How Not to Die

  If you want to drop your PLOP, eat as low as possible on the food chain.

  Coffee for Preventing and Treating Parkinson’s Disease

  Could your cup of morning coffee help prevent and perhaps even help treat one of our most crippling neurodegenerative conditions? It appears so.

  There have been at least nineteen studies performed on the role coffee may play in Parkinson’s, and overall, coffee consumption is associated with about one-third lower risk.127 The key ingredient appears to be the caffeine, since tea also seems protective128 and decaf coffee does not.129 Like the berry phytonutrients, caffeine has been shown to protect human nerve cells in a petri dish from being killed by a pesticide and other neurotoxins.130

  What about coffee for treating Parkinson’s? In a randomized controlled trial, giving Parkinson’s patients the caffeine equivalent of two cups of coffee a day (or approximately four cups of black tea or eight cups of green tea) significantly improved movement symptoms within three weeks.131

  Of course, there’s only so much you can charge for a cup of coffee, so drug companies have tried to tweak caffeine into new experimental drugs, such as preladenant and istradefylline. But it turns out they don’t appear to work any better than plain coffee, which is far cheaper and has a better safety record.132

  There are a number of simple things you can do that may decrease your risk of dying from Parkinson’s disease. You can wear seat belts and bicycle helmets to avoid getting hit in the head, you can exercise regularly,133 avoid becoming overweight,134 consume peppers, berries, and green tea, and minimize your exposure to pesticides, heavy metals, and dairy and other animal products. It’s worth it. Trust me when I say that no family should have to endure the tragedy of Parkinson’s.

  CHAPTER 15

  How Not to Die from Iatrogenic Causes (or, How Not to Die from Doctors)

  As the saying goes, an ounce of prevention is worth a pound of cure. That’s quaint, but a pound isn’t all that heavy. Why change your diet and lifestyle when you can just let modern medicine do its job of fixing you back up?

  Unfortunately, modern medicine isn’t nearly as effective as most people think.1 Doctors excel at treating acute conditions, such as mending broken bones and curing infections, but for chronic diseases, which are the leading causes of death and disability, conventional medicine doesn’t have much to offer and, in fact, can sometimes do more harm than good.

  For example, side effects from medications given in hospitals kill an estimated 106,000 Americans every year.2 That statistic alone effectively makes medical care the sixth-leading cause of death in the United States. And this number reflects only the number of deaths from taking the drugs as prescribed. An additional 7,000 people die every year from receiving the wrong medication by mistake, and 20,000 others die from other hospital errors.3 Hospitals are dangerous places, and that’s not even counting the estimated 99,000 deaths each year due to hospital-acquired infections.4 But can deaths from infections be blamed on doctors? They can if doctors won’t even wash their hands.

  We’ve known since the 1840s that hand washing is the best way to prevent hospital-acquired infections, yet compliance among health care workers rarely exceeds 50 percent. And doctors are the worst offenders.5 One study found that even in a medical intensive care unit, slapping up a “contact precautions” sign (signaling particularly high risk of infection) leads less than a quarter of doctors to properly wash their hands or use a hand sanitizer when treating patients.6 That’s right. Not even one doctor out of four washed his or her hands before laying them on the ill. Many physicians are concerned that should it become widely known how many people doctors inadvertently kill every year, it could “undermine public trust.”7 But if doctors can’t even be bothered to wash their hands, how much trust do we deserve?

  This unfortunate (and gross!) situation means that you could go in for a simple operation and come out with a life-threatening infection—if you come out at all. Every year, 12,000 Americans die from complications due to surgeries that weren’t even necessary in the first place. For those keeping score, that’s more than 200,000 people dead from so-called iatrogenic causes (from the Ancient Greek iatrós, meaning “doctor”). And that figure is based only on the data on hospitalized patients. In outpatient settings—for instance, at your doctor’s office—prescription drug side effects alone may result in 199,000 additional deaths.8

  The Institute of Medicine estimates that medical errors may kill even more Americans, up to 98,000,9 bringing the total annual death count closer to 300,000. That’s more than the entire population of cities like Newark, Buffalo, or Orlando. Even using more conservative estimates of deaths due to medical errors, health care comes in as the real third-leading cause of death in America.10

  How did the medical community respond to such damning conclusions? Deafening silence in both word and deed.11 The first such report, which appeared in 1978, suggested that about 120,000 deaths occurring in hospitals could be prevented.12 Then, sixteen years later, another scathing reminder was published in the Journal of the American Medical Association, suggesting the iatrogenic death toll may be “the equivalent of three jumbo-jet crashes every 2 days.”13 In the years between these two reports, as many as nearly two million Americans may have died due to medical errors, yet the medical community refused to comment on this tragedy and made no substantial effort to reduce the number of deaths.14 Another estimated 600,000 deaths later, the prestigious Institute of Medicine released its own landmark report on the catastrophic consequences of medical error15—but again, little was done as a result.16

  Eventually, a few changes were implemented. For instance, interns and residents could no longer be made to work for more than eighty hours a week (at least on paper), and shifts couldn’t be more than thirty consecutive hours long. That may not sound like a big step, but when I started my internship after graduating from medical school, we worked thirty-six-hour shifts every three days—combined with our other days of work, that added up to a 117-hour work week. When interns and residents are forced to pull all-nighters, studies suggest they may make 36 percent more serious medical errors, five times more diagnostic errors, and have twice as many “attentional failures” (such as nodding off during surgery).17 The patient is supposed to be asleep during surgery, not the surgeon. It’s no surprise, then, that overworked doctors may cause 300 percent more fatigue-related medical errors that lead to patient death.18

  If every single day airliners crashed and killed hundreds of people, we would expect the Federal Aviation Administration to step in and do something. Why doesn’t anyone confront the medical profession? Instead of just releasing reports, entities like the Institute of Medicine could have demanded that doctors and hospitals adopt at least a minimum set of preventive practices, such as bar-coding drugs to avoid mix-ups.19 (You know, something they do even on a pack of biscuits at the supermarket.)

  Only people on medications are killed by medication errors or the drugs’ side effects, though. You have to actually be in the hospital to be killed by a hospital error or get an infection there. The good news is that most visits to doctors are for diseases that can be prevented with a healthy diet and lifestyle.20

  The best way to avoid the adverse effects of medical tests and treatments is not to avoid doctors but to avoid getting sick in the first place.

  Radiation

  There are risks associated not only with medical treatment but also sometimes with diagnosis. A paper entitled “Estimated Risks of Radiation-Induced Fatal Cancer from Pediatric CT” out of Columbia University in 2001 reignited long-standing concerns about the risks associated with medical diagnostic radiation exposure. CT, or CAT, scans use multiple x-rays from different angles to create cross-sectional images, exposing the body to hundreds of times more radiation than a simple x-ray.21 Based on the excess cancer risk of Hiroshima survivors exposed to similar doses of radiation,22 it was estimated that out of all children who undergo abdominal or head CT scans every year, five hundred
“might ultimately die from cancer attributable to the CT radiation.”23 In response to this revelation, the editor in chief of a leading radiology journal conceded, “We radiologists may be as guilty as others when it comes to not watching out for children.”24

  The risk of developing cancer after a single CT scan may be as high as 1 in 150 for a baby girl.25 In general, the diagnostic medical radiation dealt out in one year is estimated to cause 2,800 breast cancers among American women, as well as 25,000 other cancers.26 In other words, doctors may be causing tens of thousands of cancers every year.

  Patients undergoing these scans are rarely informed of these risks. For example, did you know that getting a chest CT scan is estimated to inflict the same cancer risk as smoking seven hundred cigarettes?27 One in every 270 middle-aged women may develop cancer due to a single angiogram.28 CT scans and x-rays can be lifesaving, but good evidence suggests that one-fifth to one-half of all CT scans aren’t necessary at all and could be replaced with a safer type of imaging or simply not performed at all.29

  Many people expressed concern about the radiation exposure from the full-body scanners at airports using backscatter x-rays,30 but those machines have since been phased out. The airplane itself, however, is a different story. Because you’re exposed to more cosmic rays from outer space at higher altitudes, just one round-trip, cross-country flight may subject you to about the same level of radiation as a chest x-ray.31 (Given my past speaking schedule, I should be glowing in the dark by now!)

  Is there anything you can do to mediate the radiation risk? As with so many other health questions, the answer is that you can eat healthfully.

  In an investigation funded by the National Cancer Institute, researchers studied the diets and chromosome integrity of airline pilots, who get zapped with radiation daily, to see which foods might be protective. They found that pilots who consumed the most dietary antioxidants suffered the least amount of DNA damage to their bodies. Note the word dietary. Antioxidant supplements, such as vitamins C and E, didn’t seem to help. Pilots who consumed the most vitamin C through fruits and vegetables, though, appeared to be protected.32 Taking antioxidant supplements may be more than just a waste of money. People given 500 mg of vitamin C a day were found to end up with more oxidative DNA damage.33

  Remember that natural antioxidants in food work synergistically; it’s the combination of many different compounds working together that tends to protect you, not high doses of single antioxidants found in supplements. Indeed, those pilots eating a mix of phytonutrients, concentrated in a variety of such plant foods as citrus, nuts, seeds, pumpkins, and peppers, had the lowest levels of DNA damage in response to the radiation they were bombarded with every day from the galaxy.34

  The research team found that green, leafy vegetables like spinach and kale appear to have an edge over other vegetables and fruits when it comes to radiation protection.35 All this time I’ve been packing kale crisps on flights just because they’re so lightweight, but it also turns out they may be protecting my DNA.

  The same plant-based protection enjoyed by pilots was also found among atomic bomb survivors. For several decades, researchers have followed thirty-six thousand survivors of the nuclear attacks on Hiroshima and Nagasaki. Those who ate vegetable- or fruit-rich diets appeared to cut their cancer risk by about 36 percent.36 We saw the same thing in the aftermath of the accident at the Chernobyl nuclear reactor in Ukraine, where consumption of fresh fruits and vegetables apparently protected children’s immune systems, while egg and fish consumption was associated with a significantly increased risk of DNA damage. The researchers suggest this result could have been due to the possibility that the animal foods they ate were contaminated with radioactive elements or the role of animal fats in free-radical formation.37

  Nuclear events offer a rare opportunity to study these effects on humans since, obviously, it is unethical to intentionally expose people to radiation. However, as we’ve learned from declassified documents about U.S. Cold War radiation experiments, this didn’t stop our government from injecting “colored” people with plutonium38 or feeding “retarded” children radioactive isotopes in their breakfast cereal.39 Despite the Pentagon’s insistence that these methods were the “only feasible means” of developing ways to protect people from radiation,40 researchers have since come up with a few methods that don’t violate the Nuremburg Code.

  One is to study human cells in a test tube. Research has found, for example, that white blood cells blasted with gamma rays suffered less DNA damage when the cells had been pretreated with phytonutrients from ginger root. The ginger compounds protected DNA nearly as well as the leading radiation sickness drug41 at 150 times lower the dose.42 Those taking ginger in order to prevent motion sickness during air travel may be protecting themselves against more than just nausea.

  Other common foods that may be protective against radiation damage include garlic, turmeric, goji berries, and mint leaves,43 but none of these has been tested in clinical studies. How can we test the protective power of foods in people rather than petri dishes? To study how diet may protect against cosmic rays, airline pilots were studied. Guess who they studied to see if foods could be protective against x-rays? X-ray technicians.

  Hospital workers who routinely operate x-ray machines have been found to suffer more chromosomal damage and to have higher levels of oxidative stress compared with other hospital workers.44 For this reason, researchers recruited a group of x-ray techs and asked them to drink two cups of lemon balm tea each day for a month. (Lemon balm is an herb in the mint family.) Even in that short time frame, the lemon balm tea appeared able to boost the level of antioxidant enzymes in the subjects’ bloodstreams while also reducing the amount of DNA damage they suffered.45

  The Actual Benefit of Diet Versus Drugs

  Based on a study of more than one hundred thousand Minnesotans, it appears that seven out of ten people may be prescribed at least one prescription drug in any given year. More than half are prescribed two or more drugs, and 20 percent are prescribed five or more medications.46 All told, physicians dispense about four billion prescriptions for drugs every year in the United States.47 That’s about thirteen prescriptions a year for every man, woman, and child.

  The two prescription drugs most often brought up in doctor visits are simvastatin, a cholesterol-lowering medication, and lisinopril, a blood-pressure pill.48 So a lot of drugs are being doled out in an attempt to prevent disease. But how well are these billions of pills working?

  An overconfidence in the power of pills and procedures for disease prevention may be one of the reasons doctors and patients alike may undervalue diet and lifestyle interventions. When surveyed, people tend to wildly overestimate the ability of mammograms and colonoscopies to prevent cancer deaths, or the power of drugs like Fosamax to prevent hip fractures, or drugs like Lipitor to prevent fatal heart attacks.49 Patients believe cholesterol-lowering statin drugs are about twenty times more effective than they actually are in preventing heart attacks.50 No wonder most people continue to rely on drugs to save them! But the dirty little secret is that most people surveyed said they wouldn’t be willing to take many of these drugs if they knew how little benefit these products actually offered.51

  How ineffectual are some of the most common drugs in America? When it comes to cholesterol, blood pressure, and blood-thinning drugs, the chance of even high-risk patients benefiting from them is typically less than 5 percent over a period of five years.52 When asked, most patients say they want to be told the truth.53 However, as doctors, we know that if we divulged this information, few of our patients would agree to take these drugs every day for the rest of their lives, which would be detrimental for the small percentage of people who do truly benefit from them. That’s why doctors in the know and drug companies oversell the benefits by conveniently not mentioning how tiny these benefits actually are. When it comes to chronic disease management, practicing conventional medicine can be thought of as practicing deceptive medici
ne.

  For the hundreds of millions of people on these drugs who don’t benefit, it’s not simply a matter of all the money spent and all the side effects endured. To me, the true tragedy is all the lost opportunities to address the root causes of patients’ conditions. When people dramatically overestimate how much their prescription pills protect them, they may be less likely to make the dietary changes necessary to dramatically lower their risk.

  Take cholesterol-lowering statin drugs, for example. The best they may be able to offer in terms of absolute risk reduction for a subsequent heart attack or death is about 3 percent over six years.54 Meanwhile, a whole-food, plant-based diet may work twenty times better, potentially offering an absolute risk reduction of 60 percent after fewer than four years.55 In 2014, Dr. Caldwell Esselstyn Jr. published a case series of about two hundred people with significant heart disease showing that a healthy enough plant-based diet may prevent further major cardiac episodes in 99.4 percent of patients who follow it.56

  You don’t really have the luxury of choosing between following a healthy diet or taking a pill to prevent a heart attack because pills may not work in the near term in 97 percent of the cases. Of course, diet and drugs are not mutually exclusive, and many under Dr. Esselstyn’s care wisely continued to take their cardiac medication. You just need to have a realistic understanding of how limited a role the contents of your medicine cabinets play compared to the contents of your refrigerator. Heart disease may continue to be the number-one killer of men, women, and eventually our children if doctors continue to rely on drugs and stents. However, if you eat a healthy enough diet, you may be able to reverse the stranglehold it has on your heart. That is something doctors can be proud to divulge to our patients.