How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease

as soon as we stop eating an artery-clogging diet, our bodies can start healing themselves, in many cases opening up arteries without drugs or surgery.

The U.S. health care system runs on a fee-for-service model in which doctors get paid for the pills and procedures they prescribe, rewarding quantity over quality. We don’t get reimbursed for time spent counseling our patients about the benefits of healthy eating. If doctors were instead paid for performance, there would be a financial incentive to treat the lifestyle causes of disease. Until the model of reimbursement changes, I don’t expect great changes in medical care or medical education.

If the cure to our number-one killer could get lost down the rabbit hole, what else might be buried in the medical literature?

Until recently, advanced age had been considered to be a disease itself,2 but people don’t die as a consequence of maturing. They die from disease, most commonly heart attacks.

when people move from low- to high-risk countries, their disease rates almost always change to those of the new environment.16 New diet, new diseases. So, while a sixty-year-old American man living in San Francisco has about a 5 percent chance of having a heart attack within five years, should he move to Japan and start eating and living like the Japanese, his five-year risk would drop to only 1 percent. Japanese Americans in their forties can have the same heart attack risk as Japanese in their sixties. Switching to an American lifestyle in effect aged their hearts a full twenty years.

the extra years we are living aren’t necessarily healthy or vibrant. Back in 2011, a disturbing analysis of mortality and morbidity was published in the Journal of Gerontology. Are Americans living longer now compared to about a generation ago? Yes, technically. But are those extra years necessarily healthy ones? No. And it’s worse than that: We’re actually living fewer healthy years now than we once did.20

A twenty-year-old in 1998 could expect to live about fifty-eight more years, while a twenty-year-old in 2006 could look forward to fifty-nine more years. However, the twenty-year-old from the 1990s might live ten of those years with chronic disease, whereas now it’s more like thirteen years with heart disease, cancer, diabetes, or a stroke. So it feels like one step forward, three steps back.

we’re living longer, but we’re living sicker.

In each of your cells, you have forty-six strands of DNA coiled into chromosomes. At the tip of each chromosome, there’s a tiny cap called a telomere, which keeps your DNA from unraveling and fraying. Think of it as the plastic tips on the end of your shoelaces. Every time your cells divide, however, a bit of that cap is lost. And when the telomere is completely gone, your cells can die.56 Though this is an oversimplification,57 telomeres have been thought of as your life “fuse”: They can start shortening as soon as you’re born, and when they’re gone, you’re gone.

The thought is that if you can slow down this ticking cellular clock, you may be able to slow down the aging process and live longer.59 So what would you have to do if you wanted to prevent this telomere cap from burning away? Well, smoking cigarettes is associated with triple the rate of telomere loss,60 so the first step is simple: Stop smoking.

The consumption of fruits,61 vegetables,62 and other antioxidant-rich foods63 has been associated with longer protective telomeres. In contrast, the consumption of refined grains,64 soda,65 meat (including fish),66 and dairy67 has been linked to shortened telomeres.

There’s an enzyme in the roots of bristlecone pines that appears to peak a few thousand years into their life span, and it actually rebuilds telomeres.68 Scientists named it telomerase. Once they knew what to look for, researchers discovered the enzyme was present in human cells too. The question then became, how can we boost the activity of this age-defying enzyme?

three months of whole-food, plant-based nutrition and other healthy changes could significantly boost telomerase activity, the only intervention ever shown to do so.69

In the control group (the group of participants who did not change their lifestyles), their telomeres predictably shrank with age. But for the healthy-living group, not only did their telomeres shrink less, they grew. Five years later, their telomeres were even longer on average than when they started, suggesting a healthy lifestyle can boost telomerase enzyme activity and reverse cellular aging.

Treating the cause is not only safer and cheaper but it can work better. So why don’t more of my medical colleagues do it? Not only were they not trained how, doctors don’t get paid for it. No one profits from lifestyle medicine (other than the patient!), so it’s not a major part of medical training or practice.96 That’s just how the current system works. The medical system is set up to financially reward prescribing pills and procedures, not produce.

If people begin eating plant-based diets while still taking medications, their blood pressure or blood sugar could actually drop so low that physicians may need to adjust medications or eliminate them altogether. Ironically, the “side effect” of the diet may be not having to take drugs anymore.

The primary reason diseases tend to run in families may be that diets tend to run in families.

For most of our leading killers, nongenetic factors like diet can account for at least 80 or 90 percent of cases.

rates of cardiovascular disease and major cancers differ fivefold to a hundredfold around the world. Migration studies show this is not just genetics. When people move from low- to high-risk areas, their disease risk nearly always shoots up to match the new setting.

Your family history does not have to become your personal destiny.

Cancer cells can use epigenetics against us by silencing tumor-suppressor genes that could otherwise stop the cancer in its tracks. So even if you’re born with good genes, cancer can sometimes find a way to turn them off.

fatty deposits in the walls of your arteries called atherosclerotic plaque. For most Americans raised on a conventional diet, plaque accumulates inside the coronary arteries—the blood vessels that crown the heart (hence “coronary”) and supply it with oxygen-rich blood. This buildup of plaque, known as atherosclerosis, from the Greek words athere (gruel) and sklerosis (hardening), is the hardening of the arteries by pockets of cholesterol-rich gunk that builds up within the inner linings of the blood vessels.

The restriction of blood circulation to the heart muscle can lead to chest pain and pressure, known as angina, when people try to exert themselves. If the plaque ruptures, a blood clot can form within the artery. This sudden blockage of blood flow can cause a heart attack, damaging or even killing part of the heart.

studies of accidental death victims between the ages of three and twenty-six found that fatty streaks—the first stage of atherosclerosis—were found in nearly all American children by age ten.22 By the time we reach our twenties and thirties, these fatty streaks can turn into full-blown plaques

If there’s anyone reading this over the age of ten, the question isn’t whether or not you want to eat healthier to prevent heart disease but whether or not you want to reverse the heart disease you very likely already have.

arteries of fetuses whose mothers had high LDL cholesterol levels were more likely to contain arterial lesions.23 This finding suggests that atherosclerosis may not just start as a nutritional disease of childhood but one during pregnancy.

the only critical risk factor for atherosclerotic plaque buildup is cholesterol, specifically elevated LDL cholesterol in your blood.24 Indeed, LDL is called “bad” cholesterol, because it’s the vehicle by which cholesterol is deposited into your arteries.

Autopsies of thousands of young accident victims have shown that the level of cholesterol in the blood was closely correlated with the amount of atherosclerosis in their arteries.

To drastically reduce LDL cholesterol levels, you need to drastically reduce your intake of three things: trans fat, which comes from processed foods and naturally from meat and dairy; saturated fat, found mainly in animal products and junk foods; and to a lesser extent dietary cholesterol, found exclusively in animal-derived foods, especially eggs.26

The three boosters of bad cholesterol—the number-one risk factor for our number-one killer—all stem from eating animal products and processed junk.

The optimal LDL cholesterol level is probably 50 or 70 mg/dL, and apparently, the lower, the better. That’s where you start out at birth, that’s the level seen in populations largely free of heart disease, and that’s the level at which the progression of atherosclerosis appears to stop

An LDL around 70 mg/dL corresponds to a total cholesterol reading of about 150, the level below which no deaths from coronary heart disease were reported in the famous Framingham Heart Study, a generations-long project to identify risk factors for heart disease.29 The population target should therefore be a total cholesterol level under 150 mg/dL.

To become virtually heart-attack proof, you need to get your LDL cholesterol at least under 70 mg/dL.

For those at high risk for heart disease who are unwilling or unable to bring down their cholesterol levels naturally with dietary changes, the benefits of statins generally outweigh the risks. These drugs do have side effects, though, such as the potential for liver or muscle damage.

safety labeling on statin drugs to warn doctors and patients about their potential for brain-related side effects, such as memory loss and confusion. Statin drugs also appeared to increase the risk of developing diabetes.37 In 2013, a study of several thousand breast cancer patients reported that long-term use of statins may as much as double a woman’s risk of invasive breast cancer.

Plant-based diets have been shown to lower cholesterol just as effectively as first-line statin drugs, but without the risks.

took patients with advanced heart disease and put them on the kind of plant-based diet followed by Asian and African populations who didn’t suffer from heart disease. Their hope was that a healthy enough diet would stop the disease process and keep it from progressing further. But instead, something miraculous happened. Their patients’ heart disease started to reverse. These patients were getting better. As soon as they stopped eating an artery-clogging diet, their bodies were able to start dissolving away some of the plaque that had built up. Arteries opened up without drugs or surgery, even in some cases of patients with severe triple-vessel heart disease.

within about fifteen years of stopping smoking, your lung-cancer risk approaches that of a lifelong nonsmoker.

Your arteries are not merely inert pipes through which blood flows. They are dynamic, living organs.

Certain foods, such as meats, appear to harbor bacteria that can trigger inflammation dead or alive, even when the food is fully cooked. Endotoxins are not destroyed by cooking temperatures, stomach acid, or digestive enzymes, so after a meal of animal products, these endotoxins may end up in your intestines. They are then thought to be ferried by saturated fat across the gut wall into your bloodstream, where they can trigger the inflammatory reaction in your arteries.44

a single serving of four Brazil nuts almost immediately improved cholesterol levels. LDL—the “bad”—cholesterol levels were a staggering twenty points lower just nine hours after eating the Brazil nuts.51 Even drugs don’t work nearly that fast.52 Here’s the truly insane part: The researchers went back and measured the study participants’ cholesterol thirty days later. Even a month after ingesting a single serving of Brazil nuts, their cholesterol levels stayed down.

Brazil nuts are so high in the mineral selenium that eating four every day may actually bump you up against the tolerable daily limit for selenium. Nevertheless, this is not something you have to worry about if you’re only eating four Brazil nuts a month.

Take a deep breath. Now imagine what it would feel like not to be able to breathe. We all need to take care of our lungs.

Lung disease can come in many forms, but the three types that kill the most people are lung cancer, chronic obstructive pulmonary disease (COPD), and asthma.

smokers aren’t just harming themselves; thousands of deaths each year have been attributed to secondhand smoke. Nonsmokers have a 20–30 percent higher risk of developing lung cancer if they’re regularly exposed to cigarette smoke.

Men who smoke are twenty-three times more likely and women thirteen times more likely to develop lung cancer than nonsmokers.

Tobacco smoke contains chemicals that weaken the body’s immune system, making it more susceptible to disease and handicapping its ability to destroy cancer cells. At the same time, tobacco smoke can damage cell DNA, increasing the chance for cancer cells to form and flourish in the first place.

Compared to broccoli-avoiding smokers, the broccoli-eating smokers suffered 41 percent fewer DNA mutations in their bloodstream

While breast cancer is the most common internal cancer among American women, lung cancer is actually their number-one killer. About 85 percent of women with breast cancer are still alive five years after diagnosis, but the numbers are reversed when it comes to lung cancer: 85 percent of women die within five years of a lung cancer diagnosis.

metastasis, the spread of the cancer to other parts of the body.

What the kale did do was substantially lower their bad (LDL) cholesterol and boost their good (HDL) cholesterol

Carcinogen blockers and antioxidants help prevent the initial triggering DNA mutation, and antiproliferatives work by keeping tumors from growing and spreading.

Unsurprisingly, scientists who tried this experiment found that the urine from nonsmokers caused far fewer DNA mutations—after all, they had a lot fewer carcinogens flowing through their systems. But when the smokers were given turmeric, the DNA-mutation rate dropped by up to 38 percent.

Your cells are preprogrammed to die naturally to make way for fresh cells through a process known as apoptosis (from the Greek ptosis, falling, and apo, away from). In a sense, your body is rebuilding itself every few months16 with the building materials you provide it through your diet. Some cells, however, overstay their welcome—namely, cancer cells. By somehow disabling their own suicide mechanism, they don’t die when they’re supposed to. Because they continue to thrive and divide, cancer cells can eventually form tumors and potentially spread throughout the body.

All cells contain so-called death receptors that trigger the self-destruction sequence, but cancer cells can disable their own death receptors. Curcumin, however, appears able to reactivate them.17 Curcumin can also kill cancer cells directly by activating “execution enzymes” called caspases inside cancer cells that destroy them from within by chopping up their proteins.

Though the majority of lung cancer is attributed to smoking, approximately a quarter of all cases occur in people who’ve never smoked.21 Although some of these cases are due to secondhand smoke, another contributing cause may be another potentially carcinogenic plume: fumes from frying.

When fat is heated to frying temperatures, whether it be animal fat, such as lard, or plant fat, such as vegetable oil, toxic volatile chemicals with mutagenic properties (those able to cause genetic mutations) are released into the air.22 This happens even before the “smoke point” temperature is reached.23 If you do fry at home, good ventilation in the kitchen may reduce lung cancer risk.

If you do need to be around frying bacon or eggs, it would be safer to limit your exposure by using a backyard grill. Studies show that the number of particles deposited into the lungs increases by a factor of ten when frying indoors versus outdoors.

Chronic obstructive pulmonary disease (COPD), such as emphysema and chronic bronchitis, is a condition that makes it difficult to breathe and gets worse and worse over time.

Adolescents living in areas where more starchy foods, grains, vegetables, and nuts were consumed were significantly less likely to exhibit chronic symptoms of wheezing, allergic rhinoconjunctivitis, and allergic eczema.

A study of more than one hundred thousand adults in India found that those who consumed meat daily, or even occasionally, were significantly more likely to suffer from asthma than those who excluded meat and eggs from their diets altogether.

Removing eggs and dairy from the diet has been shown to improve asthmatic children’s lung function in as few as eight weeks.52

The mechanism by which diet affects airway inflammation may lie with the thin coating of fluid that forms the interface between your respiratory-tract lining and the outside air. Using the antioxidants obtained from the fruits and vegetables you eat, this fluid acts as your first line of defense against the free radicals that contribute to asthmatic airway hypersensitivity, contraction, and mucus production.

If it’s the antioxidants, why not just take an antioxidant supplement? After all, popping a pill is easier than eating an apple. The reason is simple: Supplements don’t appear to work. Studies have repeatedly shown that antioxidant supplements have no beneficial effects on respiratory or allergic diseases, underscoring the importance of eating whole foods rather than trying to take isolated components or extracts in pill form.57

Most strokes can be thought of as “brain attacks”—like heart attacks, but the rupturing plaques in your arteries cut off blood flow to parts of the brain rather than to parts of the heart.

Unlike stroke, which can kill instantly and without any warning, Alzheimer’s involves a slower, more subtle decline over months or years. Instead of cholesterol-filled plaques in your arteries, plaques made of a substance called amyloid develop in the brain tissue itself, associated with the loss of memory and, eventually, loss of life.

In about 90 percent of strokes,3 blood flow to part of the brain gets cut off, depriving it of oxygen and killing off the part fed by the clogged artery. That’s called an ischemic stroke (from the Latin ischaemia, meaning “stopping blood”).

A small minority of strokes are hemorrhagic strokes, which are caused by bleeding into the brain when a blood vessel bursts.

Sometimes the blood clot lasts only a moment—not long enough to notice but still long enough to kill off a tiny portion of your brain. These so-called silent strokes can multiply and slowly reduce cognitive function until full-blown dementia develops.

In addition to its well-known effects on bowel health, high fiber intake appears to reduce the risk of cancers of the colon5 and breast,6 diabetes,7 heart disease,8 obesity,9 and premature death in general.

animal-derived foods have no fiber at all. Animals have bones to hold them up; plants have fiber.

Increasing fiber intake by just seven grams a day may be associated with a 7 percent risk reduction.

fiber helps control your cholesterol14 and blood sugar levels,15 which can help reduce the amount of artery-clogging plaque in your brain’s blood vessels. High-fiber diets may also lower blood pressure,16 which reduces the risk of brain bleeds.

“A man scatters seed on the ground … the seed sprouts and grows, though he does not know how.”

Good news for all you orange lovers: Citrus fruit intake has been associated with reduced stroke risk—even more so than apples.29 Say I can’t compare them? I just did! The key may lie with a citrus phytonutrient called hesperidin, which appears to increase blood flow throughout the body, including the brain.

scientists recruited women who suffered from sensitivity to cold weather due to poor blood flow—women with chronically cold hands, feet, and toes—and placed them in a highly air-conditioned room. The women in the experimental group drank a solution containing actual citrus phytonutrients, while another (control) group drank a placebo (an artificially flavored orange drink). The placebo drinkers got colder and colder. Because of decreased blood flow, the temperature of their fingertips dropped nearly 9 degrees Fahrenheit during the course of the study. The fingertips of the women who drank real citrus, meanwhile, cooled less than half as fast, because their blood flow remained steadier.

Compared with people who slept an average of seven hours per night, subjects who got four hours of sleep or less, or ten hours or more, had roughly a 50 percent greater likelihood of dying from a stroke.

Higher stroke rates were found among individuals sleeping six hours or less, or nine hours or more. Those at lowest risk got around seven or eight hours of sleep a night.

this concept—now called the mitochondrial theory of aging—suggests that free radical damage to your cells’ power source, known as mitochondria, leads to a loss of cellular energy and function over time.

Plants get their energy from the sun. You take a plant and place it in the sun, and through a process called photosynthesis, the chlorophyll in the leaves harnesses the sun’s energy and transfers it to tiny building blocks of matter called electrons. The plant starts out with low-energy electrons and, using the energy of the sun, charges them up into high-energy electrons. In this way, plants store the sun’s energy. When you then eat the plant (or the animals who ate the plant), these electrons (in the form of carbohydrates, protein, and fat) are delivered to all your cells. Then your mitochondria take the plant’s power-packed electrons and use them as an energy source—that is, as fuel—and slowly release their energy.

high-energy electrons that pass through your cells leak out where oxygen can grab them. When oxygen gets its hands on a high-energy electron, it basically turns into the Hulk, changing from lowly oxygen into what’s called superoxide, a type of free radical. A free radical is what it sounds like—a molecule that can be unstable, out of control, and violently reactive. The superoxide is just pumped up with energy and can start smashing around the cell, knocking stuff over and tripping over your DNA. When superoxide comes in contact with DNA, it can damage your genes, which, if not repaired, can cause mutations in your chromosomes that may lead to cancer.41 Thankfully, the body calls in its defense squad, known as antioxidants.

the phenomenon by which oxygen molecules grab stray electrons and go crazy is called oxidant, or oxidative, stress. According to the theory, the resulting cellular damage is what essentially causes aging.

You can tell whether a food is rich in antioxidants by slicing it open, exposing it to air (oxygen), and then seeing what happens. If it turns brown, it’s oxidizing. Think about our two most popular fruits: apples and bananas. They turn brown quickly, which means there aren’t a lot of antioxidants inside them.

Cut open a mango and what happens? Nothing happens, because there are lots of antioxidants in there.

Antioxidants can keep your food from oxidizing, and they may do the same inside your body.

“[A]ntioxidant rich foods originate from the plant kingdom while meat, fish and other foods from the animal kingdom are low in antioxidants.”

the least healthy plant food I can think of, good old American iceberg lettuce (which is 96 percent water!49), contains 17 units (daμmol using a modified FRAP assay) of antioxidant power.

The food category that averages the most antioxidants is herbs and spices.

How about a bowl of oatmeal for breakfast? By adding just a half-teaspoon of cinnamon, you could bring the antioxidant power of your meal from 20 units to 120 units.

Antioxidant-rich diets appear to protect against stroke by preventing the circulation of oxidized fats in the bloodstream that can damage the sensitive walls of small blood vessels in the brain.

Free radicals can disfigure proteins in our bodies to the extent they become unrecognizable by our immune systems.56 The inflammatory response this triggers can be prevented by saturating our bodies with sufficient antioxidants.

“Alzheimer’s Disease Is Incurable but Preventable.”61 Diet and lifestyle changes could potentially prevent millions of cases a year.62 How? There is an emerging consensus that “what is good for our hearts is also good for our heads,”63 because clogging of the arteries inside of the brain with atherosclerotic plaque is thought to play a pivotal role in the development of Alzheimer’s disease.

We generally think of atherosclerosis as a condition of the heart, but it’s been described as “an omnipresent pathology that involves virtually the entire human organism.”68 You have blood vessels in every one of your organs, including your brain. The concept of “cardiogenic dementia,” first proposed in the 1970s, suggested that because the aging brain is highly sensitive to a lack of oxygen, lack of adequate blood flow may lead to cognitive decline.

Autopsies have shown repeatedly that Alzheimer’s patients tend to have significantly more atherosclerotic plaque buildup and narrowing of the arteries within the brain.71,72,73 Normal resting cerebral blood flow—the amount of blood circulating to the brain—is typically about a quart per minute.

Starting in adulthood, people appear to naturally lose about half a percent of blood flow per year. By age sixty-five, this circulating capacity could be down by as much as 20 percent.

The clogging of the arteries inside, and leading to, the brain with cholesterol-filled plaque can drastically reduce the amount of blood—and therefore oxygen—your brain receives.

Alzheimer’s patients had particularly significant arterial blockage in the arteries leading to the memory centers of their brains.

Consuming excess cholesterol, and especially trans and saturated fats, can raise your blood cholesterol level.80 Too much cholesterol in your blood is not only considered the primary risk factor for heart disease81 but is also unanimously recognized as a risk factor for Alzheimer’s disease.82

Excess cholesterol in the blood can lead to excess cholesterol in the brain, which may then help trigger the clumping of amyloid seen in Alzheimer’s brains.

Africans in Nigeria are up to four times lower than those of African Americans in Indianapolis.

Everyone has some form of ApoE, but about one in seven people have a copy of the E4 gene that is linked to the disease. It’s been shown that if you inherit one ApoE4 gene from your mother or father, your risk of getting Alzheimer’s may triple. If you get the ApoE4 gene from both parents—which about one in fifty people do—you might end up with nine times the risk.

What does the ApoE gene do? It makes the protein that’s the principal cholesterol carrier in the brain.100 The E4 variant may lead to an abnormal accumulation of cholesterol within brain cells, which could trigger Alzheimer’s pathology.

The highest frequency of the ApoE4 variant occurs in Nigerians,102 who surprisingly also have some of the lowest rates of Alzheimer’s.103 Wait a second. The population with the highest rate of the “Alzheimer’s gene” has one of the lowest rates of Alzheimer’s disease? This contradiction may be explained by Nigerians’ extremely low blood-cholesterol levels, thanks to a diet low in animal fat104 and consisting mainly of grains and vegetables.

The Mediterranean diet, for example, which is higher in vegetables, beans, fruits, and nuts, and lower in meats and dairy products, has been associated with slower cognitive decline and lower risk of Alzheimer’s.

simply eating a handful of berries every day, one easy and delicious dietary tweak, may slow your brain’s aging by more than two years.

active ingredient may be a class of powerful brain-accessing antioxidants called polyphenols.

Beyond their antioxidant activity, polyphenols have been shown to protect nerve cells in vitro by inhibiting the formation of the plaques125and tangles126 that characterize Alzheimer’s brain pathology.

Although some remarkable benefits have been reported in anecdotal case studies with the spice turmeric,129 the best data we have on spice-based interventions for Alzheimer’s is for saffron. A spice derived from the flower of Crocus sativus, saffron was found in a double-blind trial to help diminish the symptoms of Alzheimer’s disease.

How about putting saffron head-to-head against one of the most popular Alzheimer’s drugs on the market: donepezil (commonly marketed under the brand name Aricept)? A twenty-two-week double-blind study (meaning that neither the researchers nor the subjects knew who was on the drug and who was on the spice until the study’s conclusion) found that saffron appears just as effective at treating Alzheimer’s symptoms as the leading drug.

While there is no proven way to halt the progression of Alzheimer’s, if you do know anyone suffering from the disease, regularly cooking him or her saffron-spiced paella may help.

advanced glycation end products, or AGEs.138 AGE is an appropriate acronym, as they are considered “gerontotoxins,”139 meaning aging toxins (from the Greek geros, meaning “old age,” as in “geriatric”). AGEs are thought to accelerate the aging process by cross-linking proteins together, causing tissue stiffness, oxidative stress, and inflammation.

sirtuin suppression is both preventable and reversible by AGE reduction, avoiding high-AGE foods is seen as potentially offering a new strategy to combat the Alzheimer’s epidemic.153

studies using MRI scans found that aerobic exercise can actually reverse age-related shrinkage in the memory centers of the brain.

Aerobic exercise can help improve cerebral blood flow, improve memory performance, and help preserve brain tissue.

A wholesome diet and exercise may offer your best hope for remaining sharp and healthy into your twilight years.

Esophageal cancer, which affects the tube between your mouth and stomach, is also frequently fatal for its eighteen thousand annual victims.7 The foods you eat can indirectly affect cancer risk, for example, by exacerbating acid reflux, a risk factor for esophageal cancer, or through direct contact with the lining of the digestive tract.

Starting at age fifty until age seventy-five, you should either get stool testing every year, stool testing every three years plus a sigmoidoscopy every five years, or a colonoscopy every ten years.

Food goes through men eating plant-based diets in just a day or two, but this transit time takes as long as five or more days among those eating more conventional diets. Women eating plant-based diets also average a day or two, but the average intestinal transit time in most women eating conventional diets may be four days.

Constipation can be considered a nutrient-deficiency disease, and that nutrient is fiber.27 Just as you can get scurvy if you don’t get enough vitamin C, you can get constipation if you don’t get enough fiber.

Since fiber is found only in plant foods, it’s no surprise that the more plants you eat, the less likely you are to be constipated.

Organically grown berries in particular may suppress cancer cell growth better than those grown conventionally.

Meat consumption was associated with increased risk of dying from cancer, dying from heart disease, and dying prematurely in general.

What does meat contain that may raise the risk of premature death? One of the possibilities is heme iron, the form of iron found predominantly in blood and muscle. Because iron can generate cancer-causing free radicals by acting as a pro-oxidant,67 iron can be considered a double-edged sword—too little of it and you risk anemia, too much and you may increase risk of cancer and heart disease.

If you don’t have enough iron circulating in your body, your intestines begin boosting iron absorption; if you have too much iron in circulation, your intestines decrease absorption. But this thermostat-like system only works effectively with the primary source of iron in the human diet: the nonheme iron variety found predominantly in plant foods. Once you have a sufficient amount of iron in your blood, your body is about five times more effective at blocking the absorption of excess iron from plant foods than from animal foods.69 This may be why heme iron is associated with cancer70 and heart disease risk.71 Similarly, heme iron is associated with higher risk of diabetes, but nonheme iron is not.72

The healthiest sources of iron are whole grains, legumes, nuts, seeds, dried fruits, and green, leafy vegetables.

Avoid drinking tea with meals, as that can inhibit iron absorption.

Consuming vitamin C–rich foods can improve iron absorption. The amount of vitamin C in a single orange can enhance iron absorption as much as three- to sixfold, so those trying to boost their iron absorption should reach for some fruit instead of a cup of tea.

your best bet is to avoid tobacco, excess alcohol intake, and obesity and to eat a diet low in animal products, refined grains, and added sugars97 and rich in beans, lentils, split peas, and dried fruit.

Esophageal cancer occurs when cancer cells develop in the esophagus, the muscular tube carrying food from your mouth to your stomach. Typically, the cancer arises in the lining of the esophagus and then invades the outer layers before metastasizing (spreading) to other organs. Early

Besides avoiding tobacco and alcohol (even light drinking appears to increase risk),100 the most important thing you can do to prevent esophageal cancer is to eliminate acid reflux disease—and that can often be accomplished through diet.

Chronic inflammation caused by acid reflux can lead to Barrett’s esophagus, a precancerous condition that involves changes in the esophageal lining.

Red meat is strongly associated with cancer in the esophagus itself, whereas poultry was more strongly associated with cancer down around the stomach-esophagus border.

Within five minutes of eating fat, your sphincter muscle at the top of your stomach—which acts like a valve to keep down food inside the stomach—relaxes, allowing acids to creep back up into the esophagus.

volunteers consuming a high-fat meal (McDonald’s sausage, egg, and cheese sandwich) experienced more acid squirting up into their esophagus than those eating a lower-fat meal (McDonald’s hotcakes).109 Part of this effect may be due to the release of a hormone called cholecystokinin, which is triggered by both meat110 and eggs111 and may also relax the sphincter.112 This helps explain why those who eat meat have been found to have twice the odds of reflux-induced esophageal inflammation compared with vegetarians.

Centering your diet around antioxidant-rich plant foods may cut in half your odds of esophageal cancer.

The most protective foods for cancer at the esophagus-stomach border appear to be red, orange, and dark-green leafy vegetables, berries, apples, and citrus fruits,116 but all unprocessed plant foods have the advantage of containing fiber.

High fiber intake may reduce the incidence of esophageal cancer by as much as one-third118 by helping to prevent the root cause of many cases of acid reflux: the herniation of part of the stomach up into the chest cavity.

Hiatal hernia, as this condition is known, occurs when part of the stomach is pushed up through the diaphragm into the chest.

If you regularly strain to push out stool, over time the increased pressure can push part of the stomach up and out of the abdomen, allowing acid to flow up toward the throat.

Similar to the way squeezing a stress ball causes a balloon bubble to pop out, the pressure from straining at the toilet may herniate outpouchings from the wall of the colon, a condition known as diverticulosis. The increased abdominal pressure may also back up blood flow in the veins around the anus, causing hemorrhoids, and even push blood flow back into the legs, resulting in varicose veins.

Those who eat diets that revolve around whole plant foods tend to pass such effortless bowel movements that their stomachs stay where they’re supposed to,123 which can reduce the acid spillover implicated in one of our deadliest cancers.

fiber binds to toxins, such as lead and mercury, and flushes them away (pun intended!).130 Our bodies were designed to expect an ever-flowing fiber stream, so it dumps such unwanted waste products as excess cholesterol and estrogen into the intestines, assuming they will be swept away. But if you aren’t constantly filling your bowels with plant foods, the only natural source of fiber, unwanted waste products can get reabsorbed and undermine your body’s attempts at detoxifying itself. Only 3 percent of Americans may even reach the recommended minimum daily intake of fiber, making it one of the most widespread nutrient deficiencies in the United States.

the meat industry is trying to pass so-called ag-gag laws, which make it illegal to take pictures inside their operations. Presumably, they fear people might be less inclined to buy their products if they knew how these products are made.

Nearly three-quarters of all emerging and reemerging human diseases arise from the animal kingdom.

With every breath you take, you inhale thousands of bacteria,14 and with every bite you eat, you can ingest millions more.15 Most of these tiny germs are completely harmless, but some can cause serious infectious diseases, occasionally making headlines with sinister-sounding names like SARS or Ebola.

Ideally, you should sanitize your hands after every bathroom visit and handshake, before all food preparation, and before touching your eyes, nose, or mouth after coming in contact with public surfaces.

(Products containing between 60 and 80 percent alcohol were found to be more effective than soap in every scientific study available for review.)

Composed of various organs, white blood cells, and proteins called antibodies that form alliances against trespassing pathogens threatening the body, the immune system, apart from the nervous system, is the most complex organ system humans possess.

Your first layer of protection against intruders are physical surface barriers like your skin. Beneath that are white blood cells, such as neutrophils that attack and engulf pathogens directly, and natural killer cells that put your cells out of their misery if they become cancerous or infected with a virus.

How do natural killer cells recognize pathogens and infected cells? They are often marked for destruction by antibodies, which are special proteins made by another type of white blood cell, known as B cells, that home in like smart bombs and stick to invaders. Each B cell makes one type of antibody that’s specific for one foreign molecular signature.

intraepithelial lymphocytes. These cells serve two functions: They condition and repair the thin intestinal lining, and they also serve as its first line of gut defense against pathogens.

the immune boost provided by cruciferous vegetables like broccoli not only protects us against the pathogens found in food but also against pollutants in the environment. We’re all constantly being exposed to a wide range of toxic substances—from cigarette smoke, car exhaust, furnaces, cooked meat, fish, dairy, and even from mother’s milk33 (as a consequence of what the mother was exposed to). Because some of these pollutants, such as dioxins, exert their toxic effects through the Ah receptor system, cruciferous compounds may block them.

it wasn’t known until recently that berries may also boost your levels of natural killer cells. They may sound sinister, but natural killer cells are a type of white blood cell that’s a vital member of the immune system’s rapid-response team against virus-infected and cancerous cells. They’re called natural killers because they don’t require prior exposure to a disease to be activated

Babies delivered via cesarean section appear to be at increased risk for various allergic diseases, including allergic runny nose, asthma, and perhaps even food allergies.44 (Allergy symptoms are caused when your immune system overreacts to normally harmless stimuli, such as tree pollen.)

Normal delivery leads to the colonization of the baby’s gut with the mother’s vaginal bacteria. C-section babies, on the other hand, are deprived of this natural exposure. The resulting difference in gut flora may affect the way the baby’s immune system develops, accounting for the difference in allergy rates.

a disturbance in a mother’s vaginal flora during pregnancy due, for example, to sexually transmitted infections or douching may result in higher asthma risk for the infant.

there is already something that can boost your immune system for free and by so much that you can achieve a 25–50 percent reduction in sick days. And it has only good side effects. What is it? Exercise.

Approximately 95 percent of all infections start in the mucosal (moist) surfaces, including the eyes, nostrils, and mouth.54 These surfaces are protected by antibodies called IgA (short for immunoglobulin, type A), which provide an immunological barrier by neutralizing and preventing viruses from penetrating into the body.

Moderate exercise may be all it takes to boost IgA levels and significantly reduce the chance of coming down with flu-like symptoms. Compared to a sedentary control group, those who performed aerobic exercises for thirty minutes three times a week for twelve weeks had a 50 percent increase in the levels of IgA in their saliva and reported significantly fewer respiratory infection symptoms.

While regular physical activity improves immune function and lowers respiratory infection risk, sustained and intense exertion may have the opposite effect. As you go from inactive to active, infection risk declines, but at a certain point, overtraining and excessive stress can increase the risk of infection by impairing immune function.

In terms of healthy years of life lost, the top five most devastating pathogen-food combinations are Campylobacter and Salmonella bacteria in poultry, Toxoplasma parasites in pork, and Listeria bacteria in deli meats and dairy products.

One of the reasons animal foods are the leading culprits is that most foodborne pathogens are fecal pathogens. Because plants don’t poop, the E. coli you may get from spinach didn’t actually originate in the spinach; E. coli is an intestinal pathogen, and spinach doesn’t have intestines. The application of manure to crops has been found to increase the odds of E. coli contamination by more than fiftyfold.

Salmonella in eggs can survive scrambled, over-easy, and sunny-side-up cooking methods. Sunny side up was found to be the riskiest. The industry-funded researchers bluntly concluded: “The sunny-side-up method should be considered unsafe.”

“Most people are infected with Salmonella by eating foods that have been contaminated by feces.”102 How does it get there? In slaughter plants, birds are typically gutted by a metal hook, which too often punctures their intestines and can expel feces onto the flesh itself.

According to the latest national FDA retail-meat survey, about 90 percent of retail chicken showed evidence of contamination with fecal matter.

Consumer Reports magazine tested nearly two hundred samples from cities across the country and found that more than two-thirds of the pork was contaminated with Yersinia.129 This may be because of the intensification and overcrowding that characterizes most of today’s industrial pig operations.

pork producers can maximize their profits by confining each pig to a six-square-foot space. This basically means cramming a two-hundred-pound animal into an area equivalent to about two feet by three feet.

overcrowding presents problems, including inadequate ventilation and increased health risks, but they concluded that sometimes, “crowding pigs a little tighter will make you more money.”131 Unfortunately, this situation is not expected to change anytime soon. Why? Yersinia bacteria do not cause clinical disease in pigs.132 In other words, it’s a public health problem, not an animal production problem. It doesn’t affect the industry’s bottom line. So instead of giving these animals a little more breathing room, the pork industry just largely passes along to society the estimated $250 million cost of sickening tens of thousands of Americans every year.

physicians overprescribe antibiotics as well, but the FDA estimates that 80 percent of the antimicrobial drugs sold in the United States every year now go to the meat industry.148 Antibiotic residues can then end up in the meat you eat. Studies have revealed that traces of such antibiotics as Bactrim, Cipro, and Enrofloxacin have been found in the urine of people eating meat—even though none of them was taking those drugs.

Healthy living may help protect you against both airborne and foodborne illnesses. Eating more fruits and vegetables and exercising more frequently can boost your immune system to help you fight off respiratory infections like the common cold. And sticking to mostly plant foods can help prevent you from becoming another food poisoning statistic by reducing your exposure to some of the deadliest fecal pathogens.

Diabetes mellitus is characterized by chronically elevated levels of sugar in your blood. This is because either your pancreas gland isn’t making enough insulin (the hormone that keeps your blood sugar in check) or because your body becomes resistant to insulin’s effects.

The insulin-deficiency disease is called type 1 diabetes, and the insulin-resistance disease is called type 2 diabetes.

If too much sugar builds up in your blood, it can overwhelm the kidneys and spill into your urine. How did people test urine before they had modern laboratory techniques? They tasted it. Diabetic urine can evidently taste as sweet as honey. Hence the name.

Your digestive system breaks down the carbohydrates you eat into a simple sugar called glucose, which is the primary fuel powering all the cells in your body. To get from the bloodstream into your cells, glucose requires insulin. Think of insulin as the key that unlocks the doors to your cells to allow glucose to enter. Every time you eat a meal, insulin is released by your pancreas to help shuttle the glucose into your cells. Without insulin, your cells can’t accept glucose, and, as a result, the glucose builds up in your blood. Over time, this extra sugar can damage the blood vessels throughout the body. That’s why diabetes can lead to blindness, kidney failure, heart attacks, and stroke.

High blood sugar can also damage your nerves, creating a condition known as neuropathy that can cause numbness, tingling, and pain. Because of the damage to their blood vessels and nerves, diabetics may also suffer from poor circulation and lack of feeling in the legs and feet, which can lead to poorly healing injuries that can, in turn, end as amputations.

In most people with type 1 diabetes, the immune system mistakenly destroys the insulin-producing beta cells in the pancreas. Without insulin, blood sugar rises to unsafe levels. Type 1 diabetes is therefore treated with injections of insulin, a type of hormone-replacement therapy, to make up for the lack of production.

In type 2 diabetes, the pancreas can make insulin, but it doesn’t work as well. The accumulation of fat inside the cells of your muscles and liver interferes with the action of insulin.9 If insulin is the key that unlocks the doors to your cells, saturated fat is what appears to gum up the locks. With glucose denied entry into your muscles, the primary consumer of such fuel, sugar levels can rise to damaging levels in your blood. The fat inside these muscle cells can come from the fat you eat or the fat you wear (i.e., your body fat). The prevention, treatment, and reversal of type 2 diabetes therefore depends on diet and lifestyle.

Type 2 diabetes is almost always preventable, often treatable, and sometimes even reversible through diet and lifestyle changes.

When insulin attaches to insulin receptors on a cell, it activates a series of enzymes that escort in the glucose. Without insulin, blood glucose is stuck out in the bloodstream, banging on your cells’ front door, unable to enter. Blood sugar levels then rise, damaging vital organs in the process.

intramyocellular lipid, the fat inside your muscle cells. Fat in your bloodstream, either from your own fat stores or from your diet, can build up inside your muscle cells, where it can create toxic breakdown products and free radicals that block the insulin-signaling process.

Even among healthy individuals, a high-fat diet can impair the body’s ability to handle sugar. But you can lower your insulin resistance by lowering your fat intake. Research has clearly shown that as the amount of fat in your diet becomes increasingly lower, insulin works increasingly better.

Children who are obese at age six are more likely than not to stay that way, and 75–80 percent of obese adolescents will remain obese as adults.

For adults, a BMI over 30 is considered obese. Between 25 and 29.9 is considered overweight, and a BMI between 18.5 and 24.9 is considered “ideal weight.”

Carrying excess body fat is the number-one risk factor for type 2 diabetes; up to 90 percent of those who develop the disease are overweight.

the number of individual fat cells in your body doesn’t change much in adulthood, no matter how much weight you gain or lose. They just swell up with fat as the body gains weight, so when your belly gets bigger, you’re not necessarily creating new fat cells; rather, you’re just cramming more fat into existing ones.34 In overweight and obese people, these cells can get so bloated that they actually spill fat back into the bloodstream, potentially causing the same clogging of insulin signaling one would experience from eating a fatty meal.

being obese can be like gorging on bacon and butter all day even if you are actually eating healthfully. That’s because an obese person’s body may be constantly spilling fat into the bloodstream, regardless of what goes into the mouth. No matter the source of fat in your blood, as fat levels rise, your ability to clear sugar from the blood drops due to insulin resistance—the cause of type 2 diabetes.

flexitarians appear to cut their rate of diabetes by 28 percent, good news for those who eat meat maybe once a week rather than every day. Those who cut out all meat except fish appear to cut their rates in half. What about those eliminating all meat, including fish? They appear to eliminate 61 percent of their risk. And those who go a step farther and drop eggs and dairy foods too? They may drop their diabetes rates 78 percent compared with people who eat meat on a daily basis.

palmitate, the kind of saturated fat found mostly in meat, dairy, and eggs, causes insulin resistance. On the other hand, oleate, the monounsaturated fat found mostly in nuts, olives, and avocados, may actually protect against the detrimental effects of the saturated fat.

Saturated fats can wreak all sorts of havoc in muscle cells and may result in the accumulation of more toxic breakdown products (such as ceramide and diacylglycerol)39 and free radicals and can cause inflammation and even mitochondrial dysfunction—that is, interference with the little power plants (mitochondria) within our cells.

If we take muscle biopsies from people, saturated fat buildup in the membranes of their muscle cells correlates with insulin resistance.42 Monounsaturated fats, however, are more likely to be detoxified by the body or safely stored away.

At around age twenty, the body stops making new insulin-producing beta cells. After that, if they are lost, they may be lost for good.49 Autopsy studies have shown that by the time type 2 diabetes is diagnosed later in life, you may have already killed off half your beta cells.

The toxicity of saturated fats can be demonstrated directly. If we expose beta cells to saturated fat51 or to LDL (“bad”) cholesterol in a petri dish, the beta cells begin to die.52 The same effect is not observed with the monounsaturated fats concentrated in fatty plant foods, such as nuts.

a diet with too many calories and rich in saturated fat is considered a cause of type 2 diabetes.

even if you don’t eat extra fat, the extra fat you wear may cause the spillover effect—the tendency for overstretched fat cells to spill fat into the bloodstream.

Fruits and vegetables, on average, contain about 80–90 percent water. Just as fiber can bulk up the volume of foods without adding calories, so can water.

Those who eat plant-based diets may even have an 11 percent higher resting metabolic rate.76 That means vegetarians could be burning more calories even in their sleep. Why? This could be because vegetarians have a higher gene expression of a fat-burning enzyme called carnitine palmitoyltransferase, which effectively shovels fat into the mitochondrial furnaces in your cells.

meat consumption was associated with significant weight gain even after adjusting for calories. This means that if you had two people eating the same number of calories, it appears the person eating more meat would, on average, gain significantly more weight.

Gastric bypass surgery—which effectively reduces the size of the stomach by 90 percent or more—is one of the most successful treatment methods for type 2 diabetes, with reported long-term remission rates of up to 83 percent. These results had led to the suggestion that gastric bypass surgery improves diabetes by somehow altering digestive hormones, but this interpretation ignores the fact that patients are placed on a severely limited diet for up to two weeks following the procedure to recover from the surgery. Extreme calorie restriction alone can reverse diabetes. So is the success of surgery the result of the operation itself or due to the restrictive diet?

There’s little money to be made from prescribing plants instead of pills.

Processed meat is blamed for the deaths of more than eight hundred thousand people every year. Worldwide, that’s four times more people than who die from illicit drug use.

The number-one risk factor for death in the world they identified is high blood pressure.6 Also known as hypertension, high blood pressure lays waste to nine million people worldwide every year.

Salt is a compound made up of about 40 percent sodium and 60 percent chloride. Sodium is an essential nutrient, but vegetables and other natural foods provide the small amounts of sodium you need in your diet. If you consume too much, it can cause water retention, and your body may respond by raising your blood pressure to push the excess fluid and salt out of your system.

Reducing sodium consumption by just 15 percent worldwide could save millions of lives every year.

If we could cut our salt intake by about a half teaspoon a day, which is achievable by avoiding salty foods and not adding salt to our food, we might prevent 22 percent of stroke deaths and 16 percent of fatal heart attacks.

out-of-control high blood pressure (known as malignant hypertension)

It turns out that sodium intake appears to suppress the activity of a key antioxidant enzyme in the body called superoxide dismutase,49 which has the ability to detoxify a million free radicals per second.50 With the action of this workhorse of an enzyme stifled by sodium, artery-crippling levels of oxidative stress can build up.

since three-quarters of salt comes from processed foods rather than a saltshaker.58 By hooking you on hypersweet and hypersalty foods, your taste buds get so dampened that natural foods can taste like cardboard.

If you add salt to meat, it draws in water. This way, a company can increase the weight of its product by nearly 20 percent. Since meat is sold by the pound, that’s 20 percent more profits for very little added cost.

The poultry industry commonly injects chicken carcasses with salt water to artificially inflate their weight, yet they can still be labelled “100 percent natural.”

shoot for fewer milligrams of sodium per serving than there are calories.

In studies of two of the most important arteries in the body, the coronary arteries that feed the heart and the carotid arteries that feed the brain, people who ate the most whole grains had significantly slower narrowing of their arteries.

Ground flaxseeds alone “induced one of the most potent blood-pressure-lowering effects ever achieved by a dietary intervention.”

To lower blood pressure, you should still lose weight, reduce your salt intake, get more exercise, and eat healthier, but the evidence shows that adding hibiscus tea to your daily routine may offer an additional benefit, comparable even to that provided by antihypertensive drugs.

Nitric oxide (NO) is a key biological messenger within the body, and its message is: “Open Sesame!” When released by your endothelium (the cells lining your arteries), it signals the muscle fibers within the walls of your arteries to relax, allowing them to open up and for more blood to flow.

The nitroglycerin people take when they’re experiencing chest pain is converted into NO, which dilates the coronary arteries, allowing more blood to flow to the heart muscle. Erectile dysfunction (ED) pills like Viagra work the same way; they boost nitric oxide signaling, which relaxes penile arteries and improves blood flow to the penis.

endothelial dysfunction, the failure of the linings of your arteries to produce enough NO to properly dilate them. Nitric oxide is produced by an enzyme called NO synthase. Its enemy is free radicals, which not only gobble up nitric oxide but can hijack NO synthase and force it to start pumping out additional free radicals.142 Without enough NO, your arteries can then stiffen, become dysfunctional, and raise your blood pressure and your risk for heart attack.

scientists concluded that “nitrate-rich vegetables may prove to be both cost-effective, affordable, and favorable for a public health approach to hypertension.”

There’s a link between vegetable consumption and improved sexual function,154 as well as improved blood flow to the most important organ of the body, the brain.

beet juice made the bikers’ bodies’ energy production significantly more efficient. No drug, steroid, supplement, or intervention had ever before been shown to do what beet juice could do.

In another study, men and women eating one and a half cups of baked beets seventy-five minutes before running a 5K race improved their running performance while maintaining the same heart rate and even reported less exertion.

To maximize athletic performance, the ideal dose and timing appears to be a half cup of beet juice (or three three-inch beets, or a cup of cooked spinach159) two to three hours before a competition.

When people are overweight, they can suffer from social stigma, knee problems, and increased risk for metabolic disorders like diabetes, but this was the first person I saw bleed to death before my eyes.

Whatever you absorb through your digestive tract isn’t immediately circulated throughout your body. The blood from your intestines first goes straight to the liver, where nutrients are metabolized and toxins are neutralized.

iron-overload disease hemochromatosis.

Excessive alcohol consumption can lead to an accumulation of fat in the liver (what’s known as fatty liver), which can cause inflammation and result in liver scarring and, eventually, liver failure.

Heavy alcohol consumption can cause a fatty liver in less than three weeks,9 but it usually resolves within four to six weeks after stopping drinking.

There actually appears to be a beneficial effect on overall mortality by drinking some alcohol—but only, it seems, for those who are not taking good care of themselves already.17 Moderate drinking does appear to protect against heart disease, perhaps because of a blood-thinning effect,18 but even light drinking (less than one drink a day) has been found to increase cancer risk, as you’ll see in chapter 11. How could something that increases cancer risk still prolong life? Cancer is “only” our second-leading killer disease. Because heart disease is the leading cause of death, it explains why people who drink moderately may live longer lives than those who abstain. But this advantage may be restricted only to those who fail to practice a bare modicum of healthy behaviors.

One to two drinks a day did lower the risk of heart disease for the “couch potatoes,” those living unhealthy lifestyles. But people who practiced even the bare minimum of healthy behaviors showed no benefit from alcohol.

Fast food is so effective at instigating the disease because NAFLD is associated with the intake of soft drinks and meat. Drinking just one can of soda a day appears to raise the odds of getting fatty liver disease by 45 percent.

When the concentration of cholesterol in your liver cells gets too high, it can crystallize like rock candy and result in inflammation.

Hepatitis A is spread primarily through food or water that is tainted with contaminated feces. It can be prevented through vaccination, avoiding raw and undercooked shellfish, and trying to ensure that everyone who handles your food washes their hands after changing diapers or using the toilet.

While hepatitis A virus is foodborne, hepatitis B virus is bloodborne and is transmitted sexually. As with hepatitis A, an effective vaccine is available against hepatitis B that every child should get. Hepatitis D virus infection can only occur in someone who is already infected with hepatitis B and so can be prevented by preventing hepatitis B. So get vaccinated and refrain from intravenous drug use and unsafe sex.

there is currently no vaccine for the hepatitis C virus, the most dreaded of liver viruses. Exposure can lead to a chronic infection that, over decades, can lead to cirrhosis and liver failure. Hepatitis C is now the leading cause of liver transplants.

subsequent study found the consumption

daily consumption of caffeinated beverages can lead to physical dependence, and caffeine withdrawal symptoms can include days of headache, fatigue, difficulty concentrating, and mood disturbances.

All the most serious liver conditions—liver cancer, liver failure, and cirrhosis—can start with an inflamed liver. That inflammation can be caused by an infection or the buildup of fatty deposits. Liver viruses can be prevented by common-sense measures. Don’t inject drugs, do get vaccinated, and do practice safe sex. Liver fat can also be prevented by common sense measures: Avoid excess consumption of alcohol, calories, cholesterol, saturated fat, and sugar.

When healthy, your red blood cells deliver oxygen throughout your body, your white blood cells fight off infections, and your platelets help your blood to clot. Most blood cancers involve mutations of the white cells.

Leukemia (from the Greek roots leukos, or “white,” and haima, or “blood”) is a disease in which the bone marrow feverishly produces abnormal white blood cells.

Lymphoma is a blood cancer of lymphocytes, which are specialized types of white blood cells. Lymphoma cells multiply quickly and can collect in your lymph nodes, small immune organs that are spread throughout the body, including the armpits, neck, and groin. Lymph nodes help to filter your blood.

myeloma cells take over the bone marrow, healthy white blood cells continue to decline in number, which increases your susceptibility to infection. Reduced levels of red blood cells can lead to anemia, and reduced platelet counts can lead to serious bleeding. Once diagnosed, most people survive fewer than five years.

Animal viruses can infect people who prepare meat with unpleasant skin diseases, such as contagious pustular dermatitis.44 There’s even a well-defined medical condition commonly known as “butchers’ warts” that affects the hands of those who handle fresh meat, including poultry and fish.45 Even the wives of butchers appear to be at higher risk for cervical cancer, a cancer definitively associated with wart-virus exposure.

Workers in poultry slaughterhouses have been found to have higher rates of cancers of the mouth, nasal cavities, throat, esophagus, rectum, liver, and blood. On a public health level, the concern here is that the cancer-causing viruses present in poultry and poultry products may then be transmitted to those in the general population who handle or eat inadequately cooked chicken.

In one study, the lowest risk of lymphoma was found in people who had had pets for twenty years or longer. The researchers suspect the reason is connected to the fact that having pets may have beneficial effects on the immune system.

If your kidneys do not function properly, metabolic waste products can accumulate in the blood and eventually lead to such symptoms as weakness, shortness of breath, confusion, and abnormal heart rhythms.

Healthy kidneys work hard to retain protein and other vital nutrients, preferably filtering toxic or useless wastes out of the bloodstream via our urine. If the kidneys are leaking protein into urine, it’s a sign that they may be starting to fail.

It’s important to understand that not all protein has the same effect on your kidneys. High animal protein intake can have a profound influence on normal human kidney function by inducing a state called hyperfiltration, a dramatic increase in the workload of the kidney. Hyperfiltration isn’t harmful if it occurs only occasionally. We all have built-in reserve kidney function—so much so that people can live with only one kidney. The human body is thought to have evolved the capacity to handle intermittent large doses of protein from our remote hunting and scavenging days. But now many of us are ingesting large doses of animal protein day after day, forcing our kidneys to call on their reserves continuously. Over time, this unrelenting stress may explain why kidney function tends to decline as people age, predisposing even otherwise healthy people to progressive deterioration of kidney function.

The reason those who eat a plant-based diet appear to have better kidney function was originally thought to be due to their lower overall protein intake.19 However, we now know that it’s more likely due to the fact that the kidneys appear to handle plant protein very differently from animal protein.

Within hours of consuming meat, your kidneys rev up into hyperfiltration mode. This is true of a variety of animal proteins—beef, chicken, and fish appear to have similar effects.21 But an equivalent amount of plant protein causes virtually no noticeable stress on the kidneys.22 Eat some tuna, and within three hours, your kidney filtration rate can shoot up 36 percent. But eating the same amount of protein in the form of tofu doesn’t appear to place any additional strain on the kidneys.

animal protein tends to have higher levels of sulfur-containing amino acids, such as methionine, which produce sulfuric acid when metabolized in the body. Fruits and vegetables, on the other hand, are generally base forming, which helps neutralize acids in our kidneys.

To buffer the excess acid formed by your diet, kidneys produce ammonia, which is a base and can neutralize some of that acid. Counteracting the acid is beneficial in the short term, but over the long run, all the extra ammonia in the kidneys may have a toxic effect.35 The decline in kidney function over time may be a consequence of a lifetime of ammonia overproduction.

Under normal circumstances, a vegetarian diet alkalinizes the kidneys, whereas a nonvegetarian diet carries an acid load.

Eating a plant-based diet to alkalinize your urine may also help prevent and treat kidney stones—those hard mineral deposits that can form in your kidneys when the concentration of certain stone-forming substances in your urine becomes so high they start to crystallize. Eventually, these crystals can grow into pebble-sized rocks that block the flow of urine, causing severe pain that tends to radiate from one side of the lower back toward the groin.

Most kidney stones are composed of calcium oxalate, which forms like rock candy when urine becomes supersaturated with calcium and oxalates.

eating less meat and salt was about twice as effective as the conventionally prescribed low-calcium diet, cutting kidney-stone risk by half.

removing all meat from a standard Western diet appears to reduce the risk of uric acid crystallization by more than 90 percent within as few as five days.62 Bottom line: When urine is more alkaline, stones are less likely to form. This helps explain why less meat and more fruits and vegetables appear so protective. The standard American diet yields acidic urine. When people are placed on a plant-based diet, however, their urine can be alkalinized up to a near neutral pH in less than a week.

By switching to a plant-based diet, you can achieve a significant drop in your blood phosphorus levels even as your intake levels of the mineral remains constant.72 This occurs because the phosphorus in animal foods appears in the form of a compound called phosphate, which is absorbed into the bloodstream more readily than phytate, the predominant form of phosphorus in plant foods.

Less than half of most plant phosphorus76 and about three-quarters of natural animal product phosphorus gets into your bloodstream,77 but added phosphate can be absorbed at a rate of nearly 100 percent.

The food maker gets to determine whether or not its own product is safe for the public, a process the FDA refers to as “GRAS self-determination.” What’s more, these manufacturers can legally add things to our food supply without informing the FDA.

A class of carcinogens in cigarette smoke called nitrosamines are considered to be so harmful that even so-called thirdhand smoke is a concern. The risks of tobacco smoke do not end when a cigarette is extinguished, as residual smoke can stick to walls and other surfaces.100 Around 80 percent of nitrosamines from cigarette smoke can remain in a room, even with normal ventilation,101 so always try to choose smoke-free hotel rooms.

Nitrosamines are one of the reasons you can’t smoke indoors without endangering others, even if you smoke without anyone present.

one hot dog has as many nitrosamines (and nitrosamides, which are similar tobacco carcinogens103) as four cigarettes and that these carcinogens are also found in fresh meat, including beef, chicken, and pork?

why are vegetable nitrates and nitrites okay but the same compounds from meat are linked to cancer?110 Because nitrites themselves are not carcinogenic; they turn into carcinogens. Nitrites only become harmful when they turn into nitrosamines and nitrosamides. For them to do that, amines and amides must be present, and amines and amides are found in abundance in animal products. This transformation can happen in the meat itself or in your stomach after you eat it. In the case of plant foods, the vitamin C and other antioxidants that are found naturally in them block the formation of these carcinogens in your body.111 This process would explain why intake of both nitrate and nitrite from processed meat has been linked to kidney cancer, but no increased risk was found for nitrate or nitrite intake from plant sources.112 While nitrite from animal sources—not just processed meats—was associated with an increased risk of kidney cancer, some of the highest nitrate-containing vegetables, such as arugula, kale, and collards, are associated with significantly reduced risk for kidney cancer.113

Remarkably, eating a plant-based diet along with walking every day can improve our cancer defenses within just two weeks.

every year around the world, nearly five thousand breast cancer deaths may be attributable to light drinking.20 The carcinogen isn’t alcohol itself. The culprit is actually the toxic breakdown product of alcohol called acetaldehyde, which can form in your mouth almost immediately after you take a sip.

Right in the middle of your brain sits the pineal gland, your so-called third eye. It’s connected to your actual eyes and has just one function: to produce a hormone called melatonin.

During the day, the pineal gland is inactive. But once the sky darkens, it activates and begins pumping melatonin into your bloodstream.

Besides helping to regulate your sleep, melatonin is thought to play another role—suppressing cancer growth. Think of melatonin as helping to put cancer cells to sleep at night.33 To see if this function applies to preventing breast cancer, researchers from Brigham and Women’s Hospital in Boston and elsewhere came up with the clever idea of studying blind women. The thought was that because blind women can’t see sunlight, their pineal glands never stop secreting melatonin into their bloodstreams. Sure enough, the researchers found that blind women may have just half the odds of breast cancer as sighted women.34 Conversely, women who interrupt their melatonin production by working night shifts appear to be at increased risk for breast cancer.35 Even living on a particularly brightly lit street may affect the risk.

heterocyclic amines (HCAs), described by the National Cancer Institute as “chemicals formed when muscle meat, including beef, pork, fish, and poultry, is cooked using high-temperature methods.”52 These cooking methods include roasting, pan frying, grilling, and baking. Eating boiled meat is probably the safest. People who eat meat that never goes above 212 degrees Fahrenheit produce urine and feces that are significantly less DNA-damaging compared to those eating meat dry-cooked at higher temperatures.53 This means they have fewer mutagenic substances flowing through their bloodstreams and coming in contact with their colons. On the other hand, baking chicken for as few as fifteen minutes at about 350 degrees Fahrenheit leads to HCA production.

The longer meat is cooked, the more HCAs form. This process may explain why eating well-done meat is associated with increased risk of cancers of the breast, colon, esophagus, lung, pancreas, prostate, and stomach.

meat preparation “paradox”57: Cooking meat thoroughly reduces the risk of contracting foodborne infections (see chapter 5), but cooking meat too thoroughly may increase the risk of foodborne carcinogens.

urine levels of PhIP can drop to zero within twenty-four hours of refraining from eating meat.

Cancer develops in three major stages: 1) initiation, the irreversible DNA damage that starts the process; 2) promotion, the growth and division of the initiated cell into a tumor; and 3) progression, which can involve the invasion of the tumor into surrounding tissue and metastasis (spread) to other areas of the body.

Cancer appears to feed on cholesterol. LDL cholesterol stimulates the growth of breast cancer cells in a petri dish—they just gobble up the so-called bad cholesterol. Tumors may suck up so much cholesterol that cancer patients’ cholesterol levels tend to plummet as their cancer grows.

breast tumors may take advantage of high circulating cholesterol levels to fuel and accelerate their own growth.79 Cancer’s hunger for cholesterol is such that pharmaceutical companies have considered using LDL cholesterol as a Trojan horse to deliver antitumor drugs to cancer cells.

The cancer protection apples appear to offer is assumed to arise from their antioxidant properties. Apple antioxidants are concentrated in the peel, which makes sense: The skin is the fruit’s first line of defense against the outside world. Expose the inner flesh, and it starts to brown (oxidize) within moments. The antioxidant power of the peel may be between two times (Golden Delicious) to six times (Idared) greater than the pulp.97 Beyond protecting against the initial free-radical hit to your DNA, apple extract has been shown to suppress the growth of both estrogen-receptor-positive and -negative breast cancer cells in a petri dish.

separately dripped extracts of peel and flesh from the same apples on cancer cells, the peel stopped cancer growth ten times more effectively.

Better known as one of the richest plant sources of essential omega-3 fatty acids, flaxseeds are really set apart by their lignan content. Though lignans are found throughout the plant kingdom, flaxseeds have around one hundred times more lignans than other foods.117 What are lignans? Lignans are phytoestrogens that can dampen the effects of the body’s own estrogen. This is why flaxseeds are considered a first-line medical therapy for menstrual breast pain.

Soybeans naturally contain another class of phytoestrogens called isoflavones. People hear the word “estrogen” in the word “phytoestrogens” and assume that means soy has estrogen-like effects. Not necessarily. Phytoestrogens dock into the same receptors as your own estrogen but have a weaker effect, so they can act to block the effects of your more powerful animal estrogen.

There are two types of estrogen receptors in the body, alpha and beta. Your own estrogen prefers alpha receptors, while plant estrogens (phytoestrogens) have an affinity for the beta receptors.130 The effects of soy phytoestrogens on different tissues therefore depend on the ratio of alpha to beta receptors.

as few as 2.5 percent of breast cancer cases are attributable to breast cancer running in the family.

Green tea has been associated with about a 30 percent reduction in breast cancer risk.

Good mental health isn’t “merely the absence of disease,”

Higher consumption of vegetables may cut the odds of developing depression by as much as 62 percent.

The traditional explanation of how depression works, known as the monoamine theory, proposes that the condition arises out of a chemical imbalance in the brain. The billions of nerves in your brain communicate with each other using chemicals called neurotransmitters. Your nerve cells don’t physically touch one another. Instead, they manufacture and deploy neurotransmitters to bridge the gap between them. The levels of an important class of neurotransmitters called monoamines, which includes serotonin and dopamine, are controlled by an enzyme called monoamine oxidase (known as MAO) that breaks down any excess monoamines. People who are depressed appear to have elevated levels of this enzyme in their brains.28 Thus, the theory goes, depression is caused by abnormally low levels of monoamine neurotransmitters due to elevated levels of the neurotransmitter-munching enzyme.

Antidepressant medications were developed to try to boost the levels of neurotransmitters to offset their accelerated breakdown. But if the excess MAO is responsible for depression, why not just develop a drug that blocks this enzyme? Such drugs do exist, but they have serious risks—not the least of which is the dreaded “cheese effect,” in which eating certain foods (such as certain cheeses, cured meats, and fermented foods) while on the drug can potentially cause fatal brain hemorrhaging.

plant foods, including apples, berries, grapes, onions, and green tea, contain phytonutrients that appear to naturally inhibit the MAO, as do such spices as cloves, oregano, cinnamon, and nutmeg.30 This may help explain why those eating plant-rich diets have lower rates of depression.

Although some plant foods contain significant amounts of serotonin,33 the so-called happiness hormone, serotonin can’t cross the blood-brain barrier. This means that dietary sources of serotonin can’t make it into the brain, but the building block of serotonin, an amino acid called tryptophan, can get from your mouth to your blood to your brain.

carbohydrate ingestion does the opposite: It helps shunt many nontryptophan amino acids out from the bloodstream and into the muscles, allowing tryptophan greater access into the brain.

if you’re feeling anxious, perhaps wake up and smell the saffron.

adding sugar to coffee may negate many of its positive effects on mood, and adding the artificial sweetener aspartame (found in Equal and NutraSweet) or saccharine (in Sweet’n Low) was associated with an increased risk of depression.

Discriminating shoppers make it a priority to read ingredients lists, but the healthiest foods in the supermarket don’t even have them.

Shay

If the cancer is caught while still localized within the prostate, the chances of it killing you within the next five years are practically nil. However, if the cancer spreads far enough, your chances of surviving five years may be as low as one in three.

Compared with men who rarely ate eggs, men who ate even less than a single egg a day appeared to have twice the risk of prostate cancer progression, such as metastasizing into the bones. The only thing potentially worse for prostate cancer than eggs was poultry: Men with more aggressive cancer who regularly ate chicken and turkey had up to four times the risk of prostate cancer progression.

Higher levels of choline in the blood have been associated with increased risk of developing prostate cancer in the first place.

Men who consume two and a half or more eggs per week—basically an egg every three days—may have an 81 percent increased risk of dying from prostate cancer.39 The choline in eggs, like the carnitine in red meat, is converted into a toxin called trimethylamine40 by bacteria that exist in the guts of those who eat meat.41 And trimethylamine, once oxidized in the liver, appears to increase the risk of heart attack, stroke, and premature death.42 Ironically, the presence of choline in eggs is something the egg industry boasts about even though most Americans get more than enough choline.43 Mind you, the industry executives are aware of the cancer connection.

Patients may face twice the cancer progression risk from eating less than a single egg per day and up to quadruple the risk from eating less than a single serving of chicken or turkey daily.62 On the other hand, if you were to add only one thing to your diet, consider cruciferous vegetables. Less than a single serving a day of broccoli, brussels sprouts, cabbage, cauliflower, or kale may cut the risk of cancer progression by more than half.

The evidence suggests that flaxseed is a safe, low-cost source of nutrition and may reduce tumor-proliferation rates.72 Why not give it a try? Just make sure to grind the flaxseeds first if you don’t buy them preground—otherwise, the seeds may pass right through your body undigested.

As you age, your risk of developing and dying from cancer grows every year—until you hit eighty-five or ninety, when, interestingly, your cancer risk begins to drop.85 Indeed, if you don’t get cancer by a certain age, you may never get it.

You create and destroy nearly your entire body weight in new cells every year. Every day, about fifty billion of your cells die, and about fifty billion new cells are born to keep you in balance.

A key signal is a growth hormone called IGF-1. It sounds like a droid from Star Wars, but IGF-1 is actually a crucial factor in regulating cell growth. Levels go up when you’re a kid in order to power your development, but when you reach adulthood, IGF-1 levels diminish. It’s your body’s cue to stop producing more cells than it kills off. Should your levels of IGF-1 remain too high when you reach adulthood, however, your cells will constantly receive a message to grow, divide, and keep going and growing. Not surprisingly, the more IGF-1 you have in your bloodstream, the higher your risk for developing cancers, such as prostate cancer.

After just eleven days of cutting back on animal protein, your IGF-1 levels can drop by 20 percent, and your levels of IGF-1 binding protein can jump by 50 percent.92 One of the ways your body tries to protect itself from cancer—that is, excessive growth—is by releasing a binding protein into your bloodstream to tie up any excess IGF-1.

Hospitals are terrible places to be and terrible places to die. That is why each of us needs to take care of ourselves.

Parkinson’s is not currently curable. The disease is caused by the die-off of specialized nerve cells in a region of the brain that controls movement. It typically presents after age fifty. A history of head trauma can increase risk,1 which may be why heavyweight boxers, including Muhammad Ali, and NFL players, including Hall of Famer Forrest Gregg, have fallen victim to the condition.

It appears that blood levels of some pollutants in women may drop by nearly half during pregnancy,8 in part because their bodies pass them off through the placenta.9 That may be why breast milk concentrations of pollutants appear higher after the first pregnancy than in subsequent ones.10 This could explain why birth order was found to be a significant predictor of pollutant levels in young people. Basically, firstborn kids may get first dibs on mom’s store of toxic waste, leaving less for their baby brothers and sisters.

The oceans are essentially humanity’s sewer; everything eventually flows into the sea.

Eating nicotine-rich vegetables, especially peppers, was associated with significantly lower risk of Parkinson’s disease.

The highest levels of flame retardants in the U.S. food supply have been found in fish, though the primary source of intake for most Americans is poultry, followed by processed meat.94 This discovery helps explain the significantly lower levels of PBDEs in the bodies of those eating meat-free diets.95 It appears that the more plant-based foods you eat and the longer you go without eating animal products, the lower your levels fall.96 No regulatory limits have been set for PBDEs in food, but as U.S.

Parkinson’s disease is caused by the die-off of specialized nerve cells in a region of the brain that controls movement.

There are a number of simple things you can do that may decrease your risk of dying from Parkinson’s disease. You can wear seat belts and bicycle helmets to avoid getting hit in the head, you can exercise regularly,133 avoid becoming overweight,134 consume peppers, berries, and green tea, and minimize your exposure to pesticides, heavy metals, and dairy and other animal products.

side effects from medications given in hospitals kill an estimated 106,000 Americans every year.2 That statistic alone effectively makes medical care the sixth-leading cause of death in the United States. And this number reflects only the number of deaths from taking the drugs as prescribed. An additional 7,000 people die every year from receiving the wrong medication by mistake, and 20,000 others die from other hospital errors.3 Hospitals are dangerous places, and that’s not even counting the estimated 99,000 deaths each year due to hospital-acquired infections.

Not even one doctor out of four washed his or her hands before laying them on the ill.

Every year, 12,000 Americans die from complications due to surgeries that weren’t even necessary in the first place. For those keeping score, that’s more than 200,000 people dead from so-called iatrogenic causes

did you know that getting a chest CT scan is estimated to inflict the same cancer risk as smoking seven hundred cigarettes?

blood thinner to reduce the risk of a heart attack. As we saw in chapter 1, heart attacks often occur when a blood clot forms in response to a ruptured atherosclerotic plaque in one of your coronary arteries. Taking aspirin may help stop this from happening.

Aspirin may also lower the risk of cancer.59 It works by suppressing an enzyme within your body that creates pro-clotting factors, thereby thinning your blood. At the same time, aspirin suppresses proinflammatory compounds called prostaglandins, which in turn reduces pain, swelling, and fever. Prostaglandins may also dilate the lymph vessels inside tumors, potentially allowing cancer cells to spread. One of the ways scientists think aspirin helps prevent cancer deaths is by counteracting a tumor’s attempts to pry open the lymphatic bars on its cage and spread throughout the body.

Heart attacks are considered 96 percent avoidable in women who eat a wholesome diet and engage in other healthy lifestyle behaviors.113 The number-one killer of women need almost never happen.