Tuesday, July 19, 2011

Time for Drastic Measures 釜底抽薪


Over 2,200 years ago, the first Chinese encyclopedic classic - The Annals of Lü Buwei 呂氏春秋 wrote: 今世上卜筮禱祠,故疾病愈來,譬之若射者,射而不中,反修于招,何益於中?夫以湯止沸,沸愈不止,去其火則止矣。故巫醫毒藥,逐除治之.故古之人賤之也,為其末也。《呂氏春秋.季春紀.盡數》. Translated into English, it stated “There is an increase in illness as people resort to prayers and divination that is like moving the target to improve the score of an archer.  How could it possibly improve the skill of the archer?  To give another analogy, how could one stop a pot of water from boiling if one keeps adding hot water to the pot?  What one should do is to turn off the fire instead.  That is why our learned ancestors looked down on shaman and medicines for temporary reliefs; they don’t address the root cause of the problems.”

Recently, I was pleasantly surprised to learn that Dr. T. Colin Campbell, the Jacob Gould Schuman Professor Emeritus of Nutritional Biochemistry of the Cornell University, did just that.  He went after the very foundation of our health and examined the impact of nutrition/diet on our long term health.  With rave reviews and half a million copies sold of his 2005 best seller The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-Term Health, Dr, Campbell’s advocacy has been drawing a lot of attention.  The work also led directly to the drastic change of diets of at least one high profile case – that of the former President Bill Clinton after his second heart surgery in early 2010.  Here is the Nov. 2010 Clinton’s interview with CNN reporter Wolf Blitzer on this subject.


So what is this fuss all about?  If I can sum it up in one sentence, it is pretty simple and straightforward: Whole food, plant-based diet is good for you.  Note plant-based diet does exclude ALL animal products, fish, eggs and dairy products included. The emphasis of whole food is important as well.  Highly processed and refined carbohydrates found in white bread, snacks, junk food are NOT whole food and are not good for you.

Being an established and highly respected leading scientist, Dr. Campbell challenged the conventional wisdoms from with-in.  He took a revolutionary approach to make sense for us the hopelessly confusing relationship between nutrition, diet and health; something most of us don’t think much of it till we are hit with serious health concerns or if and when we do, we can’t figure out how true each of the contradicting claims is.

Conventional scientific and medical researches focus on isolating individual components/factors and finding combinatorial and statistical relationships between such components and markers/indicators of diseases.   Further, for many decades, much of the attention and resources have been directed at research of medicines and technologies that would alleviate acute problems and extend one’s life temporarily as opposed to help preventing diseases and improve our health and quality of life.  Take heart disease as an example which is the leading cause of death in U.S., the advances of heart bypass surgery and angioplasty has dramatically reduce the death rate during a heart attack to about 15%.  But did you know that “79% of patients showed impairment in some aspects of cognitive function seven days after the operation”, and that benefits of these procedures do not last -“Within ten years, half of the bypass patients will have died, had a heart attack or had their chest pain return.”  It is clear that surgery, while saving lives, is not the answer.

What I and many did not know was the impressive finding by few prominent physicians like Dr. Caldwell Esselstyn (formerly with Cleveland Clinic) and Dr. Dean Ornish of U.C. San Francisco in last three decades.  They offered convincing evidences that diet and lifestyle changes alone can effectively stop the deterioration and even reverse the coronary heart disease!  Dr. Ornish and colleagues published in 1990 their famous Lifestyle Heart Trial (that Bill Clinton cited in his interview above). The results reported that 82% of the heart disease patients in their experimental group that adopted a low-fat vegetarian diet, stopped smoking, took stress management training with moderate exercises showed regression in their heart disease after only 1 year without use of lipid-lowering drugs!  By the way, the patients of the control group who received the usual care did not fare too well with worsening chest pains and increased coronary blockage over the same period. 

The story did not end with the diet and heart disease.  Dr. Campbell presented similarly impressive findings with many chronic health problems such as obesity, type II diabetes, some autoimmune diseases like type I diabetes, Multiple Sclerosis, and some common cancers including breast, prostate and large bowel.  While one may argue that for each disease the conditions and component culprits are not exactly the same, one common factor, when looking at the larger picture, emerged consistently that is the linkage to animal-based diet, dairy products included.  Indeed, even for the most feared disease of cancer, Dr. Campbell cited studies and experiments that showed certain proteins found in dairy products and animal-based foods promote the growth of tumors.  He noted the clear pattern of “nutrients from animal-based foods increased tumor development while nutrients from plant-based foods decrease tumor development.”   It is also encouraging to know that compared to bad diet, genetic pre-disposition and occasional exposures to carcinogens are NOT nearly as critical as we might think in the development of cancer.

What does China have anything to do with all these and why was Dr. Campbell book entitled The China Study?  It is perhaps not surprising that there have been a lot of arguments and attacks against the findings of benefits of plant-based diet which is difficult to perform large scale epidemiologic study in developed countries like U.S. as one would be hard pressed to find enough samples of subjects with a more plant-based diet.  Luckily, in early 80’s, Dr. Campbell, Dr. Junshi Chen (then the Deputy Director of the Institute of Nutrition and Food Hygiene of Chinese Academy of Preventive Medicine), and Prof. Richard Peto of the University of Oxford pulled off the famous China-Cornell-Oxford Project in China where diseases of affluence and excess (that is what most of the diseases discussed above!) were not present.  With the support of Chinese government, the research team was able to take blood samples and conducted detailed interviews and survey, and performed thorough analysis of the diets, lifestyles and diseases of 6,500 residents - 100 samples from each of the 65 rural counties - across China.  The data provides epidemiologists unprecedented opportunities to examine and establish clearly the links between diets and health. 

In his book, Dr. Campbell summarized the results of China Study that revealed “plant-based foods are linked to lower blood cholesterol; animal-based foods are linked to higher blood cholesterol.  Animal –based foods are linked to higher breast cancer rates; plant-based foods are linked to lower rates.  Fiber and antioxidants from plants are linked to a lower risk of cancers of the digestive tract.  Plant-based diets and active lifestyles result in a healthy weight, yet permit people to become big and strong.”  That is, Whole food, plant-based diet is good for you and (too much) animal-based foods are bad for you.

As I read the book, I wonder how come I did not know about these findings and wisdom?  How come my doctors continue giving me prescriptions of wonder drugs for some of my chronic problems and did not pursue with me the possibility of changing diet and lifestyle?  If you have similar experiences, we are not alone.  In fact, the little dirty secret is that most of our medical doctors are not trained with nutritional sciences and they are as confused as we are!

In his book, Dr. Campbell is critical about the existing medical-health care system and status-quo forces from scientific community, to industries and government.  To begin with, it is probably a defect in human nature to dream of finding silver bullets and magical pills that will fix all of our health and longevity problems, ignoring the impact of our daily diets and lifestyle.  In reality, such a distorted priority merely offers opportunities for research papers, proposals, and grants to conduct gazillions of experiments and opened the doors to more confusing and conflicting results from observations of seemingly related phenomena from ever-so-slightly-different angles and assumptions.   You can find anecdotal stories of turf battles and NIH (Not-Invented-Here, not National Institute of Health) syndromes interspersed throughout Dr. Campbell’s.  Worse, business interests take advantage of the confusions and often fund purpose-designed research and lobby school curriculum to advance their agenda.  To complete the web, the industry craft clever and misleading promotions under the cover of sciences and health to further maximize their own profits.  Do you know that the dietary supplement industry recorded about $20 billion dollars sales in U.S. last year and that the pharmaceutical industry is more than 15 times larger?

Many of us have learned at one time or the other that carbohydrates, proteins, and fats are the basic macro-nutrients that provide our bodies with energy that can be measured in calories.   But how many of us know how much calories each of us needs daily to maintain a healthy weight given a particular level and style of activities?  And after consulting various tools and tables to find the reference figures, how many of us remember how much calories are in each of the foods we bought, cooked, and consumed?  Do you know roughly there are 4 calories in a gram of carbohydrate or protein and 9 calories in a gram of fat?  But do you know how many grams of carbohydrate, protein and fat are in a 10 oz. ribeye steak or a bowl of rice you ate?  Do you know how many carbohydrate, protein and fat are in a plate of Spaghetti with meatballs you just had?  And how does cholesterol fit into all these equations? 

Let us say you do know all these number.  How does it help you to maintain good health for yourself?  Do you know you can have a diet meeting the “recommended” nutrition level and calorie but will kill you?  The reality is we do consume foods in whole and not in its components from Vitamins and minerals of A to Z, proteins, carbohydrates, etc.  Foods are delivered with their nutrients together in one “package” of various forms and get absorbed and transformed in a not-completely-understood fashion by our wonderful body with a complex adaptive digestion system.  Oversimplification can be dangerous and can have unintended consequences.  For example, many had been led to believe carbohydrates are bad by the popular low-carb Atkins diet when in fact carbohydrates from fiber rich natural vegetables and fruits are essential for good health.  Similarly many, especially those in developing countries, were led to believe that animal-protein is of higher quality and more efficient and desired in bridge the “protein” gap when too much of animal proteins are known to be bad for our bodies.  The list goes on and on.  

The beauty of Dr. Campbell’s work is that in one fell swoop, he showed us a way out of this maze.  He demonstrated that while we may never understand all the interactions and positive/negative effects of component nutrients, we do know for sure that unlike animal-based diets, there is no adverse effect of whole food, plant-based diet in quantity.  He argue convincingly that as long as one makes sure that one gets sufficient Vitamin B12 (which can be obtained through supplements), persistent whole food plant-based diet alone can improve one’s long term health significantly, along with moderate exercises and without any health supplements or long term medications.  For people who have some of those long term health concerns, there is absolute no reason why one shouldn’t take up on Dr. Campbell’s advice seriously.

It may not be easy to change one’s diet or lifestyle drastically overnight and sustain it when these habits are shaped gradually over decades in social and cultural context.  I think one practical way to make the change quickly is to first become what I would call a “Social Omnivore” or a “Home Vegan”.  Just like a “social drinker” who drinks on social occasions only, if one eats only whole foods, plant-based diet at home (which is most of the time in my case) and usual diets in social occasions or when eating out (which is infrequent), one can reduce the consumption of animal-based diet down to a very low level by my calculation.  I would not be surprised that even with such a modest attempt, one stands to reap most of the health benefits.

I am excited about what I have learned from Dr. Campbell’s book.  I am optimistic about the prospect of improving my long term health through changed diet and plan to implement it shortly.  Wish me luck.  If you are interested in knowing more about this subject but don’t feel like to read Dr. Campbell’s 417 pages 6”x9” book, you may want to watch the newly released 90 minute long documentary movie called Forks Over Knives that traces the journey of Dr. Colin Campbell and Dr. Caldwell Esselstyn.  Talk to you soon!

Sunday, July 3, 2011

My Dad would be 100 Years Old Today


Today is the centennial birthday of my late father who passed away 6 years ago in January 2005. 

I don’t know anything about my dad’s childhood.  Unlike many others, I never got a chance to ask my grandparents “what did Dad do when he …” as I have never met or known my paternal grandparents; they passed away when my father, their only child, was little.  My dad himself did not have any photos nor could he recall much about his parents either as he was raised by his grandma.  Although the family wasn’t well off, he did receive a decent education with his uncle’s help and completed his high school at a reputable Methodist School – the Anglo-Chinese College鶴齡英華中in CangShan 倉山District of FuZhou City in China.  Late in his life when he visited us in U.S., he would tell us he did learn some English at that Christian school but could only remember only a few words.

After graduating from high school, it appeared that he had gone working for the Fujian provincial government.  He married my mother when he was 27 years old (relatively late in those days?) and she was 20.  Eight years later, after Japan surrendered and returned Taiwan to the Nationalist government of China, my father was sent to Taiwan with my mom and 6 years old sister in 1946 as a part of the effort to rebuild a new provincial government.  He was then a low level staff assigned to a government operated liquor distiller in the mountain town PuLi, not far from the scenic Sun Moon Lake.

Although my dad was never an alcoholic nor a heavy drinker, he did tend to drink a little too much whenever he had a chance in social gatherings.  As I grew up, it had become more and more an issue between my parents as my mother fought hard to stop him from drinking completely.  It was probably due to partly her worry about dad’s chronically high blood pressure and partly one of her own brother’s problem with alcoholism.  At the end, she reluctantly settled with a more en-forcible policy of “never drink at her presence except for special occasions”.  Even when dad reached 90 and lost much of his taste buds, he still liked to get a can of cold beer when he did his daily walks.  

My dad had always been a dedicated government employee and enjoyed his work very much.  In most part of my life, I remembered his primary job duty was to monitor and assist the fruits/vegetables and meat wholesale markets (of local governments) in managing the supply and price.  From time to time, commissioners of local markets may stop by our government provided house to visit him and discuss business.  Invariably, with the local custom of never visiting people empty handed, we would end up having some fresh or canned fruits for few days.  Once in a while, some might attempt to leave a “red envelop” which was always rejected.  What struck me the most however was that he never seemed to be listening to what the visitors were saying.  It is not unusual that he and the visitors appeared to be talking at parallel tracks with no intersection.  They were always cordial and polite but at the end, I was never sure what was actually concluded if any.  Was it how discussions were conducted and how things get done those days?  I don’t know and I would never find out from him now.  I do remember I said to myself then that I would not want to end up being like him and that I will listen attentively to people.

Like most men in his time, dad did not do much house chores like cooking or cleanings but he did enjoy taking care of the yards and growing flowers and fruit trees.  He tried to plant grape vines but failed to turn grapes into wine.  When my brother and I had to ride the bus for more than one hour to middle school and high school, he would wake us up every morning before 6:30 a.m. and prepared breakfast for us.  It usually includes a fried egg he cooked, and a bowl of hot soybean milk and a freshly baked biscuits he picked up from the nearby market.  Once when mom was hospitalized, my brother and I were impressed that he was able to cook a pot of soup for dinner with spare ribs and Bok Choy (or Napa Cabbage).  That is pretty much the limit of his cooking skill.  In the summer, he sometimes would take us with him on business trips to see places of the island.  Perhaps that seeded my interest in traveling?

Dad never commented much about daily routines or disciplined us which were more my mom’s job.  But we could all surely sense his concern on our school performance and he was proud when we did well and he was worried when we did poorly.  He seemed to feel his best contribution and support would be to make sure we eat well and be happy.  I still remember his encouraging smile with anxiety as he waited at a distance outside the classroom where I was taking the grueling middle school entrance exam.    

He retired from government service in 1973 when I was fulfilling my mandatory military service after my Bachelor degree.  I never asked him if my dream of going to a graduate school in U.S. had anything to do with his decision of early retirement.  He was the only bread earner in the house and received a meager monthly salary of a little over one hundred U.S. dollars then.  When he retired, he got a one-time retirement benefit of approximately $5,000, of which half was used to buy me a one way airline ticket to San Francisco and to supplement my partial scholarship at the graduate school.  I learned later that the other half went into a failed investment on his friend’s venture of making candles.  I guess after all I was a better return of investment!

Another significant factor of his decision for the early retirement might have been an opportunity to join a private company (which he did) found by a Chinese American businessman that became the first modern slaughter house in Taiwan.  I was probably partially responsible for his 2nd and final retirement as well, when he finally agreed to come to visit us in U.S. in 1983.  When he rushed back home few weeks later, he found out, as he had feared and my mom had predicted that he had been relieved from his General Manager duty and was reassigned to become a consultant.  He never blamed it on me.  And I never asked him how he felt and offered him any words of consolation.  

Few months after my father’s birth, the Republic of China was born on Oct 10th, 1911, rid of the Qing Dynasty with an armed revolution.  Dad liked to say, especially as he grew older, he was of the same age as the nation.  He liked even more to joke about his most “pride accomplishment”, surpassing those of the National Father Sun Yat-Sen and his successor, Nationalist leader Chiang Kai-Shek: his two daughters-in-law are from the Sun’s and the Chiang’s.

Dad had a pretty good life, I thought, thanks to my brother and sister-in-law who lived with him and cared for him.  His quality of life did go down quite a bit during the last two years of his life after two strokes.  Gradually he lost the ability to swallow food or drink liquid, then he could no longer speak clearly and later he lost the strength of his limbs as well. The cruelty of it was that he was deprived of two things he loved to do the most: eating/drinking and walking.  He passed away at the age of 93.  I am glad that I did ask and walk with him once on his routine afternoon stroll when we visited him before he lost his mobility.  He led the way down the busy city streets and paused from time to time.  We did not talk much but I could feel the same warmth and security of being able to be right next to him just like when I was a kid.  I wish I had told him how happy I was to be able to have a walk with him.  I wish I had walked with him more.  But it is now too late.  

Few years ago, I brought back from Taiwan an old family photo album that my late sister had put together decades ago.  It has photos of my parents from around the time when they got married.  In a few photos, there are some of their friends and/or relatives whom I don’t recognize.  There were places and background scenes they had been to that I can’t recognize either.    But I will never be able to ask them again. 

Look, don’t be like me.  Ask your parents any of the little details that might sound not so important to you now.  Do something with them whenever you can, as if they might be gone tomorrow.  This way, you would not regret later in your life that you could have known more about them and thus about yourself.  Oh, one other thing, dad asked me privately if I would take him to see a striptease when he was visiting U.S. the first time at the age of 72.  I am sorry that I refused his request as deemed inappropriate.  If I had a chance to do it again, I would make up an excuse to my mom and take him to a show.

Dad, I miss you.  I will see you when we go home.  If there is a heaven, I am sure I will be with you forever after I die.  If there is incarnation, I will be your son again. 

Dad, happy 100th birthday; let us drink to that!