Neal Barnard – Clinical Researcher, Founder, the Physicians Committee for Responsible Medicine
Today, I’d like to talk about turning around an epidemic. 100 million Americans right now do have either diabetes or pre-diabetes, and that puts them at risk for amputations, for heart disease, for blindness and we’re exporting this epidemic overseas.
Now the word epidemic comes from Old Greek: ‘epi’ means ‘on’, ‘demos’ means ‘people’, so an epidemic is something we study with sterile statistics, and maps, and graphs, but the truth is, it’s something that impinges directly on people, on living, breathing human-beings.
But my story actually starts in the basement of a Minneapolis hospital. The year before I went to medical school, I was the morgue attendant, or as I’d like to say, the autopsy assistant. What that meant was, whenever anybody died, I would bring the body out of the cooler, and put the body on an examination table, and the pathologist would come into the room.
And one day, a person died in a hospital of a massive heart attack. Probably from eating hospital food, but that’s another story.
So to examine the heart, you have to remove a section of ribs, and this is not done with great delicacy: you take what looks like a garden clipper, and you go crunch, crunch, crunch, through the ribs on this side, and crunch, crunch, crunch, through the ribs on this side. And the pathologist pulled this big high wedge of ribs off the chest, set it on the table.
And he knew I was going to be going to medical school, so he wanted to make sure that I saw everything. And he would say, “Neal, look at this. These are the coronary arteries,” — we call them coronary because they crown the heart — and he sliced one open, and he said, “Look inside.”
And so with my gloved finger, I poked around, and it wasn’t a wide open artery, it had what was sort of like chewing gum inside, except that it was hard like a rock, and he said, “That’s your bacon and eggs, Neal, that’s atherosclerosis.”
And we looked at the carotid arteries going to the brain, the arteries going to the legs, the arteries going to the kidneys. They all had this hardening of the arteries, that’s atherosclerosis.
He said, “We see the beginnings of this in two-thirds of people by age 23”, which happened to be the exact age that I was at the time. So, anyway, he writes up his findings, “massive atherosclerosis, acute myocardial infarction,” and he leaves the room.
So, I picked up the ribs and put them back in the chest, tried to make them fit right with the other ribs, and I sewed up the skin, and cleaned up, and then I went out and went up to the cafeteria, where it turned out they were serving ribs for lunch.
Now, let me tell you something, I knew about ribs. I grew up in Fargo, North Dakota, I come from a long line of cattle ranchers and I remember the smell of the cows out in the field, I remember the smell of the cows in my grandpa’s barn and I remember driving a load of cattle with my uncle to East Saint Louis, to the National Stockyards, and I remember the National Stockyards hotel, two dollars a night, and the smell of that room.
And I have to say, everyday in my life, it was roast beef, baked potatoes, and corn. Except for special occasions, when it was roast beef, baked potatoes, and peas. And that’s the sort of the way we ate, but my father did not like the cattle business, so he left, left the family farm, and he went to medical school.
And he spent his life at the Fargo clinic treating diabetes, he became a diabetes expert for the whole region. And I have to say my father really was frustrated because patients were given diets that they did not like. What we would say is, or what they would say, is diabetes is a condition where it’s too much sugar in your blood, so don’t eat anything that turns to sugar, so don’t eat bread, don’t eat fruit, don’t eat pasta, rice, sweet potatoes, don’t eat regular potatoes, don’t eat beans, don’t eat carrots; all these things had to be limited and while you are at it, cut calories, and that’s what people were supposed to adhere to, that gets old by Wednesday.
Patients were also given medicines, and they were given needles, and instructions on how to stick their fingers and how to inject insulin. And despite all of this, diabetes never got better, it always progressed, and it then became something that we’re exporting overseas.
And when I got out of medical school, we had more medicines, and I think we had sharper needles, but to tell you the truth, it was the same sort of result, we had unhappy patients, and we’ve never ever cured this disease, it never turned around, it was always considered a progressive disease.
But there were two scientific discoveries that really turned all this around. And the first one was taking the widest possible lens. If you look around the world, at those countries that have the least diabetes, like Japan, for example, they weren’t following anything like the diet we were given to diabetic patients. They weren’t saying, “I’m not going to eat rice, I won’t eat noodles,” they eat this kind of food all the time, it’s front and center on their plate.
And the second discovery came from looking inside the cell, especially the muscle cell. And the reason we look at muscle cells in particular is that’s where glucose is going, that’s where blood sugar is going, that’s the fuel that powers your movement.
Do you know about a person who’s running a marathon? What are they doing in the weeks leading up for it? They’re carbo-loading. So they’re eating pasta, they’re eating bread to try to get that glucose into the cell for energy. And that is the problem in diabetes, because glucose, glucose is there, outside the cell, trying to get inside. In order to get in, it needs a key. And that key is insulin.
Now, what if I get home, and I’m getting up to my front door and I take my key out of my pocket, I put it in the front door — Wait a minute, it’s not working. And there’s nothing wrong with my key, but I look in the lock, and while I was gone, somebody put chewing gum in my lock. So what am I going to do? Crawling in and out the window? No. I’m going to clean out the lock.
Well, when a person has diabetes, their insulin key is not working. Why would that be? Why could insulin not signal? What supposed to happen is the glucose is supposed to enter into the cell. And glucose is the key that makes that happen. But the reason it doesn’t happen it’s not that there’s chewing gum inside the cell. What there is is fat. Fat, little globules of fat.
Now I have to say, doctors hate words like “fat”, it’s got one syllable. So we want to call it intramyocellular lipid. ‘Intra’ means’ inside’, ‘myo’ means ‘muscle’, ‘cellular’ means ‘cellular’, ‘lipid’ means ‘fat’. Intramyocellular lipid is fat inside your muscle cells, and that is what interferes with insulin’s ability to work like a key to signal glucose coming in.
In 2003, The National Institute of Health gave my research team a grant and said, “Let’s test something completely different. Instead of limiting breads and all these kinds of things, what if – if fat is the issue, what if we have a diet that has effectively no fat in it?”
Well, where does fat come from? It comes from two sources: animal products, animal fat, and vegetable oils. So we brought in 99 people, and we asked them to do two things: to really eat a bounty of food and not worrying about quantity, we’re not counting calories here, we’re not counting carb grams or anything like that. What we’re doing instead is we’re setting the animal products aside keeping the vegetable oils low. Very simple.
Now one of our participants was a man named Vance, and Vance’s father was dead by age 30. Vance was 31 when he was diagnosed with diabetes, he was in his late 30s when he came to see us. And he said, “This is not hard!” Unlike every other diet he’d been on, we didn’t care how many carbs he ate, or how many calories, or how many portions. If he was having chilli, not a meat chilli, would be a bean chilli, chunky vegetable chilli. If he was having spaghetti, instead of a meat topping, it would be topped with artichoke hearts and wild mushrooms, and chunky tomato sauce. So that kind of thing; very, very easy.
Over the course of about a year, he lost 60 pounds, his blood sugar came down and down, and down, and one day his doctor sat him down and said, “Vance, I know you’ve had family members die of this disease.” But he said, “I look at your blood tests; you don’t have it anymore.”And can you imagine what that feels like to have family members who felt there’s this absolutely one way street and have this disease just turn around? And when I asked Vance’s permission to tell you about his story, he said, “Make sure you tell everybody that my erectile dysfunction went away too.” Write that down.
So, we published our findings in peer-reviewed journals, the American Diabetes Association now cites it and accepts this as an effective approach. And people around the world started using this and I heard from a man in England, who wanted to let me know about his experience. He had had diabetes, tried all kinds of diets without a lot of success. And then he heard about our approach, tried it for several weeks, went to the doctor, the doctor drew a number of blood tests. And he got home. The phone rang, “This is the doctor’s office. Could you come back right now?
So he goes, “Good heavens! What’s in my blood test?” And he races into his car, he’s driving to doctor’s office thinking what disease did they discover on my blood test, what did they find …” And he runs into. They say, “We need you to sit down. Explain exactly what you’ve been doing.”
All traces of his diabetes were gone. The doctor said, “Your blood tests are better than mine, and I don’t have diabetes, how is this possible?”
The doctor explained to him, “We can never say a person has been cured of diabetes because we all know that’s not possible, but technically, it’s not there.”
And the doctor was skeptical, he said, “Come back in two months, I want to test you again.”
Never came back.
Now, wait a minute. Diabetes is genetic, right? It runs in families. And there, in fact, are genes for diabetes, but this is an important thing to remember, genes are in two categories. Certain genes are dictators, I’m talking about the genes that say, ‘blue eyes’ or ‘brown hair’. They are dictators, they give orders, you can’t argue. But the genes for diabetes are committees. They’re making suggestions. And you can say, “Wait a minute, I don’t really think I want to have diabetes.” And, in fact, most disease genes, whether it’s for heart disease, or diabetes, or hypertension, certain forms of cancer, even Alzheimer’s disease, they’re not dictators, they’re committees. And their activity depends on what we put into our bodies.
So, what I’m saying is that we’re putting into our bodies foods that we’re really not designed for. Which raises the question: what foods are we really designed for?
Well there are different ways of looking at this. And one is called the dental test. Do you know the dental test? What you do is you wait for your cat to yawn, and you look in your cat’s mouth and what you notice is in its mouth are these very, very long protruding canine teeth, and on each side of its mouth, it’s just like a pitchfork that’s really good for capturing pray, killing small animals, and ripping the hide off the flesh and eating meat.
So now look at your own mouth. What you discover is that your canine teeth are no longer than your incisors. And that change occurred at least 3,5 million years ago. So our molars are really good for crunching on an apple, they’re not so hot for handling roadkill.
Now there’s the bunny test. Do you know the bunny test? You take a bunny, and you put the bunny in front of your cat and what you discover, no matter how young your cat is, the cat has this irrepressible desire to capture, attack, kill, and swallow that bunny.
Now, you put the very same bunny in front of a toddler or baby. And what you discover is the toddler say, “Bunny, bunny!” They want to play and the little baby is just absolutely delighted, the idea of killing and eating him would never occur to him in a million years.
We’re learning something here. Do you know the box test? You take a box that it was used to carry electronic equipment, and you look around at the bottom and what you find is silica gel. And silica gel is there to take moisture out of the box. And apparently, the manufacturers of silica gel have realized that human-beings are so indiscriminate in their eating habits, that they have to put these words on it, “Do not eat”.
So, here’s how I put this together: human-beings are naturally herbivores, but we’re really easily thrown off track. The fact of the matter is, before the Stone Age, people would have been just terrible hunters, really. You know this is true because we’re not very quick. Now a lion, a lion is quick, in the forest, a lion can easily catch a gazelle. A hawk or a falcon can easily catch a mouse. Humans, we sort of catch cold. That’s like it. We don’t really detect prey very well, we don’t have sensitive noses.
If you look at a dog, a dog has a very highly developed sense of smell, they can detect prey at long distances, which is why they are used in airports to detect bombs, and drugs, and that kind of things. And their sense of hearing far outstrips ours, they are outfitted to be able to detect prey.
Now, human-beings, we have cute noses and we have cute ears, but we really are pathetic as hunters. And if you’re going to succeed as a carnivore, you need good sharp claws, good sharp teeth, you need to be very, very quick, and you need to have sensitive hearing, sensitive smell, sensitive vision.
Which actually raises the question: what is the most sensitive part of the human body? What do you think? Well, I actually learned the answer. As I was coming here, I was at the airport. And the TSA agent pulled me aside and said, “I got to do a pat down, and when I get to a sensitive part of your body, I’ll use the back of my hand.” And I realized that apparently, the most sensitive part of the human body must be our back side, I guess.
So, anyway, what I take from this is that meat eating began somehow. How did it begin? I put that question to Richard Leakey. And Richard Leakey, the famous paleoanthropologist – and what he said was, “You know, human-beings as herbivores, you don’t have to be quick, you don’t have to be particularly sharp or sensitive because you don’t really have to sneak up on a strawberry, it’s just sitting, not doing anything. But to become carnivores really took some work. And it probably started as scavenging.” In other words, a lion doesn’t eat everything. When they walk away from the little pile of bones they’ve left there’s a little meat there, and humans could relatively easily sneak in and cut some of that off and take it back.
Now, that requires having some tools to do that with. So once the Stone Age arrived, then we had the possibility of actually doing that. And once we had arrowheads, and axes, and that sort of thing, then we were really on to something. Meat eating really became a big thing. But, we have pre-stone age bodies. To this day, when a person puts into their body plant foods, their arteries open up again, their diabetes starts to get better, their weight starts to come off, their bodies start to recover.
Now Americans, unfortunately, are really not on a diabetes reversal diet. Americans today eat more than a million animals per hour. And the Centers for Disease Control and Prevention say that one of three kids born in the year 2000 and in the years since is going to get diabetes at some point in their life. And you see the truth of it, turn on the television: half the commercials are for burgers, chicken wings, snack foods, the other half of the commercials are for medicines to undue the effects of all the foods that we’re eating.
So, that’s where we are. And what if it happened that instead of a hundred million Americans having diabetes or pre-diabetes, what if all hundred million had diabetes itself? Or more people than that? All of them need medicines, and testing, and hospital care, and so forth. Financially, it’s a disaster. But, personally, the personal cost is just incalculable.
Now I think we’re starting to turn the corner: my family has promoted meat for generation after generation, after generation. However, in 2004, we reached the peak at 201.5 pounds of meat. That’s what the average person consumed in that year. And in the subsequent years, it’s dropped and dropped, and we’re now under 190, and hopefully, that downward trend will continue. But to this day, doctors, dieticians, nurses they will say, “Diabetes is a one way street, it never goes away.”
But that was before we looked around the world and saw, you know, there are dietary patterns that are more helpful. And that was before we realized that looking inside the cell, we can understand how this occurs, and we can understand how to reverse this process. And it was before we realized that patients will make bigger changes than we gave them credit for. So, families like mine, that have been selling meat for generations, instead, maybe we can sell carrots, asparagus, sweet potatoes, and beans, and hopefully, the autopsy room will more neglected than ever, because people are going to live longer, and they’re going to look better, and maybe the hospital cafeteria, instead of serving ribs, could serve a bounty of helpful foods, and instead of studying epidemics, maybe we can celebrate a resurgence of health.
Thank you very much.