[687] in Vegetarian_Support_Group
interview with Dr. Neal Barnard, president of PCRM (long)
daemon@ATHENA.MIT.EDU (elsiedee@MIT.EDU)
Fri Oct 20 05:01:30 1995
From: elsiedee@MIT.EDU
Date: Fri, 20 Oct 1995 04:57:42 -0400
To: vsg@MIT.EDU
Revolution in Diet and Medicine
From SPECTRUM, #24 May/June 1992.
Dr. Neal Barnard is President of The Physicians Committee For
Responsible Medicine, a nationwide group of physicians that promotes
preventive medicine and addresses controversies in modern medicine. In
April 1991, he and three other doctors unveiled a proposal to replace
the old Four Food Groups concept initiated in 1956.
In his book, "The Power of Your Plate," Dr. Barnard documents the
scientific evidence supporting a low-fat, vegetarian diet as the most
potent regimen to reduce risk of heart disease, cancer, weight
problems and food-borne illness. Aside from serving as a practicing
physician on the faculty of the George Washington School of Medicine,
he is also an Associate Director for Behavioral Studies at the
Institute for Disease Prevention.
Spectrum: Could you tell me a little about your background?
Neal Barnard: I grew up in North Dakota, and I was completely
oblivious to nutritional issues. I ate the pork-chop-and-roast-beef
diet that everybody else eats in that neck of the woods. My father was
a doctor, and my grandfather was a doctor, but we have four people in
my family that are cattle raisers. I think all of us, both the people
that were eating cattle and the people that were interested in
medicine, really didn't appreciate the links between diet and illness.
I had a job at McDonald's in high school, but my first year of medical
school I started to become sensitive to a lot of issues, one being the
relationship of diet and disease. I would say this awareness was aided
and abetted by a realization of what animals go through in
agriculture, which is grotesque. Most people don't see it, but I did
growing up. Only later did it start to make sense to me, and in the
first year of medical school I became a vegetarian.
I started the Physician's Committee For Responsible Medicine in 1985
with an aim of taking on lots of issues, not just preventive medicine.
In that area, for example, we publish a magazine called the Guide to
Healthy Eating. Its goal is to provide user-friendly nutrition
information, with little recipe cards in every issue that you can tear
out and put in your recipe file. The magazine is also used as a
hand-out for patients in doctors' offices.
We have a nutritional program for businesses called the Gold Plan. If
you're working at IBM, or wherever, at lunch time in the cafeteria you
can get nutrition information on healthy, totally vegetarian foods.
The key is that we have to go beyond the recommendations that most
conservative medical organizations have been using... I'm not
discouraging people from getting medical care when they really need
it, but I am encouraging people to take advantage of what they can do
on their own...
As I mentioned, our organization has taken on other issues. We've done
quite a lot to promote alternatives to animal research. We've done
some work against unethical human research, and made trouble in
various other ways. You can make a lot of friends and a lot of enemies
doing this kind of work.
Spectrum: Should people sometimes think twice about going to the
doctor? What are some important ways you think that people need to
take responsibility for their health care?
Neal Barnard: The first key is to recognize that your power is far
greater than the power that a physician might have. By that I mean
that once you have heart disease, the capacity that your doctor may
have to limit it, or reverse it, is far less than the power you had to
prevent it from occurring in the first place, or even to reverse it
through lifestyle measures. I'm not discouraging people from getting
medical care when they really need it, but I am encouraging people to
take advantage of what they can do on their own, which is phenomenal.
Even two, three, or four years ago, we did not know that the plaques
in your coronary arteries could actually dissolve with lifestyle
measures alone. We now know that they can. Dr. Dean Ornish has
established beyond any reasonable doubt that a combined program of
vegetarian diet, modest exercise, stress reduction, and not smoking
can accomplish this. That sort of regimen will actually make those
plaques start to disappear without medicine, without surgery, and,
relatively quickly. Within one year he achieved demonstrable changes
in most of the patients he studied.
The key is that we have to go beyond the recommendations that most
conservative medical organizations have been using. By that, I mean
the American Heart Association, the American Cancer Society--their
recommendations will not reverse heart disease. A 30% fat diet with
lean meat, chicken and fish is not going to reverse anybody's heart
disease, nor will it prevent it. You can look at such a diet and know
that that's the case. Chicken, fish and lean meats have cholesterol
and saturated fat in them; they have no fiber or complex
carbohydrates.
Spectrum: Recent studies showed that fat reduction down to 30% did not
help much. Because of this, some people now are saying that you don't
really need to worry about fats.
Neal Barnard: Yes, that is actually one of the most devastating
effects of poorly done research, or maybe poorly interpreted research.
For example, there was a very large, and I believe well-done, study of
nurses done through Harvard University, but I think that its results
were so poorly interpreted as to have the effect that you've just
described. The results were as follows:
It has been known for a very long time that animal fat, and to a
lesser extent, all fats, increase the risk of breast cancer. The
reason is that fats increase the production of estrogen in the body,
and that, in time, over-stimulates the cells of the breast and they
become cancerous. There are other reasons, also.
In this Harvard study, thousands and thousands of nurses were tracked
year after year--what they ate, their incidence of illnesses, and so
forth. During a four-year period, the researchers noticed that those
who had somewhat less fat in their diet, as well as those who had more
fat, had the same risk of breast cancer. They interpreted that to mean
that changing your diet doesn't help.
If you look more closely, those who were eating the least fat were
still eating about 29% of their calories as fat. That's not very far
under the average in America. But compare that to Japan. When Japan
was at its very lowest incidence of breast cancer, Japanese women were
eating 7% or 8% of their calories as fat. That would be about the
typical amount found in a low-fat, vegan diet.
The fat intake of nurses in the study ranged from 29% and up. All of
them are at high risk of cancer. It's the equivalent of saying, "if
I'm smoking two packs of cigarettes a day, and I cut down to one, will
that reduce my risk of having lung cancer?" And, you may find it
doesn't. If you, then, interpret that to mean that smoking doesn't
matter, you've made a grave error.
The meat-eating women are eight times more likely to have breast
cancer. The genetics are the same...so that's not a factor.
Likewise, there was a study recently where they did a statistical
analysis of the benefit of reducing the fat in your diet to about 30%,
and they concluded your average person would gain only a month or two
of life, overall. Well, that doesn't mean diet doesn't work, it means
that modest changes in your diet don't work.
So, that's the message I want to get out to people. If you change your
diet, and do it very vigorously, you have enormous power. You can
reverse heart disease. You can prevent it. You can, I believe, prevent
most cases of cancer if you combine dietary changes with avoiding
tobacco. You could prevent probably 70% or 80% of cancers, just by
those steps alone. And, obviously, there's a whole host of other
diseases that you would be able to live without.
Spectrum: I've talked to some people who dispute those studies
indicating the superior health of traditional Japanese people. These
critics say that a lot of Japanese died young because their lives were
harder or less sanitary, and this left only the healthier ones to be
counted in the studies. Or, that their longevity might be due to some
kind of genetic effect. People come up with all kinds of reasons why
this epidemiological information isn't accurate, but I assume the
researchers controlled for those variables.
Neal Barnard: The fact of the matter is, there is not just one, but
many, many studies, and not only looking at the Japanese in their own
society, but looking at them as they changed their diet, and adopted
ours.
Spectrum: When they come to America?
Neal Barnard: When they come to America, or even wealthy Japanese
women living in Tokyo or Osaka eating a western diet with meat every
day, compared to poorer people in the same area who are not eating
meat. The difference in breast cancer risk between a Japanese woman
eating meat every day, and a Japanese woman who isn't, is a factor of
eight. In other words, the meat-eating women are eight times more
likely to have breast cancer. The genetics are the same in these
cases, so it's not a factor.
If a Japanese family comes to the U.S., their children eating a
Western diet will have the same risk of breast cancer as the
Caucasians living around them, and here again it is not an effect of
genetics.
The other things that you mentioned--sanitation and so forth--the
Japanese put us to shame in this area, and their longevity is greater,
not less than ours.
Diet has to be one of the reasons for their good health. That's not to
say that I think everyone should adopt a Japanese diet without
thought. There are things wrong with the diet. In some cases there is
too much salt and too many pickled foods, and so forth. But you can
take the best of both worlds.
Spectrum: I first heard about your work in the newspapers. I believe
the U.S.D.A. had developed a "pyramid" of foods to replace the Four
Food Groups. Your association then proposed a new, entirely vegetarian
Four Food Groups. Can you tell our readers a little about what your
intentions were, and about your Four Food Groups? What kind of
reaction did you get from the medical establishment?
Neal Barnard: The old Four Food Groups are meat, dairy, grains, and
vegetables/fruits. That's a prescription for premature mortality.
That's a prescription to kill off a sizable percentage of the
population and it's the prescription that all of us learned as we were
going through school. It started in 1956, after years of other various
schemes that the Department of Agriculture had developed. There used
to be more food groups than four. Science has come a long way in the
36 years since.
Spectrum: What was behind the development of the original Four Food
Groups? Was there any political or economic thrust behind it, or was
it concerned totally with health?
Neal Barnard: I think the original idea probably stemmed from a desire
to educate people about simple steps they could use to stay healthy
However, it has been used essentially as a promotional campaign for
agricultural products. Dairy products got their own group, and it was
prominently featured. If you look at the fine print on the posters
that are in schools, it indicates that the Dairy Council has put these
out. They print the posters, and they still promote the old Four Food
Groups because it increases sales of their products. It's the same
with the meat producers.
The original Four Food Groups is completely out of sync with all the
science that has gone on since that time. We now know that people who
eat no meat at all--who violate the Four Food Groups--live longer.
They have less incidence of disease and they are thinner. People who
avoid dairy products, far from showing signs of ill health, are
healthier than people who consume dairy products.
We felt that we had to rewrite the Four Food Groups--continue to use
the idea of a simple tool that kids could learn in school, but have it
be something that is in sync with modern science. The new Four Food
Groups are grains, vegetables, fruits, and legumes--legumes meaning
anything in a pod, such as peas, beans, lentils. If that were the
basis of nutritional teaching, we could revolutionize the health in
this country.
When we first made this proposal, it wasn't just me standing up at the
podium and waving this around, we had Dennis Burkitt with us, the
British doctor who discovered the value of fiber. He spent years in
Africa comparing different diets, and is one of the most widely
respected cancer researchers in the world. He came to Washington and
said "Yes, the new Four Food Groups could save a lot of lives."
Colin Campbell, the head of the China health study, also came to
Washington and endorsed it, as did Oliver Alabaster, a cancer
researcher. So, we felt we were on very solid ground with this, and,
we certainly are. There's a wealth of research behind it.
By the way, the new Four Food Groups is going to come out as a
curriculum for seventh and eight grades a little bit later this year.
So if teachers want to teach it, and throw out the old Four Food
Groups, I would be honored.
There was a good deal of response to our new Four Food Groups, and it
differed depending on who was giving it. The press was, by and large
sympathetic to it, and, so was the public. They would raise
appropriate questions, such as, "Will you have strong bones without
dairy?" and the kinds of things that people wrestle with when they're
first looking at this. But, lets face it, the press has known for
years that heart disease is not a question of bad luck or genetics.
It's a question of what's on your plate. So, it was no big surprise.
People have been criticizing the meat industry for years, but the
criticisms of dairy products were new to many people, and I was
surprised at how well-received that was as well.
The only real criticism I think came from conservative medical
organizations who have been promoting weaker diets for years, and
certain agricultural producers. The fruit and vegetable growers were
delighted. The rice growers thought this was the best thing they ever
heard of. But, the livestock producers naturally fought it with the
same venom that the tobacco growers have fought tobacco legislation.
That happens, you expect it, but you've got two choices. If you were
going to try to reform, to help America, you can be honest and expect
the flack you're going to get and accept it, or you can sellout and
lie to people. To me the choice is very clear. You have to tell people
the truth, and they will gradually accommodate to it, and hopefully
see its wisdom.
We knew when we did this that the Department of Agriculture would not
say, "Oh, great idea, we'll change the Four Food Groups." We knew it
would be a long process of acceptance, but we know we're right. What
we wanted to do, then, was kick off the process by getting the public
involved, getting them writing letters to the editor and complaining.
We wanted to work our way eventually into the consciousness of the
government, and I think that process has begun, and I don't think it's
reversible.
The press has known for years that heart disease is not a question of
bad luck or genetics. Its a question of what's on your plate.
Let me say a few things about the recently proposed food "pyramid."
The pyramid was the Department of Agriculture's plan to say that you
should eat less meat, but still eat it everyday. You should eat more
grains, vegetables and fruits, and de-emphasize the meat and dairy,
but still eat it. So, they created a pyramid of foods.
At the very top, in the smallest part of the pyramid, was sugars and
oils, and that was supposed to be something you have only rarely.
That's why they gave it the small part of the pyramid. And then, under
that was meats, which you're supposed to have more of than the sweets
and oils, but not as much as grains. Then, I think, it was dairy, and
then under that was vegetables and fruits, and then the grains.
The visual image was supposed to emphasize grains, but one problem
with it was that it had meats near the top, so meat looked like the
pinnacle of nutrition. Before they released it, they experimented with
turning the pyramid upside down, so that meat would be near the
bottom, but the Department of Agriculture claimed that "female
consultants" felt it looked unstable that way, so they decided to keep
it right side up.
We knew the pyramid was coming when we released our new Four Food
Groups, and we thought the pyramid was virtually no better than the
original Four Food Groups. The pyramid, how ever, was embraced by a
lot of dieticians, because it did de-emphasize meat.
The pyramid lasted three weeks. Department of Agriculture went back to
the drawing board because the livestock producers wouldn't stand for
it. They lobbied very heavily, and it was pulled back.
Spectrum: In my travels or reading I have discovered no culture in the
world that ate a truly vegan diet (no meat or dairy). Everywhere I
have been or read about, the diet contained small amounts of animal
foods, so I wonder if small amounts might be necessary. Should the new
Four Food Groups eliminate meat and dairy entirely?
Neal Barnard: The Four Food Groups, as we presented it, wasn't trying
to say what the totality of the diet should be. It only said what the
basis, the foundation of the diet should should be--grains, legumes,
vegetables, and fruits. Anything else is an option. So if a person
has a bowl of ice cream once a month, that isn't violating the new
Four Food Groups.
With the new Four Food Groups, there's a whole range of possibilities,
some of which are healthier than others. If you ask me, as a doctor,
what's the healthiest diet, I would say it is a low fat vegan diet,
without any animal products included. It's true that almost all
cultures, maybe all cultures, do have some animal products in them,
although they might vary a little bit as to what that would be and
with the amount. I suspect the reason is not a nutritional need for
it, however. I really don't think so. This is because animal products
are something that was not part of our evolution as a species.
As I say in my book, The Power of Your Plate, prior to the Stone Age,
we didn't have the capacity to hunt animals. We didn't have spears,
axes, or bows and arrows until about two million years ago. Yet, we
have lost our canine teeth that would help, say a chimpanzee, if they
want to get hold of a little monkey and tear it to shreds. They could
do that because they have long, protruding canine teeth. Those were
lost to our species at least three and half million years ago. So,
during the critical phase of our evolution as we were differentiating
from other primates in becoming the species we are now, it is almost
certain that we were eating a vegan diet.
Was there some inclusion of insects or something? Who knows, but we
almost certainly must have been vegan, eating a diet very similar to
what other primates were eating.
All that changed when we acquired the technology of tools. Once you
have the capacity to have something that was not part of your
evolution, your capacity to regulate it goes haywire. So, in America
now, people have the capacity to eat meat. People tend to crave it, I
think because of its grease content or because of some other
characteristic. People do tend to crave it, even though they pay a
health price in the long run.
The same is true of alcohol. Look what happened to the American Indian
population when alcohol wa introduced. It had not been part of their
evolution, hadn't been part of anybody's evolution, obviously, and
alcoholism became a very serious problem. The same is true of sugary
foods, cocaine, tobacco--anything we don't have built-in mechanisms to
cope with. I think that's true of meat.
If you ask me, as a doctor, what's the healthiest diet, I would say it
is a low fat vegan diet, without any animal products included.
How do I know that people are healthy without it? There are studies
that have compared ovo-lacto vegetarians to meat-eaters, and the
ovo-lacto's do better than the meat-eaters do in terms of incidence of
cardiovascular arrest. There are also studies of pure vegetarians
(vegans)--no milk, eggs or meat--comparing them to ovo-lacto
vegetarians, and the vegans tend to do better.
I think B-12 is an interesting issue though, because there isn't B-12
in plants, so where were people getting that?
B-12 isn't made by plants, and it's not made by animals. It's made by
one-celled organisms--bacteria, and so forth. Obviously, as we were
evolving as a species, our foods had a fair amount of natural
contamination with bacteria. You can imagine us picking up root
vegetables, shoots, leaves, and fruits, and so forth, and back then we
weren't sterilizing these things and processing them. Nor were we
brushing our teeth. There has been a fair amount of research showing
that even the bacteria that live in people's mouths can produce some
B-12. Was that the source? I don't know.
Keep in mind that the daily requirement for B-12 is extremely small.
The RDA is only 2 micrograms per day--not grams, not milligrams, just
2 micrograms. The actual amount you need is only about a half of a
microgram daily, and that amount could well have been supplied by
bacterial sources.
Nowadays, in modem culture, everything is sterilized. Even the miso
you buy in this country is all pasteurized, and it's dead. In Asia,
miso is loaded with B-12 because of the bacteria that are involved in
its production. Meat eaters do get B-12, but my hunch is that meat
probably was not the source as we were evolving.
Spectrum: There are many different kinds of "vegetarian" diets. Some
types include dairy, some fish, some even chicken. Can you talk
briefly about all of them? Particularly, why do you recommend against
dairy food?
Neal Barnard: I have ten main reasons why dairy food is not good for health.
The first reason why I don't consume dairy products, and why I think
other people should not, is the fat content. The fat in dairy products
is saturated fat. Now, it is true there are skimmed milk products:
skim milk, skim yogurts, and maybe one or two low-fat cheeses. But
just on fat alone, you've ruled out butter, cream, sour cream, ice
cream, nearly all cheeses, and whole milk products. The fat is
saturated fat, and you may as well be eating beef tallow. The fat in
these dairy products encourages heart disease and numerous other
problems. It's a risk factor for some forms of cancer as well.
Number two is the cholesterol content of dairy products. It's the same
story as the saturated fat. Number three is that dairy products really
are not effective in slowing osteoporosis. This was their big selling
point for years, but studies have been done measuring bone density,
particularly of post-menopausal women, the group that is at highest
risk. There is no correlation between bone density and the intake of
dairy products, or, for that matter, any other sources of calcium. In
other words, women have progressed to severe osteoporosis in spite of
consuming a large amount of milk.
Now any first year medical student would say, "Well, of course, we
know that bone density, the calcium content of bones, is not something
you could change just by eating certain foods. It is hormonally
regulated." There are things that certainly do affect bone density,
but calcium intake probably is not one of them. A recent study in the
American Journal of Clinical Nutrition showed that this is not only
true for older women, but even for young women and men as well. There
really isn't a good correlation between how much calcium you take in
and the strength of your bones as you reach adulthood.
Next is the milk sugar. The natural sugar in milk is lactose. It's
what we call a disaccharide, a double sugar. It breaks down in the
body to glucose and galactose. Galactose is a simple sugar that
infants can break down effectively, because they have a variety of
enzymes in the body to do that. As you age, you lose those enzymes to
a degree. Different people lose them more quickly than others. What
that means is that galactose can have a certain toxicity as you age,
and for women, it attacks the ovaries.
I don't consume dairy products...and I think other people should not
either. I have ten main reasons why dairy food is not good for health.
Daniel Kramer, at Harvard University, published an elegant study
comparing women with cancer of the ovary and women who did not have
cancer. The differentiating factor between these two groups was their
consumption of dairy products. Does that mean that every women that
consumes yogurt is going to get cancer of the ovary? No, but it is
elevating one's risk.
By the same mechanism, or a similar mechanism, galactose is linked to
cataracts. It enters the body, probably through dairy products in most
cases, and can be absorbed into the lens of the eye. Infants who are
born with a genetic defect in their capacity to break down galactose
get dense cataracts within the first year of life. I believe that
dairy products are probably a contributor to cataracts in older folks.
I say that because there are epidemiologic studies showing that the
incidence of cataracts is not uniform across cultures. It is much
higher in countries where dairy products are consumed. There are
other contributors, such as ultraviolet B and others, but dairy seems
to be one of the principal suspects here.
Another issue with dairy is lactose intolerance. This is something
which does not affect most Caucasians, which is why all the Dairy
Board advocates you see are all fair-skinned people, the only people
who drink milk. Asians and Africans and many others have trouble
consuming dairy products; they can't digest the milk sugar.
Spectrum: Yet, people living in these countries eating the traditional
diet have very strong bones.
Neal Barnard: Exactly. They do not have osteoporosis with the same
incidence that we do.
Milk is the number one cause of food allergies. There are other
causes, such as wheat, corn, and with some people, soy products, but
milk is number one, and any pediatricians experience would agree with
that.
Insulin-dependent diabetes is much more common in countries where
dairy is consumed. The putative link is that the dairy protein kicks
off an autoimmune reaction in which antibodies attack the dairy
protein, inadvertently damaging the cells of the pancreas that produce
insulin.
Milk is extremely low in iron, and if you're concerned about iron
deficiency, milk is not a food you want to consume.
Babies get colicky from drinking milk, and they're also colicky if
their mother is consuming milk. We now know that the cow's antibodies
can be absorbed into the mother's digestive tract, and through the
bloodstream reach her milk, then baby. I believe it was the April 1990
issue of Pediatrics that laid this out and said that the baby will be
colicky if the nursing mother is consuming milk.
So there are several reasons not to drink your milk.
Spectrum: What about chicken and the different kinds of fish?
Neal Barnard: Number one, chicken is not a health food by any stretch
of the imagination. The poultry industry has been trying to capitalize
on the criticisms that beef is now getting and they tell people to eat
their products. But there are several reasons not to.
Number one, chicken has the same cholesterol content as beef. This
always stuns audiences when I tell them, although it doesn't stun
dieticians who write nutritional analyses--they've known this for
years. Every four ounce serving of beef has 100 milligrams of
cholesterol in it. A four ounce serving of chicken has exactly the
same--100 milligrams of cholesterol. It can be somewhat lower in fat,
but not a lot lower in fat.
The leanest beef has 30% of its calories as fat. The very leanest
chicken is about 20%. Compare that to beans, with 5% of calories as
fat. Rice is even less, maybe around 7% or 8%. A 20%-fat food with no
fiber, no complex carbohydrates, and a fair load of cholesterol is not
a healthy food, and that's what chicken is. Even selecting only the
white meat and taking the skin off, it is not a low-fat food.
What is worse is that chicken and meat displace the healthy foods in
our diet. I mean, if you're eating 300 calories of chicken, that's
three hundred calories of rice or whole grain products or green
vegetables that you're not eating. So it's not just the bad stuff it
gives you, it's the good stuff that it pushes off the plate.
Chicken is not a health food by any stretch of the
imagination...Chicken has the same cholesterol content as beef.
Another interesting thing, and this is getting press everywhere, one
out of every three chickens at the retail store has live salmonella
bacteria growing under the plastic. The reason is that every chicken
goes into the slaughter operation after having lived its eight-week
life in a factory situation--a big steel building with ten, twenty or
thirty thousand chickens all swimming in chicken feces. Nobody sweeps
around them during their entire life. They're just boxed up and sent
to slaughter.
Salmonella lives in chicken feces, and the process of slaughter
actually tends to push this fecal contamination into the skin of the
chicken. At the end of the slaughter procedure, their heads are cut
off, their corpse goes through a cold water bath to cool it down so it
doesn't rot, and the water bath...it might be kind of clean for the
first thousand or so corpses that go through it, but eventually it
becomes what CBS News called "fecal soup."
People get the chicken home, slit open the plastic, and you know that
little bit of juice that dribbles down on your counter, people think
that's chicken juice. Chickens are not fruits, they do not have juice.
That is the water bath stuff that the chicken absorbed, along with a
little blood and serum, etc. One out of three packaged chickens has
live salmonella. That causes maybe four million or more cases of
salmonella poisoning a year, and about nine thousand deaths.
I think if people can't wean themselves of chicken, they ought to
leave it on their steps outside their house, and go outside and eat
it, because once you bring it in, it contaminates surfaces. You can't
see the salmonella bacteria, You can get it on a sponge, and the
contamination of utensils is the biggest problem. The greatest
incidence of salmonella comes from cross contamination to infants.
Three month old babies actually get more salmonella than anybody else.
Spectrum: What about fish?
Neal Barnard: There are several things about fish. I don't eat fish,
and there are many reasons why I don't. The good things you can say
for fish is that some of the the species are lower in fat by a long
shot compared to meat and even poultry, and some have a little bit
less cholesterol. Some have more cholesterol, however, like lobster
and shrimp. Some actually are higher in fat, while some are lower.
That's the entire extent of the good news about fish.
The bad news about fish is that it all has cholesterol and fat, and
the fat is not the kind that anybody needs. These omega-3 fats that
people talk about are also available in beans. In the American Journal
of Clinical Nutrition, there was a recent series of letters and
commentaries saying that people should probably get their omega-3 fats
from vegetables and not from fish, because the omega-3 fish oils do
seem to have a variety of negative effects, one of which is that they
promote the production of free radicals. Free radicals can damage your
tissues and lead to cancer.
There is also a contamination problem with fish. The February cover-story of
Consumer Reports talked about this. The contamination problems with fish are
ghastly.
Salmon and other kinds of swordfish are very contaminated. There are
even warnings that women who are intending to become pregnant any time
in the next several years shouldn't consume several species of fish.
The EDB content is so high, and it is stored up in human tissues.
There was a study at Wayne State University on women who had given
birth to babies. Those who never ate fish were compared to those who
did eat fish. The latter group, even those who ate fish once a month
or more, had a higher incidence of babies who were sluggish at birth,
who had small head circumferences, or who had a variety of learning
problems.
Fish is a concentrated protein, and if anything we need less protein.
High protein in the the diet leads to osteoporosis and kidney
problems.
You don't need fish.
Spectrum: If it's not a good idea to eat fish and poultry, and we are no longer
consuming wild vegetables as did the people in traditional societies, do you
recommend a B12 supplement or any other kind of supplement?
Neal Barnard: I do recommend a B12 supplement for anybody who, like
me, is on a vegan diet. If you start a vegan diet, you have about a
three-year supply of B12 in your body. But after three years, or even
before, people should supplement with B12. I suggest you take a form
that says "B12" on it, or the chemical name, cyanocobalamin. Some of
the forms that people thought were active, like chlorella or
spirulina, may not have active B12 in them.
Women who are intending to become pregnant any time in the next several years
shouldn't consume several species of fish.
If you get a One-A-Day, or any common multivitamin, it will have B12
in it. You don't need to be especially careful about it. And, there
are vegetarian supplements made of algae that are perfectly fine. It's
not something you need to worry about or take every day. Get the
smallest size you can. Probably 50 micrograms is the smallest size the
store will sell you, and take it 2-4 times per week. By the way, I
don't recommend other supplements.
Spectrum: You are saying all these things that suggest radical changes
in the way Americans eat, citing several studies to back up your
views. Yet most doctors, who are supposedly in charge of protecting
our health, will be eating a steak tonight or going out with the kids
to McDonald's. What's the problem? Is the research you are citing
debatable, or is it that it's hard to accept something new? Why don't
people eat this way?
Neal Barnard: I think things are starting to change. Things change
slowly, and doctors are creatures of habit, and they'll probably be
the last to change, unfortunately. But there are some terrific new
faces on the horizon that are becoming widely accepted, such as Dr.
Dean Ornish, who has done brilliant, carefully controlled research. He
has received a tremendous amount of attention from the medical
community.
People doing work with diabetics, and certainly with cancer, are
getting a lot of attention for vegetarian sorts of diets.
Regarding being vegetarian, I don't think the common reaction anymore
is that you must be in some sort of bizarre religious cult. If I'm
sitting on a plane and get the vegetarian meal that I've ordered, the
person next to me will always say, "I'm pretty much a vegetarian" or
"I'm going that way." They want to be vegetarian. Even if they're not
that way, they know they should be.
Doctors, like everybody else, are subject to the habits they grew up
with. It tends to cause a predictable pattern--sort of rationalization
and resistance.
There's no doubt about it, however, we're going to win, and there are
lots of reasons. For example, there are all these HMOs who are trying
to give medical care at fixed cost. It's going to be just a matter of
time before they realize that for every coronary bypass they prevent,
it saves them $20,000. Prevention is the key, and the two biggest
factors are changing diet and avoiding tobacco.
The National Restaurant Association recommends having a vegetarian
section on the menu. One out of every five restaurant-goers considers
the ability to obtain a vegetarian meal important when choosing a
restaurant. PETA (People for the Ethical Treatment of Animals) now has
these "V" stickers for restaurants. They will be displayed alongside
the Visa and MasterCard emblems.
All these HMOs who are trying to give medical care at fixed cost, it's
going to be just a matter of time before they realize that for every
coronary bypass they prevent, it saves them $20,000. Prevention is the
key.
The demand for vegetarianism is there, and I'm very optimistic, not
just about the distant future, but the near future.
Spectrum: Health am is a big political issue now in the presidential
campaign. Can you comment on the situation?
Neal Barnard: Many people have been occupied with something that I
think is important, but secondary--how do we have equitable
distribution of health care. That's an important issue, but I think
it misses something more powerful that could help solve the problem.
Health care costs are simply accumulated health care bills. The reason
you have health care bills is because you have sick people going to
see their physicians. Now, it is true that about 90% of heart attacks,
and a similar percentage of bypasses and some transplants, and so
forth--none of these would be needed if people took good care of
themselves. Eighty percent of cancer is preventable, or at least is
tied to identifiable factors that we know about. This is the National
Cancer Institute's estimate. Thirty-five percent of cancers are due
to smoking and 35% to 55% are due to diet. Other causes are x-ray
exposures, drugs, etc. We can control these cancer factors if we
choose to.
If we do that, we can keep people healthy. They won't have to go see
their doctor, there won't be a health care bill generated, and the
costs to private insurance, to individuals, and to Medicare and
Medicaid could all plummet.
Spectrum: Doctors will have to become less wealthy.
Neal Barnard: Doctors should become less wealthy.
I think that the availability of insurance has insulated doctors from
their patients. My grandfather, when he treated someone, might have
gotten some vegetables as payment, and his bills were low. Now,
because of the wide availability of insurance, doctors unabashedly
charge enormous rates because they know that the patient actually
isn't going to pay it. The patient does pay it right away--they pay it
in the insurance premiums that have been extracted from their
paychecks, but it's been smoothed out over the course of the year, and
the patients don't really mind these exorbitant fees. Doctors are
driving BMWs and Mercedes. I consider it unethical, and frankly, it's
becoming more grotesque with time.
What I want to see in the future is a reduced demand for health care.
I want doctors to focus on people that already are healthy, and ask
what they can do to maximize their health, because, hopefully, there
won't be sick people coming to see them and they need something to do.
Spectrum: Do we need a new type of health profession, given what we
now know about the causes of disease? You don't need as much training
to help people prevent illness as to cure it. Why have a doctor, who
is trained in complex operations and other disease treatments, give
people lifestyle counseling on how to stay well? It's a waste.
Neal Barnard: Also, people like you are doing this. Through an article
you write, you are reaching a lot more people than I would reach in a
typical day. People like you are the lifesavers, too. You take
information that other people have developed through research and make
it available to large numbers of people. My hat's off to you and
everybody like you who's getting the word out.
(Dr. Neal Barnard is the President of the Physician's Committee for Responsible
Medicine, P.O. Box 6322, Washington, DC 20015. (202) 686 2210)
