July 25, 2012

Dr. Ed James draws inspiration from his personal experiences with healthy lifestyle changes, having overcome prediabetes and obesity several years ago. In 2011, he founded Heal2BFree to focus on helping individuals and organizations to develop and implement action plans that help close the health disparities gap between blacks and whites.

As a medical student in the late 1980's, I recall being lectured on the importance of medical research. We were told the results of such work would occasionally lead us in directions that were not anticipated. We were also reminded of the importance of analyzing the results critically and comprehensively without bias and following them wherever they might lead. At the time the advice seemed obvious, but in the years since I have come to appreciate such action is not always easy.

I believe that my personal health journey has relevant public health implications and reinforces why we must pay attention to research, even when such results may bring into question current dogma, and even implicate our culture.

A doctor at risk
Several years ago, at the time of my routine physical exam, my doctor informed me that I was prediabetic and my LDL (bad) cholesterol was elevated. I was also obese. As a physician in my mid-40’s at the time, I was quite aware that these were risk factors for premature death. I was feeling much more like a patient--quite vulnerable, concerned, and helpless.

When my doctor gave me the prescription, it was simply for healthy lifestyle changes. He suggested I read The China Study by T. Colin Campbell, Ph.D., which I promptly did, and which thankfully changed my life......for the better. It also provided me with a different lens through which to view some of the greatest challenges that face the medical profession.

Adopting a plant-based, whole foods diet as advocated by Dr. Campbell, and a regular exercise and stress reduction program (as described in publications by Dr. Dean Ornish), I was able to lose more than 50 pounds, "cure" my prediabetes, lower my LDL cholesterol to the normal range, and lower my total cholesterol by approximately 40 mg/dL to under 150. My body inflammation (a risk factor for heart attack), as measured by a lab test called C-reactive protein (CRP), also improved significantly. I was sold.

Changing his health fate
In my family, obesity, type 2 diabetes, hypertension, heart disease, and stroke are frequent co- morbidities and have resulted in much premature death. "The China Study" research clearly demonstrates that these diseases and many others, including cancers that frequently occur in Americans, are preventable in most cases, since diet and lifestyle generally "trump genes." In my opinion, we doctors, although well-intentioned, spend considerable time evaluating patients’ family medical histories, often leaving them with the misconception that their genes hold their likely destinies. Simply put, the diseases that are responsible for the deaths of most Americans can be prevented by a healthy diet and lifestyle in the majority of cases.

The New York Times has referred to "The China Study" as the largest and most comprehensive ever undertaken on the relationship between dietary patterns and development of disease. In rural areas of China, the mean total cholesterol was 127 mg/dL. Rates of chronic disease were generally much lower than in the United States. Interestingly, when these rural Chinese populations migrate to Western countries and adopt our diet and lifestyle, their rates of chronic disease soar to Western levels.

The diet of the rural Chinese in the study consists of mainly plant-based, low-fat, whole foods with some fish, while our Western diet is high in animal-based foods, including milk and dairy, refined carbohydrates, sugar, salt, and saturated fats. The "China Study" research strongly supports that these dietary differences are largely responsible for the much higher rates of heart disease, diabetes, stroke, many cancers, and other chronic diseases in Western cultures, including the United States.

Armed with Dr. Campbell’s research, and that of other researchers, including Drs. Dean Ornish and Caldwell Esselstyn, I set out to "scream from the rooftops" how my personal experience with lifestyle changes strongly supported the China Study research, beginning with my physician colleagues. But......not so fast. While none contested the validity of these studies, most were reluctant to change their personal diets significantly. The research and clinical experience of Dr. Caldwell Esselstyn at the Cleveland Clinic has clearly demonstrated that a total cholesterol of less than 150 reduces one’s risk of a heart attack to virtually zero. Yet most of my physician friends (including cardiologists) do not consider this a reasonably attainable goal for themselves or for their patients.

Why? It is "culturally impossible." It would require a departure from the animal-based foods, high in saturated fats and cholesterol, that comprise the Standard American Diet (SAD). At recent medical conferences that I’ve attended, bacon, sausage, pastries and doughnuts were consumed. In my anecdotal experience over the last 20 years, we doctors generally suffer and die from the same "preventable" chronic diseases as our patients (heart attacks, strokes, diabetes, etc.). I once saw a cartoon of a doctor eating breakfast. In one hand, he held a medical journal whose research concluded that meat contributes to chronic disease. In the other hand, he held a fork with sausage.

The cartoon summarizes the disconnect which I have anecdotally observed. It is my personal observation and conclusion that our reluctance as a medical profession to embrace a plant-based, whole foods diet reflects a general unwillingness to re-examine and critically evaluate our dietary patterns, which are embedded in our culture. Reflecting on our societal imperfections is uncomfortable.

Yet I am optimistic looking towards the future that our approach to chronic disease will change. Continuing medical education programs such as Healthy Kitchens, Healthy Lives (Harvard School of Public Health) and Food as Medicine (Center for Mind-Body Medicine) are now educating more and more physicians and other health professionals about the impact changes in the kitchen can have on chronic disease prevention. When our medical schools begin to engage proactively and impress upon future physicians the need to "walk the talk" with regard to leading healthy lifestyles, we will become better suited as a profession to address the preventive health needs of our patients.

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