Uprooting the Leading Causes of Death by Michael Greger (Transcript)

In past years, I’ve addressed the most pressing dietary issues of our time, like what’s the healthiest variety of apple, or what’s the most nutritious nut or dried fruit, or what’s the best bean, what’s the best berry? What’s the best bowel movement?

We had fun. People got to vote. You know, some folks came away all huffy, especially the New Yorkers back there. But this year, I thought I’d lighten it up, and answer what’s the best way to prevent death?

Every year the CDC updates the latest leading causes of death in the United States. So let’s start at the top and go down the list — see what’s new in each category.

Heart disease, #1. The 35-year follow-up of the Harvard Nurses’ Health Study, just published, now the most definitive long-term study on older women’s health we have. Since the study started thousands of participants died, but that allowed them to study the risk factors for mortality. Because heart disease was the leading cause of death, it comes as no surprise that dietary cholesterol intake was a significant risk factor for dying.

The second leading cause was smoking-related cancer deaths. But what’s so neat about this study is that it’s a competing risks analysis, so it allowed them to compare different risks to one another. So consuming the amount of cholesterol found in just a single egg a day appears to cut a woman’s life short as much as smoking five cigarettes a day for 15 years.

The most protective behavior they found was fiber consumption. Eating just a cup of oatmeal’s worth of fiber a day appears to extend a woman’s life as much as four hours of jogging a week. Though you can do both.

And so it’s worth noting that, look, the intake of cholesterol, only found in animal foods, was associated with living a shorter life. And the intake of fiber, only found in plant foods, was associated with living a longer life.

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The one specific food most tied to longevity was nuts. You also appear to get four hours of weekly jogging benefit eating just two handfuls of nuts a week. Yeah, heart disease is the #1 cause of death, but what if your cholesterol’s normal?

I hear that all the time from patients. Have to break it to them: look, having a normal cholesterol in a society where it’s normal to drop dead of a heart attack — not necessarily a good thing. And remember, it’s our #1 killer.

In a huge study last year, most heart attack patients fell within recommended targets for cholesterol, demonstrating that the current guidelines are just not low enough to cut heart attack risk. Close to half of heart attack victims had cholesterol levels classified in the guidelines as optimal, though I’m not sure their grieving spouses and orphaned children will take much comfort in that fact.

What is considered optimal is still way too high. Yeah, having a below average cholesterol reduces your risk, but, as the editor-in-chief of the American Journal of Cardiology wrote more than a decade ago, it’s time to shift from just decreasing risk to actually preventing and reversing, arresting atherosclerosis. We don’t want low risk; we want no risk. How do you do it?

Well, for the build-up of plaque in our arteries to cease, it appears that we have to get our total cholesterol down to be about 150. In other words, the cholesterol must be lowered to that of your average pure vegetarian.

Now but because relatively few persons are willing to abide by the vegetarian lifestyle, you know, drugs are required to get down to similar levels. So it’s our choice.

Now notice though, even though the average vegan has a cholesterol of 150, it doesn’t mean that all vegans have 150. That’s why I do free cholesterol screenings here at Summerfest. Stop by my table. A little drop of blood. Just will take a couple of minutes. I’ll be happy to do that for you.

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All right, so it’s our choice: diet or drugs.

Why not just choose the drugs?

Well, that’s a good question. As the good doctor noted last night, the FDA just announced newly mandated safety labeling by law to cholesterol-lowering statin drugs. So this is Lipitor, Mevacor, Crestor, Zocor, Vytorin, and that kind of thing.

The FDA issued new side effect warning labels this year regarding the increased risk, brain-related risks, and associated memory loss and confusion, an increase in blood sugar levels, as well as new onset diabetes.

One prominent cardiologist described this kind of Faustian bargain: yes, fewer heart attacks, but more diabetes.

With all the memory loss and confusion caused by these drugs, folks may forget there’s actually way to lower the risk of heart attacks and diabetes at the same time, called the plant-based diet.

All right, now cholesterol is just half of the heart disease story. The other half is inflammation.

We’ve known for 15 years that a single meal high in animal fat — a sausage and egg McMuffin was used in the original study — can paralyze our arteries, cutting their ability to relax normally in half within hours of eating animal products. The whole lining of our vascular tree gets inflamed and stiffened.

And just as that inflammation — so here’s hours, right: 1, 2, 3, 4, 5,5 6 — just as that inflammation, just as that crippling of our arteries starts to finally calm down after 5 or 6 hours — lunch time! Right?

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