Getting Rich Can Kill You! A Warning to Developing Countries

1
Getting Rich Can Kill You! A Warning to
Developing CountriesLearn from Our Mistakes!

• Robin Carr, Ph.D.

2
3 Requirements of Science

1. Look for evidence! (Especially peer-reviewed.)(
   And dont accept just evidence that fits your
   theories.)
2. Dont believe any one individual or any one
   scientific finding. Assess the weight of
   evidence.
3. While its sometimes necessary to focus on narrow
   questions and specific details, always step back
   now and then to see the broader picture.

3
Investigate the research yourself!

• PubMed Central (PMC) is the U.S. National
  Institutes of Health (NIH) free digital archive
  of biomedical and life sciences journal
  literature.http//www.ncbi.nlm.nih.gov/pubmed/
  http//www.ncbi.nlm.nih.gov/pmc/
• Abstracts are almost always provided along with
  the references, and sometimes the entire article
  is provided free on-line, from a provided link.

4
http//www.ncbi.nlm.nih.gov/pubmed/
5
http//www.ncbi.nlm.nih.gov/pmc/
6
(No Transcript)
7
(No Transcript)
8
NextAbout Correlations

• A correlation is a measure of how closely 2
  variables are related to each other.
• Correlations are the most frequently used tool in
  epidemiological and human dietary research. But
  they must be used with caution.

9
Example

• Did you know that a positive correlation was
  found between eating ice cream and getting
  divorced?

10
Which is the cause? Which is the effect?
Summer
Does eating more ice cream increase your risk of
divorce?
11
Which is the cause? Which is the effect?
Or, do you eat more ice cream when you get
divorced?
12
The answer
Summer increases the chances of both!
13
When Cause Effect is Assumed
Sometimes the context makes cause and effect
obvious. But assumptions can sometimes be wrong.
14
He who does not know food, how can he understand
the diseases of man?

• Hippocrates, the father of medicine (460-357 BC)

15
A Story about Proteins

• Protein is one of the basic components of food
  and makes all life possible. All of the
  antibodies and enzymes, and many of the hormones
  in the body are proteins. They provide for the
  transport of nutrients, oxygen and waste
  throughout the body. They provide the structure
  and contracting capability of muscles. They also
  provide collagen to connective tissues of the
  body and to the tissues of the skin, hair and
  nails. There are hundreds of thousands of
  different kinds of protein.
• 20 amino acids make up protein.
• essential amino acids (9/8) must be included in
  the diet.
• nonessential amino acids (11/12) the body can
  manufacture.
• For normal adults 1.0 g protein / kg body mass
  per day.For active athletes 1.4 g protein / kg
  body mass per day.

16
The Amino Acids
Essential Amino Acids(must be obtained through the diet) Isoleucine Phenylalanine Leucine Threonine Lysine Tryptophan Methionine Valine
Conditional Amino Acids(cant be made fast enough to support rapid growth) Arginine Histidine
Nonessential Amino Acids(can be made by the body) Alanine Glutamine Asparagine Glycine Aspartic Acid Proline Cysteine Serine Glutamic Acid Tyrosine
17
Protein in Cultural History

• In the 19th century, protein was synonymous with
  meat.
• Early scientists like the German Carl Voit
  (1831-1908) found that man needed only 48.5
  grams/day, but he recommended 118 grams/day. (If
  something is good, more is better!)
• Well-known nutrition researcher Max Rubner stated
  that protein intake (meaning meat) was a symbol
  of civilization. A large protein allowance is
  the right of civilized man.
• The cultural bias was set. If you were rich, you
  ate meat. If you were poor, you ate staple plant
  foods like potatoes and bread.

18
The Protein Gap

• In the 1960s and 1970s, it was constantly
  asserted that there was a protein gap in the
  developing world.
• M. Autret of the Food and Agriculture
  Organization (FAO) of the United Nations reported
  a very strong association (correlation) between
  the consumption of animal-based foods and annual
  income, and he implied causation.

What else could explain the association
(correlation)?
19
A More Realistic Explanation!
20
Philippine Connection

• In 1967, while on the faculty at Virginia Tech,
  Dr. T. Colin Campbell began working on a ten-year
  project in the Philippines (funded by the U.S.
  Agency for International Development) to improve
  childhood nutrition among the poor.
• Ultimately, 110 nutrition mothercraft self-help
  education centers were established around the
  country, focussed on educating mothers of
  malnourished children about healthy local
  foods.
• The aim was to make sure that children of the
  poor were getting as much protein as possible,
  since there was a perceived protein gap in the
  developing world.

21
Protein and Cancer?

• Part of this project involved investigating the
  high prevalence of liver cancer, usually an adult
  disease, in Filipino children. It was thought to
  be caused by aflatoxin, a mould found in peanuts
  and corn, which is one of the most potent
  carcinogens known.
• Children who ate the highest-protein diets were
  the ones most likely to get liver cancer. They
  were the children of the wealthiest
  families.Campbell TC and Campbell TM (2006)
  The China Study. Dallas, Texas Benbella Books,
  p.5

22
The Indian Study

• One group of rats was given aflatoxin and then
  fed diets of 20 protein. The other group was
  also given aflatoxin and then fed diets of only
  5 protein.
• Every single animal fed a 20 protein diet got
  liver cancer or its precursor lesions.
• Not a single animal fed a 5 protein diet got
  liver cancer or its precursor lesions.
• 100 versus 0? This seldom occurs in biological
  sciences. It was a very provocative finding!
• Madhavan TV and Gopalan C (1968) The effect of
  dietary protein on carcinogenesis of aflatoxin.
  Arch Path 85133-7.

23
Three Stages of Cancer

• Initiation - A carcinogen enters a cell and is
  converted by cellular enzymes to highly reactive
  products that bind to the cells DNA, forming
  carcinogen-DNA complexes (adducts) that are often
  repaired. If not repaired before the cell
  divides, the daughter cells will have this new
  genetic defect (mutation). This occurs quickly
  and is usually irreversible. It represents a
  potential for cancer.
• Promotion - Some factors (promoters) may act to
  increase the growth and multiplication of these
  mutant cells over a longer period of time, while
  other factors (anti-promoters) work against
  this.
• Progression - Large foci (clusters of mutant
  cells) progress in the growth and may wander from
  their initial site (metastasize).

24
The Promotion Stage

• Many animal studies have shown that nutrition may
  be far more important in controlling the cancer
  promotion stage than the dose of the initiating
  carcinogen.OConnor TP, Roebuck BD and Campbell
  TC (1985) Dietary intervention during the
  post-dosing phase of L-azaserine-induced
  preneoplastic lesions. Journal of the National
  Cancer Institute 75955-957 (cover article).
• Nutrients (esp. casein) from animal-based foods
  increased tumour development while nutrients from
  plant-based foods decreased tumour
  development.Hawrylewicz EJ, Huang HH et al.
  (1982) Enhancement of the 7,12-dimethylbenz(a)
  anthracene (DMBA)mammary tumorigenesis by high
  dietary protein in rats. Nutr. Reps. Int.
  26793-806.

25
What about the type of protein?

• What protein consistently and strongly promoted
  cancer?
• Casein (87 of cows milk protein) promoted all
  stages of the cancer process.
• What type of protein did not promote cancer, even
  at high levels of intake?
• The safe proteins were from plants, including
  wheat and soy.

26
Protein Excesses?

• Peer-reviewed biochemical research, funded by the
  National Institutes of Health, the American
  Cancer Society and the American Institute for
  Cancer Research, resulted in dozens of articles
  published in some of the best scientific
  journals. The results were shocking
• Low protein diets inhibited the initiation of
  cancer by aflatoxin, regardless of how much of
  this carcinogen was administered In fact,
  dietary protein proved to be so powerful in its
  effect that we could turn on and turn off cancer
  growth simply by changing the level
  consumed.The China Study, p.6

27
The Human Question

• So far, most of this research had involved
  laboratory studies performed on animals rats and
  mice.
• Would similar results be found with humans?

28
(No Transcript)
29
The China Study Scientific Team

• Dr. T. Colin Campbell was Project Director
• Dr. Junshi Chen, deputy director of Chinas
  premier diet health research laboratory
• Dr. Junyao Li, one of the authors of the China
  Cancer Atlas Survey and a key scientist in
  Chinas Academy of Medical Sciences
• Dr. Richard Peto of Oxford University, one of the
  leading epidemiologists in the world, who has
  been knighted for his work.Campbell TC and
  Campbell TM (2006) The China Study.Dallas,
  Texas Benbella Books.

30
Findings of the China Study

• The largest and most comprehensive study of human
  diet, lifestyle and disease in the history of
  biomedical research was organized through Cornell
  University, Oxford University and the Chinese
  Academy of Preventive Medicine, and involved 367
  variables taken from questionnaires, blood tests,
  urine samples and 3-day diet inventories taken
  from 6500 adults from 65 Chinese counties.
• Called the Grand Prix of epidemiology by the
  New York Times, it produced more than 8,000
  statistically significant correlations between
  various dietary factors and disease.
• People who ate the most animal-based foods got
  the most chronic disease.
• People who ate the most plant-based foods were
  the healthiest.

31
Disease Groupings in the China Study
Diseases of Poverty (Nutritional Inadequacy Poor Sanitation) Pneumonia, intestinal obstruction, peptic ulcer, digestive disease, pulmonary tuberculosis, parasitic disease, rheumatic heart disease, metabolic and endocrine disease other than diabetes, diseases of pregnancy and many others
Diseases of Affluence (Nutritional Extravagance) Cancer (colon, lung, breast, leukemia, childhood brain, stomach, liver), diabetes, coronary heart disease
(from The China Study, p. 76)
32
Rural Chinese versus U.S. Diets(normalized for a
body mass of 65 kg)
NUTRIENT RURAL CHINA UNITED STATES
Calories (kcal/day) 2641 1989
Total Fat ( of calories) 14.5 34-38
Dietary fiber (g/day) 33 12
Total Protein (g/day) 64 91
Animal Protein ( of calories) 0.8 10-11
Total Iron (mg/day) 34 18
(age-standardized rates from The China Study, p.
74)
33
From Underfed to Overfed

• In the year 2000, for the first time in human
  history, the number of overweight people in the
  world rivalled the number of underweight people.
  (While the world's underfed population had
  declined slightly since 1980 to 1.1 billion, the
  number of overweight people had surged to 1.1
  billion.) Both the overweight and the underweight
  suffer from malnutrition.
• "Often, nations have simply traded hunger for
  obesity, and diseases of poverty for diseases of
  excess. Worldwatch (2000) Underfed and
  Overfed The Global Epidemic of Malnutrition.
  Paper 150 Worldwatch Institute, Washington, DC.

34
Countries Developing to Developed

• Major trends usually occur during this shift
• increased longevity (life expectancy at
  birth) e.g. Canada 81.23, U.S. 78.11,
  Philippines 71.09 CIA World Fact
  Book https//www.cia.gov/library/publications/the
  -world-factbook/
• improved sanitation and drinking water
• improved access to high quality medical care
• decrease in amount of daily physical activity
• shift from a plant-based diet to an animal-based
  diet
• increase in levels of obesity
• nutrient deficiencies infectious diseases give
  way to chronic sedentary and degenerative
  diseases of excess

35
Diseases of Affluence

• hypoglycemia
• hyperglycemia
• type II diabetes
• high blood pressure
• coronary artery disease
• strokes
• autoimmune diseases(e.g. rheumatoid arthritis,
  gout, bursitis, neuritis, and some sciatica)
• osteoporosis
• many cancers

36
Cancer in China

• Counties with the highest incidence of some
  cancers had rates more than 100 times greater
  than counties with the lowest rates of those
  cancers. (In the U.S., cancer rates in one area
  are never more than about 3 times higher than in
  the lowest incidence areas.)
• Since 87 of Chinas population is the same
  ethnic group (the Han), why is there such a
  variation in the rates of cancer? It had to be
  due to environmental factors like poor nutrition,
  lack of exercise and unhealthy living
  environments.
• (Some U.S. scientists had already estimated that
  genetics only determines about 2-3 of the total
  cancer risk.)Doll R and Peto R (1981) The causes
  of cancer quantitative estimates of avoidable
  risks of cancer in the United States today. J
  Natl Cancer Inst 661192-1265.

37
Blood Cholesterol Cancer

• Blood cholesterol levels in rural China were far
  lower than expected (measured in mg/dL)Av.
  Rural China Av. U.S. Minimal Safety (assumed)
• 127 215 150
• As levels dropped from 170 to 90, there were
  associated decreases in cancers of the liver and
  colon (plt0.01), and rectum, male lung, adult
  leukemia and adult brain (plt0.5).
• NOTEThis correlation even at very low levels is
  surprising, due to a statistical phenomenon. Real
  relationships between 2 variables sometimes
  cannot be seen when the range of data is limited!

38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41
Breast Cancer

• The American death rate from breast cancer was 5
  times higher than the rural Chinese rate. In
  fact, from an international perspective, breast
  cancer can clearly be seen as a disease of
  affluence that is highly related to animal fat
  (and, possibly just by association, animal
  protein).
• Carroll KK, Braden LM et al. (1986) Fat and
  cancer. Cancer 581818-25
• This finding has been confirmed many times since
  then.

42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
Colorectal Cancer

• A major American Cancer Society study finds
  people who reported the highest consumption of
  red and processed meat had a significantly higher
  risk of colorectal cancer than those who reported
  the least consumption. The study of nearly
  150,000 Americans, the largest and most
  comprehensive to date, adds substantially to
  previous evidence linking highest consumption of
  red and processed meat to intestinal cancer.
• Chao et al. (2005) Meat Consumption and Risk of
  Colorectal Cancer. JAMA (Journal of the American
  Medical Association) 293 172-182.

46
A Major Recent Study!

• Red and processed meat intakes were associated
  with modest increases in total mortality, cancer
  mortality, and cardiovascular disease
  mortality.Sinha R, Cross AJ et al. (2009) Meat
  Intake and Mortality A Prospective Study of Over
  Half a Million People. Archives of Internal
  Medicine 169(6), 562-571.

47
Nitrites and Nitrosamines

• Sodium nitriteA meat preservative used since
  the 1920s, it kills bacteria, colours meat pink
  and adds to the taste.
• NitrosaminesA family of chemicals of which at
  least 17 are reasonably anticipated to be human
  carcinogens.National Toxicology Program (2001)
  Ninth report on carcinogens, revised January
  2001. Washington, DC U.S Dept of Health and
  Human Services.http//ntp.niehs.nih.gov/index.cfm
  ?objectid72016262-BDB7-CEBA-FA60E922B18C2540

48
(No Transcript)
49
Value of a Plant-Based Diet

• Recent scientific findings are suggesting that
  diets largely based on plant foods, such as some
  vegetarian, Mediterranean, or rural Asian diets,
  could best prevent nutrient deficiencies as well
  as diet-related chronic diseases. These diets
  contain no or very little meat.
• Diets largely based on plant foods, such as
  well-balanced vegetarian diets, could best
  prevent nutrient deficiencies as well as
  diet-related chronic diseases.Sabaté, Joan
  (2003) The contribution of vegetarian diets to
  health and disease a paradigm shift? American
  Journal of Clinical Nutrition, Vol. 78, No. 3,
  502S-507S.

50
1960s Perspective
from Sabaté, Joan (2003)
51
Current Perspective
from Sabaté, Joan (2003)
52
Well-Planned Diets
from Sabaté, Joan (2003)
53
Plant Protein

• Plant protein can meet requirements when a
  variety of plant foods is consumed and energy
  needs are met. Research indicates that an
  assortment of plant foods eaten over the course
  of a day can provide all essential amino acids
  and ensure adequate nitrogen retention and use in
  healthy adults, thus complementary proteins do
  not need to be consumed at the same meal.
• ADA Reports Position of the American Dietetic
  Association and Dietitians of Canada Vegetarian
  diets Journal of the American Dietetic
  Association Online June 2003, Volume 103, Number
  6.Young VR, Pellett PL. Plant proteins in
  relation to human protein and amino acid
  nutrition. Am J Clin Nutr 1994591203S-1212S.
• Beans rice together provide plenty of all the
  essential amino acids.

54
Nutritional adequacy of plant-based diets

• Energy and protein intakes are similar for
  plant-based diets compared with those containing
  meat. Fe and vitamin B12 are the nutrients most
  likely to be found lacking in such diets.
  Bioactive substances present in foods of plant
  origin significantly influence the
  bioavailability of minerals and requirements for
  vitamins. Well-balanced vegetarian diets are able
  to support normal growth and development. It is
  concluded that meat is an optional rather than an
  essential constituent of human diets.
• Sanders TA (1999) Nutritional adequacy of
  plant-based diets. Proc Nutr Soc.
  May58(2)265-9.

55
Phytochemicals

• Phytochemicals (there are thousands) are found
  naturally in plants, helping them to protect
  themselves from bacteria and disease. Some act as
  antioxidants, limiting and repairing cell damage
  caused by free radicals. Others act as
  hormone-like substances to prevent cancer or
  block the enzymes that promote the development of
  cancer and other diseases.
• Flavonoids, found in apples, strawberries,
  grapes, onions, green and black tea and red wine,
  may decrease atherosclerotic plaque and DNA
  damage related to cancer development.
• Carotenoids (beta-carotene, lutein, zeaxanthin,
  crytoxanthin and lycopene) protect the eye from
  harmful oxidation reactions.
• Lignans, found in flaxseed, seaweed, soybeans,
  bran and dried beans, are phytoestrogens that
  interfere with the action of the sex hormone
  estrogen and may help prevent hormone-related
  cancers, slow the growth of cancer cells, and
  lower the risk for heart disease.

56
Position of the American Dietetic Association and
Dietitians of Canada Vegetarian diets

• It is the position of the American Dietetic
  Association and Dietitians of Canada that
  appropriately planned vegetarian diets are
  healthful, nutritionally adequate, and provide
  health benefits in the prevention and treatment
  of certain diseases.ADA Reports Position of
  the American Dietetic Association and Dietitians
  of Canada Vegetarian diets Journal of the
  American Dietetic Association Online June 2003,
  Volume 103, Number 6.256 mostly peer-reviewed
  references

57
The Mediterranean Diet

• The weight of evidence suggests that a
  Mediterranean style of eating may be the
  healthiest approach.
• In a population-based, prospective investigation
  involving 22,043 adults in Greece who completed
  an extensive, validated, food-frequency
  questionnaire
• CONCLUSIONS Greater adherence to the traditional
  Mediterranean diet is associated with a
  significant reduction in total mortality.Trichop
  oulou A et al. (2003) Adherence to a
  Mediterranean diet and survival in a Greek
  population. N Engl J Med. 26348(26) 2599-608.

58
Mediterranean Diet and Longevity

• First, there appears to exist sufficient evidence
  that diet does indeed influence longevity.
• Second, an optimal diet for the prevention of
  both coronary heart disease and cancer is likely
  to extensively overlap with the traditional
  Mediterranean diet. It is not yet clear which
  components in the Mediterranean diet are more
  important for its apparent health effects, but
  olive oil, plant foods and moderate wine
  consumption are likely candidates.
• Trichopoulou A, Critselis E (2004) Mediterranean
  diet and longevity. Eur J Cancer Prev. 2004
  Oct13(5)453-6.

59
Mediterranean Diet Leads To Longer Life

• The Mediterranean diet has been associated with
  longer life expectancy among elderly Europeans.
  The diet typically involves a high intake of
  vegetables, legumes, fruits, and cereals a
  moderate to high intake of fish a low intake of
  saturated fats a high intake of unsaturated fats
  (especially olive oil) a low intake of dairy
  products and meat and a modest intake of
  alcohol, mostly wine. Current evidence suggests
  that such a diet may be beneficial to health.
• This study involved over 74,000 healthy men and
  women, aged 60 or more, living in nine European
  countries. When dietary exposures were calibrated
  across countries, the reduction in mortality
  averaged 7 (1 to 12).
• Trichopoulou A, Orfanos P et al. (2005) Modified
  Mediterranean diet and survival EPIC-elderly
  prospective cohort study. British Med J 330
  (7498) 991.
• http//www.bmj.com/cgi/content/full/330/7498/991

60
Mediterranean Diet CHD

• Epidemiological studies as well as randomised
  dietary trials suggest that Mediterranean diet
  may be important in relation to the pathogenesis
  and prevention of coronary heart disease (CHD). A
  striking protective effect of a Mediterranean
  diet rich in alpha-linolenic acid (ALA) was
  reported in the Lyon Diet Heart Study with a 50
  to 70 reduction of the risk of recurrence after
  four years of follow-up in CHD patients.
• de Lorgeril M, Salen P (2006) The Mediterranean
  diet in secondary prevention of coronary heart
  disease.Clin Invest Med. June 29(3) 154-8.

61
Mediterranean Diet Obesity

• The sample included 17,238 women and 10,589 men
  not obese and aged 29-65 y at baseline
  (1992-96)High MD adherence was associated with
  significantly lower likelihood of becoming obese
  among overweight subjectsMD adherence was not
  associated with incidence of overweight in
  initially normal-weight subjectsresults suggest
  that promoting eating habits consistent with MD
  patterns may be a useful part of efforts to
  combat obesity.
• Mendez MA, Popkin BM (2006) Adherence to a
  Mediterranean diet is associated with reduced
  3-year incidence of obesity.J Nutr. Nov.
  136(11) 2934-8.

62
Organizations Supporting Vegetarianism

• The American Institute for Cancer Research and
  the World Cancer Research Fund call for choosing
  predominantly plant-based diets rich in a variety
  of vegetables and fruits, legumes, and minimally
  processed starchy staple foods and limiting red
  meat consumption, if at all.
• The American Cancer Society recommends choosing
  most food from plant sources.
• The American Heart Association recommends
  choosing a balanced diet with an emphasis on
  vegetables, grains, and fruits.
• The Heart and Stroke Foundation of Canada
  recommends using grains and vegetables instead of
  meat as the centerpiece of meals.
• The Unified Dietary Guidelines developed by the
  American Cancer Society, the American Heart
  Association, the National Institutes of Health,
  and the American Academy of Pediatrics call for a
  diet based on a variety of plant foods, including
  grain products, vegetables, and fruits to reduce
  risk of major chronic diseases.

63
What is stopping the change?

• Most evidence suggests that a shift to largely
  plant-based diets would reduce chronic disease
  risks among industrialized and rapidly-industriali
  zing populations. The accomplish this shift, it
  will be necessary to overcome market-place
  barriers and to develop new policies that will
  encourage greater consumption of fruits,
  vegetables and grains as a means to promote
  public health.
• Nestle M. (1999) Animal versus plant foods in
  human diets and health is the historical record
  unequivocal? Proc Nutr Soc 1999582118.

64
The Broader Picture

• Rearing cattle produces more greenhouse gases
  than driving cars.Steinfeld H et al. (2006)
  Livestocks Long Shadow Environmental Issues and
  Options. FAO (Food and Agriculture Organization)
  of the United Nations.
• On average, land requirements for meat-protein
  production are 10 times greater than for
  plant-protein production.Leitzmann C (2003).
  Nutrition ecology the contribution of vegetarian
  diets. American Journal of Clinical Nutrition 78
  (Suppl), 658S.
• Producing one kilogram of animal protein
  generally requires nearly 100 times more water
  than producing one kilogram of grain
  protein.Pimentel D, Piemental M (2003).
  Sustainability of meat-based and plant based
  diets and the environment. Am J Clin Nutrition
  78(Suppl), 662S.
• Less than half the harvested acreage in the U.S.
  is used to grow food for people. For every
  sixteen pounds of grain and soybeans fed to beef
  cattle, we get back only one pound of meat on our
  plates.Gussow JD (1994). Ecology and vegetarian
  considerations does environmental responsibility
  demand the elimination of livestock? American
  Journal of Clinical Nutrition 59 (Suppl), 1111S.

65
For your healthfor your environmentfor
compassion to animals

• Pleaseeat less meat!