In the United States, Ornish’s nutritional program is a recognized therapeutic method. The cardiologist has treated many famous patients, such as Bill Clinton, who required stents as well as bypass surgery. When Clinton was facing another surgery, he adopted the Ornish diet, and ever since then he has been slim and much healthier.
Ornish’s study has long since become a classic, and to me it remains a milestone. I realized, however, that such a demanding change in eating behavior would be an obstacle to its broad application in medicine. After all, Ornish had been promoting his diet long before plant-based food became a trend and before all physicians were familiar with the term “vegan meals.” One challenge was that this diet was meant to be strictly low-fat for heart patients. Even vegetable oils, nuts, or avocados were mostly off limits. But if you consume such a small amount of saturating fats, you have to eat a lot of vegetables to feel satiated.
This was the case for the heart patients I treated with the Ornish diet in the first few years after the study had been published. Many of them got into the habit of carrying some vegetables and other healthy snacks in a Tupperware container to still the rising feeling of hunger. Only later did it become clear that a heart-healthy diet doesn’t necessarily have to be low-fat; it’s only certain fats that are harmful—others are even important for the vessels’ elasticity. But Ornish’s diet was successful—and if you keep at it, you do good things for your heart and for cancer prevention. Later, in a different study, Ornish demonstrated that his diet has a positive influence on gene expression—meaning the manner in which the activity of genes is turned on or off—in the prostate tissue of patients with prostate cancer. In this scenario, cancer-facilitating genes were turned off.11
A Healthy Diet, According to Dean Ornish
Our daily nutrition should consist mainly of whole foods: whole meal grain products, raw or boiled vegetables, and fruit. Following this will reduce or even prevent atherosclerosis.
Our daily protein requirement should, for the most part, come from plant sources (e.g., legumes, soy). Dairy products should be reduced as much as possible.
Products containing sugar, white flour, or alcohol should make up only the smallest part of our daily nutrition.
WHAT IS SO HEALTHY ABOUT MEDITERRANEAN FOOD?
Though it is healthy to refrain from eating certain fats, there are plenty of others you can consume instead. This was the surprising message of the first large-scale study on the effects of Mediterranean food on heart diseases, the Lyon Diet Heart Study, which was published by French researchers in 1994. The head of the team, Michel de Lorgeril, from the research center CNRS (Centre National de la Recherche Scientifique), instructed his patients to eat mainly vegetables, fruits, and whole grains. Beyond that, they were allowed to consume plenty of vegetable oils that contain a lot of omega-3 fatty acids, such as canola oil, flaxseed oil, walnut oil, or soybean oil. To make it easier for the patients to consume those fats, a special canola-oil margarine was delivered to their house for free for the duration of the study.12
The study was designed to run for a few years but had to be terminated after twenty-seven months for ethical reasons: In the control group, in which patients were eating normally, too many people had suffered a stroke or died compared to the Mediterranean group. The control group was now advised to take up the Mediterranean diet. The data was already sufficient to show that the protective effect of Mediterranean food was great, greater even than that of medications such as beta blockers or ACE inhibitors.
When we hear “Mediterranean diet,” we often think of fish, to which many health-promoting qualities are attributed. People who want to eat a healthy diet often replace meat with fish. But fish is far less healthy than most of us probably think. Because fish contains concentrated animal proteins, it creates a lot of acidity in the body, which can contribute to inflammatory diseases, osteoporosis, and arthrosis.
I see an even bigger problem in the ecological question. The recommendation to eat fish regularly lacks a sustainable perspective. Many species of fish are critically endangered, and parts of the world’s oceans are overfished. Fish farms aren’t a great option because of their use of antibiotics. And many fish are polluted with heavy metals, especially fatty cold-water fish (like salmon or mackerel), which are often recommended for their omega fatty acids.
Fish isn’t the decisive health-promoting factor in the Mediterranean diet. The Lyon and the Predimed studies have shown that the beneficial health effects are based on the consumption of olive oil, vegetables, and nuts. The consumption of fish is not relevant. A second misconception is that the long-chain omega fatty acids contained in fish are necessary for treating inflammatory processes in the body, including dementia. Time and again, we hear that plant-based short-chained omega fatty acids are unable to treat these inflammatory processes. But that’s not true. It has been proven that alpha-linolenic acid from plants such as flaxseed can, if consumed sufficiently, convert itself into long-chain omega fatty acids.13 On a side note, algae also provides valuable omega fatty acids. Considering the growing global population, this food source is going to have a bright future. The consumption of algae is probably also one reason why the Japanese are so healthy.
The Lyon, as well as the Predimed study, caused so great a sensation that the Mediterranean diet began its triumphant entrance into medicine. In addition to preventing heart diseases, the Mediterranean diet is also effective against diabetes, rheumatism, hypertension, kidney diseases, and even dementia.
FOOD IS MORE THAN JUST THE SUM OF ITS INGREDIENTS
Nutritionists as well as many physicians have the odd habit of focusing on the components of food, rather than on the food itself. “Healthy” is not defined by the foods that are actually on the plate, but by the percentage of proteins, carbohydrates, fat, or vitamins the food contains. We’re no longer discussing rolled oats, tomatoes, or nuts, but dietary fibers, lycopenes (the healthy pigment found in tomatoes), and fatty acids.
The German chemical scientist Justus von Liebig—who made his contributions during the mid- to late-nineteenth century—is responsible for how food is generally seen as a sum of nutrients.14 After his colleague William Port had described the three most important components of food—proteins, fats, and carbohydrates (which together are now called macronutrients)—Liebig added a few minerals and declared the mystery of healthy nutrition solved.15 He then developed a meat extract in the form of stock cubes and the first artificial milk formula for babies (consisting of cow’s milk, flour, and potassium bicarbonate). The artificial milk formula in particular shows how simple the idea of nutrition was during Liebig’s time. After all, breast milk does not merely contain proteins, fat, and carbs, but also numerous micronutrients and antibodies that have, among other things, an effect on the intestinal flora.
In my view, it was a mistake to divide foods into components: The renowned American author Michael Pollan calls this “nutritionism.” In his book In Defense of Food, he describes a groundbreaking conference held in 1977: Since the number of chronic diseases was growing at a disconcertingly quick pace, the United States Senate Select Committee on Nutrition and Human Needs issued a recommendation for the “dietary goals” of the United States. Among other things, these guidelines emphasized that the percentage of heart diseases in the United States had increased after World War II, while the rate of this disease was remarkably low in other cultures that traditionally followed a predominantly plant-based diet. U.S. citizens were consequently recommended to restrict their consumption of red meat and milk.
Within a few weeks, however, a storm of indignation—initiated by the cattle and milk lobbies—hit the committee and its chairman, George McGovern. The committee’s unambiguous recommendations were replaced by a cunning compromise: “Choose meats, poultry, and fish that will reduce saturated fat intake.” Red meat and milk were no longer to blame. The blame had shifted to an anonymous, invisible component, a politically inn
ocuous substance.16
Back to the Mediterranean diet: After this particular diet was revealed to be so good for health, researchers began to examine other traditional diets. Studies attested to the health-promoting effects of traditional Japanese or Chinese cuisine.17, 18 In his best-seller Blue Zones, American journalist Dan Buettner identifies “regions of health”—parts of the world where people live longer while staying robust. In addition to the Mediterranean region of Sardinia, there is also the Japanese island of Okinawa, the Nicoya peninsula of Costa Rica, and the stronghold of Seventh-day Adventists, Loma Linda in California. These are also places where the fewest cases of chronic diseases are found.19
The common healthy factor that connects the people from these different regions, ethnicities, and cultures is that they all eat a lot of vegetables, fruit, spices, nuts, seeds, and whole grains. For fat, they usually use healthy vegetable oils such as olive oil or nutty fats. Meat is either not eaten at all or only on holidays and/or Sundays.
What the Mediterranean diet has taught us, then, is that approaching nutrition by only looking at macronutrients isn’t useful, because not all fats, proteins, and carbohydrates are the same. The Mediterranean diet is not, per se, a low-fat diet. The American psychologist Ancel Keys was one of the first people to research the Mediterranean diet. When he summarized his observations of the eating habits on the island of Crete, he noted that its inhabitants used such enormous quantities of olive oil that you could classify it as a drink.20 Subsequently, numerous studies have confirmed that fat derived from nuts, soy, canola oil, or avocados has mainly positive effects, while animal fats, especially those contained in meat, lead to elevated levels of cholesterol, heart diseases, diabetes, and cancer.21
One of the biggest studies on nutrition ever conducted made this point very clear. In the Predimed study, more than 7,500 patients were divided into three groups at random. One group was prescribed a Mediterranean diet and was asked to consume 0.26 gallons of olive oil per week. A second group was also asked to adhere to the Mediterranean diet and eat 1.06 ounces of nuts a day. The third group was asked to follow a normal, low-fat diet. At the end of the two-year study, the two groups that consumed large quantities of nuts and olive oil not only showed lower blood pressure and fewer cases of diabetes, they also presented with fewer cases of cardiac arrhythmia, depression, and cancer, and fewer deaths from heart attacks and strokes.22
Looking at these extensive nutritional studies, the question of what constitutes a healthy diet can be answered easily and unambiguously: We should eat a lot of vegetables, fruits (which aren’t as important as vegetables, however), and a lot of healthy fats from olive oil, canola oil, nuts (especially walnuts), avocados, and flax and other seeds. Fish is less important than initially assumed—scientific data does not attest to a particularly health-promoting effect. And another thing that unites the healthy diets is that meat makes up only a small part of the diet or even no part at all. The consumption of dairy products and eggs is also low.
HOW UNHEALTHY CARBOHYDRATES PUSHED THE SURGE OF OBESITY FORWARD
When I assumed my position as attending physician at the newly-founded specialty clinic for naturopathy in Bad Elster in 1998, the first guest we invited was Claus Leitzmann, at the time professor for Nutritional Science at the University of Gießen. Leitzmann had developed a concept called “Gießen Whole-Food Nutrition”—a healthy method for the prevention and treatment of diseases. He had devised two versions: One was strictly vegetarian and the other was predominantly vegetarian but included one meal of fish or meat a week. I still remember his lecture well: “The best meat is the flesh of fruit.” There was a controversial discussion on whether animal protein was needed for muscle development, and Leitzmann denied this categorically. His closing comment on the matter was: “Meat is not a part of vital energy, it was a part of vital energy.”
While plant-based fats are predominantly healthy, animal fats are usually harmful. This is partly due to the fact that factory-farmed livestock lead unhealthy and stressful lives and have a bad diet themselves. This has an impact on the meat. When animals are allowed to feed more naturally, for example, when cows can graze in a field, their milk also becomes healthier. The milk of a Swiss Alp cow has a completely different composition than that of a Dutch cow kept in a stable—the Swiss Alp cow’s milk contains a lot of healthy omega-3 fatty acids, for example. The Zurich-based cardiologists who conducted this study christened this phenomenon the “alpine paradox”: You can eat cheese and stay healthy, as long as you’re eating cheese made from the milk of a happy Alp cow.23
There’s a commonly-held belief that plant proteins have to be combined in complicated ways in ../images/page_116_2.jpgorder to unfold the same biological power in the body as animal proteins. According to most recent data, this assumption is wrong: The body breaks down proteins and rebuilds them in the way it needs—no matter whether they come from an animal or a plant.24, 25
One should also take a differentiated look at carbs. In their natural form found in whole-wheat bread, whole-wheat pasta, or whole-grain rice they sustain health and lower the risk of heart attacks or strokes. The hitherto largest study overview on this issue showed that the risk of cancer and circulatory disorders is significantly lowered if you eat at least three portions of whole-grain (3.17 ounces), e.g., two slices of whole-grain bread, a day.26
Whole-grain products are excellent sources of fiber. They also contain B vitamins and minerals such as magnesium and zinc, because they still hold the sprout, bran, and the outer husks (all of which are removed in ground flour). But the food industry continues to distribute enormous quantities of nutrient-deficient white bread, pasta, and polished rice. Carbohydrates in the form of soft drinks that contain no healthy ingredients whatsoever, and have therefore even been dubbed “liquid candy” in the United States, are the worst.
Breakfast cereals were invented by John Harvey Kellogg, an American doctor and naturopath, with the intention to provide healthy nourishment to the population (which was eating bacon and eggs for breakfast back then).27 But over time these cereals have mutated into a mixture of unhealthy white flour and lots of sugar, often mixed with artificially added vitamins, since those are lost in the manufacturing process. Even organic supermarkets are selling fewer rolled oats and more sweetened breakfast cereals and muesli bars year by year.
Such unhealthy carbohydrates are likely to have propelled the surge of obesity in Europe and America. White flour is quickly turned into sugar in the body. The body also turns fat into energy quickly. This is why fast food is so problematic: It combines these two negative factors: white flour and fat—for example, donuts, pizza, and burgers. The pancreas then releases huge quantities of insulin—this hormone stimulates fat synthesis and channels nutrients to the cells. This expedites weight gain (which is why insulin is also used to fatten animals). When insulin levels subsequently fall quickly—as the calories have been converted quickly—voracious appetite subsequently occurs. This is not the case with whole grains, because the energy is converted much more slowly. Instead, whole grains stabilize insulin levels.28
SUGAR’S EFFECTS ON THE BRAIN
There are many unhealthy foods available for purchase, but potato chips are particularly problematic. Scientists at the University of Erlangen found changes in more than eighty brain areas in lab animals after they consumed potato chips, especially in those areas that are connected to addiction, stress, sleep, attention, and gratification. Beyond that, the combination of carbohydrates and fat leads to gluttony (hyperphagia).29 This and other studies support the theory that attention deficit hyperactivity disorder in children could be connected to an unhealthy diet, especially one with fast-food products that contain synthetic additives that affect the nervous system.
An important aspect to consider when thinking about the obesity epidemic is the wave of fat-reduced “light” products that flooded the market as a reaction to the generalized warnings against fat. Si
nce reducing fat can lead to a loss in taste, manufacturers make up for this by adding more sugar, salt, or carbs to their “light” products. This creates new problems—mainly because consumers tuck in with great appetite because they believe that they can’t gain weight from “light” products.
In the past, sugar was used sparingly as a spice and with a certain goal in mind—the dessert. In past centuries it provided only about three to four percent of nutritional energy. Today it’s fifteen to eighteen percent. As we now know, sugar harms not only the teeth, but also the heart and the brain. Heightened blood sugar levels lead to decreased cognitive performance and ability to concentrate. Researchers such as the American biochemist Lewis C. Cantley believe that cancer is also caused by a high consumption of sugar.30 It has already been established that overweight, diabetic people show a greater risk for cancer.31
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