Proof Positive 3b4s6v

ry Risk lmervetllion Proiect (SCRIP). CirCl/IIl/iOIl 1994 Mar;89(3):975-990. 3S

Srroe ES. Koomans HA. er al. VasculaI funclion in the fore3rm of hypercholcslcrolaemic parienls offand on lipid-lo\Vcri.ng mcdic:uion. lAnce: 1995 Alig 19;346(8973):467-4 ÎI.

3{:

,1 Harrisoll DG, Ohara Y.

Physiologic con eqllcl\ces of increased vasc.ular oxidam Slresses in hypcrhole.srerolcmia and arherosderosis: impliCJtions for impaired vasomotion. Am j Canlio/1995 Feb 23;75(6):758-81 B.

133.

109

PROOF POSITIVE Minor RLJr, Myers PR, el al. Diel-induced alherosclerosis iJ1CfeaSCS !he release of nilrogen oxides from rabbit aona. } Clin Inzleu 1990 Dec:86(6):2109-2116.

I,~ Cody RJ. Cornparing angiolcnsin-converting eJ1zyme inhibitor rrial remiu; in pariellls Wilh aCUle myocardial infarclion. Archives oflntema/Medicine 1994 Seprcmbcr 26. 154(J 8): 2029-2036

9 Andrews Te. Rab)' K et al. Effec! of cholcslerol reduCI ion on myocMdial ischemja in pa!ielllS Wilh coron"r}' discase. Circulalion 1997 Jan 21 ;95(2):324-328.

4; WabJII/l"l PIHJrl7/PC)' "ell1i!pricc. Ardlllore, OklahOIJl;l oblained Fcbruary 9, 1997 for Zocor (20 mg daily).

J"

Slroes ES. Koom:ms HA, el al. Vascular hmction in dle [orearm of bypercholcslcrolaemic parjcllcs offand on lipid-lowering medicllion. LIII/cel 1995 Aug 19:346(8973):467-471. 40

Schuler G, Hambrechr R. el al. Regular physic11 exercise and low-fal dieL EfTecls 011 progression of coronar)' anery ruscase, Cireu/ot/oll 1992 Jul;86(1):I-11. 41

Singh RE, !U.
YusufS, PelO R, el al. Bela blockadc during and af!el myocardial inh.rcrion: an ovcrview of lhe ralldomized rrials. Prog Dl1y!iO"l/OSe Dis 1985 MarApr;27(5):335-371. 'J

110

Bhir SN, Kohl HW 3'~, er al. Ch:Ulges in ph)'sical firness and aii-caus,' mort;lJir)', A prospecrive lUd)' ofhc.aJrhy and ul\healrhy Ine". }AMA 1995 Apr 12;273(4): I093-1 098.

46

Ornish. D., BroWl\, S. ., cr :lI. 1990. Call LifcsryJe Challges Reverse Coronary Hean Disease?The Lifesr}'1c HcarrTrial. umal Jul21 ;336(8708) :129-133.

47

< Ornish D. Browll SE, el al. Ca.n IiI" ryle changes reverse corOlur}' hean disc~se? Tlle Litcsryle Hearr'frial. LiI1lCCf. 1990 Jul21 ;336(8708): 129-133,

se

Smith Jr, B1air S ,el"!. Prcvenring hcarr allack and dealh in pariems Wilh coronar)' disease. Cirrull/lio71 1995 Jul I:92( 1):2-4.

<'1

;0

Ornish D. Fim AJlIlIIo! COllft1'C71ct ()l1lhe Eiimilltltioll ofCoro71t11)' A1'11'1)'

Disl'osf, 7iICf07J, Ari.2IJ7m. Ol'lobn, 1991.

CHAPTER FIVE

_

THE

TRUTHABOUT

ISH D

r. Richardson was seartled. What could possibly have gone wrong? After years of Sllccess in controlling her cholesterol wirh diet, Jane's choleseerol was now again an ehe rise. In lace, in roughly ehree months her LDL Jevel had soared 50 poinrs. Like any good doctor, Richardson cried ro find ehe explanation for ehis perplexing rise. Nothing major seemed ta have changed. Jane's weight was not a problem; in fact, she had Iose ftve pOllnds since her last visit. Furthermore, there was no change in the glands Of oeher organs that can affect cholesrerol Jcvels, such as the rhyroid or liver. Fi nalIy, an fllfther queseioning, the source of che problem surfaced. Jane !lad heard about the hearr benefits of fish and had added a liberal amOllllt offish ro her nearly-vegetarian diet. Dr. Richardson discovered it was rhis addition of fish that had boosted her choleseerollevels. I If sllch a scenario sounds perplexing to you, I am sure it did ro many of the physicians who read that actual case history il) 1987. le was inc111ded in a special physician newsletter ehar was paft of a cholesrerol education program co-sponsored by Columbia Universiry aod ehe American Heart Associaeion. AJ.though we were noe raId rhe doctoc's or patienr's acrual name,

the accounr was there in print-a woman who had moved from a vegetarian-sryle diet ro a fish-based dier and had experienced a marked rise in her cholesrerollevels. What could be ehe explanarioJl fOf chis delctcrious effecr from a [ood we have heard so IDllCh good about? For weB over a decade ehe media has championed fish consllmption. They have tollted ics abil it)' ro lower cholesterol and decrease heart disease risk. In 1985, three high profile studies carne Out on the same day in the prestigiolls New EnglaJld Journal of Medjcine. In one of (hose reportS, rcsearchers studicd 20 years worch of coronary hean disease deaths among men in HoBand. They found [hat ehose who consumed loz. of fish daily reduced cheir eisk of heart dearh by 50 perccnr. 2 A second repon dcscribed rhe effecrs of fish oiI on the lowering of cholesrerol and rriglyceridcs. 3 The rhird srudy dealr wirh fish oil's effect on whiee blood cell function. 4 As a resulr of these and ocher stlldies, rnany Americans switched from red m~u ro fish, hoping ro improve cheir fat imake, lower cheir cholesterol levels, and dccrease cheir risk of heaT{ disease. In rnany cases, the strategy seems to have worked. A switch from heavy red meat usc to heavy fish consumption does (end ro lower cholesrerol

1I 1

PROOF POSITIVE levels and bring wirh it health beneflrs ro rhe hean. Howevel', medical research aIso contains ample UJf1-rnings abour rhe use of hsh and fish oiI. Before we look ar some of rhe porenrial drawbacks of fi, h consumprion, (er us look at rhe advanrages of earing flsh compared ro orhel' animal products. fu already stated, many have lowered rheir blood cholesterol levels by abandoning cheir "sreak and bacon" ways În favor of a tlsh-rich fare. The physiology of fish helping ro lower chole.srerol is sound. Compared ro mher aJ1ima.l prodllCtS, hsh has a generally more [worable P/S ratia. You wiJl recall from Chaprer 3, "Heart Disease-Conquering rhe Leading KilJer," rhat a high P/S ratio meaos hjgher in polyul1s:lturared tu. An increase in this rype of fat wilJ lower cholesrerol. Fish aJso bas less sarurared far. Sarurared fat is high in sLlch proelllces as meat, whole milk, eggs, cheese. and coconut and palrn oils.

UO

1J5

90

Cholc§lerol, rog 60

30

O 3.502.

IS g

IS g

15 g

J5 g

Figura 1

Two Sides to the Fish Story Wirh aII of these things seeming ta faUle Llse of tlsh, how do we explain the perplexing illusrr:.uion at the opening of ehis chapter? The aurhors of Jane's srory k.new the explanation and stated ir elearly: "... compared \"'irh a dier rhar is essenrially vegerarian, rhe consumption offish wiJJ increase dieta1Y cholesterol and often rhe inrake VOI

112

of sarurateel farry acid as weU. The net resuIt may be, as in this parienr, a rise in LDL levels."s Olhe.r more recent stuelies have contlrmed rhar fish oiJ consllmption wiU very Jjkely illcrease the LDL cholesterol in mosr people. 6 .7 As e.xplained in Chaprer 3 on heal"( disease, LDL is the "bad" cholesrerol rhar can produce clogged arrcric, t1uoughour rhe body. Ler us look ar rhe rwo poinrs madc in dus disringuished publicarion and see why fish presenrs a problem. Firsr, fish is an animal produce, and ie therefore contains cholesterol. In faer, rhere is nor much difference berween tlle cholesrerol conrel)( of fish and orher ;:Inimal producrs such as chicken, turke)', ar even pork and beef. These cholesteraJ Jevels aJe also rabulared in Figure 14 in Chaprcr 3 on hearr djsease. The facr rhar f1sh conrains cholesrerol purs it in a complerely elifferenr c1ass than aII planr produces. You will recall rhar aII plaur sources of nutririon have absolutely zero cholesrerol. A comparison of rhe cholesterol con tem of various fish and .fish oils is found in Figure 1. 8 orice rhar rhe cholesrerol levels are srared for rhe amounr of 15 grams of fish oiI, which is a standarei supplemenrarion dosage for cardiovasclilar disease. 9 We see mat rhese amoums ofcholesrerol in fish oii are eqllal ro ar grearer than ehe cholesrerol in a generous serving of T bone srcak, as shown in the bar on the lefr side of Figure 1. It is ilO woneler thar fish oii can raise the serum choleseerol. The American Hean Associarion is known for being soft on dielary guidelines; neverrheless, cven eheir mosr liberal diet for heaI( disease sriH forbids more rhan 300 mg of choleseerol per da)'. SlIpplemenra.l use of flsh oii GlJ1 go a long wa)' ro exce ding even rhis recommendarion. The second poinr raised by rhe aurhors of Jane's srory has lO do wirh rhe iSSlle of sarurared far. Compared ta ot!Jermeats, flsh has a favorabJe polyllnsatllrared ro saturatcd far rario (P/S ratio). However, ir does nor have as favorable a rario as mosr plam-derivedfrati•. Again, wh.ile i( is true rhar rhose who have been earing red mear can bring rheir cholesreroJ down somewhar b)' s\Virching 10

THE TRUTH ABOUT FISH a hsh-based dier, a vcgerarian dict is much more dTecrlve. The poim is mar fish raises blood cholesrerol levels less rhan red mear ar even poultry. Compared ro planr proclucrs, however, fis/' mises cholesrerollevels. Although many la} people have been drawn ro flsh because of ir adveni ed cholesrerol- [owering effecrs, ir is imeresring ro rcvisir rhe Holland smdy rhar hclped ro srir up so ll1uch inrereSL 10 When rhe aurhors published rheir dara showing a 50 percenr dmp in hean disease deaths, rhey incllldcd an irnporram facr t.har has been o[ren overlooked: rhe fish earers and heavy red mear earer had virtual!;, identica! cholesterol levels. The facr rhar flsh may Ilor lower cholesterol bcgs a quesrion: whar is rhere abour hsh rhar mighr reduce hearr disease risk even rhough choleslerollevels may nor be alrered? The answer may [ie wirh anorher compound, ealled omega-3 fars.

Omega-3 Fatty Aâds Reduce Heart Disease Risk Cerrain fish are rieh sources ofamega-3 fan)' acids. 511Ch flsh include sah110n sardines, măckerel, and some orher fany fish. II The omega-3 fars in rhese hsh are long-chain pO[Yllnsamrared farry acids which include eicosapemacnoic acid (EPA), a far wirh some unique hearc advamages. For e-xample EPA helps ro decrease rhe srlckiness of plarelers. lhe body's c10ering cdls. ll This is imporranr: anyrhing lhal helps ro prevem platelers c1umpi ng cogether decreases rheir rendcncy ro plug up blood vessels. This in rurn ean help ro decrease ehe ri k of a blood elOt forming in a hean blood vessel aud causing a hearr arrac1<. Omega-3 far can aJso help ro mildl)' decrease blood peessure. 13 Many experience an aClual decrease in rhe serum rrigl)'cerides from consuffi.Îng rhis dass of far .14 For mese re.lsons and omers, Îl Îs likely ehar rhe e omega-3 fars al leasr have some rendency ta decrease rhe rate of al.herosderosis. 1; Bc)'ond tJ)ese reasans, animal lnodels suggesll.har ifa hearr arl.ack does occur, omega3 fany acids may decrea e rhe amOllnr of muscular damage occllrring horn lhe artack. 16 These unique fars 31so appear ro

decrease rhe likelihood of blood vessels blocking up again afrer angioplasry ("rhe baJloon procedure" used ro open up blocked hearr arreries), 17 ;:md can a[so decrease lhe rare of c10gged by grafrs following by surgcry.18 A ummary of rhese omega3 benefirs is sho\vn in Figure 2.

OMEGA-3 FATS FIGHT HEART DISEASE • They help to decrease stick.iness of platelets, tbe blood's c10tting cells. • They tend to decrease blood pressure. • They tend to decrease serum triglycerides. • If a heart attack does occur, they may decrease muscular damage resulting from the attack. • Tbey appear to decrease the Iikelihood of blood vessels block.ing up again after angioplasty or by surgery. COllsidering (he evidence, should we eal. flsh to help decrease hearr disease risk? A furrJ)er look ar orher popularion studies may help ro provide rJ)e answcr. We have alread}' looked ar the DUICb srudy thar demonsrrared a 50 percenr decrcase in coronary aner)' discase dearh. among dajJy fish earers. 19 Wh.ile a 50 perccl1t reducrian is signiflcanr, a ll1uch grearer re,ducrion occurs among total vegetarians. A sludy ofSevenrhday Advenrisr men on a toral vegerarian diet showed [har cheie risk was lowered bv 86 perceI1t. ,,0 The resulrs in borh srudie~ are noe unexpecred: rhose on a poor diee may benefir from adding fi h in place of other more harmful foods. Adding hsh may lower rheir hearr disease ri k; ir mighr even Jower [heir cholesrero[ levels. However, t.hey cannor get lhe magnilLlde of benefit rhar ehe optimal dier provides. As we have seen in [he rwo previous chaplers, 111311Y lines of evidence demonserare rhar lhe oprimal dier for hearr disease preveneion is (he (Oral vegerarian diee.

Figure 2

113

PROOF POSITfVE Anomer popularion stlldy is of parricuIar noee. This published repore from Harvard Universiey represents probably che mose sIarisrically powerful research ever condueted ro examine che fish-hearr relarionship. Where che Ducch srudy looked ac only 852 men, Ihe Harvard researchers srudied a phenomenal44,895 male healrh professionals. 21 The researchers' findings were asronishing: men who ace fish several cimes a week were jusc as likely ro have hean disease as rhose who are ie only once a moneh. If anything, there was a suggestion ehae [he men who consumed six or more servillgs of fish per week had a somewhac grealer risk of coronary hearc disease ehan those who con-

DISORDERS THAT MAY BENEFIT FROM OMEGA-3 FATTY ACIDS • rheumatoid atthritis

• depression

• primary Raynaudl's disease • psoriasis

• over-aggressiveoess

• GI ul'cers • uJcerative colitis • Croho 's disease

• possible prevention of breast aod colon carcîooma • possible prevention of chronic obstructive puLmonary disease

Figure 3

• The better the diet, the less benefit rkrived from adding fish. On an excellent diet, fish wilL increase rather than decrease heart disrase risk.

114

sllmed one serving per month ar less. The explanaeion mOSI likely has ro do with whac foods other than fish were inclllded in the dieL The beuer ehe dice, (he less benefir derived from adding fish. On an exeellem dier, fish will lncrease racher rhan decrease hearc disease risk.

Smoking Negates Benefits of a Highjish Diet Inrake of omega-3 farey acids in a highftsh dier by ehose who smoke does nor pfOrect against coronary dearh. In (acr, it might have ehe opposite effect. A six year srudy

spearheaded by Dr. Pirjo Pieeinen of Helsinki, Finland, involved 22,000 middle-age srnoking men for c
Other Omega-3 Benefits Tlle advantages of a dier high in omega3 do noe Stop wim the heare. The various known non-cardiac benefiIs of following a dier high in omega-3 fatIy acids are \isred in Figure 3. 23 Omega-3 farey acids are of benefir to [hose with rheumaroid archriris and other infhmm.arory anhriric condirions. 24 . 25.26. 27 Rheumaroid archrili is a crippling eype of arrhrieis. Often Ihe hands and orher joilHs become seriously deformed. In addi(ion, ir rends eo affect the whole body and nor juse ehe rs. It can affecr blood vessels, ehe spleen, heare, lungs, and skin. 28 Funhermore, rhis disease can be notoriously difficuh ro treae. Often ehe drllgs employed have serious side cffecrs. Thus, when rhe news earne ouc thar a dierary change could help chis devaseaeing disease, rhousands of sufTerers 110 doube rejoiced. The omega-3 fars are also help/td in psoriasis. 29 . 30 Psoriasis is a skin condirion rhar can range from mild irehiness and scaI ing ro distlguring and painful rashes ehae ma)' ooze and bIeed. Omega-3 fars along wirh orher polyunsacuraeed fars can also help wirh [he healing of skin and sromach 1I1cers. 31 These fars can prevem the mulciplicarion of or even kiU Helicobacterpylori, bacreria [har are weli known to cause seomach and duodenal ulcers. 1'his provides furrher good news for armrieis pariems; many of mem suffer from sromach ulcers duc ro common

THE TRUTH ABOUT FISH arr1lfiris medicarions, especialJy if chey harbor the harmfuJ bacteria in their stomach linings. The omega-3 fars may also have a role in cancer prevenrion. The risk ofbom colon cancer and breasr cancer seems ro decrea e when rhese fars are inc1uded in the clieL 32,3 ,34 One of my special interesrs is in gasrrointesrînal diseases. One problem rhar 1 crear in my office on a daily basis is a disease caUed u1cerarÎve coliris. Ulcerative coliris is an auroimmune disease wherein rhe body atracks rhe colon, causing ulcers, in~ammarion, fevers, bJeeding, diarrhea, and abdominal pain. It tenels ro relapse frequently; that is, it will subside for awhile and then fiare lip agaiJl. A four-monrh long stlldy included 23 patienrs wieh chronic acrive ulcerarive colitis. 35 About onc-half of rJle parienrs were given duee grams daily of eicosapemaenoic acid (EPA), an omega3 fatty acid. The omer group received lookalike pills rhar had no medicinal cffeces (called a placebo). Afeer four monchs, rJle rwo groups were switched ro the opposite trearmenL The results of ehe scudy are summarized in Figure 4. Norice chac only rhree Out of ten who took rhe placebo had remission, and aII duce lacer relapsed. The stOry was rernarkably differenr for rJlOse raking ornega-3: 10 aur of 13 experienced a remission of their discase. Even rhough sJighdy morc rhan 50 percenr of chose wirh a remission later relapsed some remained disease-free. Unfortunate!y, cow's milk anei many infam formulas lack cerrain ol11ega-3 fars rhar are necessary for o~){imaJ brain and eye developmen(. Human breasr milk, however, has abllndanr omega-3 fars and may be one reason why infanrs raised on hllman milk do berter on inreliigence tescs rhan rheir formuJa-drinking counrerparrs. 36 . 37. 38 An omega-3 farry acid deficicncy can also cause depression or even over-aggressiveness in adlllrs. 39 Wirh ali the wealth ofinformation demonstraring ilie bcnefirs of omega-3 fars, it ll1ighr seern thar we should ar leasr pur a [itde /lsh on our din ner plates. Bur before final recommendarions are issued regareling our personal eating habirs, we need ro ex-

plore more flllly ilie "down side" of fish consumptlon.

Fish and Fish Oif's Bad Side Fish oii capsules anei other fish oiI sllpplemenrs may nor olter che benefies of flsh oii in its fresh, naruraJ stare. Alrhough rhe fresh omega-3 polYlll1sarurated acids tend ro help plarelers anei decrease heart disease risk. oxidized omega-3 fatry aciels may do rhe opposice. 40 While on the shelf, natural fish oil can become oxidized,4f and therefore very damaging ro arreries due ro the oxielizeel cholesrerol. Furthermore, EPA (the omega-3 fatty acid present in flSh) re:adily ox.idizes ro form peroxides, which are powerflli (ree radicals. For anyone who

EPA (AN OMEGA-3 FATfY ACID) THERAPY IS EFFECTIVE FOR ULCERATIVE COLITIS Dose = 3 g/day First Test

EPA Placebo otal subjects

13

10

No. Improved

10

3

3

O

No. Uncbanged

2

2

3

5

No. Worsened

1

5

1

5

Figure .4

is concerned aboLIt avoiding free radicals, giving up fish wOllld be a logical fim srep. Fish oiI supplemencs may nor offer me hearr and blood vessel benefits consumers aoricipare. The Nllerition Commirree of the American He:trt Association has recenr.ly gone on record staring, "fish oiI capsules cannor be recommended at this rime ... tO prevenr disease of rhe coronary aneries. "42 There are several important potenrial problems wirh eacing fish aud fish oiI. These problems have nor been well publicized. They are ljsted in Figure 5.

115

PROOF POSITIVE

PROBLEMS WITB FISH AN» FISHOIL • Can worsen blood sugar levels in diabetics. • Large amounts can dangerously prolong the blood clotting time. • Fish oii is expensive. • Large amounts cause vitam'in overloading Olr vitamin deficiency. • Can lead to an increase in body weigbt. • Sea food is a large reservoir for infeetious diseases. • Toxins acquired from contaminated waters concentrate in the fatty tissues of fish. Figure 5

116

The irems in Figure 5 deserve funher commenr: 1. Fish oiI can raise blood sugar in adulronser diaberics. A Universiry of California smdy found rhar chese so-called Type II diaberics experienced a nearly 20 percem rise in their f.1.Sting blood sugar levels after raking fish oiI for a mere four weeks. 43 The reason for the diaberic worsening appears ro be EPA; rhis omega-3 fac may reduce insu1in produccion in diabecics. 2. A dier very high in fish or fish oii can dangerollsly increase rhe blood clorring rime. 44 Eskimos, alrhough rhey have [ess heart disease. have more hemorrhagic (bleeding) srrokes ehan Americans do.'oS Apparenrly, rheir fish-rich dier causes such an impairmem of plateler fllnccion thar rhey bleed more easily. 3. Fisb oii is expensive, especially in capsuIes. Researchers used [5 capsules of fish oii daily for six momhs in arder ta decrease re-acclImularion of arherosderosis folJowin.g angioplasty.46 Remit prices are about $9.00 for 100 capsules. This rranslares imo over $245 for rhe six month course of rherapy. Continuing on rhe regimen wouJd cosr around $500 per year. 4. Large amounrs of fish oiI used as 3 supplemem may upscc your viramin baIanceY Or. Jack Yetiv has poimed out rhar

high doses of fish oiI may cause ve,.y high levels of Vitamins A and O-so hjgh thar rhey could be toxic. BOth of rhese vir3mins are fac-soluble nurrÎenr rhar are necessary for life and healrh in appropriate amoums. However, either can cause poisoning-and in some cases-death, iflevels buiJd up roo high în the bJood. On rhe ocher hand, a diet rich in fish oiI can cause Viramin E r!e-

ficiency.48

5. The large amOllnrs of fish oii rhar have been lIsed in many studies can Iead ta a signiflcanr increase in body weiglu. These prepararions are exuemely high in far and calories. 49 Yeriv estimaced a person could gain up ro 24 pounds in a year ifhe rook as mllch fish oii eacb day as some srudies wcre llsing. so 6. Seafood is a reservoir for infectioU5 diseases. There are abolit 113,000 reporred cases offood poisoning from comaminared seafood each year in rhe U.S.51 This is clearl}' an underestimare, since many iJlCidents are nor reported. Seafood concribures ro ;t disproporrionaeely high amounr of food poisoning otltbreaks. Staristics suggese rhar reporr.ed outbreaks (episodes of food-relared iJIness where more rhan (\Vo people are affccted by a commons source) 1nighr be as much as 15 ar more rimes likely ro occur wirh seafood than with beef, poultry, or pork. 52 Raw shellfish in particular (such as oysters. clams, and mussels) have a dismal record. Abotlt 20 miII ion Americ.1ns ear raw shellfish, which for more rhan 90 percenr ofseafood poisoning cases. S3 When raw sheUfish Îs earen, rhe whole living crearure is consumed complete wieh irs gasrroinresrinal uact. Thac would be equivalent to plllcking a [ive chjcken and eating il whole, guts and alI. Whar's more, shellfish feed by filtering (\VO ro rhree gallons of water an hour. That means rhe)' ral<e in wharever is floaring by-not only plankron and orller food, but viruses, bacreria, mercur)', and who knows whar else~ Unfoftunace1y, sheUfish are commollly harvesred from coasral w
THE TRUTH ABOUT FlSH orher infecriolls diseases can reslIir. Even well-cooked shellfish can infrequendy cause serious or life-rluearening illness. Two such maladies include paralytic shelJfish poisoning and neurocoxic shellfish poisoning. 54 hellfish are nor the only seafood ehar presene causes for concern. For example, over 400 different species of reef fish carry rhe risk of rransmitting ciguarera poisoning, which is rhe most common fin fish poisoning in rhe Unired Srares. 55 Some 8000 Americans a year are made il! by rhe ciguarera roxin. Altecred fish, such as red snapper, amberjack, barraclIda, and grouper, look and Tasre normal but C
rhar shell fish beds have been officially c1osed. 60 Other sources of microbi;ll water comamination include animal wastes from agriculture and municipal wastewarer discharged by publidy owned trearmem facilities. 61 7. Perhaps mosr imponandy, fish concentrare roxins in rheir fatry ti sues. These roxins include pesricides, chlorinated hydrocarbons, diox.in chlordane, and mercury. As of 1996, 47 srates had fish consllmption advisories thar wam againsr eating cenain species. They cover 1,740 rivers and lakes (including alI of the Creat Lakes) and large chunks of coastal areas. 62 The mosr COl11mon reason for consumprion advisories is mereury. which can callse brain and nerve damage, especiaJly ro feruses and young children. Large fish fike fresh tuna, swordfish, and shark have rhe highesr levels of mercury.63 Despire rhe popular belief rbar fruits and vegerables have rhe greatesr risk of pesticide contam.inarion, rhe FDA's resC<1rch reveals rhat domestic fish producrs conrain significamly more pesticide residues ehan domesric fruits, grains, or vegerables. 64 Bluefish, along wirh lake reout and orher freshwarer fish caughr in inland lakes, are most likely ro be conraminated wieh carcinogens like dioxin or PCBs (poJychlorinated biphenyls).6"

Contaminated Fish from Contaminated W0ters Pesricides are an extremely important issue. Worldwide, there are more than 900 differenr active pe,sricides in some 40,000 difTcrem chemical formularions. 66 In the U.S., abolit 600 pesricide ingrediems are used, accouming for some 800 million to 1 billion pOllncls per yearY Huff and Hascman reviewed some 200 radene studies; they concluded rJ)iH "rhere is considerable evidence that exposure ro cerrain pesricides may prcsem real carcinogenic hazards ro hunlalls. "68 How do fish become exposed t() pesticides? fu previously memioned, one big cause is agricultural runoff. When a farmer sprays !lis fields, a ponion of rhe chemicaJs will be washed ofT into neighboring creeks

117

PROOF POSITIVE and srreams, and ulcimarely imo eivers and oceans. Sewage overflows, falllry sepric sysrems, boarjng wastes, and poisonous eunoff Erom city streets have a1so coJ1tribllced ro the poUurion of warers. These watees are sometime-s considered so dangerous rhar signs like (he one shown in Figllre 6 are erecred ar some swimming beaches.

Figure (,

NUMBEROFREPORTEDF~H

KILLS CA SED BY POLLUTIO

"""RGpctlOO Q

I·IQ -

Figure 7

118

11-30

-

31-70

-

:>70

rf swimming in the warer is haz:lrdolls for humans, it i~ ironic that peaple Stil! go fishing În these areas. The sign are nOt "calJing wolf." IlInesses sucit as gasrroenreriris, dysentery, hepariris, and orhers can result from swimming in conraminared wareI. The risk of spending rime in the warers an aur globe is highlighred bya disrurbing tTend among fish. Fish have more cancer now rJlan 50 years ago. 69 A Canadian biologisr, Ron Sonsregard, has examined borrom-dwelling fish in the Grear Lakes aIld rhe rivers rhar feed rhem. In every fish spccies he has found [Umors-ofren maIignanr ones. 70 For example, 30 percene of rhe buliheads in Lake EtÎe had liver cancer. The Ph.D. nurririonisr and amhor, Dr. Winsron Craig, in commenting an these findings, added duee more sobering facrs: (1) the Grear b.kes sÎruarion is not unique: problems wirh cancerous ftsh have [Umed up from Pugct Sound ro rhe Culfof CaJifornia and from the Hudson River ro rhe F10rida Keys; (2) National Cancer lnsrittlte dara show an increased death rarc from cancer among people living in areas wherc fish have exceptionally large amounrs of tlImors; (3) tne toxic nature ofwhat Îs found in some of our watcrways is astOnishiIlg: whe-n seelimenrs [rom the bottom of L1ke Erie were painred an cl1e skin of mice, rJ1e mice developed skin cancers. 71 A1though Craig's insights may not necessaril)' prove human risk, clIey surdy raise serious concerns abour the hllman healrh hazards from rhe "epidemie" of cancers in fish. Rarher large amounrs of fish die in droves every year throughour our counrry simply due ro pollurion itse1f. The Environmemal Protection Agenc)' (EPA) of the D.S. governmenr has arrempred ro rraee rhe amount offish kills duc ro pollmÎon as well as orher causes. Figure 7 reports rJ1e nuOlber of fish kills proven ro be due ro pollution by state in 1993. 2 Each fish kjllllSllally represents lireralIy thou 'ands of fish. The EPA jts tiut rhese figllres grearIy ullderesrimare rhe aCtual number of fish kills, since 15 stJtes did nor repon oe keep track of cheir fish kiJls. Also, man}' addirional fish kiJls oceur bur cannor be definireiy proven ro be duc ta pollution.

THE TRUTH ABOUT FISH Pesricides were rJ1e mo 1 freqllenrly identifiee! wxÎc pol/mam callsing hsh kills, followed by oiI and gasoline prodllcrs, chlorine, ammonia heavy mecals, and orher toxic subsrance5.1 3 Unforrunarely, many fish rhar are ill and suffering from rhese pollulanrs bur have nor yel died are c
No Mandatory Inspectiol1 ofFish OI'. Craig has poilHed our another serious concern wirh fish safee}'. There is no governmem mandatar)' inspection program for fish ar fish producrs ar rhis wriring. Craig srares (har only "bom 1O percem of flSh undergo any rype of inspecrion, and rhis is through a voluntary program.74 Obviously, there is need for a well-ordcred inspection sysrem for fish rhar has just noe laken place. If we could find I~on-fish sources of rhe beneficial omega-3 fats, wouldn'[ it be more sensible, from aU rhar \Ve bave learned, ro JUSl ser fish aside? Such Coods would not provide a porential reservoir for cancer, infecrjolls diseases, ~U1d oeher ailmenrs. Foods of rhis kind do exisr, as we shall sec later.

Mildly-polluted wtlter Produces Super-polluled Fish \'{firh cancer being ehe greatesr concern regarding exposure ro pesricides and orher ro>âns, we musr recognize which roxins pose the grearese risk during long [enn exposure. Poisolls thar present rhe greatest long-renn rhrears ro hllmans have rwo narural characterisrics: a tendency toward "bioaccumubrion" and a rendency wwarel "biomagniflcation." 80rh of these processes cause fish from mildly poLiuceel warers ro have lalge concenrrations of rox.ins in f1sh tissues. Bioaccumularion is rhe process by which IOxins gradually build lip in cenaÎn organs of hllmans 01' ocheI' rargec organisms. Biomagniflcation refers ro a process where poisons become progressively more concentrared as rhey move lip rhe food chain,75 A c1assic example of biomagnification was discovered in Cle
abOli! 90 miles norrh of San Francisco.76 The Iake had been sprayed several rimes with an insecticide called 000 ta control rhe insece popularion. (000, a less pOleIH cousin of ebe infamolls ODT, is eechnicaIly referreel ro as a halogenared hydrocarbon,)

BIOMAGNIFICATION OF DDD INSECTICIDE

ill

parts per million (ppm) in Clear Lake, CA Figure 8

The re5l1lrs of spraying rhis insecticide are shown in Figure 8. Norice ehat the lake warer revealed bardv derectable levels of rhis pescicide. at .02 PPI~ (2 drops of 000 in every 100 million drops oflake water). Biomagnificarion. however, callsed a dramatic increase in rhe lisslle leve1s of organisms thar lived in rhe lake. The concenmHion ofDOO in rhe phytoplankcon in the lake measured 5 ppm, which is 500 rimes rhe concenrrarion in the Jake warer. furthermore, in progres rhe food chain, rhe conccnrration ofDOO approached 2500 pplll-a whopping 125.000 rimes rhe warer concenrrarion. Such examples of biomagnificarion are not rhe exceprion; rlley are lhe rule. The EPA has gone an record ebat: "Aquatic organisms may bioaccllmulare environmental contaminanrs tO more rhan 1,000,000 rimes rhe concenrrarions dereeted in the warer. .. "7Î Evidence is mounrÎng rhar rhere may be a relationship berween IOxîns a.nd chronic hllman diseases sllch as cancer

119

PROOF POSITIVE

120

and hean disease rhar altecr rhe developed narions in epidemic proportions. An example is provided by rhe halogenared hydrocarbons, which is one cIass of compounds, as we have seen, known ro be biomagnified through rhe food chain. They also bioaccumulare in humans. Elevared levels of these compounds have been found in d)e rissue of breasr cancer parienrs. 78 The researchers who idemified rhis breast cancer 1inkage conduded: "These resulrs, alrhough preliminar)', suggesr a role for environmenrally-derived suspecr carcinogens in the genesis [origin] of mammary [breast] carcinoma." But the problems do not srop wirh cancer. One invesrigaror, in rus review of rhe lirerature, found a "correIarion berween DDT plus ODE [rwo orher halogenared hydrocarbons] in the blood and subjecrs who reported hyperrensiol), arreriosderosis, and diabetes during subsequem years ..." 79 Fish present some of rhe grearesr concerns from rhe standpoinr of biomagnificarion and bioaccumularion. They have nor only bee)) found ro be conraminared wirh PCBs and various heavy merals such as mercllry, bur also wirh perroleum hydrocarbons and the halogenared organic compollnds. 80 . Rl In a prominem medical rexrbook an environmenral medical issues, Dr. Kennerh Rosenman ofMichigan Srate UlliversÎry srared: "The major ongoing source of PCB exposure for rhe general popularion is rhe consumprion of 6sh."82 Along with concerns about causing cancer, rhere is preliminary evidence linking borh PCBs and dioxins with e1evated blood cholesreral and uiglycerides. 83 Orher data indicate rhar PCBs may affect male sperm cou nts and fertil i()'. 84 Research suggesting rhar d)ese contaminams can harm the developing ferus has increased rhe srake.s in rhe PCB issue even furrher. Dt. Theo Colborn has poinred our that ilie research lirerarute suggests that PCB presem in the womb can "affect rhe developing nervous sysrem of rhe embryo, ferus, and newborn."85 RecentIy, the New England Journal of Medicine grabbed headlines when Drs. Joseph and Sandra Jacobsen further quanrified the developmemal risks

of PCB e.xposure. 8G Even ar 11 rears of age, children wirh higher exposures to PCBs brftre birth showed impaired inrellecrual development. AJrhough rhe children were nor rerarded, dwse with the highesr PCB exposures were rhree rimes more like1y ro have low IQs and f\vice as likely to be at least rwo years dela)'ed in rheir readij)g comprehension. Accllmulation of toxic merals in fish has become of particular concern recenti)' in light of the problems wirh acid rain. Acid rain Ieads ro acidified waters. This chemically-a1rered warer can then leach a1uminum, manganese, lead, zinc, ciuln, aaci mercury our of bonom sedimenrs or soil ineo the warer. Once rhese toxic merals are liberared, rhe)' find rheir wa)' imo the food chain and rend ro bioaccumulare in fish rissues. Even i Il seenie Maine, women ofehiJdbearing age and children under eighr are being urged not to ear fish from any pond or lake in Maine. Orhers are advised ro resrricr rheir consumprion ro no more than six large fish ar 22 small ones annllaHy, aU due ro rile mercur)' comene of the fish. 87 Mercury ingestion in high levels ean harm the deve10pmenr ofhuman fetuses and children, and callse nervous sysrem disorders and kidl)ey damage in children and adults. Michigan is rhe only orher srare ta issue such a sratewide warning. However, aceording ro Martha Kearing, an EPA sraff scienrist, the U .S. national average of orher lakes and srreams are jusr as hazardous as Maine's. The Boswn-based Clean Water Aetian grollp has even gone on record stating that 90 percenr of freshwater fish callghr in New England warers have conraminarion levels of mercur)', lead, PCBs, or dioxin rhat are ullsafe when consumed more thar once a week. Alrhough the group had collecred significanrly less data an salrwarer fish and thus could not make such a sweeping srJremenr, rhey did warn rhar rhe salf'.'Iater fish rested had high levels ofPCB and mercur)'. Probably the most widely publicized case of hsh-l'e1ared heavy metal poisoning had nothing ro do wirh acid rain. It involved the tragic human methyl mercury poisoning thar resulted from eating fish from Japan's Minamata Bay. Japanese facrory dis-

THE TRUTH ABOUT FISH charges of merhylmercury into rhe bay Iaid rhe foundacion for rhe problem. The biomagni/lcation rhat occurred through rhe food chain exposed humans who are ilie fish ro dangerous organic mercury levels. 88

Health Problems/rom Contaminated Fish Perhaps rhe grearesr dangers from fish are rhose faced by Illirsing infams. One srudy found rhar those who consllmed conraminared Grear Lakes fish experienced reproductive complicarions. These incLllded alrerarions in birrh size, gesrarÎonal age, changes in neonaral health sratus, an.d effeers rhar persisred inro early infancy.8? As a resulr of rhese risks, some have sllggested tim infanrs should .nor be breasr-fed becallse of rhe cancer risk. A1rhollgh rhis may secm ro make sense in aur roxin-conraminared world, a berrer alternarive may be avoiding rhe major sourees of (hose roxins. Orher researeh suggesrs rhar the borrle-feeding srraregy may back.fire. There is evidence rhar breasr feeding in alld ofirself tkcreases breasr cancer risk. A 1994 srudy found (har daughrers who 'were breasr fed by (heir motl1ers had 2S percenr less breasr cancer. 90 For convenience, a SllJnmary of previously menrioned conraminarion compounds fOllnd in fish is shown in Figure 9. Possible links ro cancer from conraminared fish are slImmarized in Figllre 10. PCB con ramil-lar ion of fish has been weU docllmenred. The evidence of the delereriDUS efTecrs of PCB on rIIe human reproducrive sysrem is sunuuarized in Figllre Il.

Fish Farmingfor Safer Fish? In fairness ro the fishing indllsrry, it shouJd be menrioned rhat aquaculrure (fishfarming) may circumvenr some of rhe concerns regarding roxins. Such fish are grown in conrrolled bodies of warer (har are isoIared from open srreams. Ifauenrion is paid (O warer qualiry in (hese commercial fish fanns, some of rhe problems assoeiated with pollution can be avoided. However, if financial inreresrs continue ro prevail, lax warer qualiry standards may also render these fish po(entially dangerous.

FISH CONTAMINATION COMPOUNDS Fish from mildly polluted water concentrate toxins up to more than 1,000,000 times more than detected in water. Toxins in their fatty tissues include pesticides, chlorinated hydrocarbons, mercury, and dioxin. . . Fish can also be contaminatcd with peRs, various heavy mctals, petroleum hydrocarbons, halogenated organic compounds, and Icad. Figure 9

EVIDENCE LINKING FISH CONTAMINAnON TOCANCER • Elevated levels of pcsticide compounds bave been found in tbe tissue of breast cancer patients. • ational Cancer Institute data ShOlV an increased death rate from cancer among people Iiving in areas wbere fisb have exceptionally Jarge amounts of tumors. • Fish have more cancer now than 50 years ago. Example: 30 percent of the bullheads in Lake Erie were found wÎth Iiver cancer. Figure 10

pes AND THE REPRODUCTIVE SYSTEM • The major ongoing source of PCR exposure for the general population is the consumption of fish. • peR may affect male sperm counts and fertility. • PCB-contaminated fish eaten by pregnant mothers are Iioked to alterations in birth size, gestational age, and changes in neonatal heaith status. • Children at tI years of age with hîgher exposures to peR before birth show impaîred intellectual development. Figure 11

121

PROOF POSITIVE Of. MÎchael Jacobson of rhe Cenrer for Science in rhe Public lnreresr indicarcs rhar farm-raised hsh are nor free from concern.?1 Based on rus research, he has highlighted several issues: (J) food coloring has iliegaHy been added ro feed ro make farmed ush look more arrractÎve ro consumers; (2) anribiories are romine1y used in the ush farming indLJsrry; (3) pesticides have also been applied by aqua-cu1rurisrs; (4) fann-raised fish may have lower omega-3 levels due ro differences in their feed.

PLANT FOODS CONTAINING OMEGA-3 (LINOLENIC ACID) Amollnt

Food Item Fla.xseedlLinseed oiI Walouts, Englisb Canola oU Walnuts, black Wbeat germ oii SoybclIn oU (Crisco/Wesson) Green soybeans Spin8ch, canned ...... AlmoDds California avocado Turnips Samower oii Swcct pot,atocs Banana Medium apple w/pccl Roasted potato, medium size Cucumber slices w/pecl Whole wbeat bread

1 Tbs. cup 1 Tbs. 1/4 cup 1 Tbs. 1 Tbs. 1 cup 1 cup 1/4 cup 1/2 cup 1 cup J Tbs. 1 piece 1 each 1 cach J each • 10 picces 1 piece

1/4

Omega-3(mg) 7526 1703 1094 1034 938 927 637 353 136 99 74 55 38 38 25 17 12 Il

----~-----

Figure 12

Get the Omega-3 Benefits Without the Risks ofEating Fish

122

There is a way ro have rhe benefirs of rhe omega-3 fatry acids without having to ear fish, fish oii, or expensive capsules. There is a way ro by rhe cholesterol and toxins rhar come w,irh rhe animal-derived omcga-3. The way is so simple, bur it is nor gening rhe publieiry it deserves. We can obrain rhe benefits of omega-3 fatry acids /Tom a planr far caUed linolenic acid.

The human body can acrually make rhe well-srudied eicosapenraenoic acid (EPA) from linolenie acid. Linolenic acid is itself an omega-3 farry acid and is an essential componenr of rhe human dier. Linolenic acid is differenr from linoleic acid. The cririeal difference is in the letrer "n" rhar is rhree lerrers from the end. StIldenrs of biochemistry may che difference berween rhese very difFerem fats by noting rhar rhe one with rhe "n" rhrec lerrers from rhe end is an "n-3" t1r (another redmical nallle for an omega-3 far). an rhe orher hand, rhe far wirhour rhar crirical "n" is linoleic acid, called omega-6 fatry acid, and is round in corn oii and safflower oiI. Mally comOlon planr foods are rich in linolenic acid. Some of rhem are lisred in Figure 12. 92 Nore rhar rhe highesr source oflino!enic acid is flaxseed oii (a1so c;ll1ed linseed oii). Onc rablespoon has over 7500 mg of linolenic acid. One-quaner cup ofEnglish walnurs conrains 1700 mg of rhe omega-3 linolenie acid. One tablespoon of soybean oii has more rhan 900 mg. Even one cup of canned spinach comaios abolit 350 mg. We do nor normally rhink ofspinach as having much far, bur it is an excellent source of omega-3. Today's generarion of morhers can now rell rhei( children ro ear rheir healrhful spinach wirh added force. Even common foods we ear every day, Wee a banana, an apple, bre-ad, or poraroes, aII make rlleir conrriburion ro our linolenic acid imake. As we can now bener undersrand the benefirs of omega-3 fatt)' acids, we can also appreciare rhar it can make a difference where we ger rhem. When adopring a balanced dier of plaJH foods, we reap the benefits of omega-3 wirhour rhe roxins, pesticides, aod cancer risk inherenr in rodav's fish. Besides enjoying ilie foods lisred abo~'e, if you are in need of eoncentrated amOUl1TS of omega-3 fan}' acids, rry grinding equal proponions of flaxseed and walnuts. We caII it "flax-nm burrer." It has a te..xture similar tO peanllt butter and is quire tasry. Patienrs suffering from significanr coronary arrery disease, rheumaroid anhritis, psoriasis, or hyperrriglyceridemia may benefir from rhe higher doses of omega-3 rhar flax-

THE TRUTH ABOUT FISH nut blltter Cln provide. It is import:tm ro poinr out [hat mosr stlldies tegarding the benefits of omega-3 f.my acids have focused on rhe oile farry acid Ibar has been considered in this chapterEPA. Many researchers seem to ignore rhar EPA is not an essential farry acid. We have already identified why it is not essential: our bodies manufacrure EPA from rhe linolenic acid char is found abunclantly in rhe planr foods listed above. The sreps by which EPA, eicosapenraen.oic acid, is derived from linolenic acid are omlined in Appendix IV. Studies clearly show that whcn a person increases his consumprion of plam sources of alpha-linolenic acid, blood levels ofEPA a1so significanrly increase as expected. 93 Anorher study demonsrrarjng conversion of a1pha-linolenic acid imo EPA in humans prornpred an inreresring observauon. This seudy shows mar linolenic acid may have llnique benefirs in irself in addirion ro rhe benefits ir provides in being converted ro EPA.9 4 Thus, ic may be berrer to ear foocls conr.aining linolenic acid rarhcr than rhose wirh EPA. In this way, rhe body can use however much ir needs for conversion ta EPA while reserving the excess for orher beneficial llses. Thjs would also avoid rhe dangers of an excess of EPA in the bloodSlream, whkh Cln trigger a stroke due ta hemorrhaging. One study of a diet enriched in alphalinolenic acid has already suggesred rhar rhis fal has a role in preveming hearr disease. 9S A cousin of alpha-Iinolenic acid, known as gamma-linolenic acid. appears effecrive in dealing with arthritic conditions.%

Vegetables and Pesticides Regarding conlaminarion wilh pesricides, man)' American consumers are mostl)' concerned abOlit conraminared fruit.s and vegerables. le is truc thar acute roxicities rrom pesricides have been rraced ro conramioared plant producrs. A 1991 repon reviewed some of the classic examplesY7 In a 1962 episode in Turkey 333 died and as many as 3000 were poisoned due ro consllmprion of seed grains treated wirh hexachlorobenzene. In 1968. severe poisonings and dearhs were documented when

individuals are bakery producrs that had been contaminated wim paratbion. Man)' also died in a 1972 Irag incidem when rhey ingested grains treared with an organomercuriaJ fungicide. More recendy in 1987, fifreen Peruvians died and 260 became il! when rhey are bread made from aldrin-contaminated flour. Acute roxiciries like rhese, although serious and frightening, are relatively easy ro prevenr in developed nations. Because of ule acute narure of Ihese tox:icities, rhey have been well srudied. Legislarion bas been enacted thal guarcls consumers againsr exposures ro roxin levels bigh enough ro Cluse acute hllman healrh risks. Long rerm or chronic effecrs, however, are not as easy ro prevenr. wherher the contaminarion is (rom vegerables or fish. The reasons for this include: (1) it may take lllaJly years for long-term effecrs ro become apparent; (2) even when the effea occurs, it may be difficulr ta pinpoinr the toxin causing rhe effecr; (3) even if an association is made, ir is difficult ro derermine how much exposure is required to produce [he effect. Chronic effecrs, particularly cancer rislc, tend ro take cemer slage regarding Americam' concerns for pesricides. As 1 talk with (he average person 011 the street abOlit pesticides, it seems tbat the greatest concern is cancer. Usually, rhe food groups they fear ro be rhe mOSt comarninared are frllirs and vegetables rather rhan animal producrs. However, the f..1Cts tell a different srory. When you look ar fmit and vegerable cOllsllmprion, rhe more of rhese plam foods we eal, rhe smaller our risk of Gl11Cer. This fact was highlighted by one of America's foremost nutririon researchers, Of. Gladys Block of rhe Universiry ofCalifornia ar Berkeley. Dr. Block and her colleaglles reviewed 170 stlldies rhar ser our ro derermine if fruir and vegetable consumprion affected cancer risk. 98 Results showed rhar 132 of rhose srudies showed a dear Cflnt:er-protective benefit rrom rhese planr foods. Only 4 studies our of 170 suggested a sratistically signiflcam increased risk of cancer. The other 34 studies were indeterminate. Let lIS consider a simple law that applies

123

PROOF POSTTIVE w statisrical srudies. Jf there is a true relationship between nvo things, and you do nearly 200 srudies, you would expecr rhe vast majority of them ta disc/ase rhat re1ationship. BecaLlse of rhe narure of statisries, however, you wouid expect SOll1e scuc\ies ro be indererrninate, and a few srudiesjuSt by chance-will suggesr a relarlonship in rhe opposire direction of rl'uth. Such is rhe case wirh Block's analysis. In summary, fruirs and vegetables emerge solidly as cancer-pwrective foocis. Perhaps rhe most imponant point of Block's repon Îs that she was not looking exclusively ar vegetables grown organically. These nearly 200 srudies simply looked ar rhe foods rhat the average person is accustomeel ta eating. Likely, most of rhe fruits and vegetables lud been spraycd with pesticides anei grown wirh fenilizers. le is deal' rhat, far from plltring us ar cancer I'isk, fruirs aud vegetab1es-even if grown wirh fenilizers and pe ,ticide -help us prewnt

cancer.

Jnspiration lnsights Because I quore inspired sources rourinely ancl believe in rhe accuracy of the Bible, I am ot1en asked Biblica! quesrions about fish. A common query is: if fish is nor an ideal food, why elid Jesus eat it? (ln faet, dus is ilie only animal product the Bible explicitly records being eaten by Jesus), First, the fish that Christ consumeel in His day were lIneloubtedly much healrhier than the marine life available ro llS currently, IndusrriaJly pollured \-"arers as we have today did not exisr in the rime of Christ and chemica.! pesticides were unknown. Second, alrhough the Bible presents Jesus as aur example, it does so from the perspecrive of His characrer-not from r.I1e minute derails of His life. JUSt as "being like Jeslls' doe.s not mean moving ro Palestine ro live, oeirher does it imply thar we will ear fish as He clici. However, Gad did record in the Scriprures His original intenrion for rhe e1ict of mankind: a total IJegetarian diet. 99 Mear and fish are not included in this

124

original diet, but c1ean mear wirhollt rlle fat were not (Otally prohibited in Chrisr's day. Christ's ex:unple. in t":lcr, does show (har Goel cliel nor rigidly enforce His original diet, bur m:lele aJlowances for rime and circull1srances. However, rhe book of Genesis also indicares rhar rhose \Vho consumed :l vegetarian eliet lived substantially longer than (heir offspring who began ro incorporate mear into rheil' dieL This can be een by comparing rhe long life span of the generarions that lived before "Noah's" flood with a s(eady decline for (hose who followed iL 100 Chapter 7 on protein, Figure 27, documems rhis life span decline. Of note. ilie Bible records (har ir was aher rlle fload that God gave bumankind permjssion ro ea[ animal f1esh. 101

Conclusion As a physician I find deep satisfacrion in helping sick f01ks regain their health and "igor. But there is somerhing eqllally and perhaps even more sa(isfying and rhat is helping indivieluals understand bow to prevenI illness. ham aII rhe research we now have an rhe causes ofhe
THE TRUTH ABOUT FISH Refere1lCl's ) Diagno ti Dilemmas: 1'00 Much of a Good ·n,ing. Choleslerol ,md CoronalJ' Hean Disease... Rcducing the Risk. 1987; 1(5); 13-14. ~ Krol11hour O, 805';chieler

EB. de Le-lcnlle Coulander C. The invers(' reblion betweco fish cOIIsurnplion and 20-rear morraliry from coron'lry hean disea . N tilgl} Ivled 1985 Mal' 9:312(19): 1205-! 209.

1 Phillipsoll BE. Rothrock DW, et al. ReduClion of plasma lipicls. lipoprotcins. and apoprolcin. bl' diclarl' fi h oils in pariellts wirh h)'jlewigl)'ceridcmia. N Eng!} Med 1985 Ma)' 9;312(19):1210-1216. I Lee TH, Hoovn RL. el al. Effecr of dietary ct
~ Di:\gnosdc Dilemmas: 100 much of a good rhing. Choleslerol and coronary hean dise:\Se... Reducing U1C risk. 1987; 1(5); 13-14. (Nore: Nt1mes

d!llllged ro prorea IlIIOJJ)'mity). \I;/jlt TJ, Lofgren JU" et al. Fi h oii supplemcl1t:l.Iion docs nor lower p!: ma. cholesterol in men \Vith hl'percholcsrerolel11 ia. Resulrs of a raIIdomizoo. pbc.ebo-cormollecl cros over slud\'. AnJJ ltl/l'rn Met/1989 Dec J: 111(11);900-905. . Slrlukawa M. Abbcy M, er al. EfTecr.s offi.sh oii farr)' acids 011 low densit)' lipoplOlein size. oxjJjzabjlit)'. and uptake b)' m:tcrophagt'S. } I.ipid RfS 1995 MaI;36(3):473-484.

1

The foood Processor for Windows: Nutrilioll Analllsis & Fimes. Sofn,.,arc !computer program]. ESHA Rcsearch. Salem, Or;gon. ,/ Bair:Hi (, Rol' L, Mel'er F. Double-blind, randomized. cOlllrollcd tri:u of lish oiI supplemcms in prcvcnriOll of recurrellce of slenosis afler coronary angioplasry. CimdtUion 1992 Mar:85(3):950-956 KromhoUI D. 130sschieler ER. de Lc""lenne Coulander C. Tbe inverse rdarion bctwc'Cn lish caJlSumplioll and 20-l'ear lllorraliry from coron.ry hean disease. N E1Jg!) Med 1985 Mal' 9;312(19):1205-1209.

1

.onnor \XfE. Davidson M. er al. Alternative approaches ro lower'ng chole ·rcrol. Patimi Cirre 1995 Nov 15. p. 110-133, 11

J: I..caf A. Weber Pc. Cardiovascular dTects of n-3 fanl' acids. N /:.ngLJ

Mrrl1988

~v"'r

3;318(9);549-557.

11 Lorcnz R, Spellgler l), CI al. P!are!er funClion, lhromboxane formarion and blood pre urc comrol during supp!cmenratioll of rhe Wesrcrn diet "ilh cod livn oiI. CirrultUi()ll 1983 Mar;67(3):504- 511.

14 Margolis S. Dobs AS. NUlrilion:u managemelll of plasma lipid disorders. } Am Co!1 N"tI· 1989;8 SuppIO:33S-4 5 . 1< I..<.-ai· A. Wcba Pc. Cardiovascular eAecrs of ,,-3 fim)' ac.ids. N EJlg!} Mt'lt 1988 M.1f 3;318(9):549-557. 1(, Culp 13R. L1nds WEM, er al Tbe efieCI of dielat')' supplemelllalion of lI:h oii on experimental m)'ocardial infarction. I'ro>foglol1dil1s 1980 Oce;20(6): I 021- J 031.

11 Dehmcr GJ. Popma.JJ. et al. R..dUClion in rile rare of earl)' reslenosis afier coronar)' angioplasl)' bl' a cliet suppIemenred wilh n-3 falry acids. N EI/gil Mrd 1988 Septembc'r 22:319(12);733-740.

l8 Et;rsland J, Arncsen H. el al, EfieCI of dieraI)' sllpp!cmelllalion witil n3 f,nr)' a ids on coronar)' "ner)' byp"ss grnfl parenC)'. Am} Dmlio! 1996 J~n 1: 77( J ):3 J-36. lry Krolllhour O, Bosschieter EB. de Lezennc COlllander C. The inverse rel~tion benveen fish consumption and 20-year monaliry from coronary he:lI'l dise:lSe. N EnglJ Ml'd 1985 Ma)' 9;312(19):1205-1209. Phillip R. Lemon F. Kuzma J. Coronar)' hean disease monaliry among Scventh-D~)'Advenrists wilh differing diet.1I'j' habit.~. Am} Clill NIII" 1978 Ocd 1(10 Suppl):SI91-S 198. .'D

Il Aschel'io A, Rimm EB, CI al. Dielary illl;tke of marine 11-3 fanv acids, fish intake, and the risk of coronary dise:l e alllong men. N EllglJ M<'fi 1995 Apr 13;332( 15),977-982. Pielinen P. Ascherio A. el:U. Inr:lke of farl)' a ids and risk of coronar)' hean disease in a cahor! of Finnis" mCIl. The Alpha-Tocopherol, BeraCHOtelle C. ncer Prevention Srlld)'. Am} Epidemio! 1997 Mal' 15; 145(1 0):876-887. .

11

, RJ)~um'lIoid An!lltri!is: Shapiro JA. Koepsc.1I TO, el al. Diet and rhculIlalOid anhrili. in womcn: a possible proreclil'e effect of fish c.onSllmpdon . .Epidnniology 1996 May:7(3):256-263. Rt~)'Jlt1l/d's Dismsc: DiGiacomo RA. Kremer JM, Sha" OM. foi.h-oil diCla')' upplementation in p.ti.enr.s wilh Illynaud's phenomenoll: a doubleblind, cOlllrolled. prospective slUd)'. IIm) Med 1989 Feb:86(2):158-164.

Psoriasis: Grimlllinger F. Ma)'ser P. el al. A dOllble-bllud, r:lOdomizeJ. placCbo-colllrolled lrial of n-3 farrl' acid based lipici inru.sion in aCUle, C;(lended gllrtale psoriasis. Rapid improvcrncrH ofclinica! manifesrations and chan·c.s in nellrropilillellkolriene profile. C/in InlJesrig 1993 f\llg;71 (8):634643. CI Ulcer!: Thompson L. Cockayne A, Spiller Re. lll.hibitory cffece of pol)'linsat urawd fali)' acid un the growlh of Hei icobacler p)dori: a possible cxplanalioo of Ihe cffect of diet on peptic ulcerarion. CU! 1994 ov;35(11): 1557-l561. U!((rariv~ Coliiis: Slenson \'lE COr! D, el' al. Dietar)' supplemcnralion with fish oiI in uIccrativc coli ris. A1I7J IlIfl'I'J1 Med 1992 ApI' 15;116(8):609614.

Bellu~l.i A, Brignola ,el al. Effecl of 311 emeric-c.oalcd li.sb-oiJ preparation on rdapses in Crohn's disease N Ellg!} Med 1996 Jun ) 3;334(24): 1557-1560.

Crolms Disease:

Depre iOIl & OfJCr-Aggn:Hivl?ws: Hibbeln JR, SaIem N Jr. Oielar)' pol)'unsarurarcd farry acids and deprcssion: when chol~ lerol does nOI s:lli f)'. Am J CLin Nllţ,' 1995 Ju\;62( 1): J -9. Bmm Callar: Rose DE COJlJIOII)' JM. Effecls of dietar)' omega-3 falry :tcid on hU1l1an bre:.t.
COPD: Shah;lf E, [:0150111 AR. et al. DiCla')' n-3 pol)'u.n a(mared fau)' . cid and smoking-relarcd chronic ob uuclive pulmonar)' disc-ase. t\therosclerosi Risk in Comrnunities SI ud)' InvesrigalOrs. N En !} Mtd 1994 JuI 28:331 (4):228-233. ~. Geusen< P. Wollters C, el' al. Lollg-rerm c/TecI of omega-3 fatl)' acid supplemenralion in ae[ive rhcumaloid arrhrilis. A 12-momb, doub1e.-blind, comrolled slud)'. Arlhrilis Rltelltll 1994 JUll;37(6):824-829.

2, Espersen GT. Grunnct N, et al.

Decrea.sed ilJlcrlellkin-1 bela level in plasma from rhcull1alOid anhritis p:llients afler dietarl' supp!emenlaljon witb 0-3 poJyunsaluutcd f:urî' acids. Clill RJlt'fItttt1toL 1992 Sep; II (3):393395. I6 Nakamur.l N. Hama'l-.'lki T. el al. The efrect of oral islution of eico apenlacnoi amI docosahexaelloic :tcids on acute inOammalion aml f:lHy acid colltposiriol~ in rats. ) Nllir Sci VitomilloL (Tokyo) 1994 Apr;40(2); 161-170.

DiGiacomo RA, Kremer JM, Shah OM, Fish-oil dietar)' suppiemellration in patiems \Vith Raynaud's pb,~nomcnol1: a double-blind. comrolled. prospect;ve stud)'. Am} Mcd 1989 l'eb;86(2): 158-164.

27

1J) )3:111 EV. Koopman WJ. Rheul1aloid Anhrilis. In: Kcll)' \'V'N. DeVita VT J r.. edilOrs. el al. Ţ,'xr Book of Inrerna! )\1,or.iieine-2"J cditiotl. Philide1phia, PA: J.B. LippÎneoll Compan)'. 1992 p. 914-919.

125

PROOF POSITIVE

r.

J9 Grimminger F, Ma}'ser el .11. A double·blind, randomized, placeboconuolled lrial of n-3 farrl' acid ba cd lipid infllsion in aCUle, eXlended gurrare psoriasis. Rapid improveJllCIll ofdinical manifesmÎons and chan<>es in neulrophilleukolriene prolllc. CIi" IJlvmig 1993 Aug:71 (8):634-643.

Fr.lti C. Bcvilacqua L, Apostolico V Associalion of e[felinare and ftsh oii in psoriasis [herapy. Inhibirion of hypenriglyccridcmia resulting from rcrinoid lherapy afrer ftsh oil upplemcnrarioll. Actl/ Dfrm Vtrlt'reo/ Stlppl (StOckh) 1994; 1860: 151- J 53.

30

Thompson L, C.-ockayne A, SpiJkr RC Inhibirory efreC[ of polyuman'ra[Cd farry acids on rhe grewth of Hdicobacter p)'lori: a possible e.xplanalion ofrheefrectofdiet on peplic u!ccralion. G"t 19941 0\';35(11):15571561.

31

Rose OP. Connolly JM. EAecls of dierary omega-3 faul' acids on human breasl cancer growth and mWtstasc in nude mice, j Nt1t1 Gmca /wt 1993 Nov 3;85(21): 1743-1747.

31

33 Narisawa T. FlIkaura Y, el al. Colon "''Ulcer prcvcnrion witil a small amounc of dielaty periUa oii high in alph'l-linolenicacid in an animal model. GilllUY 1994 Apr 15;73(8):2069-2075.

Lindncr MA. A ftsh oii diel inhibils colon canCer in mice_ Nun' Grnccr /991;15(1):1-11.

SI Food and Dmg A
;J MiJJer

RW. Get Hooked on Seafood Safery. !-DA COlIstmuy. Junc 1991

p.7-11. ;3 Food and Om!; imaljon (EDAl dala according 10: Sdwdt D, Schmidr . Fishiog for Safe SeafooJ. N1ItritioJl AClioll Hel/lrh Lrr-tel' 1996 Nov;23(9): 1,3-5.

>4 Miller

RW. GCl Hooked on Sea/ood S~fcty. FDA Cowumer. Junc

1991. p. 7-11. ~ L,1Sr JM. WaHace R13. editor. food poi.\oning. [II:

Mrl.l'cy-Rose1/rlll-LiU/ Public HMltb El/Iti PTI:llt'l1Iitle Medi";/le. Norwalk. Cl": Applcron & L"ngc.

19921'.193-201. 16

Lange WR. Ciguatcra fish poisoni ng. Am FEtm Physiârl/l 1994 Sep

1;50(3):579-584 ~7 Lasr JM, W:1.lIaec RE, edilOrs. Food poisoning. [o: Mf1XC)~RosmElu-Lrut

Public /-Irairll /Ind PrCt/emili" Metlicinc,

orwalk. CT: Applelon & Lange,

1992 p. 193-201.

J4

Stenson WF, Con O, el al. Oielary supplcmcl1tarion wiril tîsh oiI in lIiceralive colilis. Ann Inrcrn Med J992 Apr 15:116(8):609-614.

.1;

Uauy-Oagach, R, Mena P. J ulrilional rolc of omega-3 Eury acids during (he perinalal pcciod. C/in Perinlllo/1995 Mar:22(I): 157-175.

36

American Acaderny of Pcdiarrics. The usc of whale c.ow·s milk in inf:lllcy. Pedil1tric; 1992JlIl\;89(6):1105-1109. 37

LUC.1S A, Model' R, et al Brc:m milk ;Ind wbse.quellr imelligenec qlloUCIll in ehiJdren born prClcnn. Lan,..., 1992 Feb 1;339(8788) :261-264-

38

I-libbeln JR. Salem N JL DiCla!}' poll'unsalurarcd Ellry acid, and de· p=ion: when choleSlcrol docs not 5-1risfy. Am j C/in Nun' 1995 JuJ;62( 1): 1-9.

39

Giani E, Masi 1, Galli C. l-lealcd far, viramin E ane! vascular eicosanoids. Lipids 1985 Jul;20(7):439- 448.

1,0

Piehe LA, Draper HH. Cole 1'0. Malolldialdchyde excrelion by subjccls consum ing cod liver oii v. a concCf1lratc of 11-3 farry acids. Lipitfs J 988 Apr;23(4):370-37 1.)

41

42

Stone NJ- Fish cOllSumplion, flsh oii, lipiJs, and coronary he:m discase. ov 1;94(9):2337-2340.

Cimdlltiolt 1996

Glauber H, WaJlace P, el al. Adverse merabolic <"!TecI of omega-3 falt}' acids in non-insulin-dependclll diabet mellilu. AnII iltUrtI Mrd 1988 Mal'; I 08(5):663-668. 3

.. Rogers S, James KS, cI al. EfTecls of a tîsh oii supplcm"'nl Oll enUll lipids, blood prc.~urc, blceding lime. ha<"JIlo talic and rheologiGll v:lriables. A double blind tandomized colltrolkd Ui:1J in heallh)' voluJHccrs. AthertJiderOiis 1987 Feb;63(2-3): 137-143. 41

Middallgh lE Cal'diovascular Jealhs among Alaskan

ati,'c, 1980-86.

Am j Puh/ic Hcrr/th 1990 Mar;80(3):282-285. Bairali.l, Roy L_. Me)'cr F. Double-blind. r~ndomized, coTllroHed triat of fish oiI supp!emcllls i Il preveTll ion of recllrrence of srcn05is aticr coronary angioplasry. Cin:ulAtioli 1992 Mar;S5(3):950-956. 6

·17 Ycriv JZ. Clinic:ll appliellions of tî,h oil5.

JAMA 1988 AlIg 5;260(5):665-

670. .. Yeliv JZ. C1Înical appliearions offish oil . jAlvJA 1988 Aug 5;260(5):665670. ~9 Thc Food f'roc<:ssor for Windows: ulriljon Analysis & Fitness Soflware [computer program). ESHA Rcscarru. Salem.Oregon. 50 YctivJZ. C1inical applic:uiollS of fish oik 670,

126

JAMA 1988 Aug 5;260(5):665-

;8 Lee Wedig of Narional Fisherics Instilllte as quored by: Schaldl O. SchmiJI S, Fishing foI' Safe St,afood. Ntltyirioll /IctiOft Ht'rr/th Lcuer J996 Nov:23(9): 1,3-5. -

Miller RW. GCt Hooked on Seafood Safery, FDA COIISuma. Junc 1991. p. 7-[ \.

10

60 P:lncorbo oc. Barnlurt HM. Microbial palhogcns and ÎndÎcators in estuarinc envil'OnmelH a_ud shellfish. jOt/ml11 ofEnvirOllmmfl1L Helflt1J 1992 Ma(chlApril ;54(5):57 -63. 61 Pancorbo O ,Barnhan HM. Microbial pathogcns and indicators in csluariJ1C environmel\ls and shellft h. jounflfL ofEnvirvl1/11l'lIlrlf Hmlth 1992 March/April;54i5l:57-G3. 61

Schardl D, Seh miclt S. Fi h illg for Safe Seafood. Nurritiol1 AaitJn Hel1/tI)

Lma 1996 Nov;23(9): 1,3-5. 63

Schardl O, Schmidt S. Fishing for Safe Se:tfood. Nt/rririo7lActioJ] Ht:i1Lth

L<'tur 1996 Nov;23(9): I ,3- 5. 6.{

Food and Drug Aclmillisllalion Pesticide Prog(anl. Residue MonilDring

J 992, jOl/ml1l ofthr Associlttioll ofOjjicial Amilytical Chemisrs. Volumc 76: Seplemb
Sch'lrdt O, Sch midl S. Fish ing for Safe Scafood. Ntltyition Acriorl Hel/ltb

Lmn- 1996 Nov;23(9):1,3-5_ W'axman M F. Whcn pest control gers Hl'I1/rh alul Si1Jery. Ma}' )993:81-87.

66

OUl

of

COIll rol.

SdVlcidcr K. New pesticid, plan pUlS safetl' ftrsl. 143: 49,461 (Septclllber, 21,1993), p. A19.

67

Occt/plltioll111

TI),. N(IV York Tinm

HulrJ', Hasernan J-K. Ncws Forum. Rjsk assessmenl of pesticides. ExposUl'e ro certain pcsticides ma}' pose real careinogcnic risk. ClJl'llliarLl1Iul Engilll'l'YiJlg Ncw! 1991 ;69( 1):33-36. MorcU V. Fi.lhing for uouble, A canCl'r idemie in ftsh i.s warning us: You ma)' be nCxl. [nti Wildlife 1984 Jul/Aug; 14(4):40-43.

69

More-II V Fishillg for nouble. A ca.ncer epidemic in ftsh is warning lL\: You mal' b nexl. bul WildliF 1984 Jul/Aug; 14(4):40-43.

70

71 Craig W). Fishing for l-i-ouble. 111: Nurrjrioll For The N;'tefiu. E~u C1aire. MI: Golden HarvCSI Books. 1992 p. 76-84.

7! EnvironmeOlal Prorcction Ag<"llcy (EPA) , Nalion.J W:1ter Qualil)" 111\'<'IIlDr)'. 1994 Rep0rl ro Congre- S. Pg. 141,

Envirollmelllal Prorcclion Agcnc)' (EPA). venlOry. 1994 Repari to Congress. Pg. 143

7J

alional Walcr Qualit)' In·

Craig WJ. Fishing for TrOllble. In: NlI/Tition For 7he NinericJ. Eall C1airc MI: Goldcn Harvcsr Books. 1992 p. 76-84.

74

THE TRUTH ABOUT FlSH 7}

Nadalavllkarcn A. Pesr, and PC5ricide5. ln: Mall and ElivirOllllli'IJt, A

Henlth Pl"f"spcClivl', TlJirr/ EE/ilioll. Prospecl f-Ieighls. IL: \'iZweland Press. 1990. 76

N:l<J,.kavubren A. Pest.> and Pesticides. In; AI",) ""d Enviromnmt, A

Hta"h Pcnpmive, TlJird Edirion. Prospect Hcighrs. IL: Wavdand Prcss, 1990. U.S. EPA. omcc ofScience and Technolog,v. Office ofWarer. Guid:lace for assessing ehel1lic:u eontaminanl dJI~ for mc in fish advisories. Volume 1: Fish Sampling andAnl1lysis-&condEdirion. Seplembcr 1995. : EPA 823-R-9S-007; p. 1-1.

17

n Fa! k F J r, Ricci A. J r,

al. Pest icides and poly h!orinated biphenyl residues in buman breasl lipids a.nd their l'c1alion tO breasl cancer. Arch t.lwiroll Hl'IIlth 1992 Mar-Apr;47(2): 143-146. CI

sa.

19bedioh EilcCLS of agriculllmlJ peslicides on humans, anim:us and higher plJllts in developing cOllnrries. Arch blViron Hetrlth 1991 Juli\ug;46(4):218-224. 79

'o

Nicoh. RM, Branchf10wcr R. Pieree D. Chernical COlltalllinJlllS in bOl10rnllsh. JOIITfla! ofEn/Jir01l1ne11lIJ/ Hm!th 1987:49(6):342-347.

Hovinga ME, Sowers M. HU1l1phrey HE. Environmenral exposure and lifeslylc predi "tors oflead. ciurn. PCB. 3nd DDT le"e1s in Grear Lakes ftsh calces. J]rc!J Environ HMlt!J 1993 Mar-Apr;48(2):98-1 04.

SI

. R()~ent11an KD. Dioxin, po!y,.!JIoriI1lJled biphm)'Lf, fwd dibmzofim1lls il} EIII}Îronmem"! Oallpl1rionl1/Ml't/icine-Z'" ediiion (editor: \X . Rom). B()SIOII MA: Linie Brown and Co. 1992 p. 927-933.

,,,,ti

Dioxin. po/ychlori1111ud biphm)'ls, IlrId dibmwfimJll( in Elwironl)Jl'IItJlll1nd Ocmpt1riowtl M,.dicine-2"" rJition (editor: W Rom).

'.1 Rosenman KD.

Boston

~{A:

Little Brown and Co.. 1992 p. 927-933.

-.( Colbom T AnimallHea.hh Connection. In: l'roceedings oflhe VS tiwiroml/mllll Proreci;on Agemys NtltioJllt! Tt'chnil'tl! \17orks/JOp "PCBs i,1 flsh lIJJUe." Septcmbcr 1993. EPAl823-R-93-003: p. 2-27 ro 2-30. , Colboftl T. AnimaJ/I-\calrh COllncclion. In: Proce,.dings ofrbr VS EnvirOllmmlll! Prorection Agmrys Nn/ionn! llc!Jnicn! Work.shop ''PCBs in Fis!, Timll'." Septernber 1993. EPAl823-R-93-003; p. 2-27 to 2-30. Jacobson JL Jacobson SW. lnlellcclual irnpairment in children e.xposed poJychlorinalcd biphenyl in utero. N Engi J Med 1996 Sepl 12;335(11):783-789.

Rosenman KD. C/JI'Il}i"t! C()11l1lmiruui()n EpiJodes in E1JviromnC1lttr! tJml OXl/pa/io1JtllMtttirinl!-2"d rdition (editor: W Rom). Boston. MA: Linie Brown and Co., 1992 p. 935-940. i<8

S9 Swain \'q.R. EfieCIS of org;mochlorine chemic.ls on the reproductive olltcome of humans who cOllSumed conlaminared Greal L'lkes l1sh: an epiJerniologic considerarion. J Toxico/EllIfiron Hen/tiI 1991 Aug:33(4):587639. 90 Freudenheim JL lliar hali JR, CI al. Exposure ro breasr milk ln lnL1ncy and rhe risk of breasl cancer. Epidemiology 1994 May;S(3):324-331.

~l Jacobson MF, Lefferts

LY, G~rland A\Yf. Fish .. nd shellfish. In: Strfi'food: Efi/ing llJisd)' il/ a risky //Jor/d. Ven-ice. California: Living Planer Press, 1991

p.118-130 ~l The Food Processor for Windows: Nutrilion Analvsis & Firness Soft-

ware [computer program]. ESHA Researeh. Salem,Oregon. MeSI I-l), Beia J cr al. The influence of lin eed oiI diel on falry acid panern in phospholipids and mrombox:lJlc formation in plalclers În mall. X/in V70rlmuc/'r 1983 Feb 15;61(4):187-191.

9

Cunnane SC. Chen Z-Y. el al. Alpha-linolenic acid i1l humans: direcI f1ulcrion colc or dictary precursor? Nutrition 1991 Nov-Dec:7(G):437-439.

94

de Lorgeril M, Renaud S, ee al. Mediterranea.n alpha-lino1enic acid-rich diet in secondar}' prevcnrio!l of coronary bearr disease. umcer 1994 Jun 11;343(8911): 1454-1459.

95

LJ, Boyce G. Zuricr RI3. TrealmelH of rhcumaroiJ arthril-is \Virh gamrnali!lolcnic acid. Ann Intern Med 1993 Nov 1; 119(9):867-873.

% Levemhal

7 19bedioh 50. Effecls ofagricultura.1 pt'Slicide.s on humans, animals. and higher pbnrs in devcloping collntries. Arc/' Environ Hcalt!J 1991 JulAug;46(4):218-224.

Block G, Panerson R, Subar A. Fruit vegclablcs, and cancer prevenlion: a review of the epidemiological evidence. NulT CrlTlcer J992; 18(1): 129. 98

99 100

11

Gene~is 5:1-22, 11:10-32.

Tbe Holy Bibk. AUlhorized King James

version.

16

10

Gencsi 1:29. Tht Holy Eib!". Authoriud King ):uncs "<:rsion.

101

Genesis 9:3. 17Je Ho~y Eib!r. Authorized KingJamcs version.

102

3 Jolul 1:2.

Tiu Hol;' Siblt. Authori7.Cd King James version.

Mail1e issucs mcrcury warning reponcd Junc 29. 1994.

127

PROOF POSITIVE

128

CHAPTER SIX _ • •_

ONE NATION UNDER ~SSU

( I

aU seemed 50 hard (O believe. Jolul had been [he picture of healrh. Now, a( 62 years old, he had gone from eEO of a Fortune 500 compa.ny to a nursing home residem. It had been six months since hjs devastatîng suoke and rhe docrors heJd linIe hope of any significam recovery. Whar John had anen referred ro as "just a lirde high blood pressure" now took on new significance. Hîs physicians said [hat rhe srroke was undoubtedly due ro his poorly cOlllrolled blood pressure. Although John did not die from the ravages of high blood pressure, his situation iUustra(es why the condi(ion is oft:en referred (O as "(he silent kiIler." High blood pressure (a1so called hypertension in rhe medical lileratlJre) often does irs damage wi(hout warning. Indeed, the disease has lifelong and life-shorrening implicuions. In lhis chapter we wiIl explain whar high blood pressure is, what causes ir, whar damage jt does, and how Il can be colltrolled without medication.

Measurement ofBiood Pressure Each time the heart beats, i[ sends a blood pressure pulse down [he arm. The force of this pulse generates rhe sysrolic blood pressurc. The systolic measuremenr Îs the "top llumber" of the blood pressure

reading. After each heart beat, rJle hearr rests for a fraction of a second. The pressure in the blood vessel during rrus resring phase drops, and is called the "diastolic pressure." It is measured by the "bonom number" of the blood pressure reading. Blood pressure is relatively simple ro determine. You can measure it yourselfwith a device called a sphygmomanome{er ("sphyg" for short, pronounced "sfig"). The sphyg is made up of a heavy dury baJloon ar aiI' chamber thar lies inside a band ofdo{h called the "cuff." The cuff is wrapped amund the upper arm and the baHoon is filled wirh air. The increasing pressure in (he balloon eompresses the artery un tii blood flow to rhe lower arm is eompletely shur off You then graduaJly decrease the cuff pressure. During rhis time you are listening over {he anery with a stcrhoscope and warching a scale that records (he amOUJlt of pressure in the balloon. As you decrease {he cuffpressure ro the sysrolic pressure level, you will begin ro hear the pulsil1g sound of tlle heart beac. This indicates the rerum ofblood flow in {he artery. The number an (he measurement gauge at that installt is recorded as the sysrolic blood pressure. As you continue ro slowly reduce the pressure in {he cufT, {he plllsing sound conullues ulltil it suddenly cannor be heard.

129

PROOF POS1TrvE

?

How High is High?

•

Blood pressure is measured in millimeters (mm) of mercury. This dares back ro

..;.~.;;;;,;;;;..;;;;;;...;,;;;;;....;.,;;..---------------

High blood pressure (greater risk of disease)

above 140 or abovc 90 90

-----

Blood pressure that iocreases the risk of disease Optimal blood pressure

130 to 139 or 8S lo 89 (high-normal) 130

8S

120

80

120 to 129 or 80 to 84 (normal)

below 120 and below 80

Numbers opply 10 /IIJulrs who are noI laking Jmgs 10 Jower Illeir blood pressure. .lIyour sysloJic and Jias(o/ic pressures loJI inlo differenl calcgories _J'!}.l!..r ~i1k depends on Ihe higher calegory.

Figure 1

The pressure at which chese soullds disappear is recorded as rhe diasrolic pressure.

Some Causes OfHigh Blood Pressure Arteries are muscular organs [har can borh contracr aud expand. Excessive contraerion or sti ffen ing ofthe artery walls raises blood pressure. Hormones can also raise blood pressure. Some organs such as rhe kidneys and adrenal glands are espeially important ro ilie hormonal regulation ofour pressure. However, the major cause ofhigh blood prcssure is a lcss rhan optimallifesryle. Most people have some rendency ro high blood prcssurc; wherher chey develop the problem anei how soon rhey do, is large!)' a function of rheir everyday decisions. Ofcourse, there are rJ10se unusual people who seem to be generically immllne ta bypercension. You may know of someone who does everyrhing wrong-but stiH has a normal blood pressure reading. Even if rhac person is a close relarive, do not assume mat you can bear [he odds. There appears ro be many genetic factors thac have eidler a direct OI' indirect bearing on blood presslIre. lr is unlikely tlur your generic makeup is idenrical ro any relative in aII of those respects.

130

me days when aII sphygmomanometcrs used a column of mercur}' to record rhe pressure. The medical world eoday divides blood pressure readings imo faur levels of . k as s hown In . p''Jgure I .'1 1 ns Norice dur rhe safest blood pressure range i characterized by an average sysrolic pressme of 120 mm of mercury ar lower, and an average diasrolic presSllre of80 mrn ar lower, ac rest. Every person should srrÎve ro get his ar her resri ng blood pressure inro chis "120/80 mm or less" range. Highrr pressu re , carry increased risks of disease and premature deach. J However, rhe most carefuJ research suggests ehat lowering ehe diastolic blood pressure below 80 furrJ1er lowers one's risk of heart arrack ,mei seroke. In fact, there is Ha ehreshold ar which fllfther lowering of diastolic blood pres ure (DBP) does not give further lowering of risk ofborh he:lrt disease and stroke. 4 For example, a DEP of 70 is benel" rhan 80. A diastolic reading of 60 is bener stiH. Control of blood pressure begin§ with knowing whar your blood pressure is. Do not aSSllme dut just because you feei fine you are free of a blood pressure peoblem. I-ligh blood pressure is indeed G11lcd "rhe silent killer." It has this name because serious disabiliry or dearh is ofte.n rhe ver)' fim sympCOm of hypertension. Many people wiJl never reaJize rhat their blood pre,~sure is high unless [hey ger it checked bya docror, go ro il screcning program, ar get a blood pressure instrument and check il rhell1selves. In faer, it is common for people ro feeI tine with blood pressures of 200/ 100 or e.vcn higher. Indeed, you may feel grear \vhile being uuwiningly on [he verge of a disasrer such as a sudden scroke or heart arrack, or gradual kidney damage wich resulring renal failure down the road.

Prevalence ofHigh Btood Pressure As man" as 50 mÎllion Americans h;wc eJevared bl~od pressure. 5 This is ddined in Figure 1 as a systolic blood pressure of 140 mrn or more and/or a dia8rolic prcssure of 90 mm or more. Despice improvemenrs in

ONE NATION UNDER PRESSURE awareness and treatmenr, as maoy as 35 percent ofAmericans wirh dcvared pressures still are nor even a\v;u'e r.har r.hey have a probIem. 6 Even among rhose rhar knO\'". rhey have a blood pressure problem and are an medication, onll' about half of them reaUy appear tO have rheir pressure undeI' conrroI.7 Even iJl'ou recendy had yom blood presstire checked and do nOt have high blood pressure now, do nor assllme dur yOll never wil!. As il person ages, blood pressure tcnds ro rise. In [he U.S. the average person's systalie pressure rises by 15 poinrs between me ages of 25 and 55. About 60 percenr of Amerjcans aged 65 ro 74 have high blood pre sure. 8

Dangers OfHigh Blood Pressure

c • Stroke

• Aneurysm

• Congestive heart faHu.re

• Kidney disease • Disease of the retina

• Hcart attack """"';.Jf,K\W

• Atherosclerosis ("hardening of the arteries")

•

Blood vessel rupture

• Weakened memory and mental ability

What damage can high blood pressure Figure 2

do ro your body? There are many diseases assoejated with bigh blood pressure. The major ones are shown in Figure 2. 9 • 10 Stroke, the fi est maladl', is caused bl' hypcrrension through at least rwo differenr lllecharlisms. Firsr., bigh blood pressure predisposes individuals ro arherosc1erosis (often ca/Ied "hardening of the atteries"). In ,his process, large and medium sized arteries u1roughout me body become narrowed bya buildup of f~my materia!. Arherosclerosis commonly strikes the vessels in [he head and ncck that carry blood tO the brain. Evidence testifies mar high blood pressure Gln darnage the cdls rhar line these blood vessels. This damage appears ro be one of [he ways rhat me process of atherosderosis is initiated or perperuJred. \ I The bodl' does nor sir idly by as its vessels accumulatc far. It responds by covering the fatr.y deposits wirh a rough fibrous cap. This is an important response. Iffatry material comes inw direct with blood it can stimulate rhe blood tO dot. The /lbrous cap helps ro ensure thar such an cvent will not OCCUf. It is acruaJly tlus du;u process whjch gives atherosclerosis it.s name. "Amero" refers ta the "mush}/' or "gruellîke" fatr.y material and "sclerosis," meaning "hard," designates the bod)"s fihrous walling off of this materia!. Unfortunarell', areas of
pens, the fibrous cap is lost OI' damaged. A combination of flbrous aod farty material is relcascd into the blood seream. A now smaJler, eroded fauy deposit is left on the ancry wall; this is called an ulcerated plaque. If a plaque in a blood vessel sllpplying the brain breah down in this way, the resuII can be a "mini srroke" or TIA (rransiem ischemÎc attack). These episodes are very similar ro srrokes, but chel' resolve completdy. Full recovery occurs withill nunutes to hours. Worse l'et, however, ulcerated plaqlles Gtn activate platdets, (he c10rting cells of thc body. This often sers in motion a chain of evclHs thar can complctely obsrruct an)' aftcry that is alrcady narrowed by arhcrosclerosis. If complde obstruction occurs in all artety supplying blood to paft of the brain, rhe brain risslle [har \Vas dependent on dur anery will die. This deam of brain tissue is caJled a stroke. A second \vay that high blood pressure causes sHokes is by causîng more severe damage ta brain blood vessels. In this scenaria, cumularive damage ro the artery is so severe that [he vessel ruprures and bleeds. These so-called hcmorrhagic srrokes :lfe particularll' dangerous. The bleeding ofren continues for sOlIle rime. Since the brain is encased in a rigid shcll c-aJlcd Ihc skull, iI has no place ta go when an acculllularÎon

131

PROOF POSITIVE of blood comperes wirh it for roOO1. Thc more blood rhar accumulares. rhe more [!le pressure rises inside rhe brain. If rhe bleeding does nor stop, pan of r!le brain can actuaUy be pushed down duough rhe small opening for the spinal cord. Thisis calJed "herniarion of rhe brain" and generally causes elead, rapidJy.

J\C 5

4

Relative Risk

3

o 110-119 Optimal

120-129

130-139

140 or more

Norm31

lIij:IJ-Normal

Hjgh

SystoLic Blood Pressure Figure 3

6-22 times

greatcr

10 Risk 8 of kidlley 6

failure

4 2

O

120/80

130/85to

140/90

140/90 to 159/99

Blood p"ressure Figure 4

132

ovcr 159/99

Hozo Much Stroke Risk Does High Blood Pressure Cause? Studies have shown rhar the risk of developing arherosclerosis (mainly ischemie hean elisease anei cerebrovascuJar elisease) is five rimes grearer for rhose whose blood presslIre is 160/95 than rhose wirh normal blood pressure. Il Blood pressure's effecr in increasing rhe rîsk ofhean ;}rtack and stroke is illllsrra red in Fi gll re 3. 13 As we have alread)' nored, rÎsk begins ro rise ar rhe 120 ro 129 level even though rhis range îs frequendy called "normal." Risk rises even more Sh
Kidney Failure Caused by High Blood Pressure Kidney f'lilure is anorher disease callsed by high blood pressure, and rhe higher the pressure rhe grearcr rhe risk. In facr, in rhe Unired Stares hîgh blood pressure is the second leading c
ONE NATION UNDER PRESSURE bc no symproms. As rhe disease progresses, a pcrson reods [O dcvelop nausea and fatigue. Ultimare!y. when kidney funcrion bccomcs markedly impai red, dearh occu rs-unlcss dramatic steps are raken. Such steps mar include dialysis ar kidney trans· planr. Wîrhour dialysis machi nes many pcople would die soooer from rhe consequences ofrheir high blood pressure. However, even wirh diaJysis, many experience a shon exrension oftife accompanied by a signiHc.'mr decrease in their quality oflife. For this reason, some people have even chosen 10 die rarher rhan ro begin ar continue with dialysis.

High Blood Pressure and Decreased Mental Ability Numerous scudies have documenred rh;H high blood pressure rhar is nor con· rrolled by lifesryle frequently causes gradual menral decline. One recenrly published srudy showed rhar for every 10 mm of mercllry increase in systolic blood pressure ar midlife, rhere was a 9 percent increased risk of poor inrellectual ability 25 years later. 16

egor}'. This figure confirms rhar a desirable sysrolic blood pressure is less rhan 120. Since rhere are benettts ro having sy.srolic blood pressures of 120 or lower, why do physicians rend ro avoid prescribing meclicarions thar help parienrs drop rheir blood pressures from, sa)', 138 systoLic ta 118 sysrolic? The reason js rhar ali high blood pressure drugs have side efficts. When prcssurcs are only mildly e1evâtcd above rhe ideal; the risk of rak.ing a drug is generaJly greater than the benefit of funher lowering rhe blood pressure. ;-\1so, when deal1ng wirh rhe lower enel of rhe spectrum ofclear cut high blood pressure, rhere is nO consensuS on rhe benefirs of long r.erm drug rrearmen[" One recent srudy dealr with "mild hypertensives," rhose wir.h sysroLic blood pressures in the 140 ro 1S9 range ami diastOlic~ in the 90 ro 99 range. Tbe researchers observed: "concerns have been raiseel regarding rhe appropriareness of long term drug rberapy for mild hyperrensives and rhere is interesr in ilie possibiliry of trearing rhese parienrs wirh nonpharmaco'logic therapy .... "18 Thus, rhere are growing misconceprions-even in

Quality OfLift Reduced by High Blood Pressure The roll that high blood pressure ralees an rhe kidneys reminds us rhar high blood pressure does more than lull. Ir robs uS of qualiry of life. "Morbidiry level" is a measure of rhe illnesses thar cause suffering and decracr frorn life's qualiry. A study relaring morbidity level ro blood pressure is shown in Figure 5. 17 This figure demonsrraecs how rapidly m.orbidiry increases once a person's blood pressure creeps over duc 120 level. It ma)' nor be surprising ro sec rhar rhose wirh a ystolic blood pressure greare r rhan 160 have tour ril1le~~ the risk ofmorbidîry as rhose wirh a systolic blood pressure of Icss rhan 120. The risk doubles evcn when you move frorn less than 120 inco rhe 120 ro 139 range. When one exceeds 140 sysrolic, rhe risk of morbidiry is even greater. Over the 160 level, rhe risk dramarically rises and srays abolit the same in rhe grearer rhan 180 car-

Morbidity ratio

100

120

120-139 140-159 160-179

180+

Systolie blood pressure

Figure 5 the medic~11 communiry-abollt rhe wisdom of lIsing drug rherapy ro trear "nlild" high blood pressure. More are looking ro rhe non-drug or lifesryle approaches.

1.33

PROOF POSITIVE Funher cOll1plicaeing dle picture are ehe subrle side effeets of high blood pressure drugs on qualir)' oflife. 111 one study, phyicians and patienes cOllsistenrly felt d1
E./fie! ofLowering Blood Pressure on Cardiovascular Disease There is direct evidence dlat jf you reduce blood pressure, you decrease ehe risk of cardiovasClllar disease. This is illustrated in Figure 6. 20

RE UCED BLOOD VREREDUCED CARDIOVASCULA DISEASE For the general population, a 3mm decrease in systolic blond pressure would yield: • 11 percent fewer strokes · 7 percent fewer coronary events · 5 percent fewer deaths

Figure 6

134

We see ehat a relativd)' small reduction in blood pressure has a significanr impact on disease of the hean imei blood vessels. Jr is as[Ounding [O consider the implications if aU Americans with high blood pressure wOlUel lower rheir blood pressures by juSt 3 mm. Ae least 27,500 lîves would be saved each year, noe ro mcmion ehe Olany more

people whose lives would noe be markedJy worseneel as a resule of living through a srroke Of hean auack. These facts, combined with rhe ocher inforrnation (har \Ve have examined 50 far, sbollld motivate us ro do everything we can in OUl' own lives ta prevent ar cOITece high blood pressure.

How Can Pressure?

we Lower Dur Blood

aur approach ro blood pressure control depends on the rype of hypertension chae a perSOll has. There are ('\·\'O main rypes of high blood pressure: Secondary hypertension is callsed by orher diseases. There are many examples of dlis. For insrance diseased adrenal glands, the small hormolle-producing gJands 10cated JUSt above che kidneys, can produce excess hormones cilat c
ONE

ATION UNDER PRESSURE

answer. We now know that this is usuallv not the best answer. There are several re;sons for thk 1. Every drug has muJdple potential side effects-including cffecrs an quaJiry oflife thar ofeen go unnoriced by rhe medicaeion . 22 2. High blood pressurc, cven if controlled by medicine (and nor Jifesryle), causes a slow deecrioration of brain maner whidl wealeells rhe parienr's ability and inrelligence. 23 Unconrrolled high blood pressure causes rhe same problem. 3. Less than halfof rhose who take drugs lower rheir presSUre below 140/90. 24 4. The cost of drugs. 5. Lowering blood pressure with medication is not equivalent to lowering blood pressure natllrally. People takjng antihypereensive drugs have higher rates ofhean disease than people who have identicaJ blood pressures wiehour drugs. 25 It is obvious rhar rhe preferred method of conuolling blood pressure is ro adopt lifesryle changes ro bring ehe blood pressure down in a natural way. Since lifesryle caused rhe high blood pressure in the fim place, why nor lower it with lifesryle changes? Is it possible ro reduce blood pressure with lifesryle changes? The good news is thar medical srudies demonstrate that rhis approach does indeed work. Moreover, 1 have scen ie rourinely work in my practice. A logical quesrion is, "How much of a reduction in blood pressure can 1expect ifI am willing ro make lifesryle changes?" Thc answer depends on how much change you are willing (Q embrace. Approximatdy 80 percem of hypenensives wiU be able ro reduce meiI blood pressure co a sah levdwithollt medjcation-if chey accept ali the changes oudined in this chapccr. The remain ing 20 percen t will also be able to lower their pressure to a safe level by combining rhose lifcscyle changes with some am,ount of drug cherapy. What \cind of challges in lifCSlyle will result in lowering blood pressure? We will cire rhree srudies ta answer lhis important question.

Specific Lifestyle Changes for Lowering Blood Pressure The Nationallnscituce of Heahh sponsored a swdy thar demonsrrared rhe power oflifesryle changes co lower blood pressure. Over 900 subjects (men and womeu, black and whice) wich mild hypertension were enrolled in a Iifesryle change program. SpecificalJy, program parricipams initially had diasrolic blood pressures in the 85-99 range (average 90.5). Sysrolic blood pressures averaged 140.4. 26 Some of (he subjecrs were pur on a lifesryle change regimen, while rhe remaitting ones were ueared wim a single blood pressure medicarion. The reductions in blood pressure for (he group rreaced wirh lifesryle challge alone are shown in Figure 7. As impressive as rhis daca is, lifescyle changes of a greacer magniwde than thase in rhis srudy can yield even more impressive reduccions in pressur ".We will explore thar evidence later. Anorher stlJdy derermined rhe efreC[ of just twO lifestyle factors on blood pressure. 17 le involved over 30,000 men, ages 40 to 75, who were categorized as (O rhe amounr of fiber they are and rheir degree of obesiry. The tesulrs shown in Figure 8 illustrare ehat obesiry was rhe largest sillgle factor affeering

LIFESTYLE eBA GES CAN ~AI'UCE BLOOD PRESSURE Four simultaneous lifestyle changes reduced blood pressure:

· Weight loss • Low salt diet · Alcohol reduction • Increased pbysicall activity Afler one year: Average reductian in systolic pressure = 10.6 mm. Average reduction in diastolic pressurc = 8.1 mm. Figure 7

135

PROOF POSITIVE bleod pressure. Obesiry appears ro be one of the most importanr high blood pressure facrors in America. ln rlle famolls Frarningh,un smc!y, fuUy 70 percent ofhyperrension in /nen and 61 percent in women was direerly anribured to inereased body fa(,28 A thirel study involved 73 men anei women with high blood pressure who atteoded a rhree week live-in program ar Weimar Institute in California. Their aver-

CU BLOOD PRESSURE RISK AFFECTED BY BIE A OBESITY Thin men eating ltigh liber Men eatulg low fiber

Obese men

o

2

3

4

5

Rjsk of high blood pressure

Figure 8

LARGE BLOOD PRESSURE REDucno S WITH LIFESTYLE CHANGES Lifestyle challges: • Abstinence from alcohol, tobacco, coffee • Total vegetarian diet • Aerobic exercise Length oftest -- 3 weeks • Average blood rpressure a,t the start 150/81 129/78 • Average blood Ipressure at the end • Percent off of blood pressure medicine = 80% after three weeks Figure 9

136

age age was 65. They adopred a series of lifest)'le changes during dtis supervised program anei reapeel large redllCtions in blood pressure. The resu1rs are shown in Figllre 9. 2 '1 These blood pressure redlletions arc greater rhan tlle reducrions in the fim study' rhe reason is thar more lifesryle facwrs were changed. Over 90 percent of the partieipants were on ar leasr one medication 10 control their blood pressure when they enrolled in rhe program. Thar figure dropped to 20 pereenr afrer rhree weeks; even rhose remaining on medjcine were able ro significantly reduce rheir dosage. The averagc efrecr oflifesryle changes in this study is grearer rh3n indicared in Figure 9. Two sers of changes were nude sil1111ltaneously: ehanges in lifesryle al\d reducrions in blood pressure medjcine. However. redllcing the medicine would oormally produce an average increase in blood pressure, bur the eXl1.ct opposite occurred. Why? Because rhe lifestyle changes had such a powerful effecr rhat rhey more than offser rhe blood pre Sllre increase rhar would be callsed by r.he reducrion in medici ne. Anorher inreresring resulr is tlur over half of rhe cimp in blood pressure occurred in tlle fim week. Blood pressure levels rcspond quicldy ro I ifesryle changes. The above studies ,ue in harmony wirh maoy orhers. Collecrively they firmly demonstrate rhat lifestyle change is a porenr defense againsr high blood pressure bringing quick and positive reslllts. Fatalisrs [ah nore: rhe my[h thar yaur genes enrirely dicrare yOllr blood pressure level has bem com· plerely discredjred. So far, we have seen rhe efrecrs ofseveral lifesrylc facror in combinarion. Are rhere an)' swdies thar show rhe effect of a single lifesryle factor on blood pressure? The an· swer is yes. The rcmainder of the chaprer looks ar research on individual lifestyle factors.

Dietary Factors That Reduce Blood Pressure The firsr lifesryle f:1CtOf \Ve wilJ fOCllS on is diet. Whar 1 advocare is called dietary rherapy, a self-irnposed rrearmenr. Dierary

ONE NATION UNDER PRESSURE rherapy obvÎously involves what you put inra yOllT body in rhe form of food. There are mally foods in the average dier rhar affecr blood p ressu re. Some are helpful and some ~ue harmful. If you want (O lower your blood pre.ssure, you will need ro know which foods (O cat more of and which ones ro avoid. Oiet, however, is not reaJJy a single facror. \'{fe ear many differenr foods, each of which are made up of combinations of nurririona[ componenrs. We willlook ar each of severaJ eomponents rhat affecr blood presSUIe.

S,tlt-A Major Culprit Sah is rhc first componem of r!le diet rhar we wanr ro explore. because [here is Illuch evidence rhat it significanrly raises blood pressLlre. Thc relarionship berween salt in rhe diet and blood pressure is lisred in Figure 10. 30 Ir is no exaggerarion ro say rhar salr is a major culprir in causing high blood presSUTe. For hyperrensivc patients, r!le greater rhc reducrion in dietary salr, rhe greater the rcduction in blood prcssure. One hasic caLlse of hyperrension appears ro be an inability of the kidney [O eliminare an increased sah load. To excrete rhis excess salt, rhe body makes adjusrments rhat boost the blood pressure, which then enables (he kidne}' ro eliminare rhe salr. J1 Salt consisrs of twO elemenrs-sodium and cWoride; it is 40 percent sodium. It is founei in a majoriry of foods in the supermarker, and the amount per serving is lisred (as sodium) on the concainer or package by law. Surprisingly, research suggest$ thac Îc is actuall)' the comhinarion of sodium with chloride thar does the damage. 32 In animaJ srudies on high blood pressure, neither excess sodium alone nor excess chloride alone causes high blooel pressure. 33 However, rhe labei ing of sodium cOlltenr usually provides rhe necessary informacion: sodium and chloride rypically are found in rougWy equal JlTlounrs in foods. Thus by [imiring rhe sodium intake, we generaJly limit (he chloride inrake as well. A srudy involved 20 high blood pressure paliencs who were taking no medica-

SALT RAISES BLOOD PRESSURE 1. Societies that ingest Httle or hypertension.

00

salt have

00

2. When diets very low in salt, such as the rice aud ,fruÎt diet, are given to hypertensive patients, blood pressure often Calls toward normal. 3. Chaoging to a cliet that is on'ly maderatdy low in salt produces only smal) reductions in blood pressure. 4. Salt-induced hypertension bas been Iproduced in both mao and experimental aoimals. Figure 10

tion, bur reduced their previollsly high sodiurn intake ro less rhan 3000 mg a day.34 The resulring reductÎon in average blood pressure is ourlined in Figure 11. This i, a dl'amatic demonstration of the effect ofchanging juSt one item in tlle elietsalt. The average reducrion was 19 mm systoljc pressure and 14 mm dia rolie aftcr one yeaT. We wOllld expect furrher blood presstire reducrion if rhe salt imake was further reduced. I have tre:ued many people in my practice

1. 20 patients with average blood pressures of 161/101 rom reduced their salt inta1kc for one year.

2. After one year, tbeir average systolic pressure was lowered by 19 points and diastolic was lowered by 14 points. 3. Blood pressure of 16 of the 20 patients was well controlled by simply restricting their salt intake. Figure 11

137

PROOF POSITIVE

WHICH FOODS ARE HIGHER IN SODIUM? or

Corn flak!?s, 1 c.

Peaouh, 1/4 c.

or

Tomato soup, 1 can

Sauerkraul,l/1 c.

or

EggMcMuffin

CorD

chip~,

1 c.

or

Inst.anl mashed pOlatoes, 1 c.

Ham, cured, :) oz-

or

Rlce, Chinese stylc. I c.

Freuch Frles, 1 servo

or

Ice cream, soft serve,

Bou11loD, [Il c.

or

Oill pick1c, 1 large

or

Peas canned, III c.

POlato cbips,

Peas, froz!?n

~

1/2

!mall bag

c.

Bacon. 2 slices 8ultermilk, 1 c.

~

or

Oallish pastry, I piece

or

Cottage cheese, I c.

c.

Figure 12

SODIUM CONTENT COMPARISON

OF FOODS

U

mgsodium

mg sodium

Corn chip!, I c.

163

Corn flakes. 1 e-

217

Pellnuls,l/4 c.

155

Tomato soup, 1 can

932

420

Egg Mcmuffin

821

1611

Inslaut mashed polaloes. 1 c.

491

Sauerkuut,J/l

C.

Polato chips, 1 small bag Ham, cured, 3 OZ.

10110

Rice, Chiuese style, I c.

2700 220

Frencb {ric!, I servo

123

Ice cream, sofl sen'e,l c.

Bouillon, J/2 c.

647

Dill pick1e, I large

833

70

Peas callned, lh c.

340

Pe.as, frozen

112 C.

Bacou, 2 slices

290

Danlsb pastry, 1 piece

371

ButtermiJk, I c.

257

Cottage cheese, 1 C.

850

Figure 13

SODIU

INTAKELI ITS

• Average American diet

4000 mglday

• Those witb normali blood pressure

2400 mg/day

• Tbose with high blood prcssure

2000 mg/day

• Those with ihigh blood pressure and congestive beart failure or liver disease

1000 mg/day

• Minimum necessary level Figure 14

138

250 mg/day

Ulat say, "1 :l.In already on a low salc dier," and eher firmly believe it because rhey do not add salr ar the meal rabIe. Since rhe salr shaker sic5 unused on rhe rabie (01' is removed complerely), :lnd they do nor use a huge amount in cooking, rhey are confident rhac ehey are on a low salc dier. Ar this poin.r, 1 ask my high blood pressure parients ro go duough a liale quiz rhar you mighr like ro rake regarding rhe sah comem of some COJlllllon foods. Do you know whar foods are high in sodium con(em and what foods are low? The foods in Figure 12 arc shown in pairs for compari50n. 35 1 ask rhe reader ro make choices before reading fu rrher. Which has more sodium, a cup of corn chips ar a cup of corn flakes? How about 1/4 cup of peanurs ar a call of comaro soup? Or a bag ofpoearo chips vcrsus a cup ofinstant mashed poratoes? When you finish scanning rhe list, look ac Figmc 13 which Iim rhe same foods along wirh (he amoullts of sodium. Notice (har rhe foods wirh the highesr sodiuJn conccnr are on t!le righr. You may be surprised ro see thar a cup of tomaro soup colltains six rimes as much sodium as 1/4 cup of peanurs. Sauerkraur is nor considered ro be a low sodium food, bur Egg McMuffin is rwice as high. Cured ham is a high sodium food, but Chinese style rice has almosc duee rimes as much. Frozen peas have ver)' low sodium, but canned peas are ftve times as high because sale is added in (he processing. The purpose of (his litr!c exercise is ro encourage you ro rcad labels when you shop for groceries. lf you (fuse ro guess work, you wiLllikely often be wrong. We alI need ro be aware thar rhere is a high amounr of hidden sodium in cerrain foods. What is (he maximum safe inrake of sodium? le depends an your circumstance, as shown in Figure 14Y; Notice rhar (he average American consumes 4000 mg per day, which is 16 times che minimum necessary levcl 01'250 mg. It is colllOlonly believed rhat onIy rhose wha have hypertension, hearr disease, or liver disease shollld limi[ eheir sodium intake, but rhar is nor rhe case. A recent srudy showed

ONE NATION UNDER PRESSURE rhat rhe higher the sodium intake the higher rhe risk ofhaving a hean arrack, whemer or not rhe person had hypenensiol).37 The lowering of sodium ro (he recommended levels could reduce the monaliry rate of srroke by 39 percenr and hearr arrack by 30 percenr accordiog ro a ofblood pressure expens recenrly convened by the Columbia School of Public Healrh in New York. In addirion, a low sodium dier reduces rhe risk of som.e cancers, osteoporosis, and kidney srones as listed in Figure 15.38 For example, earing more rhan 3 reaspoons (6.6 grams) of salt per day ar eating pickJed vegetables more rhan rwice a monrh significantly increases rhe risk of .'colllach cancer. 39 .40 In addirion, a recent large inrernational study showed rhat if you have normal blood pressure you wiU reduce yOU( risk of ever developing hyperrension if you are already 00 a low sodium diet.~1 If your dier is such thar rhe daily incake of sodium roeals up ro less than ehe ma.ximum safe amount, you may use some sale rrom rhe shaker. How mucb an you use? Actually very linIe. One reaspoon of sah comajns roughly 2300 mg of sodium 42 (compared tO a limir of2400 mg for a persoo witb normal blood pressure). Therefore. even if ehesodium camel\( ofyour food is lower man rhe maximum for your condition, you could use very linie additional salt from tbe shaker in cooking or ac rhe eable and stiH be sa fe. Ir is obvious ehar these limits can bc uHwittinglyexceeded. In our office we provide descripeions of diees coneaining Ofle gram of sodium per da)' rhar can be easily followed. They are inclllded for yom use in Appendix V, entirled, "One Gram $0diurn Diet". Sodillm conrenr of some addirional foods is provided in Figure 16 3 as addJtionaI help in controlling yom sodiulll inrake. Notice rhar soy sauce is bigh in sodium, and dill pickJe are even higher. Pickles in general are very high. Sauerkraur ha rhe highesr amounr ofsodium on the charr. You wil! find v
L

W~..,.

DUCE

• Hypertension and its complications • Myocardial infarction • Complications of congestive heart failure, cirrhosis of the liver, and kidney failure • Stomach and nasopharyngeal cancer • Osteoporosis • Kidney stones Figure 15

dium when lISed sparingly. Hor dogs and bologna are high, in the same range as dairy produces. Canned SOllpS and canned spaghetti sauce rend ro be very high ,u1d shoulel be lIseel sp:tringly if ar ali. Some soups may be higher or lower than those seaeed. The poinr is that labels should be read before you buy. Approximate1y 80 percent of our salt intake comes from proc ssed foods. 44

Food Item So~'

Amount

Sauee Diil PickJes Olives, Mission Catsup Mustard Thousaod Island Drcssing French Dressiog ~ Italian Dres.sing ~ Blue Cbeese Dressing .... Mayonnaise Bologn.a Bacon Canned Ham Hot Dogs Corned Beef Sausagc Link Saucrkraut ~ Prctzels Canned Soup: Cream of Mushroom Vegelarian Vegefable Bouillon Spaghetti Sauce Cbeddar Cheese Cottage Cheese Buttermilk Tomato Juicc

1 Tbs. 1 largI'

10 med. I Tbs. I tsp. 1 Tbs. 1 Tbs. 1 Tbs. 1 Tbs. 1 Tbs. 1 slice

2 sllce~ 107..

I 107..

I 1 cup 10 tbin I cup I cup 1 cup

II: cup loz. 1 cup 1 cup 607..

1039

838 782 992 198 SIS 319

364 Figure 16

139

PROOF POSITIVE What abouc resrauram food? There is much hidden sodium in food served byearing establishmems. Resrauranrs compcrc wirh each orher, and because Americans demand it, saIt-flavored food appears ro be esscnrial w remaining comperirive. Some resrauralHS, however, specialize in offering oprional low salr meals ro arrracr healrh minded cuswmers. Prepared foods, whecher chey are found in rhe supermarker ar rhe restauram, are often dangeroLlsly high in sodillm. The only prorcccion we have is ro read tlJe labels (ar ger specific nurricional informa(ion, in d)e case of resr.allranrs) so we can be aware of where hidden sodium eXlSts. Some people become discouraged ac chis poinr and wonder if rhere are any eommon faods rhar are very low in sodium. The answer is a resoundingyes. Figure 17, rhe final chan on sodium comene, lists food grollps [har are extremely low in sodium. 45 The.se foods have 50 Linie sodium chat you can eat as mueh of them as you like wirhouc being concerned abour exceeding che daily limir. Unsalced lllltS are safe [Q eac; rhe added salt found in some processed nUC5 makes rhem high in sodium. Thus, we see rhar rhere are many foods ehar can be freely earen wi(hout concern abOllt cheir sodillm conrene. Fruits provide a dOllble benefit in rhar rhey are a1so high in potas-

Food

~

Ave. Sodium Content per Serving, mg

Fresb fruit

6

Grains & cereals

7

Nuts (unsalted)

3

Vegetables Shredded wheat (loz.) Figure 17

140

15

3

sium, which tends ta reduce blood pressure even further. This is panially wh}' a natLlral diet high in fruics. vegerables, .'Ind grains is rhe answer ro the blood pressure problem. Any food rhar is low in soelium can be nude high, of eOllrse. b)' holding rhe sah shaker over it. Any person wid) hjgh blood pressure sholild keep cbe salt shaker where it belongs-resring on ehe cable, or berrer yer, hielelen .in rhe cupboard. Of eourse, if rhe prepared foods in )'our elicr concain less sodium rhan rhe chart previoLlsll' shown, )'ou mal' add a linie sale aeeording (Q rhe formula previously given. rn our house we kee.p ehe sah shaker in tlle cupboarcl, reserved for guesrs, even mough no one in OLlr famil)' has a blood pressure problem. A eornrnon reaerion ro the idea of reducjng salt in rhe diee is, "1 eannor ear food wirhollt [he Ievel of salr thar r am accustomed to. There wiU be no tasee ro [he [ood.. I am hooked on salc." YOtl m;ly be surprised. as ro rhe ehanges ehar can occur in your [asre buds wirh a Litrle efron and parienee. My grandfather Ned1ey was told by his ph)'sician ehar he shouJd reduce his sah incake because of hjgh blood pressure. He was ;1 heavy salr shaker lIser, anei said rhat i( was impossiblc for him ro CUt down. He arglled rhar wirholll his cllscomary use of salt his fooel haei no taste, and r.har he ma}' as weU ear salt and dic, because life was nor wonh )iving ifhe could not enjo)' his food. AfLer he haei a slighr stroke, he immediarely changed his stanee-he took (.!le sah OUt of his elice. My gcandmother sropped cooking with salt, avoided prepareel fooels COl)taining salt, and removed rhe salt shaker hom che table. Grandpa complained bicrerll' thar the taste of food had elisappeared. with che salt. Afrer a few weeks, howcver, his complaining faded away. One day Granelma miseakenly pur a litrle sale in his mashed pocacoes. He tOok one bite. pllshed rhem away, and said, "1 can't ear it. AJI 1 call taste is alt." His salt addicrjon was gone. The faod aelelitive rhat he OJ1ce was addieted to he J10W loathed. Masr of Illy' patiems that have undergone a similar experience with a cenajn food (Iaathing whar was once enjoyed) start rhat ir mal' rake lip ro faur months afrer {he decided dietary

ONE NAT10N U DER PRESSURE change is strietly adhered ro before this advanrageous change in taste oecurs. \'\Ihar about salr subsrjrures? The earll' versions had an llnpleasam biuer, merallic raste rhat few couJd toJerare. Cardia Sah is one brand name rhat correcrs rhe flavor problem. It conrains rorassÎllm, magnesium, and only half the sodium of regular rabie salt. Prdiminary srudies of 40 men and women sbow dur replacing regular rabIe. salr wirh Cardia Salr lowered blood pressure an average of 13 mm diastolic pressure and 8 mm sysrolic pressure in six monrhs. Otber studies bave shown similar resul ($. 46 Salt subsrÎrures bave rhree drawbacks. The main one is rhar the)' onl)' conecr parr of (he sodium problem-rbe amount of sodium adeled wirh rhe sah shaker. Processed foods sucb as soups, dairy producrs, and omers lisred in rhe preceding charts will remain as bigh sources ofsodium in rhe dieL Tbe second drawback Îs thar some people with renal fajlure ar on cerrain blood pressure medicine (such as C~lporen and orher ACE inhibirors) will dangerollsll' elevare rheir serum porassillm by consumjng salr subs(imtes and risk sudden cardiac deatb. The thirel drawback is rhat they increase the desire for the "real rhing," and the vicrory (har ml' grandfarher obtained becomes duSlve.

Monosodium Glutamate Not a Problem What ahout anorher source of sodium. monosodium gllltamaee~ This chemical has been labeled as a hidelen subsrance ehar is unclermining aur health. It is commonll' found in food served in Chinese resraurams, and is an addieive presene ill some foods thar we buy in d1C supermarker. Ir has been blamed for c.'l.llsing sweating anei mall)' orher biLane symptoms in some people. Be aware of an important and basic facr regarding monosodilll1l glutamate (MSG)-ir is not a substance that is foreign ro rhe bod)'- It is a comhination of rwo narural subsrances: odillm anei glutamic acid. Gluramic acid is one of 20 amino acids naturally presenr in the bod)', and is necessary for normal body funcrions.

As a resulr of the many complaints again t MSG, it has been the subjecr of manl' srudies, with surprising results. The srudies have ali been consisrent in proving rhar MSG Îs nOt a problem. The resulrs of one of rhe stlldies are shown in Figure 18. 47 lf there is a "Chjnese Restauram 5)'0drome," it does not appear to be re1ated ta monosodium glllramate. le may be re1ated ro some(hing else thac is in the food. Since sodillm apan from chloride is not as harmfuI as sadium chloride wirh respeCt to blood pressure, MSG would nor be expecred to raise one's pressure. In fact, studies show thar blood pressure is actually lowered somewhat by consuming MSG.48

71 subjects we,re randomly ~ed MSG or a pllacebo in their food for five days. Result -15 % of those consumblg MSG had symptoms. - 14% of those conslJmIng a placebo haEI symptoms.

Figure 18

What abollr se-a alr? Is ir Iess damaging ehan "regular" salt? No, it has the same sodiurn and ehe Sal11e chloride. Sea sale will tend ta misc your blood pressure jllsf as much as regular sale. Granred, d1ere mal' be some trace amounrs of addirional nutrienrs in sea salt thar could be helpful ro other body fUllctÎons; noncrheless, it wiU do as mllch dalllage tO your blood prcssure as regular sale.

141

PROOF POSITlVE

Losing Weight For individuals who are overweight, iniriaring a weight los5 program can ignificantly lower tlle blood pressure. The blood pressure will usually dmp as much as a low salt diet will dmp ir,49 The hyperecnsive parienr does nor neeel ca rcach optjmuln weight for a drop in blood pressure ro oecur. Jusr iniriating a weight 105s program and shedding about 5 pounds will bring rhe blood pressure down substaruiaJly in mose ca es. In order for the cHeer to be mainrained, however, rhe individual needs to sra)' 011 ehe weighr loss program umil ideal weight Îs achieved. A simple four-step plan is prescribed for mosr of my overweight pariell[s ro achieve rheir desired weiglu. 1. o SIlacks. Drink onl)' warer bef\veen meals. 2. Ear a good breaki'lSf :lJld a moderate lunch. Eliminate the evening mea!. If somerhing "must" be eaten in the cvening, whole fruir is ali rhat is allowable. 3. Eliminate OI' ar teast greatly reduce refined sug;u and free fars or fatty foods in the e1iee, wbile emphasizilw foods high in fi bel'. 4. Dail)' moderate eJ<ercise for approximately 45 minures a da)'-

Foods Hig!? in Catcium are Beneficial

weight loss.

Foods wirh a high calcium conrent can also significanrly lower blood pressure. Over 6000 men and women wilh high blood pressure were dassifled as ro theÎr calcium inrake. The resuh was rhar each gram of calcium consumed per day seems ro lower rhe risk ofhigh blood pressure by about 12 percent. Professor Jamcs Dwyer, who reporteei on rhe research ar rhe American Hean Associaeion annual meering in November 1992, warns against raking Iarge amounts of calcium supplemems, however. "Inslead," he saiel, "people shou1d ger ca1cium rhrough rheir diers ... green leat}> vegerable.. are good sources of calcium."

CafJeine and Alcohol

Oatmeal Helps

Studies show [har caffeine affecrs blood pressure. One cup of coffee per day (OI' rhe equÎvalenr in cola drinks) may raise rhe diastolic and systolic blood pressure ftve to six points. 50 It follows that e1iminating caffeinared drinks has dle potential ro lower blood pressure by rhe same amounr, Caffeine nor only rajses resring blood pressure, bur if consumed before Of during exercise, ir can raise blood pressure anei hearr rare collsiderably above rhe levels achieved during exercise alone. 51 This could turn a healthy activiry into an unhealrhy one by increasing [he risk of il sign.ificam ardiovascular evenr during exercise. Whar is the effecr of alcohol on blood

A common bremlsr food, oarmeal, has been founel ta reduce blood pressure. In one s[lldy, 850 people were caregorized for the amounr of oatmeal they cOllsumed. One-bowl-per-day s had lower blood pressure and lower cholesterol..53 The effeer was independent of age, weighr, and inrake of sodiurn, potassium, and alcohol. The conc1usion is rhat people who are trying ro control their blood pressure narurall)' may ger an unexpecred benefir hom eaeing a bowl of oatmeal each day. Thus oatmeal offers a double beneflr for our hearrs. Most of us have known for some rime rhar oaemeal helps ro lower blood cholesterol levels bccause ic is rich in warer-

~

Virtually aII of my patients thar srick ta chis simple program achieve lasting

142

pressure? Many people are unaware rhat alcohol raises blood pressure. Jusr an mmce ar two per day is ali rhat is necessary ro cause signiflcam hyperrension. 52 This is one of the reasons why cven moderare s of alcohol have a signiflcanrly increased risk of suoke. 1 have had some people come imo my office, follow our low sodiU1l1 eliet, ger on an exerci e program, anei do aH tlle right rhings. They have come back and said, "Dac, rny blood pressure is srillup." Ofren when 1 raise rhe alcohol qucstion, they silently leave. However, if they are bold enough ro rake my advice, cheiI' blood presslIfe is usuaJJy undeI' control when rhey rerurn. Eliminacing alcohol is a necessary pan of reelucing blood pressure rhe narural \Vay.

ONE NATJON UNDER PRESSURE soluble liber. The informacion an blood pressure provides an addirional cndorsemcm for rhis versatile grain.

Smoking Increases Blood Pressure Smolcing is anorher lifesryle factor that raises blood pressure. S4 After smokil1g just one cigarerre, borh systolic and diasrolic blood pressures can remain e1evated for as long as 30 minure .55 In fact, blood pressure C4n rise by 10 rom of mercury. AIrhough a single cigarerre does not seem to eause a iasrjng increase in blood pressure, many smokers have enough eigarenes in e.he day rhar [hey are conrinually raising r.heir pressure. Dr. Norman Kaplan, oue of rhe world's forem05t aurhorities on high blood pressure, poims aur e.har a (ypieal pack-perday smoker is e1evaring his blood pressure for most of [he day.5 6

Life's Stresses and Blood Pressure Along wich dietary factors, life's stresses ean raise blood pressureY' 58 Stress does not seern ta afTecr rhe diascolic blood pressure much, but tends ro act more on the sysc.olic blood pressure, the rap number. Stress is a broad subjecri in facr, 1 have devored an en[ire chapeer ta ir. To rOllch on rhe subjecr here, I will poim out [hat rhe exrernal pressures thac confram us (called srressors) are very differem from aur imernal reacrions (Q chose srressors. Wirh inadequare coping mechanisms, stressors cake a toU on our physical and mental well being. Boch aspecrs are addressed jn Chapcer 14, "$eress Wi[houe. Disrress."

Exercise Aerobic exercise--exercise rhar calls inro play [he hearc and lungs- igniflcanr!y lowers blood pressure in hyperrensive pauenc.s. In one srudy, eighreen sedenrary indjvidual, wirb high blood pressllre eompleted a 16 \Veek exercise progr,un. During che program, [hey rode an exercise bicycle rl1Tee days a week for abolit 45 minures per day. They exercised ar a moderare inrensicy (60 ro 80 percenc of their predicred maximum hean race). N[er e.he four monrh program, (he average sysrolic blood pressure fell 7 nun ;:1I1c1 che average diascolic pressure. 5 mm.

The exercise program also helped to prevent cheir blood pressure from rising as high during exercise. Their average systolic blood pressure when exerdsing was 19 mm lower anei diasrolic 10 rnrn lower than before che program. 59

Low Blood Pressure Many people with low blood pressllre, around 90/50, ask jf ir is tOO low. The answer is no, noc if the)' are feeling well. In fact, che lower che blood pressure the less rhe risk of the many diseases and complications mencioned ac the beginning of the chapter, as long as che individual is feeling weU. However, if the individual fee1s "washeel OUt," lightheaded, or generalI)' ilI, or if the blood pressllre drops signi.ficandy when sranding up (normally r:he blood pressure is consranc. or rises slighdy lIpOO seanding), then the blood pressure ma) be toO low. lf your blood pressure drops more man 10 points diasc.olically when you quickJy go from a lying down posirion ro scanding lip, you have significant postural hypotension. This condition is srrongly associated wirh tlle chronic facigue syndrome. Finding rhe reason for rhe postural hypotension and rreae.ing ic wiU ofcen help rlle chronie fatigue syndrome. 60

Su:mmary In this chaprer an hyperrensiof), we have looked ar a number of key f:las. Some of che mose im.porc.anc poincs are lisred below: 1. High blood pressure is dangerous c.o your healch; it is rhe cause of mally debilitatillg and facal diseases. 2. An opcimal blood pressure will noe. exceed 120/80 ac rest. 3. The majority of those with high blood pressure can bring ie. under control by nacural means, rhar is, by lifeseyle changes. 4. Making changes in lifesryle is che besc and safesc approach c.o reducing blood pressure, as opposed ro raking drugs. lf you wane ro use lifeseyle ro lower your blood pressure, you will wanr ro make che foJlowing c.hanges:

143

PROO F POSITIVE 1. Ear plenry of fruits, vegetables, grains, aod unsalted nllts il) moelerarion, anei orher low sodium foods. 2. Avoid fooels such as dill pickJes, cured ham, Chinese riee, bouillon, anei orher high sodium foods. Read rhe labei:;. 3. Avoid low fiber foods such as mear aJ1d d:'liry produets. 4. Eliminare eoffee, eola drilJks> and alcohal from rhe diee. 5. Stop smoking. 6. Keep the sah shaker ar fese 7. Bring your weighr down ro the recommended level for your height and build. 8. Aelopr an aerobic exercise ratiune, such as brisk waJking. 9. Learn ro cope wirh srreS$. Wirb rhe above changes in lifesryle, you have a very good chance of reducing your blood pre sure ro a normal level and keep-

ing ir rhere wÎrhour rhe need for medicanon. Take rhe rime now ro make sure your blood pressure Îs in rhe ideal range. Il' Îr is nor, do nor pur off rhose simple lifesryle changes. None of LIS like ta change aur lifesryle at fmr, bur an)' one can develop new enjoymclHs for new ways of living. Be)'onel thar, [he lifesryle changes we have eliscllssed are smalt compared ro rhe Ijfes[yle change yOll may have ro make as a '[roke ar hearr arrack vîcrim. And rhe cliet dur a kîdney fâilure pariem is an is much more difficuh ro adjust ro [han a pure vegeraria.n djer. Jt also lacks rhe rich variety of the vegcrarian die[ ancl is much less sarisfYing. Yes, you may be one of rhe ltlcky ones who, [ike tn)' grandfather, received a "wake up call" before it was coo late ro change. But yotl may nor be sa fortunare. The nursing homes and cemeteries of our nation are filled with many people who JUSt had "a litde hîgh blood pres .lIre. "

Refermces -

PA.: JP. Lippcou COlllpanr. 19n p. 2%-237.

Klag, M]. Whelton. PK, el al. Blood I'reswre and End- rage' Renal Disca e in tv1en. N E"gl} Md 19% Jan 4;334( 1): 13-18.

Lallner LJ, Masaki K, el al. The association berween midlifc blood I'ressllrc levels and latc-life cognilive: funcrion. The HOllOlulu-Asia AgiJlg Study. JAMA 1995 Dec 20;2.74(23): 1846-1851.

1

~ Tbe fifth repon of lhe JOÎm Narion:u Commiltce on Derenion, Evalualion. and Trealmenr of High Blood Pressure UNC V). Arc/' 11/1cI"'1 Metl 1993 Jan 25; 1')3(_): 154-183.

The fifth report of lhe Joilll arion,,1 Com'uirrcc on DClection, Ev"lualion. and Trc31mem of l-ligh 13I00d Prcssure UN V). Arci} !lItern j'-"etl 1993 ]an 25; 153(2): 154-183.

10

II Hancock WE. Coronary Arter)' Discase: Epidemiology And Prcve"rion. 1991. In 5ciwrijic J1mericf1ll Mcdiâlll' (eD ROM), 1995.

12 Isselbacher KJ, Braullwald E, edilOrs, el al. Atherosclerosis and Other Form,S of Aneriosclewsi. In: Hnl"risolls Principl,·] o/ll11tTTUll Medicille13'" rdirion (CD-ROM). New York, Y: McGRAW-HILL. Ine. Heahh Profc:ssion, Divi ion. J 994 p. 1113-l119.

M"cMahon S. Pero R. er al. BlooJ pressure. troke. 3nd COrOl\3ry heaT( diSea5e. Parc 1. Prolonged difl"rcnces in blood pressure: prospe tive ob-ervational slUdic correcrcd for I.hC regres ion diJution bi:u. L/lnci't 19(JO Mar 31 :335(8692):765- 774.

u arion,,1 l-ligh B100d P~essurc EduCllion Prog~am Working Group repon 011 pri.mr)' prcvenlion of hyperrension. Al"Cb Intem Mt'd 1993 Jan 25: 1')3(2): 186-208.

S

The fiflh rOM of the t National COml1li(ICC on Dereclion. Ev:uua(ion. aod Trealmenr of High Blood PrCSSUIC U C V). Ardl !l1ll'nJ Med 1993 Jan 25; 153(2): 154-183.

14 K:lplan M. l-I)/pcrtemion in the Population at Lugc. In: Cliniml H)'Pl:rtelIJiolJ-6'/' tdirioll. Balrlmore. MD: Williams .1nd Wilkins. 1994 p. ).22.

G The

lS

4

fifrl, report of rhe Joil1l National Commillee on Delccdon, Evalua(ion, and TrCalltlem of High Blaod Prcssure (1 C V). Arcb !mnn Mt'd 1993 Jan 25; 153(2): 154·183.

The Jihb repon of tlle r National ComJ)~ilree on Dcrecrion, Ev:tluation, and Treatmenr of l-ligh Blood Pressure (JNC V). A,.d; !fJ/cm Mcd 1993 Jan 25; 153(2): 154-183.

7

, Kapl:tn NM. Hypcrlcnsion in lhe Popuiarion al LaIge. In: ClinicfJ! HYPI"'ll'lIJion-6'" I'tli/ion. Baltimorc. MD: Williams and Wilkin;, 1994 p. J-22. Weinbcrger MH. Syslemic hypcrtension. In: Kdle)' \Yl , DcVila VT ]r.. cdiwrs. el al. Textbook o/!mt'mnl Mtdiâne-Z'" ediliol1. Philadelphia. ?

144

Klag, MJ. Whc!ron. PK, cr al. Blood Prcssure. and End-.tage Renal Diseasc in Mcn. N EnglJ M{!d 1996 ]an 4;3340): 13-18.

It, Launer LJ. Masaki K. e' al. The assoc.iatioll berwcen midlifc blood pressure levels and laIc-Iii" cognilive fi.lllc,ion. The Honolulll-Asia .Aging Study. jAMJlI995 Dee 20;274(23):1846-1851.

McGee D. UJC Fmming/'nm 5t11dy: An Epidemiologiml111vesrigrl/ioll of Dis(f1se. SeClion 28. U.. DepanlllCI1l Health Educarioll and Welr.~lC, DHEW Publication No. 79-618. 1973. )7

Crlrdiollf1Smlflr

Elrner PJ. Grimltl R Jr, et al. Lifesrylc inrervenrion: resulis of lhe Trea'fllelll of Mild HypCrtCIlSioll StlJd)' (TOMHS). Puv Mcd 1995 Jll.I:24(4) :378-388. I

ONE NATION UNDER PRESSURE

l'

Jachuck SJ ' Brierle}' H . el al. The dkcr of hyporcnsive drugs on rhe qllalily oflifc. J R Coli Gen ['ma 1982 Feb;32(235): 103- 105.

1 ElliOI P, Slamler]. er al. Il1Iersalr r('vi irecl: furrhl'r anal}"es 01'24 houl odiulll excretion anO blood prcssLlfe within ,
10 1995 St11ll711l'1II Fro/ll tbc Nfllionn/ Higb 8/001/ ['rr .fIUr' EdltrlltiolJ Pr()'gmm Coordimlling ommit/el'. Belhesela, MD: Nalional High Blood Pressure Educarion Program.

H

vr.

4

21 Weinberger MH. Systcmic Hypencnsion. In Kellcy \'V'N. DcVila editors, et al. Trxtbookoflll1{'mnl Ml'liiciTl1\ Phih,delphia, pi\: J.r. LipI' Co.. 1992 p. 238.

0((

Jachuck SJ , Bricrley H . er al. The efrecr of hypolensivc drug: on rhe qllalicy of li!c. J R L'ol16m Pma 1982 Fcb32(2:~5): 103-105. l

van Swieten Jc, Gc)'skcs GG, er al. Hypencnsion in lhe elderll' is as OCial(·d wirh w!lire mauer lesion and cognilive decline. AmI Nt'1Irol 1991 Dcc;30(6):825-830. 2.\

Thc fiflh repon of the Joim National Commincc on DClecrion, Evahlalion, and Trearmem of High Blood Pressure ONC V). Arr/' Intern Med 1993 Jan 25: J53(2): J 54-183. l4

Hl'penension in rhe Population al Largt·. In: C/iuir(r/ HyperumioIJ-G" rE/iiion. Baltimorc, M D: Williams :uld Wilkins, ) 994 p. 1-22.

25 Kaplan N}"t.

Elmer PJ. Grimm R Jr. et al. Life lyle imervemion: restlhs of tlw Tre;lrmenr of Mild Hypertension Study (TOMHS). ['rtl) Mu/ 1995 Jul;24(4):378-388. 26

Ascherio A. Rimlll Efi. er.L A prospeclivc sludl' of nuuitiol13.1 faCtor> ami h}'penen ion among US mCl1. Cirr:ulillion 1992 Nov;86(5): 1475-1484.

!'!

Kanncl WB, Garrison RJ. Dannenberg AL Secular blood pressurc lfl'l1ds in Jlorl11otensivc persons: rhe F,,,mingham Study. Am Hrtll'/ J 1993 Apr; 125(4): 1154-1158.

28

Cran" MG. Diehl H. el al. Eflecr of I.ife.,ryle Modification on H}'pcrtCllsion. SulJlninctifor publirllrioJl 1996.

29

The Food I'rocessor for Windows: Nutrition Anal)'sis & Fjmcss SoftWaIe !computer programl. ESHA Rescarch. Salem.Oregorl.

44 StllUnWJII !'imI} file NII/ionlll High Blood Prl'JfUl'l! EI/IIl'rl/ioli Progrll1ll Coonlinl1ting Commimt'. Bcthesda. MD: National High Blood Prcssure Eou-

cation Progrnm. 1995. The Food Processor for Windows: NUllition }\mlysis & fimcss Soft· ware [computer programl. ESHA Rcscarch. S, Icm, On.:gon.

45

Neurel J. Replacing regubr salt ",itI. a reducee! odilltn ah conl:lining porassium and magnesium mal' ofTa a l1on-pharrnac: 1 approach !O 10\\lcIiJ1g blood pressure. Cirl'llill/ion 1996;94(8 sllpp):341.

-lG

Tarasoff L, Kelly MF. Monosodiun, I~gllt(:lm:lte: a oouble-blind stlJdr and review. Food Clmn 1'oxico/1993 Dec:31 (12): I O19-1 035.

47

4~ Corr"ea I:M, Saavedra JM. Chemic11 lesion of (he cir Lunvelllricuiar organs witll monosodium gluramale reduces rhe blood pressure ofsp0nlaneollsll' hypertensive bur not olone kidney-one clip h)'pcrtCl1sÎve rat_,. BrtlZ J Med Biol Rtf 1992;2S(5):515-519.

Etrects of weight Joss and sodiulll reduction intervention on blood pressurc and hypenension incidence in ovcrweighr rcople wirh high-normal blood pressur~. The Trials ofHypenension Prt'vt'ntion, pll, e J1. Thc Tri"I, of Hrpcnension Prevent ion ollaboralive Research Group. Anb II/lem Mtd 1997 Mar 24;157(6):657-667.

'o Sung BH. \X1hilsen TL, et al Prolonged incrtase in blood pres urt· by a singl~ ora.! close of caffeine in milclly hypC'rtcnsiw men. Am J Hypenm.t 1994 Aug;7(8):755-758. SlIng BI-I • Lovallo \':(iR. CI al. Cafte.ine e1evales blood pressure reSpollse eX('Icise in mild hypemalsivc men. Am j Hypt'rrens 1995 Dec;8(l2 Pr 1):1184-1188.

51

Freis ED. The role ofsa.!r in hypcnension. Blood Pm.s J 992 Dce: 1(4):1 96200.

10

Freis ED. The role ofsalr in hl'pcnension. Blood Prm 1992 Dce: 1(4): 196200.

51

30

31

31

Kaplan NM. Primary Hrperrension: Parhogene. is. In: C1iJliotl/~vp<'Y

IClISion-61. t:dition. Bairimore, MD: William; ano Wilkins. 1994 p. 55. ;; Kaplan NM. Primary Hypenension: Parhogcnesis. In: Clinirnlliypertewion-(Jh edilioll. Balrimore, MD: Willia.ms and Wilkins, 1994 p. 55. H MacGregor GA, Marl"'1.ndu ND, Ct al. DOllblc-blind .nldl' of three sodium imake ano long-rerm efrecrs of sodium reslricrion in e seruial h}'pertcnsion. Ll11lce/ 1989 Nov 25;2(8674U244-1247.

The I'ood Proa'Ssor for Windows: NlIlriliolJ Anal)' is & Fimes., Softwart· [computer program]. ESHA Re.s<·arch. S"lem,Oregon.

35

The Food Proccssor for Windows: Nurrilion Analysis & Filncss Soft-

ware [compurer progrmnJ. ESHA ReSC:llch. Salem.Orcgon.

Wabb:ly. shi K. NakamLlra K, et al. Al ohol onsump,ion and blood pressure: m extendcd slUdl' ofself~defence officials in Jap'l11. Inr J Epicli'wiol 1994 Apr;23(2):307-31.1.

5 Hc J, Khg MJ, CI al. O:ltS and buckwhe:1I inra.kes anei cardiovascular oi case risk taCtorS in an ethnie minoricy of China. Am J Clin Nwr 1995 Fe.b;61 (2):366-372-

Slcight I~ Smoking :Ind hl'penension. Nov;15(6):1181-1192.

5

C/in Exp H,yperlt'm 1993

'> Kaplan NM. Mea.surcmem of Blood Pre urc. In: Clil/ien! H)'/'t'1'lmsion-6" ecli/ion. fhlrimore. MD: William and \X'ilkins, 1994 p. 23-45. Kaplan NM. Mea urcmem of Blood Pressure. In: C/iniml HYP,'rtt'nsion-6,h edilio/). Baltimore, MD: Williams and Wilkills, 1994 p. 30.

5i;

From thc Nl1/ioml1 Higb Blood PreHuri' EtluCrllion Progmm Coordinn/ingummillee. Berhesda. MD: Nalional High Blood

.1(,

Adaplcd trom:

Stdtl7/1t'1IJ

Prcssure Eduattion Program, 1995. AJderman M H. Madllavan . er al. Low minary sodiulll is associalcd wirh grcatt'( risk of myocardial irll'arction amollg treated hypertensive men. HypmtJlJion 1995 J1In:25(6): J 144-1152.

37

38 Anronios TE MacGregor GA. Sah imake: potential dclelerioLls e!Tens exdlle!ing bJoou prc:-s ure. J Hum Hypertt:ll.f 1995 JlIn;9(6):511- -1-.

Ch'lI1g.Cbude J. Raedsch R. et al. Prcvalence of Helicobacrer pl'lori infeclion and gastritis amOllg l'oung adu.hs iJ1 China. /:.;tr J Cllnrf}' !'reu 1')')5 Fcb:4(I):73-79.

.I?

Naz:lrio CM. S.kJo M, el al. Salt amI gastri Q1I1cer: a case-conrrol in Pueoo Rica. Inl J tpidt:miol1993 Ocl'22(S):790-797.

iO

SI ud}'

57 Boone JL. Strcss ami h}'peftcn ion. Prim Cuc 1991 649.

ep;18(3):623-

;~ Yo,hiuehi K. NOll1ura S, CI:l1. Hemod)'n:unic and cndocrine responsi\'eness 10 mental arilhmcli task and mirror drawing test in patiems with es enri:.! hypcncnsion. Am J Hypel'ltll.f 1997 M. r; 10(3):243-249.

Kokkinos PF. Naray,n P, el al. EHens of regul;u e.~er ise on blood pressurc and lefl ventricular hrpenropby in African-Americ:ln men wid, severe hyperrclIsion. IV Eug! j ivled 1995 No\' 30:333(22): 1462-1467. 59

BOll-Hol.aigah 1. Ro",e PC, el al. The relalionship betw.,en nellralll' mediatd hl'pOlension and Ihe chroni fatigue synd(ome. JAMA 1995 Sep 27;274(12):961-967.

GO

145

PROOF POSITfVE

146

CHAPTER SEVEN

THEGREAT MEATAND

ROTEIN MYTH

R

Ob'S behaviorwas highly unllsual. However, he did nOt feel he had any choice in rhe marter. Each day he came ro rhe college cafeteriawirh a container ofhigh prorein food. One day it was peanucs, rhe nexr day roasred soybeans. the nex( day sllnflower seeds OI walnuts. Rob wOllld ear r!lese high protein foods Iiberally. His morivation: he had recenrty become a vegetarian and was worried thar he wouJd nor get enough protein on his new dieI. A year or sa iarer when Rob took a good college nurririon class, he was astonished. He leamed that he was gerring (Wo ar rhree rimes rhe amollnc of protein he needed in his diet. Worse (han rhat, he djscovered rhat c:lting (00 much protein posed health risks. But rhen rhere was even worse news: when Rob analyzed his djet. he was hard pressed ro {jnd a way [Q lower his prorein in(ake sufficiendy ro be ,u an oprimallevel. Even on a vegerarian dier, he was having a hard rime avoiding his incalce of too muc); protân.' Rob's rruc srory need never have happened ifhe had bcen aware of research rhar was done ar Harvard and Lama Linda Universiries in the 1950s and 60s. There. researchers Drs. Hardinge and Stare had discovered mar individuals on a [Ota) vegetar-

ian diet ger sufficient amouncs of al) the proper rypes ofprorcins needed by rhe human body.l However, long before Hardinge and Stare arrived on rhe scene, other eminent sciencisrs were quescioning rhe long-held dogma of the imporrance oflarge amounrs of prorein in rhe die(. The renowned nurritional researcher, Dt. T. Colin Campbell, recendy described SOme of our cultural biases toward high prorein diers aud mearbased meals. 2 Dr. Campbell, Professor of Nuuieional Biochemistry ar Cornell Universiry. srands in a unique position to evaluare this subject. He is rhe director of rhe massive Cornell-Oxford-China Diec aI,d Healrh Project, and bas seen rhe healch advantages of a lower protein diet such as is common in Mainland China. In rhe July 1996 issue of his New Cemury Nurrition healrh leuer. Campbell shared the experience and research of rhe famous Yale Universiry Professor, Russell Chirrenden. 3 Chinenden was among the firsr in clIe modern era ro challenge che nurrirional dogma chac had persisced for centuries. He had heard rhe standard line chac rhe high prorein animal-based foods promored screngrh and energy along with mental and physical fitness. BlI( he wondered, was this realJy rhe case? In ilie carly 1900s Chirrenden

147

PROOF POSfTIVE conducred at least rhree sllIdies rhat examined rhe qucsrion ofwherher mear and high proreÎn were reali)' necessary for oprimal performance. The capsronc of his research was a srudl' of well-rrained arhleres. Ar ilie beginni ng of his stlIcll', these athletes were aII on a rypicalmeat dier. Chinenden haei rhem {hen swirch ta a planr-based dicr for hve momhs. Ar rhe end of rhe swdy period when rheir fimess levels were rcanaIyzed. the atllJeres had improl)ed a- .(ţ)'iking 35 percent. As Campbell commenred, "only ilie dierary change could have accounred for rhese remarkable resulrs."4 Whar Chinenden suggesred years ago is now bei ng re-ccha ci by hundreds of vaices. Earing animal flesh and animal prorein is nor necessary in order ro obrain oprimal prorein intake for proelucrivit)' and performance. So where did this grear meat aod prorein myth come from?

History OfMan's Knowledge ofProtein

148

Prorein was discovered as a nutrienr class in 1838. 5 By then, ir was also recognized rhar proteins were associateel with ali forms ofLife from rhe simplesr single-ceUed organisms ro man. No wonder rhere has been such fascination with prorein-anyrhing rhat is necessary for aII forms of life is rruly awe inspiring. In f;lCr, Webster suggests thar rhe verl' word "prorein" is derived from rhe Greek roor "prows" which means "hrsc"6 Our appreciation for protein has grown over rhe years; we now know rhat ir is viral for such diverse roles as musc1e function, hormone synrhesis, and the producrion of enzymes.7 Furthermore, aur need for protein is increased during our growth years, during rhe repair of rissues (afrer an injllry ar surgery, for example), anei during musclebuilding exercise. 8 Thus rhere is no myth regarding rhe importance of protein in aur diet. However> rhe confusion about rh so-called superioriry of a-nimal protein sOllfces emerges when we look a linie closer ar the natllre of proteins. Proreins are complex molecules that are nude up of molecular builcling blocks called "amino aciels." There are 20 amina aciels rhat the human body uses w build the proreins it needs for life and

healrh. 9 In adulr humans eight of these amina acids are called essentiaJ, because rhey must come from the dier. The names of rhese amina acids are isoleucine, leucine, lysine, methionine, phen}'laJanine, ducanine. tryprophan. and vaii ne. 10 The remaining 12 amino acids CUl be made by the human body. If we compare a protein molecule ro a train, the amino ;\cids are like (!le individual cars of rhe train. Just as a nain cannot be built out of al! box cars or ali cabooses, so rhe body needs amina acicls in rhe right proporrions w constfLlCt funcrioual prorein molecules. At rhis point animal protein bias begins ro creep in. It is obvious rhar animals are physiologically more like humans rhan planrs are. Therefore, it shouJd come as no surprise rhat În comparing meat rrom a singLe animal species (Iike beeD widl food from a single plam species (like oatmeal), the mixture of amina acids in ilie animal product will reml ro be closer ro the proporrions În which humans ueeel rhem. Because of chis. manl' have incorr ctll' reasoned rhat a eliet based on animal protein sources like mear is superior ro a eliet based on plam products in providing adequate amounts of rhe cssenrial amina aciels in the right proportions.

Plant \!ersus Animal Sources of

Protein This brings LIS back ro rhe basic quesrion: do animal sOllrces of nutrition provide berrer "quality" protein rhan planr sources? If you look ar the cliet as a whole, the answer is no. This is exactly wh:lt Hardinge and Stare faund in their dassic research in rhe 1960s. Il They lookeel ar the complere diets of duee groups: meat-eatÎng Americans, pure vegerarians (rhose who exclllded alI animal producrs from (heir dier), and lacro-ovo vegerarians (rhose \Vho exduded aII animaJ proelucrs excepr for dairy products anei eggs). The researchers measured the actual amotlnt of each amino acid consumed by each of rhese groupsj7mn their whole diets. They then compared rhar inrake wirh the ideal balance of amino acids needed by man according ro twO standarels: (1) rhe srandarel determineel bl' Dr. Rose in

THE GREAT MEAT ANO PROTEIN MYTH rhe 19405 and 505 and sriU llsed by rhe World Healrh Organization ro rhis day, and (2) hllman breasr miLk. The only food specifically designed ro mCCl aII ilie amino acid needs of a human is human breast milk. Amazingly, rhe best qllaljty prorein among rhe rhree complete dier was rhe pure vegerarian diet. The mix of amina acids in rhe total vegetarian dier mosr closely resembled rhe mix in Rose's recommendarions antL in human breasr milk, as illustrared in Figure 1. The message from this classic research is simple. lfyou look ar a single food, 31\imal prodllcrs have r!le upper hand in providing prorcin qllaJiry. However, when yOll look ar rhe emire dier, rhen the pure vegerarian dicr cmerges as superior in prorein quaJity. The non-vegetarian diet departs from bom srandards alrnosr ("\vice as far as rhe pure vegerarian diet.

Comparisons ofProtein in MiLk of Different Species The protein conrenr of milk is an indicarion of rhe protein requirement of a newborn. wherher rhar new-born is human or animal. Ler us exallline rhe differences in amounr of prorcin in milk in the differenr mammaJian species. The)' are tablliated in Figure 2. 12 This comparison demonsuates that humans actuali)' need less protein rhan rhe ani maJs an the lise. Notice that the relative growrh rare is grearer in rhose rhat have greater alllOlllltS of protein in t!le rnilk, as wOllld be expecred, because of the grearer protei n requirement to bllild body rissue. lf a human con umed a rat's milk [rom birth, would rhat baby be able ro dOllble irs birrh weight in days insread of monms? The answer is obviously no, since the rare of growth is !argely genetically determined. The excess protein wOllld not be utiJjzed and, as we williarer see. cOllld actually harm rhe developing child.

Is the "CompLementary" Theory VaLid? Ar rhis poiO[ Oll,1e may cOllnrer: "what Hardinge and Srare did was unfair-yoll musr ear a perfecr balance ofamino acids ar

TOTAL VEGETARIAN DIET PROVIDES THE BEST PROTEIN QUALITY Typeofdiet

Percent variallce /1'0111 Rose's standard

pure- egetariaD

280/.

DOD-vegetariaD

48% Percellt variallce /1'0111 ''''mall hreast lIIi1k

pure-vegetarlaD

13~

DOD-v~etariaD

22%

Figure 1

PROTEIN COMPARISONS OF MILK IN DIFFERENT SPECIES \ \~

Mean values for Jlrotein content, mg/liter

Time required to double birtb weight (days)

Ruman

1.2

120

2.4 3.3

60 47

4.1

19 8

H~-rs~

Cow Goat Dog . -,... ..Cat Rat ~

-.-.

7.1 9.5 11.8

7

4.5 Figure 2

a given meal ro uriJize rhem properly." This argument is based on an old theory thar argued yOll mllst "complement" plant proreins at a given meal ro get the proper protein balance. Tbis would require an impractical rask of weighing each serving rhar makes IIp a meal, calculating the amino acid content of each, and rhen adding them lip. Elaborate charts were drawn up thar listed whar foods vegetarians needed ro combine at a given meal ro get rhe same "quality" prorein that a mear-eater was gerting. This

149

PROOf POSITIVE dogma went by rhe wayside long ago. Historically, rhe American Dicreric Association (ehe professionaJ associaeion for dietirians in the Unieed Srates) has nor been known for adVOc.1ting a vegerarian diee However, in 1988, ehey came out solidly in sllpporr of vegerarian diers. They stated: "It is the position of dle American Dieectic Association rhat vegctarian diets are health/i.Ii and nurrirjonaJly adeqllare when appropriately planned."13 They addressed rhe issue of complementing proteins in rheir paper. « •.• it is not necessary that complememarion of amino acid proflles bc.precise and at exacrly dle same mc.al, as the recently popular 'combined proteins rheory' suggested." The reaJiry is rhac a vegerarian dier rhat conrajns fruits, graillS, nurs, and vegerables is fully adequate in protein.

EIGHT ESSENTIAL AMINO ACID CONTENT

OFCOMMON PLANT FOODS

.Isol.

Swcel Potato

Baked Potato

BroWD Ricc

Tomatocs Pumpkin

Leue.

Whole Wbe.al Flonr

• Lys.

• Melh.*

16 14

• Phen.*

12

'"EIO

• Thre. - • Trp.

~8

li 4

--i • Val.

~---

2

o

~MertllOnlnl

Corn

Rolled Dat

White Btlns

Asparagus Broccoli RECOM-

..

Cysl1n.

M'ENDED '~:.:..~nl"+

Figure 3

Whether you are a roraJ vcgerarian or mear earer, you should "appropriately plan" your diet beyond the llartOw scope of alnino acids. Other nurrienrs need ro be included in the planning. o one withour some rhought inro his regular earing praccices can simpJy expect to be gening a nurritionally balanced diet-regardJess ofwhether or nor meae is induded in me fa re. There is no evidence that vegeearians musr be more knowledgeable man meat eaters in order to be an a healrhful dier. In face, (he cvidence

150

Jeans solidly in the opposire direcrion. lf you know llorhing about nutrit ion, you wîU likely be heahhier by leaving meat out of your dier rather (han including it. The information in rhis chapter establishes (hat you can ger aU the essenrial amino acids evcn wÎth what may look like a very "lInbalanced" vegerar:ian dict, as we will sec.

Can Plant Proteins Furnish Ali ofthe Essential Amino Acids? Let liS rake some examples of the lIJtimate in "unbalanced" vegetarian c1iersnamely, single planr foods-and see how they measure up ro the amina acid requiremenrs. We have aJready made reference ro Dr. Rose's work in derermining amino acid requiremenes in hllmans. A number of other researchers have each offered rheir own version ofamino acid requiremems nor only for adult men, but aJso for adult women, and for infants and children. 14 MlILHO and Crim have pllbtished a comparison ofRose's requiremenrs wirh rbose of rwo orher experrs. 15 For rhe sake of assessing how planr produers fare in rheir protein conrem I have chosen to compare rhem ro the highesl (most stricr) adulr daily requiremem for each of rhe essenrial amino acids as compilecl by MUlHO and Crim. 16 Since we arc looking at the wildly hypotherical example of a person earing only a single food aJI day Jong, rhe comparisons must be based on a sufflcient (Ocal dajly caJoric imake. 1 have chosen tO use a level of2,500 caJorÎcs, which is the basis of tlle Percem Dajly Values (as seen on rJ1e food labei) for many Americ.1n men anei active women. J chose e1even foods commonly eaten by non-vegetarians and vegetarians alike. The quanriry of each of the eighr essenrial amino acids for these e1even foods is tabulaeed in Figure 3. The essentiaJ amino acid color codes are shown on the extreme right of (he f1gure. The recommended daily amollnts of rhese amino acids are represenred by the clllster of shorr bars on the lower righe. The contem of dle amino acids in each of 11 plant foods is represemed by ehe raHer bars in rhe main body of rhe figure. Note rhar these bars are much eaHer for aJl 11 foods (han

THE GREAT MEAT ANO PROTEIN MITH ehe bars represeming rhe recommended amolllltS, signifying mar planc foods supply much more proeein than is needed. This is rrue for every amino acid of everyfood. In facr, if you chose virrually tmy vegerable or whole grain you would find mat rhey have more rhan adequare quanrities of ali eight essential amino acids. The recommended daily quantieies are the srriceesr requirements ofMunco and Crim, (highcr recommended qualHities rhan others recommend) which are similar ro rhose of rhe World HeaIrh Organ izario o. Thus, rhere is no shorrage qf proreio here. Any ooe ofrhem alone fumishes more rban sufficient amounrs ofeach ofehe cighe essenrial amino acids. It follows [hat a diet eonsisting o/a variny o/plan! foods wilf have a greater content ofali essential amino acids

rhan is needed.. NorÎce thar rhere is no fruit on this list. Frwr concains a lower amount of pcoreill, aod some varieries may nor comajn an adequare amounr of each individual essential amino acid when earen alone. There may be omer planr foods thar are similar ro fmir. However, when you rh..Înk abolit ir, mllch of rhe world's popularion for centuries has survived primarily on plant proreins. They havc been ablc ro do rhjs simply because vcgcrable protein provides alI ehe amino acids needed for good heaJch. Once when I was lecruring on ehe subjece of prorein, a woman raised her hand and said, "Por rhe firsr rime 1 undersrand why our family survived the Grear Depression." 1asked whar she meant. She replied, "Our family was very poor ar the rime of rhe Grear Depression. My parents had many chjJdren and rhe only thing we had availablc ro ear during rhase years were potaroes. Thllt WI1S ali. 1 never could undersrand how ali of us not only survived on such a diet, bur also grew up healthy. Now 1undersrand how we did so wdl." She went an ro say, "However, afrer rhe Depression, I was so rired of potatoes that 1 did nor have another one for 15 years." It may have been a monotonous dier, bur it was nurritionally sound in ali rhe essential amino acids. 1 do not recommend rhar yotl eat only one vegeeable ehroughour rhe day and nom-

ing else. Such a cliet would lack a balance of vitamins, minerals, aud phyrochemicals, even though the protein intake would be adequate. Such a balance does come easily, however, by eating a variety of vegetables, grains, nuts, and fruits. We see dut we do nor need a college degree in nmrirjon ro get "qualicy pcorein" an a vegetarian dier. , Drs. Hardinge and Stare found mat even pure vegerarians living in ilie 1960s wirhout aII rhe benenrs of knowledge mar we have today were doing jusr fine regarding their intake of essential amino acids. The daea on amino acid contene of foods helps llS ro appreciare why this was the case. Perhaps one of rhe bese summary sratements on this whole topic is provjded by a respecred nutrition scienrisr, DI. Mark Messina. Dr. Messina holds a Ph.D. in Nutririon Science from Michigan State University and has worked in the National Cancer Insrirute's DieI and Cancer Branch. Afrer speaking in derai) about the balance of amino acids in plam producrs, he made t he following sum mary srarement: " ... when people ear several servings of graillS, beans, and vegerables rhroughour the day, and get enough calories, ir is virrually impossible to be deficiem in protein."17

Can W'e Get Too Much Protein? Mosr Americans are weU aware ehar ie is possible ro gee too rnuch fa! in rheir diet. They also know rhar eating too much sugllr can be harmful. However, mauy do nor realize thar rhere is much evidence ehat shows ehe serious consequ.ences from earing

too much protein.

Osteoporosis and Protein Osreoporosis-a condition thar refers ro a loss ofbone densicy or mass-has become a household word in America. Among the mOSI feared complicarions of this bone-rh..înning process are hip fractures. Fracrures of ehe backbones (vertebrae) and wrisrs are also commonly related to osreoporosis. One in rhree women over 50 years of age worldwide have oseeoporosis. 18 A1iliough rhe disease hies white women aftcr menopallse the most, it affecrs ali races and both sexcs.

151

PROOF POSITIVE Some 70 percenr of aII fracrures rh:u occur in Ameri ans over 45 have been reIared ro osteoporosis.l 9 Furrhennore, the srarisrics indicare rhar over h,tIf of alI posrmenopausal women will suffer a fracrure due ro osreoporosis ar sorne rime in rheil" lives. 20 AbOlit 1.3 miLlion osreoporosis-I"eIared rracwres occur each year in me Unired Statcs. The annllal medic.,] costs for 05reoporosis fracwres among adults ages 65 and lip wtaled 13.8 bilLion dolJars in 1995. 21 These fracrures can signiflcandy decrease rhe quaJity oflife, and can also ser rhe srage for premature death as a result ofcomplicarions like pneumonia. For example, in rhe year f(>l\owing a hip fracrure, risk of death increases 15 ro 20 percenr. 22

IDGH PROTEIN DIET ROBS BODY OF CALCIUM Ate 48 gms. protein/day

Ate 95 gms. protein/day

Ate 142 gros. protein/day

20 ~Gajn

S

â

= -;

O

-20

'Cj

-40

U Loss

-60

-70

Figure 4

A growing bod)' of research evidence indicares rhat e;
U.5. recommended daily aJlowance (RDA) of 1000 mg per day for women. During rhe srud)', rhe invesrigawrs also conrrolled rhe subjecrs' protein int/lkes ar two levels, namely, 48g per day anei 141 g per da)'. These two levels of prorein are below and above rhe currenr average inrake in rhe U.S. of 105 g per day, according ro rhe btesr St3risrics from the U.5. Deparrment of Agriculture. 24 The amollnr of calcium gain Of loss in each subject was measured ar {he twa levels. Resulrs showed dl,l[ when on rhe 1lJW protein diet. rhe yOllng men g/1ined 10 mg of calcium ro rheir body srores each clay. On rhe high protein dier rhe very same men lost an average of84 mg each day. The amhors concluded, "The calcillm loss of 84 rng dail)'. which oecurred when rhe high prarein dier was fed, was substantial and ifconrinued ()ver a period of rime woulcl resuir in eonsiderable loss of body calcillm." A follow-up stlldy was conducred by Linkswilcr and associares in 1981. 25 The srudy was similar ro rhe srudy cired abovc, excepr rhar ir added a rhird level of protein intake of95 grams per day, which was close ro rhe average D.S. intake ar rhar rime (99 g). They divided their sllbjecrs into duee groups, each wirh a differenr level of prorein inrake. AlI three grollps were consllming 1400 mg of calcium per day in rheir diers, which is identical ro rhe previous srudy. The researchers looked ar caJcium gain or loss of each grollp by measuring rhe amollnr of calcium excrered in each parricipam's uril1e and srool. The results of rhis srudy are shown in Figure 4. Notice that rhe grollp eating 142 grams of prorein per day actllally losr 70 mg of caJcium daily. Where clid mar calcillm come from? It carne from rheir bone reserves. This is an obvioLls conclLlsion since 99 percent of rJ1e caJcilltn in our bodje.s is in our bones. The high prorein inrake group was losing calciu-m el}e~y doy silnply because of rheir high proteil1 cOrJSumption. The excessive prorein was leeching calcium from rheir bones even though theywere gerring plem)' of calci li m in their diel. he group rhar con umed rhe amounr of prorein close ro rhe dail)' U.5. ave rage

THE GREAT MEAT ANO PROTEIN MYTH a150 lost calcium. Their 105s was Iess. as expected, because rhey consumed less protein. The group on che so-called low prorein dier was rhe only graup dlat had a ner calcium gain. The gain of 20 mg per day would help maintain thicker and stronger bones. It is one thing ro look at data from a llurrieion lab, buc ie is even more compelling tO see evidence of chese same relationships in people '""ho are living normallives da~' in and dayour. Internaeional comparisons ofoseeoporosis lead ro some of rhe same conclusions. The esteemed researcher. Dr. D.M. Hegsred, has poinred out thar osreoporosis is lugher in coumries th;H consume higher amounts of caLcium. l6 He looked ar {he average calcium inrake and number of hip fracrures in 16 coumrie.s. The resulrs are tabulated in Figure 5. The councries are listed in ascending oreler ofcalcium intake. Noeice char in general, those wieh {he higher imakes of calcium tend to have the highest rates of osreoporosis. 27 The first seven countries. which consume an average ca1cium below 900 mg per day, have less than 100 hip fracrures per 100,000 people. Seven of t.he nine other countries, a11 ofwhich consume more than 900 mg, have 100 or more hip fracwres per 100,000. An exceHem case in poinr is provided by the Alaskan Eskimos. By direct measuremem ofbone densiry. twO orher Universicy of Wiscoosin researchers Richard Mazess anei Warren Marher found thar Eskimos over the age of 40 had 10 ro 15 percem more bone 1055 tban white Americans in dle sam.e age range. These losses were true of borh sexes. 28 lnreresringly, when these rescarchcrs reviewed the medicallirerature on Eskimos' dîetary iIHake, they found (hat they consumed a high LeveL 0/2500 mg ofcaLcium ddiLy.29 Where did t.hey get 50 much calcium? Apparently they were eating large quanti ties of fish, inci uding rhe bones. However. (hey a1so had a high protein intake, in che range of 250 to 400 grams per day, probably becausc of rheir high consumption offish, walrus, and whale. 30 The aurhors concluded: "The most obvious f:.lClOr in rhe ... higher rate ofbone loss in middlc;lged Eskimos would be r.heir mear diee:'3]

These stlldies anei orhers like rhem indic<1te thar osteoporosis, contrar)' ro popular opiniol1, is nor reLued ro a Lack of caLâum in the Jiei. The bigger problem seems ro be excessive calciurn losses as a result of conmming 100 much protein. \Y/e would nor expecr the American dair)' industr)' ro advenise rhis. Afrer aU rhey have worked for years ro convince liS rhar drink.ing more milk and eating more cheese and yogure wou1d heJp us prevcm osreoporosis. The fact is chis: if your diet is high in pwrein, you can car ali (he calcium tha( the dairy association has ro offer and you are stiH likely incre.asing yom risk of rhinning your bones and pcrhaps facing a hip fracrure latcr in

• Eskimos comuming over 2000 m-g ofcaLcium dai!), have the highest raW ofosteoporosis in the world

RELATIONSHIP BETWEEN CALCIUM INTAKE AN» HIP FRACTURE RATE Hip-fractllre Rate (per 100,000 people) • Nonuy

200

• S'w('dtn

I7S [){'nm.r.....

150

Unifrd Stah'5 •

125

. . . •

nited KinKdom

100

......1

75 lIoo~

50

.

Koog

25

N,... Z..land

•

• Pînlaud

HolI.nd

1~I.nd

.

\'UItOJlll~ia

o O

• N'ew Goinea

200

400

600

800

1000

1200

1400

CalciwlI llllake (nrgldaJ' approx.)

Figure 5

life. E'lCcess protein Leads to il decrease ofcalcitim storn even when (aLrium intake is Lib-

emL.

Why Does Meat in the Diet CaUJe Bone Loss? What is ir about meat eating and dicrs high in proeein (har causes bone los5 and an increase in oseeoporosis risk? Onc explanarion is t.hat meat rcnds ro be rich in amino acids rhat contaln sllifur, such as merhionine. When consllmed in excess, dlese amina acids Icad ro a buildup ofsul fur ions. Some

153

PROOF POSITIVE

• Vrea is produced in the metabolism ofprotein and in excess acts IlS a di uretic

believe that th.is inerease il\ sulfate alone may eause [he kidlleyS to excrete more calcium in the urule. 32 Others provide a more complicated explanation for [he relationship. They argue mat the excess sulfur makes the blood more acidic. The body [hen uses bone eonstiruents ta neutralize this acid load, rhlls causing a loss ofbone tissue. Increased ealcillm in the mille then provides a teHtaJe sign of this bone loss.33 Another explanation is stiH more complicated. It hinges an a well-known physi-

L FESTYLE FACTORS AND IP FRACTURE RISK Variable Factors SignificantIYJ!1cr~asin Risk

---Rl!l«#ve Risk

Current use of anticonvulsive drugs Current smoking History of maternal hip fracture Resting pulse rate> 80 beats/min. Current use of long-acting benzodiazepines Current caffeine intake' (equal to 11/2 cups per day)

2.8 2.1 2.0 1.8 1.6

1.3

Factors Not Affecting Risk Current estrogen use Daily calcium intake

1.0 0.9

Factors Significantl Decreasing Risk Walking for exercise On feet more than 4 hrs per day

0.7 0.6

Figure 6

154

ologie fact: essential amina acids are needed in faidy precise amollnts. When intake of these essential amino acids exceeds the body's needs, liver emymes are tumed an [Q break down rJlese amino acids. Some of the c1assic experimems in this regard vere done by Elwyn. 34 He fed dogs excessive amounts of mcat and traced [he path rrave1ed by rhe amino acids. The protein was broken down in the sromach and inrestine aod [hen rhe amino acids were raken up inra the blood vessels surrounding the intestine. From rhere, they were carried ro [he liver. At this point, beeause of the exeessive amounts, a large portion of the amina acids was immediately broken down when

rhey ed through rhe liver. Over half of them were converred ro a breakdown produet ealled urea, whiJe anly 23 percenr of the amina acids ed from the liver inco [he general circulation where they could be used by other body tissues. What happens ro rhis excessive urea~ [t acrs as a diuretic. 35 A diuretic causes e1imination of water, bur in the process it elinlinates not only water, but a1so lIseful mincrak A similar effect occurs when ;~ person rakes dillretic mediatiolls. That individual often must take potassium becallse cerrain diuretics can eliminate potassiuJn a10ng with water. Excess urea eallses calcium loss \Virh rhe water loss. AlI of rhese mechanisms may be panial explanacions. Whatever the case, it is well established dur a meat and h igh protein fare incrCdses the risk of osreoporosis. This line of evidence may prove very disconcerring ta mally readers. What are we ro do wirh rhe revered mineral, calcium? One of rhe most comprehetlsive srudie" on osteopowsis helps ro put [he mie ofcakiulll in perspective. This srudy was nor restricred ro the lone effect of Gllcium intake, bUl looked ar man)' additional lifestyle facrors in relation to hip fractures. Faur major [esearch cenrers worked rogether to analyzc the risk of hip fracrure Îll nearly 10,000 white women over 65. 36 The)' found [har a low calcium imake-even below 400 mg per day - did nor cause hip fractures in chis exrensive srud)'. This result agrees with t!le smdy shown previously in Figllre 5. Beyond calcium, chey [ollnd many orller factors thar were damaging. They are listed in Fîgure 6. Notice thar mose whose mothers had had hip fracmres experienced double rhe risk afhip fracrure. Those wha did not exercÎse regularly were at higher risk. Caffeine consumprion equivalenr to ]1/2 cups of coffce per day was aha dearly assoeîared wirh an increased risk, as was taking anri-anxiery (benzodiazepines) 01' anri-seizure medications. Numerous addirional smdies have shown rhat the higher rhe animal protein inrake, the lower rhe densiry of rhe bod)"s bones and rhe greater the risk for hip fracrure.37 Interesringly, higher consumptjon

THE CREAT MEAT AND PROTEIN MYTH of vegerable prorein does nor appear ro be relared ro osteoporosis or bone fracrures. 38 AlrJlOugh cakium intake and hip fracrures are unrelated in many studies, some swdies have shown that an increase in caJciuffi intake. can prevenr osreoporosis, parricularly when rhe CaJCiUffi consumption is adequate and the prorein inrake is relativel)' low before rhe age of30.3~) Omer known risk tac[Ors rhar addirional studies have identÎfied for osteoporosis include inadequare sl.lnlighr (ar low Vitamin D levels), alcohol consumprion, caffeine consumption, and lack of regular physical exercise. 40 Many srudies have shown rhar thin posr-menopausal women who are nor taking eserogen supplemenes are also ar risk. 11 A diet plenriful in cakiuffi comained in plant foods is srill recommended. Calciuffi is not only essential for strong bones; it is beneficia] in orher important body functiOM. For ex.ample, it may help to prevem high blood pressure. Tr :uso appears ro "assisr ehe heare in beaeing wieh greater viraJiry.42 A number of foods rhat have goodly amounrs of calcium are listed in Figure 7. 43 Sa)' beans and greens are a good natural source of calcium. Some green leafY vegerables-like coLlards and Jamb's-quarrershave even more calcium per serving rhan soybeans. Greens also have propenies rhar help prevent cancer. rnd ed, we C<1n obrain adequare C<1kium from planr sources. Fllrrhermore, rhese foods are lower in prorein and merefore should noe extracr calcium from our bones. If we avoid an excess levei of prorein inrake and ear a good \Iariery of plam foods, our body ca1cium swres wiU likely be more rhan adequare. Tables like rhar above fail ta reveal one orhcr important fact abOli( cakium ba.lance. Namel)', it is nor on.!)' rhe quantity of calcium in a given food that is important, but how well that cakiulll .is absorbecl. And calcium absorption is dependent ro some degree on the composirion of the whoLe diel, nor merely an [he nurririonaJ characterislies of a given calcium-rich food.

CALCIUM IN COMMON FOODS

~FOodltem

Amount Calc (mg)

Oatmeal le. Lentils le. Quinoa grain le. Rutabagas le. Dandelion greens le. le. Mustard greens . - . Baked beans .., le. 2 Tbs. Sesame seeds (dried) Blaekstrap eane molasses 1 Tbs. Kale te. Turnilp greens lc. Filberts/Hazelnuts (dried) le. Green s o y b e a n s l c. Figs (dried) 10 Whole milk te. Amaranth grain lc. Nonfat sitim milk lc. CoUard greens lc. Carob flour .1 c. Lambsquarters lc.

I

19 38 102 115

147 152 154 176 176 179 249 254 261 269 290 298 301 357 ~ 358 464

~-----------------F-ig-U-re--j~

Absorption ofCalcium from Plant Foods vs. Milk Although milk has a high calcium contem, 60 to 80 percmt of it is nof absorbed through rhe human intestine. 44 Of. C.M. Weaver and associares ar Purdue Universiry have observed rhar, in general, hllmans ab· sorb a.r much or more ofrhe calcium in plam products rhan rhe)' do from mi.fk:l5 • 46 (The main exceprions are planr foods rhat conrain high concentrations ofcompounds thar bJock calciull1 absorption. Examples include spinach with irs oxa.lic acid and wheat bran cerea] wirh irs liberal amounrs of phyric acid). Since Îr is now recognized thar calcium can be assimilated as well or better from vegetarian sOllfces rhan from milk, we musr simply become aware of the rich

155

PROO F POSITrvE sources ofcalcium in the vegerarian diet and ehoose ro regularly consume these items. One possible reason for the very favorable absorption ofcalciull1 from plam producrs like green leafY vegetables is uleir low phosphorus comem. Dark green leaf vegetables can have rhree ro Ave rimes as much calcium as phosphorus. By way of COIllparison, (he rypical U.S. dier is reversed: i( has more rhan twiee as much phosphorus as calciulll. And diets with a phosphorusro-ealeiull1 ratio over two have been linked

CALCIUM / PHOSPHORVS RATIO OF SELECTED FOODS Food Item:

Calcium ('!!1:) PllOspllOrliS (mg)

Diel Pepsi (12 /1. oz.) O Lcan T-bone steak (3 07_) 6 Cund bam (3.5 Ol.) 8 Atlantic salmon (3 Ol.) 14 Polaloes (3 oz.) 4 Calush (3.5 oz.) 39 T.ofu, raw (lh c.) ~ 258 Skim milk (1 c.)~- \ 301 Whole milk (1 c.) 290 Scsame seeds (1 Tbs.) 88 Human miJk (1 c.) 79 SpiDacb (1/2 c.) 277 Mustard greens (1 c.) 1S2 Turnip grccns (1/2 c.) • 194 Kale (1 c.) 179 [,amhsquarlers (1 c.) 464 Collards (1 c.) 357

CIP Ratio

41 198

279 237

239.

<0.1 < 0.1 < 0.1 < 0.1

43

0.1

234

0.2

248 228

57 34 91

36

P"!'!"'"I"'~ n.lr\.L..-

0.3 1.2 t.3 1.6

2.4 3.0 4.2

44 :"""-=:=...0_ 4.4 4.9 36 81 5.7 7.8 46

Figure 8

WHERE DO WE GET OUR PHOSPHORUS?

to inereased bone Joss in animalsY High levels of dietar)' phosphorus lead ro inereased losses of calcium in rhe Stool. It is recolnmended rhat ar Ie..ast as mueh caleium as phosphorus is consumed in rhe dict if you want ro oprimize calcium absorption. 48 The balance of calcium and phosphorus in a variery of foods is 'hown in Figure 8. 49 There is a problem with looking ar rarios: they can be misleading. For example, some may conclude thar carfish is equaJ ro poraroes because rheir rarios are equaJ. Nor so-rhe rario ll1ul the cotaJ phosphorus arc imporranr. To keep your phosphorus load down, you wOllld favor the poraro, which bas onJ}' rvvo-ehirds as much as G.1.dish; and neilher of them eomribure much in the way of calcium. Thus, in addition ro looking at calciumto-phosphorus ratios, we need tO consider ehe phosphorus cOnteOf itself in common food groups. The average American dier has been eva1u
Catcium in the Urine Causes Kidney Stones

Grain products 19%

Figure 9

156

legUll1CS. Eggs

4%

Iluts &

soy 5%

~

1#~

We havc seen tiut losing calcium in the uril1e increases rhe risk of osteoporosis. It also presenes ocher problems. One of these is an increased risk of kidney stones. A Harvard stud)' of abour 45,000 heaJth professionals found rhat rhere was a 33 percenr increase in kidlley srones in (hase eaeing the largesc amounrs of animal protein. The resulrs suggested that inrakes of more tllan 61 grams of prorein daily inereases kidney srone risk. Anotller result suggests rhar a 50 percene decreased risk is produced by

THE CREAT MEAf AND PROTEIN MYfH eating high potassium foods from frllirs and vegerables. S' As expected, me researchers also found dut drinking plenry of water decreased kidney Stone risk. Another scudy done in Brirain reache<\ similar conclusions; namely. rhar a high animal protein diet increased calcium in the urine and rhe risk of caJcium srone formarion.)2 rf you have already had a kidney srone. you are mucll more likely ro form a recurrem kidney stone if you have a dic[ high in animal prorein. It is obvious lhar rlle besr way ro reduce rhe risk of kidney seones is simply ro ear an abllndance ofplant foods rhar are naturally lower in prorcin.

Cancer is Linked to Eating Ey:cess Animal Protein Cancer is anorher problem linked to excess animaJ prorein. International comparisons suggest that coumries where more animal prorein is eaten have more Iymphoma,S3 a deadly cancer of rhe lymph glands. Some rypes are parricularly devasraring becausc rhey strike younger adulrs. ForruoareJy. modern advances have rendered many Iymphomas rrearable with chemorherapy and/or radiarion. Nonetheless, lymphoma sriJl c1aims over 23.000 lives per year in rhe Unired Srates. The link berween animal prorein consumprion and Jymphoma appears solid. An even stronger relarionship is fouod wirh one parricular rype of animal protein; namely, bovine (cow) prorein. The New York rese.archer, Allan Cunningham, found rhar r11e suongest internarional relationship exists between dairy and beef protein and Iymph gland cancer. This re1arjonship is iIJusrrared in Fig1.lre 10. Nore rhac the U.S. has [he unenviable distincrion. of sraoding in the rop tier of counrries regarding the inrake of dairy aod beef procein and Iymphoma risk. Grher popllla.tion srudies have found an association berween animal protein consumprion and increased incidence of cancers mher than lymphoma. 54 Armstrong and Doll found mat increased animal protein consumption increased rhe risk ofcancers of the breasr, colon, prostace, kidney, and womb (endomerrium).5S With a.U of

rhese associations, the quesrion could be asked wherher i[ is animal protein that is so bad, or wherher rhe bigger problem is lack of certain nurrienrs fOllnd abwldalltly in a planr-based dier. ActuaIIy, there is some truth in borh assllmprions. Animal protein irself does increase cancer risk when compared to vegerable protein. In addition, nutrielHs inund in many planr products appear ro prelJent cancer. Thus, rhose who consume large amounrs of animal protein are likdy shortchanging rhemselves regarding an adequare inrake of healrhful plan[ products. The soybean provides an example ofhow difficulr it may be ro confirm the reason(s) planr protein may help decrease cancer. Dr.

AN MAL PROTEIN AND LYMPH GLAND CANCER 5.0 USA • • New uRlind • Denmark Italy •

Switzerlaod • • F"m laod Norway • Unlted Kingdom • Netherlands • Belgium Swed en

•

• Yugoslavia

2.0 • JlIpan

o

•

10 20 30 40 50 Per capita bovine protein consumption (g/day) Figure 10

Mark Messina, a noted soy bean researcher, has listed a number ofsoy proteÎn products rhar have a cancer-fighting role. These include soy protein isolare, soy flour, and textured vegerable protein. 56 Furrhermore, human popularion studies suggesr that soy has a role in preventing a variety of cancers incllJding colon. rectum, prosrate, sromach, lung, and breasr. 57 Messina explains ehar the primar)' reasoo for the anricancer beneflts of rhese producrs probably resides largely in their liberal supply ofanriox:idants,

157

PROOF POSITIVE which are chemicals ular can block cancer formarion. Thus, rhe example of soy illusrrares rhat it may be difficulr ro reU how much benefir comes from rhe plalH protein irself (and rhus avoidance ofanimal prorcin) and ha\'{ much arises from other compound.s faund in liberal amoulHs in proreinrich planc foods. The evidence is char plam producrs often have a hosr of Cll1cer-prorecrive properries rhar may be of even more benefir rhan thcir superior rype of prorein. Chapte.r 2 on cancer addresses {!.lese properries more fully. Specific cancer research, however, identifies animal protein i{self as a cancer-promot ing factor. Researdlers ar Cornell University in ew York have provided striking evidence of a relarionship berween animal prorein intake and liver cancer. In humans, tWO of rlle main causes of liver cancer are generic changes caused by che hepariris B virus sS aJld exposure ro a carcinogen called aflatoxin B 1. 59 (Ailaroxins are a graup of chemica1s produced by certaln molds rhar are capable ofcontaminaring ordinar)' foodsrufTs, such as moIdy peanurs.) The Cornell group has now shown rhar in anima1s these twO patent causes of liver cancer can be rhwarred b)' following a dier with reduced animal prorein. When Illice are given a.flaroxin or have Heparitis B-related generic changes ro increase rhe cancer risk, a lowcred animal protein dier can elramarically reduce rheir liver cancer risk. One recent srudy involved rwo groups of m.ice prone ro liver cancer mac had Hepatiris B-altereel genetics. Dr. Cheng and colleagues fed one gratiI' of rhese mice a srand:ud 22 percenc milk procein (casein) diec. They feei rhe ocher group a dier wirh casein reeluced by abouc 75 I'ercenc. The difference in cancer developmenr was suibngly proportional (Q the casein in rhe diec. 60 Whereas 64 percenr of rhe mice an rhe srandard eliet contracred liver cancer, onI)' 16 percenc of chose on rhe low animal prorein dier did (a reduc(ion of75 percenc). Similar results have been found in rheir tab with aflaroxill rarher rhan Hepatitis Baltercd genetics. Increasing the procei n COIl(em ro the same 20 percem range by usi tlg soy ar orher planr proteins insread of miile

158

I'rotejl) did nor increase che cancer risk. T!lis makes a $rIo11g case tJlat ir is the animal prorein itself, not protei Il in general, rhac is the problem. These cancer-promoring effects of a higher animal protein-based e1ier also appear ro occur in hUll1ans. For example, afla(oxin exposure in China does not seem ro increase liver cancer risk becausc of their low prorein dier. 61 Why eloes a high animal procein diet increase cancer risk? Oile explanarion may be rhac animal proteins lead to increased levels of cerrain growrh hormones thar srimulare cancer growth. One such growrh factor is called insulin-like growth factor II (lGF2). T!lis facror is needed for rhe normal growth of the human embryo, and cencls ro decrease as we get older. 62 . 63 Howevcr, IGF2 is often found in high amOUlHS in tlImors. 64 . 65 Some researdletS belicvc rhar rhis growrh f:Kcor helps ro give the cancer cells a growth. advamage. Of particular importance, fGF2 levels were over four rimes higher in mice with the hepatitis B generic chaJlges that were given fhe 22 percent casein diet compared to those with rhe same genetic changes for mice thar were an rhe 6 percent casein diet. 66 There lllay be orher rea ons for the Sllperiority of plant protein regarding cancer. Immune sysrem effects may a1so be pan of rhe explanation. Although rhe reseacch is far from conclu ive, we are srarting ro learn abollt some iJlteresting relariollships berwecn diet and a grollp of cells called natural killer cells. Nanual kiUer cells are a special type of whire blood cell. These ceUs have rhe ability ro destroy foreign cells such as cancer cells. 67 There is now sorue evidence demonsrrating that the consulllptioll of larger amollnts of proteill, especîaJly from animal sources, can decrease rhe number of narurai killer cells. The higher pwrein illrake may al50 adversely affecr rwo orher rypes of whire blood ceUs; rhe T helper cdls and the T cytoroxic cells. For example, oile scudy determined dlar resrriction of rwo amino acids, phenylalanine and ryrosine, could Împrove [he immune sysrems of healrhy human voluntcers. 68 For 28 da)'s, rhe elice

THE GREAT MEAT ANO PROTEIN MYTH of rhe panicipams was changed ro restrin the rwo amina acids, aher which rheir diers were swirched back ro rhe eypical American dieI with higher amoul1ts of tbe amina acids. The effecrs of {hese dier changes are rraced in Figure Il. Notice rhar the nacural killer cells doubled. from 3 ro 6. Two orher importalH cancer-prevenring ceUs, the T helper ceUs and rhe T eytoroxic cells, also increased. In rhe last 2 weeks of rhe srudy rhe individuals were given back their eypical American lJleac diet rhar is naturally high in phenylalanine and eyrosine. As a resulr, their healthy high immune cell levels dropped, excepc for the T-killer cells, which had a more delayed drop. Whar kinds of foods have t!le amino acids phenylalanine and ryrosine? A lisr of such foods is shown in Figure 12. 69 Notice that various meats have a high cantene of rhese amina acids, a10ng wirh lentils. Fruits are among rhe besr foads for avoiding eyrosine and phe.nylalanine. Fasring, of course, would reduce the intake of {he amina acids to zero. Ir i5 inreresring in liglu of rhesc observations ro {ake nore of {he advice writtcn by E1len Whire as quoted in Figure 13. 70 There is IlOW evidence rhat resericting cerrain essential amino acids such as phenylalanine and eyrosioe may help co creac certain deadly cancers that have already sprcad ar merasrasized. Several srudies were done in mice rhat had rhe deadly skin cancer, called melanoma, which had already sprcad ro the liver and IWlg. However, when [he mice were placed an a diet 10w in rhese [WO amina acids, the tumors stopped growing. Me:u1\vhilc., the mice an rhe "normal" dier died quickly from rapid melanoma [Umor growth. This research raises some serious concerns. Many would consider rhe amounr of amino acid resericrion in these srudies as extreme. Even an a eypical vegerarian dier, such lowcring would call for specific vegetarian food resrricrions. Thus, one queseion rhar emerges is: can a1rering even a vege[arian die( in cenain ways (such as a very low phenylalanine dic[) acrually assisr metastatic cancer human pariem' longeviry? The

IMMUNE SYSTEM BENEFITS FROM REDUCING THE INTAKE OF TWO AMINO ACIDS 40 35

30 Cell 25 Count

20

18 _11

15

iiiiii_--==:;~~~:: 9

10 . 5 3.O

Natur I killers Day 28

Day O

IŢypicD/

Diet 10'" in ]; Dmino acid.\'

Day 42 American diel

Figure 11

PHENYLALANINE AND TYROSINE CONTENT OF FOODS Food Item: Plant

'*

Plren (mg)

Applesauce (Ill c.) Mediulll Apple (2 uch) • Cabbage (1 c.) CoUard Grccns (1 c.. ) Muslard Greeos (J c.) Dried Figs (10 ellch) Lentils(l c.)

6 14 48

61 90 ,138 881

Tyro (mg) 4 II

.26 47 180 247 477'

/lI,imal Egg (1 each) Whole milk (1 c.) Crab (3 oz.) Tuna (3 oz.) BeefSirloin Sleak (3 OI.) Chicken Breasl (1 eacb)

S:'

332 388 799 970

255 388 632

1012

836 868

1147

960

Figure 12

BENEFITS OF FASTING "10 many e-ases of sickness, lhe very best remedy i5 for the patient 10 fast for a meal OI' two, that the overworked organs of digestion may have an opportunity to rest. A fruit diel for a few days has often brought great reliefto brain workers. Many times a sbort period of entire abstinence from food, followed by simple, moderate eating, bas led to recovery through nature's own recuperati ve effort. An abstemious [self-restraining] diet for a month or two would convince many sufferers that the path of selfdenial is the path ta bealth." Figure 13

159

PROOF POSITIVE

LOW OTEIN DIET ARRESTS EY FAILURE DIABETICS 100 Kidney filtering ability ml/min.

80 60

50

40

20

Diei challged

O

One year after diet change

_ Normal American _ _ Ouc )'car of low diet protein diet Figura 14

LOW P OTEIN DIET INCREASES BLOOD P OTEl IN DIABETICS 5

Serum Albumin (iodicates

blood protein)

4

3 2

One year after diet change

Dict changed

o One Year Figure 15

answer ro rhis quesrion has nor yer bcen found.

A High Protein Diet Deteriorates Kidney Function

160

We have known for years rhar diseases like high blood pressure and djabcres can destroy the kidney's microscopic ftltering units called nephrons. For examplc, among diabecics, kidney disease is one of rhe leading causes of death and medical disabiliry.

One OUl of duee diaberics who are dependenr an insulin evcmually develop kidney failure requiring cither dialysis or uansplanrarion.?l More rhar 20 million Americans suffer diseases of rhe kidney and urinary rracr and more than 90,000 dic cach year. A high protein imake can progressively destroy kidney nephrons, which weakens the kidney filtering abiJilY. Such damaged kidneys normali}' continue ro dereriorate. AlthOligh tightly conrrolling [he blood sugars and blood pressures of diaberics can help. rhe disease will srill progress and worsen wirh rime. A dassic study was done on chronjc kidne)' failure parients who had already Iose signjficam kidney funceion.l- These paeienrs had protein in the urine, which is rhe resllir of weakened kidney flltering. Normal kidneyl> do not produce urine thar colltains protein. Doctors had measured their kidney filtering ability. In normal individllals ehis value is around 125 milliliters per minute (ml/min). However, rhese kidneyimpaired individllals had values rhar averaged only 50 ml/min.. which mea1lS tiut their kidney fi.lIlcrion had already deteriorared by more t.han 50 perCel)L The researchers placed these patiems 011 a low protein diet of 40 grams per dar Thc purpose of rhe srudy was ro derermine it" kidney dererioration could be arresred by redllcing prorein in the dieL The resulrs are shown in Figure 14. Note rhat one year laeer, rheir kidney funcrion remaÎned Slable, srill with a fileering ability of 50 mI per minute. This landmark seudy demonstrated whar sOlUe had rhollghr was unrhinkable; namely, rhat signit-lcant diaberjc kidney disease could actually be held ar bay. But the nexe questioll was, will ehe reduce ion in dietll1y?rottin cause a.n undesirable reducrion in proteil1 in the Mooel? Blood albumin measuremenrs, which are an indicator of the level of protein in rhe blood, were done ae rhe beginning and end of rhe rese The resulrs are shown in Figllre 15. Note [.har tllOse in the study saw rheir blood protein leveJs rise significantly, even though they were an a low prorein elieL This was rrul)' surprising: man)' docrors had

THE CREAT MEAT ANO PROTEIN MYTH raughr for years thar diaberics wha were losing prorein in rheir urine musr eat a higher prorein eliel. A high prorein eliet was dlOughr neeessary tO make up for mine protein losses. This sruely c1early clemonsrrared dtar a IOUJcrprotein diel was realI>, what was called for. Haw is ir possible rhar rhe levels of prorein in the blooel inereased while the prorein inr~tke was lowereel? Ţhe answer is found by looking Olt the measurem(~ntS of protein lost in rhe urine ar the begiillling anei enel of rhe test. Thcse measuremenrs are shown in Figure 16. AfteI" a year on rhe low protein elicr, rhe parienrs' urinary prorein losses elropped signiflcandy. The effeer of rhe lower prorcin intal,e was more rhan o.ffser by the sharp reduction in protein IOHCS rhrough [he urine, resulring in an actuaJ increase in protein in the blood. Blooel pressures aJso seerned ro benefi r from rhe low prorein elier since both rhe sysrolic anei diastolic came elown slighdy. Although conrrolling a kielney failure pariem's blood pressure can help prevenr the worsening ofrhe disease, rhe aurhors' clcafly St:lre rhar rhe milel reeluction in blooel pre sure could nor, by irself~ have dramatieally prevenred the worsening of the elisease seen in this srudy. Thus, rhe prorein resrricrion irselfwas the imponanr element in prevenring worsening kidney funcrjon. To summarize this srudy, rhe resulrs of a low prorein clicr in pariems with signifieanr kidney f1ltering clamage proeluced four posirive eftecrs: arrcsred kidney failure, increaseel blood protein, sharply reducecl mine protein, anei lowered blood pressure. This study and numerous adelicionaJ subsequenr sruelies add kidnev failure ro [!le lise of diseases tiut are besr tr~ateel by protein resrrÎcrÎon.73. 74

Weight L055 Inhibited by Milk Protein A Stuely indieares rhar ir is more difficulr for an individual to Iose weighr if rhe diel conrains a high amollnt of milk prorein. OI'. Cheng anei his associares ac Cornell have found rhar mice feei a elice higher in milk prorein (casein) gain more weighr man mice feei a elier coneaining less casein. To

3000 Urioe 2400 proteio, mg/d 1800

2000

1

1200 600

One year after diet cbange

Diet changed

100

o Ooe Year

Figure 16 gain e!le same amoum of weighr, rhe mice had ro ear 25 percenr mor of a dier conr,lining 6 pereem casein than wirh one containing 22 pereenr easein.7 5 Cheng auributed this elifference ro che fact rhar rhe body generares more he-ar {thus consumjng more ealories} when it is funerioning on a elier thar is lower in animal profein, ehus maJ(ing it easier ro Iose weighr on rhe same amoum of food. le is important ro nore [hat wirh the lower <1mount of casei Il, the

SWITCHING TO VEGETABLE ROTE LOWERS CHOLESTEROL 20

o Cholesterol change, -20 mg/dl -40 -60

-80 Crosso\'cr poinr

-100 -120 L -

_.+-

--L

3 wecks

_

3 weeks

figure 17

16]

PROOF POSITIVE dicr was sciH fOllnd ro be consisccnc wich good growth and long term healrh.

Vegetable versus Anima! Protein for Heart Disetlse In controlling blood cholesterol, rhere are a nllmber of srudies ehar now show rhe advantages ofplant or vegerable protein over animal protein. One classic six-week studl' was conducred by Or. Sirtori, who puc two grollps of patients with high blood cholesterol levels on diets ehat, on thc surface, appcared equalll' good. 76 Borh wcre low in cholestcrol and saturaccd fac, but high in fiber, which sholild help (Q control blood cholcsterol. There was, however, one significam difference: onc dicc was based on skim milk procein, while [he oehcr diee was based on sol' protein. The cffccts of [hese two diets on e!le blood cholesrerollcvels are shown in Figure 17. We see rhat during the firsr duce weeks, rhe milk protein grollp lowcred rheir blood cholesterol by 20 points. The soy-based group did significanrll' berrer, however, wirh a 60-point drop in cholestcrol. Afrer [hree wceks, [he two groups were rhen reversed ([his Îs called a "cross-over study"). Those who had been on rhe skim milk-based dier changed ro the soy-based menu and cxperienced a furmer and much sharper choles-

VEGETABLE PROTEIN PROMOTES LOWER CHOLESTEROL IN RABBITS 200

~~~~~~~~-

---------175

rerol reduction of80 points in rhe Ilcxt duce wecks. Those who wcre srarted on ilie vcgerable protcin (sol') die[ now swilched to rhe skim milk-based regimen. They saw cheir cltolestcrol risc neaely 40 mg/dl. Sirtori's research is not alone În demonscraring rhe imponance of eating vegerable protein inscead of animal procein ro lower che risk ofcoronary hearr disease. Researchers ar the Universiry of Kencucky used advanced statisticaJ computer methods ro anaIl'ze 38 separate stlldies in rhe medical lircrature that have looked ac rhe use of so)' protein ro lower cholesrerol. Their :lnaJysis showed rJlat when compared to animal pro[cin, soy protcin signiflcantly decreascs blood levels of toral cholesrcrol, LOL cholesrerol (rhe "bad" cholesrerol), and rriglycerides. 77

Why the Type ofProtein Matters for Atherosclerosis Animal foods are generaHy high in rhe amino acid lysine and low in argininc. Conversely, the average ptanr or vcgerable food is much higher in arginine than Iysine. The proporlioJls of rhese two viral amino acîds appear ro play a role in how our body responds hormonaHy (O a meal. Proteins rhar are low in arginine like rhose found in animal producrs have been observed tO rai e human cholesrerol levels, apparenrly chrough scimularing inslllin producrion.78

Anima! Proteins Increase eho/estero! Levels Two renowned cholesrerol researchers,

K.K. Carroll and M.W Huff, have do ne

150

Average cbolesterol, mgldl 100

50

o Figure 18

162

r----f-

Rabbits 00 plaotbased proteio

Rabbits 00 aoimalbased prote.io

cxtensive rese-arch on how differenr planr and animal proteins affccr cholesrerollevels. In eheir research, rhey lJsed a "laboratorl' chow" diet thac was low in fat and had absolutely 120 choLesteroL. The onll' item that was varied from ooe subjcct ro the next was rhe source of procein in cite chow, which was from bodl animal and plant sources. The animal protein was isolated from the animal product aud added [O rhe chow, such [hat rhe chow remained free of cholesrcrol. r imagine alI the fare was indisringuislt-

THE CREAT MEAT AND PROTEIN MYTH able and looked nondescripr-probably similar ro dog food. No one could reasonably expecr humans ro accepr such a dier for the fuI! four weeks of rhe srudy. The researchers (Umed ro rhe New ZeaJand whire laborarory rabbit an animal rhar has dier and cholesreroJ re/arionships rhat are similar ro humans. Each of I I specific arumal proteins and 10 specific planc protcins were evaluared on 21 groups of five ro six rabbits in each group for rhe emire four week period. The drecr on rhe blood cholcsrerollevels of rhese 100-plus rabbirs was remarkable, given rhar the diers had no cholesrcrol and differed only in theÎr source ofpcorein.19 Figure 18 conrrasrs rhe average cholesrerol Jevel for rabbirs on planr-derived proreins wirh rhe cholesrerol Ievel of rhose on proreins from animal sources. Note rhar on rhe planc prorein-based chow their average blood cholesterol was low, averaging 67 poims; however, on rhe animal protein-based menu rheir cholesrerol valllCS raJl markedJy higher ar 175. , however, in rheir research rhere wcre 21 groups of rabbirs, wirh each group earing a protein from a differenr source. Figurc 19 delineares how blood cholesrerol values were affecred by differenr rypes of planc prorein sou(ccs. The average cholesrerollevel for rabbirs earing animal protein (J 75) is shown for compaflson. Figure 20 provide a similar breakdown for [hose an animal protein-based diers, wirh ilie ave rage of rhe animals on rhe plant prorein diets shown for reference. Note rhar rhe rabbits on animal proreins had a range of cholesrerol leve/s of 101 tO 270, whereas the range of [hose an planc proreins was 43 ro 96. The ranges did nor overlap. C1early, subsrituring planc proeein for animal prorein in the diee, regardLess of which specific plant or animal loura is used, would reduce elle risk of ali disease.s relaeed ro high blood cholesterol.

Other Advantages o/Plant Protein Orher advafleages of earing planc prorein are just now surfacing in nucrieional resea.rch srudies. A recent seudy of women

TEN PLANT P OTEINS CAUSE LOW CHOLESTEROL IN RABBITS Ave. Animal Protein • • • • • • • • • • 175 Rapeseed Flour . . . . . . 96 Wheat Gluten

80

Peanut Protein

78

Dat Protein

76

Coltonseed Protein

75

Sesame Protein

63

Soy Protein holate

58 51

Sunflon'er Proteill Pea Protein

46

Faba Bean Protein

43

o

50

100

150

200

250

300

Blood Cholesterol Level, mg/dl Figure 19

TEN ANIMAL PROTEINS CAUSE IDGH CHOLESTE OL IN RABBITS Egg Yoke Proteill Skim Milk Protein Turkey Protein

••lIiiiiiiiiiii•••·~·iii·-ii-iii·i i 270

.-----1111!1-.•

215 225

Casei II •

~-.

203

Whole Egg Prolein Fish Protein Beef Protei.D Chicken Protein Pork Protein Raw Egg White

Ave. Plant Protein

._I!III_.

107

...

~.

101

~~67~ o

50

100

150

200

250

300

Blood Cholesterol Levcl, mg/dl Figure 20

suffering from severe hor flashes was conducred. These uncomfortable episodes of intense heae sensarion freqllcntly accompany rlle dropping esrrogen levels in menopausal women. le was demonseraeed iliar eating 20 grams ofsoy proeein a day (eqllivalene ro a half-cup or 4.5 ounces of rofu) significancly rcdueed the severi'y of thei,. hot flashes. 80 Thc stlldy's (ead researcher, Or. Gregory Burke from Wake Foresr Universiry and ehe Bowman Gray School of Medicine in Nord) Carolina, believes the improvemem

163

PROOF POSITIVE

AMERICAN VS. CHINESE BASIC FOUR DIET PLANS American Basic Four Milk Meat FruilS and Vegetables Cereai GraillS

Chincsc Basic Four Green Leafy Vegetables

.,

Soybean Products Sweet Potatoes Cereals

Figure 21

is due ro plaot estrogens in rhe so)' protein which "may have the same beneficia! dTects of e~rrogen, but may not have some of tlte downside." These plam esrrogens do nor seern ta increase che risk of uterine cancer like cheiI' human and piU form counrerparrs. Ali ohhe women eating the soy protein aho experienced a beneficial "side efTect" of tl

significant drop in tlle totltl tind LDL dJOlesterol (l0 and Il percenr respeGive1y) wirh no drop in their good HDL cholesterol during ilie six week sttldy.

CHINESE BASIC FOUR PROTEIN CONTENT BasicFour

Recommended daily amollnt (g)

Profein supplied (g)

Green leafy vegetables

500

5

Soybean producls

60 400

18

400

40

Sweet potatoes Cereals ~

8 Total

Figure 22

164

71 grams

Protein in Growth and Development The average age of menarche, rhe age rhar gir1s begin ro have mensrruaJ periods, seems ro be connecred wirh rhe amotlllt or rype of protein thar is conStlmed in ch.ild· hood. For illsrance. severaJ years aga when rhe Japanese were consuming a very low me:lr and animal producr dier, rhe average age of menarche wasl Î. 81 This cOlllpares wirh the average age of menaI'che in rhe U.S. ofless rhan 12.8 years ofage. 82. 83 Many experrs believe rhar an early age of menarche is a significanr risk facrar for the later developmeru of breasr and uterine cancer84 and may hdp expbjn why American women have ovcr faur rimes the I'isk ofbreast cancer compared [O japanese women. 8 The only srudy 1know of dur has compared ule growrh of vegeearian ehildren with meatconsum ing children in the same geograph ic arca showed rhar rhe meat-earing children were slighcly raller than che vegerarians unt.il age ten. However, when both groups had reached rhe age of 18. the vegerarians had caughr up wirh and rhen smed (heir meat eatÎng counrerparrs. being ar lea 'r an inch raJler as aduJts. 86

USDA Basic Four Food Groups For Proper Nutrition The U. S. Departrnenr of AgricuJrure published dierary recommendarions for good lluuirion that srood for 40 years. They divided rhe foods imo faur food groups caUed rhe "Basic Four. " As a rhird grader, J learned whac r "must eat" every day ta have good healrh based an these food groups. Contrary ro rhe USDA recommendatiolls, che Chinese Medical Association recoOlmends four food groups rhat are in sharp contrast. The Chinese approach ro nurririon is especiaJly imerestjng because China has a very low illcidence of cancer, heart djsease, diaberes, and many of the odler degenerative diseases common in Western socieries. The American and Chinese "basic faur" djets are compared in Figure 2). Nore thar rhe Chinese ear rhree vegerable caregories plus cereaJ grains. Animal producrs are conspicuous by cheir absence. In clle U.S. basic faur lisr, rwo of the faur irems

THE CREAT MEAT AND PROTEIN MYTH are animal products, while fruirs aod vegetables are dowoplayed by combin.ing r11em . . 11HO one [[em. As we have seen in this chaprer, a vegerarian-based diet like the Chinese dier can easily provide aH rhe prorein oeeded wirhout the use of animal products. lf we look at rhe daily amoum of each food caregory in rlle Chioese basic four recommenda(ions we see fhat rhe protein comem is ample. These daily amountS, along WirIl rIle prorein comem, are tabu Iared in Figure 22. The 7I-gram total prorein exceeds r1le U.S. recommended daily aJlowance of 56 grams.

us. Government Switches to Lower Protein Recommendatioll Why clid rhe American faur food groups differ sa much from (hose of rhe Chinese? The USDA recommendarions were nor based on health 50 much as an American cultural eating habits. It was nor umil very recently that our governmellt undenook the fask of producÎng new recommendarions rhar shifted emphasis from nutrient deficiencies ro chronic diseases. Their new recommendarions reduced meat and diary consumptJon. As expecred, rhe daicy and mear industries were disrurbed abolit rhis change and pressured the governmem so heavily rhar rhe new food gujde was wirhdrawn for monrhs while the speciaJ interesr batcle raged. In rile end, the mear and dairy indusrries succeeded in having rile wording changed from "decrcase consumprion of meat" ro "have rwo or three (daily) servings [of meat]."87 Excepr for rh is unforrunare alreratiol1, rhe new (ood guide, which is in rhe form of a pyramid, is an improvemenr over clle older four-food groups. The chan is reprodllced for Y0l! in Figure 23. The foods shown ar rhe base of the pyeamid are ro be earen witil rhe great st fi'equency. This is based on healrh reasons, not cultural reasons. Grains are abundant in natural fooru. Mosr Western cOllnrries have adopre<:! rhe pracrice of refining man)' of rheir grains. However, we need ro car Ulholl' f?:'tlin foods ro receive the maximum

beneflrs of fiber, viramins, and minerals. FruÎrs and vegerables are rhe nexr carcgory. Today rhere are numerous stlldies, O1any of which arc: presenred in Ihis book, rhar clearl)' indicat.e the procective benetlts of rhese faods. Those who ear rhe mosr frllirs and vegerables have the leasr amounr of cancer and hearr disease. Unfonunarely, rhe average American has failed ro follow rhese pracrical recommendarions. L'uesr sllrveys indicate rhat mosr Americans ear an average

USDA FOOD GUIDE PYRAMID Fats, oils, and sweets Use sparingly

DairL

Meat, nuts, eggs

2-3 Svgs.

2-3 Svgs.

Fruit 2-4 Svgs.

Grains 6-11 Svgs.

Figura 23 of onl)' 3.4 servings of fruirs and vegcrables per day, far from the 5 ro 9 rhe pyran:tid recommends. 88 Meat.s, l1UtS, and eggs are now dassified rogcther in the prorein group. However, \Ve have seen (hat vegerable proreins (including legllmes) are by far rhe safest [orms of prorein to consume. Dairy is also represen red probably because ofdai ry association pressure. Bur soy milk, which 1S a substiture for cows milk, is now commonly available, and is cholcsreroI-free :lod low in far; rhere are many flavors and varieries (Q choose from. Ac the rop of rhe pyramid, fars, ous, and sweers are lisred. We agree ",;irh rhe message of llsing [hese sparingJy. In facr, rhe 1e.ss rhe benCf. What would be the re.sulr if Americans followed rhe full recommendations of the bonom half of rhe food guide pyramid by

165

PROOF POSITIVE

GRAMS OF PROTEIN CONTENT PER 100 CALORIES Plant Source Apple Banana Orangc Baked potato Brown riee Corn, frozen Whole wheat Cabbage Chickpeas Pinto bea ilS

~ro.t~.in(g) Animal SOllrce

0.5 I 2

2 2 4

Pl'otein(g) 5

Whole miJk American cheese

al •

I'ork/ham

6 8 10

Nonfat skim milk

10

Whole egg

~

Beefrump

II

4

Pink salmon, calloed

14

5 6

Chicken breast

15

Tuna, canned

22

4

Figure 24

ommenda[ions? It wOllld drop dramarically lO a sa fer level, becallse animal prodllCls would have a smaller parc in our dier. Ta consume a given amOllllt of calories each day by using a large amoum ofanimal foods. a person would have a high inlake of pro[ein. This is simply because the nllmber of grams of protein in anjmal foods is high in relaljon lO fhe calories they comain. Conversely, consuming ehe same number of calories by eating a Iarge amOllnt of planr foods wOllld result in a lower prolein inlake, becallse plant foods comain less grams of prolein for a given number of calories. A comparison of planr and animal foods in lhis regard is tablliared iJ1 Figure 24. 89 We see rhar plam sOllrces of food are generally mllch 10we1' in prolein for a given calorie comene than animal SOllfces. For those rcaelers who desire to know the percent of calories from protein in [he foocls listeel, mllltiply the vaJues by four.

Basic Four Diet Based on lnformation /rom this Chapter If we were ro COnSr.Illct aur own recommended food groups baseel on the informa(ion shared in d1ÎS chaprer, we could serve lhe callse of health well WiUl a simple four fooel grollp plan. This basic faur plan is shown in Figure 25. [fwe were ro subsÎsr wholly on lhese faur food groups, we could prevent a whole host of diseases, improve both our quafity arid quantity oflife, anei make a hllge difference În [he hcalrh of lhe emire Wesrern \Vorld.

lnspired lnsights

Figure 25

166

earing Il servings of grains, 5 servings of vegelables, 4 servings of fruit, and 3 servings of lllHS each day? Obviollsly, there would not b much room left for the undesirable items listed at lhe rop pOliion of dle pyramid. And that is precisely rhe point. Whar wOllld happen ro rhe level of pro[ein imake if we followed [he pyramid rec-

If you believe in the Bible as Ido, you will bc fascinated as you read lhe seclions in the book of Genesi [har have a bearing on elier anei longevicy. [n the days of our earliese ancestofs, the eliel \Vas wholl)' vegcrarian, no dOllbr including a wide variecy of fruirs, vegetables, grains, and I1U[s.90 In Genesis, chaprer njne, lhe elier changed ralher dramarically. Meal and animal produers were aeldeel. Forrunatdy, the Bible also records rhe life span of inelivieluals represeming ten generatjons before meat earing anei ule nexr len generarions after mear was

THE CREAT MEAT AND PROTEIN MYrH ilHroduced. A human longeviry Cl1rve plot ofBible charaeters is shown in Figure 26. We see thar rhose living in the first ten generations on a vegetarian diet lived an average of about 900 years. After meat and animal produces carne inro the diet, a life span of 600 years is recorded, ehen several ar abom 450 years. The steady decline conrinued uncil reaching ehe "ehree score and ren" (70) level stated in Psalms. The essence of ehis biblical was reiterated in the 1800s by Ellen White. Over 100 years ago, White wrate: "the liability to take disease is increased ten-fold by meat eating."91 In the 1800s vegetarianism had noe gained (he populariey thac it has roday. Toclay, however, we know with eereainty th;u meat eating does increase rhe risk of a nost of degeneracive diseases.

Conclusion Te is high timewesee aside tlte greac mear and proeein myth. Preoccupation wim meat and ies proeein raeher chan improving healrh, has comributed (Q mally degeneracive diseases such as hearr disease, cancer,

LIFESPAN mSTO YOFMAN Longevlly, ~'cars

900

'JU 'Il !NS 910 ii.

. ,'"

(Genesis 5 and 11) 9,.

800 700

.lOO

100

1001-iJlH'flHI!l

F100d

1000 B.C.

Figure 26 osteoporosis, kidney failure, and kidney seones. Plant sources of nutrieion are generally modese in protein and reasonable in fat coocentj furchermore, ehey never contajn any cltolesterol. Wirh our growiJlg underst:lnding of protein physiology, a planrbased diee has emerged as the optimal way to ear for chose interested in maximizing longevity and the quality ofliving.

PhiJade.lpnia, PA: Lea and Fehiger, 1988 p. 29.

RefermcesJ

Am Din Assoc 1966 Jan;48(I):25-28.

11 J-1ardillge MG, Cmok> H, Stare FJ. Nurririona1 seud.ies of vegerarians. ) Am Diel Assoc 1966 Jan;48( 1):25-28.

Campbcll TC Mliscling Out rhe meat myrh. New Ci:mury Nutrilioll 1996 Jul;2U):1-2.

12 BeJl G. lb:lbook ofl'byrio!ogy and Bioclmnistry--4iJ' l,dilion. Baltimore. MD: WilLiallls aud Wilkins. 1959 p. 167-170.

) Campbell Te. Musclillg OUl lhe. mear Ill)'lh. New Century N/IIrition 1996 JlIl;2(7): 1-2.

I PositiOIl of t!le American Dieleric Associatioll: vcgctari,\11 diet.~-rechlli cal paper. J Am Din Assoc 1988 Mar;88(3):3S2-3S5.

, Campbdl Te. Musding Olll rhe meal m)'lh. New Cmmry Nlllririoll 1996 Jul;2(7): 1-2. l

I~ Munro H , Crim Me. The proteins and :lIniIlO acids. In: Shils ME, Young VR, eclilOrs. !viodem Nur,.ilion il! fI,'a!lb and Diseau-7lh ttiilio1/. Philadelphia, I>A: tea and Febiger, 1988 p. 30.

6

15 Munro J-11 , Crim Me. The proteins :\I\d amino acid. In: Shils ME, Young VR, edilOrs. Modem Nttt,.iliol! ill Hcallh and Distt1se-7Ih edilioJl. l'biladelphia, PA: Lea and Febiger, 1988 p. 30.

1 Hardinge MG, Crooks H, St:uc FJ. NlIrritional sllldies of vegerarians. 2

Munro HN, Crim MC The proleins and :unino acids. In: Shils ME. Young VR, edilOr8. Modern N/II,.itioll in Hen"b ami DiSftut--1llJ edilion. Ph.iladelphia. PA: Lea and Febiger. 1988 p. l.

P,.ouil1: Mish EC Ed.ilor in Chief. Merrif1JIl-V?l'b5ters Collegillfc Dicrio-

11II1J-1fY' cdilion. Springl1e1d, MA: Merci, m-Wcbster, Iocorporated. 1994.

p.938. Munro H . Crim MC The proteins and amino acids. In: Shj)s ME, Young VR, edirors. Modem Nurrition in Health Imd DisclIse-7th rdilioll. Ph;ladclphi,\. PA Lea and Febiger, 1')88 p. 1.

7

Torun B. Scrimshaw NS, Young VR. Effcct of isornctric c.xerci.es ou bod}' pOlassillm :1.nd dierary protein requiren1elll of )'oung mell . .Am J CIi" Nllir 1977 Dcc;30(12):1983-1993. Munro J-lN, Crim MC The pcolcins and amino acids. In: Shils ME, YOllllg VR,. cdilOrs. !vIodan Nutrilioll in Heo!Jh and DiullSr-7lb Niitiorl. Philadelphia, PA: Lea Jud Febiger, 1')88 p. 1-2.

9

.0 MlInro HN. Crim MC The protc.ill, and amil\o acids. III: Sltils ME, YOllng VR, edilors. Modern Nutrition in Hellllll mul Disellsr-lllJ etlition.

16 The Food Proccssor for Windows: Nurrition Analysi, & Fitness Soft· \Vare [computer program]. ESHA Rese,\rch. Salem, Oregon.

17 Messina M, Mcssina V. SClcheU KD. Thl' Simp!l' Soybean And Hl"l!tJJ. GJrden Ciry Park, NY: Aver)' Puhlishjng Group, 1994 p. 24.

y,,,,,.

18 World Health Organization (WHO). The World flcaltb Reporl 1995: B,.idgillg ilu Gllpl. Geneva, Swi=rbnd: World HcaJlh OrganÎz.uion, 1995. 19 US Preventive Services 1ask Force. Scrcening for Posullellopausal Osleoporo.;s. In: G11ide la CiiniclI! Pre/JtnJivc SfTlli(fs. Baltimore. MD: Willi,uns and Wilkim, 1996 p. 509-516.

US Preventive Serviccs 1,. k Force. Screeni ng for POSI menopausal Osreoporo.is. In: Guide 10 Ci;',i,," Prrvmlillr Srrvias. Baltimore, MD: \X'i1liams and WiJJâns, 1996 p. 509·516. 20

167

PROOF POSITIVE II Cel1lcrs (or Diseasc Comrol and PtCVelllÎon (CDC). Incidence and COStS to Medicare of fractures among Meditare beneficiaries aged 365 years-Unitcd States, July 1991-Jul1c 1992 .MMWR 1996 OCI 18;45(41 ):877-883.

US Prn-clltjve ServiC~"5 Task Forcc. Screcning lor Postmcnopausal Osrcoporosis. In: C/litie /0 C/iniml P""IOlliveS,""viaf. Ballimorc. MD: \Xlilliam and Wilki ns. 1996 p. 509-5 I 6.

4

45

Johnson NE, Alcallt,tra E ,Linkswiler H. EfTeCl of level of prolein inrake 011 urinary and !cca.l caJciul\1 and calcium rClenrion of yOllng adulr males. ) NIItr 1970 Dcc;100(l2):1425-1430.

Unilcd States Deparullem ofAgriculnllc Agriculmr:J Research Service. N/ltriml Commt ofrlJe U.S. Food StlPPOI 1909-1990. Home Economic Rcst.":lrch Reporl No. 52. Sepeember 1994 p.53.

14

2; Linkswiler HM, Zemd MB. ee al. Prorcin-induced h)'peecakiuria.

hd

Proc 1981 Jul:40(9):2429-2433. 26 Hegstcd OM. Ca!cillm and osreoporosis. Nov: 1/6(11):2316-2319.

} N"l/' 1986

Abdow BJ, Holford TR, Insogna KL Cros,-cllllural association belWCCll ruel'uy anim:tl prolein and hip fraelure: a h}'pothcsis. Calcif77wit' lnl 1992 Jan;50( Il: 14-18. rJ

lJl M;uess RE , Mather W. Bone mineral CQlltellt of NorUl ALL,kan Eskimos. AmJClin Ntltr 1974 Sep;27(9l:916-925.

Mau:ss RB , Marher W. Bone mineral conrent of Nonh Alaskan Eskimos. Am} Clin N/ltr 1974 Sep;27(9):916-925.

\Xle.aver CM. Calcillln bioavailabiliry and ilS rclalion

W

oSleoporosi..

Proc Soc &p Biol Med 1992 JlIn:200(2): 157-160

12

B

Weavcr CM. Calciulll bioavailabililY and ilS rel:uion ta OSlcoporo is.

Pror or &p Biol Med 1992 Jun;200(2):157-160.

6

Hcancy IU~ Wcaver CM. CalciulTI absorprion (rom kak Am} Clill

Nutr 1990 Apr;5 1(4):656-657. 7 Craig WJ. The Calcium Crau. In: Nutririoll for lh~ Nintlief. Eau Clajre. MI~ GoJden Harvest Books, 1992 p. 131.-146.

Cr;lig WJ. 11,e Calcium Crau. 111: Nutritioll fir th,- Ninelies. Eau Claire, MI: Golden Harvest Books, 1992 p. 131-146.

4

Pennin~ton JA. Bowrs and C!Jllrthi Food Valun ofPorliolH Commollly Usrd-15' edition. Philadelphja, PA: J.B. Lippincou cOlnpan]!, 1989.

.9

so Unired Srale Deparrmel1l of AgricuIturc AgricuJlIIral Research Service. Nutrienr COJH""t of lhe U.S. Food Supply, 1909-1990. Horoe Economic Re eard, Reporl No. 52. Seplcmber 1994 1'.98-99.

ce,

51 Curhan Willelt \X!C, et al. A prospeclivc slUd]! of dietary mlcium and olher nurriellls :Uld risk of s)'mpwlIla[ic kidney stones. N Dlgl) Md 1993 ~'Iar 25;328( 12):833-838.

me

52 Robenson we, Peacock M, er ,1. hould reeurrel1t cakiulll oxalale srone former" beconle vegetarians? Br} Urol1979 Dec;51 (6):427-431. 53

al

Cunningham AS. Lyrnphomas and animal-protein COllSurnplion. U/Il1976 Nov 27;2(7996): 1184-1 186.

29

Ma.1.es> RB , Malher W. Bone mineral COlllent o( mOS. Am} Clil/ NUfr 1974 Sep;27(9):916-925.

30

onh Alaskan Eski-

Ma= RI3 , Malber W. BOlle mineral COlllelll of Norrh Alaskan Eskimos. Am} C1in Nutr 1974 S;27(9):916-925.

li

Ma:less RB . Malher W. Banc mi$lcra! COJlleI1l of mo.'. Am} Clin Mltr 1974 Sep;27(9):916-925.

au

orth Alaskan Ei;ki-

56 Messina M, Messina V, Selchell KD. Tii" Simpli' SOJbelln And Your Heul/II. Gardcn CiI)' Park, NY: Aver)' Pliblishing Group, 1994 p. 84.

EI""y" D\X/. Thc rolc of rhe livcr in rcgul:uion of amino acid and prorei_n metabolism. [n Munro I-lN, editor. MmllmlllidlJ ['rouiIJ MC1J1boli.<m Val. New York, NY: Academic Pres..', 1970 p. 52:3-557.

rv

); Guyron AC. Renal Oisease, Diuresis, and Micltlrilion. In: Tex/book 0/ Mtdjfal P/~YJiology--8Jh edilion. Philadelphia, PA: WB aunders Ca., 1991 p.351. . Ctunmings SR. Ncvirr MC. er al. Ri.,k (acrors lor hip fracrur<' in whjre \Vomen. Sludy of Osreoporolic FraclUrcs Research Group. N El/gII Med 1995 Mar 23;332(12):767-773. Feskanidl D. Willerr Wc.. et al. Prorcin COIl ump[ion :lIld bone (racrure> in women .. Am} l:.pidemioI1996 Mar 1;143(5):472-479.

37

Fcskanich D, Willen wc. el al. Prolein eonsllmprion and bone (ractures in womeo .. Am) Epidemio/ 1996 Mar 1;143(5):472-479.

38

Recker RR. Davies KM, el al. Bonegain in }'oungadlllrwomen. }AMA 1992 Nov 4;268(17):2403-2408.

39

4u

Ross PO. Osteoporosis. Frequency, consequences. :wd risk facrors. Arch

lnlern Mei 1996 Jul 8;156(13): 1399-1411. -Il

Ro$S pD. OSlcoporosis. Frcqllency. conseqllences, and risk 1'leror5. Arrh

Ilium Med 1996 Jul 8; 156(13): 1399-1411. Issdbachcr KJ, Bra.ullwa.ld E. el al, editors.. Normal and Abnornd M)'ocarclial Function. In: HIl,.,.is01JJ Principlrs ofIJJu1"11IlIMedicilll'-13JiJ edition. New York, NY MeGRAW-HILL Ine. Healrh Profes.,ions Division. 1994 p. 994. H

T!lc Food Processor for Windows: NlItrilion Analysis & Filncss Software [compuler program]. ESHA Ik,earch. Salem,Oregon.

43

168

ernmClH Prinling OfTice. DHHS (PHS) Publicat ion number 88-50210, 1988 p. 220-222. ss ArmSlrong B, Do11 R. EnvironmeJHallaclOrs and c.'lncer incidence and mort;llit)' in difTerelll coulltries, wirh spec.ial rtfcrencc ro dicrary praclices. ba} Cancer 1975 Apr 15;15(4):617-631.

2 Craig \X!"J. The Calcium Cr:ne. In: Nutrition jiJr rhe NiIJeJies. C1aire. MI: Golden Harvest Books, 1992 p. 13 I-146.

33

54 US Oanmem of Heallh a.nd Human Se.rvices. Cancer. In: TluSlIrgeolI Gmeral's RepOrllJl1 Nu/rilion tllld HealtlJ. Wasrunglon, DC: US Go\'-

Mcssina M. Messina V. Selehell KO. Tbe Simple SoybCJ1Jl AJld YOllr Hmlth. Garden Ciry Park, NY: Avery Publishing GlOup. 1994 p. 80-82.

;7

58 Di Bisceglie, A. M., and Hoo(nagle, J. H. Hepaljtis B virus infecrion and halOccilular carcinoma: eriologic rdalionship and c1inical implicalions. PrilJracOneol, 1:1-10,1987.

Inrernarional Ageney for Research on Ca.ncer. Aibloxins. Lyon, Francc: Inrcrnation;l] Agen y for Research on Cancer, 1987 p. 83-87.

59

Cheng Z. Hu J, cr al. Inhibilion of de\'c1opmem of beplOcellular carcinoma in harilis 13 virus lra.nsfecled mice by low ruelarycasein. Heplltolog} In Prcss, 1997.

611

(" Jll1pbell Te. Chen JS el al. Non~ ociarion ofallalOxin wilh primary liver cancer in a cro s-secriolla1 ecological survcy in ehe Peoplc's Republic of China. Cl1ncer Res 1990 Nov 1;50(21):6882-6893. DeChiara TM, E.fsrraliadi A. Roberrson EJ. A growrh-delicielley phenorype in hererozygous mice carrying an insulin-like growt.h JâClOr II gene rusrllpted by largetiJlg. Nl1tlll'i: 1990 May 3;345(6270):78-80.

61

63 d'Arville CN. Nouri-Aria KT. el al. Regllhrion of insulin-like growth !;iCtOr II gene expression by hepar;ris B virus ill bepalOcellular carcinoma. Hepfl/olog} 1991 Fcb;13(2):310-315.

Tric.oli JV, RaII LI3. el al. Enhanced Ic\'C!s of insulin-like growrh faclor mcssenger ftl'lA in human colon c.:nciJloma. aJld li posarcomas. CI/nur R~s 1986 Dcc;46(12 Pl 1):6169-6173.

';4

Carianj E, LlSSen'e C, el al. Di.fTerential cxpressioll ofinsulin-like growlh iaclor II InRNA in human primary liver cancer", benign !ivCf lumors, and liver cirrhosis. COl/ce" Rts 1988 Dec 1;48(23):6844-6849.

65

THE CREAT MEAT AND PROTEIN MYTH Hu.I, Cheng Z, el al. Low animal prmein diel reduc('S Ule e.'prcssion of hmilis 13 virus lrmsgene in ear!y slages ofhepalOcareinogenesis. OUC()/og} In Pres.>, 1997.

fi,

CarmI! KK. Vcgcl:lble l'rOlein: pOlentiallipid lo\Verillg e!fecrs. l'vfEDiCiNE NorII) Amn-iCll 199/ Mar 17 p. 2279-2282. Also cjled In: emoll

79

Guyton AC. ehaplel 34: Resislance of Ihe Body 10 Inff'Clion: II. InuJll.lniry ane! AJlergy, lexlbook of Medic.11 Physiolog)', Eighrh Edilion. 1991. \XfB Sal.lnders Ca. Philadelphia, PA. p. 374.

KK. HulT M \'il. Dietary Protcin a.nd Cardiovascula r Diseases: E!fc t· of diela.ry prolein on plasma chole lcrol levels 'lI1d cholestcrol metabolism. In: Santos \Xf, Lopes N, et al. edilOrs. Nurritioll Imi i=i!od Scimce. \-Vi 3.. New York, NY: 1'IellulJl Publishing Corp., 1980 p. :379-385.

Norris JR, Me.adow. CG, el al. Tyrosine- a.nd phenylalanine-rf'slritted formula diel augmellls lmlllunocompelence in heahhl' hUl1lalls. Am} Oin lv',ur 1990 Fcb;51 (2): 188-196.

'0 Burkc GL. AIIlhony M, Vitolins M: Dielary SOl' prolcin :lmllipids: a Slratcgl' for primary prevention of cardiovascubr disease? Cu,.,. Opin f.:.'lldocrinol Diabem 1996;3:508- S13.

The Food Processor for \Vindo"'s: Nutrilion Analysi; & Fime.>. Software lcompuler program). ESHA Researeh. Salem,Oregon.

Kagaw:l Y. Impacl ofWcsterni7..arion on rhe nuuilioll ofJap:mese: changcs in physique, cancer. longevit)' amI celltcnarians. P,.,,/.' AI,," 1978 Jun;7(2):205·217.

6

68

69

o WhilC EG. COlmspl.oll Diet and Foods. HagerslOwn, MD: Review ane! Herald Publishing Associalion, 1938 p. 310.

" Chase HP. Jackson \XfE, et al. Glucose control :lJld llle ren"land relinal compl ications of illSulin-dependent diabeles. }AMA 1989 Feb 24;261 (8): 1155-1160.

nu.

n Ihle Bcckcr GJ, el al. The effect of protcio rcsrrinion on the progres ion of rena.l i.nsufficiency. N Engl} Md 1989 Dec 28;321 (26): 17731777. Brenna BM, Mel'erT'X', HOSlelterTH. Diel"ry prOlein inlakc and the progressive nalure of kidncy discasc: lhe role of hemodynamicaJJy medi3led glomeruJar injury in the palhogenesis of progressive glomerula.r sclerosis in aging, renal ablation, ami imrinsic renal di5e3Sc. N ElIgI} Med 1982 Sep 9;307(11):652-659. 73

81

'2 SperoffL. GhlSS RH, K:l.Se NG, editors. Abnormall'ubetry 1997 Apr;99(4):SOS-512.

A:uena A, Zen 1~ Ct al. Risk factors for brea;l cancer. Case-control slUdy results. EUl"} Gyna~col Ollco/1994; 15(5):386-.392. DoU Ro PerD R. Thc causes of alncer: quantit;ltive cstimates of avoidable lisks of cancCr in lhe Unlled State, tod'l)'. } NI/el Ca)}ee,. lIHI 1981 Jun;66(6): 1 J 91-1308. 85

Sabare J, Lindslcd KD, el:tl. Anained height of IaCtO-Ovo vegeTarian ch.ildren and adolcscel1ls. Eul'} CIi" N/ltr 1991 Jan;45(1):51-58.

86

PeJrini M'C Levey AS, el al. The Cfleel of diClary protein rcminion on [he progression of diabelic and nondiabelic renal diseases: a mela-ar1.1ly is. AmI infern lvft'd 1996 ApI' 1;124(7):627-632.

87

7~ Cheng Z, Hu J. el al. InhibitiOl1 of developmelll ofheplOcelll.llar carci-

S"

7

noma in hepalilis fi vÎru.llransfeaed mice by low dictary casein. Hepawl()gJ. In Press, 1997.

Nestle M, Food lobbics, the food pyrarnid. and U,S. nUlritioll poli }'.

Inr} HeaM Scrv 1993:23(3):483-496. Brcrs T. Dierary lrends in thc Unir<x1 Slales. Relevanc"". to cancer prevemion. Cancer 1993 Aug 1;72(3 Suppl): 1015-10 18.

76

9 The Food Processor for Windows: uuition Anal)'sis & Fimess Software {compuler program]. ESHA Rcse:uch. S;t1em,Oregon.

n Anderson J . JohnslOnc fiM, Cook-Newell ME. Mera-analysis of the

9'

irrori CIt, Agradi E, Ct al. Soybean-prorein diel in the tre:llInenl of rype-II hyperiipoproreinaemia. UlIICt'I 1977 f'eb 5;1 (8006):275-277.

efrecls of sol' prolt'in imake on serum lipids. N blgl) Med 1995 Alig 3;333(S):276-282.

~

Gellcsis 1:29,3: 17. The Hol)' Bib/~. Authorized King Jamcs vcrsion.

\X/hite EG. COIIIJJe/s 011 Dia tlJIII Foods. Hagemown, MD: Review. nd Herald Publishing Assoeiation, 1938 p. 386.

Sa.nchez A. HlIbbard RW. er al. Testing a mL'chanism of control in human cholesterol n)(:labolism: relarion of argănine and glycine 10 insulin and glllcagon. Ar/mosclerosi.< 1988 May;71(I):87-92. 73

169

PROOF POSITIVE

170

CHAPTER EIGHT • • • •_

BITTER

VES:

The Sugar and Diabetes Story

5

he called the Lifescyle Cencer of America desperately for help. Thirty years of diaheces had caken a cremendous roll an her healeh. The high blood sugars hâd done their work silenrly for years, but now the biner harvesr was undelliably obvious. Jenoy had kidney failure and resulting fluid accumularion. Of more concern to her, however, was rhac she was going blind. Her vision had been gecring progressively worse, and dle docrors had given her no hope. Wirh those discouraging prospcctS ahead she became excired as she heard about a lifescyle approach toward reversing the effects of diabeces. The Lifescyle Cemcr ofAmerica, a place in Oklahoma thac provides a three week rherapy live-in program, is nor unique in offering a program to reverse the ravages of diaberes. J have been giving my patienrs similar information for years and have seen some of rhe same dramatic resulrs thar the live-in centers achieve: people decreasiog or gening ofTinsulin and oral medications with a lifesryle approach ro chis killer disease. Sadly, however, there are many people like Jenoy who come to me wirh advanced diaberes. In many of dl.Ose cases we are not able [Q "cum back rhe clock" and resrore rheir vision or their kidney function. Yes, we may be able ro provide some help in

rhose areas, but onen the severe damage rhat has already been done is beyond the point of complere reversal. Whar is tragic is rllac ic ofcen rakes irreversible complications before people really ger serious abOLit doing ali they can ro control their diabcres. By rhen it is roo late ro accomplish aH we could have if rhey had goncn seriolls years earlier. The cases of a thollsand Jennys eloquently proclaim: diaberes needs to be prompcly recognized and treated. MaJly newly diagnosed diabericsas well as those srruggling wirh the disease for longer periods of rime-----ea.n control rheir diaberes wirhollf drugs by following an exceHem lifescyle. Do nor wait umil a heafr auack, ar ampuracion, or blindness serves as a wakc lip cali. Thc wake up c~1I should be mar first "borderline blood sugar"-the slighresI slIggestion of diabcrcs. In rhis chapter we will look ar important information about diagnosing and dealing wirh diabetes. Even if you do not have diabetes, you wiJl want ro give special acrenrion ro the closing secrions of rhis chaprer; rhere 1 focLiS on ilie dangers of earing sugar even for rhose who have no problem wich diaberes. You will learn abolit rhe effecrs ofsugar on the immune syscem, its rale in weîghr gain, and omer fascinating areas. Also in dus chaprer I comrast sugar wirh its

171

PROOF POSITIVE

DIABETES IN AMERICA -THEFACTS• Approximately 16,000,000 Americans are diabetic (50% are unaware). • About 625,000 new cases are diagnosed per year. • Over 6% of tbose 45 - 64 years old and as many as 20% of those over 65 have diabetes. • Total costs may be as high as 90 to 130 billion dollars per year. Figure 1

AFFLICTIONS OF DIABETES • Life expectancy is sbortened by 5 to 10 years or more • It contributes to 160,000 deaths eacb year • Two to twelve times the risk for heart disease • Two to four times the risk of stroke • Number one cause of blind ness in adults with 12,000 to 24,000 new cases annually • A factor in half of aII foot and leg amputations • Over 60,000 amputations yearly in diabetics • In any given year, over 50,000 diabetics are either on dialysis, or have had a kidney transplant (due to diabetic nepbropathy) • Cause of peripheral neuropathy • Increased risk of breast and uterine cancers Figure 2

two carbobydrare cousins: complex carbohydrares and fiber. We willlook ar some of rhe exciting bcnehrs of these more healrhfui carbohydrares.

What Exactly is Diabetes?

172

Diaberes mellirus or "sugar diabetes" is a condition where an abnormal response ro insulin and/or inadequare insulin producrion causes high blood sugar levels. This is

lIsual1y deflned by a fasting b100d sugar of greater rhan 125 on two occasions,) or a positive glucose rolerance rest (rhe individual drinks a specified amOunt of glucose, usually 75 grams and rheir blood sugars are evaluated over a rwo hour period). Over rime, these high blood sugar levels and rhe orher metabolic chal1ges thar go aJong with diabetes are exrremely taxing on rhe body. Consequemly, diaberes dramatically increases one's risk of dearh and disability. Current staristics are sobering. In America [here arc now duee rimes as many diabeties as there were .in 1958. 2 Estimates are that some 16 million Americans now have this condirion, up from Il million as recenr as 1983. DepeJ1ding on rheir type of diabetes and orher characrerisrics, rhey run aJlywhere from 2 ro J 2 times rhe risk of death when compared ro theil' non-diabetic peers. 3 Diabetes increases the risk of hean disease and other diseases l'e1ated ro amerosclerosis such as srroke ar rhe loss of an arm 01' leg from blood vessel blockage. Diaberes also dramaric.1l1y iocreases one's chance of infeetions, kidney failure, and an eye disease called retinopad1Y, which can resuh in blindness. The number of people in the U.S. rhat are affiictcd bv diaberes is shown in Figure 1. 4 ' The rnyriad ofaffiiccion . rhat result from diabetes is lisred in Figure 2. ),6.7.8.9 Although hearr disease is the leading cause ofdearh among diabetics, 10 somerimes rhe debjliraring efTecrs ofblÎndness and kidney disease are more frightetting. Wirhin onIy seven yeaJ's of diagnosis, as man)' as 50 percenr of children with dîaberes have developed diaberic retiJlopathy, a disease of the e)'es rhar can result in blind ness. 1I Diabeties Jleed ro ger checked by eye docrors regularly. Diabetic eye disease is prevenrable, nor only thl'Ough Iifesryle, bur also byearl)' rreatmenr. Furthermore, diaberics run a significanc risk ofdeveloping kidney disease. In any given yeal' some 55,000 Americans are suffering wÎth what is caJled "end-srage renal disease" due ro their diaberes. 1•. 13 These Îndividuals have such poor kidney funcrion rhar they al'e alive only by vÎrrue ofa transplant or regular dialysis treaunenrs. End-srage renal disease arnong diabetics is

SWEET TOOTH, BlTTER HARVEST increasing dramaricaUy in the Unired Stares. Whereas 5.000 new cases were being diagnosed per year in rhe early 1980s, a decade !ater the ftgure had jumped co 18,000 new cases per year. 14 In f.'Ier. over 35 percenr of aII patients with elld-stage kidney disease are diabetic. 15 Diabetic women arc also more prone co develop breast and uterine cancer. 16 No doi Iar amount can eclipse the thousands of personal tragedies duc ro diaberic complications. everrheless, in a llarion where health care costs are skyrocketing, the flnancial impact ofdiabete5 is rruly relevant. The direct and indirect cost ro sociery for diabetes is esrimared ro be berween 90 and 130 billion dollars per year in America alone. 17

Al! Diabetics Are Not the Same Diaberics are ofren divided inro four c.1regories. Of rhese four caregories, rhere are actually rwo main types of diabetes: inslllin-dependem diabetes mellirus (IDDM). often refened ro as Type 1, and non-insulin-dependent diabetes me1lirus (NIDDM). otl:en designated Type ll.18 A1though some diabetcs purisrs will rake pains ro usc the IDDM and NIDDM, in rhis chapter I will use rhe rerms Type I and Type II. A r!lird rype ofdiabetes OCCllrs in pregnancy and is called gestational diaberes mellirus. Tbe fourrb cacegory of diabeces takes in a hosr of rarer callses of rhe disorder such as those duc ro hormonal abnormalities ar ocher medical condirions. Typc 1 diaberes is rhe most severe form of rhe disease. It rypiC.111y occurs in childhood (bur can develop at any age) and for rhis reason was previously caJJed "juveniJe diabetes." The most common c.1use of Type I eliabetes is destrucrion of che insuJin-making cells in the pancreas by the person's own immune sysrem. This is referred ro as "auroimmllne destrucrion." The specific facrors rhar rrigger this auroimmune process have proved e1usive. AJtbough some cases have been linked ro viruse.s or chemical roxins, much is sriH unknown abollr the beginnings of rhe Type 1 diabetes process. 19 There does seem ro be a generic suscepribiliry ro the disease, plus an envllonmental

factor thar rriggers the disease process. Sorne of rhe most imeresring recent research links some cases ofType 1 diabete.s ro an abnormal immune reaction ro milk procein. We now know dl;1t children who are breasr feci [ar a shoner rime or who are sr.
PROOF POSITfVE

(

174

sense, che body's cells are srarving for energy. This can cause fatigue, weight los5, and excessive hunger. Forrunately, only abolit 5 ro 10 percenr of diaberics in America fali under rhe 'fype 1 diabetes category.22 The remainder are Type II diabetics. These individuals eirher have a problcm called "insulin resistance" or a less severe underproducrion of insulin than rhose with the Type 1 varicry. In actualiry, mosr fully developed Type II diabcrics have boch of these problems. 23 There appear ro be many differenr causes ofType II diabercs; rnost seern lO have a generic basis. The majoriry of individuals wirh chis rype of diaberes have a family member that had also been diagnosed with rhe disease. For cxample, many NativeAmericans have rllis genetic rendency; howevcr, it appears rhey did nor have diabetes umil rhey adopred a Western dier wirh an overabundance of sugar and far. Simply pur, ir usually t;\kes a combination of MO facrors (O develop adult onset diabetes. One is genetics, and rhe orher is a poor dier-like rhar consumed by rhe average American. Many individuaIs wirh Type II diaberes generate plenry of insulin but their body is resisranr ro ir. This cond it ion of illsulin resistance can be addressed by lifestyle changes. By maintaining an exceiient diet, achieving an ideal weight, and embarking on an exercise program, many Type Il diabetics can control their blood sugars with rhese lifesryle changcs alone. Some may need diet changes plus a pili ta help control cheir blood sugar. Because of the more subrle narure of Type Il diabetes compared ro Type 1, it often goes undiagnosed. A person with Type II diabetes may not have any of the classic diabetes signs like excessive urinat ion, cxcessive thirst, excessive hunger. farigue, or weight loss. Ar any poinr in rime, it is estimared thar fully 50 percenc ofType Il diabetics have not yer been diagnosed. 24 Of course, unrecogrlized diabetes still does irs damage steadily and sîlenrly. Abolit 20 percenr of newly diagnosed Type II diaberics already had damage to rheir eyes (retinopathy).25 Sometimes an unsuspecring person will be told rhey have diabetes when a rou-

tine blood screen ing reveaIs Iligh blood sugar. If the blood sugar is above 125 after an overnighr fast, it indicates diaberes. 1ndividuaIs caJ) have diabetes, however, wirh fasring blood sugars below rhar leveI. If a doctor suspecrs diabetes in a person with a relarively low fasting sugar, further testing can be dane. The oral glucose tolerance test checks for diabetes by measuring a person's blood sugar response tO a sugary beverage. Pregnanr women routinely have such a test ro make sure chey are not diabetic. Some doccors recommend that orhers in the general popularion should have a glucose (01erance test. Depending on rhe physician, some will recommend the test for those wirh significanc obesity and/or genetics. Others advise the g1ucose colerance test in anyone with fasting sugars higher than a certain level. Sorne will check ali those Wir11 fasting sugars over 105; some very conservative docrors will advise the test ro ali their patiems who have fasting sugars consisrenrly over 95, since th.is usually indicates dur at least the individual has rhe gene for Type II diabetes. A glycosylated hemoglobin level (discussed later in rhe chapter) may be able ro substirute for che glucose rolerance test in derecring diabetics wirh fasring blood sugars less man 125. 26 AJrhough Type fI diabetes can be picked up by suell blood tem for e1evated sugar, mauy Americans do nor seek out health professionals for sucb preventive services. They wait umil rhey are sick. This is unforrunare. As a resule, many Type II diaberics only become aware of their disease when r11ey experience potenrially irrevcrsible problems like eye ar kidney disease, nerve problcms, or a heart attack. Regarding gesrationaI diabercs, two to five percenr of ali pregnanr American women are affecredY This rranslares into abour 200,000 children being born ro mothers with gestational diabetes each year. 28 , 29 Th.is is signific
SWEET TOOTH, BITTER HARVEST or if you develop gestational diabetes, you should have yom blood sugar monitored closely. Your diet and lifestyle need ta be well regulated. Furrhermore, any woman who develops gestationa1 diabetes has a genetic rendency for diabetes. She is at high risk ro develop fuB blown diabetes later in life. 31 Pracricin&..healthy habits rhroughout her life span mus becomes critica1.

Control/ing Diabetes: Can the Ravages ofDiabetes be Prevented? Recently, a landmark Diabetes Control and ComplicadonsTriaI (DCCT) was completed. Thjs six-year study looked at 1441 Type 1 juvenile diabetics. Those diabetics who strove ro keep their blood sugars as clase to normal as possible (using insulin and lifesryle ch:mges) had 76 pereenc less chanee of developing diabetie retinopathy, a serious eye diseaseY They also experienced 54 percent fewer cases of significant kidney disease and 60 percenr fewer cases of nerve problems involving the hands and/or feet (peripheral neuropathy).33 The participancs also significandy lowered theÎr blood ehoIesrerollevels, suggesting rhat right control could decrease heart disease risk by up ta 35 perccnr. 34 These improvemencs are summarized in Figure 3. Diabetics in this smdy who keep their sugars as c10se co normal as possible are said ro be praericing "intensive therapy" or "tight control." Trus begs a question: in the rese.arch JUSt referred ro, exaerly how intensive was "jncensive" (or how tight was "tight COnt ro]")? The DCCT had very clear blood sugar goals. Fasting blood sugars in the morning as weU as blood sugars before each meal were ro be between 70 to 120. Aftermeal levels were to sray below 180. Furthermore, a middJe-of-rhe-night sugar at 3 AM was ro stay above 65. To find out how weB the participants were adhering to rhese goals, an addirional blood rest called glycosylated hemoglobi.ll was taken regularly. This test measures rhe amount ofsugar that becomes attached to a person's red blood eells. The amount of attached sugar in turn is directly related ro the average amouor of sugar in the blood throughout

the life span of the red blood ceUs. SiJlce red blood cells rypicaHy live for 90 ta 100 days, the glycosylated hemoglobin value gives an approximation as to the average blood sugar level over a three-month period. In tbe DCCT smdy, levels were aboUI 6.05 percem. This compares favorably with a value of 7.5 percenr, which is considered the upper limit of normal in a non-diabetic population. 35 How does intensive therapy differ from the standard or conventional way of treating diabetes~ First, intensive therapy always refers ro r.reatment using insu.lin. Second,

RESULTS OF BLOOD SUGAR CONTROL FOR TYPE 1 DIABETICS • 760/0 reduction in diabetic retinopathy • 54 % reduction in significant kidney disease

• ,o%

Ireduction in peripheral neuropathy

• 350/0 decrease in cardiovascular risk

Figure 3

with intensive therapy there are no flxed doses of insu.lin. For example, a diabctic on this rype of program does not take a fl.Xed amount of insulin every morning. The amount of insulin is adjusted according ro the level of blood sugar at ehe time tlte insulin is given. This differs from the old way of giving insulin (hat is stiH called a "conventional fixed dose program. "36 That approach assumed rhat insulin requirements would be the same each day. In fact, we now know t.hat insu.lin needs can vary tremendously from day ro day. This knowledge ofcbanging insulin needs provides the rationale for intensive eherapy. Intensive insulin therapy attempts [Q artificially simulare how aur bodies' insulin-

175

PROOF POSITIVE

L76

producing organ, the pancreas, works: rbe pancreas consrantly secrere.~ insulin inra {he blood so thar mere is always some insulin presenr. This is whar is called the basa.! insuJin Ievel. The pancreas aho secretes exua insllJjn in response ro rhe food we earY To reproduce rhis effea of basaJ insuJill some diabeties \viJluse a 10ng-acring insulin shor, while orhers willuse an insulin pllmp (har works continllollsly ro deliver rhis basal Însulin level. To reproduce rhe food-relared insulin surge, wherher on shots or on rhe pump, addirional regular inslllin or a new shon-acring insulin (Humalog) is given. If the shor method is used, ar leasr rhree shots per elay are given on rhe intensive insuun program. To evaluare rhe body's needs for insulin, frequenr blood sugar monitoring is necessary. Blond is obtained for this purpose by prick.ing d1e f1nger wirh a smaJl needle-like insrrumenr caUed a lancer. Then this blood is anaJyzed by a home sugarmoniroring device. The diaberic who is on an intensÎve schedule lIsua.!l)' pricks his or her finger a minimum of four times and an ideal of seven rimes per day: before each mea.! and ar bedrime, plus ideallyan hour afrer each meaP8 Alrhough tighr conrrol makes a profoune! difference for rhe Type 1 diaberic, it is a much more cumbersome and expensive process in the shorr run. Many have felt thar rhe DCCT resulrs could be extended ro apply (Q Type II diabe:rics; rhis inrerprerarian is nor based 011 any facrs obrained from dlar seudy. In my opinion, we should noe be roo qllick ro try ro rigorously control dle blood sllgars of a Type II diaberic wÎrh an inrensive insulin program. In addition ro the time, expense, aod discomforr involved in finger pricks and mllhjple injeetions, rhere are even lllore pressing coneerns. Before we look ac those concerns, some words of exphHlation are in order. Although Type 11 diabetics are called "non-iJlslIlin dependent," , this simply means that rhey do not have a life or deadl need for insulin shots. Man)' docrors nonerheless put these individuals on insulin to bener conuol rheir bloodsllgars. In faCt, rhe National lnscirutes of Health indicate thar 50 per-

cent ofknown Type II diabeucs in America are eirher using insulin alone OI' insulin in combination with oral medjcarions. 39 This grearly confuses many in lay cirdes. They erroneoLlsly think rhar jusr because someone is on insLllin, the)' are a Type I diaberic. More ofren rhan nor, a diabetic who is on illslliin has the Type II variery. Afeer aU, esrimares are char rhere al'e over 3.5 miII ion inslILin-usÎng Type II diaberies in aur narion. This compares wirh only 800,000 Ţype I diabeues in rotaJ:1O Now rhar we have paused ro recognize rhat many Type II diaberics L1se insulin, we need ro look ar one of rhe most worrisome problems wirh rhis practice. It is whar I caB "rhe vicious cycle of insulin use." The cyele begins with a 50bering face: usjng ÎnsuJin aggressively srimulares weighr gain. In the DCCT, rhe average participanr 01.1 rhe inrensive program weÎghed 10 pounds more rhan the control subjects after 5 years.'lI This is ('speciali,. ominolls for rhe Type II diaberic. Type I diaberies are oftel) rhinner and more resistanc ro weiglu gain relative ro the Type Ils. However, some rend ro gain weighr afree rhe onser. of rhe disease. Type Ils ofren have overweight problems ar. rhe onser of diabefes, and experience further weight gain as the disease progresses. In my medical experience when 1 am asked ro see a Type II diabcric who has been placed on insulin ro rry ro improve blood sugar control, T generalIy expect rhem ro have gained a signiflcanr amollnt of weÎghr. Thjs inrroduces rhe nexr part of that vicious cycle. Weight gain conrribures ro the Type II diabetic's resisrance ro the effects of insulin; t1ms, as weighr increases so do Însulin necds. The cycle comes full circle when insulin dosages are furmer increased, only to srimulare funller weiglu gajn. The significance of this dilemma has been appreciared by the Narional lnsrirures of Healrh. Because of rhe tendency of intensive inslllin therapy ro promote weighr gain, rhcy have srared, "Intensive rreatmem may not be appropriate for dlaberies who are 'overweighr,"42 which includes mosr Type II diabetÎcs. The tighr control of diaberes with insulin also introduces orher problems. The

SWEET TOOTH, BITfER HARVEST DCCT srudy parricipants ran a much higher risk of low blood sugar (hypoglycemic) reactions rhan those who were nor pracricing imensive eherapy. Alrhough hypoglycemia is usually no more ehan a physically uncomforcable inconvenience, severe re~1.ctioJls can actually be life threarening. At chis poim, someone may poun out: yes, rhere are problems wich insulin therapy for the Type II diabetic, but is ic possible for these individuals ro keep cheir blood sugars in an ideaJ range by using oral medication-wÎthollr ali the ftnger scÎcks and insulin? It is true rhac early in the COUfse of ilie disease it is often possible for a Type II diaberjc ro use medicarion ro oprimaJly control their sugars. However, over rime, ilie oral medicatioJls ofcen become insufficiem ro keep blood sllgars in c.he righr control range demanded by imensive rreaemen.L Even if blood sllgars can be cOlurolled with pills by mouth, this does nor prove rhe wisdom of using rhem. Although 1 do lIse oral medicarions in some of m)' diabetÎc patiems, rhe practice is parr of one of the longest sranding controversies in medici ne. The main drugs that continue ro be used for blood sugar comrol belong ro a class called the slilfonylureas. Common drugs in this family include DiaBet,;t, Micronase, Glucocrol, Glynase, Amaryl and Diabinese. Today, if you look up any of rhese drugs in the Physician's Desk Reference, you will (ind a warning in bold prim encided "Specia] warning on increased risk of cardiovascular mortaliry."43 Thac warning goes on ro explain the findings of a study published back in 1970 by whar. was called the Universiry Group Diabetes Program (UGDP). Researehers found chat diaberics who rook tolburamide, an oral pili used in ehe seudy, had more than dOlJble the risk ofdying from heart disease as iliose who treaced their diaberes with diee aJone. Today, some urge thar the drugs in this family are vastly differenr now than the tolbllramide of the 1960s. However, ilie FDA still requires [hac even ilie newest drugs in rhis class carry a bold prillr warning ehae reads, "A1though only one drug in rhe slllfonylurea c1ass (rolburamide) was included in chis [UGDP] sClldy, ie is prudent from a safery standpoint ro

consider thar dus warning may also apply ro orher oral hypoglycemic drugs in this class, in view of rheir c10se similaricies in mode of acrion and chemical srrucUlre." Some of the newer medications for diabetes such as Precose, Glucophage, and Rezulin are not in rhe same c1ass and have differing mechanisms of aerion. Thus they may be less likely ta increase tlle risk ofheart disease, although [hey have not been on the markec long enough ro make afirm derermination in this regard. My concllJsion, based an published medical research and my personal experience, is that careful blood sugaf conrrol is important in Type II diaberics. However, rhe use of inslilin and ora.! agents in rhese individuals carries che potential ro do more harm ehan good. Thus, {he mose important quesrion iJl my mind always is: how can I help myType II diabetic patients concroi their sugars withour drllgs? Slich an approach scands co reduce the eomplicacions of high blood sligars whiLe decreasing the risk of problellls from rrearmenr.

Non-Drug Approach Brings Startling Results Man)' seem to think rhat using a nondrug approach would increase the risk of diabetic complicarions and decrease the likelihood ofanaining optimal blood sugar control. Ironically [he evidence suggesrs ehar rhe opposite is tfue: an optimaJ Lifesryle program seems ro help maJly diabetics more than an)' drugs available. One recene example of rhe power of a comprehensive lifesryle program comes [rom Weimar [nseÎcuee in California. Researchers there scudied the benefits of a live-in 25 day comprehensive lifesryle program on Type II diabetic parienrs. A frequent complicarion of diabeces is peripheral neuroparhy, a conditÎon rhat often manifesrs Îtse1fas burning ar aching sensations in the feer and legs and may aJso involve rhe hands and arms. The pain is ofcen described as excruciating and sharp. The disease can larer progress ro Ilumbness, as heat, cold, and pain can no longer be felr in rhe affecred areas. Although medicariolls may somerimes help che condjrion, they

177

PROOF POSITlVE ofren make no significant impact. Thc smdr's lead researcher was Dr. Milron CTane (an cndocrinologisr who speciahzes in reversing [he effecrs of diabetes throllgh lifestyle changes). He showed mat a mearless diet, free from ali animal prodllcts and high in llnrefined (Oral vegetarian foods, will bring complere relief ro painflll neUfOpathy in over 80 percent of diaberics with rhis condition in juSt 4 to 16 days.14 Other clemenrs of rhe program. included: regular exercise, hydrorherapy rreatmenrs, cooking c1asses, grollp lectures, exclusion of a variety of beverages (coffee, rea, and alcohol) exclllsion of tobacco, and for rhose who desired ir, religiolls cOllnseling. Previously, diabetic neuropathy was thought (Q be inCllrable. This srudy shows rhat rhe condition can actually be reversed cluollgh a C0111prehensive lifesrylc program thar includes diet and exercise. Blood sugars and cholesrerol a1so dramatically improved on this dieL The benefits of complere relief of djaberic painful neuropathy conrinued according ro a ot)e ro four year follow-up programY Keeping blood sugars as clase ro normal as possible 1S one of rhe keys {Q kjdney health in the diabetic. A comprehensive lifestyle approach will gready assisr this process.

EXE CISE RISK OFDIABETES Decrease risk ofdeveloping diabetes by 50% in those with high risk defined by: • High blood pressure • Family history Relative risk of ·Obesity developiog diabetes

1.00

0.75

0.50 500 Figure 4

178

Kcal of Exerclse per week

3500

Furrhermore, a11 optirnal d.iet, \Vbich is torai vegerarian, generaHy has much less protein in it rhan t-he srandard American farc. Such a lower protein diet rends ta put less srress on th kidneys, again providing a boon ro kidney heaJrh 46 (see Chaprer 7, "The Creat Meat and Procein Myth," for more information). Not only can a cornprehensive lifcsryle program help accomplish these goals, but such a broad-based lifesryle approach will a1so likely diminish ocher risk facrors rbar could in rime furrher warsen kid.ney function. Examples of some of rhe ot-her facwrs dlat can worsen diabetic kidney problems include high blood pressure, cigareue smoking, and e1evared blood fars (LDL chobrerol and rriglycerides),47 One little-recognized factor that also seems ro increase rhe risk of kidney problems in diaberics is the use ofTylenol OI' other brands of aceraminophen. Srudies show rhar using as lirde as rwo pills oncC' a week doubled the risk of severe kidney disease in diaberic parienrs. 48 Controlling diaberes pain with an approach Like mar used at Weimar would be expected ro result in a decrease OI' e1iminarion of rhe need ofsuch drugs among afTected diabetics.

Exercise - First Element Needed in a Comprehensive Diabetes Lifestyle Program Exercise pl.ays a powerjiti rol.e in lowering blood sugar levels. Evidence suggests rhar musdes in morion reduce resisrancc ro insulin; dut is, insuljn sCllsitiv1ty 1S improved by regular physical exercise. 49 More simply put, exercise-in a sense-works like Însulin in a diabetic: it helps sugar go out of the blood and imo the musde tissue. In fact, the prestigiolls Joslin's Diabetes Medical textbook Îlldicates rhat lack of exercise is "a key factor" in the development of insulin resistance as people ger 0lder. 50 Since diaberics need insulin on a daily basis (eirher their own body's insulin or injccted insulin) sa do diabeties need daiLy exercise ro optimally control their blood sugars and tlleir disease. Exercise not onJy helps diabeties control rheir blood sugars, it aJso help non-

SWEET TOOTH, BITTER HARVEST diaberics decrease [heir risk of ever developing diaberes in rhe fim place. Oile srudy showed rhar cxercisc dramaricaLly decreased rhe risk ofdeveloping diabetes among rhose who were ar high risk for the diseaseY As rhe amounc of energy expended in exercise increased frorn 500 calories per week [Q 3500 caJories per week, rhe risk of devdoping diabctes dropped by 48 percenr. In other words, regular exercise nearly cuc the risk ofdeveloping diabetcs in h,tlf, as shown in Figure 4. Interesringly, those who were ar che highest risk of developing c1iabetes benefited rhe mOSt from regular exercise. Individuals c1assified as high risk in rhis srudy induded those who were overweight, had a Family hi rory of c1iabetes, or haei high blood prcssure. The bonom line is thar'exercise is important for eVeJ)'one. However. ir is especially cririca1 for the diabetic and for rhose at high risk of developing cbe disease.

Proper Diet-Second Eltment in a Comprehensive Diabetes Lifestyle Program Umil recenrly, diabctics wcre rold rhat în order ro control rheir blood sugars they had ta e1imi mue most of rhe carbohydratcs from their diet. They were cold co avoid sugar, bur rhe message did nor srop rhere. Planr food.s-narurally rich in complex caIbohydrate.s-werc also an the "hir lisr. ' The resulr leh diaberics gravitarÎllg ro a heavy mear dier. S2 The medical communiry did nor realize ar rhar rime whar we have already nored; namely, a high protein diet promotes kidney destrt/etion. \'V'ith hea")' mear consumprion also carne increased ingesrioll of cholesterol and saturated fat. Galloping <}rherosderosis men foJlowed dose behind. "Missing the forest for the tred' was cerrainly truc in rhis case. The trees were rhe high blood sugars, rhe forest was the whole pariem. Yes, earing a low carbohydrare (rugh mear) diet can control the blood sugars, but rhe number one cause of dearh atnong eii.\betics is heart and blood vcssel disease. In faer, the American Hearr Associarion has gone on record rhar fully 80 percellt of diabetics die of some form of hearr ar blood vessel disease. S:l The roor cause ofhearr and

blood vessel disease is arherosclerosi . This process is, of course, accelerared by meat wirh its high content ofdlolesterol anei saturared fu. Ironically, rhen, by rrearing his ar her blood sugar wirh a high mear dicr) a diaberic may likely rrade the coneml of blood sugar for an early dearh from he~m disease. Since ir is rhe complicarions and afflictions of diaberes rhat need ta be particularly avoided (nor jmt rhe control of blood sugars) rhe dier needs ro be tailored ro avoid 01' creat rhese complicarions as well as control rhe blood sugar. Obesiry is often oue of the main dererminanrs of insulin rcsisrance (the primary cause ofType Il diabercs). Thus ir is imperative for an obese diabetic ro Iose weighr if conrrol of the disease is ro be obrained by lifesryle changes alone. Mear is a1so dens~ in calories and makes weighr 10ss more djfficulr. On the orher hand, whole fruits vegerables, and grains (without fany roppings) are l11uch les$ dense in calories, rhus faciliraring an exccUeor weighr loss program.

Meat and Death from Diabetes Norwi(hsranding rne faer thar mear Gll1 help control blood sllgars În diaberjcs, a large Southern California srudy dane among Seventh-day Advenrisrs showed rhar rhose rhar

MEAT & DEAm FROM DIABETES Risk ratio in Seventh-day Adventist men

UseofMeat

RiskRatio

• Less than 1 day per week

1.0

• 6 or more days p'er wee'k

3.S,x Figure 5

179

PROOF POSITfVE

GOODSOURCESOFSOLUBLE AND INSOLUBLE FIDER Foods high in solubLe alld insolublefiber Amount II1 cacll 1 cup 1 cup 1 cup 1 cup I cup I cup

Food Item

Soluble Fiber (g)

Dried figs Garbanzo bCllns/cblckpea Large lima bcaos Soybeans-dJ'Y Red kidncy bean~" Corn grils ~.. Carob Oour ...

Insoluble Fiber (g)

7.5 8.6

9.9 15.4 24.9 18.0 22.4 2.5 10.9

8.9 12.6 12.7 15.4 30.1

F oods high in insoluble fiher Amount lh cup I Clip 1 Clip 1 cup 1 cUJ!) leul) 1 Clip

Food Item

Insoluble Fibcr (g)

Wheal br:1Il Oricd c.oconul Pislachio nuis Blackc)'cd cowl'cas Almonds LClltiJs .... Corn bran ~

11.6 12.3 13.4 15.4 18.3 22.1 62.6

~.......~'""'!!i;;:::;r,

Figure 6

are mear six or more rimes per week were ar 3.8 ames grearer risk of dying from diaberes rhan rhose who are mear less (han once per week, as illustrared in Figure 5. 54 Other research indicares an addirional benefit ro diaberics whe avoid meat and animaJ produce.. These anîmal-derived irems have no fiber in them wharsoever. And fiber is emergjng as a critical ingredienr in the con-

DIABETIC BENEFITS OF A ffiGHCARBOBYDRATE, ffiGH-FIBER BIET • Reduees levels of serum cholesterol and triglycerides • Reduces blood pressure in those with hypertension • Promotes discontinuation of insulin therapy for 1I0n-insulin dependent diabetics • Reduces r,isk of death from beart disease • lmp1roves gastrointestinal fUDetion

• Reduces body wdgJht in the obese • Reduces risk of kidney damage • Reduccs insu1În requilfements • Improves glycemic control Figure 7

180

trol of blood sugar. In fact, some are suggesring rhar an abundant supply of fibee is one of the main reaSOllS dur a vegerarian dier bcnefits diabetics.

Fiber Facts Fiber is a (errn (hat refers ro plant consriruenrs rhat are resisranr ro human digestive enzyrnes. 55 AJmost aII of rhe diHe;enr r)'pes of fiber are acruaJly indigesrible carbohydrares (rhe only cxceprion is a fiber called lignin).56 Some of the other fiber rypes include cdlulose, hemice1ll1lose, prerins, and gums. 57 Fiber is generally c1assifled as either solllbie (disselves in warer) or insoluble. As we will sec shortly, rhese two types of f1bers have different benefirs. One of the bonuses of eating a balanced diet of naruraJ planr foods is thar we rend ro ger liberal amounrs ofborh rhe soluble and insolllbie flbers. There are man)' foods rich in fiber. A high content of insoluble fiber is found in wheat (especially the bran) and bananas. Foods s(rong În soIuble flber include m05r fruirs, vegerables, legumes (fresh or dried), oars, brown rice, and barley. Mosr foods rhat are strong În soluble fiber are also srrong in insoluble fiber. Examples of foods high in fiber are shown in Figure 6. 58

Fibel; Jnsufin, and Blood Sugar Rcsearch makes evident rhar foods (har are high in fiber lead ro a slower rise in blood sugar, and as a reslllr, reqllire less insulin ro handle (he meaJ.S9 Fiber, especially soluble fiber like rhe pecrins and gurns, slows rhe emptying of food from the stomach60 and helps ro slow rhe absorption of simple sugars in the small intesrine. 61 This should be conrrasted wirh high far meals thar can resuit in high blood glucose levels for up ro 5 hours after [he mea!. 62 Addition of these rypes of fibers ro tlle diet has been demonsrrated ro improve diabetes COntrol. 63 Indeed, eatjng a low far. high fiber, vegetarian dier keeps blood sugars low even wben fruÎrs are eaten. Dr. James Anderson and colleagues at rhe Universit)' ofKenrucky found rhar by lIsing a high carbohydrare and high fiber diet, rJle need for inslliin was grearly reduced. Blood sugar

SWEET TOOTH, BITTER HARVEST control was better and fasring Jevels of cholesterol and (figlycerides feLl. These and od1er benefl(s ofilie high carbohydrare, high fiber diet are listed in Figllre 7.64.65.66 Many nlltririon experrs recommend that aur diers should contain benveen 20 and 35 grams of fiber per day when i[ comes ta issues I.ike cancer prevention. 67 1owever, even higher amoums offiber seem oprimaJ for diaberes conrrol. Stlldies thar demonstrare consisrenr deereases in insulin requiremelHs by improving fasung and post-meaJ blood sugar levels have lISeel berween 25 and 35 grams of fiber for every 1000 calories ea[en. 68 This ean easily bring daily fiber consumption inro rhe range of 50 ro 100 grams per day. Consumption of solllbie fiber a1so appears ro be imporram in non-diabetics. As we have already nored, wherher or not a person has diaberes, rhese fibers prevellt (he rapid rise in blood sugar, with a resulting lower peak level. Therefore, insulin reqlliremenrs are aCll1ally deereased when rhese fibers are added ro rhe diet. 69 ll,-is is no smaJi 111atrer. As imporranr as inslliin is in COI1trolling aur blood sugar, ongoing reseaJch demonstrates rhar higher blood inSlllin levels increase the speed at which the blockagcs of arherosderosis devdop.70. Îl ThllS, we ShOllld help our bodies by placing fewer demands for high insulin OlltpUr. One wa)' we can do rhis is by e
srances and carcinogens found in our food supply. Fiber helps prevent colon cancer, and may help against several orher cancers as well.7 3 A e1ier rich in fiber helps in healing peptic ulcer disease?4 Fiber is effeetÎve in curing al1d preveluing chronic constipa[ion. It can also be effecrive in curing ehronic diarrhea. We have come a long way since fiber gained worldwide attention in 1970. It was then tlur Dr. Denis Burkirr, a renowned Brirish physieian, published a repon rhar ver)' effeerively sounded the aJarm. He ob-

DISEASES ASSOCIATED WIm A LOW FIBER DIET • Diabetes mellitus

• Hemorrhoids

• Const1ipation

• Bowel cancer

• Appendicitis

• Bowel polyps

• Varicose veins

• Heart disease

• Hiatus hernÎa

• Strokes

• Divcrticular disease

• Gallbladder disease Figure 8

served thar in counrries where diers include large :lmOUlHS of fiber, rhere were few cases of rhe many degenerative diseases common in rhe Wesrern world roday. These diseases are lisred in Figure 8. 75 , fiber is found on1y in piant foods such as fruirs, vegetables, grains, anei nurs. Fiber is nor presell( in an] ani.mal produc[s. There is no Aber in meat, milk, eggs, ar cheese. Yes, a eow eats plel1ty of fiber and is a vegetarian by namte, bur ir rerains n-o fiber in its jleJh or its milk.

Other Benefits ftom Fiber Fiber from plant foods helps dilure, bind, inacrivJte, and remove toxic sub-

181

PROOF POSITIVE

More on Proper Diet:Meal Timing on an Optimal Lifestyle Program Most people do nor rea.lize dMr rheir glucase lOlerance decreases as the da)' progresses. This means rhar tDward evening, your body's abilif)' ro hand1e sugar decreases. In a srudy ofsubjecrs with Type II diabcrcs, absolure blood sugar leveLs were 10 ro 15 percenr higher when eati~1g six rimcs a da}' (rhree meals and rhree snacks) compared to just duee meals a day.76 Years ago, before veI')' precise insulin rypes were avaiJable, a snack at bedrime was recommended for djabetics because the insulin Ievels peaked in the middle of the sleep period. The bedtime snack helped prevenr hypoglycemia. ar low blood sugar. Today, wirh r.he rypes of insulin available, this is not only unnecessary, but counrerproducrive. aur hcaviesr me."11 shouJd be in the morning, emphasizing fruÎrs and grains. This prares liS for the most active paft of rhe day. A subsrantial meal for lunch, including several servings ofvegerables, is also imponanr. As rhe day progresses, our abiliry ro hand le blood sugar decreases, so a lighrer mcal in the evening (ideali)', for obese Type II djaberics, no evening meal) wirh no reflned sugar is the besr rule ta foHow. Asking your doctor ro cailor yOllf insulin injecrions so rhar dus progran; can be followed can produce gre~lt beneflrs.

1s Sugar OKfor the Diabetic? Many docrors who uear diabetes seem ro have grown more lenienr about sugar consumpeion. Therefore, it is not llncommon for diaberic patients ro w,tlk away wirh rhe idea rhat earing sugar "in moderation" is OK. This seemed ro be the attÎmde ofLois, a 75 year old Type II eliaheric. Alrhough she was raking abour 50 llnits ofinsulin per day she saw no problem wirh an occasional ice cream. There was a major wrinkle, however; Lois hael whar I would caJ) an addictive relationship wirh ice cream. She could nor control her consumprion of rhat high fat, high sugar "treat." When she adopted a healthful program, she left OUt heI' ice cream and made orher heahhful changes in

182

her lifesryle. Consequenrly, she losr weighe :lnd saw her insulin needs drop by ovel' 60 pacent in less than three weeks. Parc of Lois' uccess was due ro tlle face that she flnally faced rhe realization thar high sugar foods were a real problem for her and her diaberes.

What Other Problems Does Sugar Present? It is imporranr eo recognize rhar wllen eaten aparr [rom flber, simple sugars are asociateel wieh demal cavities, obesiry, high rriolvcerides, malnutrition, and decreased t> , resistance ro disease. This is true whether (he simple sugar is in rhe form of wluee sugar, brown sugar, honey, molasses, corn syrllp, maple syrup, milk, or [ruit juice. Furthermore, rhere is concern thar higher amOUlHS of sugar in the blood can combine wirh LOL cholestcrol ro produce a compound rhar is damaging tO che lining of blood vessel walls, rhus srimlliaeing aeherosderosis. This "glycared LDL" (LOL cornbineel with sugar) ma)' become oxidized LOL rhar increases rhe risk ofhearr diseaseF See Chapter 3, "Hearr Disease-Conqucring rhe Leading Killer," for informarion on the problems wirh oxjdized cholesrerol. Retlned sugar has effects rhar also impacr our qualiry of life. A high s'}gar diel and rhe consllming of fruir juices and sodas inerease the severit)' of premenseruaJ syndrome symproms in college girls.7 8 Sugar also may decrease cognitive or inreUecruaJ funetion, especially in children. 79 Soroe hypothesize mat rhe reason for chis mental dererioration is a result of fhe body overreacrlng ro refmed sugar consumption. A load of sugar srimulaees rhe pancreas ta release excessive amouJlts ofinsulin, which ln turn leads in a few hours ro a blooel sugar rhae is lower than normal. 80 Therefore, children ma)' ger poor grades on thei r reSIS alehough they are weU prepared. Eating natura! but nOt rdlned, ugar, such as is found in apples, oranges, pears, etc., should be encouraged because these foods are packed wirh nutrienrs, including fiber, along \Virh rhe lInreflned sugar. Ar the risk ofbeing redundant, let me reirerate: flber slows rhe rare ofslmple

SWEET TOOTH, BITTER HARVEST sugar absorption, allowiog utilizaeion of ilie EFFECT8 OF FOOD PROCESSING energy from rhe food we ear ac a steadier ON BLOOD GLUCOSE LEVELS rare. One classic srudy examined rlle effects mgldl of earing apples in one of ehree differenr physical forms: as whole apples, as 90 applesauce, or as apple juice. Even though rhe same number of calories was consumed 85 from each prepararion, eaeing the apples ~ kepe blood sugars sreadier rhan drinking ~ > 80 apple juice or llsing applesauce alone. The ~ change of blood sugar levels rhrough a pe~ ~ 75 .~ riod cime after earing apples in rhe rhree (,j forms is shown in Figure 9. 81 '&l 70 Nore rhar ilie blood sugar levels peaked ~ for aU eheee ar the same level 30 minutes 65 afler eating. Then aII levels decreased as ~ sharplyas ehey rose, but each ro a different ~ 60 low poinr. The level for rhe apple juice consumer feU the lowese, ro 50. The level for 55 Apple Juice (he apple sauce earer went down ro 61, while rhe whole apple eater had a high 66 level as 50 -I his lowesr point. The raw applc eater's level srayed constant ar (he high level for che re'-'--'--.L-l-.L---'--'-_LI J __LJ-L maining rwo hours, while {he level for (he 30 60 90 120 150 180 ocher rwo stayed ar lower values. AJehough Minutes after meal rhis scudy was do ne in non-diabeeics, rhe blood sugar peaks arc more pronouncedFigure 9 (higher) in diaberics consum ing rhe juicc Sugar and the Jmmune System or sauce in comparison wirh rhe whole Researchers performed a series of srudapple. ehus indica,ing thar the natural whole ies ehar examined how sugar consumprion apple will produce a steadier blood glucose weakens (he abiLiry of white blood cdls ro tim rhe body can more easily handle. This seudy demonsrrares that eating food in iu naturalstate is ehe safesc and-ultima(elyehe mase satisfying way ro enjoy sugar.

-

=

!

~

More on Sugar and Diabetes Anoeher concern wirh sugar for rJle diabetic is rhar sugar itself provides plenty of calories, bue very liede in rhe way of rrace minerals and orher nutrienrs. There are growing concerns rhar cenain minerals may help wich diaberes conrrol. Two examples are zinc and vanadillm. 82 Ocher minerals and viramins suggesced [Q have an important role in diaberes include magnesium, manganese, chromillm, potassium, and pyridoxine (vitamin B().83 The more you fiII lip on sugar, ilie less capaciry you will generally have for che nurrienc-rich foods like fruits, grains, and vegerables.

SUGAR WEAKENS WHITE BLOOD CELLS' ABILITY TO DESTROY BACTERIA

Teaspoons ofsugar

No. bacteria destroyed

O

14.0

6

10.0

12

5.5

18

2.0

24

1.0 Figure 10

183

PROOF POSITIVE

EIGHT CA CERS LINKED TO SUGAR CO SUMPTION • • • • • • • •

Colon cancer Rectal cancer Breast cancer Ovarilan cancer Uterine cancer Prostate cancer Kidney c·ancer Cancers of the nervous system

Figure 11

184

desnoy bacreria. The srudies showed tlur rhe capacicy for whire blood cells ro desrroy bacreria is weakened as sugar consumprion rises. Rcsu!rs of rhe whire blood cell smdy are rabuJared in Figure 10. 84 Note rhat if a person consumed no sugar for 12 hours, each whire blood cell could dcsuoy an avcrage of fourrecn baneria. If rhar samc individual are r11c cquivalenr of six reaspoons of sugar (such as found in a half-cup of pudding or a mere (\vO ounces ofcand y85), each whire blood eell cOllld only eliminate tcn bacteria-a 25 percenr decrease in killing power. Progressive dereriorarion in the white cells' baereria fighting capaciries beyond 25 percenr occurred when J 2 r.easpoons and rhen 18 reaspoons were ingesred. When 24 re
inco why rhe immune sysrcm is weakened when blood sugar levels rise in diaberics. The researchers funher demonstrated dut sugar's impairing efTeers on whire blood cclls are not shon-lived. The impainneIlt lasred a full five hours in normal subjecrs. S7 This means thar during rhar five-hour period rhe whire blood cdls coule! nor perform optimally.When you considet how ofren rhroughom the day some people consume sugar, ir becomes apparent rhar their whire cells are nor funcrioning very effecrively for many hours of each da)'. These researchers also discovered an illteresting sidelighr: a 36 hom fast seemed ro candy il1creast' rhe abilit}' of the whire blooe! eells ro kill off bacreria. When you are sick anei nor hungry, it may rhus be ro your advanrage !O avoid earing. or ac least ro car very sparingly for a dal' OI' nvo. One orher sobering linkage involves sugar and cancer. 88 A nllmber of different cancers have been sfarisrically linked ro sugar consumprion in scienrific seudies. A listing of rhese cancers is shown in Figme 11. There are a number of rheories why mese linkages exisr; however, a fiiII explanarion for them is nor l'ec clear. However, rhe dara rhar is available provides 'ln. addirional reason ro chink seriousll' abour being aware of l'our imake of sugar, and making adjusIlllenrs as indicartd. In lighr of ali rhis research ir is imeresring ro nore che caurions of Ellen Whire. Over a hundred l'ears ago she wrore: " ... sugar, when largely useel, is more injurious rhan mear."89 Predacing Whire bl' man)' cemuries, the Holy Scriptures aJso recorded reservarÎons abolit simple sugars. Alrhough honey was melltjoned, the principle seems ro apply wirh equal force ro any simple sugar: "It is nor good ro eat much hOlley.' Proverbs 25:27. Americans are beginJling (O beed rhe \varnings regarding meat, bur somehow we have failed ta make ir clear rhar sugar ar rhe levels con umed bl' rh average American lnay be, in some respecrs, even more harmfuI rhan consllming mear. The emerging dara on sugar suggesrs [har we should nor rake Lghtly che counsel of modern day scienrisrs tlur coneur wirh rhe reservarions

SWEETTOOTH, BITTER HARVEST voiced by dle Scriprures and Ellen White about the dangers of excessive sugar intake. Sugar. indeed, eems ro be a probJem for mosr Americans, whether diabetie ar noc.

ls Sugar Comumption Really a Probtem for Me? lf you are Jike most Americans, you are e:uing large amounts ofsugar withour even realizing ic. The average U.S. eitizen eats over 147 pounds of sugar each year. 90 Thi rrans!ates Ulto a whopping 46 tetlSpoons per day. The trends are even more disturbing. Americans IOday are eating nenrly 70 percent more sugar than their grandparenrs did in 1909. 91 Despite aII the emphasis an healrhier Jiving and healrhier eating, since 1970 rhe average American yearly ugar consumprion has cominued tO increase by 25 pounds. 91 One reason for this is rhar even whiJe we may speak more abolit health, Americans are consllrning more candy and soft drinks per person roday than ever before. 93 These foocis seern to be replacing rhe heaJrhful cereaI grains. While rhe average U.S. eitizen in 1909 are 300 pounds of Aour and cereai products, caday we average only 199 pounds annually.94 Ali cald, 38 percent of the rotaJ carbohydrates in the AJnerican diet now come from rehned sugars. This compares to 40 percent of aur total carbohydrares coming from grain. 95 Therc is callse for serious concern in view of the problems associated with sa much sugar in the diec. Virtually no one ears 46 rcaspoons per day from rhe sugar bowl. How is it possible, then, ca consume this much sugar? Mos[ of rhe sugar in our dier is "hidden." lrs presenee in [he foods we ear often goe unnoriced. Some of rhese hidden sources are hsted in Figure 12. 96 Notice that one of the main sources of hidden sugar is soft drinks or sada pop. Soft drinks were unknown umil modern times. However, in 1994 rhe average American consumed 52.2 gallons of soft drinks, with 40 gaHom of it in rhe form of regular (nondtet) beverages. 97 This amounrs ro the equivalent of 427 rwelve ounce cans per

year, or more rhan one per day for every mall, woman, and child. Since a rypica1 non-diet soft drink packs 150 calories,98 each year the average American consumes over 64,000 calories of sugar from soft drinks alone. This is no small rl1auer when you recognize rhar i[ rakes only 3,500 excess calories in aur diet ro gaiu one pound. What nutritional qualities do soft drinks comain? Very little. They are the souree of a liberal amount of simple carbohydrates rhat must be classitied as (empty calories." In faer, rhey aptly illustrate whar an empt)' calorie food is: ir eolltains many calories but is largely devoid of vieamins and minerals. Whar, then, makes soda pop so popular? It is rasry and cheap well d. and available almost everywhere. Furrhermore, many soft drinks are eaffeinated, making (hem part of an adJictive process.

HIDDEN SUGARS IN FOODS (TEASPOONS) Malted milk

12

02

42

Soft drinks

12 02

10-12

Canned fruit (Iight syrup)

1 serving

Chocolate cake C!Q!!) t

(402

slice)

8 8

Chocolate candy

10I

7

Fruit pie

1 sUce

7

Ice cream

1 scoop

5

Donut, glazed

1 each

4

Jam,jeUy

1 Tbs

3 Figure 12

Complex Carbohydrates: A Better Choice than Sugar The rnain sources of food energy originare Eram d1ree catcgories of Illltriencs: carbohydrate, fat, and protein. The body can most casily eonvert G.'l.fbohydrate inro energy

185

PROOF POSITIVE for our everyday acrivities. Sweer. empty calorie foods give rhe blood sugar a quick boost, bur this rise is not sU5tained. To rhe conrrary, we have learned thar the boost may he followed by a sharp drop in blood sugar. We would do well to make carbohydrates the largesc percemage of our diet, bur nor the empry calorie ones. Gur energy should come from quaIiry carbohydrates (called "complex" carbohydrates) like natural fruits. grains. and vegerables. We have already looked in derail ar many of the ben.efirs of foods with rhese kinds of carbohydraresone of rhe mosr important being thar rhey tend ro be packed with liberal amounrs of fiber along wirh orher nurrienrs. The conc1usion is rhar for diabetics and non-diaberics alike, complex carbohydrates should make up the major part of a healrhfuI dier. Most Americans consume 10 to 15 percent of meir ca10ries from prorein. (eight percenr would be more hcalthful). and planr sources of protein are the best. An ideal amount of fat consumption is approximately 25 percem of calories with an emphasis an the unsamrated and omega-3 [ars. One recent study from Australia has shown that a diet high in monounsaturated far (such as is found in olive oii) using 38 percenr total fat and 21 percent monollnsaturated fat can adequately control blood sugars in diabetics withour adversely affect-

FOODS BlGH IN MONo-UNSATURATED FAT Foodltem Macadamia Almonds Pecans Hazetnut oU Olive oiI Avocado Pumpkin kernels Sesame lleeds Olives Figure 13

186

Amount

Fat(g)

--------

19.5

.U.O 11.4 10.6 10.0 9.7 7.4

6.8

3.8

ing the cholesterol and trîglycerides. as long as the roca 1 calorie inrake remains controlled. 99 Figure 13lists foods rhac are high in monounsatllrated fat. 1oo Carbohydrates should makc up the bulk of rhe diet at approximate1y 55 to 70 percent. They provide rhe most efficient aud readily available source of energy for our bodies. The brain and nervous system r1ssues use carhohydrares almost exclusively for energy. Carbohydrates will act ro detoxify harmful substances that are manufaccured by Of raken ioto Dur bodies. Complex carbohydrates are abundant in vegeeables as well as in whole grains such as rice, wbole grain pasta, and potaroes. Adier rich in complex carbohydrates and fiber is also [he best way to address the problem of obesiry. which, as previously mentioned, is ooe of the major reasons for the insensitiviry ro Însulin ehar characterizes diabetes. In fact, the Joslin Diabetes Center's textbook srates: "the mosr COOlmon and important cause of insulin resistance is obesity."lOl That may be why, as important as exercise is in an overweiglu individual, weight /{lSS seems ro be even mOTe important, at least in prevenring heart disease, improving HDLcholesterol (the good cholesterol), and in reducing blood pressure and blood sugars. 102 There is. however. an old myth in America mat says [hat if you eat starchy foods you will gain weight. The fact is. starchy foods in moderate amounts should be paft of a weight ioss diee. The extra fars and c.-uories rhat we add to the starchy foods make them fattening. For example. it would take 60 potatoes ro equal the amount offat in one tablespoon of butter. One medium sized potaro has onIy 145 calories and a mere trace of fat, 2/10 of a gram. If we add JUSt one tablespoon of buner. rhat one potato jumps up ro 247 calories wirh 12 grams offat. I03 &ting a liberal supply of complex carbohydrate and fiber-rich fruits, whole grains. and vegetables will go a long way to provide benefirs beyond improving blood sugars. As we have seen, these foods have a desirable short-term effecr in decreasi.ng insulin needs. But they aIso have long-term benefits. in ehar rhey form che optimal diet

SWEET TOOTH, BITTER HARVEST for weight loss. When combined wirh reguIar exercise and oprind meaJ riming (people Iose more weight if rhey ear lightly-or nor at aH-in rhe evening), such a diet can help rhe overweight diabetic tO shed a significam number of pounds. As the weighr comes down, sa do the insulin needs.

ArtificialSweeteners What about artificial $wcctcncrs? Today many believe anificial sweeceners are a good alternarive ta sugar in everyrhing from soft drinks ca cakes and candies because rhey conl
A Betier Alternative Research scudies as well as my personal experience as a physician make an eloquenr poinc: if we adopt new and betTer ways of eacing and living-and srick wich chemwe will likdy devewp an enjoymem for (har

new lifestyle-. In other words, inscead of concinuing ro car foods that are characrerizcd by excessive sweerness, regardless of wherher rhe sweet raste comes [rom sugar ar from arcificial sweeteners, why not ler your raste. develop for foods rhar are naturalIy sweec.? Try ro fUld more enjoymellt in a crisp apple, a ripe banana, ar perhaps even a home grown carcor ar a garden-fresh squash. Our rasce buds are rrainable. AJrhough I can rhink of many examples among my parienrs of"rrainable tasre buds," [here is one example from someone who is nor my pariem dlat is especially "close (O home"-my f.1ther. When 1 was growing up in Michigan, my father, although not a diaberÎc, was suffering from a number of minor healrh problems. As a mechanical engineer, he was nor acquainred wirh medical or healrh subjecrs. He happened across a book caJJed "Sugar Blues" and bec.'1mc convinced [har his overweighr condirion and healrh problems were rel:ued ro his high sugar inrake. He had always been an avid milkshake drinker, and an ardem consumer of Reese's peanut bUlter cups and chocolate covered cherries, among mher sugary foods. One evening he inrriglled the family by announcing he had decided la give up refined sugar emirely. My morher, however, conrinued ro cook for our family [he way she always did. When ir carne time for rhe dessen, my father would leave and go work in rhe garden. When he carne bome from work and choeolate-chip cook.ies were baking he wOllld go ourside and do some chore ta avoid rhe aroma and accompanying temprarioll. We aII quierly wondercd how long he could COntiIlue with his decisioIl. After abour four monrhs, Jlly farher carne home and anorher sweet dessere was baking, buc rhe appeal and desire were no Jonger present. In fact, he described rhe odor as a "sickening sweet." He now enjoyed apple pies made withouc sugar (my morher finally broke down and would make him desserrs wirh no refined sugar) as much as he had enjoycd his former dessercs. My unele, who would frequendy visit liS from lexas, commenred on how ir was worrh {he ctip just ro sec how "Bud" obviously relished and delighred in plain simple. foods. My

187

PROOF POSITIVE f.uher's weighr came down and bjs healrh probJems disappeared, but his enjoyrnellt for food and life, ifanyrhing. improved. As a youllg boy, this obvious "before and after" difference thar 1 had observed in my own farher launched my interese in lifestyle and heald). Althollgh ir reqllired disciplined sacrificc for a few monrhs, the resulrs demonstraee rhat tasre bllds Crin be rrained for the bener.

Putting It AII Together: Principles of Diabetic Nutrition Mall)' of my diabetic patiems requese that l give rhem a very specific menu thar will help conrrol rheir diabetes. However, for mose diabetics, menlls are nOt as imporram as knowing (and practicing) the dietary principles of diabetic control. This is especially truc for rhe non-illSulin dependent lype II diabetic. The principles are really very basic-we have 100ked at aH of them in this chapter. The more natural fruirs, vegerables, and whole grajns the bener (Ilms aJe also good in moderation). The less mear and dairy prodllcts rhe bener. The less refined sugar ehe bcner. The more fiber rhe bener. Eat a good breaHm and linie ifany supper. If you are overweighr ir is of lltmosr imponance dur you reduce your weight ro yOUI" ideal weighe (thus, rhe less far in the dier the bener) and follow an earing sryle ehar allows you to attajn and mainrain rhis reasonable weight. Aerobic exercise, ar leasr 30 mjnures in durarion, should be parc of the daily diabetic ramine. 1 am happy ro provide my patieors wich de1icious recipes incorporaring rhe balanced low far, low sugar, high fiber vcgcrarian diee rhat is besr for diaberes. l avoid giving them a menll, however. Once rhey understand rhe principles, 1 le( rhem thoughtfully plan

188

rheir own meals. l would give the same advice tO each rcader. Do nor feel bound ro some restrictive way of eaeing. Take rhe principles ro hean. Experiment with ditTerenc options. You will be surprised ar how enjoyable a hcalrhy lifestylc c~n really be.

The Surprising Truth-Even for NonDiabetics. Some people find ir hard to believe this simple rrurh: rhe diabetic Iifesryle 1 have been describing is also the best lifesryle for Ilon-diaberics. Whether you are concerned about preventing diabetes or merely trying to oprinuze your healrh, rhis program will also pay you rich dividends. And you will not have ro sacrifice pleasl1rc eirher. Almosr every day at rhe Lifestyle Center of America in Oklahoma you will find diabetics enrolled În OUl' live-in prograrns for the purpose of reversing rheil' djsease process. YOl! will also find some oehers-individuaJs fram the surrollnding communities who come ro cnjo}' a meal in our dining mom. They are ofren earing rhe very Same fare mar the diabetic across (he room is en)oymg. Ofren our fear ofcbange is large1y driven by ignorance. Pick up a good cookbook or find a fTiend who can make some tasty mearless entrees, and embal'k roday on a more vegetarian-type ofearing program. A lisr of cookbooks (har specialize in healrhfi.ll menus can be found in Appendix Il. You wiU find what our neighbors around rhe Lifestyle Cenrer of America havc found: food can tasee good, your life can have enjoymenr, and you can sriH be on rhe finesr dier and lifesryle ro reverse, control" or prevent diaberes, in additjon ro reducing )'our risk of mally ocher diseases.

SWEET TOOTH, BITTER HARVEST References , V)if ii tbe new ditlgnoslic qirrritl. Repon of dl(: Expert Commitlee on thc Di,lgnosis and CJassitÎcaliofl of Diabetes Mellitu" Diabetes Cm 1997 July;20(7):1183-J 197. 2 Harris MI. Summary. In: Harris MI. Cowie Ce. CI al. edilOrs. Ditlbe/rS in AmericII-2"d edition. Nationallnsti[llles of He"hh, Nmionallnsnrule

of Diabctes and Digeslive and Kidney Dis(':L\~'S; NIH Publicalion No. 951468, 1995 p. 1. Harris MI. Surntnary. I.n: Harris Ml. Cowic Ce. el al, edilOrs. Dillbl'ln in 11.mericlI-2'ul edirion. Nalional InSljllltes of Heahh, NalionallnslilUte

3

of Diabeles and Digestive and Kidney Diseases: NIH I'ublication 1468, 1995 p. 4.

0.95·

, Harris MI. SUlllm'lry. In: Harris MI, Cowie Ce. el al, edilOrs. Dillbem in Amerirll-2',,1 erlirion. r~lional Institutt~\ of Health, 1 aliona! [nstinllc of Diaberes and Digeslive and Kidney Discascs: NIH Publicalion No. 951468,1995 p. 1-13. , telson RG. K.nowler \XIe. el al. Kidllel' dise-dses in diabclics. In: Hanis Ivll. Cowic Ce. el al, edilOrs. DittbeteJ i,; Amcricll_2'ur edilioll. Natiol1:11 !rlSlilules of Hcalrh, National Institure of Diabelcs aud Digestive and Kidncy Disea.ses; N[H Publi~tion '0.95-1468,1995 p. 358·361. Kuller LH. Srroke and Diabeles. In: H:lITis MI, Cowie Ce. el al, edilors. Dillbnes ill AmrriCiJ-2",{ editioll. Nat iOl131 Institures of Heah.h, alional InsI; IUle of Diabeles and Digestive and Kidney Diseases; N J1-1 Pub\icalion No. 95-1468,1995 p. 449-456.

6

US Preventive ServicC$ Task Foree. Screening lor Dial>eles Mellitus. In Guide /0 CfiniclIl PrevenlilJe 5erlliees-2",{ etiilioll. Balrimore. MO: WiJliaOls and \XIilkins, 1996 p. 193-194. 7

s Nalional lnSlinue of OiabcrC$ and Digeslive and Kidne)' Diseases. Diabeler 5uJlis/Îes. 1996. Hup:l/wwW.lliddk.llih.gov:80/DiabcteSSlalisrics! OiabelesSlatisl ies. hunI. Cowie Ce. Eherhmh MS editors. DiabelC>' 1996: Virtl1511fllslics. AmeriCall Diabett'\ Associalion. 1996 p. 62. 9

Harris MI. Summary. [o: Harris MI, Cowic Ce. er al. editors. DittbeLt'S ill Alllfrica-2",{ edi/jon. NallonallnsljlUteS of Healrh, N:uionaJ InstituIe of Diabele.! and Digeslive and Kidncy DiscasC.\; NIH Publicarion No. 951468, 1995 p. 8. 10

'H Bcnneu PH. DeÎ1nition, Diagnosis, And C/assillealion Of Di"bcles Mcllirus And Impaircd Glucose Tolerance. In: Kahn CR, Weir ;C, el al, cdirors. jos/ins Dit/bel(.< lvMliwi-13'" edirion. Malvern. PA: Lea & febigcr 1994 p. 193-200. 19 BennCll PI-I. Definilion, Diagnosis, AmI Classificcr(cs MeliilUs And lmpaired Glucose loleranee. In: Kahn CR, Wcir GC, er al, cditor . jos/ins Diabl'U'5 Mellil/l.s-J 3'/' editio". Malvern, PA: Lea & Febiger 1994 p. 193-200. ~

20 I-Iarris MI. SUlllmary. In: Harris J"II, Cowie Ce. el al. eJilOrs. Dirlbnes ill/lJllt'rica-2'ul edirioll. NationallnslilUles of Ht.'3lrh, NationaJ Institute

ofDiabele 'Ind Digesliw and Kidney Discases; NII-I Publicat ion No. 951468, 1995 p. 3. 21 CavaJlo MG. Fa,,:! O, et al. cU-medialcd immune rcsponse to beta eascin in recenl-ollSet insuJin-dependelll dial>elcs: implicarions for disc:lse parhogencsis. U/IIW 1996 Ocr 5;348(9032):926·928.

n Harris MI. llmmary. [n: Harris MI, Olwie CC, CI aI, edilOrs. Dirlb,'w ill Amrrim-2"" edirioll. Nalionallnslilll((:S of Healrh, J',;,uional In !ÎUHe of Diabcles 'Hld Digesli,'e and Kielney Diseases; 1468, 1995 p. 1.

IH Publjcarion '0.95-

Bmnetl PI-I. OetÎnilion, Diagnosis..And C1assifieation Of Oial>etes Mellillls And Impaited Glueose '!'oler:!nce. In; Kahn CR, \Veir Ge. el al, cditoTS. ]oslillJ Diabe/fS Me/lirlt -13'~ ,'dilioll. Malvcrn, PA: Lea & Febiget 1994 p 193-200. 23

Kenny SJ. Auberr RE. Geiss LS. Prevalcnce and lncidcnce of NonInsulin-J.)enelent Diabercs. JII: Harris MI. Cmvie Ce, el al. editors. Dittbeu'.< in AIJII'rim-2",{ ,y/itioll. National Instimrcs of Hcalrh, 'uiona! lnslinue of Diabclcs al,d Digeslive and Kidney Diseases; ) IH Publicarion No. 95-1468, 1995 p. 47.

24

2'

H'lrris MI. Sllmmary. In; Harris MI. Cowie Ce. el al, edilor . Ditlbn~

in Amerim-2",{ edition. National InSliluteS of Hcalrh, lationallnslinlle ofDiabeles :It\d Digestive aud Kidney Diseases; NIH PlIblication No. 95) 468. 1995 p. 5. Percrs AL, Davidson M 13. A c1inical approad, for thc diagnosis of diabeles mellilus: an anaJ)'sis usingglrcosylatcd hemoglobi.n levels. Meta-aHaJ)',is Re earch Group on lhe Diagnosis of Diabeles Usin" Glvcaled Hemoglobin Le,'el. ]AA1A 19960Cl 16;276(15):1246-1252. ' 26

Palmberg P, Smidl M, cr al. The mtural history of relinop,l[hy in insulin-dependelll juvcnile-onsel diabeles. Opblbl1lmology 198 I Jul;88(7):613618.

27 COUSlall DR. Gestarion,,1 DiabelCS. In: Harris MI. Cowic Ce. et al, editor;. Dil/bem il/ Amcrim-2"'" edition. N;uiOJul !nstillllCS of Hcalth. Nationa.llllSlitUIC of Diabete and Digestive and Kidney Diseasc:.5; NIH publiC:lIion No. 95-1468, 1995 p. 703.

Il Nelson RG, KnowlerWC, el al. Kidnev discase·. In: H:mis Ml, Cowic CC, el al. edilOf'S. Dillbew in AmericJI-2",{ etii/ioll. Nation'llln tilules of HC:lhh, National InstitUIe of Di"beles and Digeslive and Kidlley Oiseases: NIH Publicatioll No. 95-1468, 1995 p. 359.

de Veciam M. Major CA, el ,,1. PostprandiaJ versus preprandial blood glllcosc monitoriJlg in women with gcsrarional diabetes meilillis rcquiring insulin therapy. N Englj MrtlI995 ov 9::333(19): 1237-1241.

NationallnSlilllte ofDiabelcs and Digestive and Kidlley Diseases. Diabeles St:lrisfÎcs, 1996. Hup://www.nidd.k.nih.go":80/DiabclesSralisrics! OjabercsSlalistics.html

Srll/i /ics Repnl't, CDC 44 (3) Suppi Sepl 21. 1995 p. 1.

II

l'! 13

I~ Nelson RG, Knowler WC, el al. Chapret 16: Kidney disease,. In: Harris MI, Cowie CC, el al, editors. Di,lbeTe,; ill Amrrim-2 M etli/ioll. Nalionallnslitutcs of Healrh, NalioruJ Inslirure of Diabetcs and Digestive aJld Kidney Diseases; NIH public.alion No. 95-1468, 1995 p. 360.

" Nclson RG, Knowler \XIe. CI al. Kid ney diseasc.!. In: Harris NI 1, Cowie CC, CI al, edilors. DÎJJ.bem ill America-2',J edirioll. NationaJ InstitUles of HcaJlh, Nalionallnstirlltc of DiabelCS and Digeslive and Kidney Diseases: NIH Publieation No, 95·1468,1995 p. 360. '6 Wciderp:m E, Gridlc)' G, el al. Risk of endomeuial and brc,lSl ~nccr in paliems Wilh diabetes mellilus. /m j Callcer 1997 May 2;71 (3):360-363.

Harris MI. Sllmmarl'. In: (-brris MI, CowicCe. et al. aLilOrs. Dillbcw ;'1 America-2'Jă ..di/jo~. Nalionallns!Înltes of HC'3lth, mionallnSlit\Jlc of Diabctes and Digeslive :Hld Kidne)' OisC:l.Scs; NLH Publication No. 951468.1995 p, II. 17

US DeparUDcnt of [ealth and HlII11all Services. Birth". MOlll!JIy Villll .

US Prevelltive Se,,-ice. T:lsk Foree. Screen ing lor Oiabetes MclJjms. In: 10 Clinical PmN'mill" 5ertJias-2'"r rt!itioJl. Baltimorc. M D: Wil!i~ms :Ind Wilkins, 1996 p. 199·201.

JQ

Guirle

31 Couslan OR.. Gesr;uiol13l Diabetl·. In: Harris MI. Cowie CC, el al, editors. Dil/bem in Amerim-2',d e,ji/ioll. National InSlitutcs of Health. Nationallllslilule of Diabeles alld Digestive alld Kidney Diseases; NIH Publicat ion o. 95-1468, 1995 p. 712-713.

31 The elTeel of imcnsive trealJllCIH of diabctes on the ekvcioplllClll and

progression oflong-Ierm complicatiolls in insulill-depcndelll diabcrC.\ mellirus. T!lc Di:tbelcs Conrro! a.nd Complieations TriaJ Rest';lrch Grollp. N EiJg/] Mu/1993 Sep 30;329(14):977-986. 3 Tile effccr of imensive 1reatment of diabclCS on the devclopmem :l1ld

progression oflong-term eomplications in insulin-depcndenr diabcres mei· lil\1s. Thc Diabeles Control 'lIId ComplieatiollS Tri:ll RCS('3feh Group. rV Engl j M,ed 1993 Sep 30;329(1 ti):977 -986.

189

PROOF POSITIVE N'llion:l.1 Inslirulc of Diabclcs and Digcslivc and Kidnc)' Diseascs. Diabclcs Comrol and CampJic.llion Trial (OCCT). 1996. !-jup:// www.niddk.llih.gov/ DCCT / D CT.hllnl

.H

Krolcwski AS, Warl'3ffi JH. Epidemiology of Lare Complicnion of [)iabcles. In: K.,hn CR. Wcir G . CI al. cdilors. foslins Diabcm Mdlirlls-J3,h ediriolt. Malvern, PA: Lea & Febiger 1994 p. 606.

3S

Bcascr RS. Ollfftllartirrg Diabcw: A Dyllamic Approachfor Rfdllcillg riu E.Oixu oj/nmlin-Depmdml Dill.hmr. Oo.lill Diabeles Ulller Bostoll. MA). Minncapolis. MN: Chronimcd Publi.hing, 1994 p. 10-11.

.)6

Be.1ser RS. OUlSmarring Diab(./cs: JI Dyllllmic IIpproac/} ftr RedllcÎlIg riu EffictJ oj/nmlin-Depmdmr Diabeli'S. Oo.lin Oiabetcs Ccmer Boston. !'viA). Minneapolis, M : Chrollimed Publi hing, 1994 p. 13

37

Bea er RS. Ollr mal'ting DilrbelCi: A Dynamie ApprO/uh/or Redl/cing tiu Effic/S o/lllmlill-Depl'lldl'l1t Dilrbem. Uoslin Diaberes CCntcr Boston. MA). Minneapolis. MN: Chronimed Publi-hing, 1994 p. 31.

.lS

Narional [nsrirUlC of Di:tbctcs :Uld Oigesrive ,nd Kidnc)' Diseases. Dillbew5ill/irlics, 1996. Hup:/Iwww.niddk.llih.go\·:80/DiabctesStal isticsl DiabclesSlarisl ies. hUlll

3?

Nalion:l.1 [II lirUle of Diabcle and Digestive and Kidnc)' Oiseases. DillbtU'.J 5tI1l1.lies. J 996. H up:llwww.niddk.nih.gov:80/DiabelesSwÎsricsl DiabelesSlari li ·.htl11l

40

Beaser RS. Ol/umar/illg Diab,w's: A DyJJlllnic Approacl)for RrducÎllg ille Effiet5 <>/lml/lin-Di'jJt!J(ielll Diabete.<. (loslin Oiabetcs Ccnlcr Bos[On. MA). Mi'lneapoHs. MN: Chronimcd PlIblishing. 1994 p. 4.

·1

National InSlitUle of Diabcles amI Oigeslive and Kidney Diseases. Diabew Con/rol 1I11d Complirt/lioTlS Trial (DCCT). 1996. Hup:/I www.niddk.nih.go,·1 O CT / O CT.hunl

41

H Pbysiâalls Dtsk Refrrmu (PDR®). 1996 50,h --cdilion. (CD-ROM). MontvcaJlc. NJ: Mcdical Economies, 1996.

Crane MG. Samplt C. Re ression of Diabetic Ncuropathy wilh Total Vcgcl:uian (V"'!;.Ul) Dicl. f Nutri/ional MtllicÎne 1994:4 :431-439. 4-4

5 Cranl' MG. :l.mplc C. R('grcssion of Diabelic NClIlopalhy \\Iilh TOlal Vegetarian (Vcgan) Oiel. f Nlltriti<>nal Medirine 1994:4 :431-439.

Brcnncr BM. Me)'l'lTW, HOStl'llCr TH. Oiclar)' prolcin imake and th,' progressive nature of kidncy disease: the rolc of hcmodynamical.l)' ll1e
7 NclsOll RG, Knowlcr Wc. Ct aL IGdncy discascs. Jn: Harris MJ. Cawic CC, el al, edilors. DinbrUi in Am"riClr-2",t ({/iLiol/. ~lionallnslillllCS of Heallh. alionallnSlilUte ofOiabC[e and Di!;cSlivc and Kidncy Discases; NIH Publicalion No. 95- 1468, 1995 p. 361-367.

.~

Pemeger lV, Whehon PK, Klag MJ. Risk of kidney 1:.ilure associated Wilh rhe " e of accraminoplren. aspirin, and nOllsll'roidal anliinllammatory drugs. N Efigi f Med 1994 Dec 22:331 (25): 1675-1679.

'. O·~'lcal:l. M, Polollsky KS. Insul in • ecrelion in vivo. In: IGhn CR. Weir GC, el al. (:di[Ors. fo lins Dit/brll'J Mel/irlls-J3,h ({Ii/ion. MalvCln. PA: 1.K.l & Febiger 1994 p. 85-86. O'Meara NM, Polonskv KS. In "lin Secrcrion in vivo. In: Kahn CR. Wcir G ,el al, cdilors. f~slins Dillbe/l'! Mellims-J3'h ediri<>l/. Malvcm, PA: Le-a & Fcbigcr 1994 p. 86. \0

Hclmrich SP. IUgland DR. CI al. PIt 'sic:l.[ a liviry and reduced occurrence of non-insulin-dcnd"11l diabelc mdlirll . N Engl] Med 1991 Jul 18;325(3): 147-152.

51

U.S. Dep!. of Hcahh and Hwnan ervi es. Oiabele. In: Th, SlIrgeon Croerali Rl'porl on N/llri/ion IlJId Henltb. Public Hcalth Service, WasJlington. D.C: DHH Publication No. 88-50210,1988 p. 250-253. 5'

American Hearl As ocialÎon. 1997 H,,1J'l and troRe 5/lIIi lical Updill/:. AmcriolO Hearr Associarioll. 1997 p. 25.

53

190

Sno.....don DA. PlriUips RL. Oocs a vegclaria.n diel reduce thc occurrcnce of diabelcs? Am] Public Hl'IIlrb 1985 May;75(5):507-5J2.

<

JCllkins DJA. Carboh}'dralcs: (B) OielaJ)' Fiber. In: Shils ME. Young VR. edirors. Modrm Nl/m'Jion in Healtb alld DiwlS ll!J "dirion. Philadelphia. PA: Lea and Fcbigcr. t 988 p. 52-53. S5

Jellkim DJA. arbohydralcs: (B) OicI:l.r)' Fibcr. In: hils ME, Young VR. edilOrs. Modem Nmririon in Hl'I1lrb alld DiJt'asl'-7lb cdi/ioll. Philade[phia. PA: Le;l and Fcbiger. 1988 p. 52-53. S6

\7

Jenkins OJA. Carbohydr3lcs: (B) Oielar)' fjber. In: Shjls ME, Young

VR. edilors. Modem NurritiOIl in HCdll!) nlld DimlS1'-71b editioll. Philade/phia. PA: Lea and Febiger, 1988 p. 52-55. \8 The Food l'rocessor for WiJldows: ulririoJl Anal)'sis & Filllcss Soflware !computer program]. E HA Re earch. alem,Oregon . 9 B"aser RS. OIllJIIlllrtillg Di"beles: A D)'lUrmic ApprOllcbfor ReducÎng t!Je EfjcrtJ oflllSulill-Depl'lldml Dillbrres. UosliJl Diabeles Center Bo ton, MA). Millneapolis. MN: Chronimed Publishing. 1994 p. 75.

"" Bcaser RS. Ouwllarting Din.bew: A D)'lIItmic Approacbfor Reducillg /be l:.ffifi; o/lmulin-Deperll!em Dilrbete.<. Ooslin Oiabcles Ccnler BoslOn. MA). NliuncapoHs. M : Clrronjmed PlIhlislring. 1994 p. 87. Jellkjns DJA. Carboh)'dwcs: (8) Dictary Fiber. In: Shils ME, Young VR. edirors. Modem Nlltririoll in HMltb mll/ DiJl'lJSI'-7tl) ,dition. Philaddphia, PA: Lea and Febigcr. 1988 p. 61·63. 61

(" Be-oLSer RS. OlIIsnulrling Dilrb<'l('f: A DYlIIlJllieApproncbfor RcducÎn.~ Ibt Ejjcm oflrwr/ill-Depm.r/m/ Dillbl'lfJ. Ooslin Diabete., Cefller Boston. MA) Minlle:..polis. MN: Chrollimed Publishing. 1994 p. 80. Jenkins DJA. Carbohydrates: (6) Oielary Fibcr. In: hils ME. Young VR. editor. Moc/rJ'lJ Nlflririon ill Hralrb I/nd Disrasl'-7rb fdirion. Philadclphia, PA: Lea and Febigcr, 1988 p. 61-63. (,j

(, Ander on JW, 5mith BM, GlIslaf.son NJ. Health bcnefils :lIld pl
6S

Anderson JW. Akanji AO. Oiclar)' liber-an over"ic...... Dil1be/(J Cal'( 1991 Dec; 14(12): 1126-1131.

66

" U.5. De-pc. of Heallh and HUlllan Services. Can":r. [n: Tbe 511rgeol/ Genltmls Repon 0/1 NlllritioJl 11IId HlItI/IJ. I'"bli Hcahh Service, WashingIon, OC: DHHS Publicalio/1 No. 88-50210.1988 p. 192. U.S. Depe of Hea!lh and Hum:lll Scrvice_~. Oiabcles. In: TIu 5urgcol} Cmcmls Repor/ 011 Nlltri/ioll IlIId HtIlltlJ. Public Healrh Service. Washington, DC: DHHS f'lIbliOllion No. 88-50210, 1988 p. 260-261. Chri tiansellJS, Bonnevic-Niclsen V, el al. Effecl Ofgll:ll gUIll on 24hour inSlilin reqllirements ofimuli.\-dependclll diabcljc SUbjCCIS as :l.SSesscd b)' an :milicia! pancreas. Diahrli's Cnrr 1980 Nov-Dec;3(G):659-662.

(,9

Scour RW. Thc rolc of inslllin in alheros Icrosis in djahelies and nondiabetics: a review. Di"bcw 1981 :30(Supp! 2):54-57.

70

SCOlit RW. Hypcrinslliinernia and alheros Il'rosis. Di"bl'lrJ 1996 JlIl;45 SuppI30:S45-46.

71

- Suzuki ivi [kebuchi M. el al. McchaniSIll .nd c1inical implication o( insulin resiSlance s)'ndromc. Diabem 1996 JlIl;45 Suppl 30:552-54. J Armsllong B. 0011 R. Environmenlal faclors and cancer incidencc and mortaliry in di({erem oumrie>, Wilh special re(erenee 10 dielary praelices. Im] Cnllm 1975 Apr 15: 15(4):6 J7-631.

R)'dning A. BcrSlad A. Diclar)' a.spcc-ts of ptie lIlcer disease:. 5clJlld] Gnslroeme-roI5I1pp/1985;1100:29-33. 7<

Burkill D. Nmritiol1 TrJtll)' 1976 Jan/Feb p. 6-13.

SWEET TOOTH, BITTER HARVEST Bcebc CA, Van aule( E, el al. Ef'ICCI of tempornl disuiblltion of calorie on diurnal p:merns of glllc05e level. and insulin secrerion in NIDDM. Ditlbtirs Cu" 1990 JuU3(7l:748-755.

76

Colaco CA. Roser BJ. Aeherosclcrosis and glYCleion. Bioe.(.fllys 1994 Feh; 16(2); 145-147. Rossignol AM, Bonlliander H. Prevalence aIld severicy of ehe premensrrual 5yndromc. EA"cc(> of foods alld beveragcs rhat are sweee or high in sUg;Jr comenc. j Reprod Med 1991 Feb;36(2);131-136. 7S

Priut RJ. RidJJe DB. Associaeions betwcen nurririon aud bchavior in 5year-old childrm. Nu',' &v 1986 May;44 SupplO: 151-158.

79

Vai mall r, Voer H, er al. EflecI of brcakfasr eiming on ehc cognitive fUllceions of clemenrary 5chool srudents. Arcb PCI/illlr AtkJ/~,sc Mt-d 1996 OCI; 150( 10):' 089-1 092. 80

SI Habcr GB, Heatoll k"W, cr.1.1. Deplctioll and disrllplion of diclary fibre. E/TcclS on saricly, plasma-glucosc. and serum-insulin. Ltrnur 1977 OCI 1;2(8040):679-682.

Sprieesma JE, Schlliremaker GE. Diabcles C.111 be prevemed by reducing insulin produclion. Mrd Hyporbcm 1994 Jan: 42(1): 15-23.

52

SJ Jovallovic-T'crcesoll L, Pelcrson CM. Vilamill aJld mineral dcliciellcies which may predisposc 10 glucose illlOlerilnce of prcgnaJlcy. ) Am (,0/1 Nlllr 1996 Feb: 15( 1): J 4-20.

Kijak E, Foust G, Slcinman RR Rdatiollship ofbJood sugar level aud leukocytic phagoC}'lOsis. SOU!lJer11 Califo,."ill DenrnlAssoc 1964;32(9):349351. Penningron JA. Supplemellrary T.1bles: Sugars. III: Bou)(J Il11d ClJIlrcl/s Food \/tI/rw of Por/iollS Commolll)' Used. Fifimll" Edilion. PhilaJelphia.

S

PA: JB Lippincon ComparI)'. 1989 p. 269-277. PenninglOn JA. Supplcmenrary Tables: Sugars. In: &wes I1l1d C"Ulrbs Food \/nluu of I'oreiom CommoJlIy Un/' Fifiamb Edirion. Philadclphia,

86

PA; JB Lippinoolt Company, 1989 p. 269-277. Sanchez A. Reesec J L. el al. Role of ugars in human neuerophilic pllagocylosis. Am) Clill Nlltr 1973 Nov;26(11): 1180-1184.

87

Armsrrong B, DoU R. Environmemal factors aod cancer incidence and mor"llity in diflercOl cOlllllries. wirh pecial reference 10 djerary praceic~. /111) GlIIm 1975 Apr 15; 15(4):617-631.

HR

9 Whirc EG. ChriSt.ian Temperance. In: Timimolliesftr riu ClmrclJ, Volume 2. Nampa. ID: Pacific Press Publishing Associalion, 1868-1871, p.

.FO. Pumam JJ. AJlshouse lE. Food Comumplion, Prim. IlI1d Expmdil1lm. 1996. Seatistic.,1 Bu1Jerin No. 928 US Dep;lfllllem of Agrieuhure, p. 20.

'}(l

PlIlnam JJ. AUsholise JE. Fond C01lSumpriolJ, ?rius, and Expmdil1lrt'i. 1996. Slalislical Bullcein No. 928, U Departmenl of Agriculture. p. 21.

9l

PUlllam JJ. Allshouse JE. Food C01lSllmprioll, ?rius. tind Expmtlil1lm. 1996. Swislical Bullelin No. 928. US Depanmenr of Agriclliture, p. 28.

9)

Purnam jJ, Allshouse JE. Food Conmmprion. Prim, Imd E'1>mtlillires. 1996. Statistical Bullelin No. 928, US Deparlmelll of Agriculmrc, p. 27.

94

('urnam jJ, AJlshouse JE. Food COIIJumplion, Prices. tind E...pmdil1lrt'!. 1996. Slalistical Bulletin No. 928, US Deparrmenl of Agriculrure, p. 21.

9~

96 The Food l'rocC&Sor for Windows: Nuerition Analysis & Firness SOflware !complJler program]. ESHA Rescarch. Salem, Oregon.

Purnam JJ. AlJsbonsc JE. Food COIlSllmprion, Prices. IUJd E'
97

PenninglOn JA. Carbonated Beverages. In: Bowei and Churel/s Food VJ!llw ofPorriol1.J C-ommon!y Umf, Fifrmub EdirioJl. l'hiladelphia, PA: JB

98

Lippincou Company. 1989 p. 5-7.. C1mpbell LV, MarmOl PE, el al. The high-rnonounsatllraeed fat diet 1\ a pr:lcrica.1 alrernarive for NIDDM. Diabcw Cnre 1994 Mar; 17(3);177182. 99

100 The Food Proccssor for Windows: urrilion Analysis & Firlltss Soflware [compuler program). ESHA Rewarch. Salem,Oregon.

ec

101 WeiJ" u>:Ih)' JL. Palhogenesis of Non-insulin-dependenr Oypc II) dÎabeecs mdlitus. In: K.lhn CR. Weir el al, eJilors. )oslin's Diabms Mrllirus.-/31h tdir.ion. Malvern. PA: Lea & Febiger 1994 p. 85-86.

ec.

10! Katzel LI. Bleecker ER.. ee al. Effects of weight loss vs aerobic cxercise lr.lining on risk lactors for coronary disease jn health)'. ohese. middle-aged and older men. A rallJomizecd concrolled trial. )AMA 1995 Dec 27;274(24): 191 5-1921. 10) The Food Processoc for Wmdows: NUlrilion Anal}'sis & Fimess Softw:uc [compUler program]. ESHA Research. Salem.Ocegon. l(}.i Slellman SD, Garfinkd L. Pauerns of anificial sweeeener use and weighl chaJlgc in an American C'Ulcec Sociel}' prospcclive sllldy. Appt-riu 1988: 11 Suppl 10:85-9 \.

IO} Tordofl'MG, AJleva.A.M. Eflcct of drinkiog soda swcclcned wirh asparlamc or high-fTuClose corn syrup OII foo<1 imake and body weight. Am) CIi" Nlllr 1990 Jun;5 1(6):963-969.

106 Jacobson M, Liebmall B, el al, edilors. NlJr,.i'ioll Ac/iou Hmlrh Lnur. Washington. DC: Cenrer for Scicnce in the Public Imeresl (CSPI), June 1995 p. 9. (800) 237-4874.

Purnam JJ, AJlshousc JE. FoolL Comumpeioll, Pri(('s. nlld ExpendilllreJ. 1996. Slalislical Bullclin No. 928. US Deparemem of Agricllirllre, p. 28.

91

191

PROOF POSITIVE

192

-----------

"1

CHAPTER NINE

E rONIN: Agentfor Rest and Rejuvenation

A

li was quier in rhe Jones household.

Suddenly there was.a srirring in ilie bedroom. Richard rubs his eyes and looks over ar rhe c1ock: "Oh, no June, we've overslept. It's 7:30. Get our of bed. Wake ilie kids. We've aU got ro go." Suddenlyall is pandemonium in rhe Jones household. Whar made ehe d.i.fference in those few moments? An awareness of rime and its pressure. We ali generally recognize that we are living in a time~pressured environmenr, regardless of whether or nor we overslept rhis morning. Ir afren seems rhar there are just not enough hours in the day. We tind ourselves longing for more energy [Q accornplish ali rhar we want or need ta do. Somerimes ir may seem rhat we are wresrling wid1 rwin enemies: frusrration and fatigue. Farigue is a major problem worldwide. Srudies from ehe U .S. and abroad suggest thal in Wesrern narions millions of people have signiftcanr problems with fatigue. In rhe Unired Srates, farigue is one of ilie 10 masr common reasons for visiting a physician. l Making rhings worse, a significam porrion of those rroubled by farigue C
ro be at greaeest risk for rhis problem. As many as 34 percenr of Amerieans over 65 have problems wirll Însomnia. 3 A recent srudy found that sleep problems are cornmon even in YOllllg aduJes aged 17 ro 30. Researehers surveyed abour 3000 individuals regarding problems wieh sleep, such as: difficulry faHing asleep, waking up frequendy. "disrupted sleep," napping dUIing ehe day, nighrmares, and waking up roo early or wakillg tip rired. Only 36 perceJl( responded rhar they were free of ali of these indicators. 4 In Western nations, insomnia and related concems have even been documenred in preschool children. For example, a German srudy found that 12 perceot of four ro five year old children had difficulries falling asleep. 5 The research is clear. For a variery of reasons lireral1y millions of people iliroughotlt the world are legirimarely erying our: "Why am 1 so eired? And whar can I do abOlit it?" Onro rhis srage srepped a ntlrrirÎonal suppLemenr named melatonin. In 1993, newspapers rhroughour the U.S. carried wo.rd of researeh from rhe Massachrs Institute ofTeehnology. Seientisrs ehere had demonsrrated rhar small amounts of melaro Il i Il aered as a na tu raL sleep aid. (, Melaronin's populariry grew in 1994 when

193

PROOF POSITIVE the Iay press reporred ehac ic could decrease jet Iag? I ncerest in the compound grew further as leading periodicals continued ro fan che fire. an Augusc 7, 1995, NEW$WEEK fearured melatonin. 8 Since rhen, ehe compolllld has concinued to receive rave reviews and has demonstr;aed ics abiliry co generate saJes of millions of dollars for bookstores and heahh food establishmelHs. When one of the. world's leading melatonin researchers, Dr. Russel ]. Reitec, wtote a book in 1995 on rhe subject, he gave one scriking indicacion of melawnin's popularity. He observed that 24 difTcrent U.S. companies were rhen marketing the hormone. Furthermore, a steady scream of new companies was ing the markecing ranks an a monrhly basis. 9 Melaronin is nor a foreign substance ro the body, but a narural hormone produced in rhe body and found in cenain foods. Even thollgh meJatonin sllpplemen(s have been a commercial success, chere is another particularly exciting line of research regaJding this hormone. Namely, we are learning (hac we ean boost me!awnin produccion in our own bodies in natural ways, wichollt having to resort to costly supplemencs. 1 will address this research lacer in the chapter and make practical suggestiolls on how ta boost your own body\ producrion of this compound.

SLEEP AND JET LAG EFFECTS OF MELATONIN SUPPLEMENTS Helps insomnia Espccially in the efderly Decreases time to fali asleep by 14 minutes Improves sleep efficieocy but oot total sleep time

Lessens jet fag When tsken the day of the flight and conthmed for 5 da)"s

Adverse effects unkn.own Figure 1

194

The research daims for me1atonin now go far beyond its abiliry ro enhance sleep and relicve jet lag. However, before looking ar. the oeher far-reaching effecrs of chis natural compound, we need. ta look more closely at cite areas of research ehat fim lIshered me1atonin into rhe limelighr.

Enhancing Sieep Israeli researchers led by D. Garfinkel looked ae melatonin's effeces an a dozen individuals whose average age was 76. 10 For rhree weeks, half of rhe grollp was given 2 mg per day of conrrolled-release melatonin and rhe othcr group was given a placebo. Afcer a one week break (called a "wash our period"), the srudy was repearcd with the other half of ehe subjects getting the active melatonin, while ehe remainder goc t11e placebo. The reslllcs demonstrared an increase in "sleep efficiency" while on meiatonÎn. Sleep efficiency measures [he totaJ time asleep as a percenrage of the rime in bed. 11 Ic improved [rom 75 pereent, wimollt melatonin sllpplementation, to 83 percenc while an the me1atonin. This and ocher srudies I2• 13 have also shown evidence ehac melatonin helps decrease ehe time it cakes ro fali asleep (19 verSlIS 33 miJllHeS in rhe Israeli data). Garfinkel and his colleagues conclllded that mdaronin helped ro improve the efficiency of sleep alr.hough it did not improve tOtal sleep rime; this means that a person will spend a shorrer r.ime in bed to get a given amount of slcep.

Coping with Jet Lag Me1atonin has been documenced ta help wich one of rhe major aggravations of modern travel, namely, jet lag. A number of sllldies, lIsing a varîety of doses and regimens, have looked at chis effecr.. 14 . 15 One repore concluded tluc the mose effeceive regimen involved takjng melaconin 01\ che day of che flight and conrinuing ir for five days thereafter. 16 A summary of chese benefics of melaronin is shown in Figure 1.

Aging, Healing, and General Repair Perhaps nor.hing has eaptured rhe huOlan imaginarion as much as the quesc for a

MELATONIN founrain ofyouth. Some [Oday are sllggesring rhar medical research may have provided ar (easr a parrial candida re for a "yourh reswrer" in melaronin. These senrimenrs grow our of rhe recognirion thar meJaronin may ease rhe daily wear and tear rhar our bodies susrain. Consequenrly, ir has been dubbed rhe "fix and rejllvenare" nighttime hormone. J7 These healing and genera.! repair effecrs of me1aronin may actUally help ro delay some of rhe changes rhar we normally 3mibure [O aging. There are omer lines of evidence rhar suggest rhar melatonin ma)' help [O slow rhe aging process. Ir is weJl known rhar hllman melaronin levds fali rhrollghollt life, as depicted in Figurc 2. 18 Nighuime levds reach a peak in children berween one and five years of age and decrease sreadily throllghout puberry. By rhe end of puberty, peak mdaronin levels have decreased 75 percenr. 19 Levels conrinue ro FaJI sreadily rhroughour adult life.

Melatonin Jncreases the Longevity ofAnimals Melaronin levels aJso decrease in animals as {hey get older. Giving melaronin ca animals increases rheir longeviry.2o Could rhis life span enhancemenr be due ro some rype of a.mi-aging effecr exerted by melaronin? Ifso, how specifically would rhar efl-ecr come abour? A variery oflines of research suggesr thar melaronin's ami-aging efl-ecrs in animals (as well as in humans, perhaps) may hinge largely on irs role as a free radical scavenger.

What Are Free RadicaLs? AJI matter is made up of molecules. A free radical is an unusuaJ moleeuJe-it is "llnbalanced." Every molecule consiscs ofa nucleus of protons and neurrons which is surrounded by electrons. These e1ecrrons travel in orbit around che nuc1eus-something like rhe ean:h traveling around rhe sun. In living organisms, such e1ecrrons are usually found in pairs. However, some molecules have elecrrons mar are nor in pairs, calJed "unpaired e1ectJons." These molecules are caJJed "free radicals." The unmared e!eccrons in free radicaJs

have grear signiflcance. They have a powerful drive co acqllire a parener. Ofren wirhin a fraerion of a second, a free radjcal will "ste.11" an e!eccron from a neighboring

FALL IN MELATONIN LEVELS THROUGH LIFE 120 :::;.

e

100

~

80

=

60

Q. --"

'i: o Ci

Oi ~

40 20

10

20

30

40

50

60

70

80

Age (years) Figure 2

compound. Thar neighborwho IOSt an e!ecrron is said ro have been 'oxidized." Furrhermore, rhe oxielizeel compollnel irself rypically becomes a free radical. Since ir now is missing an elecrron, ic has a srrong desire co steal one from one of its neighbors-and ir usually does so in shon oreler. The result is a chail; reaction, where oxidarion and damage can spreael f(Om one molecule co rhe nexr umil somerhing StopS rhe process. A10lecules thaf can stop fhis chain reaetion are ca/led amioxid.ants. Free radicaJs are nor ali bad. In faer, given rhe proper rime and place, chey are esselHiaJ ro heaJth. For example, one of rhe ways the body destroys poisons is rhrough a syscem wltich uses oxidarion reactions and free radicals. 21 Free radicals are also essencial for cIte effeccive destrucrion ofgerms by rhe body's whire blood cells. 22 On che ocher hand, free radicals can be extremely dangerolls when presem ourside of rhe body's appropriate desrruccÎve pwcesses. They have been found ro have a role in ar leasc 50 diseases.H Of particular relevance, rhey have been observeel ro darnage DNA and are experimentally linked ro can-

195

PROOF POSITIVE

196

cer. Cancer-e\using substances like cigareue smoke perform some of rheir diny work by acring as free radicaJs. Small amOlllUS of free radicals are aho creared as byproducts of rhe normal process ofliving. Tbe powerhouses of OUl' body cells, called mirochondria, can acrually "leak" a lirrJe bir. Rarher than leaking raxic chelllicals, rhey leak some of rheir elecrrons. These e1ecrrons can be taken up by oxygen. The resulrs are free radic.lls know as superoxides. 24 Superoxides also elUer rhe body through rhe lungs, becausc a smaJl pereenrage of the oxygen we breathe is acruall)' superoxide. Frec radica!s are al50 created in the process of the body when fighring infecrions. Ahhough rhese reactive molecules are necessary ro fighr off germs, an excessive number of rhem (or their presenee in rhe wrong places) can be damaging ra healrhy bod)' tissues. Severa! sugars, including the normal blood sugar glllcose, can combine wirh body proteins ta produce free radicals. Some believe rhar high levels ofblood sugar in diabetics cause diabetic complicarions in part due ro rhe crearion of excessive levels of frec radicals. 25 Radiarion is yer anorher well-known cause of frec radicals. 26 Free radical produc(ioll by rhis roure may peovide much of the explanarion for (!le increased cancer risk in rhe arom-bomb survivors in Hiroshima and Nagasaki. Free radicals and (he oxidarion rhar rhey cause are also being linked ro hean disease. Oxidi-zed cholesrerol is being implicared as a major culpril in causing heart disease. Chapter 3 on hearr disease has more information on this imporram relationshjp. Tbere are, of course, things we can do ta limit aur exposure ro frec radicals. However becallse ali living crearures produce (hem, we eU1nor completely avoid rhese highly reacrive compounds. It is for rhis reason [hat mosr experrs are encolleagillg individuals ro srrengrhen rheir anrioxidanr defenses besides avoiding free radicals. These encouragemenrs have helped fuel a fascination with antîoxidam supplemenrs such as Vitamin C, Vitamin E, and betacarotene. r hardly need to menrion [har Americans have largdy raken [hese recom-

mendarions ro heart. Amioxidanr supplemenrs appear to be OI} the besr seller lisr of virtuali)' every health food srore in [he land. Despite cheiI' popular appeal, anrioxidanrs are not aII good. Excessive all10UllIS ofanrioxidanrs can paradoxic.t.lly act as "prooxidanrs," compounds (hat acwaHy fiLVor (he formarion of free radicals. This is (rue ofViramin C and Vitamin E as welJ as olher anrioxidants such as superoxide dismlltaSe and glmarhioneY

Melatonin's Rofe as an Antioxidant The mosr toxic of r!le oxygen-free radicaIs is a compound called rhe hydrox:yl radiCelJ.28 Forrunarely, melatonin is an effecrive anrioxidanr in dealing wirh dus radical. It is even more powerful than the widely taured narural anrioxidan( called glurarhione. In one laboratory model, melaranin emerged as a five-fold more po[ent amioxidant than glutarhione. 29 Melaronin is superior ro Viramin E in handling [!le toxic peroxyl radical. Overall, the lireratllre indicates tiut me1aronin peotects againsr free radical damage from cecrain carcinogens, herbicides and radiarion. 30 11I11srrarions of cerrain free radicals are found in Appendix VI. Melaronin's role as an antioxidanr is also illllsrrared in rhe Appendix VII.

Preventing or Helping to Fight Cancerom Tumors We have a.lready seen how meiaroniJl as an anrioxidanr can exert a powerflll effecr in helping ro prevenr cancers duough this means. However, this hormone appears ro have stiH other alHi-cancer propenies. Research has demonsrrared rhar mdaronin can slow [he groweh of breast cancer cells. 31 Some of mese additional benefits in rhe arca of cancer prevenrion and rrearmenc may resulr from rhe immunosrimularillg properries of melaronin.

Immune Enhancement OI'. Georges Maesrconi and colleagues from SwirLcrland have perfonned some fascinaring research rhar looked at rhe cririca! role rhar melatonin performs in the immune sysrem. One of [heir groundbreaking ex-

MELATONIN perimenrs involved two groups of micc. BOlh were deliberarely infecred wirh a dangerous virus and rhen subjecred ta a srressfuI sÎm
Helps to Cope with Stress and Maintain a Positwe Outlook TheworkofGeorges Maeseroni and bis Swiss collaborarors provides evidence rhar melaronin has a role in decreasing the impace of stress on rhe immune sysrem. 34 Melaronin a1so appears to have significanr effeclS upon orhcr ways our minds and bodies relate ro srress. Wheeher ic is stress or or11e[ fac[Qrs rhat rcnd ro pulllls ioro a negative frame of mind, rbere îs evidence dut melaronin may play a role în maintaining a posirive mood and ourlook. The research in rhc mood-e1evarîng ef.. fecrs of melaconin is important ro note. There are severallines of evidence ehar melaromn may contribuee (O one's scnse ofwell being: (1) Some of rhe mosr popular dl1.1gs [O crear depression, such as Prozac, Zoloti:, and Paxil, increase Ievels of seroronin, a com-

pound used by rhe pineal gland to make melaronin. (2) An auropsy series of suicide vicrims found significantly less melalOJ1in in d1cir brains than in rhe brains of orhers who died at rhe same age and rhe same rîme of day.3)

It May Help to Lowel' Cholesterol and Blood Pressure There is evidence rhar meJaronÎn may helI' ro lower cholesrerollevds. This cholesccrol-Iowering property has been idemified in both animal and human models. Hong Kong rescarchers srîmlliated raes ro develop high blood cholesterol leve!s by feeding r11cm a cholesrerol-rich diet. These rars wich high cholesterollevels were rhen given melaronin. The rars dropped rheir toral cholesterol levels as weLi as the combined vall1e for rhe rwo "bad" cholesrerols (VLDLand LOL).36 The authors measured an jncrease in bile. acids in rhe stools of rhe rars following rhe me!atonin isrration. This indicarcd chat rhe rars' livers were converting rheir blood choleseerol into bile and chen eliminaring it in the stOol. The same srudy also looked at rars with high cholesterol levels caused by underacrive thyroid producrion. These rars, when given melatonin, demonsrrared a rise in rhe prorecrive HDL levels. The authors concluded ehar rhe rwo srudies indjcued that melaronin could stimulare natural cholesrerol clearance mechanisms by encouraging cholesrerol ro be tlIrned inro bile and by increasing procecrive HOL levels in rhe rat. Besides rhe animal (esrs rhat show rhar melaronin can enhance cholesrerol removal, rhere is evidence [rom human cissue studies thac melaronin can a1so decrease rhe amOUlH of cholesrcrol thar human cells make. German researchers demonstrated rhar melaronin callsed human cells ro decrease cheir level of cholesterol producrion.J7 The level of decrease was impressive-measuring nearly 40 percent. Anorher imporranr facror in hearr disease and stroke Îs high blood pressure. Animal research sllggesrs rhar me!aronin may also he.lp ro lower blood pressure. 38 In animal models, melaronin manifcsrs rhe abiliry

197

PROOF POSITrVE

PROBABLE EFFECTS OF MELATONIN

• • • •

Protects against free radical damage from certain carcinogens, berbicides, and radiation Prevents or helps figh,t tumors Delays .some effects of aging Immune enhancer Assists in coping with stress Increases the ability to experience pleasure Lowers cholesterol, blood pressure, and risk of heart rhythm problems Lowers risk of osteoporosis

Figura 3

ro counrer sympatheric nervous sysrem activity. This decrease, in turn, has been demollsrrated ro lower blood pressure as well as heart rate. 39

CONTROL OF MELATONIN IN ENGLAND, CANADA, AN» THE U.S. England and Canada ban sale • Considered a drug, must be obtained from physician for specific medical condition

U.S.--Dietary Supplement

•

~_, D t i ~

• Due to a 1994 Act ed by Congress, FDA cannot review dietary supplements for effectiveness or safety. • Manufacturers are not required to present evidence of purily or even to demonstrate that any melatonin is presenl in Ihc prodUCI. _ • Bottles in the U.S. do not identify the mallufacturer "proprietary info." • Some melatonin products are made from bovine pineal glands. • Recent analysis fouod Ibat 4 of 6 melatonin products contaÎned unspecified impurities. Figure .4

Stimulatjon of whar is called the symparheric nervolls system rends ro increase blood pressure and risk of hearr rhyrhm problems. Hliman stLIdies sllggesr thar melaronin protccts againsr rhese efTecrs by roning down rhe syrnpatheric system. 40

198

Partial Solution for Osteoporosis? Dr. Reuven Sandyk of Albert Einstein CoHege of Medicine in New York recendy made a case for a pivoral role of mdatonin in osreoporosis prevention. 4 ! The honnoJle appears ro play a number of roles in this regard. Melatonin appears ro be necessary for oprimal calcium metabolism and helps ro lower the levels of a calcium-robbing hormone called corrisol. Melaronin also affecrs a group ofchemicals caJled prosraglandins (PGs). One particular prostaglandin, PGE 2, appears ro cause the 105S ofbonc mass. Melaronin blocks prosraglandin synrhesis, rhus decreasillg levels of a compound rhar is desrrucrive ro bone health. 42 The manifold benefirs of melaronin be}'ond sleep enhancemem and jer lag relief are summarized in Figure 3.

Melatonin: Is AII the News Really Good? Wirh ali of rhis going for it, what could ger in the way of melaronin cominuing ro be a sweeping international success? One [actor i nterfering with melaronin's drive ro be [he world's most popular supplemem is governmenraJ acrions. England and Canada h,llldie melatonin differendy man the U.S., as shown in Figure 4. Notice rhat in England and Canada the compollnd can only legally be obrained by prescriprion. 43 In me United States, melaton in is considered a dietar}' supplement. The Jaw forbids [he FDA from reviewing compounds markered as dictary supplemems for effecriveness or safery.44 This lack ofmoniroring or accollmabiliry raises somc concerns.

Questiom- OfPurity One of the foremost concerns is the purity of the compollnds marketed as mdatonin. In rhe U.S., supplemenr manufactUfers are nor required ro presem cvidence of puriry ro any regulatary body, nor even idenrify the manufacturcr of [he melaronin. Disrributors apparently consider d1is "proprierary informarion."4s Concerns as to chese pracrices are warramed. aur of six products analyzed, four were found ro con-

MELATONIN rain impuriries rhar, ar leasr iniriaJly, could nOi be idencified chemically.46 In view of a previous c.'\se of L-rryprophan, rhis is an ominous scenario. Many wiU recall how Lrryptoph:tn. a compound srruc[lJrally related to mehuonin, was linked ro over 40 deatbs and some 2000 crippling illnesses duc to impuriries in ilS manufactureY According ro their own labeling, some mclaconin producrs have been obtained from animal sources including cattle pineal glands:1R This iS5ue has raken on new significance wirh rhe recelU realization thar neurologic diseases in animals, such as mad cow disease, ma)' be nansmissible ro humans. Chaprer 10, "Animal Oiseases and Human Healrh Risks," deals wirh rhis and mher diseases in animals. In addition, as ro quesrions regarding melatonin cOlUaminaeion, there is anoeher signitlcanr concern. ManufKrurers do nor have ro demonstrare ro anyone chat any melaronin is even presenc in cheir products. This, of course, raises questions aboul the effecriveness of che supplement.

Danger ofLong Term E.ffects Are Unknown Even iI we could be assured tiut ali melatonin supplemenrs were 100 percenc pure and concained jusc as much of the com· potlnd as they promised, there are still severai lingering doubes. Despite rhe initial suggestions of melatonin's safery, whar are the potelUiallong-rerm problems wirh taking large amounrs ofa sllpplement wirh such br-reaching effeces? Even Dr. Reiter, one of mdatonin's biggcsr proponents, was constrained co it as recently as 1995 ehat mOSt melaronin studies had involved only small numbers of people and rhar we do not yet know who ShOllld not be raking melaronin supplemenrs. 49 In fact, doses raken far above normal physiologic levels of many supplemenrs over a period of time often cause more problems rhan rhey address. 50 An ironic n....ist to one of meJaronin's earliest claims tO fame is worth noting at chis poinr. Jet lag actually worsened in a group who were assigned ro begin raking the supplement several days before travel

rather rhan wairing umil che day of thei]" flighr. The implicarion of this finding is rhar rakiJ1g melatonm on a regular basis may prevenr some of rhe bendicial effecrs of rhe compollnd when lleeded. 51

Sexual and Reproductive EfJects of Melatonin: a Possible Two-edged Sword In the arca of sexual effecrs, melaronin has not proven ro be of benefir. le cOlild turn our ro be a two-edged sword. Wirhin normal physiologic limics, higher blood leve1s of melatonin may bencfit sexual healrh. Howevcr, in abnormally high amounrs, there may be undesirable side effecrs. Lay reporrs hypc melaronin as a sexual performance en.hancer, but there is no scienrific evidence ro back up such a claim ar rhis wrieÎng. Even De. Reiter, who seems quick ro interprer rhe medicalliterarure on melatonin in a positive liglu, is erue to his colors as a reputable scienrific researcher and ies that 'there is no convincing proof" that "melaronin wiU improve one's sex life ... "52 On balance, Reieer does poinr out (hat some of the anri-aging effecrs of melaronin may help preserve sexual function ro an older age. However, dlis would be expecred. If me hormone is really helping preserve a more general stare of yourhfulness, we would expece dlar benefits would accrue ro ali sysrems including the sexual and reproductive sysrelns. Some reproductive benchrs of melaronin have bcen found. A South Afric.'\n study found rhat men wieh higher amounrs of melatonin in their blood had higher amounrs ofie in their seminal fluid. These individua.ls had berrer sperOl moriliry, a qualiry associared wirh illlproved fertiliry.53 On the contrary, ehere is other evidence rhar sllggesrs rhar melaronin may interftre with sexual and reproduccive functions. High melatonin levels prevenr animals from going t1uough puberry.51 This action is called an "antigonadorropic efTecL "55 A case hisrory of a man in his mid-20's who had never gone rhorough puberty iIIustrared this effecr. He was evaluared because ofhis delay in sexual rnaturatiol} and was found ro

199

PROOF POSITlVE have melatonin levels rhar were five rimes higher rhan normal. He finally wenr rhrough puberry afIer his mdaronin levels came down ro a normal range. 56 Excessively high melaronin levels are also associared wirh inferriliry in humans. A recent srudy of female athleres found rhar those who had losr rheir mensrrual periods had melaronin levels rwice as high as arh[eres who were srill mensrruaringY Of course, this begs rhe chicken-or-the-egg quesrion. As we williarer see, rhe higher melatonin levels may be a resulr of rhe exercise. In turn, it is possible that rhe resulting highcr mdatonin levels chen depressed rhe female reproducrive fllnctions. 5S Thus, abnormally Jligh melaronin levels (such as rhose obrained by taking a slIpplemem or doing very rigorous arhleric rraining) may work againsr ~l person's reproducrive imerescs.

CAUTIONS AND UNKN'OWNS OF MELATONIN SUPPLEMENTS · Purity • Labei accuracy regarding quantity • Potentiallon.g term adverse effects • Possible undesirable side effects of high doses, such as reduced fertility • Possible dangerous interaction with prescription drugs Figure 5

Melatonin Jnteracts with Prescription Drugs

200

]n our earlier ex.planauon of rhe funcrion of oxidarion reacrjons and free radicaJs, ir was meJltioIled rhar rhey can desrroy poisons or unwanred foreign marerial. Since melaronin is a free radical scavenger, ir wiU decrease che body's free radical [oad and

could disasrrously affecr individuals an prescription drugs. The reasoll for chis is rhar mosr ofwhar we rerm "drug rherapy" roday involves chemicaJs rhar che body rreats as poisons. Oxidarion reacrions and free radicaIs help ro eliminare several of mese drugs from the systern. The concern is thar by decreasing rhis acrion, rhe blood leve1s of certain drugs will rise, resulting in potentially disastrous effeccs. For example, Mevacor (1ovastarin), the popular cholesterol-Iowering drug, and Coumadin (warfarin), a common antj-dorring drug, boch rely on frec radicals and oxjdation using rhe famous cyrochrome P450 sysrem in che liver. Lowering rhis funcrion has been ShOWll ro cause severe muscle pain and actual muscle desrruction duc ro an excessive buildup of lovasratin in rlle blood. Worse srill are rhe resulrs wirh warfarin. When rhis function decreases, excessive levels of thc drug can build up. In turn, chis can predispose ta serious OI' faral bleeding episodes duc ro excessive "blood chinning." Mulcirudcs of conUllon drugs rely on this sysrem some of which include: the antibiotic eryrhromycin; the blood pressure pili nifedipine (Procardja); quinidine (a hearr rhyrhm stabilizer); rhe anrifungal drug keroconazole ( izoral);
Where Do ~ Go From Here? Is rhere any way ro safely make use of chis wonder suppJemem in Ijght of ilie possibiliries of its undesirable dTectS, rhe banning ofover-the-counrer saJes in some COllllrries,
MELATONIN

How to Jncrease Our Melatonin Levels If a plam foreman desires ro improve production on a11 assembly line, the likelihood of success will be increased if he is rhoroughly acquainted with every aspect of rhe production process. Similarly, if we wanr ro optimize our melatonin levels, we must understand how the body makes chis vita! hormone. Melatonin production occurs in the piueal gland, a tiny organ that is located in ilie exact center of [he brain. 60 Its location is shown in Figure 6. This gland is only about the size of a kernel ofcorn and has the shape of a miniature pinecone. Its appearance explains the roors of its name: the Latin pinea/is is derived from pinea which means pinecone. 61 As a testament ro its importance, the pinea! gland is rhe fim gland to form during human fetal development. It is dearly discinguishable a mere chree weeks after conception. 62 It is important to note [har the pineal gland is more than just a melatonin factory. At leasr four important compounds are seereted by chis riny gland,63. 64 as listed in Figure 7. There are several steps in the chemical production ofmelaronin. They are oudined in Figure 8. For {hose acquainted with biochemistry, a biochemica1 flow chart of (he biosynehesis of melatonin is induded in Appendix VIU.

Regulation ofMelatonin Production In spice of whac may seem Iike a very seraigheforward chemical process, rhe body carefully regulaces melatonin produeeion. 65 The process is largely conrrolled by the lightdark cycle. Optimal melatonin production only occurs ac night and is dependent on a dark environment. Nighttime levels genera1ly peak around 2 A.M. ro 3 A.M., as depicred in Figure 9. In ehose wee hours of the night, melaronin levels are five co cen cimes higber chan during the day.66 Light-dark signals are fed through che opcical nerves co a control

PINEAL ANATOMY Pîneal gland

Figure 6

PINEAL GLAND SECRETIONS -Epithalamin • Protein thought to iDerease learDiDg eapacity and slow dOWD aging

-Serotonin • Elevates mood and has innuence on sleep and pain

Arginine Vasotocin • Potcnt protein capahle of rapidly induciDg deep sleep

-Melatonin • The "fIX and rejunnate" night-time hormoDe

Figure 7

STEPS IN THE PRODUCTION OF MELATONIN 1. The pineal gland draws tryptophan, an amino acid, from the blood.

2. Tryptophan is converted to serotonin in the gland. 3. Serotonin is converted to melatonin. 4. An enzyme called NAT must be present for the final step. Without sufficient amounts ofNAT, melatonin production suffers. Figure 8

201

PROOF POSITIVE

MELATONIN LEVEL VARIATIONS THROUGHOUT THE DAY 80

r------------

70

M..Jalon'n 60 (pglml)

50 40 30 20E----10

o

2:00PM

Darkn....

2:00 AM

7:00 AM

TilllC of D.~·

Figure 9

FACTORS INVOLVED IN THE PRODUCTION OF MELATONIN • The body does not store melatonin. A daily production is needed. • Light/dark signals from the retina travel through the optical nerve to the brain where they combine with sîgnals rrom our "body clock," teUing the gland to start and stop melatooin production. • Melatooin can also be produced directly by tbe retina itself under conditions of darkness, with DO involvement of the pîneal gland.

NATURAL LIGHT IS REST FOR MELATONIN PRODUCTION 4.5 J.S 3.0

Z.5 1.0 1.5

0.5

o.t

IOAJlI

Figure 11

202

Boosting Melatonin ...Naturally How can we now apply the undersranding of [he chemisrry and regularion of mel.aronln in such a way as ro increase [he producrion of rhis viral hormone by OUI own bodies? The remainder of rhe chap[er will provide answers ro rhis qllesrjon.

Get Exposure to Bright Light early in the Day

Figure 10

Mdaronin (-&!Iiltr)

cemer in the brain where our "body dock" is located. This dock, in turn, rdls the pineal gland nor ro produce melaronin when rhe daylighr signal is rransmined from the eyes. When rhe dark signal from rhe eyes is received by rhe comrol cemer, ir rriggers rhe gland ro produce melaronin, which is fed imo rhe bloodsrream. 67 Animal resrs indicare rhar melaronin can aho be produced direcrly by the rerina. Under conditions of darkness, rhis rissue on rhe back of the eye can aer alone in producing mdaronin. 68 Melaronjn is nor stored in rhe pîneal gland; ir leaves rhe gland rhrough simple difTusion. 69 Its half-life is shon during rhe inirial few milllHes, followed by a second longer phase. 70 As a resuJr we carmot rcly on yesrerday's meJatonin for roday. We nced a liberal supply of mehronin each cvening. Some of the factors involved in rhe body's producrion of meiaronjJl are shown in FiguIe 10.

2PM

'PM

IOM.1

lPM

'AM

IOAM

Oile of rhe fim and highly respecred srudies probing the daylighr/melaronill COIlnecrion was published in 1988. Researchers in Filliand found rhar rars who were exposed ro Datural daylight had signific.înrly higher evening melaronin levels rhan anorher group of rars who had an equal amounr ofexposure to artificiallighr. 71 The difference in melaronin levels of rhe rwa groups is shown in figure Il. Ourdoor ljght is incredibly more imense [han the arriftciaJ variery. Ollrdoor lighr can reach 3000 lux on a bright sunny day.72 A brighr indoor environmenr may provide only 400 lux, less thao ) 5 perecHt of daylight brighmess. 73 This medical research verifies the counsel given by EJlen Whirc a

MELATONIN cenrury ago, quoted in Figure )2. 74 There is an interesting observation regarding a special need for more sunlight as we get older. Consider rhese rhree facrs: • Melaeonin appears to slow rhe aging process. • The older \Ve get, rhe less me1aeonin ourpur we have. • NatllraJ lighr exposure in dayrime increascs melatonin ourpur ar nighr. We conclude chat

ta

SU LIGHT - ATURE'S WONDERFUL HEALING AGENT

slow rhe aging pro-

cess, we can boosr Our melaronin ourpur by being exposed ro more sun.lighr which helps ro off.ser r!le narurai weakening of melaro!lin producrion. Ellen White undersrood this need for rhe e1derly ro ger more sunlight, according to he.. srarcmenr shown in Figure )3.7 5 Brighr Jight, such as sunlighr. also m.ay increase seroronin producrion in the dayrime which can in turn prevenr dression and farigue.7 6

Figure 12

OLDER PEOPLE NEED MORE SU LIGHT

Avoid Light Exposure al Night Years ago rhere was recogoirion rhat evening iighr suppressed meiaeonin production in humans.7 7 Ir is important ro avoid lighr exposurc ar nighr while maximizing ir during (he daytimc hours. Wc know (har low inrensiry Jighr (50 lux) is not a probJem bur levels of500 lux and above ar nighr significalldy suppress melaronin release. Considering rhis lnformauoll, ir is prudent ro minimize lighr exposure ar nighr, and where Jighr is necessary in the nighr rime hours (e.g., waking up ro use ehe baehroom), llse a lighr as dim as possibJe. rn Wesrern narions, rhe habit ofsraying up Iare ar nighr is generally associared wirh significanr amounrs of lighr exposure during rhose hours. From rhe srandpoinr of mc!aronin producrion, ir would be beerer ro go ro bed early ro take advanrage of rhe nighrrime darkness and rhen risc eatly. The health advamage of going to bed early was poinred our a cenrury ago by EHen White, quoeed in Figure 14.

"Vigor dcclines as years advancc, 1caving lcss vitality with which to resist unhc~dthful influcnccs: henn' the grcatcr necessity for the aged to han plenty of sunlight and frcsh. pure air."

Figure 13

SLEEP IS BEITER BEFORE MIDNIGHT

"Sleep is worth far more before than after midnight. Two hours' good sleep before twe)ve o'clock is worth more than four hours after twe)ve o'clock...."

Exercise Boosts Melatonin An carly srudy by Carr and colleagues looked ar seven healrhy women. They

Figure 14

203

PROOF POSITlVE

FOODS BIGR IN MELATONIN (pico-gran/S/gram offiMa) Barley Banana

demonsuated rhar one ham of exercise on a srarionary bicyde could double or [riple ll1e1aton.in levels.?8 0rher studies have also demonsrrared (hat physical exercise can boos[ melatOnin levels.?9

Eat Foods Rich in Melatonin

TomalOcs

MelaeonÎ..n is presenr in many foods. Earing foods rich in natural melaronin 80 eall raise melaton,in levels in rhe blaodsrream. Foods rich in me!aronin are listed in Figure

Gingcr

Rice Corn

15. 8 1.82

Oats

Eat Foods High In Tryptophan

Figure 15

FOODS meH IN TRYPTOPBAN (mglIOO grams) WhoJemiJk BllIcke)'cd Cowpeas I Blac.k Wall)uts • • • • • •

AJOlonds 5easame secds Clutell f10ur Roasled pumpkin !eeds Toru t 00

200

300

400

SOO

600

700

Figure 16

FOODS RIGH IN VITAMIN B6 (mgl100 grams) Lima beans

As we have observed, trypcophan is necessary for rhe pineal gland fO make borh serotonin and melatonin. Thus we would rhink (har rrypcophan is an important compound ro ingest in abundance if "ve wane ro opeimize our melatonin levels. 83 Animal research has demollsrrared il1deed rhar increased amounrs ofL-rryptophan can cause a fourfold rise in blood melaronin levels. Surprisingly, animals rhar had no pineal glands showed rhis SJme remarkable risc. This provides evidence of rhe imestine's ahiliry ro make melacon,il1 from rryprophan. This is good news, since aging animaIs' pineal glands rend to Iose rhe abiliry ro make melatonin [rom thc build.ing blocks of tryprophan and seroronin due to decreases in the enzyme, NAT, which was previously mentioned in the producrion of melaronin. Rich sources of (ryptophan are listed in Figure 16. 84 In medical school, 1 was told thac mjlk is a rich source of tryptophan, but as you can see, many planr foods are much richer in rhis imponam amino acid.

Lentils English WalDul BanaDa

Vitamin B6 May Increase Melatonin Levels

t.56 0.51

5esaoll.' seeds

..."

Sunllower seeds

UI

....

Artichoke hearls Sweet beII peppers

2.21 0,5

Figure 17

204

1.0

1.5

2.0

In animal studies, viramin B6 appears ta be necessary for the production of secownin from tryprophan. 85 Seroronin, you wiU rceal!, is a compollnd rhar che pineal uses ro make melaronin. Ifhumans also require B6 for serotonin production, rhen boosring intake of this viramin will help ro raise mclaronin levels. Rich sources of vitamin B6 are lisred in Figure 17. 86

MELATONIN There is evidence that calcium is an imporcam molecule for the pineal ro produce melaronin. One srudy showed that animals that were given a dier deficie.nc in caleium developed shrunken pinea! glands. 87 Furrher supporr ofcalcium's imporrance is seen in rhe delererious resulrs of calcium channd-blocking drugs on me!aronin levels. In animal srudies, rhese common drugs for heart and high blood pressure problems decrease melaronin levels. 88 . 89 Foods high in cakium are listed in Chapter 7, "The Grear Mear and Protein Myth."

Food Restriction and Fasting Boosts Melatonin Production Resericted food intake in experimental animals has been found ro produce a more youthful melatonin cycle and prolong life spall.?O There may be a number of reasons for rhese advamageous ettecrs. Animal tesrs show rhar there is actually a preservation of pineal function on a chronieaJly sparran dier. In one srudy, consranr food resrriction decreased the faH in me1aronin and lev~ els of rhe enzymc NAT that usuaJly occurs wim aging.'l By t!le end ofrhe srudy, rhe rars who were allowoo ro eat as much as rhey wanted had levels of mclaronin and NAT that were only half rhose of ehe sparsely fed rars. Both groups of rats, however, showed e1evared levels of seroronin in rheir pineal glands. The implication of this researeh is thae older :mimaJs Iose rheir abiliry ro effectively makc melatonin due ro falling levels ofNAT, which is the crirical enzyme needed tO converr serotonin inro me!aronin. A sparse dier rends tO preserve some of the loss of NAT funcrion that occurs wirh. aging. Noe only is food restriction beneficiaJ but fasting irself secms ro hdp preserve pineal funcrion. Dr. GeraJd Huerher of the Psychiatric University in Goningen has looked eomprehensively ar rhis issue. 92 Fasring actuaJJy lowers pineaJ produce ion of melaronin, but increases melatonin in the dayrime ro levels usually seen only ar nighr. 93 The soJurion ro chis paradox hinges on the &ct thar Hueeher and others have recognized ehat fasting raises producrion of melaronin outJide of the pi-

neaJ gland. The key place where this happens is in speeialized intestinal cells caLled rhe enterochromalfUl cells. His theory is mat fasting preserves the pineaJ by aJlowing ir not ro work so hard, and letring rhe intestinal sysrem take over some of rhe pineal's work of produclng mdatonin. His meory is compelling, yet, most wonder how food restriction would he1p rhe intestine make more melaronin. Huerher postulares rhat this is due to a relative increase in the amounr of tryprophan in rhe inrestine during fasting. You will recall rhat tryprophan is the key amino acid (or protein buiJding block) rhar is used by the body ro manufacture melaronin. Mally people think rhar most of rhe protein our bocly digesrs comes from rhe foods we eat. Hawever, in normal siruations, rwo-thirds of rhe prorein digesred by the intestine comes from rhe body jrself. For example, intestinal cells have a very shorr Ijfe span, and as they die, they rhemselves are digesred wirhin the intesrine. Significant amounrs of protein-rich

HABITS THAT INCREASE MELATONIN PRODUCTION • Increase exposurc to naturalligbt and minhnizc exposure to artificiallight. • Slcep in complete darkness. • Eat foods rich in melatonin, tryptopban, and vitamin 8 6. • Avoid a calcium deficiency. • Restrict food intake in general. • Practice fasting, especially in evening hours. Figure 18 mucus are also digested each day. The fact is rhar rhese rissues are rich il} tryptophan eompared ro ehe rypicaJ foods we eat rhat are relatively poor sources ofrhis amino acid. The resulr is that the fasring srare provides rhese special intestinaJ cells wim easier access ta tryptophan from which rhey can make melaronin and relieve (he pîneaJ of some of its work. We have seen severaJ dierary practices and orher actjons ehar can increase our body's production of melatonin in a naturaJ way.

205

PROOf POSITlVE

LIFESTYLE FACTORS THAT REDUCE THE MELATONIN PEAK • Stress • Caffeine Cuts me!latonin production in halI for 6 hours

• Alcohol Up to 41 percent reductioD

• Tobacco Figure 19

These practices are summarized in Figure

18. Some llabits wiU result in a lowering of melaronin production. They are listed in Figure 19. Research suggests (hat stress and poor coping skills reduce melaronin production. 94 Thus, finding adeqll:l.te coping mechanisms for conrrolli ng seress as described in Chapter 14, "Stress Wirhom Disrress," is essenrial in narurally oprimizing melaronin levels. Caffeine should be avoided; it srimulares the body's stress hormone system (the sympathetic nervous system) and tends ro weaken mebronin proclllerion. It can cut melatonin production for six hours. 95 In-

DRUGSANDSUPPLEMENTS mAT REDUCE MELATONIN • Non-steroidal anti-inflamma1tory drugs • Beta & Calcium Channel Blockers • Anti-anxiety drugs & sleep aids • Vitamin B IZ (3 mg a day) • Anti-depressants Figure 20

206

somnia or disturbed sleep is usually the resuit. Prohably rhe mose common drug llsed in ,mempring tO deal with stressful simarions worldwide is aleohol. Alcohol, however, can not be endorsed as a drug tO improve a. rressed person's melaronin supplies. Alcohol depresses melatonin levels. 96 As lirele as two mixed drinks raken araund 7 PM have been demonstrated ro depress melaronin production even five or more hours later. Producrion of melaronin was down as Illuch as 41 percenr at 12 midnight. Tobacco appears ro be another mehuonin depressor. Research indiGltes (har smokers have lower evening melaronin levels than flon-sll1okers. 97 This may he.lp ro exptain a well-kJlown side effecr of smoking: sleep quali(y generally suffers.

Melatonin Production Reduced by Certain Drug MedicatioflS Symparheric nervous stimulation is essentiaJ for melatonîn production. It can be impaired by a number of drug medications even ifthe essenrial condirion of night rime darkness is provided.9~ Certa11l medîcarions reduce me!a(onin levels. The major tranquilizers haloperidol anei chlorpromazine block (he fmal srep in ilie conversion ofseroronin tO melatonin. 99 Beta-blockers like propranolol anei orhers have been demonsrrared ro markedlv decrease melaronin levels. 1oo They blo~k the key chemicaJ messenger stimulatîon of dle pineal a( nighr. Orher drugs Gln depress melatonin leve1s. Sleep aids including the benzodiazepînes are problems in (his regard. 101 Psyc!liarric drugs including rhose d,at work by increasing seroeonin levels can compromise melatonin production. I02 Nonsteroidal anri-ini1ammatory drugs are commonly used [O tr~H aehes, pains, and inf1ammarion. They have found their way inco headache preparations. mcdic.;uions for premenstrual syndrome. 3nd even ccld anei fiu combinariolls. As litrJe as 400 mg of t!le commonly used ibuprofen has been dcmonstrated ro reduce pineal productÎon of meiaronin. 'OJ The long-acring sus(ained

MELATONIN release form of indomerhacin when taken in a dose of75 mg ac 6 PM was observed ro complerdy prevem rhe rise in melaronin rhat oecurs at nighc. 104 Even excessive imake of Bl2 can imerfere wich melaronin productjon. One study doeumenced depressed melaronin in connection with B12 imakes 00 mg per day.105 Drugs and supplements rhar reduce melaronin outpur are listed in Figure 20.

Certain Trauma Reduces Melatonin What public health professionals once caJled "accidents" are now ealled "uninrenrionaI injuries." The reason for the change in termi nology is mar these oM:en life-threatening or erippling mishaps are often preventable-they are nor just a bad twist of fate. Quadriplegie patients rypically havc an interrupcion in the nerve conneerions beeween the group of cells that release the chemical messengers (superior cervical ganglion) aod me pineal. They have been observed ro have no day/oight variation in urinary melatonin levels in spite of secreting larger amOllnts of melaronin which actually peak in me day time. The fact is that the quadriplegic has diminished periods of toeal sleep and redueed pereencages of the deep rescarative stages of sleep (teehnieally called stage 3 and stage 4 sleep).

ShouLd we Avoid Electromagnetic FieLds? There are probably few areas that are as comroversial as electromagnetic fields. The area is emotioflally charged because of rhe technological world we live in and [he signifJcant exposure that most of us have ro such sources. Dr. Reiter makes a case for minimizing EMF exposure, citing some preliminary research mat suggests soroe sources of EMF may lower melatonin (evels. 106 The argumems are noe impressive enough to cause me ca move inro a cave in

the woods (Reiter is not suggesring such a dramatic approach), bur it is hard ta argue with the wisdom of try1ng to avoid EMF as much as possible. Fot example, sitting a bit farther from your compurer monitor, trading in your eleceric blanket for some old fashioned wool blankets and comforters (ar use it only as a pre-warmer), or keeping as much disrance as possible between you and other home electrical devices may be prudent.

Summing Vp Melatol1.În is a compound with incredible promise. We are just beginning, however, ta learn about ies side effects. The use oflarge amounrs of melaronin supplemems may in some cases pose significant harm. The mosr prudent approach seems ro emphasize natural lifesryle approaches chat boose levels of this remarkable hormone. To some rhis may sound too simple. le may even sound strangely reminiscenr of those things our mothers and grandmoehers emphasized: a healthful diet, regular physical exercise, regularity in sleeping, avoiding late night acuvities, sunshine, etc. Despite the simpliciry of these measures, medical research is demonsuating rheir effecuveness. However, there are some things ehat even mom and gralldma did not recognize: the importance offoods high in trypcophan and melatonin, and the dangers of drugs once thought innocenr. Our growing understallding of melatonin may, indeed, change (he way we attempt to answer that oft-posed queseion, "Why am 1 50 tired?" When we srruggle with personal fatigue issues, we may find ourselves running down a mental checklist of factors (hac affect me1atonin levels. Such an approach is calculated ro help the majority of people safely boost (heir energy leve1s, minimize farigue, and experience a whole host of other benefits.

207

PROOF POSITfVE RefernlUS -

l.l

Nelsoll E. KJrk J, el al. Chief complainl r.~ligue: a longilUdinal tudy from the p:lIiem's perspeclive. hmz PrtW Rri} 1987 Summcr;6(4):175188.

24

I

1 R.~decki SE. Brunton SA. Manageme.nt ofinsomnia in olltcc-based practice. National prevalence and lherapeulic patterlls. Arr/) [am MrrL 1993 ov;2(11}:) 129- J 134.

Foley OJ. Monjan AA. el al. Sleep complaints among clderly persons: an idemiologic study of lhrec commwlitics. Slcep 1995 Jul: 18(6):425-432. 3

Coren S. The prevalellce of sdf-reponed sicep disturb'lIlces in young aduJts. 1", j NruroscÎ 1994 011;790-2):67-73. 4

Wolkc D, Meyer R. Ct:tl. Incidence and persistence of problems at sleep onsel and sl""p continu:uion in the prcschool period: resulrs of;1 prospecti\·c srody of a rresenlative sample in Bavaria. PI'tL>: Kindtrpi)'chol KJ1Iderprychirur 1994 NovA3(9):33 1-339. 5

Dollins AI3. Zhdanova IV. et al. EtTecl uf indueing nocturnal cnun melalon;n concel\rrat;oJls in daylÎflle an slcep. mood. budy temperalUre. and performance. Proc Nul Acad So' USA 1994 Mar 1:91 (5): 1824-1828.

6

Halliwell B. Reaclive oxygen specie in living s}'stem.: source. biochemistr}'. and rolc in human diseasc.. Am} Mrd 1991 Sep 30;91 (3C): 145-225. Halliwell B. Rea tive oxygcn spccics in living s)'stems: source. biochemisuy. and role in human discasc. Am} MerlI99 J Sep 30:91 OC): J4S-225.

Halliwell B. Reactive oxygen species in lilling systcms: sourec. bio hCIll;Slry. and role in hunml diseasc. Am} Med 1991 Sep 30;91 (3C): 14 -22$.

II

26 HaJliwell B. Reacrivco"ygen peeies inlivingsyslems: source, biochcl1listry, and role in human diseasc. Am} Mtd 1991 Sep 30;91 (3C): 14S·22S.

Bast A. Hacnen GR. Doelman CJ. O"id:ult aJ)d anrioxidallls: Slale of lhe an. Am} Med 1991 Sep 30;9i(3C):2S-13S.

27

Reiter RJ. Melchiorri O. el al. A revie", of the evidence supponing melalonin's rolc as an :lntioxidaJlt. } PiJlttll Rti 1995 J:tn: 18(l): 1-11.

l..<

Reilcr RJ. Mdd,iorri O. Ct al. A review of the c\'idence supponing mel:llonin's role as an alllioxidam. } PiJlenl Rei 1995 Jan: 18( 1): 1-11.

l?

Reitl'r R]. Mdchiorri D. et al. A review of rhe evidence upponing melatonin',\ role as an alllioxidam. J Pillftl! Re! 1995 Jan; 18(1): l- 11.

JO

Ibt prcss ill 1993, prior to scitllrijrr

Blask DE. Hill S~'1. Ef1ecrs of mci:uonin on canCer: sludies OI' MCF-7 human breast cancer cdIs in cuhure. J Nel/ml Tl'a/UrJI Supp/1986:21 ():433449.

7 Pelrie K, Oawson AG. el al. A double-blind lrial of mel:1toniJl as a tre'lImenr for jel lag in international cabin CItw. Riol P!ycbiatry 1993 Apr l:33(7):526-530.

.' Mal.moni GJ. Comi A. Pierpaoli W. Pillc:tl mc1atollin. ilS fimdammt,,1 immunoregularor)' rolc in aging and C:lIlcer. AnII N Y Acad So' 1~88:521 O: 140-148.

Nolr: l/IId)' rrmllJ lIJi'rt amlouT/ad publimtioll.

li)

31

Maestloni GJ, Comi A. Immuno-derived opioids as medialOrs of thc imll1uno-enhancing and ami-stress aCI ion of mdatonin. Aoa N,,"rol {Ntlpoli} 1991 Aug: 13(4):356-360.

Cowtey G. Pushing Back Time? Mebronin. N,'/vswl'ek. AUgUSI 7. 1995.

33

Reiler RJ. Robillson). Meel Mclalonin. 'fhe Lit'e-giving Molecule. In: cw York. NY: BalHam l3ooks, 1995 p. 4.

.l4

8 9

Mrlatollill: YOllr Bodjs Naltl1'f11 \"ţIlmdrr Dmg.

10 Garllnkcl O, Laudan M, et al. Improvemellt ofsleep qualiry in c1derly pcoplc by conlrollcd-rclease mclatonin. Lallul 1995 Aug 26;346(8974):541-544. II

Melatonin. Tiu Mtdieal Lmrl' 1995

ov 24;37(962): 111- 112.

1 Dollins AB, Zhdano\'a rv. et al. EIIcel of indueing noclurnal crum meialOnin cOllcclltrauon in dayume on sleep. maad. bodr tcmpcra(Ure. amlperformance. hoc MulAcadSci USA 1994 Mar 1;91 (5): 1824-1828.

13 Zhdanova IV. Wurtman RJ. Ct al. Slc-inducing elteels oflow doses of mclatonin ;ngeslcd in the cvening. Clin P1J1lnnucol TIJer 1995 May:57(5):552-558.

P('!fie K. Oawson AG, el al. A doublc-blind rrial of mclalonin as a lr<:almelll for jel lag in international cabin crew. /Jiol P~ychit/ll'J 1993 Apr 1;33(7):526-530.

Maestroni GJ . Cont; A. Ami-stless rolc of lhe melalonin-ill)munoopioid Jlctwork: evidcnce for a physiological mechanism involving T cIIdcrived. immUJIOreaetive beta-endorphin and MET-enkephalin binding 10 thymic opioid reelOrs. 1111 j Neuro.
tanle)' M, Brown GM. Melaronin levels arc reduced in rhc pineal gland of suicide victims. PiyrhophtlnJwcol 81/1/ 198 :24(3):484-488.

3S

han IT. Tang PL. Efrect of melatonin on the m:timenance of holesterol homcostasis in tbe raI. tildoCT Re! 1995 Aug:21 (3):681-396.

.l6

3 Muller-Wicland D. Behnkc 13. Ct al. Melaronin inhibirs LOL receptOr aCliviry and choleslcrol s)'nlhesis in freshl)' isoblCd hllman mononlldear !cukoc)'te. lJiocll,-m Biopll)') Rrs Com71JulI 1994 Aug 0:203(1):416-421.

IS Kawashima K. Miwa Y. er aL AJllih)'pcnensivc aClion of mclaronin in rhc spot\l:lncously hypertensive rat. CIi" 6p Hypc'lUIIS [A] 1987:9(7): 11211131.

15 Ctausrral 13. Brun J. el al. Mebtol1in andjcl !:tg: conflrmatary resulr L1.ing a simplifled protocol. Biol P~yrIJiatry 1992 OCt 15;32(8):705-711.

Chuang JI, Chel' S • Lin MT. Mclatonin decreases brain serotonin rdease, arrerial pressure and hean r,l[e in rars. PIJllmMcology 1993 Aug:47(2):91-97.

lG Clau.llrat 13, Brun J. et al. Mclaronin and jel Iag: cunl1rmalOry resulr using 3 simplifitxl protocol. Biol P,)'c/)itrrry 1992 Oct 15;32(8):705-711.

40

17 GalCS J. Gcuing MeialOnin Naturally. Dec:I(6):4.6.

41

Nlllricion i1dlJocnle 1995

l~ Reiler R). Robin.son J. The Best Antioxidanl. In:

Natllrol WOlldtr Drug. New York.

MtlflIonin: Yollr Body!

Y: Banram Book . 1995 p. 20.

I~ Erlich SS, Apu7.Z0 ML. The pincal g1and: analomy. physiology. and diniCl! signillcal1ce. } Neul'oJllrg 1985 Sep:63(3):32l-341.

39

lIrugger r~ Ma.rkrl Vii, Herold M. Impaircd nocturnal secrelion of melaIOnin in coronary hem discasc. I.,,"eer 1995 Jun 3;345(8962):1408.

Sand}'k R , Anaslasiadis PG. el al. Is poslmcnopau al o teoporosis (elated 10 pineal gland fllnctions? l/It) Neul'Osci 1992 Feb;62(3-4):21 5-225.

Sand)'k R . AJ'asta iadis pG, Ct al. L postrnenopaus.~1 oStcoporosis reIared to pinca! gland functions? IIII} NeT/rOici 1992 Feb;62{3-4):21 5-225.

4l

3 The Medical Lctler. 24;37(962): 111-112.

McialOnin.

Tiu Mrdical LrITa 1995 Nov

BrOtsl4yJ 1992 Mar;14(3):169-175.

Thc Medical Lener. 24:37(962): 111-112.

Mclaronin.

Tilt Mtdieol Lftur 1995

l'

BaS! A. Hamen GR, Ooc1man CJ. Oxidams and aJllioxidams: state of ,hean. AmjM~d1991 S30;91(3C):2S.13S.

45

The Medical Lwcr. 24;37(962): 111-112.

Melalonin.

TIJr Mrdi,-,r/ Leua 1995 Nov

Basr A. Haencn GR. Ooelman CJ. OxidalllS and alll;oxidanlS: Slare of thon. AmJ/vIrdl991 Sep30;91(3 ):25-13S.

46

Thc Medical Lem'f. 24;:>7(962):111-112.

Melatonjn.

TIu MtrLical Lurel' 1995 Nov

10

Reilcr R). The ageing pineal gland and ilS physiological consequcncs.

22

208

O"

MELATONIN , Hcrhcrr V. MclalOnil1: Harm (rom a Pseudo-Cure-AII. NlIlrition O\'clIlber/December 30(6);24).

To-

t"l)' 1995

The Medical Lener. 24:37(962): 111-1 12.

'8

MclalOnin.

Thr Mrdiml Lnul' 1995

10v

L1.a.kso ML. Porkka·He-iskanen·I el al. Twenty-fo\Jrhour parrerns of pineal melatOnin and piluirary and plasma prolacrin in male rar under 'nalural' and artificial lighting condilions. Neurorf/docrinolog;' 1988 ep;48(3):308·313. 71

R iler RJ. Robinson J. MecI Mehlonin. The Li(e-gi\'ing Molecule. In: Mrlltlollill: YOllr Body's Ntl1ural ('(I()T/du Dmg. cw York. NY: Bamam Books. 199' p. 9. ?

\0

Erlich SS. Apuzzo ML. The pineaJ gland: anatomy, physiolog)'. and .Iiniea] signiÎtc
70

Herbcn V. MelaloniJ1: Harm frolTI a Pseuoo-Curc-AJI. 1995. NUIn'7~"~)'. November/December 30(6):245.

lioll

" Perric K. Dawson AG. CI al. i\ ooublc-blinJ rrial of melalooin as a Irearmenl for jet IJg in imernalional cabin crcw. Biol P~yrllli1fry 1993 Apr 1:33(7):526-530.

" Reiler RJ. Robinson J. l3ack in Sync. In: MrfatD/lin: YOIII' Body's NawrallY1ond..r Drug. lew York. NY: Banlam Books. 1995 p. 161. Reiter RJ. Robinson J. [I"ck in Sync. In: Melatonin: Body's N/lturtll \~Ollllrr Dmg. New York. NY: Ba.n· ram Books, 1995 p. 161.

7

YoUI'

Reiler RJ, Robinson J. Melatonin and Your Mind. In: Mdmonif/: YOllr Bod)''s Ntl/ul'f1l Wolldel' Drug. New York, !'-TY: Bal1lalll Books. 1995 p. 129.

\!

van Vuuren RJ. du Plessi DJ. Theron JJ. Melawnin in human semen. SAftMrd} 1988 Mar 19:73(6):375·376.

H

SI Erlich SS. APU7.20 ML. The pincal l;land: all:tlOmy, physiology. ;md diui .1 ignificance. } Nrurosurg 1985 Sep;63(3):32 1·34 1. \j Erlich SS. ApU7J.O ,"IL. The pineal gl:rnd: an:uomy. ph)'siology. and dinid sil;nillcance. } NrurflslI1g 1985 ep;63C31:321-341.

Pllig-Domingo M. Webb SM, e-t al. BricE ron: melatonin-rclarcd hypogonadolropie hypogonadism. N Engl} Med 1992 Nov 5:327(19): 13- 6-1359. j'

;] Lallghlin GA. Loucks AB. Yen 5 . Marked augmem'llion of noclurnal melatonin secrelion in amenorrheic alhlere . bur nOI in cyc.ling alhleles: llnahcred byopioidergi or dopaminergic blockade.} C1in Endorrino/ Metab 1991 Dcc;73(6):1321-U26. Reirer RJ. Robinson J. A MaSler Sex Hormonc. In: MrldlQnin: YOllr B00''s Mlluml Wo'lItlrr Dmg. New York. NY: Banram Books.. 1995 p. 126.

\S

While- EG. Exercise and Air. In: 7i:stimolJirs jor the Volume 2. Nampa, ID: Pacific Press Publishing A...,ocialiol1, 1868-1871 p.527. N

CJmIT/},

i~

White EG. General H)'gicne. In: Tiu Minimy of Hrtllillg. N/lmJ>t1, I D: }~Iciftc Press Pub!irhillg i1JsocÎarioll, 1905 p. 275.

Rao ML. Muller·Oerlinghauseo B. CI al. The inl1uence of phororhcrap)' 011 serolOl1in and meLllonin in nonseasonal dression. Plllll'lIIacopi)'r!Jiatry 1990 Ma)';23(3): 155-158. 76

Lew)' AJ. Wehr TA. el al. Lighr uppre ses mcialOnin secrerioll In humans. S<"irna 1980 Dec 12;210(4475);1267-1269. Carr D13, Rpcn 5M. CI al. Plasma mclalOoin in· creases dlU'ing exercise in women. } C1ill Emloa';l1ol Mt"lab 1981 Jul;53{l}:224-225.

7S

Diaz B. Garcia R. er al. Mdaronin and gonadotropin hormones in pubcnal sponsgirls. &v Esp Fisiol1993 Mar;49(1 ):17-22.

Isselb:lCher KJ, Braunwald E. edilor . el :lL Clioicall'hannacologr. In lew York. NY: McGRAW·HILL Ine. Hcalrh I'rofc.ssions Division, 1994.

7'J

Re-ilet RJ. Robinson J. Meer Mcl:uonin. The Lite-giving Molecule. In: : Banr,,!\) Books. 199' p. 3.

80

;9

J-ltzrrLsOl,i Principiei of ImalJlu Mrdicilll'-13,h t!dition CCR-ROM).

ilO

Mr/Iltonin: }'imr Borly's Ntltuml W'arllll'T Dl'I1g. New York.

61 Erlieh S5. Apu7.7.0 ML. The pineal gland: an"rolll}'. physiology, and clinical significa.occ. } Nmroiurg 1985 Sep;63(3):321-341. (.1

Reirer R], Robinson J. MeCI Mclalonin. Tbe ife.gi\'ing MoJe.cule. In:

,"fI·latonin: Your &tlyi N/I/JImlWourlr1' Dl'IIg. New York, NY: 13 Biol M"d 1992 Feb; 113(2): 194-195.

6.1

Golei rl'in R. Arginine-vasotOcin (Avn-a pineal hormone in mammals. Rom) Elldocl'ino/ 1992;30(1-2):21-44.

t\.I

Erlieh SS, Apuzw IvIL The pint"al gbnd: allalOt1ly. phy iology. and clinical significancc. } NClIrosurg 1985 Sep;63(3):321-341. 6;

Hanori A, Migitab H. er al. Idmlificalion of melaronin il1 pbllls and ilS dTccts on plasma mdatonin levels ;lI1d bincling 10 melalonin receptor in vcncbr'llc- . Bioclmn lvlol Biollm 1995 Mar;35(3):627 -634.

82

8,' Yaga K. Reiler Rj. Riehardson BA. TrYPlOph;lIlloading incr . e c1aylime semm mcl"ronin levels in inract and pin<'alcclOmi-LCd ralS. Lift Sci 1993;52(14): 12311238. The Food Processor for \'\?indows: NlIlrilion Anal~'sis & Fimess Software [computer program]. ESHA s<:arch. alcm. Orcgon.

Reiler RJ. The ageing pinea.! gbnd and ilS physiological conscquences.

; Dakshinamurti K. P"ulose CS, el al. curobiology of pyridoxine. Ami N VAmd ci 1990;5850: 128-144..

1995 p. 17-18.

BiociSa)'S 1992 M"r: 14(3): 169-175. Tosi"i G , Menaker M. Circadian rhYlhms in culrurcd m3mmalian retÎm. StimCt" 1996 Apr 19:272(5260):419-421.

68

Erlich SS. Apuzzo ML The pineal gland: :tllalOIllY. physiolog)'. a.nd diniC':lI signil'canCt'. } Nf1Irosurg 1985 5"p:63(3):321-341. 69

Dubhd. R. Reia'r RJ, el al. Melalonin in ~
81

Id Molecule. In: MeY: Banram Books.

;r, Reiler RJ. Robinson]. The Three-Billion-Vear-

I/lronill: Your Body's Naruml \VOlldrr Dl'IIg. Ncw York. ~7

Hatlori A. Migilab H. er al. Idemijlcalion of melaIOnin in p13111S and ilS effecLS on plasma melaronin lev· d and binding tu melalOnin receplors in verrebralcs. Bioclmn MoI Biollm 1995 Mar;35(3):627-634.

84

Re.

•r. Thc Food Proccssor for Windows: NurritiOIl AJlalysis

& Firness Sofrware- [computer program]. E HA Research. Salem. Oregon.

209

PROOF POSITIVE 8i

Monon DJ. R.eiter RJ. [nvolvemenr of caJcium in pîneal g1and lunceion. ProcSocb:pBiolMed 1991 Sep;197(4):378-83

ogy. malignanc or noc, and autopsy ftndings. ActJ1 Enducril/ol (Copm!J) 1985 Jan; I08(1): 135-144.

Meycr AC , Nicuwenhuis JJ , er al. Dihydropyridine ealcium amagonists depress the amplitude of the plasma melatonin cycle in baboons. Lift Sci 1986 Oce 27;39(17):1563-1569.

• 8 Erlich SS. Apu7.:w ML Thc pioea! gland: anatom)'. physioJogy. and clinicaJ signific:mee. J N(IIT'Omrg 1985 Sep;63(3):321-341.

88

89

99 Erlich SS. Apuw> ML Thc pineal gland: anatomy. phy iology. and clinicaJ significance. J NeuTOSUrg 1985 S;63(3):321-34 1.

90

100 Schlager DS. Early-morning istration ofshort-accing beca blockm for crcatmenc of winter depressîon. AmJ PsycIJilllry 1994 Sep; 151(9); 13831385.

uwilskaJB, NowakJZ. Calcium chmnd dru~ afrece nocturna! serotonin N-aceryleramferasc (NA'D aaiviry in rat pineal gJand. J Nn.ral TranJm Gm Sm 84(3): 171-182. Reiter RJ. The ageing pinea! gland aud its physiological conscquenccs. 1992 Mar;}4(3);169-175.

Bio~JSlJjJ 91

Slokkan KA, Reiter RJ, CI al. Food reslficlion retards aging ofthe pinea! gland. Broin &s 1991 Apr 5;545(1-2):66-72.

101 McInryrc IM. Burrows GD. Norman TR. uppression of plasma n\elalonin by a single dose of the bcnwdiaupine alprazolam in hcunans. 8io/ PsyclJilltry 1988 May;24(1): 108-112.

'Yl

Huethc.r G. Mdatonin synehcsis in [he gastrointestinal IraCI and [he impaa of nuerieional faaors on circulating mdatonin. Ann N Y Acad Sâ 1994 May 31;7190;146-158.

'02 Mclncyre IM. Burrows GD. Norman TR. Suppression of plasma OlC· latonin bya single dose of che berlwdiazinc a1prazolam in humans. Bio/ PsychiJlIry 1988 May;24(1): 108-112.

9.'

Wilamowska A, Pawlikowski M, et al. Food restrictian enhances mei atonin cfrca:s on the piluiwy-gonadal axis in femalc rats. J Pineal R~s 1992 Aug; 13(1):1-5.

10) ChiJds PA. Rodin ,el al. Effcct of fluollctinc on mdaronin in paliems Wilh seasonal afTcctivc disorder 'Ind malched conrroLs. BTJ PsyclJit1try 1995 Feb; 166(2): 196-198.

~ Massion AO, Tl.4S J. ec al. MeditalioJl, mclatonin and breast/prosface CUlcer: hypoth<:sis and preliminary dala. M~d Hypotheus 1995 Jal\;44( 1):3946.

'().j Surratl K, Smith JA, cc al. EffcCI of ibuprofen and indomcchacin on human plasma mdatonin. J PIJI1TJ1J PIJllnnllCol1987 Occ;39(1 0);840-841

Reiter RJ. Robinson J. Drugs That Deplete Mclaeonin. In: Mtla,umin: Your Body's Natural Wonder Drug. New York. NY: Bamam Books. 1995 p. 188.

9S

Ekman AC. LeppaJUOlO J. et al. Ethanol inhibits mdatonin secretion in healthy volumeers in a dose-
97 Toweou Y. Fl."Vre---Moncange M. et al. Agc- and sex-associated modifieation of plasma mclaronin ooncenrrations in man. Rdalionship to pachol-

210

IO~ Surrall K. Smieh JA. el al. Etfccc of ibuprofcn and indomelhacin an human plasma melatonin. J PIJIITm PIJar»lIIco11987 Oct;39( I0):840-843. 106 Honma K. Kohsaka M. CI al. Ellccts ofvita.min BI2 on plasma meblonin rhyrhm in humans: increased light sensiliviry phase-advances circadian dock? Experientil1 1992 Aug 15;48(8):716-720.

me

107 Reiter RJ. Robinson J. The Elusivc enemy-EJccrromagnccic fidds. In: Mc1alollill: YoUT Body's Natural Wonder Drug. New York, NY: Banwl! Books, 1995 p. 169-180.

CHAPTERTEN

ANIMAL

IS

SES

ANDHUMAN HEALTH RISK n Wednesday, M:~rch 20, 1996, "Mad Cow Disease" grabbed headlines worldwide. The shock waves were generated by a group ofprestigious Brirish scienrists who rcve~ed that ilie (araI caule disease was likely being rransmÎtted ro humans. 1 The news broughr the Brirish mear indusrry to a virrual srandstill. English folk avoided rhe mear markecs. The European Union and a casGlde of orher countries banned Br;rish beef. When rhe dust had senled, beefimportS had been banned by 23 nations. Since 1986, auropsies of Bririsb canle dying wirh mad cow disease reveaJed a nervous system infecrion (hat are tiny holes in rhe brain. When viewed under a microscope, rhe brain acrually looked like a sponge. This sponge-like appearance gave rise ro rhe disease's scienrwc name: Bovine Spongiform Encephalopaehy Ot "BSE." This cumbersome nalJJe could lirerally be translated: cows' (bovine) sponge-like (spongiform) brain disease (encephalopaehy). The lay (erm, "mad cow disease," in addition ro being much casier ro pronounce and , also conveys rhe fact thar iJlfeceed cows often develop menta! deeerioration and behavioral abnoemalieÎes. "Formerly" docile animals become irritable,

O

nerVOlls, or aggressive. They often Iose weight, and develop severe coordination problems before dying within rwo weeks to six monilis. 2 The J1umber of caede affected is staggcring, as st3ecd in Figure ). 3 Beside being a terriblc rragedy for ilie carrle populatioll, BSE has powerful emotional appeal for other reasons. It is one of a group of faral brain diseases that clln be transmitted from one Living Cl'eature to an-

C~ESOF~COWD~E~E

Over 168,000 bead of cattle were infected between 1986 and 1997. About 120 new cases, per week are being found in Britain at this writing.

Figure 1

211

PROOF POSITlVE

ANIMALS AFFLICTED WIm DISEASES RESEMBLING BSE · · · ·

Cattle Mink Oomestic Cat Ostrich

• Sheep' · Muie Oeer · Cbeetah · Monl{cy

· Pig · Puma

--

· · · . · ·

Mice Goats Elk Ocelot Gemsbok Arabian Oryx

· Nyala · Greater Kudu · Eland · Scimnar Horned Oryx

Figure 2 other. These diseascs are eechnically C
DESTRUCTWE POWER OFPRIONS • Prions are infectious substances found iUr animal products used for animal feed. • They cause several types of transmissible spoog;iform cncephalopathy diseases in humans and anima,ls. • These diseases are fatal, with Figure 3 212

DO

known cure.

have ali eome down wirh a spongiform encepbalopathy when givcn mear from calde rhar were known ro have [he disease. Roughly 20 animal speeics have been documenred to corne down wirh diseases resembling BSE. They are lisred in Figure 2:l Furrhermorc, caule rhemselvc' likely conrracted rhe disease from a differenc species. The epidemie in Brirish cows has been rraeed ro a similar sheep spongiform eneephaloparhy ealled scrapie. 5 This sheep disease gers its name from rhe facr rhar afflicred sheep can become menrally deranged and are Imown ro lirerally scrape the wool off rbeil' own bide. Before concerns abollr mad cow disease surfaced, Îr was eommon for British eanle ro receivc protein supplemenrs in the form of mear and bone meal rrom orher animals such as sheep.6 Evidence suggesrs rhar the practice of feeding mese reproeessed sheep careasses (which included their brains) ro canle allowed rhe cow populatiol) ta acquire BSE. Before ehe full cxrenr of the problem was rccognized, disease tr:Ulsmission was furrher amplified when rhe carcasscs ofBSEinfecred cows were also used in the process of making animal feed. 7 ,8 Thus, healehy cows were nor only fed infectcd tissues of sheep but also of other cows.

Prions: Frightening Carriers of Disease One might think thar processed meat and bone meal from sheep ar cows could noI' carry any kind of serious infecrion. Aher aU, carcasses are boiled as pan of rhe process of"renderi.ng" rhat ultimarely convcrrs the dead animals i.nro teed for living creatmes. It is rruc ehar the high temperatures rypical in rhat rendering process would be sufficienr ro kill mosI' disease-bearing orgarusms. However, rhe type ofinfectious agent that is responsible for BSE is very wlUsuaJ. Unlike mosr illncsses that are caused b}' bacteria or viruses, BSE is caused by something called a prion (pronouoced "pree-on"). The destfuctive powers of prions arc outlined in Figure 3. Prions are very resilienr proteins that are particularly worrisome because they are resistant ro mOSI forms of disinfecrion, They

ANIMAL OISEASES ANO HUMAN HEALTH RISK reraill their intecrivic)' cven afeer normal stcrilîzarion procedures uch as rhose using heat and ioniziJ1g radiarion. In facr, prions are nor even desrroyed by remperarures well above the boiljng point. In a laborarory rest of rhc scrapie prion, some infictivity stilL re1110ined after a [ull hour of exposure ro dry heat at 68(fJ F (36(fJ Cj.9 Prions are also impervious ro freezing and drying. 10 Much of the re.1Son for rheir hardiness is no doubr rehted ro cheir unusual eomposirion. Prions have no generic material and consise enrirely of prorein. l' They arc composed of a complex combinarion of thousands of amina acids. Since some srerilizarion processeslike ionizing radiarion-work by desrroying an organism's generic marerial, prions can nOt be harmed by rhese measures.

CEUUlACTEBlSl1CS OFPBlO S • • • • •

Prions are unlike bacteria or viruses. They consist of protein only. They attack only the nervous system. The immune system does not attack them. Their infectious power is not destroyed by sterilizing Ouids, freezing, drying, or high temperatures of sterilization. • The shape of the prioD protein is slightly different from a normal proteio. • They produce a chain reaction ,that causes normal proteins to change shape.

How Do Prions Cause Disease? One of the most perplexing quesrion abollt prions is how an agenr with no generic material can cause disease. The renowned prion researcher, De. Stanley Prusiner has come up wirh a likely explanarion based on his years of research. In an excellenr artide in Scientific American, Prusiner explained rhe current undersranding of how prions do their dirry work. 12 Research suggesrs dur these prion proreins are similar in srcucture to proreins rhat occur naturally in the brains of humans and animals. The prions differ from rhose similar normal proteins, however, in slight differences in rheir three dimensional shape. 13 The subcle differences allow these proreins ro combine into abnormaJ aggregares rhar are responsible for rhe brain changes produced bya malady calJed Creutzfe1dr-Jakob disease (C]D) and mher re1ared diseases. 14 Furrhermore, when abnormal prion proreins come imo conracr wirh normal brain proteins, rhey can influence the normal proreins ta rake an rhe prion prorein's rhree dimensional shape. This change in shape appears ro ser up a chain reacrion in which (he changed proreins larer influence lleighboring proleins ro do the same. The resulr is a progressively devastaring and ulrimarel)' faral disease th.ar has no known rrearment. The characrerisrics of prions are SUIl1marized in Figure 4.

Figure 4

HUm4ns Can Get Transmissible Encephalopathies It is nor only animals (har contracr rhe prion-induced transmissible spongiform encephaloparhies. Humans caJ1 also get rhree such diseases, as listed in Figllfe 5. 15 These rarely diagnosed diseases can be rhoughr ofas rypes offasr-acting AJzheimer's disease. CJD. (he most common. of rhe three, rypica.lly oecurs in late middle age and gelleraJly callses dearh wirhin six monchs of diagnosis.1 6 The SOUfce of mosr cases of CJD has nor been derermined.

PBlO -INDUCED DISEASES FOUND IN HUMANS Creutzfeldt-Jakob disease - found in Europe and U.S. (most common prion discase) Gerstmann-Straussler syndrome (or GerstmannStraussler-Sheinker syndrome) Koru - found

În

New Guinea Figure 5

213

PROOF POSITlVE

Transmitted From One Human to Another Prion-relarcd disea es have been founel ro be uansmissible from one human ro an-

other. This was discovered from srudies of a formerly cannibaJisric popuJarion in New Guinea who honoreel their dead by using ritual cannibalisric rites. Chilelren rypically are the brains ofd1cir deceased parenrs c1uring these rituals. Mall}' of rhem contracred a discase similar ro CJD called "kuru" (which, in rheir narive ronglle, means shivering OI' rrembling).17 The elisease somctimes rook lip ro 30 years ro develop. Young

BRITONS DIED OF CREUTZFELDT-JAKOB DISEASE 10 youog Britaios died of variant CJD. Average age at death was 28. The disease Iiogered for up to 23 months. Several British dairy farmers have also died ofCJD. ..........

Figure 6 children who engaged in rhese cannibalistic pracrices seemed ro develop rhe illness sooner rhan rheir older siblings or peers who also cOJlsumed infecred brains. 18 Orher examples of human-tO-human tral1smission of these devasraring illnesses exist. Before synrheric human growrh hormone was available, indivieluals who were deflcicnr in d)is important compound often received ir from piruirary gland removed from hllman cadavers. There are repom of CJD being transmirred by rhis proce s. Orher body producrs from human cadavers have also been linked ro CJD transmi. sion. These include eye (cornea!) risslle and dura marer (a narural brain covering

214

lIsed during some brain surgeries}.19 Medical devices have transmiued CJD. induding conraminared e1ecrrodes rhar are llsed to measure brain waves in a special EEG resr. 20 Oue fascinaring scudy emphasized rhe tenaciry of rhese disease-bearing prions,2l Elecrrodes were used to probe rhe brain of a dememed pariem who rurned om ro have CJD. The disease was inadverrenrly transmined ro rwo orher pariellts when rhe same e1ecrrodes were used on rhem. Following rheir lasr lIse in humans, over rwo }'ears ed. During thar rime rhe dectrodes were c1eaned rhree times anei rearedly sterilized wirh ethanol and formaldehyde vapor. N: rer rhis long interval, the elecrrodes were reimplanred in a chimpallzee's brain. Within 18 mOllths rhe chimp haei come down with CJD. The aurhors concluded: 'This finding serves ro re-emphasize rhe potemjal danger posed by reuse of instrumcnts colltaminated wirh rhe agenrs of spollgiform encephalopathies, even aher scrupulous atremprs to c1ean them."

Ten 10ung Infected Britons Awakened

Public Health Officials It was Creunfeldt-Jakob srarjstics rhar really gor the medical communiry's arrentiou in Mareh 1996. By thar rime 10 young Brirons and several farmers had become vietims of dus devastaril1g iUness, as described in Figure 6. Tbe fact that the disease affecred a group of inelividuals whose average age at death was less rhall 28 (and who were ali younger rhan 42 when diagnosed)22 was exuemel)' unllsllal. As we have alreacly pointed out, CJD is (ypicaUy a disease of older adllhs. Fllrthermore, aII 1Oof these indjvidllals had similar symproms-but rhose symproms were differem from rhose mar usually accompanied CJD. For example, insread of callsing dead1 wiwn 6 momhs, dus apparent CJD varianr lingered for lip ro 23 months. The brain wave parrerns of rhe diseased individuals differed from rhe usual CJD parient, as did rhe rype of memal impairment rhey suffered as rhe disease progressed. 23

ANIMAL OISEASES ANO HUMAN HEALTH RISK These lInusual disease fearures prompred a grollp of leading Brirish scientises ro raise rhe concern thar a new variant ofCJD had emerged. They fdr rhe mose likely source ofchis varianr WI1S BSE,24 meaning rhat rhis form ofCJD was uansmlued from rhe meat of cows infecred with BSE. Flirther rhickening rhe plot was the occurrence of a worrisome c1usrer ofCJD-infecred Brirish dairy farmers. Four sllch farmers had died with CJD in rhe pasr rhree years. Srarisricians said rhar such a c1usrer wOllld be very unlikely ro oceur simply by chance. 25 According ro rhe microbiologist De. Jeffrey AImond, a researcher and spokesman (ar rhe Conference on Emerging Infecrions ar Harvard Ulliversiey) for rhe British govern.ment's BSE advisory commirree, as ofJlIne 1997 rhere had been 19 confmned cases of rhis new CJD causing death, one of whid1 oceurred eaeh in Franee and ltaly.

CJD Cases in the u.s. There are CJO cases in our country among yOllng adults,26 but ar chis wriring ehey are not rhoughr ro be directly relared ro mad cow disease. However, rhe sympeoms are nor unlike rhe British form ofCJD. le is always fatal, and is especiaJly hearr wrenching when family watch such a young vicrim die. The symproms are listed in Figure 7.2'- 28 The disease eypically begins wirh mild symproms rhar advance wirhin a few weeks. The disease can rhen progress ro the point where rhe parient can no longer funcrion alone.

PROGRESSION OF SYMPTOMS OF CJD IN U.S. CASES • Mild early symptoms, such as changes in ea-ting and sleeping habits • Difficulties in concentrating, slowness of thinking, and memory loss • Bebavlioral changes, vision loss, incoordination, incontinence • Muscle spasms and rigidity, and seirzures • Inability to eat, dress oneself, and use toilet facilities, folJowed by death Figure 7

heaJrhy looking carele rhar were incllbating BSE ar rhe rime of rheir slaughrer for beef purposes.

Mad Cow Disease Not Confined to Britain . Unforrunare!y, the problem does Jlor appear (Q be eonhned ro Brirain. Ir has been fOllod in several orher cOllnrries, as shown in Figure 8. 30 . 31 Over rhe pasr rhree years, CJD showed up in farm workers in Franee and Iraly. Five

COUNTRIES WHERE PRIO

INFECTED HUMANS AN» CATfLE HAVE BEEN FOUND Domestic Prioninfected Coule

Almost Two MilNon Infected Cattle Eaten by the }far 2001

Prion-infected HllnrOllS

As rragic as (he Brirish deaths were, there was an even larger concern. Were we jusr glimpsing rhe beginning of a massive new epidemie? Will scores more eome down wirh CJ D because of BSE? These answers are nor yet known. However, rhe amounr of human exposure is sraggering. Drs. Dealler and Kenr have scared rhat by 2001) a conservative estimare of rhe number of infecred carle earen by humans will be 1.8 million. 29 This huge nllmber represenrs

Eogland Britain ._------=(relaod Italy Portugal Switzerland Italy

lnrporled Prioninfected CaJtie (/ronr EngJond)

Denmark Canada Falkland Islands Omao

Figure 8

215

PROOF POSITIVE cases were reporced in and three in h.aly.32 A]though the United Stares Oepartment of Agriculture has not found BSE in U.S. catde, (here are questions as [O wherher it may be present in our country. We wiU turn our attencion [O rhis issue larer in rhe chaprer.

Difficulties in Containing the Disease

216

To comain r!le disease, some have suggested rh;a we simply round up and slaughter ali animals infecred with prioos. This may sound like a way ro prevent human exposure. Unfortunately, i( is nor a viable option. There is currently no practical way [O determine whether a cow or mher animal has a prion infecrion umil it enters the final stages of the disease. A long incubation period is typical; animals have the infection but have not yet shown any symptoms. Most infectious illnesses-wherher rhey are in humans or animals-have short incubation periods that range from a few days to a few weeks. Such diseases include measles, the common cald, and mosr intestinal infections. There are orher human diseases, however, wirh long incubarion periods; one example is AlOS. As maoy as ten or more years can elapse berween the time of infecrion wim HfV and the development of AIDS. Oiseases wim long incubarion periods are especially worrisome because a person or animal can have the disease and transmit the infecrious agent wirhout ever showing any evidence ofhaving tlle illness. This has heen one of the worrisome features of AlOS. Thousands of healthyJooking HIV-infected individuals have ed the disease to others before they ever developed signs or symptoms of AlDS. This same concern surfaces with BSE. Among catlle, the incubation period for this illness (time berween infeccion with the disease-bearing agent and actual developmenc of symproms) raoges from rwo ro eight years. 33 When humans come down with a spongiform encephalopathy, they may never have eaten meat from a cow ehat WtlS known to have BSE. However, it is collceivable that rhey are meat from BSE-infecred eatrle mat were in rhe incubacion period and had not yet manijested the disetJse. We have aJready

roade reference ro me incredible amounr of human exposure ro BSE. A minimum of nearly rwo million infected cows will have been consumed by the end of this deeade:l4

No Laboratory Test For Prion Diseases Further difficulty in diagnosing BSE in asympromatie catrle comes from the fact thar, unlike human HIV infeetion, there is no blood test for asymptomatic cows with the BSE prion. Jnfected animals' immune systems do not appear ro mount any respoose against prions. It is for chis reason thar we cannot detecr prion infect ion by measuring anribody levels as we do with HIV or hepatitis. Prions also C.1I1not be growo in the lahoratory because they are not, in the strictest sense, living organismsthey are merely proteins. In fact, until Stember of 1996, there was 110 rcadily available Jaboratory test that could identify BSE in a live animal. Now rhere is a test requiring a spinal tap (a long needle is inserted berween the bone in rhe back ro the spinal fluid) that can detect the priOiI protein itself and may be up ro 95 percent accurate. 35 The technical names for the special tests that 100kspecificaIly for me abnormal prion protcins are immunohisrochemistry a.nd immunoblotting. 36 The test can be falsely positive in people who have had a stroke or encephalitis. Unforrunately, me test cannot detect the presence of prions in the spinal fluid umil they have multiplied enough to cau-se symptoms ro appear. 37 Thus, rhe test cannor give a forewarning of the presence of the disease, but can ooly its presence when symptoms begill ro be apparent. Furthermore, special post mortem microscopic brain srudies are generally needed to make the diagnosis with more cenaiory, but even they may miss the detection of the disease. It is especially important to note mat a cow may have BSE even if rhe telltale spongiform brain changes are not found on alltopsy. The reason for this is that microscopic studies of animal brains at the time of theie death may miss some of the disease's ballmarks. 38 Thus, the actual prevalence of the disease may be grossly underestimated both in catt1e and

ANIMAL DISEASES ANO HUMAN HEALTH RISK in humans. A summary of rhe difficulties iJ1 detecting or conraining prion diseases is shown in Figure 9.

How Many Humans Have Prionre!ated !llnesses? Orher rhan handfuls of cases in Europe and rhe relatively few individuals diagnosed with CJD worldwide, are rhere orher cases wirh prion-relared conditions? Is ir possible th;u orher individuaJs wirh demenria may have prion-induced illnesses? There are concerns in some qU:lners that some cases of"AJzheimer's" may actually be spongiform encephaloparhy. Researchers ar rhe University ofPirrsburgh srudied pariems thar were rhoughr ro have died from AJzheimer's Disease. On c10ser exami narion rhey found rhar some of rhem had actuaJly died from rhe prion-relared Creurzfeldr-Jakob disease..w Whar was imeresring abour rhis repon is rhar rhese individuals had a slower progression ofdisease rhan rhe typical CJD pariem. Such slow progression is reminiscent ofone of the diflerences in rhe varianr CJD duc has been diagnosed in Brirain. NeuroparhologisLS wirh rhe A1zheimer's Disease Research Consorrium occasionaJly do an auropsy of a parient who has c1earcU! CJD bur whose paperwork sllggesred only Ahheimer's.40 Despice carefuJly searching rhe medicallirerarure, I have nor come across any sysremaric srudy of rhe number of CJD parienrs misclassified as having AJzheimer's Disease. The experience of a couple of demenria research neuropathologists left me wirh a reasonable guess thar anywhere becween 1 in 50 ro 1 in 200 parienrs who are c1inically diagnosed with Alzheimer's reaJly have unequivocal auropsy evidence of CJD. This may not sound like a very large percenrage. However, when you consider the rotal number with AJzheimer's, this srnaJl percenrage of cases accoums for a significanr number of people. Cunenrly, some four million Americans have AJzheimer's disease. 41 According ro a Harvard medical repon, rhe estimares are rhar by 2050 rhe number will be over 10 millionY If even one in 100 diagnosed Ahheimer's parienrs had CJD,

DIFFICULTIES IN DETECTING PRION DISEASES • Some may have a long incubation period. • An after-the-fact autopsy may reveal the

spongy appearance of the brain, but not in aU cases; the disease is sometimes present with no sponginess. • If therc is

DO sponginess, a test to detect the abnormal p'rion proteins in the brain is ible in an autopsy or in an examination of spiDal fluid.

Figure 9 rhis wouJd rranslate into 40,000 cases CLLrrendy and 100,000 by rhe middle of rhe nexr century. So far, we have only been raJlcing abour dear-cur auropsy cases of CJD. There are concerns thar not aH prion-relared conditions can be easily diagnosed even if an auropsy is done. For example, a recenr medicaJ repon observed rhar in some cases, rhe disrincrion berween AJzheimer's and CJO is "gray."43 Anorber eepon conunented 011 rhe brain changes in a 32-year-old man who died with a demenria. The aurbors concluded: "This pacient had features ofboth Creurzfeldr-Jakob disease and Alzheimer's disease, providing additional sllppon forthe e.xisrence of an overlap berween rhese disorders. "44 The human prion-relared disease called Gersrmann-Straussler syndrome provides addirional human evidence that these rransmissible encephaloparhies may strike and nor leave rheir c1assic foorprinrs. An indjvidual who was demonstrated ro have this prion-rdated condition did not show ilie sponge-like brain changes under the microscope. 45 The researchers concluded rhat spongiform encephalopathy in humans "cannor always be excluded on neuroparhologic grounds in an individual dying of a demenring condirion, and rhe truc prevalence of rhese diseases is likely ro be underesrimared." In other words, among people

217

PRoa F POSITIVE

PARALLELS BETWEEN PRIO -RELATED DISEASES AND ALZHEIMER'S • Both are diseases of the brain. • The symptoms are similar. • They are always fatal. • There is

DO

blood test that can detect tbem.

• They caD usually be detected in an autopsy. Figure 10

wirh demenrias (condirions like Ahheimer's where rhere is severe loss of mental faculcies), we are probably missing Ce1ses of prionre1ated diseases because nor alI such cases show the expecred microscopic changes. Perhaps an even more srarding reporr found spongiform changes in d1e brains of 50 OUT of 66 parjents with Alzheimer's disease. Smid1 and colleagues said that rhesc changes were "virrually indisringuishable hisrologically [meaning, under rhe microscope] from the spongiform change characreristic of Creutzfeldt-Jakob disease (C]D)."46 Alrhough the aurhors rhollghr it

MILK FROM BSE-INFECTED CAITLEISBANNED • The Uoited Kingdom banned the sale of milk from BSE-infected cattle in 1988. • The milk was to be destroyed in addition to the cow that produced it.

Figure 1 T

218

unlikely thar rhey were seeing evidence of CJD ar anorher prion-relared condition, they did ar leasr raise thar possibiliry. From my perspecdve, rheir work rajses coocerns rhat subrypes of Alzheimer's may exisr. A vital quesrion is: could some of rhese subrypes be relared at leasr in parr ro prion exposure? The impliCe1tions of such a possibiliry are far-reaching. The paralle1s berween prion-relared dise'ases and Alzheimer's are recorded in Figure 10. The sobering message from rhis colleerive body of research is: we need ro seriously question our assumption that CJD is a rare disease. If just a small percemage of individuals who are diagnosed with Alzheimer's rruly havc CJD (in cirhcr rypicaJ or arypieal forms), rhe numbers wirh rhis prion-re1ared disease would be sraggering.

What Animal Products are Pree ofPrions? Many consumers have bccomc aware of ar least some of these compellirlg starjstics regarding prion-relared diseases. This has naturally prompted quesrions as ro which animal producrs presenr risk r.o bumans. Mosr of rhe foclIs of late has been on beef, which is warranred. Alrhough organ rissue carries rhe grearesr risk. animal stlldjes do suggest duc meat (from animal muscle alone) can rransmit prioll-re1ared diseasesY This is not surprising since musc1e is imerlaced wirh Iyrnph and nervous rissue-rwo tissucs known ro be infecred wirh BSE. 48 However, we cannor exclude rhe possibility that milk may also cauy disease-inclucing prions. Many may reeall how some ye.'lrs ago assurances were given thar a moriter cOllld nor HfV ro her child by nursing. 49 Of course, we now Imow rhat HIV Ce'lI1 be rransmitted in breast milk. 50 Granred, prion diseases are vasrly djfferent from HTV The risk (rom milk does appear to be much smaller than from earing beef or Ce1rrle organ risslles. Nonerheless, a British BSE expert has poinred our rhar ar leasr one human case suggesrs age of prions in milk. A Japanese woman dying ofCJD was fOllnd ro have rhe infecrious agent in her colosrrum (rhe rype of

ANIMAL OISEASES ANO HUMAN HEALTH RISK breast milk made in rhe inirial clays folJowing delivery).51 Milk h.as becn undeI' suspicion in est.ablished medical cirdes. It was one rhe producrs targere.d when rhe Unired Kingdom was beginning to recognize rhe magnitude of the mad eow problem. The aerion raken againsr milk by the British government is explained in Figure 11. 52 Borh h.umans and animals were banned from coosuming an infected cow's miile Un forrunare!y, as we have already nored, animals are infecred wirh the BSE prionlong before rhey manifesr any symproms. When infected symptom-free cows are milked, rheir milk is mixed in collection ranks wirh milk from healrhy cows. lf rhe prion is presenc in milk, it coulel theoretic.aUy COlltaminate rhe whole eollecrion rank. Pasreurizarion ednnor desrroy prions, so rJ1at process provides no consolatÎon. Although ar rhis rime ir cannor be stJtcd for ce-ftain thar milk can uansmit a prion-relared discase, many are wondering: is it worrh raking rhe chance? Earing rhe flesh of animals orher rhan cows ar drinking rheir milk may nor be safe eirher. These mher animals may also be infecred with prion-related diseases. As aJready menrioned, some 20 animal spccies, induding sheep and goars, can become iofected wirh rhe rraosmissible spongiform encephaloparhies. Suspicions are also raised concern ing products made from animal glands. Health food scores onen fearure a variery ofsupplemenrs thar include glandular exrracts. These agents appear ro have a higher risk of prion conraminarion and thus 1 think ir is prudent tO avoid them.

or

Is There Risk OfMad Cow Diuase in the u.s. or Other Non-European Countries? Even in rhe V.S., a country rhar officially srates that rhere is no evidence ofBSE, rhere have beel) reports rIrat are less rhan comfoning. One piea of evidence comes from Americ.an cases oiTransmissible Mink Encephaloparhy. Fîvc ourbreaks ofrhis disease affeccing rhousands of mink have been

documented in rhe U.S. The disease bears a srrikjng similariry ro borh BSE and CJD. causing rapid demenria and dearh with spongiform braio changes. Three of these five outbreaks occllrred in large mink filf111S [har had a pracrice of feedjng rheir mink "downer" ar "non-ambularory" carde. These synonymous rerms rerer ro cows rhar die in the fidd or faU down and are unable ro risc and srand up wirhollt supporr. Oeemed unfir for human consumption, such cows have been lIsed as a food SOUtee for mink alld mher livestock. (Of note, diseased carde may have been food sources for che mink in rhe orher two outbreaks as well).' In oile ollrbreak, rhe only animal prorein rhar had been consumed by rhe mink had come from a U.S. downer cow and aJmosr rhe emire mink herel died rrom a spongiform encephaloparJly.54 Or. Mark Robinson and colleagues ar Washington Stare Universiry have demonsrrated rhar mink can ger a spongiform encephaloparhy by earing BSE-infeceed cartle eissue. ss The original research repon describes rhe eransmission as occurring wirh "relative ease" even b)' rhe oral roure. In comrasr ro rhis, ir has nor beeo possible ro infecr mink by feeding (hem scrapie-infecred sheep riSSllC. One chjlhng possibiliry is rhar U.S. cows are harboring rhe BSE prion and rhar rhe mink haei rhen conrracted the disease rrom rhis source.

Government Search for Prion Diseases Has Narrow FocUJ How could BSE exist in carde in view of aU of d1e U.S. Deparrmenr of Agriculture (USDA) reassurances ro rJle contrary? Some are suggesring rhar the USOA is being far roo naJfOW in irs foclls. Currenr BSE surveilJance in the D.S. largely focuses on recognizing rhe BrÎrish form of BSE. To rhis end, rhe U.S. governmenr has arrempred tO provide rhorough education ro vererinary pracririoners, diagnostic labs, and vetcrinary colleges. The USDA has disrribmed videorapes of British c.anle wi(h "mad cow" disease and microscopic slides showing BSE infecrion as ir appears in England. They have even senr specialisrs ro Great

219

PROOF POSITIVE

220

Brirain ro get fim hand experience in disease recognirionY; The USDA its ro whar may have been an oversighr up ro rhis poil1l: as mosr BSE surveillance in rhe U.S. is bascd on che presumption rhat clinica.! signs and neuroparhology would be rhe same as rhac seen in Great Britain. There is growing evidence rhat t!le USDA surveillance methods may be misguided. The research suggests that BSE may cause other rypes ofillness bcsides rhe "mael cow" syndrome afllicting Brirish cows. Some of chis research comes from USOA researchers themselves. Or. Cuuip anei colleagues made some remarkable observations when they infected American canle wirh scrapie from American sheep. They were able ro transmit the disease by injeeting a suspension of scrapie-infected sheep brain tissue into rhe brains of ca.lves. The ca.lves clid develop BSE but it was very differenr from that seen in England. The animals did not show the t)'pica! "mad cow" signs dur cactle elisplay in Brirain. There was no aggressiveness, increased excitabiliry, or accenruation ofsensory reaccions that are rypical in the British varianr. Furrhermore, when dle brains of dle affccted carde were srudied microscopically, they did nor show the lIsual spongiform changes. The diagnosis could be made with certainry only by virrue of special tesrs that demonsrrated prions jn their brains. The authors conc1uded thar "undiagnosed scrapie could contribure to the 'downer-cow' syndrome and could be responsible for some ollrbreaks of transmissible mink encepha.lopathy... "57 There is other indirect evidence that suppom rhe possibiliry rhat BSE has infected American cattle but looks different from che British varianr. Smdies in other animal species have now demollsrrared tllar differem strains of prions do exist. For examplc, a British researcher found rhat when he injected rhe prions from an infected group of goats illto mice, those mice developed an encephaJopathy (brain disease) characrerized by drowsiness. The prions from a difTerenr group of infected goats a1so causcd brain disease wheu injeered inco mice; however, insread ofbecoming lerhargic, the diseased mice turned hyperactive!58 The message was

cIear: there were apparently ar least rwo cliffereIU strail1s of prion-related illness in goats. Alrhough rhe disease looked the same in ilie goats, when it was transmitted ro another species (in this case the mice) they wOllld develop one of rwo very differenr diseases. SlIch research has mised an important question. If a prion disease in goats could give rise to djffercm-appearing diseases in mice, cOllld sheep scrapie resulr in more than one type of co,...· disease? As we have atready seen, rhe answer seems ro be yes. One strain or rype of BSE may sllrface in rhe U.S. as a cause of "downer cow" discase. Another BSE strain is preseJl( as mad cow disease in England.

Prion Diseases Have Long Incubation Periods There is one other very importanr aspect thar needs ro be reemphasized. T!lesc transmissible spongiform eneephalopathies have extremely long incubarion periods. As already mentioned regarding hllmallS, there is evidenee thar kllrll can take up ro 30 years ro manifest itself. Thjs is likely ro be rhe same with CJO. As we have seen with BSE, it may rake lip ro six Of eight years Of more before infected cows show signs of rhe disease. Again, dle impon;t1lt implicat.ion is rhat ulOusancls of animals and humans may now be infected bur may nor develop symproms for many years. However. an infeered cow can theorerically trammit the illness whether or not it bas yet developed symproma(ic disease. The widely plIblicÎzcd ban on feeding dcad animal parts ro Brirish catde has nor sropped rhe epidemie, although it has appeared 10 slow it down. When the statisrics were reviewed in a 1997 repore, 31,903 British canle that had developed BSE were born after {he ban was implememed. 59 The important message is thar yollng COWS may be infected and may be able to transmit disease to humans.

"CalfMilk Replacers" Fed to Calves Contain Animal Products Furthermore, if BSE is indeed preselH in eounrries like the U.S., agricultural pro-

ANIMAL OISEASES ANO HUMAN HEALTH RlSK cesses have likely disseminared rhe disease quirc wiclely. Up umil April 1996 in rhe Unired Srares, as much as 15 percem ofprorein in caHle feecl was from rendered (animal) sOlirces. 6O Oile surprising place ehar remnallt materials have been used is in the feed for calves. On many f.1rms calves receive "calf milk replacers," a cype of artificial milk. This praccice allows the morher's miJk ro be sold on rhe marker taeher than fed to het calr. Up through the beginning of 1996, if you had read an ingredienc list on rhese calf milk replacers, you would have found such irems as "animal plasma" and "animal protein producrs" thar may include "mear and bone meal."61 These milk replacers may rJ111S expose calves ro rhe infected blood constiruenrs ar other body pam of diseased catrle. Even with the knowledge that BSE likely resliited from rhe practice of feeding rendered meae ro British cartle, rhe United StJres had for years appeared unwilling ro make any laws forbidding such practices in our narlon. However, in [he wake of aII the ITlad cow furor, rhe FDA has finally pur fonh a ban on feeding ruminant animals any paft of rhe carcasses ofother ruminants (ruminant ;mimals include canle, sheep, and goars). This became effecrive August 4, 1997.62 However, blood producrs, milk, milk products, and gelatin from ruminants and protein solely from pig or horse sources wiU srill be allowed ro be included in feeds in the U.S. An FDA advisory committee has asked rhe FDA to also exclude gelatin for feed, saying rhar rhere is not enough dara ro prove rhat gelatin is sare, parricularly gelatin that comes from Europe. As of rhis wriring, rlle FDA has not yet decided on the gelatin issue. Ir was nor until 1996 rhar Creat Brirain banned the feeding of allanimals or animal parrs ro orher animals. Some have suggesred rhar rhe U.S. government's delay in imp!ementing a ban an rendered animal tissues illustrares a very real conflict of interesr in rhe depawnenr's organization. Like rheir Brirish counrerparrs. the USDA serves rwo roles: ta safeguard rhe narion's food supply and ar rhe same rime prorecr the iruerests of the agricultural communiry by promoring the sale

of animal producrs. It is readi!y apparenr thac rhese dual goals can often conflict.

Other Pri01I Diseases Although our focus in discussing prion diseases is rhe possibiliry ofCJD, other less frighrening diseases are beginning ta emerge as possibly resulting from prions transmitreel ro humans from animals. One such disease is a disease rhat significanrly decreases tl1e quality of life, calleel Pager's discase. Pager's disease of tl1C bone disrupts rhe process ofbone formarion, causing chem ro weaken, d1kken, and become deformed. Bones usually affected include the pelvis, collarbone, skull, spine, and long bones of rhe leg. Chronic pain in the bones may resuit. Overall. the disease suikes lip ro duee percenc of rhe U.S. populacion over age 40, bur the race increases with age. Recent evidence points to a possible different peion as rhe cause of this disease, again being transmitted from animals. Risk factors for develOpi'1g ehe disease include eating brain or other organ meats (2 rimes grearer risk) , earing meat uaceable to sick livestock (2.7 times greater risk), and hanelling carde through farming or carele breeding (2 times greacer risk).63 Regular wieh dogs

EATING MEAT SHOULD BEAVOIDED " ... there is now an overwhelmiog scientific and medical case for avoiding the consumption of meat aRd meat products despite the government's atteRlpts to persuade os otherwise." Dr. Richard Lacey, prominent microbiologist and BSE researcher. Figure 12

221

PROOF POSlTlVE or cars may aJso increase rhe risk in cereain geographic areas.

What Should W~ Do? The ConSlImers' A~sociation, an independenr British '\vatchdoggrollp," has been quored as saying rhar rhe onl)' way ro avoid BSE risk would be ro stop ea(ing beef aJrogerhee. This concurs wi(h ilie recommendarion of rhe esreemed BSE researcher and Professor of Microbiology ar Leeds University, Oe. Richard Lacey. His simple answer 64 [O rhe problem is stJred in Figure 12. Many peoplc in Grear BrÎeain have (aken his advice ro hean. Ar rhis wriring, 47 percent of homes do not purchase beef in rhe Unired KingdoJU. 6> Orhers are saying even more. Some are suggesting due (!le eime has come ro recognize rhar disease in animaJs has become so rampam worldwide rhar we aII need ro seriousl)' consider becoming vege(arians. They poinr our rhar BSE is jusr onc of many faeal diseases Iinked ro animaJs. LireraUy hllndrcds of dearhs have been documented in rhe U.S. alone from a hastof animal-relared infecrions. Some of the mose signiflcant

from rhe Wesrern World's rwo leading killers, cancer and heart disease, rises wirh increasu\g consllmprion of animal producrs.

W'orse Than AIDS? Wirh conservarive esrimates ofsome rwo million BSE-infecred Glttle being eaten, there is rhe porential for a large-scale worldwide epidemie tim could rival AIOS regarding {he number ofpeople touched. We reaUy wiU nor know umil abour rhe ye.1r 2000 if rhe epidemic [har occllrred in cows will tOllch on a similar scale (in rhe thollsands) in humans. 66 However, CJO appears from many perspecrives ro be even worse rhan AIOS. With HIV we can diagnose lhe infection ar a very early stare. Ar ehat poinr, pharmacologic or other rherapies can be institutcd ro rry ro prevenr the progression of rhe infecrÎon ro AlOS. Even when AIDS strikes, treaunenr oprions are available. In rJ1C case of CJO, however, rhere is no abiliry for early detection and no treaunenrs ar any srage of the disease. Ir is a frighrening disease (har generaHy suikes quick1y, causes symproms and incapacirarion often far worse than AlOS, and progresses inexorably (Q cause death.

OTHER DISEASE-CAUSING AGENTS ls It Aiready Too Late? have been e;ating beef and using IN MEAT ANO MEAT PRODUCTS otherIf you animal products for years is it already Salmon elia Listeria Campylohacter Yersinia Figure 13

222

callsative agems may nor yer be household words; however, mosr will recognize ar leasr Ol\e of rhem, as lisred in Figure 13. Adding [O aII of rhe foregoing, we cannor forget rhal rhe risk ofd)'Îng premarurely

roD Iare? The answer is clearly no. Ir is probable rhar many peoplc have nor yer becn expo ed ro rJ1e prions that causc (he rransmissible encephalopadues. These individllals could mainrain rheir low risk of cver colning dowll wirh prion-relared diseases by compleeely avoiding animal prodUClS. Some may not feei [har (hey are rcady tO adopr a vegetarian dier. Orhers feel rhere is no reason ro do so bccause the)' have likely been exposed by rhis rime ro r!le infecrious ptions. Even for mese individuals rhere is good news. In rhe case of rhe transmissible spongiform ellcephaJopathics, rhe evidence suggesrs [har rhe total amOlll1C of prion exposure affecrs rhe incubarion period of [he disease. 67 Specifically, in animal resrs, rhe more prions rhe crearure is exposed to, rhe sooner it wiU rend ro develop the disease. Of course, 110 such srudy could erJlically be

ANIMAL DISEASES ANO HUMAN HEALTH RISK done in hurnans. (An answer is also not likely from observarionaJ srudies because we have no way ro measure or even esrimate how much BSE-infecred meat any given person has earen in his or her lifetime.) However, in harmony wirh rhe exisling animal research, ir is expected rhat rhere will be variarions from one person ro anorher in cite delay rime between earing prion-infecred marerial and cOluracting me disease. Perhaps someone who cars large amounr of foods conrainillg prions will develop rhe disease in 10 years ar less, while someone with modera re, yet sîgnific;mdy less exposure may develop rhe condieion in 15 ro 20 years. Another wirh stiH smaJler exposure may nor mme down wirh rhe iJlness for 30 years or more. Thus, even if tI person is doomed ro come down with a condition like CJD because of previous exposure ro prions, ir may be possible ro de1ay tile ooser of the disease signifteamJy.GR And do nor forger: a diee rhat moves away from animal producrs can dramatically provide an added rew,lrd by helping ro decrease your risk of ocher diseases [ike heart disease, diabetes, and cancer. The epidemic of BSE În rhe Uniled Kingdom has eaused tlS 10 focus an four Îssues rhar are more expansive rhan the discase irse1f. They are lisred in Figure 14. There is evidence that governmenrs worldwide have failed to vigorously address Ihe concerns of animal diseases and rheir impacr on human health. Why wair uneil the next epidemie strikes c10ser ro home when rhe warni ng signals are aJready sOllnding~ Why should mousands more die premarurely from demenring diseases? Why not begin making changes today thar will decrease your risk of mese diseases?

Beyond Mad Cow Disease It was in 1996 thar mad caw disease captured world headJines. However, in rharsame veac, Olher cliseases [in.ked with aoimaJs were ~Iaiming thousanm ofJmman /ives even rhough rhey clid nor garner from page caverage. Few Americans are aware of rhe hosr of porenrial1y faral diseases rhar are caused by germs Ihar lie no furrher away rhan rhe 10-

cal grocery srore, or even ilieir own refrigeraror. Some of rhese bacreria and viruses cause illnesses rhar are well understooel by public healrh professionals as posing a rhrear ro hurnan healm. The links benveen orher germs and hllman risks are more specularive. However, almosr ali of rhese diseases are largely linked ro animal prodllcrs. InfeerÎous illnesses have again beeome a bigh prioriry in me public health arena. Of

ISSUES RAISED BY THE BSE EPIDEMIe • Feeding practices in agriculture • Food safety • Speed at which government respoods to new epidemics • GoverDiment competence and commitment lIIIIIIIIIII... to human safety .

Figure 14

particular concern are growing thre
223

PROOF POSITfVE

Lowly E. Coli E. Coli is onc of thc mosr common bacreria known ro man. AU of us have lirerally millions of rhese germs living in our incesrines. Unforrunarely, some rypes ofE. Coli can be dangerolls and evenlife rhrearening. Two such dangerous variecies are rechnicaHy referred ro serorypes 0157:H7 and 0104:H21. Borh of rhcse c.1n causc severe intestinal sympwms includ ing bloody di-

DANGEROUS E. COLI BACTERIA DISEASES • Several E. Coli types are known, including serotypes 0157:H7 and 0104:H21. • They cause severe bloody diarrhea. • They cause Hemolytic Uremie Syndrome in children (kidney failure and destruction of red blood celIs), which c·an tead to deatb. • The bacteria can be found in beef, milk (raw and pasteurized), sausage, apple cider, and venison. Figura 15

DISEASE-CAUSING E. COLI IN U.S.A. TOTAL NUMBER OF REPORTED CASES IN 1995 - 2,296

r

"I~O.

_

,

- - _J 60 89 > 'l"" al (63

---"-

(

23 118

CA

-

w,

1)

,

-- -. t

1

j

--,

I

""" •

29

a/"

ut

23 7 I ro wv 1---. 42 " ~-..1-. ,

29

, - __ ~ ca

'(

-~

26'

'Iol

I

Figure 16

IeS

'--~

l

10 N'"

'. 1'11

199

ND

I '93 I

224

L

IS"'~

~~

VI

.,/

, ->.

,,~

-L

-

~8 MO

15 M

~

l

r('(

...,.t'

3

16

J) .... \ ...

1)(

lA

"-

(

19 ...-J

i-: . .,. . ~

38

.-,"

1169 N'f

.."

/"

1.- ~ >IA T_,L.-

118

... { ,/=",. J~ 3 ~ 1'" .., ~ PA • _ _ NJ 66 Cl 37 126, M I.~) -~ ~ • ,N ~3r.,J,DE, I h... '1W/ 32 l~MD8

1'~-23

-

\

............. '

'1750' .-'44

'M f

20.....

118{r'l

MN \

N"2'l~65\

..~~

.-

~.""

,,-

29

~ __\ ~ ., oc 45.;.

IO~

(sc(

(GA' -

~~'-,

r

De

O

arrhea. Worse yer, chey can cause a life threareningdisease in children known as che hemolyric uremie syndrome (HUS). HUS is rhe most common cause of acute kidncy failure in children,72 Irs name is derived rrom rhe fact rhar rhis disease causes destruccion of red blood cells (hemolysis) aod, commonly, kidney failure. The laner problem causes a buiJdup of wasres in rhe blood (known as uremia). It can be severe enough to lead ro dearh. Survivors may develop chrollic kidney problcms wirh a nced for dialysis and/or uansplant.7 3 In late 1992 and early 1993, dangerous E. Coli serotypes caused over 600 infections and claimed 4 lives in rlle well-plIblicized cvems associared with fast food hambllrgers in wesrern America.74• 7S Over 2000 infections are reported ro the Centers for Disease Control with many more esrimarcd cases occurring rhar arc nor reponed, wirh approximarely 20 dying each year.7 6 Some estimate thar as many as 20,000 people each year ger sick from E. Coli wirh lip ro one-rhird reqlliring hospitalizarion . Beef, however, is nor lhe only food rhat can harbor this seriolls infectious agent. Human disease from E. Coli varieties has been traced to raw milk as well as ro cornmercially pasreurized milk. In lhe Iauer situarion, disease-causing E. Coli, which is found in large aJl10UIHS in some carrle wastes, can apparently conraminate milk I1fter pasreurizarion. 77 Other sources of Înfeclion have included sausage,78 roast beef, and apple cider, since some appJes rhat go into apple cider are taken from {he ground where canle roam aud are conraminared with canle manure.7 9 Meat harvesred from wild game such as deer can a1so harbor rhe infectious agent. 80 One percent of all cartle harbors rhe diseased E. Coli. 81 Because of processing pracricc-s, mear from many animals may comprise one hamburger, thus maJcing ground beefand hambu rgers responsible for more human ourbreaks ofthe disease t1laO any orher single source.82 A summary of E. Coli diseases is shown in Figure 15. In 1995. evcry state in America repaned olltbreaks of disease causing E. Coli. Figure 16 porrrays the numberofcases reported ro the COC for each state. 83

ANIMAL OISEASES ANO HUMAN HEALTH RlSK These numbers greatly underestimare che actual numbers of disease in each stare since only about 50 percem of laboratories even cest bloody diarrhea for diseased E. Coli. 81 The COC has now formally recommended that alliaboratories tesr bloody diarrhea at least for E. Coli 0157:H7. 8s

Listeriosis Listeria monoeycogenes is a bacteria that can also cause life-threarening disease. The sympeoms of the disease are similar ro rhe flu. Although we are making progress in decreasing the number of Listeria cases, it sriH causes hundreds of needless deaths each year in ilie United States alone. A 1995 repore in rhe }ournal ofthe American Medical Association indicated ehat about 1100 Americans each year are aftlicted with Lisreria infection. About 250 of these die of che disease. 86 An earlier Cemer for Oisease Control evaluation of this germ showed a similarly sobering death rate. 8 ? In boeh reporrs, over 20 percem of those who developed infeelion ulcimately died from it. Although Lisceria poses particular tisk for pregnant women and newboms, only onerhird of ilie recenc cases occurred in such categories. Ocher individuals ac high risk for chis infectioh are the elderly and chose with weakened immune syscems from condicions like cancer, diabetes, Of AIOS. Food categories associared with me highest risk are soft cheeses and undercooked chicken. 88 Other items idemified as carrying risk were foods from store deli councers and "non-reheated hot dogs." The link of Listeria cases with hot dogs and chicken is srated in. Figure 17. 89

Campylobacter Campylobacter is thc leading eause of bacrerial food poisooing in the U.S., a1rhough it does not rend tO make the headlines. Each year over ewo million Americans are Înfecced with this organism and develop symptoms such as abdominal pain. fever, nausea, and vomiting. In up to 20 percenc of cases, ilie disease can be prolonged alld severe. Each year as many as 200 dearhs in our councry are traced to Campylobacter. 9o Campylobaccer infecrion

can also cause Guillain-Barre syndrome, a serious and potemially life-rhreatening discase. 9I Guillain-Barre is a rype of rapid paralysis that usually bcgins in rhe legs aod travels up the body. Ir can affect tbe muscles ofbreaming, and can chus cause respiratory deam. 92 Cases ofGuillain-Barre can be triggered by omer causes beside Campylobacter. However. Campylobacter tends to cause a worse paralytic disease that is usually associated with severe disabiliry even if the person recovers from the acute illness. 93 Whcn assessing foods for Campylobacrer risk, chickcns head thc list. More than halfofhuman cases is uaccd to chicken consumption. As recencly as 1990, a Universiry of Wisconsin study of over 2000 egg-Iaying hens from tnree different flocks found thac ali bur eighr birds were infected with rhis potentiallydangerous germ. 94 AI· though the organism is usually JUSt harbored in the birds' imestioes, this is still a problem since most modern chicken are not killcd the way grandmother used ro do it (chopping irs hcad off), but are now killed by auromared machi nes while the chickeus go by 00 conveyer belts. The bodies of rhe chicken can be opeoed by the sharp knives in the kiUiog process and rhe gur contents are men spilled inta the meat irself. Other

LISTERIA BACTERIA IN HOT DOGS AND CBICKEN 20% of Listeria cases are linked to uncooked hot dogs and undercooked chicken. The V.S. Department of Agricul1tore tested t 9 brands of hot dogs and found that 200/0 tested positive for Listeria.

figure 17

225

PROOF POSITIVE foods involved in Campy-Iobaeter disease ourbreaks include beer, cake icing.. raw milk, anei eggs. 9 )

Salmonella

226

Among baereria causing signifieam diarrheal illnesses in rhe United Srares, Salmonella is second only ta Campylobactcr, causing an estimated rwo miHion illnesses annually.9G There are over 2000 different varieries of SalmoneHa (referred ro as serorypes). One of the mosr common serotypes of SalmoneHa is callcd Salmonella enteriridis. Each year this serotype causes mally Outbreaks where many people are infected from a common source. An annual average of 55 such ourbreaks is reportedro the Centers for Disease Control-a figure thar undoubtedly uoderesrimates significamly tile Illlmber ofoccurrences. A recem well-publicized outbreak indjeated thac only three our of every 1000 cases are ever reporteei to public healrh aurhoriries. 97 Most vicrims develop an uncomplicated intesrinal infecr.ion with diarrhea, fever, and chills, but over 10 percenr of pariems require hospir.alizacion. Roughly chree Out of every 100 who are hospiralized dje. 98 Severe ar life-chreatening complicarions from infeccion with the Salmonella family of germs include: infection around the brain (meningiris), blood infeetions (sepsis), and chronic anhriris, wirh death resulting in some cases. 99 Again, inf.1.l1ts, rhe e1derly, and rhose wirh immune sysrem problems run rhe highesr risk for severe ilisease. Salmonella appears ro freely cause largescale ourbreaks. Oile of the most strilcing single source ourbreaks callsed ne:.lfly 200,000 human infeetiolls. The whole epidemie was traced back ro pasreurized milk produced ar a single dairy plant. 10o Anorher large outbreak r.har srruek over 200,000 individuals was traced ca infeeted commercial iee cream. 101 The latter case highlighred rhe power of relacively few Salmonella organisms ro cause seriolls disease. In spir.e of the thousands of people infeeted, public health researchers found rhar even rhe most contaminared ice cream specimens had onl)' six Salmone1la baeteria per half"cllp serving

of ice cream. 102 The porential of sllch few nurnbers ofbacreria ro cause serious disease highlighrs ilie danger ofthese organisms and illustrares how difftculr it can be ro ensure rheir complete eradicarion from even a single food. Other food icems thar have caused outbreaks of Salmonella infecrion include home made iee cream, ehocolare, eggs, and producrs nude from eggs. The e,gg situarion !las disturbed mally consumers, because perfecdy normal appearing grade A eggs can be infeeced. Even when the eggshells are completely intacr and disinfected, SaLnonella can stiU be residing inside. The reason for the SalmoneUa-inside-rhe-shell is thac t!le bacreria can silendy infect the egg-Iaying organs of apparendy healrhy hens. Since the shell is formed after the rest of ilie egg, rhe eggs eUl become SaJmoneHa-infected before the shell even exists. 103 Even in rhe highesc risk region of r.he country-che U.S. Norrheasr-oJlly abOlit one in 10,000 eggs are infected with Salmonella. For rhis reason some consumers have fclr rhat rhe risk from eggs is small. In ilie days ofthe family chicken f.1.rm rhat mal' have been true. However, in roday's world of mass food producrion, risks are multiplied. The Cenrer for Disease Control has poiJlted Out that many dishes ruade in res.. taurams and commercial esrabJishmenrs llse "pooled eggs." In orher words, the conrents of ofcen hundreds of eggs are put togerher co make a huge barch of food. The CDC makes tlle following observarion: "If 500 eggs are pooled, one barch in 20 will be comaminated and everyone who ears eggs from that batch is ar risk."J04 Another disr.urbing outbreak of Salmonella occurred recendy in rhe western paft of rhe COllJltry. Ar least 90 individuals becarne ill from eating cOllraminated beef jerky. Jerky rhus ed a lisr that now incllldes sausage and salami as important disease-bearing agents. The reason this is so disrurbing i5 that such animal product5 are (ypicaJly cOllsidered "ready co eaL" The average consumer sees no need to cook or sterilize these items. 10S Chocolate also pose' a concern since most of ilie rime it is not heated prior to eating. A summarl' of the

ANIMAL OISEASES ANO HUMAN HEALTH RISK characteristics of Salmonella diseases is shown in Figure 18.

Yersinia Enterocolitica Infection Yersinia has me unusuaI distinetion of being a common cause of unnecessary surgery. Many a yOllng person with Yersinia infecrion has llndergone an appendectomy. The reason for this is thac the germ causes fever and severe lower abdominal pain rhar mimics acute appen,dicicis. 106 Foods conraminated wirh Yersinia include pork, raw and pastellrized milk, choco[are milk, and rhe Southern delicacy, chimerlings l07 (made of pig inteseÎnes, known as "chitlins").

Clostridium Perftingens Infection Clostridillm perfringens is anorher COn)mon cause of food-borne ouebreaks of infecrious ilIness in the Unieed $rates. UsuaUy, over J 000 cases are reported each year ro t!le Cemers of Disease Comrol, but again, this is an underestimarion of the actual cases. 10 & lr is particularly common when rhe fcod souree implicared in the ourbreak. is cooked beef. 109 In addition to beef, chicken meat is also ofren infested with this germ. When infect ion develops, abdominal cramps and vomiting are the rule, aJthough the symptoms usually last less than 72 hours and hospitaliz.·\tions are unusua1.

Beyond Vpset Stomachs It should be apparenr that food-borne intecrious iJlnesses C.111 c;U\se many problems beyond me simple incestinal upscr or diarrhea. As we have already seen, many ofmese germs can cause life-rhreacening infections. Orhers can cause chranic crippling diseases. Campylobacter, as we have noced, can cause Guillain-Barre syndrome mar onen cripples wheo ic does not kiIl. Salmonella can eause a chranic and permancnr anhritis. The fact is mat more and more infecrious diseases are being Jinked ro chronic medical problems. A new infectious link has emerged ro an oftcn-devastacing ineurable intestinal illness known as Crohn's disease. Crohn's can cause such symptoms as bloody dianhea, fever, severe abdominal pain, arrhricis, and incapaciry, as well as obstrLIction of che intestines rhat requires

SALMONELLA DISEASES • SalmoneUa causes two miUion iUnesses annually. There are many large outbreaks, witb up to 200,000 peoplle linfected at a time'. • Symptoms are diarrhea, pain, and dehydration. • The infection may lead to meningitis, sepsis, and chronic arthritis. • Tbe bacteria has been found in raw milk, pasteurized milk, eg,gs, chocolate, ice cream (commercial and homem'ade), beef, sausage, OI

salami, aud chickeu.

I_......;~

_

Figure 18 surgery. This disease up to now has had no koown cause and has bewildered medical seiemists for years. 1 clinencly treat many Crohn's parienrs and alcllOugh I have had suecess in colltrolling the condirÎon in mosr patienes, rhe disease remains a lifelong one wirh no cure. Researchers now have nored a link tha( ac leasc some cases of Crohn's may be caused by Înfeetion with a germ c.a.lled mycobacrerium pararuberculosis. IlO, III This organism is exuemely common in animals Iike sheep and canle. The bacrcria eause a chronic inrestinal disease called Johne's disease (hat affecrs approximate1y 25 perccm of U .S. dairy caule. 112 One of the mosc frighcening aspecrs of this disease is that healrhy-appearing cows can be infecred and transmit the germ in dleir milk. In one study of a heavily infected Ohio herd, over one in four healthy-appearing cows had the germ in meir srools and onc in 12 had the germ in cheir milk. l13 These are parriclIlarly cbilling statistics when you reaJize thar che germ can survive common paseeurization methods. 114

Leukemia/rom Cows? Mally people rhink (har cancer is only an adult discase. Norhing could be {urrher fronl rhe umh. Cancer is che second leading cause of death among U.S. children. ll5 Only aeeidencs daim more young lives.

227

PROOF POSITlVE

CANCER IN CHlLDREN Cancer is the number 2 cause of deatb among children (accidents are the number j cause). Leukemia is the le'ading cause of childhood cancer dea'ths.

Figure 19

POTENTIAL DANGER OF THE BOVINE LEIJKEMIA VIRUS • The bovine leukemia virus is present in up to 70% of U.S. dairy cattle. . It can cause a cattle· disease called bovine

Iymphosarcoma. • Most BLV-infected cows release infectious viruses or infeded Iymphocytes in their milk. Figure 20

BLV INDUCES TUMORS • BLV milk has been fed to sheep. Sheep have developed Iymphosarcoma. • BLV milk has been fed to chimpanzees. Chimps have developed leukemia and pneumocystispneomonia.

Figure 21

228

Lellkemia, a cancer of the bJood and blood forming tissues, is rhe leaeling cause ofchildhood cancer deaths in our country, as srateel in Figure 19. 116 Why is this ofspecial concern in a chaprer on djseases in animals? Becallse mere is anorher disease rhat is rampam il) the American cattle populat ion. This disease is bovine leukemia virus (BLV). The possible connection ofleukemia in children wirh rbis carele disease is explained in Figure 20. 117 Notice, as wirh BSE, rhere is a direct connecrion ta cattle. Bovine lellkemia virus (also called the Bovine Leukosis Virus or BLV) refers, of course, ro a form of leukemia occurring in canle. Noce how prevalenr chis virus is in American dairy herds. Beer carde usually have a lower rate of infec[ion. Nonetheless, ar any time, roughly 20 percent of che U.S. caule popularion is infecred. 11S In addition to leukemia, rhis virus can cause bovine lympbosarcoma, a cancer of c!le Iymph tissues in cacde. Nore thac the leukemia-infecred cows chemselves are nor the only ones ar risk. The virus es inro che milk. 119 This milk appcars ca have che pore.ntial ro cause disease in animals of orher species who drink the infecred beverage. BLV-comaminaced milk char is unpasreurized, when fed ro sheep and chimpanzecs, has been linked ro serious diseases, as shown in Figure 21.110.121 Srill orher species have been shown ro be susceprible co BLV: white tail decr, pig, tbe domesric rabbit, anei car. 122 Ferrer and associates cired evidence years ago rhat in the laboratorv human cells also become infecteel widl 'the bovine leukemia virus. 123 Pasceurization kills rhe virus, 124. 125 bur we have already seen thar milk can become tainred due ro conramination afier the pasreurization process ar because of mechaJ1i· cal problems wich pasteurization equipmem. Ourbreaks ofhuman infections rrom pasteurized milk duc ta germs like E. Coli, salmonella, aod Yersinia aII provide examples of pasceurizarÎon's shoncomings. In shorr, alrhough pasreuri7.<1rion is a useful procedure dl:lr has increased milk safery, it by no means sterilizes dairy products. EVeJ1 after pasreuri7.ation, milk is actuaJly teeming with vintscs and bacceria. Chapter II

ANIMAL OISEASES ANO HUMAN HEALTH RlSK entitled "Milk, Friend or Foe?" has more information on rhis subjccr. Ulrimarely we ask ourse1ves, i.s BLV a tlueat [O human health? The 3n$Wer so far is rhar we do not know. AJrhough a single srudy showed more cases of human leukemias in areas that had more carde, 126 other stlldies reviewed by Dr. Reginald Johnson of rhe U.S. Animal and Plant Health lnspection Service found no relationship between BLV and human disease. Ir must be poinred out, however, rhar bovine leukcmia virus is vel)' similar ro the human T-cellleukemia virus Type.I (HTLV-I ).127 Borh are in the family of reeroviruses mat also include HIV. The abiliry of rhis family of viruses to infect ceJls and rhen cause discase years later is of particular concern. Consequenr1y, rhe propensiry for human risk seems to be presem a.1rhough I am currenrly unaware of any definite human rhreat. In shon, BLV may ar may not be causing human healrh problems. However, rhe BSE story provides an eloquenr example of how an infecrious disease may appear ar firsr eo presen{ no human risk only to turn out later ro be a serious rhreat. The face rhat BSE and BLV can both infect a wide variery of species is wonhy of a final note. It seems prudent [O avoid any germ mat can cross species barriers and cause life-threatening illnesses in unre1ated creatures.

Cow AIDS (BIV) Jn 1991 the Wall Srreer Journal captllred rhe aerention ofits readership with a healrh segmene enrirled "AIDS Cousin Infecrs Canle." 128 The Journa.l went on to depreciate any pocemial risk from "Cow Al OS." Their reporring was accuratc; so far, medical research has noe raised aoy grave COI1cerns about this disease. 129 However, chere are worrisome fearutes abol)[ che virus. Some evidence of immune alrerarion has been observed in infeceed cows. I3O Crossspecies cransmission of the virus ro sheep, rabbies, and goars has also been demonstrated. 13 \ Th is combinarion offacrors raises similar conctellS tO rhose I havc cxprcssed wirh regard ro rhe bovine leukemia virus. [n view of rhis, combined wich rhe realiry of rhe long incubation period of HIV, [ raise

concern abouc rJle long-term he<\lrh eftecrs of chis agent, panieularly if ir ultimardy proves ro be transmissible ro humans. Since BIV c..ln affecr the immune function of cattle and can cross specics boundaries, it scems prudent ro take measlIfes ro avoid rhis virus umil we are cerrain there is no human risk. [n f.1Ct some, such as Jeremy Rifkind from the FOllndation for EconomicTrends, have advocaeed rhat BIV-infeceed cows should not be milked or eaken [O slaughter umil che long-cerm human healrh implicarions of this virus are clarified. 1 am sure {har many in {he livestock industry feeI this is lInnecessary. But in other cOllnuies such as Swirzerlalld, chis is exacdy what is being dane, as described in Figure 22.

• Bovine Leukemia Virus (BLV) inftcts up to 70% of ddiry cows in some regions and can Ctluse Iymphosarcoma

us.

SWITZERLAND'S PROTECTION AGAlNSTBIV • Switzerland eliminates their cattle that have the BIV virus. • They allow RO imported caUle 0r beel infected by BIV. · The U.S. caD no longer export beef to Switzerland because we have DO eradication program set up for BIV. Figure 22 Swirzerland has also been concerned abouc r!le similarities between BIV and HIV Until long-rerm studies darify {he issues, they do nor want [O expose their cirizens ro chese infectioLls agents found in cattle ar rheir milk.

Most Food Poisoning Involves Animal Products Animal products are not the ooiy prodUCtS Ihat can be contaminared wirh bacteria. However, che vast majority of infected

229

PROOF POSITIVE foods are red mear, dairy prodUCIS, fowl, eggs, and seafood, according ro che Cemer for Disease Control's reporrs on infectious illncsses from foods. A significam decrease in these serious diseases would occur if a vegerarian cliel were more widely adopted. A summary lisr of the aforememioned diseases of aniOla1s rhar are a dueat ro rhe healrh ofhumans is shown in Figure 23.

The Risk ofHuman Association with Animals Other (han risks from eating animal prodare there hazards merely from UJorking with animals? The allswer is yes. Dai ry farmUCIS,

LIST OF AFOREMENTIONED ANIMAL DISEASES THAT THREATEN HUMAN DEALTU • BSE and other prion diseases

• Cow AlDS (BIV) • Crohn's disease

• E. Coli bacteria disease • Listeria • Salmonelia disease • Bovine leukemia virus (BLV) disease

• Cancer • Clostridium perfringens • Campylobacter • Yersinia

Figure 23

DISEASES ASSOCIATED WITH TDE BANDLING OF ANIMALS • Hodgkin's disease • Multiple myeloma • Leukemia • Cancers: melanoma Iym~phoma

ers, vererinarians, and mear handJers have signil1candy increase
stomach cancer

prostate cancer • Paget's disease Figure 24

230

A More Complete List ofHuman Diseases Contractedfrom AnimaLs The information in (his chapter has provided appreeiable evidenee regarding rhe

ANfMAL DISEASES ANO HUMAN HEALTH RlSK serious nature of disease in animals :wd rhe risk ro humans. However, 1 have only rouched rhe surface of an exrrcmely broad subjecr. Dozens more pages couJd have been included thar deal wirh rhe roxicologic and infecrious diseases that are increased byeating animal produc[s Of having wirh animals. IfI were making a more complete lisr of animal-relared condirions rhar affect humans, it would include aii of those listed in Figure 25. 138

Futuristic Animal Jnsights About one hundred years ago a.n amazing warning was wrirrcn concerning rhe dangers of eating dairy products. Ellen Whire went on record wirh this onitjon: "Jfmii k is used, ir should be thorough~y sterilized. With dus precaution, rhere is less danger of conrracring disease from its use."139 How do you thoroughly srcrilizc milk? Ir is simply old-fashioned boiting. She funher explains: "Let ... diet reform be progressive. Ler rhe people be raughr how ro prepare food withour [he use of milk or buner. Tel! them rhar rhe rime will soon come when there will be no safery in using eggs, milk, cream, ar blltrer, because discase in animal.s is increasing in proportion ro (he increase ofwickedness among men."140 The scientific dara prescmed in this chaprer has proven thar rhis prediction was correct. A sraremenr by rhe same author in 1898 provides insighr into why rhis ropic is 50 imporram. "The lighr rh:u Gad has given me is rhat rhe curse of Gad is an rhe earrh, rhe sea, rhe carde, on rhe animals. There wiU soon be no safery in rhe possession of Aocks ar herm. The eanh is decaying under rhe curse of God."'41 The Scriprures presem a similar picrure for r!le lasr days. Thjngs are nor going ro get berrer; ehey are desrined (O ger worse. Sbe conrinued. "By precepr and example. make it plain chac rhe food which God gave Adam in his sinless stare is rhe besc for man's use as he seeks ro regain rhar sinless srarc."142 She is referring ro rhe Bible book ofGenesis dut lisrsAdam's original diet, which was eorally vcgerarian., devoid of ali animal producrs. 143 TIle evi-

OTHER DISEASES ANO CONDITIONS

ASSOCIATED WIm EATING ANIMAL PRODUCTS OR EXPOSURE TO ANIMALS · trichioosis (also called triebincllosis) · gjardia lamblia · vibrio vulnificus · psittaeosis · hookworm · rabies · leptospirosis · vibrio eholera (the agent causing cholera · fish l.apcworm (dipbyllobotbriumlalum) · isospora belli

· · · · · · · · · · · · ·

scombroid bantavirus roundworm bruceUosis plague (thc agent causing bubooic plague) pork tapeworm (tacnia solium) bec! tapeworm (taenla saginata) antbrax dguatera poisooing ring worm giardia Jamblia tularemia eryptosporidiosis

Figure 25

clence sllggeStS rbar much of rhe gloorny dat.a presenred in chis chapter is just a small glimpse of what fhe furure has in storc. I do nor presem rhis facrual data ro terrify anyone, bur insread ro warn you of rhe possibilities sa rhat you can begin now ca learn. a new way of earing [har escapes rhese porcnrially dismal diseases.

Now ls Decision Time Mosr of liS pur off ;lny decision abollC changing our lifesryle umil we tire fiJrced to. However, when ir comes ro dielary changes, often rhose "musr change' siruarions come roo Iare. Changes in dier will nor help mllch ifyou are diagnosed wirh Crelltzfeldt Jakob disease. When Salmonella, Lisreria, Cam pylobacrer, ar anorher food-boroe acute infectÎon srrikes, you could be one of rhe "unlucky ones" and nor live ro choose a berter dier. Even survivors can develop irreversible physical problems rhar no nueritional program can ..esolve. The documenred informarion in this chaprer calls for a decÎsion. The decision rime is now. In lighr of rhe evidence of rhe numerous and serÎous dise
231

PROOF POSITIVE Gibbs CJ Jr. Ashc.r DM. er al. TransrnissiOIl ofCrcun:fcldt-Jakob disl':lSC by e1eclroelcs conl3minated during ncurosurgery.} Nrurol Nml'OJllrg Ps)'cbil/lry 1994 Jun;57(6):757-7511.

Reftrences -

li

, Thc Briti.h The Spongiform EncephaJoparhy Advisory eAl1lmince. Reporr ro ParliatllCIH on March 22, 1996 (prinred reporl downJoaded from Microsoft Network's BSE forum).

10 a chimpanu,e

rrm K. Bwi", Spongiftrm Enap/liI/opmby. Vpdnte. Animal and Pbm Heal.!> Inspc:ction Serviccs (API-US). U.S. Deparrmt'nr of Agricuhure. 19%1'. J.

2

Minislr)' of Agriculrurc. Fisherics. and Food (MAFF). United Kingdom (UK): BSE: 12'monlh summary of devdopmenls. Http:// ww....·.maff.gov.uk.3nimalhfbsclbscanni.hml. Updalcd ro Fcb. 28, 1997. !

l'alter901l W). De:tllcr S. Bovine spongiform t'ncephalopathy and the public h<:ahh. } f'lIb/h- Hro/r/JMrd 1995 Sep;17(3):261-268.

4

} World Hcahh Org31liz:uion Press Release (WHO/28). Inrernational Experrs Proposc ]Vle-asures To limit Sprc"d Of BSE And Reduce Possible Human Risks From Disease; 3 Apri! 1996. (prilllcd reporl downJoaded (TOm Microsoft Nerwork's BSE forum). !'rall K. Bo~inr Spongiftnll En<'lfp1J%plllb), Updlltr. AnimaJ and Pbnr He:tlth Inspeclion Scrvio:-s (APHIS). U.S. Dep.mlllc"lr of Agriculrme. 1996 p. 1.

G

7 Wilesmilh JW. An idemiologist's vie\\' ofbovine spongiform ellchaloparhy. PIJilo.< Tmlli R Soc u)1/[I13 Biol Sci 1994 Mar 29343(1306):357· 361.

World Heahh Organiz,uion rress Rcle.1sc (WHO/28). Imcrnarional Expens Propose Measurcs To Limit Spre:>d Of BSf. And Reduce PossibJc Humall Risks From Dist"'se; 3 April 1996. (prinrcd report downlo. ded (rom Microsof. Nt'lwork's BSE forum).

8

" Brown

P. liberski PP, el al. Rcsisrancc of scrapie infectiviry

10

sre:lI11

~uloclaving after form:>ldchyde /Ix,uion and limited sUI'\,iva! aher ashing at

360 dcgrccs C: praeticaJ and Iheorelical irnplicarions. } InftcI DI:' 1990 Mar; 161 (3):467-472.

21 Will RG. (Nalional CreutZfcldl-Jakob DisC'J5e Survc:-illa.nee Unit. Wcsrern Genera.! Hospital). Lener 10 Brili. h neurologim on I\""rch 2 1. 1996:

(prinud rrport dOILmlolldcdftom Microsoft Nrr;<Jorks B Efort/III). Sir KennClh 'liman. Chief Medical Oflicer of Brilain, "A new variant of CJD" (a mcssagc 10 British physicians); 3-22-96 (primcr/ rort dOllm·

lom/rd jrom Micl'osoft Nrtwork's 13SE::,/omJl1). 24 Thc Brirish The Spongiforlll EnchaJoparhy Advisory Cornminec.

Reporr

10

Parli.unent On Mareh 22, 1996 (prilltl'd rrport dOWlllolU/cdfrolll

Microsoft NellJlorks BSEfoJ'/lIll). ~~ USDA: AJ'HlS (Anima! and Plalll Heallh Inspt'Clion Sel'\'ice). Bovi"r Spollgiftrm EIll"C/,/1lJlopalby flllplicotio/lS for JIu VlliUtISIO/I'.. A Fol/ol/} Vp. Frbmmy 1996. CClllcrs for Epidcmiology and Animal He."lllh. Fon

ColJins, Colorado. p. 4. World Hca.lth OrganizatioJ) consulmion on public heallb issues reblCtI to bovine spongiform encephaloparhy and the ..mergence of a varianr of Crt·U1"l.feldl-Jakob discase. MM\'(fR MOl'b Momll \'(fk(y Rep 1996 Apr I 2A 5(14):295-6. 303. 26

""W

27

Transmissiblc pongiform Encephalopathics. [n: Lcderberg J, cdilor.

Encylcopafllirl oIMierobi%g)' Volllme 4. RockefeUer Universil)'; New York. NY:Academic Pre!iS 1992 p. 299-309. Isselbachc.r KJ, Braunwald E. el al, edirol'S. Ha/TÎso/l' Princip/r's 0lfmatia/ Mcrlicillr-f3flJ rdilioll (CD-ROM version). New York. NY: McGr:>w-

28

Hill. Ine. Health Proles ions Division. 1994. !') Deallcr SE l<enr JT. BSE: an updale 01\ rhe slatislicaJ cvidenee. BritiJlt FoodJoll77i1l11995;97(8):3-18.

30 Pran

K. BO/lim: Spollgijorm Ellcepb%plah). Upr/alr. Animal and Plam

Health Inspe<:lion Services (APHIS). 11)')6 p. 1.

U.S. Danmellt of Agricullure,

World He:thh rgani'l.alion Faa sheet: Bovine Spongiform Encephalop:uhy (BSE); FaCI shect N 1 J 3; Mareh 1996 (a\';libble via Internet al hnp:/ Iwww.who.ch)

-'1

COlllamer 0'1 Emergillg lllfirl-iom f1I HOrtlard VlliIJt·rriry. JUI1C, 1997.

Il

USDA: A!)HIS (Animaland Plalll He.1lrh Inspeclion Service). Bo~i'l'

I'rusiner SB. The prion diseases. Sci Am 1995 Jan;272(1 ):48-51. 5457.

SpolIgiftrm ElluplllJlopl1tby; IlIIplimliolls for tIJc Vlliud SlllleS. A Fo//ol/} Vp. Fe/mll1ry 1996. Ce/lters for Epidemiology and Animal Hca!th. Fort

10

1\

Plllsiner SB. The prion diseascs. Sci Am 1995 Jan;272( I ):48-5 1. 54-

12

57. Prusiner SB. The prion disC3ses. Sri Am 1995 Jan;272():48·51, 54-

Ij

57.

.\. Dealler SE Kelll JT. B E: an updare on rhe . lalislical evidcllce. BririslJ

PI':lI{ K. BOlJil/( Spongiftnn r::napiJl1/opllt!Jy. Vptl'll/·. Anim:» 'Ind I'bm

-" Hsich G. Kcnney K, el al. The 14-3-3 brain protein in ccrcbrospillal fluid as a Il'larker for lr~Ulsmissiblc spongiform encephalopathies. N ElIgI} Med 1996 Sep 26;335(13):924-930.

Misfolding lile W"Y 15;271 (5255): 1493-1495.

He:tlrh Inspec.lion SCI'\'ices (API-IIS). 1996 p. 1. IG

!()

dise"sc.

U.S. Deparrmelll of Agricuhure.

FoodJOllmrrlI995;97(8):3-18.

In: ScitTJlifir

36 Cutlip RC, Mille( JM. CI al. JlllracerebraJ lransl1lission of scrapic ro e:mlc.} !lIlm Dis 1994 Apr;169(4):814-820.

Fcinbcrg. M.B. Slow Virus And Rcrrovirus lnfeclions. In: Scimtijlt·

'7 Hsich G, Kenney K. er ,,1. The 14-3-3 brain plOteill in cerebro. pina] fluid as a marker for lr:lllsrnissible spongifonn encephaloparhics. N ElIgl} Merl 1996 el' 26:335(13):924-930.

Feinberg MB. Slow Virus And Relrovirus Jnfeetiolls.

Ameriml1 Mrdicinc (CD·ROM). 1995. 17

I'ran K. BOllillr' SpongifoJ"1JI Ellcepbltl{}pl1t/~;t Vpdll/l'. Animal atK! Planr HeaJth Inspeclion ervices (APHJS). U.S. Dep,mmenr of Agriculrun:. 1996 p. 1.

Scimce 1996 Mar

14 Tallbes G. 1j

Collins. Colorado. p. 4-5. j!

Americl1Il Mn/icillr (CD·ROM), 1995. 18 DilLler L. BSE linkcd Mar 30;3 I2(7034): 795.

10

ne\V variant of CJD in hUlIlans. BM} 1996

" Creun:fcld 1-Jakob disease in pacients who re eived a cad."cric dura maler grafl-Spain. 1985-1992. MMWR Morb Morlol Wkly Rep 1993 Jul 23;42(28):560-563. . UJ Crcul'l.feldl-Jakob ,lisea"" in paliclllS who rcceivcd a cadavericdura Inarer graft-Spaill. 1985-1992. MMWR Morb Morto/ Wkly Rrp 1993 Jul 23;42(28):560-.563.

232

38 Cutlip RC, Miller JM. el al. Irmac"rebral lr:lllSl1lission of scrapie cartle. } llfficr Dis 1994 Apr;169(4):8 I4-1120.

10

Lopn Ol, L1rumbe MR, e. al. Difficulrics in differential diagnosi of long-tcrm Crelm.l'ddl- Jakob disease. Nrurologio 1995 J:l/l; 10(1 ):37-40.

39

~o

D}D pmonol"ollllll/miclltioll wiriJ Dr. Ron Howil/oll (412-647·661 5) al Ihe Universily of Piltsbur..h (had I case in 60 \Vho had q D and had no suggcslion Oll very skeldlY clinical dala of a prioll discasc bcing suspecled) and Dr. Ltrry Hansen (619-534-6212) al UC S..n Dicgo who recalJed 3

ANIMAL DISEASES AND HUMAN HEALTH RISK qDs In som.' 500 AJzheimcrs alJlOpsies, From Hamilron. if;1 parient i SUSpeelCJ of CJ D Ihe)' arc 1101 supposed 10 go rhrough Ilie palh eval rhat rhe)' are doing for Ahhcimer's in rhe-ir regi.rr)', Taubcs G, Misfolding Ibe way 15;271 (5255): 1493-1495.

11

10

disease,

'rimre 1996 Mar

Enns DA. Eslimaled prevalence of Ab.hcimds disease in Ihe Unired St
11

Barcikowsb M. Kwiecinski H. el:t1. Crcutzfddl-Jakob disi::lse wirh Alzheimer'lype A bera-reactivc amyloid plaqlles. Hiuopalhology 1995 May;26(5}:445-50, 4}

Liberski Pp, Papien: W. Alwasiak J. Creul.7.fddr-J'lkob dis=e witb plaqlles and paired hclicallliamems. ACIIl NmrolSrolld 1987 Dec:76(6),428-432.

44

\ Collinge J. Qwen F. er al. Prion demenria wirhom characlerisric parhology. [.I1/1a1 1990 JuI7;336(8706):7-9. Smilh T\Xt, Anwer U. er :tI. Vaclloku change in Alzheimer's disease./1>'Cb Nmrol 1987 Dcc:44( 12): 1225-1228.

46

(21 CFR Pan 589) Subsrallccs prohibited from use in animal food or Iccd; Anim:tl proreins prohibi led in ruminatlt fccd,. Food and Drug islrJlion. Depanmenr ofHealth :lnd HUlllan Services. Federal RegiSll:r 1997 Jun 5,61(108):30936-30978.

61

(,3 Lopcl.-Abenre G. Mor:tles-Piga A, CI al. emle. pers, and Paget's disease of bone. Epifkmiology J 997 May;8(3):247-251.

Laccy RW. "It's a Mad, Mad, Mad. MArF World." T!Je Vrgllflriflll (publishoo by The Vcgelarian Socier)' UK) Aulumll 1993.

64

Minimy ofAgriculrure, Fi heries, and Food 0\V\FF). Unilcd Kingdom (UK): I3SE: 12-month summary of developmenrs. hrtp:/l www.maf[gov.uk.anim:tlh/bse1bsttnni.hlm. Updared 10 Feb. 28, 1997.

6

Couscns SN. Vynnycky E, CI al. PrediCting lhe CJD epidemjc in humans. Nfll1i1'r 1997 Jan 16:385(6613):197-J98.

66

Lacey RW. Crcurzfeldt-Jakob di5C'\.~e and bovine spongiform encephalopalhy. Bovine spongiform encephalopathy is being mailllaioed b)' veni· cal and hori2onral traJlSmissioll. BM) 1996 Jan:312(7024):180-18l. 67

D<:aJler SF. Lacey RW. Transmi,sible spongiform cncephaloparhics: d,e tluear of BSE 10 111:111. Food Mierobiology 1990;7: 253-279.

7 Dealler S. Laccy R. Beef and bovine pongifonn ence-ph:tloparhy: Ihe risk persists. Nlllr H''IIlth 1991 ;7(3): 117-133.

(,g

Groschup MH. \'i7eihnd F. I'f;lff E "De.lccrion of scrapic 'Igcnt in the pcriphcra\ nervous s)'srem of djsca."ed shc." Goeuingen prion mcclillg Novembcr 1995 hnp:/lwww.airrime.co.llx/bse/inlln.hrm

69

1.

Jdlill'e DR. Jdliflc EE HIVand breaStlllilk: non-provcn alarmism. ) Tr()p !'rditltr 1988 Aug;34( 4): 142.

49

'0 US Depr, Of Heahh and Hum:tn Service,. MlI1l11gillg Enr~l' HIV [lIftCli()n Quick Refl7l'lIu Cuid, ftr C!inicii1lls: Nllmbt'r 7. AHR f'ublic4tion No. 94-0573. Janllary 1994 p. 14. Tam:!i Y, Kojima H. er al. Dl'mooslrarion of .Ile transmissibk agenr in liSSlle (rom a pregnalll \Voman \Vilh Crculz(ddl-Jakob discase. N EngJ) M,d 1992 AlIg 27;327(9):649. 51

Plan K. BOl/illeSpongifoml Ellupho"'pl1/hy. FoCI ,",rl. Animal and Plam Healrh Inspccrion SClviccs (APHIS). U.S. Darrmelll of Agricuhurc. 1991JuI p. l.

\1

Robinson MM. Hadlow W), er al. Experimenral infeclion of mink ",ilh bovine spongiform encephalop;uh)'. ) Cm Virol1994 S;75 0:2151-2155.

1)

,4

Marsh RE B en RA, cr:tl. Epidcmiological and e.xpcrimemal srudics OII a new incidenr of rransmissible mink cllcephalopa.Il}'. ) Cm Virbl I99 I Mar;72 ( P. 3):589-594. " Robinson MM. Hadlo\V WJ, CI al. Expt:rimelllai infectioLl of mink wirh bovine spongiform encephalop;}rhy. ) GtIl Vit'Ol 1994 S:75 (Pr 9)():21 5 12155. '6 USDA: APHIS (Anim:tl and Plant Heahh Inspeclion Service). BOI/ilie SpolIg!(orm EIICtpIJlllopfU"y: Implicaliom jul' Ibe Uniut/ SIII/I'S. A FollmlJ Up. Feb1'1lflry /996. Celllcrs for Epidcmiology and Animal Heald,. Forr ollins. Colorado. p. 1.:3.

CUllip RC, Miller JM. er al. Inrract"rebral rransmission of scrapit" ro canle.) Inftcl Dis 1994 Apr;169(4):814-820. 7

70

71 laig WJ. Arc You Safe al r.lle Plale. In: NUlrilion jur tlJi~ Nille/ilS. Eau Clairc. MI: Golden Ha[\'cst 800ks. 1992 p. 267-279.

Updarc: Jlllliristale ombreak of E cherichia Coli 01 57:H7 infccrions from hamburgers--wesrern Unired States. MMWR Morb Morli11 \\Yktj R,p 1993 Apr 16:42(14):258-263.

7-' l3adr, KF, Brenner BM. Vasclliar lnjury tO the Kidney: Hemolyric Uremic S)'ndrome (HUS) And Thrombolic -1 hromboc)'topcnic Purpura rITP). IIl: Isselbacher KJ. Braunwald E. edirors. et al. Hflrrison's Prillriples bflllw'nal Ml"dirill~/3';' edilioll (CD.ROM). New York. NY: McGRAW-HILL. Ine. Heald, f'rofessions Oivision, 1994. MacDonald KL. Osrerholm MT. The cmcrgcnce of Eschcrichia Coli 0157:H7 i,,(eClion in the Unired Sralcs, The changing idc.mjology of foodoorne djsease. )AMA 1993 May 5;269(17):2264-2266.

7

USDA:APHIS:V. Esrlmil:hin Coli 0157:H7: Issues and Ramincariom. March 1994. Ccnrers for Epide01jology ,u,d Animal Health. Fort Collins, Colorado. P. S-1.

Notire 10 RMders-: Fin:tl repons of notjllahle disea5e. MM\VR Morb Monnl Wk6' Rep 1996 Aug 30:45(34):724-7 4.

76

n Olllbreak of aCUle gasUDemcritis altributable ro Escherichi;, Coli serolypc OI04:H21-l-Iekna. Monrana. 1994. MM1\YR Morb Mori/zi \l1k~y R,p 1995 JIII 14;44(27):501-503. COllltlluniry olllbreak of hemolytic uremie syndrome atlriburable ta M-So\lth Australia 1995. NJMWR Morb Mo..IltI Wkţ)' Rrp 1995 Jui 28;44(29):550-1. 557-558.

7R

E.~chcrichia Coli 0111:

QUlbre.aks of Eschcrid,ia Coli Q 157: H 7 înfecrion and Cf'yprosporidiosis a ociated wid\ drinking unpasreurized apple cider-Connecticur :tnd New York, Ocrober 1996. MA1U7R Morb MOrll11Wktj Rtp 1997 Jan 10;46( 1):4-

79

Minisrry ofAgriculrurc, Fislleries, and Food (MAFF). United Kingdom

8.

57. (UK): BSE Enjurumelll Bullelin [SSIl' 8: BSEJlf1lllS rl'f'0rt 10 Mfll'cb /7. 1997-

From Inrerner ar hllp:1 Iwww.mafT.gov.uklanimalhlbsc:/cnforce81 sr2lrep8.hl m 60 Rodncy Scalt' personaJ collllllllnication wirh Kcndr. Prall ar Animal and Planl Healtll Inspecrion Serviccs (APHIS). U.S. Dep:utJUcOl of Agricuhurc. 1996.

~I

Bovine A1lial)ce on Managt"mC'!lt & NurrilioJl (13AM 1). Undl1ufi A Gllid.. IQ Modern Coif Milk Replnan. USDA. Animal and Plalll I-Icallh

Ten Icading nationally llorifiablc infi:cuolls dise,a.,es-Uniloo StaICS, 1995.

MM\'fIR lllJorb Morlnl Wkly R,p 1996 OCI J 8;45(41):883-884,

Prusiner SB. The prion dise:lSes. Sci Am 1995 Jan;271(l):48-S 1, 54-

'8

59

Rlascr MJ. Haw safc is our food? Lcssoos from an Olllbre'lk ofsalmonellosi, N El/gl) Med 1996 Ma)' 16;334(20):1324-1325.

Kecne \XIE. Sazie E. Cl:tl. An ourbrcak of E.s heriehia Coli OI 57:H7 infeclions rraced 10 jerky nude from dt"cr mea.. )AM/1 1997 Apr 16;277( 15): 1229-1231.

80

OUlbrc.1k of Escherid,ia Coli 0157:H7 infc tion-Gcorgia and 1.'11nessec. Jlll)t" 1995. MMWR Morb MorlnL Wkly R,p 1996 Mar 29;45(12):249-251.

81

In pecrion Agenc)' (APHIS). 1996 p. 3.

233

PROOF POSITIVE 81

OUlbrcak o( Eschcrichi~ Coli O 157:H7 in(eetion-Georgia and Tennessee, June 1995. MM'fX/R Morb Morflll Wkly Rep 1996 Mar 29:45(12):249-251.

10J Salmollella el1lerilidis illfection. (pamphlee) Celllers for Disease Control/NaliOllal Cenlcr for 111(" tiOlIS Diseases; US Dept oEHHS; Novembce 1992-

bJ Nori« to Rmtkrr: firul rom of nOlifiable discases. MMWN Morb MortJlI Wkry Rrp 1996 Aug 30;45(34):724-754.

104 SaimolleUa emeritidis infeclion. (pamphlet) CelHers for DiSC
Oucbreotk of E.schericllia Coli 01 57:H7 in(cclion-Georgia and Tennessee, June 1995. Jv/MWR Morb Mortlll Wkly Rrp 1996 Mar 29;45(12):249-251.

fl.I

8~ Ouebrcak of Eschccichia Coli OI 57:H7 infcaion-G<.'Orgia and lcn-

nessec, Junc 1995. 29;45(12):249-251.

MMWR Morb Mortlll Wkly Rtf 1996 Mar

Tappero JW, Schuchal A, CI al. Reduclion in lhe incidcncc of hUl1lan liseeriosis in thc Unieed Sr:ues. Effecuvellcss of prevemion dlorcs?Thc Lisleriosis Sludy Group. JAMA 1995 Apr 12:273(14): 1118-1122.

li6

lJ7

Updale: foodborne lisleriosi. -Unieed Slalcs, 1988-1990. MJvJ.WR Morb

MortlIl Wkry Re; 1992 Apr 17:41 (l 5):25 1 257-258. 8S

Updatc: Eoodborne listerio"is-Unircd Stal('.s, 1988-1990. M/vfWR Morb

MorllJl Wkry Rep 1992 Apr 17:41 (15):151,257-258.

10~ OUlbr"'lk of Salmonellosis a socialed Wilh beef jerkr-New Mexico,

1995. MMWR Morb Morur! Wkry Rep 1995 OCI 27;44(42):785-788. Craig \\:1). Ne VOU Saf" al Ihe Plale. In: Nrtlrition for the Nin~tits.

106

EauCbire. M1: Goldell Harvesl Book.s, 1992 p. 267-279. 107 Cobb. LL. Filldings prt'5cmed al 97'1. General MeetJlIg o( Ihe AmeriCUI Sociely for Microbiology. Miami. 1997. 108

SurveiUallcc for Ibodbome-dist'ase outbreak.s-Uniled Sratcs, 1988OCI 25:45 No.SS-5: 18·19.

1992. MlvfWR Morlu\.1or/I/1 Wk~), Re; 1996

In? ClosrridiuJll perfringcns gaslroemerilis :lSsociaeed \Vith corned bccfserved al SL Palrick's Day meals-Ohio and Virginia, 1993. MMWR Morb Mor. ttll Wkry Rep 1994 Mar 4;43(8): 137. 143-144.

Schwarn 13, Ciesiclski CA. CI al. Associaeion of spocadic tisleriosis with consumplion of uncooke
110 Cho SN. Brcnn;lI1 PJ, el al. Mycob:lc[Crial aeliology ofCrohn's disease: serologic study using commOl! mycobaclerial anligcllS :Ind :1 specics-specific glyColipid allligen from MycobaCleriuDl paraluberculosis. Gllt 1986 Nov;27(11):1353-1356.

?O Cra.ig WJ. Ne You Safe al lhe PhHe. In: NlItritioll for tlle Ni!'letics. Eau CI.airc, MI: Goldcn Han'est 13ooks, 1992 p. 267-279.

trrJn/lemlogy Ob,rmer 1995 Nov/Dec; 14(6):4-5.

Rccs JH, Soudain SE. ce aL Campylobacler jejuni infection and GuillainBarrc syndrome. N EnglJ Med 1995 Nov 23:3.'3(21):1374-1379.

"ofllurology Oburver 1995 Nov/Dec: 14(6):4-5.

Sq

?'

Haas LE Sumner AJ. Acule Inlhmmatory Demyelinaling PolyradicuJoneuropalhies (L1ndry's or GlIillain-Barre syndrome). 10: Kelley WN, DcVilaVI' JR. ce al. edicors. lrxtbook ofll/unull Mrdici1Jl'-? rdition. Philadclphia, PA: JP. Lippineoll Company. 1992 p. 2235-2236.

n

,J Rees JH. Soud.un SE. ce al. Gmpylobaclcr jejuoj infcaion and GuillainBarre syndromc. N ElIgiJ Med 1995 Nov 23;333(21):1374-1379.

111

II

Mycobant'rium p,ll
113 Streelcr RN, Hollsis GE CI al. Isolation ofMycobaClerilllll paralubclclliosis from coJoserum and milk of subclinically infected cows. Am J ~t Rn 1995 Oel;56(1 O): 1322-1324. 114 Granl IR, BaII HJ, CI al .. Ina rivation of Mycobaelerium paralllbercu. losis in cowi milk ac pasecuIizauoll lempcr.uurcs. Appi Erwiron Mi(l"()biol 1996 Feb;62(2):63 1-636.

1991 p.91-92.

II~ Kochanek KD. Hud'on BL . Advance Repan of Final Moltality SIa· ristics, 1992. Momll/y IIi/al StJltulic, Rrporl. Ceruers for Disease Control and Pre\'C'mion. 1995;43(6) supplcmelll: page 23.

Craig WJ. Arc YOtl Safe ac Ihe Plale. In: NU/ritioll for tiu Nillrti/!.J. EallClaire, MI: Goltlcn Harvesl Books. 1992 p. 267-279.

11(, Leukcmia Socicey ofAmeriC:l. j'(JCfJ Abolit Lfllkmli'l, Lym;hollllL, Multiple Myelomll. lllUl Hodgkin's Dimur. New York, NY; 1995 p. 4.

OUlhreak of SalmoneUa emerilidi associared \Virh nationali" diStribuced ict cream products-Minnesoea, SOUdl Dakola, and Wiscon~in, 1994. MMWR Morb Mortltl \YIkry Rep 1994 OCI 14:43(40):740-741.

DxMollitor: Alli""tI Hralrh Rl'port. Winet" 1995. Fort Collins, Colorado.

?oi

Jacobson MF, LefTerts LY, Garland AW Mear, I)ouhry. :Ind Egg. In:

Soft Food: Eating Wiul)' i"" Risky World. Venice. CA: LiviJlg PlancI Press, '5

96

Henncssy T\)7, Hcdberg CW, CI al. A nalion:l! oUlbrcak ofSalmoncila elllcrilitlis infi:cliol1S rrom iec cream. The lnvc-sligation Te,u1\. N Engl J M/!d 1996 May 16;334(20): 1281-1286.

'7

Outbrcak of Salmonclla enlcrilidis ;Issocialed wilh n:uionally diStribute
?!

');) OUlbre:tk o( Salmonella cl1Icrilidis :Issoeiaeed wid, Il:lliollaliy di tribured ;cc cream producIS-MinJleSOl:l, Soulh Dakora. and Wisconsin, 1994. MMWR MorbMortAl Wk/y Rep 1994 OCI 14;43(40):740-741. OUlbrcak of SaJmoneUa elllcrilidis associaecd \Vilh n:leionally dislribulc:d ice cream producls--Minncsora, Sourh Dakola, and Wisconsin, 1994. MMWR Morb Mor/IIi Wkry &p 1994 OCt 14;43(40):740-741. 100

Hellnessy TW, Hedberg CW, CI al. A narional outbreak of Satmonella enlerilidis infeclioos from ice cream. The Invesug'lIion Tearo. N ElIgl J M/!d 1996 May 16;334(20): 1281-1286. 101

,nI HennessyT\V, I-iedbcrg Cw, CI al. A nalional olllbr....Jk ofSalmonclla

elllcrilidis ;nEecrions hom ice cceam. Thc !nvcslig:llion Team. N Engl J Med 1996 May 16;334(20):1281-1286.

234

Il,

USDA:APHIS (AJlimal and Planl Healeh Inspection Service).

P. 6-7. {Nole: Florida in rhe 3«1 quarlcr of 1995 had 31 o( 42 canle leStc:d pOSilivc (or a rale of approx. 74%). '" USDA:APHIS (Animal and l'bnr Heahh Insp('clion Service). DxMOl/itor: AlIimlll J-Ie,dtb R,'Port. Winler 1995. Fon ColJins, Colorado. p. 6-7. 119 )ohllsoll R. K:lncclle JB. Bovine Lcukemi'l Virus. Pan III. Zoonol;c POlcllrial, Molecular Epidemiology. :Ind an Animal Model. Compendium on Concinlling EducmÎon (or rhc I)ra licing Veterinarian 1991; 1.3{1 O): 1631· 1637.

IlO Baumganenc.e L, Olson C, Onuma M. ElTece o( paslcuriz.1tion and heal rreallllelll on bovinc lcukemia virus. J Am Vt-t Md /ts,OC 1976 Dec 1; 169(11): 1189-1191. I I McClure HM, Keding ME, CI al. Eryehrolcukemia in rwo infam chimpall7.Ce5 fed miJk from cows nalurall)' infcClcd wieh Ihe bO"ine C-eype "irus. Cllnar Re, 1974 Oct;34{1 0):2745-2757.

Il.!

Baumgancllee LE. Bovine Lcuktmia Virus 'Transmissioo Sludics. Diss

I1b,tr JIU ( ci) 1982;42(11):43J9-B. Il,} Ferrer JF. Ken)'on SJ. GUpl:' P. Milk of dairy cows fre(lucml)' concaillS a lcukemogcnic virus. Scimce 1981 Aug 28;213{451 1): 1O14-1 O16.

ANIMAL OISEASES ANO HUMAN HEALTH RISK Il'; Rui>ino M), Oonham K). InaClivalion of bovine lcukcmia virus-i.nfCCtcd lymphoCYlcs in rniLk. Am] Vrt &5 1984 Aug:45(8):1553-1556. IlS Baumganener LE. Bovine leukemia Virus Transmission Studics. Diss Absrr ITII ($ci) J982;42(11 ):4319-B.

Donham KJ. Berg )W, Sawin RS. Epidemiologic relalionships of lhe bovine populatioll and human leukcmia. in 10w:L Am] Epidnlli{l/ 1980 )ul; 112(1 ):80-92. 116

)oh/lson R. !<m<xoc JB. 199). Bovi.n~ Leukemi. Virus. Pan III. Ioonolic POlemial. Mole ular Epidemiology, and an Animal Modd. Compendiulll on Cominuing Educalion for lhe Practicing Velerinarian 13(10): 1631-1637. Il

118

Ingersoll B. AJDS Cous;n Infeecs Canle; No Oanger SeCll. Th,' W'ilU

Slrm JOl/mtd. 1991. Friday, May 31.

Donham K}, MerchaOl )A, el al. Prevcnling respiralory disea.e in wine conhnell1CI1t workers: ilHervelllion through applied epidemioJogy, ooucalion. and collsuJI:lrion. Am J hul Mrtl1990; 18(3):241-261. 134

13' Zuskin E, MUS'lajbegovic), CI. al. Rcspiralory IUncoon in poulrry workcrs and pharmacoJogic dlaracleriz:llion of poulrry dUSI e.xlraCI. I:.1/IJÎron 1W 1995 )uJ; 70(1): lJ-19.

136 Pederscn B, (versen M, CI al. PiS farmers havc signs of bronchia! inOammarion and ;ncreased numbers oflymphocYlcs and nClIlrophiJs in BAL Ouid. E'II' R'·'pir J 1996 Mar;9(3):524-530. 137 ]ohJ\son ES, DaLmas O. el:U. Cancer mOflalily among workers in aballoirs and meal packing plaols: an updalc. Am JInd l\1ed 1995 Mar:27(3):389-403. I 8

OUlbreak of lrichinellosis asso ialed wilh ealing c.ougar jcrky-ldallo.

1995. MM\'(/R Morb Mortlll Wk& Rep 1996 Mar 15;45(10):205-206.

Van Oer Maalen MJ. Whelslone CA. Sludics of C.1lde NalUrally and Expnim(:mally Infect d Wilh Bovine lenli\·irus. Imrnllnobiology of Vi rai Infeclions. Proc. 3'" Congress Europ. Soc. Ver. Vi ro!. 1995. (~ 353-357.

1)9 \'
130 Van Oer Maarcn M]. Upd:ue of Bovine Leukosis Viru and BO\'ine Immunoddieiency Virus. TNAVC 1993 Procecding.. Pagcs 614-615.

1 o WhilC EG. COl/web 011 Diet II/Id Foods. Hagersrowo, MD: Reviewand Herald Publishing J\SSoci:lljon, 1976 p. 349.

131 Archa.mballh O, NacLill-Davis S, el al. The Bovine Illlmunodefecicncy Virus: 1990-1992 pdalc. \1/:1 Re; 1993;24(2): 179-187.

1 1 WhilC EG. COllme!> {In DÎcllI1ul Foods. HagerSlOwn, MO, Reviewand Herald Publish ing Asso ialion, 1976 p. 414

1 1 Blair, A Ooseme i M, Heinel11an EE Canc.a and olher ClUSCS of dcalh :1Illong male and (emalc farmels from rwcllly-lhree Sl'lIes. Am} Irul Med 1993 May;23(5J:729-742.

142 Wh.ilc EG. 01l1rH,·I. on Din nI/ti Food•. Hagerslown. MD: Rcview and Herald Publishing Associalion, 1976 p. 460.

119

14J

Gcnisis 1:29. Tlte H{I(Y Bible. Aurhonzcd King )amcs ve!'Sion.

]ohnson ES. MOflalily among 1I0n while rnen in rhe meI{ induSlry. } Oemp Med 1989 Mar 31 (3):270-272. 1.1.3

235

PROOF POSITIVE

236·

CHAPTER ELEVEN

_

ILK: Priend or Poe?

I

r was an unuslial conflicL The amagooises represemed ewo grollps ehar lISUaJly ery ro work rogerher. an oile side were of rhe rnedical research commullicy, and on rhe orher was a major player in American big busilless. Whar exacuy was going on? Scienrific comrnuniry mernbers rhrough their research publicadons were, in effecr, eaking 10 rask the forces of ehe American Dairy Associarion. The clear conrenrion of rheir medical research W;IS rhar rhe Association was engaging in misleading advertising by using the slogan "Everybody needs milk." When ehe Federal Trade Commissio.n looked inro rhe matter, r11ey carne ro a surprising condusion: ehey agreed solidl)' with rhe researchers and issued a "proposed complaim" citing ehar rhe slogan «Everybody needs milk" represenred false, misleading, a.nd decepeive advertising. ' This FTC judgrnenr in 1974 called artcnrion (O a consistent srraregy of the dairy indusrry: devise marketing slogans aod approaches rhae impress people with rhe healrhfuJness and desirabiliry of milk producrs. Somc of these slogans, often accompanied by an attractive arhlere or a beaurifui person wirh a white rim ar their upper lip, are summarizcd in Figure 1.1 Ir is one rhing lO try to awaken a desire for a service or product-afeer aII, ehar is

rhe basis of mosr adverrising rhar bombards froUl day ro day. But it is quite anoeher rhing ro something off as healeh giving if ir really is nor. In view of rhis, the 1974 decis ion of rhe Federal Trade Commission raised a very important issue. Why would rhe govcrnmel)( seeI' into rhe [ray and disalJow a claim that mosr Americans accept? Whether it is today's U.S. Deparrmem of LIS

Milk, What a Surprise Real Men Drink Milk Everybody Needs Milk Milk is a Natural Milk is the Perfect Food Milk: Drink It For AII Jt's Worth Milk DrÎ,nkers Make Better Lovers Milk "as Something For Everybody Figure 1

237

PROOF POSITIVE Agriculture's Food Guide Pyramid ar rhe four food groups ofyesreryear, the implieation for decades has been that aU Americans do indeed need milk. Whar. (hen, could have prompted the FTC ro object ro the dairy indllsrry's saying rhar "everybody needs milk"? The Ilmwer 10 the questionforms thc basis JOI' this chtlpter. Immediately after the 1974 deeision., the dairy indllstry challged their slogan ro "Milk Has Some-

• ODe food dollar out of seven is spent on dairy products. • The average persoD currently consumes 586 pounds of dairy products per year. • Five cents is spent 00 milk advertising per 100 pounds of dairy products sold. ODe out of seven congressmen receive election from the dairy industry. Figure 2

rhing for Everybody." Although 00 one ehallenged the aceuraey of thar slogan, the real quesrion is: do you re.'llly wanc that "somedung"? Some may feei iliar merely suggesting rhar there may be problems associared with milk and dairy producrs is almost un-AnlerÎcan. This chapter is nor promoting a new smear campaign. 1 am merely poinring out that a litde-known FTC eomplaim against the dairy indusrry over 20 years ago eloquently argues rhat every American should become weB acquainred with rhe medical faers regarding milk. Aft.er alI, good healdl is nor based on following our preeolleeived ideas or cuJr.ivated preferences-ir is based on cooperaring wirh rhe laws ofhealrh rhar govern us. Ir thus behooves every American ro put senrimenrs aside and look seriously ar why [he U.S. governmenr would reject rhestatemcnt [hat "everybody needs milk." We deserve ro be able ro make an intelligem decision regarding our personal use of milk and milk products. The mes..~age thar wiU emerge c1early in this chaprer is rhat medical experrs have known abolit health problems wirh milk for decades, bur these eoneerns have nor reeeived much publiciry. We need ro recognize thar it is very difficult for preventive medicine messages ta be heard c1early when powerful commerciaJ inrerests are pmting millions of dolJars behind promulgaring a message of half-ulIrhs.

The Power ofthe Dairy Association

Cow's Milk

84.7

Human Milk Death rate at 9 months, per 1000 infants Figure 3

238

The magnirude of the dairy industry's influence on rhe sale of their products and the political scene in the U.S. is enormOllS, as shown in Figure 2. Few of uS arc aware that 14 percenr of the U .5. food budget is spent an dairy producrs,3 providing an average of more than one and a half pounds per day of the.se products per person. 4 With such an immense sales volume, it is no woncler rhat the Amcric;1ll Dairy Association is a powerful and well-financed organiz."lcion. A large portion oftheir da.iry reveoue is Strategically channeled into a hllge advenising budget dedieated ta a variet)' of milk promocionals. s This is wlty you see so many dairy ads an television, radio, and in prim.

MILK ~urrhermore, fhe ADA holds a eonsiderable amoum of political dom În Washington. Some amibure rhis ro irs panerns of politica] SUppOT[ thar is secured by providing cleerion campaign funds ro as many as J 5 percenr of U.S. congressional represenrarives. 6

Infants Need Their Mothers' Antibodies Scienriftc research began turning Lip problems wirh milk as far back as 1930, when infaM dearh rares were examined in re/arian ro the use of cow's milk. Prior ro rhe discovery ofanribiorics, researchers studied 20,000 infanrs in Chicago. Ooe grOllp of infanrs was fed human breasr miile and rhe orher group was fed boiled cow's milk. Thc resulrs are shown in Figure 3. 7. s A pediatrician's slandard medicaJ texrbook roday will srate rhar in rhe currenr era ofimproved medical rreatmenr, breasr-feediog is unlikely ro provide a sllrvivaJ benefic However, it srill acknowledges thar rhere are .,imarions where ir can save infams' lives. One rexrbook srares, "AJdlOUgh fiule if any difference exisrs in mortaliry rares in formula-fed and breasr-fed infanrs receiving good care, among the lower socioeconomic groups and those living În unsanirary condirions. the breast-fed iofam is more likel)' to survive."9 Regardless ofliving conditions and (he available drllgs, an infanr's immune system is compromised by feeding it cow's milk rarher rhan human milk. Srudies [0day stiU favor breast feeding over infanr formula 01' cow's milk feeding. lO · II, 12 For instance, even in r!le era of anribiotics in rhe Unired Starcs, infanrs fed formula OI' cow's milk are 80 percenc more likely ro develop diarrhea and 70 percenr more likely ro develop ear infecrions when compared wirh inGnrs who arc cxdusively breast fed. 13 What is it abollt human breasr milk rhat provides infams wirh such al) advantage in rerms of immuniry? We prohably srill do nor know alI the answers, bur severaJ important facrors arc deal'. They are (isred in Figure 4. The firsr advanrage of human miJk is (hat ir provides a child with the morher's anribodies, and rnose antibodies are very

prorecrive when it comes ro infecrious illnesses. 14 onversely, cow's mîlk or infam formula is devoid of rhese prorect.ive agenrs. Second, white blood cells caJJed macrophages can be ed from morher ro child rhrough breasr milk. 15 These macrophages may be able ro provide usefuJ immllne funcrions while in rhe child's inresrinal system. Third, breast milk comatns a compollnd called laeroferril1. This agem rends ro block ilie growth ofE. Coli in rhe inresrine. 16 This is no smalt maTter roday when many are weU aware of the deadly E. Coli srrains rhar have daimed rhe lives ofyoung children. Fourth, breasr milk is usually sterile (exeepr when a morhcr has a breast iJtlecrion or widespread bodily infeetion). This can significand)' decrease the child's exposurc ro infectious ageurs. On rhe other hand, cow's milk is dcscribed as being "regularly contaminated" as well as being a "good clllrure medium" (place ro grow) for dangerolls infecclous agcnts,17 as we shall see.

Other Advantages ofBreast Milk Human milk is also differenr from many mammalian milks because of irs relatively low comenr of phosphorollS. As 1 poinr out in Chapter 7 an prorein, phosphorus appears ro make calcium absorption more

• Mother's antibodies are ed

00

to baby.

• Mother's white blood cells are ed 00 to baby. • Bre-ast milk contains lactoferrin, which blocks E. Coli bacteria growth. • Breast milk is usually sterile, unlike cow's milk. Figure 4

239

PROOF POSITIVE difficult. Thus, a child wiU tend ro absorb more ca!ciulll from Mom's low phosphorus milk rhan from phosphorus-rich cow's milk, as explained in Figure 5. 18 Funhermore, high phosphorus imake presents orher problelJls that human mjlk also avoids. Some of these benefits may further explain why breast-fed infants fare ber-

LOW ABSORPTIO OF CALCIUM

FROMMILK • DnJy 25% of tbe calcium in cow's milk is absorbed by tbe body. • Human milk, although cootainiog less than half the calcium of cow's milk, is a beUer source of calcium because of its high absorption. • Kale, turnip greens, or sesame seeds are beUer sources as weU for tbe same reason.

Lactose (Milk Sugar) Intolerance

Figure 5

crASE DEFICIENCY HEALTHY ADULTS Bantus Filipinos Thais Japanese Greek Cypriots Taiwanese Greenland Eskimos Arabs Ashkenazi Jews American blacks Peruvians Israeli Jews Indians Finns Danes

90% 90% 90% 85% 85% 85% 80% 78% 78%

70% 70% 58%

50% 18% 2%

Mi/k will produu lower abdominal cranlps, gas, and Wdtery stools in lactase deficient individuals. Figure 6

240

rer in r!le face of infecrions. 19 First, on a lower phosphorus dier children have more acidic colon comenrs, thus making ir difficult for disease-producing germs ro grow in the intestine. SecondJy. newborns rhat are on a lower phosphorus breasr milk regimen are less likely ro come down with a evere complicatiol1 of infection ca!led meraboljc acidosis. Beyond the p,revenrion of infecrion, breast miJk has a number of additional benefits. The fat from breast milk is much more easily digested than rhe far from cow's milk. 20 Although fat may get a bad rap an toda}"s commercials and talk shows, it is a critica! ingredient for early childhood developmem. Cow's milk is also deficient in Vitamins C a.nd O, whereas breast milk generaJJy gives 5ufficient quanrities of these rwo essemial nutrients. 2 !

American humanitarian ajd backfired severaJ years ago when our nation attempted to help cenain SOllth American coumries. We disrributed large quamities of powdcred milk rhat resulred in widespread cases of cramping and diarrhea. 22 Cow's milk is rich in a simple sugar called lacrose, or "milk sugar." However, aher infancy, many people Iose cheir abiliry ro digest lacrose. Tbey develop an insufficiel1cy of the enzyme la.ctl1Sf rhat is needed ro break down lactose into rwo simpler sugars so that it can be absorbed. The resulr is thar undigested lactose rravels ro the large intestine where bacreria break rhis sugar down, producing anyrhing from gas, ro cramps, ro diarrhea. L1ctose imolerance appears to be the main factor in as many as a third of cases of recurrem abdominal pain in chjldren. n Well over half the world's population is lactose-imoleranr. 24 Some races tend to Iose the lacrase cnzyme earlier in life than mhers. As a rule, individuals of northwesrern European descent maimain cheir abiliry to digest IactDse bencr than most races, such rhat a greater proporrion of them are able ro drink milk imo adulehood wirhout unroward Înte-srinaJ effecrs. The frequency of lacra e deficiency among differem races is lisred in Figure 6.25.26.27

MILK

Broad Extent ofHealth Problems with Cow's Milk The late Or. Frank Oski was head of rhe Johns Hopkins Children's Medical and Surgery Cenrer for 10 years and professor of pediarrics and deparrment chairman ar Johns Hopkins Universiry. He was editor and founder of the jouma! Conremporary Pediatrics and was a member of rhe edicoriaJ board for The Europe
Milk ALlergies Firsr an the list is aJlergics. Allergies and asthma are an a dramaric rise in America. Infams not exposed ro cow's milk develop far fewer allergics compared ro those being fed cow's miJk. 28 Human milk may help prcvenr rhe dcvelopment of allergic diseases larer in ljfe by boosring an infanr's immune sysrem. 29 Nor only is human milk beneflcial ta a child's immune system, i[ also avoids what is probably rhe mosr common aJlergen in a child's dier-name!y, cow's milk. Nelson's Textbook ofPediarrics is quire dear an rhis relarionship: "Mosr auention has focused an cow's milk protein as rhe major cause of . . 1 fi00d a II ergy . c "30 gaSrtOlIHesUO;l tn 'JnIallts. Allergies are common in ehildren and food allergies are no exception. EstÎmarcs of [he number of children affecred are djfficulr ro aseenain, since many may have minor

symproms thar do not carne ro medical atremion. However, one study in Swedcn esrimared rhar as many as 1 in every 70 children sllffers from food allcrgy.31 Other srarisrics indicare an even more prevalem problem in cenain age groups. Aetual milk or casein (milk prorein) allergies can manifesr rhemselves in seve rai ways. These symproms include mourh 111cers, diarrhea ar consriparion,32 reeral bleeding, vomiring, recurrenr arraeks of nasaJ congesrion, skin rash, and reeurrem bronchiris. 33 . 31.35,36 One of rhe major rrearmems for childhood food aJlcrgies is a period of cow's milk abstinenee. If rhe allergy is duc ro cow's I)),ilk, acme symptoms are usually gone within rwo days, whjle chronie problems may last a week ar 10ngcrY For rheir child ro ger well, SOme

T

USI G COW'S MILK • • • • • • • • • •

Allergies Iron-deficiency anemia Lowered intelligence "Milk sensitivities" Earlyatherosclerosis Juvenile diabetes Acne Rheumatoid arthritis Dental decay Infectious diseases figure 7

241

PROOF POSITlVE morJlers who arc breasr feeding ma)' a1so need ro eliminare cow's miJk ti-om rheir own diers. Apparenrly, cow's milk prorein ingesred by rhe morher can make irs way inro her own milk supply.38 The bane of many a young parenr's life is colic. "Colic" refers (O episodes ofextreme abdominal pain in infants. The artacks rypically occur wirhour warning and may lasr for hours; rhey are ofren accompanied by comÎnuous crying. 39 lnfanrile colic occurs in abolit 20 percenr of aII in.fanrs. 5rudies indicare rhar in about one-rhird of breasrfed infams wirh colic, the symproms disappeared when rhe mother adopc.s a dicr free ofcow's milk. 40 This lends funher evidence ro (he concepr thar ar teasr ome cases of colic are due ro an allergic reaction ro cow's milk consriruenrs.

lron-Deficiency Anemia Tron-deficieney anemja can also resulr from an inrolerance ro cow's milk proreins. 4 l.42 In f.Kr, when you look ar ali U.S. cases of severe iron deficiency in infanrs, as manyas one- rhird of c.hem have blood loss due ro exposure ro a prorein in whole cow's milk. 43 Exposllre ro this prorein results in sloughing off of rhe intestinal lining cdls,

"MILK SENSITIV TY" · Chronic fatigue · Tension headache · Musculoskeletal pain · Hyperactivity · Bedwetting Figure 8

242

•Aggravation of allergies and congestion · Asthma aud other respiratory difficulties

causing smaH amounrs of bleeding. When blood js losr, iron (a constituem of blood) is lost as well. Problems are compounded because cow's milk does lirt.1e ro helI' replace iron loss. It has only abolit one ftfth the amount of iron fOllnd in human milk. 44

Loweredlntelligence The presrigious American Academy of Pediatrics recently enunciared one of rhe most sobering messages regarding iron deficiency: "iron deficieney in early childhood may lead to long-term changes in behavior tllat may not be reversed even wirh iron supplementarion slIfficienr ro correct rhe anemia."45 For example, premature inf.1nts who were raised on formula or cow's miJk have an eight to ten poinr lower IQ rhan breast-fed preemies. 46 . 47 0rher E\ctors besides iron deftcieney are involved in cow's milk-rdared inrellectual impairmem. Dr. Crook lisrs "learning difficulries" :lmollg rhe manifestarions ofmilk allergy.48 SriJl another reason for lowered intelligence ma)' be duc in pan tO the lack of omega-3 fars in cow's milk and cow's mitk-based formula. 49 . 50. 51 These fars appear ro be necessary for optimal brain growth and deve!opmenr.

"Milk Sensitivities" One of rhe most hody comesred areas in medicinc is the domain of ;IIJergies anei sensiriviries. Regarding dair)' foods, some I'hysiciam insisr rhat rhere are fonns of milk intolerance that are nor true allergies, but srill conrribute ro a broad range of physical ills. They refer to rhese disorders collecrivel)' as "m il k sensitivi des." The problcm wi rh the alleged milk sensiriviries is rhar rhe)' are believed [Q comribure to relativei)' common conditions, condirjons that are ofren re1ared ro multiple f:.1.cwrs. It can rherefore be difficult ro pinpoim milk as clIC gllilr)' culprir. Some of the condirions fOlllld in (he medical lieerarure include chronic fatigue syndrome,52 tension headaches,53 muscllloskderal pain,54 hyperacriviry,55 and even bedwerting. 56 For reference I'urposes, this list of disorders along wirh rwo more is repeated in Figure 8. I rhink tbe most construcrive way ro look ar (his area is ro be open ro rhe possibiliry

MILK rhar sorne of (hese comrnon condirions may-in certain situarions-be re1ared, ar leasr in pan, ro milk ingcstion. By no means would 1 jmply that milk is the sale cause or major cause of these problcms. However this iltlormation is in ilie medicalliterature, and a triaJ of a monrh wimoue any dairy produccs is considered a wonhwhile experimenr for most people -particularly if rhey are having significanr problems witil rheir healrh. Alrhough many physicians may be skeprical of these milk sensÎriviey associations, 1 have had enough real-life experiences ro cause me ro be ver)' open ro rhe possibiliey rhar dairy food allergies can have a mIe in more conditions than we would normali)' imagine. For example, as an Internal Medicine specialist who liS li al 1)' deals with adulrs, 1 personally have seen a number ofchildren, mostl)' boys, who were still bedwetting ar eighr or ren years old. Upon disconrinuing the use of dairy producrs, rheir bedwerting ceased. Anomer big concern in the area of milk sensiriviry is irs conrriburion ro respirarory problems. 1 have already menrioned that a full-blown dai!)' food allergy can aggravare respirarory disorders, bur now 1 am referring ro individuals who have symproms [har cannor be explained by eheir immune syseem's responses ro cow's milk. For some reason, dairy consumption seems related in some children to mucus producrion, coughs, and lung disorders. Nelson's Texrbook ofPediarrics poinrs out rhar X-ray lung abnormalities calJed "pulmonary inft.ltrates" have been relared ro cow's milk,- 7 The texr also lisrs a serious lung condirion called "pulmonary hemosiderosis" as somerimes being reversed by removing dairy products from a child's dieI. S8 Ir is inreresring rhar some of rhe children wirh this rare lung disorder also have a chronic runny nose, reCllrrenr ear infecetons, and chronically enlarged Iymph tissue in rheir nose and throar. S9 AII of rhis raises a serious question: couJd a significanr number of children wim chronic ear, nose, and rheoar problems have dai!)' food sensitiviry--even though they havc nor developed devasrating lung problcms? Many physicians would answer unequivocally, "yes."

Early AtheroscLerosisfrom Milk? Evidence suggesrs rhar oxidized cholesterol has a role in beginning ar worsening rhe artery-narrowing process calJed atherosclerosis. Iffoods cooraining cholesterol are exposed ro air rhe cholcsterol can oxidize (combine with oxygen), which makes it more damaging ro anerics. Whole milk and particularly powdered whole milk-based formulas meer rhesc criteria, and provide an ideal sertil1g for cholesterol oxidation. More information on cholesrerol oxidarion i presenred in Chapter 3 on heart disease. Children may be ger [ing an early srare roward deam from America's leading killer by ingesting cow's milk prepararions. On rhe o(her hand, when a child consumes cbolesterol from the mothcr's breasr milk, it flows direcrly from the n ipple to (he cb iJd's mourh. There is considerabl)' less opportuniry for oxidarion ro occur. In facr, when comparisolls are made berween counrries regarding hearr disease and dierary irems consumed, dairy producrs emerge as the mosr reliable food indiC<1.tor for predicting [he rare of hean disease. 60 . 61, 62. 63

Juvenile Diabetes and Cow's Milk Cow's milk may rrigger diabetes in genericall)' suscepeiblc children. A growing number of seientitlc papers suggest this relaelonship. Researchers have now uncovered cow's milk proreins rhar resemble proreins found on rhe surface of the beta ceIls of the pancreas. The rechnical namcs of t\vo of the implicated milk proteins are ABBOS (a fraction of bovine serum aJbumin),64 and beta cnsein. 65 The research suggesrs rhat a geneticaII)' sllsceprible child may begin ro make anribodies against one of rhese or orher milk proteins. Thosc anribodies may then arrack look-alike proreins on rhe bera cells of me pancreas. Beta cells are rhe insulin facrories of the body. If rhe immune sysrem desrroys them, diabetcs results. Dt. KarjaJainem, an author of onc of the srudies, said, "We ma)' have llncovered a wonderful suaregy ro prevene Type 1 diaberes. lf we are righr, it may be the beginning of rhe end of this rerrible disease." Ofcourse, mar would mean e1iminating cow' milk from the Jiers of ali SlIScrible individuals.

243

PROOF POSITIVE

Aerle andMilk Acne is a well-known major concern of adolescence. Alrhough for years. momers have dispensed free dietar)' ~ldvice w their children ro control lhis problem, mosr phl'sicÎans have moved to a medication approach and rarell" if ever, advocate dictarl' change. Nonecheless, research indicares chat diet plal's some role. Cenain fars (wirh medium chain lengchs of 8 ro 14 carhons) are identified bv Nelson's text as a "minor provocator)" factor. "66 The same souree memions that far may have a role in the formation ofblackheads. Alrhollgh mose people do not ehink of miIk as a high fat food, abollt 50 percent of the calories in whole milk came from ['1(.67 Mally cheeses are higher than that; SOme, like cream cheeses, approach 90 perccnr of theie ealories from fat. 68 (Of note, 15 ro 20 percenr of rhe fac calories in dairy products

Oski's argument was (har the progesterone is converred imo nule sex hormones (androgens) which in turn increase acne.?1

Rheurnatoid Arthritis, Dental Deca)~ and lnfectious Diseases Some cases of the crippling form oft disease known as juvenile rheumatoid arrhritis mal' be related to dairy lIse. 72 Othcr reports implicate milk prodllces as a risk factor for some forms of demal decal'.73 Infectious diseases, however, are some of (he greatcst risks to a child's healrh rhat caJ) rcsllh from daily foods. We will take a fur(her look ar (his subjece larer in rhe chapler.

Adult Dairy Food Diseases Having looked at my major concerns wirh rhe healrh effects of milk in childrell, we shall now look in derail ar seriollS dairylinked diseases rhar are lIsually manifest in adllJthood. The six condirions rhar 1am most concerned abolit are lisred in Figure 9.

Coronary Artery Disease

· Coronary artery disease · Cancer · Neurologic diseases · Allergies . Digestive problems · Infectious diseases Figure 9

244

are generally from the implieaced medium chain faes of 8 ro 14 carbolls i Il chai n length).69Wheeher it is because of this fat connec(ion or for other reasons, Dr. Frank Oski reported that aene often c1ears up when milk is disconrinued.?o Oski seemed ro favor an explanaeion apare from fat for the diet-aene link. Significam portions of milk cows are pregnant and (hus give off progesterone in their milk.

Most individuals who are eirher (rying ro prevent or reverse coronary anery disea.~e have the impression that skim rnilk and one pereel)( f;'H milk are good opeions. However, t!le program in a 1990 smdy thac gave the 1Ie1:Y best remlts in treating hean disease with lifesryle changes essentiaIly rtrrlO-lIcd rnilk from the dier. 74 The same concerns previously mentioned in the chapter regarding oxida(ion of cholesterol are even more worrÎsome for adllirs than they are for children. In children, the isslle is usuaHy rhe prevention of an early beginnîng of atherosderosîs. In adults, many rimes the issuc lakes on life and dea(h proponions as they are seeking to keep arteries open tlur may already be significantly blocked. Fur[hermore, in Chapter 7 [hat deals with procein isslles, we learn that one of [he very wors( pro(eîns that raises blood cholesterollevels is casein, a common milk prorein.?5 Ali levels of cow's milk, including skim and one percenc milk, colltain both casein and choles(crol. Two percenr anei whole milk are worse rhan eirher skim or one percem milk because they have more

MILK cholesrerol and are higher in sarurared fat, which increases rhe btood cholesterol. One pariem. Norman Mayo, age 61 from Seattle, recently made headlines when he annoullced that he was taking the dairy industry ro caurt for nor pllrting a waming Iabel o,; milk informing the consumer abOlit the increased risk ofhean disease and stroke. He stared that he drank whole milk his enrire life bealtlse he believed it was a heahhy practice. Now he has c10gged arreries and has already suffered a stroke. After he knew abOlit his anery blockages, he learned abour rhe artery-damaging effecrs of dair)' products from his healrh advisors.

The Link between Dairy Foods arzd Cancer Dr. David Rose and colleaglles at the American Healtb Foundarion examined rhe international de,uh rares fi-om a variet)' of cancers.iG They found rhat the more milk and meat eaten in a cOllnuy, the greater the risk of breasr cancer. Prostate and ovarian cancer r15ks were al50 associared with milk li e. La Vecchia and coworkers in Iraly have shown thar prostate cancer risk increases in a 'dose response" fashion wirh milk drinking. Thus, rhe more milk a person llses t!le greater the risk of rhis filtal cancer. SpecificaHy, rhose who used one ro rwo g1a.~ses of milk per day increased rheir risk by 20 percent. However, when milk intake exceeded rwo glas es per day, prosrare cancer risk jumped 400 percenr.7 7 A srudy in Spain addcd yet another cancer ro rhe list ofdairyrelared malignancies. Researchers rhere found rhat milk producrs tended ro rriple rlle risk of cancer of rhe recCllm.7 8 These are nor isolared internarional sruelies. There is a growing body of researchright here in America-rhar tends ro implicare milk along wirh other animal products in increasing c.1ncer risk. For example, a fascinaring U.S. srudy compared srate-by-srate data an dairy food lIse with the risk ofbreasr c.1ncer. The more milk a state consumed the greater rhe risk [heir populace had of dyjng rrom breasr cal1cer.79

Neurologic Diseases One very devasrating neurologic disease is called Amyotrophic Lareral Sclerosis (ALS). It is commonly know by a less imposing name: Lou Gehrig' disease (afrer the famous baseball player who contracred rhis illness). ALS tends ro cause progressive paralysis. The average victim dies within rhree years of the diagno is. 80 Alrhough the disease can rarely be inherited, most of the case are nor. There is some concern from popularion studies (hat some cases of ALS may be cause-d from an infectious agent rransmined thraugh dairy productS. 81 Multiple Sderosis (MS) is anorher porentially disabling neurologic disease. This condition strikes the tissue (ca.lled myelin) rhar insulates nerve cdls in rhe brain, eye nervcs, anei spinal cord. The disease appears ro be due ro an imml.lne system abnonnaliry rhat causes inf1ammation and deStfllction of ilie myelin rissue. 82 One srudy reported in rhe prestigious British medical joumal, Lancer, suggesred thar MS might have a relarionship ro dairy consumprion. 83

Atlergies and Digestive Problems Dajry foods may have a role in a whole hosr of other diseases rhat strike in adulthood. We have alread)' observed thar childhood aHergy is ofrell relared to milk prodllcrs; these irems can cause adulr allergic manifestarions as wel!. Lacrose inrolerance has already been addressed ro some extent. We learned (hat a signific.'lnt porrion of abdominal problems in c1tildren resulrs from malabsorprion of milk sugar. Lactose inrolerance also poses pl'Oblems for millions of adw[s. Often they do not realize that milk is eirher a conrributing cause ar rhe sale cause of their intestinal problems. Milk use is also being linked ro a growing nllmber of diseases rhar we have yet nor rouched an in rhis chapter. Perhaps rhose thar are t11e mos[ worrisome are the growing number of serious infeerious diseases. We willlook at rhese nexl.

Contaminl1nts in Cows Milk So far, we have been looking at problems re1ared ro hyporherically pure, unadulrerated cow's milk. FrankJy, as a former milk

245

PROOF POSITIVE drinker, 1view this list of problems as qllite sobering. Howcver, pure cow's milk does nor really exist.• because whacever a cow is exposed [Q cends ro show up in her milk. For example, what comes with aur breakfast milk raday is the cow's lunch yesterday. This explains why milk can taste sa different at times; when cows ear diflerenr foods, the milk rakes on a different taste. In a sample

BACTERIA MILK"LIMITED" T020,OOO U.S. Public Health Service Regulation "Mîlk, after pasteurization, should contain DO more than 20,000 bacteria per milliliter of milk and DO more than 10 coliform bacteria in each milliliter."

figure 10

of milk from processing plams in hve staces, over one-third of the milk samples contained Aavors of the feed recendy eaten by the cow. 84 This induded thc tasre of wild garlic or wild onion, corn, oats. rye, aJld binerweed. The sobering message is [hat whatever is in the cow's blood at the time tends ro show up in rhe milk. Unfortunately, more than flavor is ed in this manner. Bacreria, hormones, pes[icides, and other conraminalHs can nnd cheir way imo milk.

lnfectious Agents in Milk

246

Infcctious agenrs can be very effeccively transmitted rhrough milk These agcnts include both bacreria and viruses. Many COllsllmers believe that drinking pasceurized milk eJiminates aII potential disease-bearing agents. This is far from the case, alchough pasreurized miLk is safer to drink rhan raw miile However, pasreurization does nor srerilize rhe milk. Srerilization would require a minimum of212 degrees Fahren-

heit for a period of rime. Pasteurization hears milk ro only 161 degrees Fahrenheit for a SCa.lH 15 seconds;85 rherefore, it merely reduces the number of potenriaLly infecrjous germs, bur does nor eliminate them. Government agricultura] stJnda_rds bear witness ro rhe expecration thac milk wiIl be contaminated wirh microorganisms aner rhe pasreurizarion process. Current U.S. Public Healrh Service regulations are srated in Figure 10. In plain English, rhis regularion means rhar a glass of milk can have nearly five milbon bacteria in it and stiil be t1ccepttlbfe. The coliforms are of evcn more concern. These bacreria are germs rhar come from rhe cow's Stool. Milking, especially auromaced, can be messy in spire of precaurions; it is not uncommon for milk to be colltaminated. We see thar our govcrnmem aHows up ro 10 coliform bacreria from stool per miUilirer afler pasreurizarion. Granred, ren bacreria do not sound like much. However, ren per milliliter translares ro nearly 2500 per 8-

otmce gltus. Just as bacreria survive rhe pasrcurization process, so do many viruses. Some of the c1assic research looked ar rJle survivaJ of rhe foor and mauth disease virus afrer pasreurizarion. 86 . 87 Other viruses have been cited as being pasteurizacion-resistant. These include the maloney leukemia virus, rhe rous sarcoma virus, ilie rauscher leukemia virus, and the bovine papilloma virus. sS These diseasc-causing viruses could be destroyed by boiling, bur not simply by pasteunzll1g. A number of epidemics have occurred as a resulr of infeerious agenrs geuing into rhe eommercial dairy supply. There was a recent oucbreak of Salmonella from a narionaJly disrributed iee cream brand. Over rwo thousand cases--and severa! faralirieswere verined in Minnesora, Somh Dakota, and Wisconsin. S9 Food poisoning can also occur from cheese. In 1989. a Salmonella ourbreak siekened ar leasr 164 people in Minnesota, Wisconsin, Michigan, and New York. The infecrion was traeed ro conraminared mozzarella cheese. 90 Whar was suiking about d,is c.1se anei orhers is the relarively few bacteria rhar are needed ro pro-

MILK duce infeetion. In the mozzarella ourbreak, unopened blocks of rhe colltaminared cheese were ana1yzed. They found /e.r.r thlm tUlO safmonefla organisrns per one ou-nce sertJing of cheese. These and orher repons sug-

gesr rhar dairy producrs wirh seemingly insignjficanr levels ofcontamination may play a greater mIe in disease ourbreaks rhan previously recognized.A whole hosr of infec(ious diseases have been rraced ro milk use. These include relarively comrnon infecrious agenrs like salmonella ar srrep,?1 or rhey can include rarer diseases. One such illness is brucellosis, a somerimes chronic and unrecognized disease rhar C<"lIl cause headache, f.1tigue, weakness, and mllscle aches as weB as more familiar infecrion signs like fever . 9' an d swcanng.The bacteria dut Gl.Use Q fever (anorher somerimes-cllronic illness rhar ofren e1udes diagnosis) can also be rransmirred in cow's milk. 93 Alrhough unfiuniliar ro most COI1Slllllers, yersinill enurocofitica is a hlirly commOIl infecrious agent thar causes abdominal pain, fevet, and diarrhea. 94 It has rhe dubious disrinction of mimicking appendicitis, and is dOllbdess rhe cause of many unnecessary surgeries each year. Yersinia is generally des[royed by pasreurizarion. However, documented cases demonstrare rhar if rhere are sufficien.r l1umbers of this germ in rhe raw milk, some yersinia can survive pastcurizarion and larer multiply during refrigeration. 95 The list of organisms mar can contalninate raw and even pastellrized milk is quire exrensÎve. 1 provide more informarion in Chaprer 10, "Animal Diseases and Human Healrh Risk," including information on orher relatively common and dal1gerous infecriolls agenrs such as Listeria96 and Campylobacrer. 97 There is also a growing lisr of other diseases mat we are now becorning aware of having a lillk tO infectÎon aod ro dairy foods specifically. The chaprer an animal diseases provides fllrther infonnation. For example, mycobf1cterium paratubermlo)'iJ rransmirred through dairy foods may be a cause of Crohn's disease, an often incurable, debilirating disease of rhe bowd.91l Evidence indicates thar mycobacterittm pllrlltuberculoJiJ is nor desrroyed by rlle mosr cornmon form

of pasreurization, which arrains 161 degrees Fahrenheir for 15 secondsY9 In view ofsuch pervasive problems wirh inf(xtion, rhose who plan ro continue drinking milk sho1l1d seriously consider srerilizing dleir milk. Boiling is rhe simplest way ro sterilize dair}' beverages. Some people do not like the rasre of boiled rnilk, bur this sreriLizarion process definitely decreases rhe risk of rransmissible diseases. However, even boiling may not prevent ali risk. Oile of the most fe~ued animaJ-related diseases is Crelltzfeldr Jakob disease (CJD). One of rhe ways thar rhis condirion is believed ro be transmitted ro humans is through prions from carde WiTh "mad cow" disease. These prions are not living organisms and can wirhsTand temperar.ures far higher [han rhe boiling poinr of warer. In Chaprer 10 on animaJ diseases, J point out rhe evidence rhat dangerolls prions call enrer human breasr milk if a woman is sliffering with CJD. A1rhough it is feh llnlikely ro be conraminating dairy sources in rhe U.S. ar rhe presenr rime, some have srill raised concerns (hat some of (he American milk supply could be tainted with prions.

Beyond Bacteria and Virttses-Other Milk Contaminants As damaging to human heaJrh as bacteria and viruses are, other contamina.nts can be just as damaging. Let us look ar the antibiotic conraminarion problelll.

Antibiotics in Milk Antibiotics are commonly found in milk roday. These drugs come from a variery of SOllrces. Since rhe early 1950s amibiorics such as penic.iJLin and tetracydine have been added ta livesrock feed ro prevem infection and boosr growth. IOO Antibiotics are a1so milized ro ["reat sick cows. Alrhough milk fTom ;ltlimals undergoing drug rrearmell( is discLlrded for a period of time, drugs can sriJl be presem in a cow's mjlk even after iT has finished a course of anribioric.s. Iwo major concems have arisen abour rhe use of anribiorics as rhey reiare ro dairy prodllcts. First, [here are worries rhar widespread antibiotic use in livesrock is f.1Voring

247

PROOF POSITIVE rhe rise of organisms rhar are resistant (O [he common anribiorics. Second, there are legitimare fears rhar human cxposure tO antibiotic residues in milk prodllcts will re· suit in illness. Increasing resistance ro antibiorics among microbes has becn recognized for some time. Many diseases like pneumonia, gonorrhea, or salmonella thar formerlywere easily ueated with cenaÎn antibiorics have now become resisranr ro those dfllgS. IOI Some blame rhis problcm of growing resisrance on indiscriminare lIse of anribiotics in borh rhe hllman popuiarion as well as ill livesrock. Research suggesrs rhat rhe livesrock connecrion is very likely a f.1.cror in this process. The likelihood of an)' canon of milk having one or more drug residues is fairly

SCO G FO BREAKFAS ? r.

The cow's lunch from yesterday

,. Bacteria r

Viruses

,. Prions r

Antibiotics

,. Hormones . ., Organic pesticides Figure 11

248

high. Milk from manycows in a 'milkshed" area is pooled; rhus, milk rhat reaches rhe consumer has constituelUs that may have come from lirerally hundreds of 'Cows. Researchers ar Rurgers Universiry found rhat a signi6canr ponion of rniLk samples showed more rhan oile drug residue. I02 The presence of these antibiotic rcsidues in milk is emerging as a facror f.1.Voring rhe develapment of antibiotic resistance. In another Rurgers srudy, staphylococcus aureus (a cause of serious skin and bone in-

fecrions) was exposed ro small doses of six anribiotics. The study employed some anribiotjcs rJ)3t are commonly lIsed in lhe livesrock industry, includ ing eryrhromycin terracycline, and ampicillin. The drugs were used in amounrs small enough ro be legaUy sold in commercial milk (i.e., rJley were belaw rhe cur-off for what the FDA considers a "safe" dose). These drugs were used singly or in combinarions of three drugs. (The rarionale for using a combination of drugs was rheir knowledge of the frequency of mulriple drugs finding rheir way imo the milk supply). After rwo weeks, acrnal me.asuremem showed that the drug-exposed staphylocaccus aureus samples were rapidly developing antibiotic resistance. When comparcd tO staph germs tlur were not exposed ta antibiotics, those subje.cred ro resi· dues of a singlc drug developed resistance six times as fast. However, rhose exposed to three anribiotics developed resistance OVCt 27 rimes as fast. 103 This research suggesr5 rhat milk should be frec of aII anribiorics if we waU( to reduce rJle rapid developmenr of resisranr bacreria. A summary list of rhe various Imown conraminanrs in milk is shown in Figure Il. Alrhough I have tried ro differenriarc berwccn conditions rhar are relared ro milk irself and oUler condiuons due ro conraOlinanrs in rhc dairy supply, such a division is very renuous. The problem is rhar milk is so pervasively conraminared rhar it is oftcn merei)' cOlljecrure as ro wherher problems are relared [Q milk itself or ro rhe everprescnr conraminanrs. For example. although 1 have presented cancer risk as being due to milk itself. evidence suggesrs thar at least somc of the milk-cancer link may be related to cOIHaminants. One study dcaling with lung cancer provides a good ilJusfr
MILK toxins rhar reside in the fat portion of mÎlk. Anorher example thar illusuares the difficlIlry În disringuishing the effecrs of conraminams from the effeccs of unadulterared miJk comes from [he area of allergy. AIthough many cases of cow's milk allergy seem ro be re!ared ro milk proreins, conramÎnancs may a1so be part of rhe problell1. The coromon finding of respirarory problems following milk drinlcing (such as more mucus producrion. cough. ar infeerions) may somerimes be due ro amibioric residues in rhe milk. A person may be allergic ro penicillin. erythromycin. ar some orher drug rhar is presenr in low amouncs in milk. There is nor enough drug rhere ro callse a serious generalized aJlergic reacrion. but rhe small amoum present is sufficienr ro produce the annoying respirarory symproms.

larionship. Increasing the protein in the diet of SOll\eone who Gonsumes liberal amounrs ofcalcium-as much as 1400 mg per daycan acwally resllh În a Ioss ofcalcium from their body on a daily basis. Third, there seems to be a Ilurnber of biochemical factors that accollnt for the calcium-depleting effecr of meat in particular. These incIude effects of the higher protein contem itself, as well as problems with the excess phosphorus and suJfur that is found in meat. It is important also ro note that in Chapter 7 previously referrecl ro, 1 provide rabies listing food sources that sllpply liberal Jmounts of calcillm whi1e avoiding problems ofexcess protein. sul fur, and phosphorus. Among rhe real srars are rhe green leafy vegetables.

If Dairy Foods are Out) Where Do we

The Narional Dairy Council recenrly published a book promoting dairy foods from rhe scientific srandpoinr. 105 The book was written by lWO of its employees and a paid consultanr. Most of rhe benetlts claimed by dairy can be easily boiled down ro one mineral-calcium. Other benefirs mentioned include the consumption o[Vitamin D, which is added ro milk as a supplement. Yitamin D can eeasily be obr.ained by lDoderate exposure [O sunlighr and is mus nOI a necessary constiruent of the human diet. IfVitamill D-sllpplemenred dairy food is elimînated from the eliet anei customary sunlight exposure is not possible, 1 recolllmend sllpplemenrîng the e1iet with 400 International Units of Yitamin D a day.106 Vitamin D is acrually more imporranr in preventing osreoporosis rhan a high intake of calcium. Most of the remainder of the so-caIled "posîtÎve" dairy research does not control for oeher dierary Of lifesryle factors. For instaJlCe, a recent srudy suggested that middle aged men who were milk drinkers had a slightly less risk for developing a Stroke later in life. However, rhe srudy did not separate our (control for) other factors rhat are known ro decrease me risk of srrokc, such as daily exercise and earing several serving of fruirs and vegetables a day.IO? Even the sruely's aurhor himself srated. "There's something

Get Dur Caldum? Americans are rightly afraid of osreoporosis. a condirion rhar refers lireraJly ro a rhinning of rhe bones. The disease affeers aii races and borh sexes. causing appro,Jmarely 70 percenr of ali fracUlres in All1ericans over 45. 104 The dairy industry has been quick tO eapitalize on mese concerns. They milk, eheese. and orher dairy products as food irems ro help serengrhen bones because of [heir cakium conrenL However, despite what most Arnericans "know," more ca1cium is not whar is needed fOf improving me bone health of Americans--or anyone e1se for that maaer. In Chapter 7 an protein, 1deal with rhe true nuuirionaI culprir relared ro osreoporosis. The real villain is excess consumption of protein. not inadequate calcium intake. 1 presem [he full argumenr rhere, but let me review the key concepts briefly here. Fim. studies an populatÎon groups (epidemiology) show that the more animal protein în the dier. the greater the risk of osreoporosis. One of rhe classic groups srudied is rhe Eslcimo. Despite their hîgh conswnprion of up to 2500 mg ofcalci li m per day. they have rampam osteoporosis. Second, actual huOlan experimems have shown a similar re-

The Pro-Dairy Side

249

PROOF POSITIVE

The U.S. governm.ent recommends that the diet contain less than 30% fat and be low in cholesterol and saturated fa,ts. Federallaws requiTe schools to provide fatty wholemilk.

media as advocat.ing the liberal use of milk, they really do nor give reliable informarion abour milk. The !atest scienrific book pur out by the National Dairy Council in parrnership with rhe NationaJ Dairy Promorion and Research Board rhar endeavors "ro provide a baJanced review" ofmilk is complerely silent abour the many concerns expressed abour milk in this chapter, wirh the exceprion of lacrose intolerallce. 108

SchoolluDcbes are over 40% fat.

School Milk and Politics

Butter aud cheese amouut to 113 of goveroment schoollunch expeudîtures.

Wich aII rhe problems associated with dairy producrs, it seems prudent for our COllntry ro avoid giving messagcs rhar appear ro recommend the free use of milk. Unforrullarely, cuereJlt legislarion (probably due in pat( to dairy indusuy influence) requires public schools ro provide a wide range of da.iry producrs. The complexiry of the issue is illustrated in Figure 12. 109 Ir seems thar rhe governmenr is callglll in a conflict ofinceresc. On rhe one hand il widely promores rhe recommendarion of bringing aur narionaJ tu consumption ro 30 perceJlt ar below, and ro especiaJly reducingsarurared far in rhe diel. On rhe ot.her hand, older USDA regu1arions help dUl11p excess dairy producrs (high În far and especially high in sarurated far) imo our school IllJ1ch program. It has been argued ehat Însread of rhe healrh of children solely determining the goaJs ofschoollunch programs, powerful commerciaJ Înteresrs such as che dairy indusrry are alrering the priorÎries. A public watchdog organizarion for tood and heahh has poinred out ehar rhe USDA regllJations have pur AmerÎc.1JlS in an unacceprable posÎrion; rheir st.aremem Îs quoted in Figure 13.' 10

Only 1% of fruits aud vegetables provided are fresh; 90% are canned. Figure 12

e1se in milk [cakium], ar in the lifesryles of milk-drinkers, rhat's offering prorection. These faccors are difficult ro idenrify, bur milk drinkers [in this srudy] tended ro be leaner and more physically active and to consume foods rhar were more likely ta be healthy." He the.n added thar it would be "... inappropriate (O recommend thar milk consumption be increased to reduce rhe risk of stcoke." Thus, although rhese srudies are widely touted by rhe dairy jndustry and t.he ncws

"The Agri,cultural Department may be creating a dUrmping ground for surplus high fat and dairy products ilO the national school Junch program. We are in the unacceptable position of having tbe economic well-being of dairy interest calling the sbots ht a program that should be providing good nutrition."

Figure 13

250

M)' Own Experience with Milk A number of years ago 1 weJlt rhrollgh an experience that persuaded me ro discontinue my llse of milk. Beginning in my teen years, 1 e.xperienced repeared respirator}' uacr infectÎons. 1 would ger over one infCcrion, tllen a week larer r would come dowll wirh another. AH during college and medical schooJ my moeher would rell Lne 1 needed ro see a speciaJist ro find out what was wrongwith my immunesysrem. 1 flnalJy

MILK wen! rhrough rhe immllne syseem blood reses bll[ noehing was abnormal. 1 was cempted ro conci ude rhar 1 was a sickJy person and wouJd always have upper respiratory uaC(. infecrions. Then 1 learned during ro)' speeialry rraining in Inrernal Medicine aboli[ some of rhe complicacions of milk rhar 1 have becn describing in this chaprer. 1decided ro discontÎnue using milk, wh.ich was racher difficulc since 1 was accustomed to lIsing ic in qllanriry. 1experimenred with several of the soy, riee, and nut milks on rhe market and fOtlnd rhem aeeepcable. Even ehe soy ice creams were good and frec of animal produClS. When 1 scopped llsing miLk, my respirator)' infeceions went away and 1clid not corne down with another cold for many years. Elim Whire cHlrioned years ago, "... if orher foods ro supply rhe needed elemenrs (Imnot be obeained, milk anei eggs should noe be wholly discarded. Grea! care ShOllld be raken, however, ro obrain milk from healchy cows and eggs from healthy fowls, cJlat are well fed and weU cared for... "111 Of course, even healthy-appearing cows may be sick for days before mani{esring any symproms. Ali during the tjI11e of [heir unrecognized illness, people ~ould still be drinking rJleir milk. Wh.ire gave advice ro deal with this possibility: "If milk is used, ir should be thoroughly seerilized; wich this precaucion, there .is less danger of conrracring disease from irs use."112 She also wisely wrote, "Lec rhe dier reform be progressive. Let rhe people be e:lught how to prepare food withoue the use of milk or buner. Tell them che rime wiJJ soon come when there will be ilO safery in using eggs, milk, cream, or buuer, because disease in animals is increasing in propordon ro ehe Încrease of wiekedness among men."113 Since most of the world populae.ion does well withollt rhe use ofda.iry foods, 1 believe that Americans can do so as weB. My own personaj experienee, my work with patien!s, and medical research all poinr in the same direction-rhae a decision co give lip rhe use ofdairy foods willlikely bring us significanr heaIrh benefirs. 1 could wish (hat the news media were more objective in reporcing t!le problems

wich dairy prodllcts. Since they are nor, 1 believe it is my responsibility as a physieian ta let people know the dangers associated with {hem. When we look ar {he overaJl pierure, 1 can honestly recomrnend thar cow's milk should be reserved for baby cows. Their calves new a high-powered somce of energy to start walking the day chey are born. The American Academy of Pediatrics now recommends rhar no one under the age of rwelve momhs be fed cow's rnilk. 114 They add, "the American Academy of Pediatrics recommends chat infanes be fed breasc rnilk for (he fifS( 6 ro 12 months." Clearly, ehildren develop besr on their own mother's milk. Consequently, 1 eommend and appreeiare rhe movemenr in our counuy among professionals and lay peoplc alike advocating breast-feeding. Perhaps rhe time has come to publicize a new slogan for miLk rhar, concrary to {he American dairy inclllsrry 510galls in Figllre 1, has an honest sciemific basis. A slogan sllch as shown in Figure 14 would be fitting.

--

~

-~

_

_

• .><-

- -

-~

, Fîgure 1.4

Cow's Milk Alternatives are Now Available For children rhar are weaned-and adtllcs as well-there are uow an abllndance ofmilk-like producrs on rhe market mac are suitable tO use on breakfast cereals. Heallh

251

PROOF POSITIVE

Type ofmilk (per Clip) Protein Calcium Phosphorus g

rog

tt.g

Vitasoy (unfortified)

9

80

WholeMilk

8

290

228

West Soy Mrilk

6

300

250

Human Breast Milk

3

79

34

Rice Dream Milk

1

300

150

Figure 15

food srores uSllaHy have a liberal supply of soy milk products ofsevera/ brands and flavors, and other planr-based milk a/ternaoves such as oar, poraro, rice, and almond milks. Wirh their populariry growing and more Americans realizing rhe dangers of dairy foods, rhese irems are IlOW beiug srocked in regular grocery chains. Nor only have many consumers been surprised to see rhese prod-

ucrs on rhe aisles of their local supermarker, bur rhey aJso have been amazed ar how nurririous and sarisfying some of mese beverages are. A comparison of rhe Ilutriems in cow's milk wirh various soy milk produns is shown in Figure 15. Severa I observarions of rhe dara in rhe figure are in order. Firsr, rhe high content of phosphorus in cow's milk causes a rarher poor absorprion rare of calcium, ar 2S percent, or abour 7S mg per cup. Second, rhis amOUJlt is equa! ro rhe amount of highly absorbable calcium in human breast milk, which subsralltiates rhar the nursing illfant will absorb as mllch calcillffi from morher's milk as one who is on cow's milk. Notice also rhe desirabJy low comem of phosphorus in tllorher's milk. Third, procein Jevels of soy milk producrs are generaJly similar la rhar of cow's miJk, and CalCilltll levels for t!le forcifJed soy milks are also similar ro that of cow's milk. Fourch, che phosphorus level of fortified Wesc Soy Plus is slighdy lower (han that of whole milk, which would suggesc chat the absorbable Ievels of caJcium wou!d be similar. Inscasoy, anocher milk alternative, has slightly higher levels of pro(eÎn and c.1lcium, with a slightly lower concent of phosphorus. A listing of quamities ofB I2 and orher nurrienrs in various brands of milk alrernatives and cercals is found in Appendix IX.

Conc1usion

In DO mammalian species, except for the "iDdustrialized" human, is milk consumption continued after the weaning period. 'Figure 16

252

The eu!mination of my exrensive research on rhe subject of milk is rhar [here is absolurely no reason why any adlllc human should feei tlur rhey need rhe milk of another species for health. AH [he nutriems we need can be obrained wichollC resorring to dairy foods-and we eln avoid a host of problems by shunning this harmfu! group of foods. De. Oski roade a simple bur foecefu! observarion regarding the uniqueness of a full-grown marnmal thar consumes a food meanr srriccly for babies. His sratemenr appe-ars in Figure 16. 115 1 challenge you 110W. Take a bold srep and derermine ro do something thar wilJ likely make a significanr difference for your healrh and for rhe healrh of your family. Derermine mar by your influence and ex-

MILK ample you will help orhcrs ro break free of a disease-bearing producr line--even if you feei perfecrly healthy roday. Make a choice ro cease purting money into rhe cofiers of an industry thar is relling half-truths at rhe expense of rhc healrh of the American public. Visir your local grocery srore or healrh food srore, pick lip a sample of several soy,

!lut. or orher planr-based milk alrcrnarives, and embark on a new habir of dajry-free living. You \ViII be surpriscd at how rasry today's alrernarives are, and you will know that Y0l! are following a course calcularcd ro improve your own health, and rhe healrh of orhers arallnd you.

RejCrmces New York Timc "Fedcl1ll Trade CommissiOIl Finds Milk Advenising Campaign Deeljve: April 1974. As dcscribed In: Oskj FA Dont Drink YOII' Milk-9tlJ nlition. Brusluon. NY: TEACH Services, Ine., 1983 p. 6670. I

1 Oski FA. Don't Drink Your MilJ.'-9th edition. BrllS!Hon, NY: TEACH Services, 1ne.. 1983 p. 2, 66-68.

Oski FA. Don't Drink ieur Milk-9tb edition. Brushron, NY: TEACH Scn·ices. Inc.• 1983 p.2. 4 PlItnarn

JJ, AlIshouse JE. Food Consumptioll. Prim, tind E'
SWislica1 BuJlelin

o. 928, US DeparrrncJH of Ab'TiClII mre. p. 16.

; Oski FA. Don't Drink l'aur Milk-9th editioll. Brusillon. NY: TEACH Serviccs. Inc., 1983 p. 2. Oski FA. Doni Drink Yollr Milk-9tb dition. Brushlon. NY: TEACH Scrviccs, Ilie.. 1983 p. 2.

ZO Barncss LA Nmrilioll and Nurrirional Disorders.ln: Behrman RE, edjlor. Nebo" TextbOlJk of PedifltriCJ-1411J tdition .. PhiJadelphia, PA: WB Sallnders Company, 1992 p. 122.

B,lrness LA Nurrition and Nurririona1 Disorders. In: Oehrman RE. edilOr. Nelson Textbook of PulitltricJ-14tlJ l'dition.. Philadclphja. PA: WB Saundcrs Company, 1992 p. 122. 11

120ski FA. Dont Drink Your Milk-9tlJ l'r/ilion. Brushloll. NY: TEACH Serviees. Ine.. 1983 p. Il. Barr RG. Levine MD. Walkins JB. Recurrelll abdominal pain of childhood duc 10 bClOSC imolerallce. N Engl} Mtd 1979 JlIn 28;300(26): 14491452.

B

MacDonald. 1. C.1rbobydrares. In: Shils ME, Young VR, edirors. MOlIe", Nutrilion in HtilltlJ ilnd DiuilJt-7tlJ ~dilion. Philaddphia, PA: Lea

H

and Fcbigcr, 1988 p. 43-44.

6

Grulee CG, Sanford HN, Herron PH. Brc:asr amI Anillcial Feeding.JAMA 1934;103:735.

7

S Grulee

CG, Sallford HN. Schwarn H. Breasl and Anificially Fe
JAMA 1935:104:1986.

Barness LA Nurririon al1d Nurriliollal Disordcrs. In: Bcbrman RE, edilOr. Nr/son Tnabook of hditltricl-14tlJ editiorJ.. Philadelphia. PA: WB Sallndcrs Company, 1992 p. 116-117. 9

10 ClInningham AS Morbidity in brc3Sl-fed and ana.cially fed infill1rs. ] PtdilJlT 1977 May;90(5):726-729. 11

Cunningham AS. Morbidity in brcasl-fed and anificially fed infams. II.

J Ptditltr 1979 Nov;95(S Pr 1):685-689. Barness LA Nurririon and Nutrilional Disorders. III: Bchrman RE, edilOr. Ntbon 7rxlbook of l'tdil1trie>-14tb tdition.. Philadelphia, PA: WB Saundcrs Company, 1992 p. 116· J 17. Il

ScarialÎ PD, Grummer-Strawn LM. Fein SB. A longitudinal analysis of infam morbiclity anei lhc cxrCIII ofbreasrfcedillg in rhe lIniu~d Slale.<;. PedifUriel 1997 Jun;99(6):E5. 13

Baylcss TM. Huang SS Recurrenl abdominal pain duc \0 roiJk and IacIOse imolerancc in sehool-aged children. Ptdiatrics 1971 Jun;47(6): 10291032.

25

Baylcss TM. ROlhfdd B. el al. LaCloSC and milk imoler.rnce: dinical implicalions. N EnglJ Md 1975 May 29;292(22):1156-1159.

16

Oski FA. Dont Drink You, MiJk-9t1J edition. Brushton, NY: TEACH Service.<;, lue., 1983 p. 10.

17

Wilson NW. Hamburger RN. AJlergy 10 eow's milk in lhe first year of life and ilS prcvemion. AmI Allog,y 1988 Nov;6J(5):323-327.

18

29 Saarincn UM. Kajosaari M. BrcaSlfeeding as prophylaxis againsl atopic disease: prosp<:clive follow-lIp sludy umil 17 years old. !Anut 1995 OCI 21 ;346(8982): I065-1 069. 30

HamillOn, JR. Dierary PrOlcin IlIloleranee. In: Bchrman RE, ediror.

M'/soll Textlxx>k ofPtrlil1trie>-J4tlJl'dition.. Philaddphia, PA: WB Saundcrs

Company, 1992 p. 971-972. JI

HamiilOn, JR. Diclary Proteill Imolerance. In: Behrman RE. edilor.

Ne/soll 7l'Xtbook ofl'ediiZlricJ-/4tlJ ~dition.. Philadclphia. PA: WB Saunders

ompany, 1992 p. 971.

14.

beono G. Carroecio A, et al. Chronic constipalion as a symplOm ofcOw milk allergy. J Per/iaIr 1995 ];In; 126(1 ):34-39.

Barness LA Nurririoll alld NlItriliollal Disordcrs. In: Behrman RE, ediror. NelSOlI 'Textbook of Pditttria-14tb l'riition.. Philadelphia. l'A: WB S:lllndersCompany. 1992p. 116-117.

.H

\(, Barness LA Nurrilioll and NlIU;liona1 Disorder . In: Behrman RE, edilOr. Nl'/so>l Tcxtbook of Prditltria-14tlJ l'dition.. PhiJadclphia, PA: WB Saundcrs Company. 1992 p. 116-117.

35

lInningham AS. Morbiclity in breasl-feel and artificially red inf.mrs. J Ptditltr 1977 May;90(5):726-729. 15

Barncss LA NUlrilion and NUlrilional Di orelc:rs. In; Behrman RE, edilOr. Ncborr Textbook of Pedil1triCl-14tb tdition .. Philadelphia, PA: WB Sallnders Compan}', 1992 p. 120-121.

·2

J3

Speer F. The allergic ehild. Am Fam PlJysician 1975 Feb: II (2):88-94.

Gerrard J\X', MacKeuzie JW, er al. Cow's mifk allergy; prevaIenec and manifeSlatjons in an lInselecled series of newborns. ActI1 Piler!idrr Smnd

SllppI1973;2340:1-21.

Hamihon, JR. Dielary PrOleÎn IlHOICl1lllcc. In: Oehnnan RE. edjlOr.

Ntlson Texlbook ofl'~dil1tricr-14th ~dition .. Philaddphia, PA: WB Saunders

C{)mpany 1992 p. 971-972.

I

18

We:aver CM. C.,lcium bioavailabililY and irs rehlion

10

osreoporosis.

/>roc Soc Exp Biol Mtd 1992 JUII;200(2): 157-160.

Mall2 F. Why is lhc phosphorllS COlllem of human milk cxceplionally low? MonlJlJJelJr Kindahtilkd J992 Sep; 140(9 Suppl I ):S35-39.

Oski FA. Doni Drillk Your Milk-91h tditioll. Brushloo. NY: TEACH Servim, Ine.. 1983 p. 16,17.

36

HamihonJR. Dier:uy Prolein Inroleronc.c. In: Bchrman RE, edilor. Ntlson Talbook o/PedimricJ-I4th (dition.. Philadelphia. PA: WB Saunders Com-

37

pany, 1992 p. 971·972.

19

253

PROOF POSITIVE 3R

HamiltonJR. Oicr:u)' PrOlcin InlOlcr:mce. In: Behrman RE. edilOr. N~/soll

Tcxtbook ofPt'diall"iCJ-/4t1l "ii/ion.. I'hiladdpnia. PA: WB Saunders C~I1l pan)'. 1992 p. 971-972. Barness LA. Nurrilion :md Nurrilional Oisorders. In: Behrman RE, edilor. N~/son Talbook of Pet/ia/Tia-J4tb editioll. Philadclphia, l'A: WB S.~undcrs Comp:my. 1992 p. 128-129. 9

40 counrries bur nor in and Finland. A paradox. CiTCIIlllfioll )993 Oee: 88(6): 2771·2779. 63 Sc"aU JJ. Dierary iaClose a a possible risk faclor for ischacmic h(",'\" disca e: review of epidemiology. 111/ J CdTdiol1994 Oa; 46(3): 197-207.

cow's milk

K.1rjalainen J , Manin JM . el al. A bovine albumill pepridc as;l possible trÎgger of insulin-dependem dÎaberes l11ellilus N EJlgl J Med 1992 Jul 30;327(5):302-307.

Oski FA. DOlli DTinlr YoUT Milk-9tj, editioll. Brushron. NY: TEACH Serviccs, Inc., 1983 p.17.

65 C,,:\vallo MG. fava O. el al. CeJI-medialed il11mune rcsponse to bCla casein in rccem-onsel insulin-dependclll di;lbercs: il11plicarions for dis=c p:trl1ogencsis. Lallat 1996 Ocr 5:348(9032):926-928.

Jakobsson I. Unusual prcsem:llion of advcr e rcacrions proreins. Klin Pat/iatr 1985 JuJ-Aug;197(4):360-362.

.(0

10

-lI

.(20ski FA. lron deficiency in inf:mcy and childhood. N ElIgLJ M~d 1993 Jul 15;329(3): 190-193. U

Slockman JA 3rd. lron OchcÎcncy Anemia. [Il: Bchrman RE. edilOr.

Nelson 1r.x/book ofl'edia/rics-J4/IJ edilioll.. PhiladclphÎa. PA: WB Saunders Company, 1992 p. 1239. " Pennington JA. SupplememalY Tablcs: Sugars. In: BorUl's ami CJmTelJs Fooll VtJlllrs ofPorti01lJ Commoll/y Vsed, Fifimuh Editioll. Philadclphia, PA: J B. Lippincoll Co., 1989 p. 151.

'5

AmeriCln AcadelTl)' of l'ediauics Comminee on Nurrilion: Thc use of whole eow's milk in inf,UlC}'. J>ediIlfTil'S 1992 Jun;89(6 Pr 1): 11 05-1109.

,6 Luca.s A . Morlt]' R , e[ al. Brcast milk aml subscquenr imdJigence quo· rienr in ehildren born prercrm. [ancet 1992 Feb 1;339(8788):261-264 Walker M. Regarding higher IQs in prelt'rI11 inf.1Jlls fed human milk. BirtlJ 1993 Mar;20(l):50. -l1

Crook WG. Food aUergy-rhe grear masqucrader. Pcdiatr Clin Norr!J Am 1975 Feb:22(1):227-238. 48

Uauy-Oagach, It Mena P. NlIrrirional role ofomega-3 fau)' acids during thc petinaral period. Clin PeriTl/lfol 1995 Mar;22( 1): 157-175.

.(9

so American Acaderny of Pedianics. The liS/;' of wholc cow's milk in inElI1C}" Pcdiatrirs 1992 Jun;89(6): 1105-1109. ;1 Lucas A, Mori")'

R, er

al. Breasl milk and sub equcl1l illlcJ1igencc quoliem in cnildrcn born prererm. Lancet 1992 Fcb 1:339(8788):261-264.

52

Crook WG. Food aUergy-thc grear masquerader. PrdialT C/in NOTth

Am 1975 Feb:22(I):227-238. Crook WG. Food allcrgy-rhc grear masquerader. PrtliOtT Clill Nord} Am 1975 Feb;22(1):227-238. 53

).( Specr F. The allcrgic child. Am Flrm PJ~rsicion 1975 Fel>; J J (2):88-94. 5S Crook WG. Food aJlcrgy-rhc greal masquerader. Prtli,,/,. elin No/·t!J A/II 1975 Fc.b;22(1):227-238. '>6

Specr F. Tbe allergic chiJd. Am FO/ll Physidl1l1 1975 Fel>; II (2):88-94.

Sly RM. Adverse Reaerions ro Foods. In: Bchrman RE, ediror. Nclson Textbook ofPeditlfTics-J4r!J ~dilion .. Philadelphia, PA: \X18 Saunde!s Com-

57

p:Ul)', 1992 p. 608-610. SI)' RM. Adverse Re:1ctjons ro Foods. In: Bchrman RE. cdilor. Nrlson Trxrbook ofPedilttTies-J4t1udition.. Philadelphia, PA: WB Saulldcrs Company, 1992 p. 608-610. S8

Srern Re. Pulmon:tf}' Hemosiderosis. In: Bchnnan RE. ediror. Nl'!soll TcxtboolrofP~diarrics-/4rJlrdi/ion .. Philadclpbia.I'A: WB :tuuders Cornpany, 1992 p. 1089-1090. 59

60 Sedy S. OiCI and coronary discasc: a survey of morraljey ralCS :l.nd food consumplÎon st:UiSlics of24 counrrics. M~d Hypot!Jeus 1981 Jul: 7(7): 907918.

Rank P. Milk ami ,mcrioselerosis. Mcd HyporJmn 1986 Jul; 20(3): 317338.

(,1

6> Arraud-Wild SM, Connor SL, cr. al. OifFercnccs in coronar)' morraljry can bc explained by differcnecs in eholeslerol and salUrated fiu imakes in

25·4

64

Eslerly NB. Acne. In: Bt'hrman RE, ediror. N,,/son Textbook ofPedilu~dirioll .. Philadelphia. PA: \Xfll Sallnders Compan)', 1992 p. 1682-1684.

66

Ties-JiTll

PenninglOn .IA. Suppkmelllary 'f:lbles: lIgars. In: Bowes IlIId ClmrC/ls Food IIttlllrs ofPol'tiollJ Commoll6' Vsed, FifirnnlJ Etlitioll.l'hjladclphi;l, PA: J. B. Lippincou Co.. 1989 p. 151. 67

Pcnnington JA. Supplcl11cmary T.lbles: Sugars. In: BOIveJ alltl Ch"rrhÎ Fooll Value OfPOI·tiollJ Commoll(Y Useti, Fifia/lth Editioll. Philadelphia. PA:

6S

J. B. Lippincon Co.. 1989 p. 23-26. 69 The Food Processo! fOf \XIindows: NlIlIilio/l An:llysis & FilllCSS SoÎ[ware [c<>mplller program]. ESHA Re-s{~llch. Salem, Oregon. iO Oski FA. Dou't Drink Yo"r J.,jilJ.'-9Ih {'Ilitioll. BrushlOn. NY: TEACH Serviecs. Inc.. 1983 p. 56.57.

Oski FA. DOllf DTillJ.' You,. Milk-9rb editioll. Bellshron, Inc., 1983 p. -6.57.

Y: TI::ACH

Oski FA. DOII't Drillk l'aur Milk-9lb ~ditioll. BrushlOn. Services. Ine.. 1983 p. 59, 63. 64 .

Y: TEACH

7J

Scrviet~~, 7

7\ Oski FA. DOlli DriuJ.· l'auT MilJ.·-9tb editioll. BrushlOn, !'-TY: TEA H Service. Ine.. 1983 p. 59,64-65.

74 Ornish O. Brown SE. ('r al. C~n lifesryle ehangcs reverse coronary beatr discase?The LifcslYIc Heart Trial. Lmlm 1990 JuI21:336(8708): 129-133. 7

Sinori CR . Agradi E. el al. Soybean-prorein cliet in lhe ltcauuelll of

rypc-)I hypcrlipoprolcin;leruia. Lanm 1977 Feb 5; 1(8006):275-277. Rose O[~ Boyar AR \XIyndcr EL. Jlllcrnarional comparison of mort ali ry rares for cancer of thc brt"a 1, ovar)'. prOSlale. and colon. ;Ind per capila food conSllrnplion. Cllleer 1986 Oec 1;58(11):2363-2371.

76

n b Vecchia e. Negri E, et al. Dairy producrs :md thc risk oÎ prostatie cancer. Ollcolog'y 1991 ;48(5):406-41 O. 78 Benito E , Obrador A . et al. A popularion·based case-colllroi slud}' of colorccral cancer in Majoral. J. Dierar>' faClOrS. l/lt J Cancer 1990 Jan )5A5( I ):69-76.

GaskiJI Sl~ McGuire WL, er al. Brea.~l cancer monalicy :Uld dicr in rhe Unieed Srales. (,mee" Rrs 1979 Sep:39(9):3628-3637.

79

so Layur RB. I-leredirary aod Acquircd [ntrinsic. Moror

curoll Disea es. In: Benneu Je. Plum cdirors G'ol 7i'Xtbook o/Metlicilll'-20tIJ ,·ditiolJ. Phil:lddphia, l'A: WB Saunders COlllpa.n)', 1996. p. 2052-2055.

r.

SI Oski FA. Dorti Drink l'all,. Milk-9lh etlitioll. BrushroJ\, Serviccs. Inc.. 1983 p. 63.

Y: TUCH

sz Rudick RA. Mulliplc e1erosis and Rdalcd C<>ndilions. In: BCnlJCll Jc, Plum F. cdirotS ~ciITt'X/book ofMrtLicille-20tlJ editio". Phibddphia. PA; WB aunders Company, 1996. p. 2106-211 . AgranofT BW; Goldberg D. Oier and Ihe geographical dimiburion of multiple sderosis. Llllim 1974 Nov 2:2(7888): 1061-1 066.

SJ

84 Oski FA. DO/li Drillk .Yollr Milk-9th etlitioll. Brushwn, NY: TEACH Serviecs. Inc.. 1983 p. 53.

85

TlJc \'Vorld Book Ency"/oprtlia. Chicago. IL: World Book, Ine., voI. 13,

1993.

MILK Hyde JL, Blackweli JH, CIUis JJ. Effeet 01 pasleuri2.:ltion and evaporalioo on 1001-a.nd-mOlllh discasc virus in wholc mllk Irom inlcclcd cows. CtmJ Comp Med 1975 )llJ;39.(3):305-309.

86

100 Nad"ka.vukaren A. FQOd QUl1liry in Mall fI1ul EnlJiromnmt: A Healtb Pcrspcetiv"-3rd cditioll. Prospect Heighls, IL: Wavcland Press Ine., 1990

p.243. Nadakavubren A. Food QlUl/iry ill Mfm tilld Ellvironment: A HCIllth editioll. Prospect HciglllS, TL: WavcJand Press Inc., 1990 p.243

BladwclUH , Hyde JL. EITcel 01 heal on IOOl-and-momh dise'lse virus (FMDV) in lhc components of milk from H,,'IDV-infccled cows. J Hyg (Lond) 1976 Allg;77(I):77-83.

Pe/~pccrivt-3rd

ilS Rubino MJ. InnctiViuion ofbovine Imkemiti vims in milk. TImis, Uuiversiry of Iowa. December 1980. As cited In: Hulsc V. Mad eOUl! /Ind Mi/k Glue. Phoenix, OR: Marble Moumain Publishers. 1996 p. 157.

IMI o.fFood

87

Ccnrers for Disease Comrol and Prevention (CDC). Outbrcak of,almo"dIa cnreritidis assocjaled wirh nationally dislributed jee cream produetsMilmesota, SOlllh Dakora, aud Wiseonsin. 1994. MIvf\·'(lR 1994 OCl. 14; 43(40):740-741.

3?

'10 Htxlbcrg CW. Korlath JA, el al. A muhisl31e ombrcak of Salmonclla javi.ana and Salmonclla oranienburg infeaions duc 10 consumplion ofeon~lIl1inaled ehcese.JAMA 1992 Dcc 9;268(22):3203-3207.

" LaSI LM. WaJlaec RB. ~''''I)(cy-Rosenall-Lm, P"blic Hcalrb and Preu(//tivc Mcdiâne-13tb cdirion. NorwaJk, ef: Applelon and Lange. 1992 p. 150. 91 Last LM, Wallace RB. Max(:y-Rosel1
263. laSI LM, W..llaef' RB. Maxcy-Roscll:lu-Last, Public Healtb 1/",1 Pn'vl'nriuc Medicilu-13tb cdition. Norw:llk, CT: Applelon and bugc, 1992 p.

9)

236. ~, laSI

LM. WaJlace RE. Maxcy-Rosenall-L1St, P"blii' Hi'llltb ami P,"'JCIIrivr M«1.icine-J3rh cdition. Norwalk. CT: Applclon 'Ind unge, 1992 p. 199.

101

102

Brady MS, Karl. SE. AmjbiolicJAnlimierobiaJ Rcsidues in Milk. JourProtectio" 1988;510):8-11.

10) Br:ldy MS, While ,Kalz SE. Resislance Dt'Vclopmelll Potential of AnlibioridAlIlimicrobial Residllc Lcvels Designalcd as "Safe Levcls".JourIIfII ofFood Proltctioll 1993;56(3):229-233.

10'1 US Prcvcmive Service.s 'lask Force. Screening for Poslmcnopausal Oslcoporosis. In GlIitic ro Clinical PrelJellliuc SerlJiw. Bahimore, MD: Williams and Wilkins, 1996 p. 509-516. 105 MiUer GD, Jaan'is JK, McBcan LD. Halldbook ofDai,.y Food" tind N,,tritioll. Boea Iblon, FL: CRC Press, 1995.

D.1wson-Hughes B, OaJlal GE, CI al. ERecl of viramin D supplcmcnlaon winwnime and overall bone loss in hcaJthy postmenopausaJ womell. AnnlntemMedI9910cll;115(7):505-512. IOb

d011

'07 Abboll RO, Curb JO, el aJ. Effcel of dielary c.1Jcium and milk conSUlllplion on risk of rluQlllhocmboJic slroke in older mjddle-agcd meu. l'he Honolulu Hem Progr:un. Strokc 1996 May;27(5):8 13-818.

1ns Miller GD, Jaarvis JK, McBe'ln LO. HlllldbookofDairy Footls lmd Nutrition. Boca RaIon. FL: CRC Press, 1995. 109

Public Voiajor FOl)tI rI",I Hralth Polic)', 1992.

IlO

Ellen Ham. Public Voicc for Food fllld Hcalth Poliry. 1992.

While EG. C()uw,l, mI Din aY/d Foods. Hagcrslown, MO: Review '.Ind HcraJd Publishjng Assoei
LaSI LM, WaJlace RB. Maxcy-Rosenau-La8t, Public Hc,dtb 11",1 PUlIC}}tirJC Mcdicinc-l3rh et!iriOIl. orwalk, CT ApplelOn and b,llge. 1992 p.

95

199.

WhilC EG. Coumrls OII Diet tind FOQtis. Hagc.rstown, MD: RcviL"W alld Herald Publishing Associarjon, 1976 p. 357.

LasI LM. WaJlace RB. Maxcy-Roscnau-Llst, Public Hmltb IInd Prt.'IJeJ1tive Medicinl!-13tb edililJlI. Norwalk, el: Applewl1 and langc, 1992 p.

113 \V1hite EG. U>llIIst:ls on Dier Illltl Foods. Hagcrstowll, MD: Rcvicw and Herald Publishing A.sociatioll, 1976 p. 460,

96

591. laSI LM, Wallaec RB. Maxcy-Roscll.1u-b t, Public Hmlth illld ?relJtll!ilie Medicille-13th edi,ion. Norwalk, el': ApplcwlI :Ind Llnge, 1992 p. 591. 97

Hulse V. Crohu's disc.1se from miJk. In: MiIIi Curvs fmd Milk Ilix, OR: Marble MOlllllain Publishers, 1996 p. 251.

98

Grile.

112

II American Acadcrny of Pedialrics COll1nlillCe on NUlrilioo: The use of .....hole cow's milk in infalley. I'edi{I1,·ic.s 1992 JUll;89(6 Pl 1): 1J05-1109.

115 Oskj l'A. DOII~ D,.ink yo"r Milk-9th ţJitÎoll. BrushlOJl. NV: l'EACH Services, Ine.. 1983 p. 4.

Phoe-

99 Gram lR.

BaU HJ, et aJ. lnactivatioll ofMycobactcrillm parambcreulosis in ClJws' miJk al p:lSlcllrizarion lempaalurcs. ilppi b/lJiron Miuobiol1996 fcb;62(2):63 1-636.

255

PROOF POSrTIVE

256

CHAPTER TWELVE

THE

RONTAL OBE:

The Crown ofthe Brain SECTION I.

Function ofthe Frontal Lobe.

W

hen the sun rose on Septcm-

bec 13, 1848, no one then liv-

ing could have imagined ,rhe . momenrous evems that would bcgin ro shake the world of.medical science that day. The suange uain of evenrs centered on a respected 25-year-old railroad consuuction foreman in Vermollt named Phineas P Gage. I imagine tlle day began like ;U1y other workday. Phineas probably are breakfasr, gor ready for work. ki sed his wife and children, aud thcn headed off to his railway construction job. As he was walking om the door he may well have said, 'TU be home for supper ronight." Bur Phineas did nor make it home for rhe evening me.,.!. His Cllrrenr assignment was laying railway track rhrough a mounrainolls region. A significam amount ofblasring was necessary. Phineas was the man in charge of rhe blasring. The fOurine was wdl esrablished:

drill a long hole ioto tlle rock, fiU it partially full wirh explosive powder, then CQver rhe powder wirh sand. A ramping iron was nex( used to pound down on the sand, consolidating the charge. Finally, a fuse would be lit ro detonate the explosion. an mat farefuJ September l3 u" everything was going as planned. The long hoBow hole had been drilled, and rhe explosive charge was carcfully set in (he hole. But a glicch developed in rhe romine. Wherher Phineas was disuacted or wherher his assistant simply failed to CQvcr the charge with sand is unclear. In any evenr, Gage was sranding ar rhe hole unaware thar no sand was covering rhe explosive charge. The unwitring Gage began ramping direcdy over (he powder. Apparendy rhe rod generated a spark as ir glanced a srone inside rhe hole. The uncovered powder ignited and ser off a powerful explosion. Instead of going through t!le rock, rhe force of rhe blast came srraighr roward Phineas. The 13-pound ramping iron, abour 1 inch thick and 3 feer long, was hurled direcdy ar him. Wirh rne force of a missile, tbe iron went under his left cheekbone, behind his left eye, through his brain, aod rhen our again. The bar exired

257

PROOF POSITIVE severa! inche bebind his hairlioe after ing rhrough Phineas' skull, sdp, and hair on its way out. SA powerful was the blast rhat the raroping bar stiH had enollgh force ro fIy airborne out ofPhincas' head and "lod Olaoy yards away. The iocat.ion of Gage's

----!t

_,..-'r..·... T ....

Figure 1 injury is shown in Figure 1. You would assume ehat che dramaric explosion eerminated Phineas Gage's youog life. Bue it did not. Gage was briefly stuoned, bue wiehin a shorr cime he regained ful! consciousness and was able t.o talk and even walk with rhe assistance of his workers. Despite how well he did iJliriaUy, infeceion did rhreaten his life over the next. several weeks. Amazingly, in chac pre-ancibioeic age, Ph ineas Gage did not come down with any fatal infecrions. He survived aod made a nearly compleee recovery-as far as his physieal healeh was coneemed. The only physical traces that remained were the loss ofvision in his leh eye, a seM undeI' his left cheekbone where the tamping iron enrcred, and a scar On the eop of his head where it exited. There was juse ooe major problem: he was no longer Phineas Gage.

258

Dl1maged Frontl11 Lobe Cl1used Deteriorl1tion ofChl1rl1cter Before rhe accident Phineas was a well· loved, re.sponsible, and incelligem worker and husband. He was known as a person with high mora.ls and was described accord· ing tO one accounr as ua pious aod reverent ehurchgoer." So excellent was Phineas' charaeter that work reeords lauded him as uthe most efficient and eapablc foreman" employed by ilie Rudand and Burlington Raii· road. Aftcr rhe accidem, Gage seemed ro be physiea1l)' jusr as fit and memally just as illtelligem. He could work and speak JUSt as well as he could before the accident. His memory was just as good. But soroe major things were different aEcer che accident. His moral decline was im mediately eviden c. He became very emotional abolit things and would gec angry qll-Îckly. Nor long afrer rus injury he lost interesr in chureh and spiritual things. Phineas becameirreverent, and prone to excessive profaniry. He lost ali respecr for social custoOls and beca-Ole torally irresponsi bie. He wene from a prized employee to the unemploYOlent roUs. His company dismissed him when he cOlild no longer responsibly discharge rus duries. Dr. John Harlow, his physician, srared iliac the accident descroyed Gage's "cqllilibrium or balance, so to speak, between his inreUecwal faculry and his animal propensieies." He ended up forsaking his wife and family and ing a travcling circus. Phineas Gage's rfaumaeic froncal lobotomy cost him his personajity, his moral sean'dards, and his comrnirmem ro famil)'. church, and loved ooes. f>hineas died abollt 13 years afrer the accident. Dr. Harlow found ouc abolit his death some five years aher ilie fact, aod apparently for the sake of science, made an unusual re'quesc. He asked Phineas' family if they would allow his body ta be exhuroed and his skull kept as a permanent medical record. The family agreed, and ro chis day rhe skull along with che tamping iron (which was buried alollgside Phineas) are hOllsed in (he Warren Anatomical Medical Museum at Harvard University.1

THE FRONTAL LOBE Since 00 auropsy was done, specularioo has conrinued throughoUl rhe years as to where precisely the injury occurred. The landmark sracus of rhis illusrrious case was further resrified ro in 1994, when one of the world's mosr presrigiolls sciemific journ,t1s, Science, devoted irs cover story ro Phineas Gage. 1 The journal feamred an artide co-authored by scientisrs ar Harvard, the Univcrsiry of Iowa, ami the 5,11k Institute in San Diego. These researchers used advanced computer modeling and X-ray studies of rhe skull ro rry ro pinpoinr rhe exaCT paft of the brain that actllally had been dalllaged. They concluded rhar Phineas Gage had lost an important area on both sides of the front parr of his brain, known as rhe left and right regioJls of rhe frontal lahes. Whar do we leam from Phineas Gage's unique case? It demonsr.rated lhat a section of the brajn, r!le frontallobe, is responsible for moral reasonjng and social behavior.

The Features ofthis Chapter The chapter begins with an explanation of the funcrion of the frontal lobe. Next, facrors rhar impair rhe action of rhe frontal lobe will be e,"plored. Then, we examine the benefirs aod harm ro the fromal labe rhar dier can cause. Finally, other actÎons that we ean take ro enhanc; the f1.1nction of r11e tronrallobe will be presented.

Lifestyle Faetors Can Also Damage the Frontal Lobe This area of rhe brain has taken on even greater sigllificance roday for ar leasr two reasons. Firsr, rJlere is a growing emphasis on personaj developmenr and menraJ performance. Second, man)' feel duc socieral norms and moral reasoning are crumbling. 50me ncufOscÎenrisrs are wondering if there are physical reasons to explaÎn such pllfporrcd ch,wges. Can there be lifestyk filCtors that may damage rhis critical paft of the brain and affcct, in essence, who we are? The answer is definitely "Yes." OUl' daily lifeslyle practices can indeed affect aur remperament, aur emotions, and our behavior. The front paft of our brain

G.111 either be enhanced or eompromised by our habitul1lchoices. This revelation ofbrain science has profound implieaeions for aII of us. By understanding rhe facrors rhat af:' feer our frontai lobes, we G.1.n improve our performance in work ar 5chool, develop beuer social skjlls, be more responsible parenrs, neighbors, or spouses-and rhe list goes ono Alchough most people do not pick up a health book ro read abolit their frontal Iabes, ch.is may be ehe mosr important chapcer in my emire book. I encourage you ro reaei what follows carefully. Your abiliry to successfully implement the healthy lifestyle changes advocated in chis book may weB depend an your front al labe operating at peak efficÎency.

Functions ofthe Frontal Lobe The brajn is divided inco severa! sec[jons, or Iabes. Each lobe has specific functions. Behind che forehead are the froneai lobes. For cOllvenience, we refer ro both the righr and the lefc froncal lobes collectively as "the fronr.u lobe." It is t!le largesc labe of ehe brain. 3 It is rhe sear of judgment, reasoni.og, înrellect, and the wi11. 4. s. 6 It is the control center of our emire being. Some scienrisrs refer ca the fromal lohe as rhe "crown" of the brain. Studies show ehat rhis so-called "crown" performs a variery of

T

THE OWN Scîentific stlldies show tlle Ironta/tobe is tire seat of

· spirituality · morality frontd lotle --I:n~~iJ'\ · the will

figure 2

259

PROOF POSITIVE viral funcri~ns. Some of these are listed in Figure 2. 7 Spirirualiry, character, moraliry, and will are the characreris{ics thal give us our unique individuality. Therefore, a person with a damaged frontaI lobe may look ilie same as they always did, but if you interact wirh lhem, it is usually apparent {har rhey are "jusr nor rhe same." The Book of Books alludes ro the significance of rhe frontal lobe in knowing

"And they shall see His face; and his, name shall be in their foreheads." Revelation 22:4 Figure 3

SIZE OF LS 30!------25

%of brain in 20 r - - - - - - - - froDtal lobe I S r - - - - -

10 S

o figure 4

260

Cats

Dogs

Chimpanzees

Humaos

Gad. The last book of the Bible makes a provocarive srarement, quored in Figure 3This rext suggests thar God's characler C'His name") is reproduced in our charactcr (exemplified by rhe fronral lobe, which is JUSI behind our forehead).

Brain Size and Function It is fascinaring to observe how rhe size of rhe fronral lobe differs among men and various bcasrs. It is the fromal lobe that large1y sers humans apan from rhe rest of t!le animal kingdom, as shown in Figure 4. 8 Those wirh rhe smallesr fromal lobes have limited inslinet-driven ways of life. Those Wilh Iarger frontal lobes are able ro perform more complex funcrions. Cars, wirh only 3.5 percent of {he brain in rhe frontal lobe, are limired in judgmenr and reasoning power. They have a very limired capabiliry ro analyze informarion and make judgmenrs based an new informarÎon; rhlls, rhey basically rely on instinct. Dogs are more rrainable because 7 percent of rheir brain is in rhe fronrallobe. Among the animals, chimpanzees have rhe largesr frontal lobe-up ro 17 percenr of their brain. Humans, on rhe other hand, have 33 ro 38 percel1t of their brain in t.he fromallobe. Some animals have other ponions of the brain thar are more deliel<Jped rhan human beings. For insrancc, compared ro hllmans, chimpanzees have much largcr cerebellums-me brain area rhar conrrols coordinarion. This stands ro reason, bccause chimps need weU-honed baJance and agiliry ro swing f~om tree ro trec. Birds aJso have very weB developed cerebellums for flying, landing, and hunting. Ali of rhese activities require a high le-vei of coordination. Other animals may have a much more generolls occipilal lobe-the brain center where vision is housed. Hence, thcir eyesight is generally much better rhan thar of humans. StiH other animals have more developed parietal lobes. However, for humans. the difference is c1early our much larger frontallobe. Thus, we have r.he capaciry for elevared spiritual reasoning and superior learning abiliry. 1'0 fully appreciarc rhe significance of rhe fronlallobes. it is valuable lO examine a few

THE FRONTAL LOBE more cases from (he annals of medical hisrory. One of che reasons for rhis is rhar Phineas Gage only lost pan of his frontal lobes. Lifesryle choices can affecr our entire fi"o11tallobes-albeir in less dramatic ways rhan Phineas' loss.

Other Case Studies ofFronta! Lobe DarJUlge In rhe late 1800s psychiarrists began using a surgical procedure called a "frontal loboromy" (Iiterally meaning removal of rhe fromal lobe). Although someeimes a porrion of (he labe was physic.'lUy removed, at ocher times it was "funcriona1ly" removed by severing its nerve connecrions. The operation inieially was used ro "help" peoplc who were violenrly or criminally insane. 9 The pracrice of fromal loboromy bec.1me increasingly popular in the 1930s aod 1940s, so much so that one of che pioneers of rhe more modern eechnique, Dr. Egas Moruz, received the 1949 Nobel Prize for Medicine. 10 Anoeher measure of its populariry was its accepcance by rhe cultural elite. Rosemary Kennedy, John F. Kenoedy's miIdly retarded sisrer, underwent froncal loboromy.l J Since the procedure's heyday in the mid 1900s, we have more fully appreciatcd its side effecrs of devastating psychological consequences. Consequenrly, this operarion is rarely used today.

Patricia's Frontal Lobotomy Patrîcia was a very successful surgical nurse who was preparing for a froncal 10boromy. The hope was [hat the surgery would tesolve her man)' guilt problems ehar she had struggled wirh for several years. Following rhe procedure there were striking changes in her incere rs, attirude, work performance, and integriry. It was obvious that Patrieia was a diffcrent person. Her characteristics before and after the loboromy are summarized in Figure 5. 12

Fronta! Lobe Damage in aFouryear-old M.H., a fouryear old giel, was seruck by a car and suffered damage to both sides of her froncal lobe. After the accidenc he ex-

E

n A ' .........

-------------Before lohotomy: • Extremely efficieot operatiog room nurse • Very fond of books aod belonged to the nurses' Iiterary circle

After /ohotomy: • Lost much of her ambition • Lost interest in her work, and lost sympathy with her patients • Could only perform subordinate work. Rer attitude: "1 do not care if 1 make a mistake; it wiU turn out aII right in tbe eod." • Lost interest in books Figura 5

• Temper outbursts when frustrated • Verbally and physiciilly assaultive in an abrupt, unpredictable, and short-Iived manner • Sexually Ipromiscuous from early teens • No sustained friendships • Intermittent heavy of alcohol and mari~uana,

• ImpuJsively attempted suicide twice Figure 6 hibited depraved behavior ebat persisced inro her adult life. The changes in her character were as seriking as (hose of Parricia. These tragic changes are liseed in Figure 6. 13

Damage to a Baby's Fronta! Lobe Baby G. K. suffered bilateral fromallobe damage in the firsr seven days of !lis life. From childhood to age 31 he had the rypical characreriseic.~ of someone who had experienced Eroncallobe damage, as described

261

PROOF POSITIVE

Common Effects ofCompromised Frontal Lobes

As the ehUd developed, he · did Dot respond to parental discipline · always sought gratification of his immediate needs • Dever developed adequate friendships • blamed his difficulties on others · was irresponsible and tended to wander · was easily influenced by other deviant children • masturbated regularly and was bisexual Figure 7

• Impairment of moral principle • Social impairment (Ioss of love for family) · Lack of foresight • Incapable of abstract reasoning • Cannot interpret proverbs · Diminisbed ability for matbematical understanding · Loss of empathy · Lack of restraint (boasting, bostility, aggressiveness)

Figura 8

262

in Figure 7. 14 At firsr his f.1mily thought his irresponsible behavior was due [Q the fact chac he was merely a child. Unforrunately, these traits persisted inco adulthood. Parental discipline seemed to have no effecL He had no meaningful friendships, and he could nor see his many faulrs. Insistence upon immemace gratificaeion (including sexual promiscuiry) is a common characteriscic wilh froncal lobe impairmem.

Through srudies of accidemal damage ro rhe fronrallobes combined Wilh rhe resulcs of fromal loboromies and studies of drugs rhat aifecc the front brain, sciemisrs have idenrified many of rhe effecrs of compromised fromal lobes. These effecIs are listed in Figure 8. 15 . 16. 17. 18.. 19 As an illusrration of the moral and social effeccs of the fronrallobe, consider ilie following rrue story. One woman prior ro going inm surgery was asked. "What would you do ifyou had lost a watch rhat you had borrowed?" The lady answered, "1 would need ro pay for che watch or buy one and return it." Afeer her froncal lobe was re.moved in surgery and she had recovered, she was asked the same quescion. This rime she answered, "1 wOllld have ro bocrow anomer warch!" As a child matures, lhe effect of fronlal lobe developmenr is apparenc. A smalt child can only see ahead one day ar a cime. You can cell him someching is going ro happen lomorrow and he wiD it only if you remind him. As chat child m:llUres he will begin ro gain more foresighr. 8y che rime he reaches second grade, he real izes rhar neXl year he will be in rhe third grade. As he cominlles ro mature, he will evemllally be planning for his career. The frontallobe continues ro develop for 30 years. 10 Wirh proper craining, as rhe child matllIeS into an adulc, he wiU ultimarely reaJize (hat his aerions roday have a bearing on his ererniry ahead. This indic
THE FRONTAL LOBE of rhe parierallobe. ThllS, wirhoue lhe frontal lobe funcrioning, you can have great marhemarical skills iJ\ adei ing, subtraccing, and mulriplication. However, when it comcs ro higher mathematics that reqllires reasoning, such as algebra, geom.erry, and cspecialJy calculus, fromallobe funcrions are required for flawless resulrs. An lUlimpaired fronrallobe is also a musr if you wane ro empaehize mosr dTecrively wirh someone who is bescr wirh a problem. This is especially rrue if rhey are going rhrough somelhing thar you have never personallyexperienced. A lisr of mher common effecrs of fronrallobe impairment is shown in Figure 9. 2 1. l2, 23

'!r

~. \~,.

(!f'

· Memory impairment (especially of recent events) · Distractibility and restlessness ~...; · Flight of ideas (fantasies, ...-... emotional instability) · Apathy (Iack of initiative) . Indifference to one's condition (happy-go-Iucky)

Psychological Diseases Rooted in an Impaired Frontal Lobe It is no surprise thar some p ychological diseases have rheir roors in frontallobe problems. A lisr of rhese disord r is shown in Figure 10. Mania is an emorional elisorder characterized by remarkable acriviry, exciremenc, rapid ing of ideas, insomnia, and unsrable anention span. It can have irs root in compromised frontaI lobe funcrion. Obsessivc compulsive disorder characrerized by a seemingly uncontrolbble persisrent and reperirive inrrusion of unwanted rhoughrs, urges, or acrions, can aJso arise from froncal lobe impairmenL Anention deficit hyperactiviry disorder also can resll!r from fronrallobe problems. 24 Since 1990, rhe nllmber of people diagnosed as having arrenrion deficir hyperacriviry disorder in rhe U.S. !las risen from 900,000 ro more rhan two million in 1995. 25 Many cases of depression may also be relaeed ro the frooral lobe. Sophisticated brain Sc..1JlS (PET scans) reveal mar depressed parienrs ma)' have a 60 percent redllC(ion in frontal lobe blood flow. 26 In working wirh depressed parienrs, (here is evidence mar if OJ)e can enhance rhe aceiviry of their frontaI labe, blood flow ro rhar arca will incrcasc, and rhe depression can be markcelly lfnproved or correcred.

Figure 9

· Mania · Obsessive compulsive disorder · Appetite increase · Attention deficit Ityperactivity disorder · Depression Figure 10

Appetite and the Frontal Lobe Many common physicaL heaLth probLems rhat 1 cncollnter in my work as a physician have meir roor cau es in rhe froncallobc of rhe brain. Appetire control is onc such problem rhar is prevalenr in our sociery. Nor every overweight person has an apperire conrrol problem, but many do. The rising level of obesÎt)' in America raises concerns rhar appctire cOfl.rrol problems are becom,ing more prevalenrY· 28 Even appctirc disorders

263

PROOF POSITIVE such as bulimia appear to have their origin in the frontal lobe. The highest renter of appetite control is in the frontallobe of the brain. No.maner how hllngry you are or how srrong your desire may be for someming rhat may be harmflll, you can generaHy suppress rhar desire if your frontallobe is fllncrioning optimally. Those wirhouc a capable frontallobe have great difficulry in suppressing sllch urges. Some overweight individuals who kllOW rhey are earing too much wiU continue ta eat because their frontallobes are not fuUy able ro say "no."

Jmplications ofFrontal Lobe Research These srudies demonsrrate the frontal lobe's vital role in dererminillg our character. An impaired fronr.1llobe results in an impaired characrer. Self conrrol, rrusrworrhiness, reliabiliry, serious reading, abstract reasoning, and interpersonal reIarionships are ali complex funcrions ehar depend upon a well-funcrioning frontal lobe. The acâtUntal or surgically planl1ed damage ro me fronta1lobe rypified in our case srudies is one ming, but whar abouc damage that 111.1y unwiningly result from an unhealtlry liftstyle? The chief message of chis chaprer is nor to encourage you ro avoid professions where you are working wim dynamite, or to be eareful when erossing the street, or ro avoid surgery for psychiarric illness. AU of rhese things are important. However, the most common causes offronrallobe impa.i.rment roday are not surgeries, occuparional injuries, or other rraluna. The main causes of compromised frontal lobe fimetion are im-

proper iifestyle habits.

264

Indeed, this chapter's main message is that the negarive character traits of the individuals we have examined rhus (ar are nor limited lO those who have missing or damaged frontallobes due ro trauma. Many in our soeiery roday suffer rhe same rragic charaerer defects as rhe resulr oflifesryle ehoices. Many of our mosr cherished habits give LIS short-rerm grarification but silendy rob us of that which is ofinestimable value-who we reallyare. Unknowingly, our habits lOday are impairing rhe performance of our fronrallobes both roday and tomorrow. One purpose of rhis chapter rhen is ro

show rhar frontal lobe impairment is not Iimited ro the efTecr.s of traumatie damage ar surgical removal. In my opinion, the effecrs ofJifesryle aod nurririon on our fronrallobe are ulrimately more important than rheir effecrs on heart disease, cancer, osteoporosis, kidney failure, and ali rhe orher degencrative diseases combined. The brain deserves prioriry for protection when you realize [hat this is where our qualiry of life ongmates. Jusr as Lifestyle choices proteet the frontaI lobe, a healthy frontal lobe purs us in me best position ro take charge of our lives. This means thar as I make healrhier choices, my (romal lobe performance improves, making furure lifesryle changes even easier. Perhaps no [romal lobe function is as vital ro making lîfesryle changes easier rhan the power of the will. Willpower may nor seern ali rhar important in our daily lives but it really is essenrial. 1 have seeu many paricms die because of deficient willpower. No, 1 am not talking abour individuals who Iose rhe will ro live, as important as thar is. 1am referring ro the c.'lSes of rhousands who die because rhey fdc they did not have the willpower lO dlange rheir lifesryles before it was roo late. Today tens of rhousands are langllishing on rheir deathbeds beeause of will· power deficiencies. There are diabetics who for years did nor have che strengrh of wiU ro exereise, cat right, or keep eareful warch of rheir blood sllgars. Now they are in the end stages of hearr and kidney disease. There are smokers who Jid nor have the resolve ro "qllit for good." Now they are dying with terminal cancer. There are orher individuals who did nor have the willpower ro make necessary lifesryle changes for cheir blood pressure problems. Now they lie paralyzed as the aftermath of illcapacitating srrokes. These eases and many odlers tesri/y ro the great deanh ofwillpower in our land. In faet, ooe of my greatest concems wirh wriring rhis book is that many ofthe imponantancllife cha.nging-insighrs that 1discuss will never g,\in a foothold in many readers' lives. The reason? Lack of wiUpower. From this perspective, 1 underscore me faer mat one of me frontallobe's mosr viral fuocrions is the will. Scientists have dem-

THE FRONTAL LOBE onstrar.ed rhar whar we caII "willpower" resides in rhe frontal lobe. 29 Dr. Bernell Baldwin, Ph.D., neurophysiologisr ar Georgia's Wildwood Institute, summarized some of iliis imporranc literaeure on rhe will in an article ro leaders of fairh conununities. Baldwin poimed out rhar research on shrapnel wounds in World War 1 vereraJ1S uncovered deficirs in willpowe.r among rhose who injured thc from of their brains. Those who sustained injuries ro rhe back of their heads, however, experienced no impairmenr of thei r wilpo Closdy related ta willpower is aur abiliry co discern where the banle teally is. If we do not sec issues clearly, we will nm likely recognize rhat we need ro exert OUt willpowet ta ovetcome a chaHenge. Ta illustrate this poillr, Dr. Baldwin cited the rcsearch of the Russian scienrist, A.R. Luria. Luria found that individuals with normal [rontai lobes had the abiliry ta draw rapid conclusions about rhe meaning of ca refu lIy designed piceutes. IndividuaIs with fromaI lobe impajrmenr could accurate1y describe componenrs of the picture-bllt rhey tended nor ro see "the big pÎcrure"-rhe broader meaning behind rhe derails. This is very relevanr in rhe arena of lifestyle change. Deficiencies in insighr leave us destined ta overlook how key lifesryle concepts apply to aur own lives. WiUpower shorrfalls, on the orher hand, predispose us ro f.'tiIure even in the are.'tS where we dearly recognize we have a problem. In shon, the twin frontai labe fi.mctions of insighr anei will are indispensable ta a successful applicarion of ali rhe material that 1 presenr in rhis book. There is a final conretnporary reason why arrenrion to rhe frontal lobe is so important. Today psychological counseling and behavioral rherapy are popular, and somerimes beneficial. However, some mental healrh pracrieioners overlook the fact rhar current lifesryle habies may be important factors conrriburing ro psychological illnesses. lf those who feei rhe need for such counseling would adopt a rmIy heahhy lifesryle by paying careful artenrion ro whae rhey pur into their bodies and expose their minds to, many would experience a happier, more fulfilling existence.

SECTION II

Frontal Lobe Impairmentfrom Drugs, Nicotine, Alcoho4 Caffeine, and a Toxic Chemical. What Lifestyle Factors Affect our Frontal Lobes? To maximize the eHiciency of our frontal lobes we must focus on boch che positive things we shoulel be doing and the negarive things we should be avoiding. In fact, by fully recognizing the ways rhar we often compromise our fronrallobes, we can better appreciate how the he.alrhful facrors can aid us in expanding brain capaciries. From this perspecrive, I will begin by looking ar lifesryle habits rhat impair frontaI lobe fi.mcrion. 1 will later address some of ilie key facrors that are calculated ro impro1Je frontallobe function. A list of drugs ro avoid in order ro protect our frontallobc is shown in Figure Il.

• illicit drugs • certain p'rescription drugs • other legal social drugs: • alcobol • caffeine • nicotine Figure 11

265

PROOF POSITIVE

Effict ofDrugs on the Fronta! Lobe Many Americans have becn wringing rheir hands of late regarding our narion's heav)' and increasing use of drugs. There has been a sharp upturn recenrly in borh the acceprance of illicir drugs and che use of rhose drugs among American youm accord ing ro m3ny widely publicized surveys.3\ Parents are afraid rheir children wiJl use illicic drugs because of cheir addicrive nature and rhe physical, mental, and social implicarions of rhar addiction. They also fear whar rheir children mighr do while "under the in1luence," such as engaging in highrisk behaviors rhar cOllld ulrimarely cur shorr their young lives. This lasr concern i especially important. Even a pe.rsol1 who does nor appear ro be i 11 toxica red ca n have blunced fromal lobe funcrion. Such impairmenc predisposes ta risk-taking behaviors char can result in an automobile accident, comrac[ing HIV jnfection, or ome od1er Ijfe-changing or life-shortening event. Drugs otber tbtln il/icit drugs impair fronrallobe fllncrion. Many feel cheatedif rhey pay ro see a doctor and do nor walk away wirh ar least one prescriprion for a medicinaL drug. Television, radjo, and magazine ads bombard LIS wirh our need foc over-checOllncer cemedie.s. Caffeine and alcohol ace culrurally accepted drugs. Nicoeine use is socially stigmatized in many settings, but is stiU rreated legally as a lifescyle choice, not a powecfully addicrive mind-altering drug.

I!licit Drugs and Menta! Impairment

266

The dallgers of illieir drllgs 00 menral performance are well recognized. There seems ro be LinIe need ro belabor how such "mind alcering" drugs alter tIle mind-inc1uding rhe frontal lobe. This problem, however, is even worse chan previously thoughr. There is growing evidence char drugs of abuse affecr rhe brain long after rheir acute effects have wom of[ Recent ceseacch funded by ilie National Institute on Drug Ahuse found chat college scudents who were regular marijwma s had defec[s in their Ilttention, memory, Ilnd learning even 24 hours afrer their last lIse of rhe drug. 32 Long aher rhe high was over, t11e brain was sti II srruggling along in low gear.

Marijuana, like its cousins alcohol and nicorine, has now been demonsrrated ro harm rhe brai!) of [he developing fetus. A morhcr who lIses macijuana givcs her child a lifelong legacy of brain impairment. 33 The message from marijuana research applies to the use of alcohol, which is covered later in rhis chapter; namely, che brain performance of chose who use alcohol aJld ocher mindalrering drugs can be impaired long after the Llser chinks rhe effecrs have wom off. For optimal froncal lobe funcrion, leave illicic drugs ouc of ilie pictl1re.

Lega! Drugs Can Also Assault the Fronta! Lobe Many peescriprion and over-the-counrer drug medicarions CaJl also depress fromal lobe funecion. If you go ro a library and read a drug reference abolit rhe effecc r.har various drugs havc, you will find rhar mally have an inflllenee on rhe ceneral nervous system, and one of rhe moSt commonlv affecred areas of t11e central nervolls syst;m is the frontal lobe. Many people are on medications chat are nor acrually necessar}', and their side effeers may be harmful ro che personaliey and characcer. This is why, beforc deciding ro raxe medicarions. rhe benefits need ro be carefully weighed againsc che risks. A lisr of c1asses of drugs thac commonly affecr the mind is shown in Figure 12. 34 If you are cllrrenrly on one of rhese drugs, do not stop it 11bruptly. Instead, work wich yOlle docror. Afrer aII, ir is nor an easy decîsion ro know whar ro do wirh man}' of these medicmions. A good case in point is provided by t11e high blood peessure drugs. Some of those medkations may impair frontaI lobe funcrion. However, if the high blood pressure is nor adequately created, a srroke may be ilie resulr, causing much more profound frontallobe impairmenr. For this reason, many physicians are advocaring lifescyle therapies as che oprimal means of conrroJling blood pressure. Chapter 6, "One Narion Under Pressure: pre ents sud, rherapies. More informarion is given later in this chapter on rhe imponance of controlling blood pressure for maximizing fcontallobe function.

THE FRONTAL LOBE It is now becoming a part of mainsueam medical practice tO hdp people ger offdrugs rarher man adding new medicarions ta their program. Research an older Americans shows rhat they are ar higher than normal risk for impaired memal function, drug side effects, and also deleteriolls effects from high blood pressure. The Cenrers for Oisease Conrrol and Prevenrion (COC) recendy pointed out thar Americans 65 and olcler have nearly rwice the risk of adverse drug reactions compared ro those rhat are younger. 35 Furthermore, they highJiglued the facr that high blood pressure drugs frequently cause adverse side effects in this population group. The COC from chis perspective asserted: « ••• one important straregy for preveming adverse drug reacrions among e1derly persons is ro limir me number of drugs tJsed." 36 Ofcourse, conccrns for drug side effects and a resul ring advocacy ofljfesryle change for disease trea(menr have exisred long before this recent COC proclamatian. One of che more inrercsring hisrorical statemenrs along mese lines was wrirren by Ellen White. Her words are quoted in Figure 13. 37 Social drugs ofeen inreracr wirh prescription drugs ro produce side effects. For example, alcohol adds significanrly ro rhe risk of adverse consequences of drugs-induding effecrs on mental clariry. In a smdy of over 100 recendy hospitalized individuals who represenred a broad cross seetion of rhe popularion (men and women, 14 ro 88 years old), 10 percenr had inrtraccioJls berween alcohol and (he medications rheywere given upon leaving rhe hospiraJ.38

A!cohollnjures the Fronta! Lobe A1cohol has direct effecrs on the froncal lobe in addition ro it worsening (he risk of medicarion side effecrs. In facr, ir is one of Americ.a's most popular frontaJ labe assailants. Ler ilS exarnine some illuminaring research along these lines. Several years ago, alcoholics and nonalcoholics were srudied by rwo modern di. . agnosrlc rests: magnetic resonance lmagtng (MRI) and posirron ernission ropography (PET scalUling). The MRl is a now-f.1rniliar scan rhar can look ar rhe actual structure "

• Asthma medic.ations-Beta agonists • Blood pressure mcdications-Beta blockers, calcium cbannel blockcrs, centrally acting agcDts (CJonidinc, Methyldopa, etc.) • Tranquilizers and slcing pills--benzodiazepines antidepressants (Note: tricycllc antidepressants are also used for headachcs, insomnia, etc.) • Anti-ulcer pills-H,-blockers (Tagamet, Zantac) • Anti-inflammatory drugs- NSAIDS • Pain relievers, narcotics • Cold aud allergy medications-antihistamincs (also used for insomnia, etc.), decongestants (espcciall)' in children; c.g., preudoephedrine as in Actifed) Figure 12

o

L l. "Many are Iiving in violation of the laws of health, aDd are

ignorant of the relation tbat thcir hahits of eating, drinking, aud working, [bave) to their health." 2. They are not a,warc of their condition

UQliI

diseasc occurs.

3. If, at tbis point, the individual would make the appropriate Iifestyle cbauges: " ...the patient will generally recover without beiDg debilîtated." 4. However, instcad of changing lifestyle, medicatioDs are gencrally employed. "Tbe liver, heart, and brain, are frequentJy affected by drugs, and often aII these organs are burdened with disease." Figure 13

of the brain. Among rhe alcoholics, it revealed a srriking amouIl{ of loss of.fontal lobe grlly malta. The gray matter is where the bodies of rhe brain nerve cells are COJlcenuared (in contrast ta the deeper Iying whire marter where rhe nerve fibers (eavillg rhose cells predominare). Techl'tically caHed "cortical arrophy," rhis condi(ion of gray marter loss indicares an actual (05S ofbrain ceUs thar are involved in cri(-ical froJltallobe fUJlctions. On the omer hand, PET scanning looks ar brain funttion. In rh-is test-

267

PROOF POSITTVE ing, rhe alcoholics showed a lower glucose merabolislll-indic:uive of less fi"ontallobe . .

actllJ/ty.

39

TI;ese fronrallobe-impairing dfects are nor conflned ro heavy alcohol s. Researchers found a measurable decrease jn absrracr rhinking abilit)' :unong 1300 men and women who were social drinkers. These inelividuals drank as linIe as oue alcoholic betJerage per llJeek. The average man in rhe srudy only had abour rwo drin.king occasions per week and consumed rwo OI' duee alcoholic drillks on rJlOse occasions. The women drank even less. On the average, they only dran.k every fifrh day and consumed twO alcoholic drinks. Even wirh

• "The child of the druukard or tlle tobacco inebriate usually has tlle depraved appetitcs aud ioDs oftbc father intensified." • "Thcir children often receive tllis stamp of character before thcir birth." • "Thus unborn generations arc af.flictcd by the use of tobacco and Iiquor." • "Parents Iboth thc father and motber) who freely use wine and Iiquor leave to thcir children Ilie legac.y of a fccblc constitution, mental and moral debility, unnatural appetites, irritablc tempcr, and an inclination to vice." Figure 14

268

mese low levels of use, assessmems of menraI funcrioning ..howed iJ'J'lpairmem. In fact, as akohol inrak:e increased, [heir abiliC)' ro think ab.macrly (a measure of fromallobe pertormance) decreased evel) morc. 40 These changes eould not be explajned by acute alcohol effecrs or imoxicarion, because aII assessmems of menral funcrion werc done at leasr 24 hours aher rhe last consumption of akohol. Many people believe tiuc aucomobile accidenr.s are more fre<]uenr :Ul1ong drinkers primarily because of rhe protound ef.. fects on coordination. judgment, anei alertness seen in "drunks' and orhers who are

manifesdy intoxicated. However, in many cases rhe problem may actually relate to more subrle deficirs in judgment rJlac occur in apparently unimpaired social drinkers. Such alcohol-using drivers may have no impairmenr in coordinacion. Their speech may weU appear normal. However, a few momems later they may find themselves skjdding off rhe highway OI' involved in a collisÎon. The reason? TheiJ impaÎred judgmem f.1iled co provide adequatc warning abolit the speed ro successfully negotiare a curve or stop in rime in rhe face of an impending roadway emergency. Individuals wirh a blooel alcohollevel of 0.05-0.09 percem, Jess than rhe legal limir in mosr starcs, have ar leasr nine rimes rhe rÎsk of a hltal rraftic :lCcidencs rhan at zero. 4 ) This is Iargely duc co the facr thar alcohoJ impairs [he frantallobe long betore it impairs otller parrs of rhe brain such as rhe coordination cenrer. Alcohol also incerferes with [he developmeI)( of rhe tera1 brain. It is well recognized tlur women who usc alcohol during pregnancy adversely affecr rheir offspring for life. The Alcohol chaprer (Chapter 17 emirlcd "WaJlt a Drink?"), explajns rhis turrher. This has been demonsrr:ued in animal resrs as well. 42 The animal reseatch is particularly imeresting-and sobering-because ir poinrs (O anorher risk factor tor childhooel brain impairment: parerna.! aJcoholllse. 43 F:uhers who drink are likely impaiJing cheir chiJdren's frontaJ lobes. Ellen Wh ire decades ago wrore abolit (he imporrance of rhe inHllence ofsuch paternaJ factors. Her COllunenrs are qlloted in Figllre 14. 44 • 45

Caffiine Undermines the FUJ1ction of the Frontal Labe Caffeine has f:u'-reaching effectS on the brain. This is nor unexpecred. since it is America's drug of choice for an early morning lift. However, ~I heavy price is paid for rhar srimularion. Let LIS loole at bow caffeine works anei rhen explore some of ies assocÎared side effects. Caffeine impinges on the br;un's communic;lrion sysrem in a number of ways. In exploring rhese relationship •we need ro

THE FRONTAL LOBE recaU thar brain cells ralk to one anorher lhrough chemical imerchanges. Nerve ceUs release chemicals caUed neurotransmitters (ar "chemical messengers") (hat are picked lip by neighboring cdls. These neurorransmirrers rhen cause changes to occur in rhe ceU thar receives rhem. Some neurotransmitrers c.ause srimll.larjon of the recipient nerve ceU, while others callse depression. Caffeine's widespread influence focuses primari!y an its abiliry ro affect the levels of [\\'0 tr
excess amounts of dopamine. In fact. standard drug rherapy for these serious menr.al disorders involves rhe use of dopamineblocking agems. 50 Consequendy, i( does nor secm surprising [hat caffeinc-an agclH [hat raises dopamine levels-increases [he risk of cerrain mental illnesses, even (hough it may appear harmless on [Ile surf."lCe. Orher psychiatric diseases-wirh profound fronrallobc effecrs-may result from rhe unbalancing of brain commllnica[ions by caffeine. This is particularly true of depression. Decreased fromat lobe fllnction and blood flow appear ta be a characteristic of depression. -1. 52 Re-seareh indica[es [hat these changes may bc partly relared to dopamine levels in (he frontal lobe. H Recognizi ng rha[ caffei ne coun [eracts adcnosine's role in providing good blood flow to the brain and unbalances dopamine physiology, we would naturaliy wonder if there was a link betwecn caffeine use and depression. The inrernarionally acclaimed Norwegian research projeet known as the Tromso hean seudy has provided :lt leas[ a partial answer. The Scandinavian researchers asscssed l43,000 men ,1l1d women and fOtlnd a significant increase in depression in women who were heavy coffee lISers (but not in men who usee! similar amoums ofeoffec). The fmdjngs are shown in Figure 15. 54

COI~

- ..- - Coll't. eon$umpl.ion (;up'/d3Y) _ mort Ihao 8 _ 8 or 1•••

16 14 Peru.nt of Comp/o;IIers 1.2 (Womell) 10

8 6 4

2 O Depre:s~';on

CopillC

Pr(}b/em~'

lm'omllio

Figure 15

269

PROOF POSITIVE In addition ro the link wieh dression, women who llsed more coffee also had more problems coping with stress. The reason why ehese effecrs did nor show up in ehe men is not clear. It may indicate that women are more slisceprible ro caffeine, ar ie may reflecc caffeine's exploitation of a grcater female predisposirion to deprcssion.

The Brain's Adjustment to Caffiine Creates Dependency lf caffeine is so good for us, as somc lay peoplc (and even some scientisrs) would like llS ro believe, it is interesting 1.0 note thae the brain purs forth great effort tO ery ro unda ehe cffeces of chis popular legal drug. Under a siruarion of chronic exposlire ta caffeine, the brain tries ro compensaee il' ac teast nvo ways. Firsc, it decreases its prodllceion of acerylcholine, as previously srared. ss This appears ro be a way ro lessen the impace of ehe increased acecylcholine levels brollghr an by caffeine. Second, the brain increases ies number of adenosine receprors. 56 This is likely a response ro give adenosine more of a voice in brain communicarion-in spite of caffcine blocking irs role CO some extenr. Unfoftllnately, these brain changes contriburc tO caffiine dependmcy. ThllS, braill sr.ructure and fllucrion

• • • • • •

Tcnds to produce dependence Can cause drug withdrawal reactions Can cause or worsen psychiatric iIInesses Impflirs physical and mental performance Interferes with sleep May influence the risk of other iIInesses that in turn exert frontallobe effects through physical or mental stress • May exert effects that impact 00 spiritual and social dimeosions of our character • Can cause toxicity, and' evcn deaUI Figura 16

270

-----

have chaoged and consequently the brain acrually comes tO expecr caffeine in its environment. This is one of the reasons why cofŢee llsers are so committed ro rheir morning brew. lf they do noe get their caffeine, rhey feei ehar they are running ar less than half-throttle. Even more so, if coffee s stop using rhe bcverage, rhey are likeIy to develop withdrawaJ symptoms such as headache in addirion ro fatigucThe qllick "remedy" for caffeine Wilhdrawal headaches is ingesting coffec, caffeinated sada pop, or one of the many over-rhe-coumer headache pills rhar comain caffeine. However, none of these options is as good as "collghing our" ehe withdrawaI. Usually, within a day or rwo, ilie brain adjusrs ro a normal internal enVlronmem wirhout caffeine; the headaches will be gone; and rhe brain will be well on its way co better chemicai balance. However, I have had a few patjems rhat had severe headaches for up ro rwo weeks aher caffeine wirhdrawal. In tllese cases, there may have been an underlying teudency ro headaches that was triggered by caffeine withdrawal. In practical , caffeine's bra.lll chemisrry disruption sers the stage for more than juSt caffeine withdrawal problems and ehe frank psychiauic illnesses that we have already memioned. It may also weaken physical and I)lencal perform.ance in those who have no psychiatric symproms and are noe undergoing withdrawal. Caffeine's effecrs on worsening performance have been documcnccd. Alehough the drug tcnds to he1p pe-ople do simple tasks more quickly, there is evidence rhae it is "disruprive on more complex tasks of moror reacrio!) rime and fine motor coordination."57 The dccreased pro~uceion ofacecylcholine thae resu1ts from regular caffeine use, may aJso play a rale. 5a Rcsearchers consiseendy hnd rhar a decrease in brain aceeylcholine is associaeed with impaired menral funccioning. 59 . 60 Furehermore, despite common Iare, the aurhors of an exrensive medical review an caffeine found no evidmce (hat dus drug helped ro improve inrelleccual capacicy.6J A summary ofsome ofrhe effecLS ofcaffeine an rhe brain is liseed in Figure 16. h comes as no surprise thae caffcine in-

..-.i'-l

THE FRONTAL LOBE rerfeles wirh sleep. Caffeine consumed wirhin an haur ofbedrime makes ir haIder tO fali asleep, decre;'lses rhe roral amoul1C of rime slept, and significantly worsens sleep qualiey.62 Specifically, caffeine decreases rhe deepesr, mosr resrorarive stages of sleep (scages 3 and 4). Perhaps more sllrprising is lhar excessive amOllnts of caffeine can callse severe brain problems, indllding seizures. 63 There are also descriptions of huOlan falalities due ro caffeine. 64 1would be negligent not ro mention m:lt caffeine has a host of effecrs lhar may indircctly affecl froncal lobe funcrion. By inducing disease and both physicii and psychological srre.ss due ta those condilions, rhe frontal lobe can suffer furrher under cafTeine's woeful cuie. Some of lhe orher healrh consequences ofcaffeine use are lisred in Figure 17. 65 . 66. 67. 68, 69. 70. 71. 72 AJrhough some of these effecrs are conrroversial (wirh some studjes finding a caffcine link, bur olhers nor), we must ask ourselves if ir is worrh raking chances wirh c.affeine when we have already discovered so many other problems with it. Anorher imporrant fronrallobe effect of caffeine relates ro our spiritual dimension. This was highlighlecl by Ellen Whire yeaIs ago. She explained rhar caffeine's brain srimulation could cause rhe tongue ta "Ioosen" in conversarion. as explained in Figure 18.73 A definirion of gossip is rhe sharing of privare informarion wirh someone who is not parc of r!le problem ar pan of itS solulion. The laclies' rea parry has been histOrieally viewed as the SCIt of gossip. Note, however, gender is nor meluioned. The srarcmenr would apply ro men's or mixed garherings as well, pacc.iclllarly if "rhe right beverages" were being imbibed. Whire suggesrs mar one of the root causes of gossip may be rhe eype of beverage rhat is served ar social garherings. An undersrandjng of the effecrs of caHcine on rhe froncal labe resrihes to the reasonableness of heI concerns.

• Caffeine may be a co-carcinogen, contributing to the development of cancers ofthe kidney, breast, colon, pancreas, ovaries, aud bladder. • lncreases risk of low birtb weight in infants born to caffeine-consuming mothers. • Elevates blood pressure by 3-5 mm Hg.

:_:;.-_

• Can cause palpitations and more dangerous beart rhythms. • Stimulates excess stomach acid production and gastroesophageal reflux which is a cause of severe heartburn (for both caffeine and decaffeinatcd coffee). • May increase symptoms of premenstrual syndrome (PMS). Figure 17

CAFFEINE AND G ---IP "When these tea aud coffee s meet together for social entertainment, the effects of their pernicious habit are manifest. AU parta1ke freely of their favorite beverages, and as the stimulating influence is felt, their tongues are I00sened, and they begin the wiciked work of talking against others. Their words are not few Of' well chosen." Figure 18

Nicotine's lmpairment ofthe Frontal Lobe 1 devote an entire chapeer (Chapter 16, "Dying for a Cigarene? Kick rhe Habit and Live") ro rhe subject of rucorine addiction. Suffice it (O say rhar nicotine has srimulant effecls on the nervous system similar ro caffeine and should ehus be avoided. lronically, qualilY ofsleep, performance, and even 271

PROOF POSITIVE srrc.ss conerol alI sufler whjJc using cigarettes. For example, smokers are less able ro perform complex mental tasks than nonsmokers.74 I say alI this is ironic because many smokers believe mental qualicies are actually improved by rheir smoking. The carch is thar when they quir, rhese problems worsen initially beforc gerting berrer. Shorrly after some individuals become nonsmokers they misrakenly rhink rhar smoking was helping rhem in these areas, and so they rerurn ro rheir cigarertes after several days of abstinence. In addirion ro short-rerm memaJ effecrs, smoking rakes a roU on brain nmction over rhe long haul. Compared ro nonsmokers. smokers face doubJe the risk of developing dcmenria (permanent, significam loss of intelligence) fi·om A1zheimers ,md od)cr causes.7 s A lasr noreworrhy effecr of nicorine re[ares [Q prenatal effeers. The nieorinc lIsed bya pregnanr woman impairs brain funeaon in her child, perhaps for life. Research has shown mental deficits in children of srnokers that can onIy be explaincd by the effecrs of nicotine. One study made a comparison of mental funcrion between dueeyear-old children of women who smoked rJuoughour their entire pregnancy wirh rhe childrcn of rhose who quir during pregnancy. Children of those who had kicked the habir re ted significandy berrer.76

SECTION III

Effects ofDiet and Nutrition on the Function ofthe Frontal Lobe. Thus far we have seen [he detrimenral frontallobe effecrs of drugs, alcohol, nicotine, and caffeine. Soroe of mese facrors exerr their primary or major effect on the froncal lobe. On the other hand, most of the rhings that mhllrJce fronc brain function often have a generally beneficial effect on che entÎre braÎn. A classic example in this regard is nurrition. The more we Jearn abour nutricion. rhe more we realize rhar oprimal nutrition is vital tO superior brain perfor-

mance. Wc will sec thar our dierary choices can either ellhance brain performance or .Impalf..It.

Enhancing Brain Funetion through Breast Feeding, PolyunJaturated Fau, And Vitamins. Our earliesr dietary choices are nor really ours to make. Those who were formnare enough ro have morhers tlur chosc ro breasr fced mem were bequeathed a preciolls frontal lobe legacy. Research shows rhal children who are breasr-fed have a menlal edge mat persists at leasl for ycars aod probably for a lifelime. 77 . lI! AlI of rhe reasons for rhe breasl-mjlk advanrage are not clear. However, one factor appears to be rhe fat contenr ofbreasc milk. Or. Yokota of]apan sbowed rhar newborn rats need adequale amOllllts ofomega 3 fars in rheir dier. Withour rhose fals, learning is impaired. 79 Olher international research reams such as Bourre and his Freneh colleagues80 have made similar discoveries in animal rests. All have demonsuared rhe vital need for me omega 3 f.'HS in the deve10ping marnrnalian brain. It is weU recognized in research circles thar traditional human infam formula provides subsrandard amounts of omega-3 fars when cornpared ro breasl milk. 81 Supplemenring the child's dier with foods orher rhan formula cannoc reasonably make up rile omega-3 deficit. One group of researchers aune ro this srunning conc1usion: "Ir is COIlc1uded tiut it is virtually impossible 10 supplemcm rhe diet of formula-fed infanrs ro march the long-chain PUFA inrake of brcast-fed infants with currendy available whole foods. "82 The superioriry of breasr-feeding is ohviously important informarion for expeclam parents. However rhe proper rype of fat also seems ro be necess,~ry for shorr term learning in adtdts. Or. Coscina and colleagues demonsrrated this faer a decade ago. 83 They fed twO groups of adult ralS diets that had idenrical amounts of fat. However, rhe fat came from di.fferent sources. After only rhree weeks, rats given a cliel based on a modera re amounr of vegerable

272 _ _ _ _ _ _ _IIiiiiiiiii

...

THE FRONTAL LOBE fat (20 pereenr polyunsaturaced soybean oiI) exhibited improved leaming skills compared to mose fed a dier based on 20 percenr sacuraced fat (lard). The auchors saw rhis as solid evidence "thac shorr-cerm variarjons in rhe qualiry of dierary far can enhance mammaliallle-
Lessons[rom Carbohydrates Other parcs of the body can use far, pro(ein, ar carbohydrace for energy, but not the brain. The brain uses glucose, a simple carbohydrace, almosr exclusively as irs source of energy.90 Apparencly as a resulr of the brain's very rapid metabolism ir is dependenr on minure-ro-minute supplies of this simple carbohydrate. This becomes easier (O appreciate when you understand mac the brain has a merabolic rate 7.5 times greater rhan the average body ussue. 91 Although ir makes up only 2 percenr of our body's mass, the brain accounrs for 15 percenr ofour (Oral metabolism. The brain, however, does not ha-ve much room ro store nuuienrs-space is exrremely limired by rhe hard shell of the skull. Only a rwo-minure supply of glucose is available ro r!le brain cells-and chis is in the form of glycogen-rhc storage form of sugar. Thus, for peak performanee, the frontallobe requires blood wirh a sundy and adequate glucose lroei. In me ehapter on sugar and diabetes (Chapter 8), I point out how a ruec containing lots of refined foods can cause rhe blood sugar ro rise quickly, and then fall below normal. Sllch food options abound ar snack machines and dessert counrers. They are besr lefr out of aur dicrs. It would be benCf ro ear liberally of a wholesome variery of complex carbohydrares sueh as those found in pot.atoes, rice, whole grain breads, and cereals. Simple sllgars are carbohydrates tOO, bur ir is imporcant ro undersrand rhc distinetion be[ween the simple sugaes in eoneentrated snack foods and rhose found in natural fruirs rhar carne packaged with a wealth of ftber. Years ago when scicntists flrsr discovered rhar the brain funcrioned besc with c.'Ubohydrare fuel, some people began referring ro candy bars as "brajn food." Evenrually we learned (hat, for sustained performance, refined sugar was not brain food at all; ir was just rhe opposite, as stated in Figure 19. One study of 46 five-year old boys was parcicularly revealing. n Boys with linie ugar in cheir diet had superior artenrion spans and more aceurate responses than their high-sugar consuming peers. The differenee could nor be explained by IQ ar che

273

PROOF POSITIVE

SUG

AND THE FRONTAL LOBE

, Large amounts of sugar in the diet have been demonstrated to impair frontallobe functions in school age childrel1. Figure 19

parent's social or educarion srarus. When resred, rhe boys on a low refined-sugar dier performed rhe equivalenr of one whole grade !erter higher in sehool. Tl~is pr?vocauve srudy suggesrs rhar a berrer dlcr wIII help transform a B-srudenr inro an A-Ievel scholar. If sugar is a carbohydrare and carbohydrare is rhe fronrallobe's preferred fuel, rhen how could a h.igh sugar dier impair brain funerÎon? Ler me rry ro give you rhe besr explanarÎon J have found of this apparenr paradox. Our bodies wcre crearcd ro e~1r foods sueh as fruirs aod grains in a narural, unrefined srare. These foods help ro keep our blood sugar at a fairly constant level. However, when I't:fined sugary foods emer rhe digeStive system, the blood sugar rises dramarica!ly, and the bod)' reaers as ifir were JUSt exposed tO a grear volume of narural food. In response. rhe pancreas produces a large aJllounr ofinsulin. However, the rapid rise in blood sugar is deeeprive. Ulllike natural planr foods, foods rich in refined sug~ rend ro be quickly absorbed. The resulr IS rhar rhe (apid rise in blood sugar is shorrlived.Wirh insulin stiU presenr and no more sugar comin ba in via [he digesrive . traCt, rhe blood sugar level ean plunge. It IS nor lInusual for (he blood sugar ro drop well below where ir was before the sugary food was eaten. If a person's blood sugar level fa!ls

274

low enollgh, fronrallobe funcrions ean suffer due ro iJ1adeqllare fuel supplies. 1'0 make m:.mers worse, probably rbe mosr eommon response ro hypoglycemia is ro ear yer anorher sugary nack. AJrhough th.is will drive rhe blood sugar up quickly again. research demonsrrares rhar ir rake tI.le brain anorher 45 ro 75 minures ro regalll normal iIHe!lecmal funetion afler the blood _19394 Th e message suoar rerurns ro norm.u.· I t~ke away from this re 'e~lrch is rhar adulrs as well as school ch.ildren need ro make correct dierary choice if (hey W,lnr ro function ar peak m~nra1 efficiency. Each day sho~ld begin wirh a high-quality breakfasr ehar 11)c1udes a balanced selecrion of planr sources of nurririon, 1 prefer a variery of frui(s and whole grains along wirh ;I fe"''' nIlts. These i(cms tend ro keep rhe blood sugar in (hc proper range rhroughour ehe enrire 11l0r~1 ino withoUl a need for snacks. 1 explatn m~re fully rhe imporranee ofearing a \Vholesome breakfasr in Chapter 1, "Principles for Oprimal Healrh." A liberal slIpply of fruits, vegerables, and grains provides rhe besr nourislunenr for rhe frontai lobe. AII of [hese foods comain a healrhy quanriry of carbohydrares. n rh,c orher hand, essentially every rype of meat IS devoid ofearbohydrares. If you look at food rabies, you will see a reCUrriJ1g rhemewherher ir is red mear, fish, or ehiekenthey aiI score a big zero (01' veI')' close ro it) in rhe earbohydrare Clregory.9 Thcse foods arc generally high in fat and prorein, bur de6cienr in carbohydrare, which may be oile reason why meat appears ro bc associa[ed wirh subrle fromal lobe impairmem. The.re is, however, irony in ali this data. BeclLlse [he brain is very adaptable and becomes used ro rhe lifcsryle you are on, even healrhy changes ma)' eause a short-ierm deeline in brain dTtcieney before any improvement oecurs. It is analogous ro the siruation wirh nicorine thar 1 describe in Chaprer 16 in kicking rhe smokil,lg habic. Despire nicotine's deleterious brain effects. when a person srops smoking, sleep qua!iry and menral agiJiry tend ro ger worse beforc they ger bener. The. ame is probably true with dier. Researeh sugges[s rhar when pcople dramatically increase rheir imake of

TIfE FRONTAL LOBE fat or even crtrbohydrace, mental performance can slIffer in che shon term. However, concinuing wich che bener lifestylc will bring the expecled benefirs in time. The messagc is: no marter how diffjcult il may be il) lhe ShOIl cerm, develop new heahh habirs and stick with them. 96

False Transmitters in Rich Foods Confuse Brain Cells Orher dietary SllbSlances C<1n have a decrimental effecr on rhe froncallobe. Oue of rhem is the chemical called cyramine. Tyramine is found abllndantly in cheeses, wines, and ocher rich foods. 97 No doubt, SOll1e of cyramine's frontallobe impairmenr resulrs from irs stimulacion of rhe body's Slress hormone sysrem. When chis agent is ingesred, che symparheric nerve endings are stilUulared co release a chemical called norepinephrine, which is che primary chemical chac rriggers the body's scress response. 9R Slress dcfinitely causes an incrcase in alenncss; howevcr, it ofren incerfeles wirh the fine con croI of choughc processes needed for leaming, analytically caccgorizing icems, creative thinking, and opcimal recal!. This comes as no surprise ro those who still have vivid memories of poorer school tesc performances due ro che stress of examinations. Dr. Guycon poims our dtac c11e Slress hormooe system can actually decrease blood Ilow ro the brain. 99 This may provide one explanarion for the deteriorarion in beain performance while under real stress or the strcss-like condicioo brollglu on by tyramine mgcsuon. Because of ryramine's abilicy to stimulale nerve chemical changcs (specifically the release of norepinephrine), ic has been dubbed a false neurocransmicter. As such, ryramine can be looked at as an agenc chac on a cellular level conrnses brain cells. 100. 101, 102 It acts Ilke a brain chemical messenger or neurocransminer; however, it comes from rhe food we eac rather rhan from communications iniciated by the brain ceUs themselves. In ocher words, tyramine's stimulation of brain cells daims to bear a message when rhere is none, in realiry, co bear. Thus anocher way of conceptllalizing

ryramine's front braiJl impainnene is as a result of meneal confusion from false commUlllcatlon. Another related chemica1 tiut causes brain transmission problems is tryptarnine. Like cyramine it is classed as a "biogenic amine." Tryptamine is known for its mindaltering effeccs. It has been associated with nighrmares and is even dassed with drugs like LSD and psilocybin because ie can cause hal1ucinogeniceffeCls. 10J Interestingly, food sources of tryptamine often contain tyramine as well. Examples of foods with reported concentracions of these mind-destabilizing e1ements include cheese, 104 fish, 105 and sausages. I06 . 107 AIso, early spoilage of poultry prodllces these compounds because a high percemage of bacteria ehae conraminate domesric fowl have rhe ability tO breal< down poulery tissue imo these toxic sllbstanccs. 108 The issue of spoilage of animal prodllcts and its relacion ro mind-altering chemicals sholild not be taken lightly. Research now indicaces that significanc spoilage can cal<e place even ac normal refrigeration temperamles. One report on fish found that spoilage occurred during refrigeration and produced another biogenic amine ca1led trimechylamine. 109 (lncidencally crimethylamine is also fOllnd in other seafoods and tends ro form cancer-causing chemicals. IIO) Tryptamine may also play a role in cancer prodlletion. This compound when combined wirh aJcohol (and in the presence of che common stOmach dwelling germ, Hclieobaeter pylorz) can give rise ro of che harman familylll-a c1ass of chemicals that have known C<1J1Cer causing properties l12 . 113 as well as mencal effeccs. 114 A further intcrcsting sidelighr on the harman compounds is thar chey are found in alcoholic beverages like beer and wine. 115 Sorue of che miod-alcering effecrs of aleohol as well as some of alcohol's now established cancer risks may be related in parc ro harmans. These same hannan chemicals may even play a cole in perpemating the desire for alcohol. I16 What is che practicaI signjficance of some of this daca on che biogenic amines and their dcscabilizing effect on the mind?

275

PROOF POSITIVE There are many pertinent applicarions. Let me bridly menrion tWO of ulese. Fim, rhere may possibly be a relarionship bct\veen the biogenic amines like trypt
Arachidonic Aeid and Large Moleeules in Meat Weaken Frontal Lobe Funetion Anorher food chcmical rhat callses brain problems i.s arachidollic acid. This COIllpound inrerferes wirh rhe manufacture and storage of acetyleholîne, rhe imporranr nellrotransmitter mentioned earlier thar is exrensively Învolved wirh [rontaI tobe function. You will recaB (har a decrease in brain acerylcholine is associated wirh impaired mental funcrioning. 119 . 120 Thus, rhe result of arachidonic acid is to elecrease the ability

" ... Eating much flesh will diminish inteUectual activity. Students would accomplish much more in their studies if they never tasted meat. When the animal part of the human nature is strengthened by meat-eating, the intellectual power diminishes proportionately." Figura 20

276

of the fromallobe to fl.lnction efficiently.'21 One of rhe mase common dierary sources of arachidonic acid is mcat. In faer, arachidonic acid is found a.Imosr exclusively in animal proc!uccs. 122 Anorher problem with meat is irs adverse effect on rhe brain. Russian scientists have founel thar a single meaJ of mear can increase a particular srress hormone cal1ed 17hydroxyconicosteroic! (17-HCS). Baldwin suggestS that chemic.1ls of rhis nature, be· cause of rheir large size, may not srimulate ali regiolls of rhe brain equally. m The higher rationale portions of rhe brain a.re prorecced by somerhing cal1eel rhe "blood brain batrier" which appears to be imperviol.lsrochemiealslike 17-HCS. On rhcorher hand, such large srrcss-provoking molecules are able ro stimulate the lower porcions of the brain where no such barrier exisrs, such as che piruirary gland where many hormones are proeluced. Ali chis is excremely imporranc because these lower brain areas are where our more animalisric anei less rational faculties reside. [n ocher words, earing mcac may have a srimulating e/Tect duc ro compounds like 17-HCS, bur rhe srimuladon may lInbalance rarional rhinking in fa· vor of more impulsive behaviors. Ellen Whire wrorc words of camion abour the derrimenral eflecrs of eating meat on imellecrual activiry. They are quoreel in Figure 20. 124 In fact, both physical and mental benefits are provided by ea(ing ilie right foods. Ellen Whire made. recommenelations for such a diet as srated in Figure 21. 1,25 We see rhar Ellen White haei significant knowledge and lIJldersranding of the efTects of lifesryle on (he fllnction of rhe brain. In previous chapters wc have seen herinsights in many other areas of human health and disease. How is rhis possible in liglu of tbe bygone era in which she wrore, from the 1860s ro 1915, long before ilie explosion of sciemifrc medical informacion thar we have roday? The extent and validarion of her onitions, and evidence of rhe means by which she received ir, are explored in Appendix X.

THE FRONTAL LOBE

PCBs lmpair Brain Development A vegecarian dier for a pregnant woman also may benefir fetal brain development. As I descrihe ir.. rhe chapecr on nsh (Chaprcr 5), rhere are growing concerns wirh tQxins in our foods-parriclllarly in meae sources. In a weU-puhlicized example, ic was dcrermined rhar women who are Lakc Michigan osh during pregnancy had grearer exposure ro polychlorinared biphenyls (PCBs) and relared conraminanrs. Ar the rime of delivery, researchers eseil11ated rhe PCB exposure in newborns by measuring rhe amounr of ehese chemicals in umbilical cord blood. When che exposed children underwenc brain resring faur years later, rhe invesrigarors found rhar rhe children with higher PCB levels had brain impairment including decreased reading comprehension. diminished arrention span, and a weaker memory.126

A Spartan Diet Can hnprove Brain Performance For years researchers have known rhat animals live longer if they arc caloric:illy depriyed (i.c., givcn less ro car rhan thcy wOllld normaUy choose}.1l7 An American research ream under the direcrion of Dr. L.W. Means added new evidence of ehe beneors of a more sparran diet. Means and his colleagues, by direcr l11easurement, have shown impro1Jed brain peljorn7lUlce on it lower ca/orie diet. 128 Furrhermore, cheie research demonsrrated rhar animals received rhest' brain henefirs even iftheydid nor begin such a restricred dier until rhey were middle-aged. This is nor an isolated piece of research. Researchers from [mly firsr demollsrrared the obyious: rats on a normal diec Iose menral funcrion as rhey age. However, the invesrigarors wene on ro discover rhac old rars rhar had been on a low ca.lorie dier since birrh had memaJ ahiliries as good as rheir younger counrerparrs. OUl' brain performance roday can be affecred by rhe number of calories we COI1sumed 15 years ~tgo. Ninery-nine subjecrs age 750(' older were resred in California for meneal performance by raking the Mini-

• "Grains, fruits, nuts, and vegetables constitute the diet chosen for us by our Creator. • Tbese foods, prepared in as simple aud natural a manner as possible, are the most bealthful aud nourisbing. • They impart a strength, a power of enduraoce, and a vigor of intellect that are not afforded by a more complex and stimulating diet."

Figure 21

Menral Srare Examinarion. Those who consumed more calories in 1976 had lower rest scores in 1991. This sClIdy indicarcs rhar a higher consumption of c.11ories in middJe age accelerares rhe dedine in menral funcrion wich aging. 129 These srudies suggesrs rhar overearing (also referred co as "incel11perace eating") can impair rhe whole brain. Such global mencal decline would be expecred ro also compromise rhe fronrallobc. Decades ago, E.G. Whice expounded on the harmful effeers on rhe brain ofsuch pracrices. Her statements are shown in Figure 22. 130 1nremperanee is usually assoeiared wirh drinking aleohot, and rhe dangers are ,"vell

ITE

--.•CEA

"It Îs not necessary to drink aJcoholliquors in order ro be intemperate.

ni/iij

The sin of intemperate cating, eating roo ~ frequently, too much, and of rich, unwhole~ome food: • destroys the healthy action of the digcstive organs • affccts the brain and perverts the judgmcnt • prevents rational, calm, healthy thinking and actiog. This is a fruitful sourcc of church trials." Figure 22

277

PROOF POSITIVE recognized. We have seen in rhis chapr~r rhe addirional dangers of inremperance In eariJlg, and irs serious impact on the fromal lobe. AJrhough rhe author of rhis sraremcnr. Ellcn Whirc, wrote exrensive!y about healrh, she was primarily concerned wirh rheological and spiritual issues, as i.ndicared by rhe final sraremenr: "And this is a fruirfuJ source of church rrials." The coot cause of conrenrion, even ar a church board meeting, may not be due to a surfacc iss~c, ~u~ ro the food caten beforchand, making It unpossible to see thc issu.c c1earl~ and rationaJly. IfilHemperate eatUlg applies ro church board conr.enrions, wouJdn't ir apply ro contentions in business meetings, family reJationships, aod life in general? Anothcr sratemcnr from rhe same author fits weB wirh the informarion in this chaprcr. "Few ... realize how l~uch the!!" habirs of diet have ro do wlth thelr healrh... "131 When thiswaswrirten in 1865, there was Iiule understanding of rhe coerelation berween dier and heaJth. Today, rhe scienrwc lirerarure is full of srudies {hat c1early indicate the cOllsequences of nutrition and lifcsryle an aur health, many of which have been referred ro in rhis book. Thc completed sraremenr reads, "Few ... realize how much rheir habirs of diet have ro do wirh meir healrh, their char~lCter, rheir usefulness in rhis world, and their eternaJ desriny." 132 It is a somber thoughr, and one we should seriously consider-that what we put imo our body afTects the .parr of rhe brain where spirirualiry, morallry, and rhe will reside. This underscorcs the imponaJlce of living and pracrjciJlg the mosr he~lthfut lifesryle possible. We need aII rhe tro.maJ lobe we have been given, and we need It ro funcrion ar irs optimallevel. When we think of the cffecr of a properly nourished fromallobe on rhe ~orenrial for a fuller, richer life, it is cncouraglllg. We do nor have ro be a paft of mental health sratisrics; rarher, rhe oppoftuniry is there to provide for a high qualiry of life, wi~h longeviry as a bonus. Nurrition and 1Jfes~le do deserve aur mosr serious efforrs. T he resulrs wiU be felr day by day and year by year.

278

SECTION IV

Effects ofHypnotism, Jl.{ and Music on the Frontal Lobe. Hypnosis and the Frontaf Lobe Ler liS now move from rbe field of dict and nurrition ro anorher area rhar can impacr the healrh of aur fronraJ lobes. We now turn aur attention to a very popular merhod for dealing with rhings rallging from cornmon bad habirs ro emorionally devasraring childhood trauma. Thar method is hypnotism. Despite irs innocent demeanor culrivared by circus perforlnances, media presenrations, and mass smoking-cessation programs, hypnotism can callse some serious ide effects. Among the down sides of dus popuJar "rherapy" is fronrallobe impairment. The connection berween hypnotism and rhe fromaJ labe comes as no surprise ro those who understand rhis rechnique. Hypnosis. by design, byes rhe fronral lobe a~ it helps rhe subject enter imo a trance-like srare. Dr. Freda Morris, a former professor of medical psychology ar UCLA, has writren several books an hypnosis. In her words, hypnosis is a stare characterL~ed ~y. a sing.leminded focus an only one dlmg, IJke a blrd watching a snake."133 Wlule hypnorize~, dle subjecr is ina((emive tO aII orher en.vlronmel1taJ cues. A hypnorisr can ohen induce such a srate fim by he1ping the subjects ro remajn quier and stiU, free from ~Il ollrside diversions. Next, the hypnorlsr helps rhem dcvelop thar new Crocus " on.a certain poinr." On.ce rhey emer a hypnonc stare, rhey are encouraged ro follow the hypnorisr's mind. . rf brain waves were measured wlth an EEG (e1ecrroencephalogram) during rhis process, we would see rhat the hypnotized person loses bela waves from rhe ?r~n. This beta activirv indicares sound thmkmg mar involved d~namic frontaJ lobe acriviry. Ll the hvpna'rized stare, however an alpha . operative,' . 1,4 d ' w I1('ch brain .pa((ern IS Uflng

THE FRONTAL LOBE we do not criricaHy analyzc incoming informarion. J3S Alpha wavcs are brain waves of a lower frequency than beta waves. In this state, an individual will record inform.ltion and suggeseÎons withom imerpreration and wimoll( fromallobe f1lrering. A flickering light ehat trains (he eyes ro focus in one place has been noted ro easily induce a hypnoric state. Ouring the hypnoric srare, individllals can receive information of variOllS kinds, and can mcncaJly record the duties the hypnotisr asks them ro perform. lndeed, their memory works well, their emorÎons work tIne, and rhey can laugh and cry. Bur as rhey cominue ro foClIS 00 rhe flickering lighr rhe)' do nor cririeaU)' analyz.e rlte ioformaeion rhey receive. J36 None of the information is fIltered according ro their sense of values ar moral worth;

their lJery reasoningpowers '.lre being bypt1-fsed The fTontal tobe hm bem short-cirmited. Humans have been given large fromal Iabes for a good reason. To compromise this control cemer of the bmin, even tempararily, is dangerous. Today, hypnotism has become quite popular and comes in severaI forms. The medicalliteracure is f1lled with examples of hypnosis being used for psychiarric aod/or behavioral problems, spanning a broad speClrum from rrallmatic events of childllOod ta current problems Ivith overeating or nicotine use. There are other more sllbtle forms of hypnotism: Easrern mediration, or yoga, is promoted for Slress control, but Dr. Freda Morris poinrs Out that in rnany Cases it is reallya tcchniquc of self.-hypnosis.1 37 For rhis rcason, such mediration is porentiaJly dangerous. The paraHels between Eas(ern mediration and hypnotism are examined in Chaprer 14, UStress WirJlOUt Oisrress." Differences berween Eastern and Christian mediearion can be found in rhe same chaprer.From my perspective, stress control can be obtained in a much safer way by entering inro an experience of meditarion and prayer ro a personal God, speaking ro Him as we would a respecred friend. One of rhe reasons 1 make such a recommendation is because of my undersranding of (he mental effecrs of different types of spiritual disciplines. For ex-

ample, if you connect srressed individuals to a bio monitor (a stress-measucing device), whether (hey practice yoga OI' Eastern mediration, OI' pray ro God, they will aU very likely show signiftcant stress reducuon. However, only those who are praying sriH havc their reaJoning powersj;/.lly intact. The healthy, thinking beta brain waves will be present dllring prayer at (he same time measurable stress reduction is occurring. Thus, comrnunicating with God in prayer provides a more balanced form of medit;uion.

Prayer Even honesr skeptics are fillding it inescapable thar prayer has unique beneftts (har eastern meditation cannor provide. A case in point is provided by Or. Larry Dossey, a physician fi-om Texas. Dr. Dossey was rJised in the evangelical Protestant uadirion of rhe "Bible belt;" however, he became a self-prodaimed agno ·tic while in coHege. 138 Some years later he became intereseed in eastern philosophies like Bllddhisrn and Taoism, anei began ro practice meditatioll. However, his spiritual perspecrives were sharrered when he found that there were a host of scientiflc studies dut showed thar prayer aeruaJly made a difference in (he healrh of patienls who were prayed for. As Dossey described his initial reaction ro the compelling data, he wanted nothjng ro do with "t:llking ta God." Ultimately however, he carne ro a conclusion: "J decided chat not ro employ prayer wirh my patienrs was rhe equivalem of withholding a potent dmg ar surgical procedurc."J39 Dosse)', coovinced by tlle power of prayer, was 00 longcr content ro only meditare; he nude it a daily practjce ta commune with the Absolute Source of power. Whar 1 haye shared about Dosscy's experience does not yet address r11e effecr of prayer on the fronrallobe. However, it does demonstrare that from the perspecrive of rhinking scienrjsts, prayer has benefits that exrend beyond mere meditation. Dossey does, however make profouod connecuons bceween prayer and the fromal lobe in his book, Healing Words: The Power of Prayer and the Practice of Medicine. The book is

279

PROOF POSITIVE

280

perhaps more powerful because Dossey is nor a religiolls zealot who is rrying ro promote a particular sece. He comes across as an honest scientist who was forced ro acknowledge rhe power of prayer despire his preconceîved biases. AJrhollgh my understanciing of prayer diflers from o ossey's, [ believe he has puJled rogerher some vaJuable insighrs thar are relevant ro dlis chapter. Oile of the mosr inreresring framaJ lobe connections occurs wllell Oossey links prayer wirh one of U1C mosr enigmatic occurrences for secular physicians, the spontaneous regression ofcancer (SRC). [n SRC, a persan wirh a faral cancer survives \Virhout undergoing ally treaunent. The individual ma)' actuali}' be cured and ror.aJly free of cancer or rhere may still be evidence of rhe cancer's presenee withour ir taking any roU on rhe person. Oos ey quores rhe research of Yujiro [kemi in Japan on cancer regression. He rhen makes r!le following observarion: "Often a prayerful, prayer-like atrirude of devarion and acceptance-nor robusr aggressive prayer for specific omcomes, including eradication of the cancer-precedes dlecure.."140 lnreresringly, ir may be rhe fronrallobe's connecrion wirh a higher power rhrough prayer-and a resuJring acceprance of ill healrh or adversil)' rhar helps ro pave rhe way for healing. Larer in his book when Dossey again discusses Ikemi's research, he poinrs aur rhar "alJ tlle pariems [who experienced SRC] gave themselves toraLly ro rhe wiU of God afler learning they had cancer."14J There is actuaJly evidence (har rypicaJ medirauon or re1axarlon rraining can shorr circuit rhis proce.ss and be deleteriolls. A srudy of srress hormones before, immediarely foilowing, and (hen [wa days aher sucgeries seemed ro supporr rhese canrenrions. Oossey poinrs out rhar Brirish researchers fotlnd rhat the imU1une-weakerting srress hormones significantly increased only in {hose rhar had formal relaxarion rraining. Those rhat addressed rhei r anxieries and fears-withour using re1axation technÎques-did nor show rJle rise in stress hormones. 142 Prayer's focus is nor denial or dealing wirh sympeoms but bringing the person praying inro rouch wirh Gad.

Prayer at rimes can be primarily receprive: consenting ro God's will. Ar orher times, prayer can be exrremely acrive. Examples include: struggling widl God for answers (O difficulr questions, or seeking ro know His wjJI in a perplexing situat ion. [n rhis Ianer context, prayer can be viewed as one of tbe ultimate frontllilobe IlClivities. lt could be argued thar wirhollt a fromal labe rhat is sound and intact, we cannot optimaJly pray sllch acrive, focllsed prayers. Jntercessory prayer by deflnirion is focllsed prayer. [n such siruations, we pray for specific individllaJs, ofren requeStillg specific resulrs. Such pîdyer has been demonstrated ro result ill scienriflcaJly measurable effecIs in and of irself. One of rhe mosr widely cited sfudies is rhar performed by heart specialist RandolfB)'rd. Or. Byrd randomly assigned half of nearly 400 intensive care heart patients to receive additional prayer. They were unaware of the prayers. Those tim were prayed for had remarkably less lung problems, required less anribiotics, and experienced fewer dearhs (aJthough dlis latrer outcorne was "nor sraris(ica11y signiflcan("meaning (har roo few people died ro derermine wherher or nor rhe difference in death rare was duc ro prayer). 143 Jndeed, a heahhy Frontal lobe can help liS ro fully avail ourselves of prayer. And such prayer is vastly differenr from a hypnoric-like memal srare rhar some caH meditation.

The Home Hypnotist There may be something in your home (har unwi ([ingly pl.lrs you inro a rype of hypnoric trancc. [f you are like the average American, severa1 rooms in yOllr hOlJse are. equipped wirh somerhing rhat you focus your eyes an, Oickers every few seconds, and can produce a hypnoric-like rrance. It is one of the most popular devices ofolll" rime: rhe relevision ser. More rhan 96 percenr of American homes have at lease one. 144 AIthOllgh rhere are many ways ro be hypnotized, Jerry Mander found ehat a number ofhypnorism expens deflned the process in sllch a way rhar relevlsion aptly Ars rhe description. Tile c1assic se({ing forlV warching is similar ro a rypic.:1l enviranmenr for

THE FRONTAL LOBE hypnorism inducrion: a darkened room, a flickering lighr (rhe TV ser) as a singleminded focus and frcedom rrom aII omside diversions. 145 People wareh programs provided by TV starions cable companies, and sareilire ne[works, or rhey watch videos. The range of programming in any ofthese cases is diverse: movies, documelHaries, sir-coms, sponing evems, music, educarÎonal, naeure shows, news broadcasts. and ad inflnirum. Does whtlt you watdl make any djffere.nce on your minei and characrer? The aJlSwer is both yes and no. Although the comem you view exerts a powerful effecr on your mind, the medium itselfalso appe.1rs ro have profound menraJ efTects. Evidence suggesrs rhat the very vehicle of relevision is-in irself-usllally derrimental. This delererious frontal lobe effect appe.1rs ro be the resuh of rhe camera-switching work in mosr videos and other programming. The rechnical problem with lhe filming rechnique is refened ro as a "rapidly changing scene of reference." Speeiflcally, rhe average television program changes ilS scene of reference every duee to five seconds. The perspecrive from which you are viewing the event suddenly changes many times each minme, wherher you want it tO or nor. This is in sharp contrast ro how we normally view the world aI"Ound us: we sec reallife scenes from one perspective (where we are located at the rime the evenrs happen). We can change our perspecrive onl)' b)' voluntarily moving. Dr. Monis sires rdevision's rapid change of reference as comribucing ro the hypnoricrype effecr. 146 Research by Dr. Thomas Mulholland looked ar children's EEGs as rhe)' watched their favorite television programs. The researchers assumed rhar since rhe$e programs were their favorite shows, the kids would be menrall)' involved wim whar they were viewing and would experience an oscillation berween alpha brain wave acriviry and bettt. Tnsread, ;.lfter JUSt (WO or duee m inures of the show, they sar back and srayed almost entirely in an Illphll p:Htern. This meant that while rhey were watching rhey were "nO{ reacting, nor orienting. nor focusing, just spaced-out."147 Dr. Herbert Krugman, a brain wave re-

searcher, has gone an record: "lelevision i5 a comJJlllnicatÎon mediulll that effonlessly transmits hllge quanriries ofinformation not thoughr abollt a( the rime of exposure."148 Dr. Erik Peper, anomer inf1uelltiai brain wave researcher and wrirer, once said, "The hOTror of television is rhat rhe information goes in, bur we do nor react ro ir. It goes righr into our memory pool and perhaps we reacr ro it later, but we do nor know what we al'e reacring ro. When you warch television )'ou are training yourself nor ta react and so larer an, you're doing things wimout knowing why you're doing rhem or where the)' came from."'49 Under the inf1uence of modern fasrmoving television, rhe frontal lobe cannot fl1l1crion at its full capaciry. The brain records information; sighr, mcmory, and rJle emorions are aII functioning well; nevenheless, fhe brain is no longer crirically analyzing rhe infonnarion. Terrible scenes can be depiered but the viewer rends only ro laugh or shrug them off. Normally, if those kinds of events happened in reailife rhe individual would be appaJled. (Even thjs, however, is gradually changing as pcople become more de.sensiri'led over rhe years.) Despire how one responds-whether by laughing, aparhetically sraring, avening rhe eyes in disgust, OI' a hundred other ways-rhose scenes are indelibly imprinted upon the mind. When you see a rerun, once ir begins, you know you have seen it before. The memory is there, alrhough rhe last time you saw ir yOLlr frontal lobe was not any more active rhan it is this rime. Alvin Tomer, the aurhor of rhe 1970's best seller, Fmure Shock, gave a particularly lucid aCCOUl1t of the effeccs of artificial stimuIation. His worels sti]] strikc me as an apt descriprion of television's subtle effecrs. His remarks address more than the subjecr ofhypnorism. "Con. tam srimulation of the senses shurs down rhe analyrical processes of rhe minei and uJrimately shuts down ilie abiJiry ro think and face life rarionaJly. This leads to escape rechniques and adaptive responses which rend ro involve wirhdrawal, apath)', and rejectiol1 of disciplined thinking when faced wirh difficulr duries and decisions." 1SO

281

PROOF POSITIVE

Television Weakens Brain Power

T Activities that strengthen the ",ind: • Playiog Bridge • Crossword puzzles Activities that do noi: • Bingo -- "it kills the mind" • Television -- "tbe worst thing that could be do ne is to sit and watch television" Figure 23

Even well over a decade ago, rhere had been more than3,OOO sejenrifle srudies pubJished on rhe eftect5 of television on the mind. 151 Researeh eonriuues an rhis inrerrelationship. Over 500 books have been wrircen an [he subjecr. Ir is one of rhe most well-researehed subjects in our cu1rure, yet most people have lirrle awareness of TV viewing's solemn consequences. Television news programs often publici1.e lifesryle-reIared scienrifie srudies, but we do not hear much about the srudies do ne on the effeers of television 00 the mind. We should not expect rhe relevision media ro confess ro anyrhing. bur we do Ilor have ro stay uninformed. The referenccs at the clase of this chapter provide a range of sources deal ing wirh television. Most libraries have books thar explain rhe dTecrs of relevision on rhe mind. and university libraries are usually eonnecred ro scienrific dara sources rhar can put yOll in rolleh wirh hundreds of artides written on the subject. Six deeades afrer David Sarnoff, Presidenr ofRCA, ullveiled the [ust relevision ar rhe 1939 World's Fair, it i time ro ask-what is relevision doing to our coumry? More specifleally, what is television do ing ro me?

282

Thc efTecrs of relevision are far-reaching. One of rhe grearesr eoncerns in academic eircles is rhar rhe TV viewer's imeIesr in rCf/.ding is markedly redueed. The more relevision w;ltched, the grearer rhe ill(eresr in reading suffers. Children who spend many hours each day watching rend ro be poor readers. Their reading abiliry and reading comprehension scores borh suffer. n Learning omer sllbjects such as hisrory, geography, marhemaries, and English is based an reading; thus, poor readers have a general learning hand.icap. The reSlllt has been a consisrenr decline in rhe average reading skills of our yourh sinee TV began ro be influenrial in the 1950's. Television affecrs more than reading skills. Ir weakens brain power in general. This is true at any age, from early ehildhood ro rhe 'golden years." A recenr srudy revealed rhar cenain acriviries ofrerired persons increased menral capaciry while other aaiviries decreased il. 1B The resu1ts are shown in Figure 23. These reswrs are encouraging: byavoiding mind-numbing acrivities like warching television 3nd engagiug in ehallenging acriviries, evel) people of reriremellt age can improve mental abiliey. Retiremell( does nor mean rhat yom br
rv

THE FRONTAL LOBE ro furrher compromise of rhe fronrallobe. Thc poorcr lifesryle habirs fosrered by TV appear ro be a major facror in rhe epidemie of childhood obesity. Many studies reveal rhar relevision watching and obesiry in children are direcrly relarcd: rhe more TV a child watches, rhe heavier he or she remis ta be. In addirion ro eausing poorer food choices, Universiry of Tennessee researchers helped tO c1arify some orher re-asons for rhis relarionship. They srudied rhe effect of telcvision viewing on 31 children berwcen 8 and 12 years old. Fifreen of the children were obese and sixrcen were norlllai in weighe. Each child's merabolic rate was measured borh during relevisjon viewing and when at rest doing norhing. The findings are shown in Figure 24. 155 Tdevision viewing requires no physical involvemenr, yer occupies an avcrage of26 hours a week for mosr children. They are spending many hour~ wirhout any significam mental orphysic.u activiry. 1 sr. In addidan to increasing iviry in rhis way, rhe medium of television Îtself aerually slows merabolism more than if you were jusr sirling in a room resting. IS7 This provides a furrher argument in favor of rhc alrered "rrance-like" srare mar relevision is ablc ro induce. AII of these factors contdbute ro the rise in childhood obesiry, which has become epidemie in [he U.S., afTecting over 25 percenl of our kids. ISB Obese children ofren beeome obese adults. 1'0 further compound marrers, obesiry in adulrs increases rhe risk of "sle apnea"159 wirh its fromal tobe aod overall brajn impairmenr. Whcn an individual wirh sleep apnea relaxes during sleep, rhe "overweight' airway ofren c1oses, cau ro a minute of apnealirerally no breathing-bringing about a dramaric fali in oxygen saturarion. Such individuals not only snore loudly, but they do not obrain a rcstful sleep, and thus are frequenrly found unintenrionally falling asleep during dayliglu hours. If the individualloses weight, rhe sleep apnea is ofren cured and the brain and frontal lobe abilities improve.

TVO NOTTV: FAT IS THE QUESTIO • Metabolic rate of children ages 8 to 12 during television viewing was significantly lower than when the children were at rest doing nothing. • Lower metabolism combined with the h'igh fat snacks eaten during thc hours in front of the TV places children at high risk for obesity. • Kids watch 26 hours of TV weekly on the average. • Chndhood obesity now affects ·1 out of 4 kids. Figure 24

Television Increases Daydreaming and Non-Reaction There are other important effecrs of television viewing. In general, TV increases daydreaming, fostering rhollghrs about a non-practical fanta y world dlar many children seem lO virtuali)' live in. as do some adults. 160 Ar the same time, relevision decreases a persons crearive ingenuiry, or creative imagination. 16 1. 162 Some peopte misrakenly believe tiut daydreaming and creative ingenuiry go rogerher. Acrually, rhe more daydreaming, the less creative ingelllliry. As already alluded ro, daydreaming is nor producrive because it rends ro draw thoughts away from rasks at hand ro dwell on image.~ rhat re..~ide in rhe memory. On me other hand, creative imagin
283

PROOF POSITJVE

eTelevision viewers - 52% detected the tie (similalr to f11pping a coin) eNewspaper readers - 64% detected ,the tie eRadio listeners - 73% detected tfie lie

Figure 25 have grearer learning abiliry when compared ro cheir relevision-raised peers. 164 One staIding scudy compared small rown residenrs of aU ages before ;lnd aher the inrroducrion ofTV Wirhin two years of television coming ro a media-isolated Brirish Columbia rown, both chiJdren and aduJcs suffered a 20 percenr decrease in creariviry. rn addition, rhe residelHs became generally less persistenr when rackling a problem. '65 , 166

Ability to Discriminate Suffers under the Influence ofTelevision

284

Television reduces aur powers of discrimination. rf you were interesred in receiving the most accurate aCCOLlIH of the news, which form of media wouJd you uusr rhe most? Would it be television, the newspaper, ar rhe radio? As parc ofa psychology experimene, a prominenr Brirish commentaror purposely gave conflicting answers on rwo separare TV inrerviews. His eelevised fabrication fooled abour baiE rhe number ofviewers. His deceptian was less successfui when individuals rcad his uanscripr in rhe newspaper or heard him on the radio. In the experimenr, it wa.~ annollnced that rhe well-known politicaJ commenraror, Sir Rabin Da)', would name his favorite movie in a 25 second interview, and rhen name a differenr movie as his favorite in a subse-

quenr inrerview. The viewers were cold that he was deliberarely Iying in one of rhe interviews; rhat is, one of the stared favorites was truly his favorite, and rhe other was nor. The twO inrerviews were also published in a major ncwspaper and broadcast on radio. The TV viewers, newspaper readers, and radio lisreners were invired ro guess which one was false and ro vote by caUing either of rwo phone numbers. Over 41,000 caUs came in. The voring is rabulated in Figure

25. 167 Norice rhar rhe people who watched the inrerview on television could have fared almost as well ifrhey had /lipped a cain. But those who read rhe same inrerview ar listencd to it an rhe radio were signific;uuly more likely co be corrcct. The experimelll indicared rhat it Îs somerimes more diffi.· cult [O discriminare berween rhe true and rhe faJse when somerhing is presenred an TV rather duo occurring on radio ar in prinr. 168

TV Trains in Non-Reaction Both rhe Emerys and Dr. Erik Peper poine aur that viewing of television also rrains individuaJs ro be non-reacrive. This srate of non-reacrion deseribes a ive donorhing arritude when eonfronted wirh needs and problems. Even watehing the news day after day rends ro induce a nOI)reacrive arci rude, which is a prorecrive mechanism. When you view srarving children in Somalia, you cannor go ro rhe television set and give rhem soroe food. When you see war-ravaged lands, you cannor lend a helping hand. Yes, you could send mOlle)' ro some humanitarian organization (which may or may nor address rhe problem), but the nCxt day's evening news likely presents the same tragedy [hat you just donaeed money ro help. Perhaps even worse, two days later you will probably see another shocking evenr rhat, were we presem ar rhe scene, wOllld again caII for our wholehearted involvement. The more we see tragedies rhat we cannor respond ro, the less we tend ro reacr: we are learning ro be nonreacrive. Wherher it is on rhe news, i.n serial programs, or full-Iengrh movics, when we sec su/Tering repeatedly porcrayed bur

THE FRONTAL LOBE cannoe do anything (O correct it, we become desensitized. Thc conseqllences of training people in non-reaction are demonsrrated by violent crimes with wirnesses ively looking on, none lifting a finger to inrervene. Television and its Iegacy of non-reacrion can Icad viewers ta regard violence lighdy.

AL

TV

EWE

AGGRESSIVE BEHAVlO DECREASED AFTER FIVE MO TUS WITHOVT IT • Verbal aggression decreased 32 percent.

Television Strengthens Negative Qualities in Children Children who waech television are prane have bad areitudes aod are more irritable. lV-watching kids themselves repon thar relevision encourages chem [O show disrespecr for rheir parents, ta lie, and ro engage in aggressive behavior. 169 Typical television viewing fare a1so fosrers greaeer sex-rale seereotyping and a dtamaric increase in verbal and physicll aggressive behavior in borh sexes.'70 The increase in aggressiveness is one of rhe mosr worrisome e/tects of TV an our sociery. Many psychologisrs believe mat relevision-viewing shares a significanr porrion ofblame for rhe high rates of violence in our sociecy. Many srlldies have sOllghr ro determine rhe effects oflV 01\ yomh violence. These studies are more thorollghly examined in Chaprer 13 enrided "Stemmillg [he Tide ofViolence." re is important (O recognize [har nor ali [elevision programming is equaJly damaging. Some programming is c1early more decrimenral chan ochers, especially in the area of violencc. Inrerestingly, ie is nor only violenc fl1ms per se mat are linked wirh problems. One of d\e most trollblesome kinds of programing is [hat typified by MTV; a narional cahle TV channel rhar specializes in fast-moving photagraphic images synchronized wirh heavy rock mllsÎc. 10

MTV--Problems with Violence There is a concern [bat many reenagers are moving from more cypical celevision options to MTV and ies imitacors. This rype of music programming con randy stimulaces rhe visual senses through its provocatÎve, f1eeting images of rapidly changing scenes. Not only do rhe images rapidly change (even multiple images per second

• Aggression against objects decreased 52 percent. •Aggression against other people decreased 48 percent. figure 26

on occasion) bllt the ear is seimuiated as well. This eye-ear combinalion seems calculared ro induce an even more profound shurdown of the anaJyrical proccsses. One study chac lIniquely demonstraees mis was dane in ~l maximllm-securiry menrai hospiral with 222 paricms. During a period ofabolJt a year, parienrs were exposed ca seven months of MTV followed by five months wirhollr ir (normal TV Optiolls remained available). The resulrs are shown in Figure 26. 171 We have alrcady seen thar r.he standard, modern, rapid-paced relevision !las a wellproven negarive inf1uencc an the frontaJ lobe. However, we sec here indicaeions rhar the effecrs of MTV are even worse.

TEE

~ţ~ULTS

Tbc current bigh level of teen sexual activity results in: • Teens dealing with responsibilities and problems far beyond their physical and emotional resources. • Teens with diseases that are sexualJy transmitted. • Teens' entire future changed for the worse. Figure 27

285

PROOF POSITIVE

Television and Sex Television a1so effectively increases sexual acriviry in [eens aod younger children. Srudies show ir signi.ficanrly decreases the age of ftrsr sexual intercourse. The more celevision warched, ilie lower rhe age for thar fim sexual encounrcr. 172 Nor onJy do srudies show it, but ilie children themselves repon thar relevision encourages mem ro rake pan ~n sexual actjvity too soon. 173 The damagIng effeccs of teenage sex are spelled our in Figure 27.

Television Is Addietive

286

Most people do nor realize rhar re1evision is addicrjve. They find rhemselves gravirating roward rhe ser without rhinking about ic, and some leave it on aH day. In 1976, the Derroit Free Press conducted a survey ro help derermine why rheir newspaper circulation was decreasing. The survey resu1rs showed mat mosc people received cheir news and information from television. This is unfotnmate because, as we have seen, in some respects ir is rhe poorest source of informarion. We can learn so much more from reading newspapers, news magazines, or online computer news services rhan by watching one-sided news clips before our eyes in rapid succession. Also, we may miss a poinr, bur cannot go back and rake anomer look. Reading is by far a berter way to review the news, learn new things, and involve our frontallobe. The Detroit Free Press did nor STOp with rheir survey. They went an ro offer $500 tO auy family wha would give up relevision for one monrh. The paper extended rhe invitarion to 120 familics. A total of93 ofthem could not be enriced ro part wirh their television for even thirry days. However, 27 families accepred rheir offer. To make sure they could nor cheat, the newspaper company installed e1eerronic devices thar would interfere with any relevision used on their premises. The reswrs of rhe one-momh triaI were amazing. Family manifesred actual withdrawal symptoms. Insomnia and headaches were common. One man, noted for being a kind husband, lost his cool during me firsr week, became irrirared, and

began beating his wife. However, mroughout the mondl artitlldes changed. At ilie end of rhe monrh, ro almost everyone's surprise. aii 27 families said mat it had been a good experience. Mosr of rhe famiJies put their extra rime ro good use by gerring rhings do ne :Iround the house. One of ilie most rewarding findings was rhat rhe families were able to rdare to each omer in ways they had n.or done for ye-ars. They found mings rhey could do rogether, their minds were more creative, and rhey were acrually enjoying life more than when they had relevision. Would they go back ro relevision now rhat rhey earned their $500? They were generaIly convinced rhat they would do much better if rhey kept tdevisiol1 viewing ro a minimum. The study helped to illus[rare rdevisions' addictive aJlure alld demollsrrated thar in many respects TV viewing works against LIS rather rhan for us.This study actually provides a glimpse inro anorher danger ofTV viewing: rhe in.fluence of parenrs is greatly dimillished when TV becomes rhe main companion ro children in a home. This lack of parental involvemem in the lives of children direcdy relates back ro anorher frontal lobe robber: aleohol and robacco use. Researchers from Louisiana Sr.are Universiry Medical Center in New Orleans demonsrrated rhis when rJley srudied over 2000 fifth and sixth grad. ers for rhree ro four years. 174 Children who reporred (hat rheir parems spenr more rune wirh chem and had more communicarion wirh rhem were less likely ro llse a1cohol and tobacco. They were also less likely ro choose friends who used these substances. Unforrunately, rescarch shows what we aII would expecr: with more television viewing, rhe amount of time spenr in acrive conversa· rion wirh family signilicancly decreases. If relevision viewing is depriving LIS of aClive rime spem tOgerher as a family, parems may likely reap an extremely bi[[er harvesL

Television Robs Spiritual Qualities Television viewing, because of the rime it rakes, can keep us away from omer meaningful activities and pursuirs, including spending time with Gad. When we look ar

THE FRONTAL LOBE an ave rage person's weekly activicies before and aher che arrival of celevision, we see chac rhe amounr of time in church ar in reading spiritual material such as che Bihle, has noriceably decreased. 175 The reason for chis prohably has ro do wich more rhan TV subcly scealing away our rime. , celevisioll depresses activiry in the frontallobe, which is che se~l.t ofspirirualiry, moraliry, and the wilJ. We wouJd expecc a corresponding decrease in such incangible frontal lohe qualities as spiriruality and faim in God. However, if we consider celevision from just me standpoinc of time: ir often captivaces rhe few hours ofdiscrecionary rime chat we have in aur day. Before celevision,che rhree most profound influences on American vaJues were che family, rhe church, and rhe school. If the amOWH of cime we spend in an activiry directly corresponds (Q irs power ro shape aur values, chen in ilie 1950's releyision superseded the church. In che 1960's TV superseded ilie family; and hy me 1970's it superseded the school. Currenrly. U.S. children spend approximately 20 percem of cheir waking hours watching television. 176 The average American child, by rhe rime he graduares from high school, has spent more rime in franc of ilie celevision ser man he spenc in 13 years in (he c1assroom.'77, 17H Many believe char chese chousands of hours of random exposure to television programs h:'lVe profoundly affected our narion. They blame TV as one of che prime reasons for a dedioe in our nation's moral values. Some critics would like ro use legislation ro fix rhe problem, but we should nor and cannor legislare whar people do in rheir homes. Families should set lheirown rules. But how can a family be rnocivared ro ser cules wirhaur being adequately informed of rhe injurious effeclS of television? Somehow, accurace information as ourlined in chis chapcer should go ouc co every family in America so that informed decisions can be made. If simple, heahhy, and enjoyable TV-Iess family accivities became r.he foundation of the home life, 1 believe chere wiH be generally few regrers abour abandon ing the former life in which the TV sec held full cOlUrol. rf any are stiH wavering as co whether

1. Produces bypnotic efT«t,

byiog frootallobe filtering 2. Reduces interest in reading and learning 3. Wukens brain power 4. Encourag6 poor lifestyle babits S. Eoeourages obed!)' 6. Inereases daydruming 7. Weakens creativi\)' 8. May reduce our powers of discriminalion 9. Traiol io non-reaelion

10. Inf1uences viewers to regard violence ligbtly II. Makes cbildren more irrit,ablc 12, Increases aggrcui"eness 13. Accelerates sexual activi!)' 14. Addietive IS. ReducC3 time ...allable for producti\'e achievemcot 16. Steals lime from family inleraction 17. Advenely afTects spiritual punuits

Figure 28

television should be emphasized less in cheir homes, lec me summarizc 17 delererious effects ofTV warching rhat 1 have covered in chis chapcer. A lisring in rhe sequence in which chey were presenred appears in Figure 28. These harmful effects colleccive1y build a scrong case for personal aerion-roday. After ali, rhe very moral conscience of yOll and your family-residing in your frontal lobes-may be hanging in che balances. For those wondering if and how life can he enjoyably lived wimollt television, examine ilie related secrion in che following chapter. "Stemming the Tide ofViolence."

SIC~,v • Musie enters the brain tbrough its emotional regions, whieh include the temporallobc and limbie system. • From there, some kinds of music tendto produce a frontal lobe response tbat influenccs the wilJ, moral worth, and rcasoning power. • Other kinds of musie will evoke very JiUle, if any, frontallobe response, but will produce a large emotional response witb very little logical or moral interpretation. Figure 29

287

PROOF POSITIVE

Music and the Frontal Lobe

288

Few people undersrand [he power(ul Înfluence [hat music has on [he fronral lobe. Music enrers the brain tluollgh irs emotional regions as explained in Figure 29. 179 Depending on rl1e type of music, it can eirher inf1uence the brain beneficially or derrimenraUy. Music therapists tell us rhat cenain rypes of music, such as rock wirh its syncopar.ed rhYThm, by [!le fronrallobe and rhus escape our abilicy tO reason and make judgmenrs abour it. Evidence suggests that ir. like relevision, can produce a hypnoric effecr. 180 For many years some have argued mat rock music was ruining America's youth. Recentlya neurobiologist and a physicist teamed up ro pllt this generali7..ation to a test. They designed a srudy ro evaluate rhe neurologic.-u reaction of mice to difTerent musical rhyel-ulls. ISI For eight weeks they exposed each of three groups of mice ro differenr music seteings. One group heard rock-like disharmonic drum bear.s playing sofdy in cheir environmenr, a second group heard classical music. while rhe third heard no music whatsoever. AlI (he mice wenr through a standard maze test (with food at the end of the maze). On the fim day, aii [hrec grollps pcrformed egually weU. They groped abolit (he maze in search of (ood. By rhe end of cight wecks, however, ir was noted (hac (he second and rhird groups had leamed [he direcr parh tO rhe food. The "rock group," however, was stiU groping for ir. raking much longer ro find che food [han rhe other rwo groups. Next t.here was a rhIee week break in rheir maze rraining withollt Jl)usic foUowed by maze re-cests ro see how much kJlowledge chey had rerained of che maze's course, and ro see if rhe dfecr of che rock beat had wom of[ Again rhe rock group performed poorly. They conrinued ro have difficuhy ing how ro get ro cheir food. while rhe orher rwo groups sril! found i[ quick.ly. The rock group seemed almost ro be scarring from scrarch. They groped around and seemed disoriented. Both rhe control group and che harmonic group. on tlle other hand, could mll the maze considerably fasrer, proving rhar rheil" learning had sruck. To determine why dte poor performers

were having so much trouble, the researchers examined rheir brains, looking for changes in the hippocampus, a region in the temporal labe near the brain stern, which is usually associaeed wieh alerrness, memory, and learning. They fOllnd evidence of abnormal branching tind sproueing ofthe nerve ulls, and also disruptions in the normal amounts ofmessenger RNA, a chemical crucial ro memory srorage. The researchers concluded ehat ilie culprit causing rhe memory and learning problems was the music's rhythm, not its harmonic or melodic structure. The theory is that cenain musical rhythms help ro synchronize natural biological rhythms, mus enhancing body functions, wltile other rhythms rend ca dash wirh, ar disrupe, those internal rhyrhms. This is noe surprising since ali of our body syseems function in rhythm. The study's auchors postulate that if ehese natural rhythms are disrupted by some kind of disharmony, detrimencal effects can result, includingpermanent uarningdifficulties. This could help explain why rock music listeners are more prone ro lIse drugs and engage in extramarital sex, and why heavy meral listeners are much more Like1y to consider suicide. 182 Not only did che disharmonic rock-like music cause damage ro the temporallobes, ir also caused arrophy of the frontal lobe. This arrophy would be expeceed eo affecr moral worth, learning, and reasoning power. Harmonious rypes of hyrnns and symphonies, on ehe oeher hand, can produce a very beneficia! frontal labe response. This is the kind of musical environmenc in which aur children should be raised-music that can produce a positive radler dlan a negaeive effect. Classica! music has been demonstrated to help college studencs Jearn spatial relationships in geometry.183 A seudy showed that listening ta Mozan piano soIlaras significantly incre..sed spatial-temporal reasoning. l84 Interesringly, Mozan began composing music at the age of four. In a follow-up of rhe Mozart study, children three to five ye..rs of age who received eight months ofgroup singing and keyboard lessons scored significanrly higher on rhe "object assembly' task (arranging pieces of

THE FRONTAL LOBE a puzzle ro form a meal1Îngful whole, re· quiring frontal labe function) when compared eo children in ehe same pre-school who did noe receive music lessons. 185 Anorher swdy showed that musicians who possess perfece piech were soundl)' exposed to music before rhe age of seven. 186 The impace of music on shaping the characrer (and hence rhe frontal lobe) was recognized ar leasr 23 cenruries ago. Arisrorle, rhe Greek philosopher of the 4,h ceneury B.C., recognized thar music an cirher be beneficial or derrimenral ro aur characrer, depending on rhe kind of music we expose ourselves ro. He wroee, "Music direcrly represenrs [he ions ar srares of rhe soul-gentlencss, anger, courage, temperance, and their oppositcs and orher qualiries; hence, when one listens ta music t11at imitatcs a cerIain ion he becomes imbued wirh the same ion; and if over a long rime he habieually listens ro ilie kind of music rhar rouses ignoble [degraded ar vulgar] iolls his whole characrer will be shaped ro an ignoble form. In short, if one lisrens ro rhe wrong kind of music he will become the wrang kind of per an; bm, conversely, ifhe lisrens ro rhe righr kind of music he will tend ro become the right kind of person. "187 Arisrorle unwittingly referrcd ro the fronrallobe, where we now MOW the scat of our characrer residcs. Ellen White wfOte a summary statemenc describing rhe effeces ofcerrain amusemenrs on the frontal lobe: "The enemy of rightcousness has every kind of pleasure prepared for youth in aH condirions oflife; and they are nor presenred alone in crowded ciries. bur in every spor inhabitcd by human beings. Satan loves ro secure rhe youth in his ranks as soldiers. The arch-fiend weU kn,ows wirh what material he has ro deal; and he has displayed ILis infernaJ wisdom in devising customs and pleasures for the yourh which wiU separare cheir affecrions from Jesus Chrisr. "188 She further stared, uThe various amusements ofsociery have been the ruin of rhousands and teHS of thousands who, had it nor been for t!lese arrracrions, would have been obedient children, respectfuI ta rheir parents. uprighr, pure, and noble in rheir pursuirs and in cheir characrer." 189

Cerrainly from rhe studies we have reviewed, much of the relevision programming, induding MTV, and rock-like music in general, would fit inro the carcgory she menrions. lf our young people could grow up in a posirive, supporrive environmenr, imagine how many of them would become wholesome, eiliical individuals who would be numbered among the greatest men and women of our day.

SECTIONV

Summary List OfSeven Actions to Take for Enhancing the Function ofthe Frontal Lobe.

1. Protect it from mechanical injury.

2. Prevent or control underlying diseases that may damage tbe frontallobe. 3. Give it an adequate supply of oxygen from the blood. 4. Supply it with good nutrition by eating the right foods and avoiding the wrong ones. 5. Get adequate sunshine. 6. Exercise it. 7. Provide proper inputs by controlling what we sec and hear. Figure 30

A summary lisr of actions we can take enhance fronral lobe function is shown in Figure 30.

10

J. Protect the Frontal Labe/rom

Mechanicallnjury Mechaillcal injury can infljcr permanenr brain damage. Boxing. football, and mororcycJe riding are examples of high-risk

289

PR:OOF POSITIVE fIict fromaJ lobe damage. For this reason, car seat belts and shoulder harnesses are a must. Flirthermore, work place injuries are not confined ro the Phineas Gages of yesteryear. Take aJl reasonable safery precalltjons on the job.

,

Results ofMRl brain scans ofhypertensive and normal subjects 1. Hypertensive subjects had 10 times the ÎDcidence of white matter lesions.

2. Prevent Diseases That May Damage the Frontal Lobe

2. Intelligence tests showed a Iower level of overaU bram ability and intelligence in those with white matter lesions.

The proper use of preventive medicine principles can also heJp you to prese.rve frontaJ labe functÎon. A number ofdiseases can lead ro loss of frantaJ lobe capacity. Mauy of these maJadies are potemiaJly preventable. Srrokes are among the most worrisome; yer, they can ohen be prevemed by controlling risk facrors such as high blood pressure. Independem risk factors for stroke in people between rhe ages of 16 and 60 include: high blood pressure, diaberes, currene tobacco use, heart disease, and a.lcohol consllmption {within 24 hours preceding [he onset of the stroke).190 Women need ro add oraJ conrraceptives ro this srroke risk factor lisc. 191 Recent research indicates mat high blood pressure itself can affecc brain efficiency.192. 193 In one ofthese sflIdies, 42 hypenensives (high blood pressure paeienrs) were compared wim 42 people wichollt high blood pressure. They alI undcrwenr MRI sc.·mning, a widely available procedure [hat takes derailed pictures of tbe brain. Intclligence reses were a1so given to the sllbjects. The results are shown in Figure 31. 194 Note thar high blood pressure inf1icted visible (romaJ lobe white matrer damage as weB as damage ro rhe subjects' intelligence. The white matter poreion of the brain is involved wirh ncrvc impulse conduc(ioll and is rich in nerve fibe[s. Irs color comes from thcse nerve fibers (hat are insulared wirh a whire substance called myelin. Note, funhermore, dur [he white maner lesiolls were prcscm 110 marter how successfully rhe blood pressure had been treated wirh drug rherapy. This research suggesrs thar only by conrroIJing blood pressllre wirh lifesryle can such brain damage be prevented. Chaptel' 6 explains how high blood presSlIre can be addressed or avoided by namraJ means, wirhout medication.

3. The lesions were present no matter how weU the blood pressure had been treated wtÎth drug therapy. figure 31

actlvH/Cs. Blows ta the head while boxing frequently damage t!le tiny blood vessels, particularly in the fromaJ lobe. A boxerwith these injurie.s is sometimes referred to as being "punch drunk." Othet sporcs can lead ro similar injuries. Ali such avocations are besr avoided by those who wanr ro prorecr good fromaJ lobe function. FrontaJ lobe injury by mechanicaJ means is not limited ro spons parricipants. Head injuries from automobile collisions can in-

G Results of MRJ measu.rements ofbrain size:

Significantly more brain atrophy occurF,ed in hypertensive subjects compared to those with normal blood pressure.

figure 32

290

THE FRONTAL LOBE SriH orher research has doclIlllented anorher brain damaging effecr of high blood pressure; namely, brajn arrophy, or brain shrinknge. Brajn size as measured by MRl ,is smaJler in those wirh high blood pressure. Th is is described in Figure 32. 195 High blood pressure and srrokes are nor rhe only condirions rhar can jeopardize rhe frontal lobe. Physical condirions ofren affccr brain performance. Hearr condirions can lead ro problems that later affect rhe brain. Nervous sysrem disorders of .many sorrs compromise brain funct1on. In facr, juSt being ill wirh any serious disease will relld ro have measurable brain effecrs. The bonom line is ro follow a heaJrMullifesryle that addresses YOur body's toral needs.

3. Jmprove the Quality o/Your Brain's Blood Supply Enhanciog rhe qualiry of aur braills' blood supply is imporrant. Again, this factor srands to help the enrire brain, nor jusr the frontal labe. How can we provide ir? By brearhing dean, &esh. well-oxygenared air. 1discuss in some derail the benefirs of fresh air an mental performance in Chapter 20, Beyond the leading Causes of Death. There rdiscuss rhe body of research suggesring rhat llegatively charged ions in fresh air enhance menral performance. However, more rhan air qualiry may well be affecring mental performance. Our habirs ofbreathing may also make a difference. In a classroom o)" oftice serring we may nor reaHze thar mosr of llS reod ro rake shallow breailis. This may be onc reason why aner 30 minutes we may nnd it somewMt more difficu1r ro concentrare. Shallow breathing may have SUd1 delererious effecrs by alJowiog our blood ox:ygeo level (c.1l1ed "oxygcn saruracion") ro dip below rhe leveJ necessary for optimal fronral lobe performance. l96 Consciously taking de breadlS periodically may heJp ro coumer rhis rendency. By taking deep brearhs, parricularly offresh air, we may be able to boosr oxygen sarurarion sufficienrly ro improve fronrai labe funcrion. In addition ro raking deep brearhs while sirting, regular aerobic exercise (ourdoors preferably) wiU cause ilie hean ro pump vital, ox)'genated blood ro rhe brain.

4. Provide Good Nutrition I have foclised a targe ponion of thi chaprer an the role of good nurririon in optimal frontallobe fUllcrion. A rotal vegerarian diet thar is free from aii srimularing agen rs appears ro be rhe besr djer ro improve rhe abiliries of aur fronr brajns. Nursing infanrs should be breasr-fed.

5. Get Adequate Sunshine Sunlighr may increase seroronjn production in the daytime. This, in turn, can heJp prcvem depression and fatigue. 197 I deaJ wirh some of rhese relarionships in the conrexr of sunshine's sleep-enhancing cole in Chapter 9 on mclaronin. Funher derails of sllnshine's benefirs on whole person healrh are chronicled in Chapter 20, "Beyond the Leading Causes of Dearh."

6. Challenge Your Frontal Lobes ByaU means, exercise the rhinking power of your brajn! JUSt as our muscles shrivel if we do nor use them, so ir is witll our fromal lobe. ChaJlenging memaJ rasks will help ro maimain our menral acuiry by stimularing the fromallobe. Seriolls reading, rhe study of nature, asking questions abour ilie vast world surrounding us aod other wholesome uses of our mental capaciries rend to produce salutary [roma) lobe effects. One recent srudy found that imagining a cerrain activiry srÎmulared 80 percem of rhe brain circuiuy thar would be lIsed ro physically perform rhe very task imagined. J?8 Such menral pracrice srrengthens rhe brain cell connecrions. and when the rime comes ro execute {he acriviry, {he individual is berrer prepared. Menral acriviry in children and {eenagers is especialJy important in enhancing the abiliry ro leam. Scientisrs have now discovered rhe firsr srrong evidence thar imellecrual scimulation can significandy increase Jhe number ofbrain cells in a crucial region of rhe brain. Previously it was rhoughr iliar the number of active brain cells was moreor-less ser early in chiJdhood. This landmark srudy was performed ar rhe Salk Institute for Biological Studies. 1?? There, young mice were provided wirh an enriched environmem, with more games and toys,

291

PROOF POSlTIVE and room ro roam in exer
1. "The undcrstanding adapts itself to the dimensions of the subjccts with which it is required to deal. 2. If occupied with trivial, commonplace matters only, nc\'er summoned to earnest effort to comprebend great and eternaJ trutbs, it becomes dwarfed and enfeebled. 3. Hcnce tbe value of the Scriptures as a means of intellectual culturc." Figure 33

~

292

7. Control What we See and Hear The Ilnal point on rhe lisr is relared (Q the previOllS point. Exposing our minds ro grear inspirarional material wilJ enlarge rhe mind anei srrengthen rile imdlecr. Since spiritllaliry, morality, and rhe will are cenrered in rhe fromal lobe of rhe brain, the inspirarional material chosen ShOllld ideally appeal ro our spiritual and moral being. The study of tile Word of God fiUs this requiremem ji1<e no orher can. Ellen Whire outJined rhe impact of stlldying rhe Scriprures an rhe mind, saul, and imellecr, as quoted in Figure 34. 201 1 have used considerable space in dlis chapter making (he poim r11ar proper physical and memal habits are important for optimal fromal labe funcrion. C1early, riglu mentlll habits promote memaJ excellence. Ar the same rime, "right physic,u habirs promore mental superioriry."202 These are thc laws of nature, laws [har rhe Crearor has pUl iora aur being. "Imellecrual power, physical srrengrh, and longeviry depend upon immlltable laws. There is no happen-so, no chancc, abolIt rhis marter. Heaven will not interferc ro preserve men from the COI)sequenccs of rhe violarion of narure's laws."203

Conclusion

~r::

. .

~

1. "The Bible, just as it reads, is to be our guide." 2. '"'Notbing is so ealeulated to cnJarge the wind and strengthen thc intellcet as tbc study of tbe Bible." 3. uNo other study wiII so elevate tbe soul and give viRor to the faculties as the study of the living o'raclcs.•." 4. "As the mind is brought to the study of God's Word, the understanding will enlarge and the hi~her power will de\'elop for the eomprehension of high and ennobling truth." Figure 34

Ellen White described the effects ofchallenging rhe brain as quoted in Figurc 33.200

God has provided each one of us with rhe power ro freely choose how Vie:: willlive. Anei He llsually doc:; not ilHerfere, evel) when we make bad choices. Truly, "there is much truth in rhe adage that every person is ule archi tect of !lis own fOI rlllle. "204 IIl view of this ucmendolls power rhar you have been given ro shape your own fmure, won't you take some time today tO again seriollsly look ar your lifesryle. 1 chaJlenge you ta reflect on your cllrrenr hcalth habirs and ask yOllrselfwhat you can do ro rake advanrage of whar you have Icarned from rhis chapter. Try ta idenrify some concrete steps rhar you can rake wÎthin rhe nexr week ro help protect and enhance your frontallobe-and of course with it, your entire body. A healthfui lifesryle makes sense. Do nor merely

THE FRONTAL LOBE follow your old ways of doing chings just because iliey are comforrable, or "because everyone else is doing it." In che words of Scri ptu re, "Be not conformed ro rhis world:

bur be ye transfonned by the renewing of mind, thar ye may prove what is rhar good, and acceprable, and perfect, will of God." Romans 12:2. yOUl"

ReftrencesI /

blJ/J1' pilatl Ibl SIOry o[Pbinm.s Gage IOgnber fiom thl {OlloUJillg '·l({rn/ar.

19 Be 1 CH, Taylor N. 7/u Physiological Bmis ofMediml P,.,mirc-5';' cdilioll. Balrimorc. MD: Williams and WilkinsCompany, 1950 p. 1023.1024.

20

BaJdwin B. Thc From·Brain. Joumol ofHenlth nl/d Henlil/g 1983;9(1 ):9.

Constanti an HM. TIu COUlltr}' Donor Olltl His /Ilustriolis I'lui",}/. Worch~stt"r Mcdic:ll Ncws. Sept.Oct. 1972.

II

D;lma.,io H. Grahowski T, ct al. The return of Phinc~. Gagc.: ciu<:s aboul the br:lin from lhe skull of a famous palietll. Scimce 1994 May 20;264(5162): 1102-1105.

2l Best CH. T.~ylor N. Tiu Pbpio/{)giCIII BIISf-S ofMl'Ilil'lJ! PmL'lia-S'" tI/ilioll. Balrimore. MD: Williams and Wi1kins Cornpany, 1950 p. 1023,

Fusler JM. Thl' ?re/i'on/al COrtex. ArIi1IMI~)\ Plrysiology. Il1ltl Nmropryebo/ogy ofti}e F7'01Itf/1 Lob 2"" etlition. New York: Raven PreS5, 1989 p. 126.

lJ

Kosko/TY, Goldhurst. Prologue. 111: nit Dluk Sitk aflbt House. New York: The DiaJ I.'{css. 1968 p. .l-A'XJI. Damasio H, Grabowski'C CI al. Thc rcturn of Phineas Gage: ducs abour lhe brain from IIle skull of a famous palienl. Seimu 1994 May 20;264(5162):1102-1105.

1

Cummings JL. Fronral-subcortical circuirs and human behavior. Areh Nrurol1993 Aug.;50(8):873-S80.

1024. 5russ Dl~ Benson D. 7/Je Frollilll Lob/'S. New York: R.wcn Pres. 1986

p. 126-130, 243. George MS, Ketle.f TA. POSI " M. SPECT and PET imaging in 11\00d disorders. J ctin 1":rclJitUry 1993 Nov;54 SuppIO:6-13. 1;

Robert J. Behavioul
,·aIJol/mal. 1996 Mareh 16.312(7032): 657.

J

Moore KL. Clillieally Orun/d A1II11Omy. Baltimore, MD: Williams and Wilkens, 1980 p. 935.

l6 George MS. KetlerTA. Posr RM. SPECT and PET imaging in mooc! disorder<. J Cii" P'yc/;illlf)' 1993 Nov;54 SupplO :6-13.

• Price BH. DaffmT KR, CI al. The comporrmcnl:tllcarnillg disabililies o( carly fromallobe damagc. Bmill 1990 OCI: 113 ( Pl 5)0: 138:~-1393.

l7 Kuczmarski Rj. Fleg
Smss DT. Benson D. 7l}r Fr011l11! Loba. Ncw York: Raven Press. 1986 p. 5.204.

28

<

6 FuJIOJl jF, edilor. The FrorJtl1/ L"bes. New York: Hafner Pub1ishing. Compally, 1966 p. 27, 59.

7

SIWS DT, lIellson D. Tiu Frontlll Loh,·s. New York: Raven Pres,;. 1986 p.

6.

19 5lUSS

DT. Benson D. TI1/' Froml1! Lobes.

ew York: R.1Ven Press. 1986

p.243. [\aldwin BE. The front blain and the ministcr. Mil/im)' Milgazille. 1990 lan p. 20-23.

]O

Fusta jM. Tht T'rtfro/lll1/ Cortt'X. Arl.l1lomy, Physiol"gy, and Neuropsychology oltlli' FrOllllll Lob,·-2'''' ulilion. New York: RJvcn Prc s. 1989 p. 3-9. 125.

8

; Ko bA-V, GoldhurSL Prologul'. III: Tiu Dlrrk Sitl,· ofthr Home. New York; The Dial Press. 1968 p. I-XXII. 10 Ko kofT Y, Goldhursl. Prologue. In: Tbe Darlt Side ofIhe HOl/SI'. New York: Thc Dial Press, 1968 p. l-XXII. 11

Updale: pre"alenee of overweÎght among c1tilJren, adolescent. and aduhs-U,tiled Slalcs, 1988-1994. A1MWR Morb MorJn!'vlkly Rep 1997 Mar 7;46(9):198-202.

Darrach B. The Sorrow and lhe Suerlglh-Rosc Firzgcrald Kcnncdr 1995 (March) p. 52-63,

Lije Magllt-iJl!'

Il FultoJl jF, editor. The FrOJllll1 Lobes. New York: Hafner Publi
Priet· BH, Daffner KR, ei al. The comporrlllelllallearning disabililies of C.3rly frolllailobe damage. Braill 1990 OCI: 113 ( Pl 5)0: 1383-1393.

.\1 MonÎtoring Ihe flllure surve}'. Rekascd Deccmbcr -O, 1996 by Donna Sha.lala. Secrelrar)' Departlllenr of Health and Human Service . AI O Narillt);l1 ParcnL~ Rcseo,rch Institulc (or Drug EOllt':llioll (PRIDE) SlIrvey, Slember. 1996. Adama GA.

Malhias R. Srudiei s/;ow cogllili/le impllirmrlllS IiI/ger ill het/Il)' 1>laTijlltllUI NJDA notes (National Instilu!c on Drug Abllse) May/JlInc 1996; II (3): I. 4. 9.

32

'lSfI~.

fried PA, Cray R. WatkiflSon B. A follow.up srudy of JtlClllional bchavillr in 6-ycar-old ehildrcn cxposcd prenat;ul}, ro marihuana, eigarems. and a!cohol. Nt'IlrolOxieology & unlto!og)' J 992 Sep-Ocl; 14(5):299-31 1. .1.1

Yl

Th" MediCIII Leller 1989 Dec 29:310: 113-118.

1)

14 Pricc BH, DafTncr KR. CI al. The comporrnlclllaJ Jearning disabililics o( C.3r1y fromal lobe damagc. 8mill 1990 Ocr: I 13 ( Pl 5)(): 1384.

1; BaJdwin

R. The From·Brain. JOllmaLolHenlthanti HI'It/ing 1983;9(1):8-

10.26-27,30. Price BH. DafTner KR. el al. The comporrmemal Jearning disahilities of w'ly fronrallobc damagc. Braill 1990 OCI; 113 ( Pl 5)0: 1383·1393. 16

17 Fusrer JM. Tbc Prefrollllll Cortex, Anl1to1>ly, Physio"'gy, 'l1Id Nruropsycho"'gy ofrbr Fronll1/ Lohr-2'''' rdirio1J. Ncw York: RJvcn Press, 1989 p.

129. 154. 18 Guyton AC. Trxlbook ofMrtliCll! Physiology-6'h rdition. PhilaJelphia: WR Saundcrs Company, 1981 1'.689-690.

Surgeon Genera!'s Work hop on Hcalth Promotion ;lnd Aging: Sllmmary recolllmcndations ofthe Mcdiealion Working Group. MM\f1R Mo,.b Morral W'k~y Rtp 1989 Sep 8;38(35):605-606.611-612.

3"

Surgeon Gencral's 'J'/orkshop on I calth Prol11otion and Aging: summary recornrnendations of lh" Mcdicalion Workillg Group. A1M\.'(IR Morb MOrff// \Vk{y Rrp 1989 Sep 8;38(5):605-606.611-612.

J6

\'<'!lite EG. Disease and ils Causes. In: Selretrtl Mmagrs Book 2. Hagerslown. MD: Rcvicw aJld Herald PublishingAssocialion. 1958 p. 451452.

37

Bairstow BM. Burkc V. el al. In~dcquatc rccording of :llcohol-drinking. robacco-sllloking and oi eharge diagnosis in medical in-patienl : (ailure 10 rccognizc risks including drug imeracrions. .M",I EtiliC 1993 Nm';27(6):5IS523.

38

293

PROOF POSITIVE }9 Wang GJ, Volkow ND, el al. Funcrional imponancc of vcmricuhr enlargemcm and conical atropby in heallhy subjecls and aJcoholies as asse.~scd wilh PET, MR imagiug, and ncuropsychologic le.sring. RJlCliolog} 1993 Jan; 186(1):59-65.

Parker DA, Parker ES, el al. AJcohol use and cognilive loss among employc:d men :lJ1d women. Am J Public Hra/r1J 1983 May:73(S):521526. •0

•1 10

bdor PL Akohol-rclated relalive risk ofllual driver injuries in relalion drivc:r agc: and sex. J SiudAlcohol1991 Jul;52(4):302-310.

41 WainWTighl PE, Levesquc: S, ee al. ElTecrs of environlllelllal enrichmem on conica! depth and Morris-maze performance in B6D2F2 mjce exposed prenaeally 10 elhanol. Nl'1Irotoxicol7iraro/1993 Jan-Feb; 150): 11-20.

'} Wozniak DF, Cicero TJ, el al. Parerna! alcohol consu01ptiofl in I.he rat impairs sparia! learning performance in male olTspring. p,-yc!Jop/Jarmacology (Beri) 1991; 105(2):289-302. ,. Whire EG. A Usson for r.he 1imcs. In: Hralth Refomur, 1878. Found

In: Ellen G. Wltiee Escare. The Publishrtl W,'ilitzg; o/ElIm G. Whire. Version 2.0 (CD.ROM), 1995. While EG. A Lcsson for thc1imcs [Liquor & Tobacco). In: Sigw oftlJc Tim,'], ) 878. Found In: Ellen G. Whire fulale. Thr Publislml Writing; '1" Elim C. White. Version 2.0 (CD-ROM). 1995.

45

Moriyama 1; Ue'LU K, er al. freets of dielar)' phospllalidyldlOlinc on mcmory in memory deficient micI.' wilh low brain acerylcholine coneenImion. Lift Sâ 1996;58(6):I'LlII-118.

;'l

6<J Floyd EA, Young-5eiglcr AC. et al. Ch ronic crhaJlol ingestion proJuccs cholinergic hypoflJncrion in rar brain. Alcohol1997 )an-Feb; 14(1):93-98.

Curalolo P\'q, Roberrson D. The hcahh eonsequenees of calleinc. A1In Intern Med 1983 May:98(5 1';0:641-653.

61

6~

Cutarolo 1'~I, Robcnson D. The healrh conscquenees of calTcinc. AmI Intern Med 1983 May;98(5 PI 1):641-653.

RaII TW. CeJllral Nervous Sysrem Srimulanrs IConrinued]: rhe Mc.rhylxanrhines. In: GiLman AG, Goodman LS, el al, edjrors. Goodman ,,1/11 Gi/mart'; Tiu Pb"m1l1cologic BMis of Tberapmtics-?" etiition. New York. NY: MacMillan l'ublishing COl1lpany, ) 985 p. 595-596.

6}

Edelmann RJ, Moxon S. The eRecls of caffeine on psychologica! functioning. Mit/' Henltb 1985:4(1):29-36.

G4

6S Craig W]. CafTeine pdare: Whar's Brewing? In: Nutritiol1 for Ihr Ni1l/'/ies.. Eau Claire. MI: Goldcll Harvest Books. 1992 p. 286.

(,(, Marrin TR. Bracken MB. Thc associ'lIion bClweeu low birth weighr aJld eaffcine consumplion during pregnaney. Am J Epidemiol 1987 New; 126(5):8 J3-821. Cnn BJ, Goldhaber MK. CafTeinared bevcrages and low birrhweighr: a case-control sludy. Am J Public Health 1989 5;79(9):1299-1300.

67

Kruger A. Chron ic psyc.hiatric patiems' use of caneine: pharmacologica! c:ITccrs and mechanisrns. Pl'J'chol Rep 1996 Jun:78(3 Pr 1}:915-923. .6

Burr ML. allaeher JE. el al. Coffce. blood pressure aod plasnu lipids: a randomized comrolled trial. El/rJ elin Mar 1989 Jul;43(7):477-483.

6$

Edelmann RJ. Moxon S. The cITeels of mlTcinc rioning. NUI7 HMlth 1985;4(1):29-36.

i7

00

psychologieal func-

.. r'ure s. Popoli P. er al. Ponsynaplic amagonislic illleraclion bcrween adenosine AI and dopamine D 1 rccrors. Nmrorrporl 1994 Dcc 30;6(1):73-76. Ferte S, O'Connor wr, el al. Amagonislic imeraerion berween adcno ine AlA recepmrs and dopamine 02 receprors in lile ventral slriopallidal sysrct1l. Implicllions for me rl'l:3rmcne ofschizophrenia. Nmrosdmu 1994 Dec;63(3): 765-773.

1?

Lang T, Degoulel P. el al. Rclauon bclwcen colTee drinkjng and blond pressurc; anal)'sis of 6,321 subjecr in the Paris regioJl. Am J CI1rdiol1983 Dcc 1:52(1 O): 1238-1242.

G?

Craig WJ. Caffeinc Update; What's Brewing? In: Nlllrition fir zhr Nimtif.j.. Eau Claire. MI: Goldcn H;uvesr Books. 1992 p. 284.

70

JM, Wallaee RB, editOrs. Mnxcy-Rosmnu-iAst Public Healtb "nd Prrllmtive Mttlicill~13';' editio". 01"\ alk. ef: AppletOll and Lmge, 1992

71 laSI

p.900.

Baldessarini RJ. Drugs and rhe rreumcm of Psyehiarrie di ordcrs. In: Gilman AG. Goodman LS, el al. edirors. Goodml1n alld Cilman'; The Pilllrmacologic Btuis ofTJurapeulio-?h editioll. New York, Y: MacMilJan Publi.hing Company, 1985 p. 396-397, 595.

73

George MS. Ketler TA. Posr RM. SPE.CT and PET imaging in mood disordcrs. J Clin Psyebiatry 1993 Nov;54 Suppl0:6-13.

74

50

;1

52 ero S, Nardini M, Bani"ini N. Regional cerebral blood now dlanges

{ollowing ehronic isu31ion of anrideprcssanl drugs. Ni!urop;ycbop/JIlrmncol Biol Prychinrry 1995 Jul: 19(4):627-636.

Prog

Pas...ero S. Nardini M. Balrisrini N Regional cerebral blood now changcs following ehronic 'ldminislr'llion of anlidepressanl drug.. Prog Nellropsyrbophlfm1ltcol Biol Pl'J'rhiatry 1995 )ul; 19(4):627-636.

;J

~ Jacobsen BK, Hansen

V. CalTeine and health. Hr McdJ (Clin Res Edl 1988 )an 23:296(6617):291.

;; Lin Y. Phillis JW Chronic ealTeine exposure cnhances adenosinergic iohibirion of ccrebra.1 cortica! neurons. Bmill Rrs 1990 Jun 18;520{l-2):322323. 5(, Shi O, Nikodijcvic O, er al. Chronic cam'ine alrers lhe densily of adenosine, adrencrgie. eholincrgie. GABA. and serolOnin receprors and calcium channcls in mouse brain. Cell Moi Nmrobiol1993 Jun:13(3):247261.

5'

CuratOlo pw, RobeTlSon D. Thc healrh consequcnees of afleinc. AnII

/num Md 1983 May;98(5 Pc 1):641-653. Lin Y, PhiUis JW Chronk calTeine exposurc enhana:s adenosincrgie inhibiljon ofcerebral conica! neurons. Bmin &s 1990 Jun 18;520(1-2):322323.

58

294

TI

Craig WJ. CatTeine Updale: Whae's Brewing? In: Nutritlon fOr riu E.1U Claire. MI: olden Han'csr Books. 1992 p. 284.

Ninrties..

\Xlhjle EG. COU1lu/s 011 Diel "'ld Foods. HagcrslOwn. MD: Revicw.nd Herald Publi hing AssociarioJl. 1976 p. 423.

Seimu Ntlvs 1993 Jan 16; 143:46-47.

On. Alcwijn. AnJlollllccd Apri! 15. 1997 at rhe Amerimn AClfdrm) of Nl'IIl'%gy mecring in Boslon. 7;

7(. Fox NL. Hebcl JR. ScxtOl1 M. Prenaral exposure 10 lobacco: Il. Eftecl> on cognilive futlceioning ar age Ihrce. b7lemillionlllJOlmlill o/I:..pidrmiology 1990 Mar;19(1):72-77.

77 Rogan \XIJ, Gladcn

ac.

Breasl-Îeeding and cognilive dcvelopmelll.

Ettrly Hum DrIJ 1993 Jan;31 (3): 181-193. Lucas A. Morle)' R, cr al. Breasl mjlk and subsequellr ÎmelligclJcc quoriem in children born prelcrm. L'/IICCI 1992 Feb 1;339(8788):261-264.

78

7') Yokora A. Re\arionship belWcen polyunsaruraled hur)' acid (PUFA) and learning abililY in the brain of rar fetus and newborn. Nippon S'1IIk" Fltji"kl1 C'lkk"i Zasshi 1993 Jan;45(1): 15-22.

Bourre JM. BOl1tJcil M, er al. Funcrion of dielary polyunsarurared fau)' acids in d,c nervous systcm. Prouaglandim Lmkol EUl1It F"II) Acids 1993 Jan;48(1 ):5-15. 80

Makridcs M. Neumann MA, er al. Erydlroeyre farry acid, of rcrm infams fed cid,er brca,I mjJk. slal1dard fOnllUla. or forlllu.1a supplememcd \Virh long-chain polyunsaturale.<. Lipids 1995 00;30(10):941-948.

81

82 Jackson KA, Gibson !tA. Weaning foods canllol replace brea 1 milk as sourccs of long-chain po1yunsalurared f.~rry acids. Am J Cii" Nutr 1989 Nm·;50(5):980-982.

THE FRONTAL LOBE Coscina DV, Yehuda S. Learning is improved by a so)'bean oii dict in rm. Lift Sri 1986 Ma)' 12;38( 19): 1789-1794.

8)

Yehuda S. Carasso RL. Modulalion of Icarning. pain ehresholds, and ehermorcgulation in lhe raI b)' prepa.rations of free purified alpha-linolenic and linoleic acids: delC'rmination of the opeimal omega 3-to-omega 6 ratiu. Proc Nat! Acd Sâ USA 1993 Nov 1;90(21): 10345·1 0349.

Si

8\

B:I1dwin BE. Dier and lh... brain. Milli=) MIIgazillc. 1990 Mar :25-27.

s,; Greenwood CE, Wil10cur G.

ognieive impairmenc in eaes fed high-fae diels: a specific efrece of saturaeed fauy-acid incake. &IJlIV Nrurosri 1996 Jun; 110(3):45 1-459. Rosenberg IH, Miller JW. NUlricion:t1 faclOrs in physÎo.1 and cognitive (unceions o(e1derly people. Am) Clill NrIl1' 1992 Jun;55(6 5uppl): 1237512435.

87

'TiJcker OM. Pcnbnd JG. ce al. Nuerieion seaeus :1Jld brain function in agillg. Am} Clill Nwr 1990 Ju1;52( 1):93-102. 88

La Rue A. Koehler KM. el al. NUlrilional SlalU' :Ind cognieive funcrioning in a normally aging samplc.: a 6.y rcaSSCSsmel1l. Am j Clin N/ltr 1997 Jall;65( 1): 20-29. 89

% GUylOn AC.

Texlbook ofMedical Pb)'!iology-8'1> ediJioll. Phil.addphia:

WB. Saullders Company, 1991 p. 684-685. 91

GUylon AC. Tt:>:lbook ofMedical P"ysiolog;~8'" rdiJion. Philadclphia: 1991 p. 684-685.

wn. Saunders Compan)',

Prinz RJ. RidJle DB. Associaciolls beeween lIutritioll and behavior in 5year.old ch.ildten. Nlltr Reu) 986 May:44 SupplO: 151-158. Blackman JD, Towlc VL. ec al. Hypoglycemic lhresholds (oe cognicive dys(unction in humans. Diabl!ll'5 1990 JllI:39(7):828-835. 93

Ryan CM. Atchison J, et al. MilJ hypoglyccnlia associaccd wim delcriotalioll of mental efficicncy in children wich inslllin-Jependelll diabece mellitu$. j l'edidJr 1990 )ul; 117(1 Pl 1):32·38.

10 Veciana-Nogues MT . Hem:tndC'l-Jover T , ec al. Liquid duomalOgraphic meehod for decerminarion ofbiogenic amines in fish and fisb prodU c. jAOAClm 1995 JuI-Aug;78(4);1045-1050.

106 Eerola S. Hinkkancn R. CI al. Liquid chromacographic dccermination ofbiogcnic amincs in dry sausages. } AOAC 1/11 1993 May-Jun;76(3):575-

577. 107 Straub B. Schollenbergcr M, ec al. Exeraction and decermioation of biogcnic amines in fennemeo sausages and ocher meaC producIs using reverscd-phase-HPLC. Z Lebrwm Ulllm ForrclJ 1993 Sep; 197(3):230-232.

lOg Geornaras r, Dykcs GA, \'on Holy A. Biogenic amine formacion by poullry-associated spoilage and parhogcnic bacleria. UtT Appl Microbiol J 995 Sep;21 (3);1 64-166. lU9 Makarios-Lmam I. Levin RE. Isolacion from haddock eissuc of psychrophilic bacccria wilh maximullI growlh Icmperarurc belo\V 20 degrecs C. Appl Elluiro" Microbio/1984 Aug;48(2H39-440.

110 Lin JK. Food·bornc a.mines and amide. as poecfIlial precursors of elldogenous carcinogen,. Proc Natl Sâ GlUIIIC Repub Chi,," [U] 1986 Jan; 10( 1):20-34.

1I1 Callaway J . Airaksiocll MM, el al. formalion of lcrrahydroh;uman (l-melhyl-l ,2.3.4-celrahl'dro-bela- carboline) by Helicobacecr pylori in ehe presence of erhanol :U1d tryplaminc. Lip Sci 1996;58(21): 1817-1821.

llZ Yamashila K. Ohgaki H ,er al. DNAadduc[s (ormed b)' lhecomueagens harman and Ilorharrnall in various lissues of mice. umar [eu 1988 Nov:42(3): 179-183. Il) Oda Y. N:tkamura S. Oki I. Harman and norharroan induce SOS r('sponses and (rameshi(t mUlalions in bacc('ria. Mural Re! 1988 May;208(l );39-44.

91

114 Komissarov IV. Abra1llels II, 5amoilovich IM. Tryplamine as an eno dogenous modlllalor of neuronal sensiciviry ro scrotonin. Neirofiuologiia 1989;21 (3):352-357.

PcnningtOn JA. Supplcmelllary Tablcs; Sugars. In: Bowes alld C!Jurel/s Food Va/un ofj>orJiO/l! wmmon/y Uud, FifieCllrb &Iilion. Philadclphia,

'1, Bosin TR. Faull KE Harman in alcoholic beverages: pharmacological and toxicological implic.'lions. AkolJol Clin Exp Rcs 1988 O t: 12(5):679682.

9S

PA: JB LippincOlc Company, 1989. ?G Lloyd HM, Greell MW, Roger PJ. Mood and cognitive per(orrnancc dleces ofisocaloric IUllChes difrering in fac and carbohydrace contenc. I'b)'Jiolo,'{Y 6- 8rhavior 1994 JuI;56( 1):51-57.

Finbcrg J P. Seidmal) R. BCllcr OS. Cardjovascul;u responsiveness 10 vasoacrive agenlS in rac wÎlh ObStrllCCive jaundice. Cun Exp PhllrJl/./lcol Phy!io/1982 Nov-Dcc;9(6):639-643.

97

GUylon AC. Tf):tbook ofMedical I'hysiology--8'" editioll. PhiJadelphia: WB. Saunders Comp'~ny. 1991 p. 669-678.

11(, Rommelspachcr H, Buchau C. Weiss J. Harlllafl induces pre(ercnce (or eehanol in r.llS: is t.he cITecl SPCci~IC (or elhanol? PIJarml/col Biodwn Bt'1J,rv 1987 Apr.26(4):749-55.

, 1 Lupandin VM. t.,ndo LI, ec al. Role ofbiogenic amines in lhe palho. genesis of imclleccual disorders in childreo wÎch minimal psychoorganic syndrolllc . ZIJ Ne/lroplJlol P,.ikhilltr 1978;78( 1O): 1538-44.

9'

118

GUylOn AC. Trxlbook ofMedil'al PI'Jsiology--8'" editioll. PhiJadelphia: \XTB. Saunders Company, 1991 p. 680-681.

!llltemelJl ill 1868 illlJ1l I!arlier publislJed uolllmr.)

9')

FilJberg Jl~ 5eidman R. BClter OS. ~ardjovasclliar respon ivencss ro vasoaclive agellts in falS with obwllcrive jallndice. CIi" Exp Phllrmacol f'bysiol1982 Nov-Occ;9(6):639-643. 100

Fischer JE. False Nellwlransmisners and HalÎe Coma. [o: Plum F, ediror. Brain Dyifi111crio11 i,! Mrrllbolic Disordrr. Res. Publ. Assoc. Nerv Mem. Dis., voi 53. R.wen Press: NY. 1974. 101

Vace.,ri A. Thc ryraminc binJing sice in the cemral nervous syscem: an O\'erview. Nmroc/mll R~s 1993 Aug; 18(8):86 \ -868. 102

10J

Jafre JH. DrugAddiclion and Drug Abuse. In: Gillllan AC, Goodman

LS. CI al. eclicors. Goodmalllllld Gilmlllls Thc Pharmacologic &si! orr1urapr.TIJic.<-7}, edirion. New York, Y: MacMillan Publishing Company. 1985 p.562-563. lOi Mor~l S. Bonolomcazzi R. Lercker G. Improvemenc of cxtr:action procedurI' for biogenic amine. in foods and ,heir high-performance liquid chromacogl'3phic dClcrminalion. j C/mmll11ogr 1992 Feb 7:591 (1-2.); J 75180.

Whice EG. CouJlse/J on Din alltl FO(Nu. HagcrSlOwn, MD: RcvicwanJ I-krald J'ublishing Associalion, 1976 p. 368. (Nou: IflbiJI! fim wyore 11Jis

'l:

119 Moriyama Uau K. el:l1. Etteccs o( diel;uy phosphalid)'lcholinc on memory in mCJJlory deficienr mice wirh low brain 3ceeylcholine concenlralion. Lift Sâ 199G;58(6):PL 111-118.

120 Floyd EA, Young-Seigler Ac' el al. Chronic elhanol ingestion produccs cholincrgic hypofunccion in rac brain. Alcobol1997 Jan-Fcb; 14( 1);9398. 11' Boks3 P. M)'k:ica S. Collier B. Aeachidonic acid inhibics choline uplake and JlClCS ac.et)'lcholinc contenr in raI cerebral cortical synaplosomes. J Neuroc/mn 1988 t\pr;50(4): 1309-1318.

Adam O. Nucrition as adjuva.rH cberapy il\ chrooic polyarehriejs. Z RJJtumalol1993 Sep-Occ;52(5):275-280.

1.2

1_3

BaJdwin BE. OiCl and lhe braill. Minim] Magazilll!. 1990 Mar p. 25·

27. 124 While EG. Col/nscu on DieJ IltId Foom. HagerslOwn, MD; Review and Herald Publj hing Associacion. 1976 p. 389. (NOTe: EG Wbiu fim p/lb-

liJhcd Jhis !IIJlrm1'1It ill 1838.)

295

PROOF POSITIVE IlS Whire EG. ]7,e MiniSlry ofHen/ing. Nampa, ID: Pacific Prcss Publishing A~ ocialiOIl, 1905 p. 296.

)acobson JL, Jacobson SW, Humphrey H. Elre IS ofilI utera exposure 10 polychlorinared biphcnyls and rclared conraminams on cognitjvc functionillg in youlIg childreJ1. J Pedilltr 1990 )an:116(1):38-45. Il6

Beauchene RE. Bale, CW, el al. Efrec! of age of initiation of le.cd tt'~lricrioll OII growlh. Gody composilÎOll, and longevily of r;llS. J Getolllo/ 1986 Jal1:4 J(J): 13-19. 127

128 Mealls LW. Higgins JL, Fernandez TJ. Mid-lifc onsel of djelary remiclion cxl('nds life amI prolongs COgJliliw funclioning. Physio/ Bd1ml 1993 Sep;54 (3):503·508.

1;0

Toffier A. FtllureShol-k. New York, NY: Random HOllSC Inc., 1970.

Rllbinslein EA. Tclcvision and Bchavior. Re~e.uch COllcJusions of lhe 1982 NJMH Repon ;U1J Their PolÎcy Irnplicarions. American Psycholo· gisl, 1983 p. 820·825. 1.\1

ISI

Zuckerman DM, Zuckerman BS. Telcvision's impact

OII

children. Pe·

dinll'ic.< 1985 Feb;75(2): 233-240. IS Schaie KW. The Penns}'lvania State Univcrsiry. lkbntliol'lJ! /'/as/iciry fmd Hef;/lb BehftIJioTS: Pryc!Josotin/implicftJiomfor nn Aging Sol'iery. Sympo· sium l'resemnn'oll ollll1ewrsiJll, the /-/et1/tI~y Li{t- .'>/JLm; ArivltJtas iJl Aging tIIu! H,'alrb. AnnuaJ Meeting of rhe American Associadoll for rhe Adv;],ncemenr

of Science, San Francisco, CA, February 19, 1994.

119

Frascr GE, Sillgh I'N, Bellnell H. V.,ri.ble. associaled with cognilive fUIlClioll in dderly C;Jifornia Seventh-day AdvelllislS. Am J Epidell/io/ 1996 JUli 15;143(12):1181-1190.

154 Zucl
While EG. CbU1/$lds 011 Din dnd Foo,ls. Hagersrown. MD: Revi"w and Henlld Publish ing Associar ion, 1976 p. 50.

rics 1993 Feb;91 (2): 499-501.

130

lS5

DiclZ WH. GOrlmaker SL. TV or nOI 1V: f.,r is ,he queslion. PtdiJU·

1)1

IS6 Djelz WH, Gorrmaker SL. TV or not TV: fat is lhe quesrion. Pedimrin 1993 Feb;91(2):499-S01 .

WI\ire EG. Colltue/s on Din ,mri Foods. I-!agerslown, M D: Review and Hcr:lld Publishing Associaljon, 1976 p. 51, 52.

157 Klesgcs RC, Sheholl ML, Klcsges LVI. Effeels of tclevision OII melJbolic rale: porential implications for childhood obesil)'. Pedi,ltricJ 199:1 Feb;91 (2):281-286.

While EG. Cnun ris on Diet ,,,,d Fo{)(IJ. HagC-l"stown. MD: Rcview and Herald Publishing Associaljon. 1976 p. 51.

132

DiclZ WH. GorlJllaker SL. TV or not TV: rie.' 1993 Feb:91 (2):499-501.

is the question. P"dio/-

IJ) Ma.nder J. FOflrArgtllllems joI' rlJI' Eliminarioll of7i-1ez'isioll. New York. NY: Qlljll, 1977 p. 195-202.

lS8

1.\.4 J~rry Mander qUOling Merrelyn ;Ind Fred Emery, lbeo al rhe Cemcr for Continuing EduGuion. AUSlralian NatiOlul Universir)' al Canberra. In: Mander J. Four ArgumeJJlsfor tiN' E/imillmioll o.fTeletJisioll. New York. NY: Qllill. 1977 p. 205-21 1.

159 Dealberro MJ , P:ljor N , er al. Bre:uhing disorders during sleep aod cognilive performance in an older collllllllniry s;tmple: ,he EVA Sludy. ) IJm GailltrSoc 1996 Nov;440 1):1287-1294.

GU}'lOn AC. Textbook ofM""i,'''! PI~ysilJ/ogy-8'I' edir.ioll. Philadelpbi.a: WB.aundcrs Company, 1991 p. 662-663. 1.'\

1)(, Mander J. Four Argllml'llts for thc Elimillillion o/Te/(lJi.<-ion. N w York, NY: Quill. 1977 p. 196.

Morris. F as quoted in Mander J. Follr Argtmu'nts for tiu Elimilltuion of 7e!.+vision. Ncw York, NY: Quill, 1977 p. 208.

1)

IJ~ Dos ey L.

cille.

I

Hl'a/iug W'rJIYIs: TIJI' 1'01/1",. of!'myl'r nnd the !'metice ofMediew York, NY: HarperCollins Publishers, ) 993 p. xvi-xix.

Do se}' L. Hell!illg \\70/d.<: Tbe Power of!'myer Imei thc Prtlctice ofMedicine. Ncw York. Y: HarpnCOllins Publishers, 1993 p. xviii. 139

I.{O [ ossey 1.. Hetl/ing \Vo,.,ir: The Power ofl'r't)'l"r 1I11r1 the I'n/etice ofMerli. l"Îne. New York. NY: HarperCollins Publishers. 1993 p. 30-32.

Dos ey L. Hell/ing l\I'oms: The l'ower ofJ'1YI)'eT <1J/{J t!le Prnnice ofMedi.-illl·. New York. NY: Harperollins Publislwrs. 1993 p. 241. 141

Do"!e)' L. Hl'II!ing IVom': 77Jt PO/llt'r ofPr't)'er ,md t!le PYIIl'tiee ofMer/icine. New York. NY: HarperCollins Publishers. 1993 p. 62-63. 1 !

1<J Byrd Re. Posilive IherapeUlic effecls of Îmere-l~'sory pra)'er in a corolIar}' care un;l populalion. SOlllh Med J 1988 Ju1;81 (7):826·829.

(11

160 Valkenburg PM, van der Voon TH. (nf1ucllce ofTV an da)'dreaming aod cr{'alive imagination: a review of researeh. Ps)'cJJl)/ Bull 1.994 Sep; 116(2}:3 16-339. 16. Valkenbllrg PM. van der Voon TH. Inilllcnce ofTV on daydreaming and creali"e imagin:llion: a review of researeh. PJ)'chol Bull 1994 Sep; 116(2):316-339. 162 Wh"c!er JL. !?etIJote (./}I}lrol/ed: How 7V Afficts YOtl nnd Your Fitllli!y. Hagemnwn, MD: Revicw and Herald Publish ing Associarion, 1993 p. 39.

16J Valkenburg PM, V:ll! der Voon TI-!. Inf1ucnce ofTV on daydreaming 'lnd creativc illlaginalioll: a review of research. Psye/Jo/ Bull1994 Sep; I 16(2):316-339.

16-1 Whecler JL. Remote Crmtrolletl- How 7V Afleets J0u nlltl Yoltr Fnlllily. HagerslOwn, MD: Review and Herald Pllblishing Assooalion, 1993 p. 39. 16S William TM qlloted in Whecler JL. Remof(' Colltml/I'r/: HO/ll 'IV Af jiXl.S You fmd VoltI' Pamily. HagerslO"'n, M D: Review and Herald Puhlish-

ing Associ;llion. 1993 p. 42, 43. 166 Harrision LE Wil]:U11$ TM.. Tclcvisioll and cognilive devclopmenl. [n: Williarm TM, ediror. Tiu imfilN ofre/"vision: fI flLrt/ll'll/ experiment iri tinu eoml1Jll/lirin San Diego, CA: Academic Pr=, 1986 p. 87-142. 167

Zuckerman DM. Zuckerman BS. Television's impacr on children. Ptflilltries 1985 Feb;75{2):233-240.

Wiseman R. The Illcgalab rnllh rcst. Nrutlre 1995 Feh 2;373(6513):391.

Il\.'

Wiscman

1 ; Mander J. FOII l' Argl/men/J for tbt' E/iminfttion o(Te/rl/isiol1. New York. N'Y: Quill, 1977 p. 194-196.

I-!undt. Reed E., Chairman, fedcral Communiealion COllllJlission. Dclivaed before rhe arion;ll Prcss Club, Washingron, D.e., July 27. 1995

141

Morris. F a quOted Mander J. FlIur AI'gllml'nts for tiu ElimitltllioJl of ltIevisioJl. New York, NV: QuilJ, 1977 p. 197.

"6

14 Mander J. FOllr Argummtsfor tlJ,'l:.limil1lJlioJl ofTc/evi.
,.8 Krugman, H as CÎred in Mander J. ofl(/evisioJl.

FOllr J1';gumetlrs for tbe l;/.imÎllmioll

eW York, NY: Quill, 1977 p. 209.

Peper, E. aS ilcd in Mander). Fo"r Argllml'l1lS for Zb,' E/imillLltion of Teltllision. New York, NY: Quill, 1977 p. 211.

14<'

296

R. The.megaJab lfUth teSt. Nrrttm 1995 Fel> 2;373(6513):391.

'6?

170

\~/hecler

JL. J?mIO/e Control/eri: HoUJ

7V AfJixl.S YOIt t/lu/ YOW' Frllllily.

HagclStown. MD: Review and Herald Publishing AssocÎalioll. 1993 p. 42, 43. 1 , Waite BM, HiJlbrand M, Fo.ler HG. Reduetion of aggressive bd1a"ior afrer remoY;t1 of musie rclevision. Ho. Coml>1uflity !'sychittlly 1992 Feb;43(2): 173-175.

172 Peterson JL, Moorc KA. FUrsLenberg FF Jr. Tclevi,ion viewing and early iniliatÎon of sexual intcrcourse: i lhere a link? J HOmOJl'X 1991 ;21 (12):93-118.

THE FRONTAL LaBE 171 Hundl, Rccd E. Chairman, Federal CommuniC:llions Cornmission. Dclivcrcd bcforc the National Prcss Club. Washington. D.e., July 27, 1995.

Cohen DA, Riehardson J, LaBree L. Pareming behaviors and rhe onser PedilJfrics 1994 Sep;94(3):)68-375. 174

o( smoking and aleohol use: a longitudinal sludy.

,,' Whedcr JL. Sqllandering Gods Grealcsl Gi(l: Time. In: RmlOu Control/eJ: How TV Aj}eeu You and }Dur Fl1mi~y. HagecslOwn. MD: Re"ie'" and Herald I'ublishing Associarion. 1993 p. 45-50. 176 Lylc JL. Hoflin:lIl HR. Children's Use o(Tclevision and Other Media. In: Rubinstein EA, Comstock GA, Murray JI~ edilor. li.Jl'IJiJioJlI11ld Social Bthl1vioT, 4: 1aeviJioJl ill DaY-Io-Day Lift: ParuTIIJ ofUu. WashinglOn. OC: U.S. Governmenl Prinring Oflice. 1972.

177

Zuckcrrnan DM, Zuckerman BS. Tclevision's impact on ch.ildrcn.

!'tdiarries 1985 Fcb;75(2):233-240. 178

Diet'L WH, Gonmaker SL. TV or nOI TV: (at is the queslion. Pedial-

ries 1993 Feb;9 1(2):499-501. 179

Pmonl1/ C01ll1llUniClllioll. Juallil:1 McEhvai 1\. I'hD. Retired Chair o(

Music 'TI1erapy Depanmenr, Phillips Universily. Enid. OK. 180 Pn-sonal Commlltliclllioll. Jllan.ira McElwain, I'hD. Rerired Chair of Music Therapy Deparlment, PltiUips Universiry. Enid, OK. '81 Schn-ekenbcrg GM, Bird HH. Neural Plasticiry of MUS Musculus in Response 10 Dishannontc Soulld. Tbe Bulltlill, NrllJ Jtrsty AClldm~y ofScimct 1987 FaII;32(2):n-86. 182 Schecl KR from Universiry o( Iowa and omers roning ar lhc 104,11 al/llunl mrrring ofthr Aml'r;clln PsyclJo/ogic.n/ Associllfion in Toronro. Au-

gUSI, 1996. 18 Rauscher H-I, Shaw G, Ky KN. Lisleniog 10 Mozan Enhaoces SpalialTemporal Rcasoning: Tow:uds A NcufOphysiologiCl.l Basis. Nl'llroscima UUI'T 185,1995 p. 44-47.

18< R.'lllSCher FH. Shaw G, Ky KN. Lislening ro M07A1rt Eohaoces Spariallemporal Rcasoning: Towards A NeurophysiologiCl.l Basis. Ntllroscima ut/l'T J85, 1995 p. 46.

18;

Rauschcr H-I, Shaw GL, el al. Music and Spatial Task I'ctformance: A

Gusa! Relalionship. !'mmltdal dx Ammcan PsyclJo/qgicalkocillfioll J02',J A'IIIIIJ1/ Convmrion ill Lo< AlIgruJ, CA, August 12-16, 1994. 186 Schlaug G. Jancke L, et al. [n vivo evidence o( SUllClUl<11 brain asyrnmelry in musicians. Scil'llcr 1995 hb 3:267(5198):699-701.

IS7

GroUl DJ.

A Hiuory of Wtua MIIsit-3 d i'dirioll. New York:

1.'9

I~I Haapanit'mi H. Hillboll1 M. Juvela S. Lifeslyle-associaled risk [aclors for aCUlC. brain infarclion among persons of working age. Strok,. 1997 Jan;28( I ):26-30. 192 Schmidl R, Fazcru F. el al. Magneric resonance imaging while maller Icsion and cognilive impairmclH in hypencnsivc individuals. ArclJ Nl'lIrol J991 Apr;48(4):417-420. 19" van SWiCICll JC, Ge ske GG. el al. Hypenension in me e1derly is associaled Wilh whilc maltcr lesions and cognilive declinc. AmI N/'IIrol 1991 0<:c;30(6):825-830. 194 van Swiclcn Je. Geyskes GG. CI al. Hypertension in the elderly is associalcd with white matlcr Icsions and cognitive dcdinc. AmI N,.urol 1991 lJec; 30 (6) :825-830.

195 Salcrno JA. Murphy DG. CI al. Br:un alrophy in hypcncnsion. A volumelric magnetic re.wnance imaging srudy. HypautlSion 1992 S;20(3):340-348.

1% Moss MC. choley An. Oxygen istralion cnhances mcmory fOrIllJlion in hcallh)' young adalrs. PSyCIJplllmnJlt%g)' 19% Apr 124:255260. 197 R-10 MI-, Mullcr-Ocrlinghallscn LI, cr al. '111C inJ]ucncc of phOlOlbcrapy on scroronin and me!alonin in non-seasonaJ depressioll. P/;armacopsyc/;i'tlry J990 May;23(3): 155-158. 198 rephan KM, Fink GR. CI al. Funcrional Jnalomy o( lhe mCJlIaI represemalion of upper e.Xlremiry mo"emel1ls in heallhy subjeclS. J Nl'llroph)'Siol 1995 Jan;73( 1):373-386. 1')9 RodriguC'L-Esteban . hwabe]W, el al. Radical fringe posilions lhe apical ecrodermal ridge ar ilie dorsovemral boundary of rhe vertebrare limb. Nahm 1997 Mar 27;386(6623):360-366.

100.

\'V'hil" EG. The Bible a Ml';lnsofBolh MCl1lal and Moral Culrure. In:

Advl'IIl Rr/lil'llIlmd S'lblllllb Hrrald, 1883 Sepl 25. p. 25. round In: Ellen G. Wh.ile Esmc. Thr P7IblislJrd Wrilings of Elim G. Wbiu. Version 2.0 (CD-ROM), 1995. Whilc EG. Mind. ChnTIICll'T, d7Jd Ptmonll/ily. HagerslOwn. MD: Review and Herald l'ublish.ing Associalion, 1977 p.93.

2uI

WhilC EG. COIIIlSl'IJ on Dil'llllld {.'oodJ. Hagerstown, MD: RI"Viewand Herald Publishing Association. 1976 p. 29.

10'

Whitc EG. R.fll'cring Christ. HagcrslOwn, MD: Rcview and Herald Publishing Assoc-iarion. 1985 p. 142.

203

w.W.N01'1011 & Company. ) 980. 188 Whilc EG. Guiding Principlcs. In: MtSJages 407-408.

I?O Haapaniemi H. Hillboll1 M, Juvela . Lifeslylc-associmell risk faclors fl r aCule bl"J-in in(arclion among persons o( working age. Srrokc 1997 Jan;28( I ):26-30.

10

YlJfmg ,topI/.'. 1930 p.

White EG. We Choosc rhe Bcsl. In: SOnJ alld DauglJleT5 o/God. 1955

Whire EG. RJ.fli'CIillg Christ. HagcrslOwn, MD: Review and Herald Pllblishing Associarjol1. 1985 p. ) 42.

2M

p. J77.

297

PROOF POSITIVE

298

CHAPTER THIRTEEN

STEMMING THE TIDEOF

IOLENCE D

o you feel safe walking down your streer late ar nighr? Even if you do, there are milJions in aur councry who do noI. For many individuals nothing is more unsenling than ta live in a place where chey reaUy do nor feei "ar hame." They are surrounded by violence and wonder when it wiU eome knocking at their door. Even those gifted wirh. pleasant home surroundings ohen 6nd their feelings ofsafery confronted when tiley go ta work, travel, ar even run a few errands. The loss of securiry wirh our living sÎcuarjons is understan.dable. Violence in rhe Un iled Stales seems ro increase dramarîcally wirh each ing generarion. The pervasive scape. of violent and abu~ sive behavior is hard ro measure. Statistics only give us a glimpse imo thc magnitude of the problem. For example, each year 2.2 million Amerieans are the vierims of violent injuries. 1 Over 3 million more violent crimes oeeUT annually where rhe vietim does nor get hun. 2 Suicide anei homicide combined amounced ta rhe fourth leading C'luse ofyears oftife lost before age 65 in AmeriGl,3 When you look at one of America's leading killers, injury-related deaths, over one-chird ofrhese 145,000 allnual fatalities are reLated to violenc and abusivc behavior. 4 This statistic does not count rhe many dearhs rhar

are cL1ssified as aceidenrs alrhough tIley were actually homieides. Alrhough sratistics may occasionaUy show improvemenrs in certain areas of our coumry for shon periods of rime, despire all our reehnological advances violence colltinues on a generally upward trend. There really does not appear ro be any lasting solution on the horiwn. Concerns are espeeially warramed abollt vi.olence perpetrared by America's yomh and young adults. Suicide and homicide are eaeh in the top causes of death among ali 15 ro 24 year olds.',6 Homieide is rhe leading cause of dearh among blaeks aged 15 through 34. 7 The lifetime risk ofdearh from homicide is a staggering 1 in 28 for black males, and 1 in 164 for whitc males. 8 Or. James Fox, Oean of the Col1ege of Criminal Jusrice ar Nort.heasrern Universiry, srares thar murders commined by ehildren ages 14 ro 17 have increascd 165 percem since 1985, ancl (hat the number of murders will surge even more as some 40 million young chjldren mature ro rheir teeus. He fureher declares, "Unle.'>S we act taday I uuly believe we will have a blood barh in ten years when aii of these kîds grow up." Are we headed for a blood bath because reens and young adults are becomil1g progressively more out of control? Unless we do somerJling abour it, that is what many

299

PROOF POSITIVE experrs are predlcting. Alld rhe problern is nor confined [Q urban areas as illllsrrared by the [acr thar New Mexico, largcly a rural Srare, has rhe highesr homicide rarc for children ages 10 rhrough 14. We have a narionwide problcm. And ir is a problem thar we need ro seriollsly address. Ir fim demands recognirion rhar CUfrenr efforrs are insufficienr ro adeqllately address aur violence-relared problems. Then

III

Homicide

III

Suicide

III

III

Aggravated assault (often with a weapon) III

Spouse abuse III

III

III

Elder abuse Robbery (theft directly from a person) Arson

Rape and sexual assault Child abuse including ehild sexual abuse

Figure 1

• Whites are at greater risk for suicide, but blacks aud Hispanics are at greater risk to be victims of homicide. • Compared to women, men are at grcater risk of both homicide aud suicide. • Teenagers and young adults uoder 25 are at particularly high risk of suicidc; bowever tbey are at less risk of bomicide when compared to individuals 25 to 44 years old. • Unemployment ahd substance abuse are risk factors for committing eith~r suicide or homicide. • Serious pbysical iIIness is a risk factor for suicide, but is not usually associated with bomicide. Figure 2

300

it requires ilie commltmem, rime, and energy ro work out and implemcnt a solution.

What Are the Causes ofthe Violence Epidemie? To taclde any problem, we musr begin by being aware of why the problem exisrs. Ouce we have rhat awareness, rhen we can look at solmions. The sciemists rhar give us some of the earliesr indicarions of causes of social condjrions are epidemiologisrs. They study groups of people anei examine how problems are relared ro meir lifesrylc. rheir enviJ'OlUnenr, and other factors. However, in cite case of violence, ir can be difficult to derermine which rhings are really causes and which rhings are merely coincidelHallyassociated. For example, ifwe look c10sely ar American crenels, we would find rhar in rhe last century violence has increased dramaricllly; so has rhe purchase of nylon srockings. Just because these rwo characrerisrics have risen in frequency togerher does nor mean thar buying nylons causes violence or vicc versa. Careful analysis is rherefore needed once we identify associated facrors ro dcaw conclusions that uulyare reasonable and rhus wonhy of rhe rime and energy ir takes to address them. What then do rhe epidemiologic srudies suggest are really rhe causes of violence? Before we can even answcr the quesrion, we need to recogni7..e rhat violence is a problem \Virh many di/tercnt faces. Some factors cause one rype ofviolence. bur nor others, while other facrors are common causes for many or even aII rypes of violent acr.5. Some of rhe torms of violence dut need ro be considered are lisred in Figure 1.9 As you could guess. each of rhese differem forms of violence has differenr causes ar "risk facrors" that increase the like1ihood rhar such an evcnr will occur. Ler us compare some of rhe risk factors for suicide and homicide ro provide an indicarion of how facrofs rhar contribure ro differenr rypes of violence can be both scriklngly similar and remarkably differenr. 10 •11 Figure 21isrs mese factors. One of rhe rhemes of this emire book is {hat you can, ro a Iarge extcnr, play a role in

STEMMING THE TIOE OF VI0LENCE dcrermining your own hea.lrh anei rhe healrh of aur natjon. From rhis perspective, 1 believc rhar rhere are cenain key tasks rhat r shouJd engage iJJ personally, and do my urmost ro encourage others to undertake. Thesc Tasks should nor be misconstrued as offering a rotaJ solurion [O rhe problem of violence in aur nation. They are, however, a series of personal commirmems rhar can make a profound difference regardless of what exrernal facrors look like. Wherher or nor gun control laws are implememed; regardless of who your neighbors are; in spite of any deficiencies in our nation's meneal health services; no marter how we deal polirically, eelucarionally, ar legally wirh child ;lbuse and spousal abuse; the rasks presenteel here can anei will make a difference. As a society we do need ro address as many of violence's risk f.îcrors as possible, but as inelividuals we can begin now ro promore severai facrors that individually and collecrive1y will dramariC2l1y decrease rhe roU ofvÎolence in our lanel. Whar then are rhese key individual rasks rhat 1 believe every American should personallyaddress? Fim, avoid aU illicit drugs anei alI mind-altering lnedicarîons-unless absolurely necessary. Second, espouse sound values and be secure wirh rhose values. Third, spend your recrearional rime in acrjviries dur builel your characrer, rather rhan undermine your vatues. These few succincr suggesrions may seem simplisric, bur r believe rhe)' hold rhe keys ta many of rhe deepesr roors of the problems we face regarding violence.

TtlSk Number One: Avoid Mindaltering Drugs The U.S. Deparrment of Health and Human services has dcrermined rhar an important facror associated with homicide is the use, manufacrure, and disrribmion of illicir drugs. 12 They cire rhree reasons for violence occurring in rhis conrexr. Firsr, the mÎnd-alrering affects of drugs can increase the likelihood dur violent actÎviries will occur as a result of bcing under the influence. Second, ro secure funds for drugs, addicts engage in crimes rhat sometimes pur.

lives at risk. Third, [he "drug business" carries mulribillion doUar srakes: violent dearhs can resulr from confrontarions regarding the manufacrure.. sale, or dislribution of drugs. No national staristics are available rhat give LLS a feel for rhe percentage of homicides re!ared ro [he illegal drug indusrry. Howcver, studies in New York Cir)' and Miami indicare rhar ar teast 25 percenr of ali rhe homicide,~ in those cilies are re1arcd ro drug use. J3 AIcohol is a key player among rhe causes ofviolcnr dearhs. Many srudies have shown rhar roughly 50 perccnr of rhe vicrims and pcrpeuators of assaultive violence are under the influence of aicohol. 14 AIcoholism is ranked as rhe second mOST commonly reponcd mental illness associated wirh suicide (only depression olltsrrips it) .15 Concerning child sexual abuse, alcohol use occurred in conjuncrion wirh anywhere [rom 19 ro 70 percent of the offenses. 16 Statistics like rhese provide a srrong argllmenr for ratai abstinence from alcohol and iI1icit drugs if a person is concerned abour being ei(her a vicr.i.m or perperraror of violent acrs. 1 explore the broad range of iS5ues deaJing with alcohol more rhoroughly in Chaprer 17, "Wanr a Drink?" Many prescription elrugs also have mind-alrering effecrs. Wherher il be Valium, Ativan, Xanax, Codeine, Lonab, Percocet, or a hO$r of oIher Jess familiar drugs, many of Ihe agenrs rhar we resort to for pain, anxjery, OI' discomfon can împair aur mental c1arity. We shollld look ar such drugs as rhe cause of problems rarher than the sollirion. There m,ay be a legirimare short-rerm use for some of rhese agents. However, if you are using an)' mind-alrer~ ing drugs on a regular basis, you sholild view thar as an indicarion rhar you need furrher help.

Task Number Two: Espouse Sound Valttes Even standard medical rextbooks focus on issues relaring ro value.s and spirituality when they discuss violent crimes. For cxample, Dr. Donald Balaban, when describing risk factors for eirher commitring or

301

PROOF POSITTVE being a vicrim ofhomicide. sires duee parricular areas ofpsychosocial deficieney. Specifically he Jisrs "Iack of rradirional supporr sysrems (such as family and religious insricurions)." lack of"moral consciollsness' and lack of a "sense of identiry."17 The concern for a lack of moral consciousness srrikes a resonaring chord wirll many Americans. Many feei rhar aur nation is experiencing a steady moral decline.

• 75% of adults and teens reject. the concept of absolute moral truth. • Over half of teenagers say that lying is sometimes necessary-- "not merely convenient, common, understandable or acceptabie, but necessary." • Young people today look at suicide as 8 viable option and a rational choice depending OQ circumstances.

Figure 3

Crimes committed by our youth:

• Carjacki'ng • Knoekout • Ride-by shootings on bieycles • Wilding (ficndish gang aetion) Their philosophy: "Hatred is hip. Killing is cool." "We are seeing a eallous disregard for human life that we have never seen before." Figure 4

302

and rhis sers rhe srage for violem acIS. Is such an assessmelH justified? George Barna and his Barna Research Group have condllcred exrensive inrerviews, parricularly of rhe young Americans who are somerimes referred ta as "Generarioll Xer ." He has drawn some srriking conclusions thar provide insighr inro our narion's furure generarion ofleaders. 18 Some of rhese conclusions are Jisred in Figure 3. FlIrrhermore, yOllng people rhroughour urban-and rural-America are displaying a call1lsed disregard for hllman life. In mally cases, rheir ignominious deeds are "crimes of fashion" according ro Jack Levin, a wellknown criminologisr ar Nonhwesrern Universiry. Some of rhe crirnes al)d Jack Levin's qllotes are listed in Figure 4. Many cire evidence like rhar presenred by Barna and Levin as jusrificarion for reasoning [har rhe moral underpinnings of aur sociery are coming loose, and rhar rhe rise in violence is one of rhe consequences.

Task Number Three: Choose Character-Building RecreationalActivities Whether we ralk abour drug use ar vallIes in general, ir is necessary ta look ar rhe inpurs rhar impacr an [hese areas. Many believe rhar one of rhe prime conrriburors ro aur values is who we spend our leisurc hours wirh and whar we do during rhar rime. There are man)' recrearional acriviries rhar we could profJrably discuss in rhis chaprer. Some would be powerful morivarors for good. and orhers would have significam delercrÎous consequences. Let LIS focus an two of rhe mosr pervasive leislire acrivirics in aur sociery. 1 agree wirh rhe researchers who believe rhar rhese two acriviries share no small pan of r!le bJame for rhe American violence epidemie. They may even be rhe mosr dangerous, bur rhey Jook so respecrable and are sa well accepred rhar ir renders rhem more capable of enricing people ro faH under rheir influence. The clrst of rhese inf1l1ences is tefevision.

STEMMJNG THE TIDE OF VIOLENCE

TV tind Attitudes toward Violence in Americtl Srarisrically, relevision viewing i rhe major leisure rime acciviry ofAmericans. In fact, media as a whole occupies more of our day rhan eicher work or sleep-an ave rage total of nine hours. The largesr share of mose nine hours is spent facing rhe TV cube: an average of more than four hours daily.19 One of the mosr disrurbîng characrerisrics of chis leisl1re acriviry is irs power ro hape our values. TV programming is feeding Americaos a sready diec of violencc-and che amount of violence depicted seems ro beeveron rhe rise. Forexample, from 1980 (when rhe relevision industry was dereguIared) ro 1990, children's programming showed a dramatic 40 percenr increase in violence (going from 18.6 violenr aers per hour up ro 26.4 violent aers per hour).lO There are some who exeuse TV vio1enee by saying. "We eaeh derermine for ourselves whac we will ar wiU nor be inOueneed by. Watching a (itele violence an relevision should noc h ave any sign i ficam effece." lc is inreres[ing ehat ilie adverrisers sharply disagree with the concept rhar behavior is nor affecred by whar a person sees an rhe TV screen. They are willing LO spend hllndreds of chousands of dollars for a few flcecing images. They have learned thac opinion polls ofconsumers always underescimare rhe influence of adverrising an marker demand and sales. They are well aware rhar. even though \Ve may not seeing cheir commerciaJ. we will be unwittingly inflllenced ro huy rheir product. Look ac a case in poinr: TV adverri 'ing rhae rargers children. The average child pays plenty of anenrion ro Madison Avenlle warching more rJlan 20,000 commercials each year. 21 Abour two thirds of rhose eommercials are for food, lIsuaJly sugar-rich irems. 22 There seems ta be linIe question char rhe adverrising rraregy is working. A srudy conducred in a supermarket demonstrared [hac pre-school children attempced ro influence rheir morhers' purchases approximarely once every rwo minllces, primarily for C<"lndy 3nd sugared cereals. 23 If aur purchasing judgmenr is inflllenced by

advenising. it follows rhar aLU moral judgmem will be influenced by me greater rime spenr in viewing rhe images seen before and after rhe adverrising.

Dangers o/IVProgramming Are Recognized Ir is becoming more and more difficule

ro deny rJlar TV's portrayals of sex and violence are damaging our sociery. Umil recenrly, mosr liberal rhinkers have raken rhe po irion rhar freedom of expression is paramoune in America. Their rhetoric became very familiar: "We are in a free country 311d we shouJd place no resrricrions on rhe por[rayal of violence or sex." However, some of [!le mo t sraunch proponenrs of freedom of expression 011 rhe airwaves have now reversed themselves. Some are even caJJing for restricting damaging TV marerial from home viewing. A seJf-proclaimed liberal organization, che Child Developmenr Unir ar Nottingham Universiry. Eogland issued a sratemenc signed by 25 psychologisrs and pediarricians in which r11ey confessed thar mey had made a serious misrake in rhis regard. -4 An. excerpr from cheir sr3rement is shown in Figure 5. Ir is remarkable rhar they confessed rhar meir former srance assening rhe harmless-

"Many of us hold our liberal ideals of freedom of expression dear, but now begin to feei that we were naive in our faUure to predict tbe extent of damaging material (on TV] and its all-too-free availability to children. .." "By restricting such material from horoe viewing, society must take on a necessary responsibility in protecting children rrom this, as from other forms of child abuse."

Figure 5

303

PROOF POSITIVE ness of TV violence was incorrecr. Even more srarriing is rheir description of some relevision viewing f.·ue as a form of chiM abuse. Despice such issions, ehere remain some who seitl deny rhe hannfulness ofTV violence. They hold ehac rhere is 1\0 absolute proofof a cause and effect re1aeÎonship, assening that rhere are roo many O!her facrors thar inf1uence yourhful behavior, sueh as home envirotunenc, moral rraining, and peer pressure. However, as a WalJ Srreer

"A eausal relation between TV violenee and aggressive behavior by the young (has been denied] by u.nreconstructed liberal academics." "IHowever], there is an abundance of circumstantial evidence that points to the existence of sucb a relation -- evidence so strong as to raise DO reasonable doubt in tbe minds of ordinary people."

Figure 6

11, Notei, CANADA: ,II. Hitting, sho"ing, and biting increased 160% in fint and second grade shldents within Iwo years. 2. Violent crime had a spectacular increase, cspecially among Ibe young. In Soutlt Africa:

I

1, In the 30 year span of timc beforc TV was introduced, tbe bomicide rate decrcased 7%. 2. }lomicide jumpcd 130% in the 12 year period after TV was introduced (1975 to 1987). J. This jump is grealer than that which occurrcd in Ibe U.S. 12 years after TV was introduced (1945 to 1957). 4. TV was more violent in Ihe1975 to 1987 era Iban in Ihc 1945 10 1957 era, whicb may explain the greater homicide jump in South Africa. Figura 7

304

JournaJ edirorial ofMay 31, 1994 indieated, rhe circumsrantial evidence overwhdmingly poil1ts ro TV sex and violence as being one of ehe rom causes of aggressive behavior in yourh. 25 Their assessmenc of rhe evidence is recired in Figure 6.

Evidence ofHarmful EjJecu ofTV Violence Ler LIS examine some of rhe evidence ehae supporrs the Wall Srreec JOllfllal's srarcmenr. Dr. Brandon CenrerwaJl, professor of epi. demiolog)' ac rhe Universicy ofWashingron, explored rhe effece of relevision when inrroduced inco eornmuniries rJlae previously had no TV. The firsr communiry, referred ro as "NoreI" by sOllle of the original researchers, was il cown in a remore area of Canada which for years had problems wirh television signa) reeepeion. Those difficulries were finali)' resolved in 1973 and rhe residents gained access [Q TV. The second eommuniry scudied were a11 of rhe [wo million Callcasians living in Sourh Africa in rhe middle 1970s. This group included a variery of lifescyles: rich and poor, urban and rural, educared and uneducared. For cultural aud political reasons the $outh African government did nOt allow TV broadcaseing in eheir counrry untiI 1975. The inerea e in violence when TV recepeion became available in rJ1ese [\Vo COI\1· IHuniries is summarized in Figure 7.2C' Bath srudies were very carefuUy done so thae ehe effece of eelevision could be isolated as complerely as ible. In ehe Canadian research, noe only were children in Notei evaluated; children in rwo similar communiries also underwenr behavioraJ measure· ments. These comparison communities \Vere similar excepr for rhe fact rhar rhey had had access ro television for some rime. Furthel'more, dlOse measuring rhe children for aggressive behavior were "bIÎnded." In or.her words, r.hey did nor. know which children were gcuing rheir first exposure ro TV and which had been viewing ie for years. Physical aggression did noe ehange in rhe rwa companion communirÎes-bur jumped t!le starding 160 percenr in NoteI.

STEMMING THE TIDE OF VlOLENCE The Sourh African smdy .1.Jso used a carefui research plan. The srudy's allthor cornpared rhree similar cuhural groups ro evaluare rhe impacr of rdevision. The groups smdied were Caucasians in rhe U.S. and Sourh Africa, and aII Canadians (of whorn approxim:uely 97 percent were Caucasian araund rhe rime of rhe srudy's inirial focus). In borh Canada and the Unired Stares, homicide rares nearly doubled wirhin 10 ro 15 ye:m following the introduction of television. By 1974, borh narions were seeing a yearly rare of homicide deaths rhat was dOllble where ir staod in 1945. Imeresringly, it was during lhis same rime period rhar Sourh Africa haei ballned TV broadcasting in irs entire narion. (Afrikaner whires did nor wanr English whires ro ger an unfair cultural adv'Ulrage by lISillg a medium rhar was dominared by U .5. and British producrioos). Concerns abour violence did not inf1ucnce rhe decision. Whilc othcr nations were seeing homi· cide rares SOflr, Sourh Africa saw irs homicide rares fir" seven percem between 1943 and 1974. Aher the TV ban was lifred in Somh AFrica, rheil' homicide rate more than doubled in 13 years. During mose years, ending in 1987. the rares in the U.S. and Canada srayed essenrially r!le same as rhey were in 1974. Careful analysis of orher facrors dur could have affected these rrcnds left Dr. CenteIW:lJl wirh no orher condusion bur that relevision was the culprir. Whar more can we lcam from this phenomenon? Centerwall's exrensive research on the subject of television and violence has led him [O conclude rhar TV has ies greatesr effecr on children prio,. to adoLescence. 27 AJrhough we hear ofviolenr crimes beiJlg committed by chiJdren, most homicides are commirred by adulrs. For this reason, we wouJd expecr mally ofTV's cffccrs on violence ro be delayed some IOta 15 years. Afeer .1.11, it wOllld take rhis long for preadolescenr children ro age sufficienrl)' ro commit rhese heinous crimes as adulrs. These srudies establish beyolld a reasonable dOllbr mar relevision viewing is a promiIlenr mor cause of aggressive ,Uld violent behavior. Canadians and Sourh Afi'icans found rhar rheir lack of access to television had

unwiningly been a benefir ro their COIl"'IIT\Uniries by keeping violence ar a lower level rhan it wOllJd have been orherwise. A srud)' mar seemed to conrradicr the experiences in Canada and Sotlth Africa cOllcluded rhat eelevision "increases aggression in only cighr percenr of d1e population." Mr. Cenrerwall examined this srudy and found thar rhere was no conrradiction. His summary is shown in Figure 8. 28

AVERAGE Ilriliil~)j

EX. a'-Il:o'I.Y.~ "Aggressive impulses, like most human phenomena, are distributed along a bcll-shaped curve, and it is at the margin where the signifieant effcet is to be observed: 'It is an intrinsic property of sueh beII curve distributions that small changes in the average imply major changes at the extremes. Thus, it' an exposure to television causes 8% of the population to shift {rom below-average aggression to above-average aggression, it follows that the homicide rate will double.'"

A

Figure 8

Staristical srudies of rhe relarionship berween youthful aggressiveness and TV can be deceptive if rlte}' focus an the overall average response-which indeed seems to indicate a doubrful relatiollship. However, a smaLlpercentâge increase of rhe entire popu!arion that becomes more aggressive. such as eighr percent, tmnslates into a doubLing of rhe homicide rare, because it is only a small percenrage of the population rhar produces the many violent acts ar the ourser. Orher research has established a [ink between an early experience wirh relevision and violence in adulthood. An exrensive srudy fim gauged how much and what kinel of TV violence eight-year-old boys were watching. Afrer 22 years. che history ofthese boys was evalu;}red wirlt respect ta law enforcemenr records. The re,mlt: television violence viewing ar 8 yeal'S old frighteningly predicted rhe seriousnesS of rhe cril11es rhey commirred by age 30. 29

305

PROOF POSITIVE Without these studies, many would find ir hard to believe that viewing of violence during rhe ehildhood years collie! influence crimes ill adulrhood. Yet, the facts speak for rhemselves. I see an iIHeresting paralJei ro the effects of smoking. When a yOllngster starts smoking, rhe damage being done is not apparenr, but we now know thar years larer it may ulrimate!y Qluse significamand even life r.hrearening-consequences. Ta prevem problems years later, we righrfully rry ro inJluence our children ro avoid smoking. Why shouldn'r we rake rhe same approach regarding television viewi ng?

Small Children and Television

306

Parellts are pleasamly amazed ar how early their infa.l1rs imitate rhem. Widun a shon time ofbirrh an infam smiles back ro their sJniles. But bcware-infams do not possess the ability ro screen Out rhe good from the bad; rhey imit
cxciting, charisma tic, and efficacious."34 In shon, when ehildren see the m
STEMMING THE TIDE OF VlOLENCE nine who were exposed w a mere 3.5 minutes of a violent television program ("The Unrouchables"), were more willing ro hurc anoeher child man were childrcn who viewed a nonviolcnr program. 38 To make mareers worse, childrm's televjlO

sion programs are more violmt than adult television. TV Guide. which usually sides with the television industry, recendy conrained a surprising arride entided, «Is TV Violence Banering Our Kids?"39 One of the saJienc points in the arride was the idenrification of the most violenr form of programming: C;Utoons. This was not surprising to media scholars. Earlier data rhat compared childhood and adult viewing fare found thar children were exposed ta six times as much violenu as their parenrs. 40 The problems creared for young children by TV watching are summarized in Figure 9. 41 Each sraremenr is based on che resulcs of one ar more fac tu al srudies; ehey are not in toe rcalm of opinion.

E.ffects o/TVon Teens and Adults As prc:viously sratcd. Centc:rwall argues rhar rhe primary damage from celevision violence COlues from that which we view as young chiJdren. However, chac which reenagers and adulrs vie:w also has its effcccs. The Iare adolescent and early teen years are a panicularly high-risk time. Ooe of [he reasons for this is rhar many in this age range have an i nordinate amounr offree unsupervised rime on rheir hands. A summary statement issued by the Carnegie Corporation is shown in Figure 10. 42 This unsupervised rime is of particular concern because one of dle most popular celevision networks with chis age group is MTV. In Chapter 12, "The Fronca) Lobe: ilie Crown of the Brain," I have poinred OUt thar research imo the ohen expljcidy violent themes of music television has demonsrrated chat, in general. even adulr viewets dramatically increase aggression againsr borh objec[s and people. Sexual porrrayal on TV increases reenage and adult sexual drives. It has been shown [har rhe more TV a reenager views the younger the age of the firsc sexual incercourse, and it is usually ouc of wedlock.

1. [nfants are unable to judge wbicb behaviors should be imitated and which should not be.

2. Infants at 14 months of agc Imltate behaviors seeI! on TV. 3. American chiJdren ages two to fivc sec an average of 27 hours of TV per week, and cannot distinguisb râct from fantasy even wben coacbed to do so. 4. TV exposure bas been demonstrated to

significantly increase cbildren's aggressiveness in tbeir spontaneous, natural behavior by at least 160% in two years. Figure 9

1. An estimated half of 20 million kids age 10 to 15 are at risk. 2. They have too much free unsupervised tirne after school. 3. Parents and others raii to provide healthy activities.

Figure 10

1. Decreased interes,t in reading

2-. Decreased interest in learning 3. Poor health habits 4. Poor attitudes 5. Increased sexual activity and decreased age for first sexual encounter Figure 11

307

PROOF POSITIVE

1. Television violence viewing at age 8 in

boys significantly predicts the seriousness of crimes for whicb they are convicted by age 30. 2. Up to 34% of imprisoned felons report having consciously imitated crime techniques learned rrom TV programs, usually successfuUy. 3. Aggression also increases in late teens and adults with TV viewing. 4. The evil effects of TV are responsible for half of the current number of homicides, rapes, and assaults in the U.S. Figure 12

The annual crime rate in the U.S. would be lowered as follows il TV technology had never been developed:

• 10,000 fewer homicides • 70,000 fewer rapes • 700,000 fewer injurious assaults Figure 13

308

-----

When heaJrhy activities are provided for teenagers in place ofTV waeching, they wiU be mllch less likel)' involved in this kind of behavior. Thc negaeive effecrs ofTV on rhe lives of ceens aJld adulcs are shown in Figure 11. 43 .41 Althollgh chese effeccs are eechnically separace from violenc behavior, ehey ean be indireccly relared ro violenee. As ro rhe pocencial for relevision ro affeer adulrs, consider rhe tollowing example. Research bas demonsrrared rhar 22 ro 34

percent of violent male criminals who are serving rime for erimes like murder, rape, and assaulr, ir having consciously imitl1ted crime teclmiques dur rhey learned from TV-usllally successfully.45 In addicion, how many fdons are chere who may have been unwiningly inf1uenced by relevision, and do nor recognize che conneccion berween cheir crime and TV? Consumer surveys show rhac when people are asked why chey buy a cerrain brand of soap, mal1Y rimes chey do nor know, bur willusually deny chac TV advertising had any inf1uence on rheie choiee. Pcople are more inf1ueneed by relcvision advercising rhan dley realize, as proven by rhe decJine in sales of a producr whcn TV adverrising is cuc back. le follows rhar rhe inf1uence of viewing violenee on TV will have rhe same unwirriog effect. A summary of Brandon CeneerwaJl's analysis of eesearch on celevisio/1'S effecrs on adulr criminal acriviry is provided in Figure

12:16 Haw many violent crimes are commÎrced because of TV viewing in America? Again, epidemiologisr and physician Of. Brandon Cemerwall demonsrrares his COlllmand of [he subjeec. Althollgh he recognizes rhar a number of orher t1.crors have a mie in our nacional epidemie of violence, Dr. Cenrerwall has acrempred ro isolace che effecr of relevision by using staristical cools co analyze rhe avaibble researeh. He chus has esrimarcd how mueh violel\[ crime wOllld have been prevemed had relevision never been incroduced in America. His resulrs are shown in Figurc 13.47 In short, relevision viewing appears (O be responsible for fully one-half of today's violent crimes. Thus, ic likely is che largesr single underlying cause and eonrribucor to violent crime in rhe develaped world.

What Can Ee Done? Wirh such a devasr:uing impacr ofTV on our sociery, many have rhe mi raken nocion rhar we need ro appeal ro Hollywood and the TV induscry ro voluntadly reduce rlle immoralic), and crime being poruayed. Many appeals have already bccn made from cangressmen, U.S. Presidenrs. a.nd variolls

w

STEMMING THE TIDE OF VIOLENCE altruistic organizations, bur ro no avail. Dr. Ccnrerwall has exposed the f:1l1acy of sllch reasoning. He compares it ro appealing ro robacco companies to volumarily reduce their cigarene sales 50 that Americans will experience be[(er healrh. His analogy tIrs. The Surgeon GeneraI's pllblîshed repon on Television anei Social Behavior back in 1972 concllleled thar televisioD viewing was Lnked ro violenr behavior. In the wake of that public;ltion, TV network officials promised (Q reduce levels of violence in ilieir programming. However, when ilie inelustry's pracrices were analyzed een years larer. they haLi not delivered on their promises. 48 What could have prevelHed (he TV magnates from decreasing violcm programming? le is a simple f:1cr: rhe more violent and groresque scenes thar are poruayed on ŢV, tne higher the Nielson rarings. which dicrare rhe income from advertising.

Should TV Programming be Regu!4ted? Should we have governmenraJ conrrols

as advocared by rhe Nottingham Universiry group whom I quoeed earJier? The previollsly menrioned Wa1J Srreer Journal editorial al50 supporred such a concept. 4? The writer acknowledged thar such conecols would limir rhe enrertainmel1t choices of adulrs, as statee! in Figure 14. We see ehat ilie preference ofadultI for freedom ro choose rheir relevision encercainment may be It large part of the problem. Many lamenr rhe damage ehar TV infucts on aur children, bur at rhe SJme rime are willing to allow it [O conrinue because of cheir own desires for emen:ainmenr. Are OU1'

chi/drm being Jacrificed for adult pLeasure

seeking?

What Parents Can Do.to Control the TV Monster Nor aH parents are wi.lljng ro Jer TV's educational influence conrinue ro permeate mcir homes. Somc wane ro do rheir parc in sropping this injurious f,1ctor. WhJr can such a parent do? One ste.p is [O sitnply use the "OFF" button-tLlrn the TV off and

srop buying or reming violent aod sex-Iaden videos. However, a person C3n itnplemenr an even mOfe Iasring solurion---earry rhe set ourside and put ir in rhe garbage can. Eelieve ir or nor, years aga, ehar is what we decided [O do in our housc. We have never regretred our decision. Some wil! say, "How do yOll find OUt whar is going on in America roday wÎehoue relevision?" It is very simple. There are plcm)' of sources of news rhar are more informaeive aod objective dlan the TV news. Ca1ling it "news" is a misnomer. 1 here are newspapers, daily news journals, weekly news magazines, computer websites, and on-line services, any of which wil! give yOLl rlle "hard" news. This is much better and more compleee informariol1 rhan the shallow TV news repons. You can even down-

"It is certainly true that any such controls (on TV and videos] wiIl involve some IJimitatioDs on the freedom of adults to enjoy the kind of entertainment they mi,ght prefer. But modest limits on adult liberties ought to be perfectly acceptable it tbey prevent tens of thousands 01" our children from growing up into criminal adults."

load news photOs and video dips of your choosing on the computer. We are living in an age in which rhe best sources ofinformarion are noe provided by relevision. Wheeler highliglm eh is facr when he points aur, " ... rhe rexe of rhe entÎre evening news ,lJ110Ul1tS ro no more rhan half a page of newspaper copy."so Funhermore, it is accompanied by a host of commercials thar stretches out rhe viewing time that could be pur ro much berrer lIse. TV is, in reality. an enrercainmenc box. Even rhe nctwork news producers rhemselves have stated openl)' rhae they consider

Figure 14

309

PROOF POSITfVE eelevisioll news ro be elHenainmem. Consequemly, it needs to be phorogenic and exciting ro be acceprable ro viewers. lf the programming is Ilor designed to be emertaining, mosr viewers switch ro anorher channel. The TV news has its own quantiry of the porrrayal of violence. Violence now pervades TV programming ro such an exrent t!lat it has crept into the Local TV News broadcasrs in increasing amoullts. The Detroit News surveyed 40 TV news broadcasrs on faur stations in December, 1996. and January, ] 997 and found that "crime was by far rhe most common type of story on each st.1.(ion."51 They also discovered rhar 'disaster stories-accidents, floods, blizzards"-were second. "Largell' nonexisrem an ali four stations were srories on local politics and governmem, education, etc." No longer can we escape the viewing ofvi 0Jence bl' switching ro the news. Channel restrictors are now available that wiU block out selected channels. Time limiters can also be retrofined mat will block our alI channels for seleaed inrervals oftime. Other rechnologies are being discussed ehar may provide concerned parenes with a measure of conuol. However, there are problems. Recent research deal ing with the V-

"By beholding we become changed. If you allow your mind to dwell upon the imperfections a,nd moral deformi,ties of others, you will be chan.g'ed into the same image. You will become deformed tin character, and mentally one-sided and urnbalanced. Let the mind dwelll upon the perfect life of Christ. If the thoughts are centered upon him, and the conversatioo is 00 heavenly themes, you will be 'changed into the same image from glory to glory.' You will become 'partakers of the divine nature, having escaped the corruption that is in the world through lust~'" Figure 15

310

chip reveals a sobering fact: regardless of how sophistjeated the TV-resrricting gadgets, thel' are of lirnited use unless there is some cype of cIear and uniform ratjng sys· tem rhar allows parems ro choose whar shows to make of}".·ljmirs. Even if rhe rating issues are solved, parencs must do their homework and lltilize rhe rechnologywhich may be roo much ro expect from many in our societl'. The simplest, lease expensive, posirive, and most effective method of control is probabty rhe one we used in our famill'-compleee removal of the sec. It complcrdy eliminates the problem anee and for alI. A few years ago rhe news wires carried a story abour some residems of Bombal" India, who rebelled against TV in a dramatic wal'. Hundreds of people sick of tdevised violence and sex hurled dlcir TV sers our rheir windows in Deeember of 1994. Today, none of the 1200 residems in this fashionable Bombay ncighborhood owns a TV set. They repon rhar their f:1.milies' lives irnproved as a resulr. Many feei that rhey colild nor cope wirh the chaoges in their lifesryle necessitared by giving lip TV. What could rhel' fiII ali of thar rime wirh? There are a variery of family activities, hobbies, home improvements, and orher pursllirs memioned near rhe cnd of rhis chapter thar couJd pl'Ofltably fiU the rîme. In Chaprer ] 2 an rhe frontaI lobe, 1 cite a sttJdy conducred by dle Detroit Free Press newspaper. When people were paid to give lip telcvision for a lUomh, some iniriaUy had great djfficulties, buc by the eod of r,he srudy they alI had fouod plenry of consrructive activiries. In facr, if we are interested in character developmem and viaJence prevencion, rhe best dling we could do with more free time is to plan activities rhat help ro focus our minds an moral thougIu.s. Ellell White was afirm advoc.ate of this concepe as she re-echoed the teaching of Scripmre. Her onition in rhis regard is quored in Figure l5. 52 Evcn though rhis was wrinen long before rhe advent of television, it addresses d,c concept ofdwelling "upon rhe imperfccrions and moral deformities ofothers," which are

STEMMING THE TIDE OF VrOLENCE depicted regularly an T'I. Such viewing changes [he viewer "imo [he same image," resulting in ilie person becoming "deformed in character and menmlly one-sided and unbalanced." White's solUlion to this tendency is to "let (he mind dwell upon the perfect life of Chrisc." 1, roo, believe we shouJd help aur children do this. We should tell them srories of the life of Chrisr. He lived an illvigorating life that most children have never hcard aboUl except for perhaps one ar cwo events. Wilh ehe thoughts cenrcred upon Him and the conversation ceneered on "heavenly themes. you wiU be changed inca (he same image from glory to glory"SJ,s'l and "become panakers of the divine nature, having escapcd the corrupeion that is in rhe world through Iust.")) Some parents may say, "1 am aware of the damage [hat vile programs can inflicI an borh children and adults. We do nor walch them. My kids are spending meir atter-school hours pan..icipating in competitive sports. At least rhere's no harm in that." We will now examine the second recreational concern and its relationship ta violence.

Competitive Sports-Do They BuiLd Charader? Well before the turn of the cenrury. Americans had embraced a powerful mindse( regardîng competitive spores: "SpOftS builds characrer." This perspective seems ro have been perperuated-virrually unchallenged-in our couoery for genera(ions. In fact. sa firmly ingraioed is chis ethic, rhar ro question it seems un-American. However. Andrew Miracle, an anrhropologist, was rrained ro ask whar mîght appear on rhe surface ta be foolish questions. Dr. Miracle searched rhe research lirerarure for proof of the "sporrs builds characrer" truism. He had a vesred inrerest in rhe subject. He .had played competitive sports in high schoo1 and college; he was also che son ofa high school coach. But more rhan chis, Miracle was a social sciemist. He wamed ro be assured lhat sporcs did ali thar he grew up bdîeving ehey did. Furrhermore. the answer was noe only of personal and academic inrerest-rhe re-sulrs of his quest

srood ro influence a myriad of social decisions. Should a smali rown bllild a new high school foorball field? Should I encourage my son ar daughter ro play comperirive sporrs? Should the financially strapped .local school board ClIC che arhletic budget or lay off teaehers of core subjecrs? The lisc could go on and 00. Surprisingly, Miracle's review of cite published research literarure did not turn out me way he had hoped. It did not demonstrate a clear benefit of sporrs on character. However, a number of unanswered questions were broughr ro light. In rhis context, Miracle collaborated with rwo other scîenrisls and embarked on their own srudy.56 They fim identified a nationaliy represenrarive sample of 1600 male high school senÎors. Then they analyzedrhe S(Udencs' personalities ta altempt ta measure me etrecrs of parricipation in varsiey arhleties. Miracle and his colleagues fOllnd thar characrer trails were affected. but the effecrs were "small in absolure size" sa rJlar dley concluded. "high school sporrs did linie ro benefic or hann rhe social developmcnr of parricipams." However, rcading their resulcs carefully gives cause for concern. Al· though rhe effeccs on character may have becn small, they wcre in fhe wrong direction as illuscrared by Figure 16.51 Aggression and irrirahiliry, instead of decreasing. were increased. Honesty and

1600 male high school se"iors were analyzed as to t/te ei/eet ofparticipation in v{lrsi(v utllleties. The effects:

• • • • • •

Increased aggression lncreased irritability Reduced honesty Decreased self control Decreased independence Slight increase in self-esteem

------------~ Figure 16

311

PROOF POSITIVE self-control, instcad of increasing, were decreased. The anly change {hat was judged ro be positive was an increase in self-esteem. Nthough self-esreem mal' seem on rhe surface ro be desira bIe. rhere is reason tO believe fhar wherhcr ar nor rhis factor is desirable depcnds on why one esteems fJirnself There are seriolls concerns rhar increased self-esteem based on one's dominance of orhers mal' fosrer pride, egotism, and aggression. This concern is re-echoed by Chrisropher L. Srevenson in his dassie review ofthe lirerarure on sporrs and personaliry. Throughouc a multitllde of srudies, he observed thar ath1eres generally scored higher on the psychologicaJ fanor of"dominance. "58 AH in aII, rhe research raises the question as ro whether competirive arhleries mal' be one factOr t-hat is subrly increasing rendencies that-given orher filCtors anei circumstances-may actualiy predispose to violence rarher rhan prorecting againsr it. A New Zealand srudy of a thollsand 15 ro 18 l'eal" old boys and girls found tim juvenile delinqucncy is grearer for those involved in competirive sports. S'J Boys heavily involved in sporrs ar age 15 were ewice as likely ro be delinquelll as rheir peers ar age 18. Girls similarll' involved in sporrs ar age 15 were almost duce rimes as likell' ro be ddinquenr as rheir peers ar age 18. Even at

The more CtullUIiIIn boys play youth hockey, the more they: • feei cheatiug is important • think violent behavior is legitimate aud expected • are likely to mimic iIlegal tactics used by the pros on TV Figure 17

312

•

a moderate parriciparion level, girls were twice as likell' ro be delinquent. The delinquem behavior included C<1r rhen. burglary, shoplifring, and fighting with a weapon. One theory. called the "arhleric delinquent" hypothesis, views the aggressive behaviors associared with comperitive spom as nor being Cdused by comperlriveness on the playing fielel; instead, t-hey supposedly are caused by contacr with delinquenr groups t-har may be involved in ream sporrs, rhus exposing yomh to older delillquenrs. However, rhe stuely did nor supporr this popular hypothesis. The sportS involved in the snldy include rugby, cricket, baskerball, soccer, and hockey. 50 far, we have seen d1e negative efTecrs on characrer C<1useel by parricipation in high school sporrs, both varsiry anei orherwise. Whar abolit parricipation of younger children in SpOfts? Mirac1e anei Rees have surnmarized several Canadian studies that raise concerns abollr character deteriorat ion even in an apparendy younger age groupf,o Researchers have found dut rhe longer young hockey players are involved in rhe sporr, ilie more negative character trairs rhey develop. These characcer rrairs are listed in Figure 17. In some places in rhe United Stares, ice hockel' mal' seern like an example thar is not very representative of the "more ennobling" sporrs rhar our e1emencary srudents play. Bur how does a more mild sport such as a good soccer march ar recess srack up? Jusr such a quesrion was answered in a sruely on t-Ile efiecls of competirive. SpOftS on S4 children, age 10 a.nd Il. Some were assigned ro an experimental group t-hat playeel a Jcick soccer "world series" durij1g recess for rwo weeks. Scores were kept anei rrophies were awarded ro alI fhe players on ilie winning team. Orhers were assigned ro a control group that did nOt compete in tlle tournament. The finelings are shown in Figure 18. 61 These findings are similar ro rbose of rhe varsiry spons srudy anei rhe hockey srudies. In rhe environment of competitive spom, negative characrer rraics have rhe porenrial ro be nurtured. In spire of chis research evidence, Miracle and Rees indic.are rhar rhe ctlrrem consensus among yourh spons experrs is rhat com-

STEMMING THE TIDE OF V10LENCE peritive sports generally do not exerr a negarive effecr on rhe parricipanrs. However, if we are concerned abolit sllbrle effecrs on characrer, I rhink rhere is grave cause for concern. Less ahruism or increased rivalry may seem rrivial, and withollt any apparenr sociaJ impact. Yet, whar happens if some years larer rhese rendencies are superimposed on a job loss followed by an evicrion notice? Is such an individual more predisposed (Q violence rhan a person wirhollt rhe sporrs expericnce? Some "experrs" mighr sa)' rhar rhe answer lies in rne field of conjecrure. However, 1 would respond: can we afford ro rake chances when a body of research demollstrates r:har parriciparion in sporrs has damaging effecrs. and we are in rhe rhroes of an epidemie of violence? Furrhermore, because of the bell-shaped characterisrics of human aggression as ourlined previously in Figure 8, a small increase in ave rage aggression results in major changes ar the eXtrenle ofhuman aggression and will thus have a significam impact on violence sratisrics. J have rcad enough ro conci ude thar competitive spons do 110t bui/d chamctel' in e1emenrary $chool children or 12rh graders; on the conrrary, they damage charaerer. The sharp increase in competitive sporrs panicipauon byschool chiJdren could very well be another reason why violence in our sociery conrinues to increase among rhe young. What about older athJeres who compere ar the college level? Do sporrs build their character? Researchers recenrly looked ar over 100 cases of rape, atrempted rape, 'Uld fondling on NCAA college campllses. 62 Ar 10 of rhe schools srudied, 19 percent of the assaulrs were committed by male athleres even rhough they made lip a mere 3.3 percent of rhe male student body. This suggested rhat the ;uhleres had over f1ve rimes the risk of engaging in violent behaviar. Todd Crosset, who conducted rhe study, said, "When you're rrained to be violent ir can spill over ro your privare life."63

Sportsmanship-Faet or Fiction? A sponsman is defined as someone " ... who can rake a 10$s or defear wirhout

1. Quarreling occurred on a regular basis;

even a fist fight broke out. 2. Crying occurred on several occasioDs, generally in the context of perceived failure or injustice. 3. Rivalry with other children increased. 4. AUruism significantly decreased. Figure 18

•Athletes tend to be less sportsmanlike than non-athletes. ·"Major" sport athletes are less sportsmanlike than "minor" sport athletes. -"Starters" are less sportsmanlike than "substitutes." -The longer an athlete is involved with a sport, and the higher level at which he competes, tbe more Iikely he is to believe that breaking tbe rules and committing injurious acts is legitimate. Figure 19 complaint or vicrory without gloaring, and wha trears his opponenr wirh fairness, generosity, and courresy."64 Many people faJsdy assume thar rhe higher you advance in competirive SPOrtS the betrer yOUl' characrer becomes. Chrisropher Srevenson found jusi the oppoJite when he reviewed six different studies of college arhleres. 65 John Si!va's research r;lised imilar cOllcerns. 66 Their resulrs are summarized in Figure 19. On average, the best-performing arhleres have a rendency ro be the least sporrsmanlike. Ofcourse, mere are notable exceptions.

313

PROOF POSITIVE

Name Mike Tyson ScoUie Pippin baseball ba5ebaU hec'key

Darryl Strawberry WiU Codcro Mark Fitzpat.rick

golf footbaU

John Daly Dan Wilkinson

footbaU

Warren Moon

football football

Johnnie Church Teako Brown

football

3 SMU players

football foothall football football

Rabsctou Jeokios Walter Smith 3 Idaho SI. players Nilo Silvan

football

O.J. Simpson

rape shoving his fiancee against a car several domestic beatings beating rus wife kicking his pregnant wife beating his wife punching his pregnant gÎl:Lfriend in stomach slapping and choking his wife assaulting bis \Vife slapping girlfriend, throwing her to tbe ground aggravated sexual assauIt 00 girl, ) 6 rape assaulting his girlfriend rape assaulting and raping girl, 17 murdering his wife and her companion

Figure 20

the berter the arh~ lere (as reflecred by his reaching higher leveJs of competitive play), the greater the tendency to rhink rhat breaking rules and inflicring uljury on a competitor is jusrifiable. This raises definite concerns regarding vio~ lene rendencies off the field. In some athletes, the impact may be nothing more man acting more intense and hostile during an informal church volleyball game. However, could it predispose others to engage in behaviors that are more serious? What about sportS beyond the college level? Ifcompetitive spons reali)' build character, we would expect atllletes at this level to rarely-if ever-be involved in violene acriviry. In his insighrful repon on competitive sports, Rick Warner observed jusr the opposite: "Rarely a week goes by withour a repore of a college or pro player bearing a woman, getring inco a fight at a bar or

Of stiU greater concern,

314

restallriUH, or starcing some mher rype of physical altercalion." Wamer went on 10 idencify some of the high proftJe professional arhleres who have recemIy been accused of physical violence againsr women. 67 Some have been convicted. A lisr ofsome of these athletes is shown in Figure 20. Actually, such examples probably represem only d)e tip of the iceberg. Before O.J. Simpson stood rrial for murder, the wellpublici1.ed history of his alleged long-rccm spousal abllse suggesred ro many rhar amletes often get off easy when it comes to [he law. Miracle aJld Rees have raised the same concern: "It is possible mat [law enforcemenc] auchorities may ueat arhletes differencly, more leniently, than non-athleres from similar social posÎrions. "68 Furthermore, mally wonder how such outsranding and disciplined arh!etes could be so violent. Karhleen Holgerson of rhe Universiry of Connecricllt Women's Center does nor seem surprised ar rhe record of violence among foorball players. She points ro rwo underlying problems:first, foorball stars are applauded for beillg violent in their games; second, respect for women is nor a parc of their "macho culrure."69 In her mind, these problems set the srage for violence direcred ar women. But what abouc those who are involved wirh other sporrs? Alrhough some sports may tend to promote violence more rhan ochers, as we have already seen competitive SpOftS in general seem ro atJect tlle parricipancs. If il child's kick-soccer world series can cause measurable effecrs in two weeks, what influences do comperitive spons have when they are the center of a person's entire Ijfe? It does nor rake agreat Icap of faith ro conclude thar intense spom involvcme.nr can be a risk facror for engaging in violent crime.

Americans Raise the Stakes in Competitive Sports Unfonunately, the fabric of American life rends ro accenruare-rather rhan amcliorate--the deleterious effecrs of competirive SPOrts. AJmost every town and city in America roday has athleric fields built for the purposes of entertaining parems who

STEMMING THE TIDE OF VIOLENCE warch rheir reenagers compcrc in foorbaJl, baskerbalJ, soccer, and or.her sporrs. The social symbol ofsporrs also has some of che mosr. insightful experlS worried. In their book, Lessons of rhe Locker Room,l° researchers Miracle and Rees argue rhat America's currenr spores obsessioo conf1icrs wirh our narioo's rruc long-eerm needs. lf America is ro successfully compete economicaJly in r.oday's global markerplace, we need skilled workers, nor extraordinary athletes. We cannor afford ro allow sporrs ta continue ro dominate edllcarion. We are also surrounded by the fauaricism of spons enthusiasts who a muhi-biUion dollar indusrry thar rewards ies top professional athleees wirh huge saJaries. Mauy condemn r.he ar.hler.es and/or team owners for rhese lavish paychecks, bur ir is rhe American public that is large1y responsible. The fanatical inreresr in SpOftS provides rhe money for large salaries r.hrough r.he sale of rickers and TV adverrising. Sporrs faus are also well aware of rhe unsporrsmanlike conducr ofsrar players; yer, many applaud it. For example, in a oottOo-disrant season, the Deeroir Pisrons baskcrball players were finding chemselves slapped with an unusllaHy high number of penalties because of rheir unsportsmanlike behavior. Mauy of their &os were proud of ir, however, and dubbed rhe local heroes "Derroir's Bad Boys." These words appea.red an bumper srickers and T-shirts, and found uleir way into newspapers and spons magaZlOes.

The American publ ic ac large seems blissfully unaware of rwo conclllsions rllar seem clear in rhe scientific ar.hletic literature: 1. The idea thac "sports build characreI'n is a myth. 2. The trurh is mat sporrs acttlally have a rendency ro cause a dedim: in characrer. OI'. Mirade aud Rees in rlleÎI book Lessons [rom (he Locker Room stare it this way, "Rcmlrs of in deprh analysis of moral reasoning in spon have shown Ular athleres have a rendency ro shrug off moral decisions as not their responsibiliry and thar r11ey also exhibic a self-serving bias when judg-

ing what violent behavior is appropriare. Moreover, arllieres tend ro adopr a less aclvanccd form of moral reasooing to jusrify aggressive behavior rhan do non-arhleres. The belief rhar participarion in sports leads ro the developmenr of pro-social personaliry trairs, rhar ir makes one a bercer persoll, and dur. it builds characrer in high school or in aoy other contexr, is in no way jllstified. On rne conuary, research an the moral reasoning of athleres rends (Q painc a negative, nor a positivc, picture."71 UnriI we as a narion recognize these problems aud make spending decisions accordingly, athlerics will srill draw huge sums ofmoney. Those doUars invested in elcmenrary, high school, and college arhlerics will continue (Q sap funds from educarionaJ activiries. Furthermorc, rhese invesrmenrs speak (Q aur youth abour rhe presrige and privilege of playing sporrs rarher rhan rhe importance of being skilled, producrive workers. And rhe big pOt ofgold ar rhe end of the rainbow in rhe land of professional superstardom will conrinue ro lurc many young people into areas ofcompetirioll that will uhimate1y mar r.heiT characrers. 1 am aware rhat rhis is a very sensitive ropic. Spons have afirm grip on a broad segment of our sociery, but we ali need ro be aware of how comperirive sports aEfecr aur YOllch. Mari)' parenrs believe rhar they are inf1uencing their children posirively by encollraging (hem ro compete in spores. They spend rime and efi-of[ buying rhem equipll1ent and driving them to practice sessions and games. Unfonunately many are largely Of rorally Wlawarc of rhe damage rhey may be doing ro their children. It is truc rhere are some arhleres rhat, because of t11eir environmem and their ocher rrairs of characrer, wiU oever have problems duc ro rhese inf1uences. However, many oc11ers wiII. I should aJso emphasize rhat rhere are ocher inf1uences 00 our yomh r.hat are worse rhan sporr.s. IfI had ro choose berween my child playing in an evening baskerba1l1eague and running with an inner ciry gang, 1 would unhesiraringly choose rhe formeI'. In fairness, 1 ulink rhat chis is one of the reasons thar sports rend ro "look good." If we

315

PROOF POSITIVE

"Some of the most popular amusements, such as footbaU and boxing, have become schools of brutafity." "They are developing the samc cbracteristics as did the games of ancient Rome." "The love of domination, tbe pride in mere brute force, the reckless disregard of life, are exertiog upon tbe youtb a power to demoralize .hat is appalling." Figure 21

• "Other athletie games, though not so brutalizing, are scareely less objectiooable beeause of tbe exeess to which they are carried." • "They stimulate the love of pleasure and excitemenl, thus fosteriog a distaste for usefullabor, a disposition to shunpractical duties aod rcspoosibilities." • "They teod to destroy a relisb for life's sober realities aod its tranquil enjoymeots." • "Thus the door is opened to dissipation and lawlessness with their terrible results." Figure 22

"Vigorous cxercise Ihe pupils must have. Few evils are morc to bc dreaded than indolence and aimlessness. Vei the tendency of most athletic sports is a subject of anxious thought to those who have al heart the wellbeing of Ibe youth." '"Teachers are troubled asthey consider the infl'uence of these sports both 00 the student's progress in school aod on his success in afterlife. The games that oceupy so moch of his time are diverting the mind from study." "They are Dot helping to prepare fhe youfll for practical, earnesl work in life. Their influence does not tend to\vard refioement, generosity, or real manliness." Figure 23

316

compare a young athle(e wi(h aJlother peer who is into drugs or gang activiey, sportS looklike a wholesome inf1uence. Ahhough sporrs may have value in keeping someone away from worse activities, we must always that there are inherem probtems with compec.itive ac.hletics. Better alternatives do exist, as we shall sec.

Jnsights about Sports[rom Yesteryear Years ago, Ellen Wh..ite addressed rhe slIbject ofcomperi(ive spom. She displayed more insight into the true naeure of these games (han many of rodays experrs. She referred ro spons, such ,lS football and boxing, as "schools of brurality," as quoted in Figure 21. 72 What abolit spons o(her than cOlllact sporrs, rhose that are nor so viciollS, like baseball, rennis, or volleyball? Befor:c research was do ne in modern years, Jid Ellen White foresee any problem~ wirh these activiries? Did she think it was possible rhar dley wOllld produce good charac(er eraits in Dur children? Her comments are recited in Figure 22.7 3 Shortly before she wrore rhe sratements above, Whi(e presented even srl'Onger rheroric. Her assessments of sporrs c.1me in the contexr ofencouraging physical ac(ivity, yet wariling of the problems with competirive sporrs, as srated in Figure 23.74 A summary of EJlen White's concerns abolit spom could just as well have been enunciared by an up-ro-date research sociologist. These concerns are summari7.ed in Figure 24.

Another Pitfall ofthe Sports Craze SportS, whethcr you actively panicipa(c in them, or observe them on TV are ar tlte very teast agreat diversion. Those who regard thernselves as "sporrs fans" ullwittingly acknowledge rhar rhey are fanatical abOli( sporcs (rhe word "fan" is, of course, an abbreviation for "fanatic"). Dwelling on spons leaves less room for God in our thoughts. It tends ro prevent lIS from inquiring "How is it wi(h my soul?" Those attcnding a SpOrting event would have a difficult (ime even (hinking about thcir rclationship with their Makcr, bccause rheir minds are captivated

STEMMING THE TIDE OF VIOLENCE by ilie comperitive spirit and the excÎremenr of the conresr. Indeed, rhere is little that is morally uplifring abolit a sporring evene. The minds of players and observers aIike are /lxed on one objective-conquer rhe opponent-beat him imo the ground. We need ro provide supervised activities for aur childIen rhar are healrhy, rhar fosrer crea tjvi ry and imaginarîon, and that provide useful labor. EHen White slIggesrs a balance between lIsehtl work, recrearion, and reading and srudy as olldined in Figure 25.75 If sllch activities ftlled a young person's day. he OI she would nor have time ro parricipate in or view sporring evenrs that fosrer violent behavior. When compared ro regulat competitive sporrs involvemem, they would likely be more occlIpied and insllIared hom becoming involved wirh gangs, drugs, or sex. Indeed, if American yOllng people received guidance along these lines, yourh violence would be sharply reduced. tlleir learning skjlls would irnpIove, and life in general would be brighter for rhem and for ali of liS.

1. Interferes with stlldents' scbool progress.

2. 3. 4. 5.

Diverts tbe nlÎnd from academic studies. Intensifies love of pleasure and excitement. Produces a distaste for usefullabor. Fosters a disposition to shun practical du'ies and responsibilities. 6. Destroys relish for life's sober realities. 7. Undermines life's 'ranquil cnjoymenls. 8. Increases lawlessness. 9. Intensifies love of domination. 10. Foslers a reckJcss disrcgard of life. I 1. Cultivates pride in brute force. ''''

1,

'Figure 24

While it is right and necessary for lehi/drenj to have recreation, they !iIIOUld: 1. De taught to work

2. "ave regular hours for pbysicallabor

Historic Para/leL to the Problems Facing America In this chapter we have seen some of the roors of violenee in our sociery. Making decisions abOli( drug use, values. and recreation would have a tremendous impact even if only a portion ofAmericans rook ro hearr r11e need ro make changes in these pervasive risk facrors. lam realistic enough, howcver, ro recognize that many of rhose who most need ro rake a stand in rhest areas will only eriricize and ridieule my words. Their value jlldgmenrs are beld by the majoriry and thus rhey find it easy ro rarionalize: "everybody is doing it-how cOllld rhese things possibly be harmful?" Such argumenrs bring ro mind the similar excuses used in ;tnorher cui ture wllere vice and violenee occurred in epidemic proporrions. Ir seemed rhar JUSt abour everyone was swept away in a tide ofcorruprion. Alrllough I do nor believe rhat America has yer came ro rlle point of this ciry, [here are some srriking paralJels. The city in question is Sodom of [he ancienr Middle Easr.

3. "ave regular bours for reading and study 4. "ave employment suited to their years 5. De supplied with useful and interesting books Figure 25

"Behold, this was the iDiquity of thy sister Sodom, pride, fulness of bread, and abundance of idleness was in her and in her daugbters, neither did she strengthen the hand of the poor and needy." EzekieI16:49. • Figure 26

317

PROOF POSITIVE The whole world has heard of Sodom. Ies hisrory is doclImented in the Bible. The word "sodomy" was derived from rhe name of rhis city; ir denores oue rype ofcrime that was freely commirted in Sodom. Violence and sexual crimes seemed to be ar t11e top of the lisr in rhar ancienr urban area. lnteresringly, rhe Bible provides four reasons for mese crimes, as quotcd in Figure 26. Note the four characterisrics of Sodom: 1. Pride 2. FlIllness of bread 3. Abundance of idleness 4. Lack of comion for rhe less forrtmare

318

Let us examine (hese root causes. Thc hrsr one, pride, may be difficulr ro differentiate [rom the cuerently popular concepr of "self-esteem." What do we hear abolit self-esreem roday? Many sociologisrs rell us rhar me crime rare in our society is due ro 1JJw self-esteem, which seems on rhe surface ro be at variance wirh me Scriptural aCCOllllt ofSodom's problems. The highest and most powerflll form of "self-esreem" is nor usually discussed. This trair arises from a sense of our inflnire value becallse ofbeing God's sons aod daughters and precious ro Him. Whar is commonly called "self-esteem" in our country comes from within rhe person rarher than from a Higher Power olltside. Commonly, those individuals who are dee1ared as exemplif)ring high self-esreem possess certain characterisrics, talents, or abilities which allow rhem ro stand wirh rheir heads up rall. Alrhough often unrecognized, this self-esteem is lIsuaHy based on comparing one's self with orhers. Consider some examples. Shirley has a good sense of self-esreem because she is rhe most talented lawyer in (he ftrm-everyone comes ro her when rhey have problems. (Whar would her self-esreem be likc if her skills were JUSt as good, but she was the least skilled lawycr in rhe ilrm?) Bob has high self-esreem becallse he is agreat football player. (Great compared ta whom? lf he played the game jusr as well, but aU rus competitors improved dramatically overnight, would he sriH feei so good abourh.imself?) Sue has a high sense of wonh because she is

intelligem and artractive. (Would she srili feei good abour these same qllalities ifgiven rhe same abilities and appearanceshe was, Iloncrheless, less imelligent and artracrive rhan ali her peers?). Harry hnds special satisfaction in how weH he has done as a farher: cach of his four children bas grown up to be a professional. (How would he feel if everyone he knew had lcids mat. [Umed Otlt better than his-even ifhis children were jusr as accomplished?) Thesc illusrrariolls indicate thar the basis ofso-called self-esteem is pride arising from a competitive spirit. Wc compare ourselves with o(hers, and then feel good abolH ourselves. The scriprures speak ro this rype of self-esteem: "Pride goerh before destruetion, and an haughty spirit before a fall."76 A search of the word "pride" in an exhaustive Bible COIlcordance reveals many warnings as to ilS dangers. Those who feel superior ro orhers are more prone ro inflict bodily harm as a whim or even in a plor ro accomplish their objecrives. The apostle Paul stated "Let nothing be done through srrife Of vainglory; bur in lowliness of lUind let each esteem orher betrcr rhan rhemselves. "77 In some socieries, rhose who thought rllemselves [Q be superior daimed the "right" tO determine wherher rhe "inferior" ones should be subdued or even exterminared. A gbring example of mis occurred in ooc of the darkesr chaprers ofAmerican hisrory: the insrirution of slavery. Nazi , with irs "master race," provided anothcr sad cOllunentary as to r11e resulrs of me human tendency to pride. Perhaps surprisingly, we also find soeiologises using some of the same language in tallcing about rhe "macho" tendency fed by competirive spons. They poinr Out how, in essence, it causes some men ro boost rheir self-image by demeaning the value of women. We have already discussed some of [!le reperclIssions regarding spouse abuse and relared crimes. The second reason given for rhe crime În Sodom is "[ullness ofbread." Some sociology specialises, conversely, say that ir is not fullness of bread bur poverty rhar is at fhe root of ollr crime problem. This is agaill in disagreemenr wirh rhe Holy Word's aCCOllllt

STEMMING THE TIDE OF VIOLENCE of Sodom. Alrhough poverry is an importanc facror in violence, ic is nor the core problem leading ro violence as some wOllld have us believe. The Holy Word does bring poverty inro the picture in rhe case of Sodom. We wi1J de/ve inro rhac shorely. However, Jer lIS consider how "full ness of bread" can resulc in crime. America roday is rmiy an affluenc socicty. Granred, aur country is dramaric31ly differenr from Sodom. Today in America, Jespitc recent "re(orms," wel(are stiH providcs more [han rhe basic necessiries for many low income cicizens. Americans living in "poverty" own more dishwashers per capita rhan aII people in rhe Netherlands, England, and IraJy; more c10rhes dryers rhan aU people in Sweden; more VCR's rhan 311 people in wesrern European narions except for Brirain; and more microwaves rhan 311 people in any European counrry.7 8 Our counrry rruly has "fullness of bread" as did Sodom. Even if it were true rhar many live in real poverty, ir is nor a cause ofviolenr crime as the media would have us believe. I( poverty caused violence, aur greare.~r violence sholild nave been ar rhe rime of rhe Grear Depression. Surprisingly, rhe crime rare was much lower ar dle rime of ilie Depressiol1 rhan ir is now. People were srarving on rhe succes, srarving in rheir homes. Foocl wa.s scarce; money was scarce; anyrhing of v31ue was scarce ar rhe rjme of rhe Grear Depression, yer our cirizens did nor kill each orher as a resulc. FuUness of bread, inseead of being a blessing ro Sodom. became a curse. lr is dosdy rela[cd ca che ehird cause lisred by the prophe[ Ezekid, an abundance of idleness. Idlencss olien resulrs direcrly from "fullness of bre-J.d." Apparenely in Sodom, Illany did not need ro work ro keep bread on rhe rabie. We have much idJeness in our country for similar reasons. It is certainly wonh cOl"lsidering thar idlencss, and not poverty ieself, may be one ofthe reasons why in America che "poorer dasse.s" have disproponionare crime rares. When people coJleet welfare or uoemploymenr checks, by definition, rhey are nor working, rhus further opeoi ng fhe possibiiity for idJeness. An

old proverb stares rhar "idleness is rhe devil's workshop." La cer in t!le chaprer we will say more abolit idleness. The fourrh reason identified for Sodolll's crimes was failing ro helI' the poor. "Neirher clid she suengchen tIte hand of rhe poor and needy." There apparenrly were some, even in Sodom, that were truly poor. Our sociery has rhe same problem roday. Many have become insensitive regarding thase who oeed help. They expecc rhe government to take care of rhe poor aod ullforrunaee. If someone is in need, the government is supposed ro provide housing and suppon. Many seem ro feel rha[ if ('hey cannor qualifY ro get ir from che governmelll, they are undeserving; rherefore, 1 will nor help [Item. Thus, our great welfare sociery is ar the coot of much of rhe lIoconcern for rhe poor and needy. As I have alluded ro, research does demonserare an associarion between poveny and violent crime.?? The experience of Sodom speaks ro the importance of addressing rhe needs of rhe poor for che mental and spiriruaJ heair11 of rhose doillg r11e giving as well as for those on che receiving end of acts of kindncss. Althollgh welfarc programs no doubr bring cenain benefits ro ehe needy, 1 am impressed again-in che contexr of [his chaprer-rhar it would be fulfilling ro use aur leisure cime ro help individu31s who are in need. Thar help collld rake many forms. le may be helping chem paint cheir apanmenr. le may mean baking chem a loaf of bread. It may email raking some rime ro helI' rhem with purchasing decisions. Imagine rhe bellefirs ro borh giver and receiver if more time were spent he1ping others, and less rime warching television or wraI'ped up III SpOfts.

fdle Time)

ru and Violence

Ler LIS look furrher ar rhe rhird charac(eriscic, the abundance of idleness. What are Americans doing with rheir idle rime? Whar is the major acciviry dur occupies rhe idle rime in America? It is no secret; ir has been well publicized. Many statisrical srudies have been made that verit)r ie. It is watching television. Tdevision is rhe Ilumber oile" idle acriviry" ofAmericans across rhe

319

PROOF POSITfYE

• Family councH me,etings • Teach children t6 express gratitude • Invite friends who wiU abide by family rules • Special weekend meals • Special occasions witb exteoded family • Routine phone tradition • Give insclribed books as gifts • Make and show home videos Figure 27

n:uion, across age groups, across even socioeconomic groups. As has already been poilHed om, we are reaping r!le resulls of rhis idle acriviry in the form of continually increased violence and immoraliry.

Living Without TV 1 am often asked how 1 and my family can live in eoday's warld wirhom relevision. Mally people seem to respond wirh blank looks when asked whar rhey would do with cheiI rime iJ rhey did nor warch TV. 1 have

SE • Learn geography, science, math, or art • Learn to cook and bake • Develop hobbies and related skills • Visit the library • Quilting, sewing, etc. • Learn to handle money • Learn a musical skill • Subscribe to newspapers or magazines Fîgure 28

320

thus lisreel some of rhe wide choices of acrivities dtar can enrich your life and yom family's life in many ways. You will now have time for rhings rhar are meaningfulsuch rhings as family and social acriviries, self-improve.menr acriviries, physicaJ acriviries, development of family values, aod recrearional acriviries.

What to Do 'ifter Pulling the Plug Suggesred family anei socÎal activiries are lisred in Figure 27. 80 The above figure deserves a few commenrs. It is remarkahle how many children are starving for a home where wholesome acriviries are r!le rule insread of rhe exceprion. Such home is possible ifit has 00 TV. Ir is amazing ro me how mucb children enjoy and parricipare in family cauncil mccrings where dley arc given rhe opportlJniry tO help set the "rules of the house" and even help set rhe possible punishmems, erc. If they are involved in the planning process rhey wiU be mucll more willing ro acknowledge rhe imponaoce of following the f~un il)' rules. Children do nor naturally express graritude. When rhey are given gifts ir is imporrant ro rake lhe rjme ro help them express graritude nor only in worel bur also in wrÎring expressive rhank-yoll notes. If lhis is dane r!ley will avoid growing up wirh rhe ielea rhar rhe wotld owes rhem somerhing; it will be a pleasure ro have dlem arounel. When friends of yaur children are invited aver and are wiLling ro fo[Jow your family rules, rhey will rend ro bring even more joy ro rhe home in cheir association wirh rhe f...mily. Planning, preparing, and parraking in special weekend meals can be a f:lmily evenr worrh ing. Having ramine phone traditions where grandparenrs and exrcnded family are called, are not only enjoyable at the rime, but will endear your children ro rhcse rautine phone eraditioos when they grow up and have rheir own children. There are al50 maoy self-improvemel1t activities rhat could be engaged in. Some of rhem are lisred in Figure 28. Deg games and orher graup ways tO make the learning ofgeography, science,

STEMMING THE TIDE OF VIOLENCE marh, and an will nor only be fun bur wiU be rewarding in rhe ye.1r· (O come. 1 ftnd it amazing how many children (as well as adulrs) love ro learn to cook. We have seen rhe imporrance of nurririon in this book. Having rhe family learn togerher ro cook hea1thfully as well as tasrcfuLly can be another grarifying family event tim will a1so be eminen.rly pracrica!. Some youngsrers roday respond wirh a blank stare when askcd whar rheir hobby is. A child withour a hobby was unheard of prior ro (he advcm of tdevision. Guiding children inro Ln(cresting and wholesome hobbies [har agree with their individual personalicies and preferences wiU noc only stimulate crearivicy but wiil also bring lasting self-respect. There are seemingly exhausrive resources ar locallibraries rhac children should know how ro tap. When your child asks you a quesrion that you can't answer, rake rhem tO rhe locallibrary nor just so rhey may seek an answer, bur help [hem in an imeresting way ro find answers ro rheir own quesrions. Ofcen. by finding an answer ro their quesrion, many more rhoughrful questions will surface and the library will become a fun place where answers are found. Quilrs can incorporate family hcritages and rradirions and chis acrivicy as well as Jearnlng co sew can be accomplished by both sexes. Children as well as adults can learn how ro play a musieal insrrument or rwo much more easily in a TV-Iess home. A number of scientific studies demonscrare rhar rhe developmenr ofdassical music skills in particular may actuaHy increase imelligence as well as memory abilities. More is said abour this in Chaprer 12 on rhe froma] lobe of (he brain. Wirhour TV you will have rime ro engage in physicaJ acrivities iliat will invigorare rhe mind and body. Some suggesrions are listed in Figure 29. AJrhough competitive sporrs are ro be largely avoided for reasons oudined earlier. (here are an abundance of ourdoor non~ competitive sports iliar can bllild endurance, increase physical fitness) and involve rhe entire family. Growing a garden can be aero-

t

bic, especially withollt a [iUer and the ground is prepareel by digging. Our OWIl children (pre-schoolers) are given a special corner of rhe garelcn rhar rhey arc enrirely responsiblc for preparing, planring, weeding, warering, and harvesring. It is asronishing ro sec how many lessons of life are learned by rhe simple acr of gcowing a garden. Even yOllng children can participare in daily chores. At rJle enel of every day, rny wife prepares a picrure lisr of the chorcs rhat OlH five
• Outdoor non-competitive 'exercise • Grow a garden • Participate in daily chores • Make home comfortable and serene • Help others; offer your services Figure 29

321

PROOF POSITIVE

• Use meal time as an educational event • Daily devotioDS and Bible study • Hymn singing • Prayer aud discussion of spi1ritual values • Read tGgether

Figure 30

Figure 31

322

special coy, a book, erc. A1rhough rhere are maJlyways ro teach cit Jdrcn tlte significance ofchorcs, ir is important rhac they be taught. The home should bc a place rhar is comfonable and ar times guier enough ro allow crearive rhinking. Displaying the children's artwork as well as having "masrer" arr\'/orks or replicas around (har can be studied and colltcmplaced wirhour a discraeeing celevision will bring greac rewards. Leuing chem assisr wirhin cheir capabilities in laying ouc

the fumirure and artwork wiU add incerest. Children need co bun how rewarding ic is ro helI' orhers in need. There are people in need in every communiry. Helping a disabled person chat lives alone wirlt housework ar yard work as well as involving rhe yOllllg in wholesome commllniry projeees will teach the children [O seek our rhese rcfreshing and memorable experiences. Spend rime in associaring with the famJy wirh a goal of developing famiJy values. Some of the sllggesrions in Figure 30 1l.1ay be helpful. As a kjd, J my farher asking me ar sllpper, "Wbat did you learn in school roday?" It was nor only a reminder of why 1 was in school but ir lIsually generared a discllssion that was mllch more educacional and enrercaining chan the Ie.lrning experience ac school (har had prompted lhe discllssion. Family mealtime can be a nonintimidaring, rela.;(ing, but a highly educational event. DaiJy spirirua.l devotions with associated reading of the Bible, either in a group or individllaHy, can gteac1y enhance ehe moral and spiritual aspect oflife. Our young boys have rhoroughly enjoyed learning some of che great hYIllns. Their memory of rhe sranzas is grearly enhanced by the music. Taking rurns reading greac lieerature cogether is not only pleasanr but thoughr provokjllg and always gene.raees fascinaring discussion. There are many kinds ofwholesome recre~eion available, some of which are listed in Figure 31. Withom TV in the home ir will be rnuch easier to rolltÎJlely engage in ehese recrearional activiries lhat will likely be both memorable and enjoyable.

Conclusion Violencc in America is here ro stay unless we make some dramatic changes. 1 have neithcr attempred ro denne the emire scope of che probJem nor described ali rhe necessary changes ro fully address (his socieral parasire. However, 1 believe we can do much ro shift che momenrum away &om the growing problem ofviolence by individual commirrnenr ro rhe duce rasks olldined ar rlte beginning of rhe chapter:

STEMMING THE TIDE OF VIOLENCE • Avoiding mind-aJrering drugs, including alcohol. • Re-prioritizing vaJues an.d embracing high moral principles. • Choosing whote.some and true characrer-building acrivjries in our free rime while avoiding activities assocÎ-

ared with fosrering unnecessary aggresslOn. With each of us commining ro rhese rasks, we will reverse rhe currenr rrcnd of increased violence, and move in rhe direcrion of srcmming irs ride.

References Uni led Slalcs Deparonent of Healrh and Human Services. Violem and Abllsive Bebavior. In: Healrhy hopk 2000. Washjngton, DC: US Govt'rnlllenl Prillling Office. DHHS Publication number. (PHS) 91-50212, 1991 p.226. 1

Rosenbcrg Ml., Mercy JA. Assaulrive Violence. In: 1.,sl JM, Wallaec RB. edilOrs. Maxcy-RofC1I1/li·l!w Public Hl'I1lth ilrlll !'rro"miv, M,dicinr13r11 ({Iition.. NorwaJk, CT: Appleton & Llnge, 1992 p. 1038.

1

J

T,cJmimUJI the fourW kadiag raliu Qj,Yrllf'S qfporrntillilift lost bc/orţ llU

fii. Unilcd StalCS Deparrlllelll of Hc-alth and Hllman Serviees. Violent alHI Abllsive Behavior. [n: HfI1/rhy I'eople 2000. Washington, DC: US Governmcm Prillling Offiee. DHHS Publiollion number. (PHS) 9150212, 199[ p.226 ~ Uniled Slalcs Deparunent of Hcalth and Human Se{Vices. Violent and

Abusivc l3ehavior. [n: Hralthy Peoplt' 2000. Washington, DC: US Gov. ernrnelll Priming Office. DHHS Publication Jlumber. (PHS) 91-50212. 1991 p.226 Uniled Stales Depanment of Heallh and Human Services. Violent and Abusive Behavior. In: Healthy People 2000. Washjngton, DC: U Governmcnt Prillling Office. DHHS Publicarion numbcr. (PHS) 91-50212. 1991 p. 226 j

Rosenberg ML. Mcrcy JA. Assaultive Violenee. In: Last JM. Wallacc R13. edilo~. Maxcy-Rost'llltll-um Public Ht'I1Lt" ,mri PUlJmlive Medicim·13th rdirion.. Norwalk. CT: Applelon & i.ange, 1992 p. 1035.

6

Unitcd S'alcs Depanmelll of Hohh anei Human Services. Violent and Abusive Bchavior. In: Healt"y People 2000. Washington, DC: US Governmem Prillling Officc. DHHS Publicalion number. (PHS) 91·50212. 1991 p.226.

7

Rosenberg ML, Mercy JA Assaultive Violence. In: L,sr JM, Wallacc RE. edilors. MIL'Ccy-Rosmall-Lasl Public Hen"" Imd Prclir.nâvt' M,dicillr13r" etlition.. NorwaJk, el': Appleloo &. bnge, 1992 p. 1035.

8

Roscnbcrg ML, Mercy JA. Assaullivc Violence. In: Last JM. Walhcc Rll, edilors. Maxcy-Rosellau·Lasr Public Health I/1ltl ?m,mtili/' Medicine13r1urlition.. Norwalk, Cf: Appleton & L31lge, 1992 p. 1035-1062.

9

Babb:lJl DJ. Epidemiology al1d Prevention of Selected Chrooic U1In: Cassens BJ, editor. Preventive Mtdicine Imri Public Heallh-zo J edition. Philadelprua, PA Harwal Publish.ing. 1992 p. 147·149.

ernment Printing omce. DHHS Publicarion number. (PHS) 91·50212. 1991 p.229. Rosenberg ML Mercy JA. Assaullive Violence. In: L1St JM, Wallace RE, cditors. Maxcy-RoSt'MI/-Last Public Healrh and !'rrlJentive Medicine13th "tiilion.. Norwalk. el': ApplelOn & i.ange, 1992 p. 1037.

14

1~

O'Carroll p~ Suicide. In: Lut JM, Wallace RB. edilOrs. MaxqR01f'l}(m-I-llJr Public Hel1lt» Imri !'revmtilJt' Mediâ/lr-13th edition.. NorwaJk, CT: Applclon & L1J1ge, 1992 p. 1055. 16 Finkelhor D. Child Sexual Abuse. In: LlSI JM, Wa.llace RD, eJitors. MIL'(cy.Rosmtltr-l..iw Public Ht'ollb and Prrvt:lUivr Medieine-13th edition.. Norwalk, er: Applelon & L1nge, 1992 p. 1050.

17 Balaban DJ. EpidcruioJogy and Prevemion of Sclcctcd Chronic [11ne.sscs. In: Cassen& BJ, edilOr. Prromlivt' MNlicillt' ond Pllblic H"fllrh--2"" edilion. Philadclphja, PA: HarwaJ Publishing, 1992 p. 149. 18

Barna G. Genrrl1/ion N"xt. Velllllra: Regal Books, 1995 p. 24-31.

19 71ie (Washington PasI Feb 1990. As ciled in: Whecler JL. The Long Blood)' Trail-Violence in America. In: Rnnoff Colltrolkd: How 7V Afficts You al1d Your Family. HagerslOwn. MD: Review and Herald Publish.ing Association, 1993 p. 96. 20 Whcelcr JL. Sqllandering God's Grealesr Gi[l: Time. In: Rt'1110ff Controlled: How 7V Affic/S YoII ilrul Yotlr Family. HagerslOwn, MD: Review and Herald Publishing Association. 1993 p. 49.

Daulo BM , Zuckerman M, Rosemhal R Humans as lil' deleclors. Comm/llt 1980 Spring;30(2): 129-139.

21

1

li Zuckcrman DM. Zuckerman BS. l'clevisÎon's impaC! on children. Pediolr-ics 1985 Fcb·75(2):233·240. 2.\ Zuckerman OM. ZlIckerm3J1 BS. Tdcvision's impacI on children. Pr· dil11riN 1985 Feb;75(2):233-240.

Professor Elizabclh cwson, head of rhe child dcvdopmcnt unit at Noningh:un Universiry, England. As qU!lled Q).'. lrving Krislol. Sex. VioIence, and Video[ape. Tlie Wall StrutJoltr1urlTuesday, May 31, 1994.

1';

Kristoll. Sex, Violence, 3Jld Videolape. The WaJt StrurJouma/Tue day, May31,1994.

25

10

Centcrwall BS. Tclcvision and violence. The scalc of rhe problem and where 10 go from here. lAMA 1992 Jun 10;267(22):3059·3063.

IlCSSCS.

26

11 Rosenberg ML, MerG)' JA. Assauhive Violenee. In: bSI JM. WaJlace R13, edilors. M4Xcy-Rosmall-LJt.lI Public Hea"h and AYlJmtÎlJe Medicine131h ,tlilion.. NorwaJk, CT: Appleton & Lange. 1992 p. 1035-1062.

27 CemerwaJl BS. l'devision and violence. The sClle or rhe problcm and where 10 go from here. JAMA 1992 Jun 10;267(22):3059-3063. 18

Uoitcd Slates Department of HeaJlh and Hllman Scrvices. Violent and Abusivc Beha\'ior. Il): Ht'althy hople 2000. Washington, DC: US Government Priming Oftice. DHHS Publicalion number. (PHS) 91·50212, 1991 p. 229.

29 Huesmann LR Ps}'chological proccsses promoting the rclation berwccn exposure 10 media violence and a.gglessive behavior by rhe viewer. 1 SOl' ISSlw 1986:42(3): 125-139.

11

I Unilcd Sl3les DepanmelH of Health :lIld Human Services. Violent and Abusive Behavior. In: HelrltJry Peopk 2000. Washingron, DC: US Gov-

Celllcrwall BS. aur Cultural Perplc..'titics (V): l'clevision and Violent Crime. TIu I'IIb1i,.ll1ffWI Nlllllber III, Spring 1993 p. 56-71.

Mell7..ofT AN. [mitalion of ll'levised Illodels by in[,nlS. ChiM Dro 1988 OCI;59(5): 1221· [229.

.10

323

PROOF POSITIVE 31 MelrrofTAN. Memory in infancy. In: Sqllirc LR, Byme J. cdjrors, el al. EI/C)'cwpdii/ ofLeamini i/I/d Mtmory. New York. NY: Macmillan Publishing Co loc., 1992.

S7

AC Nielsen l"ompany. Nidsen Repon on lek'vision 1990. Nonhbrook, III: Niclsen Media Research: 1990.

58

Flavell JH. The dcvclopmcm of childrcn's kJlOWledge "boutthe appeardislinClioJl. Am 1',-)'cbo/1986 Apr:41 (4):418-425.

19

32

J)

an<x-r~1Iil)'

}.( Cenlerwall BS. Tc1evision and violena. The scale of the problem and where ro go from here. JAMA 1992 Jun 10:267(22):3059-3063. ~I

Oldenberg D. Prima! Screen. II1dJbingtoll PoIl April 7, 1992..

Bllshman BJ, Geen RG. Role of cognitive·emotional mediarofS and individual di(ferenccs in the e/leets of media violcnce on aggression. j I'm Soc Psyelio/1990 Jan:58(1): I56-163. )6

37 Lieben RM. E(fccrs of Idevision on childrcn and adolesce/lts. j Dcv &liav Pcdiatr 1986 Feb;7( 1):43-48. 3B Zuckerman DM, Zuckerman BS. Tclevision's impact diarrics 1985 Fcb;75(2):233-240.

OI)

childrcn. Pe-

Hickcy N. "Is TV Violcnc.c Bal'lcring Dur Kids?" TV Gllirk August 1992.

\9

'o ROlhel)berg MB.

E/fecr of rclcvision violence on childrcn and yomh.

JAMA 1975 Dec 8:234( 1o): 1043·1 046. <1 Cenlcrwall BS. 'lelevision and violence. Thc scale of Ihe problem and where ro go from here. JAMA 1992 JlIJl 10;267(22):3059-3063. 42

Carn(:gie Corpomion. Report, 1992.

43 Zuekerman DM, Zuckerman BS. lcJcvision's imJXlcr on chjldren. Pe-

diatries 1985 feb;75(2):233-240. « Peterson JL, Moare KA. Furstcnberg FF Jr. lelevision viewing and c.vly initialion ofsexual inrercollrsc: is lhere a link? j HOlJlosex 1991:21 (I -2):93118. Heller MS. Poisky S. Swdil'J in Violma and 7eIl'lIisioll. New York, NY: American Broadeasling Company 1976.

'S

Cenlerwal1 BS. Tdevision ami violena. Thc scalc of lhe problem and where 10 go from bere. JAMA 1992 JlIn 10:267(22):3059-3063.

•6

Cenlerwall BS. Television and violence. The scale of lhe problem and \Vhere ro go rrom here. JAMA 1992 Jun 10:267(22):3059-3063.

.j]

.B Rubinslein EA. Tclevision and Behavior: Rescarch condllsion of lhe 1982 NIMH Report and lheir policy implicatiolls. Amcricitl/ Psye!JologiJt, Jul)' 1983 p. 820-825.

<9 Krisloll. Sex, Violcllce. and Videola!'e. Tbe \'VIdISII>'l'ljourllJdTuesday. May 31, 1994.

,0

Wbt:der JL. Remore C01llro/ltd: HOIIJ 7V Affiru YOII rl1ld Your Frwtily. Hagerslown, MD: Review and Herald Publishillg Association, p. 66.

,1 Drrroit NnllS.

Feb 16, 1997.

I1Whil<: EG. Sigl1J ofrli" Tim"s. Mlmpil. ID: Pacijic Pms Publisbillg AJfOcil1tion, May 8, 1884. 53While EG. Signs oftlil' ]imrs. MUl1pa. ID: Ptreific!'reu PliblislJingAssocil1sion. May 8, 1884.

Rees CR. Howell FM, Mir;leie AW Jr. Do High 5chool sports build characler? A quasi-experimenr on a nalional samplc. Social ScimaJOllrllal 1990;27(3):303-315. $Il:vellson CL. SocialiZ:llion e(feets of participatioll in sport: a cririca1 re\·iew. Researeh Quarterly for Exercise and Sprir 46(1975):287-301.

Begg DJ, Langley JD, el al. Sport and delillquency: an examinalion of rhe dcrerrcnec h}'pothcsis in a longiludinal lUdy. Br J Spom Med 1996 Oec;30(4):335-341.

Miraele AW Jr, Rees R. Evidenceof Ihe MYlh. In: Lmomoltlu Locker Room: Tiu mJlh ofscbool sporrs. 1994. Ambcrsr, NY: l'romerheus Books. p. 88.

60

61 KJeibcr DA, Roberts Gc. The EffeclS of polt Experience in rhe Dcvcl· opmcnl ofSo jaJ Characrer: An exploralory invcsligation. jOlmllllofSp0r1 l'syel}ology 1981 ;3: 114-122. Todd Crossel. Univcrsiry of Massachrs (and coauthors ar Northea lern University .) quoled in \'V'arner R. AllItlysis: Football's lIiolma can

61

spi/l i11l0 priVflIt /ivrs, 1994. 6.'

Dmoil News

OC[

24, 1995 p. I IA, 13A.

64 Sportmllm: Gumlnik DB, editor. \flruslers New Word Dietio11dry-2'"' Collegr erlition. lew York. NY: Simon ano Sehumr. 1984 p. 1377.

(os Srewnson. eL. College Alhletics and Characlet: Thc Oedinc and FaJl of S()ciaJi~3tion Rc.~earch. In: Chu O, Segravc JO, Becker BJ. Sport imd Higher Edllcntion. Champaign. IL. Human Kjnelics, 1986 1'.254-255. Silva JM. The pcrceived legilimacy of rule violat ing bebavior in sports. Tlu JOIlrIlIll o/Sport Psyehology 1983;5:438-466.

G6

r,7 Detroit NnllJ, OClOber. 24, 1995. (.ţ Mirade AW Jr, Rccs CR. Evioence of Ihe MYlh. In:

Less01/J oftbe Lock" Room: Tbc mJth oj.fcbool ;poru. Amhersl, NY: Promelbeus Books. 1994 p.

223. 69

Quoltd in Detroit Nl'lVs. Oct. 24, 1995.

ro Mimde AW Jr, Rees CR. Ll'lJ011J ofrlu Loeker Room: TI)/' mytb Ofs{l1ool spom. Arnhersl. NY: Ptomctheus Books. 1994. Miracle AW Jr. Rees CR. Evidence of rhe MY1h. In: LI'SJo1lSofthe Locker Room: TIu mytb ofscl1ool spom. Amhersl, NY: Prometheu5 Books. 1994 p.

il

94-95. \'Vl1ile EG. ErllICfllio1l. Nampa, 10: Pacilic Prcss Publishing Associarion, 1952 p. 210.

72

While EG. Educ{uion. N:unpa, ID: Pacific Press PubLishing Association, 1952, 1'.210-211.

73

'.\ While EG. EduClItion. Nampa, 1D: Pacific Press Publishing Association, 1952 p. 210. \X/hile EG. MOlhers Helper's. In: Ad'femist Home. Hagersrown, MD: Revic\V and Herald Publishing Associarion. 1952 p. 284.

7\

76 Proverbs 16: 18. TI}e Ho~y Bible. AUlhorized KingJames version. 77

PhiU;pians 2:3. TI1" Ho(y Bib/c. AUlhorized KjngJal1lcs vcrsion.

78

Banlert,B. NationaJ CelHer For Policy Analysis. QUOlcd in Detroit

Nnvs, OCI 23, 1995.

}} 2 Peler 3:4. T!J" Holy Biblr. AUlhorized Killg James version.

BaJaban DJ. Epidcmiologyand Prevenrion of Sdccred Chronjc 11Inesse. In: Cassens BJ, editor. Pr,.vmrive M,.dici",. anrl Public Hl'altlJ--2"" et!ition. Philadelphia, PA: Harwal Publishing, 1992 p. 147-149.

S6 Rees CR, Howell FM. Miradc AW Jr. Do High school SPOTI build character? A quasi-c'xperimenl OI) a ualional sample. Social Scil'l1aJolimal 1990;27(3):303-315.

am ind"burlto lor! Whr,,/er fOr br/p in eompiling this and thefollotving Wheeler JL Which DireClion 10 go? In: Remot" Colllrolkd: HOIIJ TV Affim }Di arid }Dur Family. Hagerstown, MO: Reviewand Herald Pub-

\4

2 Corinrhi2llS 3: 18. TIu Holy Biblr. Authorized King James ve(sion.

79

80 /

li11L.

lishing Associalion, 1'.13.3-151.

324

CHAPTER FOURTEEN

STRESS WITHOUT

"B

IST

uroed out." "Overloaded." "Exhausted." "Overwhe1med." Many of the words we use ro describe life's rensious reflect the impact of stress an aur lives. lndeed, in aur rime-pressmed sociery, few escape withour feeling-at least sOlne of ehe eime-rhar ehey are batding with srress. Thousands of books and anicles have been wrinen an the subjece of stress. Each, no doubt. has imparred some ideas on how co address stressrelared problems. However, 1 find that mase people are sorely in need of soroe very simple, basic understandings aboue stress and how ro begin to master it. ConseL\uemly, my desire in chis is noe to deal with srress în a compleee and exhaustive way. My gaal is rather to provide a way of underseanding the srrcs-s process and ro share soroe key ideas for deaJjng wirh seress in your Jife. The imenr is nor ro give alJ rhe Jaresr breaking insighrs an how srress can affect aur healrh-new repons seem ro come out daily. Few need ro be convinced ehat suess can undermine meir heahh. The great cry 1hear is, "Yes, I know srress is affecring me, but whar can I do abour it?" This chaprer is designed ta provide praceical answers ro rhar queseion. When you have grasped rhe coneepts here, you should be able [O deal wirh seress in a new and consrrucrive way.

SS Seress affccrs us in cvery aspect of our being, and the more hea1rhful aur lifesryle, rhe bener we are able ro manage seress. Implement.ing the complete lifesryle advocared in rhis book wilJ go far in enabling you [O mascer the srresses in your life. Before presenring ehe mcasures we can take ro manage srress, we wiII fine describe what srress is and what it is nor, and then examine how it affects us physically, mentaUy, socia1Jy, and spirirually. We will aJso look ar diseases and omer ailmenrs ehar can be triggered by stress. Ar this poinr we wilJ be ready to deal wieh ways ro maseer rhe srress in Dur lives.

Differentiating between «Stress" and «Stressor" In dealing with stress, most of us already have ewo serikes againsr us. The very language we rypically use ro describe srress decreases our abiliry ro deal with ir most effeceiveJy. Most people define seress by what confronrs them-by the problems and concerns thar thel' have ro deal with. Such al1 understanding makes us victims of whaecver is going 011 around us. However, a huge bodl' of research indic.1ees mat it is noe what we have ca deaJ with bur ratber haw we deal wirh it ehar diceaees ehe severity of seress in

325

PROOF POSITIVE our lives. Simply pur, ro begin ro understand the mosr hllldamcnta! aspecrs ofstress, we must unelersrand a critical disrincrion: rhe difference between "srressors" anei "srress," as iUusrrared in Figure 1.1

STRESSORS AND STRESS

Stress is your response to stressors

Good and Bad Stressors

Figure 1

EXAMPLES OF STRESSORS Heat

Pollution

The flrst srressor on the list is rhe weltrecognized environmemal air pollurioll. Let us as. ume rhar you mave from the country Înto a heavily pollureel foreign ciry. AJmosr immediately you may begin coughlng as a specific physical response ro rhe ph)'sical strcssor of air pollution. We see rhat srressors carne ar us an aII aspects of our being. In addirion ro p/~ysical srressors, rhere are mental stressors. These may confronr us in rhe form of deadJines or finances. The sociaL environmenr presents irs share of srressorSj rhe)' ma)' occur in rhe home, ar school, an (he jab, or in rhe neighborhood. There are 31so spiritual stressors. These arise especially when aur externa! circumstances ar internal clecisions conflict wirh our goals, values, ar religious beliefs.

Deadlines Overload Death

A popular misraken notion is ,hat srressors are ali bacl. Some may be good in rhemselves, bur may evoke a bacl response. For example, 1 once heard a true story of a woman who died when she was being handed rhe gralld prize check from a lucrarive lotrery. Her anitude was emirely posirive, but rhe stress response was fatal. Odler more common happy evenrs can be significam Stressors. Family relarionships, although they may be healu1Y anei pleasant, can have periods of stress. Consider a family wedding. The prepararions leading up ro the wecldjng day provide imense stressors for ali rhase imimately involveel. Incleed, the wedding experience is an example of a joyful occasion dut is also srressful. Anorher example is rhe srress associated with bringing a new child imo rhe falluly.

Benefits ofStress Finances

Ulness

Figure 2

326

"Stressors" refer tO olitside jOrces, which are rhe problems anci concerns rhar we must deal wirh in life. The rerm "srress" refers ro rhe response of rhc individual ro rhese srressors. Some examples ofsrressors are depicred in Figure 2.

Some stress responses ma)' be beneficia!. AJulOugh mosr think ofsrress as somerhing negarive, Dr. Selye recognizeel borh a good anei a baei rype of srress. Selye deflned ('disrress" as the stress rhat was damaging or llnpleasanr, 2 while rhe srress rhar resulted in pleasurable ar satisfYing experiences he called "eusr.ress."3 Or. Phillip Rice !las poinred OUt thar eusrress can improve our sense of awareness, promote aJertness, anei can ultimarely resulr in superior perfor-

STRESS WTTH OUT DISTRESS rnance. His examples are the scresses of sports compedtion, a rhearrical performance, or a wedding ceremony.4 This relatjonship was fim published in 1908 by R. M. Yerkes and J. D. Dodson. 5 The YerkesDodson law or curve described a relarionship berween srress and performance. An adapearion of rheir curve is illustrated in Figure 3. The Yerkes-Dodson graph compares work pressure and job performance. In place of "work pressure" we could juSt as easily Subs'ÎlUre the term "stressor." Regardless of what cerms you use, work pressure can affect job performance in a negative Of posirive way. 0,0 the far-left side of the graph where work pressure is low, job performance is aJso low. The individual is not sufficiendy chaJlenged tO be very productive. Moving lOward the righr, as rhe work pressure and chaJlenge increase, job performance increases-finally ro its maximum amounr. This is labeled "optimum work pressure." Once a pe::rson reaches rhis optimal level of performance, adding more pressure will cause job performance (O dereriorate. Ultimare1y, r!le very hjgh pressure/high srress environmenr resulrs in extremely poor performance. lf maximal ourpUl is rhe goal, neirher over-pressure nor under-pressure is optimal. These observarions illusrrate ehat, contrary ro popular opinion, stress and srressors are essenrial ingrediems in our ]ives. In fact, rhey are necessary components of an efficient, useful, producrive, and sarisfying life. These insights provide an explanarion for individuals who seem to rhrive in rhe face of many externa] pressures. Not onJy are rhey producrive and positive; rhey are also free of disease and have healrhy interpersonal relationships. In realiry. each of us has our own YerkesDodson curve. Some need a large amounr of work pressure, challenge, or stress ro achieve cheir optimal level of performance. This sarne level of stress would ovelWhelm others. Nonetheless, [he principle is the same for alI. Wc each do our best wirh a certain level ofseress. Too Jiule ar too much stress is coumerproducrive. A certain level of srress is also necessary

WORK PRESSURE AND JOD PERFORMANCE Optimum work pressure Inadcquate work load

Added work pressure

Work underload

..- Work overload

Low • •

Work pressure

High

Weak performance Acceptable perlormallce Peak performance Figure 3

in aur social relarionships and orher aspects of our lives. We would nor want ro evade rhe pressures and stresses of life. They provide morivarioll and help us ro accomplish more rhan we would orherwise. We allneed ro havc a compelling reason ro ger up in rhe morning. If our coping mechanisms are intacr, we will often be able lO rolerare and even rhrive on more pressure and become more efficienr and producrive. One purpose of chis chaprer is ro offer more powerful coping mechallisms. This may al.low readers tO rolerare more srressors, such rhar the increase wiU work for them instead ofagainst rhem. As Rice put ir, "The aim of stress managemenr is IlOt ro eliminare srress entirely, bur ro control ir 50 thar an oprimallevel of arousa.l is presenr."6

List YtJUr Top Ten Stressors Many people raday suffer from rhe impacr of srress in their lives and need he1p in coping wirh jr. Ooe way rh:u 1 have rried ro help is by conducting stress management seminars. My rypical formar is ro meet with the group one night per week for eighr weeks. In rhe firsr meeting, 1 ask ali the artendees to lisr their tap ten s[ressors. The reason for rhis is simple. The very fim srep in learning ro cope wirh srress is tO recognize rhe sÎgnificam stressors in one's life. The awareness tlur the stressor and the srress

327

PROOF POSITIVE response are nor idenrica! is cririca! ro objectively examining life's streSSors. Thosc wirh a faralisric arrirudc rhar porenr srressors are unconguerable are more prone ro deny the prescnce of rhe very srressors rhar rhey need ro idenrify and address. for example, if I rhink misrrearmenr \ViII likely make mI" ill, rhen I am more Likely ro deny ehar mistrearment exists, rarher rhan ro accept ir and rry ro deal wirh it. On t11e orher hand, jf I recognize rllar my response ro stressors is Iargely a personal choice, rhen 1 will be free ro acknowledge the stressor and address it in a constructive way. Many people have nor made a ddiberare evaluation of rhe primary stressorsin rheir lives. IdentifYing the ten leading srressors opens the wa)' for planning a process ta cope wid1 chem. 1 would encourage each reader ta wrire down his or her most signiftcanr srressors. The challenge in doing this exercise is ro

physical challenges Jike remperamrc C:ln bc srressfuJ in rhe form of excessive heat or cold. l Il rhis case, recognizi ng rhar you are living in a c1imarc rhat is a ignificant stressor for you may be rhe ftrsr srep in cbanging ro a different line of work, ar making differeJll living arrangemcnrs if you rema.În in dlar c1imate. ro also include rhose 'good strcs ors." Finances, whether in povef(y ar in wealrh, c.ln bc srressors. Individuals oflimired means often lisr ftnances as significant srressors. However, insighrful wcalth)' people may recognize ehar fUlances are even gre.arer stressors for rhem. They may feei great pressures in detcrmining whar ro do \Vith rheir money, how (O invesr ir, aneI ho\\' ro keep from squandering it. Others becolllc plagued by a consranr fear of remrning ro their former condition of poverry. We will refer ro your lisr of ren srre.sses in rhe nexr secrion.

Three Progressive Respon.ses to Stressors

REACTIONS TO STRESSORS Phase 1

Alal'm reaction

Phase 2

State of resistance

Phase 3

Stage of exhaustion

Figure 4

328

apply what we have seen up ro uus poinr; namely, srressors are not merely rhe mental trials that lead us ro feei "srressed out.·' They include physicii illness and social relarionships. Dearh of a close family member is known ta be one of rhe grearesr srressors on rhe average individual and can have longterm implicarions. Even relarively mundane

_ _ _ _ _IIIIIIIIIIIi

Our response ro each of rbese srressor is in parc a genera! response thar occurs as a rea tion ro ali rypes of rressors. This is what fhe srrcss pioneer, Dr. Hans Selye refecred ro as the "General Adaprarion Syndrome." He popularized a view of whar happens to a person when exposed ro a suessor. AIthough mall)' stress rheorisrs have gone far beyond Selye's insighrs, bis observarions provide a good overview of rhe srress process. According ro Sell'e's observarions, an individual's reacrion ro a new srressor is predicrable and progrcssive, moving rhrough rhree srages. as illllsrrared in Figure 4. 8 As we explore rhesc reacrions, ask yourself it" you can see any of rhem transpiring in your life. Particularly observe an}' associarion berween rhe tressors on your list and rhese phases. Following rhar broader description of rhe stress process, l'ou should be able ro determine how import;lllr it is for l'ou ro masrer rhe srressors in )four life. The fim phase is an alarm reaerion. This is the body's "caII ro arms" and is somerimes ciiled the acute or immediare srress response. Phl'sic.ll symptoms tend ro predominare in rhis rarher short-lived phase. If rhe stressor cominues and rhe individual

\J

STRESS WTTHOUT DISTRESS is "bie ro cope wirh it, Phase Il resulrs. In rhis phase. the person is resisring rhe srresSOL The acure body [unction ehanges of Phase Iare mosdy resolved ar this poinr, and rhe person often appears ro be coping weB. Those who are able ro cope with the srressor ma)' remain in this sr.age in a heaJthy state of resisrance. Orherwise, as rhe rressor is resisred, rhere is an expense. Energy is expended as rhe person copes with rhe eOI\tinued presence of the srressor. Such a phase can last for a prolonged period of rime; as this stage progresses, coping ma)' become more difficuit, anel menral and social efTects of stress may surfaee. New physieal responses may al50 arise. If rhe srressor COI1rinues ro be present, it ma)' ultimately push the person into Phase III, exhausrion. Onee in rhis phase, if the suessor persists, disease or even dearh ma)' be inevirable.

Body Responses to a Sudden Stressor Upon sudden exposure ro a srressor, rhe body auromaricall)' reaers to eause many sillluiraneous ph)'sieal effeets during Phasc 1. Thesc efTect5 are designed to help in dealing widl the srressor. Let us illustrate how these effecrs serve such a useful purpose by imagining a siwarion where you are confronred by a stressor. Assume that you are reading chis book in your bedroom, and aJl of a sudden you norice a full-grown riger beside your bed. The feroclous animal has apparendy come our of nowhere. and now it is growling ar you, eyeing you as if you look like a good mea!. This is a far-ferched illusrrarion, bur it graphically illusrrares a stressor. lmmediately upon noricîng the riger, your body enters a stare of alarm wirh a number of physical changes predom inati ng. These changes are rhe result of far-reaehing nervous system eifects called symparheric nervous sysrem aerivation. Some of the cbanges are lisred in Figure 5. 9 These responses have often been referred ta as rhe "fight or Aighr response"-gearing you up ro eidler physîcaJly do banle wirh rhe sm:ssor or run from it. Your blood pressure rises as your hearr rate and the foree of pumping increases. These changes allow for grea(er dclivery ofblood to your museles so

that tl1ey can be active in rhe physical response of either fighring or running from rhe srressor. While blood flow increases ro the museles dlar need ro be active, (he blood supply ro orher organs decreases. Since your intestinal sysrem and kidneys ean get by for a while wirh a redueed blood supply, rhe body decreases blood flow (O those areas so rhar more blood is available for rhe acrive muscles. The pup ils dilace or open up ro rake in more Jight. The bronchial tubes also open up ro aHo\\! more air exchange in the lungs. (More o"Tgen, ofcourse, will improve physical performanee). Musele strength increases. Sugar is reblsed from rhe liver and overall merabolism is stimulared. Even mental acrivity is quickened. As helpfl.ll as chis alarm reaerion wOl.lld bc in dealing wirh a tiger, man)' srressors in OUl' lives do nor call for such ph)'sieal responses. Acrivation of Phase J may actllally be counrerproducr.ive if rhe seressor is a deadline, Ilnancial pressure, ar il home life challenge. The body is geared up for aetiviry but physical responses will nor be hclpfuI. Ahhough mental activiry is incrcased under rhe aClIle effecrs of stress, the mind ma)' actually be less foclIsed ro make an

PHYSICAL EFFECTS OF A SUDDEN STRESSOR • · · ·

Increased blood pressure Increased beart rate Increased beart contraction ~ Increased blood flow ta active muscles Decreased blood flow to areas not needed for . rapid activity such as the kidneys and intestines

· Dilated pupils · Dilated bronchial tubes · Increased muscular strengtb · Release of glucose from Iiver · Increased mental activlÎty · Increased metabolic rate Figu're 5

329

PROOF POSITIVE intelligent decision. In fact, rJle mind ofren has even greater problems when a seressor persists and coping resources begin ro diminish. [n later stages ofPhase II, you may begin ro notice some of the more worrisome mental efTecr.s ofstress. Similarly, undeI' the persistent effects ofa stressor, problems also tend ro deve10p in your social relationships. Ofren these deleterious mental and social effecrs are closely related.

MENTAL EFFECTS OF AN ONGOING STRESSOR • Mental fatigue with a loss of spontaneity and creativity • Confusion, including forgetfulness and difficulty in making decisions • Anxiety, including feelings of panic • TensioD, frustration, irritability, anger, and resentment • Depression • Lower self worth • Lower inteUectual functioning • Boredom

Mental and Social Responses to an Ongoing Stressor Dr. Phillip Rice has described the menrai and social effects ofpersistene job-related seress. 10 His observations are generally applicable ta any ongoing mental seressor. His descriptions of thc mencal and social effects ofsuch stress in adapted and modified form al'e preseneed in Figures 6 and 7. Clearly, concillued exposure ro a stressor can remit in a variery of bodl mental and social cffects. An awareness of the great variery of ways that stress C'l11 rake its toll can help LIS W be more undersranding when we 01' others clase ro liS are dealing wirh rhe ongoing effects of srress. Ali of the mental and social effects of stfess are red flags that should be inrerpreted as indicarors that Phase 3, Seage of ExJ\austion, could be imminenr. In fact, some of the more dramatic manifestations rhat 1 have poinced outsuch as depression, or loss ofcoutrol-may even indicate that Phase III has been reached. In such cases, immediace action ro deal efTectively with scre.ssors is urgenr. lf you f1nd yourse1f in such a situation, look carefully ac yom ten major scressors. YOtl need ro deal wirh rhese areas as soon as possible.

Figure 6

SOCIAL EFFECTS OF AN ONGOING STRESSOR • Procrastination, avoiding important work and home responsibilities • Lack of concern for others and a resulting deterioration in relationships • Reduced effectiveness in communication, including an inability to listen to others • Emotional hypersensitivity with a tendency to overreact to others, or feelings of isolation and alienation with a tendency toward suppression of feeliogs and even witbdrawal • Loss of control, quick temper,aggression • Increased risk-taking behavior mcluding gambling • Increased drug use aud abuse Figura 7

330

Spiritual Responses to an Ongoing Stressor The likelihood of successfully dealing witll ongoing stressors Cal\ be signiftcantly enhanced by a strong spiritual basis in one's life. Unfoftunarely, persistent stress can .also erode our spiritual moorings. Indeed, not oltly does scress affecr our physical, mental, and social nalures; stress can a1so affect the spiritual djmension of our charac[er. It is interesting ro note mat some people seem "inoculated" from spirirual disn:ess because of the be1ief system they espouse. Since I am a Christian, most of my experience with strong spiritual beliefsys[ems comes from a Christian perspective. 1 have noriced [hat [here are some individuals who never seem distressed no matter what confroms rhem. In general, they have imernalized biblical princÎples such as, "we know that aII things

STRESS WITHOUT DISTRESS work rogerher for good ro chem dur love God, ro [hem who are rhe called according tO His purpose." (Romans 8:28). Even when chings rhar look bad happen ro such individuals, chey believe mat some good wiJl ultimately resulr. On the orher h,Uld, rhere are peopleincluding Christians-who have incernalized ocher spiritual principles that are neirher helpful nor biblica!. One of rhese principles is the so-called "prosperiry docrrine." This teaches rhar ifa person is good enough (or has enough f..irh), rhen he or she will have bendlrs such as financial prosperiry and healing from any physical disease. It is obviolls how desrrucrive (Jogoing srress can be ro such a spirirual beliefsysrem. When a spiritual sysrem can nor incegrace difficulry and adversiry imo a positive life outlook, chen chranic srress can produce some distressing spiritual effeces. Some examples are listed in Figure 8. Those who believe thac God will always prevem adversiry may have difficulries ehat can cause them ro qllesrÎon their values and faiili. lf rheir religion was rlle main influence in giving meaning :lnd purpose ro their life, rhen such questioning usually leads co a loss of chese critical emotional bulwarks. Their faÎth may be blamed ar abandoned in rhe face of che very difficulries rhar it was supposed ta prevent. Solurions ilien must be looked for beyond dle Spil'irual framework that rhey had once embraced. Ironically, rhis may be a very healrhy-aliliough disrressing-process. It is often rhe case thar significant spiritual dismss indicares a faulry betief syscem and a need ro re-evaluate ilie assumprions of spirirual convictions. Throllgh such a process, many have carne our of difflcllities with a stronger anei more endllring faith. Ooe of rhe c1assic examples of this is found in rhe 73rd chapter ofPsaJms. There ilie psalmist describes how he h;ld cspoused rhe doctrine of prosperiry and experienced severe srress as he wenc rhrollgb difficulry while "wicked" people prospered. He describes his severe spiritual dîstress in these rerms: " ali che day long have 1 becn plaglled ~ and "... ir was tOo painful for me." However, his questioning causes him

ro re-examine his fairh. As he reflecrs on God's revelarion in "rhe sancUlary," he appreciares a new dimension to God's characreI' and faid). He wrires, "Unei! 1 wene inco the sanctuary of God; chen understood 1 theu end." He rhen lIndersrands how a JUSt God can a1low the wicked tO prosper il) rhis life and someone like him wirh faidl ro srrugglc. His burden is lifted and he ends rile Psalm on a note of praise.

SPIRITUAL EFFECTS OF AN ONGOING STRESSOR • Questioning your values aud faith • Losing the meaning aud purpose of life • Blaming God for problems • Abandoning faith • Trying Ito tind solutions apart from God aud religion Figura 8

1 nnd rhis Psalm very inreresring because it depicrs someone who, becallse of s(ress, qllesrioned his faith in God bur did nor give it up. The individual only leii: ilie erroneous porrions of his beliefs. It is a tragedy rhac many individuals (especially, but not exclusively, younger individllals) have misunders{,mdings about God and rhe teachings of the Bible. When ehey have problems, rhe)' rejecc (heir Elirh rather rhan follow t\le Psalmist's example. lf rhey would re-explore cheir [-uth in lighr ofGod's reveJarion in rhe Bible, which may prompt a deparrure from cheir former understanding of God, iliey may find answers ro life's deepest problems. Spiritual discouragemcnr reslliting from ongoing srress demonsrrares dlat a person is nor coping well on a spiritual level. This is an indication of a need for a higher power rhar can ilHegrate adversiry inro a healrhy ourlook on spirituallifC.

331

PROOF POSITlVE

Physiological Damage/rom an Ongoing Stressor We have aIready examined the physical effecrs of sudden scress. Regarding an ongoing srressor (har produces serious ongoing stress, che social, memal, and spiritual effects are often ilie mosc visible. Physical effecrs of che srress may be occurring invisibly, under the surface, only ro explode in an acute illness or a dramaric life-rhreacening evenr. Some of chase chronÎc effects are relared ro a weakening of the immune sys-

STRESS-RELATED ILLNESSES Stress affects the onset, treatment or recovery from , . , ' the following diseases and conditions. 1 ~ajor

iIInesses

Other ai"~,ents

• Cardiovascular diseases • Muscle - rclated conditions (e.g. coronary artery disease, and Uroke)

• Cancer . • DepreSSlOn • Angina pectoris • Diabetes mellitus • Tuberculosis • Rheumatoid arthritis • Hypertension • Ulcers • AIDS

(e.g., (ension beadacbes, oral condllions, body aches and pain.)

• Allergies (e.g., a,thOl., bin's, bay fever) • Common colds • Premenstrual tension svndrome • Warts . • Skin rashes • Loss of hair • Graving of hair, dandruff G "t • ou • Herpes

Figure 9

rem; others may reiare ro an acceleracion of arherosc1erosis (hardeniug of the arreries). There are many indicacions rhac chronic scress cal1 be a ca/ISI! of disease, a factor in intl!nsifYingan exisril1g djsease, Of an impediment ta the Tecavery from disease. There is no scientific measuremem, however, such as a blood resc, thar can or measure a person's level of srress. AII Stfess level indicarors are subjective. A$ a resuJc, one can never be cercain in any specific case rhar a disease was caused by suess or rhac srress was even a factor in che callsacioll or lack of recovery from a disease. However, I have seen cercain cases in which there were definice indicacions poincing ro stress as che cause of a disease. 1 have seen other cases in which srress appeared ro be one of severa!

332

causes, and still orhers in which suess appeared tO hinder recovery from a disease. On the ocher hand, 1have seen patiems wid, ca.rdiovascuJar disease, for example, in which srress did nor seem tO be involved. A c.lassic example is rhe happy-go-Iucky person who from aiI appearances leads a low scress life, yer smokes, fails ro exercise, and ears unhealrhfully. A hearc arrack may oeeur for obvious reasons, wirh no apparenr involvemem of srress. Many rimes after a hearr attack is diagIlosed, (he pariem asks, "Could srress cause this?" 1 respond dur stress can conrribure ro hearr arracks. 1 aJso poinr ouc chac even when stress is a faecor ic usually does nor act alone. Typically, there are orher underIying factors such as parciaJly blocked arreries, an unhealchfuJ diec, and perhaps high blood pressure and/or h igh cholesrerol. Unconrrolled anger or soroe orher reacrioll caused by scre. s eould have rriggered (he hearrarraek. But such an emorional response wouJd not likely have caused a hearr arrack if che hearr's arceries had been free of cholesrerol blockages. Many illnesses are known ca be affecrcd by suess. The major ones are lisred in Figure 9 in the left hand eolumn. 11 1 have seen many cases of heaT( disease and cancer in individuaIs who were deaIing wich major life srresses. Afrer che deam of a loved one, me surviving spouse has been found to have a grearer risk of a heaT( actack, especially within six monchs of che 105s. 12 Similarly, in rhe comexc of bereavemenc, the remaining loved one may develop a fatal canccr-presumably because stress weakened his or her immune sysrem. The mose exrensive research smdy thar 1 have found on rhis subjecr observed over 1.5 million married Finnish persons for five years. 13 The researchers conc.luded: "The resuhs are consisrenc wirh rhe hypochesis mar excess mortaliry afrer che death of a spouse is partly caused by scress." Diaberes ca.n be more difficulr ca control in patienrs under stress. 14 Infeccious diseases such as ruberculosis are more likely ro spread and dominare rhe body if me immune sysrem is weak; such weakened immuniry can occur if che pariem is unable ro cope with srress. 15

STRESS WITHOUT DISTRESS Ailmenrs other than major illnesses are also stress-related. These are listed in the right hand column ofFigure 9. You do nOt have ta be llnder an excessive amount of stress [O develop any of these ailmenrs. Howeve.r, stress seems sufficient ta increase rhe risk of these conditions or ac least hasten their presentation in mose genetically or environmeneally predisposed.

Depression/rom an Ongoing Stressor One of my particular concerns is the

great increase in the number oftkpmsion cases rhae 1 have been seeing in my oftIce practice. O[her physicians are reporring similar increases. 16 Somc facts about deprcssion are listed in Figllre 10. Fi rst episodes of major depression his~ torically occurred ac middle age. We are now frequendy seeing mose initial episodes at age 25 or younger. Furrhermore, ehose who are currendy ac middle age have a greater risk ofsuffering a major depression now [han in previous generations. What are [he reasons for these increases? Some have suggested [hat there is more to be depressed about in our sociery. Others have asserted that fewer people today have deve10ped adequate copillg mechanisms for suc.ss. Thus far, we have examined some ofthe widespread physical, mental, social, and spiritual effeccs ofstress. AJI of this begs ehe question-what can we do about it? How can we bring suess under conrrol? The remainder of ehe chapter presenrs some key, yet oh:en overlooked, stress conrrol concepes ehat can revolurionize your dealing with life's srressors.

Eight Keys to Successful Stress Management There are many techniques mat can be helpful in dealing with srress. However. 1 have idemined eigbe key stress con eroi or seress managemem measures duc I believe are underurilized, but are of profollnd irnportance in helping us deal with srressors. Review ilie list of ren leading stressors ehac I encouraged you eo wriee earlier. With these srressors in mind, look ac ebe control measures pre-semed below. Sec if you can iden-

rif)r ways ro use these me-.lSures ro address your mose significam stressors.

Healthy Adaptation The first key suess control measure is what r caH "healthy adapr
DEPRESSION IS INCREASING 1. The number of people developing depr·ession worldwide hacs steadily increased sinee 1915. 2. The disease appears to be striking at an earlier age. 3. Major episodes of depression nQW occur frequently by age 25. 4. OveraU risk of depression bas increased over time. Figure 10 ta turn up the heat. A rhird option is ro get

up and shut r.he window. A founh might be co flrst close the window, and rhen get dressed and prepare for the day's workpareicularly if you are wide awake and feel refreshed. If you choose the final option, rhe stressor may acrually have been turned inta an advamage.lfyou really had adequate sleep, the srressor worked for you instead of againsr you. You got tip earlier and accomplished more than you would have orherwise. Ultimate1y, ehat 4:00 A.M. rising rime probably helped you ro relieve stress. It he1ped you ro ward off orher potential stressors: maybe you paid some bills, c1eaned ehe kitchen. or finished up a projecr you broughr home from work. Although we eould debate the merits of each of ehe four different options for dealing with the cold room. aU of chem were accually examples of

333

PROOF POSITIVE heaLthy adaptation. In each of those sce-

334

narios, l'ou addressed the srressOf and wem an with your life. What would rhen be an jl\usrration of an unheaLthy response? One example would be tO arrempt ro ignore the stresSor, continue lying in bed, and try ro go back ta sleep. This approach may leave you shivering-and frustrared that you cannor sleep. The message is that ignoring a srressor is rarelya healthy response. However, when a seemingly overwhelming srressor confrollts liS (particularly on either ilie social, mental, Of spiritual level) sometimes the best option that is apparent is ro ignore the stressar. We may be so stressed that we do nor see construcrive oprions. Ignoring the presence of the stressor may allow us ta transi~ tion from the stage of "alarm" ro thar of"resistance" where we can then look more consrrucrive1y ar ways ta adapt. There are mher unhe.1lrhy ways ro deal wirh srressors. Another example in our cald room scenario would be escapism. An application of this technique may fiud you shivering at 4.00 a.m. as yau call yotlt 24hour national rravel agency and reserve a place on the nexr plane ro Hawaii. While you are on the beach in Hawaii, it may seem that the stressor worked ro your advanrage. YOl) have escaped the cald weather and are enjoying Hawaii. However, when you return home ro find the window still wide open, snow in your bedroom. and the bathroom pipes frozen, yau realize you should have addressed c.be stressor by c10sing the window before you leh:. Besides rhat, when you are fired from your job for an unapproved absence and then get the credit card biU from the trip, rhere will be more stress. Escapism is not an optimal way ro respond ta a srressor; it can sometimes email somc hllge COSts. However, it may be the only strategy someone identifies ro "buy time" in the face of an overwhelming stressor. Many see escapism as an extension of ignoril1g rhe stressor. Whel\ you mentally ignore a stressor, the implication is that you are remail1ing in rhe environment where the seressor is confroming you withollt addressing it. The stressor cominues ro work an yOUf physiology no matter how successful

you rhink yau are in ignoring it. When you physicaUy escape from a srressor's sphere of inf1uence, yom body can get some respite. The trip ta Hawaii il1usmHed this. Yer, if rhe escape was impulsive, rhere may be heavy prices ro pay. Most of the time, howcver, escapism occurs on a mental leveland is, indeed, an extension ofignoring ehe srressor. The person remains in rhe presence of the stressor, but tmns ro a mind-alrering escape to help forget about its presence. Such an escape can be as diverse as warching relevision ar raking a mixed drink. This rype of escapism is worse than a futile artempr ro ignore rhe srressor. Since you are stiU in the scressor's domain, your body conrinues through rhe phases of rhe General Adaptation Syndrome with progressively weakened coping reserves. Ar rhe same time, your reserves are usually furrher sapped by the agent used ta effecr rhe escape. For example, alcohol impairs rhe brain's frontal labe where decision making and construcrive solurioIlS are based. On rhe other hand, viewing television, even in ies highest form, cakes time away from activities such as exercise that could help enhance your coping reserves ar defuse srress.

A Healthy Lifestyle The second key mechanism for coping with srress is a healthy lifesryle. The more efficienrly yOllr body fUllcrions, the better you will be able ta have rhe coping resources ehar you need. Expressed another way, a healthy body aod mind give you the upper hand in coping wirh the srresses that you face. Even ifyou are exposed ta srressors (hat you have not yer removed ar adapted ro, better healrh will heIp ro shield you for a longer period of time from some of rhe healrh-robbing effects of mess. One critica! element ofa healthy lifesryle is proper nutrition. The consistenr dietary plan that I describe throughour rhis book is a general health-inducing program. The same basic guidelines that help prevem hearr disease and cancer also help to boost energy levels (see Chapter 9 on melaronin), improve menral dariry (see Chapter 12 an the fronral lobe), aJld thus enhance one's abilit)' to deal with life's stressors. Ideal with

STRESS WITHOUT DISTRESS this in many ways througholit this book; detailed repetition here is unnecessary. Suffice it to say mat eating foods exclusively from plant sources provides oprimal nurririon (O help one cope mosr effectively with Stress. Also beware of "refined foods"--even if rhey are from planr sources. For example, choosing refmed grains inscead of whole grains (such as white flour in place of whole wheat flour), deprives yourself of the oprimal mix ofvitamins and minerals found in the natural planr produce. Anorher key component of a healrhful lifestyle is regular exercise. The medicallircrarure documenrs rhac regular physical exerc.ise is very beneficial in menral healrh and srress control. l ? Regular moderate exercise also appears ro help the immune syscem, cJms conceivably helping ta ofTsee srress-related immune suppression. 18. 19.20 When my paeients are under excessive stress, 1 instrucr them co adopc a regular aerobic exercise program. A daily brisk walk in the fresh air for 45 minuces, or a cun, or a swim, or bicyding proves ca be very helpful. Within one week's time chey are lIsllally coping much bener wirh their stress. In face, many of my parienrs have mld me that daily exercise is one of [he most helpful seress-relieving recommendarÎons that 1have ever givcn rhem. Beyond nucrition and exercise, chere is mllch more rhat could be said abolit a healthy lifestyle. It is one of the principle theme.s of rhis emire book. I would refer you particularly co r!le mapters on ilie frontallobe (Chaprer 12) and melatonin (Chaprer 9) for ocher aspects of lifestyle that deal with enhancing menral and physiologic functions mat are crucial to oprimal srress management. In addition, 1 will address anorher of che key lifestyle factors, adequate resc, later in this chaprer when we look ar dea!ing wirh arWety and worry.

Commitment to a Cause That Helps Others and is Approved by God The third key measure for conrrolling srress is commirmenr co an honorable cause thac he1ps others and is approved by God. The Bible provides some exceUel\t examples along rhese lines. One of my favorires is

found in Isaiah chapcer 58. This entire mapter is one of rhe Bible's mose sublime prescriptions for health. Ooe age describes ehe posirive rcsults experienced by those who help others, as quoted in Figure Il.

SPEEDY RECOVERY "Is not this the fast !bat-J--.,-ave-cho~? to loose the bands of wicke(lness~'o undo the -heavy burdens, and let thti~pressed go fr~~d that ye break every 10~~? Is it not to ~eal ~ttiy bread to thi hungry, ~d tbat thou brmg the poor thatjre cast o~t'to thy bouse? when t u seest the,Daked, th~t thou cover him; and t at thou hide not thys,lf from tbine own fleţh' Then shaU t;t{y light brţakl;forth as the mornin ,and thin/health shall springforth speedi y: and thy f-igllteo l l slU\SS shall go before thee;}be glory of the Lord shan-beYflty-ure~

10

Isaiah 58:6-8 Figure 11

Isaiah states thac our OWI1 healrh will be improved by helping others, sLlch as sharing our food wieh tile hungry Jnd providing dorhing for those that need it. AII this, of course, includes helping our own family as weB as strangers. Modern science indicates thar there are quantifiable healrh-giving benefits to this Bible-ordained approach. One way of looking ar rhis issue is to scudy the medicalliterature 00 the subjece of"volunteerism." In general, this rese-arch seudies people who have made a commitmenr [O help those around them by giving [heir services free of charge. In a recent srudy of retirees, those who volunreered more rhan 10 hours weekly demonsrrated a grearer sense of meaning as documented by significantly higher scores on a specific Purpose in Life tese. 21 Helping others provides a sense of meaning or purpose in life that is cricica! in dealing with cerrain seressors. In one study ofphysicians, those who had the gre-acesc sense of purpose in life had the least amount ofanxiery regardi ng death-the fcar

335

PROOF POSITIVE of which can be agreat stressor. 22 Panicipating in the lives of odlers on a sociaJ basis has been found ro have significam physiological benefits. For example, in one study of patiems who had recenrJy uodergone he.art surgery, higher levels of social parricipation were associaced with betcer health six months after surgery.23 This cumulative evideoce in rhe research literature dearly indicaees the srrcss-relieving benefits of engaging in causes thar are respectfui ro both Gad and man. It is well established tim tbose who go through life fulfiJling their own personaJ desires, bue noe being mindful of the needs of others, acwaJly deprive themselves of the healrh-giving benefirs of altruism. We cach actually need [O become personally involved in causes that meer God's approval and help humaniry. lsa.iah 58 provides further insighrs reiating personal healrh to performing deeds of kindness. Notice the age quoted in Figure 12. As we "saeisfy ehe affiiered souL" we experience God's special guidance and blessing. When we go through our own personal rimes of crisis, ir may look spirirually as if we are in a rime of droughr-cur ofl from ali spiritual aod emotional sustenance. How-

IMPROVING THE IMMUNE SYSTEM "Aud if thou draw out thy soul to the hungry, and satisfy the afflicted souI; then shall thy fight rise in obscurity, aud thy darkuess be as the Doonday: and the Lord shall guide thee contiuually, aud satisfy thy soul in drought, aud make fat thy bones: aud thou shalt be Jike a watered garden, and like a spring of water, whose waters faiI not." Isaiah 58:10,11 Figure 12

336

ever, even in mase situations, God promises ro satisfy our souls ifwe are helping orhers. We sec in rhis promise a profound description of a person under srress mat ultimateiy f1nds reliefas a result ofhelping othees. Parc of the hllfillmenr of that promise comes as a God-ordained consequence of assisring others in affliction. God's promise ro "make fat ehy bones" ,couJd also be rranslated as "strengrhen thy bones." The Hebrew word rendered "make fac" or "srrengrhen" is ofren used in che Bible wich strong miJitary connotations. Fot example, in Numbers 31:5 the Bible speaks of "rwelve rhousalld rmen] armed for war." The word rranslated "armed" is the very same Hebeew word chac is rranslated "made f.·u" in Isaiah 58. This woed rhen has che connoeation of equipping ca fighc. In other words, God's promise tO "make fat ehy bones" suggests mac our bones are ouctitred for banle, JUSt as a soldier is anned for war. This banle imagery is very appropriaee when we think of the role of aur body's immune syseem. Whiee blood ceIls are critic'll immune syseem ceIls ehar form in t,he internal recesses of aur bones known as the marrow. ThllS, if an individual's immune syscem has gone awry, it is noe uncommon ro extracr a sample of rhe bone marrow eo seudy the probJem. Our key immune system cells depend an a heaJthy banc marrow. In addirion, ehe red blood celIs, which carry vital oxygen ro ali pam of me body, also form in [he bone marrow. Furrhermore, the platelets, which protecr us from bleeding ro death when we are injured, are produced rhere. Our bones clearly play a vital role in protecring our heaJth. It is thus no idle promise for [he Scriptures ta pledge to serengthen our bones. In mese words is a sublime assurance of God's exua help in fonjfying us againsl stress and ilJness if we become involved in causes thar honor Him as well as our felJow humans.

Plan Properly The fourm key approach for conrrolling stress is ro take cÎme to plan properly and be organized. Many people sufTer srress-reIared problems because chey have noe

STRESS WITHOUT DISTRESS planned properly. Life becomes confusing and uncertain withour order and organi7.ation. In Luke chaprer 14 Jesus asked a reUing question thar sheds lighr on rhis ropic. His words are quoted in Figure 13. Proper planning and organizarion are required ro determine whar it wiU rake ro accomplish a task before you begin. We c.an ali r.hink of insrances in aur own lives in which rrouble-and perhaps even miseryresuhed from a lack of planning.

Do NOf Be Anxious About the Future The f1frh key approach ro conrrolling stress is to refrain Erom being anx.iolls about the future. At first. this may seem inconsistent with the previous poinr that emphasized planning and organization. However, rhe rwo ptinciples complemenr each other. Without proper planning, it is natural ro become anxious abour the future. A student who is preparing for an tesr is benefired bya cereain amounr ofsrress. This rype of ('eustress" sholild provide motivation ro srudy and prepare for the examination. However. it would be self-defearing ro be worried and anxious abour the test. Acrually, worry tcnds ro incapacitate, whereas a healthy i1rritude roward rhe srressor-seeing it as a chaJlenge-rends [Q motivate. Fearful of his lack of knowledge the student may be tempted ro say, "Wby even rry? I can never master this subject in time for rhe test." A more constructive arrirude would involve organizarion and planning wirhour worry. The student may say: "1 have rhree hOUfS yet rhis evening; let me see what 1can leam." Agai n, rhe Scriptures are ofhelp on this poinr. as quoted in Figure 14. Jesus is nor speaking against planning. This wOllJd conrradicr His previollsly quoted statement in LlIke 14 rhar lends implicit suppon ro rhe importance of planning. Jesus is saying. "Once you properly plan and carry our rhar plan. do not worry abour romonow." ln orher words, tOO1orrow will bring what jr will. However, in our iUustration of taking a tesr. it would be foolish for a student who was nor srudying ro say. "1 am ar peace. 1 wiU nor worry abour the tesr nexr week. God will help me when rhe day comes." On me ocher hand, the Stll-

PROPER PLAN G AN» ORGAN ZATION "For which of you, intending to build a tower, sitteth not down first, aud countetb the cost, whether he have sufficient to tiuish it?" Luke 14:28 Figure 13

dent who is djfjgently studying should not worry that the teacher will make rhe rest roo diftlClllt, or rhat srudying willnor help, or thar a failing grade will be rhe reslIlr. Worry and anxiery abour rhings rhat we cannor change are sdf-defeating. No one roday can address what romorrow \Viii bring. However. if r.he problem exisrs roday and needs ro be addressed roday, men we should

DO NOT BE ANXIOUS ABOUT TOMORROW

Figure 14

337

PROOF POSITIVE address it roday. This takes planning, organization, and morivarion. Before we have rhe rime or opporruniry ro address the issue, however, we should nOI worry abour it. Jesus is calling us ro do whatever work or planning rhat is necessary for roday. Ar rhe same time He is advising us ro stop agonizing over rhe fmure. Such worrying wiU always be a source of significam srress, and be counterproducrive. This dimension of freedom from worry may nor only have benefits concerning srress management, it may also have profollnd physiological bendtts regarding our body funcrions. As 1 poinr out in the chapter on rhe frontal lobe, spontaneous regression of cancer (SRC) may be Linked ro a mental arrimde that is free ofworry. In SRC a person wirh a fatal cancer survives independenr of any rreatmem. Based on the research of Yujiro lkemi, Dr. Larry Dossey bas observed: "Ohen a prayerfuI, prayer-like ani-

THINKO THESE THINGS ."FinaUy bretbren, ,vhatsoever things are true, ~hatso~Ver things are 6&n,est, whatsoever things are just, whatso~ver things are pure, rhatsoever thingi are lovely, -Whatsoever things are of good report; if therţ tie any virtue, ana if ther.e/be any praise, think 00 thjse thiQ:gs." ( / . Phili ']Jians 4:8 '--~

E

Figura 15

338

rude of devotion and acceptance-nor robust aggressive prayer for specific omcomes, includ ing eradication of the cancer-precedes the cure."24 He furrher pointed our "aII rhe paeienrs [who experîenced SRC] gave themselves torally (O the will of God after learning rhey had cancer."25 It may be connecrion wirh God duough prayer-and a willingness ro accepr even il1 healrh and adversiry that besr paves rhe way for healing.

Furrhermore, anxiety has the abiliry ro shorr circuit one of the most importam suess-relieving lifesryle choices; namely, adequate rest. Four dimensions of rest are presemed in Chapter 20, "Beyond rhe Leading Causes ofDearh." Two observarions regarding rese are applic.1.ble here. First, sleep is a needful rescoracive process thar is essentiaI ro mainrain our maximal coping resources. Second, sleep expens idemify srress and anxiery as key causes of insomnia. Dr. James Peri in his book, Sleep Righr in Five Nights, observes rhar anger-one of rhe most common human responses ro srressors-is a cause of insomnia for many people. 26 These two poinrs lay rhe foundarion for a "vicious cycle." Srress interferes wirh sleep leadillg ro more difficulry dealing wich scressors. This in turn can promore more distress and furrher worsening ofsleep difficulries. One way to break the cyde is ro address rhe anxiery or anger by bringing your concerns ro God rhrough an acrive process of medirarion and prayer. Realizing rhar you can trUSt God wirh the future may be che missing ingredient in addressing rhis dilemma. Orher cycle-breaking approaches focus on maximizing rest and sleep even in the midsr of disrress. Please refer ro rhe information in Chapcer 9 and Chaprer 20 for sleep-enhancing insighrs.

Think on Elevated Themes The sixth key defense against srress

comes from thinking an elevaring rhemes. The Holy Scriptures again provide meauingful guidanee here, as quored in Figure 15. The Scriptures here onish liS ro direct our minds tO e1evating arrribures such as rrurh, honesry, puriry, and goodness. If we wam ro masrer srress and have ir work for liS rather than against us, we need [O focus on uplifting themes. Unfoftunate1y, most of us have a tendency ta dwell on rhe negative. It is easy ro forger rhe many good rhings rhar we have enjoyed in rhe pasr and are presently experiencing. But is aur pessimistic bem withollt foundarion? Madison Avenue is successful largely because rhe)' foeus our attenrion an whar we do nor have, awaken in us a desire ro acquire rhose very

STRESS WITHOUT DISTRESS things, and make lIS disconrenr. Fanning [he flames of disconrent Jnakes for good marketing. However, we make the choice to listen to the ads on the radio and watch them on TV We c!toose to reaei newspapers ehae coneain me ads. We need to realize chat what we see and hear-even in che way of commercials-is largely under our comro!. If we wanr to deal opeimally wieh scress, we wiU do whaeever it takes to protect oursclves from ehe commercial cuhure of our day and (he spirie of discol1tene thar it arouses. We must srrive ro focus on what we do have-rather than on what we Lack. Let us nor allow the baei to overshadow (he good. but in ehe words of the old hymn, let us "coLIne aur many blessings, name chem one by one." Such an aui rude wiU help ro strengthen aur immune systems and our abiLities to cope with difficulties. Advice mac should be a hclp to alI who wanr ro opcimally manage stress is quoted in Figure 16. 27 Some families formaJly express gratirude and praise (Q God ac mealtime. This is a good start, bur a spirit ofgraeitude and praise goes beyond a few shorr prayers each day. It implies a cominuous auirude of ehankfulness for ali the good gifcs God has given us. Such a realizacion ofGod's blessings will go far in warding off diseress. A "spiric of gracitude and prajse" should be awakened in alt of us in this coumry because of rhe many blessings chac the Locel has provided. There is a sharp conrrasc berween rhe many comforrs chat che average American has in life wim ehe lack of such comforcs in mally other parrs of the world. The severiry of seressors in the life of the average American is small by comparison. In my stress conrtol seminars I give aJlocher assignmenr to the parricipants chat, ironically, at nrse ehey usually find co be srressful. The assignment is ro refrain from saying a.nyehing critical about anyone or anything for a minimum of twa weeks. Not one crieical word is aJlowed. During chose fourreen days, ifmcir children do something good, they are encouraged ro prajse them for it. If they did sometrung bad, no criticism is ro be given. In rheir work and ocher associations, ilie scipu1ations are the same. The class pareieipanrs can only say good or

nelltIal things. Criticism is srriccly forbidden. Fucchermore, if they cateh themselves saying anything critical, the rwo-week process must begin again. Fortunately, the senunar spans eighr weeks because virrllaJly everyone finds it necessary ro begin again the second da)'. Some may require a chird ar even a fouerh beginning. The first few days are very srressful. However, when the cwo weeks ate successfully hnished, no oue as yet has expressed regrec regarding (he assignmenr. In general, parricipams feei chat it was a rewardillg experience ehat helped ro chauge rheir olltlook on life and encollraged chem ro focus on (he gaod.

"Nothing tends more to promote health of body and of soul than does a spirit of gratitude and praise." Figure 16

This does not mean chac critieism should never be offered. The dass exercise is simpl)' caiculated to help people become more aware of cheir habits of [;lUltfinding. Il is designed ro demonstrate ta the panicipanrs thac, with effon, chey can control (heir acrs of criticism; and thereby realize benehcs to ehemselves and others. Cerrainly, criricism can be beneficial, if it is appropriate, conseructive, and eacefully given. However, much ofour criticism has ics roOtS in a negarive ani rude. Worse scill. we often are critical of things that we have absolutely no controlor influence over. Such criticism

339

PROOF damages ourselves and orhers. Funhermore, ir rends [Q foster negative anitudes in rhose arouncllls. Nearly 100 years ago Ellen White caprured the essence of such conccrns in the powerful counse\ ro feUow Christians stared in Figllre 17. 28

"Wben we arc tcmpted to murmur or complain at sometbing someone bas done, praise somcthing in that person. Say, 'Satan, I have defeatcd your temptations this time.' Cultivate the habit of thankfulncss. Praise Cod over and over again for His wonderful lovc in giving Christ to die for us. It never pays to think of old grievances. Cod caUs upon us to cultivate Ris mercy and Ris matchless love, tbat we may be inspired with praise."

Figure 17

Christian Meditation

340

The sevenrh mcasure for conrrolling srress is Christian meditation. 1 believe we have a crirical need for meditation anei prayer on a daily basis. lt i$ a form of rest and rejuvenation rhar few appreciare ro ies fullesr extenc This topic is explained more fully in the fronrallobe chapter and in rhe final chapter in the book. However, the imponance of this subjecr warranrs a descripeion here as well. Meelitarion anei prayer have their gre~lt est benefirs when chey provide a respite frorn srressful rhollghrs and feelings, and an opponuniry ro find solurions for dealing wieh life's mosr pressing srressors. [n order for slich processes ro occur, the reasoning pOUJers of the brain must be active during rhe meditative pwcess. Our highest illtellecrual powers, including spiritual reasoning. resiele in parr of the brain called the frontallobe. A5 described in (he chaprer on rhe frontal lobe, when rhis brain region is intimately involved in our thinking, a type of brain

posn (VE wave caJled the beta wave predominarcs. If you were ro measure brain acrivÎty with an e1ecrroencephalogram (EEG) anei it shows ehe bera wavc, it would indic.1te tlur healdlY rhinking is occurring, characteri'led by dynamic frontallobe acriviry. Smc!îes show tiut Christian meditation involves the frontal lobe anei beta acriviry. This is what one woulel expecr. After aLI, prayer from the biblical perspective is an exrremely active process. Whether \Ve are re1lecting an God's goodness, rhanking Him for helping liS in specific ways, seeki.ng ro know His will in a perplex ing sitllarion, ar praying for individuals who have specific necds, Chrisrian mediration and prayer involve an active frontal labe. Even rhough it can involve a high leveJ of mental activitJ, ChristiaJl mediration and prayer are also very relaxing. A bio monitor can be used ro detect the relaxation inherenr in sllch mediration. For those UI1familiar wirh the process, bio is simplya means of making an)' internal process of the human bod)' cxtcmally visible by rhe use of moniroring e1evice.s. 29 One method of assessing tcnsion is by measurîng rlte skin's electrica 1 resisrance. 30 \'V'hen a person is emotionally teme, rhere rends ro be a drop in this resistance. The skin more readily conducts an electric current which can be measured bvan electric meter,31 The familiar lie derect~r testworks an this principle. As parc of a medic.t1 school class, 1carried a porrable bio moniror rhar tOok such a measuremellt as I wenr through my daily romine. 1 was impressed rhat it demonstrated ehe !)lost relaxed state when 1 was actively praying ro Gad. Not every form of meditarion however, is charaererized by bera activity aJld fronta] labe involvement. In sharp contrast tO Chrisrian meditarion stands ehe meditarive pracrices popularized in (he eas(ern hemisphere. called "eastern medit
STRESS WITHOUT DISTRESS A1pha waves are brain wave of a lower frequcncy (8 ro 13 cyeles per second) 33 rhan bera waves, that indicate a person has entered inro a trance-like srare where ji-onraL tobe activily is wcak. When the brain has an alpha rhyrhm, we cannor cririGIJly analyze ilKoming inform'llion. !-rom the tandpoint of borh rhis alpha brain rhyrh m and rhe means ro induce the meditative stare, easrern mediwrion is srrikingly similar ro J~yp

110tism. Hypnosis, by design, byes rhe frontallobe as ir helps ule subject cnrer il tranceljke srare. Easrem religions use rhe principle of a solitary fOCl1S ro induce a meditarive srate. As one author put it, mental focus for Transcendental Medirarion can be achieved b)' focusing on a single word (calJed a manna), a single shape, or a body parc He melltions thar "anorher ancieO( pracrice is ro focus an the navei, the forchcad, OI' some orher body pan."34 Jusr as the hypllorisr requircs this single-minded focus and an environmem free from ali outside diversiolls, sa does fhe meditaror. Dr. Herberr Benson, the Harvard rcsearcher and physician, has presenred what some have cal led a "secular version" of easrern medirarion. However, Benson lIses rhe same elements of the eastern meditator and the hypnorisr: a quier environment and a single-minded focus (in his case a word or phrase of Hindu worship).35 Benson also meJltjons al10ther "essential element" in this process: "a ive auitude." In fact, he states rhat this is "perhaps the most important of rhe elements."36 Rice observes that ali of these eastern-style meditative re1ax.ation rcchniques "emphaslze a ive arrirude."37 It is rhis "ive attÎrude" with a prominem alpha brain wave rhar illusrrates one of the greatesr problems wirh this meditarive sryJe. Alchough it may provide reliefand relaxat ion by removing the mind's focus on cerrain srressors, rhe practice does nor appeaJ able 10 help in cOllstrtlcrively addre-ssing srressors. This srands in sharp contrast ro the reflecrive medirarion of me Chrisunn. Wirh biblical meditation and prayer, the emphasis is an an active refIection that helps ro foclls the fronrallobe. Rarher rhan srriving for a ive state that represses

thought.i, hristian mediration emphasizes communion witll God, thinking His thou.ghts, sensing His presence, and knowing His will. In addition [Q providing release for srress, rhis rype of meditarion also provides an opportuniry ro get lJ'Jetmingfitl tl11swcrs arJtL solutions to problems. There is further concern that rhe ive mental stare culrivated by cenain meditative techniques may do more harm than good. It has long been known thar eastern meditation and secular relaxation training may have delererious effecrs on the nervous sysrem. A classic srudy found higher levels of s)'mpathetic activity with increased adrenaline output resulring in rhe acute pbysical effects of srress mentioned earlier in rne chaprer in mosr measllfements made on eastern yoga practitioncrs when COIllpared ro an American control group.38 In another srmly, subjccts who received training in Transcendemal Meditation actlJally displayed a higher cardiovascular stress response after Iearning rhis meditarive practice. 39 It is possible mar problems arise when escapist meditatÎve practices are employed in place of constrllctive strategies ro deal with srressors. Such a hypothesis i5 consistent wirh work cited by Dr. Lury Dossey. Research that studied stress horrnones before, immediately following, and rhen twO days after surgeries )'ielded a slIrprising resulr. lmmune-weakening srress hormones signific.llHly increased only in those rhat had formal relaxarion rraining. Those dlar apparently addressed theÎr anxieties and fears-withoLlt lIsing escapism relaxation techniques-did not show rhe rise in stress hormones. 10 A third difficlllry with eastern methods relates ro rheil' potential danger when employed in a group sening. mar in easrcrn-sryle meditatioll, alpha waves predominate and the reasoning powers of the frontallobe aJe suppressed. In sllch a hypnotic-like stare an individual may record informarion and suggestions withoLlt interpreration and withom fronrallobe evaillarion. $ome have mus wondered wherher easrern religious CllltS talee advamage of adherems \vho enter a meditarivc Stare in a

341

PROOF POSITIVE group selring. Such crirics point out thar rhe brain would be in a S[
Exercising Trust in Cod Exercising rrusr in God is ilie eighth key defense againsr stress. It is human narure ro become overly concerned aboUf circumstances in our life anei ignore rhe help rhar God is willing ro provide for us. Trusring God involves complere confidence in our Heavenly Farher. We pllt Him and His will fim in our lives. Then we depend on Him ro acr on aur behalf in the way and ar the rime rhar is according ro His will, while using rhe energy that Gad has given LIS ta do whar we are able to do. This defellse againsr srress may be looked at as a direct extension of rhe previous aspect of not beîng anxious. r find trcmendolls help in trusring God when dealing wirh rempraeîons ro worry. Trust in God will provide a buffer againsr srress and a hedge againsr anxiery. Thousands-perhaps millions-of fajrhfu1lives tesrity ro God's faithfulness and rne reasonableness of placing our full conftdence in Him. We have many documented

PAUL'S BARDSHIPS "Of the Jews fiye tirhes received 1 forty stripes save ODe. Thrice was 1 beaten with rods, once was 1 stoned, thric' I suffered shipwreck, a night and a day 1 bave)Jeen in tbe deep; In journeyings oftţn, in perils of waters, in perils of robbers, in perils ~y mine owf countrymen, in perils by tbe beat~en, in perils in the city, in' perils in tbe wilderness,/in perils in the ~ea, in periJ~ ~moung false bretbren;/In wea ness and painfUlness, in watchings o/ten, in bunger and thirst, in fastings often, in coid and

Dakedn~

Figure 18

342

I

Corinthians 1J: 24-27

examples in rhe Holy Word of individuals wlto, through rheir living faith in God, remained "in conrrol" despite facing staggering srressors. Chrisr srands out as rhe model in demonsrracjng the power of faith in rhe midst of stressful surroundings. Who has f.1ced greatcr srressors chan JesllS? His 40 day fasr followed by tempt
roday. The Aposde Paul was anorher biblical character wha was subjecced ro incredible stress. He, roo, was ablc to rise above the srrcssors tluc ac cimes tmeacened ro englilf him. In his second lerrer ro the Corinchian dmrch, Paul summarized some of che srressors thal plagued him, as quoted in Figure 18. Despire the stressors ehat Paul suffered, he was not overwhelmed. He couId say with confidence: "1 have learned, in wharsoever state 1 am, therewith to be conrent." Philippians 4: 11. He revea/ed the results of

STRESS WITHOUT DISTRESS rrusring in God for Sfre5S conrrol, as quoced in Figure 19. True srress conrrol does nor provide a promise for diminaring srressors, but ir does provide rhe necessary coping resources sa rhar even rhough we may be [roubled on every ide wc need nor be distressed. Paul, himsel[ a champion of srress conrrol, provides rhe ride ro rhis chaprer, "Srress Wirhaur Disrress." He revealed rhe secrer of his conrenrmenr in rhe leHer he penned ro rhe Chrisrians in Rome. His words are reproduced in Figure 20. Paul asks rhe rherorical quescion, "Who shall separare LIS from rhe love of Chrisr?" His answer is resounding: not even rhe mosr harmful srressors can inrerfere wirh Chrisr's love for liS. Through Christ, Paul starcs rhar he won rhe vicrory: "in alI chings we are more rhan conquerars rhrough Him char loved us." Ycs, Paul's fairh was rewardedrJuough Chrisr he became a conqueror. 1believe rhat PauJ's use of rhe term "more than conquerors" is significanr. Being a cooqueror should be enough, but why "more rhan conquerors"? Paul was execured as a Chrisrian, a member of a hated secr rhar was falsely blamed for rhe burning of Rome. (History reIls us rhar rhe Roman Emperor Nera was acrually responsible for rhe cicy's fire bur ne areempred ro fusten me blame on rhe Chrisrians.) Tradirion holds [har [here was a scame ofNero in ancienr Rome wirh rhe inscriprion "Nero, Conqueror." It is likely tlur Paul had pa sed thar sratue many times. His sraremenr, "we are more rhan conquerors" was in contrast ro rhe caprion on rhe scame. Yes, Nero was a conquerar. But because ofGod's [ove for us, we are mQre rhan conquerars. We can conquer rhe srressors rhar are around us mrough che power given ro us by God.

Conclusion To conclude chis chapter. ir is fitting ta list the cighr key measures to conrrol stress mat we have examined. The summary lisr is shawn in Figure 21. TIlese eight key scress management principles have been invaluable in my life. They have also been a help to many who have artended my srress seminars. They may

TRUSTING GOB IN STRESS CONTROL "We are troubled 00 every side, yet not distressed; we are perplexed, but not in despair; Persecuted, but not forsakeD; cast down, but Dot destroyed." 2 Corinthians 4:8,9 Figure 19

CHRIST IN THE HEART -

I

;

-

"Who shaU s--eparate us from the love of Chrisţ? Shall tribulation, or distress or persţcution, or famin~or nakedness, or perii, or sword? • '! NaY'/in aII thes~ things we are rqOre thaJl conqUt;rOrs through him t)lat lov'ed us." . / '" Roma~s 8:35,37 Figure 20

KEYSTRESSCONTROL MEASURES • Healthy adaptation • Healthy lifestyle - including good Dutrition and exercise • Commitment to an honorable cause that helps others and is approved byGod. • Proper planning and organization • Dwell on the good • Christian meditation • Don'l be anxion. aboul lomorrow ~ • Trust God ~J!!J

!

Figure 21

343

PROOF POSITIVE sound coo simpJisric, bur rhar does nor detract from rheir power. 1am convinced rhar rhere are (\vO reasons why many people who rry co control srress fail in rheir atrempt. Firsc, rhey misundersrand the basics of rhe srress process and thus fail ta address rhe srressors rhar are confroming rhem. Second, even when rryilJg co coofronr rheir srressors, rhey do nor use rhe basic key principles rhar

RefermcesI Sdye H. The evolurion of dle Slrcss concepL Am Sâ 1973 Nov-Dec:61 (6):692-699. Selye H. StTm Witholli Disrress. PhiJadelphia PA: LippincoH, 1974 p. 31.

2

Selyc H. The seress concept and SOllle of ies implicarions. In: Hamileon V, Warburlon DM, cdirors. HUl1l1ln Stress And Cogl1ition: An lnjOrmlltioll PromsingApprollch. New York, NY: WiJey, p.70. 3

4 R..ice PL. Stms Anei Hea"h: Principles And Practice For Coping AndWelfness. Pacific Grave, CA: I3rookslCole Publishing Com-

1 have enumerared as rhe foundarion for successful control of Dur srresses. 1 would chaJIenge you anew ro openly assess your stressors and apply rhe principles presemed in rhis chaprer. You likcly will be surprised as to how far they wiU go in heiping you master srress-rarher rhan aJlowing Stress ro master YOll.

14 Gonder-Fredcrick LA, Carrer WR, cr al. Environmental srress and blood glucose changc in insulin-dependem diabetes mcllitus. Hcalth PsychoL 1990;9(5):503-515.

i; Shcrîdan JF, Dobbs C, 8rown D, Zwilling B. Psycho.neuraimmunology: strcss effecls an parhogenesis and immuniry during infeceion. elin Microbiol ReI} 1994 Apr;7(2):200212. 16 Johnson J, \ţTeissman MM, Klcrman GL. Service urilization and social morbidîty associated wirh depressive sympeoJnS in rJl(: communily.]AMA 1992 Mar 18;267(11):1478-1483.

17

Glenisrcr D. Exercisc and mental health: a rev1ew. ] R SOl"

pany, 1987 p. 18-19.

Heaith 1996 Feb;1l6(1):7-13.

5 Ycrkcs

18 HofTman-Goetz l. Pedersen BK. Exercise and tbe immune sysrem: a model of t11C seress response? lm 111111101 loday 1994 AlIg; 15(8):382-387.

RM, Dodson JD. The rclaeion of serengeh of Slinwlus

ro rapidiry of habie formation. ]ollmal Comparative and Neuro-

Ingiml PsychologJ 1908; 18:459-482. As cited In: Rice PL. Stress And Health: Principles And Practice For Coping And WelLnm. Pacific Grave. CA: Brooks/Cole Publishing Company, J 987 p. 19. 6 Rice PL. Stress And Health: Principles And Practice For Coping AJldWellness. Pacific Grove. CA: BrookslCole Publishing Company, 1987 p. 19.

Selye H. The evolUlion of lhc srress concep!. Am Sci 1973 Nov-Dec;61 (6):692-699.

7

Sclye H. The evolueioll of the mess concepl.. Am Sci 1973 Nov-Dec;61 (6):692-699.

8

19 Nieman DC, Henson DA, ee al. Physical acriviry and immllne funcrion in e1derly women. Med Sci Sports Ewrc 1993 JlIlj25(7):823-831.

211

Nieman De. Exercise, infeceion, and immuniry. lnt] Sporls

Med 1994 Oce;15 SlIppl 30:S13I-141. 21 Weinseeul L. Xie X, Cleancholls Ce. Purposc in life, boredom, ;tnd volumcerism in a group of reeirec$. Psychol Rep 1995 Apr;76(2):482.

9

22 Viswanarhan R. Dearh anxicty, locus of cOlUro!. and purpose in life of physicians. TheÎr relationship ro pariene deaeh Ilotifieaeion. PsychoJ"omatics 1996 Jul-Aug;37(4):339-345.

l~ Rice PL.

CD. Srancon BA, Jono RT. Quancifying and predicling recovery after heart surgery. Psychosom Med 1994 MayJlIn;56(3):203-212.

Guycan Ae. The allloJlomic nervous sysrem: ehe adrenalmcJuHa. In: 7fxtbook ofMedical Physiology-8th etlition. Philadelphi3, PA;WB Saunders, Co., 1991 p.672-676.

StI"fSS twd Health: PriJlcipus tUrd Prtlctiee ftr Copirrg

23 Jenkins

tInd Wel/ness.

Pacific Grove CA: I3rookslCo\e Publishing Comp:my, 1987 p. 209-21 1.

2 Dossey L. Healing WOrth: The Power ofPmyer nnd l!Je Practice ofMedicine. New York, NY: HarperCollins Publishers, 1993 p.

II

The American Instituee ofSeres . Suess-Americas #1 Helllth Probum. Internet: hnp:llvAV\v.srress.org/problem.htlll (2/4197).

30-32.

Manikaincn P, Valkonen T. MonalilY after ehe deaeh of a spouse: raees and cause.s of deaeh in a large Finnish cohorl. Am] Publi.c Health 1996 Aug;86(8 Pr 1): I 087-1 093

ofMedicine.

\2

Maflikainen I~ Valkonen T. Morcalit)' afeer ehe deaeb of a SpOIlSC: rates :lJld causes of death in a Iarge Finnish cohorl. Am] Public Hcalth 1996 Aug;86(8 Pr 1): 1087-1093_ Ij

344

Dossey L. Henling Worth: The Powe,. ofPrnye,. and tIu Prtletice Jew York, NY: HarperCollins Pliblishers, 1993 p. 241.

lS

PerI J. Sleep RigJn in Five Nights: A eLear and effictive Cuitlefor Conqueri17g Insomnia. New York, NY: William Morrow and

26

Company Inc., 1993 p. 167.

STRESS W1THOUT D1STRESS While EG. Mind Curc. In: T!Je Mit/istry ofHet11ing. Nnmpll. ID: Pruijie Prt'Ss Pub1ishing Assocuuion, 1905. p. 251. 28 Whire EG. True Worship. In: Eible Tmining Sc!Jool 1902-

Rice PL. The Concemralion Techniques: Medit;llion and Bio. In: Stms t1l7d Heolth: Principiei and Practice for Coping tind \flellnm. Pacific Grovc, CA: Brooks/Cole PlIblishing Company, 1987 p. 308.

27

34

1917 (a periodkal) OClOber p. 1. Found [n: Ilen G. Whire Eslarc. The Pub1isheJ Writings of Elim G. W!Jiu. Version 2.0 (CD-ROM), 1995.

:}5

Rice PL. The Concencration Techniques: Medirarion and Bio. In: SITeSS and Hell1th: PrincipIes Ilnd Practice for Copitlg aM Wel/ness. Pacific Grove, CA: Brooks/Cole PubJishing Com.pany, ) 987 p. 309. 29

Rice PL. The Concencrarion Techniques: Mediration and Bio. In: Strm and Health: PrincipIe-s tind Praniee foI' Coping and Wellnm. Pacific Grove, CA: BrookslCole PlIblishing Company, 1987 p. 313.

.lQ

Ricc PL. The Concel1lrarion Techniqlles: Meditarion ;Ind Bio. In: Strl'S'S and Healt!J: Principles and Practice for Coping and We1lnm. Pacific Grove, CA: Brooks/Cole Publishing Company, 1987 p. 313.

31

Rice PL. The Concemralion Techniqlles: Meditarion and Bio. In: Stress tJnd Health: PrincipIes tlnd Practice for Coping tJnd Wellnm. Pacific Grove, CA; Brooks/Cole Publishing Company, 1987 p. 305-312. 32

Benson H. The Relaxa.tion Response. New York, NY: William Morrow and Company Inc.. 1975 p. 19.

Benson H. TIu Relax,ltion RespotlSe. New York, NY: William Morrow aud Company Inc., 1975 p. 19.

36

Rice PL The COllcemrarion Techniques: Medirarion and Biofccdback. In: Sems aud HenLth: Principles tlnd Practice for Coping and \flellness. PacifIC Grave, CA: Brooks/Cole Publishing Company, 1987 p. 308.

37

Wenger MA, Bagchi BK. 51l1dies of auronomic funCtion in practilioners of Yoga in India. Behavioml Seieince 1961 ;6:3] 2323.

38

Puentc AE. Beiman I. The efTecrs of behavior rherapy, selfrelaxarion, ,Uld rransccudeuraJ medirarioll on cardiovasclllar srress response. J elin P5)l cho11980 Jan;36( 1):291-295.

39

40 Dossey L. Hctr/ing Words: The POUJcr ofPrayer dlld tIu Practice ofMedicil1e.. New York, NY. HarperCollins Publishers, ]993 p.

62-63.

AC. Textbook ofMedical Physiology-8th eJition. Philadelpbia, PA: WB. Saunders Co" 1991 p.662-663.

33 GlIyton

345

PROOF POSITIVE

346

----------

I

....U

CHAPTER FIFTEEN

IDS AND

The Untold Story

A

IDS: the diagoosis srrikes fear into rhe hearrs of yOllng and old alike. It is impossible to describe rhe devasraring emotional impact ofbeing told tIUt you have theAlDS virus. Immediarely images rend to come ro mind: an emaciated body, pain and suffering, men[al incompetence, and social exclusion. However, perhaps more tragic than ilie results of AlDS is [he faer mar most victims eOliJd have avoided getting the disease in ehe first place. Hence, it seems fining ta focus primarii}' an how ca prevem becoming infeceed with ehe AIDS virus, known as {he HlIman Immllnodeficiency Virus (HIV). This virus paves me way for AIDS. !nsighes into how HfV-infeceed individuals can boose their immllne syseems ro live ehe longest and fllllest life possible will also be emphasized.

AIDS Definitions AIOS stands for "acquired immllnodeficiency syndrome." This na.me aptly describes man)' of rhe key aspects of rhis condieion. Firse, AIDS involves immunodeficiency. This mea.ns thar me disease cUlses a weakening of ehe immune sysrcm. Becallse of {his we.akened immune seate, AlOS parienrs can develop devaseaeing condirions such as lifedHeaeeniog cancers and infectiollS.

_

• •

Second, AlOS is properly defined as a syodrome. The word "syndrome" eonveys rhe idea ehar a number of sympeoms or problems can occur rogeeher in this condition. This is an especially appropriarc designation for AIOS where intestinal effecrs. nervous system changes, and a host ofother problems can accompany (he headiine-grabbing cancers and infeceions. Third, this syndrome wirh its immune system weakness is acqllired. An individual moves from a siruation of normal immllne stams ro a compromised one as the result of something ehar he or she acquires. One th.ing [hat is acqllired. of course, is the virus called rhe human immunodeficiency virus or HIY. A person cannor ger AIDS unless they are infected with HlV. However, not aH individuals with H IV infection will necessarily develop AlOS with ies profound immune system weakness and accompanying symproms. Even after 10 ye-ars, only abOlit half of those infected with HIV have actually developed AlDS,l This distinceion is crieica!. The disease ofAlOS with ies weakened immune syseem and relaeed findings is very diffcrenr than simply having HIV infection. Again, HIV infeceion is necessary for AIOS ro develop. However, millions of people worldwide are HIV-il1fected but have not yee come down

347

PROOF POSITIVE

MAGNITUDE OF THE AIDS PROBLEM IN THE U.S. • Over 575,000 AIDS cases sinee it was discovered in 1981 • Over 350,000 dead • Over 40,000 deaths in 1996 • Leading cause of deatb in ages 25 to 44 Figure 1

MEDICAL COST OF HIV

INTRE U.S. • Lifetime medical cost per HIV-infected patient = $119,000. •As bigh as 15 billion in allDual medical costs in the U.S.

Figure 2

HIV WORLDWIDE •Over 21 million people bave HIV. •8500 people become infected with HIV each day. • By the year 2000, AIDS will have killed more than 8 miJIion people. • By the year 2000, 30 to 40 million people could bave HIV infection. • By the year 2000, over 5 million children will be infected with HIV and another 5 to 10 miJUon children will bave been orpbaned by AIDS. Figure 3

348

wirh it, and some may nroerdevelop AIOS.

Seriousness ofAlDS in the Us. The number of people in ilie U.S. infliered with rhis dreaded disease is lisred in Figure 1. 2 Only 39 percent of rhose wirh MOS have survived at dus writing. 3 Most of rhe deaths are in an age group rhat is ofren considered ilie prime oflife. 4 AlOS deaths have ourpaced even the classic killers ofthe young like accidenrs and homicides. 5 It is now ilie eighth leading cause of death across aiI age groups in the United Stares. 6 Even ehough ie has nor reached the yearly dearh toll of diseases like hean disease, cancer, or srroke, AIOS is still a major killcr in America. Along wirh aII the human suffering caused by AIOS, the disease has taken a heavy financial ro1l on our nation. Medical costs are shown in Figure 2. 7 ,8 Worldwide, HIV has caused mauy difficulties as well, as shown in Figure 3.9. 10. II Over 90 percent of those with HIV worldwide live in developing counrries. In hve Afric.'lII counrries, more than 10 percenc of ehe population is infected.

How the AlDS Virus is Transmitted How can 1 avoid ilie AIOS virus? Ta answer that question, we must first examine how it is transmirted from person ro person. You can only ger the AIOS virus by receiving it from someone else. Whar are the various ways it is erallsmined? The mosr common way it is transmirred in ehe U.S. is through homosexual . But mere are aJso orher ways, as Ijsted in Figure 4. Heterosexual contacr can also transmit the AlOS virus. HIV acquired by iliis method has bec~ome more prevalent in recent years. Contaminared blood or blood plasma rhar is used in blood rransfusions can cause a person ro become HIV-Înfected. Ncedle sharing of drug abs is a high risk practice that !las been increasing in relative imporrance. The number of AIOS parients who reporred ilie practice ofinjecting drugs was 17 percenr during 1981 ro 1987, and illcreased to 27 percent during 1993 ro October 1995,12

AIDSAND HIV Not only are illicit drug s ac risk of comracting the virus from a contaminaeed needle. Healrh cuc workers can acquire che infeccion ifebey are inadvertelltly stuck with a needle mar had been used on an HIVpositive patient. However, this appears eo be a relatively uncommon cause of viral rransmissiofl. Through rhe end of 1995, less than 50 healch care workers have developed HN infecrions ehac were c1early documenred as being relared to rheir work. 13 Even parienrs can be ar risk from contaminared needles. Alrhough ehe re-use of UJlsrerilized needles is not a problem in the U.S., ie is in ocher parts of rhe world. This is one of rhe reasons why AIDS has risen so fast in Romania. 14 Financial pressures combined with poor hospital supervision lead ro me re-use of unseerilized needles for injections-parricularl.y ro young patienrs. Many innocent young people have devcloped HIV infection as a resulc. wirh blood or mher HIV-infeceed body fluids can, ofcourse, occur wichaur sexual or needle sticks. le is cheoreeica1Jy possible ro ger rhe virus if an open WOUJ1d or sore is exposed to discharge from an HIV-positive pariem. Transmission may a1so occur if those infected secretions come imo comact with che mucus membranes of rhe moueh ar ocher body openings. However. sllch memods oferansmission are unlikely. A recent documented HJV infecriol1 C3me from a human bice from an AlDS paeient. 's The U.S. Ceneer for Disease Control and Prevention has gone an record rhat HN may be able to be eransmitced by oral kis-sing, a1chough rhey state a person is "noe likely" to become infected in this manner. 16 They acknowledge char there have never been auy documenced cases of the virus being transmitted in this manner. In concrasr, oral sex may be the highese risk aaiviry in developing HTV infectionY Ocher rouces of transmission for ehe AJDS virus include transmission from a lTlomer eo her child. The vase majoriry of children who develop AlOS (approximaeely 90 percenc) acquire the virus from cheir HIV-infecced moeher either while in the womb. during the delivery process. or in che eatly days of life. 's There is no qucscion

KNOWN ROUTES OF

TRANSMISSION OF mv Sexual: • Heterosexual (male to (emale and vice versa) • Homosexual (male to male) lnoculation ofblood: • Transfusion of blood and blood products • Needle sharing among intravenous drug s • Health care workers - needle stick, open wouod, and mucous membrane exposure • Human bite • Iujection WÎth unsterilized needJes Newborn: • Within tbe womb • In tb.e birth canall Figure .4 that while În che womb. HIV can be carried from the mother's blood inro rhe baby's circulation. Newborns can also acquire the infeceion when going through the birrh canalac rhe eime of delivery. The virus apparencly infecrs these children by entering eirher rhrough mucus membranes (Iike rhose lining the mourh ar privaee area openings) ar through small skin wounds due eo normal birth trauma. Transmission from rhe mother to the child accouncs for only a relatively small number of toral AlDS C3ses (slightly over one percent of the rotal cases 19 ). However, the numbers are significanr when measured in of the human suffering of infancs and children. Nearly 1000 children each year in the U.S. are diagnosed wieh AlOS that they acquired from cheir mothers. 20 Of particular imporrance is {hat many of ehese cases C3n be prevenred. If an expectant morher is tes{ed for HIV and knows {har she is infecced, precautions can be raken during pregnaney and delivery thac wiU dramacically decrease rhe risk of her child becoming infected. Wichout such preclUcions, an HIV-infecred mocher subjects her child ro a ] in 4 cbance of becoming infecred. The odds drop ro 1 in 12 when appropriare precaucions are taken. 21 Since che beginning of the AIDS epi-

349

PROOF POSITlVE demic, roughl}' rwo perccnr of U.S. AJOS cascs have been naced to blood rransfusions, other blood products (Iike c10tting factors), or tissues (such as organ donarion). This figllfe has dropped to one percent of cases in more recent years (1993 through 1995).22 The number ofcases rdated ro rranstlJsions and relared producrs should conrinue ta decrease due to rhe careful scruriny rhat blood now gets in the Unired Statcs. Recenr studies of rhe risk of H IV rransmission from blood banks are encouraging: the risk of HIV rransmission is onl)' about rwo cases for every one million units of screened blood. 23 However, some HIVrainced blood stiU gets inro our narion's blood bank supplies. This blood comes from donors wirh early HIV infecrion who have not yet tesred positive for rhe infecrion. The reason for rhis de1ay is thar rhe standard HIV blood tesr measures amibodies ro HIV-and it takes rhe bod}' up ro rhree monrhs tO develop rhose anribodies. Nmosr aII people who are infecrcd wirh HIV will have sufficienr anribodies ro show in a resr wirhin rhree months;2,j before rhat rime, rhe rest can miss rhe illfenion. This period of time where HIV infection is presenr bur nor derecred by the standard HIV blood resr is c.alled the "window period." Fortunately, other special HIV tem are done tiUt allow blood centcrs ro discard some infected bJood even when it is in this window period. 25

RlSK OF HETEROSEXUAL TRANSMISSION OF HIV IF PARTNER IS HIV-INFECTED Womao infected byman

20

Risk 10 -

Mao infected by woman 1 Figure 5

350

HemophiLiacs (individuals Wilh hereditary bleeding problems) have historicaUy suffered a hcavy toU from transfusion-related AlOS. Ahhough only abour one percent of toral AIDS cases are hemophiliacs,26 many contracted rhe infect ion before blood could be reliably screened for HIV, Tbe reason fOf dus is that hemophiliacs require man)' blood transfusions throughollt rheir lifctlme. Many received contaminated blood in rhe days before blood was screen.ed for HIV, The material we have juSt cxamined is vital, for it rcveals how HIV is commonly spread. Every person should understand exactly what consrirures high-risk behavior. Only in rhis way can personal risk be optimall}' minimized.

The GroU/ing Role ofHeterosexual Transmission Before 1988, heterosexuaJ transmission accoumed for onl}' rhree percenr ofaLI AIOS cases. 27 Since 1993, however, the figUIe has more rhan rripled. Currendy, II percenr of AJOS cases contracred HIV by heterosexual relations. 28 About 13,000 new Al OS cases each year in che U.S. are concracted from hererosexual re!ations. Most of rhese case$ are women who have been infected by men. Approximare!}' 40 percenc ofaII AJDS cases among women have been associared wirh heterosexual intimacy.29 The AIOS virus uansmits much more easil}' from an HIV-infecred oun ro a woman rhan ir does from a woman ta a Olan. 30This is illustratcd in Figure 5. Heterosexual relations aCCOUlH for onJy six percenr of AJOS cases among men. A comparison of rhe number of new AIOS cases each }'ear in rhe U.S. caused by homosexual and heterose:ma! in men is shown in Figure 6. 3 1. 32 Worldwide, when compared wirh ali ocher l1leans of rransmission in boch men and women, homosexual is rhe souree of a relatively smaller proportion of cases. In srarisrics published in late 1995, homosexual transmission explained only 45 percenr of roralworldwidc AIOS cases, down from 64 perccnt carlier. 33 . 34 Ho\\'-

Al OS ANO HIV ever. in rhe V.S .• homosexual rransmission remains ilie major cause ofAlDS infeclion.

NEW AIDS CASES OCCURRING AMONG HOMO.. AND HETERO..SEXUAL MEN

How H1V is NOT Spread It is aho essenrial ro recognize how HIV does nOf appear t.o spread. There are ali kinds of rheorerical concerns aboue routes of (ransmission over which we have no coneroI. However, worries aboue these unavoidable conraces are coumerproduceive when we consider ehe ways (hae we know HIV is rransmitted. This is not just an ac.'ldemic poinc. If you focus on .111 (he questions (har are not complerely answered-and over which you have no control-you are likely ro neglecc co take the precaucions rhar C3n vircually ensure ehat you will not become HIV-infecced. A list of ehe ways tim che AIOS virus is nor spread appears in Figure 7. Clase personal (wirhoue che type of exposures already menrioned) has noe been shown ro eransmit the disease. Contacr wirh an HIV-infec(ed person in the household. ilie work place, the school, (he public resrroom, ar even (he hospi(al is of no consequence. 3S The reason for chis is ehar rhe AlDS vi rus C.1nnO[ survive for very long in [he normal environmenc olltside of a living cre;uure. The virus is also easily destroyed by common disinfectants. Furthermore. (here appears ro be no risk of rransmission Eram insect5 such as mosquitoes. 36 If we are going ro dramarically decrease ilie rate ofHIV infection in the world, we need ro focus on (he known risk facrors.

40,000 New AIDS cases per J'car

30,000 20,000

in U.S.

10,000 3299

O

Homo-

Relero-

Figure 6

WA

us

s o

Close personal : • Housebold • Workplace • School • Health-care workers without exposure to blood

lnsects Figura 7

NOT ALL WITH IV GET A DS

1s the AlDS Virus a Death Sentence? Jusc rwo weeks prior [O chis writing, I had tO rell another person in my office (har they were HIV posi(ive. Mose of my HIVposj(ive parienrs are younger men; bue rhis rime it was a woman in her seventies. She was seeing me for orher problems, and we were borh surprised rhar she was HIV posirive. Ir rurned out rhat she contracted rhe virus from a wayward husband who had divorced her three or four years ago. Now, whar abour rhis woman and the thousands of others who aJready have ilie AIDS virus? Is the AIDS virus a death senrence? Can they be sure ro develop ilie disease

27,316

60

50

40

38 151038

Pereenl who gel

perrenl d('~nding

AlDS 20

upon aee and olber (atlon

o After 3 years

AfIer 10 years

Figure 8

351

PROOF POSITlVE ofAI OS sooner or lafer? HIV stJristics provide some good news in this regard. JUSt because l'ou are infected wirh the virus does nor mean iliat you are going ro ulrimatell' come down with Al OS. Srudies have been made by tracki ng thousands of Americans who have conrracted HTV infecrion since its discovery in the early 1980's. Many have survived, as illustrared in Figure 8. 37 . 38 Note fhat even aher 10 vears, ani" 50 percenr had developed AlOS: This suggests thar having the HIV infection does nor mean thar l'ou will necessarily get AIOS.

STREET DRUGS THAT WEAKEN THEI~UNESYSTEM

• Opiate Drugs (Narcotics such as Heroin) • High Doses of Cocaine • Amyl Nitrate • Alcoholic Beverages • Tobacco Smoke Figure 9

PRESCRIPTION DRUGS THAT WEAKEN THE IMMUNE SYSTEM · Anesthetics--at least in conjunction with surgical stress (includ ing elher, h.alolhane, nitrous oxide, pentobarbitol, etc.) · A variely of agents used to treat infectious diseases: antimalarials, antihelminthics (used 10 Ireat worm infections), antibiotics, and antivirals • Cortisone and related steriods • Cancer chemolherapy drugs • Major tranquilizers · Tricyclic antidepressants (cxample: Amitriptyline) · Progesterone Figure 10

352

The Path /rom HIV Jnfection to AJDS In rhis secrion we willlook ar the path from HIV infecrion (Q AIDS. This irtlormarion is critica!, because ir could help an H1V-infeercd person ro delal' or even avoid rhe onser of AlOS. The healrh of rhe imrnune sysrem ar rhe rime a person is exposed tO HIV appears (Q be viral. If l'au become infecred wirh HIY: keepingyour immune system as hetllthy fIS possible also appears ro be crucial.39 A growing number of r:esearchers are focusing on issues other (han HIV infection rhar conrribure ro lhe dcvelopmenr of AIOS. In facr, if rhe immune svstcm's C04 cells (a cerrain rype of whire blood cell or Iymphocl're) are verl' healthy, it will take up to 200 times the numbcr of viruses [Q infect thcsc cells :md bring abom an HIV infecrion. 40 This probabil' cxplains whl' some people dur are repeatedly exposed ro the AIOS virus never: becomc infccted wirh HIV, 1 have rwo separate parienrs who have AIOS and have been HIV posirive focl'ears. Up umil thel' wcre diagnosed wirh AlOS, however. they were reguJarll' having unprotecred inrercour e wirh their wives, both of which are stil1 negative for HIY: These women had been rearcdll'exposed tO HIV in a wal' known to be very dangerous, yer have nor come down wirh rhe disease. Robert Roor-Bernstein, Associarc Professor of Physiology ar Michigan Srare Universiry, has documenred much literatllfe on rhe immune sysrem anei AIOS in his rivering book,

Rethinking AlDS: The Tragic Cost Of Premature Consensus. 41 His well-researched book does nor necessarily mini mize the imponance of the human immunodeficiency virus in the AIOS disease process. However, it suggeslS that although HfV infec(ion may be rhe fim srep leading ro AIOS, other facrors cal) ulrimate!l' hasten rhe developmenr of rhe disease. Manyof rhese facwrs directll' impair the immune sysrem. Avoiding these facrors as much as possible will be ro the advanrage ofan HIVinfected person. The fim group of facrors is srreer drugs. They are lisrcd in Figure 9.42. 43 . 44

AIDSAND HIV Som.e prescription drugs will also reduce thestrength of ehe irnmunesystcm and help to bring on AlOS. They are lisred in Figure 10. 45 • 46 1n addition ro drugs, other factors will damage rhe immune system. They are liseed in Figure 11. 47 ,48.49.50 There are stiH orher factors that, rather than doing damage ro the immune system, seern to srimulate activiry of the HIV, as listed in Figure 12. 5 1. 52 Figures 9 rhrough 12 help us begin ro appreciaee some of the facrors that may ultimately inl1uence rhe developmel1t ofAlOS afla HIV infecrion has occurred. Many of rhese factors are under an individual's personal control. The mcssage is rhat we should avoid anything ehat cends [O supprcss the immllne function or stimulate the acriviry of the virus. In view of its frequency of use, one class of immune-suppressing drugs seems worthy of special arreneion. This dass is alcoholic drinks. Thc consumpeion of aleohol is a cwo-pronged danger, as shown in l'igure 13. Alcohol suppresses me brain's fronral lobe--the seat of judgmenc and reasoning power. This suppression poses a risk for HIV transmission. Undcr ehe inl1uence of even socially accepted levels of alcohol, a person is mote likely ro follow impulse rather than principle. and may engage in acrivities (hat would have been avoided if ful1y sober. MiIJions ofalcohol drinkers are unaware of its effecr in deprc.ssing the immune system cven when consllmed in "social" or "moderate" amoul1ts. For some time now rhere has been evidenceli.llkingalcohol with HJV infeccion. In one srudy, researchers showed thar social dri.nki.ng can increase the likelihood that you wil1 become HIV infecccd if you are exposed to the AIDS virus. In their experiment, Or. Omar Baga ra and colleagues found thac drinking four beers made human white blood cells more susceptible to HIV infecrion. The aJcohol C<'lused measurable harm ro rhe T-cells of rhe social drinkers. These cells, of cOllr c, are ofcritical imporcance in HIV infeceion. Even seven hours after aU che alcohol was

OTHERFACTORSTHATWEAKEN THE MUNE SYSTEM Malnutrition Multiple lnfections: · · · · · ·

Herpes Syphilis Hepatitis B Cytomegalovirus Toxoplasmosis Tuberculosis Figura 11

FACTORSTHATAPPEARTO STIMULATEHIV AC VITY Cocaine use Viruses: · Hepatitis B · Epstein-Barr (EBV) · Herpes Simplex, Type 6 · Human T Cel! Lymphotrophic Virus, Type 1 · Cytomegalovirus Figure 12

ALCO OL AND A

S

· Alcohol suppresses the frontal lobe of the brain, which weakens reasoning power and causes a lack of control of sexual desires. · Alcohol weakens the immuoe system. Figura 13

353

PROOF POSITlVE removed from the blood, testing srill revealed immune system impairment. S3 Other research suggests that in addicion ro alcohol helping ro cause HIV infeccion, ie may also adversely affect a persons immune system after becoming HIV-positive. 54 ThllS, the immune-weakening effeccs of habitual social drinking may increase rhe likelihood mat an HIV positive person will develop full-blown AIOS. Unfoftunately, che media has largely ignored the impact of alcohol consumprion and other lifestyle facrors on HIV disease. It may be that the me.ssage of an immuneenhancing lifestyle could have done more ta prevenc me rapid spread of Al OS than the more popular message of condom usage.

Stress andAIDS Srressfullife events associated wieh depression can worsen HN infectioll,5S probably due [O an additional suppressanr effect an rhe immune system. Severe life scre.sses increase ehe odds of HlV progre.ssing into AJOS four-fold. Ir may not aJways be possible to control the stressors in one's envÎronmenr, but devdoping the coping mechan.isms ro combat scress may be cricicaJ for an HIV positive patient. Ways te accomplish chis are deeaiLed in Chaprer 14, "Srress Wirhour Disrress." Besides avoiding facrors rhar harm our immune sysrems, there are posicive things

AIDS EMOG..-.... .... THE U.S.

cs

New Coses in 1996 Three popu/alion groups Duounl for Ihe "asl majorily

Homosexual IV drug use

54% l7%

Homosexual & IV drug use

5%

11%

Heterosexual Newboro Transfusion Hemophiliac Figure 14

354

Preventing HIV Infection

<1%

o

10

we can do ro enhance aur immune mechanisms. One example ofan immune-e.nhancing life.style measure is physical exercise. In individuals wirh HrV infeccion, moderate exercise may decrease the likelihood of progression ro AlOS. S(, Studie.s have shown that mase with the highesr blood levels of vitamin E (anained by a diee rich in rhe viramin and nO( with supplements) have a 34 percenc reduction in rhe risk ofcoming down with AIDS COI11pared ro those with low blood levels of the vitaminY The whoJe plant foods, because they are high in beneficia] phytochemicals, have many cheoreeical advamages over viramin E supplements. Chaprer 2, "Good News About Cancer-It Cari Ee Prevented," Iim foods rich in vitamin E. Orher blood levels of vieamins sucb as vitamin B I2 are aJso important. Those HIV posÎrive subjects wirh low viramin B'2 levels had twice the risk of progressing ro AIOS compared wirh rhose with high blood leve1s. S8 Since plam foods are nor usually rich in vieamin B12 , 1 recommend ro rhose thar subsisr eneirely on a tocal vegerarian diet ro rake a B12 supplement. A high planr-food diet may al50 increase blood levels of glutarhione, a patent amioxidanr pcoduced by the body. High levels of glutathione may have a pivoca] cole in slowing the progression of the HIV infection. People wirh HIV who have low glurarhione levels have a much lower probabiliry of surviving over rhe course of duce years ehan do people with normal glueathione levels. S9 There are many mher ways ro boosc ilie immune system. The borcom line is that stronger Îml11l1ne systcms render us less likely ro become HIV infecccd-and feasibly Icss likely ro develop A10S if we are already HIV positive. More information an how ro keep {he immllne syscem strong aJld heaJmy is presented in ehe cancer chapter (Chapter 2).

20

30

40

50

60

Ir is much bener not te contracr HIV chan [O attempr ta boosc the immune system oncc it is diagnosed. Whac is che mose effective way of ensuring rhat you never become infected with che AlOS virus? Let

AIOS ANO HfV us look at the popularion groups that have developed AJOS in 1996 in Figure 14,60 which provides rhe basis for the answer ro rhis quesrion. Nore that 97 percent of AJOS parieIHs would nor have rhe disease if it were nor for rlle personal choices that they mode regmding sexual activiry or drug use. Oespire what many seem ro want us ro rhink, ilie answer ro the AlOS epidemie h.1S not becn nor is it condoms. Condoms are nor a reliable barrier against HJV infecrion. Sinee condoms sometimes allow pregnancies to oecur, rhey can much morc easily ilie AIOS virus as well 3S orher sexually rransmitted diseases. The AIOS virus is l11ueh smaller rhan a sperm. So whar is rhe besr prevenrive approach? AJberr Whiring, M. O., made a bold sr.arement rhat blends praetiealiry and realiry in a way rhar few are willing ro eeho. His sratement is shown in Figurc 15. 61 Monogamous marriage wirh a liferjme commirmenr would certainly help us take a quanrum Icap roward the solurion of rhe AIDS problem. Who is rhis physician who expresses such an unpopular assessmCIH? Or. Whiting is rhe Hcalth Direccor for the emire Sevenrh-day Advenrisr Church. In rhac posieion, he has a unique perspeccive on world healrh issucs. This is because Seventh-day Advenriscs are doing organjzed medical work in nearly 500 church-owned hospirals and clinics throUghOlH the wodd. 62 From his involvement wirh rhe worldwide work of this global church, Or. Whiting has a unique v:mrage poim. AIOS is a global problem, and is much more prevalent in many orher counrries rhan in che U.S. [s it roo much ro restrice sexual activiry ro monogamous lifelong marriages berween rwo of opposite sex? 1 believe Whiting's words hold rhe key ro prevenring HIV infecrion. The doctor's sta temem, howevcr, is not novel. It is a clear expression of the Bible's timcless ideals. Beyond rhar, from a public healrh srandpoinc, Or. Whiting's words make sense. Becallse of rhe imporrance of chis perspective on preven(ion and irs relationship ro moral srandards, it is warranred ro examine carefully rhe biblical principles mar have a bearing on HIV

GOD'S SOLUTIO TO THE AIDS P OBLEM • God's ideal is monogamous mardage with a lifetime commitntent. • Sexual activity outside this commitInent is a sin. • This single pcindple followed wou1d do more to solve the AIDS problem than any appcoach currentlyavailable.

Figure 15 transnusslon. The principles and rhe spiritual power ro implemenr them are c1early described in rhe SeriptlJres. However, before looking ac thcse timeless biblica! il1sights, we need ro expand our focus. The inspired counsel that we will examine has a bearing not only in dealing wirh AJOS but aJso an a hosr of orher sexually rransmirted illnesses ehar are eaking a rremendous roll.

Other Sexually Transmitted Diseases Sexual pracrices ean put individuals ar risk of ocher diseases and fatal eondieions besides AIOS. Seven common sexually

OTHER SEXUALLY TRANSMITTED DISEASES IN U.S. • Human PapUloma Virus cer~i.'( cal/cer • Hepatitis B chronic Iiver infecJion Iiver cancer

5000 dcalhs and 15,000 new cases per year --- ----.---1600 deatbs per year

• Pelvic Inflammato~' Disease tubaJ pregllaflcy

• Genital Herpes (incurable) • GonorrhCll • Syphills heDrt problems brDin diseDSe nervous system diseDSe ·Chlamydia

1 miUion new cases and 150,000 sterile women per year

20 millIOD infected, 270,000 new cases per year _~.~!Jjoo new cases per year 35,000 new cases per year

2 miUion cases per year Figure 16

355

PROOF POSITIVE

WOMEN A LOW RISK FOR CERVICAL CANCER • No sex until after age 18 • No more than two sexual partners throughout their Iifetime. • Each partner must not have had sex with more than ODe other partner.

figure 17

transmitted diseases and some of ilie maladjes that can result from them are listed in Figure 16.

Sexually Trammitted Diseases Cancer of rhe cervix or opening of the womb is one of the mosr common cancers occurring in women. In the U.S. alone, each year there are over 15,000 new cases and oearly 5000 deaths. 63 Worldwide, cervical cancer is the second mosr common cancer (following breast cancer) and afflicts 471,000 women each year. 64 Although there are a variery of lifesryle facrors that have a beariog on whether or 00( someone wiU develop cervical cancer, rhere is ooe factor rhar is almost always preselH if rhis cancer develops. This single faCtor is infecrion wirh rhe human papiUoma virus. A receor National Institures ofHeaJrh (NIH) expert emphasized rhe srriking relarion between this infecrion and cancer: "Cervical cancer is unique in rhat ir is me fim major solid tumor ro have been shown ro be virrualJy induced in mentiai/y every case. Humao papillomavirus (HPV) DNA is found in yinually aU cervicaJ carcinomas ... worldwide. "65 It is important ro emphasi7..e that HPV is a sexually transmitted disease. Women contract rhis cancer-causing infection through sexual reIations with someone who has rhe virus.

356

Dr. PatricÎa S. BraIy, a gynecological cancer specialist at. Louisiana Scate Universiry and co-chairperson of the NIH cervic..'l1 cancer expert , has identified rhe srartling prevaIence of chis cancer-causing infection. She has poinred out that one in every four women who become sexually active in college wiU become infecred with HPV within one year. This oecurs even though such women only ave rage two maIe partners. Based on the frequeney with which HPV strikes, Dr. Braly has gone on record that che only women who are not ar high risk of this devastaring cancer meet each of duee criteria, as listed in Figure 17. HPV and other sexuaUy transmined diseases are stiU afflicting Americans in epidemic proportions. 66 Each year 12 million people in America will be newly infected with a sexually cTansmitted disease. Even if a person e1udes HIV and HPV infeetion, the stakes in other infecrions can stiU be very high. Heparitis B is orren sexuaJly rransO1i[[ed. It can cause chrooic uver infection with cirrhosis and even liver cancer. Esrimates are mar each year 1600 Americans die from sexually acquired Hepariris B. 67

Sexually Trammitted Diseases and Quality ofLift Sexually transmitted diseases (STDs) do more than pur individuals ar risk for early death. They c.m aJso rob {hem ofquaJiry of life. For example, each year in America abour one mi/lion women deveIop pelvic inflammarory disease (PID), a severe complication of common infections like gonorrhea aod chlarnydia. Nor only is this disease painful, bur it reoders lip ro 150,000 women sterile each year. 68 A woman who has had pelvic inflammarory disease is suseeprjble ro a rubaJ pregoancy. In rhis siruarioo, rhe fertiLized egg can become lodged in one of rhe scarred Fallopian rubes rhar lead from rhe ovary ro the womb. As the fetus grows rhe rube srrerches, and if undcrecred, will rupture. This cau be a life-rhrearening evenr. 10deed, [he physical and emotionaJ costs ro a woman who has had PID can be great. Sociery as a whole a1so incurs a significaIlr financiaJ cost for rID with irs associared

AJDSAND HIV inferciliry and eccopic pregnancies. One study put the yearly COSt jl) the U.S. ar $2.6 billion. 69 Women and men alike are afflicted wirh genical herpes. Each year in che United States there are some 270,000 new cases, while 20 million are already iJlfecred and suffer with recurrenr episodes of this incurabJe condition.7° Gonorrhea and syphilis may be our of rhe limelight, bur rhey: r?o, are alive and well. Each year rwo mlll10n Americans are affiicted wirh gonorrhea, and 35,000 carne down with syphilis. 71 The laner condition, if nor prompcJy and CQfrectly treaced, can resuh in hean problems as weU as brain and nervous sysrem disease. Perhaps one of me greatesr rragedies of the epidemie ofsexually transmined djseases is rhar reenagers and young adulrs are rhe hardesr hir. Of rhe 12 million STDs mat oaur each year in our country, 86 percenr occurs in individuals berween rhe ages of 15 and 29. 72 Stanlingly. among sexually acrive recnagers, one in four wiIl come down wirb an STD whiJe rhey are still in fheir reens. 73

Sexual Behavior Ranks 5ixth in Causing Death We sec ehar sexual behavior js responsible for causing pain, misery, and death in many ways. It perhaps carne as no surprise. but the data was sril! shocking when researchers McGinnis and Foege, aher anaIyzing 1990 sratisrics, stared rhar abou r 30,000 Americans clie every year because of rheir sexual behaviors. This was a resulc of cheir studies on "The Actual Causes of Dearh" in which the researchers found that sexual behavior ranked sevenrh in the externa! faccors rhar cause deach.74 Unfortunacely, sexual behavior has been a rapidly iocreasing cause of deach in the U.S. since 1994, when about 40,000 Americans died as a direct reslllr of cheir sexual behavior. Consequendy, sexual behavior is now the sixrh leading acmal cause of death.75

Condoms versus Abstinence As we have seen. despice years of HIVprompted messages urging rhe increase .in condom usage, non-HIV sexually uanstnuted diseases are on the i~lCrease. This has occurred in spice of the increasing condom usage in America. Many experrs had taughr that the solurion to HIV and sexually rransmitted diseases was ro increase condom usage. Condom sales and usage are up, buc so are sexlIally rransmitted diseases (STDs).76 This has been qllite perplexing ro mally condom advocates bur rhe message we hear from them is that we need tO use mal1Y more condoms. Alchough condoms, if pur co lIse, can prevenr the spread of Hrv and STDs (alrho~gh the)' are by no means 100 percenr reltable), a much berter message is how 10 practice abstinence, sÎJlCe ic works every time it is tried. Those who have sex outside of marriage, more often than not, are allowing the emorions and desires to take precedence over meir beuer judgmem, foresighc, and reasoning abiliry. They have permirted the fromal lobe of their braÎ.n to become suppressed so thar desire will mie over reas~n. No one who is in such a state can be relted on ro go rhrouoh an objective check1ist ("1 will not do chisb 1IlUeSS 1 have a condom") before parraking in the acr. This is why che condom message has largely failed in America. It is analogous to che following reasoning: 1. Many accidents occur on the road with drivers who are lInder the inf1uenee of alcohol. 2. We must put out the message "Be exrra careful on the road when you drink alcohol." But wait a minute, alcohol suppresses che froncal lobe of the brain so becoming "carefu1 enough" is nearly impossibJe. So it is wich illicic sex. Becoming "careful enough" is l1exr ro impossible because of ~he slIppressed fronrallobe state. The solutJon ro the alcohol-related accidenrs and ro the sexually transrnitced diseases is notto be sa~er when parraking, but not to partllke ~ll; 111 a word. abscinence. Teaching al1 indIvIdual

Il:

357

PROOF POSITIVE

THESEVENTHCOMMANDMENT "Thou shalt not commit adultery."

Exodu.~ 20:14

"But 1 say unto you, That whosoever looketh a woman to Iust after her hath committed adultery with her already in his heart." Matthew 5:28

00

Figure 18

how ro be abscinenr is actuaJly much casier and will mecc with m,uch more success, since rhe froncallobe of che brain will remajn in control on such a program.

Changes Needed to Combat AIDS and Other STDs The consequences of HIV and other sexually transmiered diseases remind us mat our sexual practices have a far-reaching im-

THREE BIBLE PRECEPTS THAT PROTECT AGAINST AIDS "Thou shalt not tie with mankind as with womankind: it is an abomination." Lev. 18:22 Prostitution strictly forbidden. Deut. 23:17 Sex with beasts strictly forbidden. Ex. 22:19 Figure 19

358

pacr on our healrh and well being. Whar changes are necessary ro decrease rhe bUIden of death and destruccion? Ler us look at some cimeless principles thar deal with this important ropic.

The Bible Reveals the True "Safe Sex" Early in rhe Scriprures God spoke with His own voice and wrote wirh Hjs own hand a unique set of ren moral imperatives known as rhe Ten Commandmenrs. The Bible does not call mese words ten suggescions or ren good ideas but rather Ten Commnndments. 77 Their very namc coupled wirh rheir unique manner of delivery-the only ponion of Scriprure wrÎeren direcdy by God Himselfshould provide re.ason enough for solemn reflection. Those Ten Commandmems provide a moral com thar many lack raday. They speJl our me difference bcrween right and wrong. Reflecr for a momenr on rhese ten inspired rules for living as found in Exodus 20. The ftrSt group offour commandmellts describes haw we should rdace to God. Thc last group ofsOc commandments focuses on inrerpersonal relarions. Ar rhe hearr of thar last group, we find commandment oumber seven presenred in the Old Tesrament. Jesus a150 referred ro chis specific commandmenr in the New Tesrament. Both rexrs are quored in Figure 18. Merriam Wehster's Collegiate Dictianary describes today's understanding of rhe word "adultery" as "volunrary sexual intercourse berween a marrieel man and someoile other than his wife or berween a married woman and someone other rhan her husband. ~78 However, the sevenrh commandmeru's injunction ro sexual puriry deals with more than JUSt physical acLS berween married individua1s. In His famous Sermon an thc MouJlt, Jesus revealed mat the sevenrh commandmenr was so broad thar it even exrends ro rhe levd of our thoughts. This New Testament quote refures rhe myth mat ollly the Old Testament, but nor the New, calls for sexual puriry. Elsewhere in the fim five books of the Bible (aD ofwhich are believed ca have been

AlDS AND HIV penned by Moses under inspiration), we read even more aboli[ the high st:tndards of sexual pUTiry embodied by the sevemh commandment. Three additionai aspects of sexual puriry are referred ta in Figure 19. We see tiut the Scriprures forbid homosexualit)', prostirurion, and besriaIity. If the world's populace had heeded the principle prohibiring homosexual relations, HIV likely would never have become a worldwide epidemie. Furrhermore, note rhar chis command is nor given wirh any reference ro marital srarus. The Scripture's caU for sexual puriry exrends to ali individuals-not jusr the married. The command forbidding prostiturion is no surprise-we have civil Iaws today forbidding it. The breaking of this commandmenr has had a major impact on the spre.ad of AIDS throughollt the world. Regarding the forbidding ofsex wirh beam, some have theorÎud mar HN was firsr introduce
God's Primary Pocus is an Our Thoughts AlI of rhe Old Testament principles we have looked ar are reinforced in the New Testament--ohen in even srronger . The words ofJesus earl)' in His ministry illustrate tne sinfulness of Iooking "on a woman ro Iust afrer her." This onition highlights a recurring biblical cheme. Gad al1d His Scripeures are not jusr concerned with sinful acrs, e.hey are concerned wirh a more central issue: sinful thoughes. Invariably, before sin is carried out in the life, it is conceived in the mind. This is why the Holy Wrjt is direcred toward rhe citade! of the soul, which is the human mind. Jesus' c1arification rhat the commandments extend ta sÎnful thoughts îs nor bad news. Instead, this insighr provides a powerful force in conrroUing the behaviors chac

seem ro be rhe mase difficuh ro hamess. If we never make a break with a behavior ar che level of our thoughrs, we are desrined ro eirher succumb ro temptation ar ro live in a consrant stare of frustrarion. For example, if you long for and dream of a forbidden acriviry, ulrimately you will likely eirher engage in that sin or wiU feel cremen· dOllsly deprived. If, an the other hand, you choose to accepc che Bible counse! thac sllch acrs are inappropriate ro even rhink abolit (ler alone engage in), chen you wiJl make real progress. IfI am tempted ro sin "in my rhoughcs," r can shifr my menral focus in anorher direction. This very pracrice will soon become habirual, and my mind will develop rendencies to think in different direcrions. The Bible rells us "...whacsoever things are true, whacsoever things are honest, whatsoever rhings are jusc, wharsoever things are pure, whatsoevcr rhings are lovely, whatsoever things are ofgood repon, ... think on these rhings. "80 Rather rhan adding ro my discomfort and sense ofdeprivarion, these new mental habirs will assisr me in resisting rempcacion. They will help me ro experience the freedom ofbeing conrroUed by my will rar.her than having emotional drives comrol me. Success in this line will require a person ro avoid reading and viewing sexladen films, videos, books, and magazines rhat are in direct opposition ro puriry of rhought. The parh t.o success wUllie very dose co the efforc in guarding the avenues of rhe soul.

The Bible Elaborates on Homosexual Relations As previously srated, homosexual reiations are srill che number one callse ofAIDS in rhe U.S. For mis reason, ir is imperarive to funher darify rhe biblica! counsel on this tOpic. The prohibitiol1s agaiosc homosexual relations are nor confined to t!le Old Testament, bur are enunciated in rhe New Testamem as well. In the New Tesramenr in Romans chapter L we read abolit the "vile affecrions" (verse 26) ofindividuals who are characrerized by 'ungodliness alld unrighreousness"

359

PROOF POSITIVE

OMOSEXUALI Y ADDRESSED THE NEW TESTAMENT "Wherefore God also gave them up to unclcanness through the lusts of their own hearts, to dishonour their own bodies bctween themselves..' . God gave them up unto vile affectiolls: for even their women did challge the iDaturall use iO'to that which is against nature: And likewise also the men, leaving the nS1tuul use of tbe woman, burned in their Iust one toward anotber; men witb men working that which is unseemly, and receiving in themselves that ~;---.... recompence of their error which was meet." Romans 1:24, 26-27 Figure 20

RISK "Know ye not that the unrighteous shall nof inherU the k1ingdom of God? Be not deceived: neither fornicators, nor idoJaters, nor adulterers, nor effeminate, nor abs of themselves with manki,nd, n9r thieves, nor covetous, Dor drunkards, nor revilers, nor extortioners, shall inherit the kingdom of God." 1 Cor. 6:9~10 Figure 21

360

(verse 18), Among ehe "vile" practices thac are menrioned is a c1ear reference ro homosexual relatiolls, as described in Figure 20. As cxpecred. mis age is in full harmony wirh che previoLJsly quored Old Testament prohibieions againsr homosexual aces. h is very importanc (Q disringuish between homosexual /lCU and homosexual tendmcies. There is evidence suggesting ehat some homosexual eendencies are rhe resule of foeces beyond che individual's concrol or

choice. Both human and animal research are beginning ro provide some valuable insiglns in chis regard. For example. Dr. Gumer Domer and colleagues have published a series of reports chat identifies an association between highly stressed mothers and birch ofmale homosexual offspring. In one scudy they found chac a signiftcantly higher numberofGerman homosexual men were horn during ehe stressful late World War Il and early pOSt war years. 81 They have do ne anjmal research suggeseing mac prenacal hormonal differences (which can he affecced by such chings as seress) can increase the likelihood of male offspring being born wi ch homosexual cendencies. 82 83 Studîes like ehese suggest chac ac lease some of che homosexual populacion may have inborn desires for cheir sexual preferences. This is importanc ro underscand. It should be made clear ehac oriencaeion does not provide license (Q engage in activities chac the Bible forbids. The Bible does not permit an individual with heterosexual tendencies to engage in sexual accs outside of marriageeither in chought or in deed. Neicher does che Bible permit chose with homouxuaLtendencies such license. In shore, che issue of sin /ies noe with the orimtation but wich what we do with that orimtation. Thete are many documented cases of individuals who formerly had a homosexual oriencacion. but now-through the power of God's grace-have heterosexual tendencies. Some of these individuals have encered into monogamous heterosexual reiat ionships.84. 85 The desire for homosexual relationships is parallel ro ehe desire. for adulcerous heterosexual relacionships ar the desire to steal. Ali ofchese desires can be overcome by the grace of Gad in a person's life. The New Testament has another warning co homosexuals. as quoted in Figure 21. The phrase. "abs of memse/ves with mallkind" in the New Testamem's original Greek indicares a man who engages in sexual activicywith anocher man. 86 Such individuals are classed with adulterers, rhieves, drunkards, etc. The cexe explains ehar those who are guilcy of such sins are risking cheir eternal destin}'.

AlDSAND HIV

WOrse Than AIDS? Whar could be worse rhan geuing AIDS? This Scripmral warning presents the thought that the eternal consequences of the sexual act that caused AlOS is worse than ilie eanhly suffering ofhaving AIOS. Consider this: wouldn'r it be better ro suffer and die with AIDS (even at a young age) and have eternal life in the Kingdom of God than to «live prosperously" for 75 or 80 years but not have the privilege ofenjoying God's eternal Kingdom? This is the essence of the meaning of the Scriptural age. The text spells ir Out c1early: those who engage in fornication, adulrery, and homosexual acrs will not inherir rhe Kingdom ofGod. Contirnuing in sexual pracrices that pur lIS ar high risk for AIDS has worse consequences than conrracting physical diseases.

God is More Interested in Giving Than in Taking Away Far from God talcing someming away from homosexuals, He is rrying co give them something of infinirely greater value. He is asking chem ro forgo their currenr sexual desires in view of a better existence for eterniry. Yer, as we have noted, God's counsel is /lot only "other-worldJy," it poincs out the way to rhe happiesr, healrhiesr existence in the "here and now." In realiry, God asks norhing more from rhose with homosexual tendencies than He does from [hose wirh a heterosexual orientation; namely, follow My words rhar are spoken with your presenc and eternal welfare in mind. le is nor cruelry but love mar asks a person co forsake a damaging desire in exchange for somerhing betcer. The recovering akoholic may often srruggle with strong desires ro drink. He may long for thar which he once found grear pleasure in-jusr one drink. Yer, those who uuly [ove him will provide every encouragemenc ta say no ro even the first sip. He is not being unfairly rreared-he is being loved. Yes, he may find instanr satisfaction in drinking, but if he jusr says no to rhis one pleasure-rhe door is open for him ro avoid the devastarÎng effecrs of alcoholism and

enjoya thousaJld more pleasures in this life and in rhe world ro come. Sa it is with rhose who have sexual desires rhat the Word ofGod describes as destructive. Manywith heterosexual rendencies as well as rhose with homosexual rendencies will have to say no ro forbidden sexual aets rhar once gave rhem sarisfacrion. Probably me greatesr irony is rhar wirh aii of r!le marital mife and discord in our eoul1try many married couples virrually curse rhe day thar rhey were wed, longing ro "break frec from a galling yoke." Some !lave broken free in rhe divorce couns. In spire of this, many of t!lose who are unable ta emer iota a marriage relationship feei cheared. Those rhat cannot emer inro a mOllogamous relarionship duc ro past infideliry, homosexual rendellcies, or some other reason-feel mar they are being deprived of something rhat is desirable. Despire what sociery may rry ta [eli us, rhere are plenry ofindividuals who are perfecrly comem and happy who do not have a «lover." Clearly, rhere is norhing that says happiness is dependent on being married and living wÎth a committed parrner. For instance, the Aposrle Paul felr that his not being married was better for his spiritual mini~rry (l Corimhians 7:7-8,32-34).

A HAPPY AND FULFILLING LIFE " ...in thy IGod's] presence is fulness of joy; at thy right hand there are pleasures for evermore." Psalm 16:11 "1 lJesus! am come 'hat they migbt have Ilife, aud tha. tbey might have it more abundantly." Johll 10:10 "And the Lord commanded us to do aII these sta.utes, for our good always, that he might preserve us alive, as it is this day." Deuterollomy 6:24 "O taste and see that the LORD is good: blcssed is thc man that trusteth in Him." Psalm 34:8 Figure 22

361

PROOF POSITIVE

[s the Bible Really Contrary to an Enjoyable Lift? There are rwo common myths about the Bible commandmenrs rhar should be brollght into focus. We have already been looking ar one of rhem in some derail; namely, thar following biblical principles "rakes ali rhe fun our oflife." Let us examÎne some Scriptural ages rhar refer ro a sarisfying life, quored in Figure 22. Those who 1 hear complaining about

REASONS FOR BETTER HEALTH AMONG RELIGIOUSLY OBSERVANT PEOPLE - AS PROPOSED BY SCIENTISTS

• Emotional wellbeiog fostered by a sense of belonging to a religious community • Relief in God • A relaxation response induced by frequent prayer · Higbly stable maribl and family bonding • Social providing a buffer against stressfullife events Figure 23

GOD'S LOVE IS STILL EXTENDED TOALLOFUS • "God created man perfect and holy. But mao fell from his holy state because he transgressed God's law. • Since the faU there has been a rapid increase in disease, sufferlng, and death. • Vet notwithstandiog man has insulted his Creator, G6d's love is stiJI extended to the race... • ... in order to Iive a perfect life, he must live in harmony with those naturallaws which govern his beiog. • Therefore it is of tbe greatest importance that he know how to live so that his powers of body and mind may be exercised to tbe glory of God." Figure 24

362

whar rhe Bible asks them ro give up often have never tried ro follow the Bible's way of life. But norice the phrases in ehese eexes: "fuJness ofjoy," "pleasures," "Iife more abundanr1y," "for our good always," "blessed is rhe man." Followiug a scriprural principle here or rhere may leave us feelillg deprived. However, we will experience the blessing ofa true sense offreedom ifwe accepr the Bible's (Oral message rhar includes an awareness of God's love, repenrance for pasc sins, forgiveness, and a commitmenr ro a Jifesryle mac is pleasing ro our Saviour. ''And ye shall know the rfUth, and rhe trurh shall make you free." Oohn 8:31-32). Far from resrricting our libereies and enjoymencs, following God's ways frees lIS from ehe ryranny ofbad habirs and other de1ererious ways of living. We arc freed ro live the most satisl)ring, fulfilliug, and gllilr-free life. Indeed, to ehe person fearful of contracting AIDS, ehe Bible poinrs tO a way of safery. To an individual suffering wieh the disease and dealing with guilt, the same Bible otlers the keys ro resolving the very guilr lJ1any accuse it of causlllg. In (he medical lieerarure there are indications that individuals who truse God live longer. For example, Dr. Jcremy Kark and colleagues recencly compared two ethnically Jewish groups ehar seemed ro be very similarexcept for religious observance. 87 Among of a secular communiry, ehe risk of death ar any age was nearly dOllble rhat ofthose of a religious comll1unity, rhat is, rhose who were religiously observam. In a similar srudy, recent stressfullife evcnts increased the risk of health problcms in a secular communiry. ofa comparison religious communÎry seemed ro be protecred from me negative effeces ofstress. Dr. Kark's tcam proposed some reasons why the of rdigious communities expericncc srress-buffering and improved longevity. They are liseed in Figure 23. Perhaps just as imporranr as Kark's reasons is that true believers have rhe assurance mat ifehey know what is right and trusr in God, He will give them me power ro do what is right, which will rhen spare them numerous diseases.

AIDS AND HIV The disease.s ofhumankind have muhiplied since the beginning of man's sinful existence. However, if we live in hannony wim natural laws, che risk of contracting disease is greatly reduced. God's love is ca1ling us ta sllch a lifesryle, as expressed by Ellen Whire in Figllre 24. 88

GodAddresses YtJUr Power Shortage A second myth about the Bible principb relacing ro sexuaIity is thar even if we ali wanted ro follow them, we Iack the power tO do so. Many believe chac it is impossible for che average adult (Jet a!one a reenager ar yourh) ro follow rhe scriptural commands deal ing wich sexualiry. Consequenrly, rhey promote merhoru mar when compared with abstinence, actually increase the risk of spre
lastillg solucions. The mast sllccessful way tO deal wirh guilr is ro acknowledge our guilr and seek the forgiveness of the one we have wronged. The very ission of wrongdoing is difficulr for many of us. In chis era it has become unpopular ro it doillg anyrhing wrong. We are a people who go ro grea[ lengths ro avoid saying we made a misrake. Blaming circumstances or someone else seems Like a much easier course. However, accepting thac you have sinned (done wrang) is the fim srep in spiritual healing.

Forgiveness is Abundantly Available The Bible is aha plain mat God's forgiveness is avajlabJe. The Scripcures reveal that if we humbly curn ro God, confident ofHis desire ro forgive us, and repent (Jeave behind our sinflll wavs) then God wiU forgive us (" ... He will abundandy pardon."89). Fairh (confidence) in a loving anei forgiving Saviour leads liS to true repentance (sorrow for sin) and a desi re for reformation ("... the goodness of God leadedl chee ta repencance. "90). This, in rurn, prompts us ro confess and forsake our old ways of wrongdoing. Individuals who have cOlllmitted sinfu! acrs can indeed inherir che Kingdolll of Gad rhrough faith and repentance. Even when individuals become HIV-infecred because of pracrices condemned by the Bible. their situarion is noc hopeless. Chrisc will and does forgive mem. Tha[ is indeed good ncws.

The Nature ofGod's Coming Heavenly Kingdom Man)' misunderscand God's forgiveness. Althougll God forgives us when we exercise faith in Him, rhis does not provide a license ro sin. In Romans 3:31, Paul addresses rhis direcdy. He says that by fairh we acmaUy establish the law rarher than abolish it. Alrhough rhe Bible promises a new body when believers emer into heaven ar che resurrecrion (" ... rhe elead shall be raised incorrupcible [indesrrucrib!e]"91), ir does nor promise a new characrer. It is true, we are given a "new birrh" when by faich we embrate Chrisr as our persona! Saviour. The

363

PROOF POSITIVE devdopmenr of a new character Jiarts with chis new beginning, and continues throughout aur liferime as we allow Gad ro develop in us a nature chac is in harmony widl His. Ali of rhis is important because aur loving Father is now seeking ro prepare che cluracters of rhose who love Him for an erernity of joy in heaven. Whar will heaven be Iike? The principles of sexual purity wiJl nor be changed there. Homosexual re1ations, prostirmion, and bestiality will not suddellly bc "ali righr." What would heaven be like if tl1e inhabitams there (lever conrrolled SUcil sexual desires? There woutd be no pleasure in an eternicy of hea.ven for rhose whose charac(ers llad nor a1ready been cleansed of (heir sinfui paHerns of thinking. So when Gad speaks againsc sexual sins in ali their forms, He does so in [ave, wich aur good in mind. Our heavenly Facher is showing us whac aur characcers need to be like ro enjoy ecemit}' wirh Him. As rhe aposde Paul put it: "Al1d be noc conformed ro chis world: but be ye cransformed by the renewing ofyour mind, rhar ye may prove whac is that good, and acceptable, and perfect, will of God."92 Furthermore, Gad is cOJnmitted ro give success in this work of character cransformation ro aII who choose it; otherwise, He

would not command it. Indeed, God never asks us ro do anyching chac we cannot accomplish by worlcing together wirh Him. Let us look at severat Bible promises rhat give us assurallce rhar God will give lIS the power ro live che very tife He has called us ro live; rhey are showll in Figure 25. In rhe believer's life, God rakes t!le responsibiliry both for rhe desire to do right ("ro will") and che doing of righc (' ro do"). It is important ro emphasize rhat when \Ve choose ro cooperare wirh God and rely on His power, He changes our wiU. The sin fui desires, rhe tendencies ro sin thar have seemingly erched ineletible channels in our minds, are overcome by God who causes llS "ro will and ro do" whar He has revealed is righc. The mie of human and divine cooperacion is similar ro driving a car wirh power steering. 1 must make che choices, 1 must turn the wheel, bm when I cllrn the wheel, a power beyond my humall.ity (ellgineers caII it 't "power assist") makes che rufll easy for me. YOl! will find more biblical ioformat ion 011 how yOll can obtain access ro rhis Source of Divine Power who forgives our wrongeloing and aSSllfes liS ofvictoriolls living in Chapter \8, "DeaJing Wirh Bad Habits and Addictions."

HIV Jnfection and the Brain

Figure 25

364

Unfortunately, many HIV-infected individuals do noc rake advancage of che forgiveness tiUt God makes freely available. In fact, as rhe HIV disease process peogresses, ir may become difficult-if noc impossible-ro choose God's forgiveness. How can J make such a bold statemenr? My conc1usion comes from an understanding of how HrV affects chc body. Lec us look al some additional dimensions of HJV infcecion {hac have raught me (his importanr message: che sooncr an HTV-infecced individual addresscs the spiritual issues, the be{cer. Onee the AIDS virus gains access imo a person, ic cends ro proliferace and multiply: It has ac !e.asc two primar)' effecrs an {he human body. One is fhe weal(ening of the immune system, and tlle orher is rhe dererioration of che br.lin, The infC::(;lions and

AlOSAND HIV cancers are secondary effeCls ofHI'/, caused by rhe weakened immune sysrem. The damage ro rhe brain is described in Figurc 26. 93 A very important practical considerauon aJÎses from aur undersranding of HIV's attraCrlon ro rhe brain. Namely, rhose who are diagnosed as being HIV posirive should "ger rheir life in order." Even if a person CaJ1 survive rhe severe infecrions and orher disorders rhar stalk rhe HIV-infected, brain funcrion may rapidly dereriorare due ro the AlOS Oementia Complex. In orher words, once a person is diagnosed wirh AIOS, rhere is no guarantee of how mueh rime is lefr before losing menral comperence. The hours rem;lÎning are golden. A personal reJarionship wirh God should bc fim prioriry. before rhe opportuniry slips away into ererniry. If rhere are financial afElirs ro arrange, now is rhe rime to arrange chem. lf rhere are misunderstandings to clear up among friends or family, there should be no delay.

Conclusion Wherher you are seeking to avoid HIV infecrion or deal wirh an already csrablishcd infection, [ can poinr you to no more powerful answers rhan rhose found in [he Bible. In facr, when we rhînk of [he sobering realicies of AJOS, none of us has any rime ro wasre. Those who are nor HIV positive eould become infected as the result of jusr one incident ofbreaking God's commandments. Those wirh [he infecrion may al~ ready be movîng down rhe slippery slope of AIOS dementîa. lam convinced rhar God never wanred rhe disease of Al OS ro ravage humaniry. He poinred out a way ofliving rhar would have prevenred rhis scourge from ever gaining a foorhold. Yet, it is nor too Lare (O redis-

AIDS . . . . . . . . . • The most important direct clinica! effect of HIV infection is 00 tbe nervous system. • The brain appears to serve as a privileged sanctuary for mv replication [multiplication ofthe virus]. • Fully two-thirds of those with AlDS have AJDS Dementia Complex, causing progressive behavior changes and loss of intellectual faculties. • There is also a slowing of movements, as well as changes in discrete areas of the brain that resemble a stroke. • Affected individuals may Iose strength or develop paralysis in an arm or a leg. Figure 26 cover lhe power of God's commandments and God's promises. We, as individuals, as a narion, and as a world cOllununiry can beat the AIOS epidemic. We can bear ir wherher or nor a vaccine or "magic eure drug" is ever devdoped. I believe we can stop HIV rransmission dead in ilS uacks by rerurning ro the Bible, rhe Bible's Gad, and His inspired tules for living. Nor only will HIV rransmission be dramarically eurtailed, bur 40,000 lives will be saved each year in aur nation. not ro mention the diminishing of lIJltold suffering and finallcial loss from sexlIally uansmirrcd diseases,94 Now is indeed rhe rime ro take advantage of God's graciolls offer of forgiveness. Now is rhe rime to rely on Him for rhe power ro live a life rhar is in harrnol)y wirh His commandmenrs. Such a life wiU enhance our immllne sysrems, keeps us from high-risk acrivities, and mOSt imporranrly, prepare us for an erernÎry of jay wirh Him.

365

PROOF POSITIVE References Centcrs for Diseasc Control :tnd l'revcnLion ( DC). VOI1/11I111Y H/V Cbll/lulillg nnd urrillg: Fllcu, /sSlIl'5 nndAJlJweYS. Publicarion NAIEP 7/94 D545, 1994 p. 4. I

1 Centcr for Disease COl1lrol and P(cvcnrion (CDC). Upclale: rrencls in AJDS incidcnce, d"'llh, and prt.'Valence-Unilcd Slalcs. 1996. MM\f?R 1997 Fcb. 28;46(8): 165-173.

Cenrers for Oise;ue COlllrol and Prevcnrion (COC). Upd:llC: lrcnds il1 AJOS incidcncc. deam. :tnd prcvakncc-Unilecl lalCS. 1996. MMWR 1997 Fcb. 28;46(8): 165-173. J

Ccmers for Oisease COlJlrol aJld Prevclllion (COC). Vol1l1lTOry HIV COlimeJillg 1I1/(} lesling: NWS. IrSlles linII Amwm. Publicalioll NAIEP 7/94

I

0545.1994 p. 19. 25 l.:lckrirz EM. Sanen GA, el al. Eslimaled risk of tr;Ulsmission of lhe

hllrnan immunodc/lcicncy virus by crcened blood in Ihe Uniled Stales. N ElIgl J Med 1995 Oec 28;333(26): 1721-1725. M

Cemers for Oisease

on(rol and Prevemion (COC). HIl/IA/DS Sur-

otil/atlet Rrparl. 19'>5 Oee.;7(2):5. 17

Fim 500,000 AIOS ca.cs-Unitcd (ales. 1995. MMWR Morb Morllu

)'(Ikly Rep 1995 Nov 24;44(46):849-853.

4 enrers for Ois"'''e Conlrol :tnd Prcvcnrion (COC). Updale: Morraury attriburable LO HlV in(ecrion among persons aged 25-44 yea.rs-Un;red Stare'>, 1994. MMWR 1996 Feb 16;45(6):121-125.

,. Centers for Ois"'l5e Control and Prevention (CDC). HIVIA/DS SIIToril/otla Reporl. 1996 Oec;8(J): 10.

Cemers for Oi5e:l5" Conrrol and Prevemion (COC). Vpdarc: Monaliry :U1riburable 10 HIV infeetion among pcrsons aged 25-44 ycars-Unilcd Slales. 1994. MMWR 1996 Feb 16;45(6}:121-125.

oril/nlla R~port. 1996 Oec;8( 1):31.

G Ccllters

Inc. J-l<':llrh Profe..<.
1

for Oiscase COl1lrol and Prcvelllion (COC). MOrl>LlilY PaucrnsUnilccl Slalcs, 1993. MMWR 1996 M:u 1;45(8):161-164. . Hdlinger FJ. Thc lifetime COSI of m'ating a person Wilh H!V. JAMA 1993 JuI28;270(4}:474-478.

7

Helli nger

FJ.

ForeclSl of lhc com of mcdieaJ care for persons \ViI h H!V: 1992.1995. /nfJuiry 1992 Fall;29(3}:356-365.

8

World Hcallh Orgotnization (WHO). TIJe \'(/or/d HealtlJ Reporl 1995: Bridging tIJe GaJ>f. Geneva, Swiro:rland: World Ht.-alrh Organi1..1tion. 1995.

9

Brown LR, F1.lvin C, el al. HIV/AIOS Pandemic Sprcacling Fasler. In: Vila/ S(~I 1996: Thr TrmdJ TIJOI Are Sbltl'illg Our FI/tIm. New York: W. W. Nonon & Co, 1996. 10

It

Il

United Nn.f.ums AJDS progrl1m e5limales July. 19'>7. Fil'$t 500,000 AJOS Cl5cs-Unil<.-d Slate:;, 1995. MMWR Morb MartIri R~ 1995 Nov 24;44(46}:849-853.

Wkl)' 'J

Celllc" for Oisc::l5c Control and Prevelllion (COC). H/VIAJDS Sur-

IJrilkmtt Rrpan. 1995 Dce;7(2):5. I~ Hcr h BS. Popovici F. el al. Aequircd ilTllllunodd'ciency syndrome in Romania. Lanctl 1991 Sep 14:338(8768}:645-649.

Vidmar L, Polj'lk M. el al. Transmission of HIV-I b}' human bite. umcet 1996 Jun 22:347(9017): 1762. Il

CClllers for Oist:1se Control al1d Prevenlion (COC). AJDS Prellt'ntion Gllitle. Publieatioll OHA 8/94 D458. 1994 p. 5. 16

Baba TW, Triehcl AM, el al. Infeclion and AIOS in adult macaques afr('r JlOlllTaumatic oral exposure ro cell-free srv. Sârncr 1996 JlIn 7:272(5267}: 1486-1489. 17

Updarc: Acqllircd lmmunodeficicncy Syndrome--Unilcd Slales. 1994. MMWR 1995 Fcb 3;44(4}:64-67. lB

19

Updare: Acqllircd rmmllLlodefie.iency Syndromc-Unjlcd Statc~. 1994.

MMWR 1995 Fcb 3;44(4}:64-67. 10 Upd:lle: Acquircd ImmllllOdcficicney Sylldrome-Ullilcd Slares. 1994. MMWR 1995 Fcb 3;44(4):64-67.

Celllcrs for Oisease COl1lrol and I'revclllion (COC). Vo/llnulry HIV lrmer mld Ansrufr>·. Publication NAIEP 7/94 0545, 1994 p. 8.

2>

Cowlse/illg Ilnd l~slillg: NICU. l.!

FiTSl500,000 AJOS Clscs-Unilcd SralC5. 1995. MMW'R Morb Mortal Rrp 1995 Nov 24;44(46):849-853.

W1kţy

bckrilz EM, Sallell GA, Ct al. EsIJrn~tcd risk of lr:msmÎ"Sion of tlle human immunode/lciency virus by screeocd blood În lhe Vnilcd SI:1ICS. N ElIgl] Mrd 1995 Oec 28;333(26):172)-1725. 13

366

I?

emer. for Oise,lse Comrol and Prevcmion ( OC). HJVIA/DS SI/r-

o lsselbachcr KJ, Br,nlJ1wald E. el al, edilors. Horrisolls Prillciples of/merIIIIL Mrr/icitlI'-13,lJ etlilioll (CO-ROM ). New York. NY: McGraw-HiU. Ccnrcrs for Oiscase Control and I'rc"clllion (CDC). H/VIA/DS Surveillmm Repol·!. 1996 Occ;8( I}: 10.

31

) Upd,l(e: Acqllired ImmwlOdcficicnc)' Syudromc-Uniled Sratcs, 1'>94. MMIVR 1995 Feb 3:44(4):64-67. 33

First 500.000 AJOS cases- nilcd SI31es. 1995. MJtIlWR Morb Mlmlll

\'(Ikly Rep 1995 Nov 24;44(46):849-853. IsselbadlCl KJ, BrallJ1\vaJd E, cr al, edilors. HnrrWlJi Prilltip/~s oflmrrlIoL M~dicinI'-13fl' editioll (CO-ROM). New York. Y: McGraw-l-lill, Ine.

.l-l

H"'Ilth l'rofcssions Oivision, 1994. .1\

Ccmers for Oiseasc Conlrol and Prcvemion (COC). AJDS Pr~omlioll Publicllion OHA 8/94 0458. 1994 p. 5-6.

GI/id~. .16

cnlcrs for Oiscase Conrrol al1d Prcvclllion (COC). AIDS PrevmriOIl

Gllide. Public.1tion OHA 8194 0458, 1994 p. 7. Ji Ljf on AR, Icssol NA. RUlherford GW. Progres ion and dinie:tl outcome of infccrion due 10 human immllnoc:lefieiency virus. C/illlnftCl Dis 1992 Apr;14(4}:966-972. 3Il Alclb"s P. Munoz A. Incubation period of hllman immllnodcficiency virus. Epil/elllio/ /Q·v 1993; 15(2):303-318.

39

Fauei AS. Hosl factors and Ibe pamogenesis of H!V-indlle.cd d;se;ue.

NOfI/T( 1996 Occ 12;384(6609):529-534. I'axron WA. Marti" SR. el al. Relative re~iSlancc ro HIV-) infcerion of C04 Iymphoeylcs from pcrsons ",ho rClllain lInJnJc led despilc multiple high-risk sexual exposurc. NlJllv/fd )996 Apr:2(4):412-417.

40

Rool-J3ernslcin, RS. RrrhilJking A1DS: TlJt Thlgir Caft Of Pmnt1ll/rt' Y: The Frec Pres. (A Oivision of Macmillan and Co.),1993. 41

COllmmlS. New York,

4, Rool-BernSlein RS. Alternative H),p{)Lhese~ for Explaining AJDS. In: Relbinkillg AIDS: The Tragic COfT OfPremllwrr COI/S~muf. New York, NY: The Frec Press (A Oivision of Macmillan and Co.). )993 p. 334. J Rool-BernSlein RS. Immuno upprcs ion ~ncl AlO . In: Relbinking A/DS: TIu Tragic COSI OfPrelllll/1I1"/: COlIJeIlSllS. Ncw York, NY: Thc Frec

Pre55 (A OivisiOl1 of Macmil1al1 and Co.). 1993 p. 121-127. <1, Turner 13), Hauck WW. er al. Cigarerrc smoking and malcmal-child HIV rransmission. J Alfllir /mmllHI' Dtf1e Syndr Hllm RnrooÎl-01 1997 Apr 1; J4(4):327-337. ..~ Rool-Bcmstein RS. Alternative HYPolheses for E."pla.ining MOS. In:

RrlbiJlkinK A/DS: Tbr Tragic COSI OfPre1llot1lr~ C01lSeI/SUf. -ew York. NY: Tlte Free f'ress (A Oivision of Macmillan ,md Co.). 1993 p. 129-133. 6 Scirmijlc pmmllllion given516J96 iti l'(/osbillgtOIl, D. C. by Preston Marx of lhe I "ew York Universiry Scbool of Medieinc and lhe A2ron Oiamond

AIDSANDHIV AlOS Rcscarch Center in New York Ci!)' on Proge lerone and the Risk of SIV Transrnission. i

J)'" Im~rrullio,utJ Confermce 011 AlD5 iti

VrJru'ouver B,-itisb Columbia as

report~ by Dr. Judilh Wasserheil, director of lhc division ofsexually uans·

mincd disc.ase, prevenlion al lhe U.S. Cenler' for Discase COlllro! and Prcvelltioll. JlIly, 1996. Root-Bemslcin RS. Immunosuppression and AIDS. In: RellJillkillg A1D5: Tbe Trrlf{ic COJI OfPrenll1t1tre CommslIJ. Ncw York. NY: The Frec Prcss (A DivÎsion of MacmilJan and Co.), 1993 p. 136-140.

•

9 Root-Bemstdn RS. A1ternalive Hyporheses for Exptlining AloS. In: Rethillki1lgAlDS: Tbe 'Ţ,-tlgie COSI Offumatlo'" Commsus. New York, NY:

Tlle Frec: Press (A Oivision of Maemillan and Co.), 1993 p. 327-349. o Fineberg HV, Wilson ME. Social vulnerabili!)' and death by infectioo. N E1Igl} Mcd 1996 Mar 28;334(13):8S9-860.

II Rool-Befl1s1ein RS. Immllnosuppressian and AIDS. In; Rt'thi1lking JUDS: The Trrlgje COSI OfPrmllllure ComenslIJ. New York, NY: The rree Press (A Oivision of MacmiJlan and Co.). 1993 p. 121.

(, National 1nSIitlltes ofHealth Consellsus Dcvelopmem ConfcrenceStatemenI on Cervical emcer. (Draft of statc/lle/ll prepared based on April4. 1996 basoo on April 1·3. 1996 eonference). 66 MeGinnisJM. roege WH. Acmal Causes ofoe.:llh in tlle Unilcd Stale5. JAMA 1993 No\' 10;270(18):2207-2212. 67 McGinnisJM, fooege WH. Anual Causes ofDealh in lhe Unitcd Srales. JAMA 1993 Nov 10;270(18):2207-2212. 68

McGinllis JM. Foege WH. Acrual Callscs of Dealh in the Unieed Slarcs. 1993 o\' 10:270(18):2207-2212.

JAMA

US DeparUllCnl of Health and Human Services. Sexually Transmiued Diseases. In: Hl'izlrby Pl'op/~ 2000. Washington, o.e.: oHHS PlIbJic.1lion No. (PHS) 91-S0212, 1990:496.

69

o US Prevenlive Services Task Porcc. CounsdiIlg tO ['revent Human Immunodeficieney Virus Infeetion and Other Sexually TNlIlsm illCd Diseascs. In: CI/ir/,· to etilliml Prevmtivl'Servias-2"J cdiriol/. l3altimore. MD: Williams and Wilkins. 1989 p. 331.

ROot-BertlSlein RS. Alternaci,'c Hypotheses for Explaining AIDS. In: Relhinki1lg AlDS: TIu Tmgie Cost OfPtr.JIllltlll-e Commsw. New York, NY: The Free Press (A Division of Macmillan and Co.). 1993:327-349.

US Prcvemive Services lask foree. Counseling 10 PrevenI HlIlllan Imlllunodelicienev Virus Infecrinn :Uld Olher Se.xuallv Tr:lllSmiued Diseascs. In: Cllitl~ 10 CtilliCllJ Pmmui/Jc Serviees-2"'/ edi~ion. Bahimore, MD: WiUiams and Wilkins, 1989 p. 331.

» Bagasra O, K.1jdacsy-B:llla A. Lischn~r

i2

2

HW. [lleCI ofalcohol ingeslion

on in vitro susceplibiliry of pcripbcral blood mOl1onudear cclls 10 infec-

tion witb H I V and of sdected T-cell functions. Akohol Clin Exp Res 1989 Oct; 13(5):636-643. ;, Rool-Bernstein RS. Immunosuppressioll and AJOS. In: Rl'lhinkillg AIDS: Tlir Tmgir Cosi OfPrm1Jlttire COlIStIlSllJ. Ntw York, NY: The Free I'ress (A Division of Macmillan aod Co.). 1993 p. 127. II Evans OL. Leserman J. ee al. Severe life Slress as a predictor of early diseasc: progression in HIV infection. Am} Psyehilllry 1997 May; 154(S):630-634.

il

US Darrmellt of HeaJrh aod Human Services. Sexually Transm1lted Diseases. In: Hl'illlhy P"opl,· 2000. Washington, De OI-II-IS Publication No. (PI-IS) 91- S0212. 1990 p. 496. US Deparrmenr of l-IeaJlh and !-Iuman Serviccs. Sexua!Jy li-ansmiued Djseases. In; HMlrby P~ople 2000. Washington, De oHHS Public31ion No. (PHS) 91-S0212, 1990 p. 496.

7;

74 McGiIUlisJM. FOl'ge WH. Actual CausesofDeath in tl" United States. }AMA 1993 No" 10;270(18):2207-2212.

Extmpolaled rrom. McGinnis JM, Foegc WH. Actlla.l Causes of oeath in ilie United Slates./AMA 1993 Nov 10;270(18):1207-2212. combined Celllers for Dis~as(' Control and Pre\'enlion(CDC). HIVIAIDS SlIrveill,mce RepurI. 1995 Dcc:7(2):19. Erom 1920 to 1994 lhe estimatcdAlDS deaths duc 10 sexual behavior well{ (rom 21,000 10 31,000, 1hu.< l!le 1994 llpdated fil;t~ 75

1(,

m

17 Tang AM. Graham NM, ee al. Associalion beeween serum vitamin A :lnd E Jevds and HIV-I disease progression. AJDS 1997 Apr:) t(S):613620.

7(,

Blair. JE. linies in SpOrlS medicine. AIDS and the athktc: Does comperitian carry a risk? Ftlmily ?rlUriu Rremifri'iltiu/I 1994 May: 16(5): 1627.

IS Tang AM. Graham NM. el al. Law serUIl1 vitamin B-12 concentrations are associaled widl fimer hllmal1 illlf11unodeficiency virus !)'pc 1 (HIV-l) disease progression. J N/I/r 1997 Feh: 127(2):34S-351. 19 Her/..enberg LA. De Rosa

se, el al.

Glmathione ddl.cieney is associaeed witll impaired survjvaJ jn HIV disease. hoe NrlllAtlld Sâ USA 1997 Mar 4;94(5): 1967-1972-

Chlam}'dia uaehomalis geniral in(ecliollS-Unile.r:! States, 1995. MMWR

Murb MOr/rJ/ \Vkly Rep 1997 Mar 7;46(9): 193-198. 77

DelllerOnOm)' 4: 12-13. TIu Holy SiMt'. Aurhor~ed KingJames version.

78

Arillli"'y w"bstel'5 CoJ1egirlte Dietionf1ry--}(Ji: editioll. Springfield, Mas-

sachusetts: MerriaJl\ Webstes, Ine.. 1994 p. 17. Sassnau R. Monkcy AIDS. a New Zoonosis? Ticmrzrl Pmx 1993 Jlln;21 (3):271-273. 79

so Philippians 4:8. The H09' BiMt!. Authori'l"''CI King Jal11e,< version.

Adapte,l frorn Centers for Disease Control and Preventioll (CDC). HIVI AIDSSurveilltJnu Rrporr. 1996 D('<:;8(1):10. Aod from Fim 500,OOOAJDS cases-Uniled States. 1995. MMWR Morb MorttlJ Wkly R"p 1995 Nov 24;44(46):849-853.

87

Whiring A. He:thh & Temperance Dep!., General Conference of Se"elllh-day Advenlis15. Silver Springs MD. Publi.shed in the Mvmtist Rl'vit./IJ 1992.

8;

60

61

General Conference of Sevenul-day AdvenriSlS. Health Dep'trtmelll. Stlver Spring, MD. Pl'I'solllll communiCtllioll. (RWS) ,1996. (,2

National in5tilUlCS ofHe;I.hh Consenms Dc.:vdopmelll Conference Slatement on Cervicai Cancer. (Dmit of st,uemem preparcd based on April4, 1996 bascd on ApriJ 1-3. 1996 oonference).

63

(,.( NalionallnstiruresofHealth Conscl.lSus Deve10pmcllI ('.on(erence StalemCIll on CervicaJ Cancer. (Draft of stal<;meJlt prepareJ basl,d on April 4, 1996 based on April1-}. 1996 conferenee).

Domer G. Geicr T, el aL Prenatal stress as possible aetjogenelic factor of homosexuality in human mal" . ElIIJokrillologie 1980 Jun;7S(3):36S-368.

81

Domer G. Poppe 1, el al. Gene- ;Ind en\'ironmelll-dependenl neuroendocrine etiogenes.is or homosexualiI}' and transsexuaJisrn. Exp Clill EndoL"'iIl011991 :98(2): 141-150.

Dame! G, Doeke F. ce al. Sexual ditTerellli,uion of gonadotrophin sec.retion. sexual oricmalion and gender role bcha\'ior. } Staoid Bioebem 1987;27(4-6): I 081. -1 087. Onee Gay Always Ga)'? Foms Oll rb" Famiţ" Ml1g'lzint, 1994 March p. 3-5.

84

81 O\'crcoming the biologieal impemri\'e. Leners ta the Editor. WaJl SlTrl'r }OIlYllfll, Feb. 2 1997.

StrongJ. AbingdoJ/5 511'01Ig5 ExbllwtiVl' Crmeorr/Ilnce ofthl! Bibll'. Nashville, T : Abingdon Pres>. 1986. (New 7csta/f/mt refirme" /lI/mbm 730.

'6

733, tll/d 2845).

367

PROOF POSITIVE Kark }O. Shemi G. el al. Oocs rcligious observ:locc promate heahh' morulicy io secular \'li rdigious kibbut7.im iJ' Israel. Am j P"biic Ht'ltlt!J 1996 Mar;86(3):341-346.

8;

While EG. TrJtimollif$ for tiu CJmrr!J (Volume. 3). Nampa.10: l'acific Press Publishiog Associ:lIion. 1872-1875 p. 162.

l!8

Th~

Holy

Bibl~.

81

IsaÎah 55:7.

'JO

Romaos 2:4. TIu Holy

91

1 Corjnthians. 15:52. Th~ Holy Bib/~. AuthorÎ7.cd Kiog James version.

92 Romaos 12:2. Th~

368

Bib/~.

Authorizcd KingJames version. Authorizcd Kiog Jamcs versioo.

Holy Bibk. Aurhoriz.cd Kiog }ames version.

Rubin RH. Acquircd Immuoodeficieocy Syndrame, 1993. tific AlIlt'riClt1l Mdicin~ (CO-ROM), 1995.

93

10:

Scim-

EX1r:tI'Qbrcd rrom. McGinnis JM, Fo(-ge WH. Acrual causcs of dcarh in the Unite
94

CHAPTER SIXTEEN

DYINGFORA

IGA

TTE?

KICKTHE HABIT ANDLIVE r wasn'r supposed ro happen chis way. Sure, Melissa knew that she was cur ring her life shorr by smoking. "Buc who cares," she reasoned, "wherher I live inco my 70s or my 80s. Besides, I can aIways quir long before men." No one had prepared her for chis, however. At oniy 42 years of age she had heard those terrible words: "Jung cancer" and "terminal." Like most smokers who get lung cancer, Melissa's disease had already spread far beyond her lungs. It was too late for lifesaving surgery. Now in a desperate atlempt for a few more weeks or months, Melissa was going through rhe ordeal of chemomerapy aud radiation. Melissa never reaUy wanted ro smoke. She sraned in grade school because "ali the other girLs were doing iL" The habit was popular in high school, (00, so she stuck wirh it-"just sociaUy." She knew rhac she could quir ar any time. She would never become addicred. Bur a yea! aher she graduared from high school me rerrible realiry sunk in: like over 95 percent ofsociaJ smokers, Melissa had become adrucred. After severa! unsuccessful quir arrempts, she reasoned mat she enjoyed the habit anyway and would wait until she was older-or had

healm problems-before she rried ro quir again. Unfortunare1y, her first smoking-reIated health problem was eerm i nall ung cancer. She uJtîmately rud guit. Aboue faur monrhs afrer rhe djagnosis of cancer, MeIissa was dead. l Tobacco addicrÎon. Ir is by far America's leading addjcrion when assessed in of damaging our narion's healrh. However, (obacco docs nor need ro have d1is unenviable distinction. Millions of America.ns atresc thar this Iubit can be kicked, bcc.1.use they have done it. And rhe best news of aII is that if you are a smoker, YUli c.1.n be successful in "kicking the habit." This chapter is divided into eight sections: Section I explores the widespread damage dane by smoking. Section II examines the various cancers related ro smoking. Section III addresses heare disease and diseases of blooe! vessels. Section IV deaJs with che far-reaching effecrs of smoking on nonsmokers. Section V deals wid1 chronic lung diseases caused by smoking.

PROOF POSITIVE

INFORMATION ON THE DANGERS Motivation to Quit There is no quesrion ehar rhe knowledge OF SMOKING HELPS SMOKERS of smoking's physical harms can provide some of rhe mosr powerful motivations co KICK THE RABIT J. In 1963, per capita tobacco consumption in tbe U.S. peaked, witb smokers estimated at 42 percent of the population. 2. The following year, tbe U.S. Surgcon General announced that smoking caused lung cancer. 3. From that poiot on, ~here bas been a steady decline in the number of smokers by about 1 percent every two ye.ars. 4. Only 25.5 percent smoked in 1990 compared to 40.4 perccnt in 1965. 5. Over 44 million Americans Ihave quit siDee 1964. 6. Thc steady decline in smoking ratcs following the 1964 Surgcon General's rort is evidencc that I knowledge of smoking's harros potentiates the pow.~_r to quit the habit.

.-

Figure 1

Seetjon VI covers healrh problems

callsed by cigarettes (hat rob us of qua.liry of life. SectÎan VII presenrs the deva5t
SECTION]

The Cumulative Impact ofSmoking Alrhough rhe majoriry of smokers express a desire ro quir smoking. only a minoriry have real plans ro (ake mat step in rhe near fumre. What are ule facrors rhar lcad up ro someone finally saying. "It is rime for me ro lcick the habir"? Aud of equal imporrance. whar facrors will help a person who makes rhat decision be successflll? This chaprer is dedicared ro helping nonsmokers remain nonsmokers. helping smokers see mar the besr time ro quir is roday. and giving everyone t!le {Ools ro be free of robacco in alI its forms.

370

quit. Such information has helped morivare mally ro kick rhe habir. as shown in Figure 1. 2 The rrends following the Surgeon General's announcement provide srrong evidence that knowledge of smoking's dangers can help a smoker decide ro quit. Some of [he information in rhis chapter on the physical harms of smoking will be familiar. However, much of it will not be. The full scope ofsmoking's damage has not been \VeI! publicized. In a 1983 Harris survey, healrh professionals rared "not smoking" as tile very fjrsr prioriry among acrivities that Americans could do ro proreCt meir healrh. The public, however. rated "nor smoking" a distanc 10rh on t!le lisr of imporranc health prorecrive behaviors. 3 Public healrh professionals oCren srand amazed at how complacenc we are as a sociery regarding smoking. For nearly 20 years, influenrial public health voices have called smoking rhe most dangerous public issue marwe face. In 1979, me U.S. publichealm service called smoking uthe largesr single prevenrable cause of illness and premature death in rhe United Srares." C. Everett Koop made a bold pronouncement duee years later during his renure as Surgeon General. He pronoul'ced smoking "the mosr important public hea)rh issue of OUT rime." Dr. RonaJd Davis, in citing such statements, poincs out, uFurure hisrorians willlook back wirh amazemenc that it rook sociery so long ro conrrol rhe use of {Obacco."4 Why does the public seem ro have a diIferem view of rhis addiction rhan professionals? Parc of thc rcason re!ates ro robacco industry pracrices of exercising a rype of ccnsorship againsr bad press regarding nicorine and smoking. They accomplish rhis by influencing the coverage of informarion in magazines rhar are dependent on robacco advercising dollars for their exisrence. S Ac[Ual research srudies show rhar magazines (har depend largely ou cigarene adverrising are less likely ro feature arric1c.s dealing wirh

DYING FOR A CIGARETTE? smoking's hazards. This is particularly noticeable in women's magazines. 6 There are mher risks from smoking besides rhose that affecr the personal healrh of smokers. We will also examine rhese issues in this chapcer. Each can play a role in helping a smoker see more clearly rhe negacive aspects of the smoking habit. This will help each smoker advance in the process of ultimately quirring for good. Some of rhese orher risks include the damages of secondhand smoke, the COStS of smokiJ\g-nor only ro che indiyidual-bm ta his or her family ;lJld employer, and the smoker's personal example and ies effecc on the nexe generarion ofAmericans.

The Far-reaching Devastation of Smoking As a physician, 1 find myselfin a significanc role regarding robacco. 1 have seen sa many people suffer and die premacurely as a direct resulc of smoking. As a result, 1 feel a heavy burden ro do ali 1 possibly can ro help smokers e1iminace chis deadly habic from their lives. Few things quantify the dangers of smoking berrer than a knowledge of how many deaths are caused by iL Various eSUmares ofsmoking morraJiry have been made by speciaJisrs in epidemiology. Epidemjologisrs srudy groups of people and rheir diseases; chey draw conclusions using advanced statistical mechods as ro how much of a rale various factors play in conuibming ro disease and death. One of the more widely published epidemiologic studies was co-authored by the former Director of rhe Cencers for Disease Control, Dr. William Foege. He and his colleague, Dr. J. Michael McGinais, compared deaehs due ca smoking wich those from seven other c.1uses, as illustraced in Figufe 2. 7 Notice that over 450,000 deaths per year are caused by smoking. Other seudies indicate chat in the U.S. alo ne, smoking accounrs for as many as one ouc of every five deachs, and a toral of five miII ion years of porenriaJ life lost annually.8 Clearly, robacco is the leading single lifistyle ftctor chac produces mass kiJling. But much more publiciry is given to ocher causes of dearh, such as drugs or AJDS. Consider aII of rhe money

poured iara agencies ro stop illicic drugs; aII of che international attempts ofour government to get ro the center of the drug cartels; and alI of the information about drug trafficking rhat we hear abollt daily. Yet, there are 20 times as many deaths each year due to smoking as comparedto drugs. The news coverage of the damage tobacco inflicts on our heaJrh is smalJ compared ro the magnitllde of the hayoc chac it causes. Smoking silenr.ly performs its insidious devasration, whereas drug buscs are more dramatic aJ\d exciting to news consumers. Similarly, massive pllbliciry is given ro AIOS, slightly over 40,000 deaths per year 9 which is onJy abolit nine percentof the nUJnber caused by smoking. The news media has given ample personaj interviews ofAI OS viceims who are shown wasting away. Have you ever seen a news interview of a smoker who is wasting away with a facal disease caused by smoking? Many cimes the neighbors of an afflicced smoker do noc eveo know that smoking was {he callse of the disease. lf that person had AIOS, it would be newswonhy.

Smoking Shortens the Lift Span What is rhe expected life span of smokers? Some may say, ''!'m going ta die of something; ifit is noc from smoking, it will

ANNUAL MORTALITY FROM SMOKING VS. OTHER CAUSES Smoking Alcohol Microbial agents Toxic agents Sexual behavior Firearms Motor vehicles IIlicit drugs Figure 2

371

PROOF POSITIVE be from something else." Many are nor aware how much the average smoker's life is shonened. Estimates vary depending 00 the group stlldied and who conducts the research. One of the mosr sobering sraristics comes from the U.S. Depanment of Heahh aJld Human Services. They srare mat one quarrer ar more of ali smokers die premarurely from a smoking-induced illness with an average loss of life of 21 years. 1O

MORTALITY OF SMOKERS • At least 25 percent of aII smokers die prematurely rrom a smok1ing-induced Ulness. • Those individuaJ.s Iose an av.erage of 21 years oflife. • In other words, if 30 year old nonsmokers could eX'pect to live to 82, 30-year-old smokers are playing Russian roulette witb a four cylinder gun. · If they get tbe loaded chamber, they are Iikely to die at 61 years of age. Figure 3

EUROPEANS ARE DYING FROM SMOKING Eastern European men • HaU die at middle age • Half the cancer deaths are due to smoking • Tbey bave the world's highest deatb rates from smoking Western Europeans • One-tbird of the men die at m,iddle age • A half million die from smoking each year Figure 4

372

Figure 3 furrher emphasizes rhis relationship. What a tragedy ro die in your carly 60s and be cheated out of 15 or 20 years of reriremenr! I rhollghr abour rhis recenrly when one of my smoking patienrs died. He had been smoking alI of his adult life, yet was relarively healrhy unril the age of 64. Wirhout warning, he sliffered a brain stern stroke caused by robacco and died a few days later. Ifhe had nor smokcd, since there were 110 obvious problems with his generics, risk facrors, or orher lifesryle habirs, ir is likely that he would still be alive and well today. Instead, he losr his life before he had a chance ro enjoy rhe "golden years" of retiremenr aod see his grandchildreo grow up. Even more sobering are cases like Melissa's rhar opened chis chaprer. Some die from smoking ar a very young age. re is true, however, rhat some smokers seem ro beat the odds by living inco rheir 70s, 80s, or beyond. However, even rhey are likeIy suffering health consequences, as we wilJ see as rhis chapter lInfolds. Premarure dearh ar disabiliry docs nor have ro be your experience. You can make a difference srarting roday by stopping your tobacco habir. Of course, premature dearllS from cigarette smoking are not confined ro America. Ir is a major scourge worldwide. The World Health Organization recenrly published a paper enrirled: "The Tobacco Epidemie: A Global Public Health Emergency."l! Ifyou rhink we have problems here in rhe Unired Srares, consider rhe following sratisrics. When rhe World Health Organization ranked 87 cOllnrries by the pe.rcenrage of ma1e smokers wirhin their borders, rhe Unired 5rares ranked 7Bth. Based an male smoking paererns, we have some of ilie lowest smoking rares in the world. Even regarding female smoking rares (which have riscn dramatically in aur counrry), rhere are sriU 30 aur of those same 87 nations who have more women per capita smoking than here in the U.S. As women make progress in social equaliry globally, we can expeCt [Q see rising numbers ofwomen smokers in developing economies. These faets are revealing; they teU us (hat robaeco's burden of suffering will impact orher na-

DYING FOR A CIGARETTE? tions even more heavily than here in rhe U.S. Ifyou are impressed with this chapter's srarisrics on death, disability, and disease rhar 1quore mainly for America, rhar this is only rhe rip of t.he iceberg. The impacr ofsmoking in ilie eountries of Europe is srared in Figure 4. 12 Nor are these impressive death fares confined co Europe. Throughour the devdoping coullrrÎes, more than one-third of men of age 35 to 69 die from smoking. 13 Furthermore, globally, women's deaths are catching up. The rese.arch indicares rhat we are looking at a female epidemic of smokillg-relared morraJiry. As I a1ready have alluded to, women's smoking rates are highesr in rhe developed nations. Staristics involving middle-aged women in those countries arc sobering. In 1955, ooly rwo percem of those women died from smoking. In 1995 the figure was lip ro 13 percent and was stiH rising rapidly.14 The impact ofsmoking on morraliry in the developing coumries of the world will be even more devasraring if tlle present trends cominue. Sinee more Amerieans are giving up smoking, the tobacco companies are vigorously promoring their deadly producrs in foreign lands. Tobacco induscry's aC[ions in pouring advertising moncy ioro ulese narions suggest an attempt tO regain lost profits from reduced sales in this eounrry. As the smoking habir spreads abroad, devastarion follows. The World Hea1rh Organization (WHO) estimates that smoking causes over 3 miHion dearhs per year worldwide. 15 Even more sobering are rhe WHO predictions. lfclIrrem rares ofsmoking continue, by the 2020s or early 2030s the yearly dearh coU is expected ro reach 10 miJIion. 16 Furthermore, 500 minion now living will u1timately clie as the resulr ofcigarerte smoking. 17 These statistics arefurrher profiled in Figure 5)8. 19

Effects ofSmoking on Dur Youth Most smokers begin smoking when rhey are young. Statistics indicate that 60 percem of aU currenr smokers in the U.S. begin by the age of 14. 20 And over 90 percen t begin by (he age of 19. 21 Experimemarion

GLOBAL IMPACT OF SMOKING -It present trends continue. 500 minion people worldwide wiU die from smoking. · This translates to app,roximately 10 % of the entire world popullation and roughly double tbe entire D.S. population. . Half of these deaths, or 250 million, wiU occur in the developed countrie-s. · Thus, smoking wUl accouDt for 200/0 of aII deaths in these nations. Figure 5

SMOKING AND YOUTH, AGES12TO18 • 54% do not expect to be smoking a year later. • 75% who try to quit are unsuccessful. · Girls are as Iikely as boys to smoke. · White teens are 3 times more likely than blacks to smoke. · Teens are more likely to smoke if familly aud friends do. · Risk takers are more Iikely to smoke. Figure 6

with cigarettes sometimes begins in children as young as 5 years of age. 22 Every single day in America 3000 children begill to use robacco. 23 Why do the young pick up trus habir? What informarion do they lack that would help them tO see the folly of acquiring rhe smoking habit? The American Cancer Soeiety questioned 10,000 yourhs, age.s 12 ro 18. abom smoking. Figure 6 lists the resulrs.

373

PROOF POSfTIVE Notice rhat half do nor expecr (O bc smoking a year later. [n oU1cr words, lUany young people who are JUSt beginning ro smoke believe thae wiehin a year chey will no longer be smoking, and will have no ineencion of srarring agail\. They regard it as a temporary phenomenon, someebing [Q do for u1e rime being, perhaps because cl1ey feei that the situation demands it because of peer pressure, ar for some other reason. They do nor visllaJize thar ehey are beginning a )ifetime habic. They do I)Q[ reaJiz.e chac 75 percenc who rry ro quit are unslIccessful. Althollgh a majoriry thinks they will qllit, a greater majority will not pur fonh the effon ro qllit even rhough they walH to. This statistic holds rrue across the board, an r1uough the life of a smoker-75 percenc who cry ro quic each year are lInsuccessful. This low rate ofSllCCesSfui "kickers of rhe habic" can be increased, as we will sec in Pan VII 1; rhis habir can be kicked by everyone who applies rhe proper procedllre. !f the p1'Ocedu.re is faUll], the effim wil! fail.

Prevention Efforts Must be Focused on Youth

374

We need ro focllS a good share of our prevenrion effons on children and adole.scenrs for a number of reasons: 24 1. It is easier for young people never ro srart smoking than ro stop once ehey become addicted. 2. The earlier individllaJS Start smoking, rhe more years rhey are exposed ta the injurious effecr.s of tobacco, and rhe greater the risk of seriOllS diseases. 2S 3. Smoking has immediarc physical and social effects rhat can undennine healrh, impair performance, and weaken career opportllnities. 4. The tobacco industry is acrively rargeting yOllng people as theic hope for rhe fururc;26 we musr actively foclls on this age group ta help empower them to determine rheir own fmure. 5. lf we reaJly believe in prevention, we wiJl start wirh rhe group who has not yet taken lip the habir-rhis is the grearest way to minimize rhe health risks of sllloking.

Ali rold, of rhosc 3000 young people who stan smoking today, ar leasr 750 of rhem will clie prematllrely from a smokingre!ared îllness. 27 Funhermore, each of rhose 750 vietims will Iose 21 ye.1rs of life on average. This eranslaces ro a flgure of 15,750 life-years fost-a total rhat is 5 to 6 times tlJllt

e.'..:aeted by tmffic accidents and murders

combined. The dangers of youth smoking do not relate ro merely rhe damage wroughr by the nost of toxic chemicaJs in cigarette smoke. Many cxperrs look ar tobacco as a "gateway drug." What this means is that smoking (~wd other forms of Wb;lCCO use) ofren opcns the gate ro the use of illicir drugs larer on. Research suggests rhar dliJdren who use {Qbacco are more likely to go on ro use in sequence aJcohol, marijuana, and rhen orher illegal drugS. 28 The emphasis throughour this book is on prevenring diseases as opposed to rreating U1em afrer they become problems. The approach in this chapcer is no di.fferem. The best way ro prevem diseases C
DYING FOR A CIGARETTE? coupons. This is an effecrive way ro pur cigarenes in rhe hands of )'oung people ar no COSt ro rhem, and wirh linie chance of their being caught. A recene Camel adverrisement was obviollsly directed ar yomh. Along wim rhe collpon it suggested that you have a friend or a "kind looking stranger' redeem ilie coupon for you ifyou were "uneam fortable. n 33 And the free sample strategy works. Consider the case of Sean Marsee. Thîs OkJahoma yourh gOt his firsr raste of tObacco as a minor when a robacco company represenrarive gave him a free pack ofsn uft ar a rodeo. Sean's habit carried a heavy price, however. Ar the age of 18 he died from mourh cancer caused by smokeless (0bacco. 34 In (hose who have objectively studied smokeless tobacco markerîng, there îs no questîon mar the robacco indusrry has been rargeting minors in rheir placemenr of adverrising as weU as in their distribution of free samples.J~ How can we help our reenagers aod younger children avoid this deadly habit? For chîldren 3 ro II years old, me rask may be as si mple as convincillg them rhar smoking is dangerous ro rheir health. 36 However, by the rime rhey reach puberry, mosr researchers feei mar knowledge of healrh consequences is nor enough. Parc of the problem is me rendency ofyoung people ro view rhemselves as "immonal." Even if rhey acknowledge thar smoking is dangerolls, rhe)' ofren do nor see it as a personal risle 3? A grear variery of facrors seem ro play a cole in youth smoking, stlch as the influence offriends, poor scholastic performance, etc. Some experrs feel that efforts focllsing on robacco alone are doomed ro fail wirh r!lis age group. They argue mat messages tO quir smoking will only be bro:rdly effecrive if rhey are part of more comprehensive eÎfom eo address some of [he social cond.irions [hac feed imo smoking behavior. Pareneal smoking is one factor th:1t influences chîldren ro smoke. Parents are role models wherher they recognize it or nor. 38 In fact, Dr. Flay, in his comprehensive chaprer on yomh robacco, says rhat maoy srudies demonstrate (hac parental smoking is che very scrongesr prediccor of whecher ar noc a

child will smoke. 39 This role-modeling effeer is especialJy important with yOllnger children. ChiJdren may gec che Illessage from rheir parems rhar smoking is acceptable, and rhat ic is a legitimare way ta deal with seress or boredom. This poinr emphasizes thac aparent stopping the smoking habit is one ofthe most important strategies for pre-

IJmting tobacco use by their childrm. An approach to the social aspecrs inf1uencing youch smoking involves more rhan rhe example provided by parcnts and orher adults. Research indicues that dassroombased programs are mosr dTecrive when ehey address social influences in a scrucrured way. Such progra.l11s obrain filr better sllccess rhan programs thac only impart knowledge about smoking's healrh effecrs. 40 Some of the elemenrs rhac dle mosc successflll programs ueilize are enumer:Hed in Figllfe 7. 4 1, 42

ELEMENTSOF SUCCESSFUL YOUTH SMOKINGPREVENTION PROGRAMS 1. They provide information on the results of tobacco use, with special emphasis on short terrn health effects aod social effects. 2. They combat misconceptions about tbe percentage of aduJts and peers who smoke. 3. They educate on social inf1ueoces 00 tobacco use, dispelling myths provided by the media, peer groups, parents, aud other adults.

4. They help children to know how to resist pressures to smokc. Figure 7

Clearly, for chiJdren aod youth who see rhemselves as imJnorcal, a good case can be made for emphasizing rhe shorc-term derriments of smoking. Thcse may include decreased athJeric endurance, case, scained fingers, premature graying and baldness, bad breath, cough, phlegm prodncrion. shortness ofbreath, body odors, cigarette butns, and risk of srarting a fire. 43 . 44 Even armed with this knowledge, ir Îs sciH important ro

375

PROOF POSITIVE

EXPECTATIONS OF TEENS "Teenagers greatly underestimate the addictivenes,s of tobacco and greatly overestimate their ability to control it. By far, the surest way to be a Donsmoker is to never start." Dr. Louis Sullivan, former Secretary ofHealth and Human Services.

Figure 8

A SMOKING CATASTROPHE Even if current rates of smoking were merely to stay the same, 20 million of the 70 million children in the United States today would become smokers. At least 5 million ofthem can expect to die of smoking-related diseases. Figure 9

376

impart an awareness dlat smokers are in che minority, and co dispel mychs abolit tobacco's benefics. In the face of aU of these good teasons nor [O smoke, experts chen recognize a need for special training in refllsa! ski Ils. 45 YOllug people need [O leam ro say no in a way rhar they feei is acceprable co t.heir peer group. Giving reasons [O peers may actuaJly be one of rhe most effeccive ways ro legitimatize their Slance. The child may say," o thanks, it makes my c10ules

smell", or "No chanks, ic will interfere wirh my playing SpOfts." Anorher element char may help decer yomh ti-om smokiJlg is by confroming t.hern more squarely wirh the addictive natllre of nicorine. Recenc researeh confirrns thac young people who smoke daily tend ro smoke for the same reason that adults c1odley are addicted. Furrhermore, statistics also illustrace che deceptive powers of cigarettes. Many young smokers apparently take up the habic thinking char they can remain "in conrrol."46 But here is where rhey are deceived. That small paper roll of tobacco conrains nicotine-a powerfuHy adclicrive chemical. Dr. Louis Sullivan, former U.S. Secretary of Health and HlIman Services, sums up the relacionship berween teenagers and smoking as quoted in Figure 8. Even if we can halr the emerging rrenel ofan increase in yomh robacco lIse and keep sl)loking initiacion at ics presenl level, the furure stiH looks bleak for aur children. Figure 9 expresses the grim realiriesY The death of five million children is a carastfophe rhar we must do our utmost ro prevenr. The informarion in this chaprer cao play a pivotal role in preventing this epidemie. lf smokers take these message ro heart and qllir now, and if aU parelll:s can impart this informarion ro t.heir own children, we can make a sign.ificant impact.

The Dollar Costs to Society ofSmoking When yOll think of rhe human devastat.ion eaused by smo1cing, any finan~ial coSts tend ro paie in significance. However, in an environment of shrinking hea.lt.h care resources, we must look at the financial impact of this habit as weB. What are the healrh care cosrs for smokers? Figure 10 i!Jusuares some of rhe beSl curtent estimares. 48 We have seen startling escalaling health care COStS each year in America. One of che major reasOlls lS [he hllge price tag dut robacco cHries. Many parienrs rhat 1take care of in our hospital intensive care unÎt on a daily basis 'lrt chere because of rhe effecrs of robacco. If you have not been a patient in

DYING FOR A CIGARETTE? an inrensive care unic, consider yourselfforrunare. The diseases thac land l'ou ehere are tlsually serious and rhe daill' price eag is very high. Hean aceack parients rypicall)' are caken inco intensive care unirs for a number of dal's. Orher smokers find chemselves in che intensive care unic because che)' need a ventilator (a mechanical breaching machine). Alc.hough these machi nes can be lifesaving. rhe)' are probabl)' among che mose difficuh procedures for the patiem ta colerare. Just imagine lying awake wich a large plascic rube going chrough l'our nose or mouch, down your c.1uoac, and into l'our windpipe. On top of ali chis, the machi ne breathes for l'au. In man)' such circumsrances, you are actually unable co eake a breach an )'our own, even if you want to. What is rhe best wa)' ca end up 00 a ventilator? Continue smoking. As l'our lung efTecciveness dereriorates, normal recoverl' from surgerl' or normal improvement from pneumonia mal' well e1ude l'au. When l'ou get inca such sicllarions, p;trt of l'our recovc.rl' mal' rake place in c.11e inrensive care unir an a ventilator. Noe only are c.1lOse inrensive care stal's demanding on rhe pacient phl'sically; chel' are, ro repeat, extremely cosell" Where does aII the monel' come from? From Medicare fllnds, medical insurance companies, and, yes, even rrom patienrs' OWI1 personal bank accounrs. Regarding illnesses due ro smoking, alI of rhe expense arise$ from wholll' prevenrable condirions broughe an by an individual's own acrions. le was a volunrarl' ace by the individual in adopring the smoking habir rhat collecrively rotals 50 billion dollars per year in healrh care cam. Ifwe cOllld eliminare e!le smoking problem in America, we would cerrainly relieve r!le crisis in !lealth care cost. The problem of escalaeÎng cosrs or rhe need co cur those COSts would be diminished. The need tO clase down aur hospirals or medical research programs for lack offunds would be diminished ar even disappear. Fifty billion dollars of savings each l'ear would surdy go a long wal'. Cercainl)', rhe pressure ro make "Medicare cutS" would disappear enrirell" Some have framed rhe I1nancial argumenr in ocher rerms. When rhe additional

HEALTH CARE COSTS OF LIFEWNG SMOKERS AII told, the excess lifetime medical expenditures for ali of those smoking today in America will amount to approximately $500 bUlion. This amounts to $50 billion in annual medical expenses for smokers. Expressed another way, each year more than one miUion young persons start to smoke, addiog an estimated $10 billion during tbeir lifetimes to the cost of health care in the U.S. Figure 10

costs of ehings like disability and premaCllre death are added inco the equarion, every family of faur in our counrry is probabil' paying c10se ro $1000 per year (in raxes and increased inSllJance s) so rhar oeher Americans can have the "privilege" of smoking. 49 In view of chis, manl' cieizens are concluding rhac ir is wrong for the American raxpayer ro, in essence, be subsidizing rhe tobacco companies and smokers. Orhers have made even bolder sllggesrions. One of the boldesr is the proposal ta reStfUCtllre Medicare sllcb ehar aII smokers are rotally barred from Medicare benefits. I menrion rhis radical proposal because it highlighrs the economic issue.s. Merely discussing some of r11ese more eccenrric proposals may hetp smokers be[(er realize mar io the pre.senr U.S. system ehey are not only harming cheir health, buc the)' are asking someone else ro pal' for maol' of ehe related costs.

Smoking Reduces Productivity on the Job le is noe juse raxpayers and health insurance compallies, however, who pa)' chese bills. Smoking puts a toll an a person's employer. Employers face cOStS bel'ond ehose involved in providing insurance.

377

PROOF POSITIVE

Over 4,000 different compounds have been identified in tobacco smoke!!

more per year d1an nonsmokers and, an average, rhey miss more days from work. so 0ther sources suggest rhat toral excess costs per year for employing a smoker may reach $1200. SI Srill orher dara indicares rhar over rhe liferime of a twO pack per day smoker in his early 40s, an employer could save abolit $30,000 if rhat individual sropped smokingY The cosr of a one week live-in smoking cessation program is onJy a fracrion of dlat amount. The message ro employers is c1ear: rake advantage of every opporrunit)' ro hclp your smoking employees "kick the habiL"

Pollutants in Cigarette Smoke

Figure 11

378

These include the cosrs ofdecreased produc{iviry because of absenreeism, and expenses to train new employees when smokers leave me work force early due ro smoking-related disabiliry or premature rnorraliry. A physician friend rold me of a young lady who, in de perarion ro srop smoking, enrolled in a live-in stop smoking program. Mrcr rhe week-long program, he realized a previollsly unattainable goal-she became a nonsmoker. However, she found rhar her employer would nor help with any of the stop-smoking program co ts. This is nor an isolated instance. re is difficulr ro undersrand why employers are nor more supporrive of nicotine addiction trea[mem. Numerous employee assi. rance programs will pay for akohol and illicir drug treannent ro the tune of rhousands of dollars. Why won' r dley fund programs for nicorine addiction rhar are muci, less cosrly and have me porential ro save rhem even more money, panicularly when rhe number of employees affected are considered? Statisrics suggest rhar the employer would acrual.ly save money in hnancing a stop-smoking program for an employee. Compared (O nonsmokers, smokers in rhe work force have nearly twice as many hospiral issions and spend over rwice as many days in rhe hospir.aI. Their yearly healrh care c1aims average $400 ro $500

When we recogllize ilie number of toxic chernicals in tobacco smoke, ir comes as litde surprise rhat these products callse exrensive bodily harm. The number of mese polluranrs is srared in Figure 11. 53 Many of rhe 4000 compounds are known ro be carcinogenic; many are toxic ro arrerie.s. Many, as individual componenrs, should have been dedared as pollurants and regularcd by laws rhar require them ro be burîed safely benearh the earth in tOxic waste durnps ro prevenr LIS from being exposed ro rJlem. There are no such regularions becausc rhey arc in a commercial wrapper and profits are being nude from selling tobacco.

SECTION II

Smoking and Cancer As was prcviously starcd, in lQ64 rhe Surgeon GeneraJ accurately and empharÎcally srated {har robacco c.1uses lung cancer. It is hard ro hnd a smoker roday {har does nor. accept thar fact. The lung cancer messagc has been heard loud and dear by smokers. Whar has nor been pllblicized is rhar smoking increases [he risk of many other cancers. There arc ar Icast 16 other cancers related ta smoking. They arc listed in Figure 12. S4. S5. 56. 57. 58 These cancers are in 16 crÎtical areas of [he body. AII rold, estimates indic.1rc rhat every year in the U.S. some 150,000 smokers die from cancers rhat are a direcr resulr of their smoking. 59. 60 Nearly one-third of

J..

DYING FOR A CIGARETIE? aII cancer dearhs are due to moking. 6J Some of tbe cancers that smoking causes rend ro be rapidly fatal, such as cancers of [he esophagus lung, pancreas, and liver. Orhers offer more chance for cure, bur aU are potentially devastating iI nor facal.

Dozens ofCarcinogens in Tobacco Smoke Tobacco smoke conrains a vericabJe wicches' brew of compounds rhac aJmos[ seem purposely designed to cause cancer. Of the 4000 idenrifled chemicals, 43 are knOWll co be carcinogens. Carcinogens are able, in and of chemselve~, tO cause rhe beginnings of cancer. For rhis reason they are sometilne referred ro as cancer ÎnÎciarors. Also, tohacco itself concains a variery of carcinogens. Thesc compollnds are unable ro cause c.'U1cer themselves, bur when rhey are presenr in rhe company of full-blown carcinogens, they increase rhe risk of cancer. 62 There are srill mher chemicals in rne smoke thac are calJed tumor acceleraro rs. As rheir name indicaees, these speed up fhe growrh of cancer once it has begun.

Tobacco Jmpairs the Mucus-C!earing Mechanisms ofthe Lungs Tobacco impair.s rhe normal. c1earing mechanisms of rhe lungs. Microscopic hairs, caJled cilia, Jine rhe air ages and help ro keep t!le lung dean. These minure hairs are immersed in a layer of mllCUS rhar is viscous enough ro cling ro dle lining of [he lungs, bu[ fluid enough ro bc propelled by chose lirele hairs. Healrhy ciJia work ro conrinuously propeJ the mucous marcriallining the air ages away from the lung. Thc)' funcrion like oars an a ship, aII beating in a single direcrion from the lung up coward rhe mourh. As they beat concerredly, rhe mucus layer movcs up the roain brearhing tube and finafly inco rhe region of rhe mourh and rhroar where ir Îs either cOllghed out or swallowed. This process provides signiFicanr lung prorcction. Most foreign parricles become imbedded il) che mucus. Unforcunately, however, the cilia of smokers are paraJyzed. Becausc of deficient

SMOKING CAUSES MORE THAN LUNG CANCER It may also cause these cancers

· Lip · Liver · Mouth (oral cavity) . Pancreas · Throat (pharynx) . · BI.adder · VOlce box (Iarynx)!.~dney C. · ervlx · Trachea . Leukemia (wind pipe) . Colon · Esophagus . Skin · Stomach · Penis

.

acrion of thesc rin)' hairs, when a smoker is exposed ro cancer-stimulating chemicals, rhe bod)' is less likely to get rid of them. Somc of [he more nororiOliS agenrs found in robacco smoke thac are direcdy poisonous ro the ciJia are: formaldehyde, hydrogen cyanide, oitrogen dioxide, and amlllOnia. 63 Carbon monoxide generated by cigarectes ilio can impair rhe clearing functions of rhe lungs and air ages. 64 Thus, we sec thar agents like formaldehyde in cigarette smoke acruall)' er rhe srage for more harm from tobacco's orher consriruents.

Figure 12

Nicotine and Carcinogens are Jnseparable As a resulr of aII of r.he combinarions of chemicals in robacco smoke, it has long been recogni7"cd rhar cigarette moke is even a more potent cancer-causing agent rhan rhe stim of aII rhe cffects of irs known carcinogens. 65 Some other points are woerh noting. It is impossible to malle ti cigarette that has no carcinogens. Soene of rhemost toxic carcinogens are rhe resulr of chemical changes involving nicorine ir.self. These changes can occur during curing and ocher processing procedures performed an leaI tobacco, ar they Gln occur during robacco burning as rhe cigarette is smoked. 66 Thus, as long as Il cigllrette contains nicotine, it wilf

379

_

PROOF POSITNE have carcinogens in it. Since rhe cobacco indusrry has already experimemed with and rejected nicorine-free robacca cigareues, smokers are doomed ro be exposed ro cancer-causing agents for as long as they smoke.

Tobacco Smoke Contains Cancercausing Radioactive Substances Today many are wary of rhe effeccs of radiation. Conscienrious consumers minimize demal or medical X-rays because of concerns about unnecessary radiation. Probably che mosc frightening case of radiarion exposure in history was caused by cbe Chernobyl nuclear reactor accident in rhe former Sovier Union. Europeans and even the Middle Easterncrs were lcgicimately concerned about rhe radiarion exposure from mar terrible nuclear catasrrophe. A recene report in The (oumal of che American Medical Associarion examined exposures in Israel relared ro Chernobyl. The auchor poinred our thar rhe average Israeli wilJ have absorbed an average of flur units (mrem) of excess whole body radiation due ro ehe Chernobyl accidenr. 67 This would be expecred ro resulr in only four cancer dearhs among Israel's 4 million people. However, one cigarette exposes a smoker's lungs

to as much as sevm units. 68

LUNG CANCER MORTALITY BY NUMBER OF CIGARETTES SMOKED PER DAY

Morta.lity

Rate

20 15

10 5 Non-Smoker

1-9

10.-19

20-39

Cigarettes Smokcd Per Day Figura 13

380

40+

Over rhe course of a year, chis would translacc inca over 12,000 times che Chcrnobyl exposure. The radiation comes from radioaccive Polonium-210 that is fOllnd in cigarette smoke. The polonium finds ilS way inco cobacco in rhe fie1d because the glandular hairs of the robacco Icaf can rake rhis [face pollutanr out of che air and concentrate it in the plam. 69 Ocher sources of polonium in eobacco are impurities in some phosphate ferrilizers used ta ralse tobacco'?o Animal stlldies have demonsrrated thar polonillm-21 is a carcinogen in its own righe. Furrhermore, radioactive polonillffi acts together wich other cancer-causing agems ro c.ause even more cancers lhan you would predicr from adding their effects. 71 Unfortunare1y, the radiacion is nor rescricted [O ehe smoker; greacer rhan 75 percem of rhe radiation is found in side-scream (secondhand) smoke. 72 This radiarion appears ro be doing irs share ofdamage. Recent repom have Iinked smoking ro leukemia and che rheory is rhat radiation may be the causarive facror.7 3 This linkage combined wirh the recognition of higher amoums of radiation in side-stream smoke may be the explanacion for a long recognized re1ationship: ilie offspring of smokers have more leukemia.

°

Lung Cancer Ar rhis point we will concentrare on the number one cancer killer of American smokers: lung cancer. Lung cancer is rhe leading cancer-killer in America for both smokers and nonsmokers, and me.n and women.7 4 Some years ago, lung cancer sured breasc cancer as being the leading final malignancy in women. It long has been [he leading cancer kiIJer of men. Each year over 100,000 Americans die from lung cancer caused by smoking?S MortaIiry from this cancer Îs proportional co ehe number of cigarerres smoked daily, according to a 25-srare study performed by the American Cancer Sociery, as shown in Figure 13. 76 Norice rhar the more cigarerres smoked per day the greater che risk. Those who smoke ewo or more packs per day (40 or more cigarencs) have an excremely high risk

DYING FOR A CIGARETTE? of lung cancer, over 18 rimes thar of the nonsmoker. Even the person who smokes very linie (Iess rhan 10 cigarerres a day) sriil mns nearly five rimes rhe risk of contracring rhis deadly cancer. Some feei rhey have made grear srrides by cuning down ro slighrly more rhan half a pack daily. Yes, they are helping themselves. bur they sriU have over eighr rimes rhe risk of developing-and likely dying from-America's number one cancer. .As expecred, rhe nonsmoker has the lowesr risk of alI; rhar risk would be lower yer ifir were n.or for secondhand smoke, an issue rhar we wiU examine larer in rlle chapter. Although rhe risks of lung cancer as a resulr ofsmoking are impressive, even more sobering is rhe risk ofpremature death from lung cancer. Researchers calculared rhe risk of dying from smoking fTom a number of diseases ar difFerenr ages. 77 They based their calcularions on an average 35-year-old man who was smoking somewhae over a pack a day (25 or more cigarerres daily). When compared ro a nonsmoker, chis individual had 30 times the risk ofdyingjYom lung can-

ence in who developed anorhcr cancer? The answer is illusrrared in Figure 14.79 Quicrers had only 1/3 rhe risk of deve!oping a second primary lung cancer (a new lung cancer rhar was nor of the small cell rype) compared with rhose who conrinued ro smoke. Resulrs from scudies like chis

SMOKING CESSATION REDUCED CANCER RISK IN CURED CANCER PATIENTS · 55 smaU celliung cancer patients survived 2 years. · Some continued to smoke. · Continued smokers had nearly triple the risk of developing a second lung cancer compared to those that quit during treatmenf for their original cancer.

cer before he reached 65 yea" ofilge. 78 Some people, when rhey learn rhar they have lung cancer, may say, "Since 1 already have lung cancer, why should I quic smoking? Ir's roo Iare. Chances are ehar chemorherapy and radiarion will noe help much. Besides. I am addicted: It is roo hard ro quit." The informarion available raday indicares rhar chis is nor logical chinkjng. A research srudy looked ar some 540 smokers who developed a particular rype of smoking-relared lung cancer called "small ceU cancer." In keeping wirh rhis generally fatal cancer, 90 percenr of rhe parienrs had eirher died or were scill scruggling wirh rhe cancer a shorr MO years larer. However,55 parienrs (ren percenr of rhe original 540) Were cancer-free ar rhe end of MO ycars. 1 hcse individuals were appropriare1y considered cured. (Due ro rhe aggressive narure of srnall celliung cancer. a rwo year djsease-free survival usually means rhar rhe cancer is cured.) Mosr of chose surviving parienrs had afready quir smoking; however, 12 conrinued rheir robacco habir. Thc quesrion was: would conrinued smoking make auy differ-

Figure 14

show rhar stopping smoking am help prevent a second mflcer. This fact brings rhree basic messages abour cancer and smoking inco focus. 1. If you have no known cancer, kicking the habir will sharply reduce your risk of getting it. 2. lf you have cancer and are cured, kicking the habÎr gives you a much berrer chance of avoiding addirional cancers. 3. Recognirion of rhese benefirs can be an aid ro helping you Stop riIe habir.

Bladder Cancer Recent research indiones rhar both cigarenes and coffee increase rhe risk of cancer of rhe bladder, rhe organ thar stores urine prior ro irs e1iminauon. "Bladder cancer" may not be a hOllsehold word, bur ir is among rhe top five cancers rhar kill older American men. 80 Heavy smokers rriple rheir risk of rhis dangerous cancer. 81 On the other hand, heavy coffee drinkers-

381

PROOF POSITIVE defined as those using rwo ar more cups d;~ily-double {heir bladder cancer risk. Since ilie cigarette-relared bladder carcinogens are held in the bladder, it is expected chac smokers who drink more water aud void more frequently may be able ro decrease the risk of this cancer somewhat. However, the best preventative is ro leave of[ the cigarerres and coltee alrogether.

Smoking lncreases Colon Cancer Risk Colon c.1ncer (cancer altecting rhe large intestine) is one of the most recent malignancies ro be added ro the list of robaccordated cancers. Although prostare cancer kills more meo and breast cancer kills more women, colon cancer is the second leading cancer kilter when men and women are combined. We have known for years that a poor diet can cause colon cancer; this is documented in the chapter on cancer (Chapter 2). However, few ever imagined rhar colon cancer was relatcd ta smoking. Now, Harvard researchers have confi rmed this relationship in both Olcn and women, as stared in Figure 15. 82. 83 Why wasn't the effect of smoking an colon cancer risk recognized sooner? The authors speculate that because of the insidiDUS nature of the chemicals in tobacco, colon cancer risk increases decades afier expo-

SMOKING ANO COLON CANCER • Smokers can d&uble their risk of colon cancer. • Smokin,g leaves caocer-producing effects on the large intestine that probably persist throughout Iife. · Therefore, the sooner you quit, the better, regarding the risk of future colon cancer. Figure 15

382

sure. Simply put, the research does suggest tluc chemicals in cigarette smoke have a carcinogenic cltecr an rhe colon lining. Yet, this effect does not appear ta be sufficienc in itself ta causc a full-blown colon cancer. The cigarette toxins prime the large intestine ta develop cancer years from now. Because of this, yOllr risk of colon cancer taday has more ta do with your smoking habies 35 years aga rhan ie does with how much you smoked yesterday. Thus, smoking can nave cancer-producing effeees long into rhe fumre. The less you sllloke now, the less those risks will be. This evidence illustrates that taday is rhe very besr time ta quit. At the poinc in time when colon cancer srrikes, it ooly indicates thac you should have stapped smoking long aga. Furehermore, the persistent elfect of smoking an colon cancer underscores the need ta impress on young people that smoking at a young age may catch up with chem up ta 35 years ar more later.

Breast Cancer, MeLanoma, and Penis Cancer Breast cancer, [he second cause of cancer deaths in WOll1en, is yet another cancer chat has been found ro be reLated ta smoking. Unlike the other cancers mentioned in chis chapter, smoking may not eduse breasc cancer; therefore, 1did nor include it in rhe figure that imroduced this secrion an cancer. The best evidence so far suggests that smokcrs do not have more breast cancer, but if chey ger it cheyare more likely ta die from it. 84 One theory is that smoking's well-documented power ro weakcn the imml1ne system provides a better chance for spreading breast cancer and ultimately killing the victim. This evidencc is based an at least rwo studies. 85 . 86 The most recent looked ar over 600,000 women who had nearly 900 cases ofbreast cancer in some 10 years of evaluation. The findings appear in Figure 16.87 Smokers who develop melanoma have a greater risk of bJood-borne spread of the cancer than nonsmokers. 88 Anorher rype of skin malignancy, squamous cell cancer, is increased by 50 percent in currenr ciga-

DYlNG FOR A CIGARETTE? rette smokers compared ro rhose who never smoked. 89 A cancer rhar has relarively recenrJy been linked ro smoking is cancer of t1JC penis. Compared ro mose who never smoked, current smokers had nearly uiple the risk of thjs devasraring caneer. 90 This malignancy may also have an immune sysrem link. Research has linked cancer of rhe penis wim geniral wans. 91

What About Ali Those Pictures of Attractive Heaithy Smokers? Tobacco rs have bombarded us since childhood wirh images mar are nor depicred as images ofdisease aud death. We have seen attracrive women and masculine men, alI apparemly in rhe peak of healrh, holding or pufftng an cigarettes. The magazine ads and billboards of roday continue ro glamorize smoking. In realiry, rhe smoking models such as rhe "Marlboro Men" have paid a priee as a resulr of rheir labors. Man)' of these individuals who achieved Carne in tobacco company ads have been disabied or losr their lives because ofsmoking. Five examples of such rragedies are lisred in Figure 17. 92 The rwo survivors 0/1 rhe lisr have rried ro undo rhe tie ehey have helped perperuare. Borh David Goerlitz and Janet Sackman have become ourspoken critics of smoking's harms.

Stop Smoking, Change the DietfOr the Best Protection Against Cancer Therc is no doubr rhar cancer is "muleifactorial;" many facrors add togerher ro uleimarely resulr in cancer. There are smokers who never get cancer. Perhaps they were relarively prorecred by meir genetics or ocher lifesryle facrors. Unforrunarely, regarding genetics, we can ger an idea of whar we are

at risk oJ but not what fUe are protected/rom. For example, it borh your parems smoked and died ar age 40 from lung cancer, and you, roa, are a smoker, yau run a very high risk of dying from lung cancer at an early age. However, ifborh yom parenrs smoked and died of narur:I1 causes in cheir 90s, ehar

SMOKINGAND BREAST CANCER Compared to nonsmokers, women who smoke suffer a 25 to 75% increased risk of fatal breast cancer. The more they smoked and the longer they smoked, the higher ,their risk. Figure 16

FIVE ILL-FATED "MARLBORO MEN" Name

Tobacco ~ Company.

Wayne McLaren Marlboro

Fate dead -lung cancer - age 51

Janet Sackman

Lucky Strike

cancer - voice boxllung removed

David Goerlitz

W,inston

had a stroke in bjs mid~30's

!David Millcr

Marlboro

WiII Thorobury

I Camel

I dead - emphysema - 1987 I dead - lung cancer - age 56

is no guaranree rhar jf you smoke you will escape dearh from lung cancer in your 40s. "Recessive gencs" are one of rhe hereditary reasons why children can suffer from diseases mat rheir parenrs never had. Yes, borh parems can bave a generic tendency 10 an illness thar chey never experienced. It is only when both of rhose parenrs comributed a gene with rhis rendency that it shows up in their children. In addirion ro the unconrrollable factor ofgenerics, many Iifesryle facrors, which are conrrollable, also influence cancer risk-

Figure 17

383

PROOF POSITlVE

384

even among smokers. Dierary choices play a profound role in cancer risk. For example, rhere are over 25 srudies rhat show ehat earing pleot)' of fruits and vegetables rich in beta-carorene, a vÎramin A family compound, can hclp decrease lung cancer risk in borh smokers and nonsmokers.')3 Men in Western New York who are more beracarotene from the fruirs and vegetables in rheir diet had only abour 55 percenr of the lung cancer risk as those earing lirde beracaroreney4 However, rhe prorective effecrs were most beneficial in never smokers and ex-smokers. Alistair Moodie, in his excellent review of rhe role of nurrition in slllokers, idenrifies a wealth ofimporram research on this ropie. He presems dara demonstrating rhar sllloking lowers blood levels ofcancer-protecrive vit.unins like bera-carorene as well as viramins C and E. Furthermore. Moodie cires scÎenrific evidence linking low levels of these vitamins {Q a number of smoking-related cancersYs The point that concinues ro come through in the medialliterarure is rhat eating more fruirs and vegetables has a role in cancer prevenrion-bur rhe benefirs are grearest if a person has first stopped smoking. Funhermore, taking supplemenrs will not provide rhe same benefit as eating rhe plant foods rhat are naruraJJy rich in rhese prorecrive vitamins. A case in poim was provided by a Finnish srudy rhar looked ac male smokers-some who were raking vitamins and others who were nor. The male smokers who {Qok both vitamin E and betacarorene supplements showed 110 elJidmce of lung cancer prevenrion. 96 In fact, raking bera-carotene supp1ements acrually appeared ro il1crease the risk of Jung cancer. Or. Robert Jacob, a PhD research chemisr wirh the U.5. Oepartmem of Agricu1rure, made an insighrful sraremem that purs rhe medical [irerarure on nutrition and smoking in perspective: "Besides quirrjng smoking, the most useful change (hat smokers can make is ro increase cheir imake of fruirs and vegerables."97 Dr. Jacob went on ro menrion that taking supplemcnrs was not an equal alternative: many of ilie beneficial compounds found in fruits and vegerables are noe yet available in piUs.

It is clear rhar ~'wb9.1af an abun. mg orhcr candance of planr fpoas a: cer-prorecrive bene6ts besitIe vltamins. The average American-and espeeially the average American smoker or e,x-smokerwould be wise to eat mpre fcuits and vegetables. However. alrhot1gh a good dier helps, it does not came close ro undoing rhe risks of smoking. ~p.r. li}! kicking rhe habir. Then improVe yoUr pier ro help your body repair t11e daina~il}flK;ted by smoklOg. ~

Conclusion ofSeetioii

...

The information in'dUs ~rion regarding rhe devasration wroughr by smoking is massive. Ir is consişfen.r~rpţre are no conrradictions in the dar~.t Ci~rettes cause disease. desrru"';Q-,' ~jni -aeath: Being a nOllsmoker ill:tbe tUQS 'p~~ful wayw prevem cancer. If yau snlolff, yrtlove Iife and wanr ro live, rhe very be5t de~ion yau can make is ro kick the habu 1l0~

SECTION III

1:

Smokin:g, Hei,rt

Disease, aiul ~Otber Diseases ,ofBIo'oil ~sseb Many are aware- tha tobacco causcs cancer, but few of my paticmt's stern ro realize rhar smoking causes dis.eases of rhe heart aod blood vessels. 98 Corop?-.ry· hearr disease (hean disease caused l>Y blockage. of rhe hearr arteries) is the "J:lmher ooe killer in America roday partly because of the large number of people who are addicted to robacco. Another top l{UI~r. sr.roke, is a1so relared ro smoking. 99 Diseases of rhe blood vessels of rhe arms and legs, known as peripheral vascular disease, are a1so dramarically increased by smoţ<.iJlg. 100 The cammoo denominaţoc~~ aU~f rhese diseases is a process caUesJ a(Qero le-rosis. which is greatly accelerated by smokjng, 101 How many Americans die.of diseases of the hearr aod blood vessels? When added eogcrher, srrokes, coronary hean disease, aod

DYJNG FOR A CIGARETTE? peripheral vascular disease chim nearly a million lives each ycar. Clase ro 300,000 of thesc dcarhs are rhe direct resuh of cigareue smoking and its effects upon rhe blood vessels. 102 Simply pur, if rhese people had not been smokers, rhey wouJd probably srill be alive roday. It is well esrablished thar a singular factor, smoking, is the cause ofa massive number of dearhs cach year because of irs eEfe.cr on me blood vessels alone. The whole world should bc made aware of rhis tragic ncws. A nurnber of years aga, fhe Surgeon General sem a lereer ro every American abolit the AIDS virus. 1 received one, as did evcry mher American who had a mailing address. The lener served a good purpose: it rold us how ro avoid dying of AIDS. However, comparing the bigh number of hean discase deaths caused by smoking Wifh rhe much smaller numbcr of AIDS dearhs every year, rhe Surgeon General should have sene out five letters ro each American ro warn us of fhe cardiovascular evils ofsmoking.

How Much Does Smoking Jncrease the Risk ofa Heart Attack? Studies show rhar those who are berween rhe ages of 45 and 54 and smoke more rhan one pack per day increase their risk of a hem attack by ovcr four rimes. 103 Older smokers increase rheir risk berween 70 and 200 percem depending an their age. 104 Moreover, when combined wirh other risk factors such as high cholesrerol and hypertension, rhe effccr of smoking is even greater, according ro a summary ofsrudies an smoking published by rhe Pooling Project Research Group.105 The findings are lisred Figure 18. Notice mat 23 of 1000 nonsmokers wirh diasrolic blood pressures below 89 and cholesrerollevels below 249 had rheir fim hean attack before they were 59 years old. For ulOse who smoked (wirh neither of rhe orher risk factors). rhe risk was more than doubled, al 54 hean anacks. On the orher hand, (hose nonsmokers wirh high blood pressure and high cholesrerol had a risk faur rimes thar of someone wirhour those risk facrors. However, if rhose persons add

IMPACT OF SMOKJNG, mGH BLOOD PRESSURE, AN» mGH CHOLESTEROL ON FIRST MAJOR HEART AITACK Males aged 30-59 (10 year iocldence) Nont of 3 major ri.k faclors Smoking only HigJl diaslolic blood pressure :> 89 or Iligh tholellleroJ > 249 only High di••lolit bJood pressure and higb choleslerol; wilhoUI smoking Smoking wilh dthcr hiJ:h blood presture or high tholulerol Smoking and high blood pressure and high cholesterol b-'--

o

.....J

20 40

60

80 100 120 140 160 180

RaJe pe' J 000 MaJes.

Figure 18

SMOKING ANO CORONARY HEART DISEASE • Cigarette smoking is a major cause of coronary heart disease in the U.S. for both men and women. • It is estimated to cause 30% to 40% of aU coronary heart disease (CHD) deaths in the U.S. each year.

• In those younger than 65, smoking is responsible for 45% of male CHD deaths and 41 % of female CHD deaths. smoking tO rheir lifesrylc, rhe risk jumps ro eighr rimes thar of the low-risk individual. Those with aH rhree risk facrors are obviously in the most dangerous group; rhey are living on rhe brink ofhaviog rheir firsr major heart arrack. In ilie Pooling Project data, wirhin 10 years, nearly I in 5 of rhese relariveJy young individuals (30 ro 59 years old) had a hean anack. This is a greater risk than expecrcd, when compared to totaling up the risk of cach factor separarely. The condusions drawn from this and a host of ofher srudies are compelling. Some of thc key poirtrs are listed in Figure 19. 106 Many find the srrong relationship between smoking and hearr disease deaths hard ro accept. Nonetheless, (he s(atisriGlI

Figure 19

385

PROOF POSITIVE

THE PILL, SMOKING, AND HEART ATTACKS NODsmoker, DO pili NODsmoker USiDg the pili Smoking > 25 cig/d, DO pili SmokiDg > 25 cig/d, using the pili 10

20

30

40

Risk Figure 20

S OKI G ELEVATES SUDDEN DEAm RISK · Sudden death risk for smokers is 2 to 4 times greater than for Donsmokers. · The risk increases with the number of cigarettes smoked per day. · The risk appears, to diminish as soon as the habit is kicked. Figure 21

386

researeh is ciear. Amang Amerieans wha are under 65, smoking is responsible for fuUy 45 pereem of male hearc auaek dearhs and 41 pereenr of female heart attaek easualties. In yaunger women, che risks may be even greater. One researcher suggescs that about 76 percenr of heart actacks in young women are due ro cigarette smoking. 107

Similar relacionshîps are fOllnd in omer Western nacions. For example, a recenc Bricish srudy fOllnd rhac smakers in their 30s and 40s were, remarkably, five times more likely ro surfer heart arraeks thaJlllonsmokers. I08 This researeh indicates thac, in the United Kingdom, robacco is ro blame for the majoriry of heart auaeks scriking chose younger chan 50 afborh sexes. Young women who smoke can fllrrher increase cheir risk of hearc attaek if chey also use che oral concraeeptive piU. These striking relaeionships are shown in Figure 20. NOlîce that combining smoking wieh pilI usage causes a mueh grearer increase in hearc arlack risk rhan expecced when compared tO che effecc of eicher one a1one.

Fatal Heart Attacks Caused bySmoking Not only are smokers more likely to have a hearr arraek, chey are more likely ro die from one. Furthermore, chey are ac higher risk from slldden death due to hearc disease. When death occurs wichin 24 hours of some distinct change in an individual's state ofhealch, it is calJed sudden deach. 109 le can happen ro an apparendy healthy individual while on che job, enjoying leisure time, or wim che f.1Jnily. Ir rypiC.111y eomes suddenly, withouc warning; life may lip away in a matter of minuces. Figure 21 quantifies che inereased risk ofsudden death in smokers. IIO • 111 Notiee that smokers have up ro four rÎmes rhe risk ofsudden death compared ro nonsmokers. Fortunately, however, (he risk diminishes dramacieally when a person srops smoking. In fact, so quickly does che risk fali, rhat within one year che risk of sLJdden deach from a hearc attack has dropped 50 percenL Why is chere sllch a rapid decrease in sudden dearh risk? One of (he answers seems ro lie with nicotine. Nicotine in cigareeces increases rhe risk of sudden dearh by predîsposing ro facal hcart rhythm problem.i. In other words, if a smoker has a hearc :ltrack, sudden deach is more likely because nicoc:ine in me blood renders the hearr more irricable. Nicotine, however, is rapid]y

DYING FORA CrGARETTE? c1eared rrom rhe blood O/1ce a perSO/1 srops smoking. Within just a few days of the last cigaretre, we would rherefore expeer a person ro be ar much lower risk of death from a hearr artack. Your dotting sysrem also rapidJ)' changes when you srop smoking. One of the key accors in this process is rhe platelecs. Whae are rhe place1ers and whar is rheir funcrion? Plarelers are very riny subsrances in our bloodscream thac are smaller (han white or red blood ceUs. They go into acrion when a blood vessel is cut. Wiehout plarelers, a cut would continue to bleed umil ir was fatal. PlateJers prevenr this from happening by c1umping rogether and seaJiog off the cur. The clump (or c1or) grows until it is large enough ro seal rhe broken blood vessel, sropping the bleeding. Plate!ers do a wonderful work for rhe body in seaJing off broken blood vessels, usually wirhin minutes. These c10ui ng cells become more sticky and rend tO c1ump in an unnarural way when a person smokes. 112 They reod ro c1ump inside a vessel where there is no cur, usually ar pJaces where rhe blood vessels /}arrow down. lf the narrowing is located in a coronary arrery or ilie blood vessel ehar carries blood ro rhe brain, c1umped platelets may Stop me flow of bJood. This may affecr rhe control oflimbs, affect speech, or evcn result in sudden dearh. When a person stops smoking, plare1et functioll begins ro rerurn ro normal-in JUSt a marter of days. 113 Since the average plate1et only lives 10 daYS.114 in less than two weeks you wiIJ have a whole new population of normal platelers in rhe body. These changes seem to play a significanr role in decreasing hearr disease risk within a shon rime of sropping smoking. The facrs regarding hean rhyrhm stabili.zarion and normalizatiol1 ofc10tting function should provide further encouragemcnr for smokers ro kick the habit. The rapid change in risk of sudden dcarh is jusr onc example of the body's marvelolls abiliry ta repair irself and recum ta a normal state of funcrioning. 1 will cite more examples of how rhe body can bOllnce back from srnok~ ing-related damage iater in the chapter.

Smoking Jnjures the Brain The hean is nor the only organ mar suffers from ill effects induced by smoking-related cardiovascuJar disease. The aneries supplying (he brain also rend to experience accelerated amerosc1erosis due ro smoking. rf rhe narrowing becomes severe enough, a "brain attack" can occur-commonly called a srroke. The evem is similar ro a heart atrack, excepr that the blockage occurs in a blood vessel supplying rhe brain, causing desrruction of brain tissue. This is known as cerebrovascular disease. The facrs regarding the impacr of rhis disease have been determined by a wealth of seudies, and are lisred in Figure 22. 11 S Compared ro women wha never smoke, rhose who used 1 to 14 cigarettes per day have over double rhe risk of both faral and

CEREBROVASCULAR DISEASE · Smoking increases risk of cerebrovascular disease. · 15 percent of the nearly 150,000 stroke deaths occu.rring each year in America are due to smoking. · Risk is most evident in younger age groups. · However, even after age 65, sOloking significantly iDcreases stroke risk.

nonfaral stroke. Heavier-smoking women, using 25 or more cigarcrres per day. have nearly faur rimes rhc srroke risk. 116 Smoking more profoundly increases srroke risk in younger individuaJs. Risk of srroke dearhs in both men and women under 65 is generally tripled. 117 However, older individuals also pay a price for smok~ ing. Men over 65 have a risk of deaeh from srroke thar is 94 percenr greater than nonsmokers their age. FemaJe smokers over 65

Figure 22

387

PROOF POSITIVE experience a 47 percent increased risk of IIS

srroke deam. These srudies arc in harmony wirh my hospical emergency room experience as a consulcant physician. JUSt a few days before rhe rime of chis wriring, 1was called ta examine a 45-year-old stroke vietim who had arrived at the hospical; she had Iose che funetion ofher right arm and right leg and could not speak. 1 knew she was a smok~r befoee I examined hee. Large thrombotle strokes (strokes caused by blood vessel blockage) of chac severity generally do not happen ro people at that age who do. not smoke. Young people, beware. By cont1nl1in a tO smoke, you dramaticaUy inceease your risk of a devascating disability ac a young age. Imagine che tragic conseql1enc~s! T.his 45-year-old woman had been expenencl~g the joys of caring for her rwo young c~J1dren. Despice state-of-the-arr aggresslve treatment, che srroke brought an abrupc end ro mac experienee. She eould not even speak ro her ehild.ren; rhe stroke damaged the speech area of her brain. Her personaliry changed. She was subjecced ro ,:eeks and weeks of rehabiliration. AlI of dus resulted from the body-desrroying cobacco habir chat she had ehosen.

ATHEROSCLEROTIC PERIPHERAL VASCULAR DISEASE AN» AORTIC ANEURYSM • Smoking is the major risk factor for atherosclerotic peripberal arterial disease, increasing the risk ten times or more. • Kicking tbe habit is effective in aiding the medical and surgical management of the disease. • Death from rupture of an abdominal aneurysm is two to five times more commOD in smokers. figure 23

388

Smoking Damages Other Blood V'essels We have nored the profound effecrs of smokin a on the he-an and brain. We need now {Q °examine its effecr on ocher blood vessels including those in rhe abdomen, arms, and legs. Smoking is a major ~u~e of the fatry buildup of arherosclerosls In blood vessels throughouc the body. "Atherosclerorie peripheral vascular disea:e" is the term used ro deseribe a peoeess of narrowi.ng of the aneeies mat most co01mol11y affeccs aneries ;11 the legs. Compaeed ro nonsmokers, evel1 smokers ofless than onc paek per day have 1.I:S times tl~e risk of developing chis condltlOI1. Heavler smokers of more dlan one paek per day increase cheir risk 15.6 rimes. 119 An aonie aneurysm is one particulari)' devasrating conseguence of rhis process ~f fatcy buildup in the aneries. The aona IS r11e large blood vessel in che cemer of ilie body ehar carries blood away fron~ che hearr ro the leg-s. If chis major vessel IS severely affecced wid1 atherosclerosis, it ean be weakened and Iose irs abiliry tO rolerare the high pressures generaced by che heart. In r11is simarion, che aorea tends ro balloon ourward like a weak spot on a cire. Thar ballooning is called an aneurysm. Under the persistent high pressures that resulr from normal hean pumping, rhe aOTrie aneurysm wiU continue to grow in size until it ultimatelv ruprures. If [har happens, the result is lIsu'ally sudden death. Medic.11 re.search eonfirms thac cigarene smoking is a major cause of this fatal disease, as documented .In F'Igure 23 . 120 ' 121 . . There is a dose-response relatlonshlp berween the amount smoked and rhe risk of death from aonie aneurysm. This is SI)Qwn .111 F'Jguee 24 . 122 Noce me sharp rise in risk thar results me number of cigarerres from increasinO' o . smoked. Ar rwo packs per day, ehe flsk of death from this cause is inereased eight times. Even one ro nine cigarettes per day more rhan doubles the risk of dying from rhis signifieanr e3use of sudden deaili. It is worth pondering whar really happens ro your body every cime yOll take a drag on a c.igarene. It is clear that robacco smoke can

DY1NG FOR A CIGARETTE? be devasraring ro blood vessels rhroughour rhe enrire body.

AORTIC ANEURYSM MORTALITY RATIO BY AMOUNT SMOKED

How Smoking Damages BIood \1esselr

for Men and Women at age 40-79 at entry

We have already seen rhe effect of smoking on plarelets in [he blood. The chernicals iJl cigarerre smoke have orher farreaching effecrs thar increase [he risk of cardiovasculaI disease for a number of reasons. Some of rhe likely reasons are lis[ed in Figure 25. 12 . 124. 12 Smoking a1so affecrs more conventional heaC[ disease risk facrors. Research indicares thar smoking tends ro bo[h lower [he "good cholesrerol," HOL, and raise [he "bad cholesterol," LOL. 12 6 The resulrs of one study iliat documenred rhe cffec[s of smoking on lowering HOL are shown in Figure 26. 127 No[Îce tbar rhe more you smoke the worse your HDL tends ro be. This is anorher example of rhe so-called dose response effect, which provides a reiltaJe sign thar rhere is a genuine relationship between The two irems in question-in chis case smoking aod lower HOL levels. Smoking is also a powerful oxidant iliat would be expecred ro oxidize cholesterol. Oxidized cholesterol is covered more fuUl' in Chaprer 3, "He.1rt Oisea 'e-Conquering rhe Number One Killer." IT is particulari)' damaging (Q rhe blood vessel waJls and appears (Q play a kel' role in arherosderosis.

S...kiIIg Ctdegory

MOrlllllty Rist

NODsmokerl

1.0 -

1-9 CigaretteslDay

2.6

1~19

CigaretteslDay

3.9

2~39

CigarettesJDay

4.5

40+ CigarettesJDay

-

8.0 Figure 24

WAYS THAT SMOKING CONTRIBUTES TO ATHEROSCLEROSIS

-----------------

• Platelets become more sticky under tbe influence of tobacco smoke. • Cigarettes raise fibrinogen levels, which tend to make blood elot. • Carbon monoxide in tbe smoke damages the lining of blood vessels. · Carbon mODoxide increases beart work while decreasing oxygcn delivery. • Smoking lowers HDL lcvels in a dose response relationship. · If an individual has high blood pressure,

smoking worsens blood pressurc control.

SECTION IV

Dangers ofive Smoking

Figure 25

SMOKlNG LOWERS HDL (Ages 20 to 69)

ive Smoke Jncreases Heart Disease Risk Tt is bad enough thar smoking affects the smoker. In addirion, ir increases the risk of hearr arrack dearhs in nonsmokers by 20 ta 30 percenr. Ors. Glana and Pannley of rhe Universiry of California ac San Franci co ideorified a number of reasons for illcreased hcarr risk in nonsmokers in their comprehensive review ofilie subjecc. 128 Orher srudies have added ro rhis body of informarion.ll9.130.131 Secondhand smoke damages nonsmoker as shown in tile following lisr.

C;garettes per diIy

HDL v.lues for

meu HDL values for

womeD

1-19

20 or more

46.2

43.9

40.9

59.7

55.2

SI.I

CholesteJ'ol/e",!ls "djuslttdfor "ge, uinsil), "/,,ohol. and cnrds'-

Figure 26

389

PROOF POSITlVE

U.S. DEAmS PER YEAR FROM IVE SMOKING (EST.) • Heart disease deaths:

35,000

• Lung cancer deaths:

5,000

• Deaths from other cancers:

10,000 Total

50,000

Figure 27

EFFECTS OF IVE SMOKING 1. Reduces che blood' abilit}, ro deliver oxygen ro che hearc 2. Compromises me hean muscle's abilIt)' ro use oxygen 3. Lowers HDL Jevels as much as in aceive smokers 4. Increases plardec accivicy 5. Damages ehe lining of blood vessels

CANCER RISK FROM "IVE SMOKING" Women who have never smoked face over twice the risk of developing lung cancer it they Iive for a signUicant period of time with smokers.

Figure 28

390

6. Jmpairs dilarion ofblood vessels rhac normally occurs during exercise and oeher conditions 7. Causes blockages in hean bJood vessels eo form faseer 8. Increases ehe amoum of hean damagc following a hean aeeack We see ehar smoking affecrs the cardiovascuJar syseem of me ive smoker and rhe smoker in rhe same way. The dear message as enunciated by Glamz and Parmley is "Nonsmokers exposed ro secondhand smoke in everyday life exhibit an increased risk of borh fatal and nonfaral cardiac evencs. 'uz An emire chapter of Drs. Orleans and Slade's definitive book on nicocine addicrion is devored ro "robacco smoke pollueion." There they quancify [he oumber of deams caused by second hand smoke each year in our counrry.I:B Their estimaees are lisred in Figure 27. Abouc 50,000 ive smoking deaths from hean disease and cancer is a significam number. The tragedy ofive smoking is thae ie hurcs innocenr people, rhose who ehemselves have chosen oot ro smoke. Outcries againsr rhis infringemem on rhe righrs of nonsmokers have largely been responsible for legislation prohibiring smoking in public areas.

Do Smokers Cause Cancer in Priends and Loved Onest The Journal of me National C;mcer Institute reported on a seudy of2.10 wom.en who developed lung cancer but never smoked. Results are shown in Figure 28. 134 The risk ofdeveloping lung c.::mcer more rhan doubled for mase nonsmoking women who lived wirh one or more smokers. This is only ol\e of many swdies that show ehe same results: "ive smoking" is dangerDUS ro your healch. Of course, ir is nor as dangerous as "acrive smoking;" [hat is, smoking your own cigareues rather than rhose of someone else's. Remembcr, active smokers can increase their own lung cancer risk la {O 20 ar more rimes, compared ro the doubLing or tfipling in risk secn wieh

DYING FOR A CIGARETTE? ive exposure. It is noteworthy mar omer smoking-related cancers a]50 may be increased by rhe smoke of rhose around you. For example, published repons link cancer of rJle cervix (the opening of rhe womb) not only wirh acrive smoking. but also wirh secondhand smoke. 135 Anomer message from rhe medical studies on secondhand smoking is fhat ir is most devastaring for the most defenseless: the young and rhe unbom. Recalling rhe study pubLished by rhe Narional Cancer Institute, smoke exposure in childhood and adolescence was nearly twice as potent at increasing cancer risk as exposure in adulrhood. 136 An even mort' chiJling report was published by De. Dale Sandler and coJleagues ar the Nalional Insrittlte ofEnvironmental Healrh Sciences. Their research indicared thar childhood exposure ro parenral smoking (eirher in the womb or after binh) increased cancer risk years larer when the child became an adult. One group of cancers that was markedly increased was rhe hematopoiet ic cancers. These are cancers of the bloodforrnillg tissues and include rhe infamous leukemia. When one parenr smoked, risk of these devastating cancers jumped 70 percent. However, when both smoked, ehe risk increased 360 percent. When ali cancers were looked at, risk was acmally greater if the falher smoked rhan if the mother was a smoker. Risk of cancer across the board was increased by 50 percenr. 137 Orher research has demonsrrated lhar children whose mothers smoked during pregnancy are at iJlcreased risk of childhood cancers. 138 Inrerestingly. if rhe child's farher (but not mother) smoked, the chUd was al increased risk ofbrain cancerP? Upon discovery of these and other dangerous effeCIS of secondhand smoke, citi~ zens throughout our nation have ed legislation prohibiting smoking in resraurancs, airplanes, and the work place. After all. the public reasoned, \Vho has rhe righr ro endanger rhe health of innocent bystanders by Iighting up a cigarette? Such an aCI is one of "people abuse." In the wake of ali ehe attention direcred ar ive smoking, a newspaper carroon picrured a horse Iying on ilS back in a hospital bed. The animal

was ill and emaciared. It was receiving medicat ion by vein labeled "chemorherapy." The caprion under the carroon said "alI t!lose years wirh the Marlboro Man." The horse was a victim ofhis masler's smoking-a victim of ive smoke exposure. Smoking kiJls tu more people from beart disease and cancer than from any other single healrh-rdated problem. Similarly, when we look at ive smoking, many casualties come at the bands of these two leading killers. However, in many minds, secondhand smoking's greatest emorional impact comes from lhe damage ir does ro aur children and grandchildren, with some being affected rhroughour their lifetÎme.

Jnfants and Children Are Damaged by ive Smoke Studies show that infants and children are subjecred ro some of the highest risks ITom secondhand smoke-and rhe staustics are more sobering [han most Americ.1.ns realize. For example, children whose parents smoke as few as 10 cigarettes per day are more likely ro develop asthma, and if ehey do develop rhar disease ir is more likely ro be severe. Children's risks of asrhma may be tripled from SmOkiJlg by women. 140, 141 Estimates are rhat up tO 26,000 new cases ofchildhood asmma develop each year from this C<1use a]one. 142 Children of active smokers also have more coughs, colds. sore rhroats, ear infections, and tonsillectomies. 143 , 144 For childrcn younger than 18 months fhere is special risk. Each year in this age group, secondhand smoke causes up ro 300,000 respiracory infeclions such as bronchitis and pneumonia. 145 As many as 15,000 of these cases require hospitalization. One study indicared rhar for every five cigarerres per day that a mother smoked, her children's risk of problems wirh pneumonia and bronchiris jumped 2.5 to 3.5 percenr. 146 Of additional concern is the f.1.Ct that childhood smoke exposure may perlllanencly i.nceease the risk of developing emphysema as an adult. 14i

391

PROOF POSITIVE

Parental Smoking and Sudden Infant Death Syndrome Perhaps mosr frightening, howevet, is rhe s(
MOM~S SMOKING LINKED

TO

SUDDEN INFANT DEAm SYNDROME

Babies whose mothers smoked during pregnal1cy aud after are 3 times more Ukely to be victim.s of SIDS than babies of nonsmokers. Those only exposed to smoking in utero are twice as likely to be victims ofSIDS. Figure 29

THE SMOKING MOM CAUSES MULTIPLEDAMAGE Maternal smoking has bee" /inked to increased risks of:

· · · · · · ·

Tubal pregnancy Low birth weight babies Infant death Respiratory infections Asthm'a Impairm:ents of thinking Other developmental impairments

Figure 30

392

Sudden infam dearh syndrome oecurs in apparendy healrhy babies. Everything abollt the child seems normal. The mother and baby are bonding well; she is so happy ro have rhe (itele one. The child is put in rhe erib for a nap; when the morher rerurns ro rhe crib at rhe usual wake-up rime, rhe baby is dead. The pa.in and suffering of rhe parenrs are indescribable in such a deadl. The bahy of a morher who smokes during pregnaney and afrer is tfme times more likely ro become a vicrim than rhe baby of a nonsmoker. Even ifa woman stops smoking ar rhe rime she delivers, her baby who was exposed eo her smoking in the womb is rwice as likely ro be a SIOS victim. Yes, kicking the habir ar bireh reduces rhe risk, bur ir i5 stiH grearer rhan for rhe baby of a nonsmoking mom. le is dear ehar smoking shollld eease before a woman becomes pregnanr. Research published in rhe Brirish Medical Journal presenced similar findings. In rheir research, a morher who smoked during pregnancy increased the risk of het child dying with SJOS before eighr wee.ks of age. The risk ofdeath jumped by 55 pereel)( for every 5 cigarerres per day rhat she smoked. 149 Amazingly, the father's smoking was an even more powerful risk facror; however, the results were ooly apparent in infams older than 24 weeks old. Every five cigareeees rhar dads smoked each day essenrially rripled rheir child's risk of 5105. 150 Clearly, rhe risk of SIOS appears ro be relarcd bodl ro parental smoking arollnd the infam as well as ro rhe parents'. smoking habirs durÎng conceprion and pregnancy. These considerations caiI atcention ro rhe facr rhar parentaJ smoking first exens irs effecrs on children long before they are born. Other kinds of damage dur can be done ro an infam whose mother smokes during prcgnancy are lisred in Figure 30.

Tubal Pregnancy Risk/rom Smoking Probably rhe earliest prenatal effect of smoking is an increased risk of tubal pregnancy.151. 152 A tubal pregnancy occurs when a fertilized egg lodges in one of rhe rubes that lead from the ovary to rhe womb. The condition almosc aJways resulrs in the

'/t

; 'DYING FORACIGARETTE?

.-

'f .1, r f.,' b ,< loss of rhe n~Rls, '.u-t it also poses a serious risk ro the Morher. In America, such pregnancies are ţ~ leading c:ause of dearh In early pregnancy (fim mmestcr). Of particular conc.ern., nearly four times as mauy eubaJpregnanc;:ies occur in the U.S. roday as occuf~~ I\, 1%5. 153 The condirion accounrs fet fltlly ~3 percent of aII pregnaney-re~te' deith~.15.j Parc of rhe i.llcreased ruQal preJllaney risk may be due tO rhe fact tn~r s oking increases the risk of rhe female infecrion called pelvic inf1ammarory disease (PID). Lower hirth wcight has bcen known for years ro resule fl.nm maternal smoking during pregnancy. 'Ah:hough chis may sound desirable, it ac~ fOC!taSes the risk of stillbirrh aJldtdrnet mplications.15S.1SG .~

.

~

..

More MiscttiŢidg,es A-m~ng Smoking WOmen '," .t(r'\ Miscarriages are more frequenc among pregnant women who smoke. It is surprising Ulat the effcct carries through ro the daughtef ~ smoker, 1Iltimate!y affeeting rhe thirq en~ation. Or. Golding from rhe f.o\tieur.e ot Child Health. Universiry ofBj-is(~1, UK, has indicared rhe amounr of risk, sJP.vn i~ Figure 31. The cffeet of smoking on future generarions furrher undcrscorcs the urgency of helping womcl\: qreak free from rheir nicotine ~d ct~t,:· The ferllS 's iil"lohmrarily exposed ro secondhand ;smo~c when mom smokes. However, the unhom child can also be exposed to "third' hand smoke." III rhis situation. the pregnant morher is not a smoker. but is exposed ro environmenral tobacco smoke.R.?pu'tion. She. in turn. es (he stoo ' ~p.stituents to her baby. The expos~(iJ dJtd ~o develops more slowlyl57 and lţnţJ(;ro beborn smaller. 158 159 These efTecrs testify ro the poteney of thc cox.ins found tobacco smoke.

ar

ip,

Many Tobacco-related Stzllbirths Even if we put aside considerations of the father's smokliig ocher sources of "third hand" feral etposurc. the impact on ilie unborn i friU fttens!ve. If no pregnant

ana

"

.

,.

women in rhe United Srates smoked, thousands of lives would be saved. Recenr Statistica! analyses indicate thar cach year in America mere are anywhere from 19.000 ro 141,000 tobacco-rclated stiIlbirms. 160 In addition, there are other far-reaching eftecrs of maternal smoking: berween 32.000 and 61,000 infanrs with low birth weight; 14,000 to 26,000 infanrs itted ro newborn inrensive care units; and 1.200 ro 2,200 deaths from SIOS.161

More Malformed Babies From Smoking Moms Some parenrs regard a malformed child as being worse rhan the death of a child. They would rather Iose a child than give

MISCARRIAGE AFFECTS EVEN THE THIRD GENERATION • Smoking mothers are 27% more likely to miscarry than nonsmoking mothers. • Nonsmoking expectant motbers whose mothers smoked during pregnancy are 29% more likely to miscarry.

Figure 31

birrh to an infanr who is severely maJformed. Sadly. when a mother smokes during pregnaney, she aho purs her children ac increased risk of malformations. 162 These defects include major malformatÎons such as limb deficiencies. 'G3 They aJso include cross-eyes 164 and cleft lips and palates. 165 Such oral c1efts are among the mase common birrh defects. Approximately 13.5 perceJl( of rhe population have a genetic tendency to such problems. However, if a generically susceptible mother does nor smoke. her risk ofhaving a child with sllch a defect is only 20 percent greater mao mothers wirhour that genetic tendency. Buc

393

PROOF POSITlVE ifa woman with rhe impaired gene smokes, her child's risk increases 500 pe(cenr. Sadly, once she finds out she is pregnaIH it may :~lready be coo Iare. A Johns Hopkins srudy found that, in many cases, rhe damage was already done before rhe woman even knew she was pregnam. This provides aIlorher morivation for ali women of childbearing age to scop smoking.

CHILDRE OF SMOKING MOMS: LOWER IQ When compared with offspring of nonsmokers, mothers who smoke at least 10 cigarettes a day during pregnancy give birth to children with IQ's that average 9 points lower. Figure 32

THE INTELLIGENCE QUOTIENT (lQ) SCALE 145-160 aud above

very superior

130-144

superior

115-129

bright average

---

85-114

average

70-84

55-69

I

40-54

retardation I _moderate _.'._0' - mental --

1---'"

25-39 ..

.-

les. tban 25 Figure 33

394

borderline -mOd mental retardation

--

-

severe mental retardation -

profound mental retardatiou

Lower IQ among Children Whose MomsSmoked Mental impajrmellt is a common remit of smokil1g during pregnancy. When intelligence was measured ar the age ofrhIee or four, imelligenee quotiems (1Q) were lower among children whose morhers smoked during pregnancy, as stated in Figure 32. 166 It only rakes a half paek per day for a pregnant woman ro damage her baby's IQ. Other studies have showed similar results. 167 Nine poims in the IQ may nor seemlike much, but it ean make a significanr difTerenee. For those staristically minded, 15 poims are one standard deviarion in the IQ sca.le. Classific..1tions of illteiligence are therefore somewhat arbitrarily made on the basis of 15 point categories. where the middle rwo fifteen-point categories arc considered average, 168 The IQscale is listed in Figure 33. Tbis sca1e indicates thar a ch.ild can move imo a whole different illtelligence category by moving JUSt nine poims. It is nOI accurate ro use dus nine poillt statistical avertlge from population data ro predict rhe impact on any individual child. One child may be penaljzed with a 15-poim drop in IQ, while another may have only a slight penalty. However, any penalt), in a ehild's lQ is unjusr. The mental effeers of smokjng persist throughour childhood--causing the child ro have a poarer mental c1paciry than wotlld orherwise be. How unfair ro the ebi..ld-ro be penalîzed for life with Il lower IQ because o/maternal smoking. SmOkitlg nor only lowers childIen's IQs. but it c.1.n cause suffering from other brain and nerve-related problems. Among the problems reponed in children of morhers who smoked during pregnancy are abnormal muscle t.one, increased tremors, aud proble1ns processing sound ("changes in auditory responsiveness").1 9 They also have been demonstrated ro have a decreasc in rheir ability ro deal with spatial information. 170 In fact, researchers from Duke Universiry now suggest thar cigarettes ma)' be more harmful to r!le unborn child

DYING FOR A CIGARETTE? (han even coc~ine.171 Whae does smoking do co cause sllch profound menral and nervous sys(cm effecrs? Tobacco rhrough ies widespread dfccrs on blood vesscls reduees the supply of oxygen and nuerienrs to ehe fecus. l72 There are also indieaeions ehae mat.ernal smoking acruaUy decreases the number of brain nerve cdls in rhe developing fetus. 173

Mort Problem Kids ofSmoking Moms According ro recent scudies, a chiJd's

behllvior can also be affecred by secondhand smoke aner birrh, as srared in Figure 34. 174 Secondhand smoke can affecr rhe brain of rhe young child, and as a cOllsequence, rhe characrer. This srudy rried ro very earefully for any orher factor ehar would have impacred on a child's behavior. The researchcrs made sraris(ica! aUowance for sucn facrors as (he chi/d's race, age, sex, and birrh weighc. They a1so included in (heir scarlsrical analysis measuremenrs of family srruccure. income, and divorce or separaeion. Ma(erna! facrors wcre measured and accolllHed for. Spedfically, they looked al rhe morher's educarjon, her inreLligence, sclf-esreem. employmenr srarus, healrh conditions, and her use of a1cohol during pregnancy. The research ream even used a special scale ro measure che quaJiry of rhe home environmenr. Jn spice of aU cheir drom (O explain che effec(s as a resulr of somerhing e1sc, (he momer's smoking afrer birrh still emerged as a powerflll factOr afTec(ing chiJdhood behavior. The sca(isrics indicare a cause-and-effecc relacionship although (he reason rhar sll10king causes poor behavior has nor yer been dcrcrmined. [n a sociery where childhood behavioral problems oh-en cause greae perplcltiry, it somcrimes may be inaecuraec eo blame rhe difliculries on parenring sry!es-pareneal smoking may be the culprÎc.

Smoking Parents-A Form of ChiU Abuse? For reasons sucit ;\S these, obste(ricians anei pediarricians have become ehan1pions of smoking cessarÎon. Almose aII

SMOKI G MOMS RAVE PROBLEM KIDS 1. The more a mother smokes after giving

birth, the more behavioral problems her chiJdren are likely to have. 2. Researchers think the behavior problems could be caused by cigarette smoke altering brain structure or function, or somehow affecting the central nervous system. Figure 34 obsretricians inform rheir pregnant parients ro qwt smoking. Pedjarricians generaIJy give rhe same advice ro rhe smokitlg paren ts of (heir young parienrs. Truly. ir is rragic enough (har smokers damage their own bodies, but the tragedy rakes on much grearer proporrions when the habit harms cheir own children aud grandchildren. No normal parenrs would wam ro deliberately rhreaten rhe healrh or well-being of meic child. bur ie is happening daily În our soeiery. When parcurs realize che damage eheir smoking inf1icrs on rheir innocellc children, would it provide enough incenrive for chem ro kick rhe habi(? In America roday, child abuse has become a major iSSlle. Some are suggesting (har a smoking parem is guiley of a sllbrle form of child abuse.

SECTIONV

Chronic Lung Diseases Caused By Smoking Abour 60,000 Americans dic each year of chronjc lung condieions slld1 as emphysema and chronie bronchiris caused by cigarerre smoking. 175 These lung condirions are ofren collectivelv referred ro as chronie obsn:uctive puJmon;ry disease (COPO). Another published sratistic is (har smoking causes 85,000 deaths per year in our coumry from

395

PROOF POSITIVE various pulmonary diseases, including borh COPD and pneul11onia. 176 A whole hosr of changes În body funcrÎons induced by smoking sers r!le srage for chronic lung problems. Smoking CaUses widespread damage ro rhe lung's defense sysrems. These changes also ser the srage fOr chronic ob· srrucrlve lung disease.

The Cause of"Smoker's Cough" Chronic bronchiris is one of the lung coudirlons dur oecurs under rhe int1uence of cigareuc smoking. This il/ness seems ro be a direcr re~;ulr of rwo ofsmoking's effecrs: paralysis of rhe cilia and irriration ofrhe lung lioing rissues. You will recall rhar in nonsmokers, microscopic cilia help ro keep rhe lung clean. Bur because of chemicals like formaldehyde, hydrogcn cyanide, nirrogen dioxide, and ammonia, rhe cilia of smokers are paralyzed. To make marrers worse, rhere are a hosr ofirriram chemicals in robacco smoke rhar cause rhe lung ro make more mucus and rhicker mucus. The resulr is grearer mucus buildup in the lung. With deficient cilia] function, rhe onll' wal' rhar rhe bodl' can dear rhis I11UCUS is by coughing. Thus,ehe haUmark of chronic bronchiris is a persisrent "smoker's cough." A cough mal' sound hann]ess enough, bur chronic bronchiris is a progressive disease. In its advanced srages ir can cause severe impajrmenr and even death.

Smoking Causes Emphysema A]rhough chronie bronchiris kills, ies cousin, emphl'sema, is generally more feared. Emphysema also is re!ared djrecrll' ro changes callsed bl' smoking. Unforrunare!y, many smokers never realize thel' have emphysema umil rhel' begin having brearhing diffieulries. By rhat rime mllch of rlle damage has a]ready been done. Once lung tissue is losr, it ca.n never be regenerated.

Asthma Aggravated by Smoking

396

Asthma is often grouped with rhe chronic obsrructive lung diseases. Srnoking also gready aggravaees asduna. We have seen ehar chis can be especially imporranr in asrhmaric children, manl' of who never wouJd have developed rhe disease had rhey

nor been exposed to cigaretre smoke. Forrunaeely, many of ilie lung effects of smohng are fully reversible. When asr.hma parienrs Stop smoking, r11ey immediarely remove rhe 4000 chemicals in robacco smoke thar have been providing a potent stimulus for [beÎI airwal's ro rigbren and obsrrucr air ilow. Chronic bronchi{is is a]so generally reversible if a person srops smoking soon enough. Even many long term heavy smokers wirh chronie bronchiris who srop smoking will see rheir bronchi{is vanish over severa] months ofbeing smoke-free. However, ir is imporranr ro stop smoking now. The longer a person sJnokes, rhe greater ehe ehance (har rhe chronic bronchiris wiJl becarne irreversible. Wieh emphysema, rhe picrure is nor as brighr. As already mentioned, ollce lung risslle is desrroyed it can never be rcgenerated. However, rhere is good news. Because people wirh emphysema almosr always have some component of boeh chronic bronehiris ;md asthma, rhey generally improve some when they srop smoking. The improvemenr can be eonsiderable. Even more importanrly, whcn rhey stop smoking, rhey preserve life, exrend longeviry, and improve (heir qualiey of life as rhey cease rhe rapid loss of lung funcrion rhar results from smoking. 177 . 178. 179

Smoking Causes Shortness OfBreath lndividuals \,vithout any diagnosis of chronie lung problems may sem suffer lung impairmenr from smoking. Whether or nor rhel' have asrhma or emphysema, sJllokers suffer shorrness of brear11. AmI whether or nor they bave chronic bronchiris, rhe)' have more problems with cough aud spururn production. These cOlild be signs of a more serious disorder, or rhe symproms may nor have yer progressed ro a disease srare.

SECTIONV1

Smoking Degrades the Quality OfLift As Americans get older, many fear disabiliry more rhan rhel' fe.1r dealll. The good news is rhar medical researeh has found rhar

t

DYING FORA CIGARETTE? paying attention ro good health habits oow decreases our risk ofdisabiliry Iater. One of fhe key facrors in preveming disabiliry is avoiding smoking. Some of the mosr convincing research comes from srudying individuals berween 60 and 94 years old from Alameda Counry. California. 180, 181 Ongoing research on thar populatioll has determined rhat cigarette smoking significantly increascs the risk of disabiliry. HealthyeatÎng habits and reguldr exercise also helped ro decrease rhe likelihood of disabiliry as rhe parricipams' aged. 182 There is no question rhat smoking causes life-rhrearening diseases. It also incrcases aur risk ofdisabiJiry and decreases the qualicy of life in a number of ways orher man disabilicy; rhey are lisred in Figure 35.

Smoking Weakens Bones The srrength of aur bones depends on thcir densiry. The more dense our bones. fhe srronger rhey are. A decrease in bonc density and strength is undesirable: risk of fraceu re escalates. We have k.nown fo r some time rhar cigarette smoking contributes ro tlle los5 of bone density. There is a hosr of other risk facrors that conrribure ro bonc 10ss; however, smoking is a major one ro reckon wirh. 183 Many research srudics have condusively demonsuated rhat smoking women have less bone densiry. Problems, however, usuall)' do nor surface umil they go rnrough menopause and suffer further bone densiry losses. Ac rhac poior they become much more like!y to suffer a hip or other fracwre as a resulc of osreoporosis (thinning of rhe bones). Hip fracrures are serious ijl older Americans. The risk ofrhe most serious complication, dearh, increases witll the age of the patient. In older Americans, within one year of the hip frac rure, roughly 20 percenr of fhe victims will die. In rhe nexc year, another 13 percen c wi Il die. 184 Th us, roughly one ch ird of older hip-fracture patients do nor survive rwo years following rhe episode. The good news, howcver, is char aher rhose !WO years rhe risk ofdeath is similar co (nose who have never had a hip fracrure. 185 Even if a broken banc docs not cause death, it cerrainly degrades fhe qualiry of

SMOKING DECREASES QUALITY OF LIFE Smokers tend to have: 1. Reduced bone strengtb aod more fractures

Greater ,risk of back [pain aod injlury !

Hormonal aboormalities

/ More rapid loss of pbysical capacUy 1--- Accelerated skin wrinkliiog

Accelerated hair loss aud graying l, Accelerated loss of vision 1. Difficulty sleeping

1- Heartburn problems

__ . More cases of stomacl!

u~lc~e~rc:"s:..--_ _-.E===-_ _""'''''''''~~ Figure 35

life. Anyone who has been incapacitated by a hip fracrure recognizes rhe impact on life's quality. The inconvenience and miseey of surgery, hcaling, recovcry, including physical therapy ta leam ro walk again. can be a discouraging experience that stretches out for maurhs. The sratisrics suggesc [hat in many cases ali chis mjsery could have been

SMOKING ROBS BONES • 41 pairs of identical female twins were studied in which one of the pair smo1ked significantly more than the other.

• Those who smoked one pack per day had lower bone densi;ty than those who were nonsmokers. • The rate of bORe density loss was sufficient to increase the risk of fracture by the time of menopause. Figure 36

397

PROOF POSITIVE avoidecl haei tl1ar vicrim chasen nor to be a smoker. Other fracrures due ta rhin bones can also rob life's qualiry. Consider vertebral compression fracrures. These fractures of rhe backbones are nor only generally painful, bur rhey also cause a decrease in height and can cause a humpbacked posture. A srudy ar Melbourne University measured the los-s of bone dcnsity caused by smoking. The results are shown in Figure 36. I 6 This sruely of rwins on smoking and bone densîty is sigllificanr. Since identical rwins have identical genes, the possibility of generic differences was c1imina.red. One pack per day is enough ta cause dallgerous weakening of rhe bones.

Smokers Have MOfe Back Pain Back pain is costly for rhe individuaj and for his or her employer. In bce, back pain cam employers over 10 billion dollars each year. Nearly halI of aII days missed from rhe workforce are due ro back pain-and rhe condition affecrs 80 percenr of rhe working population ac some rime in rheir careers. 187 Among rhe risk f.1crors for back injury are che obvious rhings: poor posrure, poor lifring rechniques, being overweighr, lack of firness. and excessive ness. I 88 How-

SMO G LOWERS AGILITY AN» HASTE S AGING Wome1l 65 and over performed 12 different physical tasks. Smokers did poorer OII 11 ofthe tests. Areas evaluated included: . Agility . Strength . Coordination • Walking . Balance

. Smokers' performance was c1ear ly inferior to tbat of nonsmokers. • Smokers' performance was often as poor as nonsmoking women five years older. . Smokers' risk of injuries from falls may thus be increased. 1

Figure 37

398

ever also 00 the lisr is cigarerre smoking..189 Cigareue smoking is an important and often llnrecognized risk faccor for back pain. A swdy of workers in Maine found ehar smokers of more rhan I pack per day had triple !!le risk ofsignificanr back pain. Other srudies have found rhar cigarerre smokers are more likely ro slIffer from seriou!> spinal disk disease. And following sllccessful surgery for low back pain, smokers have a grearer risk ro again experience disabling low back paill. 190 One serious form ofback pain is caused by problems wirh rhe disk srruccures rhac provide cllshioning ber"veen rhe backbones 01' verrebrae. A leading theory is thar smoking limirs blood supply ro rhe dîsks so {hac rhey become more susceprible to everyday wear and tcar and ulrimately susrain damage sooner.

Smoking and Homonal Function Current evidence indicates rhat smoking can alrer a hose of hormonaj facrors. Sex hormone leve1s are affeereel, including rhe importanr follicle-srimularing hormonc (FSH) anei lureinizing hormone (LH).191 It is likely thar these hormonal effecls pIay a rale in rhe premarure menopallse mar rencls ro oceur in smokers. Pararhyroid hormone is a critical hormone involved in mineral balanee; it is deereased in smokers. ,n Furrhermore, evidenee indieares ehar smoking ma)' worsen mild ehyroid deficiency. A recenr Swiss srudy evalualed over 80 wOlnen wirh mild chvroid prablems. 193 Those who smoked haei' worse thyroid jimctio1J anei significantly higher cholesteroL levels (28 percenr higher lOtal cholescerol values and 16 percenr higher LDL levels). In fact, rhe more rhe women smoked, che more meir eholesrerol levcls rase. The research suggests that smoking may incerfere with che aerÎon of thyroid hormones.

Aging, Early Skin Wrinkle~' are Accelerated by Smoking Those smokers who live ro see ilie age of 65 are likely to funcrion at a poorer level their nonsmoking peers. A srudy of nearly 10,000 women 65 and older demonsrrared

man

DYING FOR A CIGARETTE? thar rhose who smoked had a hasrened aging proce.ss. More rapid dedines in physica1 performance were documemed in a number of rasks, as Jisred in Figure 37. 194 Physical performance in smokîng womell over 65 is reduced to a level ofren found in women five years older. Their "health age" is thus significamly greatcr than rheir chronological age. The profout\d reducrioll in muscular srrengrh and balance would also tend to make rhose women mo re prone to falling aod orher accidenrs. ThÎs particular eEfece of smoking does nor necessarily rrans[are into an earlier death, bur it surely takes fhe fun Olll of Iife duri ng rhe much-anricipared years of rerirement. Truly, smoking can rob a person ofthe joy oE rhose "golden years." [n 1992, researchers at rhe Universiry of California ar San Francisco analyzed nve seudies rhar looked ar smoking and skin wrinkling. The conclusion was lIndeniable: in whire men and women, skin 'VrinkJing was measurably increased by smoking. 195 Once smokers reach middle age, rhey rend ro look rnuch o[der because of skin wrinkling. The repom are nor pretty. One group of researchers studied 244 women wha ranged between 35 and 84 years of age. They described what they called "cigarerre skin;" a paie, grayish wrinkJed skin wim rhick skin between the wrinkles. These unbecoming changes were found in 79 percem of smokers and only 19 percenr of the nonsmokers. l96 A more recent Brifish stlldy found a pattern of prominem wrinkJing, gaunt f.'lcial feaeures, and skin color changes in 46 percent of smokers, 8 percem of ex-smokers, and nooe in {he nonsmokers. 197 I have become so accustomed [Q a smoker's skin appearance rh.ar 1 usually do not need tO ask a patiem if he or she srnokes. Those wrinkles tell the story. Anyone who wams (O avoid early skin wrinkling shouJd quir the habit now. Why do smokers get more wrinkles? Drs. Grady and Ernster have provided a compelling exp[anarion. 1?8 They poin( our (har cigarette smoking eauses a decrease in blood flow through (he (illy skin blood vesse1s. They suggesr that a chronic lack of

adequate blood supply may be one of the reasons for increased wrinkling. Smoking hastells orher processes that aflecr the smoker's appearance. Smoking i..r1Cre~lses the likelihood ofearly ba.1dness anei premature grayillg. 19? A stllely of over 600 individuals founel that smokers faced approximately four times rhe risk of premarure graying as nOllSmokers. A.nd when compared ro nonsmoking men, those who smoked were almost rwice as like1y ro go bald. The researchers speculate rhat (his and other studies indicate that smoking speeds up a person's biologica[ cJock.

Eye Diseases More Prevalent among Smokers The rapid aging effecrs of smoking are not limited ro (he nerves, muscles, skjn, and hail'; they affecr rhe eyes as well. Cataracts, age-related clouding of the eye lenses. are more- prevalent among smokers; rrearment usually involves Sll rgery. Smokers a[so increase cheir risk of an untreacable eye disease (har can le.ad ro blind ness. The condirion is called macular degenerarion, and rhere is no medical treatmenr for it. The Harvard UniversÎ(y-sponsored Nurses' Health Srudy has followed 60,000 female nurses for 12 years. A similar smdy of 21,000 maJe docrors for 14 years has comc ro similar conc1usions. Namely, [har cigarene sll10king can more than double the risk ofblindness from macular degenerariol1. Although most lay people are unfamiJiar wirh this condition, rhe disease is surprisingly common. Each year in rhe U.S. macular degenerarion callses 1.7 million cases of vision loss. Almost ali of rhose affecred are 65 or over.

Smoking Deereases the Quality ofSleep Sleep qllaliry appeal's ro sllffer in smokers. Recene research Erom rhe Deparrmen( of Preventive Medlcine at the Universiryof WiSCOl1sin has dernonstrared (har smokers have more problems faUing asleep and more difficulry with llon-restorative sleep. 200 The researchers sllggest a llumber of facrors thar

399

PROOF POSTTIVE may contribure ro these problems. Pirsr, rhe srimulane effecrs of nicotÎne make it more diffieult for rhe average smoker ro ger ro slc. Second, as nicorine levels drop in the blood, smokers begin ro go through subrle wirhdrawal syrnproms. Thcy may nor awaken, but inrerference wirh sleep quality is rhe flIle. Third, smokers rendencies ro respirarory problems may a1so interfere wirh rheir slcep qualiry. lronically, ali of rhe sleep problems caused by smoking may actually keep {he smoker coming back for more. In order ro compensare for ilie resulrs of impaired sleep quaJiry such as fatigue and mild feelings ofdepression, rbe person ofren rums ro smoking. This behavioral "viciou cycle" is best broken by sropping smoking cold rurkey." However, be persistent. During earlywirhdrawal, sleep difficulties ofren ger worse before you see improvemenr.

Smoking Aggravates the Digestive System

400

Are you troubled by hearrburn? Buming pain in rhe mid-chesr or sromach area GUl occasionaHy be a sign of serious disease. Usually, however, hearrbllrn oecurs when sromaeh acid rravels back up rhe swallowing rube known as rhe esophagus. Irrirarion of {he esophagus as a result of rhis backwards acid movemenr causes rhe pain. Technically ir is called reflux. Unforrunareiy, hearr disease, ulcers, and even cancer can masquerade as simple hearrburn. For chis reason, a medical evaluacion is wise if you have a new or recently worsened bearrburn problem. If your discomforr fUms oLU ro be due simply ro reflu.x, then some relatively simple lifesryle solurions may go a long way roward curing your problems. One of rhe cornerstones is ro stop smoking. Like alcohol and caffeine, nicorine rends ro inerease sromach acid prodllcrion. Toral avoidance of aII tobacco producrs is rherefore rhe besr approach. However, kicking the habit provides other beneflrs ro your esophagus. Nicorine has direct effecrs on a band of musde rhar lies berween ilie stomach and esophagus. This muscular band is called rhe lower

esophageal sphincter. le is designed [O be dosed at aII rime.s e.xcept when food es from rhe esophagus downward inro the sromach. It normally c10ses immediarcly after food age ro prevenr reverse flow of acid and orher sromach coneenes. Nicorine, however, weakens rhe sphincrer muscles, causing rhe sphincter ro sray open. 201 This, in cum, allows sromach acid ro'How upward inro the swalJowing rube. The combination ofa weakened sphincrer wirh more acid sers rhe stage for hearrburn in susceprible individuals. Alrhough there are a variery of medicarions rhat can rreat rhis condirion, sropping smoking is a mosr prudent firsr srep. Kicking the habir decreases aeid prodllction and allows rhe sphinerer ro rjghren up and work more normally, ofren ending rhe hc.arrburn. Sromach ulcers are al o mllch more likely ro oecur in smokers. Some srudies indicare rhar smokers have from two ro rhree times rhe risk of such problems. 202 Ulcers can C'luse bleeding wirh or withour accompanying pain. It can be difllcllir [O heal an ulcer and keep it f(Om recurring if an individual conrinlles ro smoke, even when patent medications like Zantac, Tagamer, Prilosec, and Cuafare are raken. However, if the ulcer vierim kicb the habir, the cure is ofren nor difflculr.

Smoking Diminishes Vitality and Other Qualities Of Lift 1 could conril1ue ro document on man\' pages furrher derails of qllaliry oflife issu;s dlat are relared ro cig,l(erre sllloking. Some of {hose issues would be extensions of information we have already presenred in chis chaprer. Examples may include suffering from a cancer rhar is ulrilllare1y eured but renders a person disfigured; disabiliry from a non-faral, yer crippling smoking-relared hean arrack or srroke; ar the mental anguish ofan adulr moker Living wirh a child who is menrally or physically disabled due ro rhe cfTecrs of the smoker's habit. Recent work by Dr. Ronan Lyons and colleaglles plIC aU of these facrors inro perspective when rhey used el special survey

DYING FOR A CIGARETTE? measure qualîry oflife. 203 The questionnairc cmployed was an established evaluation called the SF-36. le asked 36 questions that provide a usefuJ way of measuring qllaliry oflife in eight categories. Arnong the more imporcalH areas mea.sured were physical fi.1nctioning, pain, general hCdlth perception, and vitaliry. When rhose who ever smoked were compared with those who never smoked, the results were srartlîng. They are depicted in Figure 38. 204 The vaJues stared in this figure mean rJ)at the physical fllnctioning of 44-year-old people who ever smoked is equal to the physical functioning of 50 year olds who never smoked. The ever-smokers are OVtr 6 (Q

yean' oMer than their actual age in thiJ regard. Regarding pain, general healrJ) perceprion, and vita!iry, the ever-smokers are 14 to 15 years older than their actualage. Ifthese were the only derrimenral effects ofsmoking. they should be enough ro motivare smokers ro quit. and for nonsmokers tO keep their distance from robacco. Lyons' work provide an eioquent capstone ro t!Lis segment of rhis chapter. Tobacco is nor jusr a killer. It can do things that are worse in the eyes ofsome--stealing life's qU:lliry. destroying happiness. aud inducing disabiliry. Every smoker can significantly increase rhe probabiliry ofa full quanriry and qualiry oflife by choosing roday ro become a nonsmoker. Many people fail in rheir multiple arrempts ro quit rhis powerfllJ addicrion bccause they do not lIse rhe right methods. A descriprion of the keys ro become a slIccessfuJ ex-smoker is found in Secrion VlIl. 1 do nor Stop there, however; the secrion also includes practicaJ soluriolls on how you can kick the misel) om of kicking the habit. Before r cover rhar vira] material, we musr examine one orher indispensable ropic. All ofthe documenred problems wlrh cigarerre smoking have led some ro abandon cigarerres in favor of other robacco producr or other addictive substiturcs. lfhedlth is your goal. rhose cigarette "aJrernativcs" are nor viable oprions.

EFFECTS OF SMOKING ON FOUR QUALITY OF LIFE AREAS Ever-smokers' scores are equivalent to never smokers who are:

Heallh area

6.6 years older Pain

15.6 years older

General health perception

14.6 years older

Vitality

14.0 years older

SECTIONVII

Figure 38

ro

"Alternatives" Cigarettes Are Also Health Hazards When people give up [obacco, t.here is a danger that they will gravitate ta alrernatives thar are perceived ro be safer, bur may be equally or more dangerous in cerrain respects. A detailed presenration of such alrcrnarives is beyond the scape ofthis chapter. However, it is importanr ro menrion severa1 popular "alrernarives" ro robacco Clgarerres.

Marijuaruz-Dangerous DrugNot an Alternatt've to Tobacco One popular alternarive seems ro have [he repur
401

PROOF POSITlVE drugs in this iL/egal substance.

402

Jusr as nicorine exens deleterious fetal effecrs, 50 does marijllana. Marijllalla. like ies cOllsins aJcohol and nicOline, has now been demonstrated ro harm the beain of rhe developing ferus. A morhcr who uses marijua.na gives her child a lifdong legacy of brain impairmenr. 207 Animal tests demonsrrare rhar decreased oJ\.)'gen delivery occurs when morhers are exposed ro marijuana, similar ro rhar noted wirh nicorine exposure. 2 0 8 Of note, wirh marijuana, fhe decrease in oxygen delivery ro rhe fetus is prolonge.d, lasring long beyond any effeers on rhe morher. Furthermore, afrer birth, marijllana can also inrerfere behavioraHy, diminishing rhe morher's desire ro care for her newborn. 209 lr also rends ro decrease breasr milk producrion and release. 210 Some of rhe grearesr fears ahour marijuana are not rhe effecrs on Olhers but rhe effecrs an rhe long-term lIser. Tetrahydrocannabinol bears a srriking chemical similariry ro corticosrerone, one of fhe cortisone-rype hormones of the body.211 Currene research indicare.s rhar bCCdllse of rhis similarity in structure to rhe corrisone rype family of drugs, Tl-IC exerrs toxic dunges in a central parc of the brain known as rhe hippocampus. 1n fact, borh rhe natural srress hormones of the body and Tl-IC have been demonsrrared to acce/emte aging ofthe brain. For example, in one animal srudy, rats exposed ro marijllana showed a dOIlbling in fhe progression ofbrain aging. At rhe end of the sUJdy, the marijuana-treared rats had brains that tested rwice as old as rheir age. AII of this is extremely importaor. The hippOGllnpUS is one of the mosr vulnerable 5tfUcrures to brain aging. It is particularly hard hir in brain-deteriorating condiriolls such as Alzheimer's disease. 212 Currenr research suggests rhar the hllge numbers of Americans who habitually use marijuana may be puning rhemselves at significantly increased risk of brain deteriorarion as rhey age. Recent srarisucs indicate char 4.8 percenr of clIe entire U.S. popularion smoke marijuana at leasr once per monrh. More than 3 million are daily ar "almost daily" s. 213

As covered in Chapter 12, "The Froncal Lobe: The Crown of the Brain," marijuana a150 affeccs day-ro-day mental performance. For example. recent research funded by rhe Narional Insrirure an Drug Abuse found rhar college stlldents who were regular marijuana lIsers had defecrs in their arcemion, memory. aud Jearning even 24 hours ;lftcr rheir lasr use of rhe drug. 214 Marijuana use measurably affecred brain performance long afeer rhe thoughr rhe efTeces had wom ofI Marijuana also appears ro pose a threar ro the hearr and blood vessels. When combined wirh exposure ro everyday stresses, marijllalla significantly increases tbe heart rare and blood pressure responses tO rhose srresses. 215 Since blood pressure is a significallt risk facror for borh heaer disease and suoke, switching from cigarertes to marijuana is nor a protecrive move for your hean. Marijuana also appears to incre.ase cancer risk. Canllabis has been idenrifred as a source of carcinogens as well as being an imll)une system suppressantJI6 Recent research on the subject bas come from the Universiry of California ar San Francisco and orher centcrs. These reporrs sllow rhar marijuana and robacco smoking cause similar lung chaJlges-wirh one differencemarijuana has a much more poum ejject. In of lung dmmlge, one t is equivalent ro a JUli pll.ck of20 cigarettes. Corn1'ared tO tobacco, our national experience wirh marijuana is relarively brief-but rhe currem resulrs suggest rhar it adversely affecrs unborn children. The drug leads ro shon term and long rerm menral dereriorarion. Ir is also a powerful respiratory 1'oison, a cancer-causing agent, an immune sysrem suppressant, and a drug ehat likeJy increases hean disease risk. Clearly, marijuana is nor a safe alternarive ro tobacco.

Cigar and Pipe Smokers Have Incret/sed Risk ofDeath There are orher supposed alrernarives to smoking cigareues than illicit drugs. There are a number ofmher robacco producrs rhar

DYING FOR A CIGARETTE? seem ro have acquired rhe repuration of being safe ways 1O enjoy a nicotine high. Cigar smoking is one; some misrakenly belicve that cigars are safer than cigarerres. However, cîgar and pipe smokers do put dlemse1ves at increased risk ofdearh because of their habie ome srudies suggest their monaliry rates are 20 to 40 percent higher than nonsmokers. 217 However, the more often an individual smokes a pipe or cigar, the greater the risk. h is important tO note thar, as a group, rhose who have previollsly smoked cigarenes tend ro smoke more if they switch to a pipe or cigars. 218 Current eigarerre smokers elearly should make a cLean break wirh ali forms of robacco. The imporranee of making a elean break with aU forms of robacco becomes apparenc when we look ar heart disease risk. Cigar and pipe s pUt themselves at significantly increased risk of rhi' leading cause of dearh among cigarene smokers. One c1assie tudy from Copenhagen, Denmark, looked at a group of middle-aged men berween the ages of 40 and 59. Among the group were 3,772 slllokers that were c.~tcgorized by the type of robacco rhey used and 1,440 men who had never lIsed robacco.2I') The re ults are illustrared in Figure 39. Over rhe cOllrse of seven years, rhere were 170 hean anacks in this combined group of over 5,000 men. The results showed more than double the risk for srnokers of cigarenes, cigars, pipes, anei cherooe Pipe smokers' risk was increased by 50 petCenL

Snuffand Chewing Tobacco Increases Cancer Risk Smoke1ess (Obacco also c.arries the seeds of dearh. Most norably, llse of these products is a pocent cancer risk faccor. In 1992, then Health and Human Services Secretary, Dr. Louis Sullivan stated, "It is time that smokeless robacco take irs righrfl.ll place next to cigarene smoking...as a seriol.ls health risk that must be s(Opped." Dr. Sullivan's strong langl.lage seemed appropriate when you realizc his sratcmenr introduced a scielltific book of ovcr 300

SEVE -YEAR INCIDE CE OF FIRST BEART AlTACKS IN TOBACCO S ANO TOBACCO ABSTAINERS Cutegoryoj smoking hahi/

Amoullt Myocardial illjarction per 1,000 men smoked

Relative risk

Never smoked

17

1.0

Cigarette smokers Total

36

2.1

Total

42

Chcroot smokcrs* Total Total Pipe smokers

48

2.4 2.8

26

1.5

Cigar smokcrs

'Ch"ool is ba
pages thar detailed che hazards of smokeless tobacco. 220 The subject represenrs no small probtem. Over 30,000 new cascs of oral cancer occur in the U.S. each year. Researchers have now idenrified 28 diffcrenr cancercausing chemic.als in chewing (Obacco and Sll li ff.221 Ir is ilO wonder rhat s of smokeless wbacco increase their risk of oral cancer severaJ-fold. Tlle risk increase is even greater for some sites in the momh; longterm snuff lIse increases a person's risk of cancer by over 50 times. Likc cigarenes, the use of smokeless (0bacco prodllcrs rypically start5 at a yOl.lng age. Tlle far-reaching effects of this habjc should nor be underestimated. In somc parts of the V.S., 25 ro 35 percenr of adolescent males it ro the use of smokeless wbacco. 222 YOl.lng people sholl.ld realize rJlat even adolescems have died from mourh cancer as a result of smokeless (0baceo. n3 Whether ir is marijuana. cigars. pipes, or smokdess robacco, none are an alternative to cigarettes if a person is seeking ro maximize health. C1C'drly, the best option is (O make a elean break with cigarenes and ali of irs cousins. AH forms of nicotine delivery have long term derrimenral effecrs. No nicotine-conraining product is safe.

Figure 39

403

PROOF POSITIVE

SECTION VIII

How to Kick the Habit Most smokers try ro quit smoking at some poinr in their life. The sad fact is that most attempts to quit u1rimately end in failure. As we have already noted, when most young people begin smoking. they believe mat rhey will be able ro quir easily ar any urne. Surveys. done on younger smokers rypically find a majoriry believing that UJithin ayear rhey will srop and never smoke again. However, this is far from the case. Nationwide statisrics regardjng smokers of ali ages paint a grim picrure as illusrrated in Figure 40. m

K1CKING THEHABIT: MANY TRY, BUT FEW SUCCEED • Over 15 miJIion smokers try to quit per year • Only 8 percent succeed • Smoking restrictions at work and public places can help people quit Figure 40

404

Why only an eight percent SllCCesS rare? Thcrc arc many reasons; thousands of pages of scienrific literature address {he subjecr. However, independent of aII the other factors involved. 1an1 convinced thar mauy would have been stlccessflll if they had only used the rÎghr approach. In rhis section, 1 present an approach for kicking the habit rhat will bring success ro almost any individual who is derermined ro put smoking behind rhem for good. Funhermore, we will see how ro kick the misery out of kicking the hllbit. Using rhe techniques ourlined in this chaprer, you can be successful in kicking the habit with a

minimum of withdrawal discomfort. Ifyou are curiOliS abour the hasis for ilie infonnarion in this section. it comes from many scienrific artic1es and books in addition ro Illy personal experiences in he1pingsmokers ro break free from nicorine. 1 have also drawn from rhe expetiences of my colleagues who have. along wirh me, conducted one of rhe mosr successful stopsmoking programs ever presenred: "The Five Day Plan ro Stop Srnoking. "225 This was one of the firsr formal programs presenced ro the public to help smokers quir the habir. Since irs developmem in rhe late 50s, esrimares are that the Five Day Plan has been utili7..cd by over 14 million smokers o single in 150 different cOllntries. program has helped more people ro succcssfully quir smokjng. The program used today is a reviscd fonn known as "The Brearhc Free Plan ro Stop Smoking."

The Taper OffMethod SelMm Works Why do many of rhe common approaches to smoking cessarion faiJ? One big problern is rhat many use rhe "raper-off" method. Unforrunate1y, the taper-oIT merhod does nor usually work for rhose rhar are serious about quiuing smokjng. The reason is rhat nicotine dependence is an addiction. The 1988 Surgeon Genetal's Repore tevealed thar nicorine is six ro eighr rimes more addictive than alcohol. In comparison ro orher drugs, nÎcotine is as addicrive as crack cocaine. 226. 227 Notwirhstanding its addictivcness, tobacco companies ralk abOlit rnaking sure smokers remain "free ro smoke." Most smokers really are not frec ar aH-better rhan 95 percenr are lucodne addicts. What are some of the reasol\S why robacco is so addicrive? First, nicorine affects rne chemistry of the brain. Ir acts primarily as a srimulant but it also releases chernicals rhar give a feeling of reward or p[easure. Second, nicorine works fast. It gives the brain a "hit" wirhin ten seconds of the firsr puff. 228 Th.ird, smokers smoke more frequently rhan rhey do aimost any other dailyactiviey. The familiar hand-ro-mouth rourine of a smoker is commonly repeated

DYlNG FOR A CJGARETTE? 200 or more rimes per day or in excess of iO,OOO rimes per year. 229 • 230 Since nicorine dependence Îs an addiction, ie musr be dealt wirh like any orher addicrion. No one would e1ream of relling an alcoholic to jusr Cut down over rime. We would nor give a cocaine addict a program ro gradually decrease use. Why, then, do we rhink such a schedule would work with nicoune? Acldicrs neeel ro make a clean break wirh rhe addjcrive substancetile)' must sa)' good-bye tO nicorÎ ne once and for aiI. Ir is a prolongeel self-torturing experience ro caper of[ You conrinue ro feecl rhe addiction by cOlHinuing ta smoke. The smoker makes a srrong effore, experiences consrant rorture, anei accomplishes linie or norhing. The raperolT merhod is llsually a setllp for failure.

"Cold Turkey"-the Most Successful Method The memod mosr likely ro succeed is called rhe "cold rurkey" meehod-you srop smoking immediarely, with no taper-off. There are 46 milJîon adult AmericaJls who coneinue ro smoke. 231 However, almosr as many have quir over the years since the 1964 an nouncemenc by r.he Surgeon General linking smoking ro lung cancer. In facr, more than 3 miltion Americans stop smoking every year. The success of quitters is sumrnarized from the 1991 Cenrers for Disease Control and Prevenrion data in Figure 41. Therc are severa! important poinrs in rhis f1gure. First, it is possible ro quir, and tbat anyone who quirs has lots of company. Second, most of the successful quirrers used the cold rurkey method, and have accompljshed it on tbeir own wirhour rhe bcnefit of a sl110king cessarion dinic. 232 However, ewelve monrhs later, only 8 ro 25 percenr were still free from sJlloking. Tbird, individua1s ehar took advanrage ofsmoking cessarion dinics hacl a greater likelihood of remaining nonsmokers. The fim rcacrion of man)' smokers to rile moughr of quirring abruptly is, "It takes roD much wiU power to quir by che cold rurkey merhod. r am nOI sure I can do iL"

MOST QUIITERS USE "COLD TURKEY" METHOD al's • 9 percent of successful quitters bav quitting strategies. • 8 to percent of self-helpers remained no 12 mo ter quitting. JHttNlile:'lI)rtm~kJ' ng-cessation

ontbs. Figure 41

Whether you raper off or qui[ abrupely, will power is required bec.ause rhere likely wiU be withdrawal symproms. The weakness of r!le tapering off method is rhat it is too easy ro relieve the symptoms by lighring up. The nicotine rush brings relief, and you feei much better again. You sense [hat everything is going ro be ali right. But the urge rerurns, followed by other symptoms. You give in and smoke anorher cigarette. Progress roward your goal is minimal. Each day you hope ro smoke a linIe lcss. This rortllfing pr generally contimlCS umil you finaUy quir cold rurkey or ulcimate1y fali back inro your unrestricted habit.

Withdrawal DiscomfortMore Shortlived With Cold Turkey Method When you quie smoking abruprly, it is nor necessarily easy. However, tvithdrawal symploms do noI last as long with ehe cald rurkey method. A1r.hough mose smokers have some uncomforrable witbelrawal symproms, abolit 25 percenc go through no significallt physical withdrawal. Others have a very difficult time with ehese physical symptoms. In my private medical practice ancl in conducring smokiog cessarian clinics for ehe generaJ public, I have ofeen observed witbdrawal symptoms first hand. The American Psychological Associarion nores

405

PROOF POSITIVE

COMMON NICOTINE W1TB-

DRAWAL SYMPTOMS • Nicotine urges/cravings • Restlessness • Headaches • Anxiety

• Frustration or anger

• Irritability

· Sleep disturbances

• Difficulty concentrating

• Hunger/ increased appetite

Figure 42

thar within 24 hours of abrupe smoking cessation ie is common ro have wirhdrawal sympcoms like rhose listed in Figurc 42. 233 If you experience thesc withdrawal Symptoms, how long will they lase? For many smokers wiehin 24 hours of quiuing "cold tllrkey," ehe worst of the withdrawals are already behind them. For orhers. their worst day withollf cigareues is day number two. However. aLnosr withour exception, ar rhe end of 72 hours ehe worsr of the

OTHER PHYSICAL EFFECTS OF KICKlNG THE RABIT · Gastrointestinal problems like constipation • Increase in smoker's cough • Tremor • Sweating • lmpatience • Dizziness • Nausea Figure 43

406

withdrawal symptoms are history for those who make a complere brcak wirh cîgarertes. A1rhough the mosr severe symptoms wirhin a few days. orher symproms can linger for several weeks. Some of these bothcrsome symproms include increased irrirability and having erouble concenrrating. For the majority of smokers, aII of these remaining effects are gOlle by the end of a momh. Staristics indicate ehar cvery smoker has f1nished wieh cven the most subtle withdrawal effects by cight weeks. Orhcr annoyances are common when a person stopS smokillg. These are usually nor classed rechnically as withdrawal sympeoms; however. they often add ro rhe physical difftculry of rhc qUÎ((ing process. Some are very responsive ro orher lifesryle changes and usually lase on.!y a ver)' shor( time. Others may rake longer ca run theie collrse. They are detailed in Figllre 43. 234 H5 Withdrawal symptoms and orher physical changes are ofren feared as [!le worst pan of quitting smoking. No one will say they are fun. However. rhey are actually a sign of the body beginning to heal itself.236 Despite rhe horrible destruerive work rhar nicotine and other chel11icals have been doing, your body h,1S beeome t1sed t(~and even dependent on-nicorillc. Wirhdrawal symptoms largely demonstrate thar your body is getting back ro rhe healehy stare of living thar it experienced in the days before yOll smoked. JUSt as your body probably rebelled against smokingwhen you had your fim cigarert.e, now rhe body is agonizing again ro readjusr to rhe wCly it was designed ro work-withollt nicotine and those other 4000 chemieals.

Cravings and Mood Swings Let liS take a few minures now ro look both at rhe c1assie wirhdrawal symptoms as well as ilie othel' symptoms that may resulr from smoking eessarion. For many formeI' smokers, among the mOsr worrisome withdrawal syrnptoms are eravings, desires for cigarettes, and urges ro smoke. These eommon symptoms may bc srronger in some individuals than orhers. Howevcr, regardless of their inrensicy, cravings rypically becomc rare after a few weeks. 237 The

DYlNG FOR A CIGARETTE? other good news abolit cravings is that they aJways go away-cven in the short termwhedlcr or nor you smoke. In fact, the average craving lasr.'> only a few minures and then subside .238 Nicotine does have both stimulanc and depressant effects. However, within a short time, the regular nicotine becomes toleram ro the sedative effecrs. Therefore, in c1uonic nicotine s, the effects are mainly stimuJating. 239 The temoval of rhis stimulation probably lies at tlle root ofIllany of the physicaJ symptoms thar occur when people stop their tobacco habit. Rapid mood swings may occur-you feel grcat one minute and rerrible the next. A few minutes later you fee) good again. Rapid flucruarions in moods are very eOlllmon during (he hrst duee ro five days afrer you quic smoking. Somc wiU experience tremors, which are smaJ) quivering morions of the hands. GastroinrescinaJ problems and headaches are aJso commonly reported by rhose who stop slllolcing. 240 My commenrs on "kjcking the misery out ofkieking the habir" should afford he1pfuJ insights regarding these sympcoms.

Smoker's Cough May Linger In about 20 percenc of those who quit, smoker's cough, surprisingly, becomes warse before it improves and disappears. 241 Tllis problem can be discouraging, especiaJly for those that chose ro quir because of a cough or orher respirarory problem. Despice the tendency ro be discouraging, a worsened cough is viewed as a good sign. It is evidence [har the lung's abiliC)' ro remove phlegm is acruaUy improving-ir isasign ofimproved lung defense mechanisms. 242 Apparenrly, rhe reason has [O do with the retLlrn of cilial fUJlccion. Earlier in this chaprer we learned rhar chemicals in cigaretre smoke paralyzed the acrion of rhe ciny hairs called ci/ia char help keep [he lungs elean. When people stop smokiog, rhey remove the [obacco conslituenrs that depressed and paralyzed the tioy cilia. Wirh rhose roxins gone, ilie cilia are frec to begin working again. As ilie cilia begin to regain function, they start ro mobilize the excessive amounrs of mucus

that are stiH being produced by the now exsmoker's lung. The remit is rhat coughing may worsen as rhe lung 15 "eleaning irself out." The good news is thar chis is a shorcrerm phenomenon; witll the irrirams from [obacco smoke Out of the piemre, [he lung will begin to produce less mucus. And as dle excess mucus is c1eared out, che smoker,s cough generally abates.

Sleep Disturbances and Hunger Sleep disturbances are common, and some may have insomnia. lf problems of sleeping are the results of nicotine wirhdrawal, chey should disappear within 2 co 3 weeks. 243 When a person stops smoking they [cnd ro be hungrier for a few days. Many are aware ofthe inereased hunger thar results from lciclcing [hehabir, and they may choose co continue smoking because of che fear of becoming overweight. There is no need to have such a fear. uter in chis chapter 1 poin[ aur how you can avoid weighr gain when you scop smoking. Fonunately, no individual wilJ encoullter aII of rhese wi[hdrawal symproms. My experience is [har [he average person gers abom five symptoms. In most cases, four of those hve wiU be gone wirhin 72 hours. One may linger for a few more days-a1most as if ro make sure thar yOll maintain your resolve ro remain a nonsmoker and once and for ali kick [hc habiL Some smokers, familiar with withdrawal sympcoms, do not want ro experience any leve! of discomforr or sllffering. Thcse individuals ofcen choose ro continue smoking. However, in rhe long term [bey willlikely suffer much more by colltinuing to smoke. For rhis reason, even from the srandpoinr of minimizing physical discomfon, the wisesr choiee is [O quit now. Even tlle maximum of three days ofimense withdrawal symproms is a smaJt priee ro pay for rhe joy tmd the permanent benejits ofbeing Il

non-smoker.

Ten ~ys to Kick the Misery out of Kicking the Habit Ir is p05sible ro kjck much of che misery out ofkicking rlle habir. In my work wirh

407

PROOF POSITrVE smokers, 1 emphasize ren primary ways ro accomplish this. Many of these rimehonored techniqucs were popularized hy rhe previollsly menrioned "Five Day Plan" and rhe subsequenr "Brearhe Free Plan ro Quit Smoking." The milliollS ofpeople who have successfully gone through chese programs worldwide provide a living restimony tllar you can dramaricaJly reduce borh the wirhdrawal symproms and tlle other changes mar occur with smoking cessarion. The ren approaches ro kicking rhe misery out of kicking the habit center arollnd bringing rhe body back inro balance as quicklyas possible. . yom hody has become t1sed ro nicotine. Witlldrawal symproms indicate the body's struggle to again come ilUO balance as you readjust ro a new nicotine-free way of )iving. Some peoplewho fol1ow iliis ren-poinr act ion plan wiU not have a single signific.1m witlldrawal symprom. Orhers still have symproms, but rhey are decreased compared ro whar they wOllld be if such a program were not foUowed. The more of these ten acrjons you take. the fewer, the less imense. and the shorrer-lived the withdrawal symproms. They are Jisted in Figure 44. Choosing not /0 mlOke is thefint step. Th is is probably the most imporranr principle of

TE WAYS TO KlCK TBE MISERY OUT OF KICKING THE HABIT 1. Choose not to smoke! 9. Avoid high risk situatioDs 2. No hidden cigarettes sucb as: •special chairs 3. Deep breathing •work breaks 4. Daily exercise . people who smoke (walking) 10. Expect that others will S. Get more sleep understand 6. Water inside 7. Water outside 8. Avoid: • caffeine • alcohol • beavy meal • heavily spiced foods Figure 44

408

alI. rf you do nor make a personal choiceentirely on your own volition-ro be a nonsmoker, failure is vireually ensured. Obviously, if success is rhe aim, you will decide to be a nonsmoker because you wam ca do it, not hecause someone eold you ro quic. Furthermore, keep focused on your ehoiee nOt ro smoke: rhis is vital eo success in quining for good. rf you are a smoker, 1 eneourage yOtl to make rhe deeision now eo bre.1k free from tobaeeo. Take a few minlHes and actually pick a 'quir date" within the ncxt three weeks. On that day )'ou wiU have )'our lasr cigarenc and quit eold rurkey. From thar poinr on, you will need ro keep focu ed on your goal-no more cigarerres for rhe resr of your life. Some immediarely say. "Thar's impossible-I can'r deal wirh rhe thoughr ofhaving ro go rhe resr of my life wirhollt a cigarerre." Those feelings are natural. StiU tllere needs ro be a realizarion rhar even one cigarerre is nor acceprable: ir wiU likely throw you righr back inro rhe rhroes of rhe addiction rhar you lelt behind. On the oilier halld, you only should rake one day at a time, one hour at a rime, one minute ar a rime. Ir is only in this minure rhar you need ca mainrain your frcedom from rhe ryranny of nicorine. Choose ro conrinue ro live free from nicorine on a momenr-by-momenr basis. Do not worry about how you will remaÎn smoke-free romorrow. Today's challenges are big enough witholH worrying abom romorrow. Second, eliminate all hiddm cigarettes. There are ro be no cigarettes around anywhere. Many people fail ro rake this importa.nt step. They reaJly plan ca fail by keeping cigarertes in the glove comparrmenr, on top of the refrigeraror, in rhe Ilight stand, or in some orher easily accessible place. rf rhey do nor succumb, rhe nearness of cigarerres ofren brings rhem a form of torrure. When cravings or od1er wirhdrawal symproms are intense, rhe rhought comes ta mind: "Tobacco is c10se by; 1 can lighr up and end my misery." Therefore, when you rmly make a choice ro quÎr smoking, rhrow ali of your cigarerres away. When rhe wirhdrawal sym.peoms comc. rorrure wil1 be minimired-iliere will

DYING FOR A CIGARETTE? be no tempration ro rake an easy escape. Thi,-d, practice deep breathing. This may sound very simple bur ir is an extremely effective method for dealing wirh urges. When you feei a craving coming on, take a deep brearh. Hold it for a few seconds. rhen exhale slowly. Do it at least duce rimes. In many cases rhe craving will leave. The rechnique also plays a role in defusing anxiety and tension. Oeep breathing probably works [or a variery of reasons. rr focuses rhe mind on a positive acriviryrarher rhan allowing you ro dwell on what you are nor dojng (i.e., smoking). lr also helps ro improve oxygen saturatÎon, thus enhancing mood and central nervolls syseem performance. Oeep breathing a1so helps ta fosrer a sense of relaxat ion. Breathing out is a ive process where the brcarhing muscles are acruaJly rebxing. Some fccl rhar an awareness of this re1axed muscular state helps bring more re/ax;uion horn the deep breathi ng exercise. Founh i.s daily exercise. For mosr people ule very best exercise is brisk walking. AI, a physician, 1 must encourage any smoker ro have some medical inpur before srarting on a new vigorollJ exercise program. Because of rhe exrensive silem damage mat smoking generally causes. smokers can have a seroke, hearr arrack, injury, ar omer pwblem ifthey embark on a program of injudiciotfs exercisc. Oaily moderate exercise is recommended such as swimming, bicycling. or brisk walking. Unless you are a man over 40 al/d have ;'In addirional risk factor for heart disease (besides smoking) such as high blood pressure, family hiseory ofhean trouble, Of high choleseerol. you do nor need a medical consulr:lrion prior ro initiating a judicious moderate exercise program. Women do nor need a medica.J consulrarion unless they are over 50 and have an additional risk factor for he
exceUel)( oprion. (If circumsrances do nor allow an exerci e break, rake 30 seconds for a deep breathing break.) It is no surprise rhar research has dernonsrrated thar an exercise program ma)' improve rhe chances of successfully sropping smoking. Brown Ulliversiry researchers found rhar women who exercised were less likely ro begin smoking again. 245 For many people, an ideal time to get regular exercise is earl)' În rhe morning. This is [he rime thar 1 prefer both from the standpoinr of scheduling as well as for its beneficial health effeces. lf a morning schedule is nor possible, f1nd some ocher rime in )f0ur daily rourine, such as duriIlg a work break. , roD, exercise can be a powerful weapon in your armament ro deal wirh urges on rhe spor. You wiJI be amazed as ro exercise's effecriveness În decreasing rhose withdrawal symproms. Exercise can aJso hel.p you conuol stress, fighr lerhargy and combar rremors. Exercise is even more beneficial if do ne in the Eresh air. Fresh air in itself has a mood-e1evating eftect and improves the dearing aerian of rhe ciI ia. Whar abOlit bad wearher, yOll ask? There is an old saying [har applies to ourdoor exercise: "There is no sllch thing as bad weather, only bad (inadequare) c1orhing." Of course. that is a bit of an exaggerarion. 1 do nor advise outdoor exercise in rhllndersrorrns, hurricanes. tornadoes, etc. But if rhe wearher is cold or windy-or even snowy or rainy, dress appropriare!y and get your outdoor exercisc. lf i[ is nor reasonable OI' practicat. indoor exercîse Îs a second best choice. One way or rhe orher, pur exercise into your daily schedule.

Recommendation number five is to get more sleep. When wirhdrawing from the srimularing effecr of nicoeine, smokers rend ro require more sleep. Exrra sleep will have a benefit rhar extends rhroughour rhe day especiall)' as it affects wirhdrawal sympcoms involving rhe cemral nervous system and cravings for food or cigaretres. How much exrra sle is needed? It varics from persoll ro person. 1 recommend ro rhose who have recend)' sropped smoking rhar rhey arrange rheir schedule so {har they are able ro spend

409

PROOF POSITrvE an exrra rwo hours per day in bed. This does not mean tiut they have ro sleep two exrra hours. It just means that rhey have that opeion available if they need rhe extra rime. The need for extra sleep is most necessary for the hrst hve days or so. Some may beneht from a nap in ilie midd1e of the day. Oehers may need to go ro bed earlier. Instead of sraying up ro waech the evening news, it would be well ro ruek yoursclf inco bed earlier. By gening extra sieep, you will provide more opportunity for your nervous system [O be in baJance. Adequate rest goes a long way in preventing mood swings and rendencies roward irrirability, frusrration, and anger. Sixth is "water inside. " This means you shou1d drink plen ty ofwarer rluoughotlt rhe day. 1 reeommend at unst eight glasses daily of plain, simple water. Exceptions are only made for individuals who tfuly eannot accommodate an increase in water intake such as chose wirh cerrain heact condjtions, kidney failure, or other physical problems with fluid balance. Orher beverages are nor as effeetive. Caffeine specifically is a diuretic and rhus promotes UJater loss. Adequate water inrake is important tO keep you adequately hydrated. Dehydrarion seems ro make a number ofwirhdrawaJ effeas worse. Drinking water is also an aid in bringing the body back ioto equitibrillm. The body is under considerable physicaJ srress during che early withdrawal period. In this state, we expect the waste proclucts of normal metabolism ro be generared at a faster rate than in norma! circumsrances. Adequ:lre water intake helps ensure good blood flow ro the kidneys, a.nd more optimal excretion ofrhose waste products. Some also feei that keeping well- hydrated helps ro hasren nicotine e1imination sinee nicotine is primarily e1iminated rhrough (he urine. Within two hours, half of alI the nicotine in a person's blood is eliminated. 246

The smenth principle is "wata otltside. "

410

Water outside refers ro the liberal exrernal use of water. If you are lIsed [O taking a bath Of a shower onee a day, you will wanr co increase it ro twice a day, or perhaps even more frequenr1y. The reason for frequenr

bathing is rhat water has a nemendous equalizing effect on rhe nervous .system. If you are feeling lethargic, a cooler shower can wake you up. If you are struggling wirh anxiety or tension, a warmer showcr can help calm you down. Funhermore, the liberaJ external use of water helps to keep you dean. And c1ean pores ensure optimal eHminacion of toxins rhrough rile skin. This is an important adjunct to oprimal kidney function as your body deaJs with an increased roxin load from the srress of smoking cessation. A~ ridicuJous as ir may seem, the shower is also one of the safesr havens for avoiding smoking. 1 have had encOlJllters with thousands of smokers. Only on perhaps rwo occasions have 1 heard of someone who i llsisted rhat rhey acrually smoked in tne shower. lf you jump in the shower in rhe midsr of an intense craving, you willlikely find yourself in surroundings thac you do not associate with your nicotine habit. While the water is doing its work at nelltralizing wirhdrawaJ effects, you are efTectively removed from temptation.

Number eight is 12 list ofothel' .rubstanw to I2void As alluded ro in our discussions of water, caffeine should be avoided. Many people say ar this pOillt, «YOll are helping me to get ofT of robacco, and rhat's fine. But why get rid of my cofTee habit too? What are you trying ro do to me?" 1 find it much easier to he1p individuals kick tne cobacco habit if rhey also remove caffeine from their daily roucine. Caffeine may acmaJly undermine a person's besr efforrs to stop smoking. The continued use of cafTeine incretlses the intemity ofsome aspects of nicorine withdrawal. The reason for this is that your body's eliminarion of cat-Teine slows when you stop smoking. This atlows caffeine blood levels ro risc. In facr, afrer fOllI da)'s ofbeing a nonsmoker, cafIeine blood levels may have risen as mueh as 50 percenr. 247 As a result, symptollls like anxiety, irricabilit)', and difficlllty sleeping will li.kely be worsened as your body has tO reckon wirh higher levels of caffeine.

DVlNG FOR A CIGARETTE?

More Quitters Have Rel-apse if Coffeedrinking Continues Caffeine aho appears [O have far-reaching behavioral effects. Some nClIrophysioJogists have dllbbed it "bad habit gJue." By rhis they mean rhat caffeine lIsers have a harder time deveJoping new habirs because caffeine alters brain clJemistry. More informarion on this sllbjecr is found in thc fronta] lobe chapter (Chapter 12). Smokers IOho stop smoking hut continue drinking coffie have a higher relLlpse TIlU ehan smokers who have swpped using tobacco and coffee simultaneously. Caffeine beverage.s-parricularJy coffee-are ofeen behaviorally linked wirh smoking. le is almosr inconceivable for maoy smokers to have a cup ofcoffee wiehout accompanying it with a cigarcue. Consequendy, ehe mose successful oplion Îs eo do away wÎth the caffeinated or even deca.ffeinared drinks lhar you associare wirh smoking. This will have che cendency ro deaea-se cravings following meal eimes or ocher cimes when you habiruaJly reach for your brew. In fact, by e1iminating caffcinc in the morning, many hnd ehat ehe urge ro smoke is subdued or even absent. Avoiding caffeine may be one of your secrets ro success. Researchers at Johns Hopkjns UnÎversiry published srarrling rese.arch rhar demonsrrared that "caffeine has rhe cardinal features of a protorypie drug of abllse."248 In other words, based on irs drug effecrs, caffei ne acrs much like allY classic addictive drug. The implication is thar habiruaJ affcine s are as much drug addicts. in rile chemical sense of rhe rerm, as coaioe addicrs, heroin addicrs, or nicorine addicts. This rhought is repugoam to maoy of rhe upsral1ding American cirizens who cnjoy their morning cup of coffee. Nonerheless, many of those who resenr rhe implicarions of the research are no less hooked on caf[ei ne. The realizarion ehar caffeine is an addictive drug has been motivation enough for a number of people ro break free from {his habit as well. Alehollgh avoidance of caffeine is most important in your 6rst few weeks of being a nonsmoker, it would be

beneficial ro continue to avoid rhis addicrive stimlllant as well. Like aH drugs of abllse, caffeine has a well-characrerÎ2ed withdrawa] syndrome. In the Hopkins research, rhey discovered rhar afrer an average of abour 19 hours from rhe last consumprion of caffeine, wit.hdrawal symptoms begin ro become evident. These symproms consist of increased headache. sleepiness and laziness, and decreased alertness and activity.249 These wirhdrawal sympwms were rhe most seve.re for only a day or MO at most. Over rhe nexr five ro six days the symproms generally resolved. The decreased alertness and increased sleepiness can actt1ally be an aid in dealing wirh smoking wirhdrawal. Thc agirarion thar often accompanies nicorine e1imination is thus counrered by rhe caffeine withdrawal symproms. Thus, many individuals have an casier rime wirhdrawing from nicorine if caffeine is avoided.

AvoidAlcoholand Spicy Foods Alcohol is also ro be avoided. Why? It suppresses the performance of rhe froma] lobe of [he brain where judgmenr resides and decisions are made. Alcohol will suppress your abiliry ro srick wirh rhe decision ro be a nonsmoker. 1recommend complete avoidance from a]cohol for ar leasr as long as you are srill having urges ro smoke. As 1 describe in rhe chaprer on akohol (Chapter 17, "Wanr a Drink?"). popular press repom not\...irhstanding. total avoidance of a]cohol is [he heahhiest oprion for everyone. Heavy meals are to be avoided, especiaJJy in rhe evenÎng. They rend ro bring on rhe urge ro smoke. Surprisingly, being overly hungry can also be a higher risk time. The best oprion is ro ear ar regular intervals, no more rhan duce times daily. And keep your evening meal Jight. For some people, spiced foods increase smoking urges as well as orher withdrawal sympeoms. One lady in our smoking cessarion program was fajling in her anempts ro kick rhe habit umil she e1iminared cÎnnamon from heI" djer. Animal research suggests [hat cinnamon is a digestive irritant, and can cause srimlllarion of certain brain centers. Thjs may be rhe reason for inereased

411

PROOF POSITIVE withdrawal problems. Although some people have successfully useel cinnamon sticks as an alternative ta cigare((cs, for mhers this may be treading an dangerous groulld. Ir is prudent to avoid a11 spices dur irrirate rhe digestive lining, including mild ones such as cinnamon. The nimh J·tep is ta atJoid situatiom that you assoâate with smoking. After rhe even ing meal you may have a habit ofsirring in your special chair ro watch rhe TV news ar a11orher program. Associared wirh d1ar special chair is an afcer-dinner cigarette. Avoiding rhe chair will help avoid che urge ro light up. Your break ar work a1so may be associated wirh your smoking lubil. It is common for smokers co liglH up rogether at thar time. YOLl can choose ro work rhrough the break, or avoid the usual place where you spend break time. Instead, take a walk in the fresh air, or cngage in some other hea1thenhancing acrivÎty. Furthermore, be careful of your smoking friends. Explain ro rhem your decision and ask for their supporl. Lec chem know (hat you do nor expect chem ro stop smoking just because you did. However, also let chem know thar smoking in your presence-ar leasc for now-is dcfinîre1y not an Opt ion. You will likely wanr ro meer with those friends in senings where smoking is not an option. Some smoking friends may not bc ive ofyour decision and may try ro undermine your resolve or rempt you ro smoke. Those individuals may not reaUy be your frienels: in filct, you may need ro avoid them, Avoidance may nor be an option if rhe tempter is a farnily member. Narurally, 1 do nor recommend that you leave your smoking parenrs, spouse, or children. However, ie Îs generally bese ro come ro some agrecmenc as co where smoking is allowed in your homc, and rhen avoid dlOse areas. Expect that othm wiilunderstand. This is dle final key tO kicking the misery out of kicking rhe ha bir. Many people fear rhar they will fajj ro get through rhe withdrawal period becallse of orhers. You fcar rhar you wiIl bc more irritable roward your fellow workers. YOll know tiut you may even "b1ow up" on the job and cause someone

412

else ro Iose his temper. As a resulr of an actual or anricipated episode, you may say, "1 am hllrting my work mares and rhe people I work for as a resulc of giving up smoking. 1 sholild sran smoking again for their benefil." In reality, Others willunderstand. People al'e aware that giving up (0bacco is very difflcult, as proven by the facr that so few are sllccessfuJ. [f you realize ehar others will understand, thar chey k:now ic is a heavy addiceion, and realize thar your behavior wiU be differenr during rhe critical cime of withdrawal, you will be able ro get rhrollgh it. It would bc a tragedy for yOll (O give up on YOl1l'se1fbecause ofsomeOne e1se.

Help From Dur Maker There is one other f."lcror that man)' of rny colleagues and 1 have founel i.nvaillable in kicking rhe misery our of kicking the habie. 1 be1ieve rhac no one bas given up the robacco habir withour dle conscious or subconsciolls aid of the Spirir of God. For many people, a consciOllS recognition and dependence on God anei His power are necessary ro provide the srrengrh to give lip che robacco habit. They find God ro trul)' be "A help in rime of need."250 Trusr God ro provide ehe help dlat He has promised, submitting yOUI" will to His will. "M)' God shaH supply aH your need."2S1 God may not get rid of ali of the withdrawal syJllpCOms for you. The Bible describes how Christ suffered and learned obedience by chc chings which He suffered. Gad does nor ask us tO go rhrough life free ofsuffering: an che conrrary, he warns us that we wiU face difficulcies and hardships. The God of heaven is always willing ro give us the power ro overcome. Our parr is co be willing ro endme whaeever it rakes ro be successful. More information an d1e mIe of sllffering and hardship is presemed in Chapter 18, "Deal ing wirh Bad Habits and Addictions."

Quitting Brings Immediate JO)'5 We have seen that rJ1e damage done ro your body by your smoking habir is largely repairable-rhe repair process begins immeeliately. When you quir, your risk of gerring robacco-related diseases begins ro decrease lirerally from day oue. Some of

DYlNG FOR A CIGARETTE? rhe immediaee benef1es in seore for you wiU improve yom qualicy oflife. They arc liseed in Figure 45. You have more energy when exereising; your rasee and smeU become sharpened; your c10ehing loses ies seench; you have more money because of rhe savings in Life, hea.leh, and car insurance s. and no longer need ta buy rhe cigarerres rhemselves. le is surprising ro many ehar smokers are much more likely ro get iJHO auto accidenrs; as a resule, some companies evcn have discoumed car insurance rares for rhose drivers who do noe smoke.

IMMEDIATE BENEFITS IN THE QUALITY OF LIFE FROM QUITIING • Easier breathing when walking, running, cycling, and swimming. • Food has more flavor. • Everything smeUs better-food, flowcrs, perfume, you. • Extra money (no cigarettes to buy, reduced health care costs, reduced Iife insurance costs). • Satisfaction of conquering an undesirable habit.

Long Term Benefits ofQuitting When wiU your risk of disease reach a significandy lower level? The rime span is differenr for diff'crcnr discases. Figure 46 lisrs rhe :tI})Otlnt of rime required for various diseases.252. 153. 2 4, 25This flgure demonsrrarcs rhe miraculous power of rhe body ro heaJ irself when offending subsranees are removed. Whar abolit thc effecrs of quitring an rhose wim lung diseases? A swdy was nude ofover 5800 smokers with ehronie obsrrucrive pulmonary disease in which some of rhem kieked rhe habic. The findings are shown in Figure 47. 256 This scudy shows r11at chronie obsrnterive pulmonary disease re ponds well ro {he eJjmination of cobaceo. Chronie bronchitis is ofren [uUy reversible, as we have seen-espeeially if you qllit soon enough. Your smoker's cotlgh disappears. You have berrcr "wind" for arhlerics and orher m,uscular exerrion. Coronary hearr disea.~e ri.sk reduction was liseed in Figure 46. Anoeher srudy looked ac the numberofdellthsdue ro coronary hearr disease among ex-smokers who formerly smoked more rhan one pack per day. Figure 48 shows rhe resulr.s. 257 Noee that the Iargest reducrion in rhe chance of dying of a hearr :mack occurs in rhe fim year. The risk cOlUllues ro drop over a 20-year period. :u which time it is aJmose down ro ilie level it would have been had you never smoked. Pregnant smokers wha stop smoking at any urne up tO 30eh week ofgeseaeion have infams wim a higher birth weight than do

Figure 45

REALTU BENEFITS OF QUIT"f'ING Redllced Risk

Disease Lung cancer 10 yurs afler quilting

l6 or mor~ ~ean afler q!!t1Îog. Oral cavity cancer Esophagealcancer

30-50% 80-90% 50%

5 years afler quitling

Bladder cancer First few quittioll

~'ears

after

50%

...._... Cervical cancer SubSlanliall~'10'Ner

FinI few years

Coronary heart disease FinI year afler quiiting

Aner 15 )'cars

50% Similar 10 a ne\'er-smoker

Stroke 5-15 years aner quitiiog

Similar 10 a ne\'er-smoker

Figure 46

BENEFIT OF QUfITlNG: DEALTHIER LUNGS • Those with chronic obstructive pulmonary disease who stopped smoking experienced substantial benefit in lung function. • The benefit was most evident in the first year. • Further benefit continued for five years.

+

9

--~~-----

413

PROOF POSITIVE

BENEFIT OF QUITTING: LOWER RISK OF FATAL HEART ATTACK Risk of Corollary Heart Disease deaths ofex-smokers former/y smoking more than 20 cigarettes per day: Smoking category Never smoked Current smokers

»>

Quit less than 1 year Quit 1-4 years

») ,.

Quit 5-9 years

)

QuJt 10-19 years

•

Quît 20+ years ~_ .-..-----J~»

o Figure 48

.5

I

1.5

2

2.5

3

Morlality ratio

women who srnoke throughour pregnancy. Quirring in [he t'rst three or four monrhs ofpregnancy and absr.aining t1uoughouc the remainder of pregnancy protects the fetus [rom Ule adverse effcC(s ofsmoking on birth weight. The difficulry ofhealing ulcers in smokers was previously menrioned. Smokers wirh gastric or dllodenal ulcers who stop smoking tend ro do signiflcandy bencr rhan smokers wha continue ro smoke. Sucit ulcers heal ro uch more easily when the smoker qUits.

Will J Cain Weight?

414

One pressing concern of many wilo are conremplating quitting is "Will I gain much weight?" Others who have tried to quit respond,

And not ali of that weighr srays with [he person. Most smokers Iose SOOle of rhe excess weighr rhey pur on during the early phase of quiuing. Only 40 percenr of smokers gain and retain more (han abolit faur or five pounds. The negative effecr of rhis arnounr of weiglu gain an health îs negligible compared ro rhe huge benefirs of kicking rhe habit. Some experes estimate thar you would have ro gain 100 pounds to even corne clase ro somf of rhe heahh damage rhat smoking has been doing. 26 ! But the besr news is rhar 20 percenr of smokers do nor gain weight. Althollgh they are rhe minoriry, rhey consrîrure a group of mîllîons ofliving wirnesses who restil), rhat you can indeed stop smoking wirhollt gainillg a pOllnd. It i5 a fact, however, ehar most people do nor even wam ro gain one pound, ler alone four or more. How can it be avoided? Before rhar quescion is answered, we will examine the cause of weight gain when kicking (he habit. There is a number of reasons for this rendency. Let us look at four of che more important Olles. Fim. foods aften ta te berter. Within hours or days of sropping smoking, your nose becomes more sensitive. Commonly, exsmokets discover a new appreciaeion for sccms and rasrcs. Unforrunatdy for some, the stage is set for overearing. Second, there is ofcen a cendency ro substitute foods for cigarettes. The ex-smoker often rurns to [ood ta substitute for the oral pleasure chat smoking broughr. Third, metabolism slows down. Sînce nicorine functions primarily as a srimlllanr, rhe body's engine has been revved up during aU those ycars ofsmoking. YOllr merabolism slows abOlit 10 percent when you kick the Iubit. If you do nor eat fewer calories or exercÎse more, weighr gain may well result. FOllrth, the sromach empties more q u ickly. Researchers havc found char smoking can delay stomach emprying by up ro 40 percent. 262 If your stamach normally empties after a given mcal în two hours withouc smoking, rhat same meal eaten whjle smoking wou.ld sir in your sromach for Ilearly three hours. This would be expecred ro increase yom risk ofhearc burn

DYING FOR A CIGARETTE? and acid re(lux. However. it also may help yOll to feei full for a longer period of rime ,lfter eating.

How to Avoid Weight Gain With aII of rhese changes in mind, consider now a four-poioc program ro avoid weight gain. It is described in Figure 49. None of these points are difficult ca accomplish. The fim twO have aJready been mencioned as helpful in kicking che misery out ofkicking the habit. and are good health practices within themselves. The last rwo have been well publicized as good for rhe health. They represent a modest cha.nge in lifestyle. The fim poinc. increasing physical activiry. nor only helps ro control srress and cravings as previously mentioned, but a1so speeds lip your metabolism. This is an important poiot, sÎnce, as we have seen, metabolism slows when you quit smoking. Thus, the same rype ofexercise program that wjll help you kick the habit will help you keep off excess pounds. The second point highlighrs alcohol. This subcly add.iccive beverage is a problem on a number of froncs. It is first of ali a significant source of caJories. More than this, however, it depresses will power and has been shown to make it easier to overeat. The third and fourth poims deaJ with food choices. AlI emphasis on foods that are low in fat and sugar is best accomplished by a diet dur includes liberal aOlOullts of fruits, whole grains, and vegetables. A given volume of rhese foods is much lower in caJories [han rhe higher sugar, higher fac standard Fare. As a result, you can actuaJly eat more food whLle taking in less calories. This is anomer important way ro address the issue of metabolic slow-down. Incidemally, such a dier ilio helps ro deal wim constiparion, which can be a problem when soroc individuals fim "kick the habit."l63 Avoiding che high fac and high sugar foods a1so eliminares d1e mose COO1mon food choices that people use as oral subsritutes for smoking. Clearly, rhe best oprion is co completely avoid substÎtuting eating for smoking. Howcver. in a rime of weakness, it is rnuch better ro chomp on a

HOW TO GIVE UP CIGARETTES WITHOUT WEIGHT GAIN · Increase physical activity • Abstain from alcohol · Restrict intake of high-fat foods · Restrict intake of high-sugar foods

Figure 49

celery srick than light up again. The bOHom line is simple: continue rhe lifesryle recommended for kicking ehe misery our of kiclcing the habir and you should have no problem with weight gain. For rltose who are interesced in funher pointers on losing weighc, refer to rhe chapter on hyperrension (Chapter 6, "One Narion Ullder Pressure"). Before leaving rhis subject, I should mention rhat rhere are a number ofs010kers who are wIderweighr and aceually need to put on pounds. Surprisingly, rhey can gain weight by lcicking the habit aod combining it with daily exercise, resulting in mainraining their ideal weight. Excrcise helps ro Iose or gain weight according ro me need. For those who are overweight, it helps them ro Iose wcighr; in rhosc who are at meir ideal weight, it helps to keep weight stable. For those who are undcrweight, ir helps rhem tO gain muscle mass and rhe needed pounds.

A HalfMillion DolLar Decision not to Smoke The our-of-pocker coscs to suppon a smoking habit are enonnous-to the tune of over $500,000 in a lifetime. This is rhe amount of nest egg a person would have ac agc 65 if he invesred inscead of smoked.

415

PROOF POSITIVE

ADVANCEDWARNINGS REGARDING TOBACCO Tobacco is a slow, insidious, but most malignant poison. In whatever form it is used, it tells upon the constitution; it is aII the more dangerous because its effects are slow and at first hardly ,\ '/~ perceptible ... its effects are difficult to eradicate rrom the system. Figure 50

OTHER HARMFUL EFFECTS OF TOBACCO PREDICTED • Habit formiog idol • Slow malignant poison • Poisons the atmosphere for o'hen • Mental inability and physical weakness can result from parcntal smoking • Destroys oervc braio power aod weakeos 'he braio • Stimulates the relaxed nerves, 'hen has a paralyzing influence • Causes an inability discrimina'e between right aod wrong • The example set by parents is the reason mauy children begin smokiog • Tinte squandered in smokiog could be roade of higbes' value in being witb their chiJdren • Money spent on smoking deprives tbe family of more necessary items • Smoking health care workers are offcnsive to their sick clicn.s

'0

Figure 51

Investing rhe cosr of rwo packs per day for 50 years (age 15 ro age 65) in a good mutual fund. ar $2.00 per pack ar mis wriring, would reslllr in a fund worrh $538,000 in roday's purchasing power ar rhe end of rhe SO-year period. This assumes rhar rhe fund earned an average of 10 percel)r per year. 264

V(lrapping it Vp

416

1opened rhis chapter widl rhe grim srory of Melissa. There are literally rhollsands of "Melissas"-ofborh sexe -who go ro rheir

graves premarurely each year because of smoking. Ir is aii so tragic-and so absollJtely needless. Beyond this, rhe blame for alI this suffering is often subcly laid at aur Crearor's feec. "It just mu t have been her time ro die," we ofren hear. However, God has nothing ro do wirh the deaths caused by rhis poison. In fact, a loving God has been taking pains for decades ro keep people from ever starring rhis healrhdesrroying habir. aver a hundred years ago Ellen Whire was inspired to make people aware of the dangers of rhis habit-borh ro themselves-as welJ as ro rhose exposed ro secondhand smoke. Note her words found În Figure 50. 265 White's insigllts did not end rhere. She wrore about her concerns wirh robacco over 800 times. Her broad knowledge of rhe effects of robacco on the human system and her undersranding of omer aSpects ofhealrh and lifestyle decades before they were scienrifically proven are explored in Appendix X. The basis for her persisrence in agiraring rhe subject she attributed ro God's reveIation. When you see the accuracy of her words in rhe lighr ofmodern science, ir is hard ro doubt her c1aims as ro rhe divine sOllrce of rhe informarion. Consider some of the mher concetl)s she voiced, as recited in Figure 51. 1 see God's hand nOt in me dearh of smokers. but rather in rhe millions of individuals who have sroppcd smokingor never began the habit-and are eujoying life as a result. Whet.her dley made rheir decision based on informarion from Elien Whire ar because they were convicred by the research of rhose rhat God led ro prove scienrifically rhe dangers of robacco is nor really important. What is important is rhar many have nor given God rhe credit for rhe misery He has prevenred. Conversely, He has been blamed for [he narural consequences of robacco use. JUS[ as mere are thousands of"Melissas." [here are also rhousands of people like Catherine. Carherine, ar 91, lives on her own in comforrab1e surroundÎngs. She stiU enjoys life and has special pleasure in seeing heT grear grandchildren grow up. Catherine

DYlNG FOR A CIGARETTE? would probably nor be alive roday ifshe did not make a decision years ago ro become a nonsmoker. Her decision to Stop smoking was rnade in her 60s, bm it seems ro have paid big dividends. This is an educared guess. 1 cannot be sure rhar Catherine would not sriU be alive and doing weU roday if she had nor made rhe decision-bur sratistical srudies indicate r11at it wou/d bc extreme/y unlikely. Every day, every single smoker makes a solemn choice. Not choosing ro quir today is making a choice ro colltinue ro ernbrace a destructive habir dur is likely ro kilJ, maim, or in some orher way incapacitate you-long before youl" rime. Unfortlll1ately, rhere often are ilO warnings before ilie cancer diagllosis or rhe heart arrack, or even rhe osteopororic fracture or dle realizarion that you look 15 years older than your nonsmoking peers. Can 1 implore you ro stop playing Russian roulerre? The loaded chamber is SUIe tO come up sometime. Some of you no doubt are saying, "Ye , Docror Nedley. 1 know aII rhar you are saying is true. l am gambling wirh my life. Bur 1am powerless over rhis addicrion." For those of you who only see your weakness and your Failmes, take hearr-you can be successful. FoUow {he guide1ines presenred in this chapter; they can make aii rhe difference bet\veen success aud faiJlIre. AJso be sure tO read Chapter 18. "Dealing wirh Bad Habits and Addicr.ions." If you have rried ro qllir on your own and have given up, work wirh your physician or other health professional. Usc rhe material in rhis chapter ta undergird the

pracrical counse! al1d encouragcmenr you get from working wirh a professional. lf rhar opuon does nor sound feasible, rhen look imo rhe Bre1.rhe Frec program offered hy rhe Sevellth-day Advenrisr church or od1cr ourpariem STOp smoking programs offered in your communiry. Group suppon from orher smokers who are going through the same process of kicking rhe habir can really reinforcc aII rhar we have shared in rhis chaprer. If you have gone rhar roure and lack confidcnce in al1 outpaticnr approach, ler me make anorher suggesrion: rake a week off anei trel.t yourself ro a good live-in lifestyle program. The Cemcrs for Diselse Control have gone on record: "the limited research available suggests that these [livein programs ro stop smokingl can be quite effecrive. "266 In faer, I can hcarrily recommend such a cemer in my region. The Lifesryle Cemer of America in Sulphur, Oklahoma 267 draws people from ali over the counrry to cake advanrage of their live-in programs dut include smoking cessarÎon. They actually use this chapter of my book a their primary wrinen educarional resource for their panicipanrs. However you use rhis chaprer, wherher on yom own, widl your doctor, as an adjunct tO an ourpatiem class, or in conjuncrion wirh a live-in program, 1am convinced it can help you to be flnally successful. The good news is rhar you can stop smoking. YOl! can begin roday on a new smoke-free parh thar will enable you tO live a much higher quaJity life anei cnjoy the many beneflrs that we have presemed in this chapter.

ReftrmcesMrlimt's S/ory ""pl'rsmts II CllSr liistol'y. I

of INlr stor;rs rombi/ll·d imo

Ih;s

singlr

1 Fiore MC, Newcomb P, McBride l~ N3[ural Hisrory 3nd epidemiology of lob3CCO usc and addic[ion. In: Orleans CT. Sbde]. editOr. Nicot;ut AJd;rt;otl: Principm lltul Mllnllgrmtllt. New York: Oxford Uni""rsiry Pr • 1993 p. 89-104.

) Fisher EB Jr., Lichtcos[cin E, Hairc-Joshu D. Multiple dc[erminalHs of robacco use and c=oon. 111: Orleans CT. Slade J. edirors. N;cor;llt Add;rtion: Pril/cip/ts 1l1ll/lvfl1lragemmt. ew York: Oxford niversiry Pres•.

1993 p. 71.

Davis Rlvl. Foreword. In: Orlean ef. Sladc]. cdirors. N;cotill~ ALUiclioll: A-;lIciplts ITfld Md'Jtlgtmml. New York: Oxford Univcrsiry Press, 1993

·i

mOlllllg"

p. vij·viii.

; Flay BR. Youlh rob3cco u.'c: risb, partcrns, and conrrol. In: Orleans CT, Slade J. editors. N;colinc Atldiclion: Pr;ncipm llnd Ml11tdgtmfflr. New York: O ·ford Universiry Prcss. 1993 p. 372. 6

Warner KE. Goldcnllar LM. McL~lIghlin CG. Cigarctle advcnising alJd

m:Ijţ.IZinc covcra.gc of rhc h:tl.ards ofsmoking. A st3tistical analysis. J Meci 1992 Jan 30;326(5):305-309.

N Eng/

Aebpled from McGinnis JM, Foegc WH. Actual causes of death in thc U"i[ed t31cs. JAMA 1993 Iov 10;270(18):2207-2212. Upper rallges

7

417

PROOF POSITlVE uscd for lobaca> aRd aJcohol duc 10 addilional informalion presented in chis book. Sexual bc.havior dc:nhs updal.ed 10 reRecl 1995 rates. Cigarcllc smoking-auriburablc mO(lality and yl:ars of porenlialllfe 10 t Unired SI
"gmU11l. New York: Oxford Universiry Prcss. 1993 p. 367.

2, U

Deparrmenr ofHealrh and Human Services. SmokillgalllJ H~alth.1l IllUionill sUltus TrpOTl. A n:poTl of the Stlrgeon Gl'1Imd. /986. Rockville.

8

9 Cencers for Discasc Concrol and Prevenrion (CDC). HIVIAIDS Survtil"mCl' R~pon. 1995 Dcc;7(2):S.

io US Dartmcnr of HcaJth and Hllman Servi cs. 71Jr Imdih eOJJS~1uma. of snJokillg: 25 .~elm ofprogm.s. A r~port of riu Surgeoll Gmna/, 1989.

RockvilJc. M D: US DepartmeJ1l of HeaJlh and HllLllan Service. Public Hca.lth Service. Centers for Disease Control. Cenrer for Healrh Promolion and Educalion. Office on Smoking and Hc;.tlrh. DHHS Publicat ion no.(CDC) 89-8411. II World Health Organizalion. The Toba.cco Epidemie: A GlobaJ Public Heallh Emergcncy. Toba co Alerr. ApriJ 1996. Obtained via Ihe Internel ac hup:II....·ww.who.org

PelO R. Smoking and dc;lIh: rhe pa~r 40 ycars and che next 40. BM} 19940Cl 8;309(6959): 937-939.

12

\Xforld Healrh Org:Ulizarion. racr Shcer N 118. Th~ 7;)bl1ao Epillrmic: A Global Public H<'I1/r1J Emergency. May 1996. Obraincd via the In rernel al hup:llwww.who.org 1}

MD: U Deparrment of Health and Human ervices. Public HeaJlh $ervicc. Celllers for Disease COlllrol, O:nrer for HeaJth Promotion and Educalion, omcc on Smoking and Hea.lth. DHHS I'ublic:uion no.( De) 87-8398. Ur National uncer In rinuc. Smoking fl11I1 Tobaceo Gmtrol MonogmplJ 1. SlTtl1egii's 10 e011trol tol"uco use in tiu Unitetl Stflm: II bluc-print for ftlblic h"lril!J (mioll in tiu 1990s. NIH Publication Number 92-3316, 1991 p.

233-239. 11 Epps IU~ Manley MW Clinicallnu::rvcncions 10 I'revcllllobaeco Usc by children and adolcscel1ls. In: Glynn T). Manler MW. HoU) 10 Hdp

Yotlr Pnlil'lllS Stop Smoking: A Muiot/fli emar /mtiwu Mo/ltlltl fOr PbJliCiaIlS. National InsritUtcs of Healrh Publicalion umber 92-3064. Revised ov. 1991 p. 63. Epps RP. M:mlcy IvIW. Clinica! Inrervenrions to I'revcllt Tobacco Use by chadren and adole cents. In: Glynll TJ. Manley MW. Hotu ro Fitil'

28

YOtlr Pmil'1ll1 SIOp Smokillg: A Nnrimurl emerr 111'lilut,· Mn 11 Itftl fOr Physi. dam. Nalionallnstinues of Heahh Publicalion Numher 92-3064. Re· viscd

0\'.

1991 p. 63.

Inslilllle lor Social Rescardl. Univer iry of Michigan, Moniloring the Future Projecr. hnp:l/www.cdc.go../nccdphp/oh/hssdal:t.htm

19 1< World He
hl lp:l/www.who.org 15 Murr:l.y CJL Lope"I.A ,edilors. Stml1lJlJry: The Global Burdm ofDisCl1.!e. T1Ie Workl Hcalrh OrganiZ
World Hcalrh Organiz..1tion. Tobaeeo A/i'n. April 1996. Obrained "ia the IlHemcl ar hrtp:/I",,'WW.who.org/progra ... pr961 1.

Davis RM. Foreword. In: Orleans er. Slade). edilors. NiL"otil1l' AddiL"lion: frinciplt:J ill1d Ml1IlI1gnl1cnt. ew York: O",ford Uruvcrsiry Prcss, 1993 p. vii-viii.

30

Flay Bit Youdl tohacca use: risks. pallerns. and cOl1lro1. In: Orle

C[ Slade J. editors. NieotituA(lt/iaioll: Prilldpl"l alld M(wogeme>ll. Nt:w

York: Oxford Universily Press. 1993 p. 365. I

National Cancer Inslitule. Smoking Imri Tobaceo COlltrol MonogmplJ 1.

Srrnr~girs

to C011trol tobaCl'o uu il1 IIJe Unit~d Stau>: a bltlrprint for public bmltb aetioll in Ih~ /330s. NIH Publication umller 92-3316, 1991 p. 233.

17

National Cancer Instirure. Smokillg and Tobl/ceo Comrol Monogmph /. Stmugies tO comrol'ob(uco tiU in tiu Ulliud SUlUS: It blueprim for pllblie JmlM I/crioll ill thr 19901. NIH Publication Number 92-3316. 1991 p.

PelO R, LopC'2 AD, Ct al. Mortali!}' from rob:lcCO in d~vclopeJ counrril's: indirecl estimation rrom national vilal sraristics. LanUl 1992 May 23:339(8804): 1268-1278.

233-239.

18

19 Davis RM. Foreword. In: Orlc:an CT, SlaJe J. edilors. NieOlinc Addiction: Principles (md Mllmtg~mmt. New York: Oxford Universiry Press. J 993

p. vii-viii.

Epps RP. Manley M\Xf. C1inical!lllervcnrions tO Prcvelll Tobacco Use by children :llld adolt'Sccnrs. In: Glynn TJ. M:llllcy MW. How 10 Flelp P/~Yli

alional InsritUte of Hcahh Publication Numbcr 92-3064. Reviscd Nov. 1991 p. 63.

cÎ(/)/l.

National Cancer InSlilllfe. Smokil1g atlll Tobaao COlii rol MOllogrnplJ 1. Stmll'girs 10 controllobaeeo IIsr in tbe Unirrd S,am: a blllrim for public lua!Jh aaion i"ll)c /390s. NlH Pllblic:uion Number 92-3316, 199) p.

li

233. Epps RP. Manlcy MW. Clinic..lIlnl('fvelllions ro Pn:velllTobacco Use by d,ildren and adolesccnl5. In: Glplll TJ. Manie)' M\V. Hom to H~1p

22

YOllr ParimlS Stop Smokil1g: A Nationnl COllar !JlSIitu1l' Manlfal for P/~Yli dalU. Narional !nstitutcs of HC
23

Your PfltimlS StOp Smoking: A Nationlrl ewur /llstitutr MalJllJlt for Pbysician$. National lnstirutes of Heald, Publication Nurobcr 92-3064. Revise
In: Orleans CT. Slade J. editors. Nicoti,u Addiction: PrillcipltJ mIII Mlm-

418

J3 National C.1ncer InsritUte. Smokillg Imd Tobacco Control Monogrflph 1. Slmtegies tO comrol tobocco tiU in the Uniud S,nUl: a bitleprim for p"blic luaM aClioll ill thl' 1990s. N1H Publication umber 92-3.316. 1991 p.

236. National uncer IllSrirure. Smoki1lg 111111 Tobllcco umrol MOllograpb 1.

.

20

nllr Palimls Stop Smokillg: A NrZiional Canur !JlSIitmc Mnmlll/ for

31

Stmlrgi~s

10 comrol tobnlto II.U ill tbc Unilerl 'tJllr,: n b/ueprinr for public hrl1tih I/clion in tlle 13901. NIH Publicalion Numbcr 92-3316, 1991 p.

236. 5 National Cancer InstituIe. Smoking (1IId 'lobl/cco COli/roi MOllogmph /. Strategies /() comrol IOIMCCU IIse il1 tIJe UI/itrrl SI(/lts: II bllltpl'ilJ/ for pllb/il' hroM (Wion ;,/ rI)~ 1990,. N1H Publication Nurn ber 92-3316, 1991 p.

236. Hay BR. Youth lobacco IISl': risks, pariem. a.nd control. In: Or1c:uls CT. Sladc J. editors. Nicotine A.ddiclion: Prillâptt'J (1IId Milllfzgrmt'nt. New York: Oxford Univcrsiry Pre s. 1993 p. 375-376.

36

7 Flay BR. Yourh tobacco IISC: ri k..s. patrcrns. and control. In: Orlean CI'. Sladc), edilors. Nicoli1le Atidiclion: Principll's l/1/rl MllIlflgmJnIl. cw York: O~ford Univcr iry Ptess. 1993 p. 375-376.

Epps RP. Manley MW. Clinical Inrcrvention 1 Prevcnt Tobllcco Use by childre.n and a.Joleseent.~. In: Glynn TJ. Manie)' MW. HOfIJ to Hrlp

.\8

nlll' Pnti~lf1j SIOp Smoking: A Nati01lal Cnncrr 11lstillllr Mn11l1fl1 for l'h)'JiNation:ll Instirures of HeaJth Publication Number 92-3064. Reviscd Nov. 1991 p.69-70. cillll>.

FIa)' BR. Vamh IObacco usc: risks. pattcrns. and control. In: Orkans Nicotille Addieri01l: Prillciples a1ll1 Ml11lOgrmmt. New York: Oxford Univcrsil.)' Pres. 1993 p. 370. 9

el'. Sladc J. editors.

DYING FORA CIGARETIE? ~o FIa~'

fiR. Youth [Obacco IIse: risks, patterns, ;md conlro!. (Il: Orlean NiL'orin~ Atldiflion: Princip/es ,md NII/1J1lgmu111. N<.'W York: Oxford Universiry Press, 1993 p. 372-376.

~9 Cigarctlc .rnoking-amiblJtable morra.liry and ycars of potemial life lost-

CT. Sladc J, editors.

Unired Srales, 1990. 27;42(33):645-649.

FIJY BR. Youlh lob
60 NCWCOlllh PA. Carbonc PI~ The he-alrh consequcnces ofsLlloking. Cancer. M,'d C/ill NOrlb Am 1992 Mar;76(2):305-331.

I

c~.

n.

Glynn E'Clenli
Epps Rp, Manley MW CJinic;llllllerVentions 10 PrevenI 1(,hacco Use by chiJdren and adolescents. In: Clynn TJ, Manley MW. HoUJ 10 Hdp

4J

Yollr PII/iml< SIOp Smol'ing: A Nluionll/ Cancer Ins/illJle MiinII/IL for f'/;ysiriftnS. N:llional Instilules of Heallh publi<.·;uion NlImber 92-3064. Revised No\". 1991 p. 72. 4~ U.S. Preventive ScrviGes 1ask Forec. Counsding 10 Prcvcm Tobacca

USt. In: Cllid,! to Clillic,tI PmlCllIilJl' Services-:rJI'tiilion. fialtimore,l"1D: William. and WilkiJlS, 1996 p. 604.

Epps R'P, Manley MW. Clinic.11 Imcrvelllions ro Prevent Tohacco Use by chiJdren and adolescems. iIl: Glynn ·fJ. Manley MW. How In Hrlp YOIIT P/l/iml< Stop Smoking: A Nllliomtl GJf/c~r IIlStil1lte Ml/fllllrl for P/;ysieia.ns. National InstilUl<''S of Heallh PlIblicmioJl Numbcr 92-3064. Reviscd Nov. 1991 p. 70. OI

Re
4(,

.7

r:lay BR. VOlllh tobacco Ilse: risks, pallems, and conrrol. In: Orleans CT, Slade J, ee\irors. Nicoti1JC AddiCJiolJ: P"illeiples IIl1d Mltl1l1gt·f/Ie1Jl. New Vork.: OJlford Universily Pres..~. 1993 p. 367. U.S. Preventive Services 'Iask Forcc. CollJlSding ro Prevelll Tobacco Use. In: Cuid~ 10 CfiniCIII PJ'(j!(nliJ't'S~"lfic~.<-2'·J .-dithm. Baltimorc. MD: Williams and WilkÎns. 1996 p. 598. 4R

r:iddingJE. Smoking: J-1ea.lrh Effecrs and Conrrol. In: L1S1 JM, W:lJlace RB. {,dilors. Mllxey-Rose11l1ll,ulst Ptlblic Hl'lluh /lllli Prt,"rt1live Metli
49

DcRmc D. Dcsignillg Wellnc~.s and Healrh PromOliOIl Programs. In: Ncwkirk WL editOr. OCCllplltiolUr! I-1MlrlJ Servim; PrimicII/ Strdrcgi~s for Jmprol1illg QlJlllity fmd controlling CO$fJ. Chicago, IL: America.n Hospital Publishing. 1993 p. 18\-192.

\0

\1 FicldillgJE. Smoking: J-Ieallh Effl"'ClS a.lld Colllrol. In: LaS! JM, Wallace RB. cdilOrs. J\I/Ir.\'e-y-Ro.<mIlU-UW P"blic HellltlJ 111Id Pr.-vcmiJlc MCllieill~ 13'" uiirioll. Nor';'aIk. ef: Applclon and unge. 1992 p. 731.

MMWR MnrIJ Morinl Iflkly Rep 1993 Aug

61 Nc\Vcomb PA, Clrbone PP. The health conseqllcllces of smoking. Clnccr. Md Clill NorlliAJII [992 Mnr;76(2):305-331.

Darollclll of H{-:uh and Hllman Services. Tlie h':l/ftb conSNjllences of G~Il~TIII, 1982. Rocl-.'Villc MD: Depanmem Ofl-lea1lh and HlIlllan Scrvicl"'. pubIÎc.~rion no. DHHS (PHS) 82-50179,1982 p. 197-199.

61

,(moking: C/IIlCCr. A rtPOrt Of tiu SlIrgmll

63 Depanmclll of Hcmh ~net Hlllllan Selvicc~. nu hmlth (onse'lllcrlet,( of smokil/g: Cllllcer. Il repoTt of tiu SI/rgeol/ Gtturnl, 1982. Rockville. MD:

Dep~nmeJ1lofHeahh 'lnd Human Serviccs. Public.uion 110. DH HS (PHS) 82-50179.1982 p. 193.

Departlllcnr of Hc"th and J-Iuman Services. 17Je bellltl) cOlIScqumccs of mlOkillg: Cil1l1:Cr. A repoTI ofrlie SUl'grol/ Geluml. /982. Rocb..'Ville. MD:

(,,1

Dep
Dqxu:ll\1enr of Hearh a.nd HlIll)an Services. 71Jr 1JL'Illlb (onleqllc>lces of Tl'ţ>OTI ofrb~ 5111'[eon Cerreml. 1982. Rockville. MD: Darrment ofJ-leallh al1d HllmaJl Services. Public:uion 110. DHHS (pHS) 82-50179. 1982 p. 195.

s7Jlokirtg: CII1It'L'r. A

6G DeparrmCJ1( of He"uh and Human Services. Tltc Imrlib come1UCllCI'S of smoi'ing; CrIrlC/'/: A reporr oflhe Sllrg~on Cenerll/, 1982. Rockville, MD:

Darnnenr ofJ-l<'''3hh and J-IumaT> Services. PlIblicalion no. DHHS (PHS) 82-50179,1982 p. 200. Wcstin JB. 10I1iz..ing radiarioll {rom IOhacco. JAMA 1987 Apr 24;257(16):2169.

67

WeSlin JB. lonizing radÎation from lobaceo. 24;257(16):2169.

liS

JAMA

1987 Apr

DarrmCJlt of Heath and Human Services. Tbe IUI/IJb comeq"J'IIcrs of GCII~rIIl, /982. Rockvillc, MD: DtparrmeJll of Hcalth ;lfld Haman Services. Public:uion no. DHHS (PHS) 82-50179 1982 p. 210.

69

smoking:' CrIrlUI: A repOTI ofThe S",-gcon

Deparunem of !-Ieath ,md HlJl11an Services. TIt~ I}{'nltli "omequmces of sllloking: Canar. A l-rPOrt oftiu SlIrgeon CtJleml, 1982. Rocb:vilk. MO:

70

Depanmelll ofHeallh and J-Inmall Services. Publicalion nO. DHHS (PHS) 82-50179.1982 p. 210. Deparrmelll of Hcalh :Ind J-1uman Services. Tit" ImlftlJ comeqllertr(J of JIIwking: Gtmcer. A repOrl ofIli" SlIrgeofi Cenerlll, 1982. Rockville. MD:

71

DeRose D. Deg WdJnc.ss and He.ahh Promotioll Progr:uns. In: Newkirk WL, editor. OCCllpilliofllr/ Hellllh Services: PmcliClr! Sm/l(gi~s for ImprolJillg QIII/lity arul romrol/illg Com. Chicago. IL: AmcriCln Hospil.a.l Publish iug, 1993 p. 181- 192.

Deparrment of Healt.h and HUlllJn Services. Public
Tobacco smokillg. IARC MOllogr ElJId Cllr";lIog Risk Chem H"m 1986;380:35-394. ~~ U.S. Prevcnrive S<"rvices 'lask forcc. Collnsding 10 Prevcnr Tobacco Usc. In: CI/irlc ro Clil/iull fuVmlilleS~TlIiccs-2"J eriilion. BaJlimorc, MD: Williams and Wilkins, 1996 p. 597-609.

73

\} Newcamb PA, Clrbonc PP. The healrh conseqlJences ofsmoking. Cancer. Med C/in NnrllJ Am 1992 1\1.\1';76(2):305-33 L

74 Shopland DR. Burns DM. Medical aJld PublÎc Hcalth Implicarions of lob'lcco Addieliol1. [n: Orleans ef. Slade J. edilOrs. Nicn/irtr Jlr1rlicliort: Principles //lui Nfl/l1IIg~lII~lII. New York: Oxford Univers it)' Press. 1993 p.

2

.J

;(, Giov~nnucci E, Rim m EB, et al. A prospeclive srudy of cigarclte smoking and risk of colorcaal adenoma and calorectal cancer io U.S. O'eo. J MIII C{/l/ceT I"st 1994 r:eb 2;86(3): \83·19!. ~7

Giovannucci E. Coldir:7. CA. el al. A prospeclivc sludy of cigarclte slTloking and risk of colorcclal adcnom3 and colorcclal C;Hlcer in U.S. wOlllCtl. J Nall Cllncer InSI 1994 Fcb 2;86(3): 192-199. GrodslcÎn F. Speizer FE. HUlltcr DJ. Chann;ng A prospcerivc study of incident sqllamous etil clrcinorna of the skin in rlle nurscs' healrh slUdy. J Nad Gtnccr JllSt \995 Jul 19;87(14): 1061-1066.

\8

Wcsrin JB. loni7.ing radiarion (rom lobac.co. JAMA 1987 Apr 24:257(16):2169.

71

Ne\Vcolllb PA, Carbone PP. The heaJrh consequenecs ofsmoking. Cancer. Med Clin NOTII; Am 1992 M'lr;76(2):305-331.

I II. 7~ FieldingJE. Smokillg: He;llth Effe<:ts and COlllro1. In: LastJM, Wallace

RB, ed.ilOrs. MIIXcy-RoSL'JlIlU-UISt Publi.· Helrllb Ilnd Preventive /v/"dici,,,,131" crliJion. Norwalk. CT: Applcto/l :Uld !..:lnge. 1992 p. 715. 722. National Cancer l.nstÎtlJrc. Smokillg mut TobllCt'o Control Monogmpb 4. RespimJory I-1eltltb Ejjiew O/PIl.<silJe SmokiJlg: Lllng C/lnur And OJher Disorr/.-I'J. 71u 1?eporl OfTbe US Ertvir01/JrUnllll Proreaio/1 Ag""'J'- NI H Pub-

71,

lication NIJJ11ber 93-;3605. \993 p. 92.

419

PROOF POSITIVE n Mamon ME, PoUack ES. Cullcn J\\"'. Whal arc the odds that smoking will kill you? Am} Public H"fllih 1987 Apr:77(4):425-431. '8 Manson ME, Polbck ES, Cullen J\'V'. Whal are the odds dur smoking will kill you? Am} Public H"t/I!J [987 Apr;77(4):425-431.

7' Richardson GE. Tucker MA, et al. Smoking CCSS:ltiOLl ancr succcssfui treatmelll of smaJl-cdl lung cancer is associalcd Wilh f"wer moking-relalcd second primary cancers. AnII 11IIcm Med 1993 Sep 1; 119(5):383390. Boring Ce. Squircs TS, el al. Cancer statistics. 1994. CA umerI'J Clin 1')94 Jan-foeb;44(1 ):7-26.

80

Vena JE. Freudenheirn J, CI al. -oITee. eig~rclle smoking, and bbddcr C'::mcer in we tern New York. AnII Epidemiol1993 Nov:3(61:586-591.

81

Giovannucci E. Rimm EB, el al. A pre pective StuJ>' of cigarClte smoking aJld ri k of colorectaJ adenoma and olorectaJ cancer in U.S. men. J Nod Cunur Inst 1994 Fel> 2;86(3): 183-191.

82

J Giovannllcci E, Coldit7. GA, CI al. A prespeclive slUdy of cigaren<: smoking aJld risk of colorecr~1 adenoma aJld eoloreaa! cancer in U.S. wOll\cn. ) Mu/ Cfmccr /rm 1994 Feb 2;86(3): 192-1 99. 4 Calle EE. Mil
, Cllle EE. Miracle-MeMahilJ HL. CI a.!. Cigarellc smokiJlg and risk oI' fala.! brC:lS1 cancer. Am} EpidJ"",io/1994 Ma)' 15: 139( 1O): 100] -1 007. Oaniell HW Increased Iymph node melaSlasc at maSteclomy for breast cana'r associatcd with host obcsiry, cigarcne smoking, age. and l:uge IUmor sizc. Canar [988 Jul 15;62(2}:429-435. 86

Glie EE. Mirade-Me ofahilJ HL. el al. CigvCltc sllloking and risk of fatal breast cmcer. Am} Epidrmio/1994 Ma)' 15: 139( 10): 100] -1 007.

87

Bunon Re. Smoking. immunil)', and C:Ulcer. lvfed J AI<51 1983 00 29:2(9):411-412.

8H

89 Grodsrein F. Spe.izer FE, HlImc.r DJ. A prospecli"c smdy of incidelll squamous cell earcjnoma of lhc skin in lhe nurscs' hcalt], sludy. } Nori Conar lllsi 1995 Jul 19;87(14): 1061-1 066.

Maden C, Shennan KJ. et al. History of cir umcision. medical conditions, and SExual Jeri"ily anei ri k of pcniJe cancer. } NfltI Cal/ur bUl 1993 lan 6;85(1): 19-24. 90

Maden e. Sherman KJ, et:ll. History of circumcision, medical condiuons, and sexual aerivily and risk oI' penile c;lIlcer. ) Nlld ClIlur blSl 1993 Jan 6;85(1): 19-24. 91

n Ferrdl V. Pilgrims' Newi NOIe;. Beersheba Springs, TN: Pilgrims' Resl. Jul)' 1994. Moodie A. 17JC Smokers Cuid/' 10 ViII/mim Imri Hel/lrIJ. CroftOn. MD: Vanguard Books [nc., 1995 p. 26.

9

Haughey Br. Marsh:tll JR. el al. Oier amI lung cancer risk: findings rrom the Wcslern New York Diel Sludy. Am} 1:.i,itl/'mio/ L987 Mar; 125(3):351 -363.

9'

Moodie A. Tb/! Smokcr's CuiiU ro Vilamins Imd Hen/tl/. Croflon. MO: Vangllard Books Inc.. 1995 p. 13-80.

91

Heinonen Or. Albanes D. CI al. 'rhe e(fect of "ilamin E and helacarotcne an llle incident:(: oI' lung cancer and other cancers in malc smokers. The Alpha-TocopheroJ. 8ela--e-.Jrorene Cmccr Prc"ellljon StlId)' Group. N Ellg/) Med 1994 Apr 14;330(15):1029-1035. 06

s

97 Moodie A. Tiu Smoker Cuide ro Vilamins l//ul HI',dtIJ. CroflOn, M O: Vanguard Books Inc., 1995 p. 8-9.

U.S. Prevelllive Services l:1Sk foree. ounscling tO Prevcl1l Tobacco Use. In: Cuide 10 Clillicl1l 1'r/'tJmritJe ServiUi-:r/eclilion. 13ahimore. MD: William a.nd WiJkins. 1996 p. 597-609.

98

420

U.S. Pre"enrive Services Task Force. Counseling ro Prevclll Tobacco Use. In: Cuirl" 10 CliniciJl !nllelJtilJe!Ynlias-2'''/ editioll. BaJtÎmore, MD: William. and Wilkins, 1996 p. 597-609.

99

100 U.S. Prcvellli"c Services Task Force. Counsding ro Prevent Tob3CCO Use. In: Cuirle ro Clil/icalPrl'l/e/llilJl' Sl'l'viccJ-2"" eclition. Balrimore. MD: Williams and Wilkin . 1996 p. 597-609.

U.S. Preventive Services T.'1,~k Force. Counscling 10 Prevenr Tobacco Use. In: Cititle 10 Clillical Pre-lJellrilJe Srrvices-2"" cLiitioll. Bahimore, MD: Williams a.nd Wilkins. 1996 p. 597-609. 101

1O~ U.. Pre"emive Serviccs Task Force. Counscling tO Prevent Tobacco Use. In: euirlt 10 Clil1iml Pn!l/,·lJti/ie Servim.-2'" erlitioll. Baltimore. MD: Williams :Ind Wilkins, 1996 p. 59Î-609. 10.1 FieidingJE. Smoking: Healdl Effccts and Comrol. [n: LasrJM. Wallace RB, editors. Maxcy-RosCIII/I/-UlSf Public Henlth and !,"lJl'miv/! MellicillJ'13';' rditioll. Norwalk. CT: Applelon and Lange. [992 p. 716-719.

1114

FieldingJE. Smoking: Heahh EIl"

IS and

Colllrol. In: LasrJM, Wallacc

RB. edilors. J'vll/xry-RoSl'//I/II-Lnsll'ub/ic Heallh alul !'relJemivc Ml'djcillr-

13'" I!tlirioll. NOl\~alk. CT Applelon and LlIlge. 1992 p. i16- Î 19.

10\ Oep:mmem of Heath :\nd Human Services. TIJI' Jmdlh eOI/Scljumers of mloking: Ctlrdil/VllimitlT Di moSc. A rort of riu SurgCOII Grneml, 1983.

Rockville, MD; Depanmem of Healrh :lI1d HlilIlan Scrviccs. Publication no. DHHS (PHS) 84-50204. 1983 p. 99. 106 FieidingJE. Smoking: Hc:uth Effem and Conlrol. In: LlSI JM, WaJlact IU\. editors. Maxcy-Ro.
109 Fraser GE. PrrvCIIlive CnTYli%gy. New York. Oxford: Oxrord UniversilY Prcss. 1986 p. 24-25. 110 FieidingJE. Smoking: HeaJth E(fecrs ancl Comrol. In: L1StJM, WalJace RB. editOrs. Mnxcy-RoSCllflU-WI Public Hra/tlJ and !'rCllcntive Medici'lr13'}, edilioll. ol\valk. CT: ApplelOn anei u.nge, 1992 p. 716. III Shopland DR. Bums DM. Medical and Public HcaJrh Irnplications of Tobacco Addi lioll. [n: Orle;lIls CT, Sladc J, tdilors. NicolÎne Addit'liol/: !'ril/cip/"i atld Mallagelll/!/JI. Nt'W York: Oxford Univcrsiry Press, 1993 p. 115·116.

foraser GE. I~'rvrnlille CarJi%gy. Ncw York, Oxford: Oxford Uni"eril'y Press. 1986 p. 113.

Iil

II) Darrmelll ofHealh and H uman Serviccs. Tlic licllith bmefits ofs/Iloking willtioll: A reparI of liJe Surgeoll Ccnc7'l11. 1990. RockviJIe, MD: De·

p:l.rrmenl of Health ami HUlllall Services. PubliC:lIiol1 90-8416,19901'.197.

110.

DHHS (CDC)

II' Ibpapon SI. Het1losrasis. In: Wesl JB, ediloL &st alld7itylor's PIJysiologicol Basis ofMedicn/ Prnctice--l 1'" edirioll. Baltimore. MD: Williams

and Wilkills. 1985 p. 410. III Shopland DR. Burns DM. Medical and Public Health Implications of Tobacco Addiction. In: Orleans CT, Slade J, cdilors. Nimti,/I' Adrlierion: Principlrs ami Mlt/lflgcmcllt. Ncw York: Oxford Universily Press, 1993 p. 11(,117.

116 Coldiu GA. Bonit.a R. Ct al. Cigaretre smoking and risk of stroke in middle-agcd wome". N Etlgl) Mrd 1988 Apr 14;318(15):937-941. 117 Shopland DR. 13urns OM. Medical and Public Hcalth Implications of Tobacco Addictioll. 10: Orlcans CŢ. Slade j, editors. Nicotint Adriiclion: Prillcip/es l/Ild MI/nagemmt. New York: Ox.ford Univcrsily Press. 1993 p. 115.

DYING FOR A CIGARETTE? I[S Shopland DR. Burns DM. MLxlic.1t :Uld Public HcaJrh Illlplicalions of Tobacco Addiclion. Ln: Orleans eL Sladc J. edicors. Ni,willr Arltlicrioll: Prillciplrs I1nd Mf11J11gcmcJl1. New York: Oxford Universiry Pres.., 1993 p. 115. 119 Ficlding JE. Sllloking: Hc.aJt.h Et1ecls and Control. In: LasI JM. Wallacc RB. edilOrs. MIL\'l-y-RoJrJlllu-wrr Public HCl/lrI} I1Ilti Previ'1lrive Medicill.r-13'" rditioll. Norwalk. CT: ApplclOn and Langc. 1992 p. 719.

alional Cancer InstilUle. Smokillg 111111 Tobllceo Comrol MOllogrl1ph 5. Tobl1cco Iwd rIu Clillicil1ll: lJJ1e1'vmrio>JJ for Medicl11 I/lld Dmtlll Prl1cria.

I)J)

N1H Publicalion Numbcr 94-3693, 1994 p. 24-27. FiddingJ,E. Smoking~ Hcalch Effeet5 and Colllrol. In: La.SI JM. Wallace RB. ediTO'-. Ml1xq-RoJeJlIl11-LllSt Public He,rlrb IImi PrelJl'11rivc Mc"icinc13';' "litioll. Norwalk. CI': Appleron and Lmgc, 1992 p. 719. 121

I-[;unmond Ee. Garflnkel L. Coronar}' he-arr diseasc. stroke, and aonic aneurysm. Factor in ilie criology. Areh Ellviron Hn7lrh 1969 Aug; 19(2): 167182. III

Fraser GE. P"'IJI'lIlilJl! Gmliology. New York, Oxford: Oxford UniverSil}' Prcss. 1986 p. 99. I!)

Il4

Oeparrmcnl of H<'alh :111<1 Hum, n Services. Tbe hettltb l'O/lSequmas of

smokÎllg: Cr/IYliwllSl'1Iltrr DisCl1se.. A report of lhe SUrgeo~l Gmalll,. 1983.

us John EM. Savilz DA. Sandler Dr~ Prenaral cxposurc 10 parenLS' smoking :lIld childhood cancer. Am J Epidi.'miol1991 Jan 15: 133(2): 123-132. 139 John ,EM. Savilz DA, Sandler DI' Prenalal cxposure 10 parenLS' smoking anei ehildhood cancer. Am) Epirlnl/iol ) 991 Jan 15; I:B(2): 123-132.

'·lO OlivCli JE Kercslllar CM, Redline S. Pre- and perinalal risk faClors for a lhma in inner cil)' African-American childrcn. Am J Epi.dJ'lIliol 1996 Mar 15;143(6):570-577.

I·Ji Weilzman M. Gonmaker $, el al. Malernal smoking 'Ind childhood aslhma. Pl'dilllrics 1990 Apr;85(4):505-5 II. 1 1 U.S. PrcveJ\li\'e Services Task Foree. Counseling ro Prevem Tobacco Use. In: Gllidi' ro Cliuiml Prrvmrivc Srrvicrs-2'u1 i'tlirioJl. llaltimore, M D: Williams and Wilkins. 1996 p. 597-609.

FieidiogJE. Smoking: Heahh EffecrsandComrol. In: LlstJ"'!. Wallacc RB. edilors. A11Ixcy-RoU'l1i1U-Lw Public Healtb 11l1d Prevmrivl' Ivlrdic-im'/3,1> I'tliriol1. Nonvalk, cr: Appleroo and Lallge, 1992 p. 725.

143

.-1 Oeparrmcnl of Heath and Humau Serviccs. Tbt betlltl] cOIISeqrmrus of invol1l1ltllry smoking: A reporr oflhl' Surgl'on GourtJl 1986. Rockv.llc. M O:

DanmelH of Hc,tlth a.nd Human Service... (COC) 87-8398. 1986 p. 37-59.

Publicaliol1

110.

DHHS

Rockville. MO~ D('pannWll 01 Hcahh 'Ind HUlllan ervlces. PubhC1110n no. DHHS (PHS) 84-50204,1983 p. 55.

U.S. EovironJllclllal Prolecri.on Agene}', Respimro,] Helllrh Effi'cu of Smoki,lg: hm SI}I'I'I. Washinglon. DC: Environmemal PrOleetion Agency, Office of Rescarch 'Ind Devdopmenr (RO-689). Janll'lr}' 1993.

Il' FicidingJE. Smoking: Hcalrh EffcClS and CMUO\. In: LastJM, Wallace RB. ~xIjLOrs. M4Xq-RiJSt'nIJrl-LIISI Public Hel/llh Imd PTcvtlltivl' Ml'(liâlll~ /Y" ,"ilioll. Norwalk, CT: AppleLOn and Lange, 1992 p. 719.

14(; FiddingJE. Smoking: Healrh Effecls and Comrol. In: L1Sl]M, WaJlace RE. ediLOrs. Mrrxq-Rosenllu-Lturl'lIblic Hmltb 11I1d Prevenriv,' }\,f"dicille-/3 ,10 rdition. orwalk. CT: ApplclOn and Lange. 1992 p. 725.

1'" Deparcmcm of He:llh and Humall Serviecs. 7111' bMlrb l'OIJSequm,"'$ of Jmokillg: Cl1rrliovl1.Jc-ull1r DisettJe. A TepOrl of rbc SII'..f!,eoll Geneml,. 19~3. Rockville. MO: D:l.rlInClll of Heahb and HUOlan $erv.ee.s. Pubhcauon no. DHHS (J'HS) 84-50204, 1983 p. 53.

145

PIISSÎl)f

'47 Maril2 GS. WOOIW;lId KM, du Toil G. M,lternal niCOline exposure during pregnancy and devdopment of emphysem'l-like damagc in lhe olTspring. 5 Afi' Med J 1993 Mar;83(3): 195-198.

117

I~g Schocndorf KC, Kidr JL. Rdalionsbip of sudden infam dearh syndrome tO marernaJ smoking during and a(l~r pregnane}'. P~dialrics. 1992 Dee.; 90(6):905-908.

Gla.nl1. SA. Parmley WW. ive smoking and hcart discase. Mechanisllls and risk. JAMA 1995 Apr 5;273(13):1047-1053.

BM) 1988 Aug 13;297(6646):487-488.

Criqui MH, WaJlace R13, et 'lI. Cigaretre smoking and plasma highdensiry lipoprolein eholesrerol. The Lipid Research Clinics Program Pre,'alence Study. Cirrl
Celermajcr OS. Ad:lnlS MR. el al. ive smoking and impaired cndoLbdiulll-dependelll arecrial dilat:uion in he-alrhy young adults. N EllglJ Med 1996Jan 18;334(3):150-154. 129

I·i~ Nicholl JP, O'Calhain A. Cigarctle smoking :lnd cari}' ncanaral de.alh. 150 icholl Jp, O'Cachain A. Cigarerre smoking and carly neonaral d<",rh. Blvf./ 1988 Aug 13;297(6646);487-488.

Mi\1WR. Voi. 42 number S5--6, "Surveillance (or Ectopie PregnancyUnilt'd Slale" 1970-1989", pages 73-85. Decernber 17, 1993.

ISI

10 MofTatl RJ. Slamford .BA, 13iggerscaffKD. JnAuence of worksile ellvironlllenlai IObaceo sllloke on serum lipoprorein profllcs of fcm~Je 1101\smokers. }derl1bolism 1995 Oec;44(I 2): 1536-1539.

152 Sr~rgachis A. SdlOles O, el al. Maternal eigarelle slfloking 'Ind lhe risk ofrubal pregnanc, Am) E:.'pidcmioI1991 Feh 15;133(4):332-337.

RaceJL. lobacco Smokc Pollution. In: Orb1l1s CT. SladeJ. ediLOrs. O.~(ord Universit'y Prcss. 1994 p. 133-134.

15J LasI JM, Wallace RB, edicors. MllXcy-RoSCIllltl-LlIsr Public HI'il/lh r71ut Preventive Mtdicine--13'" crlition. Norwalk. CT: Applelon and LInge, 1992 p. 108.

[;1

Nicorine tUl.tliaion. New York:

1;1 Glanrz SA, Parmley W\Yl. ive sllloking and hcart disease. Mcchanisllls and risk. JAMA 1995 Apr 5;273( 13): 1047-1053.

133 Race JL. Tobacco Smoke PoJllllion. In: Orleans CT, Sladc J. cdilOrs.

Nit'Olilleiu/dicrion. New York: Oxford Universit}' Prcss, 1994 p. U6-137.

Goldner TE , L~wson HW ,el al. Surveillance for ectopic pregnancyUlJited StalCS, 19ÎO-1989. MMWR CDC Stlrveil! SWII111 1993 Oec;42(5S6):73-85. IS'

1 -

Slockwell HG, Goldman AL, el al. Environmental robacco smokc :md lung cancer risk in nonsmoking women. J NI1/1 Cl1llcer IIISI 1992 Sep 16;84(8): 1417-1422. 1.14

1994 Feb 1; 139(3);294-301. 156

Slanery ML. Robison LM. el al. Cigarelle smoking and exposure 10 ivc sn'lOke are risk faelOrs for ccrvical cancer )AMA 1989 Mar 17:261 (II): 1593-1598. IJS

1.'6 Slockwell HG, GoldmaI) AL. cc a.l. Environmcnral tohacco smoke and lung cancer risk in nonsmoking women. J NflIl CtmccT hlJl 1992 Sep 16;84(18): 1417-1422.

137 Sandler Dp, Everson RB, er al. Cancer risk in adulrhood fi-om cari}' Iife exposure co parenrs' smoking. Am} Pllblic HClrlrh 1985 May:75(5):4.87492.

fortier l. MareoulC $, Bris.
the risk of delivering a small-(or-geslational-ag~ infalll. Am J Epitlcmiol

Chen Y, Pedcrson U.

Lefcoc NM. ive sl1lokingand low birthweighl.

L/1I1cer ) 989 Juli ;2(8653):54- 55. IS7 Makin J, Fricd PA. Waduosoo B A. comparison of active and ive sllloking during pregnancy: long-lerm effea.s. Ni'/ll'Oroxirol Tcmlo/1991 Jan-Feb; 13( 1):5-12. I<S

ZhangJ, R.1ldilTe JM. Palernal smoking and birrhweighl in Shanghai.

Am) Public Hri1/rb 1993 Feb;83(2);207-21 O. I 9 MarlLncz fO. \XIrighc AL. Taussig LM. The dfca of parcrnal smoking on lhe binhweiglll o( newborns ",hose mOlhcrs did nOI srnokc. Group

421

PROOF POSITfVE Heahh MediCII Nsociates. A", J Public Hrdlrb 1994 S;R4(9): 1489-1491. 1~ Oi Fmu.'l JR. Lew RA. Eflcct of maternal c.igarcrrc smoking an prcgn~ncy complications:rnd sudden infam death syndrome. J ram Pract 1995

179

Glynn TJ. Manley M\'(7. Ho/{)

1\~llionl1l Cmcrr Illsliwte ManltalfOr

Apr;40(4):385-394. '~I Oi Franza JR. Lew

declinc of FEV 1. The Lung Healrh Study. 16:272( 19): 1497·1505.

RA. Elfecl of matern al cigarette sllloking on preg-

nanc)' complic.ltions and,uddcn infam death syndrome. } Fam Prar! 1995 Apr;40(4):385-394. 't>.! 1 Ilh annual mcet;ng of lhe Society of Perinatal Obstelric;ans. January 28-Februarv 2, 1991. San Francisco. California. Absrra ts. Am) ObstN erylluo/1991 J1I1; 164 (1 Pt 2):241-466.

JAMA 1994 Nov

10 Hrlp Yoltl' Patiems SlOI' Smoking: A P!Jysicilllls. Nat ion;lllnSLitulCS of! t':.llth

PubliCluon NUlllbcr 92-3064. Revised Nov. 1991 1'.38. 180 Kaplan JA. Seeman TE, et ~1. 1987. Morraliry atnong fhe e1derly in r11C Ahm(.x\a Coum)' Stud)': uehavioral and demogtaphic risk f~ctOrs. Am J Pltblic HCIJ!tIJ 1987 Mar;77(J):307·312.

Delloc NB. ReI;llionship of hcalth practice. and morraliry. Prrll Mtll 1973 Mar;2( 1):67-81.

181

'(,3 Czeiu'l AL Kodaj 1. Lcnz W. Smoking during prcgnancy and congenilallirob deiicienc)'. BM) 1994 Jun 4;308(6942): 1473-1476.

18! Breslow L Breslow N. Hea.lth praclices and disabilir)': some evidence from AJameda Count)'. Prl'tJ Mrd 1993 )an:22( 1):86-95.

164 Hakim RE. Tielsch JM. Maternal cigare{((' smoking during pregnancy. A risk faclor for c.hildhood strabismus. Arcb Oplul"rlmol 1992 Oct; II 0(1 O): 1459-1462.

183 Cumming RG. KlinebetgRJ. Case-comrol slUd)' oflisk faaors for rup fractures in theelderl)'. Am] Epidemiol1994 Mar 1;139(5):493-503.

Hwang S), Beat)' TH, Ct al. Associarion stud}, of lransforming growlh faCIOr alpha (TGF alpha) Taql polymorphism and oral defts: indicalÎon of gcne-environmem interaction in a poP"ialion-ba.~cd sample ofinf.,nts with binh defects. Am) Epidemiol1995 Apr 1; 141 (7):629-636. IM

Olds DL. Henderson CR )r. Tatclbaum R. PrevcnliolJ of imcllcctllaJ impa;rmenr in children ofwomen who smoke cig;lretleS during pregn"')cy. Pedilltries 1994 F"b:93(2):228-233. 166

Sex ton M, Fox NL, Hebd )R. Prenatal exposure to tobacco: II. Enects on cognitive functioning at age lhree. Inr J /:')MemioI1990 Mad9(1 ):72167

77. Fee. MA. Me.ntal Retardation. In: Sdl\Varrz WM. Charncy EB, et al, edilOrs. PriI/tipIc! IlI1d Practice of Clinical Pedituria. ChiG'lgo, IL: Year Book Medical Publishm Ine.. 1987 p. 618-619. 168

'"~ Ihrrcn-Connor E. The economic and hurnan co tS of o (COporotÎc. fr;lcturc. AII/) Med 1995 Feb 27:98(2A):3S-8S. 18 Ihrreu-Connor E. Darren-Connor E. The economic and human rom of osteoporolic fraclure. Am} Med 1995 Feb 27;98(2A):3S-85. 186 Hopper JL.. Seeman E. Th,; bonc denS;I)' of fcmale [Wins discorda.nt for IObacco use. N Engl.l Mn/1994 Feb 10;330(6):387-392.

187 OcRosc D. Dcsign.ing Wcllllcss and HCallh Promotion Progra.ms. In: Newkirk WL. edilor. Occupillion'lll-lut!t!J Service: Pmetical Strategirr fOr III/proving QIlJ1liry and t'olllrolling CostI. Chicago. IL: Anlerimn Hospjlal Puulishing. 1993 p. 181-192. 188 Tsang lK. Pcr. pectivc on low back pain. CU" Opin RJJf:ltmllfo/1993 Mar;5(2):219-223.

169

OeRose O. Ol'g Wellness and H<.-alth Promorion Programs. In: ewkirk WL. edilOr. Occllpatiolla! Hutltb Servius: Practical Stmurir~ for !mprovil/g Q/lality a/lll t'olllro/ling Com. Chicago. Il: Amcric-an Hospila! Publi hing, 1993 p. 181-192.

The Ter:lloJogy 33rd annual meNing June 28-July 1, 1993 ~nd the Neurobchavioral Ter:uology Sociery l7th annua.1 meeringJune 26-29. 1993. TlIcson. Ariwna. Abslraas. 7emtology 1993 May:47(5):345-469.

l'JO DeRo e O. Oeg Wellncss and Heallh Promotion !'rogr'lJns. [n: Newkitk \'ql, editor. Occup,uioJlal Hl'I1llb Services: Praerical SlrategieI fOr Improving Q/lltlity and c01ltrol/ing COSIS. Chicago, IL: American Ho pira! Publishing. 1993 p. 181-192.

Olds OL. Henderson CRJr, Talelballm R. Il\leUcclUal impairmem in chilo....,n of \Vomen \Vho smoke cigarenes during pregn:l.Ilcy. Pl'lliatrirs 1994 Feb;93(2):221-227. 170

171 CotlOn P. Smoking cigarerres may do developing feltls more h,lrm than inge ling cocainc. SOmc cxperrs sa)'. )AMA 1994 Feb 23;271 (8):576-577.

189

191 Hopper JL. Sccman E. The bone den. ity of female rwins discordanl for robacco usc. N EJlgl) Med 1994 Fcb 10;330(6):387-392.

171 Ol
19! Hoppcr JL. Scema.n E. The bone densir)' ofremalc rwins di,cordanr for IObacco use. N En_~/j Ml'd 1994 Feb 10;330(6):387-392.

l7J Cotlon P. 5moking cigarcnes may do dcveloping fe[lls more harm lha.n ing<'Sling coc.1inc. SOlJlC cxpens say. )AMA 1994 Feb 23;271 (8):576-577.

19J Muller B. Zulewski H. el al. Tlllpaired acrion of thy.roid hormone asso iared wirh sllloking in women ",ilh h)'polhyroiclism. N Engl] MCiI 1995 OeI 12;333{l5):964-969.

17'

Wei{zman M, Gonm~ker S, 5obo l A. Maternal smoking and behavior problcms of cI1ildren. j>edillfricI 1992 5ep·90(3):342-349. 171 Crowlcy TJ, Andrcws AE, et al. Carbon Monoxidc for Ass=ing aod Trealing Tobacco Dcndencc in COPO. In: Hatris LS. cditor. Prohle",s ofDmg DepmdeJlcc. 1986. NIDA Rescarch Monogmph 76. US Dep!. Of Heahh And Human ServicC5 ['ubliCllion No. () 87-1508. 1987 p. 73. 176 U.S. Prevcmive Serviccs lâsk Fotce. Counsding 10 Ptevcm Tobacco Use. In: Guidt 10 Clilticai PrI't,tmtiveServicts-2",f tditiol/. Baltimorc. MD: Williams and Wilkins. 1996 p. 597-609.

19· Nelson HO. ('\·iu MC, Cl:ll. 5moking. alcohol, and neuromuscu\ar :Ind physical functiol\ of oldct womcn. Swdy of OSleoporotic Fraetures Reseatch Group. )AtVlA 1994 Oec 21 ;272(23): 1825-1831.

19S Gradr O, Ernsrct V. OO('S cigarellc sllloking m:lke rou ugly and old? Am) Epidemio/1992 Apr 15;135(8):839-842. 196

Ippen M. Ippcn H. Approaches ro a pmphylaxis of skin aging.

J Soc

Co!mclic ClmltiJlJ 1965; 16:305-308. 197

Model O. Smoker's face: an unde/raled c1iJlic.'l1 sign? Br MedJ (Clil/

Res Eli) 1985 Oec 21-28;291 (651 1): 1760-1762.

In Depanmem of Hcalh and HumaJl Scrvices. Tlie bei/ltb COJlstqltt:llces of smokil/g: Cbrolt;'· Obrtrue!i-vt Lung Disrasr. A rl'pOI'! oftiu Surgeolt Gmeml,

19" Grady O. Ern.ler V. Does cigarette smoking makc you ugly and olo? Am) Epidemiol1992 APT 15; 135(8):839-842.

/984. Rockvillc. MD: Oepanmem of Hcalrh and Human Serviccs. Publicalion no. OHHS (PHS) 84-50205. 1984 p. 11)-116.

19'J Mosier JG • Gibbs AC. Premalure grey hair and hait los among Jllokcrs: a new oppoftunity fot health education? BM) 1996 Oee 2128;313(7072): 1616.

1 S Amhonisen NR. Connerr JE. er al. ElTeClS of smoking inrervemion ;md th" I.L~C of an inhaled amicholinergic bronchoJilator on the rate of

422

200 Wwer 0\'(1. YOllng TB. The reiation between cigarenc smokiJlg aud sleep disrurbanC-e. !'rrv Med 1994 Ma)';23(3):32fl-334.

DYING FOR A CIGARETTE? Fielding JE. Smolcing: Health Effects and ControL. In: Last JM, RB, editors. Mlzxcy-Romllw-LIIJl Public HrtI!IIJ nnd Pu"tJl/ilJe Mtdicine-/3't. edilion. Norwalk CI, Appleloll and L.1nge, 1992 p. 723. JOI

'w.~Jbce

FieidingJE. Smoking: Healrh EffeCls and Con 1 rol. In: LastJM, Wallacc RB, editors. Maxcy-Ro!mau-wt Public Henlth Iwd fuvmri"e Medicjlll:/3'1. edition. Norwalk. cr: ApplelOn and L.1nge, 1992 p. 723.

JOI

Lyons RA. Lo SV. Liulepage BNe. Perceplion ofhcalth amongst eversmokers and never srnokers: a eomparison using .he SF - 36 heallh survey qucsuonnairc. TobfJCCO control 1994 Aurumn 3(3):213-215. lOJ

Sv.

Lyons RA, Lo Lirtlepage BNC. Pcrcep.ion ofhcalth amongst .:versmokers and never slDokers: a cornparison using lhe SF - 36 heallh survey qucslionnaire. 7Obacco cOJltrol1994 AUlUmn 3(3):213-215. 204

R:u.dan RJ. Slruclurc-Aclivil)' Rdalionships in Cannabinoids: An Overview. In: IUpaka RS, Makriy:lnnisA, edilors. 5/rueturt-Aeti"i/y &14tio,uhips ofthe Gmnabinoids. NIDA Rescarch Monog"'ph 79. US Dep!. Of Healrh And Human Services Publicalion No. () 87-1534, 1987 p.3.

10j

Chiang CN. R.3paka RS. Pharmacokinelic.~ and Disposition of C:rnllabinoicls. In: R.1pab RS, Makriyannis A, "dilOrs. StNlr/ure-Aetillity Relll/ioruhips o/tiu C,mtlllbilloids. NJDA RCSc:lICh Monograph 79. US Dep!. Of Hcallh And HumaJl Serviccs Publicalioll No. () 87-1534, 1987 p.173. 106

Fried PA, W:~llcinson B, Gray R. A follow-up srudy of ~llenlionaJ bchavior in 6-ye:u-old chiJdrcn cxposed prenataJly 10 marihuana, cigarellCS, md alcohol. NeurOloxicol umrol1992 Sep-Ocl; 14(5):299-311. 107

208 SUtO HH.

Discussion: Methodologicallssucs in conr.roUed Studies on dTem of prenatal drugs. In: Kilbcy MM, Asglm K, edilOrs. Ml!tIJodologi-

cal hSlll!s in controlled sN,dies on 4ficts ofprmfJ/1I1 expomrt to drug abltse. NIDA Research Monograph 114. US dep!. ofhealth :Ind human services publicalion No. () 91-1837.1991 p.39. HUlchings DE, Rrake S, el al. De\'elopmenlal Toxiciry of Prenalal Dclta-9-letrahydrocannabinol: cffecrs of m:ltcrnal nUlrÎtion, offspring growth, and behavior In: Hartis LS. edilor. Problmts o/DNlg DepmdtJlcc, /986. NIDA Rescarch Monograph 76. US Dep!. OfHcallhAnd Human Scrviccs Publicalion No. () 87-1508, 1987 p. 363-369. l.O')

HutchillgS DE. Brake S, CI al. DevclopmcllIaI Toxiciry of Prenalal Ddla-9-lelrahydrocannabinol: dTecls of malernal nUlrilion, offspring growlh, and behavior In: Harris LS. editor. Probkms o/DN/g Depmdmu. /986. N1DA Research Monograph 76. US Depe Of Healrh And Human Serviccs PubliC:lrion No. () 8Î-1508, 1987 p.. 363-369. 210

pw.

L.1ndlleld Eldridge Je. Nc:urOloxicily and drugs of abuse: mnnabinoid inlcraclion wilh brain gluoocorricoid receplors. In: ErinoffL, edilor. Asmsing NeurofOxicity o/Drug! o/Abltsr. NIDA Rcsc.arch MOllograph 136. National Inslirules ofHcallh Publicalion Number 93-3644, 1993 p. 242257. 211

m Landftcld PW. Eldridge Je. Neurotoxiciry and drugs ofabusc: caJuubinoid inreraClion wilh brain gluoocorricoid receplors. In: ErinolTL, ,-dilor. As!ming Netlrotoxicily o/Drug'! o/Abuse. NIDA Resc:lrch Monograph 136. alion'lllnstirUles of Heallh Publicarion Numbcr 93-3644, 1993 p. 244.

Landficld PW, Eldridge Je. Neuroloxicily :Ind drugs of abuse: caJlIlabinoid iDleracljon wilh btain glucocollicoid receplors. In: ErinolTL, edilor. Assming NellrOloxiciry ofDrug'! ofAbwe. NIDA Research Monograph 136. Nalionallnsutures ofHeallh publication Numbcr 93-3644, 1993 p. 242. l1}

114 M.1Ihj2S R 5111dies SbOlIJ cognitille impoirmenu linger in beovy morijtulIIlI usrrs. NIDA nOles (Nalional InslilUle on Drug Abusc) 1996 Mayl

June; II (3): 1, 4, 9. Fohin RW, Caprioni RM, er al. ElTecls ofMarijuaJla, coc...ine, and task pcrformance on cardiovascular responsiviry In: Harris LS. edilor. Probiem! o/Drug Drymdma, /986. NI DA Rest':l.rch Monograph 76. US Depl. Of Health And Human Serviccs PubLicarion No. () 87-1508,1987 p. 259-265. liS

ll6 Srarr K. Renneker M. A cYlologic ev.t1ualion of splllum in marijuana smokers. J Ftlm Prim 1994 Ocd9(4):359-363.

m US Departmelll ofHealrh, Education aod We1fare. Smolring and Htoltb: A Repon o/t/)e urgeoll Gmrrol, Public HeaJlh Service Public.~lion 79-50066,

1979. Pechacck TF, Foisom AR, el al. Smoke cxposlIIe in pipe md cigar smokers. Serunl l1Jiocyanalc mcasurcs. JAMA 1985 Dce 20;254(23):33303332. 218

II? G)'Jllclberg F, L~uridsen L, CI al. Smolcing and risk of myocardial infarerion in C{)pcnhagen men agcd 40-59 Wilh special referencc 10 cherool smolcing. une" 1981 May 2;1(8227):987-989.

Nalional Cancer Instiluec. Smoking ond Toboreo COli/roI Monogrnph 2. Smoktlm Tob'1CCO or HelllJh: Anlmema/ionlll PrrsperlillC. NIH publicuion

2_0

Numbcr 93-3461.1992. Nalional c'1nccr Instirule. Smoking and lobacro Comrol Monogmpb 2. Smokeless Tobllcco or Hto/tlJ: AJllnlcmotioJlll1Pcrspmill(. NIH Publication

221

Numbcr 93-346\, 1992 p. 115.

m Epps RP, M:lnley MW ClinicallllIervenrions 10 Prevellt lobacco Usc by children and adolcscenls. In; Glynn 'IJ. MaJlley MW How to Heip Yollr PIIlimts Stop Smoking: A Naiio,lIr1 Canar Imtifllu MaJlual for PI'}!;cin,u. NalionallnslilUles of Heakh Publicalion Number 92-3064. Revised Nov. 1991 p. 63. Epps RP, Manley M'w. C1inical lorervenrjons 10 PrevenI Tobacco Use by childrcn and adolesccnl.". In: Glynn TJ. Manley MW How ro Heip

llJ

Your Patimts Stop Smoking: A NIl/ionlll Gmur Imlifllu Mamuli for PJ'}siciom. Nauonal lnslilUlcS of Health Publication Numbcr 92-3064. Reviscd Nov. 1991 p. 72. Michael Eriksen. Ccncers for Disease Control and Prt"VeJllion. Office ofSmoking and Heallh.

114

ll) L.1.ndo HA. Formal Quit Sllloking Trcarlllen!. In: Orleans ef, Slade J, edilors. Nicolint Adtiiction: Principles and Management. New York: Oxford Universily Pre' , 1993 p. 221, 234.

216 Darrnwlll of Healh and Humall Serviccs. TIu hM/l1J coml!'J1fellUS of !molting: NicotineAdtiietioJl. A repoN ofllJe SlIrgron Genera/, 1988. Rod:ville,

MD: Depamncnt ofHeaJth and Hum3n Services. Publicarion no. DHHS (COC) 88-8406, 1988. Henningfield JE. Cohen C. Pickwonh WB. psychopharmacologyof Ilicorine. In: Orleans cr, Sladc J. cdirors. Nieori,u adtiic/ion. ew York: Oxford Universiry Press, 1994 p. 24-45. U7

218

PefCIS JA. Nicorine-rep\acemenr thcl'2py in ccssalion ofsmoking. MllJO

Clin Pror 1990 Dec;65( 12): 1619-1623. BOlvin GJ. The ps}'chology of cigaretle smoking. P.imnry GIre fJ11d

229

Cltl/rer. November 1986; p. 22-31. l..lO

CigaIelle smoking am011!\ adulls--Unilcd Srares, 1993. MM\'(TR Morb

Mortal Wk& RJ.'P 1994 Dec 23:43(50):925-930. U.5. Preventive Serviccs 'Task Force. Counscling 10 Prevem Tobacco Usc. Jn: Guidr to Clinicnl Prt'lleJllilleSertlicl'.<-2"" cditio11. B:dlimore, MD: Williams and Wilkins, 1996 p. 599. 231

2 2 Glynn TJ, Manley MW. In: Glynn TJ, Manley MW How to He/p Your Pa/iCll/J Stop Smoki"g: A Nnrionol unc" Jmtilllu Ma11t1al for Physiciam.

National Instilules ofHeallh Publicalion Number 92-3064. Revise.d Nov. 1991 p,37. Naliorutl Hearl, Lung, and Blood InSlitule. HoUl YOIJ c'w Help Yotlr Patimts Stop Smokil/g: Opportrlllity for Respimlory CAre Prorri/iolltrS. US

l.l3

Dep!. of Healrh and HUlllan Services Nalionallnslil'ulcs of Hcalth Publication Numbcr 89-2961, 1989 p. 35.

Cons/ijM/ion .fom: alional Hearl, Lung, and Blood InsulUte. How un Hl/P }'ofir Pntimts Stop Smoking: OpporLtllliry for Rapimt{}ry ure Pmailioners. US Dep!. ofHealrh
2J4

~II

423

PROOF POSITlVE of Hcalth PubJicuion Number 89-2961, 1989 p. 17. 2.lS

[ncrcase in smokcr's cough from: Glrnn 1]. Manie}' MW. HOl/} 10 Htlp

!'Our Parinm SlOI' Smo!.:i1rg: A iValioml! Cana,. InSlilult MalllulI for PJ~ysi cians. Nalional IllSlillllCS of Hc:aldl Publication Number 92-3064. Revised Nov. 1991 p.37-38. G1rnn TJ. Manley MW. HOlV 10 I-Mp YOllr Pllliml-< SlOI' Smo!.:iug: A MllioJllr! Canc" Instilule MflJllI1l1for !'I1jsitÎ1lIIS. Nalionallnslirulcs ofHeahh

l)(,

Publicacion

umber 92-3064. Rcvised Nov. 1991 p. 43.

Glynn l'J. Manley MW. HOl/} ro Hal' Your Pnrimrs SlOI' Smokiug: A Ml/ional C01lur !tlJfillllr MantlaljUr Pbysicil1llS. Naliolla.l JnsrilU(esofHea.ILh

2j;

I)ublicllion Number 92-3064. Reviscd Nov. 1991 p.38. Glynn TJ. Manie)' MW. How 10 Hrlp Your Plltimls Stop SlIIokiug: A MllioJlll1 C/1ltl!r Inslilult' MlunrnljtJr I'hysiriafIJ. Nalioll ublicllion Number 92-:~064. Revised Nov. 1991 p. 38.

l.l8

239

Maany 1. Woody G. Fou.lks E. Nicolinc and panic a((acks. Am}

Psyehi,rrry 1987 Feh; 144(2):255.. Jarvik ME. HellningllcJd JE. PharmacoJogicll adjnncrs for (ht: lrt"atn\C/lI of tObacco dependence. In: Orlcan ef. Slade J. e'<.!irors. NicOlille 11IltIierion. New York: Oxford Universiey Pres.~. 1994 p. 245-246. 240

Glynn TJ, Manley MW. How 10 Hrlp !'O,,!' Plllimts SlOI' SlIIokillg: A Nalio/llli Callrer !Jmilltu Mmltlillfor Pbysicians. National InsIi (tIICS of Healrh Publicarion Nllmbcr 92-3064. Revised Nov. 1991 p.37. ·il

GI)'nn TJ, ManIe}' MW. HolO to Help Yollr Plltimu Stop Smoking: A Nntionll! Caltcer !lmilllle MawlJ1ljor Ph)'Siâam. alionallnstilules ofHeaIth

K

2$]

Philippians 4: 13. Tbr Holy Bible. AUlhorized King Jamcs vcrsion.

Shopland DR. Bmn OM. Medical and Public HcaIth Implicarions of Tobacco Addiction. In: Orleans Cl'. SladeJ. edirors. Nicotiltt' Addirliol/: I'riltâplrs /lltd M'magemml. New York: Oxford Universiry Prcs.~. 1993 p. 122-124. 2j2

~53 U.S. Preventive ervices Ta-
Use. IIl; Gllidt' 10 Clillical PrrumlilJe Servic. WilUams and Wilkins, 1996 p. 599.

2"" rdi;ioll. l3aleimore. MD:

National Cancer InSlilllte. Smoking dlld Tobllreo olltroi MOllogmpb 4. Rrspinllory HI'I111b E./fim OfRusivt' Smoking: LIIJlg Caltcer AJld Olher DisOI-ders. The Rl'P0rl OfT}}e US Elluiromllt'llll/I Prolerliolt Agmry NIH Publioltion NUlllbn 93-3605. 1993 p. 96 lj

lS Newcomb PA. Carbone PP. The hC:llrJl conseqllcnecs ofsll1oking. Cancer. Mt't! Clill North Am 1992 Mar;76(2):305-331. 2$6 Amhonisen NR, COJlnetl JE. et al. ElTects of smokjng iJllervemiOIl and fhe use of an inha.lcd amicholinergic brond\odil:uor ~n rhc rale of decline of FEVI. The Lung Heallh Seudy. }AMA 1994 Nov 16;272(19): 1497-1505.

257 Dep:rrrmcnr ofHearh "nd HUl11an Services. Tbc bNIIlh bmefilS ofsll1okiJl,ftwSlllion:A reportoflbeSllrgt'oll G'eneml, 1990. Rockvillc, MD: De-

p"rllllelll ofl-leahh and HUlnan Services. PlIblica(ionllo. DHHS (COC) 90-8416. 1990 p. 239-240. ~5~ Cenrcrs for Discase Contl'ol. Tht Ht'IIJrJJ Bmrfils o/Smokillg Cmalion: A Rt'jJorl ofrlJI' Sltrgt'OIl Gmrrnl. 1990 Al a GI:lncc. 1990 p. 2.

243

2;? Cenrers for Disease Control. n)r Hl'ltJlb Bmejit of 'moking Cmation: A Rt'porr ofrlu SUrgt'OIl Gt'lIl'r1I1, 1990: Al a Glancc. 1990 p. 2.

Puhlicllion Numbcr 92-3064. Revised Nov. 1991 p.37.

l6<J Cemcrs for Disea. e Couuol. 77u Hra/rh Bmefi/s ofSmokin.fJ Cml1lioll: A Rrporl o/riu SUrgtoll Gmern/, 1990: A( a Glance. 1990 p. 2.

W

NIH Consensus Collfcrencc. Ph)'sical AClivi!)' and Cardiovascular hcalrh. JAMA 1996 Ju.ly 17: 276(3): 241-246.

261 Glynu TJ, Manley MW. Holtl ro Nrlp YOllr Plllil'llu SlOI' Smoking: A Nuwn/li CII1Ct'r Imri/tiu MJ1llllaljor PJ1J~iâllllJ. NationallnstillllC;S ofHcalrh

Marcus BH. Albrecht AE. CI al. Usefulness of physic:l) excrei t· for mainlailling smoking ce alion in wOmen. Am j G,rdiol 1991 Aug 1;68(4):406-407.

l'ublic:lfion NUlllber 92-3064. Revised

Publiallion NUlllber92-3064. Rcvised

ov. 1991 p.37.

Glynn TJ, Manley MW. How 10 He/p YOIIT PlIlimu SIOP Smokiltg: A National Cnltcer !lWillllt' MtlIlllalfor PI1jsiril1llS. Naljonalln.tirulCS of Healr.h

i'

Henningficld JE. Cohen C, Pickwonh \X'B. Psychopharmacology of niCOline. In: Orlt:an Cl: Slade J. edilOrs. Nicotillt' IulditJiolt. New York: Oxford Universiry l're s, 1994 p. 26. 246

Brown CR •Jacob P 3d, el al. Changes in rale and pattern of cafreine mClabolism aflcr cigarclle abstinencc. Ciilt Ph(JYnlllcol Thl'l' 1988 May;43(5):488-491. 24

Griffiths lUt, Bigclow GE. Liebson IA. I-Iuman ColTexo Drinking: Re:inforcing and l'hysicaI Dept'ndence-I'roducing Effects ofCaffcinc In: Harris LS, cdil.Or. ProblmuofDrug Drprndmee, 1986. NIDA Rcsearch Monograph 76. U Dep!. Of I-Iealrh AmI Human Serviccs l'ublicalion Nu. () 87-1508. 1987 p. 75. 248

Griffirhs RR. Bigdow GE, Lieb on IA. Huma.n Coffcc Drinking: Reinforcing and Physical Dendence-Producing EHcclS of CllTeinc In: Harris LS. editor. hobll'lllS of Drug Depmdmrr, 1986. NIDA Researdl Monogr:apb 76. US Dc. Of Heahh And Human Services Public:llion No.() 87-1508.19871'.75. 2i9

250

Hebrew 4; 16. TlJe Holy Sible. Amhorizcd King Jarnes vcrsion.

424

ov. 1991 1'.33.

Zr.2 No"'ak A. Jondt'rko K. el al. Cigarelee smoking delay gastric cmpryin of a radiolabcl.led olid food in h~.lrh)' slnokers. Srl/nd} Ganrol'llleroi 1987 Jan;22( I ):54-58.

arional Hearr. Lung, and 8100d Institute. HO/v YoII Ct1l1 Help Yollr Plllialli Stop Smokillg: OpportltIJily for &spimlory Clrr Pmcliliollt'n. US

l6

Depl. of Healrh and Human erviees NationalI nSlilllles of Hcalrh PubliaHian Nurnber 89-2961. 1989 p. 17. an avcragc anllu'll inllarion ralC of 3%, rJH: COSI of cigarencs increlScs al rhe sa.lllt: tale. and the nonsmoker ups his deposits tO equallht: rising priee ofc;gatwes. The IIn,,1 habnce would bc $2,357.000. bur due 10 inilarion. ilS buying powcr wou.ld bc t'<Juivalelll 10 $538.000 in totlay's dolla.rs. l64 ASSUIllL's

26S Whirc EG. Tllt' Mit/islry o/He,ding. Nampa.lD: Pacillc Prcss PlIblishingAssociarioll. 1905 p. 327-328. '66 Ccnrers for Discase Conrrol. 0111. ofllle Ashrs: Choosing a nltlhod10 'Illil smoking. l'ubli 'ltion numbcr: DHHS (COC) 90-8418' 1990 p. I 1.

The Lijmyl" vmer ofAmeriCII can bc reached al 1-!l00-596-5480 ar 405-993-2327. Addre. s wriuell inquiric 10: Tbe Liftsry~ VI1l~rofAl11erim; Roule 1. Box 4001; Sulphur, OK 73086.

267

CHAPTER SEVENTEEN

WANTA

D

RINK?

r. Arnold was caJled (O rhe emergency room. When he arrived he found Jane Archley, a lechargie 70. ycar old woman, Iying an rhe bed in moro 3. After a brief exam, he realized her case was nor critica!. However, she was nor abJe to speak intelligibly-he wOllJd have to look e1sewhere for a medical history. His qllcsr took him iora rhe wailing mom where !te found rhe Archley family. After Of. Arnold took the Atchley family ro a more seclllded spor, they told him the derails of a uagic scory. Jane, it eurned Out, had been a woman in good health up lhrough her reriremem years. Bur a few years ago she srarted baving problems. Her appedrc was Iloe good, and she began losing weighr from her already chin frame. A physician had suggested (hat ir would be well for her ro rake a linIe alcohol before meals. This, he cold Jane, would likely help ro srimulate her appelire. Despice a liferime history as a nondrinker, Jane followed the physiciao's advice. The remedy worked! Her appetire increased dramatically. There was a major problem, howcver; rhe main apperire ic stimu1ared was an appetite for a1cohol. When Of. Arnold metJane on thar fareful day in rhe emergency room, she \Vas in a drunken slupor. Despice thousands of cases like Jane's,

where weJl-meaning individuals become ensnared by alcohol's deceplions; aod despire an esrimared 100,000 Americans who dic prematurely every year because of alcohoti; ir has become very popular ro extol (he benefirs of "moderate drinkiog.' Some of the recent populariry of alcohol as a "healch-giving" tonic comes from news fearures purpOrriJlg to show benefhs from moderate drinking in . The media has been preoccupied wirh whac some have called "the French Paradox."

The French Parad{)x AJthough rlle French consume more aIcohol rhan Americans, they have less hearr disc,ase dearhs. Hearr disease is the number twO killer in , while it remains nUJllber one in America. Some scientisrs believe rhat 's lower hean disease rate is due ro rheir more liberal alcohol imake. Ar fim giance, the studies seem ro point il) rhar direcrion. However, addicional srudies have provided a different solurion to rhis paradox. We willlook ar rhem in deraillarer in the chapter. No one today is suggesling thac heavy alcohol consLUnption is health fu 1. However, some are interprcring dara (like (har from ) as showing rhar "moderate" amounrs ofalcohol are healrhy for the hearr.

425

PROOF POSITlVE Unforrw1ately, many of these advocates have totally ignored rlle harmfiJ.! efficts of even moderate alcohoi use. In this chaprer we will look at ilie evidence regarding various leve1s of akohol consumpeion, from light ro moderate ro heavy. We will a1so sec mher srudies examining rhe French Paradox which explain the underlyillg reasons for 's lower level of heart disease. AII of (his information sholild be lIseful ro anyone who is asked, "Wanr a drink?"

The Widespread Use ofAlcohol Few people advocate prohibiring aleohol anymore, even though it is a dmg. AcruaUy, ir is one of the most widely used drugs in our nation; it is ofren addictive, and is a known kiUer. Governmenc research reveals dur alcohol causes more than 100,000 deaths per year in the U.S. 2 Thus, among drugs, akohol is second only ro robacco as a cause of premature deaths in our nation and is d1e third leading actual cause ofdeath overalL For more information on acruaJ (underlying) causes of death, see Chaprer 1, "Principles for Optimal Health." When researchers look ar the deam coli from aJcohol, they do not advocare "moderate amolll1ts" for purporred heart. health benefirs. Even if research did show de.uly thar alcohol could help aur heam, how could health professionals advocate any amollnc of a potentia1ly addictive drug ehat

PUBLIC ENEMY NO. 1 1. Alcoholic beverages are regarded by

social analysts as America's number one public enemy. 2. This "beloved enemy" c1aims at (east 100,000 American Iives per year. 3. This is five times as mauy as aU illegal drugs combined. Figure 1

426

,an cat/se great harm to other organs? Alcohol is dangerous even ar levels currendy called "moderate," but like any dangerous drug, it is even more hazardous in higher amOUlHS. And, where is that line between "moderate" aud "heavy," if iodeed mere is one? As we saw in rhe true case history of ]ane,3 what begillS as moderate drinking can qllickly escalate ro frank abuse in some people. It is estimaced rhar up to 15 percent of those thar use alcohol will ar some poinr become eicher problem drinkers or acrual aJcoholics. 4 . sIt is esrimated that the number of aJcohol ahllsers in rhe U.S. is more man 15 million. 6 The use of akohol often is mulriplied into rhe use of other dangerous and damaging drugs. A parellts' organizat ion caJied "National Parems' Resource Institute for Drug Educarion" (PRIDE) condllcts an annllal survey of middle aod high school srudents regarding substance abuse. DOllg HalI, PRIDE executive djrecror, says, "Use ofevery illicir drug ... is ar the highesr level PRIDE has ever recorded" by studenrs mosdy 11 ro 18 years old. In rheir 1996 swdy of about 130,000 srudems, 69 percent of marijuana s a150 drank a1cohol, compared wirh orny about 7 perecn(. ofnonmarijuana s. Regardjng cocaine s, 13 percent lIsed akohol compared to less rhan one perecnt of non-s. Use ofdrugs is preceded and accompanied by the lIse of aJcohol. Campaigns to educate our yourh an the da.ngers ofakohol wouJd be expected ro result in a corresponding reduction of hard drug usage as well. Srudenrs who use drugs are gerting more imoxicated than before. About 36 percent of 12 1), grade beer drinkers said rhey ger «very high, bombed, or stoned," compared wirh 27 percem nine years ago. Most people are somewhar aware of rhe social problems caused by alcohol. It is involved in mariral problems, divorce, problems in parcllting, violence in the home, poor job performance, missed days ofwork, unsupervised children, ilJicit sex, aod the list goes Oll and 011. Even many homicides aod suicides arc ofren directly re1ated ro me use of alcoholic drinks. For mese reasons, a1coholic drinks are rcgarded by many so-

WANT A DRlNK? cial analysls as America's number one public enemy. Some of me damage do ne by aleohol is conveyed in Figure 1.7

Dollars Spent on Alcohol How much money do Americans spend each year to buy alcoholic beverages? 1 have asked this many times in my public lectures. Some say. "Perhaps twO miLlion doLlars. perhaps ten million dollars." The highest eslimate [ have ever received is 100 miII ion doHars. These estimares are extremely low. T!te acrual amounr is srared in Figure 2. 8. '>These sratistics rranslate inro an average expendicure 0[$330 peryear for every mao, woman, and child in America for the purchase of alcohol, and over $450 per year for alcohol-relared damages, according ro omcia.! record-s. Off dle record, there are large quanriries of alcoholic drinks made and purchased "underground." This producrion and consumption are nor reflecred in the sralistics-the 86 billion-doUar ftgure is a conservative estimare. 1 he nexr rime you go ro a resrauram, think of rhese cosrs as an exrra amounr added to your bill. YOll order no aleoholic drinks. bur when you sec rhe bill you notice an alcohol surcharge of $8.80. The wairer cxplains that me four diners sining at an adjacent table each ordered a one ounce drink of alcoho\, and you must cover your share of "aleohot damage to society' which amoums ro $2.20 per ounce con· sumed. 'o He funher Sfares thar 80 cenrs of rhe amounr is for drunk driving, $1.00 is for the cost of violenr crime commirred under rhe influence ofalcohol, and 40 cenrs is for medical and healrh care cosrs. If we were aii forced ro pay lhese costs in this manner, how long would we eoierare ir? In aII fairness, rhe cosr should be borne by rhe . The surcharge should be paid by drinker and placed in a fund ro cover rhe damage ro sociery. The grearcsr benehr of this plan would be the reduction in sales of alcohol duc ro rhe increased price. Truly we have made a dramatic "about face" in aur relarively brief hisrory as a narion. From a sociecy that once prohibircd alcohol use, we arc approaching 100 billion do/lan per yetlT in legal alcohol sales. The

DOLLARS SPENT ON ALCOHOL 1. More tban 86 billion doHars are spent annually to purchase alcobolic beverages.

2. As mucb as 116 billion doHars are spent annuaHy for the cost of damage to society rrom alcobol (divorce courts, health care, lost work, premature deaths, etc.). 3. AII told, the total annual cost of alcoholic beverages is $202,000,000,000.

Figure 2

very menrion of prohibirion reminds me mar, in modern hisrory, aleohol srarisrics are almost always shrouded in a cloal< of deceprion. For example, ask any high school srudenl abollt rhe "Prohibirion Era" in America. They likely will be able ro rell you what a miserablc failure thar experimenr was. They wiIl describe quire c1early (har it dicl nor prevent people from drinking alcohol nor did it reduce rhe physical harms of alcohol use. To rhis day, many even in the medical communicy wiU circ the desperate failure of Prohibirion as grounds for legalizariOI) of everything [rom marijuana [Q coca.ine. There is only one problem wirh "rhe facrs" abour the failure of prohibition: rhey are nor facma!. Lisren ro oile of the most aurhorirative voices in Public Hea[rh and Prevenrive Medicine, rhe definitive textbook on this subject edited by Drs. Lasr and Wallace: 'The comrnonly helel view of Prohibition in the United States is t.hat ir was a failure. but t.here are major limirarions to rhis view, since during Prohibirion, healrh and social problems associared with alcohol use cenainly were reduced dramarically."ll

The Broad Nature OfAuohol's Destructiveness Ler us look now ar fhe widespreael damage rhar aleohol inflicrs on a number of front. Before we do so, we must dispei sev-

427

I)ROOF POSITIVE eraJ myths. Firsr, rhere is a common belief rhat wine and beer are nor ncarly as damaging as "hard liquor" and mixed drinks. The truth is rhar mosr of rhe adverse consequences of aleohot consumprion seem to be more related ro rhe toral 3mOllnt consumed rarher ehan where ir came from. As surprising as ie is ro mosr people, a srandard can of

EQUIVALENT AMOU TS OFALCOHOL There is roughly 1/2 ounce (15 grams) of pure alcohol in each ofthe following: • llf2

oz. of80 proofliquor

• 5 oz. of table wine

• 12 oz. of beer

Figure 3

PERSPECTIVES ON THE DANGERS OF MODERATE ALCOHOL USAGE 1. Tbe risk of alcohol-related healtb problems is greatest among tbose labeled "heavy driokers." 2. However, because "social drinkers" outnumber "heavy drinkers," the majority of alcobol-related problems occur among "social drinkers." 3. " ...acute alcohol intoxication or rdatively low levels of chronÎC alcobol consumption can produce serious adverse effects in individuals who otherWise tit within the social norms of alcohol use." 4. "As in formation grows 00 how alcohol is ;-~.., hazardous to health, we tind ourselves less secure in defining what is safe. Rather, alcobol use iDvolves a continuum of risk..."

ca,

Figure 4

428

beer OI' glass of wine has just as much alcohol as a cockrail nude Wilh 1 1/2 ounces of 80 praof liquor. 12 (For those not familiar with alcoholic beverages, mOSl mixed drinks cal1 for 1 1/2 ro 2 oz. of liquor. 13 The 1 1/ 2-ounce measure in bar terminolog)' is caJled a "jigger."14). Irs equivalence ro wine ami beer is shown in Figure 3. The essenrial equivalence of aIcohol exposure from beer, wine, and mi.xed drinks is imporrant for research pllrposes as weli. When 1 refer ro s[lldies ular measured how man)' drinks a person had, rhose drinks can be made up of any comhination of standard glasses of wine, cans of beer, OI' mixed drinks. Keep rhis in mind rhrougholH rhe chaprer. As f.'lr as [he research is concerned, a person rhat averages rwo beers each evening is drinking "two drinks" per
WANT A DRlNK? rhe only sure way to avoid becoming a heavy drinker is ro be a non-drinker. Do nor srart drinking in rhe fim place. Since my argumelHs have dispelled rile ewo common myrhs, we have esrablished a framework for evaluating even rhe moderate use of beer aud wine. Widl rhis in mind, ler us now turn our areenuon ro soroe of alcohol's physical effects.

GastrointestinaL ProbLems Reltlting to AlcohoL Use In considering the diseases and physical conditions rh:H can resulr from this addictive drug, ler us look inirially at the parc of the body where alcohol fim exerrs irs effecrs---on the sromach and intestines. Alcohol is an important cause of a number of gasrrointesrinal maladies, as listed in Figurc 5. 16,17. 18 Cirrhosis of the liver ranks among rhe ren leading causes of dearh in rhis counuy. MallY are not aware thar nearly 25,000 Americans die each year [rom liver cirrhosis aod orher chronic Ijver diseases. 19 Esophageal varices are large veins rhar form in rhe esophagus (swallowing rube), llSually duc ro cirrhosis of the liver. These veins may bleed profUsely and even C<1.use sudden death j[ rhey ruplUre. Alcoholic hepatiris, aoother debilirating liver condirion, can be caused by alcohol withollt
DRINKING IMPACTS TBE GASTROINTESTINAL SYSTEM • Cirrhosis of the liver • Esophageal varices • Gastroesophageal Reflux Disease • AlcoholÎC' hepa,titis • Acute pancreatitis • Chronic pancrreatitis • Gastritis • Peptic ulcer disease Figura 5 process destroys so much of the pancreas dlar it is unable ro secrete enough insulin. Akohol may aIso cause sromach inflammarion calIed gastriris. This condition can become so severe (hat the individual devdops stomach bleeding. Even moderate alcohol ingestion can be a factor thar rips rhe balance in favor of gasrriris in a susceprjble person. AkohoI is one of the most damaging substances ro the sromach's mllCliS laycr. This layer provides the stomach with vital prorecrion from irs own acid environmem. 21 Whereas gasrritis is inflammarion of the sr.omach lining lIkers represenr sores in the stomach uning. Heavy alcohoI intake appears ro increase fhe risk of ulcer recurrence. 22 Ciam llIcers can eat deep imo the stomach wall and erode imo an artery, causing profuse and life-threatening bleeding. Even in moderare drînkers, rhe llse of a.lcohol wea.kens the defenses of rhe stomach, and increases r.he risk for both gastritis and 1Ilcers. As an internist dlat has a dedicated interest in g;mroenterology and gasrroinresrU1,ll endoscopy, 1 sec the aforementioned condirions caused by alcohol on a daily basis, and ohen many times a day. One of the mosr common discharge insrrucrions rhat 1 must give to my gastroemerology patienrs is "No alcohol."

429

PROOF POSITNE

LIGHTDRINKING WEAKENS THE IMMUNE SYSTEM The body's ability to figltt bacteria aud viruses is reduced by 67 percent in Iight drinkers with only two drinks.

figure 6

Immune System Damage From Aicohoi A large body of research srudies proclaims that even moderate amounts ofalcohol used by social drinkers should be regarded as damagiltg to the immulte system. Wich growing concerns regarding both infectious diseases and c.wcee, the illlmuneweakening effcccs ofaJcohol are same ofthe

ALCOHOL INCREASES CANCER IN RATS 1. Rats were injected with breast cancer cells. 2. Some drank alcoholic drinks to produce a blood level of 0.15%, equaI to 4 or 5 drinks per bour for a human. 3. Others drank more, producing a 0.25% blood level. 4. A third group drank no alcohol. 5. Those that drank at the lower level had twice as many cancerous tumors as the non-drinking rats. 6. The higher level drinkers had 8 times as many tumors. Conclusion; The harmful effects ofalcoJlO1 on cancer lIIay be vastly underestimated. Figure 7

430

mast worrisome. Some of the most sobering research comes from che AlOS literature. A number of rescarch studies suggesc chac alcohol use increases the risk ofA10S. 2 3 CercainJy, aleohol weakens one's judgmenc so dur proper precaLltions ta avoid virus exposure may noc occur. 24 More imponanrly, perhaps, alcohol--even in "moderarion"-is an immune systcm sllppressant. Rese~lrch sl.lggescs that a moderate drinker exposed [Q HLV has a greater likelihood of becoming HIV positive. 25 Omar Bagasea, M.D., Ph.D. found that social drinkers developed increased sllsceptibility ro AIDS virus infection folJowing the consumption of faur bcers. Other signs of iIlUllU ne suppression persisred for rhree [Q seven hours after their hodies had metabolized ali the aleoho1. 26 Let llS examinc more dosely some ofthe effects of alcohol on the immune systcm. The B-Iymphocyrcs produce antibodies in t11e blood. Alcohol impairs their normal funcrion. It takes only two drinks [O reduce amibody production by twa-thirds, as shown in Figure 6YThis rresencs a significant immune system weakening with social aleohol use. The sUldy's aLlthor, Dr. Aldo-Benson concluded: "These and previous studies suggest that even. small amolmts ofalcohol ttlken ftequently Ilre harmfuli they can inhibic the normal immune funcrion anei could increase bacrerial or viral infeccions."

Alcohoi COnsttmption Increases Cancer Risk A number of ocher studies confirm that tlle regular use of cvcn small amollnts of alcohol can harm normal imrnllne funccion. The result is often an increase in infections. However, the immllne syscem weakening effects of aleohol cxtend far beyond che B cells. A group of white blood cells called Natural Killer ceUs (NK cells) are also weakened by alcoholic drirlks. 28 These f..scinacing killer ce Ils have long baffied scienrists because of their innate abiliry to identifY invaders and eliminate them. They do noc use anribodies, nor do they use otoer rypes of chemical warfare like ocher white blood

WANT A DRlNK? cells. NK cdls are panicularly imponam in deaJing wirh viruses (such as HIV) Jnd preventing the spread of nllnor ceUs in the body.29 As expecred, alcohol-induced NK cell impairmem increases cancer merasrasis (causing cancer ro spread). 1 his has been demonsrrated in rat srudies. The research raises rhe concern that in humans JUSt one binge may dramaricalJy increase rhe chance of spr~adil1g an existing cancer. Results of this research are shown in Figure 7. 30 Notice rhat twice as many new rumors formed in rars wirh a 0.15 percem blood alcohol level compared ro the non-drinkers. (This JeveJ ofblood alcohoJ is somewhar over rhe legal limit for human vehicIe drivers. which is generally ser ar O.l O) However, r::lts with a blood aJcohol comem of 0.25 percenr had eight times more merasracic mmors. Extrapolacing mese results from rat studies ro humans seems valid because we know by actual epidemiologic research rhat alcohol significanrly increases human cancer risk. Hcavy aleohol consumption increases rhe risk of human cancers of rhe l11outh, throar, csophagus, liver, breast, and rectum. 31. 32. 33 Even moderare alcoholuse <:an raise (he risk of some of rhese callcers. For exarnple, in a srudy of over 7,000 women, as liule as thrte drinks per week increased rhe risk of bretlSt cancer. The more rhe person drank, rhe greater the risk. 34 Alcohol consumpcion poses a signific.1ndy greater risk of cancer th;Ul minor chemicals in foods. 35 Many experts feei rhac the harmful effece of alcohol on human cancers has been vasrly underestimated. Some physicians have even raised concerns that some cancer vicrims may have been afflicced because of cheir behavior on a single weekend celebration. There are much berrer ways ro cel~ ebrace mao by volunearily weakening the immune sysrem, ro say nothing ofbenumbing me mind. "Ler's have a good time this evening," is che approach of some. But ehe resuhs may be disaserous. There are orher aspeccs of alcohol use hesides ics immune sysccm effecrs chac are likely rdated ro increased cancer rates. For cxample. ehere is good evidence rhat aleohol use increasescscrogen levels in womeo. 36• ,\7 Alchough this may sound helpfUl, it eould

also increase ehe risk of urerine and breast cancer. When it comes ro cancers of the head and neck, chronic irricacion from ,11cohoi may also be a cancer risk factor.

Increased Risk ofInftctious Diseases In addicion to c.1ncer and chranic infection with HIV, aleohol can increase rJle risks of more mundane-buc scill poccmially lechal infecrions-like pneumonia and tuberculosis. 38 Cenai n cypes of pneumonia are more common in a1cohol s, such as K/.ebsiella pneumonia and aspiration pneumonia. K/.ebsi.ella is a cereain strain of germ ehar can cause aggressive lung infeccions. Aspiracion pneumonia can a1so occur if a person becomes severely inroxicared. While in a drunken scupor, ::m individual who swaJlows his or her saliva down ehe windpipe <:an get this life-rhreatening pneumonia. There are ocher reaSOllS why rhe risk of iofeceion is increased in those who use aicohol. Normally, a cype of whice blood eell called ehe neutrophil or polymorphonucIear Iymphocyre (PMN) circularcs with the blood umil it arrives ac a location where an early infection is presem. le chen leaves rhe circulation and wages war with the invader. Sociallevels ofalcohol consumpcion weaken some of ehese whice blood cell funccÎons. MeasurabIe effecrs begin ac levels well below rhar of legal imoxicarion, as low as 50 mg per decilirer (0.05 percem blood alcohol). As the amoullt of aleohol ingesrion rises, rhe abiliey of PMNs ro go ro rJle site of an infection and rheir abilicy ro gobble up invaders becomes progressively impaired. 39 . 40 The more aleohol ehac is presellt, rhe more cheir performance suffers. 41

Side Efficts OfAlcohol Consumption Besides affecting the intestinal and immune syscems, Ulere are oc.her far-reaching side effeccs from alcohol consumpcion. Some of rhese effeccs are shown in Figure 8.42.43.44.45.46 It is asronishing ro me [hat the news media is so emhusiascic abour prodaiming the virtucs of drinking aIcohol "în moderation" when rhere is such a long lisr ofsevere

431

PROOF POSITTVE

SIDE EFFECTS OF ALCOHOL USE 1.

10. Osteoporosis

2. Stroke

II. Gout

3. Heart problems

12. Rhabdomyolysls

4. Elevated triglycerides

13. Bod,y wcight control

5. [mpaired sexual function

14. Anemia

6. lL.ow blood sugar 7. Vitamin and mineral deficicDcy 8. Chronic fatigue

FS. Decreased number of blood platelets 16. Increased severity and duration of menstrual cramps

9. Ketoacidosis Figure 8

problems caused by both moderate aud heavy aleohol consump[ion. Some of the problems lisred in Figurc 8 can occur with as litrle as one drink of alcohol per week. Ler us rake a litde time ro more fully appreciare [hese a1cohol-rdared condi[ions.

AlcohoL and High BLood Pressure (Item 1 ofFigure 8) The fim malady in Figure 8, high blood pressure, may occur as a direct resulr of al-

MODERATE DRIN:KING AND STROKE IN YOUNG ADULTS Young adull$ (16 10 40 yea~ old) wha drillk 2 10.~ drinks ar more (40g elhanol) sigllificalll/y increQ.~e Iheir risk {Jjslroke wilhin U hou~. 8

r

6.0x

6

4

pressure medicine and drinking ftlcolJol even in small amounts.

2

AlcohoL and Stroke (Item 2)

o Standard Risk

Figure 9

432

cohol cOllsumption. Women seem tO be the most stlsceprible. for example, as litt.le as twO or cluee drinks per day increases the risk ofhigh blood pressure by 40 percenr in womenY Dr. Norman Kaplan, an international blood pressure authoriry, has gone an record as saying rhar anyone wirh high blood pressure who even lIses more man onc drink a day "sho1l1d be aggressively encouraged ro cur down."48 For men and women combined, thrce ro four drinks per day incrcases one's high blood pressure risk by 50 percenr; six or seven drinks per day doubles the risk. 49 Alcohol plays a very imponam cole in the high rate of hypertension in aur nation. Estimates are that up ro 30 percent of aII high blood pressure in American men can be rclated ro alcohol consumption. 50 The detrimerual effeet of alcohol on blood pressure imposes a particular burden an older individuals in our coumry. The most common causes of death and disabiliry amollg Americans 65 years of age and older are diseases of rhe heart and blood vessels. 51 High blood pressure is one of me major risk facrors for such diseases and it afflicrs greater man 54 perccnr of cllOse in this age group. 52.53 Although fewcr Americans use alcohol after their 65th binhday, of those that drink, {heir risks of alcohol addicrion are just as high as among younger drinkcrs. 5~ As we have seen, although heavy alcohol consumption does rhe mosr damage ta blood pressure, mauy who consider themselves "Iight" drinkers are a1so ar risk. The rcurh is rhar rhe more alcohol oile uses, rhe higher his or her blood pressure rends to be. 55 . 56 1 reeommcnd ro even my hea.lrhy patienrs rhat they avoid any drug mar raises blood pressure: akohol is no exception. Of course, avoidance of alcoholie drinks becomes even more imporr.anr in rhose who already have a blood pressure problem. It simply cum not make sense to be taking bLood

Men

Women

Increased srroke risks, the second irem in Figure 8, plague botb modeme and heavy drinkers. Many people are nor aware that

WANT A DRINK? alcohol increases the risk of bQ[h common rypes ofstroke. Ţhe m'a rypes are rhe hemorrhagic stroke caused by bleeding in and arolICld rhe brain, aud rhe rhrombotic srroke c.aused by blood clOES. Some young person may say. "1 am nor a heavy drinker. 1 never have more rhan three drinks even on a weekend evening." $rudies show that even rhree dj·inks can have tragic consequences. even in the young. as shown in Figllre 9.57 Their risk is six 10 eight tinus greaterwÎrh only rhree drinks. To die under rhe young age of 40 by self-desrfllctive llse of alcohol is a rragedy of unspeakable proportions. Such levels ofconsumprion are nor unllsuaJ. A 1990 nationwide survey of soroe 17,000 high school seniors found rhar 32 percent of rhem reporred episodes of heavy drinking (five ar more drinks) wirhin rhe last twO weeks. 58 Th15 recenr evidence on the dangerous effecrs of moderate drinking is extremely important. Previously some had suggested rhat moderate aJcohol consumptîon lowers srroke risk;'9 however, mere are deflnirely problems wirh rhac posirÎon. Fim, rhere is no evidence rhat people already an an e.xcellen r 1ifes ryle ger an y furrher benefit from alcohol when ir comes ro stroke prevenrion. Second. as we have jusr seen, a couple of exrra drinks on the weekend dramarically Încrease srroke risk in younger adulrs. Third. one of rhe mase devasraeÎng types of srcoke, hemorrhagic stroke. has been known for years 10 be increased by cven very small amounts of akohol. The famous Honolulu Hearr Srudy found rhac even lighe drinkers of as liule as one ro foureeen ounces per monrh havc more (han twice rhe risk of having one of c!lese bleeding srrokes. 60 The findi ngs are summarizedin Figure 10. Notice. it is nor the blood pressure-raising effecr of akohol rhar accounred for these suokes. Even a social drinker wÎeh normal blood pressure experiences chis increased risk ofhemorrhagic srroke. G1

those who become acutely ilHoxicated run the risk ofhearc rhythm disrurbances. Cardiac arrhychmias, as rhey are caUed. can be as minor as a vague flllCccring sensarion in rhe chest" or as major as sudden death. In ("lcr, rhe. high rare of suddcn dearh among heavy alcohols is likeJy due in parc 10 t!lesc dangcrous rhyrh m disrurbances. 62 Cardiomyopathy 1S auorher dangerous and somerimes faral hearc condirion which is Jinked ro alcohol lIse. Cardiornyoparhy Iirerally means "hearc mllscle dise."lse." 1 have seen many parienrs whose hean muscles do nor \Vork as hard as ehey shouJd bec.1use of akohol consumption. As a resuit, fluid builds up in rhe lungs and rhen in orher parts of rhe body, and rhese patienrs are llsually unablc tel physically exert rhemselves. When cardiornyoparhy becomes severe enough, rhe only erearmell( available 15 hean rransplancation. Alrhough coronary arcery disease an cause heart arcac1{S and subsequenr cardjomyopaehy, current eseimates are (har 20 ro 30 percent of ali cardjomyopachy in aur counrry is due ro alcohol aklJle. 63

ALCO OLANDSTROKE • Increased strokes caused by brain hemorrhage occurred in drinkers irrespective of blood pressure level. • Even Iight drinkers of 1 to 14 ounces of alcohol per month show,ed more than two times the risk of nondrinkers.

Alcohol and Heart Problems (ltern 3) AJrhollgh wideJy rau reci for ics hem benefits, alcohol is c!eltrly linked to several heart problems. Boeh chronic heavy drinkers and

Figure 10

433

PROOF POSITIVE

ELevated TrigLycerides andALcohoL (Item 4) Aleohol, even in, the relativei)' small amounts eOllsumed by "Iighr ro moderale" drinkers, ma)' cause significanr triglyceride e1evarion. 64 "Triglycerides" is the teehnical term for rhe main srorage and rransport furm of far in the body. Due ro elevation in a hlood far curier called VLDL (very low densiry lipoprorein), eholesrerol values may be elevared by akohol use as well. Like eholesterol, rriglycerides when elevated appear ro increase rhe risk of hearr disease. If trigI)'ceride levels are very high, the)' can also dramarically increase the risk of pancreariris.

ALcoho! and SexuaL Funetion (Item 5)

434

The fifth side dfeet of alcohol is a particularly distressing effect of heavier use of alcohol-sheink:lge (arroph)') of the reseic1es. This can accuaUy femini7..e affected men. As a result iliey can acqwre female characterisries like enlarged breasts. Long term alcohol use is also associated wirh impotence due to hormonal elfects.65 Such resuhs are ironic, panicularlywhen mally men rhink drinking is a "macho' thing ro do. For many individllals an even more frighrening sexual specter looms on the horimn: homosexual rendencies ma)' resuIt from aleohol exposure in rhe womb. We h.we known for years that fital exposure to alcohol dramaricaJ1y increases rhe risk of problems with genital development in borh male and female offspring. For example, in rhe feral aleohol syndrome (FAS) over 12 percem of ehe children have geniral abnormalities. 66 Now there are seriollS concerns rhar rhe brain itself ma)' experience impaired sexual dilferenriarion-even when aleohol exposure has been relarively mild and has nOf caused FAS. The uumber of childrell affected is significant. Whereas up ro 11.000 children are bom with feral aleohol syndrome each year, as many as 30,000 or more may have ocher aleohol- relared problems that are nor as distinguishable. 67 All of this larger number are ar risk for problems wirh sexual differentiarion both of the

externa1 genital region and ehe brain. Of particular concern ro ehe sexual differentiarion questloll. animal srudies show that male raes exposed in utero ro alcohol have decreased maJe sex behavior, while femaJe rars experience defeminizaeÎon (decrease in female sex behavior).

AlcohoL General Metabolism, and Nutrition (Item 6) Low blood sugar (hypoglycemia) can occur iu both heavy and moderate drinkees. In ehildren, relatively small 3mOUlltS of alcohol can be parricularly dangerous in this regard. Dr. William Altemeier, director of the Pediarrics service ar General Hospiral in Nashville. Tennessee, poinrs oU( rhat because ofhypoglycemia, severe irreversible brain damage can resulr in preteen children who are given relatively small amounrs of akohol. 68 Normally low blood sugar is nor a problem in he.alth)' individuals who are nor on medications. However, alcohol blocks the body's abiliry ro produce sugar rhrough a process called gluconeogenesis. 69 Thus, if someone conslImes alcohol after a period of ('lsting or limited calorie intake, blood sugars can fali tO extremei)' low levels, and the brajn-which runs primarily on sugar (glueose)-can sulfer irreparable damage. Ironically, drin.ki.ng aleohol can also raise blood sugar levels. In faer, akohol is a known cause ofwhat is called impaired glllcose rolerance.7° One of the Il)echanisms for such an occurrence is also counrerilllllirive. You wOllld expect thar a depressanr like aleohol would )ower Stfess hormone levels in rlle blood, bur it can actuali)' .rajse those levels. With raises in srress hormones like norepinephrine, blood sugar cends ro rise?1

Vitamin and Mineral Deficiency (Item 7) The heavier the usage of alcohol, the grearer ehe tendeney roward viramin and mineral deficieney. From Viramm A to zinc, almost every vitarnin and mineral makes the Iisr of being porentiall)' inrerfered wirh

WANT A DRlNK? direcrly by alcohol itself or by rhe damage it can cause ro the liver, pancreas, and other pans of the digestive sysrem. 72 SOll1e of (he more common deficiencies involve magnesium, folie acid, and the B vitamins, thiamine and riboflavin.

Chronie Fatigue and Ketoacidnsis (Items 8 and 9) Another side efrec( of a1cohol rhar can affecr producrivity and performance is rhe chronic fatigue syndrome. This condirion wirh irs symproms of "feeling wasted and worn out" may result from moderare aleohol consumprion. Such a relationship may be due ro immune sysrem eftects in rhe context of a chronic viral infecrion/3 AJcohol Îs also a cause of keroacidosis, a merabolic disease rhat can be faral.

Alcohol's E!feets on the Bones, ts, and Muscles (Items 10, 11, and 12) Osteoporosis, or rhinning of rhe bones, Îs also relared to alcohol consumprion. Anomer cause of onhopedic problems ill drinkers is gOli(, a very painful arehritic condieion rhae can aJso cause kidney problems. SriU anorher alcohol-relared condition affecting rhe muscllloskeleeaJ sysrem is caJled rhabdomyolysis. This problem is ofrell associaeed wi[h ce [[ai Il roxin exposures including heavy exposure ro alcohoJ.74 In rhabdomyolysis, parc of the large mllscles in [he body acrua1ly dies. This often resulrs in hospiralization, kidney fajlure, and somerimes even death.

Body Weight (Item 13) A more mundane efTecr of alcohol relares ro its relarionship ro maimenance of body weighr. Alcohol is a concenrrared source of calories, having nearly f\vice as many calories on a gram for gram basis as pure sugar (seven calories vs. four calories per gram). Combining this wirh rhe facr {hat a1cohol accounrs for 10 percen[ of rhe caloric imake of adult drinkers in our narion. 7S rhe stage wOllld seemingly be ser for significam weighe problems. Ir is, bu( for reasons other ehan you may ehink. The cal 0-

ries in alcohol do nor secOl ro be efflciemly srored as far, so excessive use ofa1cohol does not seem ro conrribllte ro significam weighr gain for rhis reason. However, many individuals who tend ro be overweighr wil! have grearer problem.~ with weighr maintenance if rhey are liS ing alcohol-even in moderarÎon. Overweight people who wisely take special pains ro limie rheir calorie inrake (somerimes caJled "resrrained eaters"), will

tend to el1t more iflJlcohoi is on boord. 76

Alcohol and Bwod Cells (Items 14 and 15) In our commems an rhe inunune systern, we have already looked ar [he f..1r-reaching e/tects of alcohol an rhe white blood cells. Anemil1, which is a low red blood cel! COUnt,

js very common in helwy drinkers.

Even occasionals ofakohol can increase cheir risk ofanemia if their a1cohol use coneribure.s ro blood loss from their sromach or esophagus. Orher blood e1emems called pla[ders (the body's cloning cells) ;ue ofren decreased with a1cohol use. As a result, affecred individuals may bleed more easily.

AleoholAgg1'l1vates Menstrual Cramps (Item 16) A1cohol has been rhought to be efreceive as a treannent for mens(rual cramps. Ir appears ro reduce the probabiliry ofhaving cramps, bur research srudies show [har i[ increases the severiry and duraeion of rhose that ger them. 77 It was found thar drinkjng more rhan once per week doubles the odds of pain lasring more rhan rwo days. Researchers advise rhar a1cohol "should nor be recommended as a rrearmenr Uor menstrual cramps ] ."

Summary OfPhysical Problems Associated With Alcohol There are many more problems with alcohol than 1have focused on here. However, whar we have examined [hus far should be sufficie11t ro impress us wirh the broad rallge of adverse effecrs broughr on byalcohol. The sad (hing abour rhese problems is

435

PROOF POSITIVE

HEAVY DRlNKING 18 ESPECIALLY RISKY FOR YOU GER PEOPLE AND WOME

bodies more than any other lifesryle Fac[Ors. [fyou could see through my eyes, you would be strongly inlluenced to emphatically say "no" rlte next time you are asked the quesdon, "Wanr a drink?"

[ncreased nlOrtality risk by drillking six or /IIore drinks* per day:

Drinking and Mortality

400%

320%

Figure 11

rhat ifAm ericam had recognized aJcohol for what it was and avoided it, this extensive !ist would nor even exist. As an Internal Medjcine specialist, I deaJ every single working day wirlt people whose illnesses are caused by alcohol and tobacco. People are hospiralized duc ro rhese abuses of their

Malt Heavier Moderate Ligbt ~I

Abstailler

o

10

20

• Under 45

30

40

.45-54

50

60

55-64

70

80

90

100

75 ~Dd older

65-74

Fttrlalr Heavicr Moderate

........_.-.•

---~

Lighl Abstainer 20

Figure 12

436

30

40

50

60

70

80

9(l

100

lncreased risk of dram from a variery of causes has been linked to alcohol use. parriclilarly in heavy drinkcrs. However, moderate drinking also increases rhe risk ofpremature death. We wiJl see dara shordy thal qllamif1es the increased risks of umimely death from alcohol use. However, a few more commenrs are in order regarding the reLtrionship of heavier consumprion of alcohol ro dcarh. It is commonly believed rhat rhe risk of premature death from alcohol is contlned [O older men who have been drinking for years. This is nor true. Stuclies show thar the deadly effecrs of heavy aJcohol use do not discriminate based on age, bur is risky for yOllnger individuals as well.7 8 Furrhermore, rhese effects do nor engage in gender discriminarion. StlIdies have been made on women as well as men regarding rhe lifeshoncning effects of a1cohoJ.7~ These increased risks are illusuated in Figure 11. We sec rhar among rhose in the general popular ion in their 40s and younger, consumption ofsix or more aJcoholic beverage.s per day nearly doubles their risk of dearh. We also sec thar rhe risk of early dearh is parricularly worrisome in heavy drinking WOH\en of aJl ages. Afrer looking ar a hose of diseases aJld condirions linked ro moderare alcohol consumprion, it is no surprise thar even "social" drinking can shorren one's life. Drinking hiswries were obtained of men and women who died in 1986. They were caregorized as absrainers (Iess than 12 drinks in their emire life); liglu drinkers (up ro 3 drinks in a week); moderate drinkers (berween 3 and 14 drinks a week) and heavy drinkers (greater rhan 14 dril1.ks a week). The results are illustrared in Figure 12. 80 Norice rhar for borh sexes of aU age groups from childhood ro age 74. as drinking increases, rhe risk of death increases.

WANT A DRINK?

Alcohol and Decreased Mental Peiformance There are some rhings rhar are worse (han "death" in irs general meaning. The narional suicide epidemic makes chis selfevident. Whar kind of sieuaeions do individuals find so unbearable rlur ehey would choose ro rake cheie own lives? We are aII fâmiJiar wieh rerminal illness and ies connecrion wirh suicide. However, mental deciine and social or work-relared problems are alI high on ehe lisc for suicide motivarions. 81 Wirh rhis in mind, we need ro recognize rhar alcohol has the capacicy ro undermine (hac which has rhe greacesr bearing 00 who we really are-and rhar which gives us the most meaning in life. Alcohol, even in moderatioll, affects our brain. Even small amounrs of alcohol are well kJlown ro decrease a person's judgmenr, foresight, and moral reasoning. Tnis probably re1atcs largely ta alcohol's dramaric impair~ menr of ehe brain's frontallobe where many of our highesr ÎnteUeceual aod moral funcrions reside. W1th jusr a single drink and a low blood alcohol level of 0.02 percene, rhere is bluming of froncal lobe capaciries wirh a decrease in judgmenr and inhibirions. 82 Concrary ro popular belief, many of our inhibirions are extremely useful and are besr never compromised. Reservations against relling business secrers or making inappropriare commenrs ro another person's spouse are jusr rwo examples of normal inhibirions rhar serve sociali)' useful purposes. Funhermore, many rhink alcohol's memal impajrmenr lam only as long as alcohol is presenr in rhe blood. In realiry, rhe effecrs remain long afrer rhe aJcohol has lefr rhe blood srream. Srudies done on drinkers over 24 hours afrer rhey nave had their lasr drink show thar abstracr reasoning abilicy remains reduced. In one srudy, over 1,300 social drinkers in Derroir were assessed. Men drank on the average of every rhird day ;l1ld consumed rwo ro rhree drinks. Women drank 00 rhe average every f1frh da)' and generally consumed rwo drinks on those occasions. AII assessmenrs of mental funcrion were done ar leasr 24 hours ,ifieralcohol had been con-

sumed. Nonerheless, in both men and women who drank ar leasr once per week.

abstract thinking ability decreased IlS alcohol intake inC1"ea.red. 8J Worse rhan remporar)' impairing of reasoning alcohol consumprion ofren callses even more seriolls long-rerm menraJ impajrmene. Acrualloss ofbrain cells wirh reslllring brain shrinkage (rcchnically called "cerebral auophy") is known ro occur in heavy drinkers. This has bcen direccly observed with scans (har can visualize the brain like CAT scans and MRIS.84 Fonunare1y, rhere is some good news abol\( rhis condirion. Thc brain shrinkage may be reversed wirh prolonged absrinence, especiaJly in young iodi vidllals. 85 Unforrunarely, however, brain ceUs ClOnot be regenerared once the)' are Iose. So chis apparent reversal is likely due ro new oerve connecrions rarher tJlan replacing Iose brain cells. 86 This leaves us wirh an imporr
never be mmtl1lly as gifted afla 11 histmy of heallJ alcohol use. Ofbroader concern, [here is evidence suggesting thar alcohol consumprion (regardless of age and quanriry) may also hasten cerebral arrophy.87 Worse srill, heavy drinking can somerimes lead ro profound and irreversible neurological defects. Pcripheral neuropathy, a pajnful condjrion of che feer, legs, and hands rhar progresses ro loss of sensation in rhe limbs is common among heavy drinkers. Physicians are familiar wirh (he diagnosis of Korsakoff's psychosis wirh irs memory loss and disorient;lrion. This condirion occurs in heavy drinkers who also are deficient in [he B viranlÎn, rhiamin; 30 ro 40 percen( ofuldividuals who develop rhis <.!evasraring brajn wa5ringcondition musr be insriruuonalized. 88 Heavy drinking poremiares a common cause of seizures, alcohol withdrawal seizures, and also porenriares rhe rerrible liferhrearening srare ofdelirium rremens (DTs) where rhe alcoholic shakes unconrrollably and hallucinares and becomes a danger ro himself and others. Furrhermore, (here is no quesrion that psychiarric problcms and alcohol use go hand in hand. Alcohol abuse or dependence

437

PROOF POSTTIVE

BEAVY DRINKI G IMPACTS THE CENTRAL NERVOUS SYSTEM • Decreased judgment, foresight, moral reasoning • Stupor and coma • Periphe'ral neuropathy • Cerebral atropby • CerebeUar degeneration • Accidents • Mental illness • Physical dependence • Homicide • Suicide • Seizures • Delidum tremens (DT's) Figure 13

Îs more common in individuals wirh diagnoses such as schizopluenia, depression, antisocial personality, and anxiery disorders. 89 These relationships pose rhe chicken or the egg quesc.ion: which carne firsr. rhe psychiarric illness or the alcoholism? It is likely rhar alcohol increases the risk for psychialric illness for some of the reasons already mentioned, such as mental impairmenr and incrcased psychosocial srressors. However, ie also seems ro go rhe mller way. People wirh psychiaeric illnesses may be

ALCOHOL'S EFFECTS ON OTHERS BESIDE THE DRINKER • Adverse effects on tbe fetus • Accidents • Social problems including acts of violence

438

more prone ro resort ro alcohol in an arrempr to deal wirh rheir problems. We now have proof rhar drug or alcohol abllse callses specific brain damage thar can be seen on a new high-rech brain scan called BEAM, which measures change-s or disturbances in e1ecuical acriviry in rhe brain. 90 In a study of 111 subjecrs, major brail} abnormaliries were seen in rhe fronr aud an rhe sides of rhe brain thar increased wirh an increase in sevcriry of substance abuse. Some srudies have shown rhar up ta 90 percent of substance abs have psychiatric disorders. Some wirh such disorders use alcohol ar drugs ro gain relief from their problems, bur it is now kllown rhar rhey are acrually making cheir problems worse in rhe long run wirh slich self-trearmenr. One of rhe mosr dangerous resu1rs of both alcoholism and mental health problcms is suicide. There is no question mat this final and often despcrare acr is srrongly linked wirh alcohol consumprion. 91 Figure 13 summarizes {he abovc cffects of alcohol an rhe central nervous sysrem.

Alcohoi lnflicts Severe Damage to the Brains ofYouth Small amounrs ofalcohol pose a dal1ger to dle brains of young people. according ro research ar rhe Duke Universiry Medical Center. 92 Srudies of young rats show ehat rhe developing brain sustains "far more damage to memory and learning sysrems rhan an adult brain receiving rhe equivalent
Alcohoi Affiets More than the Drinker. So far, we have focused on how aIcohol affects rhe drinker. We looked ac a long Iisr

WANT A DRINK? ofphysicat problems. Then we wem on ro make observations abour aJcohol's mental effects. However, alcohol affecrs more rhan jusr the person consum ing rhis addicrive drink. To Olan)', the social efTecrs are among che mosr sobering realiries. These coodirions come as no surprise. However, 1would be remiss nor to ar leasr devore some space ro rhem in rhis chapter. A parriallisring of the way akohol affecls olhers is found in Figure 14.

Petal Alcohol Syndrome and Other Alcohol~related Birth Defects Regarding lifesryle and omer environmem.al facrors, Illcohol is the /~ading CIltlSC of merltal retordation in the Wesrcrn world. 93 Inirially described in rhe Iare 1960s and early 19705, fetaJ alcohol ~)'ndrome (FAS) is lhe designarion used for rhe worsr of rhe aleahol-rel:ued birrh defecls. These children have rhree major sers of problems. 94 Firsr, rhey rend ro lag behind in physical growm both in rhe womb and after birrh. Second, rhey show evidence of brain involvemenr wirh such problems as ÎnrelJecrual impairment, hyperactiviry, disrracribiliry, and impulsiviry. Third, rhey have a characrerisric set of facial abnormalities including small eye openings, a small head circumference, a rhin upper lip, skin folds at rhe corners of rheir eyes and a low nasal bridge. Many children are impaired by mothers who used aleohol in pregnancy, yet rhey never develop me ful1-blown picture ofFAS. These children have only some of rhe arrributes of the syndrome and are said ro have FAE (fetal aleohol dTects) or ARBDs (a1eohol-relared birch defecrs). A partial liscing of birrh defects relared ro maternal alcohol use is round in Figure 159.5. 96 MOSI aurhoriries believe thar FAS is significandy underreporred; ic is no surprise that the even less obvious defeccs of FAE are frequendy missed. Currenr estimates of FAS in North America range from as low as duee cases per 10,000 live birms ro as many as one in ni ne birms dependjng on r!le cultural group and orher risk factors. For example, individuals of African Americ.an or NaeÎve American herirage have dramaricaUy

AS ORMALITIES RELATED TO PRENATAL ALCOHOL EXPOSURE • Learning difficulties

·Immune system impairment

• Skull aud facial abnormalities ---

• Vision problems • Hearing problems • Trouble breast feeding (duc to poor sucking patterns)

• Genital abnormalities • Abo,ormal balance and coordination • Mental retalfdation • Growth deficienCÎ'es Figure 15

increased risks. AII rold, estÎmares are mar up ro 11,000 U.S. children are bom wirh feral alcohol syndrome each year, wirh 30,000 or more having other prenatal alcohol-relared problems. 97 The more a woman drinks me greater rhe risks her child t1ces; however, ir does not take large amoulHs of a1cohol ro affecc rhe fetus. In facr, aleohot consumption well within rhe legal limits for drivers can pose serious threats to the fetus. One particularly dangerous rime is in che period ofvery early pregnancy, before rhe woman even recognizes she is pregnant. As many as 1.7 million American women of childbearing age drank twO or more drinks per day when assessed in 1988. 98 These women would put rheir children ar high risk if they became pregnant. Such an assertion is not mere eanjectllre. Numerous studies suggesr thal moderate aleohol use-perhaps even bifore conception---can influence ar leasr a child's memal capaciry.99. 100 A study ar rhe Universiry of MiJlOeSOra has shown rhar leukemia can resulr in an infanc whose morher drank during pregnancy.lOI Women who consumed more rhan 20 alcoholic drinks during pregnaney were uuee cimes as likely as nondrinkers ro have a baby wirh a cerrain rype ofleukemia cal led acure myeloid Ieukemia (AML). Children of morhers who drank during c!le

439

PROOF POSlTIVE second and third uimester had a 10 rimes greater risk of AML and (wice ehe risk of anorher type oflellkemia, callcd acme lymphocytic leukemia. The umh is rhar toral absrinence is thc only way ro prevent alcohol-related birrh dcfecrs i.n children. Such a stand has been taken by rhe Surgeon GeneraJ aswell as ehe American Medical Associ;uion. 102 J also recommend rhar aH womcn of childbcaring age who have ehe poreIHial for inadverrenr pregnancy should remain [Otally absti-

HIGH RISK OF ACCIDENTS CAUSED BY DRINKING T"e sobeI' driver may "ave aII accidellt, but !lis risk illCTeases as indicated below: l.0 time with a 0.00%-0.01% BAC, *

IA times with a 0.02%-0.04% BAC,

11.0 times with a 0.05%-0.09%, BAC,

48 times with a 0.1%-0.14% BAC, - - .' . "

385 timcs w.itb. a BAC ~reater or equal to 0.15% *Blood Alcol/ol COllcCTItrafiol!.

Figure 16 nene. A simple reminder is al50 warranted: apare rrom a toral hystcreccomy (wirh removal of the ovaries), aH methods ofbirrh control have failures. Every woman who has noe gone through menopallse, even ehose Llsing "reliable" birrh control measures, should definiteIy consider tbe parh of total abstinence-for the healeh of the unborn, if not for her own hcalth. FlIrrhermore, in view of the research linking fathers' drinking pracrÎces with (eraI impairmcm, 1 also recomll1end rhar any husband remain [0rally abstinent ifhis wife could become pregnant.

440

Accidents and Violent Crime Mowr vehicle accidenrs are a leading callse of death amollg children anc! yOllng adults, amollllting to rhe leading cause of year of life losr before ilie age of 65. 103 In the U.S. alone, over 40,000 lives are claimed each year in moror vehicle crashes wirh over three million more suffering nonfaral injllries. Whar is the record of a.lcohol regarding r11is national rragedy? Over 17,000 Americans die in moror vehide accidelHs each vear who would be alive roday were it nor for rhe effects of alcohol. I04 In shorT, alcohol s for roughly 44 percellt of traffic fataJities and 40 percem of the comprehensive crash costs which cotal in rhe billions. J05 Even perfecrly legal blood aJcohollevels cause impairmellt and Încrease rhe accidem rate. As expecred, the higher the blood aJcohol level the grearer the risk of accidcllts, as shown in Figure 16. 106 Notice a lirde-appreciated fact; namely, yOll Can be driving legalI}' and sriU have your accidcllt risk dramatically higher than rhar of a sober person. Jusr a smaU :lmount of alcohol increases your risk of death by 40 percent. A mere rwo drinks for a 140 pound woman 107 pushes her over dut 0.05 percent blood aJcohol range and subjeers her ta Il rimes the risk of death when behind the wheel. Once you emer rhe legally inroxicated range your risk of dearh has incrcased nearly 50 rimes. Higher levels causc an even greater risk of death. Clearly, ifyou ger behind rhe whcel rhere is only one patrern of drinking that is safe-totaI abstinence from alcohol. , after a drink ar rwo, if you are like mosr people, you wiU feei complerely in control, your coordinarion wil! be good, but your esri· mare of youl" driving abilities uAII be e:x:aggerated. Your risk of deach on your way home wiU likely be 10 rimes greater rhan if vou were sober. , Aircraft accidents also bear a relarionship to alcohol use. Duc [Othe relative rarity of such evenes, lirde research has been dane on rhe rale of alcohol in ehese cÎrcumstances. In one evaillation of medical examiner's files for non-commcrcial aircraft EHaliries, 35 percent rested posirive for aJcohol airhough onl)' abOli( 1 in 4 of (hose

WANT A DRINK? wim alcohol on board were legally inroxictted. These resuhs carrelate well with omer data that estimate that alcohol is involved in up (O 30 percenr of fatal aviation crashes. 108 One particularly imeresting aspect of the research on pilot performance and alcahol is thar alcohol-re1ated impairmene is detectable even after alI the alcohol has been eLiminated [rom the body.109 According to the Aeronaurical Informarion Manual given by the Federal Aviation Reguhuions (FAR Part 91.17) no crew member, including me pilot, is allowed co take flight umil eight hours afeer the consumption of any alcoholic beverage. Because a pilot may stiU be under the influence of alcohol after rhis eighr-hour period istration Safety Officcrs advise pilots co allow for at lease 24 hours between "boule and mrotde."I)O Alcahol is also a significam comriblltor w our currem national epidemie of violent crime. I devore auelltion to this wpic in Chapter 13, "Stcmming the Tide of Violenee."

The Great American Alcohol Cover-up? The news media does not tend ro repOrt on medical smdies mat put moderate alcohol drinking in a bad light. Does this constiturc a deliberate "eover-up"? ar are mere other faecors that help explain d)is consistent lInderreporting? One reason eould be that many of che news media are drinkers themselves. Occasionally you wiU heat a news reporter make jokes abour drinking and rake pride in being a "moderate" drinker. Many heavy drinkers, in facr, ca.l1 themselves moderate drinkers. It is hard to find a heavy drinker who wiU own up ro it. Moreover, many politicians, lawyers, and judges use alcohol. Could they be consciously or subconsciously suppressing information 00 the evils of alcohol and resisting legislation mat would help decre.ase aJcohol use? Figure 17 summarizes some of the effects of moderate drinking that are sad1y ignored by many. Despire such biased reporting, the message of alcohol's danger seeros to be sinking in on the American public. There has been a sready increase in the number ofindividu-

RESULTS OF MODERATE ALCOHOL USAGE • Hypertriglyceridemia • Hypertension • Stroke • Decreased immune function • Accidents · Suicide • Breast cancer • Colon cancer • Menstrual pain • Osteoporosis • Obesity

• Gastritis • Gout • Chronic fatigue • Cerebral atrophy • Fetal alcohol syndrome • Leukemia in offspring • Potentiates heavy drinking • Decreases jludgment, foresigbt, moral reasoning

als who do nor drink at aII, nor even on New Year's Eve. Some of the key aspeCtS of recent polls are disrilled in Figure 18. 11 1. 112 lfyou have chosen nOt ro drink, or have cur down on your akohol eonsumption, yOll are parc of a swelling tide sweeping our nauon. This change in our eollecrive experience appears ro be in harmony wirh a charaeter trait exrolled by the Book of Proverbs.

Fîgure 17

AMERICANS ARE DRINKING LESS • In 1983, 28% of men and 50% of women -----4 were abstainers; those figures ... increased to 32% and 53% o rfo respectively by 1988. • A total of 34 % of the adult popuJation never drank in 1983; that figure increased to 44% by 1993. • In general, those that stiH drink are drinking less. The largest category of dtiokers is the "ligbt drinker" (1 to 13 drioks per montb). Among male driokers in 1988,44% fell into this category. 64% of women tbat year met this desigoatioo. Figure 18

441

PROOF POSITlVE There we are told lhat wise individuals are aware of evil but do not partake of it. whereas the foolish make no change in their praccices and end up with c11e wretched consequences. The text is quoted in the t:1miliar King James Version in Figure 19. J 13

"A prudent mao foreseeth tbe evil, aud hidetb himself: but the simple pa'S's 00, aud are punish,ed." Proverbs 22:3

F~gure

19

1 knew severa! tcenagers who died in an autO accident recendy becallse of alcohol. It happellcd on their way home aner an evening of parrying. How tragic! They could have refused to drink, but chey did noe. Anei, as Proverbs says, rhe simple on and are punished. Let us act accordillg ro ehe knowledge that we have. Ler us do whac we know is right for ourselves and for our famiJies.

Are There Healthful Benefits of AlcohoP

442

I have spent the blllk of this chapter looking at rhe broad range of harmli.ll effecrs of alcohol. However, I have yet to [uUy address one of today's most pressing issues: mighr alcohol consumption help one's hean? Notice. 1 did nor phrase che guestion as some do: Ilamely, "Collld moderate alcohol use be heaIthy?" Many are quick to answer thar question in the affirmatÎve.

However, aner seeing rlle extensive lisr of toxic effecrs of alcohoJ. it should be easy enough for the llnbiased reader ro see rhar alcohol is nor a health-giving substance. Srill, what about the hean effeces of al· cohol? Often the question is based in parr, at leasr, on reporrs about the French. Wit11 rhat in mind. let us rerurn ro r!le subjece of rhe French Paradox thar rhe news media has so eagerly publicized. Pirse, we need ro reframe ilie Îssues. Afeer ali, ae lease one news media repon posed ehis question: "Why don'r the Prench have heart disease?" Thar, of course, is a misstaeemenr. The French have plenty ofhean disease: it is rheic second leading C1.use of death. The correCt question would be, "Why do ehe French have ins hearr disease rhan Americ3ns?" This is e!le question rhar we must address. Some inreresr.ing srudies have apparently unlocked dle mystery. Before we look ar. this data, however. I ehink it is imponanr to make a telling observation. Mauy in America have been say· ing in effecc, "Just thillk, if we only drank more alcohol like ehe French. how much better off our hearrs would be." However, ehe French-who have been living with rhe results of rJleir high alcohol consumprionhave had a complerely different response. When Drs. Rankin and Ashley compared ehe alcohol use trends for 24 nations in Europe and North America, ehey made a srartling discovery ehat iIIuminaeed rhe French atrieude. On averag , from 1950 ro 1985, western naeiolls nearly doublcd cheir per capita alcohol consumption. The median percentage i.ncrease was berween 70 and 82 perccnL In filet, cvery country but one increased cheir alcohol consumptian. Do you have any idea what coulluy was the sale nation (O decrease alcohol consumprion? lfyou guess , you are right. In ehar 35-year period ehe average French citizen decreased his ar her use of alcohol by 23 percent. J 14 The explanation provided by dlese alcohol researchers is ilIuminaring: "The deciine in alcohol consumpeion in was almosr certainly in part due tO national measures ro reduce consumption because of concern abolit rhe health-related ouecomes

WANT A DRINK? associared with the highesr national per capi ta consum prion." 115 Thus, while has been working for years ro decrease their aleohol consumption becausc of rhe healthrelated roll it has been raking in their counlCy, rhe American alcohol industry and the media are idolizing the use of alcohol by rhe French. It is ironic that rhase living fim hand with alcohol's effects see it as a curse, while tho e loaking on from a disrance idoJi7.e irs benefi rs. What abom urIle French paradox"? Ler us examine rhe French lifesryle ro see why heart disease may be lower there than in America. Along with comparing American and French alcohol consumprion, we mUSt also assess omer dietary f.1crors. We have done chis in Figure 20. 116 Higher buner and lard consumption coupled wi[h higher blood pressure and cho\esrerol levels would lead one ro expect more hearr disease in . However, as we nave already observed, just che opposire is rhe case. The nexc poin[ in rhe figure is generaUy used ro explain why their heart disease is less: they have a much higher in[ake of red wirlC. Many have conduded mat red wine reduces rheir risk of heart auacks. However, we must look further. Cigaretle smoking and obesiry do not appear ro be factors; French rates in these areas are comparable to those in America. Tne French also have another dietary disrincrion: they driuk very little milk. The news media has failed ro publicize tJ1is facr. Dairy fat is srro.ngly related tO heart disease. In fact, ifyou look ar [he consumprion ofdairy produc(s in one COUlltry compared ro anorl1er, Î ncluding , tbe beart disft1se rate

is proportional to tbe amount ofdttiry products constlmed. 117 , 118. 119, )20 Thus, rhe lower consumption of dairy fat would help tO explain [he lower levels of hearr disease in . Another factOr rhal would be expec[ed [O decrease French hearr disease risk is rheir high consumprion ofvegetables and fruirs. The heart-prorective benefirs of rhese foods are presenced in Chapters 3 and 4. This important facr has also nor been widely publicized. Ano[her important but unpublicized filer: t here "'re certain groups in America tllat

LIFESTYLE COMPARISON OF FRENCH AND AMERICANS Compared to Amer;cans, the French · eat 3.8x the butter · eat 2.8x the lard · have higher serum cholesterollevels · have higber blood pressures · have a much higher intake of red wioe · have comparabie rates of obesity aod cigarette smoking But they · drink very little mUk • eat large amouots of vegeta'bles and fruits • have le-ss death from CAD Figure 20

have a mucb IOUler rate ofdeaths due to beart disease tban tbe Frencb. American Seventhday Adventisr vegetarians have far less risk of hearr disease (han does rhe ave rage Frenchman. 121 But tbey drink no wine or

alcohol. Are there any factOrs in addition ro lower milk eonsumprion aud higher frujr aud vegetable eonsumption that would explain the apparenc French advamage? What about wine-might there be something ro rhe wine conl1ecrion aner aII? Having looked carefully at the issues, we wiLl see rhar wine does have some hearr-prorecrive benefits. But before we jump ta any eonc!lIsions, 1 must poinr Out rhe obvious: wine conraills mlleh more than alcohol. Or. Oemrow and colleagues at the Universiry of Wisconsin looked direcrly at d1e constiruents of red wine, white wine, and juice made from red grapes. 122 This seudy provides some amazing insiglus inco [he French paradox. Before they embarked on the aforemelltioned rudy, [he Universiry of Wiscol1sin group already knew several things. Fim, jf the blood's c10rting ceUs, the plarelers, become

443

PROOF POSITIVE

A STUDY TBAT IIELPS EXPLAIN THE FRENCH PARADOX Arterial blood clots in 47 dogs Beverage given

Effect 00 blood flow

Group 1

Red wine

lncreased

Group 2

White wine

No effect

Group 3

Grapejuice

Increased

~

Condusion: Red wine alld grape juice /lave oile OT more beneji.âal sllbstallces for reducing b/ood elot formation ;11 arteries Ihat white wille does "01 have. Figure 21

444

sricky, rhe risk of hean arrack and similar problems increase. Second, wine and alcohol consllmprion had been elemonsrrared to make plarelers less sticky. Third, the tendency of piare1ets [Q make heart problems worse could be measured in a special dog model ehat had been developed in rheir laborarory. There WaS stiH a burning quesrion, however: how much of rhe effecr of win,e was due ro alcohol and haw much was due to other propenies in rhe grapes? Ta find the answer, rhe researchers obrained 47 mongrel dogs. In preparation for the test aEter anesrhesia, each dog had a single coronary arrery experimenrally narrowed and damaged in a way that reproduced ehe blockages occurring in humans wirh coronary anery elisease. These anery changes included elamage ro the inner lining of the blood vessel known as rhe incima. Intimal damage, in turn, srill)lIJared piatelers ro elump periodicaJly and form sticky little c!ors referred ro as rhrombi. Colleceively, rhese processes callsed periodic interrupeions of flow in the affeereel corollary arreries, known as "cyclic Aow redllCtions" or CFRs. This experimemally induced condirion thus mimicked rhe exacr mechanism for hllman hearr anacks. After rhese changes were induced in rhe elogs, rhey were then divided imo rhree major groups. Group 1 received red wine,

Group 2 received red grape jllice, and Grollp 3 received white wine. Whar rhe researchers were looking for was a reducrion in the rendency of rhe plarelets ro c1ump and a resulting decrease in the cyclic Aow reductions (CFRs). They carefully measured rhese CFRs ro see if adding rhe wines or grape juice wOllld decrease platelet stickiness. Their resu!rs are sllmmarized in Figure 21. 123 The test resllirs indicated rhar rhere were one or more substances in borh red grape juice and red wine rhar ShOllld significantly reduce rhe risk of a heart attack. That subsrance cannor be alcohol, because there was none in rhe grape juice. Moreover, white wine comains alcohol but had no significam effecr. In another study, the same lab found rhat alcohol alone, in very large amOllntS, could decrease CFRs. 121 Extremely high levels were needed-rhe eqllivalenr of about 12 drinks for a 180 pOllnd manl2S_producing blood alcohol levels well over double rhe legal limit for drivers. In contrast ro the smcly wirh pure alcohol, rhe red and white wine in the Demrow study was given in amounts rypically arrained in social drinking-approximaring one drink in a 180 potlnd man 126_ only eigh r percenr of the amount needed ro decrease CFRs. This amounr produces blood alcohol levds within legal limits ar abollt 0.02 or 0.03 gm/dl. If it was nor the alcohol, what are the subsrances rhar made rhe difference in the effects of rhe red wine and rhe grape juice? The mosr likely candidates were a grollp of subseances called Jlavonoids thar are known ro prevenr plarelet c1umping. They arc found abunclamly in grape.~, reel grape juice, anei reel wine. In fact, compared ro (he white wine, rhe red grape products-rhe wine and grape juice-had four ro flve times as much of twO key flavonoids (quercerin and nain) by acrual measuremenr. It is likely that t!le presence of ehese substances causeel rhe reducrjon ofblood elot formarion. In earlier research, the Universiry ofWisconsin group haei demonsrrated thar both quercerin and rutin couJd decrease platelet srickiness and eliminaee the CFRs in rhe same dog modcl. 127

WANT A DRINK?

GrapeJuice ~ A Multifaceted Food Flavonoids, especially querceein, as found in grapes and grape juice, have orher beneficia! e/Teers in reducing tbe risk ofhearc disease besides rheir plaeeler aceions. Some of the benefits of flavonoids are iisred in Figure 22. 128• 129 Nore thar grapes conrain porent antioxidant5. Quercerin, for example, is even more potene rhan Vitamin E. As described in Chaprer 3 on heart disease, oxidized LOL choleseerol is a major culprie in arherosclerosis and hearr disease. l3o Quercetin blocks LDL oxidarion, and thus che process of arreria! narrowing. Addirionally, ancioxidant effects are helpful in cancer prevenrion. These hearr-heahhy compounds may rhus decrease cancer risk as weU. Borh animal studies 131 aod seudies of human cancers 132 • UJ have demonsrrared such amicancer effects. StiU othcr flavonoid benefirs include amivira.1 aceiviry.1J4 Grapes are noe alone in possessing such hea!rh henefies. Figure 23 shows ocher foods ehar comain signiflcam quanrieies of flavonoids.135. 136. 137 Some grapes also appear ro comain anorher hearr-protective subsrance, called resveratrol. This naeural1y occurring fungie-ide also has promise bur did nor seem ro be one of rhe main heart-proeecrive chemicais in Oemrow's wine research. Resverarrol was found in signiflcH1r amouncs only in the beverage thar had no significanr beneficia! aff'ect-rhe whire wine. No dereccable amounrs were [ound in the red wine or the grape juice in chis srudy. Nonerheless, resveratroJ may have more benefits rhan we have given it credit for. Whire grapes and whire grape juice may thus also have some cardioprorective benefies. And do nor coune out red wine and grape juice regarding resveratrol: other srudies suggest rhar they a1so contain chis porenrially healthful compound. Consider resveratrol's beneflcial effects listed in Figure 24. 138 . 139 Resvcrau01 has recenrly been found ro prevenr cancer in mice. 140 How does rhis information fir wirh the French Paradox? The dog study evaluated the diITerences in rhe eff'ecr of plarelets on clouing. and nor rhe di/Terences in choles-

GRAPE FLAVONOIDS FIGHT HEART DISEASE Grape jllice cOlltains flavoltoids (especia/ly quercetill) wlaich:

· inhibit thc oxidatioo of LDL cholesterol. · are more potent antioxidaots tblln vitamin E. • decrease platelet aggrcgation (clumping). • arc llssociated with a dccrcllsed incidence of and mortality from coronary heart disease. Figure 22

FOODS CONTAINING FLAVONOIDS Fruits . .

Vegetables

Grains

grapes?'"

kale (Ieaf)' greens)

cereai grains

apples_ cberries

j.

strawberries blueberries

roots and tubers. onions tea

grapefruit

... Ce Figure 23

GRAPE RESVERATROL FIGHTS HEART DISEASE White grape juice contains resveratrol which: lowers totall cbolesterollevels increases HDL cholesterollevels inbibits the oxidation of LDL cbolesterol

Figura 24

445

PROOF POSITIVE terol Jevels. The differences in cholesrerol levels would have [10 effecr in such a blood c10tting srudy. There is 110 conuadic[ion here. 1 would be negligem [Q close clle copic of grapes and grape jllice withollt ar leasr listing some of [he omer beneficial qualities of this lIniqlle and delicious food grollp. To illllsrrate rhe abllndance of necessary nurrients in grapes and grape jllice, assume [har yOll were [Q live on grapes alone (which 1 do nor and wOllld nor advocare), and would eal enollgh ro mainrain your body weighr. The varieey anei qllanriey of rhe many nlltriems in such a die[ and clle lack of some negative factors in rhe rypical American diet are shown in Figure 25. 141

NUTRITIVE QUALITIES OF GRAPES Percenlages ofRecolllmended Dai/y AlIowa"ce (if eale" in t!lIoltgh quanrily 10 maintain weiglll).

DiclaryProlein ~

• No cholcsleroJ

43J

liber _

.Vcry

5

Thlamln-B, R1bona\'ln-B,

• Onl)' 5% rat low in sodium

26

Nil cin-B, Vilamin-C Vllamln-B·;::E:::22:8~:,.+.:::::::: 134

VII E-Ct equlv.

141

290

81

Follilc

1

Cakium_51

copper= lron Magncsium _

149 108

11

Pota5sium Sclcnium

205

• • • • •_511

o

100

200

300

400

500

600

100

_...

800

Figure 25 We see rhar grapes have signiflcallt qllanriries of 15 mnrienrs while conraining only flve percent fat, a very low amouJlt of sodiuln, and no cholestcrol. Notice the high quanriry of vitamins B, C, and E, as well as iron and copper. They are also vcry high in potassillm. which along wirh a low-sodium dier helps ro lower blood pressure, and very high in selenium, a trace elemenr rhar appears ro have a cancer-protective cole.

Back to the Paradox 446

Ali of rhese lines of evidence bring us back ro the major ropic under discussion,

namely, the French Paradox. The best evidence Sllggests rhat the lower hearr disease rarc in has ro do wir.h much more rhan alcohol. Conrrary to whar many lay news reports have implied, the tllcohol in the

wine is 110t the ingredient that prOllideJ the benefit. As we have seen, much of the benetlts amibuted to drinking wine should be anribllted ro the main ingredient ofwinegrapes. Alcoholic beverages do appear ro have rhe rendency ro raise heart-protccrive HOL cholesterol levels .in people who arc on a poor lifesryle. A recel}[ Tufrs Universiey Oier and Nurrition Lefter pllt rhis in perspecrive, however: "Whilealcohol boom HOLcholesterol levels, exercising and losing excess weighr raise rhem even 010re."142 The truth is tllat no one !JIIS CtlCr proven that fi. ;erson on an excellent life~·tyle gets tin} benefits whatJOCller ~y drinking in modmttion. Considering HOL in particular, as we have seen, a1coholic beverages are not ilie only dierary facrors rhar hold promise for incrcasing HOL cholestecol. Wholesome grapes and grape juiee may also raise rhis lipoprotein mrough such compounds as resverarrol. Furthermore, no one is suggesting rhar. everyrhing rhar raises HOL is desirable. For example, organic pes[icides can boosr HOL. Yet, no one is reeommending pesricide consumprion for hean healrh: we recognize irs harms ourweigh any benefirs. Why add or continue to use a roxic chemieal sllch as alcohol, when there is no evidence that ir is as beneficial as a healrhfullifeseyle in redllcing hean disease? Even the Tufts University speciaJ repon (r.hat on the surface may have. looked pro 'alcohol for your heart") reminded readers of soroe of rhe bigger eoncerns rhar we have already addressed. They cited recent Harvard data rhar showed as lirde. as rhree drinks per week raised the breasr cancer risk for women significandy. And rhey made this relling summary: "Researchers agree almost universally rhar 00 one should rake lip drinking for rhe express purpose of sraving oIT hean disease . .. rhere are mllch safer and generally more healrhful WllyS ro protecr rhe cardiovascular sysrem." 143

WANT A DRINK?

Totl11 Abstinence is the Preftrred Option The World Healrh Organizarion has become a strong advocate of total abstinence from aJcohol even in rhe currenr context of the "alcohol-for-your-heart" hype. Tbeir thinking reflects rhe judgment of many scicnriscs, physicians, and public health professionals who are weB aware of the facts mar 1 have documented in this chaprer. The WHO roday lIses rhe phrase "the less you drink, the berrer."144 It is highly signiftcant rhar this inrernational body has raken rhe stance rhat even moderare amollnts ofaleohol consumprion should be avoided. They insighrfully made a nllmber of eri ti cal observarions rhat lead tO their conclusion. Some of those insights are found in Figure

WORLD HEALTH ORGANIZATION SAYS "NO ALCOHOL" "Alcobol coosumption causes some o( tbe world '$ most serious bealth problems." • "Drinking adversely affects a significant proportion of tbe populatioD, not just a minority of alcoholics or heavy drinkers." o Light drinking is unlikely to lower beart disease risk in people who are already takiog other lifestyle precautions like exercising regularly. not smoking, and eating less (at. • The publicity given to the use of moderate amounts of alcohol for beart disease preventioo is "not the result of rigorous scientific research, but is to a large extent inspired by commercial purposes." • "The less you drink the better."

26. 145 Especially noteworrhy is th is international body's conhrmation of one of my rhcses in this chapter: for people an an alre.:l.dy healrhful lifesryle (ar who are going ro adopr sueh), rhere is no evidence rhar alcohol provides any hearr benehrs. The World Healrh Organizarion's posirion conftrms in my mind mat we uuly are in an enJightened age regarding tne effects of alcohol an. human health. Indeed, when alI the infonnarion is taken inco aCCOllnr, the only condusion that makes "health sense" is cotal absrinence.

The ''Modified French Diet"for Good Health If you wanr ro get rhe benefirs that the French are reaping, the besr plan is tO use an abundance offruies and vegetables which may include grape juice irself This pl:l.J1trieh diet defuses anocller argumenr of rne wine proponenrs. While some have touted rhe flavonoid conrenr of red wine as being superior ta rhar of grape juice, rhe relarive amouncs of .fIavonoids in grape juice and wine probably vary considerably depending an rhe rype of grape, where it was grown, and the rype and year of the wine. For example, in the Demrow srudy, measurementS of rhe acrual samples lIsed in rhe experimenr suggesred ehat rhe grape juice had somewhat

Figura 26

more rmin, while the red wÎoe had more quereetin. 146 Even if wine consistenr!y had more of aII rhe flavonoids (han grape jllice (which the evidence daes not indicate), eating vegerables and othcr planr sources offlavonoids-in addition ro grapes--wouJd be expcered ro provide a higher quanriry of t!lese compounds than moderate wine drinking alone. ThllS, the plam-rich diet

"MOD FIED FRE CH DIET" FOR GOOD HEALTH • Eat large amounts of fruits and vegetables like the Frencb. • Eat a low level of dairy products like the French. • Substitute grapes or unfermented grape juice for the wine that the French drink. • Reduce meat consumption below tbat of tbe Frencb.

Figure 27

447

PROOF POSITrvE a1so furnishes a furrher rea.~on for a lower he:m arrack rare arnong rhe French: they consume higher guanrirjes of flavonoids than Americ.1ns due ro rheir higher inrake of fruirs and vegerables. Ler us follow rhe example of the Frellch in a rnodified \vayas ouclined in Figure 27. With rhe "Modified French Dier, Americalls' risk ofhearr disease will become lower rhan rhar of rhe French.

GRAPE JUICE VI. WINE "The pure juice of the grape, free from fermentation, is a wholesome drink. But many of the alcoholic drinks which are now so largely consumed contain deathdealing potions." Figure 28

"The Bible nowhere teaches the use of intoxicating wine, either as a beverage or as a symbol of the bJood of Christ." tIt::::~ ~ ~ ~, .... ' , ....... ::;:::::;;::::: ,,"- ...' ' ....... ~ '- ' . . .~. ~ ..~ ~~

4

~

"-. . .10......0

Figura 29

448

::,. . .

"-

, ......

::'.::::

Whar a tragic misrake ir would be for a person ro drink alcohol in an atrempr ro reduce he:m disease risk, on Iy ro sufTer some of rhe irreversible consequences of alcohol use. If you re.111y are inrere red in your healrh. why nor do rhings rhe rru1y healthfuI way? A firring summary of the heahhfulness of grape juicc comrasred wirh rhe tragic eflecrs of alcoholic drinks appeared in prim nearly one hundred years aga. I have reproduced the sratcmenr in Figure 28. 147

The Christian Community's Responsibility Even rhough ilie scienrific communiry has the answers regarding rhe alcohol question, why do 56 percenr of Arnericans sriU drink?148 One partial explanation could be thar our moral instirutlOns have Ice tlS down when it COll1es ro their positian on alcoholic beverages. Indeed, some church leaders c1aim rhar the Bible sanctions-and even encourages-ehe use of fermenred wine. Thorough srudies on ali ehar rhe Bible has ro say abolH alcohol have concluded rhar the Bible nowhere approves of drinking a1coholic beverages; conversely, it gives clear counsel ro avoid cheir use. If you have an interest in the Biblical teachings concerning rhe use ofalcohol and have nor seen rhe evidence, you may wanr ro read rhe resulrs ofOr. Samuele Bacchiocchi's research. This Italian theologian has aurhored a book entirled, Wine in rhe Bible: A Biblical Study on rhe Use of Alcoholic Beverages. 149 The conclusion of Ellen Whirc, on ehe same subject, is stared in Figurc 29. ISO Our re1igious instiwrions have ler tlS down. They need to carch up wirh rhe scientific facrs and wieh rhe eheologÎans who have assiduollsly srudied rhe Scripeures and have found rhat the Bible nowhere sanctions alcohol consurnprion. In lighr of rhe overwhelming scienrific find ings againsr rhe lIse of alcohol, even in low amounrs, religious insrirurions must now accepe a major responsibility for rJle use of this legal drug and alI of irs associated premarure dearhs, disrressing medical condirions, and social trauma.

WANT A DRJNK? The devasraring social aspecrs of aleohol use were forcefully dcmonsrrared in rhe village of Barrow. A1aska. 151 In 1994. rhey vored ro ban rhe sale and use of aleohol. Many locals up ro rhar rime were nor able ro work because of drunkenness. A top police official said ehat before the ban "There was mayhem and rragedy cver)'where." Rape. suicide, and drunk and disorderly conduct were rampanr. Feral aleohol syndrome rares had skyrockcrcd. However. abrupt changcs took place aJmost immediately aher the ban went imo effect, as dcscribed in Figure 30. 152 A Narivc American he-altll care worker from rhe 10~îl Inupiar rribe caUed rhe ban "rhe beginning of rhe salv3rion of our people." An Inupiar [eader echoed similar senrimems when he said. "For our people. akohol means only bondage.' Wirh a 70 percem dmp in crime, Barrow became mOre peacefuJ than ir had been in decades. The Barrow srory on one hand demonsrrates rhe power of alcohol ro ruin lives. On rhe orher hand, it epitomizes the bendlt5 of societal decisions ro break free from aleohol's grasp. The tranquilliry rhar foi· lowed the ban should not come as a surprise. We are ali well aware of rhe moral and societal cosrs of aleohol. However. other than in Barrow, A1aska. and a few orher isolated places in our nation, where are rhe public ourcries against the damages rcsulring from alcoholic beverages? Dissemination of the srarisric;u and scienriflc E1crs regarding alcohol, coupled wirh publiciry given ro the moral evils of aleohol by rhe religious instiwtions, would have a powerful effect in reducing aleohol consumption in our narion. The influence of churdlcs in our nation as seen from rhe perspecrive of a prolific Christian wrirer is stated in Figure 31. 153

Alcohol-A Moral Issue Dur sociery is greatly influenced by moral scandards taught by the churches. Dr. Bacchiocchi wrires, "lf America W:lIHS ro deal effecrively wich che cragedy of alcohol, ir must develop an entirely new cultlual acti rude rhrough the aggressive promotion of abscinence."154 Bacchiocchi i.s dearly call-

P OHIBITION B TOALASKA • The 3,900 people in Barrow, Alaska voted to ban the sale and use of alcohol in 1994. • Alcobol-related crime and accidents plunged. Crime feU 70 percent during a ODe year period of prohibition. • Regarding acute health problems: Emergency room "'" alcohol-related visits dropped from 118 per month tQ 23 per montb in the first 30 . .\.;._ ......... ~- . days of prohibition. ing for a socicraJ arrirude thar rolerates no a.lcohol wharsoever. The role of Chrisrians in the promorion of rotal abscinencc is further described by De. Bacchiocchi: "Chrisrians can play a vital role in t!lis endeavor if rhey recover the Bibuca.l imperarive for absrinence. It is onl)' when Chrisrians recognizc and accepe rJle fact (hat drinking aleohotic beverages is nor only physically harmfui, but also Biblically and morally wrong ehae they are likely ro feei compelled. nor

Figure 30

A CHRISTIAN RESPONSIBILITY Christian churches bear considerable responsibility for inestimable human and economic costs of alcohol consumption, "because through their beliefs, teachings, aud preaching they are able to influence the moral values and practices of society possibly more than any other institution." Figure 31

449

PROOF POSITfVE

SERVE FRESH FRUITS ON FESTIVE OCCASIONS "Let us teach tbe people to eat freely of the fresh grapes, apples, lpeaches, pears, berries, and ali other kinds of fruit that can be obtained." Figura 32

only ro abstain from incoxicating substances rhemselves, but a1so ro help orhers do likeWiSC."155

In a social setting in which a light menu Îs served, we have many becrer alrernarives

Refernues Ricc DP. Thc <:conomic cost o( alcohol abusc and alcohol dependen,ce: 1990. Auohol Htl1uh 6- RJ'Uorch Wor/d 1993; 17(1): IO-II.

I

Rice DP. Tbe economic cost of alcohol abuse and alcohol dependence: 1990. Alco!Jol HelIlth & Rmarch Workl1993; 17(1): 10-11.

2

3

NlImes wm' c/Jlrngtd 10 emure cOllfidnJlWIiry.

{ C.1lla
US Departmclll o(Health and Human Services. Epidemiology ofAleohol Usc and A1cobol-Rclared Consequenccs. In: Eigh/h Spuiol RepoTI (() riu US COJlgrtss 011 Alcohol,md Htltlt!J. Nalionalln.\riuucs ofHealth (NIH) Publication No. 94-3699. Sep 1993 p. 18.

6

7

McGinni5 JM, Focge WH. AClllal cause.s of deatb in thc Uniled Stales.

JAMA 1993 Nov 10;270(18):2207·2212. B Purn:lffi JJ. A1ishouse J E. Food cOTlJl/mpâon, prim. afld expentiil"res: An"Udi Dala, 1970-91. Food 'lnd COllsumer Ec<>nomics Divisiol\, Economie Rescarch Scrvice (ERS). U.S. Depanmelll o( Agriclllllm:. Statisl;cal Bullctin No. 928, 19%.

Rice DP, Kclman S, eL al. The Eco1/omic UJSI OfA!rohoIA1/d Drug AbwI' Ami Mmlol l/lnesm: 1985. U.S. Danment of I-\calrh and HlIJ1lan Services. DHHS I'ublication No. () 90-1694, 1990 p. 22-23.

9

Mil!cr A. principal economist (or rese.lrch and evaluarion al the Pacific 1nsnru le. QUOtOO in dlc NIJlioTldl Gooa Tnnpidr 1997 Jan/Fel>; 17(1):7.8. 10

450

than alcohol. These alcernatives are good casting, satisfying, and are compatible wlrh a social, pleasant. or festive mood. Theydo nor, however, exacr the price of a dulled mind. Indeed, rhey are compatible wirh a c1imatc thar fosrers uprighr and intelljgenr conversation, a serring where we are lIsing our fromal lobes for unclollded reasoning. What are these alternatives? They are named in Figure 32. 156 We have seen thar fresh fruics and their juices in moderation canimprove and SllSrain our health as opposed ro che decline of hcalth rhat, almost inevirably, accompanies alcohol consumprÎon. We need 110 addi· rional evidence. The message is dear. As Solomon, reportedJy the wisesc man char ever Ijved said, 'Wine is a mocker, scrong drink is raging (rroublesome): and whoso· ever is deceived rherehy is nor wise." Proverhs 20: 1. The only answer thac makes sense when che quesrion is asked, "Wanc a drink?" is, "No, rhank you, hut 1wou1d enjoy some warer or juice."

11 Rankin JG and Ashley MJ. A1cohol-relatcd Ht"dldl Problems. In: LISI LM. WaJlaee RB, edilors. Maxey-R05cnau-bst, Public HmltlJlrnti tive Medieiltl'--13,1, dirioll. Norwalk. el': Applcron and La.ngc, 1992 p. 747-748.

""Vf.7l-

U.S. Dep!. of Health and Hlllllan Services. A1cohol. In: TIu Surgeo" Gi!IIcmt:-- R0r/ on Nutritioll o1/d Helllth. 1988. Public He'lhh Service DHHS (PHS) publication Number 88-50210, p. 633.

12

13 Tbe New York Public Library. A1coholic Drink Recipes. In: Fargis P, Bykofsky S. edilors. TIu New York Public Libmry Dcsk R,fi7t1/Ct.. ew York, NY: Wcbslcr's New WorJd (Simon and Schuster, Inc.), 1989 p. 524.528.

I~ The New York Publie Library. Alcoholic Drink Recipcs. In: F:lrgis P, Bykofsky S, <:ditOfS. Thr New York Public Libmry DCJk ReftTCJJcc.. Ncw York, NY: Wcbslcr's New World (Simon and Schuster. Ine.). 1989 p. 528. 1) Rank.in JG and Ashley MJ. Alcohol-relaled Heahh Problcms. In: bst LM, Wallacc RB, edirors. Maxcy-RoseMu-Lasr. Public HfI1l/h Ofltl Preventive MtdicÎlIl'--/3'J, editioll. NOfWalk, CT: Applelon and Langc. 1992 p. 741-742.

16 Issclbacbcr KJ, BraunwaJd E, et al, cditors. HnrriJOflS PriltcÎp!l'J of["uruill Mcdicine-13 c1 , edition (CD-ROM vcrsion). NL"W York. NY: McGrawHiJl, loc. Heallh Pro(essions Divisiou, 1994.

17 Kdley WN. DeVitaV1;JR .Cl al, editors. 7exrbQok of ff/lmll11 Medici1l1'--2"d edition. Philadelphia, PA: J I~ Lippincou COlllpany, 1992.

\" Diamanc E. DiseasesdrbeEsophagus. In: KeJlcyWN, DeVilaVf,JR al, editors. Tt'Xtbook oflll/enlfl1 Jvledicille-2ntl edirion. Philadelphia, PA: JP. Lippincolt Company. 1992 p. 452-454.

,CI

19 Cctllcrs for Discase Conrrol and Preventjon (CDC). Preliminary dala on binhs :ln,d d<:aths-Unitcd States. 1995. MMWR 1996 OCt 25;45(42):914-918.

WANT A DRINK? US Deparcmenr of Health arid Human Services. EfTeCts of AlcohoJ on Hcalth and Body Sy tems. 1n; EiglJlb ,/,all11 R~port UJ the US COllgresi 011 AleoJJol IIl1d HMlth. Nalional InSlilules ofH(~lh (N1H) PllbliC:Hion No. 94-3699, Sep 1993 p. )71-172. 20

Gu)'ron. AC. Physiology ofGastroim linal di order . In; Tatbook of 8th ditiol1. Philaddphia. PA; WB Saunders o.. 1991 1'.736-737. 21

Gavaler J', EfleCIS of Alcohol Use and Abuse on rhe Endocrine Stams in Expanded SlUely Samplcs of Postmenopallsal Women. In: ZakJlari S, editor. Alt-ohol IlJld Jlli' E"doer;'li" sysU'm.. N:llional InslillllC on Alcohol Abllse and Alcoholisrn: Research Monograph-23. NIH Publication Number93-3533,1993p.I71-187. 3G

Ginsburg ES, Mdlo NK. et al. ElfecIs of aleohol ingeslion on eSlrogcns in poSlmenopausa.l womcn. }AAfA 1996 Dce 4;276(21): 1747-1751.

M~dirlll Physiolog)'.

J7

21 Wa!. h JH. Acid Peplic disorders of lhe gastrOilllC5linal lracr. In: Kelley WN, DcVila VI'. J R,el al, editors. Trxlbook o/Internlll M~dicil1e-2"d ~di lioll. Philadelphia. PA: JP. Lippincoll Olllp:Uly, 1992 p. 464.

). Adams HG. Jordan C. Infeclions in lhc aleoholi . Med C/in Norrh Am 1984 Jan:68( 1): 179-200.

US Depanmcl\l of Heahh and Human cr"i cs. EAcCts of A1cohol an Behavior and Safcty. In: EigJJlh Specilll Reporllo Ibe US COllgrm 011 A/rohol II1ld Health. Narional InstitUlC5 of HeaJth (NIH) Publicalion o. 943699, Sep 1993 p. 244-246. 2J

US DepanmeJ1l ofHnlrh and Human Services. Effecls of Alcohol on Behavior and Safery. In: EigJJrh Specilll NI'/Jo/"t /'() Ihe US COllgms 0'1 Alcobol IIIItI Hetrllh. N:lljollal Jnslinlles of Heahh (NII-!) Publiealion No. 943699, Sep 1993 p. 244-246. 24

2; Bagasra, O. Ai>slrael #3111, pre.sel1lcd Mar 1988 al lne AJ1nllal MCL'ting for lhe Fcdenltion of American Scienees for Experimel1lal Biology. Probably publishecl as: Bagasra O. Kajdacsy-Balla A, L.ischner t-IW. EffCCl of alcohol inge-5lion on in "itro suseepribiliry of peripheraJ blood 1Il0nonudear cells 10 infeCtion Wilh HIV anei of seleClet.! T-ccll functiollS. Alcohol Clin Eyp Res 1989 OCI: 13(5):636-643.

Bagasra. O. Abstract #3111, prcscJ1lcd May 1988 al lhe AJlIltlal MCCIing for lhe Federation of Americln Scienccs for Experimclllal Biology. Prohab!)' pyblishcd as: Ba"asra O. Kajdacsy-B,Jla A. Lis IlI1er t-Iw. Effens of :.Jcohol ingeslion on in vilro su eeplibiliry of pcripheral blood mononuclcar cclls [O infeclion Wilh HIV :Uld of sdecleel T-cell funnions. Alcohol elin Exp Rri 1989 OCt: 13(5):636-643. 16

~7 A1do-Benson.

M. el al. Ft'di-mtioll ofAmerican Srimus for ExperillleJJlal Biology. Annual Meeling May, 1988. (Abstracl ;;7966).

US Darrmem of Heallh and Hum.n Ser"iees. Efrecls of Alcohol on HC"'.Ith and Body Syslems. In: EiglJlh Special Repor' UJ Ihr US Congrl'SS on Akohol and Hmllh. National In lillllCS of Heakh (NIH) Publicalion o. 94-3699.Sep 1993 p. 176-177. 2

US Depawllcnr of Heahh and Human Services. Efrecl.< of Alcohol on Heahh and Body Syslcms. In: Eighlh Sprcial Rrp0r/ro Ihe US Congres! on IUrohol nlul flm/lh. National lnslillites ofHeald, (Nlt-I) Publieatioll No. 94-3699, Sep 1993 p. 175-177.

1<)

Yirmiya R, Bcn-Eliphu S, CI al. Ethanol incl'cases tumor progressiolJ in rals: possible involvemcm of nalural killer cells. 8r/li" Bt'hl/IJ 1111»11111 1992 Mar;6(1): 74-86.

30

lssdbacher KJ. Bralll1-vald E, el ;11. eclitors. H'lrrisoJls PrirlCl/Jlt.I oflnter13IIJ1'dilioll (CD- ROM ,,"'sion). New York, NY: McGrawHill, Ilie. Hcald, Professions Division, 1994.

31

!/Iri Mi'fliciJl

Kelley WN, DcVilaV1:JR ,el al, editors. 7rxlbook of Jnternal Medicillr--2nd etiitioJl. l'hiladelphia, PA: JP. Lippincou Comp:u'y, 1992.

.12

US Departmcnl of Health a.nel Humao Services. Efrens of A\c.ohol on Heahh anei Body SySlerns. ll): Eighlb 'P"cilll Rrp0rl to riu US Congms on II/coho/ and Hralrh. alionallnstirUlcs of HeaJth (NIH) Publicarion No. 94-3699. Sep 1993 p. 177-178. Scharzkin A. Joncs DY, el a.1. Alcohol con umplion and breast CUlcer in the epidemiologic lollow-up sludy of lhc fim alional Heakh and NUlrilion Examinalion Survey. N EJlgl} Merl 1987 May 7;316(19): 1169-1173.

Yi

3S

Nalional Rcscarch Council repon " CnrrillogellJ I1nd Ami-cl1rl";'lOgrm in

ti" HlImlln Din: A Compllrisol1 ofNlltum/1y Ouurri>lg IIll1i Sylllbrlic Sub.. released the Thursday bcrorc 2-15-96. Commitwc of the RC ehaired by Rona.ld Estabrook. Univer iry ofTexas Soulh W($lem Medical Center in Dallas.

iIIl1Ices"

Glassman AU BennCtl CE, Randall CL. Effecls of clhyl a1cohol on hum:Ul pcriphera.ll)'mphocYle . AJ'ch Pllthol Lab Med 1985 JUJl; 109(6):540542.

39

Ma Gregor RR. Alcohol anei immune defense. }AMA 1986 Sep 19;256(11); 1474-1479.

40

I MacGregor RR. Alcohol and imtllune defense. }AMA 1986 Sep 19;256(11):1474-1479.

42 Issclhacher KJ, Braunwald E. el al. editors. H,lrriso"i Prirlcipb oflmer1lIr1 lv/editi>lr--13lh edition (CD-ROM version). New York, NY: McGraw-

Hill, Ine. Health Professions Division, 1994. Kelley WN, DeViLaVr;JR ,CI al, edi(ors. Texlbook of III/emal Medicille-2nd ediJio>l. Philaelclplua. PA: JP. Lippincoll Company, 1992. 4)

Issdbachcr KJ, Br'llInwald E, el al. edilOrs. H'I"iso"s Principlrs oflntert'dilion (CD·ROM vcrsion). New York, NY: McGrawHiII, luc. He'llrh Profcssions Di"ision, 1994.

44

>11/1 Medicine-/3th

4; Kellcy WN. DeVilaVf,JR ,el al, edilors. lexlbook ofIlI/emal Medicille-2nd edilion. Philadclphia. PA: JI~ Lippincoll Company, 1992.

Harlo\V D. Park M. A longitudinal slUdy of risk factors for ilie occurrence. duratiou and se\'erilY of menslrual eramp in '1 cohon of collegc women. ilr} ObsUl G)'lllltrol 1996 No\,:103(1J): 1134-1142.

.J6

47 Willcman Jc' Willell WC, el al. Rclation of moderate aJcohol consllmplion :ll1d risk of syslemic hypcflen ion in women. } Cnrdiol1990 Mar 1;65(9):633·637.

48 Kaplan M. Aleohol and byperren ion. 24:345(8965): 1588-1589.

Lllnul 1995 Jun

4' Ma Mahon . Alcohol consllmplion and hyperlension. flypenemion 1987 l'eb;9(2): 111-121. 'o US Depanme.1ll of Health and Human Services. Effecls of Akohol on

Hcalth ami Boely Syslems. In: EighllJ SprcilJ! Rrporl to IlJ,' US Congrrs> on Alcoholll11l1 Heldtb. NJtionallllslilUlCS of Hea.llh (NIH) Publicalion No. 94-3699. Sep 1993 p. 177-178. 1 • Dawson DA. Adams PE CnTTelll t'stimaus from IlJr Nlllio/llil HelllllJ [mrrlJirlll SlIrvry: United Sllurs, 1986. HY:lltsville, Mar)'land: US Depart-

menl ofHcahh and Human Serviccs, Public Heahh Service, 1987; DHHS publie:uion ilO, (PHS)87-1592. (Vila! and heahh slalistics; series 10, no. 164). ;2 National Cemer for HCaJlh SlatiSlics. Bloodprmure lezJeli ill P,.,.SII1/s 1874 Jl'IlI"S ofagr in J976-80, IInd ,muls in bloodpIYmm from J96010 J980 in riu United SIlim: data from the adonal Health Sllrvey. Hpnsville. Mary-

Iand: US. DepanmCIII of HeaJlh :Ulei Human Services. Public Hcalth Service. 1986; DHHS pllblic..1Iiol\ no. (PHS)86-1684. (Vilal and hea.hh Slalislics; eries II. no. 234).

I\n epidemiologieal approaeh 10 de cribing risk associaled \Vilh blood pre.sure le\'c1s. Final repoCl of lhe WOl'king Group on Risk and High B100d PrL~urc. H)'pt:rlt:llsioll 1985 Jul-Aug;7(4):64 1-65 1.

S3

Cenrers h:>r Dise:15e Colllroi and Prevelllion. Perspeclives in Disease Prc\'emion md Hcahh Promolion Surgcon Gene-rars Workshop on Hc.alth Promotion and Aging: ummary Rccommcndations of the Alcohol Working Grollp. M.MWR 1989 Jun 9;38(22);385-388.

S

451

PROOF POSITIVE ;; Friedman G. Klat-ky AL. Siegdaub AB. Alcohol intah and hypcnension. AIII1 1llu:m M~d 1983 May;98(5 Pl 2):846-849.

Med 1989 Jun 29;320(2·6}:l748-1749.

)6 Gruchow HW. Sooocinski KA, Barboriak JJ. Alcohol. nurrielH inrake. and hypertension in US adults. JAMA 1985 Mar 15;253(11): 1567-1570.

7' IsscJbacher KJ. Braunwald E, el al, editors. Hlrrrisoll's P"illcipUJ ofllller1101 Ml'dirillc-13t/J edition (CD-ROM version). New York, NY: McGraw-

Hilloom M. Haapaniemi H, et al. Recenr akohol con umption. cigarerte smoking, and cerebral infarclion in young aduhs. Sr,.okc 1995 Jan;26(1):40-45.

HiJl. Inc. H('aJth Prolcssions Division. 1994.

;7

8 US Departmel1l ofHeahh and Humat! Services. Epidc.miology of Aleahol se and Alcohol-Relalcd Conscquenccs. In: Eighlh Spl'ciol &pon ro tiu US COlIgrm 011 AlcobolltnllHen"b. ationaJ 1nsrilUles of Health (NIH) Publication No. 94-3699, 1993 p. 21.

US Depanmenr of Healrh and Humall Servic.cs. EUcers of Akohol on Healrh alUll30Jy Sysrems. In: [:.'ighrh Sp~cil/I Rl'porl ro tbl' US COllgms 011 Alcoh%lld Hel/llb. NarÎonal fnSlilUle of Healdt (NI H) Publicalion No. 94-3699. Sep 1993 p. 175. 59

(,() Donahue RJ~ Aboou RO, el al. Aloohol am! hcmorrhagic slrokc. The HonolllJu Hcan Program. )A!vlA 1986 May 2:255(17):2311-2314. DOllahue RP. Abboll RD. er aJ. Akohol and hcmorrhagic Slfokc. The Honolulu Hcarr Program. JAMA 1986 May 2:255(17):2311-2314.

61

US Departl1lenl ofHcahh ,md Hllman Serviecs. Efl"crs of Akohol on Healrh and Body Systems. In: Eighlh Speciol Rep0,.1 tO tl}e US COIIgre.ss OII Akohol tIlld Hl'Itlth. Nalional InstitUleS of Heahh (NI H) Publicadon No. 94-3699. Sep 1993 p. 174-175. 62

S Department of Hcalrh and Human ervices. EAects of Alcohol on Heahh aod Bod)' Syslems. In: Eigbth SpNi"l Rl'porl 10 riu US Longn--ss Oll AlLobol and Hl'flltb. National In tirmes of Heallh (Nil-il Public3lion No. 94-3699. ep 1993p. 174_ 6)

U.S. Depe of He
64

Barrke A. Chronic DislUrbanccs of lhe Hypothalamic-Pituir
65

G6 McGiverll RE. Rilcy EP. Inl1uence of Perin:llal Aleohol exposure on sexual diilerelllialion. hl: Zakhari S. edilor. Alcohol Ollf} riu Endocrine ~YSltm RI'JCo,.(b MOllogmpb-23. Nalional Institute 00 Alcohol Abuse aod A1coholism.; I H Publicalion NUl1Iher 93-3533. 1993 p. 223-248.

67 McGivern RE. R.iley EI~ Chapter Il: Inl1uencc of Peri natal A1mhol exposurt' on sexual differenti:llion. In: ZakJl:lri S. edilor. Alroholl1J1d tIu Endocrine sysmn Resettn'I} M(JIIogmph-23. Nationallnsliullt' on Alcoho) Al use and Alcoholism.; NIH PubJic.~tion NUl1lber 93-3533. 1993 p. 223224.

Hammond. RL. edilOr. A/most III/rou eva wllflted ro Jmow' lrbOnll/Jcohol: 'bll/ didrâ kllo1lJ wbo 101uk! Speciallssue ofThe Bonom Line on A1cohol in Sociely 1991 11 (2):56-60.

6S

U.S. Dep'. of Healrh aud Human Scrviccs. Alcohol. In: TIu Surgron Gmmrl's Reporl OII Nll/ririon I1IItI Hel/lth. Public Hcallh Service DHHS

69

(PHS) Publicarion Number 88-50210, 1988.1" 642. U.S. Dep•. of H('alrh and Human Scrvices. Alcohol. In: TIu SW'gron GU/emls Report 011 Nutrilion dlld HeoLrh. Public HCallh Service DHHS (PHS) Publication Number 88-50210. 1988.1" 642.

70

U.. Dep!. of H('alrh and Human Serviccs. Alcohol. In: The Surgeol1 Gmuali lVp0rl OII NUI/'itiolt mut Hl'Irlt!J. Public Heallh Service DHHS (PH ) Publicalion Numb('r 88-50210. 1988.p. 640.642.

71

n .5. Dept. of H(':t1th and Huma.n Services. Alcoho!. In: TIu Surgeou Gmemli R~p0rl 011 NUlritiou lInd Heolr!J. Public He"lhh S"rvice DHHS (PHS) Publicalion

452

umbcr 88-50210, 1988'1'.643-649.

RirzJ. The mie of nalUral killer cells in immun,e surveilJaocc. N El1glJ

7

Wjlliamson Df, Formali MR. el al. Aleoho! and body weighr io Uniled eales adults. Am) Public H/'IJt!J 1987 Ocr:77(10}: 1324-1330.

7;

U.S. Dept. of Hcalrh Jud Human Services. Alcohol. In: TIu urgeoll Gmerdls lVp0rl on NutritiOI1 ond Hl'oith. Public HeaJlh Service DHHS

76

(PHS) Publicalion

N~lmber

88-50210.1988.1" 639-641.

Harlo\V SD. Park M. A 10ngilUdinai sludy of risk faclOrs for the occurtence. duralion and severi!)' of menSlrual cr:unps in a cohorr of college women. ilr) Obstet Gynoelol1996 o\'; 103(11): 1134-1 142. 78 Klal ky AL, Armstrong MA. Fricdman GD. A1cohol and monaJiry. AmI lllurn Med 1992 OCI 15; 117(8):646-654.

7~ Klatsky AI .. Armserong MA, Friednlan GD. A1cohol and MOflalily. AIIII IlJum Med 1992 Ocr 15; 117(8): 646-654.

R" SriJlSon FS. Parrish K. Nob!eJ. Epidemiologic BullelilJ No. 25 Alcohol consumplion in a 1986 sample of dealh. A/cobol HL"lIIr!J Re; Wlorld 1990; 14(2): 154-162. a. quoled in (JS Dep:mmenl of I-Iealr.h and Humall Serviccs. Eig/Jlb Spl'riol R',!,oIY to rbc US Dmgms OII AflolJol ond HMItb. NJlionallnSlilllles of Healrh (Nlrl) Publication No. 94-3699, Sep 1993 p. 15. Balaban DJ. Epidemiology and Prevcnrion of Sclccled Chronic 111nCSSes. III: CaSSCllS BJ. ('ditOl. Pre/lmriv~ A1edieinel11Jd Public HroltlJ--J:'d editio1J. Philadelphia, PA: Harwal Publislling, 1992 p. 147-148.

81

82 Hammond. RL editor. A1most oII YOII e/lrr 1111I1Jud 10 k1JolU' I/bollt o!cobol: 'bllt didll't k110llJ who 10 IIsk! Special Issue ofThc BOllom Linc on

Alcohol in Sociery, 1991 11(2):34-35. Parker DA Parker ES. CI al. Alcohol lIse and cognitive 1055 among employcd mell alld womeo. Am) Public Helll,!J 1983 May:73(5):521526. 8.1

US Deparrmellt ofHeahh and Hum311 Services. Acrions of Alcohol OII lhe Brain. fII: Eighlh Spl'ciol Rt'porl 10 tiu US Congn-JS 011 AleolToll11rd HtoltlJ. Narional IllSlilUles of Healrh (NIH) Publication No. 94-3699. Sep 1993 p. 100-101.

8

~ Rou MA. Acker \VI, el al. Complltcrized IOmography of lhe brain in d1l'onic alcoholism: a Survc)' and follow-up lud)'. Bmin 1982 Sep: I 05 (Pl 3)0:497-514.

US Deparrmenr of Ht'alth and Human ervices. ACliolls of Alcohol on rhe Brain. In: l:/glJlb Speciltl Rrport to Ih~ US COlIgreS. 011 AlcolTol fl1ld H"ltltlT. Nalional InstituleS of HeaJlh (NIH) PubliC:lliUll No. 94-3699. S 1993 p.IOO·IOI.

M

Rodrigue'L Argaiz FJ, Rico Irles J, el al. Cerebral al ruph)' in chronic alcoholism. AJl Med ImmllJ 1989 Nov:6(l1):571-574.

87

U.S. Depr. of Heallh and Human Services. AJcohol. In: The Su"gco1l Gmmrl's Rort 011 NUTI'itioJllllld Heolrh. Public Healeh S('rvicc DHH

88

(I)HS) Public.1tio/l Number 88-50210. 1988.p. 653-655. Il'! U Departll1cm ofHealrh and Hunun Sel'\'iccs. Psychiatric Comorbidity wirh A1cohol Use Disorders. In: Eigbtb Special lVport 10 riu US COllgrrJS OII Aleoholl1>JlI Ht'oltb. Nalional 1nstillJrcs of Hcahh ( lH) Publication No. 94-3699. Sep 1993 p. 37-43.

Bravcrman' R , Blum K. Substance llSC disord('r exacerbare brain elecrroph)'siological abnormalitics in a psychialricaJly-ill populat ion. C/ill t{,.ctroC//cl'jJbalogr 1996;27(4 Suppl):5-27. 90

Balaban DJ. Epidemiology and PrevelHioll of e1ect('d Chron.ic 111ncsses. In: Cass(,IlS BJ, cJilOL PreVl'lllÎvl' Medici1l~ olld Public Hmlt!J-2'''' edition. Phihdelphia, PA: HarwaJ Publisbing. 19921', 147-148. OI

WANT A DRINK? n Swamwelder l-IS, Wilson WA, Tayyeb MI. Age-depcndcOl inbibition oflong-ccrm potenriation b!, edlanol in immarurc versus mature hippocampus. AlrolJol C/il/ExpRes 1995 De ;19(6):1480-1485. US Depanment of Health and Human Serv;ccs. Eflects of Aleohol on Feul and Postnat,,1 dcvdopmenl. In; EiglJlh Special Report ro riu US Cong>'Ni on AlrolJol dnd Hmlrb. National Instilult'S of /-Iea.lth (NIH) Publicalion No. 94·3699, Sep 1993 p. 221. 9)

US DepanmclIl of Hcalth and Human Services ElTects of Aleoh Ion Fetal and Postlmal developmenl. In: EiglJrh Sprcul/ Rep0rl ro tlJt US COIIgreSi on AlcolJo/lmd Hea/rlJ. ational !nslilutcs of He:llth (NIH) Publicalion No. 94-3699. Sep 1993 p. 203-205. ?oi

U-S Danmelll of Hcahh and Human Service'>. EO...·CLS of Aleohol on Felal and Postnmal developmenl. In; EigJJlh Sperial Report ro riu US COIIgress on A/coho/ and Hen/rh. ationallnstitulCS of HC:llth (N 11-1) Publication No. 94-3699, Sep 1993 p. 203-232. 9S

fmd Hea/th. National 11lStillHCS of Health (NJH) Publicalion No. 943699. Sep 1993 p. 242-243. llu Fedt'l'fr/ Aviarioll Rrgll/ I Aeronaff1iClJ/ /nfomwrion 1I1f1111ffrl 97 (FARAIM). FAR Parr 91.17. U.S. De-parrment ofTransporr Regulations.

1997 p. 132. International Organizalion of Good Tcmplars. Abslincnec in lhe US rcachcs 44%. Nl1Jiolffrl Good kmpulr 1994 Sepll'mber 40(8); 1. III

111 US DeparrmcllI of Heahh and f-1uman Sen·icl".. Epidcmiology of AIcohol Usc. nd Alcohol-Relaled Consequenccs. In: EighrIJ Specill/ &.pon ro tiu US CongrrsJ on A/coho/alld Healrh. Nalional InSLilUlcs of H(:altb (NIH) Publicllion No. 94-3699, Sep 1993 p. 3-10.

113

Proverbs 22;3. 11Je Holy BibLr. AUlhoriud King Jallll:5 version.

R.·Ulkin JG. Ashle}' MJ. AI ohoI-relaled Health Problems. In: Last LM. Wallacl' RB. cdilOrs. Ma.xcv-Rosenau-Last, Pllblic Herrlrb and Puvmlille MedicfllJ:-J3 lil edition. ~rwalk. CT: ApplClOn and unge. 1992 p. 745-747. IH

% McGivern RE, R.iley EP. Chapter II: Innuence of Perinalal Alcohol cxposure on sexual dilTcrellliatioJl. In: Zakhari S, editor. A/robol ami rhe EndorrifJt systnn.. Nalional InstituI(' on Alcohol AhuSl' and AlcoholisllI; Rcsearch Monograph-23. 1 Il-! PubJie3.tion Numbcr 93-3533. 1993 p. 223-248.

ilS Rankin J •. shley MJ. Alcohol-related Health Problems. In: L1S1 L.M. WalJace RB. edilOrs. Ma.xcy-Rosenau-usl. I'lIb/i,. Hmlth alffl Prevmri"r Ml'llicill/!-J3,b N}i/ioll. No~walk, CT: Appll"wn and Lange", 1992 p. 746.

'J7 McGivern RE. Riley El'. Influenee of Perinatal Al ohol exposure on sexual diiferenlialion. In: Zakhari S, edilOL AkohoL fmd rhe Endocrille !Jstem.. Natiollal lllStÎtlHC on Al ohol Abu C and Alcoholism; Rcseareh Monograph-23. NIH Publication Number 93-3533. 1993 p. 223-224.

116 World Hcahh Organizalion. The WHO MO rCA ReparI: a worldwide moniloring SystClll for cardjovasculu discascs. In: \'{Iorld fhaM} Sf/Irii/ics Alllllla/. Geneva, Swit'lerland: World l-Iealrh Organi'latiotl. 1989: 27·59.

US Depanmem of Healrh and I-Iuman Ser\'iccs. ElTects of AlcohoJ OII Fctal and PoslIlatal development. In: EiglJlh SpelÎa/ Rrpol'f ro rhe US CoIIgms OII Aleobo/ nlld Hra/rh, 'alionallnslitutcs of Hcallh (N IH) l'ubliC3cion No. 94-3699. Sep 1993 p. 205. 98

117 ecly S. DicL and rorona.ry djsease: a survey of morulilY rales "nd fooel consulllption stalisLÎcs 01'24 coulllrics. Med HJpotlmes 1981 Jul; 7(7); 907· 918.

99

II~ R.ank P. Milk and arreriosclerosis. Med HJpot!mes 1986 JuI: 20(3):317338.

urroque B. Kaminski M. el al. Mod<:r:ue I'ren;lIal Aleohol Exposure and Psychomolor DevclopmCl1t at I'reschool agc. AII1J Public HenLrh 1995 Dcc;85(J 2): 1654-1661.

119 Arraud-\'V'ild M. Connor L. el. al DilTerenet'S in eoron;try morlaJity can be explained by dilTercnces in chole_~lerol 'lIld salurated fat illlakes il) 40 coumries bUl nor in Franee and FinJand. A par~ldox. Cireu/miOIl 1993 Dec; 88(6): 2771-2779.

Jacobson JL, Jacobson S~ et al. TeratOgenic clTecIs ofa.lcohol on infam devclopmem. AlcohoL Ciill Exp Re! 1993 Fcb; 17( 1): 174-183. \00

101 Sbu XO. Ross JA. Pendergrass TW. el al. ParemaJ aleohol con lImption. cigareuc sllloking. :llld risk of intanl leukelllia: a Childrens ancer Group stuJy. J Narl Collccrll1Jt 1996 Jan 3;88(1):24-31.

U.S. Dept. of HCallh and Human Scrviccs. Akohol. In: TIu SlIrgeol1 Gmemt's &p01'1 01/ Ntltririol1 al/d Hca/fh. Public Hca.lth Service DHHS (PHS) Public:nion NUlllber 88-50210. 1988.1" 659-660. 101

US Prevcmi\'c Services Ta k Force. Counscling to PreV('nl Motor Vehicle Injurics. In: Gllide to C/itJica/l'revrmive Senfiaf. Baltimo,,', MD: WilliWl5 aJld Wilkins. 1989 p. 643-644. 10J

US Pr(:vcJllivc Serviccs Task Forec. Counseling 10 PreveJll Motor Vehiele Injuries. In: Guidc ro CLillic,ti PrevemÎtJ(' Services. Baltimorc, MD; Williams and Wilkins, 1989 p. 643-644. l()ol

US Preventive Servicc:s Task Foree. Counscling to Prevcnt MaIor Vehicle Injuries. In: Guitb ro Ctiniml fuVC7lrillr Servi/·ef. Balrimore, MD; Williallls and Wilkins. 1989 p. 643-644. 105

Zador PL. Alcohol-relaled relalive risk of f';lIal driver injurie in relaLion ro driver age and sex. J Smd A!L:ohol 1991 Jul;52(4):302-310. 106

107 Hammond, RL, edilOr. AJII1Q.f1 al/JOII evcr wIIJ1fed ro Imow' abOllr aleohol: 'bllr didni know who ro aik.' Speci:l.! Issue ofThe BOllom line on

Alcohol in Sociecy. 1991 11(2): 106. 108 US Deparrmenr of Health and Human Service;. Effecls of a1cohol on bchavior and safer}'. In: EiglJfh Sprcid} &p0rl ro rhe US COIIg>'r;s on A/coho/ f1lld Hta/rh. Nalional Insuttllcs of Hcahh (NTH) Publicarion No. 943699, Sep 1993 p. 242-243.

US Depanmenl ofHL-alrh and Human Services. ElTcc.ts of aleohol on behavior and safety. In: Eighrh Specia/ Rrport 10 tiu US Congl'tSi OII A1coho/ 109

120 Seg;ll1 JJ. Dielary IaClosC as a possible risk faclor for ischaemic hearr dj case; revicw of epidemiology. /m J Cttrdiol 1994 OeI; 46(3): 197-207 121 Phillip RL, Lemon FR ,el al. C:oronar)' heart discase monality alllong Sevcnrh-Day Adventisrs ,,~th dilTcring dictary habils: a preliminar)' repon. Am J C!ill Nttrr 1978 OCI;31 (10 Suppl):S 191- 19R.

Il~ DCJJlTo\V l-!S. Slane PR. Folts JD. isltalion of wine and grape juice inhibi(s in "ivo plaldet ,ctivit)' and ,hrombosis in len05ed caninc coronolr}' ancries. Cirmlatiol/ 1995 Feb 15;91 (4): 1182-1 188. 123 Dcmrow l-!S, Slane PR. Folls JD. Ad(niniSlralion of \Vine ,md grape jnice inhibits in vivo plmclcl acrivil)' and lhrombosis in slenosed e:lninc coronar)' ar!erics. Circlf/fuion 1995 Fel, 15;91 (4): 1182· 1188. 124 Keller JW, Folts JD. Relative e(fecls of cigarwe sllloke and cthanol on aeUle plalclet thrombus formation În slenosed canine coron:uy afleries. Ctmtiovf1Sc R(s 1988 Jan;22(1 ):73-78. .

l-!ammond, RL. editor" A/mosf aliJOII (1)/'1' Wf111Utl ro knoflJ' 11bo"r It!cObm didn; Imow wbo to /l.!k f Special Issuc ofThe Bonom Line an Aleohol in Socicty. 1991 11(2):106. Il;

boL'

l-Ialllmond. RL, editor. Almosl ol/)'Ott etJer walf1rd ro kll()w' abolit a/co10 ask! Spt'cial lssllc of The BOllom Linc on Aleohol in Saciel)'. 1991 I 1(2): J06. Il6

bol: 'bttr tfitlni knollJ wbo

Il Slane pR, Qurcshi M, Folts J D. Platclel inhibilion in . tenosed c.lnine artcries by qucrcetio and rUlin. polyphenolic fla\'onoids fOU1ld in red \Vine. C!ill Res 1994;42(2): 162A. (Abslract)

L.S DClllrow HS. Iane PR, Folts JD. islr:lIion of winc and grape juicc inhibil in "ivo plalelet a tivily and Ihrombosis in stenosed caninc coronary arterics. Cimrlnrion 1995 Feb 15:91 (4): 1182-1 t 88.

453

PROOF POSITIVE Il9 Hcrtog MG, T'eskcns EJ, Ct al. Dierary anrioxidant navonoids and risk of coronary bcaft dise3.~e: Ihe Ztuphen Elderll' Srudl" uma'r 1993 Oct 23;342(8878):1007-1011.

141 Tufts Un iversi 1)'. Special Report: Uncorking lhe facls aboul alcohol and you hl:ahh. Tufts Univc",ity Diet aod NUlrilion Lener. Augusl 1995. 13(6):4-6.

13U Steinbcrg D. Path3.~arad\y S, el al. l3eyond choleslerol. Modific1tions of low-density lipoprotcin thar increasc ilS athcrogeoicit),. N El1gl j Me/} 1989 Apr 6;320(14);915-924.

I j Tutts Universily. Special Reporr: Uncorking lhe f.1CtS aboUl alcohol and l'ou health. Tuns University Oiel and Ulrilion Lener. AuguSt 1995. 13(6):4-6.

nI Henog MG. Hollman PC. el al. Illlakc of porenrially anliCircinogcnic navonoids and lhcir dcrenninallts in adults in Thc Nelherlands. Nllrr Cmc" I993;20( 1):21-29.

Iflorld Hea!Jh Orgll1liUlIio11 P1't'SS Relmlr. November 1. 1994.

SC1mbia G. Randlcuj FO, er al. Inhibitory clrCCI of quercerin 00 OVeA 433 cells and prescnce of type Il OC-Strogcn bindiog sites in primary oV:Hian lumours and culturcd cdls. Br j Cmccr 1990 Dec 62(6):942-946. I 1

I 1 Yoshida M, YamamolO M. Nikaido T Quercelin arresls human leuke· mic '1'- cii in Iare G 1 phase of rhe cel I cy le. (imea Res J 992 Oec 1;52(23):6676-6681. IM Baylor NW, Fu T. Ct al. !nhibilion of hum;ul T celllcukernia virus by l!le pbnl l1avolloid baicalin (7-glucuronic acid. 5,6-dihydroxynavone) . .1 IlIfcr Dis 1992 Mar;165(3): 433-437.

I.IS Henog MG, Feskens EJ. et al. Oielary amioxid:u\t Ihvonoids and risk of coronary hean diseasc: lhe Zutphell Elderly Sludy. Ll1l1cn 1993 OCI 23;342(8878):1007-10 II.

Minisca!co A. Lundah! J, et al. Inhibition of dihyclropl'ridine melabo· lism in raI and human liwr miClosomes by Aavonoids found in grapcfruil juice. j Phamlfleol Evp Tim 1992 Jun;26 1(3):1 195-1199. lJ6

Ngul'en TO, Canad3 AT. CitTus Ilavonoid slimulate secretion by human colonic T84 exUs. J NUIr 1993 Feb; 123(2):259-268. 137

Demrow HS. Slane PR. Folls JD. Înislr:llion of wine and gr3pe juice inhibilS in vivo plalelcl activicy and thrombo is in slenosed Clnine coronary arreries. Circularion 1995 Feb 15;91 (4): 1182-1 188. 13&

\j9 Frankd EN, Walerhouse AL, Kinsella JE. Inhibirion ot human LOL oxid.uion by resvcr:lUol. unm 1993 Apr 24;341 (8852): 1103-1104.

Emblad. H. Moderate drinking: seri ou warning by WHO pedalists. 14~ Emblad, H. Moderale drinking: serious warning b)' WHO specialisls.

lVorlti Healrb Orgl1niultioJl Pms Rr/r/lir. No\"ember 1. 1994. Demrow HS. Slane PR. Foles JD. isrration of wine aud grapc juice inhibits in vivo platclcl activity and thrombosis in steno "d canine coronary arteries. CirmlatiM 1995 Feb 15;91(4):1182-1188. 146

1-17 While EG. COli/uel, OII Diu alU!Foods. Hagerstown. MD: Review and Herald J'lIblishing AssociatÎon, 1976 p. 436. 437.

HalDmond. RL. editor. A/mosr oII yOlll'vcr wanud ro knolV' I1bout alto10 'lsk! Special Issllc ofThe Bonom Line on Alcohol in Soc;iell', 1991 11(2):77. H8

hol: 'bUl ditlll1 know wbo

I 9 Bacchiocchi S. \\71"" in Ibe Bible: A biblical sIuJy on rbe USi! oftlkoboli,. belltrllgn. Berriell Springs. MI: Biblical Perspcclives. 1989.

\~O White EG. timulallls. In: /1"I1/r/'jill LilJing. 1897 p. 113. .Emw.dl.n: Ellen G. Whitc Estate. Tbe Publi.rlJed Wrilings of Elim G. VtllJiu. Version 2.0 (CD-ROM). 1995.

1<,

McCoy C. Booze flows back into Barro\V, Alaska aflcr rearlong ban.

TIu W'all Slrm }Olll"lllrl. Prob. No\'. 15. 1995.

'Il McCoy . Boo7.C nows back imo Barrow, Alaska ahcr yearlong ban. Ţhe \'(/011 Srrl'l't jourJIl1l. Prob. Nov. 15, 1995. 1'3 Bacchiocch.i S. I,(/i,ll' in riu Biblr: A bibliC/li srlltiy on rhl' Ilse oftllt:oholi,. brlJerIrges. Bcrncn SprilJgS, MI: Biblica! Pcrspeerives, 1989 p. 38.

l~' Bacchiocchi S. Winl' ill riu BiMe: A biblica! stlld:r 011 Ihe If,Jr ofalcoholie brlJemgcs. Bcrricn Springs. MI: Biblical Perspccrives. 1989 p. 36.

140 Jang M, Cai L. Udeani GO, et al. Cancer chemoprevenlive aerivit), of re$veratrol, a nalural product dcrived trom grapes. Sl'imu 1997 Jan 10;275(5297);218·220.

ISI Bacchiocchi S. \\7Irll' in ti", Bible: A biblical SIlld,'Y OII riu IlU ofaltobolic bl'llerlrger. Berrico Springs. MI: Biblical Pcr peerivcs. 1989. p. 36.

1 I Thc Food l'roc(:ssor for Windows: Nutrilion Allah'sis & Fill1css Sofrware [compulcr program). ESHA Rese:!rch. Salem, Oregon.

I 6 Whirc EG. Carmuls OII Diell11u/ Foods. Hagemown. MD: Review ;Ind Herald PublishingAssociation. 1976 p. 309.

454

CHAPTER EIGHTEEN

DEALING WITH BAD HABITS AND

DICTIONS W

h Y do we ofcen break our mosr noble New Year's resolurions? Why-ar any rime of rhe year-do we somecimes seem so powerless ro make healchful changes in our lifescyles? These are quescions chac my pariencs ofcen ask when 1 speak co chem abourlifescyle change. There is a myriad of common problems char ehey struggle wirh. There is rhe overweighc diaberic who cannor seem ro break away [rom chocolare, che habicual smoker who cannor seem ro give up cigarecces, aod rhe individual wirh high blood pressure who caunoc seem ro srick wich rhe exeecise program chac he knows he needs. No maccer whecher your challenges are similar ro or very diflerenc from chose examples, aII of us ac rimes srruggle wirh rhe need ro change our mosc esrablished habics. Why do we find it so difficulc? Some would say che problem is ehac we are deal ing wid) addicrions. No doubr chere is much Hurh in rhis insighe. However, nor every lifescyle sHuggle is rhe resuh of an addicrion, even rhough there are addictive componenrs ro many of our behaviors. Funhermore, even if the area we need co change is nor a forrhright addiction, an underscanding ofsome of che basic approaches ro dealing wich addiccive habits can help us wirh rhose lifescyle challenges.

What is an Addiction? Whar really Îs an addiccion anyway? Surprisingly, even rhe expens give differem dehnitions as ro whar conscicuces addicrion. For example, 5redmans Medica] Dictionary dehnes it as "habitual psychological and physiological dependence on a substance ar practice thac is beyond voluntary control."l This dehnirion is a good stare. To help us get a elearer view of what constitutes an addiClion, ler us look ar five common characteristics ofaddictions, as liseed in Figure 1. 2• 3. -1

cs • An overwhelming compulsioD to continually use au ageut and a resulting drive to obtain it by any mcans ncccssary. • A condition called "tolerance," where over time there tcnds to be a need for increased amounts of an agent to obtain tbe desired effects. • A psychological andJor pbysical dependence sucb tbat failure to obtain the agent results in witbdrawal pain or discomfort. • A high teodeucy to relapse, evco after a persoo bas broken away {rom babitual use for a period of time. • A detrimcotal effect ou the individual and/or society. Figure 1

455

PROOF POSITIVE Not aII of rhese criteria have (Q be fiet for a habir ta be classified as an addiction. BUl the broad scope of effects arising from addicrive agems is helpful ro be aware of. Whether a habit is cla5sihed as an addiction is nor the important issue. Whar is critical is rhat many habirs have addictive componems and dettlil1g with the habit ilS an addiction i5 Jikely (() meet wich success where other approaches have [liled. The mos( imponant aspect of an addicrion is crystallized in Sredman's dehnition where it speaks of a loss of control. This element of compulsion is the mase crirical aspect of addictive behaviors. For example, a person who decides ro eac just one chocoIare in a box bur. ends up ear.ing half the box is likely demonstracing an addierion ro chocotate based on (his probable evidence ofcompulsive eating. True, the person may not go through a wi(hdrawal syndrome if rhe use of chocolare is sropped; rhere may be no signs of desi ring progressivdy larger amounts ofchocolare-yet. rhe crioGlI compulsive element is there. The same could be truc of ice cream addicrs ar (hose who compulsively wacch t.elevision. Of course, those who are addicced co nicorine, alcohol, or drugs will fic the dassic addicrion definicions more srricdy. However. the truth is thar any habit in yom life lhat is not (()cally uneler your voluntar)' control displays an addicrive e1emem-whether or not it is called an acldiction.

The Problem with uModeration"

456

Why is a broader deflnition of addicrion so irnportalH? It is crucial in view of the faer rhat many people never break free of their most ingraincd hahirs because of rhe faUaey of"moderaeion." I finei rhis true especially in the area of problem foods. Consider the example of rhe person who could not control rhe consumprion of chocolate. Mall}' healrh educators would say it is fine to use chocolate-if it is lISed in moderation. This advice misses an important poillt; thac is. an individual who has a compulsive rclarionship ro a food can no more use it moderatdy than an alcoholic can rerurn ta "moderate" drinking or a nicotine addict can rcrum tO "moderate" smok-

ing. In deal ing with anyaddietive habit, total ttbstinenu.fOr lift is necessary.

Needfor Total Abstinence Some may thjllk that this is a cruel anei narrow-minded approach. In the short run, this may he a difficult concept tO embrace. But if you have al1 addictive habit and really want success, you will need ta make a c1ean break wirh iL The amazing ehing i$ rhat in the long run, commitring ro an immediate change is actually the easiese approach. We actually have the capacity ro choose whar we wiU enjoy. Ifwe habitually engage in cenain hehaviors, especially if ehey give us some rewarel (such as better health 01' increased feelings ofsatisfaccion). we wiU tend to develop an enjoymem for those new habits; rhar is, we free ourselves ro develop new enjoyments and new hehaviors. If, however, we "reward" ourselves wirh ehe "bad habit" periodically, as some people advocare, we undermine our ahiliey ro develop enjoyment for a lifesryle that is free of dut agenL Let us draw anocher lesson from the person wirh a chocolare addictlon. That individual may break free from daily lIse of chocolate and experience a los5 in weight, better connol of blood sugar, and may feei betrer as a result. However, if a "reward" of chocolate is raken once a monch, ehe srage is set for a downfall. Although the individual may still Iose weight and improve diabetes control on the once-a-mollth chocolate regimen, frcedom from rhe addiction of chocolate has not been attained. The desire for chocolate is being kept alive-and mayeven be increased. giving rise ro feelings of a deep, distressing sense of d.eprivation. In most cases, sooner Of iater this individuaJ will be back ro the former level of consumption-or worse. If, however, chocolare is permanently abandoned and the rhoughrs directed towarel rhe joy of being free of rhe subsrance, rhe chocolate element in liJe would not be missed. The taste buds actually become re-educared aod the desire is gone. Even if you are nor dealillg with an addicrive substance, a eemplere rejecrion of it is the best srraregy. Consider, for example,

DEALING WITH BAO HABITS ANO ADOICTIONS rhe person who realizes char the consumprion of red mear is cOlmibuting ro high cholesterol aod heat{ problems. Lcr us sa)' rhar there was no element of compulsion in rhis individual s cating habits. A small piece of stcak, pork, OI' Iamb is sarisfYing. Nonetheless, chis persoo comes ro the convicrion thar cven small amounts of red meat are making cenain healrh problems worse. It will LJsually be easier ro cut out red meat completely, racher rhan ro cut down. 1 could give onc hundred more exampb ta illusuacc rhar breaking ir dean will dramatically increase the likelihood of your success. At chis poine, some of you may be saying that it soullds good but it wiJI not work for my probleOl. Maybe your worst habir is overearillg-sure1)', you reason, you cannot stop d'lis habit sucldenly. In problems like rhis, I recommend rhar you look carefully at your lifesryle and make a change in some aspect ofthe behavior. For example, rhe overeater may have no problem wirh overeating ar breakfasr or avere.atillg vegetables ar lunch ar supper. He ma)' have a problem, however, with desserrs a/reI' supper. Perhaps a complete break should be made with desserrs. The premise of rhis chaprer is rhar we need ro take a lesson from dassic addictions and apply ic nor only ro the obvious addictio05 in our lives but ro orher habits d1ar need changing. Those who are dealing wirh smoking, a1cohol, eaffeine, ar addictive drugs are probabl)' welJ aware tim they need ro stop these habits entire1y. However, che same applies ro ocher areas of addicrion and habit-accepeing the need ro make a clean break can frec you from che cyele of making and breaking your firmest resolurions once and for aJl.

ldentify Habits that are Undermining Your Health 1 would challenge you to 100k seriously at yaur lifesryle and rhe habits that are undermining your healrh. You ma)' idel1ti~' areas where. abrupt changes nee.d ro be made in your life, yec you have no desire ro make such drastic changes. Your lack of desire may be re!ared ro the pleasure thar the habir

give , OI' your fear of railure. As )'OU read rhe remainder of rhis chapeer, however, you will learn ehar changing even your most cllerished habits will actually give you more pleasure in rhe long run. Furrhermore, regardlcss ofhow mally rimes )'OU have fatled in rhe pasc, the material dlar follows can help you be successful this rime. I want ta give you one other encouragemenr as you think abolit addressing areas ehat need changing in your life and ehe roor causes of your problems. 1er Ole ilJusuate wich an example. Let us say thac )'ou have rwo problems: overeating and lack of exercÎse. As you analyze these problems, you Mnd rhere is a rhird addiction that is the roor cause which is comribueing ro [he mher rwo. You realjze thar you are one of rhe individuaJs whose biggese obstade berween yOLl and a regular exercise program is rhe tinu: spent with tele'lJision. You also recognize ehar rhe TV providcs tlle se((ing for your biggesc problem wi[h overeating jllJlk food. YOllr lifesryle goat then may be ro address )'our televisioll addicrioll. If you are in complere conerol of yOllr viewing habies, it may be a matter of sening some specific guiddincs as ro when, whar, and how much you wiU waceh. Hawever, ifTV Ilas taken the mie of an addicrion in )'our life, a flrm and complete break may be necessary. It would allow )'ou time for dail)' exercise and desrroy rhe sening for overearing. Do not underesrimaee rhe addictive elements of tdevision viewing. Those who are addicted ma)' ar may not be aware of rlle addiction. Television viewing is linked ro mally bad habits and deleteriolls behaviors, inciuding violence. Chaprer 12, "The FrantaI Labe, rhe Crown of the Brain,' and Chaprer 13. "SremOling rhe Tide of Violenee," prescnts more informarion an this subject. Television is also a "eime-rabber." Mall)' individuals cannot control their televis ion viewing sufflciendy to aUaw cime for other areas of lifcsryle rhat need ro be addressed. For rhose. an llncompromising break with TV is in ardeI'. For some individuals, simply recognizing rhe need ro completeIy discotltiI1ue a lifesryle habit is aII rhe insighr lhe)' need. Once the)' embrace this concepr and put it

457

PROOF POSITIVE inco aerion, success is ensllred. However, addictions and other habits ofcen hold enorOlOUS conrrol over us. Many feel powerless to Stop chem althollgh rhey know ehar it is necessary. Take the example of Ralph Jones,' a patiem of mine wllo is in his early 50's. Ralph is a nicotine adclict-a cigareue smoker-and he knows rhar smoking is bad for him. Ralph also has bad coronary artery disease, and has already had by surgery and angioplasry. The angiogram shows thar his disease has beeome 50 advanced that the blockage has extended ro ilie mosr disram parrs of rhe arreries rhar ean not be byed. We cannot angioplasry him beC1Use ilie disease is so widespread: his hearr arteries are narrowed vinualJy throughout their entire length. RaIph needs ro qllir smoking and he kuows it. He has told me severaJ times, "1 know I am killing myself, hut 1 juSt cannot seem ro quit." Clearly RaIph needs more [han the imdleccuaJ acceptance; he needs ro break from rhe habit completely. He needs a SOUTee of power. The information presented in chis chapter is for him as well as for rhe man)' others (har have an addicrion ofany kind they "cannor" overcome. When you ralk witb those who have broken free from an addiction or other dim·

"But thanks be to God, which giveth us tbe victary through our Lord Jesus Christ."

1 Corinthians 15:57 Figure 2

458

cult habir, you will hear them give credir ro a variery of sources. Some will attribute Sllccess to their own resolve, others ro a program, sriH orhers ro friends or a sllpporrive group. However, in my experience one power more [han any other has been the most ef· fecrive in helping patients make needed health behavior changes---':the power ofGod. You can do somerhing abolit your addiction. Addictions do not have ro occur, and neirher do chey have tO persist. I have found thar it is necessary tO deal with deep spiritual issues ro permanendy conquer an addicrion. Otherwise, addicrions are very di/licult ro get rid of Many heahh professionals who trear addictive patienrs have failed becallse of rhe neglect of the spiritual dimension. Those who have met with long term SllCCess have approached addierion from a spiritual aspect-trust in divine power. 1 have seen God's power at work in my life and aid me in the area oflifesryle change. Such personal SlICceSS has inspired me to share that source of power wi th patiencs who are looking for help in conqllering an ad· diction. Like any physieian, what has worked În my practice is in parc what 1have experienced in my own life and what has worked in my patients' lives. The point is that 1 am sharing things dlat I know will work becallse I have seen chem work. If you have nor yet found SllCCCSS, there are methods that I have proven do work. 1 wam ro share from my experience how I have seen the principles of God's power ill His Word briug suceess in sitllarjons where it seemed impossible. Some may be sur· prised that rhe Holy Wrir eomains help for c1eaning out dle addicrions in OUT lives.

Christian Perspectives That Give Power to Conquer Habits and Addictions ter us begin by looking ar a powerflll Bible text dlat teIls us where we can find vicrory, and that has far-reaching implicarions for the subject ofaddiction. The verse is quoted in Figure 2. 6 The apostle Paul's words in Firsr Corinthians 15 reveal rhe ulrjmate victor)'

DEAUNG WITH BAD HABITS AND ADOfCTfONS rhar God provides over the power of dearh irself. From a Biblical perspecrive, [he end resulr ofsin is death. Î Thus, God's promise of vicrory over dearh implicirly means that God will provide victory over sin. Wherher we recognize ir or nor, most of [he habirs [har we see a need ro change are indeed mar(ers of righr and wrong. The book of James puts it chis way, "Therefore ro him rhat knowerh ro do good, and doeul it not, to him it is sin. "8 rf we are harming our bodies, rhe Bible makes it very clear rhar this is wrong and sinful. 9 AlI this may sound like a guilr rrip, but rJle verse offers vicrory, not guilc. God promises rhe vjcrory over sin and dearh. Sa, if we recognize (har a bad habit is sio, we have the promise (hat God will give us the victory over rhat habir. The pOiOl is rhar vicrory over addicrion is a gjFr rrom God rhar is provided t1uough Jesus ChrisL We can be rhankful (har vicrory js oUrS if we merely trust aur Heavenly Father. Yes, you can rhank Him in faith for rhe victory [har He has given you, even befim: you see the success in your life. Tobe successful in the arca of lifesryle dunge, it is nor necessary ro recognize rhar every habir is a sin. fu 1 have poinred out, however, in most areas of addicrion and pervasive habir. we are ralking about sin. We should not be afraid ro caII an area of our life sin-if ir really is exactly (hat. The recognition rhar a behavior is sin nO{ only gjves liS the prom ise of God's powet and vicrory, bur also frees us from the dual deceprions of "moderation" and "curcing down." The Bible never gives justificacion ca concinuc in sin. 10 It musr be cut our of the life, JUSt as [ruly as the surgeon curs a Clncer om of rhe body.

Daes Tapering offWork? Is it possible ro conquer an addiction by cureing down, or tapering off? Do you know of anyone who has acquired vicrory over alcohol, for example, by gradually tapering off? r have never seen it occur. It must occur suddenly, abruptly-whar is called "cold rurkey." If, for example, a person was ro begin by cutting down on alcohol or caffeine or nicorine use, ar. some poinc there must be a complere cessarion of rhe acriv-

ity. The recognitjon rhat a habic is sin calls for complete CfSSlttion of rhe behavior nolV. A word ofcamion is jn order here if you are addicred ro alcohol, prescription medications, or illicir drugs: qui[ chesc habits cold rurkey under medical supervision. Severe withdrawal symproms ofren occur. Receiving che gifc of vÎcrory as provided by God calls for an appropriace response. The individual makes a final break wirh the addicrive subsrance. Some may ask. "Would sllch a response be effecrive for someone who has aH addicrÎon ro TV?" le cenainly would be. You will find thac relevision is llor necessary. h is amazjng how one can ger along withollt it. Wichollt going inco rhe detailed a pecrs of every addiccion, rhe method is rhe same for aII addicriolls and troublesome habits-make a dean break. The recognirion chat a behavior is sin provides the srrongest motivat ion for such a dramatic departure. And it is a key elemenr in appropriating the suresr source of success: rhe vicrory that Gad has already provided.

Victory-A Gift from God Whar do we need ro do ro receive rhis gift of vicrory [rom God? Scripmre makes a very simple scaremenr, cited in Figure 3.

"lf ye then, being evil, know how to give good gifts unto your child.ren, how much more shall your F'ather which is in heaven give good things to them that ask bim?"

Matthew 7:11 459

PROOF POSITIVE

"Likewise reckon ye also yourselves to be dead indeed unto sin, but alive unto God through Jesus Christ our Lord."

reI' how foolish and wayward we have beell in the past, God 1S wiUing ro forgive, ro COI11plerely forgive, if we ask Him. If we are WilliJlg ro have Him guide LIS in :1 rcformarion in our life, He is wiUing ro provide rhe power for a roral and complere change. The Bible says dur wiJlingness ro have a compiere reformarion in the life is a necessary illgredicIH in rhe process of obraining forgiveness. 11 AFrer we have asked for cllC gifr of victor)' over an addicr10n, we need to consider it do ne, as expressed in Figure 4.

Make No Provision to Fad

Romans 6:11 Figure 4 Chrisr explains in this verse how ro obr;lin gifrs from God. We are to simpl)' ask Him, just as a child mighr ask his or her eanhly farher for somerhing. aur heavellly Facher is willing to give if we ask. Lcr us ralk ro God as ro a friend a personal frielld. Aher aU. He has a deep interest and concern for our quality oflife. The love of our Maker knows no bounds. He undersrands our problems betrer rhall we do. No l11:1r-

"But put ye on the Lord Jesus Christ, and make not provision for the flesh, to fultil the lusts thereof." Romans 13:14 Figure 5

460

We are called on ro be "dead,' or unrcsponsive ro rhe dreaded subsrance, and (O be "alive " Of responsive tO God through {he grace of Chrisr. lf a person is dead ta somerhing, rhere is no movemenr in that direction. An individual who is Iying in a grave has no morÎon. no breath. We arc onished ro be in dIis relation ro an addicrion. There should be no movemenr in thar direcrion. 1 a.Iways teU rny patieIHs who desire ro quir smoking, "Onee you have made ehe choice ro give up smoking and have picked the rime you are going ro do it, ger rid of alI of your cigaretres-do oot keep any in hiding." For mOSt peoplc, keeping che addicrive agems arollnd increases [he agony of wirhdrawal. Whcn you are seruggling, k1lOwiog dlat (he objece of your desire-such as a cigarette-is jusr aTOund [he corner, it can become more difficulr ro say "no." Ifthe cigareues are removed from rhe environmene, temptarions are more easily resisted. Therdore, jf we accept. rhe Biblical perspective ofcOllnring ourselves as dead to ehe sinfllJ habie, we will nor wanr ro makc any provision tO Gil. The Bible speaks e1oqllendy of rhis subject as seen in Figure 5. Thc Bible speaks of "rhe flesh", in con· rrasr ro "dIe spirje." "Provision for the flesh" wouJd dlUS be eonringency plans to go back inro the ways of sin (such as bad habirs and addicrions) thac God has called us [O be free from. The danger of making sueh pTOvision is funher illusrrared by the story of a young Iad named Johnny. Before leaving for school one day. his mother said, "Johnny, aftec school roday 1 do not wane you ro go

DEALING WITH BAD HABITS ANO ADOICTIONS swimmjng; come straighr home." Johnny said, "Yes, morher. 1 will come suaighe home." Afrer school, however, he arrived !lome Iare. When he came ln the door, his morher saw ehae his hair \VaS wer. She said, "Johnny, 1 rhoughe 1 cold you ro carne srraighr home from school. You are Iare anei .yom hair is wec. You wenr swimmin oo , &dn'r you Johnny?" "Yes, moeher, 1 did." 'Johnny, why clid )'OU go swimrning when I rold you nor ro?" "Bec:luse 1 was relllpeeel." "Johnny, why c1id you eake your barhing suir wirh you?" "Well, morher, because I rhoughr 1might be eempeed." Johnny made provision for rhe fle.sh. I have found ehae many adults do ehe s;une. They "think rhey mighr be rempred" and eherefore make provision ca fa il, and fajlure is ohen (he resulr. On rhe orher hand, mose wha possess a rrue [aieh in Gad wiJl foUow me scriptural advice and implemenr rhe mosr effecrive plan: ehey will make no provisions rhar willlcad ro f.tilure. Imread, rhey COUI}( (he victory as rheirs and ehe habir ro be behind rhem. AJrhough rempra(ions and cravings will carne, rhey k.now rhat God teUs rhem ro consider rhemselve.s dead ro rhe dreaded subsrance, and the)' live in the assurance thar Gad Himself will help rhem ta coneinue an Ulat parh. One reason (har people make provisions to fail is thar they are afraid of suffering roo much during rhe withdrawal process. ehat rhere are cenain habirs you snould nOf try ro simply walk away from wirhout professional help. The fact rhar medical supervision of wirhdrawal is best for an alcoholic ar drug addicr in no wa}' e1iminishes rhe power of Gad ro overcome. It is merely recognieion ehar rhese habits can occasionally cause life-rhreatening wirhdrawaJ symptoms rhar can be prevemed by close medic.1l care. Bur whar abolit habirs mat do nor need medical supervision? What abolit getting rid of rhe TV. sugar, chocoIare, ar meat? Is it reaUy necessary ro be willing lO suffer in order tO get rid of such addicrions?

Willingness to Suffer to Get Rid of Addictions Lee liS step back for a minme, away from (he issues of habits and addicriolls, and merely look at living rhe Chrisrianlife. Our model for such a lifesryle is Jesus Chrisr himself. one who was fully human anei fully divine. Bur He laid His diviniry aside when He carne here ro live an this earrh. The

"For verily he took not on him the nature of angels, but he took on him the seed of Abraham. Wherefore in ali things it behooved him to be made like unto hts brethren... for in that he himself hath suffered being tempted, he is able to succour [help J the'm that are tempted." Hebrews 2:16-18 BibJe sraees ehat Hc clid not use any power in overcoming thar we do nor have. The scriprures are also very plain in describing the suffiring of Cluisc. One of rhe rexrs rhar memions His suffering is found in Figure 6. The rext explains rhar Jesus v./as fully human, of rhe seed of Abraham (not of Adam). In ,tiI rhings Christ was made like His brerhren. He suffered, being rempred. This rexr is nor referring ro rhe suffering that He experienced an rhe cross, bm rhe sllffering He experienced from being rempted. Mase of us are aware of the physimI tofture Jesus endured (hrough rhe events leading up ro His cruciftxion. But His suffering while being tempred is related ro the fact thar He was made like unro His brethren. He inl1erired a fully human nature like Abraham had, a.nd having such a narure He was able to be tempted JUSt as we are.

Figure 6

461

PROOF POSITIVE

"Forasmuch then as Christ hath suffered for us in the flesh, arm yourselves likewise with the same mind: for he that hath suffered in the flesh bath ceased from sin; that he DO longer should live the rest of his time in the flesh to the lusts of men, but to tlle will of God." 1 Peter 4:1-2 Figure 7

462

Jesus' desires were nor ahvays in harmony with rhe Farher's will. A dassie example of this occurred in the wilderness of remptarion. There we are told rhac after 40 days of fasring, Chrisr, wirh His human nalllre, was hllngry.12 However, He did nor sarisfy chis hllman desi re when tempted, but rarher ehose God's will and clid not make food for Himself 13 As a humall, He waÎced for His Father to provide for His needs rarher rhall caking mauers imo His own hell1ds aod lISing His mirade-working divinity. So ic was with every remptarÎon in the Savior's life; He never gave in to human desires. In spice of being repeared1y tempred, He \Vas innocem of any sin fui acr. lr is exeeedingly important ro recognize that ic was possible for Christ ta fail. If rhis wcre nor the case, He cOllld not fllHy have experienced temptation. How did Jeslls have the strengt.h ro keep from yielding ro cemprarion? He relied upon His Facher's srreogch ro overcome. He conrinually surrendered His will ro rhe Fa[her. No doubr, Jeslis sutfered in the wilderness when He chose to stay hungry racher m:Ul relieve the hllman desire for food. No doubr, on ocher occasions, Jesus ofcen suffered in going againsc His own desires to go forward with God's desires for Him. Chrisc said, "1 do not my own wiU but rhe will of Him who sem me" (John 6:38). This declaration reemphasizes che fact thar Jesus'

desires and His Father's wilI were not always rhe same. Where rhey difTered, He chose ta do His Facher's will and it resulted in suffcring. Perer, one of His dosest fo IIowers, wroce furrher abour Christ's suffering as qlloted in Figure 7. Since Christ sufTered in the f1esh, we al50 should expect ro suffer in aur bodies and minds as we gain the victory over addiccion. Althollgh rhere are rare occasions where God takes away al1Y struggle in dealing with a particular Iubit ar addiction, for mosr of us there is no victory withollt suffering. Many Chrisrians have faltered on rhis poinc of suffering. Tragedy stfuck Jane Johnsoo. 14 Ar the yOllng age of 44 she suffered her first hean aerack. The prospecrs were even sc.1rier for her rhan mosr. YOll sec, Jane had her chil· dren later in life, so she still had yOllng chil· dren at home. The heart attack mus threat· ened not only her fllwre but that of her yOllng children. 1 worked witll Jane in rhe hospiral to fry ro ensure th:1C she would make an uneventflll recovery, and also to try to prevenc any future hearr attaeks. One of my first lines of insrrllcrion was to make sure chac Janc, chen a smoker, underscood chat she needed ta put smoking behjnd her. I informed her how stopping smoking was essemial to prevenr anorher heart anack and funher hearr damage. 1 was gratified that she did nor smoke during che week rhac she was in che hospital. This was nude easier because our hospiraJ, like most, has a 00' smoking poliey. When 1 discharged J:U1e ar rhe end of that week, sbe !efe as a nonsmoker with a new lease on life. One weck withour smoking was enough ro undergo aII of rhe wichdrawal symproms and eonquer d1e addiction from a physiologic srandpoim. AU she had ro do was continue on tbe good course she was ono Six weeks later Jane was back in my office for a follow-up appoinrment. 1 was surprised ro leam dut she began smoking again afeer she Ieft the hospiraJ. She stiH had a psyehological adeliccion. 1said "Jane, you have small chiIdren. YOll cold me whar yom plans are for them, al1d how much yau wanr co see them be sllccessful in life. How are chey going ro be sllccessful withour you?"

DEALING WITH BAD HABTTS AND ADDICTIONS She asked. "What do you mean?" 1 said, "Your smoking will prevent rhem from having you around much longer. You ace rea11y raking a risk." She answered, "1 know I am." I {hen reviewed with her the damage {hat smoking was doing ro her health, and assured her that {he Locd would give her the vietory if she put her truSt in Him. r fjna1ly said, "Jane, 1 know you are a C1uistian. Telllne why you conrinue tO buy cigare[[es when you know {hat God does not wanc you to smoke? Pm your truSt in Him." She said, "Or. Nedley, 1 have put my trust in Him. Buc 1 wiU rell you why J haven't quit smoking. It is because God has not raken away m y desi re for cigaretres. Because God hasn't taken away the desire, 1 am continuing ro srnoke." Jane expecred mac me Lord wou.ld somehow corne in and perform surgery on her wiU, taking away hec desire 50 that she wou.ld never want ro smoke again. She was going to continue tO smoke umil that happened. Now 1 know of cases where God has sometimes done this very thing. However, I know of many more cases where God heIped someone duough rhe diff'iculr process of saying "no" and gave them vicrory in the midsr ofsuffering [hrough rhe pains ofwithdrawaJ. If we are not willing to undergo some suffering from rhe withdrawal symptoms of an addiction, we will not have victory. We must take the fim step. God will, rhrollgh the hand of faith and the power thar He gives us, then give us the complete victory. 1 shared {hese texts about sllffering wirh Jane and I think she saw it in a new [iglu.

Some Suffer More than Others { live in Oldahoma. in rhe heare of rhe "Bible belt." so 1 have heard comments like Jane's many times. Many Christians approach an addiction problem expecting ro conquer it wirh linie or no effort an theiI parr, and then wonder why they meet wirh failure. In view of these pervasive sentimenrs, 1 wanc to be sure that this issue ls complerely dear: not ali who conquer an addiction suffer ta the same degree. 1 have seen those who nave won the vicrory with a minimum of difficulry and suffering.

The Lord takes away the desire from some more quickly than orhers, which 15 a fulfillment of anorher scriprure text abolit tempt:ltion. It statcs mat God wiJl not aJlow us ro be rempted wirh anythlng rhat we cannot bear, ar beyond what we are able ro roIeratc. 15 Those who, for perhaps some unknown reason, would not be able ro tolerate strong withdrawal sympeoms (or perhaps even any ar ali) will have the symp{ams and desires taken away by Gad. The Lord removes or reduces thc desire and makes ie possible for them ro gain the victary. Each of us can be assured that Gad will nor allow us ro go throllgh more d1an we can handle w1th His heIp. However, even those rhat have it apparendy easy in deal ing with one addiction may face a differenr stfllggle with another addiction in which God allows them to sufler ro a greater degree. Gad does not generaJly remove His people from difficulties. After aII, the Bible teaches us that difficulties actually help ro deve/op Chrisrian virrues, as we t(ust Godin the midst of aur hardships.IG Therefore, God's method ofworking i5 ro help us in the midst of challenges and difficulties rather rhan by delivering us from them.

Examples ofSuffering Which Led to Victory Bible history is replete wim examp.les. God did not prevenr the Egyptians from cornering !lis people ae the Red Sea, bur He brought the Israelires throttgh that massive bod}' of water. Gad did not keep Daniel out of rhe lion's den, but brought him throttgh the experience. Oaniel's [hree friends were broughe through rhe fire. The list goes on and an, bur rhe poim is rhat God's purpose is nor necessarily ro keep us from tempeaeions and difficu.lties but ramer ro give us the power ta make it throttgh those hardships wiehou{ falling. 17 El1ch experience

gilles us a strollgerfaith in God. Let us now look at a dOcllmented experience of a person who was f.'1ced with a deeply entrenched habit, yet was finally able ta gain a (Oral ;md permanent victory. The habit was one that many can reiate ro:

463

PROOF POSITIVE

"1 have thought for years that 1 was dependent upon a meat ~Iiet for strength.... It has been very difficult for me to go from one meal to anotber without sufferilDg from faintness at the stomach, and dizziness of the head.... Eating meat removed for the time these faint feelings. 1 therefore decided that meat was indispensable inmy case." Figura 8

addicrjon ro earing mear. The lessol1s learned from rh.is experienee should be helpfuI to anyone wirh chis ar orher difficult habi[s or addicrions. There is an increasing l1ulIlber of people IOday who have became aware of [he healrh risks of earing me·ar. The media publicizes public healrh srudies rhat implic.îre mear as

"1 suffered keen hunger. 1 was agreat meat eater. But when faint, 1 plaeed my arms across my stomaeh and said: '1 wiU not taste a morseI. 1 will eat simple food, or I wili not eat at aII. ~ Bread was distasteful to me. 1 eouM seldom eat a pieee as large as a dollar. Some things in the (health] reform 1 eould get along with very well, but when ] carne to the bread 1 was especially set against it When 1 made these changes 1 had a special battle to fight The first two or three rneals, ] eould not eat ] said to my stomach: 'You may wait un tii you ean eat bread.' In a little while 1 could eat bread, and graham bread, loo. Tbis 1 eould not eat beforej but now it tastes good, and ] have had no 105S of appetite." Figure 9

464

a cause of cancer, hearr disease, and orhcr diseases. Many are attempring ro remove it from rheir clicI, and somc are discovering rhar rheir apperircs cann.ot be sarisF.ed withOut it. Some have even experie.nced whar may be rermed wirhdrawal symptoms. Even rhough she was convinced rhar me~r was hannflll, Ellen Whire, whase commenes an healr.h have appeared in many of rhe chaprers in rhis book, had difficulry in her persona1life e!irn.inaring ir from herdiet. Prior ta her convicrion rhat she needed tO break free from mear earÎng, she had come ro a conflicring conclllsion: she could not ger along wirhout meat. She kept a journal as she wenr rhrough the batde. Her statemene in Figurc 8 expressed feelings rhar she could nor slIrvive withollr meat. 1B Some would labei this a c1assic case of psychologica.1 addiction if not actual physical dependcnee. Regardless of whar we caII her mear earing, it was withollt question a firmly entrenched habit thar secmed Jlecessary ro her. Even with meat in her diet, she was not in good healrJ1, bur the faine feelings and dizzincss were removed. Thus, marrers became exrremely difficliit when she came to the eonclllsion rhat meat was dallgerous ro her healrh-and she knew rhat she had ro give ir up. The baale lines were ser, for her emire experience tald her that mear \Vas neecssary, in facr, "jndispensable.' Nonerhe.less, she followed her convicrions and left off meat. She recorded ilie inrensiry ofher srruggle, as quored in Figure 9. 19 Ellen Whire acknowledged her grear dependence on meat. She freely irred, "1 was a grear meat earer." Those who have a firmly enrrenched habir or an addiction of anorher kind couJd perhaps make a similar sraremenr, subsrituring your own particular problem for the word "meat eater." She endured rhe feei ing of fainrness, ancl resolved ro go hungry uneil her stomach was ready ro accepr bread, which was disrasrefuJ ta her, in rhe place of mear. She knew rhar bread was a healthful food, panicularly bread made from whole grain graham Rom, bur she had no apperire for ir. In rhis bartJe, she not only auempted ro eliminate the desire for ~~ food rhar she loved, bucat rhe same rime she endeavored ro generare a raste

DEALING WITH BAD HABITS AND ADDICTIONS for a food that was distasteful ro her. Shc described ilie experieocc as a "special battle [O fight." The complere vicrory, which includes the loss ofde-si re for the harmful substance, was not instaruaneous--ir rook time. Gradually, her apperite changed ro the poiJH where she nor ooly rolerarcd bread, but it t3sred good. She recorded rhe improvement in her health after her dicrary change with rhe words shown in Figure 10. 20 Her health was markedly improved. She was using fruits and vegetables liberally; rich foods were no longer part of her diet. The former faint aud dizzy feelings were gone, her srrengrh was improved, and her appclire was satÎshed. Furrhermore, rbe food tasted better than ever. Her suffering resulted in ali of these positive effeccs. Enduring psychological and physiological disrress led ta wonderfuJ improvemenrs, greater than she expected. Was this radical change permanent? Was she tempted (Q go back ro rhe old eating hahits? Her answer is quoted in Figure ll.ll She wroee this six years aner she changed her diet. The change was permanent. She had no desire ro turn back. She "refused to yie1d to taste." Sbe acknowlcdged iliat ilie Lord was glorified by her vicrory; it was the power ofGod in her life {hat enabled her ro win the conflict.

Choose }'our Suffering-Some Now or Much More Later This story is an encouragemeJH ro alI who would conquer any addictÎon ar deeply ingrained habic. The actual advaruages of conquering a deleterious habit are onen far heyond any theoretjcal knowledge ofpotential benehcs. Thus, the suffiring that must

be endured in orda to overcome isfitr less than the sttffiring that we wilf ultimately experience ifwefitil to make a changefOr the bmer. The severity and ilie duration of suffering may boeh be of greater magnitude. Furthermore, the benefits and jay of the new improved lifescyle far aurweigb the "bcnefits" or remporary "good fcelings" that are experienced by indulging in a harmfuJ habit. Nonetheless, evcry experience in conquering addiction and habit is a batde ro be won.

"Sinee the Lord presented before me in June, 1863, the subjeet of meat-eating in relation to health,I have left the use of meat.... We use fruits and vegetables IiberaJly.... My health has never been better than for the past six months. "My former faint and dizzy feelings have Iert me.... We have no meat, eake, or any rich food upon our table.... My appetite is satisfied. My food is eateu with a greater relisb than ever before... 1 have more strength than 1 have realized for years."

The barele is more intense for some and less intense for oiliers. Trust in God and willingness ro suffer and pour atit rhe soul before God wiU lead ro vierory. The more intense rhe barde, rhe sweeter [he vicrory. Thank Him for rhe vicrory, and resolve thar rhere will be no tlIrning back. You will feei

Figure 10

"1 have not changed my eourse a particle since 1 adopted the health reforma 1 have not taken one step back sinee the light from heaven upon this subject first shone upon my pathway. 1 broke away from everything at onee--from meat and butter.... When making these ehanges in my diet, 1 refused to yield to taste and let that govern mea ShaU that stand in the way of my securing greater strength, that 1 may therewith glorify my Lord? Never!" Figure 11

465

PROOF POS1TlVE

"The Christian's strongest temptations will come from within; for he must battle against the inclinations of the natural beart."

Conquering Appetite

Figure 12

so much better (han you feel oow. You will be so thaokful ro Gad for what He has accomplished.

The Strongest Temptfltions In rhjs chap(er we havc seen that Chrisr, our Grear Example, because of His human nature, had desires (har were not always În harmony wirh His Father's will. Ellen White

"Temptations to the induJgence of appetite possess a power which can be overcome only by the help that God can impart. But with every temptation we have tbe promise of God that there shaU be a way of esc8Ipe. "Why, then, are so many overcome? It is because they do not put their trud in God. Tbey do ROt avaiJ themselves of tbe means provided for their safety. The excuses offered for the gratificatioD of perverted appetite are therefore of RO weight with God." FigtJre 13

466

poimed om that the most critical batdefronr in {he war is w bring our will imo harmony wirh God's will. Her insights are srated in Figurc 12. 22 The mosr difficulr banle that we each face is an internal banle-a banle againsr the inclinatioJls and desires of our natural hean. The Holy Scriprures speli alU rhat CluÎsr "was in ali poinrs rempted like as we are, yet wirhollC sin." (Hebrews 4: 15). He, roD, was tempred from within. just as we are. Because He is rhe Savior of mankind and Dur Example, ir was necessary thar He experience the same temptations rhar we do. He overcame ali temptation and thus He can gÎve LIS rhe victory in cvery aJca of our lives. He is willing ca besrow that vicrory upon each of LIS if we merei)' reach our and accept the gift.

We need divine power in our lives to overcome some of rhe mosr subtle temp(ations: strong apperires for foods thar mosr people consider wrally acceptable, bur are not iJl harmon)' wirh God's will. This is whar Jeslls needed when He refused ro make food for Himselfin the wilderness of remptarÎon. This is what we need when rempr.ed w indulge in any food or orller habit rhar is nor good for us. Figure 13 speaks directly w this point. 23 SalIle people who do nor even believe in God may be able ro walk away from remptarions to indulge apperire. They may Stop smoking, ar earing harmful foods, or using caffeine "an rheir own"-by rheir own willpower. However, 1believe the statemenr we have jusr looked at applies ro ali; namel)', ir is hmnanly impossible ro gain full control over appetire in nIL ir.s ftrms unless we. have God's power. One who does not avail hil1lself of God's power lllay gain many apparent victories over apperire, bur ulrimately rhere wil! bc orher barties rhat he loses because he lacks divine strength. The good news is that God will help USi yet, ro receive that help we must avail ourselves of His power. We have already looked ar (he scriptural record of one of Christ's lllOSt powerful remprarions on rhe point of apperire. 24 He ca1led on the Word of God ta

DEALING WITH BAD HABITS AND ADOICTIONS gain rhe victory. Gad will provide a way of esc.1.pe for every remptation. Let us then stop oflering excuses for aur bad habits and addicrions. Believe me, as a physician, 1 have heard many excuses for continuing uohealthful pracrices. However, God acceprs no such excuses. He has promised ro provide rhe power ro overcome.

Christ, Our Example, Overcame the Temptation to Indulge Appetite The indulgence of apperire may sometimes seem a marrer of liule import. As 1 have already poinred our, by determined self-effon sOl11e people can bring areas of rheir life inro bener control wichollt fully conquering the ryranny of apperire. For example, a person may leave ofI cenain foocis and thus Iose weight or improve the cholesrerol and blood pressure, yer stiH have oeher areas of apperire rhar remain unsubdued. Some people may see no need eo gain the vicrory over every aspecr of appecire bec.1.use mey have already reached meir health goals. However, few reaJize rhe far-reaching scope of apperire. Apperire unconquered by God's power will ultimate1y cause devastaring consequences. Indulged apperite's far-reaching effecLS on mankind are described in Figure 14. 25 "Indulged apperiec" in this context refers ro any human craving or desire [har leads us ro go contrary ro God's wjll ro sarisfy. Such indulgence carries a heavy priee; rhe craving is saeisfied ar the expense of our hody and saul. Unresrrained apperi.re provides rhe foundaeion for many of the world's probJems. Wherher ir is an apperire for money or sex, land or power, or merely for food-mosr of rhe world's grearesr con~licrs can be rraced to seekillg ehe fulfillmenr of rhese desires. Ir is true in aur personallives as well. Many of me problems we face wim our heaIrh ar among family or ar our workplace can be traced back to indulgence of apperire in some shape or fashion. Thus, gaining full control over appetire would resolve many of our personal difficulries and wouJd prevenr many of rhe prob-

"Satan comes to man as he carne to Christ, with his overpowering temptations to indulge appetite. Re well knows his power to overcome man upon this point.... Entire cities have been blotted rrom the face of tbe earth because of tbe debasing critnes and revolting iniquity that made them a blot upon tbe universe. Indulgence of appetite was the .;. foundation of ali tbeir sins. .. Througb ap,petite, Satan controlled the mind and being." ,

Figure 14

lems of suffering humaniry. The power of apperire and our Lord's power ro deliver are further illusrrated as we look once again ar Christ's wilderness conflict in Figure 15. 26 We are gready encouraged to overcollle apperire when we consider rhat Cllrist endured a fase for six weeks before being eempred. In spire ofHis physical weakness and intense hunger, He was sriU able ro overcome (he remptarjon. The fuI! significance

"The strength of the temptations to indulge appetite can be measured only by the inexpressible anguish of our Redeemer in that long fast in the wilderness. He knew that the indulgence of perverted appetite would so deaden man's perceptions that sacred things could not be discerned. Adam feU by tbe indulgence of appetite; Cbrist overcame by the denial of appetite. And our only hope of regaining Eden is through firm self-control." Figure 15

467

PROOF POSITIVE

Falling Back in the Struggle "If the power of indulged appetite was so strong

upoo the race, that, in order to break its hold tne divine Son of God, in man's behalf, had to endure a fast of nearly six weeks, what a work is before the Christian! Yet, however great the struggle, he may overcome. By the belp of that divine power which withstood the fiercest temptations that Satan could invent, he, too, may be entirely successful in his warfare wtth evil, and at last may wear the victor's crown in the kingdom of God." Figure 16

of this is described in Figure 16,21 Chrisr has provided rhe power we need to overcome every aspeCt of apperire. Consideriog char rhe rewards of o;"ercoming are even grearer than expecced, Gad is noc asking U5 ro give up anyrhing thac is nor in our besr interest to rerain. He has blessings in store for us rhar are beyond our imaginaflon.

"If you have made m'istakes, you certainly gain a victory if yOD see these mistakes and regard them as beacons of warning. Thus yOD turn defeat into victory, disappointing the enemy and hODoring your Redeemer." Figure 17

468

Some who gain che viCCOly over an addicrion for a rime hold fasc w cheir conviction ulfough che power of God but then f.,11 back imo their old habic. In mosc of such cases, cheir focus did nm remaill on God and che vicwry thar He had provided. Ac rhe poinr of a fuilure, rhe rendency is ro become discouraged and say, "1 have been defeated. It did nm work. It is nm for me. I am going to give ir aII up." Such an altitude musc be avoided. Fim, realize rhat if yOIl slip, yOll have nor undone aII rhe progress you have made. Second, recognize rhac rhe same God is rhere to help you begin a pattern ofsuccess again-righc ac cllat point. Third, realize rhar you can Icam by your mistakes. Failure sholild be regarded as beacons of waming as stated in Figure 17. 28 Analyze rhe mistake-derermine why and how it happened. Ask yourself, "How did I Iose my focus on God?" or "Why did 1abandon my faith in the screngrh God bas given me?" If rhe experience is viewed as a beacon of warnjng, then your resisrance ro another f.,ilure will actually be increased. Your long-term success will be enhanced because you have f.1iled, only ro rise up again in God's power on che road ro success. For rhose of you rhat have powerful physiologic addiccions ro substances like tobacco, alcohol, prescriprion medications such as Valium, ar illegaJ drugs, I would again remind you of rhe value of medical he1p. Although not vital for tobacco addiccion, it is for rhe ochers on the lis!. In addirion ro chat professional assiSr
DEALING WITH BAD HABITS ANO ADOICTIONS break free from the behaviors chac have hdd chem in bondage.

AII Things are Become New One final scacemenc from Scriprure, quoced in Figure 18, provides a ficcing conc1usion co the spiritual emphasis of chis chapeer. This onition meets me needs of ali ehose who wanr ro conquer an addiccion. By allowing Chrisc to rule in our heam, ali ehings will become new and t!le old life is hiseory. Lee us eake hold of Chrise as our own and rcad about Him in His Word. Srudy His life daily. Claim viceory in Him, the viccory that He has aJready won. Do noe make provision 10 fail, because eruc f.1ieh will noc make such provision. Through God's grace, we can overcome every addic(ion and every deleeerious habiL Wc will reap (he benefics ro che glory of God ehroughouc our liferime on this earth and in the ljfe co carne. Yes. (here is a special promise 10 chose who overcome (he addictions, bad habics, and croubles of chis life: "He chac overcometh shall inherit aU things; and 1 will be his God, and he sha.ll be my son." Revdaeion 21:7. those that over-

"Therefore if any man be in Christ, he is a new creature: old things are ed away; behold, aH things are become new."

II Corinthians 5:17 Figura 18

come wilJ enjoy eternalljfe with God aud with ehe saints, a Ijfe chac you and 1 cannoc even imagine. The Holy Writ says, "Eye hacb noc seeo, nor ear he-ud, nei(her have encered inco me heart of man, rhe ehings which Gad ham prepared for them (hac love him," 1 CoriJ)(hians 2:9

RefereluesAdtlirriol1: Sledmm's Electronic Medical Diclionary version 3.0 (CDROM). Based on S/rtl"liw's Medical Dictiol1llry-26'~ "didoll. Williams and

1

Wilk.in~,

1996.

A.ddiclioll: Frid JP. editor. Dor/muls Medic,,1 //IustTllted MediCiI/ DiClion12ry-28h cdilioll. PhiJadelphia, PA: WR Saunders Company. 1985 p.

Romans 6: 1-2.

2 Chronidcs 7: 14. TIu Holy Biblc. AUlhori7.ed KingJames version.

t2

LlIkc 4:2. The Holy Bibk. AUlhorizcd Killg)amcs version.

1)

LlIkc 4:3-4. Tbe Holy Bib/t'. Aurhorized King Jaml'S version.

14

NOI hrr TY!III "''''It:.

1·

1 Corinlhians 10: 13. 1/u Hol)' Biblc. AulIlOrized KingJames version.

l

29-30. j

Schu~lcr CR, Kilbey MM.

Prevenuon of Drug Abllse. In:

USI

JM,

Wallacc RB. edilOrs. MfL'
773. JalT" JH. Drug Addiclion :Ind Drug Abuse. [n: Gilman AG. Goodman LS, CI al, cdjlOrs. Coodmlllllmd Ci/mlllls TIu Pblrmlllc%gic Bmis 0ITlJeTIIpeurics-7rh cdilioll. New York, NY: MacMilh\ll Publishing Comp'Jny, 1985 p. 532·540. 4

\ No/ his ~ol nonl( 6

I Corinlhians 15:57 TIu Holy Bib!t'. AUlhorizcd KingJames version.

7

Romans 6:23. Thc Holy Bib!c. AUlhorizeJ KingJames vc:rsion.

S

James 4: 17. Tlx Holy Bib!". AUlhorized KingJames version.

I Corin lhians 6: 18-20. 3: I ~ 17. TIu Holy Bib!c. AUlhoriud King Jame verSlOn.

9

nu Holy Biblt-. AUlhorized King James version.

10 II

16

June 1:2-4. TI,,· Holy Bib!e. AUlhorize.d King )arnes version.

17

)ude 24. Tlie Holy Bib!t'. Alllhorized King )ames version.

18 While EG. Experience. In: Spiri/llol Cifis (Volume 4a). HagerslOwn, MD: Review and Herald PubJishing Associalion, 1864 p.153. I? While EG. Chrislian Tcmperance. In: l't.
White EG. ConrroJ of Appe[ile. In: COllnseu 011 Din ond Food,. Hagemown, MD: Reviewand Herald PublishjngAssocialion, 1938-1976 p.482-483.

lO

While EG. Chrisliar1 Temperancc. In: Testimoninft, Iht: Cburr:b (Volume 2). Nampa, ID: Pacific Prcss PlIbLishing Associarion, 1868-1871 p.37\.

li

While EG. "Icmplcd in Ali PoiJlls. In: Biblc Echo (1886-1913), December 1892 p. 1. FOllnd In: E!len G. While Estare. TIu Pllblish~d W,i,ing, 01Elim C. IV!Jiu. Version 2.0 (CD-ROM), 1995.

il

469

PROOF POSITNE While EG. Conlrol of Appeli!e. In: COIIIIU/s Ofl Diri Food;. Hagcrstown, MD: Revicwand Herald Publishing Associadon, 1938-1976 p. 154.

li

I1l1d

!·1

Lukc 4:2,3. TIJr Holy Biblt:. AUlhorized KingJame

version.

WhilC EG. Pawlls as Rcformers. In: Ţ,',/imollil!S for C/JlIrch (Volume 3). Nampa, ID: Pacific Press Pub· lishjng Associ:uioo, 1872-1875 p. S61.

!)

tIJ~

470

Whjle EG. Control of Appelile. [n: COlltlSt:is 0/1 Din Hagcrstown, MD: Review
afld Food;.

White EG. COlllrol of Appelile. [n: COl/flU/s 011 Din HagerslOwn, MD: Rcview and Herald Publi hing Associalion, 1938-1976 p. 167. 27

afld Food;.

Whil" EG. Taiem. [n: ClJrists Obj~~/ Lmom. Hagerslown, MD: Reviewand Herald Publishing As· socialion, 1900 p. 332. !

CHAPTER NINETEEN

UTRITION ANDTHE ENVIRONMENT

5

eemingly overnight, the issue vaulted [rom a marter of personal health [O an issue of social jusrice and respollsibiliry. Cigarerce smoking had loog been recognized as a killer. Heart disea.~e,lungcancer, and emphysema were well-known resuhs of [he robacco habit. However, when rhe dangers of second handsmoke becaJUe more widely appreciatcd, perceptions changed. The decision co smoke was no longer just a personal decision. but carried consequences for coworkers, family , and orher "innocenc bystanders." The awareness of [he social costs of smoking caused smokers ro reassess their habic. Pregnant women "kicked the habit" when they recognized rhey were purring [heir unborn children ,It risk. Parents broke free of [he addicricn when they found ic was linked ro their children's frequen[ respiracory problems and othcr maladie.~. Husbands aud wives walked away from the [0bacco habit when they realized rhey were purting [heir nonsmoking spollses at risk. Although millions of smokers now recognize rhar their habit has social implications, few individuals recognize [he COSt dlat sociery bears from chcir dieta'] choices. A wealth of evidence asserts that our food choices have far-reaching consequences 00

our neighbors, aur na[ion, and rhe world. In rhis chapter wewill examine soroe of this evidence. We will see thar rhe optimal diet from the standpoin[ ofsocial consciousness is aJso [he finest dier for individual health. This optimal eliet is rhe total vegetarian diet. Its far-reaching benefits are described in detail throughour this book.

The Global Jncrease in Meat Consumption Historically, in aJmosr every culture, raisillg lives[Ock was ioregrared wich crap farming in a way thar provided for a long-term sustainable relationship. The twenrieth cenrury's rapid rise in meat consumption bas upset chis balance and is now exposing our world [O a hosr of environmental thrtats. A large portjon of ilie world popuJation consumes very litrle meat. But when a oation's standard of livi.ng increases, meat consumptiol1 generally also increases. Nadakavukaren poims ouc that the citizens ofmiddle-income COUlltries are ing r!lase of wealrhier nations i.n shift.ing to "a greater reliance on animal produCtS."1 One of rhe reasons for t!lis is thar mear-eating has bccome an international standard for affiuence. Worldwarch's Lesrcr Brawn provi.ded ooe glimpse imo this worldwide phenomenon:

471

PROOF POSITIVE

INCREASE IN MEAT PRODUcnO Worldwide meat production 5

300% increase

3 2

o 1950

1990

Figure 1

LIVESTOCK REQUIRE ABUNDANT AGRICULTURAL LAN» . Tbey eat buge amounts of grain, requiring an enormous amount offarm land to produce it. . They require huge amounts of graziug laud.

Figure 2

AMOUNr OF GRAIN TO RE» A MEAT-EATING WORLD POPULATION The grain needed to feed a world populatio'D of meateaters would be equal to 150 percent more than aU the current global grain production used for aII purposes. Figure 3

472

Last year, wllen asked by il reporter if living conditÎons were improving, a Chinese villager responded, "OveraJl, Iife ha gotten much bener. My family eats meat maybe four or hve times a week oow. Ten years ago, we never had mear."l Indeed, more and more developing cOllnrries have now become able 10 afford .mear. As a reslIlt, meat-eating has becomc a global phenomenon. Meat production has stped up to meet tlle demaod, as shown in Figure 1. 3 This large rate ofinctcase is conrinlling. Such il rrend raises the question as (Q whether our e,urh can sustain a meat-based diet for this increasingly larger portion of the world's inhabitaJlts. Raising livestock require.~ mllch agriculturalland as explained in Figure 2. If rhe enrire world population ate a mearbased diet similar ro the average American, it would be necessary for world grain. production ro skyrocker, as shown in Figllre 3. 4 This starding esrimare was calculated by Worldwarch, one of the mosr respecred organizarions deaJing wirh environmentaJ issues. For those nor familiar wirh rhis "rhink rank,' Worldwatch is an independent. 110nprofit research organizarion thar serves as a resource for world policy makers through irs extensive research on global problems. 1r is fllnded by United ations agencies and mher privare foundations. Howcver, for some. rhe data from WOrldw;ltch is nor starding enollgh. They cire orher starisrics thar make Worldwatch's estimares look very conservative. This COI1rroversy provides an appropriate backdrop for an important digression. Throughollt rhis chapter, as a rule, ali of the figures thar 1 quore are quÎre conservarive. As a resulr, some may feei rJ1at 1 am not making the case strong cnough regarding [he powerful impacr mar dietary choices have on our envîronmenr. However, ironicaJly, 1 rhink this chaprcr actuaJI)' makes a stronger case because of rhe COl) crvarive n
NUTRITION ANO THE ENVIRONMENT ir, and rhar Illay be true. However, even the conservative esrimates J share provide a compelling reason ro soberly eX<\Inine aur eating habits. From my caurious review of the daca, rhe rise in worldwide meat consumprion undoubredly severely rhrearens aur environment. Scholarly papers that do nor even deal with this growing threar lend tacit ro it. Consider, for example, the work of che renowned epidemiologist, Sir Richard 0011. This esteemed researcher rook a frank look at t11e environmem in his artide enrided "Health and the Environmem in the 1990's."5 Surprisingly, DaU did nor put popular Jay concerns abolit roxic exposures, sucb as pollured air and water, at rhe cop of his lisc. His main concerns are listed in Figure 4. Population growth is considerecl by many orhers beside Or. DaU as one of rhe mosr critical environmenral issues. In aII likelihood, however, popularion growth would nor be anywhere near c!le problem ir is, were it nor for individual dietary choices. This brings us back ro rhe issue of mcarbasecl earing patterns. Consider this sobering (.,cr: rhe demand for mear in industrializ.ed countries !las shifted rhe economic balance even in developing n:uions. Pressures now exisr in many of the less afI-luenr counrries ro raise animal producrs for export ro more well-to-do nations. Even wirhin their borders, dierary choices are posing problems for rhe developing narions that are the hardest hit by popubtion growrh pressures. When weaJchier individuals in rhose narions dem:lnd animal proelucrs, land is lIsed for gra'ling and growing feed for livestock rhar would otherwise be availablc ta feed ilie poor direcrly wirh planr sources of nurrition. G Based an what we have already examioed, it should be apparenr (hat a popularion's need for food can be severely srressed if a large porrion of rhar popularion demands a mear-based dier. Relarively small changes in meat consumprion can make a significant global impact. Earing les animaJ producrs would go a long way ta il)creasing world grain srores. Lesrer Hrown of Worldw;}rch has calclliared rhe

SIR RICHARD DOLL'JS MAIN GLOBAL CONCE S ·Poverty ·Pressure of population growth ·Production of greenhouse gases

Figure .4

SWlTCRING GRAIN CONSUMPTION FROM LlVESTOCK TO PEOPLE · Livestock consumes 630 million tons of grain worldwide. · Reducing meat eating by 100/0 would red~ce tbe grain consumption by the same percentage, or 63 million tons. • [f this

reduction in consumption would be made available fO.r direct human consuO!Jlption, ilt would feed the growth in world population for more tban two years. Figure 5

benefic of reducing mear earing by 10 percent, shown in Figure 5. 7 The rise in worldwide mear consumprion has produced a cascade of consequcnces. Grearer dcmand for mear increases rhe demand for Livesrock feecl. This, in rurn, pressures the world's fanners ro achieve higher yielels from cheir fields. Such pressures may leacl rhem ta adopt intensive farming pracrices rhar may CJuse irreversible damage ta [he earth. 8 Furrhermore, ar.remprs ro misc an inordinare!y large number of animals in a given area can damage rhe environmenr. Consequences can include

473

PROOF POSITIVE

THE ROLE OF FORESTS •Protect top soU rrom erosion ·Are vital sources of oxygen •Moderate and regulate cUrnate •Prevent floods •Recyde and purify our water •Are homes for millions of plants and animals Figure 6

LOSS OF TROPICAL FORESTS •Tropical rain. forest losses were 28 million acres per year (1982 estirnate). •An ,t'ropical forest loss was 38 milIion Heres per year (1995 estimate) - equal. to twice tbc size of the 'nation of Austria. ']n Central and Soutb America, 5 million aeres are lost per year to cattle pasture. ']n Latin America, 50 miUion acres were lost in 20 years by conversion to cattle rancbes. · In Costa Rica, two-thirds of aU forests lost are due to cattle ranching. figura 7

INEFFICIENCY OF LAND USE FOR RAISING ANIMAL FEED IN THE U.s. 6.9 Ib. feed per Ib. pork 4.8 Ib. feed per Ib. beef 2.8' Ib. feed per Ib. chicken 3.0 Ib. feed per Ib. cheese 2.6 Ib. feed per Ib. eggs

474

Figure 8

the loss of foresrs and even the creation of new desens (a process called "deserrification").? There are some 8.2 billion acres of rangeland worldwide. However, aJready nC'
OfForests andMeat Production Forests have severa! vitaJ funcrions in the ecosystem, listed in Figure 6. 11 The rropical foresrs are of particular imporrance. 12 Approximately one-fifth of ali che industrial lumber used worldwide comes from rhe tropicaJ forests. Millions of people rhroughour rhe world depend on rhese foresrs for their livelihood. A quarrer of the pharmaceurical agents worldwide comains extracts of rain forest plants. Furthermore, some drug researchers look at the divetsiry of planrs in these tropical foresrs as offering a bank of natura! compounds rhar may in the fucure help ro creat cmerging diseases or currenrly untreatable conditia IlS. SadJy, we are losing our forests ar an alarming rate. These losses are spelled OUt in Figure 7. 13 , 14, 15. 16 The primary causes for dcforestation vary depending on the area of the world in question. However, raising livesrock is often a major contributot. A comparison of the land requiremenrs ro supporr certain "diet styles" can help us berrer appreciate how eating choices eJlcourage rhe conversion of forests ro agriculrutalland. In ordet ro suPPOtt their dietary choices, mear earers require the use of considetably more agriculturalland than vegetarians. The reason is mat using cropland for raising animaJ feed is exrremely inefficienr when compared ro lIsing it ro provide food for vegetarians. It requires many pounds offeed ro produce one pound of animal product. The inefficiency is illllstrared in Figure 8. 17 , 18. 19 Standard feed~ like grains, soybeans, and soy meal were used as rhe basis for the chan. Those fced inpurs for beefptoduction were less intensive because cartle genetally graze umil chey move ro the feedlot for their severaI months oflife. Note thar even the most efficient animal produccs waste nearly two thirds of the grain and soy thar it rook ro

NUTRlTION ANO THE ENVIRONMENT raise iliem. These f1gures can be mueh worse in omer councrie.s. In Russia, for example, ic takes 5 to 6 pounds of grain (Q produce one pound of chicken, or twice as much as in che V.S. lO

Larger Land Areas Produce Less Nutritional Value Where does ali che grain go, since it is nor converred pound for pound inca meat? A significant ponion of livesroek feed is never absorbed by [he animals. Rather, it is e1iminaeed in [he form of solid waste. Of mat which is absorbed, much is used for bodily processes mroughout che eourse of rhe animaJ's life. Still mher absorbed nucrienrs are diverred inco non-edible animaJ cissues such as bone and hair. Some have referred ro ehe process of feeding grain ro Jivesrock and [hen humans earjng the Aesh of rhose animaJs, as "cyding our grain rhrough livesrock." Mosr of rhe nutrients are lost in chis cyde, as depic[ed in Figure 9. 21 2213 Through this process, we can end up with as liule as 15 percenc of che prorein ehac was origi naUy ill ilie grain. These losses are epiromiz.ed by [he intensive animaJ-raising pracriccs such as rhe indoor facrory farms for pigs and pouJrry. Nor only does this refleer a 1055 of protein for hwnan eonsumpeion but, as we will see, ir 31so exaces "seriolls environmencal effeas" by accumulacing in animal manure. Nocice fhac ali rhe 6ber is lost) as is almost aII rhe carbohydrace. Where has chis ftber gone? By definicion, "fiber" refers ro any subsrance in a food which a hurnan cannor digesf. AJthough animaJs can digest some food irems rhar we cannor) much of \vhat we c.111 "f1ber» likely goes righr rhrough the animaJs' intestinal systems and is excrered as solid waste. On me orher hand, fiber subscances chat are digesTible by animaJs are broken down and incorporated inca their tissues. In either case, when people consume animal Aesh, they do nor get any of ilie fiber ehar was in rhe animaJ's originaJ feed. The animaJ either losr ilie fiber in ilS wasres or eonverred it inro a form (hat is digesrible ro humans.

By now, mosr Americans realize why we fuss over chis indigestible fiber. Ir is importanT in prevenring common concLtjons like appendiciti , diverriculosis, consriparion, cancer, high cholesterol, hemorrhoids, and hiatal hernia.

Additional Environmental Damage From Meat Production Besides damage from deforesration, raising livesrock produces ecologicaJ damage in severaJ other ways: the land is fim c1eared for pasrure or for growing livestock feed; the animaJs themselves then exerr adverse eftects

NUTRlENTS LOST BY CYCLlNG GRA N THROUGH L VESTOCK Nutrients

% Lost

Protein

85 - 90 %

Carbohydrate

up to 100 %

Fibcr

100%

Proteio • • • • • • • • • • • • • • • • • Wasted Used Calories • • • • • • • • • • • • • • • • Figure 9

VI O MENTALDAMAGE FROM RA SING LIVESTOCK · Clearing of forests Killing meadow grass Feedlot runoff · Topsoil erosion · Water shortages · Water poUution · Increase in greenhouse gasses Figure 10

475

PROOF POSITTVE on the environmem. Some of these effects are listed in Figure 10. The c1e.1.ring ofvi rtualI y millions ofacres of forests in Central America alld Brazii in response ta the demands of U.S. fast food chains for cheap beef has been termed "the hamburger connecrion." Meadow grass is killed by overgrazing and t!le trampling of land by livestock herds that overwhe1m the carrying capacity of the land. Feedlot runoff is a concern sÎnce damaging chemicals can pollute the soil aod water around intensive animal-raising operarions.

u.S.

EROSION

Average depth oftopsoil 200 years ago = 21 iDches N ow = 6 inches

Figure 11

YEARLY TOPSOIL OSS IN THE U..S.. (based on the world average)

Totalloss

=

almost 7 billion tons

Per capita loss = 50,000 Ib. per person

Figure 12

476

The remainder of this chapter will explain how these damages occur and what their far-reaching effects are.

Topsoil Loss For at least 200 years, erosion has been causing topsoilloss in the Unjted States. This dramatic change is indicated in Figure II. The effects of raising Ijveseock 011 the Jand and soil are extremely importanr. Topsoi! is eroding around the world. Based on estjmates from me FAO (The Food and Agrieulture Organization of the Unieed Nations), somewhere berween 11 and 15 million acres ofcropland are Iose worldwide each year due to soil eros ion. 24 Each year, ropsoil losses worldwide amount to 710 tonnes [a metric ronne is measurement equivalem to 1.102 tons] per square kilometer. This calculates out ro approximate/y 3 rons per acre. To pur chis in perspective, assume thar the U.S. experienced this average world rate ofsoil erosion across every square foot of its land. The calculated loss În topsoil is shown in Figure 12. 25 What causes this erosion? Much of it occurs from plowing and cultivating ilie land. Rainfall washes the loose soil into rivers and streams, and finally inro t11e oceans. Muddy streams after a heavy rain provide tangible evidence of this erosion. Erosion tends ro be worse when the laud is imensively culrivated. Thus accelerated erosion often results when farmers atrempt ro boost meac production by raising greater amounts oflivestock feed. In some places in the U.S., the ropsoiJ deprh has become so shallow that it no longer can be used for growing anything but fie/d grass. Some areas of the U.S. are losing 50 percent more than the world's average. The Great Plains and Western states are losing 4.5 tons of ropsoil per acre per year. The Wor1dwatch Institute atuibutes this 1055 to wind erosion in the concext of"dry climate, culrivation for raising crops, and excessive livestock grazing."26 The economic cost of soil erosion is also incredible. In the U.S., when ilie cost of decreased yields, increased fertilizer requirements, and environmental cost.s of erosioo

NUTRlTION AND THE ENVIRONMENT (runoff of sedimem and chemica! polluc.ams) are ali factored in, rhe price rag comes out ro $18 biUion per year. 2?

Wizter Supply and Dur Food Choices Our needs exrend beyond proper nurricion. We a!so need adequace supplies of waUr. In facc. many beueve ehar loomjng warer shorrages will c:!.lIse food scarciry ro pa!e in comparison. Even in rhe United States, many areas of the narion have become well acquaimed wieh wacer rarioning. Prohibirions on car washing and lawn warering may seem like more of a nllisance (han a crisis. Yec. water shorcages ean reach crisis proporcions in relatively shoTt periods of time. In America. some experrs believe (hat eurrene dietary dlOices---and rhe agricultura! pracriees dllls made necessary-are heading us loward che precipice of serious warer shorrages. Whar could possibly be jeopardizing rhe apparendy limitless supplies of warer in rhe U.S.? A high volume of warer is required ro produce me.'\{ prodllccs compared ro prodllcing grajn, as iUusrrared in Figure 13. 28 • 29 The amoum of wacer used co produce a given amoum of mear prodllees cOllld grow ren cimes as much corn. aod six lÎmes as much wheat. Perhaps rhese f1gures become more meaningful when you consider rhar [he average U.S. ciriun demands approximarely t 00 gaHons of warer each day ro produce only rhe animal products he eacs in che form of meat. miJk, and eggs. This is an amounc eqllal ro rhac person's daily use of warer for aII home uses. 30 The American Cacdeman's Association has ciced U.5. Depanmenc of Commerce and U.5. Geological Survey scacisrics rhac beuer indicaee che intensive warer needs of livesrock. Their data is in rhe form of rhe percenrage of aur roca! warer usage raken by agriculrure. The daca is shown in Figure J 4Y Wirh these sracislics, we can readjly calcula te rhar 14 percenc of aII rhe \Varer used in rhe U.S. goes lOward raising livesrock. Anorher way of looking ae the huge amounrs of wacer llsed in livesrock raising is ro look ar some of the srarisrics quored by the Beer Indusrry rhemselves. These are shown in Figure 15. 32

WATER REQUIRED TO ODUCE MEAT PRODUCTS AND GRAlNS 385 gal. water per Ib. boneless pork 360 gal. water per Ib. beef 337 gal. water per Ib. poultry S8 gal. water per Ib. wbeat 33 gal. water per Ib. corn Figure 13

PERCENT OF WATER CONSUMPTION FOR AGRICULTURE • 42 % of total water consumption is used for agriculture. • 3 % of agriculture water is direct animal consumption. • 97 % of agriculture water is for crop irrigation. • 30 % of irrigation water is for animal feed (hay, pasture, feed crops). Figure 14

FO 3.49 trillion gallons for irrigating feed crops. 2.97 tdlIion galloDs for irrigating pasturcs.

202 billion gaUons of drinking water. Total water usage - 7 trillion gaUons

Figure 15

477

PROOF POSITIVE Put another way, ifaII rhe U .S. beefcarele were being raised an one huge range anei farm. it would take 7 miII ion shipments of one million gallons ofwarer each to supply cheir needs just for one year. In m;lny pans of the world, water availability is a life or death issue. Even here in the U.S., our demands for foods wirh high water requiremenrs have scriollS economic and ecological consequences. Historically, rhe economic COSts have been largely hidelen due ro federal and stare governmcnc subsidization of rhe meat indusrry's warer consumprion. Many may not rcahze thar their [aX dollars have been helping ro provide the large quamiries of water needed ro mise livestock. Congress has esrimare-d rhat Wesrern stares have received more rhan $2 billion in water subsidies annllal1y. Up ro $1 billion of rhis amounr has gone ta farmers who raise animal feed. The farmers are able to raise livesrock feed very profirably because rhey can buy water cheaply from federal irrigarion projecrs. Somerimes they pay less rhan ehe actual cosr ro deliver rhe warer ro their farms. 33 As a case in poinr, the huge Cenrral Valley Project in California supplies irrigarion warer to farmers ar a smaH fraerion ofirs actual cost, as tablilated in Figure 16.34 . 35

Actual cost of 40 years of irrigation water:

$1 biUion

Cost billed to farmers:

$50 million

Percent of cost bor.ne by farmers:

5%

Amount of irrrigation watcr used for livestock feed:

33

Figura 16

478

O/o

Sandra PoSte! of rhe Worldwatch Insrirure poinrs om thar in the face of these huge priee supporrs for water lIsed ro produce livesroek feed-such a scenario wOllld nor likely occur were the farmers ro pay what rhe water reaUy cost. Water subsidies are jusr one example of how Iivesrock producers do nor pay their fair share whcn Ît eomes ro envÎrolunenral eoncerns. Durning and Brollgh, a1so of the Worldw;lrch Institme. have made rhis observation: "AII rold, the price of meat might double or triple if the fuIl ecological costS were inclllded in rhe bill. These costs include fossil-fuel eombusrion. grollnd water deplction, agrieultllral-chemical pol111rion. and methane and amrnonia emission."36

The Efficts OfPolitics and Farm Subsidies The need ro reform the politics of agriculrure-wirh irs ofren-counrerproducrivc subsidies-has not bern Iose on rhe World Health Organi~ltion. The WHO is aware of rhe need for counuies ta make changes in political suucrures rhar have eneouraged diers high in animal products în t.he pasc. They recognize dur governmenr economic policies dealing with food producrion can often prevent people from making rhe changes rhey need ro make. The reason for rhis Îs that r!le economic policies are often "based an ouunoded ideas abour what consrittltes a heahhful dier."37 The WHO wenr on ro make specific recommendarions ro narions in 1990 in t.heir book, "Dier, Nuuition. and rhe Prevenrion of Chronic Diseases." One of rhe recommendarÎons broughr the iSSlle of food choices into sharp focus: "Governmenrs should consider their Învestmenr and subsidy policies in bot.h agricuJture and rhe food indusuy ... Policies should be geared ro promoring the growing of pJam foods, inc1uding vegerablcs and fruits, and to limiring ehe promoeion of fiberless [and cholesrerol-coneaining) producrs."38 By replacing the nutrienrs Iose from reduced me.c·\[ production wirh those from planr sourees, much less water would be required.

NUTRITION AND THE ENVIRONMENT

Wâter Poifution from Livestock Beyond rhe excessive demands on water supplies. animal raising can comribure directly to warer pollu-tiol1. Wealrhier narions in pareicular musr cope wirh rhe problem of handling huge volumes of wasre from livesrock and dairy farms. 39 Feed lors pose a notable probJem. A feed lor is a relarively smalt, fenced plor of land rhar is crowded Wilh sa many head ofcarrle rhar rhey hardJy have space ro move. Such an arrangemenr provides an economic benefir: rhe abiliry of rhe animals ro exercise is limired and rhey rhus gain more weighr in a shorter rime. Since rhey are sold by the pound, fhe financial advanrages are obvious. Unfortunarely, lhe WHO has poinred ouc char rhese currenr inrensive "'confinement" raising pracrices can cause "localiy concenrrated producrion of slurries and manures." The wasres are generaJly high in nitrogen compounds. phosphare, and porassium. They ofren are contaminared wich significam amounrs ofheavy meraJs induding copper, zinc. and cium. lf rhese wasres are applied ro agricultural land, they can cause significanr problems. Some of these compounds can be raken up by the planrs and reinuoduced imo rhe food chain. 40 The large amounrs of waste rhac accumulare in feed 10cs can also pollme wacer sources when rain washes dle wasres away from rhe lor. One common resulr of chis feed loc runoff is an undesirable l'rocess caJled eurrol'hjcation. Anyone who has seen a pond covered wirh excessive algae growth can relate co lhis process ofexcessive, harmfuI growrh of planr life in bodies of water. 41 Of additional concern is a groul' of chemicals called nÎtrares. These compounds, when ingested by humans, can become involved in biological reactions thar yield nierosamines, some of rhe most 1'0tenr cancer-producing chemicals known. 42 The WHO poinrs dle finger ar rhe livesrock indusrry as being rcsponsible for nirrate conraminarion of our wacers. They poilH our thar applying animal wasres omo agriculturalland has pollured natural warer supplies wir.h ilie result dlar, "...drinlcing water we!ls are ofren heavily polluted, conraining nirrare levels of man)' hundreds of milli-

grams per lirer."43 As a frame of reference. 45 miJJjgrams per lirer is rhe maximum ni(fare concenrrarion allowed under U.S. Drinlcing Warer Srandards. 44 The effecrs of livestOck an water supplies are extreme!y long-lived. According ro rhe WHO, even if rhe poLiucion were sropped today. ir may stiH rake literaJly cenruries for these environmental comaminams ro be e1iminated. 45

Livestock and the Production Of Greenhouse Gasses "Greenhouse gas" is a term used to refer ro an)' gas in the earrh's atmosphere thar helps ro crap heat on rJle earch, much as panes of glass trap heac in a greenhouse. Sciemisrs, politicians, busincss leaders. and a hosr ofothers continue ro debace wherher we are currencly experiencing global warming. For che sake of this chaprer, it is noc importanr wherher you side wirh rhose wito say rhere is a problem, or chose who insisr ehere is nOL The important poinr is tluc mere are legitimare concerns rhar gasses known ro have hear-rrapping effecrs could adversely affect the earch's remperanlrewherher or not we are currencly exl'eriencing such problems. Actually, a narural greenhouse effecc has been keeping rhe earrh habirably warm for millennia. This effect is based an waeer vapor and carbon dioxide which accoum respecriveJy for 65 and 22 percent ofchis natural phenomenon. 46 le is roo much ofa good ching, however, that has raised the currenr concerns. The man-made gasses rhat appear ro be among rhe mosr worrisome are excessive leve!s ofcarbon dioxide and methane. AJso players (but ro a less significanr extent) are nirrous oxide, chlorofluorocarbons, and ozone. 47 Surprisingly, a vegerarian dier may also oA-er signjficanr bendits when assessed from rhe perspecrive of che possibiJity of a global warming problem. Meat production increases rhe Ievels of greenhouse gasses and the utilizarion of energy resources. The duee major greenhouse gasses increa ed by raising livestOck, and the causes for ilie increase, are lisred in Figure 17. Regarding carbon dioxide. we have

479

PROOF POSITIVE

INCREASE IN GREENBOUSE GASSES FROM RAlSING UVESTOCK Gas

Cause OfIncrease Defores/ation

Carbon dioxide Forests consume man-made COl. COl is produced by the decomposing of cut-down trees and burning wood.

Methane

Animal waste

Nitrous Oxide

Animal waste

nor conrriburion (O the greenhouse warming effect, ir also decreases a protective chemic..I: srratospheric ozone. 51 (Manywill recaH thar ozone at this level of the atmosphere helps to prorecr us from rhe damaging effeers of inrense ultraviolet radiarion). Nitrous oxide can be a byproducr of rhe considerable amoulHs of ammonia produced by raising livesrock. Ammonia evaporares from srables and feedlots. Large amounrs also rise imo rhe atmosphere afrer manure is spread onta agrieulruralland. 52

Energy Requirementsfor Raising Livestock Raising livesrock enrails huge energy re'1uirements. David Pimenrel, an agricultural

Figure 17

480

already learned (har when animals are raised rather (han planrs, rhe land yields less lISable calorie.~ per acre. We rhen need more acres ta raise more animals ta produce rhe calodes needed. This requires the clearing of forests ro provide land for grazing pasrure or growing feed. Less foresrs means more carbon dioxide because forests convert carbon dioxide into oxygen. To make marters worse, decomposing cur-down rrees and the buroing of wood generates more carbon dioxide (7 ta 30 percenr of manmade carbon dioxide, according (O WHO estimates).48 Furtherrnore, the animals rhemselves exhale carbon dioxide in normal breathing. whereas planrs absorb ir and make oxygen. Regarding armospheric merha.ne, The World Healch Organization has idenrjfied the world's growing cartle popularion ro be one of rhe mOSt importanr sources. 49 LivestDck accollnr for 15 ro 20 percent of global methane emissions. The m~ljority of rhis-perhaps 80 miII ion rons of the gas annually-is produced by ferrnentation which forms gas in the intesrines of cartle and other cud-chewing aniruaIs. Another 35 tons per year are emirred from rhe hllge amounrs of manllre produced in feed lors and f,.Ctory farms. 5o NitrOlIS oxide proclucrion is also relared ro livestock raising. A1rhough it h,~s a mi-

energy specialisr, has disringuished himself at Cornell Un iversiry. Pimenrel estimates rhar even in energy-efficient livestock-raising narions like rhe U.5., it rakes the energy ofabout one galion ofgasol.ine for every rwo pounds of pork sold. Beef and chicken require abolit half this amount. Thar same galIon of gas c.1n produce over six pounds of eheese or eggs. S3 When it takes l4 ta 16 gaUons of gas to fiII up an average American car, rhe amounr of energy expended in animal producrion may nor sound like mueh. However, when you consider rhar rhe average American ears over 250 pounds of meat each year,5 4 rhe numbers beeome staggering. In facr. almosr halfofali the energy used by the enrite U.5. agrieulrural sector goes inro livestOck rearing. 55 JUSt ro produce the beef raised in our counrry tak.cs the equivalenr of 3.9 biIlion gallons of gas each year. 56 The energy required ro produce aU [he reci mear and pOllItry consllmed by Americans in any given year probably approaches rhe equivalent of 13 bilJion gaHons of gas each year. S7 In fact, Pimenral has esrimated thar we coulcl decrease our roral energy invesrment in food production by fully 60 pereenr if we significantly decreased meat consumption. There are many reasons for rhe heavy energy reguirements of raising livestock. Many currcnr animal-raising practices are extremely energy intensive. For examplc, livesrock is often raised in uonatural envi-

NUTRlTION AND THE ENVIRONMENT ronmenrs referred ro as "f.'Krory farrns" such as "pig-" or "chicken-houses." A governmenr publicarion recenely describcd a srarcof-rhe-an "chicken hOllse. "58 It was 600 feer long-the Iengrh of rwo foorball fieldsand housed over 120,000 nesting chickens. Large amoullts of cnergy are needed [O operate che equipmenr ehat cools the house in che summer and hears ic in [he winter. Auromated feeding and watcring sysrems add ro che energy requiremenrs of such factory farms. StiH more energy is needed to clean and mainrain rhese hOllses. RegardJess ofwhether animals are raised an facrory farrns, on che range, or in other scnings, chere are other energy-demanding requiremencs. Animal feed needs ro bc grown, harvesred, and then rransponed ro ehe animals. SriH more energy is e.,xpended in cransporring rhe mamre livesrock ro s!aughrerhouscs, and ulen processing the animal afeer it is killed. Besides rhe environmemal ethic of bcing frugal wich fossil fuel re..~erves, this incredible input of energy imo livesrock produaion has anorher important environmentaI effecL lncreased usage offossil fuels and other energy sources produces more carhon dioxide, a "greenhouse gas." Consequenc1y, a vegecarian-st)'le diet would be expected ro decrease fossil fuel use and provide a furrher dccrease in greenhouse gas accumularlon.

Relating to Farmers' Livelihood Whar about farrners? Are che recommendatiolls in this chapter unusually harsh on a group of people rhar embody rhe very work ethic that has made America grear? It sholild be emphasized thar curtenr Iivesrock policics do not reOecr a moral failure of rhe maoy honesr t:umers r.hroughout [Ile world. In general, farmers have sought to serve cheir nations well by meering rlle changing needs th:n science, governments, and tlle populace articulared.

Similari)', rhere is no inteor here ro malign the legislarors responsiblc for current agricultura! policies. In many cases, current governmenral policies reflect "oJd chinking" abOlit nllrrition that grcw Out of rhe World War II era. Throllgh subsidies and omer means, farmers havc been encouraged economically [O foHow policies that "sought ro maximize t.he production ofmeat and milk."59 For ehose legirimately concerned about rhe plight of farmers who raise livesrock, there is good news. The WH O speaks highly of the flexibility, resiliency, and social concern characterisric of farmers. They assert: "farmcrs havc revolutionized rheir agricultural pracrices over rhe last 40 years in response tO (he demands for grearer food producrion and seem willing tO change again."60 1 belicve (hat farmers, iudecd, would rise ro [he challenge and cominue [O make strides ro provide heaJc11ier and more environmelHally conscious foods for Americans and [he world.

Condusion Jr seems thar we are sranding an the verge of a major concepUial breakthrough. Just as rhe maj ori ry ofAmericans recognize r.har smoking habirs have both personaj and socierai cffecrs, so many are bcginning ro realize thar eating habits have effecrs far beyond rheir imp:tCt on personal healrh. Indeed, ir is amazing ro realize the large exteor that our dieeuy choices inf1uence nor only aur own healrh, nor onIy rhe heaIrh of aur children, but also the healrh and welJ being of the entire world. It is no exaggeration to sa)' thar in some respecrs our seemingly small daily individual choices ultimarely affect (he destiny of life on our plancr. And perhaps no choice impacts global destin)' as much as one decis ion [hat is among our most basic and personal choices-what we pur on our plare.

481

PROOF POSITlVE ReferencesN"-Clabvukaren A. "fhc People-Food Predicamcllt. In: Man Imd ElIlIironmml, A Henil" Perspmivr--3'" edilioll. Prospect HeiglltS, IL: Waveland Pc<:ss, 1990 p. 101. 1

2

Brown L FuI! HOllse. New Perspeetivet QUItlUrly. Voi. I 1, 1 Sep 1994 p.

6. Durning AB, Brough HB. LiVCSIOCk Economy. In: Wor1duJlJldJ Pap'" 103: Toking SlOek: .Animal FI/rming IJnd tiu Environmt'nt. Washingron, DC: Worldwatch [nStllllle, 1991 p. 11.

J

Dllrning AB, Brougll HB. Liveslock Ecollomy. In: Worldwaleh Paper J03: Tolting Stock: Ani!tud J'ilrming alld the EmJirol1mml. Washington,

-1

DC: Worldwatch lrlSlirutc, 1991 p.40-41.

\ 0011 R. Health md thc cnvirOllmcll1 in the 1990s. Am} Public Hmlth 1992 Jul ;82(7}:933-941. Duming AB. Brollgh HB. Livcsrock Economy. In: \'(/orUwJltch Pllper 103: Tltking Stock: Animal Farming Ilnd the EnvironmeTl1. Washington,

6

DC: Worldwalch InstilUte, 1991 p. 6. Brown L. Avnling 11 globalfaod crisis. VoI. 98, Technology Review, I Nov 1995 p. 44.

7

Nadakavukarell A. Poplilation Dyoamics. 1n: MllTlltnd E"vironmeJlt, A Health PtT1"peclivr--3"' edition. Prospect Hcigllts, IL: Waveland J'l'ess, 1990 p.45. 8

Nadakavubren A. FaU-Out from the "Popll1ation Botnb": Impacts on Human Resourc<:s and &osystem.s. In: MIm Itlld Environmem, A Henlt" PtT$perove-3'" edition. Prospect Heights. IL: WaveJand Press, 1990 p. 127-8.131-8.

9

Durning AB, Brough HB. Liv<:slOck Economy. In: Worldwl1tch Paper 103: Tizlt:ing Sioc},; Animal Farming I1nd the e'WiTOlmWJI. W1shingroo, DC: WorldW:llch InstÎcute, 1991 p. 14. 10

WHO Commission On Heahh And Environmenr. Nalllra.l Rcsollrces for Food, Agricultura! and Fisherics production. In: Reporl OfTh~ PII1/t1 O" Food And AgTiculnllY. Geneva, Swirlcrland: World HCaJlh Organiz.1lion, 1992 p. 28. II

11 AcharyaA. Tropical Forcsts Vaoishing. 10: Brown LR. LellSsen N, Kalle H. cdilors. Vital Sigm J995: Ţhc Trelld.s Thal Are Sbaping Our FUlIIre. W.W. NOTlon and Company. New York, 1995 p. 116-117. 1) WHO Comrrussion On Healt.h And Envi{onment. Natural Resourcc:s for Food, Agricultura! and Fisheries ProdllClioll. In: Rrport ofnJe Pallcl On Food And Agrieu/zurt!. Geneva. Switzerland: World Heahh OrganizalÎon, 1992 p. 30.

I~ Acharya A. Tropic.ClI Foresrs Vanishing. In: Brown LR, Lcnssen N, Kanc H. editors. VillII Signs 1995: 77u Trmds Tbat Are Sbapil1g Our }~ltur~. W.W. NOTlon and Company. New York, 1995 p. 116-117.

Durning AU. Brough HB. LivcSlock Ecology. In: Wor!LlWlllclJ Pdper 103: liJkillg Stock: A"imal Fllrmillg alld tlle EllvÎrollnu:nl. 'W:.'lshington.

lO

DC: Worldwalch Institulc. 1991 p. 16-17. \XfHO Comrnission On Hcalth And Environmelll. Ellvuonrnclllai Effects of Intensive Agricultura! P{OdUClion. In: &porl Of TIu' Pllntl 0" F00l1 And Af:Ţim1tuY(. Geneva, Swil2Crland: World HeaJrh Organi7"l.lion, 1992 p. 48.

11

U PennjnglOn JA. NUlrienr ColllCnl Chaptcrs on "Mears". "Pollhry", and "Milk. Yogurt, Milk Beverages, a1ld Milk l3everage Mixcs. In: BOl/ln IIl1d Ch"rclJ~ rood Valuei of PorlilJlJS Commonly Used, Fifri!eJlth Edi/ion. Philadelphia, PA: J. B. Lippincoll Co., 1989 p. 135-146, 150-155, 160-165.

PenninglOn JA. NlltrieOl COOlem Chaplers on "MeatS", "Poulr.ry", and "Milk, YOgllTl. Milk Beverages, and Milk Beverage Mixcs. [n: Bowl'S and Chtlrch's Food VaII/ei of Porliom Commonly Used, Fifut1IlIJ 1:.'l/iJioll. Philadelphja, PA: J. B. Lippincocr Co., 1989 p.·135-146, 150-155, 160-165. l3

l4 WHO Colllmission On Health And Environlllelll. Consequenccs of EnvironmemaJ Change lor Food and AgricuJmral Prodllclion. In: &porr OfThe PlltIelOIl Food AndAgrirulwTl'. Geneva, Swit1.erland: World HeaJdl Organil.atioll, 1992 p. 76.

2S Gardner JL, editor. World Wormarion T.,ble. In:

Relldcr's Digm Atltts oftlJ/! World. Pbl.sanrviJle, NY: The Reader'.s Digest A.s.socÎalion, Inc., 1990 p.I96.

WiJken. E. Soi] Erosion's Tol! Continues. In: Brown tR, Lenssen N. Kane H, editors. Villil Signs 1995: The Ti,."ds TlJlu Are Shnpillg Ollr l;i,IIlrt. W. W. Nonon and Company. New York, 1995 p. 118-119.

26

WHO Colllmissioll On Health And Environmenl. Conse'luences of Environrnel1lal Change for Foo
17

Durning AB, Brollgh HB. LiveSlock &ology. In: WorltiwnulJ Pap" 103: '/iJking Stock: Anim"l Farmillg a"d the E,wironmem. Washington.

28

DC: Worldwatch Instilllle, 1991 p. 18. (convencd from "more lhan 3000 Iiters of waler 10 produce a kilogrellTl of American beer.")

Ifwe wam ro use a figure of"350-450" gallons of waler we would reference il as: DUl'I1ing AB, Brough HB. Liv''5IOCk Ecology. In: WorldwalclJ Papa 103: Tnkillg SMck: Animal J'izrming IlIzd zile EnvirolJmmt. Washington. DC: Worldwalch Insti[ule, 1991 p. 18 give ~ figure in lhe range of 350; while the Catdeman's Associarion give a figure of 440 gallons; sec The. American c.utleman's Association. 1995. SeClion "Environmclll" Ch.ptCT F-2: "Waler Use." Thc Caltle a11d Beef Halldbook (On-line electronic edition). Accessed al World Widc Wcbsite: http://www.co\Vtown.org/

15

US Depanmelll of Comlllercc. 1992 Census of Agriculture; Volume 3 ReJaeed Surveys; Pari 1 Fltrm and RllllclJ lrrigmioll Survey (J 994); AC92RS-l. US GOVt Printing Officc, Washington, 1996 p. 54,75.

16 Ach:uya A. Tropic21 Foresrs Vanishing. In: Brown LR, Lenssen N, Kanc H, cdilOrs. Vilal Signi 1995: Th~ Trmds Thal Are Shapil/g OUl' Fllture. W.W. NOrlon md Company. New York, 1995 p. 117.

Note: calculatcd by dcterminÎllg dle eotal continental US wheal harvcsl in 1994 from both irrig,lled ano non irrigatcd Iand and comparing wilh the IOI~l amount of waler used for irrigarion based On 325,851 gallons being equivalcm ro ooe acre foot of irrigarion waler. Basic data found in rabies 23 (page 75) and table 22 (page 54)

Achary:tA. Trol'ical ForCSls Vanisbing. In: Brown LR, Lenssen N, Kane H. edilol'<. Villtl Signs 1995: TIu 7rmds Thlll ATi" Shaping Our Future. W. W. NOTlon and Company. New York, 1995 p. 116-1 17.

Durning AB. Broug/t HB. Live5IOCk &ology. In: Worldwiltch Paper 103: 'loking 5l(xk: Allimal Farmillg and tiu Ellvirollmem. Washington,

17

DC: Worldwaech Institure, 1991 p. 16-17. 1. Durning AB, Brough HB. Liveslock &ology. In: WorUwnteb Pap"r 103: Toking Sr.otk: Animal Farmil/g nnd tIu ElIlIironmt1Jt. Washington. DC: WorldW3tch Instirute, 1991 p. 16-17. Durning AB, BrOUgll HB. Livcstock Ecology. In: WorMwatdl Pnper 103: Tuking Sr.otlr: Animal Farming and the Eflvirollme11l. Wa.~hinglOn,

29

De.

Obtaineci by personal corrcspondellcc Wilh USDA:

Il POlll1ds per bushcl for cach grain were: barJey: 48; Com: 56; Oats: 32; Rye: 56; Whe:ll: 60 2) Gallons per acre foot = 325.851

19

DC: Worldw;llch InslilUte. 1991 p. 16-17.

482

Thi.s is a f.1ir oomparison because rhe bcefindu.my lake., into onl)' irrigarion water meci for feed needcd in ealtle raisillg - not non irrig
NUTRlTJON ANO THE ENV1RONMENT edible pound o( beer comcs (rom dividillg l!le total warer lISed br beer oule and rhe feed rhey car by the total number of ediblc pounds o( betf produced ycarly.

~2 Nichnlson WJ. itrosamines. In: EIJlIJ'YOI/1IIr1llfll aTJd Ocrupational Mrdicille-2'''' rdilioll. Bosron. MA: Littlc Brown and Co.• 1992 p. 955-

965.

Note: S:unple caJculalion for W1Jcat

WHO Commission On HeaJth And Environment. Environmental Effccl. of Inlcn.ive Agricultural Produclion. In: Reporl OfTIJe Pallrl 011 Food And Agriclilel/rr. Geneva, Swit'ZerlaJld: World HcaJth Organiz..1lion. 1992 p. 38.

irrigale
Ol5On BH. EnvironmelllaJ Wall:r POUUUOIl. In: EnvirbTtmtmllll flnd OCCI/paliollfli Medicillc-2"J editioll. Boston MA: Linie Brown :10.1 Co.,

",heat non irrigaled aacs: 5.866. J 35 x 36 bushcls per acre x 60 Ibs per bushd '" 12.670.851.600 Ibs.

·15

U

IOtal )'idd = 26.934,475.800 pollnds 3.396. \0 1 x 1.4 acre feeI x 325.851 gallons per I acre foot ~ 1.549.272.069.731 gallons (an acre fool i.s 1he amounl of warer 1ilaI would cover 1 acre of land 1 foor dc<:pl

1992 p. 1263. WHO Commission On Hcalth And Environmenr. EnvÎronmcnral Effecls of Imensivc AgriclllrlluJ Prodllclion. In: Repbrl Of Thr Pt17l1'1 On Food AJld Agrirolture. Geneva. 5witurlaJld: World Healrh Organization. 1992 p. 39.

WHO Commission On Hea!th And Environmcnr. Consequcnces of EllvironmenraJ Change for Food alld Agricultura! Productinn. III: Reporl OfTbl' P,lllei On FOOlI AndAgrimlturr. Gencva. SlViturland: World Hcahh Orgalli'lA'\lioll. 1992 p. 72.

'.6

\VHO Commission On Healt.h And Environmcnr. Environmctl1a1 Ef. (eas of Intensive Agriculrural J'roduclion; Conseqllenct's of Environmenrai Changc tor Food and I\griculruraJ Producrion. In: Report Of17)1 Pane! On Food A,,,1 AgrimltuTe. Geneva. 5wit;lerland: World Health Orga.ni'l..ation, 1992 p. 38. 72.

17

1,549.272.069.731 gallons /26.934.475.800 pounds = 57.5 gaJlons of WlIlCr ro grow one pound of whe.at Durning AR. Brough HB. Livestock Ecolog)'. In: Worldwl1tcIJ P'lpU 103: Tnkillg Stbck: Allimnl F'lmlillg t1flli tlJt trwironmml. Washington. DC: Worldwalch InslifUle. 1991 p. 18.

30

JI The American Gulemans Associalion. J995. Section "Environmenr". Chapler F-2: "Warer Use." TIu Cutie I1Ild BeifHnlldbook (On-line electronic version). http://www.cowtown.org

J2 The American Cmlcman's Assoeiation. 1995. Secrion "Environmelll" ChaplCl F-2: "Watcr Use." The Coltle a7J4 SeifHandbook (On-line e1eet ronic version). hrtp://www.cowrown.org

Durning AB. Brough HB. 5aac:d Cows. In: WorldwalC" Pl1per 103: 7itking Slbd/: Animal Farming and ch( EnvirOTJmml. Washington. DC: Worldwalch InSlitUle. 1991 p.36.

J

POStei S. Worldwate" Pap" 93. Wolt'T fi)' AgriCll!tl/u: Facing lhe LimilS. Washinglon DC: Worldwarch inslirure. 1989 p. 37.

}I

Poslel S. WorldUJdlc!J Alper 93. ~II'T for AgriCltftl/rc: Facillg fhc Limiu. Washington DC: WOrldW:llCh Instirule. 1989 p. 37.

35

Durning AB, Brough HB. Sacrcd Cows. In: WorldwatclJ Paper 103: 7itkillg Slbck: AJJimal Ftmni1Jg a1Jd ehe Environmml. \XI;lShingron. DC:

.l6

WOrldW3lch InslilLlle. 1991 p.42. Repun of 3 WHO 5wdy Group. Nurririon and Food Policies: Pasr Experience .1Ild Implicarions for Aerion. )n: Din. NI/lrilion, alld lhe PTt'vmlion bfChronu Diu'lJm.. Geneva, Swilurbnd: Wmld Heallh Organiz:Hion. 1990 p. 141. 37

Reporl of a WHO SllIdy Group. NlIlrition and Food Policies: Past o:perienec and Irnplicalions for AClion. In: Dia, Nlllrilioll, and tiu Prcumtio1J cjChroTJil' DiJetlSeJ.. Genev:l, Swilurland: World Hcalth Org:mi'lalion. 1990 p. 160. JS

EI.AJ)ra( A. \Xlilli \V/V. el aL. Dield,in in lhe food chain: porential heaJth effecrs of recycled animal manurc. jOl/rlUlI bfEnvi'bTl171eJltal Henlth 1990;53( 1): 17-19.

39

WHO Commission On Heallh And Env;ronment. EnvironmentaJ Effeels of Intensive Agnculwral Produclion. In: Repon Of77u Pmlitf On Food AlJi Agriclilltlrt. Gencva. Swil2erland: World H~lth Organizalion. 1992 p. 38-39.

.0

~I Nadakavllhren,

A. Inlrodllelion ro Ecological Principles. irI: Mall tl1ld Ellvimllme11l. A HeflltlJ Perspectivc-3'" tiilion. Prospecr Heights. IL:

.s WI-IO Commissioll OII HealrJl And Environmenr. Conseqllences of Ellvironmcnlal Cha.lIge for Food and Agriculrural Production. In: Reporl OfThr PomI OII FootlAndAgril'ultuTl'. Geneva, Switterland: World He:lhh Organi;Gllion. 1992 p. 72. WHO CollllnjssÎon On Health And Envi'onment. Environmenral Ef· feclS of Intensive Agricultural Produeoon. In: &pO" Of Tiu PallCl On Footl AJIII AgrimltuTi'. Gcneva, Swir.a:r1and: World Heahh Organizalion, 1992 p. 39.

49

~ Durning AB, Brough HB.. In: Worldw'lub Paper 103: Talring Slock: Animal Fflrming and tiu Enl'irolltnmt. Washington, DC: Worldwatch ln-

tilllle. 1991 p. 27. ;1 \VHO Cornmissioll On Hea.lth Nld Environmenl. Environmcnral Ef-

feas of Intcnsivc Agriculmral Producuon. In: &porl OfTIJ( Panl'l On Food And AgricultuTC. Geneva. 5wit:lerl:md: World Heallh Organization. 1992 p. 38. WHO Commission On Healrh And Environmenl. EnvironmentaJ Ef· fects of inrensive Agricuhural Prodllcrion. In: Reporl OfnJI' PaIul On Fooll And Agriculturi'. Geueva. Swir:zerland: World Heahh OrgaJlization. 1992 p. 39.

52

DlIming AB, Brough HB. Livc:stock Ecolog)'. In: WorltlllJiltc" A'1"'r 103: 7itking SlOck: Anim,tI Farming tmd tiu Eiwironmmt. Washington, DC: Worldwarch Insriture, 1991 p. 16-17.

>3

;~ Durning AB. Brough HB. LiveSlOck Economy. In: Worldl/JatelJ Papa

103: 7;lking Stock: Allimal Ftmning and thc Emlirb1lmem. Washington. De: Worldwatch Institutc. 1991 p. 10. -; Durning AB, Brough HB. LivcslOck Ecolog)'. In: WorldwalclJ Pap" 103: 7itking SlOl'k: Animal Fflrlning aud tIu E7wironmml. Washington. De: Worldwalch InstituIe, 1991 p. 17. • Calculaled basc:d an C..urleman·s Assoc:uiol1 data of 15.2 billion pounds bonclcss/cdible weight beef r.used in 1994 eombined with During and Brollgh's dala on energ)' inpur per kilogram ofbeef rai ed. See The Ameri<:'111 Cauleman's Assoeialion. 1995. 5eaion "Economics". Chaprer A-8: "Produerion umbers." Tbr Cnlllrtmd BrifHandbook (On-line electronic version). hnp://www.COwlOwll.org And DUJIling AB. Brollgh HB. Livestock Eeolog)'. In: \'(/orldwalC" Fape, J 03: 7'ieking Srol'k: A7Jima/ Farmiug and r"e Enviroummt. Washington. DC: Worldwatch Inslilule. 1991 p. 17.

Wavebnd Press. 1990 p. 36.

483

PROOF POSITIVE 57

Calculared (rom dara pre. tu led in Duming AB, Brough !-iB.. In:

vcmion ofChro11ic DiJcouI.. Geneva. Swim:r1and: World He:Ulh Organi-

WorldwlJlclJ Pnpcr J03: Taking Slodr: A11imnl Fnmling nnd riu EnlJirOllmmr.

zalion, 1990 p. 121.

Washington, DC: Worldw
GO Rep0rl of a WHO Srudy Group. NUlririon and Food Policies: PasI Experience and Jmplicalion for Aerion. In: Dicl. Nlllririo11. flnd file PreIJmtion o/Chrollic DiUtlm.. Geneva, SwÎrzerland: World !-ic:l1lh Organizalion. 1990 p. 129.

C.rnpbcll D. The Goldcn Egg? Former CoopmuivC->. O.tOber VoI. 62; Superimcndenr of Document., US Govermnenr, 1995 p. 12. 58

Repore of a WHO Sllld)' Group. Nurririon and Food Policies: PasI Expericn e
59

484

CHAJPTER TWENTY

EYOND

THELEADING CAUSES OF DEATH

D

id you ever lay sleepiess in bed wondering abol)( the best treat menr for rheumawid arehriris? The answer is probably no, uo~ less you have the disease yourself or know someone who is srruggling wirh thac iUness. Our interesr in the rreatmenr or prevemion of disease is usually strong regardjng thc disease char affects or duearens us and those who are c10se to us. Most ocher topics may sti muiate our curiosiry, bur unless we are involved in a healrh profession, they rarely river our artemion. For example, if a chaprer in this book was called "Living with Von Hipple Lindau Disease," the average reader may be curious ro look ac the chapter Ollly uoril it is discovered rhar ic is a rare genetic disease ehat affeces the brain ~lI1d eyes. However, fOf (he rare person wirh [hac condirion, ic probably would be rhe fim chapter ro be read. As I was comemplating rhe c10sing chaprer of [h is book, 1 asked myself che quesrion: whar about individuals who have other diseases dut 1 have ooly barely memioned? How can ) give them the message thar a hea1rhy lifesryIe can help meec their de.sperace hcalrh needs? It is not possible ro wrire

a chaprer on every health problem recorded in rhe annals of medjcal hiswry. FinaJly, I arrivcd ar the answcr. In this final chapter 1 would give my readers a lasrjng legacy on how (Q approLUh any diset1Se or conditionftom it lifestyle perspective. This chaprer will address a number of common conditions rhar are of great interest in themselves. We wiU sec a Iifesryle approach to such diseases as arr.hrirjs, osreoporosis, cararacrs, asthma, anei a host ofother heaJth concerns. The theme, however, should be of he1p ro those widl orher diseases thar are not speeificaIly menrioned. The approach is nor a eure-aH, but rarher a sysrem ro he1p strengthen your body, improve your health, and decrease your risk of diseases in general as weB as their complicarions.

A System for Prevention and Treatment Back in rhe late 1970s, a number of health professionals, spiritual Icaders, and educators got rogether ro esrablish a new preventive medicinc center ca.lled Weimar Institute. The founders were nor Out so much ro demonstrate something new as

485

PROOF POSITlVE ;tcronym ta make ir easier tO these ciglu essenrial e1ements of health. The acronym consisred ofa simple phrasc that they made into a single word: 'NEWSTART:" Their choice of wording was fonuitous. Those twO merged words nor only pointed ro rhose eight essential e1emenrs, but (hey also gave an accurate message that (he adoption ofrhese simple factOrs could help most people begin a whole new phase of their lives-to (rul)' get a "new start" ill life. Let us look at what the letrets of "NEWSTART" stand for. They are explained in Figure 1. Mauy already J."ecognize aH or almost aII of these eiglu "natural remedies" as necessary conditions for a long and abundam life. Ln tact, these eight e1emenrs of health are no surprise to thase of you rhat have been reading rhis boak from caver tO cover. The imporrance of each should have been apparent in the material that has been presenred lip to this poim. We wiJl sec in this chapter a number of important health isslles thar have nor yer been explored. As we look ac condirions that largely have a bearing an aur quality of life, I bdieve we will sense anew [he vallle of ilie comprehensive lifesryle thar this book advoC;ltes. These eight e1emems provide the fOundation for dealing with any health con-

riition S1tccessfuLly. Figure 1 ehey were ta confirm rheir confidence in a century-old approach ta comprehensive wellness. They were convinced that ilie path ro healrh for many people rested on eight reLatively simple hettith concepts. These concepts were popularized by Ellen Whiee in the 1905 he;tlth c1assic. The Minisrry of Healing. It may seem strange rJlat health concepts ollrlined a cenrury ago could be of value roday, considering [he advance in medical knowledge roday compared wirh ehar era. Elien Whire has been quored on a variecy of health topics in many chaprers of this volume. How could a person bave sllch advanced knowledge? Appendix X probes rhe answer ro this question. Weimar deve10ped and crademarked an

486

For a specific person who has a specific healrh problem or wishes ro avoid a certain problem, rhere may be one or only a fewof the eight e1emenrs ofNEWSTART dlarare more imponanr rhan tile others. In some sÎtlIations, diet and exercise may appear to be the mose important facrors. For other people wich orher he-alrh problems, trust in divine power may seem (O hold the missing key.

NEWSTART ELement Number 1: Nutrition The first element of NEWSTART is nurrition. [have devoted many pages in this book ro the value of nutrition ro aur health. We have seen that it can help prevenr hearr disease and cancer. We have seen its value in helping ro stave off kidney failurc, kidney stones, and carly skin wrinkling.

BEYOND THE LEADING CAUSES OF DEATH We have looked ar its role in avoiding seri~ infectious illnesses as well as in improving our mental heahh. But rhe toml vegerarian dier can produce many ocher bendirs rhat I have not yer memioned. Nuuition is, of course, just one elemenr of NEWSTART bur its imponance can nor be overemphasized. OUS

~~

• High protein & high fat diet (high in meat)

(li \)~

The Bottom Line on Diet and Health In rhis era of medical cosr consciousness, Dr. Synove KnUfsen has published some fascJnaring data on rhe benefirs of [he veg~ eearian dieL I Hec resulcs provide a fitting demonseracion to rhe benefits of a vegeearian eacing sryle regarding general healrh. Knmsen found rhar among bom men and women, rhere were approximare!y 15 percent less chronic diseaBcs among vegeearians when compared ro non-vegecarians. Utilizalion ofhealrh care faciliries also decreased; rhe non-vegetarians of both sexes reported more hospiralizarions rhan rhe vegerarians. Med'ieation use by non-vegetarianswas dramaricaJly more frequem. In general they used abom twice as many medicarions as rhe vegerarians.

Vegetarian Diet and Endurance What aboli( the benefits of che vegerarian dice beyond ies resistance co many diseases? Many people feei that once they go an a vegetarian dÎee they are going ro be weaker. They worry rhar they will not feei as s[rong ar robust. Many of us have grown up wÎth rhe idea thac meac and milk builds srrong bodies. Those ideas have tumed ouc ro be myrhs. Competitive arhleres have known for years chac animal fac aud protein ii> somerhing ro be kepc at a minimum when rrying ro build endurance. [n general, eber engage in a practice known as "carbohydrare loading." Such approaches are based on years of research in ebe arca of sports medici ne. One ofrhe classic srudies was performed in the late 19605 when the Scand.inavian researcher, Doctor Per-Olaf Astrand, studied nine highly erained acWetes. Dr. Astcand changed cne diets of these athletes every mree days. Ar the end of each three-day period, he had each athlere pedal a bicycle

J1l111

il, 'III' I

1 hr 54 min. (1.9 bours)

• Mixed diet (Iower meat, fat aRd protein) • Vegetarian diet (bigh caJ'bohydJ'ate)

o

I 1.5 2 0.5 ______ Maximal Endurance (rime 10 exhausrion)

2.5

_

3

Figure 2

ar high speed umil exhausrion. His resuJrs are tabulated in Figuce 2. 2 We see thar wirh a high meat dier (high in bom proeein and fat), chey became eJ(hausred after abour an hour. When on a mixed diee, lower in meat, fat, and pcotein, and higher in plant foods, they cOlild peddle at high speed foc almost twice as long-a toral of 1.9 hours. However, when on a vegerarian diet, they weru for 2.78 hours unril exhaustÎon set in. 1'his dramatic improvemenr in endurance should noe surprise keen observers of ilie animal kingdom. After aH, che ax, the dephanr, and the horse have no problems wieh strengrh oc cndurance an a vegetarian diet. Horses can run ac high speeds for hours. Elephants are noted for running 10 ar 12 hours srraight at high speed. Can you imagine carryÎng a11 of that weight (over 6 r.ons) at 25 miles pec hour for cen or twelve hours straight? On the other hand, meat-eating big cacs such as cheetahs, tigers, and others have good speed at the stan, but they fatigue within a shorc time, often wirhin less than 5 minutes. Indeed, in the animal kingdom, endllrance, the ability ta provide top energy for long periods of rime, is largely a characteristic of vegctarian animals.

487

PROOF POSITIVE

Food Supplements TypicaJly, when I ralk ro people abour the healch benefirs of nurrition, some are nor contenr with my message ofearing more fruies, whole grains, and vegetables. They wane something more-and perhaps someching less. le reqlliees some effon, planning, and acquisirioll of new habits ro dramaticaJly increase yom fruic and vegetable eonsumprion. Many feei rhat an easier solution is ro take sllpplements ("vitamin pills") in order [Q reap rhe benefits of improved nucrition. They anempt ro improve their nutririon, not by eating subscantially betrer, but by holding ro che same foods ~tIld addingvieamin and mineral sllpplemencs ro rheir regimen. Unfoflllnace!y, takillg extra doses of vitamins ean cause problems. Take {he B vitamin, niacin, /Or example. Niacin Îs acrually an acid (.nicotinic acid-nor ro be confused wi{h "nicotine" of tobacco fame3) but acrs like a vitamin in rhe amoullts that i{ is found in natuee. However, ifyou take Iarge amounrs of this acid, Ît aers as a dfllg. 4 The reason for chis is ehar (here is onJy sa much of chis vitamin chac the body can use. The excess, which cannot be used as a vitanun, begins ro exen drug effeers. Among rhose

DANGERS OF TAKlNG EXCESSIVE WATER SOLUBLE VTAMINS Vitamin Suppkment 1_ • Niacin

heart rhythm problems peptic ulcer disease Iiver disease gout diabetes diarrhea

• Folie acid

pernicious aoemia

.Vitamin 86

nerve pro.blems Parkinson's kiduey problems

.Vitamin C

diarrhea vitamin dependence

Figure 3

488

Effect

Disorder

masks 812 deficienc)' JPotentiallY irreversible neuropathv . kidney stone forma.ion Vitamin C deficiency if supplement is decreased

drug effeccs are che lowering of cholesterol and uiglycerides.> For chis reason, many people calce niacin in drug doses to bring their blood f.us into line. Like ali drugs, niacin in drug doses can cause side effecrs. lJ\ che case of niacin, these side dTects include pepcic uJcers, diarrhea, altered hean rares, liver disease, gout, and worscning of diabeces. 6 . 7. 8 Like mher drugs, niaein in large doses may have some desirable effccts, but it al50 has some undesirable ones. The lIser of large amOUJ1[S of niacin is really using a dIlJg-noc a mere viramiJI. In face, a recent scientiflc paper on niaein concluded with ilie following remarks: "Unfoflunace1y, the side effecc profile of rhis agent [niacin] warrams ies use only in patients wirh marked dyslipidemia [exeremely bad blood fars] in whom side effeccs and potenrial toxiciry are closely moniwred. "9 The B group ofviramins, includ ing niacin, is water-soluble aJld is chus easily eliminated. For this reason, many people who lack a deeper undersranding of biocheny think {hat rheie bodies would get rid of any excess niacin and ic would cause no haem. Howevee, tbey are sadly mîstaken. Orher B vicamins can cause problems in excess. Laege amoums offolie aeit'! can cause insomnia and other mental disorders. Vicamîn 8 6 (pyridoxine) in large amoullts can worsen Parkinson's disease and G1USe oeher nerve problems. 10 Virarnin C anocher water-soluble vitamin, may increase the risk ofkjdney srones if taken in exeess. 11 It can also cause dîarrhea and abdominaJ cl'amps.12 Those who abrupdy swp {aking doses of vicamin C greater {han 500 mg daily risk developing vieamin C deficiency-apparemly because the body becomes dependent on higher doses of the viramin. '3 Their gums can easily bleed when brushing their reech. Figure 3 lists some of ehe problems caused byexcessive amollntS of wacer-soluble vitamins. The fa{-soluble vitamins such as vitamins A, O, E, and K, a.re more difficliit for the body [Q eliminate. Many people have caken modest amounts of vilamin A in slIpplemencs and have become ill as a result. A dose 0(25,000 IU ofviramin A per day

BEYOND THE LEADING CAUSES OF DEATH (abolit 5 times the amounr needed ro prevenr nutritional deflciency) can cause prohlems as diverse as liver trouble, headaches, hair loss, dry skin, bone paill, and t aches. 14 Pregnant women who rake over 10,000 IU of the vÎranun pur rheir unborn children ar increased risk ofbirth defecrs. 15 Excessive vitamin D can cause severe problems by inrerfering with calcium balance in the body, and can lcad ro calcium buildup in me blood (called hypercalcemia). This condition may produce anyrhing from mild to life-ehre3rening sympro01s. The lisr of re1ared problems includes nausea, vomiring. farigue, confusion, high blood pressure, kidney failure, and co01a. 16 Viramin E may be toxic in high amounrs, causing problems with weakness and fatigue as well as nausea and diarrhea. 17 Excess viramin E aJso predisposes cereain individuals ro bleeding problems, pareicularly rhose who are an blood thinners (alllicoagulanrs). 18. l? Of. Sheldon Hendler is a widely quoted aumoricy on vitamins and minerals. He holds a Ph.D. in biochemisrry from Columbia Universicy and an M.D. degree from the Universicy of California. He expresses much more camion for vitamin E supplemenration rhan many supplemem advocares. Dr. Hendler sees "no reason for adults ro rake more rhan 400 IU daily" and lisrs concerns for some side effeccs beginning at doses of as linie as 600 IU per day.20 There is a separare concern regarding the pracrice of rourinely raking viramin and mineral supplemelHs. Surprisingly, you can cause a vicamin or mineral deficieney by raking /arge doses ofsupplemenrs. How can such a thing happen? How can conscienrious individuals who rake exrra vitamins and minerals put memselves ac greacer risk of deficiency? The answer lies wilh a (rue undersraniling of rJle inreracrions belWeen vicamins and minerals. There are a number of ways in which vitamins and minerals are cransported and urilized by rlte body. Taking excessive amounrs of one vitamin ar mineral reslllts in an lInbalancing of the uptake and ucilizarion of orher viramins and minerals. Some of these inreractions are illusrraced in Figure 4. 21 In rhis figure, a line connecring any vi-

v Zinc

Vite

Phosphorus

Vit B. Figure 4

ramin ro a mineral indicares an inreraction. For example vicamin C has a line conneccing it ro iron. This indicaces an inreracrion belWeen chese substances. In this specific inceracrion, if you rake large doses of vitamin C day afrer day, youe body will il1cmzse irs absorprion of iron, which could cause

v

Vit BI! Figure 5

489

PROOF POSITlVE orher problems. Intcractions of orher sllbstances ma)' eause a decrel1se in the absorption of a subsrance. Many people are unaware of rhese potenrially harmful in[eracrions. The message is thar no one shollld take large doses of supplemenrs without careful considerarion. There are 11 separate interacrions shown on rhis f1gure. Nor only do vitamins and minerals illteraCt, viramins can inreract wirh orher yiramins, and minerals can inreract wirh other minerals as ilIl1srrared in Figures 5 and 6. 22

Vai:1adlum Fluoride

n -.........-.L/

Copper Manganese

Figure 6

490

There are 12 vitamins shown. and 27 possible interactions. Note [har rhree of the popular vitamins, A, C, and E, interact with each other. What about a simple multiple vitamin pili, or the sllpplemenrs in a bowl ofProdllcr 19 Of Total cereai? Unlikc many supplements, rhese usuaLly do nor provide large amOllntS of nutrienrs. It is lInlikely thar seriolls repercussions will arise from raking such products (alrhough rhe)' probabl)' are not necessary ifyou are healrhy and followÎng the diet recommended in this book). There are cerrain disease siruations in wruch large doses of vitamins ean be of benefir. However, such supplemenrs are best taken under the direction of someone who is well aware of rhe risks as weli as rhe ben-

efirs ofsllch an approach. Indiscriminare use of viramin supp1emcms may well increase health risks rarher rhan decreasing rhem. In Chaprer 2, "Good News About Cal)cer-It Can Be Prevented," 1 point Out a be[[er way ro get many of the benefirs of viramins withour rakjng supplemellts. There 1 share some of rhe excitjng new rese:trch rhat is championing whole planr foods in the anrioxidanr domain where vitamins were formecly rhoughr ro rein. For example, Cllrrenr research indieates rhat you can get an anrioxidanr benefit eqllivalenr ro 1100 IU of vitamin E by eating a cup of rhe cooked green leafy vegerable, kale. Kale does rhis wirhour exposing you ro the risks of high vitamin E doses because it only contajm 13 1U of rhe amioxidant vitamin E. Bur it also cOlltains a host of orher antiox.idanrs, making ir eqllivalent ro 1100 IU of a viramin E supplemenr. 23 The message thar 1 presented e1sewhere in rhis book is rhar many fruits and vegetables have powerflll amioxidanr efTects rhat exceed expecrarions based on rheir vitamin contene. Similarly, other naturali)' occurring chemicals in plant foods may sllbsriwre for funcrions rhar we llSllally rhink of being associarcd with specific Vlramms. Furthermore, we know rhat eating an abundance of fruj tS, grains and vegetables can acrually add years ro yom life. Stlldies suggesr that a veget.arian dier ma)' exrend ilie average person's life by more ,han a decade over that which rhey colild expect on a heavy mear, planr-poor djer. Ir shollld be obviolls ro thase wbo have read rhis book s)'stematically [har ilie way a vegeraJian diet prOlTlores longevity is by substamially decreasing the risk of rhe rwo mosr powerfliI killers, hearr disease alld cancer, as well as decreasing rhe risk of orher degenerarjve diseases. Rarher t11an thinking about rhe lIse of supplemenrs when ill qllcsr ofgood nutririon, think abollt healrhfllI food choices. The use of supplemenrs begs ,Ulother guestion: do viramin and mineral supplemenrs actuaLly increase one's lifespan? Forrunatel)'. rhey have been around long enough for us ro ger a staristical answer ro the quesrÎoll.

BEYOND THE LEADING CAUSES OF DEATH

Vitamin Supplements and }'Dur Lift Span How mllch difference do food sllpplemems make? This was the quesrion addressed nor long ago by researchers ar the Narional Cellter for Chronic Disease Prevemion and Healrh Promorion. The researchers used the extensive database f(Om the Fim Narional Healrh and Nurrition Examinarion Survey (performed [rom 1971 ro 1975), and rhen assessed [he dearh rate of pareicipams through 1987. They found rhar rhose who llsed supplemenrs did nor live any longer rhan the non-s.2 4 They concluded: "We found no evidence of increased 10ngeviry among vitamin and mineral supplemem s in rhe United Srates. ,. Clearly, supplemems do nor appear to be living up ro rheir promise. it is obvious rhar rhe foundation for nurririonai healrh does nor lie wirh viramin and mineral supplemenration. It rests with a dier based on an abundance of fruits, grains, and vegerables. Nor ooly do rhese foad choices provide the beneftrs of rhe virami ns and minerals rhar we know about, bur rhey also provide a hosr of facrors that haue not yet bem discovered. lf you are on a supplemenr program, you will nave to wair for scientisrs ro discover more of rhe healrhful compollods in plam foods, learn how ro make or isolare rhem in rhe lab, and rhen finaJly put (hem imo sllpplemenrs for commercial sale. On rhe orher hand, ifyou are earing frllits, vegetables, whole grains, nurs and seeds in moderation, rhen you will be gerring ali of the horresr prorecrive phyrochemicals (planr chemicals) before rhey are even discovered. In spite of aU of rhe scienrific evidence of rhe nurrirional complereness of rhe lOral vegerarian dier, there are srill some of "rhe old school" who believe thar such a diet is nurririonally deficient in prorein and c.alcium. As poinred aur in Chapter 7, "The Grear Meat and Protcin Myrh," Harvard researchers in ilie 1950s showed thar a roral vegerarian diet was /iJlly adequate for prorein. In the same chapcer, ir is poinred aur rhar toral vegerarians need a smaller inrake of calcium than rheir meac

and dairy-consuming neighbars. There is a variery of exceUem sources ofcakium in rhe vegerarian diec such as [he green lealY vegecables. Onlyone nurrient has been a perplexiry for total vegetarians and rhar is viramin BI 2' Interesringly, rhis viramin is needed in only very riny amounrs. Less rhan one hundredth ofan ounce is more rhan enough B lO lasr a liferime (provided you rook ir i~~mall incremems rhroughouc your life). Despire our very meager need for rhis viramin, a [Qrallack ofir am c.ause troubles such as anemia and nerve problems. Unri! recemly, no one had found a rcliable planr sourcc for B 12 . As a result, man)' who are vegerarians have felr thar becallse of the possibiliry ofB I2 deficiency, they should eirher get rheir Vitamin B ,2 level checked by a blood tese every year (ro be sure rhey are nor becoming deficient) or sllpplement rheir dier wich rhis viramin for securiry's sake. Dr A. Moz.1.tar, a Swiss researcher, has discovcred rhac cercain planrs do comain viramin B12 .25. 26 Furrhermore, he conducred a srudy to derermine if plant foods grown organically would have greater conceocratjolls ofB I2 in ilieir risslles rhan those grown wirh chemical fercili'ler. 27 His resulrs are shown in Figure 7.

16 14 12

Fertilizer • Chemical • Organic

nglg 10

dry weight 8 6 4

2

O

B u in Soybean

B u in

B u in

Barley

Spinach figure 7

491

PROOF POSITIVE Note [hat B I2 was found in soybeans, barley, and spinach, and that when grown organically, tlle amount of B]2 was signîflcantly higher. This stlJdy immediately generared shock waves. Mozafar's work flies in the face of a well-es[ablished nurrirÎolla! position (held even by vegerarian scienrists) thar B l2 is nor found in planrs as conventionally grown. Sînce he reponed B J2 leve1s even in the chemically ferrîlized plants, some nucrirional experts have proclaimed his work as suspect.

To Expelld 150 calories Volleyball Brisk walking Rak.ing leJlves or active gardeuing

,

,It

Swimming laps Playiog basketball

NEWSTART Element Number 2: Exercise

Running (1.5 miles) Figure 8

10

20

30 Minutes

• Increase in HDL arter 12 weeks of training • Decrease blood pressure • Improves i.nsulin scnsitivity • Decreases hematocrit • Decreases fibr1inogen • Decreases platelet function • lmproves fibrinolysis Figure 9

492

The rescarch has promptcd many questions. Were there misrakes in the B 12 meaSllfemellts? Was rhere somerhing differem abour rlle soil in the stlldy? Is there really an increase in B12 content in cenain orgaJlically grown plalHs? More smdîes are n,eeded ro confirm Mozafar's results. Some are now asserring that a (Orally planr-based clieI wirhout B12 supplements is sufficient for aII of our IlllttitÎonal needs. Unril alI tlle answers are in, however, 1 prefer ro erI' on rlle side of caucion. 1 still recommend thar rora\ vegetarians rake a regular B'2supplemem oreu foods in wllich B12 is added, such as many of rhe brcakfast cereals or meat subsrjtUtes. There are as teasr 12 dry cereai varie[ ies avaîlable ar rh îs wriring rhar comain substantial amounts of B12 • Some milk a1rernarives contain ,Ievels of B I2 rhat are equal (O OI' greater than rhe amounr in cow's milk. As linie as 5 micrograms every other day is prohably all that the average person needs. A listing of quantîcÎes of B 12 and orher nurrienrs in various brands of milk alternatives and cereals is faund in the Appendix:.

Reduces tendency ofblood to elot

40

50

In rhis chapter thus far we have examîned the first element ofNEWSTART, which is nurrition. The second element, exercise, is also of critical imporrance in a roral lifestyle approach LO healrh. Throughout this book, exercise has been a recurring rheme in disease prevention. As physical activity increa.~es from Iess than 500 caJories expencled per week in exercise, mortal iry rares decrease. 28 The greatest benefir is for those wha expend greaIer than 3500 calorîcs per week in exercîse, but grear benefit is obtai ned from exercising as Jitrlc as 750 c.1Jories expended per wcek. 29 To help you in planning an exercise program, activities that wol expend 150 calorics are lisrcd in Fîgure 8. 30 . In the 1990s, alroost everyone has heard of the importance of exercise for decreasing the risk of borh hean disease and cancer. Some of the cardiovascular bcnefirs of endurance training are listed in Figure 9,3l

BEYOND THE LEADING CAUSES OF DEATH Notice dut the tendency for the blood ro elor is a result of endurance exercise, which wiU protect againsr hean atracks and srrokes. HOL also increascs. We havc known for years rhar exercise is important ro boosr levels ofrhe good cholcstcrol. HOL. However, research now suggests thar there is a close response relarionship berwcen exercise and HOL levels. Simply put, rhe more yOl! cxercise the highcr yom HOL level. This has only been recently appreciared. The HOL was rneasurcd on nearly 3000 men who were c;lregorized according to rheir reporrcd exercise levels. The resulrs are tablllated in Figure 10. 32 The rcsearch documenring a dosc response relationship berween HOL and exercisc provides anorhcr explanarion for rhe heart-improving benefits of physical firness. One special nore is in order regarding this srudy. Because of the powerful HO depressing effects of smoking, ali srnokers were excluded from rhe research. In orher words. we do nor know from rhis research wherher exercise boosrs HOL in a similar manner for smokers. What we do know is thar a smoker who is concerned abour his hearr disease risk would be best ro stop smoking in addition ro exercising :Ind eating righr. ACCU311y. research suggesrs rhat exercise

i17lproves. tiu chances ofmccessfiJ.lly stopping smoking. A recent Brown Universiry seudy found rhar women who exercised were Jess likely ro begin smoking again. 33 Exercise provides a well-recognized benefit for rhose wirh diaberes or high blood pressure. .Ir is also an essenrial ingredienr of a program rhar boosrs our immune sysrems and energy levels. There are many more beneftrs of endurance uaining, as lisred in Figure I 1. 34.35 One inreresring study involved an arrempt ro improve rhe communicarion skills of twO grollps of AJzheimer's parienrs. One group was pllt in a walking exercise program, and rhe other group was given lessons in conversation. Over 40 percenr of t!le exercise group experienced significanc improvemenr in comlllllnicarion skills. while the "conversat ion therapy" group experienced no significanc improvemenr in their communicarion skills. 36

58 56

Average 54 HDL 52 level 50 48 46 44

0-2

3-6

7-10 11-14 15-20 Miles run per week

21-60 Figure 10

• • • • • • • • •

Strengthens bones Helps prevent or control diabetes Helps control obesity Decreases risk of certain cancers Helps control anxiety Treats depression Improves stress coping mechanism lmproves symptoms of AJzheimer's Improves intermittent c1audication (leg pain during exercise caused by poor circulation) • Helps control osteoarthritis • Improves fibromyalgia disease In considering aII of the rhrilling evidence abollt ilie benefirs of exercise, perhaps rhe mosc scarcling effecc is rhe widespre.ld prevenrion of disease rhar wOllld occur if everyone merely exercised regularly. Currenr esrimates are tbac (he lack of exercise in America callses up to one-rhird of dearhs from the following chree major diseases: coronary hearr disease. colon

Figure 11

493

PROOF POSITIVE cancer, and diabeees.J7 The first rwo e!emcnrs of r11e NEWSTART program (nutrition and exeecise) beautifully complement each orher. Nutrition worh eogether wirh exercise tO give more benefirs rhan eithee one alone. This is truc ofdiseascs like heart disease, cancer, and diabetes. However, it is aha true for qualiry-oflife concerns. Recall ilie elassic research thar demonsmued t.he superioriry of the vegerarian diee regarding arhleric endurance. Other qllaliry-of·life bcnefits are in the arca of mental performance. For examplc, middle-aged individuals-and even r110se up illto theie 80s who do nor suITeI' from Alzheimer's disease-have been demonstrared ta have a measurable improvement in memory following aerobic exercise programs of tune ar ren weeks in durarion. 38 In fact, older Americans have a progressive improvemem in meneal funcrlon as rhey increase their amounr of exercisc. As one research anicle put it: "There was a clear linear relarionship berween rhe Ievel of activiry and ilie level of cognitive [mental) abiliry."39 A consensus convened by the National Insti(ute of Mental HC'alth idenufied seill orher imporrant quality-of-l.if{: benefits from exercise. They are listed in figure 12. 40 Alrhough healrh professionals have CIllphasized for years the imponance of exer-

• A benefit to mental health and well-being • Short-term reductious in stress, such as anxiety aud tension • Long-term reductions in

~nxiety

• Long-term reductioDs in depressioo in moderately depresscd individuals • RcductiODS in muscle teDsiou, heart rate, aud some stress hormone levels Figure 12

494

cise in prevenring life-threaterting diseases in order ro motivate rheir paticlHs ro exercise, this is probably nOf rhe most effective straregy ro promote exercise. Improvcmenrs in the various facers of rhe qualiry of Iife appear ro be t.he most imponanr reasons rhat many become regular exercisets. RUNNER'S WORLO magazine published the results ofan excrcise survey of700 of its subscribers in 1990. Notice the various reasons for adopring an exercise program: Thesc top reasons were aII rclared ro the quality of life. Furrher down the lisr were lifcsaving reaSOI)S thar professionals rhink are the mose morjvaring. Onl)' 42 percenr identified heart disease prevention as a reason for exercising. Medica.! rcsearch cominlles to uncover more and more benefirs of exercise on qllaJiry of/ife. Harvard researchers recently docume\lted thar excrcise decreases the risk of developing diaberes in adlllthood. 41 As liule as one workollt a week cur diaberes risk by 29 percenr. The prevelHive effeet was nor merely the result of weighr redllction. Orhcr preljminary research suggcstS rhat regular exercise may hdp ro foresrall hearing 1055. 42 Or. Helaine M. Alessio and colleagues from Miam.i Universiry in Ohio exposed 28 people ro rdarively laud noise (IOD decibels). The mase fir subjecrs retained more hearing capaciry man those who were not as fir. One explanarion for rhe difference Îs rhar regular exercise may improve the flow of oxygen-rich blood throllgh ehe riny blood vessels in the ear. As a restimony ro rhe far-reaching benefits of exercise, whcn the Cenrer for Disease Control and the American College of 5porrs Medicine published recommendations in 1995, they presented an ideal schedule of "daily exercise." Gone are ilie days of recommending duce days a week as being sufficienr. In the words ofrhe repon:, "Every U.5. adult ShOllld accumlllare 30 minutes or more of moderate-inrensity physical acejviry on most, preferably ali, days of the wcek. "43 In Chapter 2 an cancer, auenrion is facuse
BEYOND THE LEADING CAUSES OF DEATH strated exercise's abiliry [O decrease cancer in general 44 as well as providing special help for devastating cancers like those ofthe lung, colon, uterus, ovaries, vagina, :Ind cervix. 45 . 46. 47 Soroe of rhe reasons thar exercise has such far-reaching stimulating effects on the immune system are presenced. A number of natural immune fighring cells and chemicals are enhanced by exercise. These same beneftts ro ehe immune syseem that heJp ro prevent life-threatening cancers can also heJp to prevenr the annoying everyday illnesses such as coughs, colds, and flues. 48 It is noe clear exactly how much exercise is needed [O prevenr cancer; however, consistency appears [O be an imporcanr factor. The same likely holds true for other immune sysecm benefirs from exercise. The conclusion regarding ilie figheing ofinfecrions and cancer is ehae exercise should be a pari of aur daily Ijfesryle. Many sedencary middle-aged ar e1derly people shy away from iniriaring an e.xercise program because of fear of experiencing a heare atcack. However, if rhey searr slowly and do nor exercise ta the point of exhauseion, cnances are ehey wiJl nor need a medical consulrauon before iniriaeing such a program. Those with cerrain physical condirions should have an evaluarion prior ro in iriaring endurance training. 49 They are lisred in Figure 13. This figure quores direcdy Eram a consenSliS conference pur on by rhe Narional Institutes of Healrh in 1996 jn which many exercise and hearr disease experrs convened ro print consensus sraremencs on physical exercise. According ro rhe above consenSllS statemenrs, if a 45 year-old man smokes and has high blood pressure, he would need a medical evaluaCÎon prior ro rraining because he has ~mul tiple risk facrors" for hean disease. lf he had only one risk factor he would noe have needed an evaJuarion. More information regarding cardiovascuJar risk factors is found in Chaprer 3, "Hean Disease-Conquering rhe Leading Killer." Years aga, Eilen White recognized the benefits of physical excrcise as shown in Figures 14 50 and 15. 51

WHO

UATE G G

• "Those with known cardiovascular disease." • "Men over 40 or women ovcr SO with multiple cardiovascular risk factors who contemplate a program of vigorous activity." • "Because the risks of physical activity arc vcry low compared with the health bcncfits, most adults do not nced medical consultation or prc-testing before starting a modcratc-intensity physical activity program." Figure 13

"Tbe more we exercise, tbe better wiU be the circulation of tbe blood. More people die for want of exercise tban througb overfatiguej very many more rust out than wear out. Tbose wbo accustom tbemselves to proper exercise in the open air will generally have a good and vigorous circulation." Figure 14

"Morning exercise, in walking in the free, invi~orating a,ir of heaven, or culnvating flowers, small fruits, aud vegetables, is necessary to a bealthful circulation of tbe blood. It is the surest safeguard against colds, coughs, congestions of brain and lungs, inflammation of tbe Uver, the kidneys, aud the lungs, and a huodred other diseases."

495

PROOF POSITIVE

w • dia betie eomplieations · stroke · high blood pressure · heart disease · sYliIlptoms of intermittent c1audjcation (leg pain due to bl'oekage !În ,Ieg blood vessels) Figure 16

One word of camion: althollgh moderate exercisc has e1early emerged as heaJrhful ro rhe immune sysrem, excessive exet'cisc; is noe. Exercise ro the point of complete e'Xhaustion-typical.in competirive arhlerescan work in rhe opposire direction by decretlSing immune responscs. 52

NEWSTART Element Number 3: ~ter

496

Thicker, more viscolls blood illcreases stroke and hean elisease risk. One measuremenr thar, in parc, derermines blood thickness is caJled hematocrir. 1'his ref1ecrs (he number of red blood cclls in rhe blood, and usually c/osely parallds fhe hemoglobin level. Hemarocrir values grearcr than 50 perceot double the risk of cardiovasclIJar evellts in men aJld increase rhe risk fourfold in women. 53 lf a persoll is not drinking enollgh water, hemarocrir rises, rhlls increasing risk of hearr arracks and srrokes. Also, a laek of warer callses dehydrarion of reel blood eells, makillg theOl less flexiblc, ,Ulei they have a greater rendency ro c1or. 54 AlI told, a wealrh of Înformation has been published on rhe subject ofblood flow characrerÎsrics and irs Împacr on a variery ofdisease sr;}rcs.'S' 56. 57. 5B The research oftcn

is published under rhe ride of "hemorheology." 1'hi5 term comes from "hemo" which refers ro blood and "rheology" which refers ro the srudy of the flow propcreies of complex marerials. All)ong the implicarions of this research is thar adequate warer drinking combined wirh mher aspecrs ofa healrbfullifesryle may help posrpone Of prevenr a variery ofdiseases and their complicarions. A few of the benefirs rhar may accrue from iluprovemenrs in blood Aow caused by a more liberal inrake of warer are shown in Figure 16. DÎaberes is associared wirh increased blood viscosit)' or thickness. As the blood sugar level is broughr undeI' bener control, viscosiry rends to improve. Unconrrolled blood sugar Ievels may predispose individuals ro high viscosiry in paft becallse of dehydr,ttion. When blood sugars are rllnning high, rhe kidneys Iose sugar, and rhe sugar rakes watet' wirh iL 1'he issue ofblood rhickness in diabctes i5 of parrÎcular concern because high viscosiry levels may play a role in dia bctes-rehucd kidney and nerve damage. 5~ Blood viscosiry also appears ro have a role in high blood pl'essure. In popll1arion stlldies, rhe higher a person's blood pressllre, rhe higher their blood viscosiry rends ro be. Ifa person can reduce hematocrÎt, the blood pressure wil! rend ro decrease. This provides a double benefic lower blood pressure anei lower blood viscosity work rogerher to funher decrease stroke risk. 60 Ironically, rhose on diuretics (warerlosing pills) for rheir blood pressure may in some ways bc perperuaring their problems. The reaSon is that dlcse drugs tend ro decrease blood volume, and rhus can conrribute ro an increase in blood thickness. Diuretics may nor only cause loss of warer from rhe body, bur ma)' also conrribure to 10$5 of fluid from red blood cells-making ulem less flexible and deforrnable. 61 RecaB that stlch changcs will, in cum, make rhe blood more likely ro dor. The same ehanges may also perpetuate rhe high blood pressurc. Some have speculared rhar warer Illay have :\Ilother mie in decreasing high blood presstlre and in prevenring srrokes. Pure warer actually acts as a mild diuretic. Ifyou drink more \Varer rhan you need, the excess

BEYOND THE LEADING CAUSES OF DEATH warer is e1iminated rhrollgh rhe kidneys. There is one subde quaJificaeion: kidneys can onl}' excrere warer rhar is accomp:Hlied by sodiull1. As a resulr, excess warer drinking resulrs in rhe loss ofsome sodjum. Thus, drinking plemy of pure water helps ro decrease bod}' sodillrn srores and thus may conrribure (Q blood pressure lowering. Orher lifesryle habirs can help ro imp rove blood fluid iry. These [acrors include sropping cigarerre smoking, e1iminatÎng rhe lIse ofakoho!, Josing weight Cif overweight), engaging in regular moderate exercise,62. 63 and adopting a high fiber, low far, low protein dier. 64 . 65. 66 Regarding exercise, modera re exerrion is beneflcial ta rhe circularjon, bur excessive exerdse may be harmful ro blood fluidity. For example, rhose who exercjse in rhe hear and are perspiring heavily ma)' be more likel)' ro have problems wirh dorring due to "rhickening of rhe blood" becallse of blood volume loss.67 Water drjnking has srill other beneftts. Your mother no doubt cold )'OU rhar it was good for your kidneys and llrinary bladder. However, she probably was nor aware of its effect in helping ta prevellt gallbladder disease. A number ofsrudies have indicared rhat drinking liberal amounrs ofwarer helps (O diluce rhe bile in rhe gall bladder and thus decrease the risk of srone formarion .68.69. 70 Those who are ovenveighr, 01' have a family hîsrory of gallstones, or who have known gallbladder disease would be wise ro seriously consider rhe benefirs of drinking more water. In m)' medical pracrice I have found thar insufficienr water jmake can even mimic hypoglycemia. This problem scems ro be more common in younger individuals wirh lower blood pressures. I will never forgeI the bllsinesswoman \Vho had extensive laborator}' re-sts ro e1erermine why she had "hypoglycemic fainting spells." None of the rests provided :In answer. Afeer this exrensive evaluarion, 1 suspected rhe problem resred with someth ing as simple as inadequate fluid inrake. I promptly encouraged her to drink a minimum of 12 gJasses of water every day. She followed my jnstrucrions and her problem was solv .d.

Drinking more warer decreases tlle risk of kielney srones by e1illiting the mineral conrenr in the urinary system. Consuming liberal amounrs of warer mal' also dccrease the rÎsk of urinar)' tract infections. Warer drinking among srllokers mal' a1so help ro decrease rhe risk of cancer of the bladder for similar re.asons. Smoking gives rise ro powerful carcinogens (as explained jn Chapter 16, "D)'ing for a Cigareue? Kick the Habir and Live"), some of which are stored in rhe bladder. The more water one drinks, rhe less concenrrarcd are those roxjns, and rhe greater rlle srimullis ro void and expel rhem. In [,1Ct, \Vater drinking has sa many benefits, thar a recent issue of the Journal of rhe American Medical Associarjon calJed artenrion ro the particular hazards facing oleler Americans from inadequare fluid jntake.7 J Harvard researchers esrÎmared rhar by makjng Stire oldeI pc-ople dr~U1k enough f1l1iels, over one million days of hospiralizarions anei over a bilhon dollars each year wOllld be saved. In chis secrion, I have rrjed ro provide in broad srrokes JUSt a glimpse of rhe excÎting rescarch th:\[ encourages LIS ro drink plenry of waIer daily. The intemal use of \V'arer can elearly reduce suffering and save dollars as well as lives. However, water (an also be applied externa!l)' ro deal with a host of physical problems. Those observarions apply in general wirh equal force ro orher painful condiriollS such as muscle aches, srrains, etc. A fuU discllssion of r!le broad science of "hydrorherapy"-or waIer rherap)'-is beyond the scope of rhis chaprer. However, suHlce Îr ro say that exrernal applicarions of warer have been used with clinical success in condirioJls as varied as headaehes, asrhma, mllscle tension, and digesrive complainrs.

NEWSTART Element Number 4: Sunshine Slinshine has gOHen a bad rap. It is rrue that exeessive ulrravjolet light from sUJlshine can increase rhe rÎsk of skin cancer and cararacrs, but judicious amounrs ofsunshine c.an be extremelJl beneficia/. For exarnple, sunshine can play a crirical rale in helping

497

PROOF POSITIVE to prevent osteoporosis. $unlighr, you wiU recall, is able ro convert cholesterol inco vitamin O, ,m essentiaJ faceor in mainL.-uning good bone healrh. 72 In Chapter 7 tiut deals with protein, we saw thar high inrake of animal prorein sources was also a signîtleanc factor in causing osteoporosis. In addition to sunshine and nutrition, howevcr, other NEWSTART factors are important in dealing with osteoporosis. Exercise is vital to sraving off age-re1ated loss of bone mass. Recent research from Washington University School of Mcdicine in St. Louis has demonsrrat.ed mat a woman can increase her bone mass by 2 ro 3 percenr per year by exereise aJone. 73 But what about skin cancer? Why not ger our vitamin O from pills or supplemented foods, so we can avoid sunshine's cancer risk? There's no question abollt it: when many Americans rhink of sunshine, rhey r.hink of an agent thar inctedSes the risk of cancer.

Sun Exposure in High Doses and Cancer

498

SunJight in high dom increases skin cancer risk. About 95 percenc of skin cancers are of MO rypes: squamous cell and basaJ cell. 74 Borh of these rypes of cancer are Încreased by substantial cumulative liferime exposure ro the sun. Fortunately, however, rhey are slow growing and lIsually remain confined ro rhe skin. Even though SOme 750,000 squanlOus .'lnd basaJ celJ skin cancers are diagnosed each year in the United States, only abOlit 2, I00 fataJiries (Iess rhan one percent) result.7 5 The f.1taJÎties occur mostly in r1lOse who fail ro get prompt and complete removal of the cancer. Melanoma, anOUler type of skin cancer, provides a markedJy di/-Terenr situarion. This usuaHy darkly pigmenced carlCer has a fearsome rendeney ro spread and kill tlle victim. Each year onl}' about 34,000 cases of melanoma are diagnosed in our eoumry; however, 7,200 (more than 20 percent) die annllally from tllis dreaded skin cancer. 76 Melanoma is currently on a rapid rise worldwide; in Europe, ir increases by three

to seven percem every year. 77 Regarding this deadliest of skin cancers, ir appears that the important facror is noe sa much the tOtal amount of sunlight you are exposed ro, but whether or nOt you get sunburned. Thus, overdoses of sunlighr are ro be avoided. More informarion on skin cancer is found in Chapter 2. Sunlighr in moderate amoullts, however, is healthfl.1l, and may even be beneficial in cancer prClJcntiol1. Research now suggesrs that judicious sun exposure and the production of vitamin D may also help to prcvenr certain types of cancer. Colon cancer is one of rhe malignancies that sunshine exposure ma)' help ro prevent. Researchers ar rhe University ofWashington srudied c;wcer rates in (line differenr areas of the United States. They discovered that men from Southern states had much less colon cancer than Nonherners,78 For example, when compared to men living in New Mexico, men in Michigan, Connecticut, and Washington had colon cancer fates 50 ta 80 percent higher. The cffeet aJso seemed ro hold true for women, aJthough it was nor as marked. Another scientific uride reviewed srudies possibly linking cancer prevention wim sunshine exposure. H.G. Ainsleigh, rhe author, poinred Out that there is a long hisrory of medical documemation suggesting mar regular sun exposure substanti,llly decreases the death rates from cenain cancers. 79 Like other researchers, Ainsleigh observed rhat the linkage between sun exposure and cancer prevention appears ro be due to vÎramin D. Viramin D and re1ated compounds appear able ro suppress me abnormal growth of a variety of cancer cells. These include leukemia and Iymphoma as well as cancers of the breast aud colon. Ainsleigh did not srop there. He went on to make somc startling calculations; namdy, fhat aJthough frequem regular sun exposure statistically c.auses 2,000 cancer fatalities per year, ir also acts to prevent

u.s.

another 138.000 U.S. annttal cancer dcaths-and could possibly prevenr another 30,000 more if ali Americans adopted the practice of regular, moderate sunning. He even raised tlle concern that blame for a 17

BEYOND THE LEADING CAUSES OF DEATH percem increase in breasc cancer incidence duri ng 1991 and 1992 may have been relaced to misplaced solar-phobia; with a "decade of pervasive anei-sun advisories from respected aurhorities. coinciding with effeecive sun ereen availabiliry." Sunscreen may induce orherwise caLltious sunbachers tO ger overdoses of sun exposure. Regarding sunshine and cancer, rwo facrs clearly scand ou (. Fi rsc. excessive, injudicious amounrs of sunshine can increase sIOn cancer risk. Second, avoiding sllnshine is nor a good alternarive. It is likely thar sunshine Jnd rhe vieamin O ie produces may acrually play a role in c.ancer prevenrion as weJl as in bone healm.

NEWSTARTElement Number 5: Temperallce The concepe of promoring personal healch by J judicious exposure ro sllnshine provides a perfecr backdrop for looking at rhe flfth NEWSTART element. The fir c "Ţ" stands for "eemperance.·' Temperance in rhe context of rhis book means "cotal abstinence from subsrances rhar are harmful and moderace use of subsrances that are helpful." Applying rhe 'temperance" concepc ro sunshine would lead us to use this helpful factor in moderatjon. Often rhe challenge concern ing remperance is ro decide which substances ro use in moderat ion and which co avoid coeal1y. The concepr of rotal abstinence has become very unpopular. Many healrh educators promote che mistaken idea ehar almose anyming we do is appropriate solong as we do it in moderaeion. From a stlldy of ehe research literature. coupled wirh personal experience from my own life and those of my pacients, it is evident that we wOllld be better off tOlolly avoiding rnany things ehar are popular to use "in moderarion." Elsewhere in chis book (Chaprer 17. "Wam a Drink?"), the case for racal avoidance of alcoholic beverages from a heaJeh perspective is presented. 1 am not a tone voice crying for rotal abSlinence from alcohoJ. The World Healm Organization has eaken rhe sarne position, now advocating "no alcohol" as ehe standard. ao In sev-

erai chapters of chis book 1 have cited concern wirh another popular addictive drug: caffeine. Caffeinared beverage present a subtle mreat ro our heahh whjch some are finally beginning ro grasp.

Problems with Moderate Caffeine Use As poinced om in Chaprer 2 an c.1ncer, medical research has raised concerns rhar cofTee and omer caffeinated beverages may increase the risk of certain cancers. The list of chose malignancies include cancers of me kidney, breasr, pancreas. ovar}', bladder, and colon. 8 1. 82. 83. 4, 85 Theobromine is a caffeine relative found parricularly in chocalate anei tea. Research suggests thar even small al1101lJltS of rhis compound raken regularly can double a man's risk of proscare cancer.sc, The concerns wirh cafTeine and its re!atives are not whol1y cheorerical: rhese drugs have porent cancer-causing effecrs. In laborarory studies they are capable of damaging rhe chromosomes ofborh plams and animals. 87 . 88. 89. 90. 91 Cerrain experrs contesc some of mese findmgs. Are you willing ro rake the risk of concinuing your caffeine habit? Many have become habiruated-if nor addicted-to moderace or large amounrs of caffeine; the suggesrion ofrota! avoidance brings up greac barriers. To illuSlrale your approach ro this decision, assllme th:u you are planning ro build a new house. You find a place on a nice piece of properry. but rlle land is over an olcl coxjc waste dump. Some experts rell you thar there is no proof of any risk from living above thac dllmp. Others have grounds for concern that living there will increase your risk of cancers of rhe kidney. breasr, pancreas, ovary, bladcler, and colon. Do you roll ehe dice aJld move in, or do you say. "why rake rhe risk?" If you had never acquired the caffeine habir, you would probably stay tocally clear of iL However, if ic is a parc of yom life, is it worrh giving up? I would say 'yes." I have worked wieh many people who have overcome the caffeine addiction. At first ir may be a srruggle, bur over rjme they nor only get along fine wirhout it but chey also rcap rhe healrh benefits of their decision.

499

PROOF POSITIVE Caffeine not only increases the rheorctlcal risk of cancer, it a1so brings a host of orher problems in irs train. Coffee and/or caffeine are linked ro an increased risk of sllch problems as miscarriages, low birth weighr babies, worsening depression, anxiery and fatiglle, elevared blood pressure, heart palpitations, heart elisease, bone loss anei osteoporosis, and other maladies. Furrher informarion is provided in Chapter 2 on cancer and Chaprer 12, "The Frontal Lobe-The Crown of the BTain."

NEWSTART Element Number 6: Air Throughout mosr of recorded hisrory, it seems rhat people have taken frcsh air for granted. However, with the advelH of the industrial revolurion, folIowed by current concerns for indoor and omdoor air pollution, fresh air has become a more valued commodiry. An excdlenr article on fresh aiI" was penned some years ago by DI". Bemel! Baldwin. Enrirled "Why is Fresh Air Frcsh?"?2 Baldwin pointed our rhar fresh air is chemically different than rhe recirclllated indoor air rhat most America.ns brearhe. High quality fresh air is acruaJly dectrified. The life-giving oxygen molecule

1. lmproved sense of well-being

2. Inereased rate and quality of growth in plants aud animals 3. Improved funetion of thc Iung's protective cilia 4. Tranquilization and relax'a,tioD (decreased anxiety) 5. Lowered body temperaturc 6. Lowered resting Ileart rate 7. Decreased sun'h'al of bactcria and viruses in the air 8. lmproved learning in mammals 9. Deereased severity of stomach ulcers Figure 17

500

'l

...

•

: '.,

. t

.wi' _-....."." . -

is negatively chas-ged or "negarively ionized." This ncgatively charged oxygen gives rise ta a nllmber ofbenehrs as lisred in Figure 17.93. 94. 95. 96. 97. 98, 99

An environmem of negative!y charged ions truly has remarkable effecrs. SOll1e of rhe most impressive have to do wirh behavior. Some of rhe research has cemered on animals rhat were raised in sllch a \Vay as ro develop rhe equivalent ofhuman anxiery disorders. When rhese animaJs were alJowed ro breathe air wirh an abllndance of negarive ions they were protecred againsr some of the physicaJ ehanges linked ro anxiery. Animals exposed ro negative ions showed a normalizatioll of peninent brain chemisrry measurements ..'Ind did nor show any tendency ro high blood pressure 01' ulccrs. 100 (In faer, even in animals with 110 behavioral disorders predisposing rhem ro ulcers, negative air ions helped tO promote less significam ulcer disease including smaller ulcers, less bleeding :lIld less acid secrerion. lOl ) In smdies ofchildren, negative ions have aJso demonstrared salurary effects. In one srudy, norm.al children and those with Iearning disabilieies showed measurable irnprovemems in brain function. 102 The authors concluded: "Negative aiI' ions are seen ro be a cool wirh porential theorerical and remedial applications. "103 Orher research further underscores the fact rhat fresh-negarively ionized-air helps to keep our mood huoyanr and positive. Baldwin and orhers cite rhe Middle Eastern "sharaw" (also eransliterated "sharav") windstortns that bring an abtmdance of unwanted positive ions with rhem. 104 • 105. 106. 107 During these storms, as Illany as 30 percellt of individuals devclop problems with increased anxiery and sllspicion, migraine headaches, nausea, vomiring, diarrhea, eye problems, irritabi!iry, respiratory congestioll, etc. The positive ions seem to alter brain levcls of seroronin, an important mood-e\cvating chemical. These hac desen winds rob rhe air of helpflll negative ions. Negatively charged air is also demoyed by recirculating air in bllildings, robacco smoke, ciry smog, and othcr pol\urams. On the other hand, good qualiry negatively ion-

BEYOND THE LEADING CAUSES OF DEATH ized air is found in abundance in naruraJ ourdoor environmenrs, especiaHy around evergreen crees, beach surf, or afcer a chundersronn. Researchers have been stlldying che harmful effeccs of polJuced air an human beÎngs. Their fjndings confirm chac pollucion depleres ehe air of negarive ions. In addition, che common poJluranc, ozone, has been demonscrared ca eause eye irrirarion, shormess of brearh, cough, worsened lung fUllccion. and decreased physical performance. I08 . JO? Worse yec. women living in one of fhe nation's mosr highly polluted regions, rhe Sourh Com Air Basin ofCJifornia, experience increased risk of cancer in proporrion ro cheir coral exposure ro particulare pollurancs. 11D C1e~rly. ic behooves aH of llS ro get as much fresh air as possible. When we are overcome by srress and worry. gecring away from aur urban dweJlings aod workplaces seems ro promise more chan a change of venuc. The medicallicerarure indieares char a drive ro che seashore, a local srare park, ar ocher natural seuing promises improved memal and physical healch as we brearhe in cite refreshing fresh aiI with ics abllndance of negarive ions. Bccrer yet, if ir can be arranged, living in a more rural serring would likdy yieJd dle blessillg of becter quaJicy air as weU as other ameniries.

viramill. lec's calJ ir viramin R. Inchis hyporherical siruation. we can now forger abour whether or noe we have rime to rest. Afrer ali, every one of resr's advanrages can be obrained from raking a pilI. Ler us now look ar this aillazing "vicamin" and see if yOll wanr ro include it as parr of your daily program. However, before we go roo far wirh our il!usrrarioIl, rShOllld clarifY rhe facc rhar resr comes in a number of differenr forms. In

v Vitamin

R}

Daily rest or sleep

Vitamin R 2 - - - - Weekly rest

R3

Recreation

Vitamin R 4

Meditation

Vitamin

Figure 18

NEWSTART Element Number 7' Rest 1 am eonvinced rhac if che benents of resr could be pm into apiU, ic would be among rhe horccsr selling supplemcms on che marker. Unfonunare1y, in order 10 rcap che benehLS of rese, we must slow down and rake cite rime co rest. SadJy, many of us do nor believe dut we ean really pause 10llg enough 10 eake advanrage of rhis vital remedial and prevenc;lrive agency. Therefore, mauy ace noc even inreresred in learni ng abour che far-reaching benehrs of rese. Thcy reason, why become eonvinced of che advanrages of somerhing thar I do nor have rime for anyway? Because of rhese biases. I'd like ro challenge you ro rhink abom resr as if jr were a newly discovered

faer, rhere are really four differenr eypes of viramin R. Just as [here are a number of B vieamins, sa rhere are faur siblings in rhe vicamin R family. They are lisreel in Figure 18. Viramin R 1 is sleep, or daily rest. Viramin R, is rhe weeklv resr: in addirion ro sleeping each nighr, ~e need a weekly day of rese. Viramin ~ is recrearion; we need ro take rime 10 get away from work, physical rensiolls, anei menral srresses of life. Vitamin R.j is also essenrial: rhi.s viramin is medicarion-and sholild be dane ar teast on a daily basis. Lec's look more clasely ac each of these faur types of viramin R. RI. che sleep viramin, is in shorr supply with many Americans. Research suggests char rhe average person does besr an seven ro eighc hours of sleep per day. This flgure

501

PROOF POSITNE

502

was associared witb the grearest longeviry in the AJameda collnry healrh stlldy thar we examined in the first ehaprer ("Principles for Optimal Health").lll Statisrics slIggesr rhar about rwo-rhirds of American adults sleep berween six and nine hours per nighr. 112 Sleep needs vary with OUT generics, Dr. James Peri, a Ph.D, psyehologist and sleep expert, poinrs out thar abour 20 percenr of the popularion genericaJly needs less rban six hOllrs per nighr. He also observes ehat 10 percenr of our popubce geneticaJly needs more than nine hours per night. 1I3 Regardless of your specific need, anyone can come lip shorr on vitamin R 1, If you do nor feel wide awake and energetic rhroughoUt your walcing hOllrs, you are likely sleeping roo liHle. And if that is your problem, yOll are nor alone. In rhe U.S., farigue is one of rhe 10 mOSt common reasons for visiring a physician. 114 In f.'lCr, each year 3.3 million Americans visit their docrors for insomnia alone. 115 Yes, problems wirh inadequate sleep are exceedinglycommon in our narion. The evidenee suggests rhar as many as 60 pereent of Amerieans have some problems relating to rheir sleep habits. 116• 117 It may seem somewhar depressing ro talk about how poorly rhe average American's sleep needs are sarisfied. There is some good news in rhis deparrmenr, however. Those who bandle srress better appear ro require less daily sleep. In orher words, if yOll are emorionaUy healrhy and positive, your body is likely ro sleep more dtldenrty.1I8 Exercise can also help you ro have more energy on a given amOlllll of sleep. Pur anorher way, reglllar exereise helps ro deerease our sleep requiremenrs. In fact, exerdse bas been demonsrrared ro deerease fatigue and boosr mental aod physical vigor. 119 Alrhough positive moods and physical exercise can help us in rhe sleep deparrment, [here are things (har work against our abiliry ro ger refreshing sleep. Television viewing is one reason why we do poorly in rhe sleep departmen (. The more relevision you watch, rhe less rime yOll have ro sleep. This is particulari)' a problem for American )'omh. Many are nor getting enough sleep

because of rbeir liberal diel ofTV. There are, of courst, many orher reasons for aur national sleep debr. ] wiU nor go iora aur tendency ro squeeze roo many activities illto a finite number ofhours per day. I would, however, llke ro srress one of the mosr fatal deceptions of the sJeep-deprived. Most of rhose who are shorrchanging themselves an vitamin R 1 feellike they can ger by WÎthoUI optimal amOUlltS of this vitamin. Unfortunalely, rhe medica1lirerature is very dear on the effects ofsleep deprivation aud irregular sleeping habils (such as shift work) , 120, 121. 122, 123 Such practices slow reacrion rime and increase the risk of bath faral and uonfalal accidents. Sleep deprivation can c1early have life-threatening consequences. Probably one of the mosr notable is falling asleep while driving. One imeresrÎng aspect of rhe currem re.search on falling asleep at rhe whecl is that accid /l{S and fatalities seem ro be rhe mosr common in those who have not learned their limits. In one U.5. study, 55 percenr of such accidems occurred in individuals 25 years old ar less, suggesting dur inexperience in respecting f.1rÎgue's cues can be costly.124 The toll of disabiliry and dearh from farigued drivers is nor confined to the O.S., ofcourse. A recenr German smdy indicates rhat falling asleep ar rhe whed is the leading cause of German roadway far.aliries, amounring ro nearly 25 percem of the toral. J 25 However, the risk of orher rypes of accidenrs also increases dramarically in those who are sleep-deprived. Aceidenrs ar rhe work place also occur more commooly when we are short on sleep, working unllsllal hours, ar orherwise farigued. Large-scale disasters like the Chernobyl fiasco, rhe Euon Valdez crash, and rhe Three Mile Isbnd incident aII occurred in early pre-dawn hours, when vigilance was at a low poinr. Dr. Fred Hardinge, an expert looked ro by the FederaJ Aviarion iseration 011 issues re!aring ro fatigue and performance, has poinred our that mosr of the "friendly fire" problems in the Persian GulfWar were due ta fatiguc. Some of rhese short-rerm sleep deprivarion problems-wirh longferm consequenees, nonerheless-may resuit from whar are called "micro sleeps." In

BEYOND THE LEADING CAUSES OF DEATH these seuings your eyes typicaJly are wide open, yer your ;}nention lapses and you do nor reaJize whar is happcning. AJrhough short-rcrm problems wirh sleep deprivation ofren grab rhe headlincs, serious problems resuJc from chronically noe gening enough slcep. ehat evcn six hours of sleep per night 1S insufficiene for many people and sers rhe sragc for problems. FrantaJ labe brain dal1lage ean occur in sleep-deprived animals. PET scans demonstrate deereased blood flow ro rlle fronrallobe ofthe b~in in ehronically sleepdeprived individuals. 126 Wirh such chronic s[eep shonagcs, irrirability and belligerence rise wlule attention span drops further. Rapid mood changes and rroub[e eoping wirll stress can resulL Withdrawal from group aetion and even depression are among rhe ourcomes of chronie s[eep deprivation. Ddusions and hallucinarÎons can also be consequences of chis downward spiral. Borh shon-rerm and long-cerm sleep deprivatioo can aEfeer your resistanee ta disease. Losing even rhree hours of sleep an a given night can cut in half the dfccrivencss ofyour immune s)'stem. 127 A I1U1llber of immune a1eerarlons oecur with sleep deprivarion: antibody levels are deereased 128 while inrerleukiJlS-l and -2 filil ta experience rhe risc that occurs wirh deeper stages ofsleep. 129 Growd) hormone (GH) requires sleep for optimal release. Absence of GH furrher impairs immunity as imporranr immune defenders, che cytotox.ie T cells (a rype of wrute blood eell), are dependent on this hormone. l3o Chronic fariguc also increases rhc risk of prob[ems ehat may nor be so obvious: hearr disease, heart related dearhs, and stomacll and imestinal prob[ems. 131 Even ifl'ou are spending nine hours each day in bed, you mal' not be getring ehe qualiry of sleep rhar you need. Sixty l'ears ago, sleep was regarded as a staric process of rest, but sleep quaJiry can radically differ even if it [ooks like rwo people spend rlte same amounr of rime in bed. Haw can you increase sleep qualiry? FiguIe 19 [ays out some of rhe basics. 1.'2 Sleep quality is actualll' relaced to the enrire NEWSTART program. Although

daily resr is an importalH aspeer of healrh, we rend not ro rest as well if we are nor fol10wing mher aspects of a heaJdlY lifestyle. Perhaps nowhere is this seen more c1early rhan in research re1aring sleep and aging. Mosr have nor questioned rhe "faer" thar s[eep quality derer10rates as a person gers older.I:H However, new research from Sranford Universiry Medical $chool and orher centers is calling rhis assumption imo question. What the newcr data suggeses is rhar people who stay healrhy and follow a good lifestyle are unlikely ta develop changes in sleep qualiry as they age. 134 • 13S

Vitamin R2: The Weekly Rest In America, ie is nor uncommon for people to put in a seven-day workweek. Many do chis repetltively and do not seem ro suJTer for it. However, the medial evidence suggests that there may be both longrerm and short-rerm consequences ro such a practice. Just as the body has a natural daily c10ck (circ.'1dian rhytbm), it also has a weekly c10ck (cireasepran rhythm). Circasepran rhythms are jusr (har: body rhyrhms ehar run about seven days in length. Medical research has demonsrrared such

WAYSTOIMP OVESLEE

ALITY

• Sleep' ,in a cool, dark, comfortable, tidy, and quiet room • Set anxieties and worries aside as you get into bed • Daily exercise aod a clear conscience will help • Eliminate ,the "sleep robbersthree": aJicohol, tobae,co, and caffeioe • Cbcek medications tba,t could interfere with sleep • Maintain a regular bedtime and do Dot eat at least four bours before • Provide (resh air in your sleeping room Figure 19

503

PROOF POSITIVE

504

rhythms in connection wirh a variety of physiological funcrions. Some rhat have been idenrified included hearr rate, sllicides, natural hormones in hllman breasr milk, swelling after surgery. and rejecrion of transplanted organs. Ta llnderstancl the significance of tllese rhyrlllns, consider the Iauer rwo items in the list. A person will tend to have an increase in swelling on rhe seventh and then rhe fourteenth day after surgery.13G, 137 Similarly, a person wirh a kidney transplant is more likdy ta rejecr rhe organ seven days and [hen fourreen c1ays after rhe surgery.138. 139 Research on circasepran rhyrhms conrinues and new relationships are conrinually being discovered. There are seven day rhyrhms thar have been observed in both humatl and animal cancers and rheir response ro trC4tment. J40, 141. 142 Fibrinogen, a blood c10tting compound that has been demonstrated ro increase rhe risk of hearr Jrrack, has now also been obscrved ro have a seven day rhyr.hm. '43 Further work has shown rhat in addition ro inflammatory responses operaring on a circasepran rhythm, so do rhe drugs rhar we ofren use ro rreat them. 144 An undersranding of circasep[an rhyrhms has lead me to more fully appreciate rhe facr thar 1 need ro pay attenrion ro weekly rhythms to protect my own healrh and rhe health of my parients. Dr. Baldwin asserced some years ago thar the cllrrenr research indicared tlur 'this seven-day rhythm is a norma] built-in fearure ofaur physiology."145 Recent researchers have becn evcn more adamanr rhan Baldwin. "From rhe medical poinr of view so-called circaseptan (abollr 7 days) reacrjve periods are of predominant inreresr. This periodicicy can be observed in numerolls adaptive aud compensaring processes. Ir does nor depend on [he external week cyele aod was already known ro rhe antiquiry."I46 Whar borh of rhese authors are saying is rhat the imponance of the seven-day rhyrluns should nor be underesrimJred. FlIrthermore, these rhythms are a part of who we are; rhey are nor a funcrion of the fact rhar we happen tO kcep a seven-day wcek in our cu1rure. Thus, rhis seven day rhy[hm "does

not depend on tlle exrerna! week cyele." From a hiswrical perspecrive the weekly c)'ele is also of great interest. We keep a 24hour day based on rhe eanh revolving on its axis. We keep a monrhly cyele based an rhe periodiciry of the moon. The year is based on rhe earth's cireling rhe sun. But whar is tlle week based on? Some have cOlljecrured rhat mankind over the years carne to the conc1l1sion rhat 00 otller weekly cyele harmonized well with our internal rhythms. It is ilueresring ro note thar although culmres have experimenrcd with different weekly cyeles, aII those that Baldwin is aware of have reverted ro the seven-day program. He poinrs in particular ro during rhe rime of rhe French revolurion. They then experimented with a ten-day (meuie) week, with disasrrous reslllrs. The mental institutions fiUed rather quick1y ro capaciry and then some. Baldwin amibures the abolition of thar program in part to rhe logical rhinking of (he renowned Iluthematician, Laplaee. However, orhers have pointed ro an even more compelling reason for the existence of the weekly cyele: ir is (he way tllat Gad creared liS. Indeed, in rhe firsr of the scriptural books of Moses, the seven-day weckly cyele is described as paft of God's design in creation. Thar cyele is described as consisring of six days of work followed by a Sabbath day of rest. Baldwin sees significance in the Sabbath concept in relation ro circasep[an rhythms. 147 He recognizes this as a "zeirgeber" ("rime-giver" in German). Zeirgebers keep aur weekly rhydl.lIls synchronized by pausing oue day in seven for a rime of rese. Jn order for tllese rimegivers 10 work, however, ir must come ar rhe same rime each week. In other words, it is not sufficient ro get one day in seven ofC; ir is optimal 10 get a specific day in seven off on a regular basis. My own experience agrees wirh this body of Inedical research. I personally need one day in seven where 1 ser thiJlgs aside and experience a true rest. Thar does nor mean 1 sleep the whole day. Instead, 1 use it as a day for recrearion, for reflection, for meditation, and for focusing in on spiritual values. Whether you keep the seventh day

BEYOND THE LEADING CAUSES OF DEATH of rhe week as I do (from sundown an Friday evening to sundown on Sarurday evening in h:umony wirh rhe biblica! injuncrion) or a differem 24 hom period, there is a benefir ro observing one specific da}' in seven as a day of rest. One other observarion is in order. In scheduling aur daily rest of sleep, we o[ten have ro priOl'iri7-c sleep even though we have nor finished aII of our work for rhe day. Mal1Y have learned by experience rhar in mosr circurnstances ie is be.sr ro go ro bed on rime. In rhe same way, evcn if your work for the week is noe compleeed, I would sriU encourage you ro [ake rhar specific day in seven ofI and rest as if )'our work was complered. In facr, a physician friend of mine once said [hac such a prÎoricy is one of the beauries ofGod's Sabbath commandmenr. Even rhough he is aware of ehe importance of rhe week1)' resr, if Gad did nor speci/)t a specific day, he feels he would nor be reguIar in keeping onc specific day per weck as a "zeÎrgeber.' I have found the same rrue in myexpertencc.

Vitamin Ri True Recreation If you look at how mosr Americans spend ilieir rime, you would think rhar [elevision i our nation's number one farm of recreation. However, in rhe sense of [he rerm as I u e ir, TV program ing does nor meet my criteria for rrue recrearion. Whcn discussed in rhe contexr of resr, 1 see recreatian as living up ro irs name, specifical1y: "re-creation." 1 believe rhar afrer engaging in true recrearion, 1should be more able ro meer life's challenges, nor less able. True recrearion is reviralizing and hdps me betrer accomplish the work and responsibili[ies [har 1 have. Wha[ kind of activities then fir rhe bill as "truc recreation?" From my experiencc and srudy, ourdoor recrearion rops [he lisr. Oprions include a hose of acrivities such:l gardening, hiking, doing pleasanr yard work, cross country skiing, walk.ing, and dozens oforher oprions. These activitjes provide a mental break from rhe romi ne, as well as ofIer the advanrages of many of the orher NEWSTART e1emenrs sllch as exercise, sunshine, and fresh air.

Vitamin R/ Meditation and Prayer Medirarion and prayer provide a form of resr rhar has been praceiced for centuries. Even secular Wesrerners are becoming more inrerested in learning abour rhis potenr form of release from stress, rension, and anxiery. In my own expericnce, 1 have found medirarion and prayer ro be a virai pact of a balanced lifescyle program. Prayer is rhe brearh of rhe soul, figuratively speaking. As moral beings and spirirual beings, we need ro spend sufficienr rime in conremplaring our rrusr in divine power. There is a connecrion berween [he "R" and "T," speei.fically viramin Rt, and "T," mlsr in Gad. It can help us in so many ways, such as in conrcol1ing srress. srrengrhening rhe immune sysrem, providing proeec[ion against hean disease, cancer, erc. The lisr goes an and an. Yes, rrusring in aur Maker, Defender, Redeemer, and Friend. Bur how can we (fUSt Him if we do nor really ra!k ro Him rhrough prayer? In Chaprer 12 on rhe frontal lobe, I poinl ro rhe example ofDr. Larry Dossey as an il1usrrarÎon of how even honest skeprics are now concluding (har prayer has unique benefits. 148 Dr. Dossey bas collecred a hosr of scientific srudies rhar demonsrrare thar when people pray ro God on behalf of oehers, healrh benefits resulr. These results even include rhe sponraneolls regression-or cure-of cancer. Dossey's experience iIIusrrares rh:u from rhe perspective of thinking sciencists, rhe benefirs of pra)'cr exrend beyond rhose of mere medirarion. It is remarkable rhat the anirllde of prayer makes a difference in whether or nor healing ensues. lr is rhe rrusrful prayer of fair.h in commirring one's life ro God rhar mosr likely resulr.s in healing-nor rhe aggressive prayer [hac prays for whiee blood cells ro desrroy cancer or arrcmprs ro raise self ro leve\s of unresrrained optimism. 149 One of the rhcmes with viramins R, and R., is rhat rhese subsrances must be 'ingesred" regularly ro provide oprimal benefirs. Jusr as \'le need daily rest in each 24 hour period, and week1y resr once in every seven days, so do we need regular periods for rccrearion on rhe one hand. and prayer and meditarion on rhe orher. Acrually, each

505

PROOF POSITIVE of rhe other rypes of rest affecrs vltamin R4 as well. As we have seen, lack of sJeep or irreglliar andJor excessively long work hours contributc ta some obviolls problems: poorer qualiry and qua11tiry of sleep, increased fatigue, poorer work performance and increased accidenrs. 150 However, inadequate sleep also affecrs us spirimally. The frontallobe appears ta be parricularly prone to sleep deprivarion. Surprisingly. our values even rend ro suffer when we are shorc on s[eep.151

1. Religious attendance and private devotion strengthen a person's relig.ious belief system.

2. Strong religious belief s.ystems, in turn, wben accompanied by a bigh level of religious certainty, have a substantial positive influence on wcll-being. 3. Individuals WiÎth strong religious faith report: • higher levels oflife satisfaction • greater personal happiness • fewer negative psychosocial consequences of traumatic life events Figure 20

This last element of resr-medirarion and prayer-also addresses the most potent robbers of rest aud re1axation, namely srressors and our maladaptive ways of handlillg mem. Al; pointed out in Chapter 14. "Srress Wirhour Disrress," rhe use of meditation and prayer offers powerful help on these levels. There 1 emphasize rhat we have a critical need for medirarion and prayer on a daily basis. 1 go 011 record as defining these elemenrs as forms of "rese and rejuvenation that few appreciate" ta their fuUest exrellt. The inreresced reader is referred ro thar chapter on srress for a furrher discussionand pracrical application---of dlis vital viramin R 4.

506

NEWSTART Element Number 8: Trust in Divine Help After presenting the all-imporrant spiritual element of rest ("viramin R/), rhis secrion may seem redundant. However, rhis final element of the NEWSTART cight bears repeating. Throughollr rhis book, 1 have demonsrrarcd how research is showing thar spiritllaliry and trust in divine power have a role in deal ing with many common diseases. We looked at the role of f.'lirh in heart disease, rhe relarionships of spiriCllaHty ro the AIDS epidemic, and the link berween religion and cancer. Later in the chapter the stress-religion-arrhritis connection will be covered. One fascinaring srudy looked ar the religious experience of rhose Americans who reached rhe golden age of 100. Among the centenarians, thc researchers found rhar religiosiry significantly enhanced physical health. Alrhough rhere are stiH many unanswered questions. the benefits of trUSt in God are due (Q more rhan simply attcnding religious services. 152 Furrhermore, che far-rcaching bendits of faith seem ro rranscend age and racial bOllndaries. A recent sClIdy of black Americans found mar rhose who engaged in organized religiolls activities had improved hcalrh and life satisfactioll. 153 Even rhose who engaged in religiolls pursuirs olltside of an organizational structllre experienced this boost in satisfactÎon. 1ndeed. one of rhe mose consistent findingsacross racial grollps-is dlat spirirualiry profOllnd1y improves qualiry of life. The profound bene6rs in the qualiry oflife brought abour by exercising fairh are described by a Duke Universiry researcher in Figure 20. 154 Another amazing aspecr of spirituaJiry is thar it not only helps believers hur ir also benefirs non-believers in rheir communiry. Research has demonstrated rhar communiries gain healrh benefirs when they have higher numbers of adhercnrs ro fairhs that emphasize implicit obedicnce to God and his standards ofconduct. 155 Oile theory for why non-believers benefit is rhat social norms (;1vor conformiry 00 the healrhier lîfesryle e01braced by cheir more relîgious neighbors.

BEYOND THE LEADING CAUSES OF DEATH Another compelling explanation as w why rrust in divine power is so important in a comprehensive health program is borrowed from an illn by Zeno Charles-Marcel, M.D., Medical Direcror of the Lifesryle Center of America in Suiphur, Oklahoma. The ba..~is for;m individllaJ's parricular health starus is depicced in Figme 21. Aher a patiem undergoes a complere "hisrory and physical" evaluation, including appropria re la bora to ry a ndJ or o t h er pertinent tests, 1 have a clear picrure of the pariem's healeh status. That health srarus, which is often tele by the patient in daily liviog as his or her "qualiry of life," is JUSt the visible rip of rhe iceberg. Undernearh are reasons that increase in imporcancc as we go deer in rhe iUustration. Health status is direcrly dependent on rhar particular individual's health habirs, as 1have demonserated distinctiy and frequenrly in this book, beginning in rhe first chapter. For instance, consider the dictary babit of eating red mear. The more red meat an individual consumes, the higher t!le cholesrerol, blood pressure, hean disease risk, cancer risk, renal failure risk, etc. tends ro be. But why is a cerrain individual a heavy mear earer? We have to go deeper ro find the answer. If a person grew up earing meat and potaroes, guess what he tends to cat now? If he grew up consum ing caffeine beverages, guess what beverages he prcfcrs now? The particular cuieure that individual grew up in largely determines the habits he has now. Fortllnate!y, the illusrrarjon does nor end (here. There is always rhar "one person" who grew lip eating mear and poraroes and had paretlts that smoke and drank who does noe smoke, doe.s nor drink, and is a vegetarian. Why did that person become "counrer-culrure" and choose differenr habits? Thar individuailet his own personal choices and values rake precedencc over his culrure. Ultimare1y, every person's own personal choices become a deeper reason than eulrure for his ser ofhabit.s. The kinds of choices a person makes and values he possesses are directly relared ro !lis sense of overall meaning and purpose in life; rhis is where the spirituallife and truSt in divine power have a direct bearing.

S

AL

IUre Personal Choices and Values --

--

Overall Meaning aud Purpose

Thus, trusring in a higher powcr besrows cerrain healrh benefits. Thar same trust has a direct connecc.ion ro the overall me.1ning and purpose ofone's litc., which then affects rhe personal vailles and choices, which then affects the culrure one chooses ro adopt, which direcdy influences the particular set ofhealrh habits, which ar last direccly affecrs the health. The original health benehrs come full circle anei are reinforced and multiplied. Cleady, rhroughour my personallife and my work as a physician, I have seeu the importance of inregraring rhe spiritual e1emenr imo a roral approach ro healing. The medical research shared tluoughout chis book, and again mentioned in rhis secrion, llnelerscores this imporranr agenc)' of rrust in divine power as both a remedy anei a basic tener of prevenrion. Now rhar we have seen an overview of each element in NEWSTART, let liS illustrate how rhese elemenrs can be applied ro some specifiC eliseases rhat have nor been dealt with e1sewhere in this book. 1 begin with rhe example of rheumaroiel arrhritis, a common djsease.

Figure 21

Rheumatoid Arthritis Arrhritis anei other bone anei r disorders are among the leading causes of disabilities in America. Currenr estimafes from

507

PROOF POSITIVE the U. S. Centers for Disease Control are rhar rhesc diseases aHlicr some 40 miII ion Americans. I 56 O ne parc icularly desrructive fOTln of arrhriris is called "rheumaroid arrhriris." Ir is a disease causcd when the body acrually auacks irs own joims and ocheI' tissues. For reasons nor yer complerely undersrood, an afTecred person's immune sysrem goes awry and sram an:lcking rhe rs, causillg what ofren becomes a permanently crippling disease. Scandinavian researchers placed individuals wirh severe rheumaroid arrluitis on a toral vegerarian dicr for an emire year. I 57 Aher a single month on rhis ci ietary program, they analyzed rhe patients and founel a decreased number of render and swollen rs. Their grip srrengrh was bener. Furrhermore, {heir problems wirh severe t stiffness in rhe mornings had

TOTAL VEGETARIAN JET EL S R8EUMATO D ARTBRlTIS Al oile month, and after one year, total vegetarian diet patients enjoyed a decrease in: • Number of tender ts • Number of swollen Joilnts • DuratioDi of rtlo rn ing stiffness • Total ibody ,inftammatioD They also had: • Improved grip strength • Improved score 00 bealth assessment questiooaire Control group had /nild decreased pain but 110 other improvemellts. Figure 22

508

improved. Even actual laborarory measuremeuts rha{ reflecred {he degree of intlammation in {he body wcre better. Two such improved blood resrs were the sedimenrarion rare, and the C-reacrive prorein level. These resulrs are demonsrrared in Figure 22. Perhaps most importandy, the pariems on the vegetarian e1ier felt ber.{er--by actual measuremenr on a healrh assessmenr

quesrionnaire. The comrol group on rheir regular dier haei a mild decrease in pain, but [here were no orher measurable improvemenrs. Of course, we cannor conci ude from this rhat ali individllals wirh rhellmaroid anhriris will be cured by a coral vegerarian diet alone. However, the research suggesrs rhar ir can significantly improve rhe condirion. For rhe rheumaroid arrhriric, nutririon alone may improve qualiry oftife, blood resrs, and ma)' even help ro decrease medic3rion needs. A decrease in drugs a150 rrans)ares inro good news. These agenrs always carry some risk of side effecrs. Dier is also important in rhe prevention of rheumaroid arrhriris. There is a growing awareness rhar some forms of rheumaroid arrhriris are apparenrly rriggered by infecr.Îolls illnesses. One wel1-described linkage is between salmonella food infecrion and rheumacoid arrhriris. 158 . 159 We have already seen in Chapter la, "Animal Diseases and Hliman Healrh Risks," rhar much of rhe risk of exposure ro salmonel1a can be avoided by moving ro a vegerarian dieL Besides rhellmaroid arrhriris, rhere arc orher forms of anhriris callsed by the body arracking irself. These forms of arrhritis include luplls anhriris and a grollp of anhritis condirions called [he spondyloanhroparhies. The Iauer include ankylosing spondyliris and Reirer's syndrome. Because they seem ro be ca li sed by a similar process, we wOllld expecr rhese djseases ro respond ro a similar nurrirional approach. lndeed, a recent repon indicared as much rcgarding spondyloarrhritis and clier. loo There, 25 parienrs were placed on a milk-free diet for six weeks. More than half of rhem made dramatic improvemem 01) the regimen, regisrering decreases in t sweUing, sriffness, and pain. They were .usa able (Q decrease medication usage. Of particular i Il reresr, some patienrs bad a retllrn ofsymproms when [bey resumcd the use of dairy producrs.

BEYOND THE LEADING CAUSES OF DEATH

The Effeet ofOther Elements of NEWSTART on Rheumatoid Arthritis. E.'<ercise is also exrremely imporcaru for dealing wirh rheumaeoid arrhritis. Nor long ago, physician would PU( arthritics on orders for bed rese. Now, however, recenr evidence suggests (har rhe more we can help a person exercise (he better off rJley wiU be. Although inappropriare exercise can worsen jOlnr problems, rhe experrs ;ae coming eo rhe conclllsion thar an e.xercise program (ailored ro meer the needs of rhe parienr can ofren help them wirh rheir arthrieis. 161 . 162, 163 For example, a recenr sm:lll srlldy showed rhar rhellmaroid arthri(is parienrs could benefic from a program of highinrensiry exercise ((echnically, a high inrensiry progressive resistance rraining program).164 They demonstrared decreases in self-reponed pain and fatigue. They could waJk measurably berrerwlth improved coordinarion and fasrer walking rimes. There was no worsening of disease acriviry ar t pain. Parr of rhe benefit may relate ro growth horrnone (GH). This viral hormone is nor only imporranr for children. Research suggesrs rhar GH srimulates (he rebuilding of carrilage and bone even in adulrs,165 and thus may play a key rale in repairing the joi nts afrer (he wear and real' of rhe da}'. Of cririca! importance ro che exercise-anhriris link is rhe following faer: grow(h hormone levels sllrge following vigorous exercÎse. 166 Exercise is also exrremely imporranr for anyone who is overweighr and has arrhrirjs. This is (fue wherher we are deaJing wirn rheumaroid arrhriris, osreoanhriris, or any of rhe ocher forms of arrhriris. The more weighr a person carries, rhe more srress rhere is on weighr-bearing r.5 like rhe hips, knees and ankles. Exercise anei proper dier are rhe rwo corl)ersroncs for arraining and mailHaining oprimal weighr. Dr. David Felson, a professor of medicine ar Boston Universiry has srudied knee osreoarthriris. He has found rhar losing weight can make arrhriris of (he knee signihcanrly beuer. 167 Overweighr individuals also run a higher risk or developing arrhriris. Of. Chad

Helmick, a Cenrers for Disease Control expert has discovered (har adllirs of eirher sex who carr}' exrra weighr-even if rhey are nor so heavy as ro be c1assified meelically as uobese"-were 30 pereenr more Iikely than normal-weighr adults ro have arrhriris. The risk for thase carrying excessive weighr was even grearer: obese men increased rheir risk of arrhriris by 70 percenr while obese women had a 50 percenr higher risk. 168 Bur rhere appears to be more ro rhe exereise-wcighr conrrol relationship (han wear and tear on rs. RecelH research suggesrs rhar overwcighr women have a higher risk of even developing rhellmaroid arrhrÎrjs.l69 Women in rhe upper 25 percem of weighr for heighr haei a 40 percenr increased risk of comiJlg down wirh rheumaroid arrhriris. Some researchers specliJare rhar (his linkage has ro do wich sex hormone levels. Water can be used exrernally ro benefir rhose wirh arrhriris; ir is efleerive for rhe rhellmaroid variery anei ocher forms ofr inf1ammarion. The applicarion of hydrorherapy (warer rherapy) can serve many purposes in individuals wirh rhese eondirions. Heac can be applied ro affecrcd rs lIsing hor waler packs, whirlpools, sream, erc. Such rrearmenrs ean be parricularly effeerive. For example, recem published work showed char rhe use ofhor mineral barhs and mudpacks could help borh rheumaroid anhrÎris and rhe relared eondirion of ankylosing spondyliris. '70 . 171 Hearing of che tissues can have very desirable benefirs. Alrhollgh rhe brain has difflculry ro[erarÎng temperatures above 104 dcgrees Fahrenheir (40 degrees Celsius), elesirable e[feers occur on rissues orher rhan rhe brain ar remperarures bcrween 104 anei 114 degrees Faluenheit (40-45 degrees Celsius) for 5 ro 30 minures.!il Krusen's prestigious cexrbook of Physical Medicine and Rehabilirarion 173 Iim some of che benefits ofhearing tissues-sllch as rs-inro this range: 1. Decreaseel sciffness due ro increased Aexibiliry of rissues (parricularly rendons and ocher strucrures nude largely of rhe fibrom rissue calJed collagen). 2. Relief of tnuscle spasm.

509

PROOF POSITIVE 3. lncreased tissue blood flow and inereased speed of body reactions. 4. Relief of some rypes of paiu. This can be due ro decreased stiffness, improvemellt in (ÎSSllC o>..-ygenation OI' by "collnterirritacion" wherc che stimlllation of temperature receprors in [he skin decreases pain sensation. Heat is aJso known to increase chc pain chreshold, chus making pain easier ro tolerate. 5. Mild heating ean provide assiscance in removing fluid bllildup and inflammation in areas with more chronic congesrion. Application of high temperature heat can, however, worsen acute inDam mation. Cald, on the other hand, can help deerease acute inflammation. For this reason, iee is the firs(-]ine natural rreatment for a recent strain or sprain. Jee can al50 somecimes assist wirh pain control. This may have ro do wirh the "collnterirritation" phenomenon. le may aJso be a resllit of nlll11bing of the pain sensors ar decreasing inf1amrnation. Becallsc heat and cold each have unique benefits. we wiU sometimes llse a combination of boch hot and cold in alteration. This is called a conrrast treaement. A common partern for sllch a trearmenr is ro apply duee milllltes of heat ro an affecced t and chen follow chis wich 30 seconds of cold. This constÎtlltes "one cyele." Four LO five cyelcs are uSllally applied at each rreatmenr. Two or duee creatments are given each day. One type of arthritis duc was previously confllsed with rheumatoid arrhritis is now eal1ed Lyme arrhritis. This form ofarehritis results from an infection wirh a bacteriuJIl called Borrelia burdorferi. 174 This germ is eypically rransmitted from the bite of an infected deer cick. The problem is greatest in the American Nonheast, but also occurs widely throughollt che U.S. There is evidence thar t!lis form of arrhritis may be able ro be improved by rhe lIse of extreme heat referred to as hypenhermia. Alchough the rcsllits are slill preliminary, rhis ilJuscrates anocher linkage between a rheumatoid arrhricis-like condition aJld infection, and suggestS mat thete may be an important role for more natural means of therapy.

510

One of the remaining questions is: may what works for Lyme work for other eases of rheumatoid arrhricis? The quese.Îon demands an answer: cheorecically, some of what we caII rheumatoid arthritis may be ulldiagnosed chronie infection, as was the case wirh Lyme. 175 . 176 Already other infecrious agems are being linked ta rheumatoid arcluitis-like diseases. 177. 178 We have aJready noted (he link becween anhritis and salmonella. Ofher baeteria cluc eause intestinal infections have also been implieated. These include Shigella and Yersinia. 179 The Chlamydia family ofgerms. known for their abiliey ro cause sexually transmitted diseases as weB as upper respiratory infcctions like bronchicis, have now also been linked wirh a rheumatoid arrhritis-like condicion. 1SO A number of viruses arealso currently listed as candidates ro cause rheumacoid arrhricis. These include Epscein- Barr virus and the parvoviruses. 181 Mycobacceria, c!le cypc of germs mat cause tuberculosis and oeher infeetions. may aJso be arrhritis culprits. 182 The reason for highlighcing the linkage betwcen some rypes of arthritis aod infeccion is thar preliminary results sllggest thac generalized heating treatmenrs may help sueh forms of arthritis. The interna! use of water also seems ro be of value in many illnesses thac affeet the bones, Il'luscles, and joims. Drinkillg water improves the flow propetrÎes ofblood-dus is rechnically referred ro as enhanced hemorheology. Such improvemenrs in blood flow may have a role in a number of conditions, such as dealing with back pain (wher.her ar not it is related ro arthritis) aud helping ro improve healing of rs and other tissues. Marjotie Baldwill. MO. aud Bemell Baldwin, a Ph.D. physiologist, borh of Wildwood Lifesryle Center in Georgia, inclllded infonnation on the imporrance of water and blood flllidiry in cheir review of arrJuitis therapies. 183 They site the research ofKniselywho found that blood with poor tlow properries was corrunon in rheumatoid anhritis, and was unable tO supply the optimal blood flow needed by [he rs. l84 We wOllld expect thac more liberal water int:ake wOllld have had significant benefits in thesc circumstanccs.

BEYOND THE LEADING CAUSES OF DEATH Sunshine has been demonstrated ta affecc che immune system. Under the influence of sunlighr rhere is some level of immune suppression which may acrually be desirable in diseases of aJl autoimluuue nature like rheumaroid arthritis. SpecificaJly, rlle Langerhans ceUs in the skin have been srudied in relation ro rhe immune-suppressing effeccs of sunlighr. Suolight also boosrs vitamin D leve1s. This vitamin is importanc for calcium balance in che body. Viramin D may also help tO prevent bone loss thar often accompanies rheumaroid arthritis. At least chis seems eo be che case in the other major rype of arrhritis, osteoarrhritis. Researchers ae Boston Universiry School of Medicine found thar individuals with [ower blood levels of vir.amin D were rwice as likely ta have their disease worsen during the fouryear study.185 The researchers speculated ehat higher levels of yiramin D might slow cartilage destfUction. If mis is indeed ilie case, then vitamin D may also offer help for the person with rheumatoid arthritis. The way Iuse the concept oftemperance is unfamiliar ro most people. By chis word, J include a very popular notion, rhat of moderation. I am afirm believer in moderation-regarding healthy lifesryle factors. For example, I believe we should be moderate in the amount and inrensiry of rhe exereise we do (roo much can be harmful). Similarly, I believe we should be moderate in rhe amount of food we eae an the vegetarian diee (you can overeat and suffer the health consequences of overeating even on rhe best of foods). However, I am agaînst ehe concept of moderation when it applies ro heal eh-robbing factors. Ta cite rwo common examples: cocaine or tobacco, even in moderation, is harmful. In shon, 1 use the ferm temperance to refer ro moderation in

(hose things thal tire good, but total avoidance ofthose things that are harmfu./. How does chis concept of rempcrance apply ro rheumaroid archritis? Ta optimally heal from chis illness, wc need to avoid anyrhing rhat will impair our body's Ilatural healing mechanisms. Some patients have noted mat when ehey do not get to bed early, cneir arrluîtis is worse che next cGy-even

if they obtained the same number ofhours ofsleep. This goes along with whac we know abour melaton.În and growth hormone, rwo compounds that are involved in building up the body after ehe wear aud tear of ilie day. Both of mese hormones may be made in slnaller amounts îfa person srays up Iare. A review of Chapter 9, "Me1atonin-the Natural Way," will remind you ofhow many faceors can interfere wieh quality sleep. These factors include tobaeco, nicotine, and caffeine, to mention only a fcw. The bonom line is ehar temperance teaches t1S ta avoid ali of these agents as well as any other factor that would sap aur body's reserves. Fresh air is also important. Pollmed air, such as that rainted by aceive ar ive tabacco smoking rheoreeically may worsen rheumaeoid arthritis. 186 There are suggestions that active smoking inereases ehe risk ofever developing rheumawid arthritis. In a study of over 1500 women from Washington State, researchers found thar rhose who smoked had a 50 percene increased risk of coming down with rheumatoid arrhriris. 187 And these women were not necessarily heavy smokers. One pack per day for 20 years was enough. Jnrere..stingly, a Scandinavian srudy demonsuated an even srrouger linkage berween smoking in men and rheumatoid arthriris. IBa In rheir prospective study of over 50)000 individuals, they found that men who were smokers had 3.8 rimes the rîsk of dcveloping rheumawid arthritis. Those who were ex-smokers still had well over double the risk of t~he neve·r smokers. The results could not be explained by age, place of residence, marital searus, social class, percepeion of general health, ar weighe. One ofthe strategies in cre-ating any rype ofarthritis is to strengthen the surrounding mllscles, other soft (issues, and bones so that less srress is borne on the r. This is ooe of ehe reasons why exercise is so important. A very little known faet abolit exercise is that outdoor exercîse is much more beneficiat (han dut done indoors. Years ago researchers discovered that at.hleres could develop greater sm:ngrhening an an olltdoor exercise program than one dane indoors_ They amibured this difference to the much

511

PROOF POSITIVE

512

grearer number of negatively charged ions of oxygen in outdoor air compared ro indoors, and the ultraviolet liglu from rhe sun. 189 Rest is necessary for oplimal recovery from rheumatoid anhrieis. During the hours of sleep, important hormones are secreted rhae build rhe body up from wear and tear sustained c!uring rhe day. 1 have already identified rwo of rhe mose imporcant hormones; namely, melaronin and growth hormone. One of the ke)'s ro optilml! melatonin production is adequate rest early in the night. For more information on this see Chapter 9 on Melaronin. The same sleeping habits scem ro favor adequate growrh hormone production. However, anorher compound appears ro have a mie in rheumaeoid arthriris ehat is <1lso helped by ade<juare sleep. It is a hormone-like compound caJled interleukin 1 (IL-l) tim is made by white blood cells. The evidence suggeses that a deficiency in inrerlellkin 1 acrivit)' may play a role in causing OI" aggravating rheumatoid arthritis. 190 . 191. In lL-1 is made bes[ when a person is gerring adequate sleep. 1~3 In realiry, rest provides a special example of temperance. It spcaks eo moderation in work noe only on a daUy level, but on a weekly level and beyond. We will explore some of ilie addirional aspecrs of rest later in the chapter. Ac this poinr, I would like tO mention [hat rhere îs a relarionship berween rest and fresh air. Few realize thar fresh air has stress relieving, mildl)' rranquilizing, and sleep indllcing effecrs. Do not hesit
arrhrilis largely bya change in his spiritual ourlook from cuhivating negativism ro cultivating joy. Cousins' improvemenr iIlustra tes (he im p0rtance of mental outlook and the spiritual dimension. Rheumaeoid arthritis îs our nrst eX31l1ple ofshowing how the NEWSTART e1emenrs highlighred by Ellen White have power roda)' ro improve qualiry of lift as well as longeviry. We could demonserate ehe same thing with dozens if nor hundreds of oeher maladies. The main message is rhae these remedies work in combinat ion ro promote heaJeh. This book, however, is nor intended ro provide medical explanations for every disease seate, but it rather !ays down prillCiples tO help individuals gain or maimain healrh. Next, we "viII see how the prîncipJes of NEWSTART can be applied to anorher ser of common diseases.

Urinary Infections The same Norwegian researchers who demonsrrated a link berween the vegetarian diet and rheumatoid arrhritis made a startling observat ion about the total vegerarian diet and urinary rract iofecrions.! 94 In a srudy of 22 individuaIs, rhese researchers found thar their program of 7 ro 10 days of f:1seillg followed by a (Oral vegerarian (no animal product) diet tended ro decrease fhe ability of mine w supporr sorne of rhe common germs rhat can C
BEYOND THE LEADING CAUSES OF DEATH surprise that drinking significant amounts ar water helps ro prellf:nt such infecrions. Howcvcr, ,he drinking of orJlcr beverages may increase the risk of urinary difficulties. Cola drinking has been found to increase urine minerals like oxal:lte and cirrate rhat set the stage for kldney stones. (9) This is important nor only because of rhe severe problems ehat srones can cause in themselves, but also because these rock-hard partides can provide an ideal environmenr for cerrain lypes of urinary illfecrions. [nrerestingly, a beverage Olher than warer may provide special help ro those with frequent urina.ry infections. Recent research has vindic.'l.ted mom's wisdom in advocating CYl111berry juice. In a Harvard srudy of older women (average age of78 1/2), researchers found chat the llse of a ctanberry beverage can decre:lSe rhe rendency 10 urinary infection. '96

Asthma Asthma is another disease rhat has a special relalionship ro diet. In {his sectian I will Jook al how a vegetarian diet can help asthmatics. Before 1 do ehat, however, 1 wanr ro poinr our one of rhe most inrerest~ ing recenr findings an asthma lh.l! ,llso brings into focus two of the orher NEWSTART e1ements: waeer and trust in divine power. In reading rhe Scriptural books of Moses and looking at the plan thar God oudined for rhc IsraeJires, 1 am stfuck by how much His guidance dealt wirh issues of a clean cnvironmenr. There wcre scrupulous laws rhat dealt wirh washing and cleanliness afrer contacl wirh dearh. There were specific instructions rhar dcalt witb rhe disposal ofhllman wastes. There were laws ,har gave explicit insrrucrions on whar ro do wirh conragious diseases Jike Irosy. This empbasis on deanliness, ofcourse, only had value as God's pcople trusled Him enough to follow His counsel. Furthermore, 3ttcnrion 10 scrupulous dearuincss can bc seen as an extension of rhe rhird element of ,he NEWSTART program. Warer is afren lhe agent we lIse ro produce c1eanlincss. Now whar does alI rhis have ro do Wilh asthma? Quire a lor. The National Cooperative Inner City Aslhma Study is

probably one of rhe largesc stlJdies on asrhma ro date. It c.'lrried a price rag ofsome $17 miII ion, and the resulr.s arc jusc now being pllblished. This monumentaJ swdy found a powcrfullinkage bcrween asrhma and exposure t.o rhe proreins of rhe common cockroach. 197 ASlhma suITerers are more likely ro demonsrrar.e abnormal immune reaCliviry ro chis pesky bug and irs droppings. In faer, ofaII rhe foreign protcins thar can uigger an allergic asthma :lnack, cockroach proreins-called "anrigens"appear ta be the mosI powerhlJ. In rhe Inner City Asthma Stlldy, 38 percenr of rhe asrhmaric youngsrers were alJergic to roaches. This relarionship helps ro cxplain why urban Americans are more likely ro suffer from asrhma. In addirion ro bcing exposed ro known lriggers of asrhma in city air such as ozonc, sulfur dioxide, nitrogen dioxidc, and orhcr air polluranrs,198 ciry dwelJers are likely ar incrcased risk of exposure ro cockroach proteins duc to the abundance of rhese pesIs in urban are-as. This linkage provides at least one insight inca why asrhma, ilic most common chronÎc childhood ilJness, is sreadily an the rise. The number of asthmaric in America has rise-n 45 percelH in rJ1e past decade. There arc now same 15 miiI ion asrhma sufferers; about a lhird of lhem arc under 18. 199 Since ]980, [he annuaJ death rate from asthma in young peaple undcr 24 has risen precipirously with a ]] 8 percent upsurgc over rhat rime period. 200 Some racial groups are hil harder rhan others. Black childrcn and yourh were 4 ro 6 rimes more likely than whites of similar age to dic ftOm asthma. 201 Unfonunately, in living arrangements which ofren include aparemenrs in crowdcd citics, we are often affected by our neighbors' Jack of c1eanliness as well as our own practiccs. Howevcr, the evidence stiH makes a powerflll case for a scrupulously c1ean environmen t. How can people reduce cheir expOSlire ro roach proteins-parrÎcularly if iliey live in an apartmenc slIrrounded by neighbors' roach-infested dwellings? Experrs suggesr dlac four srrategics can go a long way ro keeping yOllf premises free of roac!t-proreins:

513

PROOF POSITIVE

71 % improved after 4 months. 92% improved after 1 year. Significant improvements included: • stress test · pulmonary fUDction • capacity to do physical work • changes in blood tests Figure 23

514

First, kill rhe roaches rhar are in your home ar aparrment wirh fogs, sprays, all(1J ar poison bajts. Next, rhoroughly wash aU floors and su rfaces ro ger rid of roach prorei ns. Vacuum carpered surfaces for the same reason. YOll may wanr ro consider even a thorough carper c1eaning rhrollghout your entire dwelling. (These procedures will also he1p ro decrease rhe amounr of poison residues in rhe environment from the fim srep.) Then, acr preventively. Do nor leave any food out rhat would amacr roaches. 1'his inc1udes everything from [he obvious food on rhe rabie, crumbs an the floor, and food scraps in an accessible garbage can. It is a good idea ro remove ali accessible food immediarely after eating. Refrigerate thar which you wish ro save. The resr can be diminated through either a sink disposal, or by raking rhe uash olltside of yom dwelling. Lasr, sec roach [raps. This wil! help ro catch any of the bugs rhar jusr happen ro wander in. Proliferation of al1ergies and oeher causes have a role in rhe asrhma picrurc; however, oehcr Iifesryle factors are also important. We need ro look carefully ar the dier issue. Research suggesrs thar ir may have a profound role in dealing wirh rhis major disease. A rorai vegerarian dier, which i5 completely free ofanimal producrs, has been

demonsrrared ro reduce medicarion needs in asrhmarics. Thirry-flve pacients who had sllffered from bronchia1 asthma for an ave.rage of cwelve years were rhe subjeers of ;l Scandinavian srudy.201 Ali of rhe panicipams were receiving long-rerm medications; 20 were an some of the mosr porent astluna medicarions rhar we use, rhecorrisone-rype drugs such as Prednisone. These compounds can help people manage rheir asrhma berter, bur rhey can a1so have significanr long-rerm damaging side effecrs. In rhe research srudy, rhese 35 chronic asrhmarics were asked (Q go on a roral vegerarian dier for a year. Over rwo-rhirds of rhem remained an this dier for the ful1 year. Almosr ali of rhose who Followed rhe nurritional program made significant improvemelH as omlined in Figure 23. In general, asrhma symproms decreased, while physical funcrions improved. Blood tesrs also improved-including rhe IgE level-suggesri ng rhar allergies were improving. Funhermore, almosr ali were able ro decrease rheir asrhma medicarions significandy. The researchers conduded: "Seleered paTÎents wirll a fear of side effccrs of medicarion, who are inreresred in alternarive healrh care, mighr get well and replace conventional mediClrion wirh rhis . "?03 reglmen. -. 1'his is exciring news. It suggesrs rhar many asrhmarics ma)' be able ta significanrly improve their healrh and decrease Of eliminate rheir medicarions. Of course, a word of camion is in order at rhis poinL lf you ar a loved one has asrhma, cominue ro work wirh your doctol", Make sure you do nor change yom medicarion inrake muil you ger approval from your physician. Ar least parr of rhe reason for rhe sllccess ofrhe vegerarian diet regarding asrhma likely has ro do wirb a decrease in food aHergies. Johns Hopkins researchers recently discovered rhar food allergies play a major role in aggravating childhood asrhma. 204 Lung funcriOll meaSllfcmems demonsrrated rhar sllsceptible ch ildren develop more irritable airways as a response ro rhe allergyproducing foods. This irrirabiliry sers rhe srage for spasm of the air ages and

BEYOND THE LEADING CAUSES OF DEATH asr.hma anacks. In those suscepcible children, their asthma will generally not improve unless the offending foods are removed f(Om rhe diec. Some of che foods they were allergic co are common foods ehac would be avoided on a vegecarian diet, such as eggs, cow's milk, aIld fish. Also on che high-risk food lise were items likc wheat aod soy. These foods are good in chemselvcs buc mosc Americans eat mese foods daily. And that may be a p(Oblem. Some allergists believe chat repeated exposures to a given food tend ta promoce allergies in susceptible individllals. The inclllsion of wheat and soy ou the comm.on aJlergen list eends ro lend suppon ro that argument. If you read labels, it will come as no surp,rise chat mosc Americans are exposed ro wheac aud soy repeatedly every single day. If you assent {Q che daily wheat incake, but chink we as a nation do nOt use 11)1Ich say, think again. Say is used as flUer in ground beef, as a source of lecit.hin in many baked produccs, aud a comroon source of oii (as weB as mono- and diglycerides used in proce..~sed foods). The.re are licerally dozens of oeher uses. If you chink abolit ic, eggs and cow's milk, two of the other major foods assaciated wich childhood allergy, are a1so common dierary constituents. Fish probably does not find its way anco American places ne:lrly as often as these orher items. Buc there is more ro the altergy issue rhan frequency of ingestion. In my experieuce with pariems, dairy foods seem tO be one orche mose aggravating foods for allergy suffers. The medical literature seems ro be consistent wieh myexperience. Dairy foods have been linked wit.h everything from skin condirions205 ro immediare allergic reactions. 206 The bonom line on che allergy-asthma linkage seems ta be t.hac sufferers wirh lhis airway disease should seriously consider a swirch tO a vegerarian dieL They should a1so be c.1reflll ta avoid repeared exposure ro certain comrnon foods. Besides removing allergens, oeher diecary facrors likely had a rale in che asthma improvemenr ed by [he Scandinavians. There is evidence thar rhe vegetarian dier is associated wirh less inf1ammation rhan a

meat-based diet. This appears ro be related

ro less inf1ammatory leukocrienes and proseaglandins producrion an ehe vegetarian diet. Furchermore, t1lOse individuals on a less refined diee are likely ro be consuming less salt. A body of lirerature suggests rhat asthma is worsened by a diet high in table salt.. 207, 208

FOODS THAT TRIGGER MIGRA E HEADACHES U.S. h sicialls V.K. h sicians

Mai" dietary (actors · Chocolate · Alcohol · Cheese O/her dietary factors

72 67 50

87

· Monosodium glutamate · Nuts · Citrus fruits · Meats · Dairy products · Coffee · Marmite · Fish · Nitrates ·Onions · Hotdogs

29

Il

69

78

11

6

12 10

28 6

9

17 24 9

8 6 6 4 3

3 9

Figure 24

Food Allergies and Migraine Headaches There is growing evidence that migraine headaches are a1so related ca food a11ergies. The worst culprirs in a recent study were dairy products. 209 Orher repo,rts suggest that cheese in particular is one of rhe worst o f-Tenders. At a convemion of British and U.S. neurologists (brain, ncrve, and headache specialists), rhe parcicipating physicians wcre asked co list which foods triggered mÎgraine in rheir patienrs. Their responses are lisced in Figure 24. You will note that most of rhe dietary

515

PROOF POSITIVE facrors implicared by rhese physicians are not pan ofa hea1rhful vegerarian dieL There are, however, a few foods on rhe list rhar are healthful for most people, bur may be unhea1rhful for certain sensirive individuals. Examples include cercain nurs and cir rus fruirs. There are omer connections in the medical Jirerarure between migraine headache and diet. These connecrions also suggest that a healthful vegetarian diet would prove beneficial. For example, rhe fars in a plant-based diet tend ro be monounsarurated and polyunsaturated ones rarher than the saeurated variety. The research suggests that this may help prevenr mlgrames. One of the reasons appears ro be rebted ro platelcts. These c10tting cells of rhe body can apparendy c1ump and release compounds that rrigger a migraine headache. Platelets that have more polyunsarurated fars in rheir omer layer (caHed the "platelet membrane") tend ro be associated with fewer migraines rhan ifme plate1et membrane is rich in saru2lO This research suggests that inrared far. ereasing the plant producrs in the dier may help ro decrease migraine arracks. Furrher evidence of this linkage comes from research on children who were prone ro migraine. Dr Glueck and his colleagues ar me Universiry of Cincinnati have found that children wirh worse cholesterol leve1s had more migraine beadaches. 211 In facr, the deleterious eholesterol profile was the same one rhat predisposes individuals to hem disease (i.e., low HDLand high LDL). The qllesrion, of course, is whemer che cholesrerol values are rhe resll1t of a eommon process (sucit as higher polyunsatllrared far he1ping plarelet membranes ar rhe same rime it is lowering eholesrero]) or whether cholesrerol in and of itselfhas a relacionship ro migraine headaches. There is probably some uuth in both possibiJicies. We have already seen rhat dietary polyunsaturated f.m may be beneficia! in migraine pariencs if rhose fats become incorporated into rhe plateler membrane. However, research a1so indicares rhar increased amounrs of cholesrerol in rhe blood reud to make plarelers more sricky. 212

516

Stroke and Vegetarian Diet Currem research indi<..-ates rhar a dier rich in whole fruirs and vegerables decreases sriH other diseases. For example, rhe Nurses' Healrh Srudy has demonstrated a 68 percem lower risk ofstroke in women eating five or more servings of carrors per week. Those rhatateaservingofspinachperdaydropped their stroke risk 43 percem. The fan10us Harvard study of residencs of Framingham, Massachusetts has shown that meo, roo, benefit from eating more fruits and vegetables in preven ti ng strokes. 21 :l Specifically, they fOllnd that aiI strokes and «mini-suokes" (rransiem ischemic attacks) dropped over 20 percenr for each addirional (hree servings of fruirs and vegerables per day. The devastating bleeding strokes were prevenred even more. Three more daily servings of fruits and vegetables decreased the risk of rhose strokes by over 50 percenr. Neirher of the two srudies mar 1 have commemed on reported specifically on meat inrake. They were focusing simply on fruirs and vegccables. But whar typica!ly happens when you increase your fruir and vegetable consumption? You decre.ase mear intake. This Jink wirh mear eating, however, was made explicir in some recenr AusrraJian research. 214 Researchers rhere found thar eating meat more rhan four times per week increased the risk of stroke. Whar is ir abour fruirs and vegerables that help to decrease stroke risk? There are severallike1yexplanarions. As we have seen in rhe migraine headache research, a vegetarian-type diet appears ro make plarelers less sricky. When rhese c10tting cells are thus rendered less prone ro initiare a dor, we would expecr a decrease in the rendency of oarrowed brain vessels ro block off rotally and cause a srroke. It is likely mar stroke risk is also lowered as a resulr of che blood pressure-Iowering effecr of fruits aJld vegetables. One c1assic srudy was published in the British journal Laneer over a decade ago. 215 For more informarion on the dierhigh blood pressure linkage, refer ro che chapteron blood pressure (Chapter6," One Nation Under Pressure"). In preveming srroke, the vegerarian diet has becn documenred ro help reverse

BEYOND THE LEADING CAUSES OF DEATH blockages in areeries. The sllldy rhar has received probably che greacesr publiciry is thar performed by Dt. Dean Ornjsh and his colleagues. 216 1 include more infotmation on the reversal ofblockages in heart atteries in Chaprer 4, "Blocked Arteries-Clean Them aur rhe Natural Way." It seems reasonable ro think dur similar reversal will occur in blood vessels supplying [he brajn.

Cataracts Cataracts are among the most common problems (acing older America.ns. Theyare major causes of visuaJ impairmenr and bli nd ness in rhese individuals. 217 Thc evidence suggests rhar diet and lifesryle on affect the risk of rhis condicion. Cararaers apparenrly occur more readily wheo a person. is exposed ta a grearer intensiry and durarion of ulrravioler light as is found in normal sunshine. 2lS The eye lens scems ro be damaged when ultraviolet lighr converts oxygen inca reactjve compounds called free radicals or "oxyradicals."219 Thus, we have seen a popular emphasis 00 the use of sunglasses that have {Otal UV blockjng capabilicies. However, even this sun·induced damage can be prevenred-at least in parrby a group of compounds called antioxidanrs. These compounds such as vicamins A, C, and Eare fOWld in abundance in plant foods. Evidence of this conneccion was provided by rhe Harvard's Nurses' Health SLUdy. Rcsearchers rhere discovered chac a diet higher in foods concaining Ylramin A compounds decreased (he risk of cacaracrs. 220 Regulat use of Vicamin C supplemems a1so lowered otaraa tisk in the Harvard r<.':search. In ocher scien[ific studies, subjec[s who consumed fewer daily servings of fruic andJor vegerabJes had an increased risk of cararacrs, as shown in Figure 25. 221 Norice rhat rJlOse who ate less than three and a half servings of fruics and vegetables per day had nearly thirreen rimes the risk of developing cataracrs as those wirh more libera! inrake of rhese foods.

Peptic Ulcers As many as 500,000 cases of stomach and intestinal (duodenal) ulcets are

diagnosed every year in America. 222 The direct casrs of these condjrions (called colleccively "pepdc ulcer disease") amounts to nearly 2 biUion dollars annually.223 The evidence suggesr.s mat li fes ryle plays a major role in [he development of ulcers. One known relacionship berween sromach and intescinal (duodena/) ulcers is with cigarettes. Tobacco has severa! effecrs mat increase rhe risk of ulcers. First. tobacco scimuJates acid secre(ion; nexr, ir decreases blood flow co rhe Ijning of the stomach and inteseines; and lasr, ir decreases the amoune of a prorective subsrance called proseaglandin fhar is made by (he stomach lining. 224 The resuIc is rhac smokers have double ro rriple rhe risk of ulcer problems. 225 If you currently have problems wich ulcers-or believe yOll are ar risk for problems-chere are ac leasc three further

OW

NTAKE

UIT AN» VEGETABLE

OMOTES CATARACTS

Food Category with Lowlntake

Risk of Getting a Cataract Cortical cataract risk

Posterior subcapsular cataract risk

• Low fmit intake (less tban 1.5 servings daily)

2.9

8.6

• Low vegetable intake (les

4.1

7.4

• Low intake of fruits and veg,etables combined (less I than 3.5 servings daily)

5.0

12.9

I than 2.0 servings daily)

Figure 25

areas ehat relate to eemperance rhar warrane concern. The firsr is the avoidance ofcoffee and orher caffeine conraining beverages. It is well esrabJished [har these beverages stimulace acid secretion.226 For rhis reason, caffeine beverages are on the hit lisr. Secondly, decaffeinared beverages conrajn rannins rhar a!so increase acid productian and thus on interfere wirh the healing of

517

PROOF POSITIVE an ulcer,227 The rhird factor is an unbalanced lifestylc with impaired srress managemem. Many srill quesrion rhe link between psychological srress and ulcers. 228 It is cerrain rhat stress does not he1p these digesrive problems, and because stress is linked wirh other adverse ourcomes, ulcer sufferers should auempe [O manage srress throllgh changes in lifesryle. Orher aspecrs of the healthy lifesryle rhar 1 advocare rhroughour rhis book may also playa rale in prevenring ulcers. A vegemrian dier wirh its abundance offtber a.nd vitamin A-relared compounds may also be a winner in rhe ftght againsr ulcers. Recent research suggests that a dict rich in fiber and viramin A may reduce rhe likelihood of deveJoping d uodenal u1cers. 229 Cleanliness and hygiene may also be major factors in prevenring ulcers. Such concerns involve rhe rhird element of NEWSTART, which is "W" for warer. Simple hand washing would go a Jong way in decreasing our risk of a host of diseases as we have already Icarned. Although noe aII of rhe infofmation is in, this simple technique may also decrease ulcer rates. One of rhe houesr recent discoveries in the area of pepdc ulcer disease is rhe linkage with bacreria called Heficobacter ?ylori. Alrhough rhe relationship between chis germ and ulcer disease was posrulated in 1982 by rhe Australian physicians, Barry Marshall and Robin Warren, it has only recently been widely accepted as a key f:1cror in ulcer disease. 230 SimpIy pur, those wirh a chronic infection wirh H. pylori run a significandy increased rîsk of developing ulcers. One inrrîguing factor rhar has nor received much attenrion is rhe rransmissibiliry of H. PyLori. Infecrion is e1early relareel tO lower socioeconomic statlls, and may be relareel to scandards of hygiene. Z3l Thus, careful auenrion to c1eanlîness and slich simple practices as hand washing may play a mie in decreasing rhe risk of developing u1cers. Flies h:lVe even been faunei ro transmir rhe infection from one person ro anorher. 232 Another inreresling side1ighr ro the infecrion-uker connection re1ates ro foods

518

coIHaining a1lillm, such as garlic, onions, and scallions. These foods, specifically garlic, are known ro have antimicrobial effecrs and therefore ma)' help ro decrease the risk of H. pylori infectjon. 50 far, dlis connecrion has nor been confirmed. Yer, consider rhe followi ng facrs. H. Pylori nor only încreases rhe risk of ulcers, but it also increases thc risk of stomach CHlcer. AlliuJn foods. on rhe orher hand, decrease rhe risk of sromach cancer. 233 The results suggest proteerion în both animaJ tesrs and hllm3n research. Although rhese foods may work by blocking cancer developmenr or grawth, rhey may also exert a role in eradicatîng or decreasing H. pylori infection. In shorr, a balanced temperatc lifesryle chac pays anenrion ro rhe NEWSTART principlescan hdp ro prevenr OI' rrc~n ulcers as well as the ocheI' condirions thar are presented in this chaprer.

Conclusion 1 began this chaprer wirh a problem: how cOlild 1 possibl)' provide information that wOllld help ro meer rhe needs ofreaders who had problems nor speciftcally addressed în m)' book? My solurio'l was ro provide a framework for approaching an)' healthrelated concern. By championing a cenruries-old approach ro wellness, 1 have areempced to do jusr thar. AlthOllgh Weimar Institute has recently popularized ehe NEWSTART acronym, [he remedial agents rhar they advocare are as old as [he Mosaic Health Codes in the scriptures. The NEW START program is not a panacea, however. It is a complete, balanced program rhar addresses rhe viral areas of heaJthfulliving in OUl' lives. It is more rhan a low-fat vegerarian eliel' or a regular exercise program. It is a comprehensive approach ro living designeel to fosrer oprimal heaJrhphysicaJly, menrally, sociaJly, anei spiritually. The eighr elemems of rhe NEW START program offer each of us an opportuniry ro maximize healrh by focusing on the changes rhar are calculated ro promore healrh and happiness. Why nor begin chis new Stan today?

BEYOND THE LEADING CAUSES OF DEATH References-

I

KlIlll

Amand, Per-Olaf. Mllrilion

Man:us R, Coulslon AM. Waler-soluble "ilamins. In: Gilman AG. Goodmal1 LS, el al, editors. Coodmnn nnd Cil"ulIIS TIu PbnTmncologic Bmis ofTb~rnp(l/lics-7" ,-dilion. New York, NY: MacMillan Publishing Company, 1985 p. 1557-1559.

, Bro\V1l MS, Goldslein JL. Drugs used in Ihe IrC:llmenl of hyperljpoproleinemias. In: Gilman AG, Goodman LS. CI al, editors. A

GDOdmnn Iwd Gi/numi Thr PbnrmncO/Qgic Bnsis of71l"npcurics-7 rdirion. New York. NY: MacMillan Publishing Compally, 1985 p. 834-835. ~ KingJM, CrouseJR, el al. Evalualion of effecIs of unmodjlJed niadn on

fasling :lOd poslprandial plasma lipids in normolipidemic men \Vilh hypoalphalipoproleincmia. Am) Ml'II1994 OCI;97(4):323-331. Crousc JR 3rd. New developmenrs in the use of niacin for lr("armenr of hyperlipidemia: new consideralions in Ihe use of an old drug. Coroll Aru>] Dis 1996 Apr;7(4):3.21-3.26.

6

Brown MS. Goldslein JL. Drugs used in Ihe Irealmenl of hypcrlipoprolcinemias. In: Gilman AG. Goodman LS. CI al, editors.

7

Good"ul11 and Cil/lumI TIu Pbllrmllc%gic Bmis of'nleraprmics-7''' ttlilion. New York. NY: MacMi.llau Publislling Comp~HlY. 1985 p. 834-835. SS. Thr DoctOTi Vilnmin rl11d MinrnzJ ElIlyrloprdw. New York.

NY: Simon and Schu.'ler.

1990 p. 61.

Crouse JR 3rd.. New dcvelopmems in Ihe u e of niacin for trealment of hyperlipidemia: new c.on,ideralions in lhe use ofan old drug. Oroll ATlCI)' Di; 1996 Apr.7(4):32 1-326.

9

'o Marcus R, Coulston AM. Water-solublc vitamins. In: Giln13n AG. Goodman LS. el al, edilors. Cood"JfJtl 111Id Gi/mnnI TIJe PIJilrml/cologic 8aJis ofThl'rnprtllics-? ditioll. New York. NY: MacMiJlan rubli hing Company, 1985 p. 1559-1562. Hendler SS. Tlu DoC/ors ViIDmin nnd MiI/eroi Encyclopfdin. New York, NY: Simon and Schusler. 1990 p. 91-92. II

Hcndler SS. TIu Doctori Vifl1milland Millrrn/ Encyclopcdifl. NY: Simon and Schu5lel. 1990 p. 91-92. Il

cw York,

13 Hcndler SS. The DoCtor', Vilall)in and Mineral Entyclopcdia. New York. NY: Simon and Sd'USlcr. 1990 p. 91-92.

14

Napia K. Too M:uly Vit:lJ1lins? Hnrvnrd Hrfllth [rtur 1996 Jan 21 (3): 1-

3. 15

'6 Hcndlcr SS. TIu DoctoTs Vilamin rmli MinfTflL ETIL)'dop,dul. New York, NY: Simon and Schusler. 1990 p. 99.

Napicr K. Too Mmy Vilamins? Harvard Hen/rIJ Lenrl' \996 Jan 2) (3): 1-

3. IB

BJl BrcakLhrough: Missing nutrient found in planls.

26

Galt:SJ. Vilamin B'l: \Vhen mylh mecI discovcry. )VrllJ CmlflT)' NUlriov 2(1 J ):3.

tiou 1996

27 MOl-afar A. Enrichmclll of sOllle B-vilalllin in plant \Vilh applicalion of organic ferriliz.crs. P/Dnt IJlld 50i/1994; 167:305-3 J 1.

~ P:UTenbarger RS Jr, H}'dc In: CI al. The associalion of changcs in physical-activi!)' kvcl and mher lifcs!)'le characleristics wilh rnorraljry among filen. N Eug'} Mrd 1993 Feb 25;328(8):538-545. 29 Paflcnbarger RS Jr, Hyde R'C el;tl. The ", oci:lIion ofdlanges in physical-ac(jviry le"el aud orhcr Iifcslylc characlcrislics Wilh Illorraliry among men. N Ellgl} Mrd 1993 Feb 25;328(8):538-545.

}() Surgcol1 Gcneral's ron on physical activit}, amI heallh. From r.he Cenlcrs lor Disease Conlrol and Prevencion. }AMA 1996 Aug 21 ;276(7):522. Physical aClivily and cMdiovascul:u healrh. NI H Consensus DevelopmenI on Physical ACliviry and Cardiovascular Heallh. }AMA 1996 Jul 17:276(3):241-246. 3'

Kokkinos PF, Holland JC, el al. Miles run per week :Ind high-densiry iipoprOlein choleslerollevels in heahhy, middle-aged rncn: a dose respome relarionship. Arc/} Iml'1'II Med 1995 Feb 27; 155(2):415-420.

12

Marcus BH. AJbrecJu AE, et al. Usefulness of physica.l ':xercise I1:>r mai nI:uning sl1loking ccs.<;lIion in women. Am} Crlrdio/1991 Aug 1;68(4):406407.

31

Phy.ic.,1 aClivily and cardiovascular health. NIH Consensus Development on PhysicaJ AClivif}' and Cardiovaseular Hcalth. }AMA 1996 Jul 17;276(3):241-246. 1<

Surgeon General's repon on physical aCljviry and hcallh. horn thc Cenlers for DisC'lsc Conlrol and Prevenlion. }AMA 1996 Aug 21 ;276(7):522.

JI

_\6 Friedman R. Tappen RM. The cITecI of planned walking on communiCltion in Al:zhcimcrs diseasc. } Am Gf!ri4lr Soc 199) JuI;39(7):650·654.

Powcll KE. Blair S '. The public heallh burdens of scdcnrary living h"bils: Iheorelical bUl realiSlic eSlimalCS. Md Sci SpOrlS Exac 1994 Jul;26(7):85 I -856. 37

l30wers RW. el.'ll. Memory Dependent Re
16

C1arkson-Smilh L. Hartley Al\. Rcladonships bctwccn physicaJ excrcise and cognilive abililies in older adults. Psychol Aging 1989 Jll1l:4(2): 183189.

Jry

Napicr K.. Too M:lJly Vir:amim? Harvard Hrnlth Lmrr 1996 Jan 21 (3): 1-

3.

17

2~ CampbeU Te.

Nrw Crll/ury Mrlri,iou 1996 ov 2( 1J): )-2.

ToJn.r 1968; 3 (2):9- I 1.

1

~ HendJer

Kim 1, Williamson Dl~ cr al. Vitamin and mineral supplemelll USe and morcalily in a US cohon. Am} Public Hen/tb 1993 Apr;83(4):546-550.

2

en SE Lifesryle and lhe use of heallh serviccs. Am} Clill Nil IT 1994 May;59(5 Suppl): 1171S-1175S. I

Napic. K. T00 Many Vi[:lm,ins? HnrvardHel1ft{J imer 1996 Jan 21 (3): 1-

Thc Ph)'sician & SPor!< Medici ne: The Heahh Bencf'ls of Exercise (pan 1) 15: 115-132, 1987.

·10

" Manson JE. Nalhan OM. el al. A. prospeelive srud)' of cxcrcise and incidcnce of diabele. :unong US rnalc phy. icians. }AA1A 1992 Jul 1:268(1):63-67.

3.

~2 Manson J. Alcssio HM. CI al. Does cardiovaseuJar hca.lth mediate h<~r

HendJer SS. TIu Doc/ors Vililmin andMinr:ral Encycloptr!in. New York, NY: Simon and Schusler. 1990 p. 107-108.

~.l PaIe RR. Pragg M. el al.

Ig

Hcndlcr SS. TIu Doclors Vilamillll",j Minrrfll Ellc:yc!Opl'r!irl. New York, NY: Simon :ulei Schusler. 1990 p. 100-108. 10

Bodwcll CE. Erdman JW Jr, editor. Mltrimllntr:raCTions. Marcel Dekker, Inc., New York. 1988. 2\

BodwcU CE. EnIm:lJlJW Jr. edilors. Nmrimt bl/l:rncriol/s. Marcel Dekker. Inc., New York. 1988. 22

13

Wang H. Solie E, Priur RL. TOlal :ullioxidanr capaciry of vegelables. }

Agrit:' Food ["bem 1996;44( 111:3426-3421.

ing abilily? MrJ 5ci Spom Fxl7'C 1994 Jul;26(7):866-871. Physical aetiviry and public he.allh. }AMA

1995 Feb 1;273(5):402-407. 44 P:UTcnbarger RS J r , Hydc RT , CI al. A natural hislory of ac:hletici.<m and cardiovascuhtr heaJlh. }AMA 1984 Jul 27;252(4):491-495. <S Whiuemorc AS, Wu-Williams AH. CI al. Diel, physical activi.y. and colorectal cancer :ullong Chioese in North America and China. } Natl Canar Imi 1990 Jun 6;82(1 1):915·926.

Lee 1M. I'affenbarger R.S Jr. Physical activiry aud ilS relalÎon 10 canccr risk: a prospcclive srudy of college alum ni. Mrd Sci SpOTlS E.'(~r( 1994 Jul;26(7):831-837. "6

519

PROOF POSITrvE 47 Frisch RE, Wyshak G, er al. Lower I'rcvalencc of bre"SI c"':lnccr ami canceIS of Ihe reproduerive sysrcm aOlOng former collegc Jlhlcres COlnpaIcd 10 non-arhlelc. Br J Dmecr 1985 Dec; 52(6):885-891 .

menr in olda adlllts. Council on Scicnril1 AlTairs, American Medical Assoei:\Iion. jA1v/A 1995. 'ov 15;274(19):1552-1556.

48

Silllon HB. E.xereise anrllnfeclion. Thc I'hysician anei SportS Mcdicinc 15: 135-141. 1987.

71 SalaOlone LM, Dall:tl GE, el al. ConrribUlions ofvitilrnin D illlake and se.1sonal sunliglu exposure ro plasma 25-hydroxyvitamin D concemration in clderly women. Am J Clin Nutr 1994 Jan:59( 1):80-86.

49

Physical acriviey :mel caIelievaseulaI healrh. NIH Consensus DevdopIllene l'aJlel OII Physical Activity allel Ca.rdiovascubr Hcalth. JAMA 1996 Jltl 17;276(3):241-246.

73 Kohrr WM. 5nearl DB. et al. Addilive CHCClS of \Veight-bearingexercise ami e rrogen on hone minem! den iry in older women. J BO/u Ivfi,ur Re./ 1995 Sep: I 0(9): 1303-1311.

WhilC EG. Ex('rcise and AiI. In: ltJlimollies for IIJe Cbufe!J, Volume 2. Na.mp:l. ID: Paciilc l'ress l'ublishillg Associalion, 1868-1871 p. 525-526.

74 US Preven ti ve Scrvices lask Porec. Screen; ng for Skin Clncer-I ncluding counseling !O Prevt~rH Skin Cancer. In: Guid,' 10 C1il/iaz! Prevelllivr Sl'I'viw-2"d ctlitioll. B
50

Wl1irc EG. A Heallhful Life. In: M} Lift ·Tod,z}. HagcrslowJl. MD: Review ami Herald Publishi.ng Associalion. 1952 p. 136.

51

52 Nicnun De. Exercisc imrnuJlology: pracrical applications. l/It / Sporrs Metl1997 Ma.r:18 Supp] I:S91-100. 5) Grimm RH Jr, Nearon JD. Ludwig W. Prognoslic import:lIlce of t!le white blood cell courll for comnar}'. COllleeI. and all-causc monalie}'. JA/l1A 1985 OeI II :254(14): 1932-1937.

Srllart J, Ellory Je. Rheological conscquences of eryehcoC)ne dehydra!ion. Br j H,lt1IUll0/1988 May:69(1): 1-4.

54

;5 Nordr FJ. Hemorheology in cercbroV:l.lcular di'(--.a.scs: approacht'S ro drug devdopment. AmI N Y Acad Sci 1983;4160:651-661.

'" SlUart J. F.ryrhroC)'lc rheology. j Clin l'a/hol 1985 Sep;38(9):965-977.

Lowc GD. Blood rhwlogy in general medicine and surgery. Bl1illi~/ys Clin Hlumnlol1987 Sep; 1(3):827-861.

57

Blood Rbcology. j Clin "dt/JoI 1980 '

\, Sluan J, Kcnny MW. Ma)';33(5):417-429.

Hill MA. COliCI JM. Mirchell GM. Blood rbcology and microalbuminuria in (l'pe 1 diabelCs mellitlls. Ll1nuI 1982 Ocr 30;2(8305):985. \9

Grimm RH Jr. NC:llon JD, LudwigW. Prognoslic importanee of lhc while blood ceU counr for coIonary. GUlar. and all-causc mortaliry. JAMA 19850ct II ;254(14): 1932-1937.

6()

Stllan). EJlory Je. Rhcological consequcnces of cryrhrocyre dch}'dralion. BT j Hdmlll10/1988 May;69( 1): 1-4.

6.

ErnSl E. Cb:lllges in blood rhcolog}' produC(.d by cxcrcise. .lAMA 1985 May 24-31 :253(20):2962-2963.

6

rr:

Rauramaa R. SaJonen er al. Inhibilion of phlCkr aggre:gabililY by modcrare-imensilY ph}'sical exelcise: a randomized c1inical uia! in overweiglll men. Cimtld/iolJ 1986 Nov;74 (5):939-944.

63

6-l Packham MA. MUSla.rd JE The role of plate/cls in lhe development and complications of alherosc!crosis. Semi)/ HI'II1I1Iol1986 Jan;23(1 ):8-26.

Simpson He. Mann )1, el al. EHcCl ofhigh-Itbre diet on h;\emOstalie variablcs in di~beres. Br M,.tIJ (Clin Res Ed) 1982 Mal' 29:284(6329); 160B.

6>

Fisher M, l..cvine PH. et al. Tbc cITecl of vegelarian diers on plasma lipid amI plmler Icvck ATclJ IlIlerll Mell19S6 Jun;146(6): 1193-1197.

66

COSlili DL Watcr aod Electrolyte rcquiremenrs during excrcisc. Clin Spom M~d 1984 Jul:3(3):639-648.

67

re

Yamamura T. Takahashi ce al. Gallbladder dynamics anei plasma dlOlcc}'slOkinln respon es mer m~..aJs. oral wara. Of sham fecding in hCaJlhy subjccts. Am j M",{ Sti 1988 Peb 295(2): 102-1 07.

68

69

Mach MV. Drinking water tO preveot gallstone formal ion. G,wromrer-

ology 1982 Apr 82(4):822-823. 111

Ivlalh MV. Warcr ingestion and ilS rolc in bile sec.reeion. Am j Clill W~inbe[g AD. Minakcr K1..

520

US Prevenrive Services lask Forec. c{('l'I1ing for skin c:lncer-including counseling 10 prevenI skin cancer. In: Guille 10 Cliniml PUI/mlive ServiCt's-2",1 dizion. Balrimore. MD: Williams
76

TI

OSlcrlind, A. Epidemiology of l1lalignant melanoma in Europe. AC/IZ

Onl'011992; 31(8):903-908. T

Emcrson Je, Weiss NS. Colorecral cancer and sol:tr radiarion. wneer

Ct",w '1I1d COn1l'ol 19')2. 3(1):95-99. 79

Ainsleigh HG. l3eJ1el1cial t.m·CIS of sun exposurc on cancer morr:lliry.

Prrv Med 1993 Jall;22(1): 132-40. Emblad H. Modemre drinking: serious waming by WHO specialislS. Worlrl Health Organiz:uioll Prcss Relcasc. November 1, 1994.

RO

Craig WJ. CaHcÎne Upd:uc: What's Brewiog. In: Nmrizioll JOI' riu Nill{'lil'f. Eau C1aire. MI: Golden Han'ese Books, 1992 p.286.

81

81

MacMahon B, Ycn S. el al. ColTcc and cancer of lhe pancreas. N Engl Mar 12;304( 1 1):630-633.

J Metll981

83 Snowdon DA. Phillips RL. ColTee consllmption and risk of 131~11 cers. Am j PlIb!il' J-!en!tIJ 1984 Aug;74(S):820-823.

Cl1\-

.~ Vc,,~ JE. FrclIdc"heim J. et al. Coffce. cigarctle ~moking. :lJ\d bladrler cancer in wcstern New York. AJllZ E:.pitlttltiol1993 Nov;3(6):586-591. 85 SlIowdon DA, Phillips RL ColTec conslllllplion aml rLlk of faral cancer. Am J Public Helllrb 1984 Aug;74(8):820.823.

Slatlery ML Wesr DW. Smoking. aleohel, coffe", Iei. calTcine, and rheobromine: risk of proStale cancer in Utah (Unired Still"S). ({mar Dwsr Ilml COlliro/1993 Nov:4(6):559-563. S6

H7 RaiI. TW. Central Nervous System SeimuJalll [ConrinuedJ: {he Melhylx:l.nlhincs. In: Gilman AC;. Goodman LS. et al, edi10 rs. Goodllllm tJlld G'ill77iJ/l' riie Pbamwcologic Basis of TlJemp<'ll/ics-7h etJilioll. New York. NY: MacMiJlaJl Publi~hjng Company. 1985 p. 596.

Slich HE Rosin MI~ el al. A ompararivc gcnolOxicity sLUdy of chlorogenic acid (3-0-caffeoylqllinic ac.id). MWfIl R,'s 1981 Nov:90(3):20 1-212.

88

~') Nag;w M. Wakabayashi. Feljira, Y, er :11. . Mur:tgcnic Cornpollnds in Soy Saucc, Chinese cabbagc. Cotlee and Hc-rbal Teas. In: Kuudscn 1. edilor.

Galerie 7oxitology of/be Din Progn'JS in C1illi"fll i1Iul Biologicdl Rrul1reb. VoI. 206. AlaJl R. Liss. New York. 1986 p. 55-62. 90

Kasai H, KUlneno K, el al. Mlltagenic.iry of mcrhylglyoxal in c.oEfee. 1982 OCl;73(5):681-683.

GtUlfI

Parllo/1982 Aug 7ll(2):258-259. 71

75 US Preve'lCivc Services T;tsk Forcc. Screening for skin cancer-including COlUlsding 10 prevenr skin cancer. In: Gttide 10 Clillical Pn'Veltlive Sal/ices-2,,,1 nlirioll. Rlhimore, MD: WilJiams and Wilkins; 1996 p. 141152.

Dehydr-'}lion. Evaluation and manage-

agao M. Fujira Y. er al_ Melhylglyoxal ill bcveragcs anel loo
9'

Ba.ldwin BE. Why is fresh air fresh? Tilr J01l.17Itll oj'J-!tlrlzlJ a"d J-!~l1lillg 11(4):26-27.

92

BEYOND THE LEADING CAUSES OF DEATH BaJdwi n RE. Wh)' is fresh air frcsh? TIu jOlml/ti ofHCtJ!,h alld Hel1lil1g II (4):26-27.

9J

')4

OuHcc

RA. Koontz RH. Behavioral effecls ofiollizcd air on

raI•.

PSJ-

eiJophysio!ogy 1965 Apr; 1(4}:347-359. 9S

Jordan J. Sokolo(f B. Air ioni7~~lion. age and ma·/.e leaming of ralS.

.1

GtrOI/UJ!1959; 14:344-348. ReiJJ)' T. Sleven On le. An ilwesljgation of lhe e(fecls of uegative ajr ions on rcsponscs ro submaxjmaJ exercise a[ differcm ljmcs of dal" } HlIllI Ergo! (Tokyo) 1993 Jun; 22( 1): 1-9. %

MitcheU BW, King DJ. Effe<:l of negalive air ionilA~tion on airborne tran mi sion of Ncwcasde diseasc virus. Avian Dis 1994 OClOec;38(4):725-732.

'l7

IlS Ibdcckj SE. I3rulllon SA. M;Hlagcmclll of illsomnia in office-bascd praclÎce. Nalional prcvalcncc and thcrapel1lic patlerns. AlY'h Ftlm Mctl1993 ov:2(11):1129-1134. 116 Folcl' OJ. Monjan AA. el al. Sle complaims among e1derly persons: an epidcl11iologic srudy of duce communi[ies. Sleep 1995 JuI; \8(6),425432. 117 Coren S. "lhe prcvalence of self-reported slcep dislurbances in yOUJJg adulrs. lllt} Ncurosci 1994 Nov;79(1-2):67-73.

liS Peri J. Slap righr in five r/ighu: n [lear and "./fi·'·live gllil/e for c01upurillg insomnill. New York: \X!illiam Morrow and ompany, Ine.. 1993 p. 28. 119 Ulliversily of California al Berkcky S hool of Public Hcalrh. The cne.rgi7..cr. Ullivmiry ofCrlifomul ar Berkeley l'Vcllllcss uner. 1995 Aug II (Il ):4.

98 GiaIlnini AJ. Joncs BT. L.oiscUc RH. Reversibilil}' of scroronin irritalioll sl'ndrome Wilh aunospheric anioll.. } C!ill PryciJitl/T)' 1986 Mar:47(3): 141143.

120 Gold DR, ROgaC2 • CI al. ROlaring shift work. sleep. and ac.cidenlS relaled 10 sleiness in hospil.1 nurse. Am} Pllblic HCi/lth 1992 Jul;82(7):1011-1014.

Gabbay J. Dergcrson O. e[ al. Ellecl of ionizalion on microbiaJ ajr pollulion in lhe denlal clinic. E,1/Iiro1/ Res 1990 Jun;52( 1):99-1 06.

121 Budnick LO. Lernun SE. el al. Sleep and 'llertne,,~ in • 12-hour rol;\(ing shift work cllvironmelH. J Occup Med 1994 Dec;36(12}: 1295-1300.

100 Livanova LM. Nozdracheva LV. el al. Thc norma1izing e(fecl of air ions on ncuroliciux! rars Wilh dinerelll l)'pological behavioral charac[erislics. ZI; Vyssh Ncrv Dei/ulm 1 P Pavlova 1995 M:\J-Apr;45(2):402-409.

122

9')

Bor&ts E. Dek:lI\u M. luAuellce of negalive ;tir ions on experimel1lal ulcer induccd by pylorus ligalUre in albiuo fal. Mrd !mal/e 1989 OerOec;27(4):31.1-317. 101

Morron LL. Kcrshner JR. Oifferemialm-galive air ion e/Tecls on Icafl\· ing disablnl and nornul.achicving children. I/lIJ Bio1lu:uoro/ 1990 May;34(I):35-41. 10l

103 Monon LL Kershner JR. OifTcrcnri:tl negalive:l.ir ion e/Tecls on learning disabled and normal-achieving childrcn. Inl J Biol1lclCorol 1990 ~y:34(I ):3.5-41.

10 Sulman FG. Le']' O, CI al. Air-ionomelry of hot. dry dcsserl wind (Sharaw) and rrealmcm wirh air ions of wcalher-sen irive subjcClS. lnr} Biommoro!1974 Dec; 18(4}:313-318.

B:tldwin BE. Why is fresh ai, fr(' h? ThC}OIlTlln! ofHcallftl11/{l Hc,tlillg II (4):26-27.

10\

106 Giannini AJ, Jones BT, Loiselle RH. R<:'Iersibiliry of serolOnin irrilalion s)'ndrol\le wirh almospheric allions. } C!i" P;)'chin,ry 1986 Mari47(3): 141-143.

Giannini AJ. Casle\lani S. Dvort'tlsky AL. AnxÎery slalCS: relaljonship Oinl'S)'cbillll)' 1983 Jw:44(7);262264. 107

ro ,ullIospheric alions and serownin. }

IOS Linder J, Herrcn O, e[ al. EfTccr of ozone on physical pcrfonnance capacily. Soz I'mllell1;,mmJ 1987:32(4-.5):251-252.

109 Ncher JO, Koenig JQ. Health efiecrs of olltdoor air pollulion. Am

Ftml Physiri,1YI 1994 M,t}, 1;49(6):1397-\404, 1407-1408. 110 Abbey

DE. Miiis PK, el al. long-tcrm ambiel\l concenlrCuions of lOIal Sllsp('Jldcd panicuiales and oxidallls as rclared ro incidence of chronie discasc in California Sewlllh-Day Adventisls. Environ Hri/lth 1'errpa/ 1991 Aug;940: 43-50. 111 Bclloc NB. Breslow L. Rclationship of physic.11 health slatuS aJld heahh pracliccs. Prcv Med 1972 Aug; 1(3);409-421.

Peri J. Surp righ, in fi/IC lIighl5: Il c!l.'Jlr arid 4fiL"live gllide forcolllJllering imolllnia. New York: William Morrow and Companl" Tnc~, 1993 p. 28. 111

Peri J. Slc right i1/ jill" niglJl5: Il c!blr atld 1ficrillegllille for COTlllUt'Ti1lg insolllnia. New York: William Murrow aJld Company, In .. 1993 p. 2829. 113

Il~ Nelson

E, Kirk J. el al. Chief complailll faligue: a longitudinal Sllld}'

Akcrslcdt T. Work hours ;lnd sleepiness. 1995;2" (6):367-375.

Nmrop1Jysio/ Clill

Il Harringwn JM. Shift work and healtb-a criliC:ll review of rhe lilerallIre on working hours. AmI Acad A1ed SingtlpoYl~ 1994 Sep;23(5):699705.

124 Pack Al. Pack AM, el al. CharaClcristics of crashes art.ribulcd tO lhe driver having fallen asleep. Accid AmI! I'rrv 1995 Dec;27(6):769-775.

12S Zulley J. Croltlein T. el al. Falling asleep al lhe wheel: .he chief "IUSC of severe lr;t[fic accidelll. \Vien Med Woclmz.rc1Jr 1995; 145(17-18):473.

Eben D, Feislcl H. Barock.a A. Effc 1 of Jeep drivalÎon on dle Iimbie systel11 amllhe f(omal lobes in ancclive disorders: a srudy wiili Te99m-HM PAO SPECT. Psyc1Jiatry Re; 1991 Oee:40(4):247-251. 12(,

Il Peri J. Stup I"ighl ill jivc iziglJlS: n c1cnr and rfficrille gllidr for eOlltjllmng insomnia. New Yurk: William Morrow and ompany, Ine., 1993 p. 32.

L8 Brown R. Price RJ. el al. Illlerlcukin-1 bera and mura.m)'1 dipeplide call prcvelll decrea.sed alllibody respollse associ:lled Wilh slcep deprivalion. Brain Bebfllllmmllll 1989 Dcc;3(4):320-330. 129 MoldofsJ.:y H, Lue FA. cr al. The relarionship of imerleukjn-I aJld immulle fllllcrions ro sle in humalls. psyc/lOsom Mcd ] 986 Ma)'JUI1;48(5):309-318.

I.JO SIlOW EC, Fe.ldbu h TL. Oaks JA. Tbe role ofinsuJin in ilie responsc of murine T 1~'mphoCYles 10 milOgenjc slimulal;on in vilro. J !mmllllo/1980 Fcb; 124(2),739-744. lJl HarringlOn JM. Shifl work and health-a crirical review of lhe IirerallIre on working hours. Ann Acad Mcd Singl/porc 1994 Sep;23(5):699705.

lJ~ PerlJ. S!eep rigiJl ;,/ fillc tligl}/;: a rlel1l' tIIu/1ftclivc guidefo,. ron'l/Il'ring imomnit/. New York: William Morrow :tnJ Company, Ine. 1993 p. 50·

54. 105-266. 13.\ Hable-Gabr E, WaJlace RB, el al. Slc pallerns in rural c1der : demographie. heahh, and psycbobehavioral corre1alts. } Clin Epidm/iol 1991;44(1):5-13.

134 B1iwisc DL. King AC, el al. Prevalence of self-reported poor slcep in a he:tlthy populat ion agcd 50-65. Soc Sci Mcd 1992 Jan:34(1):49-55. J) Habte-Gabr E. Walla e RI3, el al. Sleep pallcrns in rural clders: demographic, health, al\d psychobehavioral corrclarcs. } CIi" Epidemio! 1991:44(1):5-13.

136 Baldwin BE. Seven-Oay RhYlhms. TIu jouma! ofHrdbh dnd H~.fl!ing 9(4):3.14. . .

from the parienr's perspective. FOI/I ProCl Res} 1987 Summer 6(4): 175188.

521

PROOF POSITIVE l37 PolI,mn L. Hildcbrandl G. Long-term conlrol ofswclling afler maxillofacial surgery: a slud)' of circasr:lI1 rcaclive periodicil}'- In! J Chrol1obiol 1982;8(2):105-114.

1~8 Ourbreak of Sallllonelia emelilidis associatcd Wilh n3lionall)' dimibuted icc cream producrs--Minnesola, Soulh D'lkota, and Wisconsin.1994. MMW/R MOl"b Morllll Wkly Rrp 1994 OCI 14;43(40):740-741.

lJS Baldwin BE. Scven-Day Rhythms. Th~ jOllrflal ofHrnl1b and H~alillg 9(4):3.14.

] R1mllllatol \ 992;21 (6):26S-270.

139 Bcsarab A, Wcsson L. el al. Ellecl of delayed grafr funclion and ALG on t!le cirClSeplan (abour 7-day) rh)'Thm of human renal aJlogrm rcjeclion. Tmlsplanr'uion 1983 )111\;35(6):562-566.

Cornclisscn G. Ham E. el al. Circadiafl 10 circascmiseptan (abour 3.5da)') Yariancc transposirion in S3livary CA J30 in apparcnr health (MecI ing absrracl). Anriolllur Rt>; 1992; 12(6A): 18 J9. 10\()

14l Blank M. Cornelisscn G, Halberg F. Circlscmisepmn (aboul-halfweekly) andlor circasepran (aboul-wcekly) paltem in hurnan milOlic aeri\'ily? 111 Villo 1995 )uJ-Aug;9(4):391-394.

Corndissen G. Berg H, CI al. Chronomc of urinar)' 6-suJfoxy-meialonin excrction, circuhlling CA 12S. cancer progres. ion :lnd IhcrapclIlic rcsponsc. 111 Villo 1995 JuJ-Aug;9(4):37S-378. 14l

K."Ulabrocki EL, Sothern RB. et al. Wcekly ,uld yearly rhYlhm in plasma fibrinogen in hospilalized nule militar)' Wlerans. IIm j Cnrdiol199S S':p I S;76(8):628-631. '43

\.14 Labrccque G. Bllreau )E Reinbcrg AE. Biologica! rhYlhms in lhe inflammalory rcsponse and in lhe ellecrs of nOll-steroidal.lll1i-inlbmmalOr)' drugs. PI}{mnl1~ol Tlur 1995 M:ly;66(2):285-300. 14\ Baldwin BE. Sevcn-Da)' Rh)'Thms. TIJr jO/lnwl ofHtallh all/j Hei/ling 9(4):3,14. '

1~6 Hildebrandl G. Rcacti\'c m.odificuÎon of the aUlOnomous lime StTUC-

lurc ofbioJogical /Uncrions in man. Ibm iSI SI/pa Sl11lilfl 1993;29(4):545557. Baldwin BE. Seven-Day Rhyrhms. Tb~Joumal ofHrtlllb and Hmling 9(4);3, 14. 147

Dossey L. Hraling Word<: Tlit POIIJ~r ofPYilyrr IIm/ rli~ Practiu ofM~di cine. New York. t-.ry: HarpcrCollins Publishers. J993. 148

149 Dossey L. Hen/ing \t1Jrfb: Th~ Powa ofPnlJrr and ti}/' PmClia ofMrdicint. New York NY: HarperCollin Publishers. 1993 p. 30-32, 24 J. 1 o Harringwn )M. Sltif, work and heahh-a cririClI leview of lhe lilerature On workillg hours. AmI ACild M"tI SingllpoYt' J994 Sep;23(S ):699705.

l~l Edell-Gu rafssoll U. Ek AC. Tlte relevance of slc:ep, circadian rh)'Thm and lifcslyle as rclared 10 a holisric lhcor>' of heallh. SCilnd J uring Sci 1992;6(1 ):29-35. 'S2 Lcvin )5, Vandcrpooll-lY. ls frequell/ religiolls allenO'lI1ce reaJI)' conducivc 10 bClIer heahh? Towartl an epidemioJogy of religiOIl. Sa,. Sci ]V1d 1987;24 (7): S89-600.

I~.J Lcvin )S, Cbaltcrs LM, Taylor R). Religious effccts 011 healtlt slatuS and life satisfaction alltong black Americans. j Grrollloi B P;ycbol Sci Sf)C Sri 1995 Ma>';50(3); 154-163.

EUison CG. Rdigious invoJvemell1 '1I1d subjective well-bcing. So,.B~hnlJ 1991 M.1r;32(l):80-99. ';oi

J Hta/ilJ

I~S Dwycr )W. Clarke LL, Milll'r

MK. Thc Cfrecl of religiolls conccntralion alld affilialÎon on cOllnry C:tnccr monaJilY rales. j HtnltlJ Sar B~balJ 1990 )un;31 (2): J 85-202.

159

Maki-lkoJa O. Granfors K. SaLmondla-lriggercd reactive armrilis. Samd

AppelboOlll T. Dure'Z P. Effcct of milk prodUCI depri\'ation on pOlldyloarrhropathy. Allll R1mlm Di 1994 Jul;S3(7):481-482.

)60

161

P:U1ush RS, L"lnc NE. Excrci,e and me musculoskeletal SYSlcm_ &iUitm

CIi" Rlml1nalo/1994 Fcb:8(J):79-102. 162 Panush RS. Holt7. HA. (s exercise good or bad for anhriris in Ihe c1dcrl)'? Soutlr Mn/J 1994 May:87(S):S74-78.

165 Yllerbcrg SR. Mahowald ML, Krug J-I E. Exercisc for arrhriris. &illi~reJ Clill RlmtJIlfllol1994 Fcb:8(J): 161-189. 164 R.ll1 Le Mcydani SN. el al. The cflect of progressive resiSlance {raining in rheumatOid arr1uilis. Increascd srrcngth wirhoul changes in cnergy balance or bod}' composilion. ArthriliJ Rhrum 1996 Mar;39(3):415·426.

16S

PA:

GU)'lon AC. Texlbook ofMtdiCfl1 Plrysio/f)gy. 8lh n!ilioll. l'hiladclphia, wn Saundcrs Comp'lJ1Y. 1991 p.824.

1(,6 GU)'lOn AC. /rxlbook o/Mrdical Plrysiology, 81!J edilioll. Philadelphia, PA: WB Sallnders Company, 1991 p. 824-825.

16 F:lclors 'lS.~ociatcd wilh prev:llenl . e1f-reponed anhritis and olher rhcumalic condil ionS'- UilCd $raecs. 1989-1991. MMWR Morb Mortal Wk(y RI'J' 1996 JlIn J 4:45(23);487-491.

16S FaclOrs as, ociaeed Wilh prevalenl sclf-rorred ardui..is and omer rheumatie condiliortS'-Unilcd Slares, 1989-1991. MM1YIR Morb Mortal Wkly l?Lp I 996 JlIn 14;45(23}:487-491. ,(,9 Voigt LF, Koepscll TD, CI al. Smolcing. obe iry. a1cohol consumplion. and ehe risk of rheumatoid arrhritis. Epidemiology 1994 Sep:S(5):52S532. 170 ElkaY-.llll O, \Xliglcr l. et al. Eflecl ofspa Iherap)' ill Tibnias on patienls \Vilb rheumatoid arrhrieis and oSlcoarrhrilis. J Rhrumarol 1991 Dec; 18(12); 1799-1803.

, \ Iishlcr M. Brosto\' ki Y. Yaron M. EfrcCl of pa lhcrapy in libcrias on p'llicl\ls with anJ...ylosing spondylilis. Clin Rlmmlillol1995 Jan; 14(J ):2125. li2 Lchmann)E De 1..alcur BJ. Dialhcrmy and superficial heae.laser, and cold dlcrap>'. 1.11: KrltJl'II! HlIntlbook ofPlrysiral Medicine fllld R~habiiiul I;on. 1990 p. 283-337. 173 Lchmann )F, De LaICur BJ. Dialhcnny and superficial heal, laser, and cold rJ'erapy. In: Kntsms Hallt/book of P!JyJiCilI M~dicin( alld Rrhabililalion, 1990 p. 285-288.

13ulmcst
17

Burmester GR. Lcsson from lI'lne anhritis. 1993 Mar-Apr; II SlIppl 80:S23-27. '

17S

Cfin op Rhrumtltol

176 \XIiltlcr RL. Crollord LJ. Do infeetious :lgcnlS cause rheumalOid arrhritis? <.:'lin Ol"1bop 1991 Apr:(265);36-41. 1i7

Granfors K. Do b
elin Non" Am 1992 Fcb; 18( 1):37-48. 17$ Toivanen A. Infection and anhrilis. Alin Md 1994 Aug:26(4l:245248.

Faclors associ:ued wid, prc\'alcl1l self-roned anhritis and olher rhcumalic condilions-Uniled Slates, 1989-1991. MM\YlR Morb Morllrl Wkly J?Lp 1996 Jun 14:45(23):487-491. .

1 9 Hazenberg MJ~ Klasen 1 ,CI al. Are illlCStinal bactcria irwol\'ed in Ilie etiology of rheurn:lloid :lrduilis? APM15 1992 Jan: 1OO( 1): 1-9.

'17 Kjeldscn-Kragh J. Haugen M. cr al. Col1lrolled trial offilSling and om:year vcgetari3n diel in rheumaloid arouilis. umerI 1991 OCt 12; 338 (8772);899-902.

1$0 Braun J, L1ilko S. Ct al. Chlanl}'dia pneul1loniae-a new call5.1live agent of reaclive anhril; and undilTerenrialed oligoarrhriris. A1111 RlJeum Dis 1994 Feb;53(2):100-105.

IS6

522

BEYOND THE LEADING CAUSES OF DEATH 151 Moreland LW. Koopman WJ. Infeclion.1S a Cluse of anhriris. Curr

Opin R/Jl'umnlo/1991 Aug;3(4):639-G49.

Lind:lhl O, Lindwill L, el al. Vcgan Regimcn with Rcduccd Medication in 11e Treatmenr of Bronchia! Asdulla. J AstJmw 1985;22(1):45-55.

182 Morebnd LW. Koopman \'Xi'J. !niecljoll as a Cluse of.1rlhrilis. 011'I' Opin Rhmlllillol1991 Aug;3(4):639-649.

203 Lindahl O. Lindw:lll L. ef al. Vcgan Regimell wirh Reduced Medica· tion in the Trc:t.lOlenr of Bronchia! Aslhma. ] As/bmlJ 1985;22(1 ):45-55.

18; Baldwill BE, Baldwin MY. New hope and belp for ,uthriris. TbtJOJlrilaI l>j /-itollb ilJJd /-i,'alillg; I 6(2): 10-22.

201 )ames J1'.1. Eigenmann PA, et al. Airwa)' rC'dctivill' changes in aSlhma(.Îc pariems undc.rgoillg blioded food challenges. Am J &ţpir Cril Care M~ti 1996 Feb; l53(2):597-603.

184 K)1isd~' MH. InWlVascular eryll1rocyrc aggrcgalion (blood sludgc). In: Hamilron WE editor. Hnntibooko/Pbysiolo!J" WahsinglOn, DC: Am Physiology Sociery. 1965 p. 2249·2292. 18; McAlindon TE, Fclson DT, et al, Reiat ion of dierarv i nrake and scrum levels of virall1in O ro progrcssion ofosleoHI,hriris ofth'e Imec amollg participams in rhc Framingham StlIuy. Alin lnu'l'I1 M/'{I 1996 Sep 1; 125(5):353359.

101

105 Abern:uhy-Carver KJ, Sampson HA, el aJ. Milk-induced eeLema is associalcd wi(h Ihe e.xpansion ofT ceHs expressing cueaneouslymphOCYle antigen. J C/illirWCJI 1995 Feb;95(2):913-918. II){. Sa.lllpson HA, Cooke SI:<. Food allcrgy and me porenlial al1e-rgenicirl'anrigenicity of mjcroparriculaled egg and cow's milk pcoleins. J Am Coli Mltr 1990 Aug;9(4):410-417.

186 Fischer KM. Hypolhe.sis: tOba co use is a risk l"3oor in rheumarojd anhrilis. Med Hypotlml'J 1991 Feb;34(2): 116-117.

107 LiebermJn D. Heimer O. Em~Cl of dierary sodium on Ihe severi Il' of bronchia! aSlhma. Tbo1'ltx 1992 Ma)';47(5):360.362.

187 Voigt LE Koepsell TD, c·t al. Smoking, obesirl" alcohol consumption. and Ibe risk of rhCllmalOid arrhritis. Epitll'llliolo!J' 1994 Sep;5(5):525· 532.

lOg

Heliovaara M. Aho K, cr al. Smoking and risk of rhcumaloid anhriti . ] Rhcumlt/o/1993 Nov;20(l1): 1830-1835. 188

Hallingar. The phl'siology of Suenglh. Max Plmck lnStirllfe . 159

Fujibwa Y. Siuilgu M. er al. Imerleukin-l receptor arllagoniSl produc. tion in ClIhured synovial cc.lls from paliem'S wirh rheut1\alOid arthrilis and oslroarthrili•. AnII RJJ~um DiJ 1995 Apr;54(4):318-320. 190

19l Mabrov SS. Ol.en Je, et al. Suppressioo of experimental arthrilis bl' gene lr:losfe.r of illterlcukin 1 recepwr anragonist cDNA. Pruc N"r1 Amd Sci USA 199G Jan 9;93( 1):402-406. 192 van de Loo AA, Arm-.t: OJ, CI al. Role of inlcrleukin 1 in anrigenioducnl exacerbat ions of murine :utluilis. Am J Porbo/1995 Jan; 14
194 Kjc1dsen-Kragh J, Kvaavik E. el al. lnhibition of growTh of Proteu. mirabilis Jnd Escherichia coli in urine in rcspoose 10 fasling and vegetarian dict. APMIS 1995 Nov; 103( 1 1) :81 8-822. 19j Weiss GH, Siuss PM. Linke CA. Chagnc:s ir1 urinary magne ium. cit rate, and oxalate Ievels duc ro cola consumpljon. Umlogy 1992 Apr;39(4):331-333. 19& Avorn J, Monane M. e[ al. Reduction ofbaclcriuria and pyul';;' after iogeSlion of cranberr}' juice. .lAMA 1994 M:u 9;27l0 0):75 1-754.

197 RosenslTcich OI., Eggleswn P. et al. The- role of cockroach allagy and exposure to cockroach aJlergen in causing tllorbidiry among inner.cirl' children with aSlhma. ElIgl J Med 1997 May 8;.B6( 19): 1356-1363. Aslhma mortalirl' aod hospiralizalion among children and youllg adulls-Unircd Stalcs 1980-1993. MM\ţtR Morb Morta/l\:lk('y Rep 1996 May 3;45(17):350-353. 198

ASlhma monalit)' anu hospilali7..:11ion among chjldrcn ~lIld young adults-Unilcd. rates, 1980-1993. MMWR Morb Morl4/l\:lkly Re/' 1996 Mal' 3;45( 17):350-353. 19?

ASlhma monaliry aud hospilJ.1il:lrion among children and }'oung adulu-Unitcu SIatCS, 1980-1993. MMlVR Morb Mortol Wk{y Re;> 1996 Mal' 3;45(17):350-353. 200

20' ASlhma. monaliry and hospila!ization among children aml l'oung adwIs-Unittd Stales, 1980·1993. M M\ţtR Morb MOI'td1 Wkl)' 1/,,1' 1996 Ma}' 3;45(17):350-353.

Medici Te, Veltet \VI. Bronchial asthma and kirchen salt. SciJweiz Mtd

Woe/)mscbr 1991 Apr 6;121(14):501·508. 209 Mylek D. Migr;tinc as one of Ihe symploms of food allergy. Pol7jg uk 1992 Jan 20-27;47(3·4):89·91. 1JU Oxman TE, Hil'lemann R), Smitlt R. Pla,e1cl membrane lipid composition and ,he frequency ofmigraine. HetJdaclu 1982 Nov;22(6):26 1·267.

211 Glueck q. Bales SR. Migraine in children: association with prima.t}' and flmilial dyslipoproreinem;as. PtiifllriCS 1986 Mar;77(3):316-321.

m Kozubski \VI. Sranczl'k L. The int1uencc of plasma frec falry acid..... nd cholcslecol on r!te aggregalion ofblood pbwlcls in rn i.grai ne pariems. H'lld· 11ch, 1985 Jun;25(4): 199-203. 2U Gillmall M'W, Cupples LA, el aL Pro[ccrive cAcct of fruÎls aod ve.gc[:lble on d('velopmen[ of slroke in men. JAMA 1995 Apr 12;273(14): 1113-l117.

214 Jamrozik K, Broadhursl R). et al. The cole of lifesryle faelOfS in Ihe eliology of Slrokc. A popuhuion-based casc-control study in Perlh. \VIeslcen Australia. Srrukl' 1994 Jan;25(1):51-59. 115 Margetts BM, BeiLin L), el al. Vegetari:1O dicI in milJ hyperrension: a ra.ndomiscd controlled trial. Br Md J (Clin Res Ed) 1986 Oec 6;293(6560): 1468-1471. Ornish D, Browll SE, e[ al. C:tJ1 lifestyle changcs r('Verse coronarl' hcan
216

m Varma SO. Scicnr.ific basis for medical rherapl' of caratac[ bl':lJHiox.idants. Am] CIi" Nurr J991 Jan:530Suppl):335S-45S. Vanna SD. Scientilic basis for medicallherapy of cararacIs by :lmioxidaJll.'i. Am] Cliu Nurr 1991 Ja.n;53( ISuppl):335S·45S.

lIS

119

Bunce GE, Kinoshita), HorwilZ J. Nurrilional factors in Qlaracl.

AII1I1f Rel)Nmr 1990:100:233-524. Hankinson SE, Srampfer MJ. et al. NUlrient imake and calaracl exmClion in women: a prospeclivc slUd)'. BM] 1992 Aug 8;305(6849):335339. 220

121 Jacques 1'1", Ch)'lack LT JR. Epidcmiologic evidencc of a rolc for Ihe :lntioxiuanr vilamms and carolenoids .ill calarac.[ prevention. Am} Clin MIII' 1991 Jan:53 (ISuppl):352S-355S.

m Vuturo AF. The role of tlte prill1ary care physician rhe- management of p:lliems with peplie ulcer discase. In: Fcone.rty MB, ediwr. Conlt?>lporory 7/1t11/llgcnU1l1

o/pepiie ulcer diultic: Crilu'/ll issu(!Jfor pri17l4ry care.

SCC:lUCUS,

NJ: professiollal Postgraduate Services, 1996 p. 7-L4. Vumro AF. The role of t.he primary care l;'hysicia.n the management of p:u iems wit h pljc ulccr djsease. 10: Fennerry M B, editor. Comnnporary numngcmem o/peplie ulerl' diselUt: Critical isSIICJfor priTlUlry CAre. Secaucus, NJ: Professioll
11)

523

PROOF POSITlVE 2:M

Soli AH. Palhogen"sis of pepric ulcer and imp!icalioLls for thcrapy. N

EI/tI] Mrd 1990 Mar 29:322(13):909-916. 21S

Fielding)E. Smoking: Flealrh Effecls and Conlrol. In: LasrJM. Wallacc

230 NIH Consellsus Confcrcnce. Hclicobaeter pylori in pepric ulcer discase. NIH Consenslls Oevclopmclll Pancl on HeLicobacler pylori in Peptic Ulcer Oisease. ]AMA 1994 Ju! 6:272(1):65-69.

RB, "dilors. Maxcy-RoUl/l1u-LasI Public Hi'IIlllJ I1l/d Prrvmrivl! Mdirillf"J3/h t!dilioll. NorwaIk, CT: Applclon aod Lang", 1992 p. 723. 226 Marona RB, Floch MH. Oiel and JlUlrilion in IIlcer discase. Mt!d Clin

231 Neri MC. Lai L. el al. P(evalence o( Helicobacler pylori infeclion in eJderly inpalienlS and in inslillJliona1i7.Cd old peoplc: correlalion wirb nu· lriliollal SI:llIlS. Agr Ageing 1996 ):m:25( 1): 17-21.

NorthAm 1991 )u1;75(4):967-979.

1 Grubel P. Hoffman )S, el al. Veclor pOlential of houseflies (MUSC2 dOlTIcsrica) (or Helicobacler pylori. ) Clin Microbiol1997 )un:35(6): 13001303.

m Marona RB, Floch M H. Oiel and nUlrilion in ulcer di ease. Mrd Clin NOTIIJ Am 1991 )111;75(4):967-979. Schindlcr BA. IUmcbandani O. Psychologic bClors associalcd wilh pepric ulcer disease. Mui Clin Norlh Am 1991 )111;75(4):865-876.

11

Aldoori WH. Giovannucci EL, el al. Prospeclive slUdy o( cliel and the risk of duodena! lllcer in ITIcn. Am] Epilimliol 1997 Jan 1: 145(1):42-50.

129

524

You WC, Biol WJ el al. Allium vcgelables and ,,'
133

APPENDrx

APPENDIXI OGE :

ALANC

EFITS AND Estrogen 's Be!!-e

IlS

-Relief from the classic symptoms of menopause: hot flashes, mood swings, vaginal dryness, thinning skin -Proven reduced bone loss (osteoporosis) associated witb menopause, including a probable reduction in hip fractures

G

SKS

Estrogen 's Risks - An increased risk of ,endometrial cancer whîcb may be partially countered by adding progesterone to a regimen of estrogen - Symptoms similar to premenstrual ones (swelling, bloatIng, breast tendemess, mood swings, headaches)

- A menstrual discharge -Probable reduced risk of beart (when progesterone is taken disease by improving cholesterol with estrogen) levels and the flexibility of blood - Incr~ased risk of breast vessels câncer -Possible improved memory and - Stimulation of the growth of uterine tibroids and better mental ~unctioning of endometriosis women with mild to moderate Alzheimer's disease - ProbabIe increased risk of gallstones and blood clots -Possible lowered risk of colon - Possible weigh t gain cancer Eram the Publishers ofNew Eng/and Journa/ ofMedicine Hea[thnews

525

PROOF POSITlVE

APPENDIXII Recommended Vegetarian Cookbooks Country Kitchen Collection Fanrastically Delicious and Nuuitious Vegerarian Meals Phil and Eileen Brewer Family Health Publications 8777 E. Musgrove Hwy., Sunfield, MI 48890 Country Life Vegetarîan Cookbook Choleseerol Free Diana J. Fleming. editor. Family Heahh Publicarions 8777 E. Musgrove Hwy. Suofidd, MI 48890

Of These Ve May Freely Eat A Vegetarian Cookbook JoAnn Rachor Family Health Publications 8777 E. Musgrove Hwy. Sunfield. MI 48890

Taste and See AJlergy Relief Cookbook No meae. dairy products. vinegar, sugar, whear, bakjng powder or eggs aod linie or no sale Ifae Penny King Family Health Publications 8777 E. Musgrove Hwy. Sunfield. MI 48890

Ten Talents Natural Foods. Vegetarian Food-Combining Cookbook and Health Manual Frank J. Hurd, D.e, M.D .• and Rosalie Hurd, B.S. Published by Dr. & Mrs. FrankJ. Hurd, Box 8GA. Chisholm, MN 557\9 NEWSTAR'J'® Lifestyle Cookbook More (han 260 Hearc-HeaJ(hy Recipes FeaCllring Whole Planr Foods Weimar Insritute 1-800-525-9192, Products Depanmenr Thomas Nelson Publishers 100% Vegetarian Earing Naeurally [rom Your Grocery Store Julianne Pickle Pickle Publishing Company Rt 1 Box 44\ Seale. AJabama 36875 Tastefully Vegan Creative Vegerarian Cooking ~îrhrynJ. McLane Lifestyle Cenrer of Ame6ca Route \. Box 4001 Sulfur, OK 73086 1-800-596-5480

The Seventh~day Diet How the "Hcalrhiest People in America" Live Berrer, Longer, Slimmer-And How You Can Too! Random House, New York These books may be ordered from ehe publisher direct or from:

526

New Lifestyle Booh 30 Uchee Pines Road # 15 Seale, AL 36875 \-800 542-5695

APPENDIX

APPENDIX III Lifestyle Centers Around the World Cedacvale Hea1th Centre 2999 Moss Vale Rd Firzroy Fatis, NSW 2577 Aalia phone and fax +61-44-651-362 Delhuntie Park Youth Care & Lifestyle Centre Ine. RMB 5540 Trafalgar E.asr, Vie 3824 Ausrralia +61-356-331688 +6l-356-33l683 fax Duke UniversÎty Hea1th aud Fitness CeRler 804 West Trinity Ave. Ourham, NC 27201 1-800-677-2 177 (919) 684-6331 Eden Valley Institute 6263 N County Rd #29 Loveland, CO 80538 970-667-0809 970-663-7072 fax Lifeseyle Cenrer 970-669-7730 Fredheim Health Center Bergmannsveien 600 3600 Kongsberg NORWAY +47-32-76-6J50 +47-32-76-7150 fax

HanJand Institute Hatdand 'WeUnes.s Center PO. Box 1 Rapidan, VA 22733 1-800-763-9355

Health & Preventive Medicine Center (CenrruJ de Sanatate & Medicina Prevenriva-Romania) Ser. A. Filimon rer 16 Tim Mures, Jud. Mures 4300

ROMANIA phone and fax +40-65-165-353 Lifestyle Center of America Route 1, Box 400 J Sulfur, OK 73086 1-800-596-5480 405-993-2327 405-993-3902 fax Poland Spring Hea1th Institute 226 Schellinger Road Poland, ME 04274-6134 207-998-2795 207-998-2894 Lifestyle Cemer 207-998-2164 fax

Pritikin Longevity Center 1910 Ocean Fronr W11k Sanca Monica, CA 90405

1-800-206-5813 (310) 450-5433 St. Helena Health Center 650 SanÎearium Rd. Oeer Park, CA 94574 1-800-358-9195 (707) 963-6207 Silver Hills Guest House RR2, Site 10, Camp 18 Lumby, BC VOE2GO Canada 604-547-9433 phone 604-547-9488 fax

527

PROOF POSITIVE

APPENDIX III, CONTINUED Uchee Pioes Institute 30 Uchee Pines Rd Seale, AL 36875-5702 334-855-4781 334-855-4764 Lifeseyle Center Weimar Institute (20601 W. Paoli Latle) PO Box 486 Weimar, CA 95736 916-637-4 tii 916-637-4408

528

Wtldwood Ufestyle Ceoter and Hospital (1 Lifeseyle Lane) PO Box 129 Wildwood, CA 30757 706-820-1493 706-820-1474

APPENDlX

APPENDIXIV HOW ALPHA LINOLENIC ACID

CONVERTS TO EPA Metabolic pathway ofomega-3 fatty acids 18:3 Delta-6 desaturase Elongase Delta-5 desaturase

0 ..

3

I 18:4 n-3 I 20:4 0-3 I 20:5 0-3

Alpha liooleDic

Eicosapentaenoic

Elongase 22:.5 n-3 Delta-4 desaturase

y

22:6 D-3

Docosahexaenoic

529

PROOF POSITIVE

APPENDIXV One Gram Sodium Diet This diet is /ow in sugar, eho/estero/ and .~aturateJifals. AJJ foods are prepared and served jthout salt (except for 1/8 teaspoon a/lowed). A salt substitute m'ajl be used.

Food Group

Foods Excluded

Foods Allowed

Beverages

• 2 c. nonfat milk • soyalac concentrate or ready-to serve

)( whole milk )( bunermilk )( exces, of DODfat milk

Breads & Cereai,

• 3 servings bread (unsa/ted whole grain or enriehed breads) • unsalted crackcrs • regulat cooked cereals made without salt • puffed rice • puffed wbeat • shredded wheat • rice, macaroni, spaghetti, noodles cooked without salt

any food made with egg, but1er, shortening baking powder, soda, x self-rising nour )( quick breads x quick cooking cereals x dry cereals except as noted

Cheeses

• unsalted Donfat cottage cheese oDly • unsalted hoop cbeese

x

Eggs

• 1 egg white • replace with scrambled tofu

x egg yolks x egg substitutes

Proteln Rich Foods

• dairy & eggs as noted above • Vegetable proteins: • uDsalted old-fashioned style peanut butter • tofu • dinner cuts (DO salt added) • soyalac • Umit intake of poultry and fish

x x x x x x

x

x x

x

)( )(

530

aU others

dairy & eggs as nored above regular peanut but1er cream cheese aII meat analogs except as Doted salted nuts bacon organ meats bot dogs sausages cold cuts sheUfisb pork

APPENDIX

APPENDIXV, CONTINUED

Food Grou,p

F'oods Excluded

Foods Anowed

Protein Rich Foods (cont.)

)( salted meats smoked, processed, canned meats x ham x corncd beef )( kosher meats x avoid aU other red meats

Fruits

• aU [ruits & juices

)( fruit drinks, sweetened juices

Fats

• unsalted margarine made with corn or saffiower oi] • corn oiI • saffiower oi] • soybean oU • unsalted salad dressings roade with polyunsaturated oib

)( bulter x salted margarine )( cream x bydrogenated shorteDlngs x Lard )( mayonnaise x palm oii )( coconut 011 x cottonseed oii x cream cbeese x salted salad dressings x nondairy creamers x Mocha Mix

Vegetables

• fresh or frozen vegetables • uDsalted canncd vegetables as desired • no salt should be added to froun corn, !ima beans, peas, siDce salt is used in processiDg

)( sauerkraut

Soups

• aII homemade soups including clear soups and ti cream 50UpS;' if tbey are made without salt aud witb nonCat milk within the milk aUowance • low sodium broth

)( olives

salted canned vegetables )( potato chip! x French fries )( aoy prepared with exduded fats as noted

x

)( regular canoed or debydrated soups )( broth or bouiUon

531

PROOF POSITlVE

APPENDIXV, CONTINUED

Food Group

Foods Allowed

Foods Exduded

Desserts

• agar flake gel made wUh Cruit julce • unsalted fruit pies if prepared with §oybean saffiower, or corn oii and natural sugar • baked goods'" made wlth baking power, unsaturated oii, and natural sugar (dates, raisins, etc.).

)( ice cream )( ice milk x any desserts made with butter, hydrogenated fat, egg yolks, cream, wbole milk. saturated fat, salt, sodium based baking powder/soda x salt water taffy x puddings & custards

Miscellaneous

• unsalted dry roasted nuts • unbuttered, unsalted popcorn • seasonings witbout salt

)( gravies unless made from uDsalted, fat frec broth x olives )( meat sauces x cream sauce x cbocolate x salt in excess of 1/4 tsp. x salted nuu, popcorn pretzels x pickles x relisbes x mustard )( catsup )( chili sauce )( soy sauce )( meat tenderizers )( seasoned salts x instant cocoa mixes )( prepackaged stuffing mixes

'" If eaten remove one serving jrom bread and cereai group 532

'------------

J

APPENDIX

APPENDIXVI FREE RADICALS 02 + single electron = 02- (superoxide)

U202 =} OU- (hydroxyl radical) · the most toxic oxygen based radical Paired electrons ~ "'-

Unpaired elcctFon

"'''-.

Stable molecule

Free radical

533

PROOF POSITIVE

APPENDIX VII MELATO IN'S ROLE AS AN ANTIOXIDANT Efficient neutralizer of OH-

.--11'--.._

- More effective than glutathione

Stimulates Glutatbione Peroxidase to convert H 2 0 2 to H 2 0 Efficient scavenger of the peroxyl radical - More effective than vitamin E

Protects against free radical damage rrom certain carcinogens, herbicides and radiation

534

APPENDIX

APPENDIX VIII BIOSYNTHESIS OF MELATONIN

p'J Q

NR/

eUl cu

I

COO-

N./

UOOJcu...... Nn/ ? 1 CU;

I I

"

N/ H

SerotoDiD

R

Tryptophan ___

ActtyJ.CoA

·-RO

31

I

Rtqms N..cttyltrusfense (NA1)

,

NR/ I

RO

~CHC~~_ N/ R

5-Uydroxytryptophan

535

PROOF POSITIVE

APPENDIXIX Milk Alternatives Nutrients per Servin/! ,

Vit. A* ViI. B/ 1 * Vit. D* Calc.

Milk Type Better Than Milk lite, plain Dari Free Instasoy So)ait Original Soy Good Soyagen West Soy, plain Wbolle miIJ< Reduced fat (2%) No fat (skim)

0%

10%

0%

40 25

10 10

0%

3

O

3

O

O

O

15 25 10

15 25

15 25 25 25 25 25

30 30 30

10 10 10

O I

I I

15 15 15

Sugar Chol. (g) (mg)

50% 30 35 24 30 10 30

10 25

fron

7 6

I

6

5 7

10 10

12

1

12

1

12

1

12

Vitamin B 11 per serving, % Daily Values

KeJlogg: AJI Bran A'pp,le Jacks Crispix Crispy Rice Nutrigrain ShTedded Wheat Miniwbeats Product 19 Post: Frosted Shredded Wheat Raisin Bran Post Toasties Genera) MiUs: Total

536

25 25 25 25 25 25 25 100 25 35 25 100

O O O O O

2

B u COD. .t ofBreaIdUt Cereals Breakfast Cereai

I

O

!

O

33 18 4

APPENDIXX

APPENDIX X Medical Enlightenment A Century In Advance

T

he informarion presenred in chis book, as you are aware, is based on a large number of references from many sources. Mose of r!le sources provide specialized information in a particular field, and are referred (O in one or perhaps rwo of the chapters. You may have noticed rhar one source, Ellen Whire, is sprinkled through more than half of ehe chapters, as het writings cover a wide scope of health and medical topics. Some may wonder, "Who is Ellen Whire?" She was a wrieer and lecturer of the nineteenth century. Her books and artides cover a wide variery of topics in addition to healrh. She wrore volumes on topics rdated ro healrh, healing, and lifesryle. MinisC!y of Healing, Counsels on Dier and Foods, Medical Minisrry, and Counsels on Healrh arc four books that comain informacÎon and advice an a wide variery ofdiseases and conditions. These books and others have UI1dergone many prinrings over the decades and are stil! available and in demand raday. As a physician, 1 have been amazed as to the validiry and usefulness of her onitions regard.ing health principles and rreatmenrs for disease. A cenrury ago she laid out a formula for personal healthfulliving in rhe areas ofdier,

exercise, temperance, rest, sunshine, hydrotherapy, and fresh air tiUt is sti]) valid today. However, it is only withiJl the last 30 years that most of her recommendations, calltions, and warnings have been scientifically verined, and none have been refllted. Mosr of her onirions had no scienrific suppon during her lifetime and rhus were nor largely acceprcd by rhe medical communiry; some were in direct concradiction ta common medical knowledge and practice of her day. For example, in hcr day, tobacco was rnought ro be lIseful as a medic3tion for rne relief of rhe symproms of asthma. Some medical associations actuaHy recommended it for chis and other brearhing disorders. Shorrly before her day, George Washington was bled ro death in an atrempc ro cure him ofa diseasc. Medical doctors istered othcr treatmenrs that we now know are damaging rarner ehan curative. He was given heavy metals; he was actually poisoned; he was scalded in order ta "ler r.he roxins Out of his body." These rreatmenrs were accurately recorded, not ro show the ignorance of rhe physicians, bur ro indicate [hat chey applied aII of the known medical rreatment in an attempt ro bring him back to healeh.

Insights on the Devastating Effects ofTobacco Use It was in this medical dimare that Ellen White wrore ehat tobacco is a stimulanr. and a depressanr. She warned that tobacco causes cancer, heart disease, and orher health problems. She caurioned that it also inf1icts damage [Q t!le mind, which has just very recently been proven. She wroee of its addictiveness, whjch has now been proven and is widely recognized, evcn by the (0bacco companies. As late as the J950s, the

position of the American Medical Associarion regarding (Obacco was ehat its bcneflts ourweigh ies harm. l The format used in this survey of her wrilillgs highlights an underlined topic, shows Ellen White's words, and compares them ro srarcmems from medical science. A few observations on the subject of [0bacco made by her and her modern medical science counrerparts fo IIow.

537

PROOF POSITIVE

Nicotine Affects the Nervous System Ellen White's Words: "Tobacco...excites

[stimubltesjan.d then paralyzes (suppres.resj tiu nerves. "1 Medical Science Speaks; A medical eexrbook on smolcing says: "Nicorine is a cholinergic agonisr [a seimulant] at low d~ses and an antagonisr [a suppressor] at hlgh doses."3

The Addictive Power OfTobacco Ellen White's Words: "Tobacco ... chairzs the wil/,' it hoU its victims in the sblvery of habits difficult to overcome... "-1 Medical Science Speaks: • Nicorine is six ro eight rimes more addictive than a1cohOp·6 • Incravenous nicotine gave scores 5 to 10 times higher rhan even intravenous cocaine. 7

Tobruco as a Gateway Drug Ellen White's Words: The "appetite far tohacco is self-destructive. It!eads to a cravingfar something stro~ger,-fi:nne~te~ UJi?:s and liquors, allofwhJch are mtoxJcatmg. Medical Science Speaks: • Chitdren who use r.obacco are more likdy to go on ro use in sequence alcohol, marijuana, and rhen orher illegal drugs. 9 • The more children and adulrs smoke, rhe more alcohol and omer drugs rhey teod ro use. 1O

Tobacco's Far~reaching Health EfJects ElJen White's Words: "Suffiring, disease, and death are the sure penalty ofindulgente fin tobacco I1nd a!cohol). "1 f Medical Science Speaks: • AII told, more than 400,000 Americans clic each year from smoking. 12 • One quaner or more of ~lll smokers in our counery die premarurely from a smoking induced illness with an average loss of life of 21 years. 13 • Worldwide smoking c1aims over 3 ' l'Ives annu alI y. 14 m ill 100

Smoking And Cancer 538

E1len White's Words: White described tobacco as a 'malignant" poison in her pub-

lished U)ritings throughout faur decades. Medical Science Speaks: • Smoking increases rhe risk ofcan.cers of t.he lung, lip, mouth (oral cavlcy), rhroar (pharynx), voice box (Iarynx), rrachea (wind pipe), esophagus, sromach, liver, pancreas, bladder, kidney, cervix, blood (lellkeluia), colon, skin, and penis. 15 . IG. 17. 18. 19 • Nearlv one rhird of aII cancer dearhs in our, narion are due (O Slll.O k'mg. 20

Tobacco: A stow, lnsidious Carcinogen EUen White's Words: "TObacco is a slow, insidious, but most malignam poison.. .it is alI the more dangerou.s because its efficts are sloU) and at fim hardly perceptihle. '21 Medical Science Speaks: This faCt is weH known roday. Its slowness required man)' years oflarge staristical srudies to .derermine that it causes cancer and oeher dlseases.

Youth and TObacco El1en White's Words: "Btrys begin the u.se oftohacco af a very early age. The habit :/JUs farmed, when body and mind .are especral~ flIsceptible to ies efficts, rmdemllnes tiu phYSIcal Jtrength... "22 Medical Science Speaks: In both men and womell, the earlier a persoll starts smoking, the greater the susceptibiliry ro lung cancer. For example, women who started smoking before age 18 had nearly double the lung cancer rÎsk of ehose who srareed beeween the ages of21 alld 34--and nearly seven rimes rhe risk of women who picked up the smokiog habit when 35 or 01der. 23

Smoking and Heart Disease Ellen White's Words: "Lately I have read ... ofthe death ofmany men... 71Jeir deatll is a/mos!always tlttributed to fâilure offhe hearl, but in retllii)' ... the use oftobacco and liquor had poisoned the system [of many of tem h ] ... ''24 Medical Science Speaks: Each year in America as many as 300,000 cardiovascuIar disease dearhs are the direcr result ofcigarerte smoking. 25 • 26. 27

APPENDIXX

Smoking AjJects the Blood EUen White's Words: "Tobacco... poiso1'lS tbe Lift currerJt"28 "... many cbew and smoke [tobaaoJ umiL tbe bLood is con·upted... '~9 Medical Science Speaks: • Smoking acce1erates atherosc1erosis by causing several changes in the blood. [n lay language there would probably be no berter way to describe rhose changes as "smoking poisons the blood." It decreases levels of a c1ot-preventing compound called pwst
Smoking Damages the Brain EUen White's Words: 7Obacco weakens the brnin andparaLyzes itsjine sensibilities; '~6 it "beclouds the brain. '87 Medical Science Speaks: • Smokers are less able to perform complex menta] tasks than non-smokers. 38 • Using as fewas 1 (Q 14 cigarerres per day ean more than double rhe risk of nonfatal stIoke,39 which can damage our highest menral and moral funetJOJlmg.

No Safe Form OfTobacco Ellen White's Words: "Tobacco, in whatever jOrm it is used, tells upon tiu constitution. It is il sloUl poison. "iO Medical Science Speaks: 1. Morraliry rates of cigar and pipe smokers are 20 to 40 percent higher than rates for nonsmokers. 41 2. Ooe reason is that cigar and pipe lISer have a significanrly increased risk of hean disease death. 42 3. Chew or dipping smokeless tobaeeo is a potent cancer risk factor. 43 4. There are 28 differenr cancer-causing chemicals in chewing tobaeco and snuff.44

Did Ellen Wllite understand the dangers of seeondhand smoke? Her insights are c1early doclImented.

Dangers ofSecondhand Smoke EUen White's words: "... by u,sing toba-cco, [smokersj poison the [ord's frec atmosphere, so that others are injured. "15 She reftrred ta the air in a room with smokers as "tobaccopoisoned air. "16 Medical Science Speaks: Oeaths in the U.S. per year from secondhand smoke is estimated at 50,000.41

Children ofSmoking Parents are Damaged Elleu White's Words: Smoking parents caTiSe ''the system of the infant [to bej flUed withpoison...it acts upon some infants... causingspasms, )its, paraLysis, amisudden death. "18 Medical Science Speaks: • When compared ro the babies of nonsmokers, infams whose mothers smoked borh during pregnancy and after are three times more likely ro become victims of SIDS-the "sud· den infam dearh syndrome."49 • Smoking f.1thers also increase their infants' risb of SIOS. 50

Mental Damage to Children/rom Secondhand Smoke Ellen White's Words: "Memal intlbility and physical weakness can resultji-om parentai smoJling; ''.51 'imbom generation5 are af flicted by the {parental} tese oftobacco and liquor. lntellectualdecay is entailed upon them, and their moralperceptions are bluntcd. " Medical Science Speaks: • Maternal smoking accuaJly decreases rhe number ofbrain nerve cells in the developing fetus. 52 • Inrelligence quotients (IQs) were an average of nine points lower among 3 ro 4 year old childre.n whose mothers smoked during pregnancyY • Other secondhand smoke effects include difficulry in processing sound, and dealing with rhree-dimensional geometry concepts.,4. 55

539

PROOF POSITIVE

Summing up Ellen White on Tobacco Ellen Whire did indeed bless rhe world wirh accurare sciemific insighrs imo rhe dangers of robacco. In addirion ro rhe benefirs ro millions of readers ofher books, she gave aII natiollS another precious legacy: she encouraged Sevemh-day Adventists to devote energy ro help smokers kick rhe habit. Her philosophy is perhaps best summarized in her own words: "Work for rhe inremperare man and the robacco . .. "56 Following White's counsel, Seventh-day Advemisrs have conducred one of rhe world's mose successful srop-smoking programs. Since its inception in the 50s, rheir

"Five Day Plan ro StOp Smoking,"57 has been used by an estimaced 14 million smokers in 150 different countries. The program is stil! used today, somerimes in a revised form known as "The Breathe Free Plan ro Stop Smoking." Modern research shows just what El!en White tallght a cemury ago: tobacco is not jusc a killer. le can sr,eaJ life's quaJiry, desrroy happiness, induce disability, and rob billions of dollars from society. Our cournry and the world would be [,u differenr roday if everyone had heeded White's words when she firsr penned rhem.

Insights on the Superiority Of the Pure Vegetarian Diet. One ofWhite's most tireless recommendarions was the health benefits of the vegetarian dier. In literaJly hundreds of places in her writings she upheld this dier as rhe ideal. Vegecarianism was linie known in the 1800s; the meaning of the rerm irself was noc generaUy undersrood. Vitamins had not yet been discovered, and the existence of bacceria was just being discovered. The circulatÎon of rhe blood had recently been discovered. Modern scienriilc discoveries have esrablished that heart disease, cancer, and many other diseases have their origins in the meat itself. Her undersranding of the rale of diet in regard to health is aswunding in ligllt of [he prevaiJing, primitive medicaJ knowledge of her day. She had much to say abolit other f.1Ctors relarîng ro diet and eating habits. Let liS look ar a few of her pronouncemenrs 00 dier that have been verified by modern medical science.

Vegetarian Diet is the Most Healthful ElJen White's Words: "Graim, fruits, nuts, and vegetabLes eomtitute the diet ehosen

for w by our Creator. These ftods prepared in

540

as simple and natural a manller as possible, are the most /u'althJUI and nourishing. "58 Medical Science Speaks: StatisticaJ stlldies combined wirh iocreased scienrific knowledge of rhe immune system and the action on che body of diecary fiber, carbohydrates, cholesrerol, protein, phycachemicaIs, ViraJllins, anrioxidants, sale, and many other substances in foods, have proven rhe superiority of che vegerarian diet. The diet has been shown ca be beneficial in the prevention and rreaunenr ofmany diseases such as rheumaroid arrhritis, stroke, hearr disease, cancer, diabetes, cataracr.s, urinary infections, asthma, kidney faîlure. kidney stones, seriolls infecriolls illnesses, and mental healdl. Vegerarians have been shown to have greater longevity, superior muscular endur'lllce, less chronic diseases, less lltiJization of health care facilities induding hospicals, and less need for medicacions. The benefits of the vegetarian diet are now found on the pages of even the mosr conservative scientific pllblicarions. Thraughouc chis book 1 have presented much of che accllmulared evidence thar remarkably indicates rhe superiorîry of rhe vegerarian dier which Ellen White advocated

APPENDIXX 125 years ago. Information on how rhis earing sryle is helpfl.ll in preventing or treating bean disease is found in Chaprer 3 an hearr djsease and Chapter 4 on reversing hean discase. The vegerarian diet aIso receives considerabie accenrion in Chapecr 2 an cancer. Chapter 8 on sugar aod diabe-

res shows some of rhe advanragcs of a diet free of animal products on this leading discase. Benefits of rhe vegetarian fare in the contexe of condirions like asrhma, rheumatoid arrhritis, cararacrs, and others are found in rhe final chapter.

More onitions Regarding the Vegetarian Diet Vegetarian Diet Enhances Physical Endurance E1len White's Words: Craim,fiuits, nulS, Imd vegetables constitute the diet choSerl joI' US by aur Creator... They impart a strength, a power ofenduranu, arId a vigor ofintel/cel, that are noI afJorded by Il more complex and stimu/atingdiet. 59 "... [!ndividuals} wi/l have greater pa/vers of endurance if thry abstain from meat than if they subsist largei; upon it. '60 "It is a mist/lke to suppose that muscular strength depends on the use ofilrlimalJâod. 'rJ; MedjcaJ Science Speaks: • Bicyde tests of athletes who follow a high far, high prorein, high meat clict, can eriple theÎr endurance by swirching ro a vegeearian rype of high carbohydrare diet. 62 • Marathon runners among many others have discovered ehar mcar is a derrimel\( ro distance running ar other endl.lrance activieies. • The belief that a dier srrong in mear is essenciaI for people thae do muscular work has been prevalent up ro jusr a few years ago.

Vegetarian Diet Enhances Mental Peiformance Ellen Whire's Words: Cmins,.fuits. nuts, and vegetables... impart a vigol" ofinteL/eet, that fis} not afJorded by il more complex and stimulating diel. 63 Medical Science Speaks: 1. Meae conrains a subsrance mat impairs brajn acriviry and lacks a subsrance rhar the brain needs to func-

rion weJl. Arachidonic acid found in mear impairs optimal funceÎoning of rhe brain cemer for wisdom, judgment and foresighr-the fronral

10be.64. 65. 6e•• 67 2. Animal foods are devoid of carbohydrare, which is rhe primary source of energy rhar rhe brain c.1.n use,6B but a vegetarian diee conrains a plenriful supply.

Meat Increases the Risk oflnfectious Diseases Ellen White's Words: "... the fiability to ti1ke disease is increl1sed tm-jold by meat eat. "69 mg. Medical Science Speaks: • Infecriolls agems transmitted especially from animal prodllcrs include salmonella,l0' 71 listeria,n. 73 campylobacrer, 74.75. 76 and dangerous varieties of E. coli (technically referred ro as serorypes O 157:H7 and O104:H21).n. 7B. 79.BO • Alrhollgh rhese agenrs often cause norhing more than severe diarrhea, rhey can cause blood infecrions (sepsis), permanent arthritis, nervous system disease, kidney failure. and far..'l1irjes. • Foods commonly associared with one or more of rhese illnesses are soft cheescs,81 orher dairy prodllcrs (inc111ding pasreurized items).B2. 8:l. 84 eggs, 85.86 sal.lsagc, 87 beef prodllcrs, 88 undercooked chicken,89. 90 and "nonreheared hor dogs. H91

541

PROOF POSITIVE

The Vegetarian Diet and Infectious Diseases Ellen Whîte's Words: "we see that mttle are becominggrently diseased. .. and wt ktlOlV that tiu tinU! wiLl come when it lVill not be best to me milk and eggs. 92 Even while Slll1Ctioning the use ofdairy products in ha day, White wrote: "lfmilk is IIsed, it should be thol'oughly steriliud; with this precaution. t/ure is less d4nger ofcontracting disease from its use. '93 Medical Science Speaks: • Even today's pasteurized rnilk is conraminated. Thorough sterilizaeion (boiling the milk) would have c1early prevcnted ourbreaks of salmonclla and listeria. • Crohn's disease (a serious, and sometimes life threatening inrestinal illness) may also be liuked ro milk. Even pasteurized milk 94 may concain . . berculOSIS ' 95.96 rnycobacrenum paratll which may cause Crohn's in susceptible individuals.

Animal Praducts, Infection, and Cancer. Elleo White's Words: "Flesh WflS never the bes! ftod; but its use is nOlv doubly objectionabie, since disease in animals is so rapld!y increasing... People are continuflI!y eatf~/gflesh that is flUed with. .. cancerous germs. 91 Medical Science Speaks: • The medical lirerature does nor yet show a definire link berween animal infectiolls illness anei human cancer. However, rhere is growing cause for concern. Animal diseases can eirher cause cancer ar immune systern changes in infecreel animals. The bovine leukemia virus c.,uses a form of leukemia in American cattlc. 98 . 99 • An animaJ form of AIOS called rlle . .lrnmunodefiIClency . . 100. 101 bovlIle vIrus affects canle.

542

Cancerftom Eating Animal Products. EUen White's Words: "fanima{} flesh ... is filled with. .. cllncerou,s germs. -102 Medical Sciellce Speaks: • American women who eat ilie most red meat double rlleir risk of Iymphoma. 103 Eating hamburgers more than four times per week more than doubles a wOlllan's risk of nonHodgkin's lymphoma. ,04 • Meat eating may also increase a host of other cancers. I{ more {han doubles the risk of colon cancer. IOS • 106.107.108.109

When ir comes [O cancer, praof rhar {he presence of cancerous "germs" in animals dirccdy causes c.11\Cer has not yet beell esrablished, bur medical evidence raises rhe question. We do know thar certain cancers are caused bv bacteria, aJld cerrain other cancers are c;u ed by eating meat. It is well esrablished that chronic bacterial inIections such as Helicobllcter Pylori can cause cancer ofthe stomach and have been linked ro Iymphoma. 11O It is now well documcnred thar Illany cancers are caused by a virus and thar cenain viruses can be translllitted from animals tO humans. It is not surprising rhat some of\X'hire's uncanny insighrs have nor yer been confirmed by modern science. Most of her counsels were not "medîcaJly proven" umil many years ;tfrcr they were written. Whire made the connection between diet, disease, alld death: "Many die of diseases wholly due ta meat eating, when rhe reaJ cause is scarcely suspected by themselves or orhers. Some do not immediately feei its effects, bm dus is no evidence that it does not hun rhem. It may be doing its work surely upan the system, yet for the rime being rhe victim may realize nothing of . 'III It.

Fish are not Safe to Eat Ellen White's Words: "Thefish that pa/'tflke of fhe filthy Sl71Jerage... mlly into waters far distAnt from the sewerage, flnd be caught in lomlities where ţhe water is pure /Ind fresh; but becauJe of the unwholesome

APPENDIXX drainage in which rhey have bemfteding, they are not saft to eat. »112 Medical Scîence Speaks: • In 1996.47 ofour 50 sraces had consumpcion advÎsories warnÎng abour earÎng cerrain species of fish. The advisories covered 1.740 rivers and lakes (including aII of (he Grear Lakes) and large chunks of coastaJ areas. 113 • Each year in rhe U.S. rhere are over 100,000 reporred cases of foad poisoning due ro conraminared seafood. 114 • Seafood causes as many as 15 rimes as many food poisoning oucbreaks as beer, poulrry, or pork. ll ) • Raw shellfish pose (he greatesr risk. 116 They are commonly harvesred from coasta! waters rha( have beel) conraminarcd wirh human sewage.

Fish are not Safe to Eat Ellen Wh.ite's Words: "In many Localitj~s rom fish ii unwholesome, and ought not to be ,ţ; use.d ... they are not saje to eat. '117 Medical Science Speaks: • National Cancer Institure data show an increased death rare from cancer among people living in areas where fish have exceptionally large amounrs of tumors. 118 • Lake Erie scdimenrs caused skin cancer when paimed Ollro (he skin of mice. 119 • Ir is commoll tO find fish conraminated by with halogenared organic compounds (induding DDT). 120.121 • Elevared levels ofhalogenated hydrocarbons have been found in rhe rissuc ofbreast cancer paeienes, suggesting a cause-and-effecr relationship. 122

• Many fish are conraminared with PCBs, diox.in, heavy mceals, anei halogenated organic compounds (induding O DT). 12). 126. 127 • Halogenated organic compounds, PCBs, and diox.ins may increase the risk of a variery of condirjons such as high blood pressure, arceriosc1erosis, C\iaberes, and e1evared blood fars. J28 · 129

• Fetal PCB exposure may cause nervous sysrem damage and loog-Iasring menral impairmenr. 130, 131 In addition ro promocing vegerarianism, EUen White ofren sil1gled aur particular foods ar food categories because of rheir unique effecrs an healrh. Sometimes ehose effeces were derrimeoraJ, omer rimes they were beneficial. 1:\2 She commenced on foods rhat we now know have a bearing on hearr disease.

Heart Disease Concerns with Cheese EHen White's Words: "Chuse is wholly tinfit for food. '~33 Medica! Science Speaks: • Oxidized cholesecroJ increases beart e1isease risk. I34 . 135 • Ripened cheese is a rop source of chis oxidized cholesterol. 136 • Cheese tenels ro be high in salt. In suscep(ible people, (his will raise blood pressure (another hearr disease risk facror). • Many cheeses are high in saturated fac, which tends tO raise blood eholesterol values.

Custards and Heart Health Ellen White's Words: uEspecia/~y hnrm-

Fish are not Safe to Eat

fiti are the custartis (md Imddings in which

Ellen White's Words: "In many LocalitieI rom fish ii unwholeIome, and ought ,JOt to be Ilsed. .. they are not saft to eat. "123

milk, eggs' aml sugar are the chief ingredienti. "/37

Medical Science Speaks: • In ehe U.S., f1sh produclS conrain signitlcandy more pesricide residues than fruits. grains, or vegetables. 124

Medical Science Speaks: • Dried cusrard mix (which typicaJly conrains sugar, milk, and eggs) is one of the worst offenders when ie comes ro containing oxidized cholesrerol

543

PROOF POSITIVE and producing measurable damage ro blood vessel Jining cells. 138 • The desrrucrion callsed by oxidized cholesrerol appears ro bc a key factor in callsing hardcning of rhe arrerics and llitimarely hearr arracks. 139. 140

Nuts and Heart Health EUen White's Words: "Mlts and mitflods are coming largely i1'1lo use to take tbe place of flesh meats. With I1Uts may be combined grains, jruits, tind some roots, to make flods that are bel1lthftl and nourishing. "HI Medical Science Speaks: • Jusr when many hearr disease researchers were abour ro cross nurs off rhe Jisr of"healrhflll foods" (due ro rheir high far conrem), researchers ar Lama Linda Universicy found rhar nurs could lower blood cholesrerollevels and provide a corresponding decrease in rhe risk of

hearr disea.~e. 142. 143

Nut Varieties and Heart Disease Ellen Whire's Words: ".. . some

are nOI so wholesome IlS othen·. Almonds are pref aable ta peanutJ... "14-4 nuts

Medical Science Speaks: • Peanur far has a spedllc chemicaJ srructure rhar makes ir harder an hulllan arreries. 145 From rhis perspective, almonds (and a variecy of orher nurs) are superior ro peaours. • A1monds boasr more yiramin E ehan almosr ali orher Ollts. Inrake of rhe

amioxidam yitamin E is associared widl a decreased risk of hearc disease. 146

The Jmportanee ofFiher EUen Whire's Words: "For use in bretldmaking, tiu superfine white flour is 110t the be-,t" .Finejlour bread is lacking in nutritive elemmts to beflund in bread made from the whole wbeat. It i-, (f frequent muse ofeonstipation and other tmhealthful cOl1ditiol1S. "111 Medical Science Speaks: Whole grajn ourdoes whire flour in a hosr of nurrienr comparisons. For examp[e, whire bread has vinually no liber; whole grain bre.ad is a good source. Fiber appcars able ro decrease risk ofa hosr of diseases Îndllding hcarr djsease, cancer, consciparion, appendiciris, and varicose veins. 148. \49. 150. 15\

Benefits/rom the Allium Family: Carlie And Onions EUen White's Woras: "Tbere is great virtue in well-cooked onions. '152 Medjcal Science Speaks: Dr. Ben Lau in his book, "The Health Benellts of Garlic,"lisrs a nllmber ofbenefirs from rhis food family. Garlic seems ro help wirh e1evared blood pressure, high cholesterol, and infcctions callsed by borh bacteria and ycasts. Onioos oftcn. hdp these condirions as well, due ro chemical simiJarities in rhese plants. 153

Dangers OfFat in the Diet Anorhcr area wbere modern science has come around ro agree squarely wirh Ellen Whire is on rhe posirion of dramaricaJly decreasing far-and specif'icaJly s;ltllrated far-in aur dier. This is important for borh hean disease and cancer prevention. In Whire's day, howcver, no one was ralking abour "saturated far." Insread rhey used

544

rhe word "grease" ro designare the main cat~ egory of sarurared fars-mose from animal sourccs. r devore considerable anenrion in rhis volume ro issues dealiog wirh animal fars (sec, for example, Chapters 2 and 3). Some ofWhite's sratements thar arc in harmony wirh chis now well-accepred scicnrific dicrum follow.

APPENDTXX

Ellen White Condemned High Saturated Fat Foods 1. ".. .prepare fOod properly. This can be done in a simple, healthfid, and easy manner, without tiu use of /ard, butter, or flesh mealS. '~)4

2. "WC do not think fied potatoes are healthful, fOr there iJ more or less grease or butter used in preparing them. "155 3. "YtJU should keep grease oU! ofyourfOod. It defiles any preparation offOod yOIl may maRe. "

Elim White, Sugar, and Cancer In addirion ro focLlsing attenrion on animal produers and sarurared fars, Ellen White provided orher insiglus thar lHay have a bearing on cancer prevenrion. For example one sobering linkage involves sugar and cancer.

'Wzrnings Against Sugar EJlen Whire's Woros: "From the light given me, mgar, when fargely lISeei, is more injuriolts thl1.11 meat. "/56 Medical Science Speaks: A number of different C<'lncers have now been srarisrically linked to sugar consumption. The risk of rhe following cancers appears ro rise when more sugar is consumed: colon cancer, recrai cancer, breasr cancer, ovarian cancer, uterine c<wcer, prosrare cancer, kidney cancer, and cancers of rhe nervous sysrem. 157

CofJee is Hurtful Ellen White's Woros: Coffie is Il Imrtful indulgenee. It temporarily excites the mind... , but tlle afier~ffect is exhaustion, prostmtion, paralysis of the menta~ mora~ and physical powers. "158 Tea acu as a stirnI/lant... The action ofcoffie. .. is similar. Fatigue is forgot-

ten, the strength seems to be increased. .. when tIu influence ofthe stimulam is gone, the UIlnaturalfOrce ablues, and the resuit is a corresponding tiegree ofIdnguor and disability. 159 Medical Scieuce Speaks: • The imernarionally acc1aimed Norwegian research projecr known as rhe Tromso heart study assessed 143 000 men and women and fOUJld a significam increase in depression in women who were heavy cofTec uscrs. 160 • Caffeine addicriveness has onJy recenti)' been proven ar John Hopkins Universiry. Researchers at Johns Hopkins published srarding research rhar demonsrraccd [hac "caffcine has ilie cardinal [eatures of a procotypic drug of abuse."161 Based an irs drug effeets, caffeine acts much like any c1assic addietive drug. 1 he implicarion is rhar habitual caffcine uscrs arc as much drug addicrs, in rhe chemical sense of che ccrm, as cocaÎne addicrs, heroin addicrs, or niCOline addicrs. • She warned ofirs elfecl 011 rhe mind, which also has only recently been proven.

Insights on Eating Habits The Jmportance ofBreakfast Ellen White's Words: ''The habit ofellt-

ing a paring breakjast flnd a large dinner is wrong. Make your bretlkfast con'l!spond more nearfy to the hcartim meal oftiu day. "162 Medical Science Speaks: • Earing breakfasr appears ro be essen-

tiaI for maximum mental and physical efficiency. J6J • Regular breakfasr earers may be able ro cur (heir risk ofdearh in half. 164. 165 • A good breakfast and a lighter (or no) supper may hclp improve blood sugar control in diaberics.

545

PROOF POSITlVE

Fewer Meab' and No Snacking ElIen White's Words: "In most cases two

meals a da} arepreftrable ta three. "16'6 "Three meals a day and nothing bettveen menls-nol elim an app1e-should be Ihe utmost limil of indulgence. "167 Medical Science Speaks: • The more frequemly a person ears, the greater !lis or her risk ofcolon cancer. 168. 169. 170 • The original Alameda Counry Srudy dara idenrified "no snacking" as a hea.lth habir associared with longevIty.

Heavy Suppers Stymie Weight Loss Ellen White's Words: "the lost meal [sup-

P"J is genmllly the most hear!)', and is oficn takm just befOre retiring. This is rroersing tiu TUlturt11 ord.er; It hearty meal shouU n~ver be taken so late in the day. "171 Medical Science Speaks: Leaving off supper ma)' be one of the besl ways IO deal wirh excess weighr. One srudy doeumentcd weighr loss in aII of ncarly 600 parienrs who ale their lasr mea! no larer [han 3:00 p.m. 172

Benefits ofFasting Ellen White's Words: "/n many coses of

sickness, the very best remedy is fOr the patient to fllSt fir a meal 01' ttllO. . .. Many times a short period of entire abstinence /rom ftod, fillowed by simple, moderate eating, hllS led to recovery through nature's oum recuperative ./1; "173 ejjort....

546

Fresh Air Enhances Mental Clarity Ellen White's Words: "Jn the comtmction of buiUings. .. care should be taken to providefOr good l)entilation andplenty ofsunlight. . .. Neglect ofproper ventilation is responsible ftr much... drowsiness and du/lness. "171 Medical Science Speaks: Fresh air is chemically superior ro re-circu1ared indoor air. 17S High qualiry fresh air is actually e1ecrrified and gives risc ro a number of benents including: • Improved sense of well being. • Mild tranquilizarion and relaxarion (decreased anxiery). • Irnproved learning in mammals. 176• 177. 178.

17~.

180, 18!. 182

Health Risks ofCity Dwelling EUen White's Words: The physical surroundings in the cities are ofien a perii to health. .. the prevalence offlul air fis among} the mt1ny evils to be met. "183 Medical Science Speaks: • Ozone pollution in urban air causes cye irrirarion, shormess of brearh, cough, worsened lung funcdon, and decreased physical performance. 184 . 185

• Women living in highly pollmed regions increase their risk of cancer in proportion ro rheir rotal exposure ro particulare pollurrtllts. 186

Exercise is Vital to Health

Medical Science Speaks: • A shon fasr may improve immune funcrioning. • Resrricring ccrtain essential amino acids sllch as phenylalanine and ryrosÎne may play a role in cancer tre-armem.

Ellen White's Words: 'The more we exerâse, the better will be the circulation ofthe blood. More people die fir Wlwt ofexercise than thl'Ough overjatigtte; very many more nw out tblln wellr 0111. Those who tUcustom themselves to proper ex"âse in the open air IVill gencrally have Il good and vigorous circulation. "187 .

Ellen Whire also singled.om many omer facrors besides clier and add.icrÎve subsrances thar can have a subsrandal a(fecr on healrh. The following is a very small sampling. For addirional exrcnsive commenrary on lifesryle and hea1rh, you may be inreresrcd in acquiring one or more of rhe books menrioned ar rhe beginning of this commenrary.

Medical Science Speaks: • Exercise lowers the risk of hean disease. 18g • Exercise lowersrhe risk of cancer. • Exercise benefirs physiology in general. • Regular exercise promotes longevicy.189. 190.. 191

APPENDIXX

Medical Advice 100 Iears Ahead ofHer Time As we see in me foregoing, sc.iemifie discoveries made long aher her dearh have proven the validicy of her medical advice. Her advanced undersrandlug of the principles ofpreventive medicine and rrearment of disease begs rhe quesrion, "How could an individual who tived 100 years aga have wrirren anything on healrh lOpics {har would be of value roday?" No orher book on heaJrh rhat was wrÎtten in her rime has survived rhe resr of rime. The informalion rhey conrain has been autmoded by the rapid advances in medical science in rhe 20 rh century regarcling rhe causes. rrearmenc, and

prevenrion of disease. She was obviously 100 years ahe...1.d of her rime. Paul Harvey, in referring (O Ellen Whire in oue of his nerwork news broaclcasrs, observed rhar "Modern science continues more and more ro say, 'She was righr!' "192 Was rhe advanced information rhar she possessed rescricred ro health ropics? Did she have advanced informarion ourside of the field of healrh? If so, has rhe informarion been subsrJJltiated? Ler us look at twa predicrions she made ar rhe rime of rhe Civil War dlar are mareers of record.

Civil \.far Predictions Monrhs before rhe war began. one srare, Sourh Carolina, had seceded from rhe Union. The milirary and governmenr leaders of aur COUntTy, includîng President Lincain, saw rhe seccssion as only a minor rhrear. The renowned edicor of rhe New York Tribuoe, Horace Greeley, wrore, "A few old women wirh broom stieks could go down rhere and beat our aii of rhe rebcllion rhat there is in Sourh Carolina." Ţhc week before, he wrote, "lfsomeone wirh rhe firmness of Andrew Jackson should go down rhere and say, Sourh Carolina, where are you going? They would reply, back inro rhe Union again, Sir." [n rhe same week, on January 12. 1861, M rs. Whire gave a public address in Parkville, Michigan. Contradicrory ro rhe arrieudc of OUT governmenc leaders and the press, she said ''A large number of scares will mar srare and rhere will be a mosr rerrible war." She cominued, "There is nor a person in ch.is house mar has even dreamed ofrhe tIouble thar is coming upon rhis !and. People are making lighr of rhe secession ordinance of Soum CaroLina. Bur 1 have jusc been shown thar a large nllmber of srates will char stare. In this vision, 1 have seen !arge armies ofborh sides gat.hered on rhe field ofbattlc. 1 heard the booming of the cannon anei 5..1W

rhe dead and dying 00 every hand. I saw the field after the barele, ali covered wÎth rhe dead and dying. Then 1 was carried to prisous and saw me su/teriogs of rhose in want who were wasung away." She coneluded by sayiog, "There are men in this house who willlose sons in rhar war." She was sco/ted ar in thc meering. Newspaper reponers rhac were ourside made light of her speech. The semimem was "Now we know she is nor a tIue prophec. This is not goÎng ro happen." Some rhree months larer, eleven srarcs had seceded and e1ecred rhei! Confcderare president. But President Lincoln called for a paltry 75,000 men for rhree monrhs ro pur down rhe rebellion, He felr rhat no more were needed. The rest is hisrory. The Norch wOllld have almost cluee mîllion men 00 the ficld ofbarde and rhe Sourh woulel have half rhar number. The U.S. losr more people in rhar war rhan aII of our mher wars combined ro rhis date. Ellen Whirc's warniogs of me coming war aod me rcrrible slaughrer ro fo11ow, rhough rhey comradieted the rhinking of our cOllorry's lcaders, were accurate and well founded. She was obviously getring her informauon from anorher sourec. 1ncidenrally, there were at least 10 men who attended het leerure that losr sons in [he wa.r.

547

PROOF POSITIVE The North did nor do well at firsr. Six momhs into rhc war she was shown what it wouJd take to bring it ro an end. The Non]) had begun national fast days because they bdieved thar they were on ilie cause of righr. They fasted and prayed for success. She made a predicrion thar rhe ride of the war wouJd mrn around if the North mer a cerrain condirion. She had wrirren much aga1nsr the evils of slavery. She wrore on January 4, 1862, "ls this not the fast rhar 1 have choscn? To Joose the bands of wickedness, ro undo the heavy burdens, and ro ler ilie oppressed go free, and rhar you break every yolk? [She quored from lsaiah 58.6J.

When our nation observes the fast which Cod has choscn, then He will accept their prayers as far as the war is concerned. Bur now d1ey enter not ioto His ear." She was predicring dut if the Nonh freed the slaves, the ride of the war would turn. On January 1, 1863, aJmose one year ro the day larer, President Lincoln issued the Emanciparion"Proc1amation which freed the slaves. At rhar pOÎnr, the war turned complerely aroLlnd jusr as her words predicted. Governor Sr. John of Kansas said in a public address, "Mter Lincoln isslled his famous Emancipation Proc1amaeion, we had swung round on God's side, and could not Iose."

Predicting the Healing Ofthe Rift ofthe Protestant RefOrmation History tells us that the Protestam Reformation eaused ehe Roman Church ro suffer a sharp decline in ies influence and presence in many cOLlotries of the world. Ar rhe same rime, Protestanrs, in breaking away from rhe Catholic Church, enjoyed a surge in world accepranee and influence. Norwithstanding chis religious c1imate, Ellen Whire in 1888 predicred that "The Prorcstants of the United Staees ... wiU reach over the abyss to clasp hands wirh the Roman powcr ... Papists [and] Pwrestan.ls ... will see in chis union a grand movement for the conversion of (he world and the ushering in ohhe long-expectcd miUenium."193 Abolit 30 years aga, when the ecumenical movement was in iu infancy, a degree of cooperation berween Catholics and Procestam leaders began ro be seen. On Marcb 30, 1994 (100 years afrer her predic(ion and just 6 years before the milleniwn), leading newspapers across the

548

U .S. posted headlines, "Catholics, Evangelicals Huddle-Statement CaIls for Aceeptance."194 Another headline was "Christians Herald New Era-U .S. Evangelicals, Conservative Catholics End Discord, Urge Shared Vision."19S A toral of391eading evangclicaJ Pro(estanrs and Roman Catholics signed a "historic declaration," a 25 page document urging (he nae10n's 52 million CathoJics and 13 miU ion evange1ica.ls ro ccase holding each oeher at ann's lengrh, and instead work together in recognition of a common fairh. Two major goals of the accord were sraredworld evangelism and common concerns for society. The signers of rhis declaration are the mosr visible and inf1uential in their respective organizations roday, such as Pat Roberrson of rhe Chriseian Coalition, Charles Coison, Cardinal John O'Conner of New York, and the director ofthe Sourhern Baptisr's Home Mission Board.

APPENDIXX

Predictions ofthe Enduring Value ofHer Writings Another predicrion rhar she made was relarcd ro rhe torward reach ofher own wri rings. In ) 907, eighr years before her death, she made a remarkable forecast. "Wherher ar nor my life is spared, my wrirings will consranrly speak, and rheir work will go forward as long as time shalllast."I96 SOlUe 90 years later we see rhar her wrirings have conrinued (O be reprinted in English and rranslared and published inco language afrer language (O meer rhe demand. This facr is evidenee rhar her writings are relevanc in aur rime. She srressed rhe imponanee of pre-naral ini1uences an rhe health and mental developmenr of a ehild ar a rime when medical science was wrally unaware of such inf1uences. She warned thar birrh defecrs eould resulr from rhe ex-

peeranr morher drinking alcohol. She wrore on rhe relarionship berween ilie healrh of rhe mind and body. She poinred our rhe value of very early rraining of children in rhe family serring, and deseribed rhe disrinel rales of rhe morher and father. Many of chese coneeprs were new and differenr from rhe convenrional wisdom of her day, and have sinee proven ro be accura.re. Whar was rhe excenc ofher formal education and rraining? Her biography reveals rhac she was nor a medieally rrained person. Surprisingly, her formal educarion was lil11ired ro ilie rhird grade. Whar eould have been rhe souree of her informarion? How did she acquire such insight? Ler us probe ehe answers to rhese quesrioJls.

Source OfInfonnation Higher Than Human Knowledge Ir is obvious tlur her souree of informarion was higher tban human knowledgea higher power. le is rhe mosr plausible explanarion of her advanced knowledge. What or who could this higher power be?

Could ir be psyclue phenomena? Hardly, since her wrirings sound dear warnings of the dangers aud deceptions of che psychic world, rhe spirirs of the dead, and hypnot1sm.

Prophets Receive Higher Knowledge From Power On High Is it possible rhar she reeeived rhe informarion directly from ilie God of Ihe Universe? We are reminded rhar Gad, in rimes pasr, has revealed information direerly ro selected individuals ro be ed on for rhe benefic of rhe human race. The person who received the informarion is referred ro in rhe Seripeures as a propher. The deseriprion of a propher, rhen, is a messenger who receives messages from God for the purpose of giving rhem ro mankind. The Bible is a eollecrion of wrirings of God's prophers rhar were produeed rluoughouc che ages of rhe histary of man up ta rhe year 100 A.D. Ir

clearly srares rhar rhe messages of che prophers eame from Gad. "Ali Scripeure is given by inspirarion of Cod ... " (2Timorhy 3: 16). Also, "Prophecy carne nor in old rime by rhe will of man: bur holy men ofGod spake as rhey were moved by rhe Holy Ghosr." (2 Perer 1:21). Thus, Bible prophers are regarded as spokesmen for Gad. The wrirings of rhe prophecs of rhe Bible conrain much informarion rhar could nor ocherwise be known by man. Thus, a srrucwral parallel exiscs berween che wrirings of rhe prophers of Scriprure and rhe wrirings of Ellen Whire.

549

PROOF POSITIVE Her writings cOllrained information nor known by the scientists and psychologists of rhat era. This fact alone does nO[ establish that her information came from God,

bur is one piece of evidence that poims in rhat direCTion. We shall sec {har mere îs more evidence in rhe same direction.

The Pattern ofBible Prophets 15 there a pattern of God's true prophets of the Bible outlined in the Bible itself? lf 50, does EUen White fit the pattern? Is there Scriptural information abour the prophets of God thar might reveal other similarities or dissimilarities berween Bible prophets

and Ellen Whire? 1know of no other somee of reliable descriprions of God's prophets than the Holy Word itself. rf we want ro probe this mystery we must search the Scriptures.

Beware OfFalse Prophets-Test the Prophets h is important ro note thac che Scriptures conrain many warnings against false prophets. They also provide informat ion for derecting a false prophet, and onish us ro search for evidence. One of the warnings is "For there shall ari se false Chrisrs. and false prophets, and shaU shew great signs and wonders ... " (Matthew 24:24).The Bible onishes us ro make a search for evidence to prove ar disprove the validiry of a propher. The counsel is, "Be-

loved, believe nor every spirit, but rry the spirirs wherher they are of God, because many false prophers are gone our inro the world." (1 Joha 4: 1-3). The warning is distincL We are ro put supposed prophets ro the rest to derermine rheir validiry. If we accept rhe advice in the Holy Word and begin the search for evidence, we shollld be able to answer rhe question as ro whether Ellen White qllalifies as a prophet.

Prophets Make No False Statements How do we derect a false prophet? Deureronomy oudines a simple tese. "And the Lord said unta me ... iftholl sa)' in (hine hean, How shall we know the word which the Lord hath not spoken? When a propher speaketh in the name of the Lord, if the thing foUow not, nor carne tO , that is the rhing which the Lord ham not spoken, but the propher harh spoken it presumptuously: thou shalr not be afraid of him." (Deuteronomy 18: 17, 21, 22). Jeremi:m also advises rhar " ... when the word of rhe prophet shall corne ta , men shall the prophet be known, that the LORD hath

550

(ruIy sem him." Oeremiah 28:9). We are not to have an)' respect for a person who c1aims ro be a prophet if his statemenrs are shown to be false. We have seen the evidenee of [he accurac)' and advanced knowledge ofElIe!) White in [he wide scape of subjects upon which she has wri{[en. 1, personally, have nor fOllnd anyrhing in her writings that has proven ro be wrong. Thus far we have seen mat her writings (1) colltain informarion rhar could not orhcrwise "be known ro man, and (2) have proven ro be true. Th se 3ttributes are characteristic of Bible prophers.

APPENDIXX

Mode ofReceiving Prophetic Messages A rhird cr;cerion for dereccing a false propher is the mode of communication by which the prophet receives messages from Gad. "If chere is a propher among you, I che Lord will make Myselfknown umo him În a visÎon, and will speak unto him in a dre.-ul1."197 Consulcing wieh "familiar spirits" such as a spirit OlediuOl, crysca! ball, ar palm reader is rorbidden in rhe Holy Word. 198 John the Revelator repeatedly wroce in the Book of Revelarion, "1 saw... " and "1 looked, and 10..." His wrjrings were descriptions of chings rhac he saw in visions. The Bible speaks of twO kinds of visiollS: "open visions" and "nighc visions." In open visions, rhe individual could be seen while in vÎsion. The aposrle Paul describes !lis well known experience of receiving an open vision while on the road ro Damascus; he was accompanied by severa! companions. He sawa lighc and heard a voic.e. His companions did nor see rhe vision. '99 Daniel, in receiving a night vision, wrore, "There remained no srrengch in Ole, neither is there breach (efe in me." (Daniel 10:17). However, shortly afrerward, when he heard a voice speakÎng ro him, he said, "} was srrengrhened... " (Daniel 1O: 19). Did Ellen Whice receive visions? She used the phrase "1 have been shown ..."; "} saw duc... "; and "It has been shown co me chat...' These expressions indicate rhat she had visÎons. Ellen Whicc was observed ro have opm visions in public meecing halls, in homes, and even while riding in a carrîage. These visions were wirnessed by so many in a large number o()oGuions over a

60 year span chac chey have been well documemed and have received much publicity. Her demeanor during the visions has been described in writing by many observers ar di!ferent cimes. John Loughborough, a friend of Ellen and James White (her husband), wroce chac he had seen her in vision an approximarely 50 differenr occasions over a S8-year period. He describes a typical scene. She would experÎence a complece loss of srrengch for abour a half minuce. "When fairly in the vision, rhe accion ofrhe hearr and pulse was natural, but rhe dosesc tests by medical mell failed ro discover a partide ofbreath in her body. The color of che countenance was natural, and rhe eyes were open, always looking upward, not wich a vacanr stare, .. .1ike rhat of onc looking ineenrly ar some objecr in the disrance. Afrer a momene of weakness, a superhuman power carne upon her."200 Her lack of brearh was dececred by holding a candle flame dose ro her mourh and nose. The brearh cest and ocher observations had been made by various medical professionals ar various times, but always wirh rhe same resuit. Those who were presene did nor see the vision. We see chat rhe mode of receiving illformarion thar she later reveaJed in wririog is similar ro rhe experiences of the prophecs of old. She acknowledged rhac ilie informarion carne from a source oucside herself. Referring to chis higher-chan-human knowledge, she wroce in 1901, "The whys and wherefores of this 1 know noc, but} give you the insrrucrion as ic is given me."201

True Prophets are in Agreement A fourch criterion for derecring a false prophec is agreemenr with ocher prophecs. A principle srared in ilie Old Testament is, "If chey speak noc according ro chis word, it is because chere is 00 Iighr in rhem." (Isai ah 8:20). The New Tescamenc simiJarly stares,

"And the spirits or ule prophers are subject ro ilie prophers. For Gad js nor [he author of collfusion, bur of peace, as in ali churches of [he sainrs." (1 Corinchialls 14:32, 33).'] ·hus. [here will be complete agreemenr from ooe rrue prophet ro anorher. There is

551

PROOF POSITlVE ro be no confusion in comparing the mcssage ofone prophet wich thac ofanother. lf the words of a propher are nor in agreemenc wirh rhe Scriprures, the propher is false. 1 personally have found that Eilen White's writings are in agreemenr wich the Scriprures regarding the advice on health and olher topics. There are millions ofher readers chat would auest to that face. She continually onished her readers co search the Scriptures for rhemselves; her

wrirings are full of quotations from Scripture. She made it c1ear that the purpose of her writings "is not ro belirde the Word of God, but to exalt it and artract minds tO it, that the beautiful simpliciry of truth may impress all."202 Unlike some others who have c1aimed ro be prophets, she had no fcar of seudents of rhe Bible scrutinizing her writings because she was confident that they would find no disagreement between the two.

A Prophet 1800 lears after the Bible? Some may be under the impression that che final prophet of God was the apostle John, who wrote che last book of the Bible. The Scriptures do nor suppon the presupposition that there wiU be no more prophers aher John. The abiliry [O prophesy is a gifr according to Ephesians 4.8. "Wherefore He... gave gifts uma men." Whac were these gifts? "And He gave some, apostles; and some, prophets; and SOUle, evangelisls; and some, pasrors and reachers." (verse Il). For whal purpose? "For the perfecting of the sainrs, for the work of t!le ministry, for the edifying of the body of Christ." (verse 12). For how long? "Till we aH come in the uniry of the faith and of ilie knowledge of rhe Son ofGod, UIltO a perfect ma.n, unto the measure of the stature of the fulness of Christ." (verse 1.3). These ages establish several important poiors abollt prophets. The first is rhar the ability co prophesy is a gift among severai omer gifrs given by God co cenain individuals ofHis choosing. That is, not everyone can be a propher, bur only rhose who have rcceived the gift of prophecy. It also confirms ehar a propher is noe appoinred

552

by any human being ar eieceed by any coostiruency of humank.ind, but is chosen direcrly by God Himself. The third point is rhac the reasons for each of these gifts are clearly srated ro be for the benefit of humaniry. The fourth poinc is that ali of the purposes for prophecy and rhe oeher gifrs have not been fulfilled, since Christians have not "aH come in rhe unity of rhe fa.ieh." Thus, according to Scripeure, ilie need for a prophet exists ar ehis time for rhe sanle reason rhat ehe gifts of evangelisrs, pascors, and reachers are needed. Does EHen White meet rhe criteria stated in these verses of Scripture? We see thar she had a gift thar no one e1se in her time had, which enabJed her ro convey information from a higher-than-human somce, as was true of Bible prophets. She was not appoinced Of e1ected, but chosen by rhar higher power. Her writings reveaJ that she did not volunteer, but was chosen, as was true ofaH of the Bible prophets. Her writings have been and stiH are providing benefit ro humaniry, also rrue of Bible prophets.

APPENDIXX

Come Behind in No Gift in the End Time Norice anorher rext of Scripture sraring rhar we are tO Iack none of rhe gifts in mese lasr days. "50 rhar ye come behind in no gih; waiting for rhe coming of aur Lord Jesus Chrisr: Who shall .usa confirm you ro rhe end, rhar ye may be blameless in rhe day of aur Lord Jesus Chrisr." (I Corinrhians 1:7-8). The Bible predicts in this and many mher places rhat Jeslls will come back (Q this earth. His followers fhar are living ar rhe rime of"rhe end" are ro "carne bdlind in no gi fr. " We are ali aware thar rhe orher gifrs menrioned in Ephesians (pasrors, reachers, erc.) srill exisr in rhe Chrisrian church in aur rime. Is ir reasonable rhar rhe gift of prophecy miglH also be expecred ro exisr? The Old Testament also predicrs rhar

rhere will be prophets ar the end rime. Tile prophet Joel wrore about rhe fmure rime when "The great and rerrible day of the Lord" comes. "1 am the Lord your Gad ... And ir shall corne ro a[rerward, that 1shaH pom out my Spirit upon all flesh; and your sons and your daughrers shaH prophesy, your old men shall dream dreams, yom young men shall see visions ... before rhe greae and reHibIe day of the Lord come." Uoel 2:27, 28,31). We see tllat the gift of prophecy shall be given rhroughollt rhe hisrory of mao umil rhe eod of rime. We see rhat idelHifying Ellen Whire as a propher is in keeping with rhe concepr of a modern prophet. The "dreams" and "visions" refer ro rhe merhods God has used ro communicare messages ro His prophcts, as we have previollsly seen.

A UIOman Prophet? Since ali of the propheric writers of rhe Bible were men, does a woman prophet deparr from rhe pattern of Bible prophets? Female prophers, called prophetesses, are menrioned in a number of places in rhe Holy Wrie, such as: • "Miriam rhe prophcrcss, ehe sisrer of Aaron" (Exodus 15.20) • "Deborah, a prophetess, ilie wife of L1.pidorh" (Judges 4:4) • "Huldah the propheress, rhe wife of

ShaJlum" (2Kings 22: 14) • "rhe prophetess, Noadiah" (Nehemiah 6:14) • "Anna, a peophetess, rhe daughrer of Phanllel" (LlIke 2:36) We see rhar (here were prophetesses in both the Old and New Tesramenrs. Ellen White as a female prophee is in keeping wiili the scriptural pattern.

Inspired Books That Are Not Part ofthe Bible? Some may believe ehar (he Books of [he Bible are the only writings that God has ever inspired, and any wrirings rhar are not inc1uded in rhe Bible c.annoe be inspired. The Holy Wrir mentions books written by rhree prophers, none ofwhich are included in {he Bible. "Now rhe acts of David rhe King, fLrst aud lase, behold, they are written in the book of Samuel the secr, and in (he book ofNaehan rhe propher, and in the book of Gad (he seer .. ." (1 Chronides 29:29).

A book by Jehu is referred ro. "Now the rest of ehe acrs ofJehosaphat, fmr and Last. behold, rhey are written in (he book of Jehu ... " (2 Chronicles 20.34). Jehu is declared ro be a propher: "by rhe hand of the propherJehu ... " (1 Kings 16:7). Thus, Nathan and Jehu are c1early stared ro be prophers, and each wrOte a book, bur rheit books were never included in rhe Bible. Again, EUen Whire's wrirings. altllOugh nor paft of rhe Bible, fie a scriptural pattern.

553

PROOF POSITIVE

Did She Claim to Be a Prophet? In rhe spirit ofhumility, BibJe prophers did nor personalIy acclaim the title of "propher," evcn though theyacknowledged rhat their messages were givcn ro them by God. Did Ellen Whire daim ilie tide of propher? No, she never referred to herself as a prophet. She wrotc, "Early in my yomh 1 was asked several times, 'Are you a prophet'? 1 have evcr responded, 1 am me

Lord's messenger. 1 know rbat many have caUed me a prophet, but 1 have made no c1aim ta this title. My Savior dcclared me ta be His messenger."203 Her attitudc roward rhe ride is in keeping with the prophets of the Bible. They did refer ro each othcr as prophers. Ellen Whire also referred ro rhe Bible wrirers as prophets.

Summary Ofthe Pattern ofBible Prophets We see that Ellen Wllite firs rhe pattern of Bible prophets in each of 9 categories: 1. Her writings, like rhose of Bible prophers, conrain informarion that could not otherwise be known ro man. 2. Her predictions have corne true in a rernarkable rnanner, which is consisrent with mose of Bible prophets. 3. She received her infonnation in visions and dreams, consisrenr with the panern of Bible prophers. 4. Her wrÎrings uphold rlIe writings of Bible prophets and are in agreernenr wirh them. Bible prophers are in agreement with each orher. 5. She was nor voted by any consrituency ro be a spokesman for God, but was chosen direcrly by God. This is true of the Bible prophers. 6. Her writings have been a benehr ro mankind, consistent with the writings of Bible prophets. 7. Her writings fit the Bible predicrion of a living propher at a later rime in world hisrory.

554

8. As a female, she fits the pattern of fernale prophets set in rhe Bible. 9. Her writings are not paft ofrhe Bible, which is consistent with soroe prophers in (he Bible. Neirher Ellen White nor any Bible prophet daimed ta be a prophet. What do we conclude from aiI of [his? The evidence indicates mat Ellen White's wrirings are inspired by rhe God of the Universe. What other plausible explanation could there be? 1 know of none. 1 invite each reader ro decide. Wharever the decision, wiU it affCct che benefit we receive from the wrirings? 1thin.k not. They speak for themselves. As 1 h;we indicated, chey have been a help ro me in my medical work apan from any consideration as to wherher they are inspired by (he God ofHeaven. Paul Harvey asserts, "Since she has been right abolit so many things, perhaps we should examine what else she said." 204

APPENDIXX

How Extensive Is the Influence OfEllen White? $he was a woman of remarkabJe spiritual gifts who livcd most of her life during the nineteenth cel)(ury (1827-1915), yet, throughoue ehe rwenriech cencury, her writings continue ta have a revolurionary impact an millions ofpeople around the world. A large number consider her tO have had the prophetie gifr. During her liferime she wrore more rhan 5,000 periodieal arricles and 49 books with 25 million words; but raday, including compilations from her manuscriprs, more than 100 ticles are available in English. 5he is rhe most translated woman writer in the emire history of literarure and rhe mose translated American author of either gender. 20S Her wric.ings cover a broad range of subjecrs, including hisrory, religion, educa-

rion, healeh, work eehics, social rdationsbips, marriage and family relaeionships, evangelism, moral issues, prophecy, publisning, and management.

N a young girl Ellen White suffered serious health problems that threatened her life, yet she lived a full Jife eo age 87. 5he rraveled widely in [he Unieed 5eares, Europe, Australia, and New Zealand. Her varied roles included speaking before audiences as large as 20,000. Her insighrs inro healthful living continue tO be remarkably accurate concepts rhac are widely accepecd today by the scientific and medical communicy. She also helped ro esrablish a sysrem of hospitais, schools, and publishing houses rhar circles the globe.

Scope Ofa Few ofHer Books Her life-changing masterpiece on successful Christian living, 5reps ro Chrisr, has been published in nearly 150 languages, with well over 100 milJion copies in circulation. Chrisrians and non-Christians alike find valuable counsel in rhis book. Her crowning lirerary achievemenr is ene fivevolwne "Conflict of rhe Ages" series, which traces the hisrory of the conflict between good and evil rrom irs origin ro irs dramatic, soon-ro-unfold conclusion. Four books ebat she has wrirren on rhe subject ofhealeb have previously been menrioned. A very exci(Îng and moving book ehar has personally given me a deeper undersranding of [he life of Christ is rhe book, Desire ofAges. The reader will gain insight as ro the morivations of Jesus as He wenr through some of the experiences recorded in ehe gospels. Many practical Ies..~ons for living a more abundant life are drawn from His experiences and teachings. The book begins before rhe concept ion of Christ and concinues through His dearh, wnen He said «It is finished," and ends aher His resurrecrion and ascension. Christ's Obiect Lessom draws lessons ,

from ehe parables ofChrisr. Parriarchs and Prophers is a hisroric book that deals with the Sacred Record ofGod's people from the time of the creation of rhe world through rhe (ime ofKing David. It draws spiritual lessons rrom the exodus experience and mauy orher hiseoric experiences ofrsraeJ. Educarion is a book rhat rescs an the premise rhat true education embodies [he developmenr of ali four aspecrs of our being: mental, physical, social, and spiritual. le presenrs ehe concepr ehat learning is a lifelong experience. Each evenr in our lives holds a lesson that, righrly interpreted, will gttide LIS inca rhe more abundant life ehar Gad inrended for us. The book recites specific experiences in the lives of Bible characters and poinrs our the lessons that were inrended for those having rhe experience as well as for aur benefic. The Great Controvers}' draws lessons from the history of man aud his rdationship ro God rrom the rime of rhe destruction of Jerusalem in 70 A.D. umil the presenr cÎme. The conrroversy berween truc and false worship is traced through the hiseory of ebe dark ages and ehe succession of rhe greae reformers up to the

555

PROOF POSITlVE presenr. The progressive sreps through the strife alld spiritual vicrories of the Reformation period are clearly ouclined. It culminares with Bible predicrions of lasr day evenrs rhat lcad up ro the second coming of rhe Savior. Each of rhese books has stood rhe rest of rime and alt are available roday. For rhe convenience of rhose who may be inreresred in probing her wrirings, a list of each ritle folJows, wirh rhe name of rhe publisher.

Pacific Press Ministry ofHeltLing MedicaL Ministry Patriarchs (md Prophets Education Great Controversy Desire ofAges

RefermcesCaJdwdl C. How Trouble Came tO Marlboro Counrr)'. Wall StTW lourtllll. Marell,12 1996. QUOlC from lAMA 1950's. ! WhilC EG. 71" Minimy ofHtoling. Namp•. ID: Pacifi I'ress Publishing 1\ssociation. 1905 p. 327-328.

Henningfield JE, Cohcn C. Pickwonh WB. I'sychopbarmacology of nÎcotÎne. In: Orleans CT, Slade J. l' al/d M'lnagtmtllt. New York: Oxford Universily I'r('SS. 1993 p. 27-28.

J

j White EG. Tobacco. In: Ttn/pera'la. Nampa.lD: Pacific l'ress PublishingAssoCi.1lion, 1949 p. 58.

~ US Oepanmenl ofHcaJrh ;U1d Human Serviccs. Tht hMllb cOI/JtqutllrtS ofmlolt·

ing: 25ytal"!ofpTOf,ffli. A T'tfOTtOfthtSllrgeon Gmtml, 1989. Rockville. MO: US Depanmcm of Hnllh and Hum.n Services. Public Heahh Service. Cemers for Diseasc ConlTol. Cenlcr lor Hdlh Promolion alld Edueation. Ofl:iee on Smolcing md Heal[h. OHHS l'ublietrion no.(CO ) 89-8411.

• Hennillg/idd JE, Cohen C, Picbvonh WB. I'sychoplunuacology of nÎcocinc. In: Orlean cr, Slade J. edilOrs. /'v/colint Addiction: Princip~ and Manag'llll1l1. New York: Oxford Univcrsiry I'ress. 1993 p. 24-45. Henninglidd JE. Cohen C. Pickworth W'B. Ps)'choplurmacology of n;corine. In: Orlnn CT, Slade J. ediror.. Nicotint Addierioll: I'Tinci;lfr alld Managmtfllr. New York: Oxford Universiry I'rc"', 1993 p. 30-31.

Pacific Press Publishing Assodatjon 1350 Nonh Kings Road Nampa, Idaho 83651 Tel: (208) 465-2500 Fax; (208) 465-2531 Review and Herald Publishing Association 55 West Oak Ridge Drive Hagersrown, Maryland 21740 Tel: (301) 791-7000 Fax: (30I) 791-7012

Conclusion The purpose of rhis profile of Ellen White is ro make you aware of rhe scope, usefuLless, beaury, and spiritualiry of her wrirings. You will frnd rhar they are uplifiing, and wiU lead you ro a higher plane of personal life in four dimensions-physic.11, mental, spiritual, and social. This is the mote abundanr life (hat Chrisr referred ro: "The rhief comerh nor, but for ro sreal, and ro kill, and ro destroy: 1 am come rhat they might have life, and rhat rhey mighr have ie more abundanrly." Oohn 10; 1O).

Review and HeraJd Counse/s on HeaLth Counse!s on Diet and Foods Steps to Christ Christ's Object Lmons

I

The addresses of the publishing companies are:

, Epps RI~ Manley MW Clinical lnrervcmions 10 Prevcm Tobacco Use by children and adolescents. In: Glynn TJ. Manley MW. HOUlto Htlp }'orIT PatimI'J SIOp SI1wking: A Nillional Cal/CtT IlIslittm MI11U1alfoT PbyririallJ. Nalional JnsrirU[e.~ of Hcallh 1\lblicalion Nurnlxr 92-3064. Rcvised Nov. 1991 p.63. Hcnningllcld JE, Cohen C. Pickworth WB. Psychopharmacology of nic.otine. In: Orleans CT, Slade J. edilOrs. Niculille AIldiction: Prii/tipIc; allrl MtllJlIgmltlll. New York: O"Joed Uni"crsil)' Press. 19'>3 p. 30-3\.

10

Il

Whitc EG. Accivaling I'rinciples of a Changcd Lifc. In: Tlm/"rallcc. Nampa.

ro: Pacific Ple s PublishingAssocialion, 1949 p. 104-105.

McGinnis JM. Foegc WH. Actual e.lIUCS of de:uh in the United Sralcs. lAMA 1993 Nov I0;270( 18):2207-2212. Fig/lTf /ltL/prrd ani IIdjtl$ud/rom fiiII ,miclt.

11

Il US Departmelll of Hcahh and Human Serviccs. TII( beaM coIIJeq"tllw of smohng: 25 JUli"! ~rprog"fîS. A TlpaTI uflbt S/lTf((O'1 GmfTiJI, 1989. Rockvi/lc, MO: US Oeparrmelll of HeaJrh and Human Scrviees, Public Hl'allh Service, CCllIers for Di. case Control, CClller for Heal[h Prornot;on :wd Education, Office on Smoking .nd HeaJlh. OHHS Publication no.(CDC) 89-8411. It Murr.ay CJL, Lopcz A, edilOrs. S/lmmary: Thf Global BIITdrll ofDisfllSf. The World HC'.uth Organualion. BoslOn: Harv.lrd School of Public Ht"Jlth Publishing. 1996 p. 28.

7

, ~'hile Ee. Tobacco. In: Ttmpera'lct. Nampa.IO: Pacific l'ras PublishingAssocialion, 1949 p. 58.

556

U.S. Prevenli"e Scrvices Task Forec. Counscling [O Prevel1l Tobacco Usc. In: Gllitlt 10 Clinical Prtvt1liiVf Savim-? tiition. Bahimore. /viD: Wi/li:uns and Wilkins, 1996 p' 597-609. (aII bmlip, lilltT. andeolonJ Il

16 Newcomb PA. Carbone PP. Thc hcalrh consequcnces ofsmoking. Cancer. Med Cii" Nortb A/111992 M,,;76(2):305-331.

APPENDIXX li Gio\'annucci E. Rimm EB. cr al. A prospl'<:tive "lUd}· of cigawle smoking and risk of eOIOf1?Clal ad"llollla and colorecul cancer in U.S. mCI!. J Natl CltIlar but 19?4 Fcb 2;86(3):183-191.

Gim"\l1Il11cci E, Coldjtz GA, el al. Aprospoctive ml(ly ofcigarclte smokilJg ~nd risk ofco!orecl1J adenoma and coloreelal anccr in U.S. women. JNilt! Gmur Imi 1994 Feb 2;86(3):192-199. 18

Grod ((,in F. Speiur FE, Hunl"r OJ. A prospcclive study ofincidcnl squamous (cII cucinoma of the skin in lhc nurscs' b",tlth 'lUdy. J Nml emer' bw 1995 JoJ 19;87(14); 1061-1066. 19

lfj Newcomb PA. Carbone PP. The heaJtb consequences ofsmoking. Gnccr. Mtd Clill NorJhAm 1992 Mar;76(2):305-331.

While EG. The MilliSl~Y o/Hrfl!ing. cialion, 1905 p. 327-328. 21

alllp~.

ID: Pacific !'ress Publishing A~5o

21 While EG. Manus ript Relca.ses (Volume T/JT(e). p. /15. hmndJn: Ellen G. Whitt Eslatt.. 71u f'lIblislxtlWriiillgs o/Elim G. {ţ1hiU'. Vmion 2.0 (CO-ROM). 1995. l}

poster prescmation can check witlt Or. Z3ng al (914) 592-2600.

19 Coldi12 GA. Bonita R, CI al. Cig:uctlt sllloking aod risk of Slroke in middleagcd womm N Engl] MrJ 1988 Apr 14;318(15):937-941.

Whirc EG. Slimulams. In: Healthfid Livillg. 1897 p. 109. .EID.!llii.!.ll: Ellen G. White Esure. Tbe f'uhlislud W,ili7lgs 0/ ElltII G_ W1hiu. Version 2.0 (CO-ROM). 1995.

40

US Deparlmenl of Hcalth. Educ:uion and WdI,uc. Smoking IlIId HraM: A Rtport oflhr Surgro/l CmUllI. 1979. Public He'tlth Service PubliGuion i9-50066.

41

.2 Gymclbcrg E Lauridsen L. et al. Smokillg and ri,k of myocardia! ÎnE..n::linn in Copenhagen l1ll'n agcd 40-59 Wilh special reJerence to cbeTOoe smoking. ul1ar 1981 Mar 2;1(8227):987-989.

Nalion:.! Cancer JnSlilltle. Smo!rillg Imd Tob,{((o CO>l!rol MOllograph 2. Smolrr1] H Publicllioll NlImbcr 933461. 1992. 43

un Tobltcco or Hril/rh: AII !mmliltiOlIltI P'rtp((tillf.

Nalional Cancer In liuue. Smo/ring and TobIJfCo Comrol MOllogrltpiJ 2. Smo/re· kss Toba((o or Henlrh: All !mtnllJliollal f'mpmilJl. NIH Publicauon Number 933461,1?92,p.1I5.

4

While EG. Ml1ItllsfTipt RelrlJ"es (Volumr SeL·rmrm). p. 42. FOlllI" In: Ellen G. Whjtc ESlate. TiJ, f'ublish~d Writillgs of F:.'lkll G. Whif(. Version 1.0 (eO-ROM). 1995.

;1

Whitc EG. MlJlltlscript Rrkam (Voltlmr Tltm), p. 329-330_ fuundln: E1lcn G. \XIhilt EStaIC. TiJe PublislJtd Writillgs o/Elim G. Whiu. VcrsLon 2.0 (CO-ROM), 1995. 1;

U.S. Prc"clIlive Services Task Force. Counseling 10 l're\'enl Tobacco Usc. In: Gllid~ tO C/iniml I'rrVtI1tivl S,.,vim-2"" u/itiolt. Ballimorc. MO; WiUiams and Wilkins. 1996 p. 597-609. (J Î to 30 t>rrtcul o(IJ/I rardiovaK/Ilar d{ttths ilr.. iltlributed 10 smokillg) !l

U.S. Preventive Services Task Forcc. Counseling 10 Prevent Tobacco Use. In: C/litle tO C!illi(1l1 PrrVfI11iVl Semim-r' ,ditiof/. B"ltimore, MO: Williams:lJ\d Wilkins, 1996 p. 597-609. 1(,

17 foielding JE. Smoking: HeaJlh ElIcas and ConeroI. In: Lasl JM. WalJace RE. editors. kli~~ry-Rostl1a/l-I.lU1 Ptlbli( Htlllth I/Ild l'rtvrmivr Ml'llicilll:-/.3,b tdilioll. Norwalk. (T: Appleton and Lmge, 1992 p. 716-719.

Whirc EG. A Caii \0 Medicli EvaJlgelism and HeaJlh Educ31ion. Jn: Tlie TrllJpertJl1Cf \Vod·. 1?08 p. 38. &wdJn: Ellen G. WhilC ESlale. TI" f'"b/isJJltl IY/rili>lgl 0/ Elli'n G. IVhitl. Velsion 2.0 (CO· ROM), \995.

II

,(, Whire EG. Brealhing Tobacco-Poisoncd Air Wltilc Tra\'cliog. In: MIIIllileript Rllmse> (VolulIle Nincttlll). p. 283. foounclln: Ellen G. While Eslate. 7/" l'ublishrdW,iIÎtJgsofElu-1l G. \'(Ihi~. Version 2,0 (CD-ROM). 1995. <7 RepaceJL Tobacco Smoke Pollmion. In: Orle"ns CI; SladeJ, editors. Ni(otillt lIiYi(tion: Pril/ciplt! Iflld MtlIlI1grmrflt. 'ew York: Oxford UnÎwrs;IY Press. 1993 p.136.137.

·'8

White EG. Tobacco. [n: Trmpm1Jlfe. Narnpa. ID: Pacific Press Publishing Associ:uion, 1?49 p. 58·59. SdlOendorfKC. Kiely JL Rdalionship of sudden inF.un dmh s)'ndrol1Je ro malernal smoking during and aticr pregnanc)'. Pcdiatrics. 1992 Dec; 90(6):905-908.

<9

Nicholl JI>, O'Cathain A. Cjgarcllc smoking md carly tleOnala! dtath. BM] 1988 Aug 13;297(6646);487-488.

Sil

SI Whire EG. TIte Minimy of Healing. Nampa. 10: Pacific Press Pllblishing As ociarion. 1905 p. 328-319.

20) Whitc EG. TrstillJolJies/or tJJe Ch",(h (Volume Fi"e). Nampa. 10: ['acific Press Publishing Associatioll, 1898 p. 440.

12

}O A!sler [~ Br;uldl R. et 'IL E/Teci of nicoline on proslacydin formation in human endocmdium in vilrD. Gm Phllmwo/1986;l7(4):441-444.

13

Cotlon P. Smoking cigarellcs mal' do de\'Cloping fetus more harm Ihan ingc.sling cocainc, somc c"~pcrtS say. JAMA 1994 Feb 23;271 (8):576·577.

}I

Olds DL, Henderson CR Jr, 'Eudb;ulJll R. I'revenrion of inteJleclual impaiIIllem in children of women who smokc cigarmes during prcgn3.ncy. P""ialriel 1994 Feb;93(2):228-233.

fof;1ser GE. Prrlimtille Cardiology. New York. Oxford: O>J"ord Univmicy Prc . ,1986. p. 113.

l< Olds OI-. Henderson CRJr, "J,udbaum R. Inrdlcclual impairmellt in children of women who smoke cigarcllcs during prcgnaney. f'rtli/tlrirs 1994 Feb;93(2):22I227.

foraser GE. PrtwntiVf ('.a,dioloK,Y' Ncw York, Oxford: Oxfold Universily Press, 1986 p. 99.

,\l

)3 Dmmcnl of HC3lh and Human SCf\~ces. nir brIJlth I'Onsrqumw ofrmoking: Cudiova.scular .lista.\(. A "po,1 oftbe SlIrgrolt GlI/tra/, 1983. Rochiile, MD: Oq)arunenl of Hcallh 'U3d Hurnan Scrvicc-s. PlIbliC'.uion no. OHHS (PHS) 8450204, 1983 p. 218.

DanmeJll of HC:llh and Human Services, Tlir ImtltlJ wnseqllcuw o/smokiIJg: C:mliovascular disl':I.~e. II repoTl o/tiu Surgl.'ol1 Gmrral, 1983. Rockville, MD: Oeparunenl of Hcalrh and Human Serviccs. Publication rlO. OHHS (PHS) 8450204. J983 p. 51- 52.

J4

31 Oepaflment of Healh and Human Service.. Tiu Imtllii (OllJf'lUlnW ofsmokillg: c.1rdiova5cuhr disea c. A report oftlte Surgroll Gmiml. 1983. Rockville. MO: Deparll1lclll of Health and Human Services. Publication no. OHHS (PHS) 84· 50204. 1983 p. 55.

White EG. Hornc and Ternperance Crusade. In: C/,ilJ Guitumcr. Hagerslown. MD: Review md Herald Publishing A.\Sociation, 1982 p. 404.

The Tcratnlogy 33rd annllal mceling June 28-Jllly 1. 1993 and rhe Ncurobeh3vioral Teratology Sociecy 17ul annual meeting June 26-29. 1993. Tuc· son, Ariwna. Abmacls. 'urlllolog,y 1993 May:47(5):345-469. II

White EG. Tl':lC.hiog and He:tling Principlc.s. In: Mtdical MiJliSlry. Nampa.lD: Pacific Press Publishing Associ31ion. 1%3 p. 268.

S6

Nalional Cancer Instimre. SmolângaiJdTobacco Comrol MOllogmph /. Smurgirs (Olllrol tobnuo IlSt in Ihe Unired Stltle>: II blllrp,imlor pllb/ic hw!rIJ /1(/101/ il, thr /990s. NIH Pllblicalion Number 92-3316.1991 p. 38-40.

\7

10

I

'IX'hile EG. OicI and Hcahh. In: The Millislry 0/ Hen/illg. Publishing Associatioll. 1905 p. 296.

ampa.ID: Pacitic

Pre~1

White EG. Diet and Hcahh. In: Tiu Millim] o/Hea/illg. N:unpa, 10: Pacir.c J'ress Publishing Associ,uioJl, )905 p. 296.

19

)<;

J7 While EG. Prl<:r j COllliul to Publi.hing Association, p. 26. )8

PtJrfIlIS.

t-!agerslOwn. MD:

Stima Newl 143:46-47. Janua.ry 16. 1993.

RC\~cw

and Herald

Whire EG. FI",h Me<\lS. 10: COIIJlSfis on Dil'f IJrld Foodl. Pres. Publishing Associalion, 1976 p. 407.

6fJ

ampa. ID: Pacific

White EG. COIlTlSlIs 011 Din IJnd FoodJ. Nampa, 10: Pacific Press Publishing Association. 1976 p. 313.

61

(,2

Aslr.lnd, Per-O!af, Murilion Today 1968;3(2):')·11.

557

PROOF POSITlVE While EG. Diel and HeaJth. In: T!Jr Minirlry 01HfII!i,tg. Nampa, ID: Pacific Press Publishillg Associalion. 1905 p. 296.

6)

Adam O. NUlririon as adjuvam lherapy in chronic polyanhrilis. Z Rlmmll/lo! 1993 Sep-Qcl;52(5):275-280.

&l

Moriyama 1; Ue'lll K. el al. EffcclS of diel:lry phosphalidylcholine on memory in memory deficienl mice Wilh low brain aceryldlOline conccmraOon. Uft Sâ 1996;58(G):PLlII-8.

65

66 Floyd EA, Young-Sciglcr AC, cr al. Chronic elh.,nol ingesrion produce. cholinergic hypofunaion in raI brain. Alco!Jo! 1997 Jan-I:eb; 14(1):93-98.

., OUlbreak of aCUle gaSlCocnrerici~ anributablc to Escheric.hia coliserorypc OI 04:H21-Helen:l, Monuna, 1994. MM\VR Morb Morta! Mly Rep 1995 Jul 14;44(27):501-503. S~ Craig WJ.

Arc You SaIe al lhe Plale. In: Nu./riri07Jlor Ih, Nintries. EauClaire, MI: Golden Harvesl Books, 1992 p. 267-279. Salmollella enrcritidis infcclion. (pamphJe.l) Ccnlers (or Disease ControUNarional Ccnrcr lor In(eccious Diseases; US Dept of HHS; Novembcr 1992.

116

Conununiry oUlbreak ofhemolyuc uremic syndrome amiburable to r:.scht'richia coli 0.111 :NM-SoUlh Australia 1995. MMWR Morb Moria! Wlt(y R~p 1995 Jul 28;44(29):550-1. 557-558.

87

Boksa P, Mykra S. Collier, B. Arachidonic acid inhibil.' choline upl.1ke and deplercs acetylcholine coment in raI cerebral corrical synaptosomes. } N(l/7YJcbrm 1988Apr;50(4):1309-1318.

•.~ OUlbreak ofEscherichia coli O 157:HÎ infeaion-Georgia and Tenncssee, June 1995. MM\'(IR Morh Morld! Wk/y R,p 1996 Mar 29:45(12):249-251.

68 GUYlOn. A.C. 1991. TCXlbook of Medical Physiology (ed.8). Phibdelphia: W. B. Saunders Co., p.684-685.

tIIl\Y/kly Rep 1992 Apr 17;41(15):251, 257-258.

Ş?

Update: (oodbomc lislcriosis-Unired StalCS, 1988-1990. MMWR Morb Mor-

Jacobson MI'. Lcffcrts LY, Garland AW. Meal. Poultl)', and EW' In: SIJj( FooJ: Etlti1lg Wi1r1y in a RiSA'] World. Venice, CA: Living Planel Press, 1991 p. 91-92.

fiii

Whil.e EG. COImrr!s un DittdlJd Foods. HagerslOwn, MD: Rtview and Herald Publishing Associarion, 1976 p. 386.

90

70

Hcnnessy ·1W. Hedbcrg CW. Slulsker l., el al. A national ourbreak of saJmonella enrerilidis infccrion.s &om icc ([om. N Eng!} Mtd 1996;334(20): 12811286.

Schwam B, Cicsie!5ki CA, er al. Association or sporadic listeriosis Wilh conswnplioll o( 1I11cooked hOl dog. and undereookcd chicken. LanUl 1988 OCt 1;2(8614):779-782.

71 OUlbrci o( SalmoneUa emericidis associalcd with nalionally dimibUlcd jcc cream prodllcr_Minnesora, SOUlh DakOla, and Wisconsin, 1994. MMWR Morb MoritJ!Wkly Rrp 1994 Ocr 14;43(40):740-741.

91

,t

Whirc EG. Cou.llJe/s 011 Ditl and Foods. Hagemown, MD: Revicw and Herald Publishing Association, 1976 p. 359.

71

,J Wbile EG. Diet and HeaJlh. In: Tht Mil/islry oIHfI1/ing. Nampa, lD: Pacil1c Prc.ss Publishing Assoeialion, 1905 p. 302.

7l

9-1 Gram I R, Baii H), el al.. Inacrj\'arion of M}'Cobactcrium par.ll11hcrculosis in cows' milk at pastellrization IcmperalUlCS. Appl EtlViron Microbio! 1996 Feb;62(2):63 1-636.

Tappero JW, Schuchar A. er al. Reducrion in rhe incidence o(human lisreriosis in the Unilc:d Slalcs. E!lectivene§ ofpl"C\'enl.ion dTorrs?The Listcriosis Srudy Group. lAMA 1995 Apr 12;273( 14): 1118-1122. Updale: foodbome Iislcriosis--United Srarcs, 1988-1990. MMWR Morb Mor-

IA!Wlt/yRrp 1992Apr 17;41(15):251, 257-258. A, HlIghcs RA. Campylobacrer jcjuni infecrion and GlIiUain-Bam' syodrome. N fllgl} Ud 1995 Nov 23;333(21):1374-

95 Cbo SN, Brennan PJ, el al. Mycob,tc.terial aCliology o(Crobo's di.easc: serologie snldy using common mycobaclerial antigens and a speeics-specific glycolipid amigen from Mycobaclcrium paraluberclliosis. GIIl 1986 Nov;27(1 1):1353-1356.

1379.

%

7~

Gtl1lromrrro!ogy Obl'lv'I 1995 Nov'/Dec. 14(6):4-5.

7~ Rees JH, Soudain SE, Grcgson

Recs JH, Soudain SE, el al. Campylobacter jejllni infection and Guillain-Bam! syndrome. N EIIg!} MnJ 1995 Nov 23;333(21):1374-1379.

76 Craig WJ. "Arc You Safe al Ihe PlaI'•.' In: Nmriliol/ for r/'r NinttitJ. EauCbire, MI: Golden Harvcsl Books, 1992 p. 267-279. UpJale: mullistate ourbteak o( E.-eherichia coli 0157: H7 infections from hamburgers-wwern Uniled Stales. UMWR Moro Morta! Wk!y Rep 1993 Apr 16;42(14):258-263.

77

7~

Badr, KF, Brenoel BM. Vascu1ar Injury 10 t!le IGdney: HemolYlic Uremic Syndrome (HUS) Aud Thromboric Thromhocyropcnic PurpurA (TIP). In: Isselbachcl K), Br.mnwald E, cdiwrs, er al. Harrijon, Princip!er olImtnur! Mcdiciur-13'}, ,dliion (CD-ROM). Ncw York, NY: McGRAW-HIl.L, Inc. HcaJth Profc§ions Division, 1994. MacDonald KI~ OsterhoLn MT. Thc emergcncc of Escherichia coli O157:H7 infection in thc United Slarcs. The. changing epidemiolog)' o( (oodborne disease. lAMA 1993 Mar 5;269(17):2264-2266. 7')

USDA:APHI$:VS. Es,/'rric!Jia roli O 157: H7: issut'salld Ramificarions. March 1994. Cenler< for Epidt'miology and Animal Hcalth. Fort Collins, Color..do_ P. 5-1. IJ<)

SI Ccnrers for Dise.1SC Comrol and Pre\·cmion. 1992. Updale: Foodborne Lisleriosis United Stalel, 1988-1990; MMWR 41 (15};25 1.257-258 Apr 17, 1992. 81

Hennessy TW, Hedberg CW: er al. A national oUlbre.1k o(SalmoneUa emerili-

dis in(ec.tions from ia: cream. The Invcstigarion TCaln. N Eng!} Med 1996 May 16;334(20}: 1281-1286. OUlbreak of SalmoncUa cmericidis associaled wilh nalional1y dimibured jce = producls--Minnesora, Soudl Dakar::a, and Wisconsin, 1994. MMWR Morb Mort4! Wltly R~l' 1994 Oer 14;43(40):740-741.

8.1

558

Anon.ymous. Mycobaclc.rium pararubercuJosis implicared in Crohn's Discase.

Whire EG. Flesh as Food. In: TI" MillillryoIHM!j1lg. Nampa, ID: Pacific Prcss Publishing Associarion. 1905 p. 313.

97

Johnson R, lG.neene Jn. 1991. Bovine u:ukemia Virus. Part m. Zoonotic Porential, Molecular Epide.miolog)', :lJld an Animal Model. Compendillm on Conlinuing Edllcation for the Pl':lclicing Vcterimllian 13(10): 1631-1637.

?S

USDA:APHIS (Animal alld Plam Hcalth Inspeclion Service). DxMonitor: Anima! Htl1!tJJ Rtl'0rl. Winter 1995. Forr Coliins, Colorado. P. 6-7. (Note.: Florida in

99

the 3'· 'luaner of 1995 had 31 of 42 canle tesred posicive for a rale of approx. 74%). Archambaulr D, Nadin-Davis S, el al. The Bo\'ine lmmunodcfcdcncy Virus: 1990-1992 Updale. Vrl ~r 1993;24(2):179-187.

100

101 Van Der Maalcn MJ. Updalc o(Bovine Leukosis Virus and Bovine Immunodel1cicney Virus. TNAVC 1993 Procccdings. Pagcs 614-615.

Whiee EG. Flcsh as l'ood. [n: Thr Ministry 01Htaling. Nampa, ID: Pacific Press Publishing Associarion, 1905 p. 313.

101

103 Chiu nc, Ccrhan JR, er al. Diet and risk of non-Hodgkin Il'mphoma in older women. lAMA 1996 May 1;275(17):1315-1321. 1(>\ Chiu BC, Cerhan JR, el al. Dier and risk of non-Hodgkin Iymphoma in oldcr women. }AMA 1996 Ma)' 1;275(17}:1315-1321. 105 van dcn Brandr PA, Goldbohm RA, el al. Cross-seclional venus longiludinal invcsrigations of rhe diel-c.allCCl rc!arioll. Epidt7llio!ogy 1990 Sep;1(5}:402-404.

106 SSleinmc17. KA, POllcr JD. Food-group consumplion and colon cana:r in lhe Adclaidc case-control Study. 1. VcgelabJes and fruir. 111/ J Canur 1993 Mar 12;53(5):711-719.720-727. 107 GioV3nnucci E, Rimm EB. et al. Inr::akc o( fal. mc;ll, and l1hcr in relation ro risk of colon cancer in mcn. Canur &j 1994 Mal' 1;54(9):2390-2397.

APPENDIXX 108 Senilo E, Obradol A, el al. Apopuhtion-based casc·control smdy ofcolorcelal canccr in Majorca. 1. Dimry hlclOrs. 'm} c,1'Iter 1990 Jan 15;45(1):69-76.

I I Jacobson JL, Jacobson SW. Inldlccrual impairnmll in childrc.n exposed ro polJ'chlorinalcd bipheoyls in Ulero. N Engl} Med 1996 Sepr 12;335( 11):783-789.

Willerr \Ve, Slampfcr MJ. " al. Rciation of me:II, Eli, and fiber inrakc 10 Ihe risk ofcolon ca.nc.er in a prospeclive sludy among womcn. N Eugl] M,d 1990 Dec 13;323(24): 1664-1672.

1)2 WhilC EG. Corlllsris 017 Din and Foods. Hage~lown, MD: Rcvicw and Herald PublishingAssocialion, 1976 p. 354.

10')

Fcnncrry MB. HcLicobaclcr pylori Archivts offII/muti Mtdicillt. 1994 April II. 154(7):721-727.

110

While EG. Comut!J OII Di" ami FoodJ. HagcrslOwn. MD: Reviewand Hcr.lld PubLishing Associarion, 1976 p. 391 III

Whire EG. Fbh Foods. In: HfaMfi" Livillg, 1897 p. 105. Em!n.d..l.!l: Ellcn G. WilllC Esla!e. TJI( PublislJtd Writillg< ofElltll G. \'IIlJiu. Vmion 2.0 (CD-ROM), 1995.

1J 1

Schardr O, Schmidl S. Fishing for Safe Se-dfood. NUIn'N'OU Aeriou Hta'rh Lmrr 1996 Nov;23(9): 1,3-5.

llj

II Food and DOII: iSlralion (FDAI daIa acror
l)j While EG. Dict :Ind HcaJrh. In: TI" Miniury ofHraling. Nampa, ID: Pacific Prcs. Publishing Associarion, 1905 p. 302.

IJoI Pcng SK. Morin RJ. EITccrs 011 membrane fUIlClion by ,holcsrerol oxidarion deri\':lrives in culrurcd aonic smooch muscle cells. Arrery 1987;14(2):85-99. Hubbard RW, Ono Y, Sanchl.°z A. Atherogenic ciTec! of ox:idi.zcd producls ofchobrerol. Prog Food NUlrSei 1989;13(1):17-44.

us Peng SK. 'l'a)'lor CB. Alhcrogenic EilecI of Oxidized Cholcslerol. In: Pcrkins EG, Visck WJ, edirors. Dinary FIIIs dlld Hufjf). Champllign, IL: American Oii Chemisl' SOCiel)'. 1983 p. 919-933. IJ{, Peng SK, Taylor CB. Alhcrogenic EiTea of Ox:idi;ted Cholcsterol. In: l'crkins EG, Visck WJ, edicors. Dinary Fals arId Helllth. Champaign. [1..: American Oii Chc.mists' Societ)'. 1983 p. 919-933.

MiUcr RW. Get Hooked on Seafood SafCty. FDA COfuuma. June 1991 p. 7·

137 White EG. CoullJrls OII Din IInd FoodJ. Hagc.rstown, MD: Review and Herald Publishing Associalion, 19i6 p. 333.

Food :Ind Drug iSlration (FDA) data according ro: Schardr D, Schmidr S. Fishing for Safe 5"'lfood. NurririoN Aerion Hetl!lh urltr 1996 Nov;23(9): 1,3-5.

PCJlg SK. Tarim CE. Atherogenic Effecr of Ox:idizcd CholesteroL [n: Pcrkin.s EG, Visck W), cdilO~. Ditlil')' FIIIS and He(lllh. Champaign. IL: Americon Oii Chcmisrs' Sociery, 1983 p. 919-933.

III

II. J 16

J 17 ''''''ite EG. Flesh Foods. [n: HCillthiul IiI/ing, 1897 p. 105. round In: ElIcn G. While Estale. 1'lJf PublisJl(d WriringJ of Elim G. Whilt. Version 2.0 (CD-ROM), 1995.

118 Craig WJ. Fishing for Trouble. In: Nrmitioll For Thr N;n(lirJ. Eau Cb.irc, MI: Golden Ha.IVCSI Books. 1992 p. 76-84.

1;8

lJ9 Pcng SK. Morin RJ. Eifecls on membraJle function by cholcslerol oxidarion deri\'atives in culrured aonic smoolh muscle cells. Amry 1987;14(2):85-99. Hubbard RW, Ono Y, Sancha A. Atherogcnic effccr ofoxidized proollClS of,hoIcslcrol. l'rog Food NUldei 1989:13(1):17-44. 1<0

Peng SK. Taylor CB. Achcrogcnic Elfecl of Oxidized Cholcsterol. [n: Perkins

Cr:lig WJ. Fishing for Trouble. In: NU/ritiOll For Tht Nintlifi. Eau C1:llrc, MI: Golden Harvtsl Books, 1992 p. 76-84.

Chemim' Societ)', 1983 p. 919-933.

NicoLa RM, Branchllowec R, Pien:c O. Chcmklll conlaminallls in bOllomflsh. }oumal ofEuvironmtlllili HelllrlJ 1987:49(6}:342-347.

J'resş

111

Hovinga ME. Sowers M, Humphrcy HE. Eo\'uonmema! cxposurc :uld lifesryle prediclOrs oflead. c"dmium, PCB, and DDT levels in Greal I..akcs fisb ealCfS. Areh Envirofl Htillth ]993 Mar-Apr;48(2):98-]04.

141 Frascr GE, Sabate J, el al. A possible protecrivc effccl of nut consumplion on risk ofcoroll:lry heart discase. Thc Advc.ntisl Hcallh Study. ArclJ Intr", Mrd 1992 lui; 152(7): 1416-1424.

121 Falck FJr, Ricci A Jr, el al. Pesticîdes and polychlorinaled bipilenyl rc.siducs in human bceast lipids and chei! rcbtion 10 brcast cancer. Areh Environ HraM 1992

14) Sabate J, Fraser GE, el al. Ef!'ecls of ,,/alnUIS on scrUIll lipid Ic\'e1s amI blood pressUl(' in normal meD. N Engl} Med 1993 M3J' 4;328(9):603-607.

119

'lO

Mar-Apr;47(2): 143-146. White EG. Flcsh Foods. In: Htalrhful Liviflg, 1897 p. 105. .fuu.n.d...l!l: EUco G. \XlhilC Es,ale. ŢJ" PubliJJmi Wririflg>' of Eilm G. Whiu. Version 2.0 (CD-ROM), L995. 12)

124 Food md Drug i5l:r:llion Pc,\cicidc Program. Raiduc Moniloring 1992. }oumal oftht AJsociluion ofOgieial AJlalytielf! CJmnislS. Volwne 76: Seplemberl Octobcr 1993.

IlS Nicol:t RM, Branchflower R. Picrce D. ChcmiCl.1 conlaminants in botlomfl5h. }ollmal ofElwironmtnral HraM 1987:49(6):342-347.

Hovinga MI:., Sowcrs M, Humphrcy HE. Environmcmal cxposurc and tifcsryle predictors oflcad, cium.. pca, a!ld DDŢ lc\-els in GrealLakes fish calers. Arch EfII,iroJl Hrill:h 1993 Mar-Apr;48(2):98-104. 126

EG. Visek WJ, cditor . Dinllry hur ilnd HMlth. Champaign. IL: American OiI

1., While EG.

Diet:tnd Htalth. In: Tiu Mi'IÎsrryqfHmlillg. Nampa,!D: Pacific Publishing Association, 1905 p. 298.

"1 White EG.

Oiel and Health. In: nu MilliJtry ofHtaling. N:unpa,lD: Pacific Press Publishing .Association, 1905 p. 298. Krilchevsky D. Die=y fal and experimemal athcrosclcrosis. fIII} T/JSue Relld 1991;13(2}:59·65.

145

146 Rimm EU. Slarnpfer M], el al. ViramÎn E consumprion and the risk of coro· nary heatt discasc illlllen. N EllglJ Med 1993 May 20;328(20): 1450·1456.

1.7 WhilC EG. Dict:tnd Hralch. In: Tht Milli,rr)' ofHrlllillg. Nampa, ID: Pacific Press t>ublishing .Association, 1905 p. 300. t48 Craig WJ. Nraritioll for Ihr NillrtifJ. Eau ClaiIC, M[: Goldcn HalVC5t Books 1992 p. 44.

14?

Burkitt D. NlItritwn Todlly JanlFeb 1976, p. 6-13-

Haskcll WL, Spillet GA. Ct al. Role ofwaler-solublc die(:lry liber i.n chc managemenI of c1C\':llet! plasma cholcstcrol in ill':llrhy subjecls. Am J Cmliol1992 Fcb 15;69(5):433-439.

117

Roscnrnan KD. Dioxifl, polycMorirlilled biplJnryls, l171d dibmZiJftlram in EnllirOUJlltJItlrl dud Oceupilli011l11 Medicinr-2"d tliitiofl (editor: WN Rom). Boston MA: linIe Brown :Ind Co, 1992 p. 927·933.

IlO

ilS

Rosenmm KD. Dioxill, polychlorinaud biphtnyis, lI11d dibmZQiurafls ill fnvirollmentalil/ld OecupariorMI Medjeiflr-2"" ,tlirion (et!iror: WN Rom). Boslon MA: Linie Browo and Co, 1992 p. 927-933.

15t Khaw KT, Barreu-Connor E. Dictar)' fiber and reduced ischemic he.lI! discase Jllonaliry nues in mcn a.nd women: a 12-year plOspecrive study. Am} Epidemio' 1987 Dcc; 126(6): I093-11 02.

129 [gbedioh SO. EfTecls ofagricultural pcsticidcs on humans, animals and higher plallls in dc\'e1oping coun!cics. Areh Enl1iroll Health 1991 JlIl.Aug:46(4):2 18·224.

112 WhilC EG. Malcrials Used in Principles ofTrue Scirnce. [n: MOllumipl &lLiJJ(s (Volume Three). p. 350. fuundln: EUen G. While Esule. 1IJ( PliblisJJ(d Wrilillg< ofEllen G. WlJiu. Version 2.0 (CD-ROM), 1995.

1.\0 Colborn T. AnimaUHcalch COtlJ1eaioIl. In: Proeuding>' ofrlJ, VS Erwiro71mmtiI! ProltelÎoll Agmrys NllfÎomrl7i:ehllielll WorkslJop "PCBs i'l FislJ 7umt." Seple,"ber 1993. EPA/823-R-93-003; p. 2-27 102-30.

Ilj

Lau B. G'lrlie for HraM. Wilmom, WJ: Lotus Publicarions, 1988.

559

PROOF POSITTVE 1~4 Whire EG. COllllJrU On Din l1Iu/ Foods. Hagerslown. MD: Revic."W and Herald l'ublisbing ksociarion, 1976 p. 353-354.

Mitchdl nw, King DJ. Efrccr of negative air ioniZ3tion on airborne transmision of Newc:lStle di.scase virus. Avioll Dis 1994 On-Dcc;38(4):725-732.

180

n While EG. COllmeu OII Din ond Foods. HagclSlown. MD: Revicwand Herald Publishing Associ'lion. 1976 p. 354.

181 Giannini AJ. Jones B'l: Loiselle RH. ReversibiHty of seroronin irritation syn· drome wirh aunospheric aniom. j Clill PJycbilltry 1986 Mar;47(3): 141-143.

1\6 WhilC EG. The Organs of Digeslion. In: HtlllJhjul LiIJilJg. p. 167. fm!lliUn: E1Jen G. While Esrare. TIJt Pllblishtd \Yfritings ofElltII G. Whirr. Version 2.0 (CD· ROM). 1995.

182 Gabbay J. Bergmon O. el al. Et1et:1 ofioni:wio/l on microbiaJ ai, poUurion in lhe denral dinic. Etwirtlll Rts 1990 Jun;52(1):99-106.

Armmong n. Doli R. Environmenral fanors ,nd canca incidence and mortalirv in difl"rem counrries. with special rebcnee ro dicrary pranices. bl! j emar Iim Apr 15;15(4):617-631. 117

1 8 Whire EG. COUIl Ils On Din olld Foods. Hagmlown. MD: Review and Herald Publishing Associalion, 1976 p. 421. 1\9 Whire EG. COl/IlSeu on Din o/Jil Foods. Hagemown. MD: Review and Herald Publishing ksociarion, 1976 p. 424.

160 Ja obsen BK. Hansen V. C1fleine and healrh. Br MIt! j (Cli)l Res Ed) 1988 Jan 23;296(6617):291.

Griflllhs RR. Bigelow GE. liebson L'\.. Human Coflt'" Drinking: Rcinforcing and Physical Dependence·Produeing Efrecrs ofC1ffein~ In: Harris LS, editor. Prob· ImlJ of Dmg Dlptrulma. /986. N1DA Re.search Monograph 76. US Depr. Of Healrh And Hum:l.Il Services Publication No. () 87-1508, 1987 p. 161

16~ While EG. COllnu/s on Din 1I1Id Foom. Hagerswwn. MD: Review and Herald Publishing Association, 1.976 p. 173.

Muhcws R. Imporran e of breakfm 10 cognilive performance and health. PmpmiIJfS in Applitd NlliriliOIl 1996;3(3):2 1O.

16!

II'; BeUoc NB. Rd:uionship of heaJth pra liccs ~nd morraliry. PreIJ Mtd 1973 Mar;2(1):67·81.

16\ Kaplan GA. Seeman TE. el al. Morralit), among the e1derly in the Alameda Count)' Srudy: behavioral and demographic risk factors. Am j Public Htlllt!J 1987 Mar;77(3):307·312.

183 Whire EG. Choice and Prepararion of rhe Home. In: Tii, MiT/islry ofHlolillg. Nampa, 10: Pacific Press Publishing Association. 1905 p. 365. 18< Linder J. Herren D. el al. Efli.'Ct of omne 00 physicaJ performance Clpaci!)·. Soz PrntltJllilmltd 1987;32{4-5):251-252. 18\ Neher JO. KoenigJQ. Health efTeCLS ofoutdoor ai, pollution. Am film PlJysirillll1994 May 1;49(6):130/7-1404. 1407-1408. 186 Abbey DE, MiJls PK, er al. Long-lerm ambienr conCt~ntralions of total SlJ.\pended particulare< and oxid:lIllS as rdaled tO incidence ofchronic disease in Californ;'1 Sevcnth-Day Advelllist<. Dwiroll Httllth Pcrspm 1991 Aug;94 0:43-50. 1. White EG. E.~ercisc and Air. In: 7istimollirsfor tbt CIJllrch, Voluml2. Namf,a. ID: Pacific Pless PublishingAssociation. 1868-1871 p. 525-526.

ISS Blair SN, Kohl HW 3rd. el al. ClJ,mges in phy.ical limcs5 and all·call5C mortal· iry. A prospecliveslud)' of healrl1)' and unhealth)' lllen. JAMA 1995 Apr 12;273(14): 1093-1098. 189 Wingard Dt., Bcrkman I.E Monaliry ri.k associated Wilh slcing parterm among aduhs. Slnp 1983;6(2): I02·107. 1'lQ Breslol\' L. Ensuom JE. PersiSlencc of heallh l13bits and their rdaliomhip ro monaliry. Prlll Nltd 1980 Jul;9(4):469-483.

191 Bla.ir N. Kohl HW 3rd, cr al. Ch;l.Ilges in physieal filnes5 and all-emse morrnJ· ily. A prospectivc stud)' of healthy and unhcaJthy men. JAMA 1995 Apr 12;273(14): 1093-1 098.

In Paul Harvey New. March, 1969.

11....,

19 White EG. The Impending Conflicr. In: GTlIlf COJllrovmy Brru'ttll Christ Imd St!roll. ampa, 10: Pa ifie Prcss PubJishing ksociarion. 1911 p. 588, 589.

Whirc EG. Dier. ln: Htallhfu/ tivillg. 1897 p. 86. Found In: ,ElIm G. While utare. 71Jt Publish,d l'Vrilillgs ofElim G. \"'hiu. Vmion 2.0 (CD-ROM). 1995.

194 Reid GE. And the World Wondcrs. In: ElIt1IlIllbt Door. HagerslOwn. MO: Revicwand Herald Publishing Associ,tion. 1994 p. 69. Quoting USA TODAY. March 30.1994.

White EG. Temperance and Dielelics. In: Educntiol1. Nampa. 10: Pacific Press Publi hing Association. 1903 p. 205.

167

168 Potler JD. McMichad AJ. Dier aJld cancer of the oolon and reClum: a case· control smdy. j Nori Cllllar Imi 1986 Apr;76(4):557-569. 16' Beajlo E, Obrador A. el al. Apopulalion-based case·control sludy ofcoloreeral Glnw in Majoreo. 1. Dierary faaors. llll J C1nw t 990 Jan 15;45(1):69-76.

dc Verdier MG . Longnccker MI'. Earing frequcncY-:1 neglected risk rnctor for colon c:U\ccr~ Gmerr emsts Conlrol1992 Jan;3(I.):77-81. IN

While EG. Cormsel. 011 Din ond Foods. Hagerstown, MD: Rcview and Herald P\lblishing i\ssociarion, 1976 p. 181. 171

Caner JP, Brown J. Dr. Cupp's Simple Approach to \XIeighr Loss. jOllTlwloflhr LOllisiona Sili/( Medicizi Society 1985; 137(6):35-38.

19~ Reid GE. And the World Wondcrs. In: E,ltll 01 rbr Door. Hagerstown. MD: Rcview and Hwld Publishing Association. 1994 p. 69. Quoring Rod] MOU1110in N~ws, Dtlwtr. March 30. 1994. 1% Whire EG. Selccted Mes.
197

Nuruhers 12:6. 71Jr Holy Bible. Alllh ri,cel IGng James Versioll.

198

!..e"itieus 19:31. Tht' Ho{y Biblr. Aurhorlzoo King J;unes version.

1?9

ACIS 9:3-7. 71)t f10ly SiMr. Allloorized IGng Jamcs version.

In

\XIhite EG. COIITIJeu 011 Die/ Imt! Foods. l-1agerslOwn. MD: Re"iewand Herald Publishing Associarion. 1976 p. 310. 17

I;~ While EG. General Hygicne. In: 17}( Millistry o/Htalillg. Nampa.lD: Pacific Press Publishing Associalion. 1905 p. 274. l7S

Baldwin BE. \X'hy is frcsh air frcsh? joun/alofHealtl} tflldHrirlillg Il (4):26-27.

17r.

Bald,,~n BE. 'l(lhy is fresh air frcsh? joun/alofHtlllllJlmd Hralillg II (4):26-27.

Duflt-.e RA. Koonrz RH. Ikhavioral efreCl ofioni1.Cd air an rau. P,-)ehophysiology 1965 Apr; 1(4):347-359. Jordan J. SokolofT B. Air iOJlÎ22tion. age and maze leaming of raLS. j &rontol 1959;14:344-348.

118

I7'J ReiUy T. Slcvenson le. An invesrigation of tbe efttclS of negari\'e air ion on l'('Jponses ro submaxiJllaJ excrcise ar difrerelll times of day. j Hum Ergol (1ol70) 1993 Jun; 22(1): 1-9.

560

l.OO Loughborough JN. HC:l\'enly Visions. In: Rcview anei Herald, August J. 1899. A. found in: Adventisr Pioneer Librar)'. \V/mu oflhr PiolutrS (CD-ROM) Second

Edition. 1995. ~Ol

White EG. COllnsru 011 Din ol1d Foods. Hagersrown. MD: Rcviewand Herald Publishing i\ssocialiOI1, 1976 p. 344.

White EG. 71u f;liliJ 1 LiVl By. Hagerstown, MD: Revicw and Herald Publishing Associacion. p. 295.

lOZ

White EG. Slluud Mml1gls (Book 1). Hagersrowo. MD: Review and Herald Publishing Associarion. p. 32.

203

104

Paul Harvey News, March. 1969.

Ellen G. Whire Estare Branch Ofllee. Andrews Universiry. Berrien Spring . Michigan 49 J04. htlp://w"w.cgwestale.andrews.eduJabour.cgw.htmJ

20\

How to Reliably Combat Disease and Achieve Optimal Health through Nutrition and Lifestyle •

Includes ali material in the book (all texr, references, illllstrations, and charts) plus addirional marerial not included in the book.

•

Search emire work. references, and illllsrrations for key words, diseases. remedies, etc.

•

four~color illustrations and charts ro primer (or making overhead rransparencies or slides. Use illustrations for computerized presemations.

•

Inc1udes cutting-edge biochemistry, physiology, anei pathophysiology mechanisms not included in the book, with associated references anei additional illustrations.

•

Purchase of CD-ROM includes purchase of permission ro use any or all material in the book for public presentations or other lIse (credit must be given somewhere in the presentation).

)

00

Caii 580-223-5980 to lordelt

How to Reliably Combat Disease and Achieve Optimal Health through Nutrition and Ufestyle "It is not easy ro teliably synthesize medical and sciencifie teehnical jargon imo readily understood language for the informed lay reader. But Dr. Nedley has done a masterful job in doing exaer1y this. I highly reeommend PROOF POSITIVE for a reliable source of information. n - T. Colin CampbeU, Ph.D., Professor of Nutritional Biochemistry, Cornell Universiry. Author of China Srudy and numerous nutrirional research articles.

PROOF POSITIVE is a marvelous undertaking. It is exrreme1y well referenced, highly readable, very informative book that is beautifully illuscrated and, if I dare say, quire enjoyable. It deserves to be in the hands of every thinking person and undoubtedly wilt need ro be translated imo other languages. The sryle is easy to read; it gives a personal feellike Dr. NedJey is speaking with the reader, not just talking down to him. Its contems are very understandable despite the profound depth of sciemifie information being conveyed. It also makes a strong statement in favor of the study of health and disease in thc context of Judeo-Christian meoIogy, in general, and of the wisdom of our Crearor specifically. Awork ofthis robust a seape that Dr. Nedley has put form is unparalleled in the eurrem literarure.-Zeno Charles-Marcel, M.D., Medical Director, Lifesryle Cemer of America. It is said mat "knowledge is power" and more imporrandy "wisdom is discretion." Dr. NedJey has gathered with careful discretion, from the vast arena of knowledge and experience, this extremely valuable reSOUIce ofwisdom to guide us in the most important health care issues for our time. PROOF POSITIVE is c1early developed for understanding and use by health care providers and the general public alike. Lifesryle intervention is the key for optimal healm recovery aud maimenance. If this message is received with corresponding aetion, the heaith care and moral crisis of today would be minimized dramatically.-Bruce R. Hyde, M.D., Medical Director, NEWSTARŢ@ Lifesryle Center, Weimar Institute.

"Doctor Nedley has hit a home run with rus Iatest Iitcrary masterpiece PROOF POSITIVE. Moreover, this very readable book is apdy subtided How ro Reliably Combat Disease and Achieve Optimal Health through Nurrition and Lifesryle. It offers olltstanding resource material and superbly drawn visual aids for healm-educators as well as many unique contributions to currem sciemiJic understanding about lifestyle issues. Docror Nedley's chapters on violence, brain science, stress, cancer prevemion, and hearr disease reversal contain much new information. Documemation is abundant, enabling further research inco each subject. The book is very readable, easy to understand, and well illustraeoo. r would suggesr that anyone imereseed in personal health. Iiving longer, or teaching the optimum lifestyle to others should acquire this book and study it carefully."-Richard A. Hansen, M.D., Medical Director, Poland Spring Health Institute. "Dr. Nedley's book PROOF POSrTlVE is ooe of the most comprehensive sources of sound references for promoting healm ever compiled. 1especially appreciate the excellem ilIustrations and figures which give this work worldwide appeal. It's a must for every person desiring a sound education in healmy living."-Jochen Hawlitschik, M.D., M.P.H.~ Director, Euro-Africa Division Healm Department, former Dean, School of Medicine, Momemorelos University. This book is the most useful book for health promotion ever written in this generation and will undoubtedly emerge as the standard handbook for aii health educators. It provides the facrs in a scieotific and balanced manner mat should be compelling for any rational being tO give reason for improving his/her lifesryle.-John Scharffenberg, M.D., M.P.H., from Harvard University, Adjunct Professor of Nurrition, Loma Linda University, Nutririon Researcher. (ove. de,ign' MoIthew McVone

Jm

158" 0-9661979-)-)

eil Nedley, M.D.

1010 14rh Sr. NW

Ardmore, OK 73401

$49.00

I

Proof Positive 3b4s6v

Overview 26281t

More details 6y5l6z

Related Documents 3h463d

Proof Positive 3b4s6v

Proof Positive 3b4s6v

Positive Words, Positive Thoughts 3g4437

Social Proof 165p1z

Positive Clamper 442k4u

Positive Revenge 3t2v4t

More Documents from "Ionela Pop" 6x3u5x

Proof Positive 3b4s6v

2.02+artikel+-+indefinite,+definite...pptx 4k3j6e

Painless Grammar 6v6e4g

Open Source Zigbee Stack 321z73

Ugly-love 1s2m4n