Fitness

Campbell, Government, Big Food, Big Medicine, and Nutrition

Posted on by Amir

In The China Study, T. Colin Campbell provides substantial insight as to the conflicts between science, government, the medical establishment, and the food industry in the fight over what constitutes proper nutrition. While he does a wonderful job articulating the mess we currently have, what he fails to understand is that this is exactly why we need to get government out of the business of recommending nutritional guidelines.

Right now, we have a system in which Big Food and Big Medicine–two establishments that wield the big money–pretty much dominate the ear of Big Government.

Big Food–which includes the meat and dairy industry, the fast food industry and related restaurant chains, as well as food companies that make products from meat and dairy–has a vested interest in protecting the status quo. They have hired guns in science and academia who wield a large degree of influence over government agencies, lawmakers, and their staffs.

Big Medicine–which includes physicians, insurance companies, medical services, and Big Pharma–is a similar opponent. While the medical world is increasingly aiming in the direction of prevention of disease, they place the emphasis on prevention that involves the work of medical professionals. Heart scans, angioplasties, bypass surgeries, radiological procedures, colonoscopies, pills, and injections–those are things that bring in the bucks for Big Medicine.

If you go vegan, you may reduce your chances of a heart attack to zero, but it makes no money for your cardiologist or your primary care doc. You’ll also hit many players in the Big Food industry in the pocketbook.

Unfortunately, Campbell seems to think that getting government on the side of the vegans is the answer to all of this. In fact, the better answer is to get government completely out of the business of nutritional guidelines and recommendations.

Ultimately, it’s not the government’s place to control what doctors learn, what doctors discuss with their patients, what citizens wish to eat, or what products Big Pharma and Big Food market to us.

Fact is, in the Internet, we have the best free market of information ever known to the world. And nutrition is not rocket science.

    If you have heart disease, a vegan diet may save your life.
    If you have naturally high cholesterol, an Atkins or South Beach diet is tantamount to pouring gasoline on a fire.
    If you have a high diabetes risk, getting your weight down will go far toward preventing Type 2 Diabetes. If you have Type 2 Diabetes, getting your weight down–and keeping it down–may eliminate your diabetes.

Do we need government to tell us any of those things? Of course not. We don’t know the “causation”, but let’s not kid ourselves: if you’re at risk, the actionable intelligence is there, and it’s on you to decide what to do with it.

People can choose to make their own decisions about nutrition. Dr. Esselstyn found that patients–once they realized the control they had over their disease via diet–were very willing to make the changes they needed to make.

The medical establishment needs to start deciding which team they are on: the side of the patients or the side of their pocketbook. Docs need not advise all patients to go vegan, but if I’m a cardiologist and I have a patient who has heart disease, you can bet that I’m going to be telling him that going vegan may save his life. If I don’t do this, then shame on me.

If I’m a primary care doc and I have a patient with diabetes (Type 1 or 2), you can bet that I’m going to be telling him that going vegan and getting weight control will cut the amount of insulin needed (for Type 1) and possibly even eliminate the (Type 2) diabetes altogether. If I don’t do this, then shame on me.

If I’m a primary care doc and I have a patient that is showing some signs of Alzheimer’s or related dementia, you can bet that I’m going to be telling him that he has nothing to lose by going vegan. (While we have not determined the efficacy of this approach with respect to dementia, it’s not like other therapies are working worth a rat’s posterior.)

If I’m a neurologist and I have a patient with MS, you can bet that I’m going to be telling him that going vegan may improve his overall quality of life by mitigating his complications. The science is unmistakable here.

You can also bet that if I have a patient that has found weight control to be elusive, I’ll be telling him that going vegan may succeed where other attempts have failed. The science may not be perfect here, but the pointers are strong enough.

You can also bet that if I have a patient that is in otherwise good health, but who eats a “standard” diet, and he asks me about proper nutrition, I’ll be telling him that at least cutting back the proportion of animal based products–and replacing that with plant-based products–will provide a foundation for long-term health.

On a different take, the patient is going to need to start taking responsibility for knowing what is best and what is not. This information is not restricted from you; it is readily available and is but a mouseclick or two away. You need not spend thousands of dollars on specialists to learn what is available at your library, or via the Internet. I don’t need government to do this for me.

Moreover, by getting the government out of the business of making nutritional recommendations, we will make the landscape more of a true free market. As more people cut back on animal-based products, Big Food will invest more capital in developing plant-based products that are healthier and taste good.

We may also see a driving down of health care costs without costly legislation. Fewer heart procedures, fewer chemo treatments, fewer surgeries…all of that means less strain on insurance costs. It also makes medical pricing for routine services more competitive. Traditional physicians (MDs) may see more competition from osteopaths (DOs) and even chiropractors and nutritionists over basic prevention of disease.

The critics will complain–with some merit–that we will see a lot of quacks emerge. At the same time, we have plenty of quacks now. They exist in the medical establishment, government, and all levels of industry. In the current setup, they are protected by government.

By getting government out of the business of nutrition, we might see a badly-needed shakeup in this area.

Re-Assessing Nutrition, Part 2 (“Correlation does not equal causation” only goes so far)

Posted on by Amir

At times, nutrition can seem like economics: get 3 nutritionists in a room, and you’re going to get 6 different opinions.

Anyone with an opinion can cite one or more studies that give them credibility. If you want to eat a high-fat/high protein diet, there are studies that appear to support you. If you want a low-fat/high-carb diet, there are plenty of studies that appear to support you. If you want something in between, there are studies that appear to support you.

The problem is that when we assess the question–“what is the best dietary regimen”–we often don’t qualify it appropriately. The proper question is, “What is the best dietary regimen for my given activity level and health situation?”

We also have to qualify it–as economists do–by indicating ceteris paribus (all things being equal). This is because some people have food allergies, others have metabolic issues, others have Type 1 Diabetes, and so forth. Dietary needs can vary. This is perhaps the main factor that makes the field of nutrition a difficult one.

Given that a third of Americans are obese, the common question is, “What is the best dietary regimen for getting off these #$%! pounds???”

If you have heart ailments, a better question may be, “What is the best dietary regimen for keeping my ticker tocking?”

If you are an athlete, the question might be, “What dietary regimen puts me in the best position to get my best performance?”

For me, the proper question is, “What is the best dietary regimen that minimizes my risks of cancer, heart disease, and dementia?”

In the world of sports–especially those that require high endurance–the science is indicative of high complex carbs/low-moderate protein/low-moderate fat. In the endurance world, vegans are not uncommon. While weightlifters and bodybuilders are still steeped in protein-mania–and science appears to support that approach in those sports that are dependent on strength–the rest of the sports world is not as big on steak and eggs as was the case 30 years ago.

But what if you are not a full-time athlete? What if you don’t run marathons? What if you’re only getting a couple hours of cardio per week? What if you just want to stay healthy, keep the excess pounds off, keep autoimmune diseases in check (i.e. arthritis) and mitigate your risk of cancer?

What if you’re like me: you want to do all those things, but still do the occasional 100-mile bike ride, or half-marathon, or half-Ironman?

It’s fair to ask what the science says about all of this.

Enter two excellent reads–Prevent and Reverse Heart Disease, by Caldwell Esselstyn, MD and The China Study, by T. Colin Campbell.

Esselstyn did his own 20-year study while he was a surgeon at the Cleveland Clinic. He took a set of patients with advanced heart disease–many of them had already had bypass surgery and/or angoplasty–and put them on a strict vegan diet. He monitored the results over a 20 year period. The results were breathtaking: those patients overwhelmingly were able to avoid further cardiac incidents, and in many cases the heart disease was even reversed.

The skeptics, however, can look at Esselstyn’s work and punch holes in it: (a) there was no “control” group, (b) it’s only one isolated study, (c) perhaps Esselstyn was personally biased.

Even then, the results are what they are. It’s a Cleveland Clinic study. Esselstyn’s credentials are impeccable. Any bias-centered criticism of Esselstyn would have to be balanced against his record of intellectual integrity as a physician.

Verdicts:

(a) Esselstyn has provided ACTIONABLE INTELLIGENCE for those who have heart disease and wish to avoid future surgeries and/or premature death.
(b) Esselstyn has provided ACTIONABLE INTELLIGENCE for those who wish to mitigate their risks of heart disease and complications thereof.

And that’s what we’re all about here: ACTIONABLE INTELLIGENCE.

And that brings me to Campbell and The China Study (TCS).

In TCS, Campbell makes a more comprehensive case for a vegan nutritional regimen. He begins by highlighting his scientific work, analyzing carcinogens (aflatoxin), and nutritional approaches in various undeveloped nations. It was in the course of studying the dynamics of aflatoxin that Campbell stumbled into the dilemmas between plant versus animal proteins. His first two chapters are foundational in this respect.

As Campbell made his case for the vegan approach–highlighting links between animal-based diets and a myriad of ailments–the skeptic in me often screamed, “Correlation does not equal causation!” Everyone with a bare-bones-basic knowledge of statistics knows that.

Unfortunately, while that statement is indeed true, it only goes so far. And every physician worth a penny knows that.

Want an example? Type 2 Diabetes.

While we have a plethora of scientific evidence correlating obesity with Type 2 Diabetes, we still have not verified conclusively that obesity causes Type 2 Diabetes. At the same time, (a) every good physician in America will tell diabetes patients to get their weight down and keep it down; and (b) when a Type 2 Diabetic drops the pounds, the diabetes usually goes away.

Correlation does not equal causation, but–if the correlation is strong enough, that constitutes ACTIONABLE INTELLIGENCE.

If dropping the pounds eliminates the diabetes, does it really matter–for your own health–if causation has not been established?

If you have the choice between eating a vegan diet or enduring painful, costly, and debilitating heart surgery, does it matter if causation has not been established?

Now some of Campbell’s proposals are controversial. For example, we have not determined that a vegan diet will keep you from getting Alzheimer’s, or Rheumatoid Arthritis, or Multiple Sclerosis.

Still, given that medical treatments for those diseases have not shown much promise, if eating less meat and jacking up the veggie intake might mitigate that risk–assuming it is a risk that you feel passionate about–then Campbell has given you ACTIONABLE INTELLIGENCE.

Correlation isn’t causation, but it is useful in forming testable hypotheses. At the very least, Campbell provides a nice basis for a myriad of such hypotheses.

Another aspect of TCS that is refreshing is the way Campbell provides insight into how the government has influenced nutrition education in ways that are harmful to Americans. While Campbell strikes me as a left-of-center type, his analysis is without respect for political parties and is more centered on the fascistic, incestuous relationship between lobbyists for the food industry, government agencies, and lawmakers. Campbell also provides a stark picture of how government influences nutrition: from the Department of Agriculture to the Department of Education, and how the food lobby has fought to stack the advisory panels with their own hired guns.

One does not have to be a vegan to appreciate the fact that the government’s recommended daily allowances are too fat-heavy and do not include enough fruits, whole grains, and vegetables. And Campbell provides an honest assessment as to why those recommendations are what they are.

At the end of the day, Campbell is no hack. He’s an honest scientist who has gone where the evidence took him. That evidence has led to many correlations, some of which have statistical significance.

We don’t have causation established, but we have the same smoking guns that appear to be showing up whenever a malady gets studied. You can decide, “Correlation does not equal causation, so I don’t care.” And that is your business. Or you can decide that you have enough inherent risk that this intel is worth acting on. That is also your business.

I would argue that it is not the government’s place to tell you what you must do, but it is on you to decide for yourself if Campbell and Esselstyn are on the money.

Maybe there’s a risk that is important to you; perhaps not. Does everyone need to go vegan? Not by a long shot. Is a total vegan approach required to mitigate the risks highlighted by Campbell? No (although Esselstyn insists on it himself.) Do we need government telling us to go vegan? No.

But if mitigating your risks of cancer, heart disease, stroke, autoimmune disorders, Type 2 Diabetes, and perhaps dementia is important, then it’s worth a look.

My only gripe with TCS: Campbell provides no vegan recipes. He does a wonderful job extolling the virtues of the vegan approach, but does a crappy job of providing a portrait of how appealing and enjoyable it can be. (Esselstyn, however, devotes a large part of his book to providing recipes.)

Campbell, however, has started a larger discussion: to what extent ought government be involved in the promotion of nutrition?

I’ll try to tackle that one next week.

Re-Assessing Nutrition, Part 1

Posted on by Amir

I had the privilege of growing up during a period in which many sacred cows of nutrition became the focus of much scrutiny.

Many people may not remember, but not too long ago, (a) world-class athletes were sold on high protein/low carbohydrate diets; (b) coaches almost universally gave out salt tablets to athletes before games and practice; (c) it was not uncommon for professional teams to drink beer after games to rehydrate; (e) marathon runners–in order to “carbo load”–ate lots of sugary foods for the carbo-boost.

Today, those practices are sacrilege. While protein still gets a lot of hype–largely due to Atkins-mania–athletes are re-discovering the benefits of complex carbs. Salt tablets have given way to electrolyte replacers that go lighter on salt and provide more balance. Beer is now understood to be a DEHYDRATING agent. And marathon runners are looking more at gels (Hammer Gel, GU) and other products that provide complex carbohydrates prior to competition.

It is arguable that tennis stars Martina Navratilova and Ivan Lendl–and 6-time Ironman champion Dave Scott–provided the impetus for that nutrition revolution.

Lendl and Navratilova embraced the high complex carbohydrate/low protein approach of Robert Haas, and became the most dominant players in their sports. Navratilova–once an overweight underachiever–became the fittest player in the history of women’s tennis; Lendl held the #1 spot on the men’s tour for a record 270 weeks; Scott was similar in his approach–although he was a strict vegetarian. He would win six Ironman World Championships. (An Ironman triathlon consists of a 2.4-mile swim AND a 112-mile bike ride AND a full marathon of 26.2-miles.)

I followed a lot of that, and–after letting my fitness slip for a few years in the 1990s–embraced that path as I reached fitness levels I had not even realized in my high school days. I know many other athletes–especially marathoners and ultrarunners–who have taken this approach. For serious endurance athletes, it’s darn close to standard.

A couple months ago, an acquaintance of mine who is in the same spin class gave me a book to read that challenged him: Prevent and Reverse Heart Disease, by Caldwell Esselstyn, MD. In it, Esselstyn–a renowned former Cleveland Clinic surgeon, combat surgeon in Vietnam, and Olympic Gold Medalist (rowing, 1958)–makes the case that, with a vegan approach, heart disease can be prevented and even reversed. The thrust of his book was his own study–during his Cleveland Clinic days–of a set of cardiac patients who had advanced heart disease. He put them on a total plant-based (vegan) diet, and the success was overwhelming.

The study wasn’t perfect–there was no “control” group. But still, his results are nothing to sneeze at. He had my attention.

I also noticed that the forward for his book was written by T. Colin Campbell, author of The China Study. A friend of mine–KM, who is a physician–recommended that I read that book as it is one of her favorites. So I read it, too.

I’ve had many conversations with KM over the years. And she, like Campbell, lamented that physicians do not get a lot of nutrition training. While she is not a vegan, she appreciates the principles that Campbell provides, and has adopted many of them.

Personally, I loathe most vegetarians, especially the envirowackos who are out to castigate anyone who eats chicken, fish, beef, or pork. I have no use for those types.

Still, I’m all about mitigating my controllable risks, and Campbell and Esselstyn provide a good case for anyone with known heart disease/cancer risks who wants to control those risks without medical approaches.

In part 2, I’ll discuss why I agree with Campbell and Esselstyn. (Hint: The “correlation does not equal causation” argument only goes so far.)

Marriage May be Bad for Physical Health

Posted on by Amir

This has not been the case for myself or for MrsLarijani.

In all seriousness, here’s my observation on the matter. I know couples who were fit until they got married, and then–after the fact–made their fitness less of a priority. Maybe after she had a couple kids, she was not getting out much, not getting to the gym, not going out of walks, and perhaps slacked a little in the food discipline. The husband often did the same: became a homebody, didn’t get that hour of cardio in as he used to, and things got away from him.

Those, however, who continue to at least make their fitness an important priority–even after having kids–still manage to remain fit. They may not get to the gym like they did when they were single, but they still exercise. They may not count every calorie or fat gram or carb as they did when they were single, but they remain sensible with their food discipline. For them, weight gain is light, if at all. A couple with whom Cubbie and I are good friends has managed to do just fine, even with hectic work life, homeschooling, and two kids.

MrsLarijani and I get out to the gym often. I don’t exercise to the same degree that I did during my single days, but my fitness hasn’t suffered. MrsLarijani is in better shape today than she was a year ago: she’s dropped some body fat, added some muscle, and even finished her first half-marathon.

That said, it would be interesting if the Marriage Mandate crowd shows some intellectual honesty in conceding that there is credible research showing that marriage is no panacea.

Anakin and others have done a good job showing that married men are not necessarily happier than single men. Now the evidence is out there showing that marriage is no guarantor of physical health either.

Marriage is a very good thing–MrsLarijani and I are very happy in that–but we were not unhappy as singles. We were not looking to marriage as something that was going to fix everything that was wrong with us.

For the Christian, marriage can be a vehicle for sanctification. The same can be said, however, for singleness. To ask, “How can I be holy without marriage?” is to fail to understand either sanctification or holiness. Neither are dependent on your marital status, although marriage can be a vehicle for those.

Even in sexual matters, marriage is no panacea. I will say this much: marriage, done rightly, makes that battle easier. It will not, however, eliminate all threats of sexual immorality. A married man will find women–otherwise attractive ones–interested in him who would not have given him the time of day when he was single.

For women, the dynamics are a little different, but the threat is the same. It’s no big deal if you’re doing marriage rightly, but if you’re not doing marriage rightly, it’s not hard to see how one can get drawn to those to whom one is forbidden. Don’t believe me? Read Anna Karenina and let’s talk.

I’ve seen pastors walk away from their wives AND CHILDREN–and churches–for other women. I’ve seen pastor’s wives abandon their husbands for other men. Trust me on this: Total Depravity is exactly that. Given the right stimulus and opportunity, anyone is capable of anything.

Marriage doesn’t roll back your depravity. It can make some of the battles easier. It can provide the accountability that you need to face some matters that you might have overlooked as a single. What you–and your spouse–do with that framework is a different matter.

But make no mistake: marriage, in and of itself, is not some magical institution that is going to transform you into a better person.

Prescription Drugs and Jackson’s Death: My $0.02

Posted on by Amir

For the record, Michael Jackson lasted longer than Elvis; Elvis being only 42 when he died. Jackson was 50.

Sadly, Jackson’s worst fears seem to have come to pass: he worried that he may die the same way Elvis did.

In his final years, Elvis was barely coherent due to his extreme use of and addiction to prescription drugs. Apparently, Jackson had the same problem.

The accounts I’ve read have his back problems as the culprit that started him down that path.

In 2000, I never fathomed not being able to run. I was active, ran about 30 miles every week, and had completed two marathons and an ultramarathon over the course of 3 months. The following year–2001–I finished two more marathons.

Then, in early 2002, I started feeling a twinge in my lower back. I figured it would go away. It only got worse. After a month of this, I got x-rayed.

Diagnosis: degenerative disk disease. I scaled back my running, worked on strength exercises, and had some improvement. I even got to where I was trying to get into the Army Reserves, as they had lowered the age limit.

Then, in late 2005, I blew my back out. I could no longer run. I could barely sleep at night. I could barely walk, and had a very bad limp. My weight climbed, as my exercise routine was decimated. At 5-3, I got up to 175 pounds.

In June 2006, I got the word from my doc: either take drastic action or the options get ugly.

The options?

  1. Lose weight, and develop core strength. This could buy me soem time before eventually needing surgery.
  2. take some pain killers from time to time, relying on injections and eventually surgery when things got worse.

As much as I loathed the idea of surgery, I loathed even more the prospect of pain-killers and injections. I knew the horror stories of addiction. Narcotics are nothing to screw with.

What did I do?

  1. I started seeing a chiropractor. At first, it was every week.
  2. I started focusing on exercises that could help strengthen my core muscles while providing decompressive relief for my back. I settled on the dip chair, doing knee-lifts.
  3. I found a recumbent exercise bike on eBay for $450. I bought it, and proceeded to ride the hell out of it.
  4. I started eating more sensibly, looking for ways I could cut calories without being too restrictive. My biggest adjustment? Not eating out as much.
  5. I reviewed my plans with my doc and chiropractor, and evaluated the progress.
  6. Oh, I didn’t take one freaking pill. (Ask me how I really feel.)

The end result? Between July and December 2006, I dropped 20 pounds with only small dietary adjustments. I was able to function. I could walk without a limp.

I didn’t stop there. I continued my fitness journey, and–by the end of 2007–ended up in the best shape of my life. (I’ve not let up either, as the future Mrs. Larijani can attest. Recon keeps my on my toes!)

I say this to point out that

  1. The solution to a medical problem is not always medical.
  2. A physician who resorts to narcotics for back pain–without exhausting other options–is doing his patient a gross disservice.
  3. Michael Jackson did not have to embrace a path of medically-induced misery.

Elvis Presley’s physician–Dr. George Nichopoulos–had doped him to the point of incoherence, feeding the furnace of addiction. The Elvis-Nichopoulos relationship became the classic case study in medical ethics. At the time, it was the highest-profile case of combined drug intoxication. Since then, Anna Nicole Smith also succumbed in similar fashion. Sadly, this appears to also be the case with Michael Jackson.

With his stature, Jackson could have hired a real physician (one who is bent on drugs as a last resort and not a first option) and personal trainer–even a physical therapist–in pursuit of lower back remedies outside of pharmaceuticals. A personal trainer could have kept him in tip-top shape.

Unfortunately, in Jackson’s case, there was probably a whole littany of bad decisions, and his personal health was probably not the largest of his concerns, even though–by tossing that to the wind–he only set himself up for disaster.

A serious lesson I’ve learned in my 42 years is this: you cannot afford to neglect your health. There are things most people can do to minimize their chances of serious problems, not the least of which include a sound diet, and a robust exercise regimen.

Even with profound difficulties–such as a bad back–this is possible, albeit with some adjustments.

Trouble is, you have to have the right doc who will put your feet to the fire to exhaust non-medical options, as most MDs are predisposed to prescribing this or that drug. After all, pharma companies pay big bucks and perks to docs who prescribe the products.

Call me presumptuous and/or cynical, but I’d say Jackson was poorly-served by his medical help.

Perhaps I need to become a personal trainer for celebrities.