Eat to Live
by Joel Fuhrman, M.D.
Eat to Live
DIGGING OUR GRAVES WITH FORKS AND KNIVES
THE EFFECTS OF THE AMERICAN DIET, PART I Americans have been among the first people worldwide to have the luxury of bombarding themselves with nutrient-deficient, high-calorie food, often called empty-calorie or junk food. By "emptycalorie," I mean food that is deficient in nutrients and fiber. More Americans than ever before are eating these rich, high-calorie foods while remaining inactive - a dangerous combination.
The number one health problem in the United States is obesity, and if the current trend continues, by the year 2230 all adults in the United States will be obese. The National Institutes of Health estimate that obesity is associated with a twofold increase in mortality, costing society more than $100 billion per year.1 This is especially discouraging for the dieter because after spending so much money attempting to lose weight, 95 percent percent of them gain all the weight back and then add on even more pounds within three years. This incredibly high failure rate holds true for the vast majority of weight-loss schemes, programs, and diets.
Obesity and its sequelae pose a serious challenge to physicians. Both primary-care physicians and obesity-treatment specialists fail to make an impact on the long-term health of most of their patients. Studies show that initial weight loss is followed by weight regain.
Those who genetically store fat more efficiently may have had a survival advantage thousands of years ago when food was scarce, or in a famine, but in today's modern food pantry they are the ones with the survival disadvantage. People whose parents are obese have a tenfold increased risk of being obese. On the other hand, obese families tend to have obese pets, which is obviously not genetic. So it is the combination of food choices, inactivity, and genetics that determines obesity. More important, one can't change one's genes, so blaming them doesn't solve the problem. Rather than taking an honest look at what causes obesity, Americans are still looking for a miraculous cure - a magic diet or some other effortless gimmick. Obesity is not just a cosmetic issue - extra weight leads to an earlier death, as many studies confirm. Overweight individuals are more likely to die from all causes, including heart disease and cancer. Two-thirds of those with weight problems also have hypertension, diabetes, heart disease, or another obesity-related condition. It is a major cause of early mortality in the United States. Since dieting almost never works and the health risks of obesity are so life-threatening, more and more people are desperately turning to drugs and surgical procedures to lose weight.
Health Complications of Obesity
The results so many of my patients have achieved utilizing the Eat to Live guidelines over the past ten years rival what can be achieved with surgical weight-reduction techniques, without the associated morbidity and mortality.
Surgery for Weight Reduction and Its Risks
According to the National Institutes of Health (NIH), wound problems and complications from blood clots are common aftereffects of gastric bypass and gastroplasty surgery. The NIH has also reported that those undergoing surgical treatment for obesity have had substantial nutritional and metabolic complications, gastritis, esophagitis, outlet stenosis, and abdominal hernias. More than 10 percent required another operation to fix problems resulting from the first surgery.
Another tempting solution is liposuction. Studies show that liposuction begets a plethora of side effects, the main one being death! A recent survey of all 1,200 actively practicing North American board-certified plastic surgeons confirmed that there are about 20 deaths for every 100,000 liposuctions, whereas the generally acceptable mortality rate for elective surgery is 1 in 100,000.10 Compared with the 16.4 per 100,000 mortality rate of U.S. motor vehicle accidents, liposuction is not a benign procedure. Liposuction is dangerous.
In addition to undergoing extremely risky surgeries, Americans have been bombarded with a battery of gimmicky diets that promise to combat obesity. Almost all diets are ineffective. They don't work, because no matter how much weight you lose when you are on a diet, you put it right back on when you go off. Measuring portions and trying to eat fewer calories, typically called "dieting," almost never results in permanent weight loss and actually worsens the problem over time. Such "dieting" temporarily slows down your metabolic rate, so often more weight comes back than you lost. You wind up heavier than you were before you started dieting. This leads many to claim, "I've tried everything, and nothing works. It must be genetic. Who wouldn't give up?"
You may already know that the conventional "solution" to being overweight - low-calorie dieting - doesn't work. But you may not know why. It is for this simple yet much overlooked reason: for the vast majority of people, being overweight is not caused by how much they eat but by what they eat. The idea that people get heavy because they consume a high volume of food is a myth. Eating large amounts of the right food is your key to success and is what makes this plan workable for the rest of your life. What makes many people overweight is not that they eat so much more but that they get a higher percentage of their calories from fat and refined carbohydrates, or mostly low-nutrient foods. This low-nutrient diet establishes a favorable cellular environment for disease to flourish.
Regardless of your metabolism or genetics, you can achieve a normal weight once you start a high-nutrient diet style. Since the majority of all Americans are overweight, the problem is not primarily genetic. Though genes are an important ingredient, physical activity and food choices play a far more significant role. In studies on identical twins with the tendency to be overweight, scientists found that physical activity is the strongest environmental determinant of total body and central abdominal fat mass. Even those with a strong family history of obesity effectively lose weight with increased physical activity and appropriate dietary modifications.
Most of the time, the reason people are overweight is too little physical activity, in conjunction with a high-calorie, low-nutrient diet. Eating a diet with plenty of low-fiber, calorie-dense food, such as oil and refined carbohydrates, is the main culprit. As long as you are eating fatty foods and refined carbohydrates, it is impossible to lose weight healthfully. In fact, this vicious combination of a sedentary lifestyle and eating typical "American" food (high-fat, low-fiber) is the primary reason we have such an incredibly overweight population.
Killing the Next Generation
This book may not appeal to many Americans who are in denial about the dangers of their eating habits and those of their children. Many people will do anything to continue their love affair with rich, disease-causing foods and will sacrifice their health in the process. Many American consumers prefer not to know about the dangers of their diet because they don't want to have their pleasures interfered with. This book is not for them.
If you have to give up something you get pleasure from, your subconscious may prefer to ignore solid evidence or defend illogically held views. Many ferociously defend their unhealthy eating practices. Others just claim, "I already eat a healthy diet," when they do not. There is a general resistance to change. It would be much easier if healthful eating practices and the scientific importance of nutritional excellence were instilled in us as children. Unfortunately, children are eating more poorly today than ever before.
Most Americans are not aware that the diet they feed their children guarantees a high cancer probability down the road. They don't even contemplate that eating fast-food meals may be just as risky (or more so) than letting their children smoke cigarettes.
The 1992 Bogalusa Heart Study confirmed the existence of fatty plaques and streaks (the beginning of atherosclerosis) in most children and teenagers! You wouldn't let your children sit around the table smoking cigars and drinking whiskey, because it is not socially acceptable, but it is fine to let them consume cola, fries cooked in trans fat, and a cheeseburger regularly. Many children consume doughnuts, cookies, cupcakes, and candy on a daily basis. It is difficult for parents to understand the insidious, slow destruction of their child's genetic potential and the foundation for serious illness that is being built by the consumption of these foods.
It would be unrealistic to feel optimistic about the health and well-being of the next generation when there is an unprecedented increase in the average weight of children in this country and record levels of childhood obesity. Most ominous were the results reported by the 1992 Bogalusa Heart Study, which studied autopsies performed on children killed in accidental deaths. The study confirmed the existence of fatty plaques and streaks (the beginning of atherosclerosis) in most children and teenagers! These researchers concluded: "These results emphasize the need for preventive cardiology in early life." I guess "preventive cardiology" is a convoluted term that means eating healthfully.
Another recent autopsy study appearing in the New England Journal of Medicine found that more than 85 percent of adults between the ages of twenty-one and thirty-nine already have atherosclerotic changes in their coronary arteries. Fatty streaks and fibrous plaques covered large areas of the coronary arteries. Everyone knows that junk foods are not healthy, but few understand their consequences - serious life-threatening illness. Clearly, the diets we consume as children have a powerful influence on our future health and eventual premature demise. There is considerable data to suggest that childhood diet has a greater impact on the later incidence of certain cancers than does a poor diet later in life.
It is estimated that as many as 25 percent of schoolchildren today are obese. Early obesity sets the stage for adult obesity. An overweight child develops heart disease earlier in life. Mortality data suggests that being overweight during early adult life is more dangerous than a similar degree of heaviness later in adult life.
Drugs Are Not the Solution
New drugs are continually introduced that attempt to lessen the effects of our nation's self-destructive eating behavior. Most often, our society treats disease after the degenerative illness has appeared, an illness that is the result of from forty to sixty years of nutritional self-abuse. Drug companies and researchers attempt to develop and market medications to stem the obesity epidemic. This approach will always be doomed to fail. The body will always pay a price for consuming medicines, which usually have toxic effects. The "side" effects are not the only toxic effect of medications. Doctors learn in their introductory pharmacology course in medical school that all medications are toxic to varying degrees, whether side effects are experienced or not. Pharmacology professors stress never to forget that. You cannot escape the immutable biological laws of cause and effect through ingesting medicinal substances.
If we don't make significant changes in the foods we choose to consume, taking drugs prescribed by physicians will not improve our health or extend our lives. If we wish true health protection, we need to remove the cause. We must stop abusing ourselves with disease causing foods.
Surprise! Lean People Live Longer
In the Nurses Health Study, researchers examined the association between body mass index and overall mortality and mortality from specific causes in more than 100,000 women. After limiting the analysis to nonsmokers, it was very clear that the longest-lived women were the leanest. The researchers concluded that the increasingly permissive U.S. weight guidelines are unjustified and potentially harmful.
Dr. I-Min Lee, of the Harvard School of Public Health, said her twenty-seven-year study of 19,297 men found there was no such thing as being too thin. (Obviously, it is possible to be too thin; however, it is uncommon and usually called anorexia, but that is not the subject of this book.) Among men who never smoked, the lowest mortality occurred in the lightest fifth. Those who were in the thinnest 20 percent in the early 1960s were two and a half times less likely to have died of cardiovascular disease by 1988 than those in the heaviest fifth. Overall, the thinnest were two-thirds more likely to be alive in 1988 than the heaviest. Lee stated, "We observed a direct relationship between body weight and mortality. By that I mean that the thinnest fifth of men experienced the lowest mortality, and mortality increased progressively with heavier and heavier weight." The point is not to judge your ideal weight by traditional weight-loss tables, which are based on Americans' overweight averages. After carefully examining the twenty-five major studies available on the subject, I have found that the evidence indicates that optimal weight, as determined by who lives the longest, occurs at weights at least 10 percent below the average body-weight tables. Most weight-guideline charts still place the public at risk by reinforcing an unhealthy overweight standard. By my calculations, it is not merely 75 percent of Americans that are overweight, it is more like 85 percent. The Longer Your Waistline, the Shorter Your Lifeline As a good rule of thumb: for optimal health and longevity, a man should not have more than one-half inch of skin that he can pinch near his umbilicus (belly button) and a woman should not have more than one inch. Almost any fat on the body over this minimum is a health risk. If you have gained even as little as ten pounds since the age of eighteen or twenty, then you could be at significant increased risk for health problems such as heart disease, high blood pressure, and diabetes. The truth is that most people who think they are at the right weight still have too much fat on their body. A commonly used formula for determining ideal body weight follows:
Women: Approximately ninety-five pounds for the first five feet of height and then four pounds for every inch thereafter.
5'4" 95 + 16 = 111
5'6" 95 + 24 = 119
Men: Approximately 105 pounds for the first five feet of height and then five pounds for every inch thereafter. Therefore, a 5'10" male should weigh approximately 155 pounds.
All formulas that approximate ideal weights are only rough guides, since we all have different body types and bone structure. Body mass index (BMI) is used as a convenient indicator of overweight risk and is often used in medical investigations. BMI is calculated by dividing weight in kilograms by height in meters (squared).
Another way to calculate BMI is to use this formula: BMI = weight in pounds X 703 height in inches (squared)
A BMI over 24 is considered overweight and greater than 30, obese. However, it is just as easy for most of us merely to use waist circumference.
I prefer waist circumference and abdominal fat measurements because BMI can be inaccurately high if the person is athletic and very muscular. Ideally, your BMI should be below 23, unless you lift weights and have considerable muscle mass. As an example, I am of average height and build (5'10" 150 pounds) and my BMI is 21.5. My waist circumference is 30.5 inches. Waist circumference should be measured at the navel.
The traditional view is that men who have a waist circumference over forty inches and women with one over thirty-five inches are significantly overweight with a high risk of health problems and heart attacks. Recent evidence suggests that abdominal fat measurement is a better predictor of risk than overall weight or size. Fat deposits around your waist are a greater health risk than extra fat in other places, such as the hips and thighs.
What if you feel you are too thin? If you have too much fat on your body but feel you are too thin, then you should exercise to build muscle to gain weight. I often have patients tell me they think they look too thin, or their friends or family members tell them they look too thin, even though they are still clearly overweight. Bear in mind that by their standards you may be too thin, or at least thinner than they are. The question to ask is: Is their standard a healthy one? I doubt it. Either way: Do not try to force yourself to overeat to gain weight!
Eat only as much food as your hunger drive demands, and no more. If you exercise, your appetite will increase in response. You should not try to put on weight merely by eating, because that will only add more fat to your frame, not muscle. Additional fat, regardless of whether you like the way you look when you are fatter or not, will shorten your life span.
Once you start eating healthfully, you may find you are getting thinner than expected. Most people lose weight until they reach their ideal weight and then they stop losing weight. Ideal weight is an individual thing, but it is harder to lose muscle than fat, so once the fat is off your body, your weight will stabilize. Stabilization at a thin, muscular weight occurs because your body gives you strong signals to eat, signals that I call "true hunger." True hunger maintains your muscle reserve, not your fat.
Once your body gets to a certain level of better health, you begin to feel the difference between true hunger and just eating due to desire, appetite, or withdrawal symptoms. Your body is healthier at this stage and you won't experience the withdrawal symptoms such as weakness, headaches, lightheadedness, etc., that most people associate with hunger.
It is our unhealthy tendency to eat without experiencing true hunger that contributed to our becoming overweight to begin with. In other words, to have become overweight in the first place, appetite, food cravings, and other addictive drives that induce eating have come into play. Poor nutrition induces these cravings (addictive drives), and nutritional excellence helps normalize or remove them. My experience with thousands of patients following my healthful, high-nutrient eating plan is that most of these people no longer get the discomfort that they formerly mistook for hunger. Even when they delay eating and get very hungry, they no longer experience stomach cramps, headaches, or fatigue accompanying their falling blood sugar. They merely get hungry and they enjoy this new sensation of hunger in the mouth and throat, which makes food taste better than ever. Many of my patients have told me they enjoy this new sensation; they like being able to be in touch with true hunger and the pleasure of satisfying it.
The one point I want to emphasize is that it does not require any precise measuring of calories or specific diet to maintain a thin, muscular weight. It only requires that you eat healthy food and that the hunger drive be real.
Very few Americans have ever experienced true hunger. The ability to sense true hunger, which is a mouth-and-throat sensation, does not occur until after you are eating healthfully and have a high nutrient-per-calorie diet. Then, when the period of withdrawal from excessive eating of unhealthy foods and caffeine is over, you can be in touch with true hunger. You will learn more about headaches, hypoglycemia, and hunger in chapter seven.
The Only Way to Significantly Increase Life Span
The evidence for increasing one's life span through dietary restriction is enormous and irrefutable. Reduced caloric intake is the only experimental technique to consistently extend maximum life span. This has been shown in all species tested, from insects and fish to rats and cats. There are so many hundreds of studies that only a small number are referenced below.
Scientists have long known that mice that eat fewer calories live longer. Recent research has demonstrated the same effect in primates, (i.e., you). A recent study published in the Proceedings of the National Academy of Sciences found that restricting calories by 30 percent significantly increased life span in monkeys. The experimental diet, while still providing adequate nourishment, slowed monkeys' metabolism and reduced their body temperatures, changes similar to those in the long-lived thin mice. Decreased levels of triglycerides and increased HDL (the good) cholesterol were also observed.25 Studies over the years, on many different species of animals, have confirmed that those animals that were fed less lived longest. In fact, allowing an animal to eat as much food as it desires can reduce its life span by as much as one half.
High-nutrient, low-calorie eating results in dramatic increases in life span as well as prevention of chronic illnesses. From rodents to primates we see:
In the wide field of longevity research there is only one finding that has held up over the years: eating less prolongs life, as long as nutrient intake is adequate. All other longevity ideas are merely conjectural and unproven. Such theories include taking hormones such as estrogen, DHEA, growth hormones, and melatonin, as well as nutritional supplements. So far, there is no solid evidence that supplying the body with any nutritional element over and above the level present in adequate amounts in a nutrient-dense diet will prolong life.
This is in contrast to the overwhelming evidence regarding protein and caloric restriction.
This important and irrefutable finding is a crucial feature of the H = N/C equation. We all must recognize that if we are to reach the limit of human life span, we must not overeat on high-calorie food. Eating empty-calorie food makes it impossible to achieve optimal health and maximize our genetic potential.
To Avoid Overeating on High-Calorie Foods, Fill Up on Nutrient-Rich Ones
An important corollary to the principle of limiting high-calorie food is that the only way for a human being to safely achieve the benefits of caloric restriction while ensuring that the diet is nutritionally adequate is to avoid as much as possible those foods that are nutrient poor.
Indeed, this is the crucial consideration in deciding what to eat. We need to eat foods with adequate nutrients so we won't need to consume excess "empty" calories to reach our nutritional requirements. Eating foods that are rich in nutrients and fiber, and low in calories, "fills us up," so to speak, thus preventing us from overeating. To grasp why this works, let us look at how the brain controls our dietary drive. A complicated system of chemoreceptors in the nerves lining the digestive tract carefully monitor the calorie and nutrient density of every mouthful and send such information to the hypothalamus in the brain, which controls dietary drive.
There are also stretch receptors in the stomach to signal satiety by detecting the volume of food eaten, not the weight of the food. If you are not filled up with nutrients and fiber, the brain will send out signals telling you to eat more food, or overeat.
In fact, if you consume sufficient nutrients and fiber, you will become biochemically filled (nutrients) and mechanically filled (fiber), and your desire to consume calories will be blunted or turned down. One key factor that determines whether you will be overweight is your failure to consume sufficient fiber and nutrients. This has been illustrated in scientific studies.
How does this work in practice? Let's say we conduct a scientific experiment and observe a group of people by measuring the average number of calories they consumed at each dinner. Next, we give them a whole orange and a whole apple prior to dinner. The result would be that the participants would reduce their caloric intake, on the average, by the amount of calories in the fruit. Now, instead of giving them two fruits, give them the same amount of calories from fruit juice. What will happen? They will eat the same amount of food as they did when they had nothing at the beginning of their meal. In other words, the juice did not reduce the calories consumed in the meal - instead, the juice became additional calories. This has been shown to occur with beer, soft drinks, and other sources of liquid calories.
Liquid calories, without the fiber present in the whole food, have little effect at blunting our caloric drive. Studies show that fruit juice and other sweet beverages lead to obesity in children as well. If you are serious about losing weight, don't drink your fruit - eat it. Too much fiber and too many nutrients are removed during juicing, and many of the remaining nutrients are lost through processing, heat, and storage time. If you are not overweight, drinking fresh-prepared juice is acceptable as long as it does not serve as a substitute for eating those fresh fruits and vegetables. There is no substitute for natural whole foods.
There is a tendency for many of us to want to believe in magic. People want to believe that in spite of our indiscretions and excesses, we can still maintain optimal health by taking a pill, powder, or other potion. However, this is a false hope, a hope that has been silenced by too much scientific evidence. There is no magic. There is no miracle weight-loss pill. There is only the natural world of law and order, of cause and effect. If you want optimal health and longevity, you must engage the cause. And if you want to lose fat weight safely, you must eat a diet of predominantly unrefined foods that are nutrient and fiber-rich.
What if I Have a Slow Metabolic Rate?
Your body weight may be affected slightly by genetics, but that effect is not strong. Furthermore, I am convinced that inheriting a slow metabolic rate with a tendency to gain weight is not a flaw or defect but rather a genetic gift that can be taken advantage of. How is this possible? A slower metabolism is associated with longer life span in all species of animals. It can be speculated that if one lived sixty thousand or just a few hundred years ago, a slower metabolic rate might have increased our survival opportunity, since getting sufficient calories was difficult. For example, the majority of Pilgrims that arrived on our shores on the Mayflower died that first winter. They could not make or find enough food to eat, so only those with the genetic gift of a slow metabolic rate survived.
As you can see, it is not always bad to have a slow metabolic rate. It can be good. Sure, it is bad in today's environment of relentless eating and when consuming a high-calorie, low-nutrient diet. Sure, it will increase your risk of diabetes and heart disease and cancer, given today's food-consumption patterns. However, if correct food choices are made to maintain a normal weight, the individual with a slower metabolism may age more slowly.
Our body is like a machine. If we constantly run the machinery at high speed, it will wear out faster. Since animals with slower metabolic rates live longer, eating more calories, which drives up our metabolic rate, will cause us only to age faster. Contrary to what you may have heard and read in the past, our goal should be the opposite: to eat less, only as much as we need to maintain a slim and muscular weight, and no more, so as to keep our metabolic rate relatively slow. So stop worrying about your slower metabolic rate. A slower metabolic rate from dieting is not the primary cause of your weight problem. Keep these three important points in mind:
1. Resting metabolic rates do decline slightly during periods of lower caloric intake, but not enough to significantly inhibit weight loss.
2. Resting metabolic rates return to normal soon after caloric intake is no longer restricted. The lowered metabolic rate does not stay low permanently and make future dieting more difficult.
3. A sudden lowering of the metabolic rate from dieting does not explain the weight gain/loss cycles experienced by many overweight people. These fluctuations in weight are primarily from going on and getting off diets. It is especially difficult to stay with a reduced-calorie diet when it never truly satisfies the individual's biochemical need for nutrients, fiber, and phytochemicals.
Those with a genetic tendency to overweight may actually have the genetic potential to outlive the rest of us. The key to their successful longevity lies in their choosing a nutrient-rich, fiber-rich, lower calorie diet, as well as getting adequate physical activity. By adjusting the nutrient-per-calorie density of your diet to your metabolic rate, you can use your slow metabolism to your advantage. When you can maintain a normal weight in spite of a slow metabolism, you will be able to achieve significant longevity.
An Unprecedented Opportunity in Human History
Science and the development of modern refrigeration and transportation methods have given us access to high-quality, nutrient-dense food. In today's modern society, we have available to us the largest variety of fresh and frozen natural foods in human history. Using the foods available to us today, we can devise diets and menus with better nutrient density and nutrient diversity than ever before possible. This book gives you the information and the motivation you need to take advantage of this opportunity to improve your health and maximize your chances for a disease-free life.
You have a clear choice. You can live longer and healthier than ever before, or you can do what most modern populations do: eat to create disease and a premature death. Since you are reading this book, you have opted to live longer and healthier. "Eat to Live" and you will have achieved the crucial first step.
Copyright © 2003 by Joel Fuhrman, M.D.
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