastogofirst,andmaybethatsomeoneneedstobeyou.

PP:CatTimmonshasaninspiringstory.Thisonegoesbackalongtime;we’vebeen following her for a while. She joined TheWellness Forum in her earlythirtieswhenshewasbattlingleukemia.Shewasreceivingchemotherapy,whichwasmakingherworse.The leukemiawasalsogettingworse; thesituationhad

progressed to theplacewhere shehad a lot of infection inhermouth (cancerpatients often get infections because of the chemotherapy).As a result of theinfection of her mouth, her teeth were starting to break off at the root. Shecouldn’tchew.Shewasindevastatinglypoorhealthandwenttothedoctor,whotoldheritwasworsethanever.Catwenthome,gotonherkneesonthefloorofherhouse,andprayedtoGod,“I’mgoingtodieunlesssomethingelsehappensand if I’mdestined to live, please send somethingmyway because I really dowanttolive,God.Andifyou’reupthere,hearingme,sendsomething.”

She went to a networking meeting the next day and met somebody whoworksforTheWellnessForum.ShecametoTheWellnessForum,adoptedthelow-fat, plant-based diet, while continuing her chemotherapy treatments, andmaderemarkableprogress.Shehadtopureeallherfoodbecauseherteethwereso compromised that she couldn’t chew. In six weeks, the situation turnedaround enough that she wanted to stop the chemotherapy treatment. Herhusbandwas concerned and her doctors were hysterical because they believedthat chemotherapywasheronlyhope; theyattributed the success she’dhad tothechemo,notthediet.Shegotthemtoagreethatshecouldstayoffthedrugsfor aweek and seewhat happened; she promised to go back on chemo if hercondition deteriorated. But her condition continued to improve, so she neverwentbackonthechemo.

Intime,shemadeacompleterecoveryfromtheleukemia.Sheeventuallyhadimplants;nowherwholemouthisfullyrestored.Butwhenawomanundergoeschemotherapy, she undergoes early menopause. Cat was only in her thirtieswhenthishappened,andwasclearlynevergoingtohaveanychildren.Well,shestayedwiththelow-fat,plant-baseddietandeventuallythemenopausereverseditself.Shenowhasafour-year-old.Wecallthesekidswhoweren’tsupposedtobebornWellnessForumbabies;weallfeellikethey’reourown.EverytimeCatcomesintotheofficewiththiskid,he’sfawnedoverbyallourpeoplebecausehereallyisamiraclebaby.Sothat’sCat’sstory;she’sjustlivingherlifenow.Thisisallreallybehindher.SheeventestifiedinfrontofanOhiolegislativecommitteeaboutallowingnondieticians to talkaboutnutrition.Shetestified thedayaftershehadsurgery for the implantsandsaid, “Iwant to tellyousomething.TwoyearsagoIwasalmostdeadandyesterdayIunderwentall thissurgeryandyettodayIcanstandupandtellyoumystory.Soyouneedtopayattention.”

CATTIMMONSINHEROWNWORDS......................

Things were going well in my life. I had money, success, anexpanding business, family, friends, a decent home, plus time toplayandenjoylife.

Then, in 2002, I contracted a viral infection inmy sinuses. Mydoctorsbegantreatingmeforasinusinfection.Iconsumedseveralrounds of antibiotics. X-rays and CAT scans showed that theinfection was spreading throughout my facial features, specificallymyjawbones.Theinfectionwascausingdeteriorationofmyjawandteeth.Abiopsyoftheinfectedareasoonrevealedcancerouscells.

At this point, the doctors did not want to perform surgery toremovetheinfectionbecauseofthefearofexposingthecancerouscellstootherpartsofmybody.Theywantedtotrytofindamedicinethatwouldeliminate the infection.But noneworked.Soultimately,the infection mutated and spread throughout my body: a cancercalledacutelymphaticleukemia.

This diagnosis changed the treatment plan altogether. Nowmynew doctors wanted to treatme with chemotherapy. Soon after, Ibecame physically unable to keep upwithmy daily routine. I wastired,sicktomystomach,feverish,andmentallyconfused.Iwastoldthatthesesymptomswerenormalinmycondition.

IbegantolosejobsbecauseIcouldnotkeepupwiththework.Mymedicalbillsbegantopileupbecausemyinsurancewouldpayonly a portion of the actual cost. My prescription co-pays rose to$3,000 each for a four-to six-week supply ofmedicine. And I wasfeelingworseinsteadofbetter.That’swhenthedepressionbegantosetin.

Myheartwasinturmoil.Iwasagoodperson,andyetmylifewasbeingdismantledandtakenaway.EverythingIhadworkedsohardfor was being stripped from me. My life savings, my clients, mypossessions,mymentalstability,myhealth——allgone.

AbusinessassociateintroducedmetosomeonewhoworkedatTheWellnessForumwhobecamemy“wellnesscoach”and talkedtomeabouthowimportantdietwasinregainingmyhealth,andthat

Ihadtoworkonmymind,body,andspirit if Iwantedtogetwell. Imade a personal choice to begin changing my eating habits andattemptedtobeginhealingthroughnutritionandherbaltherapy.

Duringthenextseveralweeks,Iimplementedapowerfulblendofnatural plant foods into my diet. And I stuck to it. Every day, foreverymeal, I blended these foods into a smoothie. I had alreadybeen on a liquid diet for months, so this was easy for me toimplement.Sixweekstotheday,IwokeupandIactuallyfeltbetter.Ibegantofeelnewhopeandexcitement.

NowIhadtomakeadecisionwhethertocontinuechemotherapyor to stop this treatment and rely completely on food, herbs, andfaith.My familybeggedmenot tostop thedoctor’s treatmentplanbecausetheywereconcernedformyhealth.SoImadeadealwiththem——givemejustoneweek.IwilldowhatIwanttodoforoneweek.Ifmybloodtestswereworse,thenIwouldcontinuewiththechemotherapy.Ifmybloodtestswerethesameorbetter,thentheywere to leave me alone and let me continue with alternatives.Agreed.

Thedoctorsaid,withanger,thatifIweretostoptreatmentnow,Iwouldcertainlydie.Since Iwassosick, sobroke,and threedaysfrom losingmyhome,deathdidnotseem likeabadalternative tome.

One week later, my blood tests were just slightly better. Notworse, though! I receivedmy family’sblessing tocontinuemyowntreatment plan. A couple of months later, my blood tests showedgreat improvements. My infection and my cancer cells werebeginningtodissolve.

Oneyearlater,Iwasinfectionfreeandcancerfree!Notonlythatbutmyallergiesweregoingaway,myarthritiswas improving,andmanyotherailmentswerenonexistent.

But the story doesn’t end there.When Iwas a teenager, I hadmanysurgeries toeliminate cysts inmyuterusandovaries. Iwasleftwith90percentscartissue.Iwastoldthathavingchildrenwouldbe impossible. Well, with just six months of healing from my lastsurgery,IfoundoutthatIwaspregnant.Iwasinshock.WhenItoldmyhusband,therewassilence.HethensaidthatwhateverdecisionImake,hewouldsupportme. I toldmyhusband that thedecision

hasalreadybeenmade.Godwouldnotputmethroughallthisonlytoletmeandmyunbornchilddienow.So,asmydoctorsexplainedtheseriousdangersofthispregnancyandthecaseforterminatingit,myfaithjustbecamestronger.

As part of the high-risk pregnancy, we had an opportunity toevaluatemy uterus. To our amazement, the doctors could find noscartissue.TheyevenhadmyoldX-raysshowingthescar tissue.Nowtherewasnone.Aswebegantotrytoexplainthis,werealizedthatsomeherbs Iwas takinghadactuallyhealed thescarringandenhancedmyfertility.

At thirty-nine years of age, after eighteen years of marriage, Idelivered a beautiful, healthy baby boy.My son is now four yearsold.Alongwithus,heeatsallnatural,organicfoods,andhelikesit.

I am now working part-time from home and raising my son. Ialways look forward to sharing with him how to be healthy andhappy.

PP: JanetTriner isa schoolteacher inChicago.Ichose this storybecauseasateacher, she really cared about paying it forward. She had a gastrointestinaldisorder—lots ofdiarrhea, gas, discomfort, nausea, and that sort of thing.Weattract a lot of members who have GI disorders because so many have beenhelpedafteradoptingourdiet.Fortunately,Janethadnotprogressedtothepointwhereshehadhadsurgeriesorbeenhospitalized,butshewasplentymiserable.

Andsoitwasjustanicecleandeal.WhenJanetlearnedhowtoeatright,shefound that she didn’t have these problems anymore. But Janet teaches in thiselementaryschoolandfeltthatthekidsshouldhaveadifferentviewofnutritionthan theyhave. In thepastwhen she’d raise the subject,her colleagueswouldmakefunofher.Allthesame,shebegantotalkaboutnutritiontoherkidsandwaswillingtotaketheflak.Itoldherthatwhatoftenhelpsusintheschoolsissomebodywithsomestayingpowerwhokeepspressingfornutritionalchangesuntil he or she gets a chance to have some influence. So she got herselfappointedthewellnesscoordinatorforherschool.Shecalledmeandsaid,“Pam,now everybody has to listen tome.” She’smanaged to train a lot of teachers;she’steachingthemaboutplant-basednutritionandisgettingthemtotalkaboutitintheclassroom.Janethasconvertedherownsuccessstoryintoonethathas

really influenced countless kids. They’re all experiencing a different view ofnutritionnowbecauseJanetgotwellandbecamepassionate.

JANETTRINERINHEROWNWORDS......................

Iwasapersonwhowasverymuchcaught in themedicalmill thatDr.Poppertalksabout.IhadalotofGIproblemsandIhadalotofallergy problems. Doctors were always doing all kinds of tests; IwouldhaveCTscansandother tests toseewhatwasgoingon inmyabdomen.Fromabout theageof twenty, Iwashaving irritablebowelsymptoms,andtheyjustkeptgivingmemedicine.

I heard Dr. Popper speak at a conference and I was justfascinated.Soonafterthat,IwasdiagnosedwithasthmaandIwasputoninhalersandmedicineandIwashavingabdominalpain.MyOB/GYN thought it was endometriosis and she wanted to dosurgery,andanotherdoctorthoughtitwasaherniaandhecouldn’tseeitonthetestbuthewassure ifhecouldget intherehecouldfind it. I called Dr. Popper’s Wellness Forum and set up anappointment and she talked tome on the phone. I thought I waseatingahealthydiet,butshesaid,“Icanseewhyyou’resosick.”IwaseatingtonsofdairyandIwaseatingtonsofsugarbecauseI’mverythinandwasabletoeatstufflikethatandnotgainweight.Shesaid, “You have to cut out sugar. You have to cut out dairy. Youhavetocutoutgluten.”Shedescribedthediet Ihadtoeat tohealmy gut, and I changedmy diet that day. I stopped that night andthenIstartedeatingthehealingdietandtakingaprobiotic.

My asthma symptoms disappeared and then my abdominalissues eventually completely disappeared. I have not had to havemoretests; Ihavenothadtogobackonmedicine. Ihaveamuchbetter body. I am healthy, I am educated, I have been able toeducatemyfamily,andwe’veallgottenhealthierbecauseofthat.

In addition to my own health issues, I’m a teacher concernedaboutchildren.Ihadreceivedtrainingonbrainfunctionthroughmyschool district, which included only a passingmention that protein

was needed for brain function. But after taking classes from TheWellness Forum, I was convinced that children needed to eat abetter diet in order for their brains to function well. I decided toattendTheWellnessForum’sconferenceonchildren’snutritionandatthatconferenceImetsomanypeoplewhohadmadeadifferenceintheirschooldistrictandIrealizedthatIwantedtodothat,too.

Ireturnedhomeandtalkedtosomeoneinourcentralofficewhotoldme thatwe’dneed toorganizea committee to changeschoollunches. I am very shy, so I surprisedmyselfwhen I said Iwouldheadthatcommittee.Duringmytenure,wechangedschoolmeals,whichmeantchangingfoodserviceproviders.

Lunches definitely improved——kids were offered whole wheatproducts,rice,vegetables,andfruit.Thefoodserviceproviderevenagreedtodofood-tastingeventsforthekids.

We instituted a wellness class for kids and provided a trainingprogram for parents. I’ve given presentations to our teachers atteachermeetings. I, of course, use information on healthy diets inmyownclassroomandnowteacherscometomeforinformationonwhattodointheirclassrooms.

Itelleveryonewhowilllistenthatweareeducators——weteachkidshowtoread,howtowrite,andhowtodomath;weshouldbeteachingthemhowtomakegoodfoodchoices,too.

PP: Some of the work we do is in employer settings. Employers pay foremployees to take our classes in order to improve their health and lower theirinsurancecosts.Forexample,thecityofDublin,Ohio,asuburbofColumbus,isa client ofTheWellnessForum.Aswithourother employer clients,wehavehadsomeincrediblesuccesses.OneofthosepeopleisLarryNicol.LarrydecidedtotakeourWellness101classatwork,andhere’swhathappenedtohim.

LARRYNICOLINHISOWNWORDS......................

WhenIheardDr.PamPopper’stalktoouremployeesinearly2012,I thought shewas talking directly tome.My numberswere barelygoodenoughtopassthe“HealthybyChoice”criteriaatwork,so itwastimetomakeachange.AlthoughmywifeandIhadtriedotherdietswithoutmuchsuccess,wethoughtthiswasworthatry.

WhenItoldmywifeIwantedtodothis,herresponsewas,“Whatarewegoing toeat?”Meat,dairy,andoilwerestaplesofourdiet.For a while, it seemed like all we ate was beans and rice. Butgradually,welearnedthroughtheclassestomakesubstitutionsandhowtoshopforhealthieroptions.Weincreasedourconsumptionoffruit,vegetables,wholegrains,andlegumes,andwedecreasedourintake of animal foods.We now eat meat only once or twice perweekinsteadofeveryday.

We’vefoundthatplant-basedrecipesareeasytofindandwe’veactually enjoyed experimenting with new meals and foods. Thebiggestchallengeformywifewaseliminatingdairy,butwe’vebothlearnedtofocusonwhatwecanhave,insteadofwhatwecan’t.Andthereareplentyofgoodchoices.

Justeightweeks into theprogram, I feltbetter than Ihave inaverylongtimeandIwasfittingintoclothesIhadnotwornfortwentyyears. I am not taking any medications and now food is mymedicine.Iwillnevergobacktomypreviousdiet——foronething,I’mincontrolofmyfoodinsteadofanyfoodcontrollingme.AndalsoIfeelsogoodnowandIneverwanttogobacktofeelingbadagain.

Somepeoplehavetoldmetheythinkthedietisdrastic,butItellthemthateveryoneshouldlookinthemirrorandsaytothemselves,“NoonecaresasmuchaboutmeasIdo.”Ifyoudothat,thenthisprogramisworthit,andthebenefitsfaroutweightheefforts.

GM:DidtheotherparticipantsintheDublinprogramdoaswell?

PP:Yes,theydid.Thecomplianceratewasover90percentforthegroup.Afteronlyeightweeks,eight individuals reducedoreliminated theirmedications forconditions like type 2 diabetes and hypertension, and two had scheduledappointments with their docs to discuss their meds. All of the overweight

participants lostweight, and one person lostmore than twenty-seven pounds.The city scheduled more classes for employees who became interested afterseeing their peers get such incredible results. Just think if every employer inAmericaofferedthisprogram—wecouldmakeemployer-sponsoredhealthcareplansaffordablereallyquickly!

GM:What’syourbestweight-lossstory?

PP:ThatwouldbeDel,ourChefDelSroufe.Del’sstoryisstillunfolding.

GM:IsawhimonYouTube.

PP:Well,nowhe’seventhinner.He’sdownto250from475.

GM:Inhowmuchtime?

PP:Infiveyears.

GM:Howtallishe?

PP:About six-three. So at 210 or 215, he’ll be gorgeous.There are somanyaspectsofDel’sstorythatareinteresting.Let’sstartwiththefactthathewasa475-pound vegan, living proof that you can be vegan and still be profoundlyunhealthy. Being vegan doesn’tmean anything if you don’t do it right. Thenthere’sthefactthathewasanemotionaleater;hisweightproblemsstartedwhenhewas eight. It’s possible, after all, to overeat even healthy foods; he used toovereatboththerightandwrongstuffbecausehewasdistressed.Hejusthatedexercise;hewouldn’tmindmetellingyouthis,butheusedtocryatthegymandwouldcallmetheDaughterofSatanforpushinghimtoexercise.

Delhadallofthetypicalstrugglesthatobesepeoplehave.Hehadlostweightand gained it back, plateaued, gone back to emotional eating, eaten in secret,battledallofthedemonsassociatedwitheating,andthensethimselfrightagain.Butheneverwentbacktoanimalfoods.Inalltheseyearsthathe’sbeendealingwithhisweight,heneverpickedupapieceofcheeseandheneverhadachickenwing.Hetendedtoovereatpretzelsandbeerandpotatochips.

GM:Sosincehe’sbeenonyourprogram,hashehadtheserelapses?

PP:Oh,yeah.It’sneverastraight line tosuccess. I thinkDel typifiesa lotofpeoplewhostrugglewithfoodbecausetheirreasonsforeatingaredifferentthanyoursandmine.Imean,IlovefoodandIlovetoeat,butifI’mnothungry,I’mnotgoingtogogorgeonsomething.Andifyoumakemeangry,I’mmorelikelyto skip lunch than eat two lunches. Del, on the other hand, has alwaysanesthetizedhimselfwithfood;he’shadtolearnnewbehaviorstonotdoit.Andhe’salsohadtolearntoprioritizebecausewhenyoudon’tliketoexercise,it’sthefirstthingthatgoeswhenyou’rebusy.Allyourbesthabitsgooutthewindow.Inthelastyear,he’sgottentotheplacewherehedisciplineshimselfallthemoretostaywiththerightbehaviorsthebusierheis.

I’ve told Del that an alcoholic always has to get up every morning andremember how to avoid alcohol, but you can’t do that with food. Thatcomplicatesthematter.Analcoholicisonedrinkawayfromdisaster,andadrugaddictisonepillawayfromdisaster,butyoucan’tsaythatafoodaddictisonecalorieawayfromdisaster.Soeverydayyou’vegottogetupandrememberyourstrategies for not abusing food and not anesthetizing yourself with food. Youalwayshave tobemindfulbecause that’s the firstplace thedemons insideyouwanttogo.Forananorexic,thefirstplacetheywanttogoisstarvation.Forafood addict, the first place theywant to go is overeating; that’s how theydealwithlife,soeverydayyou’vegottobemindful.He’sfinallygottentotheplacewhereit’snotsuchastruggle.Itwillalwaysbemoreofastruggleforhimthanforme,butit’snotgoingtobelikeitusedtobe.Sohe’sovercome,andIhavealotofrespectforhim.Plus,asachef,heworkswithfoodandhasitinfrontofhimalldaylong.

GM:HasDelhadotherproblemswithhishealththathavegoneawaysincehe’slostweight?

PP:Yeah,hehadgastroparesis.Delwasapersonwhocouldeatbreakfastatfiveinthemorninganditwouldstillbemakinghimsickateightinthemorning—hemighteventhrowitup.Thatcompletelywentaway.

GM:Anddoeshestillhateexercise?

PP:Not asmuch.Hebitches andmoans about it, buthebasically enjoys thegym.Helikesbeingfitandhelikesthewayitmakeshimfeel.Henownoticesthat you feelbetterwhenyoudo it thanwhenyoudon’t.And sometimes you

dread it themostwhen youneed it themost. I’ve draggedmy butt into yogasometimeswhen I think I’m going to die, but that’swhen I need to gomorethanever.

GM:I’mstilltryingtopicturethescenewhenthisguycomesinat475poundsandyoudecidetomakehimapartnerinWellnessForumFoods.

PP:Withtwocaveats.Thetworuleswhenhejoineduswere:One,hehadtolosetheweight.Two,hehadtotaketheoilsoutofthefood.

GM:Andhisresponse?

PP:Heagreed,buthesaid,“Pammy,I’lldoalotofthingsbutI’mnotgivinguptaste.”Isaid,“Well,youdon’thavetogiveupthetaste;justfigureouthowtodoitwithoutthefat.”Andhisfoodisamazing.Thisguyisamazing.

Now,Delalreadyhadabusiness.Hehadalargeclienteleofpeopleforwhomhewasmakingfoodonaregularbasis.

GM:Ameal-deliveryservice?

PP:Right.We bought the delivery service andmovedDel into the building.And he was nervous about one thing. He said, “Well, Pammy, what are wegoing to tell all thesepeople I’vebeencooking forall theseyearswhen theoilcomesoutofthefood?”Isaid,“Well,howaboutthis:Whydon’twejustnotsayanything?And then if someone complains,we’ll explain thehealthbenefits ofeating without oil.” This was back in 2005. And not one person ever saidanything about the missing oil. Well, actually no, I shouldn’t say that. Oneperson said, “Hey,Del, since you got hooked up withWellness Forum, yourfood isn’t as greasy anymore!” The other three hundred people never noticedanythingatall;they’venevercommentedaboutit.

GM:Sohekeptthesameclientsandtheydidn’tevennoticethechanges?

PP:Exactly.Sothere’sanotherreasontogettheoiloutofthediet:notonlyisithigh in fat and calories and contributory to cardiovascular disease but it’s alsocompletelyunnecessary;thereisabsolutelynoreasontoincludeit.We’venevershown somebody how tomake food without oil who threemonths later was

saying, “Gosh, I reallymiss theoil. Ifonly I couldhave someoilonmypastadish,lifewouldbefine.”Noneofthemsaythat;theyjustdon’tcareaboutit.Ifyoudon’tmiss itwhenit’sgone, if itdoesn’tchangehowfabulousthefoodis,and if it’s detrimental to your health, thenwhy include it?Del has become amasteratshowingpeoplehowtocookwithoutaddedfat.

DELSROUFEINHISOWNWORDS......................

Myweightproblemsstartedasachild. I rememberbeingputonadiet of only eight hundred calories per daywhen I was only eightyearsold.Ioverateandmymotherdealtwiththatbyhelpingmetocontrolportionsize.Itdidn’twork;myweightproblemscarriedoverintoadulthood.

Severalyearsago, Istartedmyownbusiness,aveganbakery,andconvertedtoveganeatingatthattime.Ihadpreviouslyworkedina“healthfood”restaurant,whichIlaterlearnedwasnotsohealthyafter all. That is wheremy consumption of vegan junk food reallybegan.

Believeitornot,Igainedonehundredpoundswithinoneyearofstartingmybakery,andtheweightgaincontinueduntil Ipeakedat475pounds.Youmightbewonderinghowanindividualconsumingavegandietcouldaccomplishthis.Here’showIdidit.

Every day I started my day with two fresh scones and coffee.Then,Iproceededtoeatacashewbarandmuffinforlunch,orcake,orwhateverwashandy——Iwasworkingveryhardand rarelysatdowntoeatafullmeal. Icontinuedtomunchonsugaryfoodsanddrink caffeine-filled beverages throughout the day and for “realmeals,”Iwouldeatvegetarianfoodspreparedwithlotsofoilandfat.In the evenings, to relax, I’d eat potato chips and drink beer. Allvegan,butcertainlynothealthy.

Inthesummerof2005,Ireachedmywit’send.Iwasexhausted.Mybodyached,mykneesached.Ifellandmyinjuredanklewouldnotheal.Ineededhelp.

I went to my good friend Dr. Pam Popper and told her I was

readytochangemylife!Iimmediatelyconvertedtoawell-structuredplant-baseddiet;insteadofsconesandcoffeeforbreakfast,Istartedhaving fruit smoothies and whole-grain cereal. I replaced myconstant snacking with meals comprised of beans, whole grains,potatoes,andsalads.Andtheweightstartedcomingoffrightaway.

Ilostfiftypoundsinthefirstsixmonthsandhitaplateau,atwhichtimeDr.PamtoldmeIhadtostartmoving.Istartedwalking,sincethat was the least painful thing I could do. The weight starteddroppingagain.

Atseventy-fivepounds,Ihitanotherplateau,andtheadvicewastostepuptheexercise.This iswhenIstartedworkingoutwithDr.PamandtakingWellnessForumhotyogaclasses.Andthatiswhenthe weight started dropping like crazy. People started tellingme Ilookeddifferentalmostfromdaytoday.Imustconfessthatsteppinguptheexerciseprogramwasthemostmiserable thingIhaveeverdoneinmylife.IusedtohissatDr.Paminthegym,andlayonmyyogamatpraying fordeath.Fortunately, thisdidnot last long,andalthough Ihated toadmit it, I started toenjoygetting intoshape. Iactuallymissedworkingoutwhenmyschedulecausedmetomissaday.

Istillhaveanotherthirtypoundstolose,butit’sgettingeasierandeasiereveryday.Idon’tevenhavetothinkaboutthingsmostdays.Ijust eat the way I’ve formed the habit of eating, do the requiredexercise,andtheweightcomesoff.

Here’sthebestpart——I’mworkingharderthanI’veeverworkedinmylifeandI’mlesstiredasaresultofdoingit.Myankleisfinallyhealing.I’mwearingclothesthatIhaven’twornforyears.Ifeelgreataboutmyself. Imayeven runamarathonwithDr.Pamnow that Ihaveallofthisenergy.

So, letmeemphasizea coupleof things.First, conversion toavegan diet does not, in and of itself, lead to health. You have toconverttoawell-structuredvegandiet.Ihavequitsabotagingmyself——the wrong foods are like drugs for me——and when I thinkabout not eating healthfully, I remembermy goals and I don’t eatthem.Iamlearningtomakeself-careapriority;nomatterhowbusyIam,Imaketimetoeatgoodfoodandtoexercise.AndItrytobearoundlike-mindedpeoplewhoreinforcemygoodhabits.

IhavenodesiretoreturntothewayIusedtobe.

PAM’S NOTE: Del will never return to the way he used to bebecausehenowunderstandsandfollowsthedietaryprinciplesthatwill preventa slideback intoobesity.Meanwhile, his recipeshavehelpedthousandsofothersenjoymealscreatedaccordingtothosesameguidelines,especiallynowthroughhisbestsellingForksOverKnives——TheCookbookandhis forthcomingBetter ThanVegan.The insert section in this book contains a never-before-publishedsamplingofsomeofDel’sfavoriterecipesthatweusehereatTheWellnessForum,andthateveryoneloves.

HummusSERVES8

4cupscookedgarbanzobeans,warmed

3clovesgarlic

¼cuplemonjuice

2teaspoonscuminpowder

Seasalttotaste

Combineall ingredients inablenderandpureeuntilsmooth.Addwaterasneededtomakeasmoothpaste.Servewithpitabread,crackers,orfreshvegetables.

MisoAlmondSpreadSERVES6

1poundextra-firmtofu

6tablespoonstoastedalmondbutter

3tablespoonsmellowwhitemiso

3clovesgarlic,minced

2tablespoonsfreshdill

½mediumredonion,minced

Place tofu,almondbutter,miso,andgarlic intoa foodprocessor.Blenduntilsmoothandcreamy.Removethetofumixturetoamixingbowlandaddtheremainingingredients.Stirtocombine.

Del’sBigGreenSaladSERVES4

8ouncesmixedgreens

1cupgarbanzobeans

1cupredcabbage,grated

½cupraisins

½cupsunflowerseeds,toasted

1carrot,grated

SweetandSpicyMustardDressing,recipefollows

Divide the mixed greens between four dinner plates. Arrange theremaining ingredients on top of the greens and serve with Sweet andSpicyMustardDressingontheside.

SweetandSpicyMustardDressingMAKES2½CUPS

1packagesilkentofu

½cuppreparedmustard

½cupmaplesyrup

2tablespoonlemonjuice

½teaspoonseasalt

¼teaspooncayennepepper

Combineall ingredientsinafoodprocessorandpureeuntilsmoothandcreamy.

PotatoLeekSoupSERVES6

3largeleeks(about1pound),thinlysliced

6cupsvegetablestock

4or5mediumrussetpotatoes(1pound),peeledandchopped

¼cupparsley,minced

¼cupchives,minced

Seasaltandwhitepeppertotaste

Sauté the leeks over medium heat in a large stockpot, stirringoccasionally, until the leeks have begun to soften and brown slightly,about eight minutes. Add water one to two tablespoons at a time, asneeded,topreventtheleeksfromsticking.

Addthevegetablestockandpotatoesandbringtoaboiloverhighheat.Reduce the heat to medium-low and simmer until the vegetables aretender,about35minutes.

Blend the soup until smooth using either an immersion blender or bycarefullytransferringthesouptoablenderinbatches.

Return the soup to the pot and add the parsley and chives. Cook fivemoreminutesandseasonwithsaltandpepper.Serveimmediately.

TomatoVegetableSoupSERVES8TO10

2largeyellowonions,diced½inch

3largecarrots,diced½inch

3stalkscelery,diced½inch

6clovesgarlic,minced

1tablespoonfreshthyme,minced

2bayleaves

4cupstomatoes,diced

1½cupscorn

1½cupsfrozengreenbeans

1½cupsfrozenpeas

6cupsvegetablestock

1cupbasil,finelychopped

Seasaltandblackpeppertotaste

Sauté the onions, carrots, and celery until the onions are translucent,about seven to eight minutes. Add the garlic, thyme, and bay leaves;cook anotherminute. Add the tomatoes, corn, green beans, peas, andvegetablestock.Cook,covered,overmediumheatfor20to25minutes.Add the basil, season with salt and pepper, and cook another fiveminutes.

BlackBeanChiliSERVES6TO8

2mediumyellowonions,diced

2tablespoonsgarlic,minced

1½tablespoonscumin

½tablespoondriedsage

1tablespoonchilipowder

2teaspoonsoregano

2greenpeppers,diced

4cupscookedblackbeans

4cupstomatoes,diced

3cupsvegetablebroth

Seasaltandblackpeppertotaste

Sautétheonionsinalargestockpotforeightminutesovermediumheat.Add water one to two tablespoons at a time to keep the onions fromsticking. Add the garlic, cumin, dried sage, chili powder, and oregano;cookoneminute.

Add the remaining ingredients and cook, covered, for 20minutes overmediumheat.Seasonwithsaltandpepper;cookanotherfiveminutes.

MilletLoafSERVES4

3½cupswater

1¾cupsmillet

2largeleeks,dicedsmallandrinsed

3celerystalks,dicedsmall

3clovesgarlic,minced

¼cupfreshbasil,minced

2teaspoonsfreshthymeleaves,minced

1cuptomatosauce,divided

Bringthewatertoaboilinamediumsaucepan.Addthemilletandcookcoveredfor20minutes.

Preheattheovento350degrees.

Preheat a large skillet overmedium heat and add the leek and celery.Sauté for eight or nine minutes, or until the leeks start to brown. Addwater one to two tablespoons at a time, as needed, to keep thevegetablesfromsticking.

Add the garlic, basil, and thyme; cook anotherminute. Add half of thetomatosauceandthecookedmillet.Mixwellandspoonthemixtureintoanonstickloafpan.Topwiththeremainingtomatosauceandbakefor35to40minutes.

Removefromtheovenandletsitfor15minutesbeforeslicing.

NorthAfricanChickpeasSERVES4

1mediumyellowonion,diced

1greenbellpepper,diced

3garliccloves,minced

2teaspoonscumin

½teaspoonturmeric

2cupstomatoes,diced

3cupscookedchickpeas

1cupvegetablebroth

1pinchsaffronsteepedinhotwaterfor15minutes

Seasalttotaste

½cupcilantro,chopped

Sautétheonionandgreenbellpepperinalargeskilletovermediumheatforseventoeightminutes.Addwateronetotwotablespoonsatatimeto

keep the vegetables fromsticking.Add thegarlic, cumin, and turmeric.Cookanotherminute.Addthetomatoes,chickpeas,vegetablebroth,andsaffron, and cook 10 to 12minutes.Seasonwith sea salt to taste andcookanotherfiveminutes.

Servegarnishedwiththechoppedcilantro.

SpringVegetableStirFrySERVES2TO3

1smallyellowonion,thinlysliced

1carrot,cutintomatchsticks

½bunchasparagus,trimmedandcutinto1-inchpieces

1cupsugarsnappeas,trimmedandcutinhalf

1tablespoonfreshginger,peeledandminced

3clovesgarlic,chopped

¼cuptoastedalmonds,coarselychopped

2tablespoonshoisinsauce

¼cupcilantro,chopped

¼cupchives,chopped

Seasalttotaste

Heatalargeskilletoverhighheat.Addtheonionandcarrot;stirfrythreeminutes. Add water one to two tablespoons at a time to keep thevegetablesfromsticking.Addtheasparagusandsugarsnappeas;cooktwo minutes. Add the remaining ingredients and cook three minuteslonger.

QuinoaPilafSERVES4

1mediumyellowonion,diced

2stalkscelery,diced

1mediumgreenbellpepper,diced

2clovesgarlic,minced

1teaspoonfreshsage,minced

1teaspoonfreshthyme,minced

One28-ouncecandicedtomatoes

1cupvegetablebroth

1cupquinoa,rinsedanddrained

Seasaltandblackpeppertotaste

Sauté theonion, celery, andgreenbell pepper ina largesaucepan forfiveminutes.Addwaterone to two tablespoonsata time tokeep them

fromsticking.Addthegarlic,sage,andthyme;cookanotherminute.Addthetomatoes,vegetablebroth,andquinoa;bringtoaboiloverhighheat.Cover thepan, reduce theheat tomedium,andcook thepilafuntil thequinoa is tender, about 15 to 20 minutes. Season with salt and blackpepper.

LentilCakesSERVES6

3½cupsvegetablestock

1½cupsgreenlentils

2mediumleeks,dicedsmallandcleaned

Combinethevegetablestockandlentilsinamediumstockpotandbringtoaboiloverhighheat.Coverthepot,reducetheheattomedium,andcookthelentilsuntiltender,about45to50minutes.

1largecarrot,dicedsmall

2celerystalks,dicedsmall

2teaspoonsfreshthyme,minced

2clovesgarlic,minced

Seasaltandblackpepper

1tablespoonarrowrootpowder

2cupswholegrainbreadcrumbs,divided

Whilethelentilsarecooking,sautétheleeks,carrot,andceleryinalargesaucepanovermediumheat for8 to10minutes.Addwaterone to twotablespoons at a time to keep the vegetables from sticking. Add thethyme and garlic; cook another minute. Set aside until the lentils arefinishedcooking.

Whenthelentilsaretender,drainanyexcessliquidfromthepanandletthelentilscooltoroomtemperature.Mashthelentilsjustenoughsothatsome of the texture remains in them. Add them to a bowl with thevegetablemixture,arrowrootpowder,onecupofthebreadcrumbs,andsaltandblackpeppertotaste.Mixwell.

Divide the lentilmixture into 12 parts and shape each part into a half-inch-thick cake.Dredge each cake in the remaining bread crumbs andplaceeachonanonstickbakingsheet.Bake thecakes for20minutes,

turnthemover,andbakeanother20minutes,oruntilbrowned.

PierogiesSERVES4

Dough

2cupssemolinaflour

1teaspoonsalt

¾to1cupcoldwater

Filling

2mediumrussetpotatoes,scrubbed,peeled,anddiced

1teaspoongranulatedonion

Seasalttotaste

CaramelizedOnions

2largeyellowonions,dicedsmall

HorseradishSauce

1packagesilkentofu

1tablespoon,moreorlesstotaste,preparedhorseradish

Seasalttotaste

Combine the flourandsalt inamediummixingbowl.Add three-fourthscupwaterandmixitintotheflour.Kneadthedough.Ifitisdry,addmorewater—youshouldhaveafirmbutpliabledough.Continuekneadingforfiveminutes.Shape thedough intoaballandwrap inplasticwrap.Set

thedoughasidewhileyoumakethefilling.

Addthepotatoestoamediumsaucepanandcoverwithcoldwater.Bringthe pan to a boil over high heat. Cover the pan, reduce the heat to asimmer,andcookthepotatoesuntiltender,about12to15minutes.Drainoffallbutone-fourthcupofthecookingliquid,addthegranulatedonionandseasalttotaste,andmashthepotatoes.

Add the onions to a large saucepan and cook over medium heat forabout15minutes,oruntiltheonionsarewellbrowned.Addwateronetotwo tablespoons at a time to keep the onions from sticking. Set thecookedonionsasidewhileyoupreparetherestofthedish.

Combineallingredientsinablenderandpureeuntilsmoothandcreamy.

TOASSEMBLEANDCOOKTHEPIEROGIES

Divide the dough into two parts. Roll one half of the dough until one-eighth-inch thick. Cut circles with a three-inch cookie cutter. Add ateaspoonorsooffillingtothecenterofeachcircle.Foldthecirclesinhalfover the filling and pinch closed.Make sure the seams are airtight sotheydon’tburstopenwhencooking.Seteachpierogiona flour-dustedcookiesheetwhileyoupreparetherestofthem.Rollouttheotherhalfofthedough,thencut,fill,andseal.

Tocookthepierogies,bringapotofwater toaboilandsalt it.Addthepierogiesoneatatimeandboilthemforfourminutes,oruntiltheyfloat.

Addthecookedpierogiestothepanwiththecaramelizedonions,seasonwithsaltandpepper,andservewithhorseradishsauce.

SweetandSourTofuSERVES4

1poundextra-firmtofu,drained

¼cupBraggLiquidAminos

¼cupmaplesyrup

3clovesgarlic,minced

2tablespoonsfreshginger,minced

Blackpeppertotaste

1cupSweetandSourSauce,recipefollows

Preheattheovento350degrees.

Cut the tofu into three-fourths-inch cubes. Place the cubes on a smallbakingsheet(thesmallerthebettersoallofthemarinadewillabsorbintothetofu).Setasidewhileyoupreparethemarinade.

Combine all the ingredients for the marinade and pour over the tofumixture.Letsitforonehour.

Bake for 20minutes. Turn and bake another 20minutes. Remove thetofu from thebakingsheet intoabowlandadd thesauce.Toss tomixwell.

SweetandSourSauce1½cupsappleciderorapplejuice

¼cupcidervinegar

¼cupBraggLiquidAminos

¼cupplus2tablespoonsmaplesyrup

1garlicclove,minced

2tablespoonsarrowrootpowder

Combine everything in a saucepan and whisk to mix well. Bring themixturetoaboiloverhighheatandletcookoneminuteuntilthickened.

BarbecueTofuSERVES4

1poundofextra-firmtofu,drained,rinsed,andpatteddry

3 tablespoonsunsweetenedalmondmilkmixedwith 1 tablespoonarrowrootpowder

3tablespoonswholewheatpastryflour

3tablespoonsnutritionalyeast

1½tablespoonsgranulatedgarlic

1teaspoonseasalt

1cupsBarbecueSauce,recipefollows

Preheatovento350degrees.

Cut the tofu into three-fourths-inch cubes.Place cubes in a large bowlandtosswiththealmondmilkmixture.Inaseparatebowl,combinetheremaining ingredients.Add to thebowlwith the tofu and tossgently tocoatthetofu.

Placeonanonstickbakingsheetandbakefor20minutes.Turnthetofuandbakeanother20minutes.

Toassemble,combinethepreparedoven-friedtofuandonecupsauceinamixingbowl.Stirtocombinewell.

BarbecueSauceMAKES3CUPS

1mediumyellowonion,dicedsmall

2clovesgarlic,minced

2cupstomatosauce

Zestandjuiceof1orange

½cupmaplesyrup

1tablespoonmolasses

½cuppreparedmustard

1teaspoonallspice

1tablespoonBraggLiquidAminos

Sauté theonion ina largesaucepanovermediumheat for10minutes.Add water one to two tablespoons at a time to keep the onion fromsticking.Addthegarlicandcookanotherminute.

Addtheremainingingredientsandcookfor20minutes.

Caribbean“Chicken”andOlivesSERVES4

1mediumyellowonion,dicedsmall

½teaspoondriedthyme

1clovegarlic,minced

One18-ouncepackage“Chicken”-styleseitan,minced

4greenonions,sliced

¼cupseedless raisins, soaked inwarmwater for10minutesanddrained

Crushedredpepper

¼cupvegetablestock

4cupscookedbrownrice

Sauté theonionovermediumheat foreightminutes.Addwaterone totwotablespoonsatatimetokeeptheonionfromsticking.Addthethymeand garlic; cook another minute. Add the seitan, green onion, raisins,crushed redpepper to taste,andone-fourthcupvegetablestock.Cookforfiveminutes.Serveoverthebrownrice.

VegetableChowMeinSERVES2

8 ounces brown rice noodles, cooked according to packageinstructions

¼cupBraggLiquidAminos

3tablespoonsmaplesyrup

2clovesgarlic,minced

1teaspoonginger,minced

1smallyellowonion,cutintothinslices

1carrot,julienned

2cupssmallbroccoliflorets

Cookthebrownricenoodles.Whilethepastacooks,combinetheBraggLiquidAminos,maple syrup,garlic, andginger ina small bowlandsetaside.

Heata largeskilletoverhighheat.Add theonionandcarrot;stir-fry for

threetofourminutes.Addwateronetotwotablespoonsatatimetokeepthevegetablesfromsticking.Addthebroccoliandcookforfiveminutes,addingmorewaterasneeded.

When the vegetablesare tender, add theBraggLiquidAminosmixtureandcookanotherminute.Addthecookednoodlesandmixwell.

SpinachEnchiladasSERVES4TO6

½poundextra-firmtofu

1packagesilkentofu

2tablespoonsnutyeast

1mediumyellowonion,dicedsmall

3clovesgarlic,minced

1tablespooncumin

1tablespoonchilipowder

Seasaltandblackpeppertotaste

One 10-ounce package frozen spinach, thawed, wrung dry, andchopped

12corntortillas

2cupsEnchiladaSauce,recipefollows

Mashtheextra-firmtofuandsilkentofu inamixingbowlusingapotatomasher.Addthenutritionalyeastandsetaside.

Sautétheonionovermediumheatinalargeskilletforeightminutes.Addwateronetotwotablespoonsatatimetokeeptheonionfromsticking.Addthegarlic,cumin,andchilipowder;cookanotherminute.

Addtheonionmixtureandspinachtothemashedtofuandsetaside.

Heatthecorntortillasuntilsoftened,afewatatime,inalargeskilletovermedium heat. Place each on a flat surface and put three to fourtablespoonsofthespinachfillingdownthemiddleof thetortilla.Rollupthetortillaaroundthefillingandplaceitseamsidedownina9x13-inchbakingdish.Repeatuntilallofthetortillasareusedup.

Pourthesauceovertheenchiladasandbakefor20minutes.

EnchiladaSauceMAKES2CUPS

1smallyellowonion,diced

1teaspooncumin

2teaspoonsoregano

2garliccloves,minced

One15-ouncecandicedtomatoes

2anchochilesinadobosauce

Sautetheonionovermediumheatfor10minutes.Addwateronetotwotablespoons at a time to keep the onion from sticking. Add the cumin,oregano,andgarlic;cookanotherminute.

Pureethetomatoeswiththeanchochilesinadobosauce;addpureetothepan.

Cookovermedium-lowheatfor20minutes.Tasteforsalt.

Twice-BakedPotatoesSERVES6

6largerussetpotatoes

1mediumyellowonion,diced

1redbellpepper,diced

Corncutfrom4ears(about3cups)

1largeheadbroccoli,cutintosmallflorets

1mediumzucchini,quarteredlengthwiseandthinlysliced

3clovesgarlic,minced

1packagesilkentofu,pureed

½cupnutritionalyeast

Seasaltandblackpeppertotaste

Preheatovento350degrees.

Scrub the potatoes and wrap them individually in aluminum foil. Placethemonanonstickbakingsheetandcookforonehour,oruntil tender.Remove potatoes from the oven and set aside while you prepare thefilling.

Sautétheonion,redbellpepper,andcorninalargeskilletovermedium-high heat for six to eight minutes, or until the vegetables start to turnbrown. Add water one to two tablespoons at a time to keep thevegetablesfromsticking.Addthebroccoliandcook,covered,foranotherfiveminutes.Addthezucchiniandcookuntil tender,aboutthreetofourminutes.Addthegarlic,seasonwithsaltandpepper,andaddthepureedtofuandnutritionalyeast.

Whenthepotatoesarecoolenoughtohandle,cutaslitlengthwisedownthemiddleofeachpotato.Squeeze it openandscoopoutmostof theinnards, leavingahalf-inchwall.Coarselychopthescoopedpotatoandaddittothecookedvegetablefilling.

Divide the fillingevenlybetweeneachof thepotatoesand return to thebakingsheet.Cookfor20minutes,oruntilthepotatoesarehot.

StirFryPastawithVegetablesSERVES4

12ounceswholegrainpennepasta,cookedaccording topackageinstructions

½mediumyellowonion,julienned

1mediumcarrot,cutintomatchsticks

1largeheadbroccoli,cutintoflorets

1cupsugarsnappeas,endstrimmedandcutinhalf

3clovesgarlic,minced

2teaspoonsfreshginger,minced

3tablespoonsBraggLiquidAminos,moreorlesstotaste

Blackpeppertotaste

Cook the pasta. Heat a large skillet over high heat. Add the onion,carrots, and broccoli. Stir-fry for fourminutes, addingwater one to twotablespoonsatatimetokeepthevegetablesfromsticking.Addthesugarsnappeasandcookfortwominutes.Addthegarlic,ginger,BraggLiquidAminos,andcookedpasta.Cookanotherminuteandseasonwithblackpepper.

SpicyThaiPeanutNoodlesSERVES4TO6

12clovesgarlic,minced

¼cupfreshginger,minced

1jalapeñopepper,minced

1tablespoongroundginger

½tablespooncayennepepper

½cupBraggLiquidAminos

2tablespoonsredwinevinegar

¼cupplus2tablespoonscanesugar

¾cupwater

1cuppeanutbutter

1poundlinguine,cookedaccordingtopackageinstructions

½bunchgreenonions,thinlysliced

1mediumcucumber,halved,seeded,andthinlysliced

For the peanut sauce, combine the garlic, ginger, jalapeño pepper,

ground ginger, cayenne pepper, Bragg Liquid Aminos, vinegar, sugar,andwaterinalargepot;bringthemixturetoaboil.Letcookoneminuteand remove the pot from heat. Add the peanut butter and whisk tocombinewell.

Whilethesauceiscooking,preparethepasta.

Drain the pasta and add it to a bowl with the sauce. Mix well. Servegarnishedwithgreenonionsandcucumberslices.

ThaiPizzaMAKESONE12-INCHPIZZA

Oneprebaked,12-inchwholegrainpizzacrust

½cuppeanutsauce(seeSpicyThaiPeanutNoodles)

1cupsnowpeas,slicedonadiagonal

1cupgreenonion,sliced

1mediumtomato,diced

1cupmungbeansprouts

¼cuptoastedpeanuts

½cupbasil,chopped

Preheattheovento375degrees.

Spreadthepeanutsauceover thecrustandtopwithsnowpeas,greenonion,andtomato.Placethepizzaonabakingsheetandcookfor12to13minutes.Removefromtheovenandtopwith thesprouts,basil,andpeanuts.

Del’sFavoritePizzaMAKESONE12-INCHPIZZA

Oneprebaked,12-inchwholegrainpizzacrust

½cuptomatosauce,moreorlesstotaste

½greenbellpepper,diced

1cupmushrooms,sliced

½cupredonion,diced

½ batch oven-fried tofu (use recipe for Barbecue Tofu, withoutsauce)

Freshbasilforgarnish

Preheattheovento375degrees.

Place the pizza crust on a baking sheet and spread the tomato sauceoverit.Topwiththeremainingingredientsandbakefor13to14minutes.Garnishwiththefreshbasil.

PestoPastaSERVES4TO6

1poundwholegrainlinguine

1cupCreamyBasilPesto,recipefollows

Cookthepastaaccordingtopackageinstructions,thendrainit,reservingone-fourthcupoftheliquid.

Addthecookedpastaandpestotoalargebowlandmixwell.

CreamyBasilPesto2cupsfreshbasilleaves,packed

½packagesilkentofu

¼cupnutritionalyeast

¼cupwalnuts,toasted

2clovesgarlic,chopped

Seasaltandblackpeppertotaste

Combine everything in the bowl of a food processor and puree untilsmoothandcreamy.

StuffedBakedSquashSERVES4

2acornsquash,halvedandseeded

Seasalttotaste

1½cupsvegetablebroth

¾cupquinoa,rinsedanddrained

1mediumonion,dicedsmall

1stalkcelery,dicedsmall

1mediumcarrot,dicedsmall

2clovesgarlic,minced

1teaspoonfreshthyme,minced

1teaspoonsage,minced

Saltandblackpeppertotaste

¾cuppecans,toasted7to8minutesina350-degreeoven

Preheatovento350degrees.

Cut both acorn squash in half crosswise; remove seeds and fibers.Sprinklesaltovercuthalves.Placehalves inashallownonstickbakingpan.Addonecupwater to thepan.Bake forabout40minutes,oruntiltender.

Whilethesquashbakes,preparethestuffing.

Inheavysaucepan,bringbroth toaboil.Add thequinoaandcover thepan.Bringittoaboiloverhighheatandthenreduceheattomediumlow.Letsimmerfor20minutes,oruntilthequinoaistender.

Sautétheonion,celery,andcarrotforsevenminutesovermediumheat.Add the garlic, thyme, sage, salt, and pepper; cook another minute.Removefromheat;foldinthepecansandcookedquinoa.

Spoonthequinoamixture intothebakedsquash.Coverwithfoil, returntotheoven,andbakeanother20minutes.

Dr.Pam’sVanillaIce“Cream”SERVES1

2wholebananas,peeled,sliced,andfrozen

¼cupunsweetenedalmondmilk

¼teaspoonvanillaextract

1packetsteviaormoretotaste

Combineall ingredients in a foodprocessor or blenderwith a powerfulmotor,andprocessuntiltheicecreamissmoothandcreamy.

FruitCrispSERVES6TO8

9cups(about2pounds)pears,cored,peeled,andsliced

¼cuporganiccanesugar

2tablespoonsfreshlemonjuice

1teaspooncinnamon

¼teaspoonnutmeg

Topping

1cuprolledoats,regularorquick-cooking

½cupwholewheatpastryflour

½cuporganiccanesugar

1teaspooncinnamon

¼cupplus2tablespoonsunsweetenedapplesauce

Preheattheovento350degrees.

In a large bowl, combine the pears, sugar, lemon juice, one teaspooncinnamon,andnutmeg.Mixwellandtransferthemixtureintoa9x13-inchnonstickbakingdish.

In a medium bowl, combine the oats, flour, sugar, and one teaspooncinnamon.Addtheapplesauceandmixwell.

Sprinkletoppingoverpearmixture.Bakefor50minutes,oruntiltoppingisnicelybrownedontop.

5

THEDIETARYESTABLISHMENT....................................

GM:Pam,IjustwentonthewebsiteoftheAcademyofNutritionandDietetics(AND). I clicked on “nutrition for growing bodies” and saw that theyrecommendwholegrains, fruits,andveggies, including100percent juice, low-fatdairy foods, and thenaproteingroup that is leanmeat,poultry, fish, eggs,beans,andnuts.

PP: Right. Hey, it’s the dietary recommendations of the United StatesDepartment of Agriculture (USDA). If the USDA issued recommendationstomorrow for everyone to drink ten ounces of arsenic before breakfast, it’d bepostedonAND’swebsitebynoon.

GM:Ha!

PP: I’mnotkidding!And this stuff is importantbecause these are thepeopleprovidingthedietaryguidelinesthatarebeingusedtodesignschoollunches.

GM:IreadintheNewYorkTimesaboutastudythatshowedthatchildrenwhoeat school lunchesare29percentmore likely tobeobese thankidswhobringtheirownlunchestoschool.1

PP:Andsincetheirownlunchesprobablyaren’tsogreat,thatgivesyouanidea

of just how awful the school lunches are. The Physicians Committee forResponsibleMedicine(PCRM)filedalawsuitagainsttheUSDAoverthelatestdietaryguidelinesbecause they’resohorrific.NotonlydoesANDnotsay thattheguidelinesareterriblebut itspresident issuedapressreleasegushingaboutwhat a great job the USDA committee did and how hard it worked to sortthroughall this science tocomeupwith thiswonderful recommendation.Thepresident also remindedus,by theway, thatAND is thegroupofpeople youwant to look to for dietary information.2 It’s almost like the USDA has putANDonthepayroll,whichwouldn’tbesurprisingbecauseeveryoneelsehas.Ifthe USDA isn’t paying AND, then that would be the one group that hassomehowbeenexempted.

GM:Whatdoyoumeanbythat?Who’spayingAND?

PP:They’reheavilyfundedbysponsors.Millionsofdollarsayear.

GM:Thedairyindustry?

PP:Oh,therearen’tanythataremissed.Thedairyindustry,thebeefindustry,food manufacturers like Wrigley and Hershey’s and Kellogg’s—there’s nodiscernment. If youowna foodcompanyandyouwant to sponsorAND, juststepuptotheplatewithyourwalletopen.There’snofilteringthatsaysyouhaveto qualify based on promoting a healthful food.3 So the American DistillersAssociation,thelambindustry,there’snobodyexemptfromtheirendorsement,providedtheyshowupwithacheck.

GM:IstherenogroupofcriticswithinAND,nogroupofdietitians,thatfightsthissystemandcallsitcorrupt?

PP:NotwithinAND.Youhave thesamethinggoingonwithdietitians thatyouhavegoingonwithmedicaldoctors.Whenwe talkabouthowbadhealthcare is and how corrupt the medical system is, it all starts with corruptprofessionalorganizations. JustasDr. JohnMcDougall isnot representativeofthemedical profession, there are great dietitians out there, someofwhomareclosefriendsofmine,whohavegonetodieteticsschoolandheldtheirnosesinorder to get their degrees. They’ve reengineered themselves to practicecompletelydifferently,toopposewithintheirownpracticetheguidelinesoftheir

umbrellaorganization.Butthere’snoforcewithinANDthatistryingtochangethesystem.Ofcourse,AND’spublicstanceisthatitcan’tfunctionwithoutthistype ofmoney.Howwould the organization operate, after all?Of course,myresponseisthatwe’vefoundawaytooperatehereandnottakemoneyfromanycorporatesponsors. IfANDsendsrepresentatives, I’ll showthemhowtodo itwithsomethinginterestingcalledearnedincome.

GM: Why couldn’t AND function just on the dues of practicing members,ratherthanfundsfromcorporatesponsors?

PP:Or selling services.There’sno reasonwhyANDcouldn’t actuallymarketservices in some ways directly to the public, but it’s easier just to take thecorporatebucks.Idon’tmeantopickonAND,becausetheAmericanAcademyof Pediatrics, the American Medical Association (AMA), and the AmericanDiabetesAssociation(ADA)alldoit.They’reallonthetake.They’realltakingmoney. It’s pervasive in the health care business. So we have terriblerecommendations that come from the federal government, and all of theseorganizationsarecorruptedbythesamemonetaryinfluence.

GM:Whogivesmoney,forexample,totheAMA?

PP: The drug industry,mainly in the form of advertising in its journal. TheAmericanPsychiatricAssociation sends its journal free to itsmembers.Guesshow it gets to do that? Drug ads. Most of what psychiatrists are seeing ismaterial promoted by the drug companies. I’d like to think that the averagepsychiatristissmartenoughtoknowthat.Aretheysmartenoughtosay,“MaybeIshouldautomaticallybeskepticalofanythingtheseadssaythatareprintedinthesejournals?”Idon’tknow.Psychiatristsareprettydrug-happythesedays.

GM:WhogivesmoneytotheADA?

PP:Well,the“healthtipoftheday”onthewebsitewassponsoredbyEskimoPie for about eighteen months. Because if you’re diabetic, you can never getenoughEskimoPie.

Theartificialsweetenercompaniescontributealot.CadburySchweppesgavetheADA$1.5millionafewyearsago.Cadburyisthethird-largestmakerofsoftdrinksintheworldandalsomakesthosecrèmeeggsavailableatEaster.Those

aresomegreatitemsfordiabeticsalso!

GM: Letme try towrapmy head around this. You’re amanufacturer of softdrinksandyousay,“Uh-oh,millionsofpeopleinAmericahavebecomediabetic.That’s not good for us because, after all, we’re selling flavored sugar water.Here’sanidea.Let’sgivemoneytotheAmericanDiabetesAssociationsothatdoctorswon’ttelltheirpatientsthatsoftdrinksarebadforthem?”Isthatreallyconceivable?

PP: Well, they basically want the ADA to make mushy, meaninglesspronouncements,whichitfaithfullydoes,asdoestheAcademyofNutritionandDietetics.Theparty linethatANDproudlyannouncestothegeneralpublic isthatthereisroomforeverythinginahealthydiet;thateverythinginmoderationisfine;thattherearen’tanygoodandbadfoods;thattherearen’tanygoodandbad dietary patterns; and that different things are appropriate for differentpeople.Andessentiallyitpromotesthiswholeideathatsure,youcangoaheadandhavethatsoftdrinkwiththatEskimoPie.

I did a television interview recently in which this was a big topic ofconversation.Thepromotionofthisideathatyoucanjusteatwhateveryouwantwithoutconsequences.“Youmaybewanttodoalittlelessofthatandalittlebitmoreof this,butnothingyoueat is clearly rightorwrong.”You’ll seea lotofstatements fromtheAmericanDiabetesAssociation, forexample, to theeffectthatit’simportanttolookatthewholerangeofproductsavailabletodiabetics.Lookatallthesugar-freedrinkproductsyoucanhave,forexample, ifyou’realittle more sugar sensitive than somebody else. And the beverage industry isdoingagreatjobbydevelopingartificiallysweetenedsoftdrinkssothatdiabeticscanenjoytheseproducts, too.Yay!Now,ofcourse,myemployeeshereatTheWellnessForumjokethatthey’vegotguaranteedlifetimeemploymentaslongasthisnonsenseisgoingon,butIdon’treallythinkthat’sourobjectivehere.I’dbehappy to find something else to do withmyself if we could fix the country’shealthproblems.

GM:Let’stalkaboutAND’srecommendationtoeatleanmeatandpoultryandfishandeggs.WhatisAND’sfactualbasisforthis?Iknowthatyoumakeyourdietaryrecommendationsbasedonscience.Maybeit’saskingtoomuchtoexpectANDtodothesame,butisthereanymedicalliteratureanywherethatsuggeststhat there’s anythinghealthy about poultry?Has there ever been a studydone

thatifyoueatpoultry,it’sgoodforanyofyourorgansorhasapositiveeffectonlongevity?Is thereanystudy in theworld thatsuggests thatpoultryhashealthbenefits?

PP:No.

GM: Sono studyhas ever beendone that eatingpoultry is anybetter for youthaneatingriceorbeansorlentilsorbroccoli?

PP:No.Wehavestudiesthatshowthecontrary.4First, chicken contains just about asmuch fat as beef.Even chickenbreast

withtheskinremoved,andisbroiledratherthanfried,derives23percentofitscalories from fat. And four ounces of chicken contains almost one hundredmilligrams of cholesterol, about the same as four ounces of beef.And a studyconductedby thePhysiciansCommittee forResponsibleMedicinedeterminedthatalmosthalfofchickensoldingrocerystoreswascontaminatedwithfeces.5Yet Americans have been told that chicken is better for them than beef andpork. This has caused chicken consumption tomore than quadruple between1950and2007,whilebeefconsumptionincreasedbyonly50percentandporkconsumptionwent down.6Of course,Americans have continued to get fatterandsickerallthetime.

GM:Well, isthereanystudythatmakesanypositivecaseatallforpoultry?Isthere any study that shows that eating poultry is at least better for you thaneatinglizards,horses,chipmunks,orrats?

PP:No.

GM:Sothey’rejustpullingtheserecommendationsoutoftheirass?

PP: They would clearly recommend the nutritional benefits of eating rats iftherewerearatfarmlobbyorifpeoplefoundfriedratsdeliciousandtherewasachainofKentuckyFriedRatrestaurants.

GM: Is it fair to say that a group like ANDwill promote some informationoccasionally that’sbasedon science, and thenother information—likeadvisingpeopletoeatleanmeatandfishandeggsandpoultry—that’sjustasafewayof

endorsing the status quo, affirming the general culture and the standardAmericandiet,withoutanyscienceinvolvedatallsoasnottoruffleanyfeathersin,say,thepoultryindustry?

PP:Yes.AndwhatmakesthisconfusingtothegeneralpublicisthatpeoplegetontheANDwebsiteand,firstofall,theyhavenoideahowdietitiansaretrainedandtheyassumethebest.Thentheyseemessagesthatareclearlyright:eatmorefruitsandvegetables.Imean,whoreallydisagreeswiththat?Wholegrainsandbeansaregoodforyou.Sotheyseesomethingsthatarerightanditmakesthemthink this organization is probably right across the board. Even when there’sclearlyasponsorshiprelationship,suchasinthepositionpapers.(It’sprintedinvery small type in thewebsite’s right-handcorner.) Idoubt theaveragepersonknowsthatthepaperwaswrittenspecificallyinresponsetosponsorshipmoney.TheWrigley ScienceFoundation sponsored a piece that stated you could addenamel to your teeth by chewing gum.Now, I have a lot of friends who aredentistsandI’veaskedallofthem,“Whatdoyouthinkofthis?”Theylaughoutloud and say, “Whogave you that crazy idea?”Well, itwaspostedonAND’swebsite.

Theaveragepersoncan’tbeexpectedtofactorintheconflictsofinterest.Alltheaveragepersonseesisthattheseorganizationsappeartobeauthoritativeandtheexperts in the field. Ifyouknownomore than that, following theiradviceseemslikethesensiblethingtodo.

GM: How about the governmental organizations? Do you feel the same wayabouttheFoodandDrugAdministration(FDA)asyoufeelaboutthesemedicalassociations?

PP:Oh,it’sprobablyworse.

GM:Thenlet’stalkabouttheFDA.

PP:There are a few different issues to discuss: drug approval and regulation,andregulationofsupplements,fortifiedfoods,andthefunctionalfoodsindustry.IntermsoftheFDA’sdrugregulation,theflawisthatthedrugcompaniesmakea lot of the decisions about study design, even aboutwhat’s considered a sideeffect;theynegotiatewiththeFDAonwhatshouldbelistedasasideeffect.

GM:Howdoyounegotiateonwhatshouldbelistedasasideeffect?

PP:Well,Prozacdoesn’tlistwithdrawalsymptomsasasideeffectbecauseboththemanufacturerandtheFDAagreedthatifthelistofsideeffectswastoolong,itwoulddiscouragepeoplefromtakingthedrug.7

GM: I’malwaysamazedby theTVcommercials fordrugs.Theymightbe forrestless leg syndromeor erectile dysfunction or something and they say, “Maycause headaches, fatigue, nausea, diarrhea, dizziness, suicidal thoughts, stroke,heart failure, kidney failure, unusual bleeding, or sudden death.” And I’mthinking,howbadlydoyouwanttokeepyourappendagesinacertainposition?Imean,afterhearingthesewarnings,whothehellisbuyingthesethings?

PP:Well, thedrugadsworkbecausethereareplentyofpeopleouttherewhohave these conditions.They go in and ask their doctor for thedrugs, and thedoctors feel as if they should accommodate their patients.What they shouldreallydoissayno.It’sokaytosaynotosomebody.Ofcourse,doctorsworrythatthepatientwillswitchtothedoctordownthestreet.Myresponsewouldbetoletthem.Letthemgotothedoctordownthestreetandgetthebadtreatment.Youdon’tgetithere.

Even the way that adverse events are reported ismanipulated by the drugcompanies and the FDA, in collusion with one another. You have aninstitutional conflict of interestwith theFDA: the organization that approvesdrugsshouldnotberegulatingtheminthemarketplace.Why?Becauseinorderto withdraw a drug, the FDA essentially has to admit that it was wrong toapproveit.Onestepintherightdirection,inadditiontopostingtrialsonlineinadvance,wouldberequiringproofthatthedrugisnotonlybetterthannothingbutalsobetterthanotherdrugsonthemarket.Thatway,weavoidthe“metoo”drugsthatdonomorethanmimicotherdrugs.WeshouldalsosplittheFDAintotwoagencies—onethatapprovesdrugsandonethatmonitorssafety.Thatway,theonethatmonitorssafetyinthemarketplacemightnotbesoinclinedtoallowabaddrugtostayonthemarket.

IfyougobackandlookattheMerckdebaclewithVioxx,youwillfindthatformany,manyyearsbeforethatdrugwastakenoffthemarket,theFDAknew,asdidMerck,thatthedrugwasseriouslydangerous.ThesamethingistrueforAccutane and Crestor. These are dangerous, terrible drugs; they shouldn’t betakenbyanybody.Yetthegovernmentdidn’tdoanythingaboutVioxxuntiltens

ofthousandsofpeoplehaddied.8The FDA is no less flawed when it comes to regulating supplements,

functional foods,andfortifiedfoods.Thesupplementandfoodindustrieshavebeen able to influence decisions at the FDA for years. The FDA long agosucceeded, unintentionally, at getting public sentiment on the side of thesupplementmakersbyusingtacticsthatweresooutrageousandoverthetopasto provoke a backlash. Before theDietary SupplementHealth andEducationAct(DSHEA)of1994waspassed,theFDAhaddonethingslikeraidtheofficeof a doctor who was making his own vitamin C formula. They used heavilyarmedAlcohol,Tobacco,FirearmsandExplosivesagentstoholdpeopleintheofficeatgunpointastheagentsconfiscatedtheofficerecords.That’sanexampleof a kind of governmental overreach that breeds contempt of government.DSHEAgottheFDAoffthebackofthesupplementindustryandallowedthesupplement manufacturers to make generalized, unsubstantiated claims abouthowagivensupplementmaysupportthefunctionofagivenorgan.TheFDAisnowtoothlessindealingwiththesupplementindustry,andgiventhehistoryoftheFDA,we’reprobablybetteroffthatway.

GM:TheFDAmaybe ineffectivewhen it comes todoing things likepullingdangerousdrugsoffthemarket,butitcanberemarkablyeffectiveandtenaciousopposingnonconventionalformsoftreatment.

PP:Ohexactly,exactly,becausetheirrealclient is thedrugcompanies.IfyoulookatmostofthedecisionsthattheFDAmakes,it’sactingintheinterestofthe drug companies. When Andrew von Eschenbach was head of the FDA,Avastinwasapprovedforbreastcancertreatment.Itdoesnotextendthelifeofbreastcancerpatientsbyasingleday,butsigningthatorderresultedinbillionsofdollarsinsalesforGenentech.9

ThatdecisionbenefitedGenentech,butitdidnotbenefitmostofthewomenwhotookthedrug.Andwhilepeople lovetobeatupthe insurancecompaniesovertheseissues,considertheplightofaninsurancecompanythatwasforcedtopay$90,000—that’swhatAvastincoststheaveragepatientannually—foradrugthatdoesabsolutelynothingatall,becausethedrugcompanieslobbyCongressto force Medicare to pay for it. Once Medicare pays, then all the insurancecompanieshavetopay.Weliketobeatuptheinsurancecompanies,butthey’rebeingmandatedtopayforalotofineffectivetreatment,yetstillhavetomakeaprofit, make their shareholders happy, and pay for all these unnecessary

diagnostic testsandannualvisits to thedoctorsandonandonandon.SothewholesystemisscrewedupandtheFDAisavitalcoginthatveryscrewed-upwheel.

GM:Still,it’stheUSDA,nottheFDA,thatcomesupwiththeFoodPyramid,ortheHappyPlate,orwhateveritcallsitsrecommendationsnow.

PP: That’s correct—and in conjunction with the Department of Health andHumanServices.

GM: How did the USDA get involved in deciding what the healthiest dietshouldbe?Whydowetrustanagencythat’ssupposedtodealwithfarmissuestotelluswhattoeat?

PP: We shouldn’t. The conflict of interest stares us in the face. Itsrecommendations are all about promoting certain sectors of agriculture, notabout what the healthiest diet should be. The most blatant example of thecorruptionisthe“checkoff”program.

GM:Explainhowthatworks.

PP:Withthedairycheckoff,forexample,foreveryhundredpoundsofmilkthatdairy producers sell, they are mandated to contribute fifteen cents to theprogram.Thatmoney is spent onmarketingdairyproducts to thepublic, likethe“GotMilk?”campaign.It’salsospentondirectmarketingofdairyproductstoschools,onpromotingtheuseofbutter,onpartneringwithfast-foodchainstooffermorecheeseintheirpizzasormoremilkintheircoffees,andonresearchtocreatenewandmoredevastatingusesofdairy.

But it’s not only dairy. There’s also a pork and a beef checkoff program.Cattleproducerspayadollarahead.Letmereadtoyoufromawebsitefundedbythebeefcheckoffprogramalittledittycalled“FeelGoodaboutLovingBeef”:

Isn’titgreatthatafoodyoucravecanbesogoodforyoutoo?Beefiseasyto love because it tastes so great, but it’s also a naturally nutrient-richsourceoftenessentialnutrients.Theproteininbeefhelpsstrengthenandsustainyourbody.Evidenceshowsthatproteinplaysanimportantroleinmaintaininghealthyweight,buildingmuscleandfuelingphysicalactivity.

Andwhenyou’vegotallthatgoingforyou,youandyourlovedonesareonebigstepclosertoahealthierlifestyleandatlowerriskfordisease.10

GM:That’sverynice.Conservativesarealways saying thatgovernment shouldget out of the way and let private businesses run things efficiently withoutbureaucraticinterference.Butthecheckoffprogramseemstomeagoodexampleofgovernmentandbusinessworkingincompleteharmonyonadisinformationcampaign.

PP:Yes.Workinghandinhandtohelpmakepeoplesickandobese.

GM:DoestheFDAgetinvolvedinnutritionatall?

PP:Itgetsinvolvedonlytotheextentthatitregulates,alongwiththeFederalTrade Commission, the sale of supplements and the approval forstructure/function claims that can be made about certain nutrients and thelabelingoffortifiedfunctionalfoods.SowecanthanktheFDA,forexample,forallowingcholesterol-loweringclaimstobemadeformargarineproductsthatare100percentfatbecausethecompaniesfortifythemargarinewithbetasitosterolorplantsterols,whichhavebeenknowntolowercholesterol.

GM:You’rekiddingme?Inotherwords,youcouldtakeporkfat,injectalittlebitofniacininit,andmakeacholesterol-loweringclaimforthat?

PP:Basically,yeah.You’vecomeupwithaviablebusinessmodel.

GM:Butitdoesn’tseemkosher.

PP:AndthisconstantbanteringbackandforththatgoesonbetweentheFDAand the food companies about fortifying foods by adding omega-3s to whitebread, and the health claims that can be made for that nonsense, isunconscionable.Ifwewanttoreducetheincidenceofcoronaryarterydisease,forexample, thatmeans thatwe’vegot to,on the federal level, startgivingpeopletherightadvice.Here’swhyit’snothappening.Ifyougivethepeopletherightadvice, it means you’re going to tell them to eat more of something, less ofsomething,andnoneofsomething.Thenyou’regoingtotickoffmanufacturersandagriculturalgroups,somethingthegovernmentisunwillingtodo.Sowhose

side is thegovernmenton?It’swillingtosacrificetensofmillionsofpeopletohorribletreatments,drugs,unnecessaryprocedures,andevendeathseveryyearsothat it doesn’t tick off the National Dairy Council? So that it doesn’t upsetKellogg’s?That’swhothefederalgovernmentisworkingfor,notus.Itdoesnotfunctionintheinterestofthepublichealth.

GM:DoyouhaveatheoryaboutwhetherthedecisionmakersattheFDA—andfor thatmatter theAND, theAMA, and so forth—believe that they’redoingtherightthing?Doyouthinkthat they’resimply inthedarkscientifically,butthattheyatleastbelievethatthescienceisontheirside?Ordoyouthinkthatthey know that what they’re promoting is untrue and evil and corrupt, butthey’rejustmakingaliving?

PP:Ithinksomeofboth.Firstofall,healthcareprofessionalsingeneraloftendonothaveaverygoodunderstandingofhowtoreadandinterpretresearch.Acommon issue is reportingdata in relative versus absolute terms.For example,patientsare told that a50percent reduction in the recurrenceofbreast cancerresultsfromtakingtamoxifen.Andboy,withthoseresults,whowouldn’ttakeit,right? Then you discover the recurrence rate is 1.3 percent; with tamoxifen,recurrence is reducedto0.68percent,which isactuallya49percentreduction,buttherealorabsolutebenefittothepatienttakingtamoxifenisone-halfof1percent.11Once someone looks at the side effects, nobody in her rightmindwouldsay,“Oh,I’mwillingtoendureallofthistoreducemyriskofarecurrenceofbreastcancerbyhalfapercent;it’saninsanetrade-off.”So,partofitiswellintentionedbutpoorscience,combinedwithamind-setthatallthesolutionstoourproblemsmustbedrugrelated.Theyviewtheirfindingsthroughthatfilter.

Andthentheothersideofitisjustpuremoney.We’renotgoingtotickoffanybody who’s in a position to hurt us. The late Senator GeorgeMcGovernlearnedthatlessonlongago,andit’shadachillingeffectthat’slasteddecades.

GM:WhathappenedtoSenatorMcGovern?

PP:SenatorMcGovernchairedaSenatecommitteethatstartedlookingintoashiftfromAmericansbeingmalnourishedtoAmericanssufferingfromdiseasesof excess.AndhehadAncelKeys testify in front ofhis committee.KeyshaddonetheSevenCountriesStudythathelpedestablishtheroleofcholesterol incardiovasculardisease.Asaresult,SenatorMcGovernandhiscommitteeissued

somedietary recommendations; youand Iwouldn’t like themawhole lot,butthey’re a whole lot better than the guidelines at the time. They discouragedoverreliance on animal foods and processed foods. The food business—theagriculturegroups—wereincensedbythisandgottogether,determinedtotakehimout.SenatorMcGovern losthisbid for reelection in largepartbecauseofthe enormous amounts ofmoney that came from the cattlemen’s associationsand the dairy industry and the agriculture groups that said this guy’s bad forbusiness.Soallthepoliticianslookedaroundandsaid,“Youknowwhat,it’snotprofitabletostanduptotheagri-foodscomplex.”

GM: In the end, the recommendations of the USDA and the FDA and theAND tend to get filtered throughdoctors, so let’s talk aboutmedical doctors.Theygethowmanyhours,typically,oftraininginnutrition?

PP:TuftsUniversityisthebestandthosedoctorsgetseventeenhours;that’snotseventeencredithours;that’sseventeenclassroomhoursinnutrition.They’rethebestinthecountry.

GM:Andtheworst?

PP:Thatwouldbe about three-fourths of them,where the subject’s not evendiscussedatall.Andinmostoftherest,acursoryreviewofnutritionisaboutthebestyoucanhopefor.I’vehadcurrentmedicalstudents tellmethatwhenthesubjectofnutritioncomesup,it’sdismissedasinconsequential.Theirattitudeisthatpatientscanalwaysbereferredtoadietitianorwhatever.Thereisabsolutelynoawareness—andthisistrueforallhealthcareprofessionals.Nobodyistaughtthatdietisthecauseofthediseaseswebattleandnobodyistaughtthatdietwillreverse them. A doctor or a dietitian or a nurse practitioner or a physicianassistant who goes to school is not taught that you can reverse early-stagemultiplesclerosiswithdiet.They’renottaughtthatdietcausesitandthey’renottaught to reverse it. In fact,noneof themare taught to reverse anycondition.They’retaughttotreatsymptomswithdrugs.

GM:Now,wecanassumethatmostmedschoolstudentsarehighlyintelligent.

PP:Undoubtedly.

GM:Is itpossiblethattheycouldgotomedschoolforfouryearsand,evenifthey’re not taught anything about nutrition in med school, not see therelationship between, for example, diet and heart disease, and just focus onpharmaceuticalandsurgicalinterventions?

PP: Well, even if they see the relationship, they need to be quiet about it.Friends of mine who are physicians advocating a low-fat, plant-based diet intheir medical practice have children who have applied to medical school andmentionedintheiressaystheir interest inhelpingpatientsregainandmaintaintheir health with diet. Their applications were met with disinterest and insometimesopenhostility;inoneinstance,anapplicantwasinstructedtosanitizehisapplicationofthisinformationinordertobeconsidered.

GM:Allthesame,thereareobviouslymanydoctorswhogiveadviceaboutdiet,even if they’vehadno formal training in the subject. Iwould think thatmostdoctors who have patients with heart disease discuss with them whetherhamburgers or cheeseburgers or hot dogs are a good idea. I mean, even thegeneralpublicknowsthatcheeseburgerscontributetoheartdisease.

PP:Thereareafewthingsthatneedtobesaidabouttheadvicethatpeopledoget fromdoctors.Thefirst is thatdoctors tellpatients toreducethefat, loseafewpounds,totrytoeatlessredmeat.Theybuyintothemyththatifyoueatchickenandfishinsteadofredmeat,itwillhelpyoutameyourcoronaryarterydisease, which we know is not true. The second thing is that therecommendationstendtobesogeneralthatthepersonhasnoideawhattodowith them.One thing that we’ve learned at TheWellness Forum is that thespecificityoftheinstructionhasalottodowiththeoutcome.IfItellyou,“Hey,Glen,eatalittlebitlessofthis,”youdon’treallyknowwhatthatmeans.IfIsay,“Glen,donoteatthis;Iwantyoutoeatthatinstead,”younowhaveaspecificdirective. The likelihood that you’ll know what to do and be able to followthroughonallmyadviceisamuchgreater.Theinformationfromdoctorstendstobevague; in thecontextof the shortofficevisit, that’s aboutasgoodas it’sgoing to get. The third thing is that some doctors don’t even do thatmuch.Theybasicallysay,“Okay,youhavecoronaryheartdiseaseandhighcholesterol,butyourdadhaditandyourgrandfatherhadit.Itrunsinfamilies,sotheearlierwetreatyouwithmedsoranangioplasty,thebetter.”Thepatientiseffectivelytold that he or she is the helpless victim of bad genetic wiring. That victim

mentalityshinesthroughandsometimesprecludesanyadvicewhatsoeveraboutdietfrombeingdispensed,ortakentoheartifitis.

GM: There’s also the problem of low expectations, isn’t there? Doctors mayrecognize thatmeatandcheese in thedietareharmful,butbelieve that it’s allbutimpossibleformostpeopletochangetheireatinghabits.

PP:Yes,that’saproblem.Theideathateitherpeoplewon’ttryitortheywon’tstickwith it—that’s takenasgospel,althoughthereare somestudiesout therethatsuggestotherwise.Youknow,Dr.NealBarnarddidtheoriginalcompliancestudy onDr. DeanOrnish’s diet and showed that patients whomade biggerchangesweremore compliant andhappierwith theirdiets.12He conducted asimilar study with diabetic patients who converted to a plant-based diet thatshowedsimilarresults.13

GM: If doctors believe that their patients can’t possibly change their diet andthey approach themwith that philosophy, then that’s likely going to be self-reinforcing:patientswillembracewhat’spresentedasthedifficultyofchangingone’sdiet.

PP:Themore insidious aspect is getting unhelpful dietary advice.Let’s say IdevelophighcholesterolandhighbloodpressureandIgotoatraditionaldoctor.Perhaps she is even enlightened enough to have a dietitian in the office.However,thatdietitianistrainedonthepartyline,sothedietitiansaysI’vegotto have skim milk on the cereal, give up hamburgers and cheeseburgers andpizza,butIcanhavesomechickenandfish.SoIreallyworkatthis,I’mtrying.I’mdrinkingtheskimmilkthattasteslikecrapandeatingalotofsalmon.Idothis for sixmonthsandI showbackupatmydoctor’soffice.Mycholesterol’sactuallygoneupandmyA1Clevels,amarkerfordiabetes,havealsogoneup.Ihadaprediabeticconditionandnowitlookslikeit’sdevelopingintofull-blowndiabetesdespitemybesteffortsforsixmonthsandyouknowwhatIsay?“Thisdietarychangedoesn’twork,givemethedrugs.”Andsothemedicalskepticismaboutdietbecomesaself-fulfillingprophecybecausethedietaryadvicegivenouthasnochanceofhelpinganybody.

Ontheotherhand,whenweputpeopleonthetypeofdietthatactuallydoeswork, we get a different form of reinforcement. People get better, they loseweight,theygetofftheirmedications,andtheydon’twanttogoback.Wegeta

greatdealofcompliancebecausetheyactuallyseeresultsfromtheireffort.Andthat’sthebigmissinglinkinwhat’sgoingoninthegeneralmedicalcommunity.

Doctorsneedtoknow,andIbelievemostofthemdo,thatpartoftheirjob,ifthey’regoingtobeinpracticeandpresentthemselvesasdoingrightbypeople,is tocontinue to learn. It’s the responsibilityofanyphysician inpractice tobereadingandlearningallthetime.Now,itwouldbelovelyifonewaytheywouldcontinue their learningwouldbebyvisiting, say,Dr.McDougall’sHealthandMedicalCenterinSantaRosa,California,orourWellnessForuminColumbus,Ohio. But that’s not what happens. Doctors go to continuing educationconferencesthatarelargelysponsoredbydrugcompanies.Thecompanieshavedoctorsmakepresentationsabouttheuseoftheirdrugs,manyofwhichareoff-label applications, which the drug reps can’t recommend, but doctors andcontinuingmedicaleducationprogramseffectivelycan.

GM: Now, doesn’t a lot of that additional education sponsored by drugcompaniestakeplaceatresortsinplaceslikeMaui?

PP:Ohyeah,andoncruiseships.Andyougettobeapresenterbybeingahighprescriber.Therearerewardsforbeingahighprescriber.Forexample,youandyourspousegetanall-expenses-paidvacationformakingapresentationonhowtoprescribe for off-label uses. So even the systemof continuing education fordoctorsiscorrupt.

GM:Ididn’tknowabouttherewardsforbeingahighprescriber.I’veneverseenadoctor advertise on awebsite, “Number-oneprescriber ofFosamax.”Why isthat?

PP:Professionalmodesty.

6

MANAGINGYOURDOCTOR....................................

GM:Pam,whatdoyouseeastheidealroleofdoctorsinpeople’slives?Shouldpeoplegoforannualcheckups?Shouldtheydoanyteststomonitortheirhealth?

PP:No.Newsweek had a cover story titled “OneWordCan SaveYourLife:No!”1It’saboutsayingnotodiagnostictests.Thearticledoesn’tmakequiteasstronga statement as either IorDr. JohnMcDougallwould,but it’s rightupthere.Itbasicallypointedoutthatthemoretestsyouhave,themorelikelyyouaretodiscoversomethingthat’sinsignificantbutgettreatmentforanyway.Mostmajor organizations, including the U.S. Preventive Services Task Force, havesaid that there’sno value to the annual exam.2One interestingpoint thatDr.McDougallmakeswhenhespeaksaboutthisissue,andithadaprofoundeffectonme,isthathegrewupwhereyougotothedoctoreveryyearforaphysical.He said during that time he gained fifty pounds, he developed an intestinalobstruction, had to have surgery, and had a stroke. Obviously, the annualphysicaldidhimnogoodatall.Theannualexam,thewaywe’vestructuredit,isabsolutelyuseless, soIdon’tgo.Idon’t thinkyou’ll findmanypeoplewhoareinvolved inthisplant-foodsmovementspendingmuchtimeindoctors’offices.Probablythefurtherawayyougetfromdoctors,thebetteroffyou’regoingtobe,inmostcases.

GM: All right, let me play devil’s advocate here. I’ve always gone for annualcheckups.Formanyyears,mycholesterolwasabout160orsoandthenitstartedcreepingup.Itoldyouthestoryabouthow,alittlebitmorethanayearago,itwentashighas212.That’swhenIspoketoDr.McDougall.Hetoldmetocutoutthefructose;nowI’mbackdowntomynormallevelsagain.IfIhadn’tgonefor an annual checkup, I wouldn’t have known I was at 212. I would havethought,“Gee,I’monagreatdiet.I’mfine.”Iwouldhavecontinuedeatingmyfewcookies in theeveningandmysweetenedsoyyogurtandso forth. Ihadasignificant problem brewing and I learned about it only from my annualcheckup.

PP: First of all, you’re a littlemore enlightened than the average person, andhavebeenforquitesometime.Second,youdidn’thaveadoctor,obviously,whowastryingtogetyoutodomorethanjustcomein,checkin,getabloodtest,andgohome.Third,youwereluckyenoughtobeabletodiscussyourproblemwithDr.McDougall.

You’re not the one I’m concerned about, Glen. I’m concerned about theaveragehealthymalewho showsup and thedoctor says, “Let’s do a prostate-specificantigen(PSA)testbecauseyou’regettingtothatagewhereyououghttohaveone.”SoyougetaPSAtestandit’salittlebitelevated.Soontheyidentifyafew cancer cells and you’re rushed into having a prostatectomy. Now, in alllikelihood,ifyouhaddonenothing,ifyouhadneverknownaboutthosefunnycells,youwoulddiewiththatcancerattheageofninety-seven—diewithit,butnotofit.

I’mconcernedabout thewomanwhogoes to theOB/GYN’soffice forherannualcheckup,andthedoctellshersheneedsamammogram.Asaresult,theydiscover a carcinoma in situ and next thing you know, she’s labeled a cancerpatient.Shehassurgery,she’stakingtamoxifen,andshe’shadenoughradiationto increaseher riskof aheartdisease significantly.Those are themore typicalscenarios,whichiswhythewholesituationissoinadvisableforpeople.WhatItellpeopleis,firstofall,learnwhattheresearchshowsintermsofresultsfromcommon diagnostic tests. Once you do, you’re likely to do none of thisdiagnostictestingthatdoctorswanttosubjectyouto,andI’mnottalkingaboutabloodtest togetyourcholesterol tested.Mygosh,youcangotoadrugstoreandgetthatdonenow;youdon’tevenneedtogotoseeadoctor.

Inmybooksandlectures,Iadvisepeopletodononeofthesediagnosticteststhatyou’rebeingpushedtodowhenyougoin,whetherit’saDexascan,PSA,

mammogram,colonoscopy,etc.;they’renotgoingtosaveyourlife.Alltheydoislead tomore tests andmore treatments thatdon’twork.Abloodpanel is fineonlyifyouareasmartconsumeraboutmedicine.Here’swhatImeanbythat.Inyourcase,yougotothedrugstore,getabloodtest,seethatyourcholesterolisup—notice that you didn’t ask your doctor what do to about it, you askedDr.McDougallwhattodo.Whatdoyouthinkwouldhavehappenediftheaveragepersonaskedthedoctorwhattodoaboutit?

GM:Probablyastatin.

PP:Yeah.Because it runs inyour family,Glen.That’s the typeofadvice thatyouwouldget.Sotobeasmartmedicalconsumer,youdecidewhatstepstotakeonyourownbehalf.Youmaywanttolookforanywaytodosooutsideofthetraditionalmedicalestablishment.

Now,ifIhadarelentlesspaininmyside,Ididn’tknowwhatitwas,anditdidn’tgoawaybyMonday,Iwouldclearlygoseeadoctor.That’ssmartmedicalconsumerism.ButshowingupinthisperfectlyhealthystatethatIamintosay,“Listen,IjustwantyoutopokeandprodandtellmethatI’mokayafterasmuchpoking and prodding as you can getmy insurance company to pay for,” well,that’swheretheproblemis.

GM:Soyoubelieveingoingtodoctorsifyoufeelpainorifsomethingunusualisgoingon?

PP:Ofcourse.Awomaninherthirtiesmissesfourmenstrualperiodsinarowandshe’snotpregnant—Ithinksheoughttocheckitout.

GM:At that point, do you dowhatever tests the doctor orders?Howdo youmanagethisrelationshipwiththedoctor?

PP:Youshouldaskalotofquestions,butdon’tconsenttoanythinguntilyouhaveacompleteunderstandingofit.Yougotothedoctorandsay,“Look,I’vegotthispainonmysideandIcan’tfigureoutwhatitis.”Andshesays,“Well,weneedtodosomeimaging.”Okay,well,whatkindofimaging?ShemightsayaCTscan,butifyouinvestigateCTscans,youmaydecidethatthat’swaytoomuchradiationand thatyou’llprobablybebetteroffwithanMRI.Whatyoureallywanttodoisgatherinformation.Ifyoudon’tknowtheanswerstosomeof

thesequestions,gohome,dosomeresearch,andthendecidewhatyou’regoingtodo.I’mnotsayingyoushoulddillydallyforanotherninemonths—youmaybeonafairlytightscheduleofneedingtofigureoutwhat’swrong—butyoudon’tjustdowhatyou’retold.Somedoctorswilltestyoutowithinaninchofyourlife.Again, the worst thing you can have if you walk into a doctor’s office or ahospitalisgreatinsurancebecausethey’regoingtouseit.

GM:Whatiftheyfindatumorandsayweneedtooperateimmediately?

PP:Thenumberoftimesthataconditionissolife-threateningthatwefindoutaboutitthisafternoonandweneedtohavesurgerytomorrowmorningissuchatinypercentagethatitisn’tevenworthtalkingabout.Yousay,“Great,I’dliketohave any images and any other information that you can giveme so that I’mreallyclearonwhat’sgoingonwithme.”Takenotesandthensay,“Thankyousomuch,I’mreallygladwe’vegottentothebottomofthis.PleasetellmewhatyouthinkIoughttodoandI’mgoingtotakerealcarefulnoteshere.Bytheway,pleaseunderstandwhenyou’retellingmewhatyouwantmetodo,Iwouldlikesomeoutcomes and expectations in absolute rather than relative terms. Iwantyoutotellmethestraightstory.I’mgoingtogocheckthisoutwithsomeotherpeople, get someotheropinions frompeoplewhohavedifferent tools in theirtoolbox,andthenI’mgoingtomakeupmymindaboutwhattodo.”Andthat’swhen you get in touch with somebody like me or Dr. Ralph Moss or Dr.McDougall, get some other points of view, and thenmake your best decisionaboutwhatyouthinkisrightforyoutodo.Don’tgetherdedintosometypeofprocedurewithoutlookingintoitfirst.

GM:Okay.WhatifawomanhasaPaptestandtheyfindprecancerouscellsonthecervix,dysplasia, andshe’s told sheneedsaLEEPConebiopsy? Isn’t thatpotentiallyalifesaver?

PP:Well,yes,butthere’salsoagoodchancethatthetreatmentshewasgettingfromtheOB/GYNcauseditinthefirstplace;that’swhathappenedtome.

GM: Say that again?A chance that the treatment shewas getting caused thedysplasia?

PP:Yes.Firstofall,birthcontrolpillsarecarcinogens;they’refullofhormones.

We know that supplemental hormones are carcinogenic; a lot of women gettheseconditionsbytakingbirthcontrolpills.3

That’swhathappenedtomewhenIgotcervicaldysplasia.WhataddedtoitwastheterribledietthatIwaseatingatthetime;thisepisodetookplaceaboutfiveyearsbeforemyconversion.Ialsogotthehumanpapillomavirus,whichisaminorplayerinthewholething.However,allofthiscouldhavebeenavoidedifIhadbeeneatingtherightdietandhadn’tbeentakingthosedreadfulpills.Evenafter you’re diagnosedwith dysplasia, if you get off the pills, stop drinking somuchalcoholandeatingdairyproducts,andeattherightfoods,thatconditionwillrightitselfmostofthetime.

Sinceit’snotimmediatelylife-threatening,it’soneofthoseconditionswhereit’sworthittogohome,practicedietaryexcellence,dotherightthings,gobackto thedoctor in fourmonthsandhaveanotherPapsmear,andsee if it’sgoneawaybeforeyoudoanythingaboutit.KeepinmindthattheLEEPConebiopsyprocedurerequiresageneralanesthetic,somethingthat’sbesttoavoidwheneverpossible. So, in my case, not only did this doctor who did the LEEP Conebiopsy give me the birth control pills, which were a major part of why Idevelopedtheconditioninthefirstplace,butIstayedonthebirthcontrolpillsbecausehedidn’ttellmetostoptakingthem.Iwenthomeandcontinuedtoeatcheeseanddrinkalcoholandeatcookiesforanotherseveralyears.Somyriskofrecurrencewashuge;I’mluckyitdidn’thappentome.

GM:Butwouldn’tawomaninthatsituationwhodelaystheprocedurefeelthatshe’stakingariskthatitmayspreadifthedietdoesn’tcontrolit?

PP:That’swhyyouputastop-lossonit.Youdon’twalkoutthedoorandsay,“I’m just going to go changemydiet and I’mnever comingbackhere again.”Therearewaystofigureoutifit’sprogressing,stayingthesame,orregressing.Ifit’s staying the same, you don’t do anything about it because it can’t kill youunless it progresses. Medicine does have a way of quantifying the situation.That’swhyit’ssoimportanttobeknowledgeable.AtTheWellnessForum,theinformationweprovideaboutthistypeoftopicisasimportantashowtoeatthediet;ifyoudon’tunderstandhowtomanageyourrelationshipwithyourdoctor,youcouldbejustasvictimizedbythehealthcareprofessionandendupinjustasmuchtrouble.

You have to gain enough knowledge and confidence to go in and tell thedoctor, “I hear what you’re saying and I appreciate that because you have

malpracticeinsuranceandamedical license,youhavetotellmecertainthings.Goaheadandnoteitinthefile.I’llevensignsomethingsayingthatyoutoldmethisstuff.ButI’velearnedenoughaboutthisnow,havinglookedintoitonmyown,toknowthatthere’sabsolutelynothingtobelostbywaitingthreeorfourmonthstoseeifthisconditionclearsupwhenIstopfertilizingit.Iunderstandnow that I’ve been fertilizing it with alcohol, cheese, sugar, and birth controlpills. I’m going to try to protect myself now by eating a lot of whole foods,includinglotsthatarerichinfolate.”

GM: I think we need to acknowledge that one reason for overtesting is thelegitimatefearonthepartofdoctorsofmedicalliability.

PP:Certainly true, but on the other hand I accompanied a friend to theERwithasinusinfection,andthedocrecommendedanMRI—forasinusinfection.Idon’tthinkhewasworriedaboutbeingsued.Consumersshouldbeespeciallywary of doctors who do tests inside their own offices, because they have thestrongest financial incentive to overtest, but the root of the problem is deeperthanjustgreed.

GM: Let’s review different types of testing and get your opinion about theharmful effects, if any, of each type. I know that you’re an opponent ofmammograms. Is there ever a use for mammograms, or are they alwaysworthless?

PP:Iwouldneveragreetoonemyself.Ithinkthey’reworthless.

GM: Iwould imaginethat this is fairly shockingtomostwomenwhohaveallbeentoldthatmammographycananddoessavelives.

PP:Remember,though,thatthesearemarketingmessagesformammography,notmessagesreportingthescientificfindings.

Mammography ishighlyunreliable. It tends tomiss aggressive tumors thatgrow between screenings, while detecting small, benign tumors, such ascarcinomainsitu,thatareusuallynotcancersatallandareoftenreferredtoas“pseudo-cancers.”As a reminder, theword “pseudo”means “false.” It’s a falsecancer.

Inspiteofthefactthatmostofthesepseudo-cancerswillnotdevelopintoa

cancer thatwill require treatment,womendiagnosedwith themareadvised tohave lumpectomies, to receive radiation treatments, and to take drugs liketamoxifen.Thisisovertreatmentforaconditionthatishighlyunlikelytobelife-threatening.Particularly troubling ishowthesewomenareclassifiedas“cancersurvivors.” Almost all of them would be alive five years after diagnosis (thebenchmarkforsurvivalforcancerpatients)evenwithnotreatment.Thisskewsthesurvival statisticsnumbers,making it look like treatments forbreastcanceraremuchmoreeffectivethantheyreallyare.

Whilemammography detects pseudo-cancers resulting in overtreatment, itdoesnotreducetheriskofdyingfromrealcasesofbreastcancer.

A research letter published in 2001 in Lancet reported the findings of aCochrane Review that looked at the efficacy of mammograms for reducingbreastcancerdeaths.ItisimportanttonotethattheCochraneCollaborationisthemostindependentmedicalresearchorganizationintheworld,andthereforeitsconclusionsaboutvariousissuesrelatedtomedicinearetakenmoreseriouslybymanyofus.

The article stated, “In 2000,we reported that there is no reliable evidencethat screening for breast cancer reduces mortality. As we discuss here, aCochraneReviewhasnowconfirmedandstrengthenedourpreviousfindings.”4

Cochranehas further concluded that screening led toan increase in radicaltreatmentsduetooverdiagnosisof25to35percent;that49percentofscreenedwomen would experience at least one false positive; and that the absolutereductioninriskofdeathwas0.1percent.5

The Cochrane researchers also concluded that studies showing thatmammograms reduce the risk of dying from breast cancer do not take intoconsideration the deaths related to breast cancer treatments, and that morewomenareharmedfromovertreatmentthanaresavedwithmammography.Thegroups stated, “There is no reliable evidence from large randomized trials tosupportscreeningmammographyatanyage.”

Another study published online by the British Medical Journal6 wasconducted inDenmark, agreat country for studyingmammographyoutcomes.Forthepastseventeenyears,onlyabout20percentofwomeninDenmarkhavebeenscreened,leavingalargecontrolgroupfromwhichdatacanbegathered.

Two geographic areas were included in the study: Copenhagen, wherescreeningwas introduced in1991;andFunen,wherescreeningwas introducedin 1997. Between 1997 and 2005, deaths from breast cancer dropped by 5

percentforwomenbetweentheagesofthirty-fiveandfifty-fiveinbothoftheseareas.Forwomenbetweenfifty-fiveandseventy-four,thedeclinewas1percentinmortalityrate.

InthenonscreenedpopulationinDenmark,thedeathratefrombreastcancerdeclinedby6percent forwomenbetweentheagesof thirty-fiveandfifty-five,and2percentforwomenbetweenfifty-fiveandseventy-four.

Theresearchersalsoobservedthatthediagnosisofcarcinomainsitudoubledin thepopulationofwomenwhowere screenedand remained the same in thenonscreened population, reinforcing the idea that mammography results inoverdiagnosisofpseudo-cancers.

Studies even show that mammography is contraindicated for women whocarry the BRCA1 or BRCA2 gene mutation, which predisposes them to ahigherriskofdevelopingbreastcancer.Inonestudy,researchersconcludedthatmammography screening beginning at twenty-five to twenty-nine years of ageresults in a higher risk of breast cancer due to increased lifetime radiationexposure, and that mammography may have a net harmful effect for thesepatients.7

GM:Whatdoyousaytothepersonwhoreportsthatafriendorfamilymemberwasdiagnosedwithbreastcancerviamammographyanditsavedherlife?

PP: Since the data is clear thatmorewomen are harmed thanhelped, this ishighlyunlikely.Inotherwords,whathashappenedinmostcases,wherewomentrulyhavesurvivedandthrivedforalongtime,isthattheywerediagnosedwithpseudo-cancerandtreatedforit.Thetreatmentsformetastasizedbreastcancerarenotmuchmoreeffectivetodaythantheyweredecadesago.

AnotherthingIwouldaddisthat,accordingtoCochrane, if twothousandwomenarescreenedfortenyears,onewomanwillbenefitfromearlydetection.Youmayhappentoknowtheoneintwothousandwhoactuallybenefitted,butit’sstatisticallyunlikely.

One of the best resources for understanding this issue is PeterGotzsche’sbookMammographyScreening:Truth,LiesandControversy.It’satechnicalbook,butIwouldlovetoseeitbecomerequiredreadingforwomensincethisissuchanimportantissue.

GM:Let’smoveontoCTscans.

PP:Incertainsituationstheycanbevaluable,butbecausethedoseofradiationis so high, and it’s a well-established fact thatCT scans increase your risk ofcancer,8theyreallyshouldbereservedforsituationswhere it’s theonlywaytogettheinformationyouneed.They’rewayoverused.

GM:Andthey’rehighlyoverusedwithchildren,isn’tthatright?

PP:Yes.Notonlyaretheyoverusedbutthey’reoverusedonthesamepeople—individualsgettingmultiplescans.It’snotunusualtoseeCTscansthatmakethewholesituationsomuchworseforthem.CTscansshouldbethelastresort,notthefirstlineofaction;unfortunatelythat’snotthewayitgoes.

GM:MRIs?

PP:Valuable and lessdangerous.For example, in the caseofbreast cancer, itcansometimesbeavaluablewaytofindoutexactlywhat’sgoingon.Thebiggestrisk may be that because the imaging is so good, you’re going to discoversomethingelsethatyoudon’twanttoknowabout.Iwasatadinnerparty lastnightandlistenedtothestoryofawomanwhoisoneofthosepeoplewhogoestodoctorsallthetime.She’sovermedicatedanddoesn’twanttohearwhatIhavetosay,soIjustlistened.

SheapparentlygotanMRIforonereason,buttheyfoundsomethinginherbrain that they weren’t looking for. They sent her to specialists; she wentthroughninetydaysoftestingandwasscaredhalftodeath.Thespecialistsputher on Coumadin because they weren’t sure it wasn’t a blood clot, but thenfoundoutthattherewassometypeoftangledorturnedveininherbrain.Ifyouspendtoomuchtimeallowingdoctorstopokeandprodyou,you’reliabletofindoutthingsthatyou’rebetteroffnotknowing.Thelastdoctorshesawabouthercondition said, “This isn’t evenworth spending timeon.Go live your life andforget about it.”Whichwas good advice, but that’s after ninety days, $10,000worthoftests,andthinkingsheeitherhadabraintumororwasgoingtodropdeadanyminute.That’saprettyfrighteningsituationtobeinfornothingatall.

GM:Ultrasounds?

PP:Notdangerousandveryhelpfulsometimes.Thesearetheleastinvasiveofalloftheformsoftesting.

GM:There’sreallynorisktodoinganultrasound,right?

PP:Themainrisk,andthisistrueofallformsofimaging,isfindingsomethingyoumaynotwanttoknowabout.

GM:Wouldyousaythesamethingaboutultrasoundsforpregnantwomen?

PP:Today,havinganultrasoundisaroutinepartofmedicalcareforpregnantwomen.Noonequestions it,but theproblemis that itoften finds things thatlook suspicious, even when there is nothing wrong. One analysis of fifty-sixstudies showed that follow-up testing for abnormalities detected as a result ofultrasoundwouldresultinmoremiscarriagesthanconfirmeddiagnoses.9

GM: So ultrasounds aren’t inherently bad, but it sounds like they causemoreproblemsthantheypreventsometimes.Whataboutotherimagingprocedures?

PP: There is a great book on this topic by Dr. Gilbert Welch calledOverdiagnosed. I recommend that all of ourmembers read it. It describeshowimaging and testing tends to identify clinically insignificant abnormalities thatwouldbebetterleftalone,butthisisseldomtheresponsetofindingthem.Tinyabdominalaneurismsandsmallthyroidnodulesareexamplesofconditionsoftenfound in completely asymptomatic people who are subjected to testing. Allimaging, includingultrasounds, shouldbeusedwithcaution. In thebook,Dr.Welch10discusses thenewepidemicof thyroid cancer.Howdidwe suddenlyget an epidemic of thyroid cancer? Is it something in the water? No, what’shappening is that people are getting X-rays and MRIs and they’re findingthyroid cancer.They’renotnecessarily looking for it,but theyendupwithanimageofit,anyway.Alotofpeoplehavelittlenodulesontheirthyroids,whichtheynowcallcancer.TheyarethenadvisedtohavetohavesurgeryforitbecausetheAmericanCancerSocietyhasgoneallouttomakesureeverybodynowgetsscreenedforthenewepidemicofthyroidcancer!

GM:Well,Ihaveafriendwhoithappenedto.Hehadanultrasoundperformedforneckpain,andtheyfoundanoduleonhisthyroid,completelyunrelatedtothepain,ofcourse.Theydidabiopsyandtoldhimhehascancer.Hefacesthechoiceofanoperationwithseriousrisksor“watchfulwaiting.”I’mcertainhe’lloptforthe“watchfulwaiting.”Iaskedhimifhewouldratherneverhaveknown.

Hedidn’thesitateforamoment.Hewouldmuchratherneverhaveknown.Thediagnosis has taken an enormous emotional toll on him and his family, to nogoodend.

Let’smoveontoanothertest.Isthereanypointtoanangiogram?

PP:Thevalueofitreallywouldbetoscaresomebodyhalftodeath.Toputtheimageupthere,ifdoctorsdidthisright,andsay,“Seethis?Thisisgoingtokillyou.Now,medicinesaysI’msupposedtoputastentinthatartery.Icandoit,Iknowhow to do it, I’m trained to do it; I’m just telling you it’s useless, eventhoughyourinsurancecompanywillpayforit.Oryoucanchangeyourdiet.Ifyou don’t change your diet, this is going to kill you.” So it has some value intermsofscaringpeoplealittlebit,ifdoctorswouldbewillingtoengageintheright conversation with their patients. Unfortunately, that’s not what they’redoing.

GM:Okay,ifsomebodywashavingchestpainandwaswillingandeagertostartachangeofdietandlifestylethatyouwouldendorse,wouldtherebeanypointinhisdoinganangiogram?Orshouldhejustgetstartedeatingalow-fat,plant-baseddiet?

PP:He should just start eating the low-fat, plant-based diet.Now, there arefactorslikehowmuchchestpain,wasthereamyocardialinfarction,havetherebeenpreviousevents?It’shardtoanswerthesequestions ingeneralbecause, intherealworld,they’realwaysspecific,whichiswhypeoplereallyshouldconsultwithamedicaldoctor.Butifyourcurrentdoctorwon’tdiscusstheimportanceofdietandwon’tevenentertaintheideathatyouateyourwayintocoronaryarterydisease andwill probably be able to eat your way out of it, youmaywant toconsider finding another doctor. There are docs who aremore open-minded,eveniftheydon’tcompletelyunderstandtheissueswe’vebeendiscussing.

GM: Are there any times you feel a situation is so severe that, even thoughthey’regoingtoeattheirwayoutofit,itmighthelpthemnowtohaveeitherasurgicalinterventionorapharmaceuticalintervention?

PP:Yes.Ifthereisseveredamagetotheleftventricle,I’dthinkwe’dallagree,thenbypasssurgeryisprobablyvaluablethen.Theotherisrelentlesschestpain,which is not usually theway thesepatients present.Theyusually presentwith

intermittent chest pain or pain from exertion. But if somebody has constant,relentlesschestpainanditkeepshimfromsleeping,Ithinkthatpersonshouldbeinthecareofagoodinterventionalcardiologistbecausesurgeryisneeded.Iwouldendorseitunderthatscenario.

Thereare fewdrugsor surgeries that Iwould sayhaveabsolutelynovalue.It’sthemisapplicationofthemthatcausesmetosaythethingsthatIdo.Idon’tthinkweshouldeliminatebypasssurgery.I’msayinginsteadofperformingfivehundredthousandofthemannually,weshouldperformaboutfifteenthousand.

GM:Whataboutcolonoscopies?DuringmyfirstcheckupafterIturnedfifty,myratherhumble andverydecentdoctor said tome, “Youknow,Glen,honestly,thereisn’talotthatdoctorscandoforpeople,butthecolonoscopyisonethingwe do that’s really helpful for the general public. I recommend having one atfifty.”AndIsaid,“Well,arethereanydownsiderisks?”Hesaid,“Occasionally,weperforatethecolon.”Isaid,“Hey,it’sbeenverynicevisitingwithyou,doc.”

PP:They’venowfoundoutthatthecolonoscopyisnotanymorevaluablethanasigmoidoscopy.AcoupleofresearchersatColumbiaUniversitylookedatthreedifferent studies and determined that a colonoscopy does not offer anyadvantages over a sigmoidoscopy.11However, it does offer significantlymorerisk,andthepleasureofatubeupyourrectum,ifthat’ssomethingyou’vealwayspinedfor.

GM:Exactlywhatisasigmoidoscopy?

PP:Sigmoidoscopyinvolvestheuseofaflexibleendoscope.Itprovidesaviewofthe large intestine from the rectum to the sigmoid, themostdistalpartof thecolon.Itdoesnotallowexaminationoftheentirebowel,buttheportionthatisexaminediswherecolorectalcancerismostlikelytooccur.

GM:Soshouldpeopledoasigmoidoscopy?

PP:Iwouldn’thaveone.Byeatingahigh-fiber,low-fatdiet,peoplewillreducetheirriskofcoloncancerasmuchastheypossiblycan.

GM:What’sthevalueofaPSAtest,inyouropinion?

PP:Zero.Worthless.Andthat’snotjustmyopinion,that’salsotheopinionofDr.RichardAblin,whodiscoveredthePSAprotein.Tohiscredit,he’ssaidthathe didn’t realize that his discovery would lead to “the overdiagnosis, theovertreatment,andthebillionsofdollarsthatarebasicallywastedonatestthatcan’tdowhatit’spurportedtodo.”12

Furthermore,theU.S.PreventiveServicesTaskForcehasnowsaidthatPSAtests are useless andmen should not have them. The task force’s conclusionswerebasedonfiveclinicaltrialsthatshowedPSAtestingdoesnotsavelivesandthat having the test leads tomore tests and treatments that cause impotence,incontinence,andothersideeffects.13

Theleadresearcher,Dr.VirginiaMoyer,stated,“Unfortunately,theevidencenowshowsthatthistestdoesnotsavelives.Thistestcannottellthedifferencebetweencancers thatwillandwillnotaffectamanduringhisnatural lifetime.Weneedtofindonethatdoes.”

GM:AndtheDexascanforosteoporosisisworthless?

PP:Completely.

GM: How about genetic testing to find out if you have the genes for breastcancerorsomething?

PP:Harmful,terrible.Itlabelspeopleaspatients.Itturnsthemintovictims.

GM:Thecase forgenetic testing is that it simplymakespeopleawareof theirriskprofile.

PP:Yeah,andthenyouhavetolivewiththatinformation.I had amember who recovered from an autoimmune disease who’s doing

quitewell,actually.Shehasbeenpracticingdietaryexcellence.Hersisterdiedofovarian cancer, so her family andher doctor pressuredher to undergo genetictesting.Theyfoundthatshehadthegenemutationthatpredisposedhertohaveovariancancer,sothedoctorremovedherovaries.Whiletakingthemout,theyfound out that she had some diverticular pouches, so they recommended acolonoscopy.

She asked me for my opinion. I said, “I want you to think about what’shappened in the last thirty days. You were happy, living your life with two

ovaries; now you’ve had two ovaries removed and the doctor wants to do acolonoscopy.Whenareyougoingtostopthis?Howmuchmoreareyougoingtoletthemdotoyou?Youhavetwowell-formedbowelmovementseveryday;youhavenobowelproblems.Thosediverticularpouchesareprobablyleftfromthedayswhenyouwereacheeseeater.”

Iftheseinterventionsjuststoppedwithnotifyingsomeonesheiscarryingthegenemutationandshecouldputitinthebackofherheadandforgetaboutit,thatwouldbegreat.Butnobodyputsitinthebackofherheadandforgetsaboutit.Wethinkwehavetodosomethingaboutit.Humanbeingsaredesignedandengineeredtosolveproblems;generallyspeaking,that’saprettygoodidea.IfIhave a flat tire, Ineed toget anew tire;we’vegot to solve thatproblem.Butwhen you get into a lot of these testswith their dubious results about geneticpredispositions,allyou’redoingisputtingterriblestressonpeoplewhoarenotmedicallyknowledgeable.Youmaybesolvingaproblemyoudon’thave.

GM:WhataboutPaptests?

PP:WhileIdon’topposethePaptestasmuchastheothers,itsimportancehasbeenoverstated,andthetesttoooftenresultsinovertreatment.AccordingtoDr.WelchinOverdiagnosed,afifteen-year-oldgirlwhohasannualPaptestshasa75percent chance of eventually having a colposcopy14 (the procedure to biopsyabnormalcells).Thereisnowatchfulwaitingordietarychangerecommendedinresponse to an abnormal Pap, and the treatments range from simple freezingwith local anesthesia in the doctor’s office to hysterectomy. The AmericanCollege of Obstetrics andGynecology now recommends that screenings startmuchlaterandbeperformedlessfrequently.15

GM: Iwonder if the tide is turning.Ninemedical societies, takingpart in aninitiativeofagroupcalledChoosingWisely,havecomeupwithalistofforty-fivedubiousmedicalservices,mostinvolvingtesting.16,17

PP:That’salongoverduefirststep.

GM: Let’s turn to mental health. Can diet be related to the condition ofdepression?

PP: Itcanbe.First, therearea lotofpeoplebeingdiagnosedwithdepressionwhoareeatingaterriblediet;they’redehydrated,sedentary,outofshape,tired,have no energy, have low sex drives, sleep poorly, and suffer other relatedsymptoms. These are also common symptoms of depression. I think somedoctorsarequicktolabelpatientsasdepressedwhenthereareotherthingsgoingon.Sometimesanoptimaldiet,drinkingadequatewatereveryday,andexercisewillcausethepersontofeelbetter,tohavemoreenergy,feelmoreclearheaded,sleepbetter,haveanimprovedsexdrive,andothernoticeableimprovements.

Thenwehavepeoplewhoaredepressedforvisiblereasons,suchasthelossofa loved one or a job. We are labeling everyday stress and disappointment asdepressionandmedicatingpeopleforit,whenwhattheyreallyneedisjusttimetoprocesstheiremotions.

Evenforthosewhoaretrulyclinicallydepressed,dietisimportant;theywillfeelbetterandthinkbetter,whichwillhelpthemtogetmoreoutoftherapyandto resolve their problems. Of course, nobody is saying that diet is the wholeremedy;atrulydepressedpersonwon’tovercomehisissueswithbroccoli.

For the clinicallydepressed, therapycanbehelpful if it is the right typeoftherapy. I recommendCognitive Behavioral Therapy (CBT), which has beenshown to be very effective for treating conditions like depression, anxiety,ADHD, and othermental and emotional disorders. Itworks quickly—usuallyfourteensessionsorso—there’savery lowrecidivismrate,anddrugsare rarelyused.ThetherapistswhopracticeCBTaretothemindandemotionswhatDr.CaldwellEsselstynandDr.McDougallaretothecardiovascularsystemandtheendocrinesystem.

Ifyouseekhelpfordepression,Ithinkthefirstthingyoushouldsaytoyourdoctoristhatyou’renotinterestedinapharmaceuticalsolutiontoyourproblem.You’reinterestedintalkingandworkingyourwaythroughit.Psychotropicdrugsare beingdispensed like candy in this country and their side effects, includingaddiction,canbehighlydestructive.Youwanttoavoidthematallcosts.

GM:Whatdoyouthinkunderliestheoverprescriptionofantidepressants?

PP:There’sarealarrogancetodaytothepracticeofpsychiatry.Rightnow,weknow that taking antidepressant and antianxiety drugs not only increases yourrisk of suicide but theyultimatelymakepeoplemoredepressed.18That’s whypeoplehavetotakemultipledrugs,whichhavetobeconstantlyswitchedouttobeeffective.Fortypercentofthetime,there’sabsolutelynoresponsetothedrugs

at all,19 other than the depression getting worse. However, it doesn’t stoppsychiatristsfromprescribingthem.Thetrendinthepsychiatricprofessionistodolessandlesstalktherapy,sotheprofessionisnowattractingpeoplewhodon’tlikepeople.Theyhavenointerestinrelatingtopeople;theydon’twanttotalktothem,andtheydon’thavetotalktothem;theyjustprescribedrugs.

Doctors are very smartpeople,but I thinkmany timeswe’re admitting thewrongpeopletomedicalschool.We’rebringingpeopleintotheprofessionwhoareverybrightandtechnicallyveryproficient,buttheydon’thavetherightideaaboutwhatmedicalpracticeshouldbeabout:preventing,stopping,andreversingdisease.So theygo toworkeveryday andgetused to the idea that everybodygets worse, everybody has to have more drugs, everybody has to have moreprocedures.Mostofthemarestillmakingalotofmoneyanddon’treallyhavemuchinterestinchanginganything.Isuspectthatmanyofthemlikeremainingignorant. When confronted with evidence, they’ll get upset about beingconfronted,butmanywilljustcontinuetodowhatthey’redoing.

GM: You know, you’re remarkably antidrug and antisupplement for awomannamed“Popper.”

PP:MaybeIovercompensate.

GM:Out of curiosity, whenwas the last time youwent to amedical doctor,Pam?

PP: Thatwas in 1994, about nineteen years ago.A cat bitme, and I got aninfection.Iwent toadoctor, toldhimIneededanantibioticandwhichoneIwanted,andgotoutofthereintenminutes.

I want to make it clear that I have nothing against doctors. I’ll go backpromptlythenexttimeIneedone.

7

PROVINGTHECASE....................................

GM: Before we discuss specific clinical evidence, let’s talk about the fact thatpeople are understandably confused by studies. You hear on the news thatvitaminEisgoodfortheheartandthenyouhearthatvitaminEisn’tgoodfortheheart.Oryouhearthatfishoillowerscholesterolandheartattacksandthenyouhear that itdoesn’t.Whydoweget contradictory results?Canwebelieveanyofthesestudies?

PP: The first thing that I tell everybody when I’m giving public lectures, orwhen they joinTheWellness Forum, is that you should always look at everystudywith some skepticism.No studyby itself is really important; it’s a studytakenintoconsiderationwiththepreponderanceoftheevidencethateitheraddsweighttoitsimportanceorcompletelydiscountsitaltogether.Forexample,thedairy industryputout a study—yes, it actuallydid commission sucha study—thatshowedthatdairyhelpspeopleloseweight.Soyoureadtheheadlinesandyou think, “Gosh, I’dbettergoget some ice creamandcheese to slimdown.”Butifyoulookatallofthestudiesthathavebeendoneonthetopic,andthereareacoupledozenofthem,onlyacoupleshowthatdairyhelpsyouloseweight.And, oh, by the way, they were done by the same guy at the University ofTennesseewhowaspaid$1.7millionbythedairyindustryforthosestudies.Ontop of which, it’s patently illogical that calorie-rich, dense, fatty foods shouldhelpanyoneloseweight.

And so when we take a look at all of the rest of what’s out there, thepreponderance of the evidence says these two studies are irrelevant.Then let’stake an opposite example. Dr. Caldwell Esselstyn’s study shows that you canreverseheartdisease,stopitsprogression,andactuallyreverseitwithdiet.Thatalone isprovocative,but thenyouadd in theChinaStudy, you lookat all thepopulationstudiesthatshowthatpeoplewhoeatmoreofaplant-centereddiethavelessheartdisease,andyouaddintherestofwhatweknow,suddenlythatone studywitheighteenpatients starts to seemsignificantlymore important. Itellpeoplenottogetcarriedawaywiththelateststudyorthelatestheadline,buttotakeadeeperlookandusetheirbrainswhentheyreadsomethingthatsoundstoogoodtobetrue.

Therearealsoways,whichweexpounduponinoneoftheclassesweofferfromtimetotime,tosortthroughnutritionalconfusionwithresearch.Weshowpeople how to evaluate research and go through why they don’t need to beconcernedwithshort-termchangesandbiomarkersthatmaynotbesignificantfor their long-term health. Remember, we live in a country where people aredyingwith excellentbloodwork, soweneed toweighmoreheavily studies ofhealthpracticesthatproduceimprovedqualityoflifeandlongevitythanstudiesof health practices or drugs that produce better biomarkers. There are someguidelines that you can use to look at research even as a layperson andmakesomeprettygooddecisionsaboutwhat’sreliableandwhat’snotreliableevidence.

GM:Howdid the researchermanage to devise two studies that showeddairyhelpsyouloseweight?Howdidherigtheresults?

PP:Well, you cando a lot of things.You cando some thingswith selectioncriteria.Forexample,ifyouwantedtoskewastudytoshowthatpeopleeatingaplant-based diet don’t fare better than people eating meat, just make theselection criteria the answer to thequestion “Doyou eatmeat anddairy?”Noothercriteriainvolved.Soyoucouldchoosetoenrollinthestudya475-poundperson(likeDelusedtobe)whowouldsay,“I’mvegan;nomeat,nodairy,nofish.”Obviously,he’sdoingsomethingwrongorhewouldn’tweight475pounds,sohe’sprobablygoingtobeworseoffthanthemeateaters.Youthenpublishastudythatstatesaplant-baseddietisn’tveryhelpful.

One thing that the drug companies do is recruit what we call “perfectpatients.”Let’s say theyneed to find1,700peopleoutof themore than threehundredmillioninourpopulationtodoastudyonanewcholesterol-lowering

drug.Sincetheywanttominimizethesideeffects,theyfind1,700peoplewhohavehigh cholesterol diagnosed for the first time recently andhave absolutelynothingelsewrongwiththem.Theresearchersputtheseperfectpatientsonthedrug;theircholesterolgoesdownwithminimalsideeffects.Oncethedruggetsapproved, that’snothow thegeneralpublicwill use it.Thedruggetsusedbymanypeoplewhoaretakingfourorfiveotherdrugsandhavelotsofotherthingswrongwiththem,includingsideeffectsthataresignificantlymoresevere.

Anotherproblemwithstudiesisthattheresearchcanjustbeplainsloppy.Ihatetosaythat,butinthisdayandage,particularlyifthere’sindustryfunding,thestudydesignisnotcarefullyscrutinized.Anduniversities,inmyopinion,aresimplyhappy to seemoneycoming in.A lotof these researchershave to fundtheirowndepartmentsoroffices,sothe lureofmoneytoproduceastudythatshowsacertainresultcanreallyleadtosomesloppystudydesign.Theycanalsoskewtheinterpretationoftheresults;thestudymaynotactuallyisolatedairyasacausativefactorinweightloss,ortheresultscanbesovagueorinsignificantastonot make any difference, but it can be reported in relative terms as if it’ssignificant.

And then the study may only see a two-pound difference in weight lossbetweentwogroupsbut it isreportedaspeoplewhoeatdairyproducts lost50percentmoreweightthantheothergroup.Well,thefirstgrouplostfourpoundsandthesecondgrouplostsixpounds,whichis50percentmore,butit’saprettymeaningless number. There are all kinds of things that researchers can do,rangingfromselectioncriteriaforthesubjectstohowtheydefineandmeasuretheoutcomeandatwhatintervalstomeasureit,tohowtheyreportthefindings,whethertheyareframedinabsoluteorinrelativeterms.

Sometimes, too, you can portray an apparently positive outcome withouttakingthenegativeconsequencesintoconsideration.TheobviousexampleinthedietbusinessistheAtkinsDiet.PeopleloseweightontheAtkinsDiet,buttheyalso get sick. I’ve always said if the only thing we’re considering is that “itworks,” then let’s throw ineverything thatworks.Cocaineaddictionworks forweightloss.I’vehadlotsofcocaineaddictsinthisofficeovertheyearsandtheywereallskinnypeople.Now,wecanallagreethatcocaineaddictionwouldbearidiculous approach to weight loss. Well, so is the Atkins Diet in terms ofadversehealtheffects.

GM:There’salsothematter,whenanisolatedfoodordietisbeingstudied,ofwhatkindofdietit’sbeingcomparedto.Veryrarelyarestudies,let’ssayofdairy

or fish consumption, compared to a low-fat, plant-based diet; it’s alwayscomparedtothestandardAmericandiet.

PP:Yeah,that’sabigissue.Andevenwhentheydouseacontrolgroupthatiseatingaplant-baseddiet,or theyconsider that the interventiondiet, it’snotawell-structureddiet.Ourchefatehiswayto475poundsonaplant-baseddiet.Justgivingupmeatdoesn’tmakeyouahealthyeateratall;ithastogobeyondthat.That’swherethecomparisongroupcanmakeallthedifferenceintheworldintermsofshowingaresult.

Take Loren Cordain, the guy who promotes the Paleo Diet. One of thereasonshisdietlookssogoodwhenhetellsstories(andhedoesn’tusealotofresearch—he tells a lot of stories) is that he takes people who are eating thestandard American diet, which includes fast food and cheese and pizza andtoasterpastriesandallthisstuffyoushouldn’teat,andputsthemonthePaleoDiet, which is heavy on meat, vegetables, and fruit. And they generally getbetter,sincethey’vecutoutdairy,refinedsugars,andalotofprocessedfoods.Soyouconclude,“Mygosh,thePaleoDietisspectacular.”Well,thePaleoDietisspectacularcomparedtowherepeoplewerebefore,butintermsofcomparingittopeopleeatingthedietthatIrecommend,it’snotspectacularatall.Whatthecomparisongroupisdoinghelpsdeterminethevalueofthesestudies.

GM:Ioncecalledtheleadresearcherofastudythathadledthenationalnews;thestudywasthathighprofile.Thiswasa2002studypublishedintheJournalofthe American Medical Association that found that dairy consumption reducesinsulinresistancesyndrome.1 I found that very remarkablenews, the idea thatdairycouldreduce insulinresistanceandthereforereducediabetes.Here’showthe lead scientist designed the study: it was a self-reporting study; he dividedfoods people ate into three categories: dairy, non-dairy, andmixed.He didn’tincludedatafromthemixedgroupinhisstudybecause,well,Iguesshefoundmixed foods inherently ambiguous. It turns out that cheeseburgers wereconsideredmixed.Macaroniandcheesewasmixed,andsoweredouble-cheesepizzas;noneofthatwasconsidereddairy.Imean,ifadouble-cheesepizzawasmixed,Iwondered,thenwhatwasconsideredpuredairy?

PP:Maybedeep-friedbutteronastick?

GM:Yeah,maybedeep-friedbutteronastick,althoughthesugaryglazecould

make it amixed dish. You know, these are the kind of questions that only ahighlytrainedscientistcananswer.Thereareclearlysomenuanceddistinctionsherethatareovermyhead.ButI’mprettysurethatifyousuckleddirectlyfromtheteatofabovine,itwasconsidereddairy.

I called the man up and said, “Look, you’re claiming with evidence thatexcludes pizza and many other cheesy foods that insulin resistance can bereduced with dairy. Since you want to isolate the effect of dairy on insulinresistance,whydon’tyouactuallydoastudythatcomparespeoplewhoeatdairyinallitsforms,includingpizza,withpeoplewhoeatnodairyatallandlookattheresultsthere?”Andhesaid,“Hmm,that’saninterestingidea.”Likeittookremarkableinsighttocomeupwiththat.ButIdon’tbelievehe’severdonethatstudy.

PP:Becauseit’ssomethingthatthedairyindustrywouldneverfund.

GM:Infact,IbelievehisstudyhadbeenfundedinpartbyGeneralMills.Okay,let’stalkaboutsomestudiesthatyoufeeldohavevalue.

PP:Well, let’s startwith theworkofDr.Esselstyn that Ialluded toearlier. Iwanttostartwithhimbecausehisworkhasrightlygarneredsomuchattention,leadingBillClinton to essentially adopt the dietwe recommend.What I likeabout Dr. Esselstyn’s results is that they’re based on clinical practice; they’reclear,impossibletodispute,andreallyunimpeachable.

Backinthemid-1980s,Dr.Esselstyntooktwenty-fourcardiacpatientsandaskedthemtofollowalow-fatvegandiet.Therulesofhisdietweresimple:noanimalfoods,nooil,norefinedgrains,andnonuts.Hedidnotaskhispatientstoeliminatealcohol.About9to12percentofthecaloriesinthedietwerefromfat.Itturnedoutthateighteenofthetwenty-fourpatientswerecompliantwiththediet.Thoseeighteenvery sick individuals, someofwhomhadbeenallbutgivenupfordeadbystandardmedicalpractitioners,hadcollectivelyexperiencedforty-nine cardiovascular events in the eight years before they adopted Dr.Esselstyn’sdietregimen.Therehadbeenfourheartattacks,threestrokes,sevenbypasssurgeries,andnineofthepatientssufferedfromincreasinganginaattacks.

After dietary intervention, the blood cholesterol of the compliant patientshaddroppedfromanaverageof246mg/dltoanaverageof137mg/dl.2Follow-up angiograms determined that not only had the progression of disease beenreversed in all patients but at least eight had actually reversed their disease,

meaningthattherewasasignificantopeningoftheircoronaryarteries.Withtheexceptionofoneparticipantwhostoppedbeingcompliantwiththedietsixyearsintotheprogram,therewerenonewcardiaceventsinanyofthepatientsduringthefirsttwelveyearsoftheprogram.

Now consider the odds.What are the chances thatDr. Esselstyn just gotluckyandhiseighteenpatientsbyrandomchancehappenedtogethealthyandavoid cardiac events for the twelve years onhis diet after theyhad collectivelysuffered forty-nine of them in the prior eight years? For any single individualwhohadhadseveralcardiaceventsintheprioreightyears,youmightestimatehischancesasbeingoneintenthathe’dmanagetosurvivethenexttwelveyearswithoutanothersuchevent.Forthattohappentoalleighteenindividualsbasedonrandomchance,you’dbelookingatoddsofonein10tothe18thpower.

Theefficacyofthedietbecomesclearerstillwhenyoucomparetheresultsofthoseeighteencompliantpatientswiththesixwhodroppedoutofthestudyinthefirstyearorsoandwentbacktotheiroldwaysofeating.Whathappenedtothemwasjustwhatyou’dexpect.ReviewedbyDr.Esselstynin1998,theircasesof heart disease all progressed, and they had four more bypass operations,increasingangina,heartfailure,andonedeath.Soit’sjustnotpossibletomakethecasethatitcouldhavebeenanythingotherthandietthatwasresponsibleforthe remarkable results thatDr.Esselstyn achieved. It’s alsoworth noting thatDr. Dean Ornish has conducted similar studies, with a slightly different butsimilarlylow-fatdiet,andmoreemphasisonlifestyle,andachievedcomparableresults.AsDr.Ornishoncesaidaboutthequestionofevaluatingstudies,“Themoresignificantthedegreeofchange,themorelikelyitisthatthechangeisnotduetochance.”3Well,thedegreesofchangeinhealthoutcomesthatbothDr.Esselstyn and Dr. Ornish have achieved in clinical studies have been highlysignificantandparallel.

GM: So the efficacy of diet has been proven, but do we have studies todeterminehowimportantarolegenesplay?

PP: Yes.Many studies have demonstrated that genes are less important thandiet.Thisisanimportantideatocommunicatebecausemanypeoplehaveaverydefeatist attitude about their health that gets reinforced by their very learnedcardiologists and other medical doctors who say, “Well, it’s certainly notsurprising that you’ve developed diabetes. I’ve been treating your mother fordiabetesforthelastfifteenyearsandyourgrandfatherdiedofit.Ofcoursethis

was destined to happen to you, and because you’re a helpless victim of thisrelentlessdisease,wehavetoputyouonthesemedications.”

It’softenoneofthereasonswhypeoplewon’tseekcarefromsomebodyelseor get a second opinion; they just think they’re stuckwith it. I see thiswhenpeople come todinnershere atTheWellnessForum.They’ll come as a guestwithsomebodyelse;theyreallydon’tknowmuchaboutwhatwedoandthey’rejust flabbergasted to find out. They’ll raise their hands and say, “I have highcholesterolandI’vedonethedietthing;I’vetriedeverythingandIjustcan’tgetmynumbersdown.I’vebeentakingstatindrugsandmydoctorsays that’s justthe way it’s going to be. Now you’re telling me that you can get rid of thatproblem?”WhenIestimatea95percentchancethatproperdietwillridthemofthatproblem,theyalmostcannotbelieveit.It’sbreathtakingtothem.

It’s very important that people understand thedifference betweenhaving agene and genetic expression, and the effect that your behavior has on theexpression of certain genes, including those that predispose you to developingdiseases.Wehavelotsofevidence.

First, we have migration studies that have shown that when people movefromoneareatoanotherandstarteatingthetypicaldietoftheirnewhome,theysoonhavethesamediseaseriskoftheareatowhichtheymoved.4Forexample,Japanese women in the United States are significantly more likely to developbreastcancerthanJapanesewomenlivinginJapanandotherAsiancountries.5OneofthereasonsisthatthetraditionalJapanesedietislowerinfat,particularlysaturatedanimalfat, thanthetypicalWesterndiet.Inthe1940s,breastcancerwasrelativelyrareinJapan;atthattime,theJapanesedietwascomprisedoflessthan10percentofcaloriesfromfat.6ButwithinashorttimeaftermovingtotheUnitedStates,JapanesewomenhavethesameriskofbreastcancerasAmericanwomen.

Theirgeneticmakeupdoesnotchangeas they flyacross theocean to theirnewhomes;themaincauseistheincreaseinconsumptionoffat,particularlyfatinanimalfoods.Theirbehaviorchangeswhentheygethere—that’sthecauseoftheir health deterioration. One of the first such studies was published in theJournaloftheNationalCancerInstitutein1968;itdemonstratedthatwhenpeoplemigratefromoneareatoanotherandadoptthetypicaldietintheirnewhome,theyacquirethediseaseriskoftheareatowhichtheymigrated.7

Therearesomeinterestingpopulationcomparisonsthathavebeendone.OneoftheminvolvesthePimaIndians,whoareessentiallydividedintotwogroups:

one leads amostlyWesternized lifestyle inArizona, consuming adiethigh inanimalproteinandfat;theothereatsamoretraditionalIndiandietinMexico:agrainandstarch-baseddiet,withpotatoes,corn, rice,beans,and locallygrownvegetablesandfruit—adietwithmorethanfiftygramsoffiberperday.Sotheyhave the same ethnicity, essentially the same genetic makeup, and are closegeographically,yetwefindahugedifference in thediabetes ratesbetweenonegroup and the other.Naturally, the farworse outcomes arewith theWesterndietandlifestylehabits.

GM:Howbigisthedifference?

PP:Diabetesratesareabout38percentintheArizonaPimaand6.9percentintheMexican Pima, according to the 2006 study published inDiabetes Care.8That’sabigdifferenceforpeoplewhoareessentiallyethnicallyidentical.

Wehavetoeducatepeoplequiteabittogetthispointacross.I’lltellyouanareawhereitaffectspublicpolicy.Thiswayofthinkingisgoingtotakealongtime to shift, but controversy arises when insurance companies and othercompaniesseektorewardpeoplefor improvingtheirhealthand losingweight.Therearealwaysthosewhoobjectthatcompaniesarediscriminatingwhentheyreward people for improving their health, since they see people as helplessvictimsof theirgenetichistory. Ifweassume thatpeoplehavenocontrolovertheirownhealth,itseemsunfairtorewardthosewholoseweight.Howthendowecompensate thepeople thatcan’tpossibly loseweightbecauseeverybody intheirfamily’soverweight?Well,thisisthedefeatistprevailingwisdomoutthere.Weneed to tell employers that for thevery tinypercentageof employeeswhoactually can’t change their health status, then we agree—they shouldn’t bepenalized.But for the rest of the groupwho can do something about it, theyshouldberewardedfordoingitandpenalizediftheydon’t.That’sanareawherethis misconception about genetic predisposition really influences what can bedoneinthepublicarena.

GM: Let’s move on to supplements, since a lot of studies are designed todemonstratewhetherornottheyprovideabenefit.

PP:Whatwefindisthattheweightoftheevidenceshowsoverandoveragainthatsupplementsfailtoprevent,stop,orreverseanydisease.Sometimesthey’reevenharmful.Theadvocatesofthesupplementsarenotusuallytheconventional

doctors,butrathercomplementaryandalternativeandintegrativepractitioners,whoIrefertoas“holisticpharmacists.”Theyaregainingmoretractioneverydaybecause of dissatisfaction with the traditional medical community. Thatdissatisfaction iswidespread,andI firmlyunderstand its roots.But theholisticpharmacistssaytotreatyourhealthproblemswithhealthsupplementsinsteadofdrugsbecausethey’renaturalanddon’thavethesametoxicsideeffects.

Therealityremainsthattreatingsymptomsinsteadoftheunderlyingcauseisabadidea.Youcouldarguethatsomeofthesupplementsarelesstoxicthanthedrugs,buttheystilldon’tsolvetheproblem.You’vejustgotadifferentmethodof symptom control. Second, it’s premised on the same defeatism toward dietthatconventionalmedicineoffers:peoplewon’teattherightdiet,sowehavetogivethemsupplements.Itotallydisagreewiththatwholelineofthinking.Andifyou lookat the studies, theyclearly showthatyoucannotmakeup foryourdietaryindiscretionsbypoppingacoupleofvitaminpillsinthemorning.Muchof the public has bought into the attitude toward supplements that they’reharmless.Eveniftheydon’thelpyou,theybelieve,supplementsaren’ttoxic;theworst-casescenarioisthatyouendupwithexpensiveurine.Istillhearalotofcommentslikethat.

Infact,therewasahugestudyreportedintheBritishMedicalJournalin2006that looked at tens of thousands of participants and addressed the issue ofwhetherornotomega-3supplementationactuallyhelps.That’sahotissuerightnow.Lotsofdoctorsarepromotingtheideathatomega-3deficiencyhastobemade up forwith supplements.The study demonstrated that supplementationresultedinnobenefits,foundnoreducedriskoftotalmortalityorcardiovasculareventsinparticipants,andcouldn’truleoutanincreasedriskofcancer.9That’sapowerful study that supportsmy premise: you can’t make up for your dietaryindiscretionswithsupplements.

ThenwehaveTheCochraneCollaboration.IlikestudiesdonebyCochranebecause, again, it’s one of the more independent groups out there. They dometa-analysesofpreviouslypublishedstudies.It’shardtofindpeopleandgroupsthat aren’t corruptedby industry influence in some formor another.This is ahuge study: sixty-seven randomized trials, with close to a quarter of amillionparticipants.Andtheresearchersconcludedasfollows:

[N]o evidence to support antioxidant supplements for primary orsecondary prevention. Vitamin A, beta-carotene, and vitamin E mayincrease mortality…. Antioxidant supplements need to be considered

medicinal products and should undergo sufficient evaluation beforemarketing.10

Andpeoplearejustflabbergastedatthiskindofstuff.YoumeanvitaminCandvitaminEmighthavemedicinalproperties, and I shouldbe careful abouttakingthem?Well,yes,aquarterofamillionpeopleinsixty-sevenrandomized,controlledtrialsisaprettygoodsample.Idon’tthinkwecanfaultthemfornothavingalargeenoughcohorthere.

Then there’s the Folate After Coronary Intervention Trial,11 a studypublished in the New England Journal of Medicine in 2004. This study tookpatients who already had stents implanted and randomized them into twogroups: one got folic acid; the other received a placebo.After sixmonths, theresultswere clear: thosegetting the folic acidhad their arteries clogging againfasterthantheothers.Thebigtake-homepointhereisthatsupplementsshouldbe treated like medicine. In that regard, they can be useful for specific andtargeted purposes. But if you’re self-medicating by buying this stuff over theInternet,throughyourneighborinamultilevelmarketingbusiness,oratahealthfood store, and you’re thinking that theworst-case scenario is endingupwithexpensive urine, you’re wrong. People really need to rethink the money theyspendonsupplementsandthepotentialdamagetotheirhealththesupplementscancause.

GM:Whenyou talk about expensiveurine, I’veoftenwonderedhowmuchofthesesupplementsarejustexcreted?

PP:Well,alotofitisexcreted.Butexcretingsubstancesnotneededbythebodycancausehealthissues,rangingfromkidneystresstoincreasingriskofdisease.TheFolateAfterInterventionTrialshowedthatpatientstakingfolicacidafterangioplasty were developing arterial thickening faster than patients taking aplacebo.Thestudywasendedearlyasaresult.

And there really is no such thing as a “natural” vitamin. In whole foods,nutrientsareallbundledup inpackageswithcoenzymes,conutrients,andthatsortofthing.Wepurifythesenutrientsandtaketheminpillform,butthefirstthingthebodystartsdoingisdrawingcofactorsoutofthecell’stissuestotrytocreate a complex that looks familiar. We’ve seen people develop what I callcompensatorydeficiencies.Apersonwill takehighlypurified isolatednutrientsandinthebody’sattemptstofindsomethingtodowiththesenutrients,itwill

actuallydepletestoresofothernutrients.

GM:Soyou’re saying thebodydoesn’t reallyknowwhat todowithadoseofisolatedvitaminEorisolatedascorbicacid?

PP: Right. The other problem you encounter is flooding the receptors. Forexample,thereareaboutsixhundreddifferentcarotenoidsinfoods.Soyoutakein amassive dose of beta-carotene, for example, and that’s one out of the sixhundred. Well, you only have one carotenoid receptor in every cell, so youoverwhelmthecellswiththismassiveamountofbeta-caroteneyou’retakingineveryday.Thenyoustarteatingactual foodandyourbodycan’tuse theothercarotenoidsyou’retakinginfromthefoodsthatyou’reeating.

GM:Howaboutsomeonewhotakestheattitude,“Well,I’llpopamultivitaminonce adayoronce aweek just in case I’mmissing somenutrients somewherethatIdon’tknowabout.”Stillabadidea?

PP:Well, the first thing I would do is laugh because nobody comes to TheWellness Forum with deficiency conditions. What, I wonder, do you thinkyou’remissing?AndtomycolleagueswhomImeetat“alternativeconferences,”whotellmethat theysupplement theirpatients, Iask, “Why?When’s the lasttimeyouhadsomebodyinyourofficewithscurvy?Howmanypeopleinourlineofworkare treatingberiberi thesedays?”All thepeoplewhoarecoming touswith health problems have diseases of excess. We’re way too worried aboutdeficiencyinaplacewheredeficiencyisjustnotanissue.ThesecondthingIaskpeople is, “Do you own stock in a vitamin company that you buy this stufffrom?”Ican’tthinkofanyotherreasontotakeit.Inotherwords,wedon’thaveany evidence showing that this helps people in any way in the long term, sounlessyouownstockinthecompanyandit’syourwayofsupportingitsefforts,Idon’tknowwhyyou’dwanttowasteyourmoney.

GM:TheoneexceptionyoumakeiswithvitaminB12,right?

PP:Yes,butit’sverymisunderstoodbecausemostpeopleassumethatassoonasyouadoptaplant-basedorvegandiet,B12deficiencyisanimminentrisk.WeseeB12deficiencies, and I dohere,muchmore inmeat eaters thanwedo in

planteaters.Andthereasonis,whilethey’retakinginalotofB12intheanimalfoodsthatthey’reeating,theyarenotoriousforhavinggastrointestinalproblems,whichrangefromsimpleconstipationtoseriousinflammatoryboweldiseases.Alot of times these people are deficient in intrinsic factor, which is a proteinmanufacturedinthestomachthathelpswiththeabsorptionanduseofB12.SoyoucanbetakinginplentyofB12andnotusingitwellatall.Havingsaidthat,mostpeoplewhoeataplant-basedorvegandietareeatingsomefortifiedfoods.We’reconsumingplantmilksthatarefortifiedwithB12,forexample,andB12requirements are really low. It’s not very likely for somebody to develop adeficiency.Thepeoplemostat riskare the rare individualswhoeatnoanimalfoodsandnofortifiedfoods.TheycandevelopaB12deficiency;supplementsareprobablyagoodideaforpeoplelikethat.

BeforeIwrotemylastbook,IdidsomeresearchlookingfortoxiceffectsofB12 and I couldn’t find any. I don’t discourage people who take a B12supplement theway I discourage taking other supplements because you’re notgoingtohurtyourselfwithit.SoI’mfinewithpeoplesayingthatsupplementalB12isaninsurancepolicyandtheyfeelbetterfortakingit.

GM:Ifthebodydoesn’tknowwhattodowithamassivedoseofascorbicacidorvitaminE,doesitknowhowtoprocessasuddenmassivedoseofB12?Doesthesameproblempresentitself?

PP:Well,wedon’treallyhaveanystudiesshowingwhathappenswhenyoutakeamassivedoseofit.

GM:Idon’tmeanadosebeyondwhatyouwouldrecommend,butfivehundredmicrograms iswhatmybottle says. It’s fivehundredmicrogramsofB12that’sbeenisolated,notintegratedinfood.Doesthebodyknowhowtohandlethat?

PP:Yes,andhere’skindofaninterestingthingaboutB12that’sdifferentfromothersupplements.B12isboundtotheproteininfoodandhastobeseparatedfrom the protein by enzymes in the stomach; intrinsic factor helps a little bitwiththat.Andwhenyoutakeitinitssupplementforms,it’salreadyinwhatwecall its free form, so it’s actually pretty immediately useable. It’s one situationwhere a supplement is actually easier to contendwith thanB12 in its natural

form.

GM:Whatdoclinicalstudiestellusaboutoils?

PP: They tell us that they’re not health foods. This goes heavily against thegrainof popularwisdom.There’s amyth that it’s not the amountof fatwe’reeating, but it’s the type of fat; that olive oil is heart healthy and fish oilparticularlyhearthealthy.Unfortunately,theevidencejustdoesn’ttakeusthere.Infact,oilscanbesuccessfullyusedtotreatautoimmuneconditionsbecausetheysuppress immune function.12 I don’t think it’s the right way to treatautoimmuneconditions,butthefacttheysuppressimmunefunctionshouldtellahealthypersonyoudon’twanttobetakinginalotofthisstuff.

IparticularlylikeastudythatDr.DavidBlankenhorndid;hewaslookingatpeople consuming a “normal” diet versus those eating more of their fat asmonounsaturatedfat,whichiswhatcomesfromoliveoil,supposedlythehealthyoilthatweallwanttoincludemoreofinourdiet.Itbasicallyshowedthatthedisease progressed just asmuch in thosewho consumed olive oil, high in thesupposedly healthier monounsaturated fat, as it did in those who wereconsuming more saturated fat.13 The study proves that people have got toratchetthefatconsumptiondown;theywon’tseeanybenefitbyconsumingoliveoilinsteadofsaturatedfatinchickenorbeef.

Andweknowthatifpeoplemakedramatic,sweepingchanges,they’remorelikelytostaycompliant;that’sbeenproveninclinicalstudies.

GM:Tellmeaboutthosestudies.

PP:They’recrucialstudies.Ican’ttellyouhowmanytimesovertheyearsI’vehadpeople(manyoftheminhealthcare)saytome,“Okay,let’sassumeyou’rerightabouthowhealthythisdietis.Nobody’sgoingtodothis.Evenifyoucangetthemtodoit,they’renotgoingtostickwithit.”

Dr.NealBarnarddidsomeearlystudiesonDr.Ornish’spatientsandfoundouttheircompliancelevelsweremuchhigherthanexpectedandtheyweremuchhappierwiththeirdietsthanthepeopleeatingthemoremoderatediet.He’salsosurveyed patients in his own studies to assess satisfaction and compliance onwhatwewould think is apretty strictdiet and found the same thing.They’rehappier eating the stricter diet; they’re happier with the results and they staywithitlonger.

Hedid twoof these studies, actually.One study showed thatDr.Ornish’spatients were compliant on his diet to treat heart disease,14 and another ondiabeticpatients.15

GM:Morecompliantthan…?

PP: More compliant than patients following dietary guidelines set by theAmericanHeartAssociationortheAmericanDiabetesAssociation.Yousee,ifyou’reinthebusinessofhelpingpeoplechangetheirdiets,thespecificityoftheadvicethatyougivebecomesveryimportant.Partoftheproblemwiththedietsrecommendedbyourcolleagueswhostressmoderationisthatnotonlydotheynotworkbuttheirhealthstatusdoesn’tchange.Ourcolleaguesdon’tknowwhattheheckthey’retalkingabout.Vagueinstructionsabouteatingalittlelessofthisor a littlemore of that are unclear and unworkable because “a little less” canmean something completely different to two different people.However,whenpeoplecomehereor theygo tooneofBarnard’sprogramsor they’rewithDr.Ornishor they’rewithDr.McDougall, thedirectionsare really specific.Now,you can choose to not follow them, but all of us are very clear inwhatwe’resayingtopeople,sotheyhaveamucheasiertimewithimplementation.

I can tell you from personal experience that people will stick with dietaryinstructionsifthey’representedwiththerightevidence,whichispartlyamatterofunderstandingthefutilityofwhatthey’recurrentlydoing.Wecangetthemtomake thechange,but,contrary to theconventionalwisdom, ifweget themtomakethebigsweepingchange, they’remuchmore likely tostickwiththedietthey’veadopted.Thereasonisthatbigchangesindietbringaboutbigchangesin health; the changes are highly motivating. There’s a clear discernibledifferenceintheirhealthandintheirweight.Doctorsaretellingmeallthetime,“Itellpeopletoaltertheirdietthiswayorthatway;theytry,buttheydon’tstickwith it.”Well, that’s because it seems like awhole lot of effort for notmuchreturn.Butifyoutakeatype2diabeticandputhimonadietthatreverseshisdiabetesintwoweeks,orifyoutakesomebodywitherectiledysfunctionandyousolve the problem in amatter of amonth, those people aren’t going to be asinterestedincheeseburgersanymore.Theyseetheresultsofthedietarychangesthey’vemade and itmotivates them to stay compliant.Anddiet alwaysbringsresultsquickerthandrugs.

GM:Asstudiesprove?

PP:Absolutely.Dietchangesworkincrediblyfast,aswasinitiallydemonstratedinastudydonebyDr.JamesAndersonattheUniversityofKentucky.Hedidstudiesondiabeticpatientsusinga low-fat,high-fiber,plant-baseddiet in the1980s.Heshowedthatinthreeweeks,type1diabeticscouldreduceinsulinby40percent,cholesteroldroppedby30percent,and twenty-fouroutof twenty-five type 2 diabetics were able to completely discontinue their insulinmedication.16Ifyoutalktoendocrinologistswhoareusingmetforminorinsulinorwhatevercombinationofdrugsthey’reusingtotreatdiabetics,theycan’tgetthe treatment right in a three-week time period, let alone reverse the type 2diabetes or reduce insulin needs in a type 1 inside three weeks. These arenothingshortofmiraculousresultsthatcannotbeduplicatedwithdrugs.We’veseenpeoplehavetheircholesteroldropbyeightypoints infivedays.Youcan’tdothatwithastatindrug.Andsonotonlyisthisdietbetterthanthedrugsfromahealthperspectivebutit’smoreeffectivethanthedrugsandworksfaster.

GM:Well,whatdoweknowfromstudiesabouttheeffectivenessofdrugsandsurgicalinterventionsforcardiovasculardisease?

PP:Therewerethreemajorstudiesthatshowedthatsurgical interventionwasnobetterthandrugtherapy:the1984VeteransAdministrationCoronaryArteryBypass Surgery Cooperative StudyGroup;17 the European Coronary SurgeryStudyGroupof1988;18andtheCoronaryArterySurgeryStudyof1990.19Allthree studies showed that the outcomes for patients who have bypass surgeryversus patients who only take drugs are the same, with the exception of anadvantagetothesurgerygroupforthosewithdamagetotheleftventricle.Therewas also the AVERT study that showed that patients who did not receiveangioplastybuttookLipitorexperiencedfewerheartattacks,lesschestpain,andmadefewervisitstothehospital.20

Angioplasty involves risk: often the inflating of the balloon releases plaqueandcausesheartattacks.Andveryoftenthearteriesareblockedagainwithinafew months of the procedure. Yet we spend billions of dollars a year onangioplasty.

The research shows that bypass surgery is really only warranted about 3percentofthetime—inthosecaseswhendoctorscangettosomebodyduringorrightafteramyocardialinfarction,orwhenthere’sextensivedamagetotheleftventricle.Other than that, it’sa totallyvoluntaryanduseless surgery thatcosts

about$100,000overafive-yearperiodforthesurgeryandfollow-upcare.Whenweconsiderhowuselessthesesurgicalinterventionsgenerallyare,we

need to factor in thatabout twenty thousandpeopleperyeardieasa resultofangioplasty21andanothertenthousanddieasaresultofbypasssurgery.22It’sunconscionablethatthispracticecontinues.Sothequestioncomesup,andI’veaskeditofDr.Esselstyn,“Whydowekeepdoingthis?”Hesays,“Well,Pam,somebody’sgottopayforthesecardiaccathedralsthattheybuild.”Theaveragehospital, after all, thrives on bypass and angioplasty. So it’s the unwittingpatientsandtheirinsurancecompanieswhowinduppaying.

GM: We’ve talked about studies that show that surgical intervention forcardiovascular disease is generally no more effective than drug therapy. Butexactlyhoweffectiveisdrugtherapy?

PP:Notmuchatall.Wehavemanystudiesthatshowthatcholesterol-loweringdrugsdon’tsignificantlyreducetheriskofheartattack,stroke,ordeath.SowhywouldsomeonetakeauselessdrugunlesshehasstockinMerckandfeelslikeheoughttosupportthecause?Nooneshouldwanttotakethesedrugs.Infact,thepackageinsertsonthedrugsprettymuchsaythatinsmallprint;Crestorisone.The prescribing information states that Crestor reduces the risk of majorcardiovascular events by 1.2 percent.23 That’s not much of a risk reduction,particularlywhenfactoringinthesideeffects.Soitwilllowercholesterollevels,butit’snotveryeffectiveforactuallysolvingtheproblem.Whatitwilldoishelpapersondiewithgoodbloodwork.

GM: It seems to me such a powerful, provocative statement to say thatcholesterol-loweringmedicationdoesn’treducetheriskofdeath.Howdoesthataffectanationofdoctorswhoareprescribingsuchdrugs?Dotheyrealizeit’snotreducingtheriskofdeathorseriousevents?Dotheyacceptthat?

PP:Alotofthemdo.Butsomanydoctorsgettheirinformationfromdrugrepsand through continuing medical education programs sponsored by drugcompanies.This,combinedwiththefactthatmanydon’treadmedicaljournalsregularlyanddon’tknowhowtointerprettheresultsofthearticlestheydoread,iswhysomanypatientsgetbadadvicefromdoctors.

GM: When my mother was about seventy years old, my parents moved to

Florida.Shehadsufferedfromanginasincehermid-fiftiesandafterseeingher,my mother’s new cardiologist immediately recommended she have anangioplasty. Luckily, my father, who was always skeptical of the medicalprofession,wasintheofficewithherandsaid,“Well,youcoulddothat,honey;it’syourheart,afterall. Justkeep inmindthat ifyoudo it, I’mgoing to leaveyou.”Sotherewasabigfightinthedoctor’sofficewiththedoctorsaying,“Whoareyougoingto listento,himorme?Whatdoesheknowaboutmedicine?Ifyou’regoing to listen tohim, thenyou’re fired. Idon’twantyouasapatient!”Well, my parents had been happily married for more than forty years. Mymother obviously didn’twant to get divorced, so she refused the intervention,thedoctorfiredmymother,andsheneverwentbacktohim.She’sninety-threeyearsoldtodayandhasneverhadaheartattackoranycardiacevent.I’vegotheronalow-fat,plant-baseddiet;she’llprobablyoutlivethatcardiologist.

PP: I always find it interesting when doctors fire patients. It’s despicable.Basically, what the doctor is saying is, “You’ll do as you’re told. I’m notinterestedinhavingyouasapatientifyoudecidetohaveanoriginalthoughtorbecome proactive on your own behalf.” They don’t say it in those words, butthat’stheessenceofwhatthey’recommunicating.

8

IT’STHEFOOD,STUPID....................................

GM:Pam,we’vetalkedalotaboutindividualdietarychoicesandtheireffectonhuman health. But there are also collective choiceswemake as a society thatinfluencehealthinallkindsofways,notleastbydirecting,ormisdirecting,thecitizenry inmaking their individual choices. So let’s discuss public policy andproposesomechangestothestatusquo.

PP:Well,publicpolicyhastochangebecausewesimplycannotaffordtokeepspendingasmuchaswespendonhealthcareandexpecttohaveeitheravibranteconomy or a balanced budget. It’s simply impossible. We spent $8,000 perpersononhealthcareservicesin2009,themostofanycountryintheworldbyalongshot.PoorNorwaylimpedalonginsecondplaceat$5,000perperson.Sowe’re spending 60 percent more than the second most expensive health caresystemintheworld.1That’sinsane,particularlyforacountrythatranksthirty-sixthintheworldinlongevity.Ifacompanymadelaptopsanditwasspending60percentmore formicroprocessors andotherparts than its competitors, andyet its laptops came in thirty-sixth in a test for durability, I don’t think thatcompanywouldbeinbusinessverylong.

GM:WhenIthinkofourhealthcaresystem,I’mremindedofwhatmydoctorsaid tome once.As Imentioned, he’s got a humble approach to his practice,which is why I return to him annually. He said, “I’m not interested in the

practiceofhealthcare.I’minterestedinthepracticeofmedicine.”Iaskedhimwhatthedifferencewas.Hetoldmethatheseeshealthcareasthesystemthatdoctorsgetcaughtupin:hehastoseesomanypatientsperhour,dealwiththeinsurance companies, diagnose and treat according to guidelines, etc. He’sdismissive,toputitmildly,ofthehealthcaresystem.He’spassionateaboutthepractice of medicine; medicine to him means a lot of talking and listening,gettingtoknowhispatients,andtreatingthemasindividualhumanbeings.Hehappenstobelieveincolonoscopyscreening,butwhenIturnitdownannually,hehearsmeoutandhe’sfinewiththat.

PP:Theproblem ismedical education.There areplentyofdoctorswhohavethe best of intentions, but they’ve never been schooled in nutrition. If they’reseeing patientswith degenerative diseases and they’re not practicing nutrition,they’renotpracticingmedicine,period.

Doctorsaretaughttomitigateandtreatsymptoms.Weneedtosetthebarhigherintraininghealthcareprofessionals.Healthcarehastobecomeoutcome-oriented.Wehavetoteachdoctorsthatstoppingtheprogressionofdiseases,andevenreversingdiseases,isanoption.

GM:Howdowedothat?

PP:Be the first one to showup in your doctor’s office reversingdiseasewithdiet. Doctors were never taught in school that you can eat your way out ofdisease.However,beyourdoctor’sfirstpatientwhodoes,andmaybeyourdoctorwilltakeafreshlookatdietasaninterventiontool.Untilmedicalschoolsgivedoctorsapropereducation,patientsmayhavetodoit.

GM:And then there’s the education of the rest of us.The schools are key togettingchildrenofftoahealthystart in life,yetschoolnutritionguidelinesareeffectivelywrittenbyagribusinessesthroughtheirshillsintheU.S.DepartmentofAgriculture (USDA).Whatcanbedonetohelpkidseathealthy lunches inschools?

PP:Well, first,ofcourse, ifyoucanpackahealthy lunchforyourchildthat’sgenerally best, but that’s not an option for everyone. We need to concernourselveswithwhat’s offered in the cafeteria. The federal nutrition guidelinesallowformealsthatare30percentfat,whichisagoodwaytopromoteobesity,

andit’sbeenquiteeffectiveatdoingjustthat.

GM:Infact,theproblemisevenworsethanthoseobsceneguidelines,becausein2005only30percentof schoolsmet theguidelines formaximumsaturated fatallowedinschoollunches.2Sofirsttheysetpreposterouslyunhealthyguidelinesandthenfindeventhoselaxguidelinestoooneroustomeet,sotheyviolatethemwithimpunity.They’remakingchildrenobeseanddiabeticandsickincountlessways, and we know that obese children and adolescents often become obeseadults.Sothedegreeoffailurehere,bothmoralandnutritional,isstunning.

Representative JaredPolis ofColorado, a rare congressmanwho’s aware oftheseissues, introducedTheHealthySchoolMealsActof2010,forwhichthePhysiciansCommitteeforResponsibleMedicine(PCRM)isfightingthegoodfight.Thiswouldbeonlyafirststep,butaterrificfirststep,towardimprovingschool nutrition. It would increase the availability of plant-based foods inschools,incentivizeschoolstoprovideplant-basedoptions,suchasplantmilks,and remove the restrictions currently in place for non-dairy milks. Childrenwouldnolongerhavetobringinanotefromtheirdoctorexplainingwhytheydon’tchoosetodrinkbovinelactationfluid.Unfortunately,thebillmaynothaveachancetobevotedonuntiltheChildNutritionActnextcomesupforrenewalin 2015. But in themeantime, before the government acts, parents and evenchildrenhavetotakemattersintotheirownhands.

PP:Right.Oneof the reasonswhyourown foundation’s focus is at the locallevelisthatagreatdealofauthorityhasbeentakenawayfromthelocalschoolorschoolsystem,butnotsomuchthatagroupofconcernedparents,teachers,orstudentscan’tmakesubstantivechangesintheirlocalschools.Ifyouwantbetterlunches foryourkid, youcan startgatheringagroupof interestedpeoplewhocanbegintoputpressureontheschoolsystemtosetupacommitteetogetthisdone. You don’t want to focus on getting all the unhealthy foods, like cow’smilk,outoftheschoolbecausethat’snotlikelytohappenanytimesoon;instead,you want to focus on insisting that healthy alternatives be made available. Asaladbar,atleastonelow-fatveganoption,andaplantmilkshouldbeofferedevery day.Thiswouldmake life easier for the nutritionally aware parentwhonowwon’tbe forced topreparea luncheveryday, and itwouldexposeall thechildren,whethertheirparentshaveaconsciousnessaroundtheseissuesornot,tosomehealthychoices.Peopleshouldn’tfeelhopelessandpowerlessatthelocallevel;that’swherethemostimmediatesolutionsareavailable.

GM:Let’ssaythere’sahighschoolkidwho’sonthedietwerecommend,andhewould liketohavenewkindsof foodchoices inthecafeteria.Whatshouldhedo?

PP: Let me tell you the story of a very exclusive private school here inColumbus.Agroupofstudentsgottogetherandsentalettertotheheadmaster.They wrote something like this: “We get a great education here. We haveunparalleled opportunities andwe appreciate that.Our facilities are second tonone.”Andtheywentonwithpraise.Andthentheysaid,“Butthere’soneareainwhichwefeelthattheschoolhasnotpaidmuchattentionto—it’snotuptoparwiththerestofwhatgoesonhere—andthatisthefoodthat’sservedinthecafeteria. We think that an educational institution that strives for excellenceeverywhereshouldpayasmuchattentiontothisissueastoacademics.”Itwasaverywell-crafted, polite letter; Iwas astounded that it came fromhigh schoolstudents. After it stimulated some parents to get active on the issue, changesweremadeinthecafeteria.Now,thatwasinaprivateschool.Youcanimaginethatwithtuitionbillsbeingashighastheyare,privateschooladministratorsarelikelytoshowresponsivenesstotheconcernsofparentsandstudents.

Ihaveanotherexamplefromapublicschoolsituation.Imetayoungwomanwhosemotherhad converted to a plant-baseddiet forhealth reasons.Shegotinto it after hermom and discovered that therewas nothing for her to eat atschool.Shestartedaskingwhy.Shespoketothepeoplewhowererunningthecafeteriaandwastold,essentially,“That’sjustthewaythingsare.”Sherefusedtoaccept that, so, as a sophomore in high school, she started a campaign thatactually resulted in changes in the cafeteria. I think that kids canmake a bigdifference because when kids initiate a campaign for healthy food, thatimmediately overcomes the argument that the advocates for the status quoconstantlybringup,which is thatkidswon’teathealthy food.Well,presentalettersignedbytwohundredkidssaying,“Wewanthealthyfood,”andtheycan’tusethateasy,thoughtlessexcuseanymore.

Let’skeepinmind,too,thathighschoolissupposedtobeaboutgettingkidstothinkcritically.Sowhynotgetthemtothinkcriticallyaboutsomethingthat’scriticallyimportant,liketheirhealth?Weoughttobeassigningkidscomparativeresearchonhealthissues.Forexample,givethemtheassignmenttoresearchthequestion, “Is cow’s milk good for you or bad for you?” Give them a dozenwebsites to visit, equally divided between those that do and do not advocateconsumptionofcow’smilk,andletthekidspreparetheirfindingsandoffertheir

ownopinions.TheycanweightheopinionsexpressedbyPCRMagainstthoseofferedbytheAmericanDiabetesAssociation.Idon’tthinkyou’dfindtoomuchpushback on that idea. I don’t think a lot of parents are going to protest,“Forcingmy kid to do research is a bad idea.”We can be considerablymoreadventurousinahighschoolclassroomthaninagradeschoolclassroom,andweshouldbe.

GM:Soweshouldinvitekidstoactuallythinkabouttheirhealth?

PP: Absolutely. That’s going to pay dividends in untold ways. I have everyconfidence that high school students who research these issues will wind up,moreoftenthannot,makingbetterchoicesfortheirhealth.Ibettheywillalsowindupknowingmoreaboutnutritionthantheirdoctors.

GM: Hospitals, like schools, are sometimes public and sometimes privateinstitutions,but it seems tobe thecase thathospital food isalmostuniversallyatrocious.

PP:Hospitalsarerunbyhealthcareprofessionals;wehavetotrainhealthcareprofessionalsaboutdiet.IfyouorIwalkeddownthehallsofahospital,we’dbeappalled at the food served: meatloaf, eggs and bacon, greasy pancakes andbutter,chickenandturkey,andmacaroniandcheeseservedtopeoplewho’vehadheartattacksandstrokes.Now,ifsomeonecametothehospitalforemphysema,theywouldn’tbeofferedcigarettes.However,iftheycomeinforanynumberofmedical conditions, they’re served thevery foods that caused them.Yetdoctorafterdoctor,nurseafternurse,anddietitianafterdietitianwalkdownthehallsofahospitalandseepatientseatingthesemealsthatarecounterproductivetotheirrecovery. By doing nothing about it, they are essentially saying, “This is okaywithme!”

GM: What would happen if doctors, nurses, and dietitians told hospitaladministrators,“Wecan’tfeedpeoplelikethis.”

PP:Ifenoughofthemspokeup,Ibelievethatitwouldchangeovernight.Inthemeantime,patientsneedtocomplainandbringinhealthyfoodfromtheoutside.Andifyou’rebringinginfoodfromtheoutside,Isuggestyounegotiatewiththehospitaltoreducethebill,sincethere’snoreasonyoushouldpayforfoodthat,

foryourowngood,yourefusetoeat.

GM:IreadanarticlerecentlyaboutfilmdirectorDuncanRoy,whowaswronglyimprisoned in the LosAngelesMen’sCentral Jail for a period ofmonths, inwhich he said, “People in that jail are hungry, and nobody gives a damn.”3 Idon’tthinkprisonfoodissomethingthegeneralpopulationcaresalotabout,butit’snothardto imaginethatthefacts, if reported,wouldbeDickensian.Whatcouldorshouldbedoneaboutprisonfood?

PP: Dr. Antonia Demas is a friend of mine who did a remarkably low-costproject inMiamiattheBayPointSchool,aresidentialschoolforviolentmalejuvenileoffenders.Sherecruitedagroupofkidsandaskedthemtoeataplant-baseddiet, toparticipate in thepreparationof the food, and tokeepa journalwhile they were engaged in the project. And the kids started getting bettergrades, their health improved, their athleticism improved, and their behaviorimproved.4Shebrought tooneofourconferencesexcerpts fromtheir journalswiththeirnamesredacted.Inthebeginningofoneofthe journals,thewritingwassobadyoucouldhardlyreadorunderstand it.Andthen, thirty-fivepagesin, the kid’s writing is completely legible, the grammar has changed, thesentencesarefinished,thethoughtsareclear,andthestatementswereamazing.

GM:Istheimplicationthatthedietitselfisimprovingclarityofmind?

PP:Oh,absolutely.This isexplainable fromamedicalperspectivebecauseweknow that the brain is a huge user of water, oxygen, and glucose.When youdon’teatwell,it’snotjustthatyou’renotfuelingyourbody—you’renotfuelingyourbrain.Whenpeopleeatthefoodthattheirbodiesaredesignedtoeat,theythinkmoreclearly,theyareabletoparticipateinlifebetter,andtheymakebetterdecisions.Irememberonekidwroteinhisjournalabouthowoneofthebenefitsofthisexperiencewasthathewouldonedaybeabletomakehealthyfoodforhiswifeandhisfamily.Now,fora juvenileoffendertohavepositivethoughtslikethattowardwomenandfamilybecausehe’sbeenexposed,inacaringway,toadietthathelpspeoplecareforthemselves,speaksvolumes.

I think a lot of people would perceive feeding prisoners a good diet asproviding them with an undeserved luxury. Actually, I think the people whowouldbenefitmostwouldbesocietyatlarge.Theguardsandthewardenswouldcertainlyhave an easier time andwewould returnprisoners back to society as

moreproductivepeople.

GM: I don’t see why even those who have a “tough love” attitude towardprisonerswouldobjecttofeedingthemveryplain,simple,inexpensivefoodslikeoatmeal, riceandbeans,potatoes,corn,wheat, fruits,andvegetables.Prisonerscertainly shouldn’t go hungry, so let’s feed them inexpensive, filling, starchyfoods.Noneoftherichfoodsofroyalty,likemeatandfishandcheese.Whythehellwouldwe feedmeat anddairy,which require somuchenergy,water, andcost to produce, to peoplewho have presumably committed crimes?Let’s putthemonaninexpensive,low-fat,starch-based,plant-baseddiet;they’llwindupbeingthehealthiestpopulationinthecountry.Shouldn’tthisideaappealtobothconservativesand liberals?Let’s“punish”prisonerswithcheapfoodthatmakesthemhealthy.Andsincethey’rewardsofthestate,whentheygethealthy,thatsavesthetaxpayersmoney.

PP:Meatanddairy,unfortunately,aren’tasexpensiveastheyshouldbe.That’stheresultofanotherpublicpolicy—farmsubsidies.

GM:Andyou’dfavorendingthemoutright?

PP:Yeah,let’sgetridofthem.

GM:I’dbefinewitheitheroftwooutcomes.Thefirstisthecleanest:getridofallfarmsubsidies,asyousay.Getgovernmentoutofthebusinessofpickingthewinners in agriculture—and it has effectively picked large-scale, animalagriculture interests—and turn it into a freemarket.Again, that’s an idea thatshouldappealtoconservatives.I’dalsobefinewithsubsidizingonlycropsraisedorganically and intended forhumanbeings,not animals.Thenat leastour taxdollars would be helping farmers help the population get healthier, whileincentivizingstewardshipoftheland.

PP:Thereasonwhyit’sbesttogetgovernmentoutofthiscompletely,andyouandImayhavesomephilosophicaldifferencesonthisscore,isthatIdon’tthinkthatgovernmentgenerally solvesproblems; I thinkmoreoften it creates them.Onceyouproposethatwe’regoingtosubsidizethisinsteadofthat,who’sgoingtodecidewhat to subsidize?How is thatdecisiongoing togetmade inawaythatisn’teffectivelycorrupt?Wecannotaffordtocontinuetogrowgovernment.

Wecannot afford to continue tokeep throwingmoney atproblems.Wecan’tjust build another USDA down the street staffed with different people whosubsidizedifferentfarmcropsandmagicallyfindawaytopayforit.We’redone.I’mallforgovernmentsimplygettingoutofthatbusiness.

GM:Thatwouldbemorethanfinewithme.Anotheractivitythatperhapsthegovernment should consider exiting is the business of issuing nutritionalguidelines.

PP: Absolutely. USDA has screwed it up beyond recognition and it’s not aproductiveuseoftheagency’stime.We’vealreadydiscussedtheproblemswithindustry and agriculture influencing theUSDA, but in preparation for a classthat I teach, I visited the websites of a number of other countries that issuedietary guidelines. I spoke in South Africa last year, so I went to the SouthAfricangovernment’swebsitewhere itpromotesdietaryguidelines. I’ve lookedatAustraliaandseveraldifferentcountries.

GM:Isanycountrydoingagoodjobofit?

PP:No, and for very familiar reasons—they’repressuredby the samepoliticalinfluencesfromfoodandagriculturalgroupsthatwearehere.Ifwecan’tfindamodelgovernmentpolicyanywhereontheplanetthatmanagestoeliminatethislevel of influence and provide impartial information to the public, maybe weshouldjustgetthegovernmentoutofthedietaryrecommendationsbusiness.Itcan’tbeanyworsethanthestatusquo.

GM: Actually, I hope you’re right about that last point, but I wonder: Asmisguided as the current guidelines are, if there were no guidelines at all forschool lunchrooms,wouldsomestatesbeginservingchildrenmealsthatare50to60percentfat?Inotherwords,arewebetteroffwithlousyguidelinesthataretheproductoftacitcorruption,ornoguidelinesatall?It’sahead-scratcherforme.

I think I’d favor retaining a role for government in issuing guidelines, butmoving it from theUSDA to the surgeon general’s office.And then all we’dhavetodowouldbetogetDr.JohnMcDougallorDr.NealBarnardappointedsurgeongeneralandwe’regood.

PP:Ifwecouldbeguaranteedthatthesemenorsomeonelikethemwouldbeinthatposition,I’dbeallforit.Theproblemisthereareonlyafewdoctorsinthecountrywhounderstand these issues and are capable, inmyopinion,ofdoingtherightthing.Thelikelihoodthatoneofthemwouldbeappointedisnotgreat.In fact, a few years ago,PCRM resolved to influence the appointment to theDietaryGuidelinesAdvisoryCommitteeofsomenutritionprofessionalswithnoties to industry.PCRMsubmitted severalhighlyqualifiednames;notonewasappointed.Givenitstrackrecord,we’rebetteroffgettinggovernmentoutofit.

GM:Theotherguidelinesthatarecrucialtoconsumersarethelabelinglawsthatgovernwhat iswrittenonthepackagesoffoodwebuy.Boldhealthclaimsaremade about various types of foods, and the nutrition labels can be confusing.Whatshouldbedone?

PP:Themost important thing thatwe coulddowouldmeetopposition fromfoodmanufacturers, but it would be a simple law to draft and pass. The lawwouldsimplytellmanufacturersoffoodsthattheonlythingtheycandoisputtheingredientsonthelabel.Inotherwords,amanufacturercansayit’sdeliciousanditsmellsgreat,butitcan’tmakeanynutritionalorhealthclaimsabouttheproduct.Thatwouldstopallthissillygame-playinginwhichmanufacturerstakeastickofmargarinethat’s100percentfat,fortifyitwithplantsterols,andsayit’sgoodforloweringcholesterol.ThenextthingI’drecommenddoingwouldbetoreducethenutritionfactslabeltothebasics:caloriesandcaloriesfromfat.That’sit.

GM:Whataboutpeoplewhoneedtorestrictsodium?Shouldn’ttheyknowhowmuchsodiumisinagivenfood?Or,forthesugar-sensitive,howmanygramsofsugarareinfood?Orcholesterolcontent?

PP:Sodiumwouldbelistedintheingredientslist,aswouldanimalfoods.Weteach our members to pay attention only to the ingredients list and to avoidproductswith long lists of ingredients,manyofwhich are not recognizable asfood.Itworks.

GM:Medicareremains themostdebated, themostcomplex,andcertainly themostfiscallysignificantpublichealthpolicyissue.It’seasytoimaginesomeonewriting a scholarly tome exploring all the complexities of the program and

analyzinginathousandpagesaraftofcompetingideasonhowtokeepitafloat.Not so easy to imagine anyone actually reading that book. Meanwhile,journalistsandpolicywonksdebatetheissueendlessly,politiciansrantandraveandposture,andnothinggetsdone.So,tosaveeveryoneamountainoftimeandtrouble, and to save the country from tens of trillions in increased deficitspendinginthecomingdecades,Isaythatwetrytosolvetheprobleminafewminuteshere.

Labels should be simple and easy to read. The current, complicatedlabel systemcostsa fortuneas federalagenciesare forced tospendtime reviewing labels, policing manufacturers, and responding tolawsuits filed by manufacturers over claims that are denied. Andconsumersarestillleftwithalabelthatfewpeoplepayattentiontoandmanydon’tknowhowtointerpret.

Onthe left is the frontandbackof thepackageofapopularproduct.Ontherightismyproposedversion.Sincenohealthclaimswouldbeallowed if my rules were adopted, the front of the box would notmislead people into thinking that this product promotes good healthbecauseofitsfibercontent(thefiberisduetoaddedfiberfromchicory

root, not because the ingredients are high in fiber), and the term“naturallyflavored”wouldnotbepermitted.

“NutritionFacts”chartswouldnotappearonthebackofthebox,whichwouldpreventmisrepresentationabouttheamountoffiber.Sugarsandoilswouldbegroupedtogether,makingiteasierforconsumerstoseejusthowmuchoftheseingredientsareintheproduct.

With this simpler label, consumerswould readily see that the frontoftheboxshowsessentiallyapictureofacandybar,andtheingredientslist isconsistentwithacandybar.Someconsumerswouldstillbuy itbecauseittastesgood,butmorewouldnotconsideritahealthfood.

PP:Happytohelp.

GM:Medicare’sfiscalnightmareloomsbecauseofacombinationoffactors:

1. Demographics, with an aging generation of baby boomers (eightymillionpeoplewillbeonMedicareby2040);

2. Asickandobesepopulationofseniorsmadeunhealthybyunhealthyfood;and

3. A health care system geared toward incessant, expensive testing,oftenfollowedbyexpensiveintervention.

As we know, high-tech medical intervention doesn’t always lead to betterhealthoutcomes,butitdoesalwaysleadtohighercosts;inthecaseofMedicare,those costs are borne by the taxpayers. The trend is unsustainable, to say theleast.

I believe a decent society provides its senior citizens with an affordable,accessiblesystemofmedicalcare.Idon’twantAmericanstolosetheMedicareentitlement. But it’s simply unsustainable on the present path. So here’s mysuggestion:societyshouldhaveapactwithitsseniorcitizens.Ifyou’vepaidintoMedicareduringyourworking life,wewill takecareofyou inyourretirementyears.Ifyou’resick,Medicarewillcontinuetocoveryourcostsifyouneedtogotothedoctororthehospital.Butanendlesshuntformedicalproblemsshouldnotbepartofthatcompact.Norshouldmostinterventionsconsequenttothat

hunt. If you’re a senior citizen and you for some reason want a “preventive”colonoscopy or mammogram or stress test or angiogram or prostate-specificantigentestorvitaminDtestorEKGorDexascan,itshouldbeonyourdime.If you are asymptomatic, but your preventive testing leads to an intervention(other thanremovalofa tumororpolyp), let thatbeonyourdime, too. IfweendMedicareasadiscretionarytestingbenefit,wemaysaveenoughmoneytokeeptheprogramsolvent formanymoreyears.AndIsuspect it’ll save livesaswell.

Myparentshadaverygoodfriendwhowasaboutninetyyearsold.Shewentto a doctor complaining of chest pain, so the doctor proposed an angiogram.Duringtheprocedure, theynickedheraortaandshedieda fewdays later. It’sunconscionable.Theycouldhavejustputheronalow-fat,plant-baseddiet,butinsteadtheykilledher,andchargedittothetaxpayers.

Whenmy father,who at this pointwas a frail oldman inhis late eightieswithParkinson’sdiseasedementia,passedoutathome,wemadethemistakeofcalling911.Themedicstookhimtothehospital,whereheremainedforaweek,ostensibly to combat his orthostatic hypotension. They ran every test on himimaginable.Hewasafrail,dyingoldmanwhodidn’tevenknowwhatstatehewas in—when asked that question by his neurologist, I swear he said“confusion”—but theone thingheknewwas thathewanted togetoutof thehospital.Theyranonetestafteranotheronhimandbilledthetaxpayers$70,000for it. They still didn’t stabilize his blood pressure, but they did give him aurinary tract infection from the catheter. Iwaswrackedwith guilt for puttinghiminthehospital.Sothenexttimehepassedout,wekepthimhomeandtookcareofhimuntilhecameto.OnethingI’mproudofisthatweallowedhimtodieathome;heneversawahospitalagain.

PP:Thedisturbingfactisthattheovertestingandovertreatingwe’vediscussedbefore is especially targeted at the senior population. The situations youdescribedwithyourfamilyandfamilyfriendarenotisolatedincidents.

NeilArmstrongdiedasaresultofcomplicationsofbypasssurgeryattheageofeighty-two.AsImentionedbefore,onlyatinyfractionofbypasssurgeriesintheUnitedStatesaremedicallywarranted;theprocedureisevenlessusefulandmoredangerousinpeopleovertheageofeighty.5ButafteraroutinestresstestthatArmstrong failed,heunderwent a quadruple bypass.Althoughwe’llmostlikelyneverknowthedetailsoftheconversationhehadwithhiscardiologist,Iwouldbewillingtobetthatthediscussiondidnotincludetherecommendation

toadoptalow-fat,plant-baseddietorarecommendationtoreadDr.CaldwellEsselstyn’sbook,bothfarlessexpensivealternativestobypasssurgery.Itwouldbe hard to believe that Armstrong would have opted for bypass had he beeninformed properly of the risks andminimal benefits of the procedure and thepotentialbenefitsofplant-basednutrition.

GM:Pam,howwouldyousaveMedicare?

PP: The way to make Medicare sustainable is to stop paying for tests andprocedures that have no basis in science. You mentioned before that societyshouldtakecareofhealthcareforitsseniors.Iagree.Here’showwecoulddoitinawaythatwouldhaveapositiveeffectonallpayers.Weshouldincorporatethe findings of independent research groups like Cochrane into the decision-making process. For example, Cochrane’s research, which is extensive, showsthatmammograms are inadvisable for any group. For everywoman saved, sixwomendieunnecessarily.NeitherMedicarenoranyotherentityshouldpayformammograms. If you want a mammogram, you can pay for it yourself, butneither the government nor insurance companies should pay for those tests.Same with Dexa scans, PSA testing, colonoscopy, and other diagnostic tests.Andthesamewouldholdtruefortreatments.IfAvastindoesnotaddasingledayof survival forbreast cancerpatients, it simplywouldnotbe reimbursable.Youcouldpayforityourselfifyouwereconvincedyouwantedit.

Independent groups likeCochrane should be hired to conduct research ontests,drugs, andprocedures todeterminewhichareworthwhile.Congressandany bureaucracy susceptible to political influence should be kept out of thediscussion.TheNationalInstitutesofHealthatonepointconvenedapanelthatconcludedthatbreastcancerscreeningshouldnotbeablanketrecommendationbased on the evidence; Congress overrode the scientists and overturned thepanel’srecommendations.6Thisshouldbeunacceptable.

If we develop a system that relies on evidence, instead of confining ourdiscussiononly towho shouldpay for any testor intervention that anydoctorordersoranypatientwants,wecouldcontaincosts,whichwouldfreeupenoughmoneytoprovidescientificallyjustifiedcaretoallseniors.Doctorsandhospitalshaveafinancialincentivetopreservethestatusquo,butweknowthatthestatusquoisterriblehealthoutcomesatunsustainablecost.

GM:Areyouoptimisticthatgovernmentwillreformitselfandmakethesekinds

ofchangeshappen?

PP:No, but I thinkwe can educate thepublic oneperson at a time, until somanypeoplehavedroppedoutofthesystemthatthesystemdoesnotexistinitscurrent form. The only workable solution to our Medicare problem and ourlargerhealthcarecostproblemistoreducedemandforhealthservices.Thewaystodothataretocreateahealthierandbetter-informedpopulaceandtodemandthat science, not a profit-oriented medical establishment, determines what isworthpayingfor.

GM:SincewedidsuchagoodjobofdevelopingaplanforMedicare,let’shelpbalancethebudget.WeraiseandkillmorethantenbillionlandanimalsayearinAmerica,andkill another fifty-threebillionaquaticanimals.7 Ifwewere totax this carnage at an average of only about a dollar per animal—considerablymoreforthelargemammalsandconsiderablylessforthesardines—withthetaxburden shared by the producers and the slaughterhouses and the commercialfisheries,thatwouldgenerateabout$60billionperyearfortheTreasury.Someofthatmoneycouldthenbededicatedtoremediatingtheenvironmentaldamagetothelandandriversbroughtonbyanimalagriculture.Ofcourse,theargumentwould be made that such a tax on producers would be passed along to theconsumer.Totheextentthatthat’strue,itwouldonlyincreasepricesonfoodsthat aremakingAmericans sick, thereby discouraging their consumption, andleading to reduced medical costs, a further savings to the government, and aboosttotheeconomygenerally.So,whileIdon’tbelieveit’sonanyone’sradar,theoretically a slaughterhouse and fisheries taxwouldbe a superbway to raiserevenuesforagovernmentawashinredink.

PP: Iagree.Thosewhopollute thewatersupplyanddestroy theenvironmentshouldberesponsibleforpayingforit.Andthepriceofanimalproductsshouldhave some bearing on the true cost of producing them, which includes thisdamage.

GM:NewYorkCityMayorMichaelBloomberghasbeeninthenewsinthelastfew years, first banning trans fats from restaurants, then banning sodas andsugary drinks larger than sixteen ounces from restaurants,movie theaters, andstreet carts. Some are attacking themayor for acting likeBigBrother.What’syouropinionofhisinitiatives?

PP:WeliveinAmerica,notChina.Iworryaboutwhoisgoingtomakeupthefood police and what guidelines they are going to use. If we’re going to letMayorBloombergdecidethesizeofthesoftdrinksandwhetherornottransfatisallowed…well,whatifMayorBloombergtalkstoDr.BarrySears,whotellshim that bakedpotatoes arebad for you? Is that thenext foodwe’re going toeliminate?Themoregovernmentgetsinvolved,themoremessedupthingsget.

GM:Igrantyourlogic,butallthesame,Isupportthemayor’sactions.Itmightnotbethemostsensibleorideologicallyconsistentwaytoimprovepublichealth,butwhenyou’re inacrisisof theproportionsthatweface,Iappreciate thatatleast somebody in a position of power is trying to do something.More than adozenotherstateandlocalgovernmentshaveemulatedMayorBloomberg’sbanon trans fats, and it appears to have changed eating habits in NYC, at leastslightlyforthebetter.8Andwhileitseemssillytobansugarydrinkslargerthansixteenounceswhileallowingconsumerstobuythreeeight-ouncesugarydrinks,I’llwelcomeitfortheattentionitbringstotheissue.

PP:I’llcontinuetodisagree.Growingtheproblem,asinmoreregulation,doesnotmake itbetter.AsAlbertEinsteinoncesaid,“Youcannotsolveaproblemwiththesamethinkingthatcreatedit.”Amajorcontributortoourhealthcarecrisisisgovernment;let’sgetitoutofthepicture,insteadofrearrangingit.

GM:Personally,Iwouldn’tobjectifMayorBloombergweretoreallyshowsomeguts and tax cheeseburgers. They clearly cause evenmore damage to people’shealth thangiant softdrinks. In fact, Ihavea theory thatObama’spresidencywasnearlydestroyedbythecheeseburger.

PP:I’malsoveryanti-cheeseburger,butcouldyouexplainthatone?

GM:Sure.WhenObamafirstranforpresident,Iagreedwithhimonmostoftheissues,butIhadonequibble:hekepteatingcheeseburgersathisphotoops.Proofthathewasaregular Joe,even ifhisnamewasBarack.Well, Icertainlywasn’tgoingtolethisdietaryindiscretionskeepmefromsupportinghim,soIthoughtofitasaquibblewithoutconsequence.Butitwasindicativeofhislackof understanding of health, and his tendency to conflate health with healthinsurance.

Imagine an Iraqi bureaucrat at the worst point in the insurgency in 2004,

with carbombs exploding inmarkets all overBaghdad, and IEDsblowingupAmericanHumvees.Thebureaucratsurveysthecarnagearoundhimandhasa“Eureka!”moment:“Whatthiscityneedsiscarinsurancereform.”

That’spreciselyhowObamahasapproachedtheatrocitythatisthestateofAmerican health. Our real problem isn’t the large number of uninsured,lamentable as that factmay be.Our real problems are obesity, diabetes, heartdisease,cancer,andalltheotherailmentsthatcomefromeatingfoodslikethecheeseburgerthatourpresidentissodelightedtochompdownonatphotoops.Obesityissowidespreadthatheapparentlycouldn’tfindanyonetobesurgeongeneralwhowasn’tobese.SoIrealizenowthatwhatthosecheeseburgerphotoops really demonstrated is that the man knows nothing about health. Andknowing nothing about health allowed him to believe that having healthinsurance is amatterofgreater significance thanhaving the real thing,health.TheAffordableCareAct,hissignatureachievement,hasnothingwhatsoevertodowithhealth.

PP:Iwanttosayfirstofallthatit’snotentirelyhisfault.Thereisatendencyforthemarkettopayattentiontowho’spayingforhealthcareversuswhethertheremight be a way to obviate the need for those services in the first place.He’scaughtup in a system that emphasizeswho’sgoing topay, insteadofwhetherthere’sanotherwaytoprovidecare,soit’snotentirelyhisfault.

Whatishisfaultisthat,inspiteofpublicsentimentagainstit,thebillpassedanyway. It’s very difficult to manage any situation that involves significantchangewithzerobuy-infromthepublic.

GM:AsaDemocrat,Iagreewithyou.

PP: I don’t find many who don’t. This is not a partisan issue; this isn’tRepublicansagainstDemocrats;thisispracticalitysettingin.Itdoesn’tmatterifyou’reRepublicanorDemocrat;ifyouhaveasimplegraspofeconomics,you’llunderstandthatifabreastcancerpatientdiagnosedyesterdaypaysherfirst$175healthpremiumtodayandthensucksup$50,000worthofcare,youcan’thaveawhole lot of that going on before it becomes unsustainable. We can’t printmoneyattheinsurancecompanies.Sothisisabadpieceoflegislationthatwilleventuallyhavetobedismantled,atleastinpart.

In government, we have to be very careful of the law of unintendedconsequences.Weneedtothinkthroughallthethingsthatwillhappenasaby-

productofanewlaw,outcomesthatwereneverintended.Themorepeople,andespecially businesspeople, understand theAffordableCareAct, themore theywillobjecttoit.Whenthathappens,thefederalgovernmentwillhavetomakemore exceptions to keep disaster from happening. And that’s where all theseexceptionscomein—

GM:Yeah,allthesewaiverstobusinessestosidestepthelaw.

PP: Oh, they will have to keep doing it. I read a survey recently where thispollingcompanycalledCEOstosay,“We’renotgoingtouseyourname,butifthis law stands, will you drop your health insurance?” And some alarmingpercentage of CEOs said, “We wouldn’t be the first but we would be a fastsecond.”Inotherwords,allweneedisonelargecompanytodropcoverageandthedominoeswillstarttofall.Ithinkthatthegovernmentcannotaffordtohaveamajor player say, “Wegive up.We’re not going to provide insurance at ourcompanyanymore.”Sothey’vegrantedallthesewaiverstryingtokeeptheshipfromsinkingandtheycan’tkeepdoingthatbutthenagaintheyhavenochoice.

GM:It’s likegettingspecialdispensationsfromthepope.It’sanabsurdwaytocreatenationalpolicy.Andlet’snotforgetthatwhileChiefJusticeJohnRobertsupheld themandate’s constitutionality as a tax, he also struck down the law’senforcementprovisionstoeffectivelycompelthestatestoexpandtheMedicaidprogram, the mechanism by which roughly 15 million more people were toobtain health insurance. So the lawwill not bring us anywhere near universalcoverage, in spite of the mandate. I do approve of the law’s provisions forgovernment-sponsored insurance (thepreexisting condition insuranceplan) forthosewhoare refusedcoveragebyprivate insurers,but thatwasanice, simpleprovisionthatdidn’trequireamandate.Unfortunately,it’sgoingtobereplacedbythemorecomplexexchangesin2014.

The absurdmandatehasbeenpositedby almost every commentator in themedia,withthenotableexceptionofLawrenceO’Donnell,asthesinequanonofObamacare.Thetruth is that it’sashamandamirage,a toothlessresponsetothe largely imaginary problem of people “gaming the system” by going to theemergency room for a cold. In fact, people don’t fail to buy health insurancebecausetheywantto“gamethesystem”; theyfail tobuy iteitherbecausetheycan’tafford itorbecause they feel theydon’tneed it.There isnoenforcementmechanismforthemandate.Whathappensifyoudon’tbuyhealthinsuranceas

mandated by the law?You get fined—$95 the first year, or 1 percent of yourincome.Whathappens if youdon’tpay the fine?Nothing.There’snopenaltyfornotpayingthefine.Here’swhatthelawsays:“Inthecaseofanyfailurebyataxpayer to timelypayanypenalty imposedby this section, such taxpayer shallnotbesubjecttoanycriminalprosecutionorpenaltywithrespecttosuchpayer.”Soifthemandateisaviolationofconstitutionalfreedoms,assomepassionatelyargue, it’s only a symbolic one; in a very real, practical sense, it’s merely aninvitationtobreakthelaw.Thatdoesn’tstrikemeaswisepolicy.

PP: No, it’s not, but I’ll tell you what I think the take-homemessage is foranyonewhoisreadingthisbook,regardlessofherpoliticalconvictions.Whetheryouaresickorhealthy,whetheryouhavehealthinsuranceornot,whetheryouareaRepublicanoraDemocrat,thebottomlineisthesame.Youhavetotakeresponsibility for your ownhealth.You’ve got to get the information that youneedtomakeinformedchoicesabouthealthcare.Itdoesn’treallymatterwho’sgoingtopayforit;itdoesn’treallymatterwhetherObamacarestandsordoesn’tstand.Ifitgoterasedtomorrow,andwewentbacktothewayitwastwoyearsago,thepersonwithcoronaryarterydiseasefacesthesamechoice:hecaneitherdowhathisdoctors tellhim,which isnotmedicallywarrantedorscientificallysupported,orhecantakemattersintohisownhandsandfindhisownsolution.Ifyouareperfectlyhealthyandyouwant tostay thatway,you’renotgoingtostaythatwaylisteningtomostoftheauthoritieswhoyougenerallymightseekoutforadviceaboutsuchthings.You’vegottodropoutofthesystemandlookfor alternative options. And when I say alternative, I don’t mean “alternativemedicine”;Imeanalternativestoalltraditionalhealthcare.

You can go visit doctors, do what you’re told, and keep eating what’sadvertisedontelevisionandwhat’sservedinfast-foodjointsandrestaurants.Oryou candropout of all of that and take care of yourself. If enoughpeopledothat,wewon’thavetoworryaboutwho’spayingforhealthcareanymorebecausewe’regoingtogetridofsomuchofthishealthcarecostthatit’llbeanonissue.

GM: I confronted Michael Moore on this recently at a public event in LosAngeles.Again,I’maleft-wingguyandI’veadmiredseveralofhisfilms,butnotSicko,because,asItoldhim,hedoesn’tunderstandanythingabouthealth.HisoverridingissueisthatfiftymillionAmericansdon’thaveinsurancecoverageandhemadethepointthatfiftythousandpeoplediedlastyearbecausetheycouldn’taffordmedicalcare.Nowifthat’strue,it’sofcourseindefensible.

PP:Itis,butmorepeoplediedfromtoomuchmedicalintervention.

GM:Ipointedthatouttohim.Probablyatleastfivetimesasmanypeoplediedbecausetheyhadexcessiveandunnecessaryandbadmedicalcare.Hedidn’thavearesponsetothat.Hewassittingonthestage,allthreehundredorsopoundsofhim, arguing thatwe shouldhaveMedicare for all. So in otherwords, peopleshouldbefreetoeathotdogsandpizzaandcheeseburgersandthenforceustodo unlimited medical testing on them and provide unlimited surgicalinterventions, with the government picking up the tab.That’s the progressivesolution? What exactly is progressive about bankrupting the country so thatMichaelMoorecanhaveasmanyangioplastiesashiscardiologistrecommends?What’s progressive about bankrupting government so that it won’t have anymoneytospendoneducation,cleanenergy,infrastructure,theenvironment,andalloftheotherthingsthatMichaelMooreandIbelievein?

PP:Healthcarecostsaregoingtostrangleoureconomyifwedon’tputalimitonthem.Whatthegovernmentseemstowanttodoismakeitlimitless.

GM:Right.As a progressive, just as I don’twantmy tax dollarswasted on abloated defense budget, I don’t want my tax dollars paying for unnecessaryangioplastiesforbloatedcheeseburgereaters.AndIdon’twantmytaxdollarstocontinue subsidizing the animal agriculture interests that are producing thoselow-cost cheeseburgers that are killing Americans. Stop subsidizing animalagriculture and let’s see the realmarket cost of a cheeseburger,whichmay befifteen dollars or more. Letting that cost rise to the market cost—somethingthose free-market right-wingers should believe in—would dowonders for thestateofAmericanhealth.

PP:Here’smy suggestion forMichaelMoore, if hewould ever listen tome.Michael, before you produce anymore documentaries onhealth, I’m going tochargeyouwithgettinghealthy.Yourobjectiveistogetthinandhealthy.Onceyougothroughtheprocessof tryingtodoso—andyoumaywellhavealreadytried—andyoufindouthowimpossibleitistodobygoingthroughtraditionalmedicalchannels,thendoitlikeBillClintondidandtrythiswholefood,plant-baseddiet.Gooutsidethesystemtofindtheanswerstoyourhealthissues.Dothat,andthenyou’regoingtoproduceadifferentkindofdocumentary,whichwillbewellworthwatchingbecauseyou’llhavesomecredibilityonthesubject.

GM:LawrenceO’Donnell,whoasImentioneddeserveskudosforhighlightingtheabsurdityofthemandate,nonethelessappearstoagreewithMichaelMoorethatthebestsystemofhealthcarewouldbeMedicareforall.Iwasfortunatetohave the chance recently to have a little private informal exchange withO’Donnellonthesubjectofhealth.Now,letmeprefacethisbysayingthatthelast thing in theworld that Iwouldwant to dowould be to attackLawrenceO’Donnell, who is a national treasure and as eloquent a spokesman forprogressivevaluesasanyonealive.But,likeMichaelMooreandsomanyotherson the left, he espouses ideas on public health policy that are reflexiveexpressions of an ideology that, despite its good intent, doesn’t questioncommonassumptionsthatoursocietymakesonhumanhealth,manyofwhichareprofoundlywrong.

SoIwasdelightedtohavethechancetoexpresstoO’DonnellmyfrustrationwithmediacoverageofObamacareover the last threeyears. I thoughtImademycaseeffectively,andhereisthegistofwhatIsaid:

ThemediakeepsreferringtoObamacareashealthreformwhenitismerelyhealth insurance reform that affectshealthbarely at all. Its essential flaw is itsfocusoninsurancepaymentsinsteadofhealth.Iasked,withrhetoricalflourish,wouldyouratherhavegoodhealthinsuranceorgoodhealth?Therealprobleminthiscountryisn’tthemillionswithouthealthinsurance;therealproblemsareobesity, diabetes, heart disease, and cancer. It’s the food, stupid! Studies haveshown that access to medical care has minimal effect on health outcomes;indeed, I noted, the third-leading cause of death in America is medical care.(O’Donnell disputed that assertionbut Iwouldpointhim to anop-edbyDr.Sanjay Gupta in the New York Times, in which he estimated two hundredthousandiatrogenicdeathsannually,whichputsdeathbymedicalcare inthirdplace, as I contended.9) The one thing that truly has demonstrable effect onhealthoutcomesisthefoodweeat.Ifweweretostopsubsidizingthemeatanddairy industry with farm subsidies, allowing the price of a cheeseburger toskyrocket, thatwoulddomoreto improvehumanhealththanObamacareevercould.Somebodyinthemedianeedstoletanothervoiceintothedebatebesidesthe usual detractors and supporters of Obamacare.We need a voice like Dr.McDougall’sthatwouldmakethecasethatwe’llneversolvetheproblemunlesswechangethefood.

AndIrestedmyargument,ratherproudofmyself.

PP:Washeleftspeechless?

GM:Actually,no.There’sa reasonLawrenceO’Donnellhas risenas farashehas.He’saverypersuasiveguy.Hedismissedmyargumentslikehewasswattingsomanyfliesandthenmovedontohisnextinterlocutor.First,hesaid,giveuponthefantasythatwe’lleverendfarmsubsidies.Second,hesaid,Isimplywasnotallowingforhumanfallibility. Icecream,hesaid, isdelicious.Herepeatedthatstatementoverandover,withincreasingemphasis.“Icecreamisdelicious.People will always eat ice cream because ice cream isDE-LIC-IOUS!That’snevergoingtochange.Humanbeingsarefallibleand,beingfallible,willalwayseat ice cream because ICE CREAM IS DE-LIC-IOUS!” I was wasting mybreathwithallmyimpossiblysevereideasabouteating.

I walked away deflated. Here I thought I had made several powerfulargumentsforwhyweneededtochangethedebateabouthealthinthiscountry,and yet I had made a rookie error, failing to factor in the extraordinarydeliciousnessoficecream.Ididn’tknowwhethertokeepfightingfortheplant-basedcause,orjustchuckitallandheadtoBaskin-Robbins.

PP:Here’swhatO’Donnellisnottakingintoaccount.TheAmericanpublicisnotgiventheopportunitytomakeaninformeddecision.Yourcholesterolis220,soyourdoctorsays,“Youknow,yourcholesterolisgettingupthere.We’regoingto need to put you on a statin drug.” So he puts you on Lipitor and yourcholesterolcomesdown.Yougetthisfalsesenseofsecuritythatthingsarebetterbecauseyouwereneverreallytoldthewholestoryaboutyourcholesterol.Thatsenseofsecurityendswithaheartattack.Nowlet’sreplaythisconversationtheway it should happen.You go to your doctor and your cholesterol is 220 andyourdoctorsays,“Hereareourchoices.WecanuseLipitor,andit’llreduceyourriskofdyingofaheartattackbyabout1.8percent.Iwanttoreadtoyouthelistofsideeffectsofthedrugverybriefly;it’sjustsixorsevenpageslong.Soyoucantakethisdrug,orIcanshowyouhowtoeatadietthatwillworkfasterthanthedrugandwillreduceyourriskofdyingofaheartattackalmostentirely.You’llalso reduce your risk of dying from cancer, diabetes, and other diseases. Andtherearenosideeffects.Now,whichwouldyouliketodo?Icaneitherwritetheprescriptionrightnow,orIcanteachyouhowtoeatthisdiet.”

Ibelievethatmostpeople,whenpresentedwiththosealternatives,wouldatleast take a look at this diet. I’veworkedwith all kinds of people: blue-collarworkers,white-collarworkers, peoplewhomake $400,000 a year, peoplewhomake$20,000ayear.Theydon’talljumpatthechancetochangetheirdiet,buta heck of a lot of them want to do it when presented with that kind of

information.Ithinkthepublicshouldbeinsultedbythemind-setthatpresumesthat itdoesnothave thewillor the intelligence tomakeachange for itsowngood.WhatLawrenceO’Donnellisbasicallysayingisthatpeoplearesostupidandweakthatwemightaswellnoteventell themabouttheidealhumandietbecause they’d rather eat ice creamand lose their limbs todiabetes thanmaketheefforttocleanuptheirdiet.

GM:Ithinkhe’ssayingthatpeopleknowthaticecreamisn’tahealthfood,buttheyeatitanywaybecausetheyarefalliblecreatures.

PP: No, they don’t know. They’re misled a hundred different ways. They’reeating fat-free ice cream. They’re told that dairy products provide calcium tostrengthentheirbones.They’retoldthatchocolateisasuperfoodandthatnutsare indispensable for brain function. And they’re taught that they can’t affecttheirhealthor theirweightverymuchinanycasebecause it’sall inthegenes.They look to the Academy of Nutrition and Dietetics for dietary advice andthey’re told that there’s room for everything, including ice cream, in ahealthydiet. They think that because they buy extra virgin olive oil, fat-free dairyproducts,andimportedorganiccheese,they’redoinggreat.LawrenceO’Donnellwasbasicallyimplyingthat160millionAmericanswithdegenerativediseasearewellawarethattheircurrenttreatmentsdon’tworkandthattheycaninsteadeatthemselvesoutofdisease,butthey’vejustchosennottodosobecausetheyloveice cream. Well, that’s not been my experience. I find it unfathomable thatpeoplewouldcaresolittleaboutthemselvesthat,inspiteofbeingwellawareofhowto regain theirhealth, they justwouldn’twant tomake theeffort. Idon’tbelievethat’sthecaseatall.

I’ll tell youwhatmy experience has been, notwith one or two people butwithmanythousandsofpeople.Whentheyunderstandthetruthaboutwhatismakingthemsick,manyactonit.Theyarewillingtochangetheirdietsnotjusta little bit, but entirely. And the diet they adopt is full of foods that, to thepalates theycultivate,areeverybitasdeliciousas icecreamoncewas to them,whentheirpalatesrespondedonlytosugarandfat.And,incidentally,onceinawhileonspecialoccasions,theymaystillindulgeinsomedeliciousnon-dairyicecream.But they know that there’s no reason to ever again touch dairy or thefoodsthathavemadethemfatandsick.

Thisisthewayourpublichealthcrisisends.Thegovernmentisn’tgoingtodoit.Peoplehavetodoit.Theyhavetotaketheirhealthintotheirownhands.

Thejobofthemedicalcommunityistogivepeopletheknowledgeuponwhichtheycanact.Ifthemedicalcommunitycontinuestofailinthatresponsibility,weintheplant-basedfoodsmovementwillpickuptheslack.Wewillgetthewordout in books, in films like Forks Over Knives, on the Internet, througheducational ventures like TheWellness Forum, person-to-person, and in anyother way we can. We will treat people with respect by giving them theknowledge upon which they will act to save their own lives and to save thecountry from a fiscal nightmare. I firmly believe that people can do this, andthat’snotblindoptimismonmypart.Iseeithappeneveryday.

GM:Pam, it’sbeenapleasurechattingwithyou,butI’vegot togohomeandstayuplateandtypeallofthisup.

PP:Haveacupofcoffee.

NOTES....................................

CHAPTERONE

1“Indiareworksobesityguidelines,BMIlowered,”iGovernment,November26, 2008, www.igovernment.in/site/India-reworks-obesity-guidelines-BMI-lowered/.

2K.Trakas,K.Lawrence,andN.Shear,“UtilizationofhealthcareresourcesbyobeseCanadians,”CanadianMedicalAssociationJournal,160,no.10(May18,1999):1457–62.

3 “F as in Fat: How Obesity Threatens America’s Future,” Trust forAmerica’s Health, last modified September 2012,www.healthyamericans.org/assets/files/TFAH2012FasInFat18.pdf.

4 “Adult Obesity Facts,” Centers for Disease Control,www.cdc.gov/obesity/data/adult.html.

5H.Vorster,“FructoseandBloodCholesterol,”AmericanJournalofClinicalNutrition 57, no. 1 (January 1993): 89,www.ajcn.org/content/57/1/89.2.full.pdf.

6 D. Farlow, X. Xu, and T. Veenstra, “Quantitative measurement ofendogenous estrogen metabolites, risk-factors for development of breastcancer, in commercial milk products by LC–MS/MS,” Journal ofChromatographyB877,no.13(2009):doi:10.1016/j.jchromb.2009.01.032.

7 F.Crowe,T.J.Key,N.E.Allen,etal.,“TheassociationbetweendietandserumconcentrationsofIGF-I,IGFBP-1,IGFBP-2,andIGFBP-3intheEuropean Prospective Investigation into Cancer and Nutrition,” CancerEpidemiology,Biomarkers&Prevention18,no.5(2009):1333–40.

8R.Heaney,D.A.McCarron,B.Dawson-Hughes,etal.,“Dietarychangesfavorably affect bone remodeling in older adults,” Journal of the AmericanDieteticAssociation99,no.10(October1999):1228–33.

9J.Chan,M.J.Stampfer,J.Ma,etal.,“Insulin-likegrowthfactor-1(IGF-1)andIGFbindingprotein3aspredictorsofadvancedstageprostatecancer,”JournaloftheNationalCancerInstitute94,no.14(July17,2002):1099–1106.

CHAPTERTWO

1R.Prentice,B.Caan,R.T.Chlebowski,etal.,“Low-fatdietarypatternandriskofinvasivebreastcancer,”JournaloftheAmericanMedicalAssociation295,no.6(February8,2006):629–42.

2D.Hegsted,“Minimumproteinrequirementsofadults,”AmericanJournalofClinicalNutrition21,no.5(May1968):352–57.

3A.Prentice,“ConstituentsofBreastMilk,”UnitedNationsUniversity,Foodand Nutrition Bulletin 17, no. 4 (December 1996):http://archive.unu.edu/unupress/food/8F174e/8F174E04.htm.

4T.C.CampbellandT.M.CampbellII,TheChinaStudy(Dallas:BenBellaBooks,2004).

5R.H.Chittenden,Physiologicaleconomyinnutrition,withspecialreferencetotheminimalproteinrequirementofthehealthyman.Anexperimentalstudy(NewYork:FrederickA.StokesCo.,1907),24-33,255.

6Ibid.,327.7 Howard Lyman andGlenMerzer,MadCowboy (New York: Scribner,

1998),147.8 “Livestock’s Long Shadow,” Food and Agriculture Organization of the

United Nations, last modified 2006,www.fao.org/docrep/010/a0701e/a0701e00.HTM.

9J.Chavarro,J.W.Rich-Edwards,B.A.Rosner,andW.C.Willet,“Dietandlifestyle in the prevention of ovulatory disorder infertility,” Obstetrics &Gynecology110,no.5(November2007):1050–58.

10J.Chavarroetal.,“Proteinintakeandovulatoryinfertility,”AmericanJournalofObstetrics&Gynecology198,no.2(February2008):210.e-1-210.e-7.

11J.Chavarroetal.,“Aprospectivestudyofdairyfoodsintakeandanovulatoryinfertility,”HumanReproduction22no.5(May2007):1340–47.

CHAPTERTHREE

1J.Karjalainen,J.M.Martin,M.Knip,etal.,“Abovinealbuminpeptideasapossibletriggerofinsulin-dependentdiabetesmellitus,”NewEnglandJournalofMedicine327(1992):302–7.

2 H.AkerblomandM.Knip, “Putative environmental factors andType1diabetes,”Diabetes/MetabolismResearchandReviews14(1998):31–67.

3 E.Savilahti,H.K.Akerblom,V.M.Tainio,andS.Koskimies, “Childrenwith newly diagnosed insulin dependent diabetes mellitus have increasedlevelsofcow’smilkantibodies,”DiabetesResearchandClinicalPractice7,no.3(March1988):137–40.

4W.Oddy,P.G.Holt,P.D.Sly,etal.,“Associationbetweenbreastfeedingand asthma in 6 year old children: findings of a prospective birth cohortstudy,”BMJ319(September25,1999):815.

5 S.Koletzko,P.Sherman,M.Corey,A.Giffiths,andC.Smith,“Roleofinfant feeding practices in development of Crohn’s disease in childhood,”BMJ298(June17,1989):1617–18.

6 A. Austin, A. Santhanam, and Z. Katusic, “Endothelial nitric oxidemodulates expression and processing of amyloid precursor protein,”CirculationResearch107(2010):1498–1502.

7N.Shepardson,G.Shankar,andD.Selkoe,“Cholesterollevelandstatinusein Alzheimer disease: II. Review of human trials and recommendations,”Archives of Neurology& Psychiatry 68, no. 11 (November 2011): 1385–92,doi:10.1001/archneurol.2011.242.

8 A.Mandell,M.Alexander, andS.Carpenter, “Creutzfeldt-Jakobdiseasepresentingasisolatedaphasia,”Neurology39,no.1(January1989):55–58.

9 M.Morris,D.A.Evans, J.L.Bienias,etal., “Dietary fatsand the riskofincident Alzheimer disease,”Archives of Neurology & Psychiatry 60, no. 2(February2003):194–200.

10A.Neviaser,J.M.Lane,B.A.Lenart,F.Edobor-Osula,andD.G.Lo-rich,“Low-energyfemoralshaftfracturesassociatedwithalendronateuse,”JournalofOrthopaedicTrauma22(2008):346–50.

11P.Sedghizadeh,K.Stanley,M.Caligiuri,etal.,“Oralbisphosphonateuseand the prevalence of osteonecrosis of the jaw: an institutional inquiry,”JournaloftheAmericanDentalAssociation140,no.1(January2009):61–66.

12R.Moynihan,I.Heath,andD.Henry,“Sellingsickness:thepharmaceuticalindustryanddiseasemongering,”BMJ324(2002):886–91.

13 D. Marshall, O. Johnell, and H. Wedel, “Meta-analysis of how wellmeasures of bone mineral density predict occurrence of osteoporoticfractures,”BMJ312(May18,1996):1254–59.

14D.Hegsted,“CalciumandOsteoporosis,”JournalofNutrition116(July15,1986):2316–19.

15A.WachsmanandD.Bernstein,“DietandOsteoporosis,”Lancet291,no.7549(May4,1968):958–59.

16U.BarzelandL.Massey,“Excessdietaryproteincanadverselyaffectbone,”JournalofNutrition128,no.6(June1998):1051–53

17 S.Margen, J.Y.Chu,N.A. Kaufmann, andD.H.Calloway, “Studies incalciummetabolism. I. The calciuretic effect of dietary protein,”AmericanJournalofClinicalNutrition27(June1974):584–89

18 M.Hegsted,S.A.Schuette,M.B.Zemel,andH.M.Linkswiler,“Urinarycalciumandcalciumbalanceinyoungmenasaffectedbylevelofproteinandphosphorusintake,”JournalofNutrition111(1981):553–62.

19AmyJoyLanouandMichaelCastleman,BuildingBoneVitality(NewYork:McGraw-Hill,2009),111–14.

20FoodandAgricultureOrganizationoftheUnitedNations,TheStateofFoodandAgriculture–1948(Washington,DC,September1948).

21 R. Swank,O.Lerstad,A. Stromm, and J. Backer, “Multiple sclerosis inrural Norway: its geographic and occupational incidence in relation tonutrition,”NewEnglandJournalofMedicine,246(May8,1952):721–28.

22R.SwankandB.Dugan,“Effectoflowsaturatedfatdietinearlyandlatecasesofmultiplesclerosis,”Lancet336,no.8706(July7,1990):37–39.

23Ibid.24 R.Swank, “Treatmentofmultiple sclerosiswith low fatdiet,”Archivesof

Neurology&Psychiatry69,no.1(1953):91.25 R.SwankandR.Bourdillon, “Multiple sclerosis:assessmentof treatment

withamodifiedlow-fatdiet,”JournalofNervousandMentalDisease131,no.6(December1960):468–88.

26 R. Swank, “Multiple sclerosis: twenty years on low-fat diet,”Archives ofNeurology23(November1970):460–74.

27 H. Sampson, “Food allergy. Part 1: immunopathogenesis and clinicaldisorders,”JournalofAllergyandClinicalImmunology103,no.5(May1999):717–28.

28A.Host,“Frequencyofcow’smilkallergyinchildhood,”AnnalsofAllergy,AsthmaandImmunology89,no.6Suppl1(December2002):33–37.

29P.Potter,M.Klein,andE.Weinberg,“Hydrationinsevereacuteasthma,”ArchivesofDiseaseinChildhood66(1991):216–19,doi:10.1136/adc.66.2.216.

30 M.Gunnbjörnsdóttir, E.Omenaas,T.Gíslason, et al., on behalf of theRHINEstudygroup, “Obesity andnocturnalgastro-oesophageal refluxarerelatedtoonsetofasthmaandrespiratorysymptoms,”EuropeanRespiratoryJournal24(2004):116–21.

31 A.Barbas,T.E.Downing,K.R.Balsara, et al., “Chronicaspiration shiftsthe immune response from Th1 to Th2 in a murine model of asthma,”EuropeanJournalofClinicalInvestigation38,no.8(July17,2008):596–602.

32 J. Lagergren, Y. Weimin, and A. Ekbom, “Intestinal cancer aftercholecystectomy:isbileinvolvedincarcinogenesis?”Gastroenterology121,no.3(September2001):542–47.

33M.Dominguez,E.K.Costello,M.Contreras,etal.,“Deliverymodeshapesthe acquisition and structure of the initialmicrobiota acrossmultiple bodyhabitatsinnewborns,”ProceedingsoftheNationalAcademyofSciences107,no.26(June29,2010):11971–75.

34L.Morelli,“Postnataldevelopmentofintestinalmicrofloraasinfluencedbyinfantnutrition,”JournalofNutrition138(2008):1791S–95S.

35 S.Zar,D.Kumar, andM.Benson, “Reviewarticle: foodhypersensitivityand irritable bowel syndrome,”Alimentary Pharmacology& Therapeutics 15(2001):439–49.

36 K.Heaton, J.Thornton, andP.Emmett, “Treatment ofCrohn’s diseasewithanunrefinedcarbohydrate,fibre-richdiet,”BMJ2(1979):764–66.

37ShannonBrownlee,Overtreated:WhyTooMuchMedicineIsMakingUsSickerandPoorer(NewYork:Bloomsbury,2008).

38 B. Starfield, “Is U.S. health really the best in the world?” Journal of theAmerican Medical Association 284, no. 4 (July 26, 2000): 483–85, doi:10-1001/pubs.JAMA-ISSN-0098-7484-284-4-jco00061.

39 N.Allen,C.Sauvaget,andA.Roddam,“Aprospective studyofdietandprostatecancer inJapanesemen,”CancerCauses&Control15(2004):911–20.

40 P. Barter, M. Caulfield, M. Eriksson, et al., “Effects of torcetrapib inpatientsathigh risk forcoronaryevents,”NewEngland Journal ofMedicine357(November22,2007):2109–22.

41 W. Connor,M.T. Cerqueira, R.W. Connor, et al., “The plasma lipids,lipoproteins, and diet of the Tarahumara Indians of Mexico,” AmericanJournalofClinicalNutrition31(July1978):1131–42.

42J.Bernstein,“TheroleofIgE-mediatedhypersensitivityinthedevelopmentofotitismediawitheffusion,”OtolaryngologicClinicsofNorthAmerica25,no.1(February1992):197–211.

43H.Juntti,S.Tikkanen,J.Kokkonen,O.P.Alho,andA.Niinimäki,“Cow’smilkallergyisassociatedwithrecurrentotitismediaduringchildhood,”ActaOto-Laryngologica119,no.8(1999):867–73.

44 D. Malosse and H. Perron, “Correlation analysis between bovinepopulations, other farm animals, house pets, and multiple sclerosisprevalence,”Neuroepidemiology12,no.1(1993):15–27.

45J.ChanandE.Giovannucci,“Dairyproducts,calciumandvitaminDandriskofprostatecancer,”EpidemiologicReviews23,no.1(2001):87–92.

46 D. Feskanich, W.C. Willet, M.J. Stampfer, and G.A. Colditz, “Milk,dietarycalcium,andbonefracturesinwomen:a12-yearprospectivestudy,”AmericanJournalofPublicHealth87,no.6(June1997):992–97.

47J.Karjalainenetal.,“Bovinealbuminpeptideasapossibetrigger,”302-7.48 H.Akerblom andM.Knip, “Putative environmental factors andType 1

diabetes,”Diabetes/MetabolismReviews14(1998):31–67.49 C. Verge, N.J. Howard, L. Irwig, et al., “Environmental factors in

childhoodIDDM,”DiabetesCare17,no.12(December1994):1381–9.50 L.Appel,N.J.Howard,L. Irwig, et al., “A clinical trial of the effects of

dietary patterns on blood pressure,”New England Journal ofMedicine 336(April17,1997):1117–24.

51H.Cohen,S.Hailpern,J.Fang,andM.H.Alderman,“SodiumintakeandmortalityintheNHANESIIfollow-upstudy,”AmericanJournalofMedicine119,no.3(March2006):275.e.7-14.

52M.Alderman,“Reducingdietarysodium:thecaseforcaution,”JournaloftheAmericanMedicalAssociation303,no.5(February3,2010):448–49.

53A.BernsteinandW.Willett,“Trendsin24-hurinarysodiumexcretioninthe United States, 1957–2003: a systematic review,”American Journal ofClinicalNutrition92(2010):1172–80.

54“GlobalStatusReportonNoncommunicableDiseases2010,”WorldHealthOrganization,www.who.int/nmh/publications/ncd_report_full_en.pdf.

55 A. Buitrago-Lopez, J. Sanderson, L. Johnson, et al., “Chocolateconsumption and cardiometabolic disorders: systematic review and meta-analysis,”BMJ343(August29,2011):d4488,doi:10.1136/bmj.d4488.

CHAPTERFIVE

1 RoniCarynRabin, “ChildhoodObesityandSchoolLunches,”NewYorkTimes,February8,2011,D6.

2 “DietaryGuidelines:Urgent Prescription for anUnhealthy Public, SaysAmerican Dietetic Association,” Academy of Nutrition and Dietetics(formerly American Dietetic Association), Media Room,www.eatright.org/Media/content.aspx?id=6442462223.

3 Academy of Nutrition and Deitetics. Who Are the Academy’s CorporateSponsors? www.eatright.org/corporatesponsors/ (accessed November 7,2012).

4T.C.CampbellandT.M.CampbellII,TheChinaStudy(Dallas:BenBellaBooks,2004).

5“FecalContaminationinRetailChickenProducts,”PhysiciansCommitteeforResponsibleMedicine,April 2012, www.pcrm.org/health/reports/fecal-contamination-in-retail-chicken-products.

6 “U.S. per Capita Meat Consumption 1950–2007,” USDA, EconomicResearch Service,https://d3n8a8pro7vhmx.cloudfront.net/foodday/pages/24/attachments/original/1342127278/High-Meat_Diet_Consequences.pdf?1342127278.

7PeterBregginandDavidCohen,YourDrugMayBeYourProblem(DaCapoPress,1999):125–26,128,133.

8 Statement by David J. Graham, U.S. Senate Committee on Finance,HearingonVioxx,November18,2004(accessedNovember7,2012).

9ThomasM.BurtonandJenniferDooren,“KeyFDAApprovalYankedforAvastin,”WallStreetJournal,November19,2011.

10 “Feel Good About Loving Beef,” Beef Checkoff,www.beefitswhatsfordinner.com/beefhealth.aspx.

11A.AultandJ.Bradbury,“Expertsargueabouttamoxifenpreventiontrial,”Lancet351,no.9109(April11,1998):1107.

12N.Barnard,L.Scherwitz,andD.Ornish,“Adherenceandacceptabilityofalow-fat, vegetarian diet among patients with cardiac disease,” Journal ofCardiopulmonaryRehabilitationandPrevention 12, no. 6 (November 1992):383-453.

13 N.D.Barnard, L.Gloede, J.Cohen, et al., “A low-fat vegan diet elicitsgreater macronutrient changes, but is comparable in adherence andacceptability, compared with a more conventional diabetes diet among

individualswithType2diabetes,”JournaloftheAmericanDieteticAssociation109,no.2(February2009):263–72.

CHAPTERSIX

1 SharonBegley,“OneWordCanSaveYourLife:No!”Newsweek,August14,2011.

2R.S.Hayward,E.P.Steinberg,D.E.Ford,M.F.Roizen,andK.W.Roach,“Preventive care guidelines: 1991,” Annals of Internal Medicine 114, no. 9(May1,1991):758–83.

3J.Smith,J.Green,A.BerringtondeGonzalz,etal.,“Cervicalcancerandtheuseofhormonalcontraceptives:asystemicreview,”Lancet361,no.9364(April5,2003):1159–67.

4O.OlsenandP.Gotzsche,“Cochranereviewonscreeningforbreastcancerwithmammography,”Lancet358,no.9290(October20,2001):1340–42.

5 Peter Gotzsche, Mammography Screening: Truth Lies and Controversy(London:RadcliffePublishing,2012).

6 K. Jorgensen, P. Zahl, and P. Gotzsche, “Breast cancer mortality inorganisedmammography screening inDenmark: comparative study,”BMJ340(March24,2010):c1241,doi:10.1136/bmj.c1241.

7 A.BerringtondeGonzalez,C.D.Berg,K.Visvanathan,andM.Robson,“Estimated risk of radiation-induced breast cancer from mammographicscreeningforyoungBRCAmutationcarriers,”JournaloftheNationalCancerInstitute101(2009):205–9,doi:10.1093/jnci/djn440.

8 C. Schmidt, “CT scans: balancing health risks and medical benefits,”EnvironmentalHealth Perspectives 120, no. 3 (March 1, 2012): doi: a118–a121,doi:10.1289/ehp.120-a118.

9 R. Smith-Bindman, W. Hosmer, V.A. Feldstein, J.J. Deeks, and J.D.Goldberg, “Second-trimester ultrasound to detect fetuses with Downsyndrome:ameta-analysis,”Journal of theAmericanMedicalAssociation 285,no.8(2001):1044–55.

10H.GilbertWelch,LisaM.Schwartz,andStevenWoloshin,Overdiagnosed(Boston:BeaconPress,2011),138–40.

11 A. Neugut and B. Lebwohl, “Colonoscopy vs sigmoidoscopy screening:gettingitright,”JournaloftheAmericanMedicalAssociation304,no.4(2010):461–62,doi:10.1001/jama.2010.1001.

12 RichardAblin, “TheGreatProstateMistake,”NewYorkTimes,March9,2012.

13 “Screening for Prostate Cancer: U.S. Preventive Services Task ForceRecommendation Statement,” U.S. Preventive Services Task Force, last

modified May 2012,www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatefinalrs2.htm

14 A. Kavanagh, G. Santow, and H. Mitchell, “Consequences of currentpatternsofpapsmearandcolposcopyuse,”JournalofMedicalScreening3,no.1(1996):29–34.

15 “Ob-GynsRecommendWomenWait3to5YearsBetweenPAPTests,”TheAmericanCongress ofObstetricians andGynecologists, news release,October 22, 2012,http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/.

16 Ryan Janslow, “Doctors unveil ‘Choosing Wisely’ campaign to cutunnecessary medical tests,” CBSNews.com, April 4, 2012,www.cbsnews.com/8301-504763_162-57409204-10391704/doctors-unveil-choosingwisely-campaign-to-cut-unnecessary-medical-tests.

17 “Five Things Physicians and Patients Should Question,”http://choosingwisely.org.

18 PeterBreggin,YourDrugMayBeYourProblem (Boston:DaCapoPress,1999),72–73.

19 J.Gotto andM. Rapaport, “TreatmentOptions in Treatment-ResistantDepression,” Primary Psychiatry 12, no. 2 (2005): 42–50,www.psychweekly.com/aspx/article/ArticleDetail.aspx?articleid=53.

CHAPTERSEVEN

1 M. Pereira, D.R. Jacobs Jr., L. VanHorn, et al., “Dairy consumption,obesity,andtheinsulinresistancesyndromeinyoungadults:TheCARDIAstudy,”Journalof theAmericanMedicalAssociation287,no.16(2002):2081–89.

2 CaldwellB.Esselstyn Jr.,Prevent andReverseHeartDisease (NewYork:Penguin,2007),48.

3BillMoyers,HealingandTheMind(NewYork:Doubleday,1993),89.4 W.Haenszel andM.Kurihara, “Studies of Japanesemigrants:mortality

from cancer and other disease among Japanese and the United States,”Journal of the National Cancer Institute 40, no. 1 (1968): 43–68,doi:10.1093/jnci/40.1.43.

5 B.ArmstrongandR.Doll, “Environmental factors and cancer incidenceand mortality in different countries, with special reference to dietarypractices,”InternationalJournalofCancer15(1975):617–31.

6W.Lands,T.HamazakimK.Yamazaki,etal.,“Changingdietarypatterns,”AmericanJournalofClinicalNutrition51(1990):991–93.

7 W.Haenszel andM.Kurihara, “Studies of Japanesemigrants:mortalityfromcancerandotherdiseasesamongJapaneseintheUnitedStates,”Journalof the National Cancer Institute 40, no. 1 (1968): 43–68, doi:10.1093/jnci/40.1.43.

8L.O.Schulz,P.H.Bennett,E.Ravussin,etal.,“Effectsoftraditionalandwestern environments on prevalence of type 2 diabetes inPima Indians inMexico and the U.S.,” Diabetes Care 29, no. 8 (August 2006): 1866–71,doi:10.2337/dc06-0138.

9 L.Hooper,R.L.Thompson,R.A.Harrison,etal.,“RisksandbenefitsofOmega 3 fats for mortality, cardiovascular disease, and cancer: systematicreview,” BMJ 332, no. 7544 (April 1, 2006): 752–60,doi:10.1136/bmj.38755.366331.2F.

10 G.Bjelakovic,D.Nikolova,L.L.Gluud,R.G.Simonetti, andC.Gluud,“Antioxidantsupplementsforpreventionofmortalityinhealthyparticipantsandpatientswithvariousdiseases,”CochraneDatabaseofSystematicReviews2008, Issue 2, Art. No.: CD007176,doi:10.1002/14651858.CD007176.pub2.

11H.Lange,H.Surypranata,G.DeLuca,etal.,“Folatetherapyandinstentrestenosisaftercoronarystenting,”NewEnglandJournalofMedicine26,no.

350(June24,2004):2673–81.12 D.WuandS.N.Mevdani, “n-3polyunsaturated fatty acids and immune

function,”ProceedingsoftheNutritionSociety57,no.4(November1998):503–9.

13D.Blankenhorn,R.L.Johnson,W.J.Mack,H.A.elZein,andL.I.Vailas,“Theinfluenceofdietontheappearanceofnewlesionsinhumancoronaryarteries,”Journalof theAmericanMedicalAssociation263,no.12(March23,1990):1646–52.

14 N.Barnardetal., “AdherenceandAcceptabilityofaLow-FatVegetarianDiet,”383-453;N.Barnard,L.Gloede, J.Cohen, et al., “A low-fat vegandietandaconventionaldiabetesdiet in the treatmentof type2diabetes: arandomized, controlled, 74-wk clinical trial,” American Journal of ClinicalNutrition89,no.5(May2009):1588S-1596S.

15N.Barnardetal.,“Vegandietelicitsgreatermacronutrientchanges,”263–72.

16 J.W. Anderson, “Dietary fiber in nutritionmanagement of diabetes,” inDietary Fiber: Basic and Clinical Aspects, ed. G. V. Vahouny, and D.Kritchevsky(NewYork:PlenumPress,1986),343–60.

17P.Peduzzi,A.Kamina,andK.Detre,forTheVACoronaryArteryBypassSurgeryCooperative StudyGroup,Twenty-two-year follow-up in theVACooperative Study ofCoronaryArteryBypass Surgery for StableAngina,”AmericanJournalofCardiology81(1998):1393–99.

18 “Long-term results of prospective randomised study of coronary arterybypasssurgeryinstableanginapectoris,”EuropeanCoronarySurgeryStudyGroup,Lancet2,no.8309(November27,1982):1173–80.

19B.R.Chaitman,T.J.Ryan,R.A.Kronmal,etal.,“CoronaryArterySurgeryStudy (CASS): comparability of 10 year survival in randomized andrandomizablepatients,”JournaloftheAmericanCollegeofCardiology16,no.5(November1990):1071–78.

20 D.Cohen, J. Carozza, andD. Baim, “Aggressive lipid-lowering therapycomparedwith angioplasty in stable coronary arterydisease,”NewEnglandJournal of Medicine 341 (December 9, 1999): 1853–55,doi:10.1056/NEJM199912093412415.

21 “Coronary Angioplasty and Stenting,” University of Michigan HealthSystem Cardiac Surgery, www.med.umich.edu/cardiac-surgery/patient/adult/adultcandt/coronary_angioplasty.shtml.

22“BypassSurgeryandMemory,”TheHarvardMedicalSchoolFamilyHealth

Guide,www.health.harvard.edu/fhg/updates/update0206c.shtml.23 “CrestorHighlightsofPrescribing Information,”AstraZeneca, fact sheet,

www1.astrazeneca-us.com/pi/crestor.pdf.

CHAPTEREIGHT

1 David Squires, “ExplainingHighHealth Care Spending in the UnitedStates: An International Comparison of Supply, Utilization, Prices, andQuality,” The Commonwealth Fund, April 2012,http://www.commonwealthfund.org/˜/media/Files/Publications/Issue%20Brief/2012/May/1595_Squires_explaining_high_hlt_care_spending_intl_brief.pdf

2“TheHealthySchoolMealsActof2010(Rep.JaredPolis,CO)”factsheet,http://static.usnews.com/documents/whispers/Healthy_School_Meals_Act_of_2010_Fact_Sheet.pdf

3 RichardRushfield,“TrappedinMen’sCentralJail,”L.A.Weekly,April5,2012,http://digitalissue.laweekly.com/display_article.php?id=1025278.

4 “Bay Point School for Boys,” The Food Studies Institute,www.foodstudies.org/index.php?option=com_content&view=article&id=19&Itemid=27.

5 B. Scott, F.C. Seifert, R. Grimson, and P.S.A. Glass, “Octogenariansundergoing coronary artery bypass graft surgery: resource utilization,postoperativemortalityandmorbidity,”JournalofCardiothoracicandVascularAnesthesia19,no.5(October2005):583–88.

6 V.L.Ernster,“Mammographyscreeningforwomenage40through49:aguidelines saga and a clarion call for informeddecisionmaking,”AmericanJournalofPublicHealth87,no.7(1997):1103–6.

7 “Animals Killed for Food in the U.S. Increases in 2010,” blog post,OneGreenPlanet.org, October 21, 2011,www.onegreenplanet.org/news/animals-killed-for-food-in-the-u-s-increases-in-2010.

8AlicePark,“NYC’sTransFatBanWorked:Fast-FoodDinersAreEatingHealthier” Time, July 17, 2012,http://healthland.time.com/2012/07/17/nycs-trans-fat-ban-worked-fast-food-diners-are-eating-healthier.

9Dr.SanjayGupta,“MoreTreatment,MoreMistakes,”NewYorkTimes,July31, 2012, www.nytimes.com/2012/08/01/opinion/more-treatment-more-mistakes.html.

D

ABOUTTHEAUTHORS....................................

DR.PAMELAA.POPPER,PH.D.,N.D.

r. Pam Popper is a naturopath; an internationally recognized expert onnutrition,medicine,andhealth;andtheexecutivedirectorofTheWellness

Forum.Thecompanyofferseducationalprogramsdesignedtoassistindividualsinchangingtheirhealthoutcomesthroughimproveddietandlifestylehabits;toassist employers in reducing thecostsofhealth insuranceandmedical care foremployees; and to educatehealth careprofessionals abouthow tousediet andlifestyle forpreventing, reversing,andstopping theprogressionofdegenerativedisease.

Dr.PopperservesonthePhysicians’SteeringCommitteeforthePhysiciansCommittee forResponsibleMedicine inWashington,D.C.She is alsooneofthe health care professionals involved in the famed Sacramento Food BankProject,inwhicheconomicallydisadvantagedpeoplewereshownhowtoreversetheirdiseasesandeliminatemedicationswithdiet.

Dr. Popper is part ofDr.T.ColinCampbell’s teaching team at eCornell,teaching part of a certification course on plant-based nutrition. She has beenfeatured inmany widely distributed documentaries, includingProcessed People,MakingaKilling,andForksOverKnives,whichopenedintheatersinMay2011.SheisoneofthecoauthorsoftheForksOverKnivescompanionbook,whichisontheNewYorkTimesbest-sellerlist.

GGLENMERZER

len Merzer is coauthor with Howard Lyman of Mad Cowboy, and withHowardLyman and JoannaSamorow-Merzer ofNoMoreBull!He is also

coauthor ofChefAJ’sUnprocessed, andof the forthcomingBetterThanVegan,withChefDelSroufe.Heisalsoaplaywrightandscreenwriter,withthreeplayspublished by Samuel French, Inc. He has been a vegetarian for almost fortyyears,andaveganforalmosttwenty.