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Neal D. Barnard M.D.

Revolution in Diet and Medicine
An interview with Dr. Neal Barnard, President of the Physician's Committee for Responsible Medicine
From SPECTRUM, #24 May/June 1992.

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Spectrum: Could you tell me a little about your background?

Neal Barnard: I grew up in North Dakota, and I was completely oblivious to nutritional issues. I ate the pork-chop-and-roast-beef diet that everybody else eats in that neck of the woods. My father was a doctor, and my grandfather was a doctor, but we have four people in my family that are cattle raisers. I think all of us, both the people that were eating cattle and the people that were interested in medicine, really didn't appreciate the links between diet and illness.

I had a job at McDonald's in high school, but my first year of medical school I started to become sensitive to a lot of issues, one being the relationship of diet and disease. I would say this awareness was aided and abetted by a realization of what animals go through in agriculture, which is grotesque. Most people don't see it, but I did growing up. Only later did it start to make sense to me, and in the first year of medical school I became a vegetarian.

I started the Physician's Committee For Responsible Medicine in 1985 with an aim of taking on lots of issues, not just preventive medicine. In that area, for example, we publish a magazine called the Guide to Healthy Eating. Its goal is to provide user-friendly nutrition information, with little recipe cards in every issue that you can tear out and put in your recipe file. The magazine is also used as a hand-out for patients in doctors' offices.

We have a nutritional program for businesses called the Gold Plan. If you're working at IBM, or wherever, at lunch time in the cafeteria you can get nutrition information on healthy, totally vegetarian foods.

As I mentioned, our organization has taken on other issues. We've done quite a lot to promote alternatives to animal research. We've done some work against unethical human research, and made trouble in various other ways. You can make a lot of friends and a lot of enemies doing this kind of work.

Spectrum: Should people sometimes think twice about going to the doctor? What are some important ways you think that people need to take responsibility for their health care?

NB: The first key is to recognize that your power is far greater than the power that a physician might have. By that I mean that once you have heart disease, the capacity that your doctor may have to limit it, or reverse it, is far less than the power you had to prevent it from occurring in the first place, or even to reverse it through lifestyle measures. I'm not discouraging people from getting medical care when they really need it, but I am encouraging people to take advantage of what they can do on their own, which is phenomenal.

Even two, three, or four years ago, we did not know that the plaques in your coronary arteries could actually dissolve with lifestyle measures alone. We now know that they can. Dr. Dean Ornish has established beyond any reasonable doubt that a combined program of vegetarian diet, modest exercise, stress reduction, and not smoking can accomplish this. That sort of regimen will actually make those plaques start to disappear without medicine, without surgery, and, relatively quickly. Within one year he achieved demonstrable changes in most of the patients he studied.

The key is that we have to go beyond the recommendations that most conservative medical organizations have been using. By that, I mean the American Heart Association, the American Cancer Society--their recommendations will not reverse heart disease. A 30% fat diet with lean meat, chicken and fish is not going to reverse anybody's heart disease, nor will it prevent it. You can look at such a diet and know that that's the case. Chicken, fish and lean meats have cholesterol and saturated fat in them; they have no fiber or complex carbohydrates.

Spectrum: Recent studies showed that fat reduction down to 30% did not help much. Because of this, some people now are saying that you don't really need to worry about fats.

NB: Yes, that is actually one of the most devastating effects of poorly done research, or maybe poorly interpreted research. For example, there was a very large, and I believe well-done, study of nurses done through Harvard University, but I think that its results were so poorly interpreted as to have the effect that you've just described. The results were as follows:

It has been known for a very long time that animal fat, and to a lesser extent, all fats, increase the risk of breast cancer. The reason is that fats increase the production of estrogen in the body, and that, in time, over-stimulates the cells of the breast and they become cancerous. There are other reasons, also.

In this Harvard study, thousands and thousands of nurses were tracked year after year--what they ate, their incidence of illnesses, and so forth. During a four-year period, the researchers noticed that those who had somewhat less fat in their diet, as well as those who had more fat, had the same risk of breast cancer. They interpreted that to mean that changing your diet doesn't help.

If you look more closely, those who were eating the least fat were still eating about 29% of their calories as fat. That's not very far under the average in America. But compare that to Japan. When Japan was at its very lowest incidence of breast cancer, Japanese women were eating 7% or 8% of their calories as fat. That would be about the typical amount found in a low-fat, vegan diet.

The fat intake of nurses in the study ranged from 29% and up. All of them are at high risk of cancer. It's the equivalent of saying, "if I'm smoking two packs of cigarettes a day, and I cut down to one, will that reduce my risk of having lung cancer?" And, you may find it doesn't. If you, then, interpret that to mean that smoking doesn't matter, you've made a grave error.

Likewise, there was a study recently where they did a statistical analysis of the benefit of reducing the fat in your diet to about 30%, and they concluded your average person would gain only a month or two of life, overall. Well, that doesn't mean diet doesn't work, it means that modest changes in your diet don't work.

So, that's the message I want to get out to people. If you change your diet, and do it very vigorously, you have enormous power. You can reverse heart disease. You can prevent it. You can, I believe, prevent most cases of cancer if you combine dietary changes with avoiding tobacco. You could prevent probably 70% or 80% of cancers, just by those steps alone. And, obviously, there's a whole host of other diseases that you would be able to live without.

Spectrum: I've talked to some people who dispute those studies indicating the superior health of traditional Japanese people. These critics say that a lot of Japanese died young because their lives were harder or less sanitary, and this left only the healthier ones to be counted in the studies. Or, that their longevity might be due to some kind of genetic effect. People come up with all kinds of reasons why this epidemiological information isn't accurate, but I assume the researchers controlled for those variables.

NB: The fact of the matter is, there is not just one, but many, many studies, and not only looking at the Japanese in their own society, but looking at them as they changed their diet, and adopted ours.

Spectrum: When they come to America?

NB: When they come to America, or even wealthy Japanese women living in Tokyo or Osaka eating a western diet with meat every day, compared to poorer people in the same area who are not eating meat. The difference in breast cancer risk between a Japanese woman eating meat every day, and a Japanese woman who isn't, is a factor of eight. In other words, the meat-eating women are eight times more likely to have breast cancer. The genetics are the same in these cases, so it's not a factor.

If a Japanese family comes to the U.S., their children eating a Western diet will have the same risk of breast cancer as the Caucasians living around them, and here again it is not an effect of genetics.

The other things that you mentioned--sanitation and so forth--the Japanese put us to shame in this area, and their longevity is greater, not less than ours.

Diet has to be one of the reasons for their good health. That's not to say that I think everyone should adopt a Japanese diet without thought. There are things wrong with the diet. In some cases there is too much salt and too many pickled foods, and so forth. But you can take the best of both worlds.

Spectrum: I first heard about your work in the newspapers. I believe the U.S.D.A. had developed a "pyramid" of foods to replace the Four Food Groups. Your association then proposed a new, entirely vegetarian Four Food Groups. Can you tell our readers a little about what your intentions were, and about your Four Food Groups? What kind of reaction did you get from the medical establishment?

NB: The old Four Food Groups are meat, dairy, grains, and vegetables/fruits. That's a prescription for premature mortality. That's a prescription to kill off a sizable percentage of the population and it's the prescription that all of us learned as we were going through school. It started in 1956, after years of other various schemes that the Department of Agriculture had developed. There used to be more food groups than four. Science has come a long way in the 36 years since.

Spectrum: What was behind the development of the original Four Food Groups? Was there any political or economic thrust behind it, or was it concerned totally with health?

NB: I think the original idea probably stemmed from a desire to educate people about simple steps they could use to stay healthy However, it has been used essentially as a promotional campaign for agricultural products. Dairy products got their own group, and it was prominently featured. If you look at the fine print on the posters that are in schools, it indicates that the Dairy Council has put these out. They print the posters, and they still promote the old Four Food Groups because it increases sales of their products. It's the same with the meat producers.

The original Four Food Groups is completely out of sync with all the science that has gone on since that time. We now know that people who eat no meat at all--who violate the Four Food Groups--live longer. They have less incidence of disease and they are thinner. People who avoid dairy products, far from showing signs of ill health, are healthier than people who consume dairy products.

We felt that we had to rewrite the Four Food Groups--continue to use the idea of a simple tool that kids could learn in school, but have it be something that is in sync with modern science. The new Four Food Groups are grains, vegetables, fruits, and legumes--legumes meaning anything in a pod, such as peas, beans, lentils. If that were the basis of nutritional teaching, we could revolutionize the health in this country.

When we first made this proposal, it wasn't just me standing up at the podium and waving this around, we had Dennis Burkitt with us, the British doctor who discovered the value of fiber. He spent years in Africa comparing different diets, and is one of the most widely respected cancer researchers in the world. He came to Washington and said "Yes, the new Four Food Groups could save a lot of lives."

Colin Campbell, the head of the China health study, also came to Washington and endorsed it, as did Oliver Alabaster, a cancer researcher. So, we felt we were on very solid ground with this, and, we certainly are. There's a wealth of research behind it.

By the way, the new Four Food Groups is going to come out as a curriculum for seventh and eight grades a little bit later this year. So if teachers want to teach it, and throw out the old Four Food Groups, I would be honored.

There was a good deal of response to our new Four Food Groups, and it differed depending on who was giving it. The press was, by and large sympathetic to it, and, so was the public. They would raise appropriate questions, such as, "Will you have strong bones without dairy?" and the kinds of things that people wrestle with when they're first looking at this. But, lets face it, the press has known for years that heart disease is not a question of bad luck or genetics. It's a question of what's on your plate. So, it was no big surprise.

People have been criticizing the meat industry for years, but the criticisms of dairy products were new to many people, and I was surprised at how well-received that was as well.

The only real criticism I think came from conservative medical organizations who have been promoting weaker diets for years, and certain agricultural producers. The fruit and vegetable growers were delighted. The rice growers thought this was the best thing they ever heard of. But, the livestock producers naturally fought it with the same venom that the tobacco growers have fought tobacco legislation.

That happens, you expect it, but you've got two choices. If you were going to try to reform, to help America, you can be honest and expect the flack you're going to get and accept it, or you can sellout and lie to people. To me the choice is very clear. You have to tell people the truth, and they will gradually accommodate to it, and hopefully see its wisdom.

We knew when we did this that the Department of Agriculture would not say, "Oh, great idea, we'll change the Four Food Groups." We knew it would be a long process of acceptance, but we know we're right. What we wanted to do, then, was kick off the process by getting the public involved, getting them writing letters to the editor and complaining. We wanted to work our way eventually into the consciousness of the government, and I think that process has begun, and I don't think it's reversible.

Let me say a few things about the recently proposed food "pyramid." The pyramid was the Department of Agriculture's plan to say that you should eat less meat, but still eat it everyday. You should eat more grains, vegetables and fruits, and de-emphasize the meat and dairy, but still eat it. So, they created a pyramid of foods.

At the very top, in the smallest part of the pyramid, was sugars and oils, and that was supposed to be something you have only rarely. That's why they gave it the small part of the pyramid. And then, under that was meats, which you're supposed to have more of than the sweets and oils, but not as much as grains. Then, I think, it was dairy, and then under that was vegetables and fruits, and then the grains.

The visual image was supposed to emphasize grains, but one problem with it was that it had meats near the top, so meat looked like the pinnacle of nutrition. Before they released it, they experimented with turning the pyramid upside down, so that meat would be near the bottom, but the Department of Agriculture claimed that "female consultants" felt it looked unstable that way, so they decided to keep it right side up.

We knew the pyramid was coming when we released our new Four Food Groups, and we thought the pyramid was virtually no better than the original Four Food Groups. The pyramid, how ever, was embraced by a lot of dieticians, because it did de-emphasize meat.

The pyramid lasted three weeks. Department of Agriculture went back to the drawing board because the livestock producers wouldn't stand for it. They lobbied very heavily, and it was pulled back.

Spectrum: In my travels or reading I have discovered no culture in the world that ate a truly vegan diet (no meat or dairy). Everywhere I have been or read about, the diet contained small amounts of animal foods, so I wonder if small amounts might be necessary. Should the new Four Food Groups eliminate meat and dairy entirely?

NB: The Four Food Groups, as we presented it, wasn't trying to say what the totality of the diet should be. It only said what the basis, the foundation of the diet should should be--grains, legumes, vegetables, and fruits. Anything else is an option. So if a person has a bowl of ice cream once a month, that isn't violating the new Four Food Groups.

With the new Four Food Groups, there's a whole range of possibilities, some of which are healthier than others. If you ask me, as a doctor, what's the healthiest diet, I would say it is a low fat vegan diet, without any animal products included. It's true that almost all cultures, maybe all cultures, do have some animal products in them, although they might vary a little bit as to what that would be and with the amount. I suspect the reason is not a nutritional need for it, however. I really don't think so. This is because animal products are something that was not part of our evolution as a species.

As I say in my book, The Power of Your Plate, prior to the Stone Age, we didn't have the capacity to hunt animals. We didn't have spears, axes, or bows and arrows until about two million years ago. Yet, we have lost our canine teeth that would help, say a chimpanzee, if they want to get hold of a little monkey and tear it to shreds. They could do that because they have long, protruding canine teeth. Those were lost to our species at least three and half million years ago. So, during the critical phase of our evolution as we were differentiating from other primates in becoming the species we are now, it is almost certain that we were eating a vegan diet.

Was there some inclusion of insects or something? Who knows, but we almost certainly must have been vegan, eating a diet very similar to what other primates were eating.

All that changed when we acquired the technology of tools. Once you have the capacity to have something that was not part of your evolution, your capacity to regulate it goes haywire. So, in America now, people have the capacity to eat meat. People tend to crave it, I think because of its grease content or because of some other characteristic. People do tend to crave it, even though they pay a health price in the long run.

The same is true of alcohol. Look what happened to the American Indian population when alcohol was introduced. It had not been part of their evolution, hadn't been part of anybody's evolution, obviously, and alcoholism became a very serious problem. The same is true of sugary foods, cocaine, tobacco--anything we don't have built-in mechanisms to cope with. I think that's true of meat.

How do I know that people are healthy without it? There are studies that have compared ovo-lacto vegetarians to meat-eaters, and the ovo-lacto's do better than the meat-eaters do in terms of incidence of cardiovascular arrest. There are also studies of pure vegetarians (vegans)--no milk, eggs or meat--comparing them to ovo-lacto vegetarians, and the vegans tend to do better.

I think B-12 is an interesting issue though, because there isn't B-12 in plants, so where were people getting that?

B-12 isn't made by plants, and it's not made by animals. It's made by one-celled organisms--bacteria, and so forth. Obviously, as we were evolving as a species, our foods had a fair amount of natural contamination with bacteria. You can imagine us picking up root vegetables, shoots, leaves, and fruits, and so forth, and back then we weren't sterilizing these things and processing them. Nor were we brushing our teeth. There has been a fair amount of research showing that even the bacteria that live in people's mouths can produce some B-12. Was that the source? I don't know.

Keep in mind that the daily requirement for B-12 is extremely small. The RDA is only 2 micrograms per day--not grams, not milligrams, just 2 micrograms. The actual amount you need is only about a half of a microgram daily, and that amount could well have been supplied by bacterial sources.

Nowadays, in modem culture, everything is sterilized. Even the miso you buy in this country is all pasteurized, and it's dead. In Asia, miso is loaded with B-12 because of the bacteria that are involved in its production. Meat eaters do get B-12, but my hunch is that meat probably was not the source as we were evolving.

Spectrum: There are many different kinds of "vegetarian" diets. Some types include dairy, some fish, some even chicken. Can you talk briefly about all of them? Particularly, why do you recommend against dairy food?

NB: I have ten main reasons why dairy food is not good for health.

The first reason why I don't consume dairy products, and why I think other people should not, is the fat content. The fat in dairy products is saturated fat. Now, it is true there are skimmed milk products: skim milk, skim yogurts, and maybe one or two low-fat cheeses. But just on fat alone, you've ruled out butter, cream, sour cream, ice cream, nearly all cheeses, and whole milk products. The fat is saturated fat, and you may as well be eating beef tallow. The fat in these dairy products encourages heart disease and numerous other problems. It's a risk factor for some forms of cancer as well.

Number two is the cholesterol content of dairy products. It's the same story as the saturated fat. Number three is that dairy products really are not effective in slowing osteoporosis. This was their big selling point for years, but studies have been done measuring bone density, particularly of post-menopausal women, the group that is at highest risk. There is no correlation between bone density and the intake of dairy products, or, for that matter, any other sources of calcium. In other words, women have progressed to severe osteoporosis in spite of consuming a large amount of milk.

Now any first year medical student would say, "Well, of course, we know that bone density, the calcium content of bones, is not something you could change just by eating certain foods. It is hormonally regulated." There are things that certainly do affect bone density, but calcium intake probably is not one of them. A recent study in the American Journal of Clinical Nutrition showed that this is not only true for older women, but even for young women and men as well. There really isn't a good correlation between how much calcium you take in and the strength of your bones as you reach adulthood.

Next is the milk sugar. The natural sugar in milk is lactose. It's what we call a disaccharide, a double sugar. It breaks down in the body to glucose and galactose. Galactose is a simple sugar that infants can break down effectively, because they have a variety of enzymes in the body to do that. As you age, you lose those enzymes to a degree. Different people lose them more quickly than others. What that means is that galactose can have a certain toxicity as you age, and for women, it attacks the ovaries.

Daniel Kramer, at Harvard University, published an elegant study comparing women with cancer of the ovary and women who did not have cancer. The differentiating factor between these two groups was their consumption of dairy products. Does that mean that every women that consumes yogurt is going to get cancer of the ovary? No, but it is elevating one's risk.

By the same mechanism, or a similar mechanism, galactose is linked to cataracts. It enters the body, probably through dairy products in most cases, and can be absorbed into the lens of the eye. Infants who are born with a genetic defect in their capacity to break down galactose get dense cataracts within the first year of life. I believe that dairy products are probably a contributor to cataracts in older folks. I say that because there are epidemiologic studies showing that the incidence of cataracts is not uniform across cultures. It is much higher in countries where dairy products are consumed. There are other contributors, such as ultraviolet B and others, but dairy seems to be one of the principal suspects here.

Another issue with dairy is lactose intolerance. This is something which does not affect most Caucasians, which is why all the Dairy Board advocates you see are all fair-skinned people, the only people who drink milk. Asians and Africans and many others have trouble consuming dairy products; they can't digest the milk sugar.

Spectrum: Yet, people living in these countries eating the traditional diet have very strong bones.

NB: Exactly. They do not have osteoporosis with the same incidence that we do.

Milk is the number one cause of food allergies. There are other causes, such as wheat, corn, and with some people, soy products, but milk is number one, and any pediatricians experience would agree with that.

Insulin-dependent diabetes is much more common in countries where dairy is consumed. The putative link is that the dairy protein kicks off an autoimmune reaction in which antibodies attack the dairy protein, inadvertently damaging the cells of the pancreas that produce insulin.

Milk is extremely low in iron, and if you're concerned about iron deficiency, milk is not a food you want to consume.

Babies get colicky from drinking milk, and they're also colicky if their mother is consuming milk. We now know that the cow's antibodies can be absorbed into the mother's digestive tract, and through the bloodstream reach her milk, then baby. I believe it was the April 1990 issue of Pediatrics that laid this out and said that the baby will be colicky if the nursing mother is consuming milk.

So there are several reasons not to drink your milk.

Spectrum: What about chicken and the different kinds of fish?

NB: Number one, chicken is not a health food by any stretch of the imagination. The poultry industry has been trying to capitalize on the criticisms that beef is now getting and they tell people to eat their products. But there are several reasons not to.

Number one, chicken has the same cholesterol content as beef. This always stuns audiences when I tell them, although it doesn't stun dieticians who write nutritional analyses--they've known this for years. Every four ounce serving of beef has 100 milligrams of cholesterol in it. A four ounce serving of chicken has exactly the same--100 milligrams of cholesterol. It can be somewhat lower in fat, but not a lot lower in fat.

The leanest beef has 30% of its calories as fat. The very leanest chicken is about 20%. Compare that to beans, with 5% of calories as fat. Rice is even less, maybe around 7% or 8%. A 20%-fat food with no fiber, no complex carbohydrates, and a fair load of cholesterol is not a healthy food, and that's what chicken is. Even selecting only the white meat and taking the skin off, it is not a low-fat food.

What is worse is that chicken and meat displace the healthy foods in our diet. I mean, if you're eating 300 calories of chicken, that's three hundred calories of rice or whole grain products or green vegetables that you're not eating. So it's not just the bad stuff it gives you, it's the good stuff that it pushes off the plate.

Another interesting thing, and this is getting press everywhere, one out of every three chickens at the retail store has live salmonella bacteria growing under the plastic. The reason is that every chicken goes into the slaughter operation after having lived its eight-week life in a factory situation--a big steel building with ten, twenty or thirty thousand chickens all swimming in chicken feces. Nobody sweeps around them during their entire life. They're just boxed up and sent to slaughter.

Salmonella lives in chicken feces, and the process of slaughter actually tends to push this fecal contamination into the skin of the chicken. At the end of the slaughter procedure, their heads are cut off, their corpse goes through a cold water bath to cool it down so it doesn't rot, and the water bath...it might be kind of clean for the first thousand or so corpses that go through it, but eventually it becomes what CBS News called "fecal soup."

People get the chicken home, slit open the plastic, and you know that little bit of juice that dribbles down on your counter, people think that's chicken juice. Chickens are not fruits, they do not have juice. That is the water bath stuff that the chicken absorbed, along with a little blood and serum, etc. One out of three packaged chickens has live salmonella. That causes maybe four million or more cases of salmonella poisoning a year, and about nine thousand deaths.

I think if people can't wean themselves of chicken, they ought to leave it on their steps outside their house, and go outside and eat it, because once you bring it in, it contaminates surfaces. You can't see the salmonella bacteria, You can get it on a sponge, and the contamination of utensils is the biggest problem. The greatest incidence of salmonella comes from cross contamination to infants. Three month old babies actually get more salmonella than anybody else.

Spectrum: What about fish?

NB: There are several things about fish. I don't eat fish, and there are many reasons why I don't. The good things you can say for fish is that some of the the species are lower in fat by a long shot compared to meat and even poultry, and some have a little bit less cholesterol. Some have more cholesterol, however, like lobster and shrimp. Some actually are higher in fat, while some are lower. That's the entire extent of the good news about fish.

The bad news about fish is that it all has cholesterol and fat, and the fat is not the kind that anybody needs. These omega-3 fats that people talk about are also available in beans. In the American Journal of Clinical Nutrition, there was a recent series of letters and commentaries saying that people should probably get their omega-3 fats from vegetables and not from fish, because the omega-3 fish oils do seem to have a variety of negative effects, one of which is that they promote the production of free radicals. Free radicals can damage your tissues and lead to cancer.

There is also a contamination problem with fish. The February cover-story of Consumer Reports talked about this. The contamination problems with fish are ghastly.

Salmon and other kinds of swordfish are very contaminated. There are even warnings that women who are intending to become pregnant any time in the next several years shouldn't consume several species of fish. The EDB content is so high, and it is stored up in human tissues. There was a study at Wayne State University on women who had given birth to babies. Those who never ate fish were compared to those who did eat fish. The latter group, even those who ate fish once a month or more, had a higher incidence of babies who were sluggish at birth, who had small head circumferences, or who had a variety of learning problems.

Fish is a concentrated protein, and if anything we need less protein. High protein in the the diet leads to osteoporosis and kidney problems.

You don't need fish.

Spectrum: If it's not a good idea to eat fish and poultry, and we are no longer consuming wild vegetables as did the people in traditional societies, do you recommend a B12 supplement or any other kind of supplement?

NB: I do recommend a B12 supplement for anybody who, like me, is on a vegan diet. If you start a vegan diet, you have about a three-year supply of B12 in your body. But after three years, or even before, people should supplement with B12. I suggest you take a form that says "B12" on it, or the chemical name, cyanocobalamin. Some of the forms that people thought were active, like chlorella or spirulina, may not have active B12 in them.

If you get a One-A-Day, or any common multivitamin, it will have B12 in it. You don't need to be especially careful about it. And, there are vegetarian supplements made of algae that are perfectly fine. It's not something you need to worry about or take every day. Get the smallest size you can. Probably 50 micrograms is the smallest size the store will sell you, and take it 2-4 times per week. By the way, I don't recommend other supplements.

Spectrum: You are saying all these things that suggest radical changes in the way Americans eat, citing several studies to back up your views. Yet most doctors, who are supposedly in charge of protecting our health, will be eating a steak tonight or going out with the kids to McDonald's. What's the problem? Is the research you are citing debatable, or is it that it's hard to accept something new? Why don't people eat this way?

NB: I think things are starting to change. Things change slowly, and doctors are creatures of habit, and they'll probably be the last to change, unfortunately. But there are some terrific new faces on the horizon that are becoming widely accepted, such as Dr. Dean Ornish, who has done brilliant, carefully controlled research. He has received a tremendous amount of attention from the medical community.

People doing work with diabetics, and certainly with cancer, are getting a lot of attention for vegetarian sorts of diets.

Regarding being vegetarian, I don't think the common reaction anymore is that you must be in some sort of bizarre religious cult. If I'm sitting on a plane and get the vegetarian meal that I've ordered, the person next to me will always say, "I'm pretty much a vegetarian" or "I'm going that way." They want to be vegetarian. Even if they're not that way, they know they should be.

Doctors, like everybody else, are subject to the habits they grew up with. It tends to cause a predictable pattern--sort of rationalization and resistance.

There's no doubt about it, however, we're going to win, and there are lots of reasons. For example, there are all these HMOs who are trying to give medical care at fixed cost. It's going to be just a matter of time before they realize that for every coronary bypass they prevent, it saves them $20,000. Prevention is the key, and the two biggest factors are changing diet and avoiding tobacco.

The National Restaurant Association recommends having a vegetarian section on the menu. One out of every five restaurant-goers considers the ability to obtain a vegetarian meal important when choosing a restaurant. PETA (People for the Ethical Treatment of Animals) now has these "V" stickers for restaurants. They will be displayed alongside the Visa and MasterCard emblems.

The demand for vegetarianism is there, and I'm very optimistic, not just about the distant future, but the near future.

Spectrum: Health am is a big political issue now in the presidential campaign. Can you comment on the situation?

NB: Many people have been occupied with something that I think is important, but secondary--how do we have equitable distribution of health care. That's an important issue, but I think it misses something more powerful that could help solve the problem.

Health care costs are simply accumulated health care bills. The reason you have health care bills is because you have sick people going to see their physicians. Now, it is true that about 90% of heart attacks, and a similar percentage of bypasses and some transplants, and so forth--none of these would be needed if people took good care of themselves. Eighty percent of cancer is preventable, or at least is tied to identifiable factors that we know about. This is the National Cancer Institute's estimate. Thirty-five percent of cancers are due to smoking and 35% to 55% are due to diet. Other causes are x-ray exposures, drugs, etc. We can control these cancer factors if we choose to.

If we do that, we can keep people healthy. They won't have to go see their doctor, there won't be a health care bill generated, and the costs to private insurance, to individuals, and to Medicare and Medicaid could all plummet.

Spectrum: Doctors will have to become less wealthy.

NB: Doctors should become less wealthy.

I think that the availability of insurance has insulated doctors from their patients. My grandfather, when he treated someone, might have gotten some vegetables as payment, and his bills were low. Now, because of the wide availability of insurance, doctors unabashedly charge enormous rates because they know that the patient actually isn't going to pay it. The patient does pay it right away--they pay it in the insurance premiums that have been extracted from their paychecks, but it's been smoothed out over the course of the year, and the patients don't really mind these exorbitant fees. Doctors are driving BMWs and Mercedes. I consider it unethical, and frankly, it's becoming more grotesque with time.

What I want to see in the future is a reduced demand for health care. I want doctors to focus on people that already are healthy, and ask what they can do to maximize their health, because, hopefully, there won't be sick people coming to see them and they need something to do.

Spectrum: Do we need a new type of health profession, given what we now know about the causes of disease? You don't need as much training to help people prevent illness as to cure it. Why have a doctor, who is trained in complex operations and other disease treatments, give people lifestyle counseling on how to stay well? It's a waste.

NB: Also, people like you are doing this. Through an article you write, you are reaching a lot more people than I would reach in a typical day. People like you are the lifesavers, too. You take information that other people have developed through research and make it available to large numbers of people. My hat's off to you and everybody like you who's getting the word out.

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