Getting Rich Can Kill You! A Warning to Developing Countries… Learn from Our Mistakes!

1. Getting Rich Can Kill You!A Warning to Developing Countries…Learn from Our Mistakes! Robin Carr, Ph.D.

2. 3 Requirements of Science • Look for evidence! (Especially ‘peer-reviewed’.)(And don’t accept just evidence that fits your theories.) • Don’t believe any one individual or any one scientific finding. Assess the ‘weight’ of evidence. • While it’s sometimes necessary to focus on narrow questions and specific details, always step back now and then to see the broader picture.

3. Investigate the research yourself! • PubMed Central (PMC) is the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature.http://www.ncbi.nlm.nih.gov/pubmed/http://www.ncbi.nlm.nih.gov/pmc/ • Abstracts are almost always provided along with the references, and sometimes the entire article is provided free on-line, from a provided link.

4. http://www.ncbi.nlm.nih.gov/pubmed/

5. http://www.ncbi.nlm.nih.gov/pmc/

8. Next…About Correlations • A correlation is a measure of how closely 2 variables are related to each other. • Correlations are the most frequently used tool in epidemiological and human dietary research. But they must be used with caution.

9. Example • Did you know that a positive correlation was found between eating ice cream and getting divorced?

10. Ice Cream Divorce Which is the cause? Which is the effect? Summer Does eating more ice cream increase your risk of divorce?

11. Ice Cream Divorce Which is the cause? Which is the effect? Or, do you eat more ice cream when you get divorced?

12. Summer Ice Cream Divorce The answer… Summer increases the chances of both!

13. Pant Length Leg Length When Cause & Effect is Assumed Sometimes the context makes cause and effect obvious. But assumptions can sometimes be wrong.

14. He who does not know food, how can he understand the diseases of man? Hippocrates, the “father of medicine” (460-357 BC)

15. A Story about Proteins • Protein is one of the basic components of food and makes all life possible. All of the antibodies and enzymes, and many of the hormones in the body are proteins. They provide for the transport of nutrients, oxygen and waste throughout the body. They provide the structure and contracting capability of muscles. They also provide collagen to connective tissues of the body and to the tissues of the skin, hair and nails. There are hundreds of thousands of different kinds of protein. • 20 amino acids make up protein. • essential amino acids (9/8) – must be included in the diet. • nonessential amino acids (11/12) – the body can manufacture. • For “normal” adults: 1.0 g protein / kg body mass per day.For active athletes: 1.4 g protein / kg body mass per day.

16. The Amino Acids

17. Protein in Cultural History • In the 19th century, protein was synonymous with meat. • Early scientists like the German Carl Voit (1831-1908) found that “man” needed only 48.5 grams/day, but he recommended 118 grams/day. (If something is good, more is better!) • Well-known nutrition researcher Max Rubner stated that protein intake (meaning meat) was a symbol of civilization.“A large protein allowance is the right of civilized man.” • The cultural bias was set. If you were rich, you ate meat. If you were poor, you ate staple plant foods like potatoes and bread.

18. Annual Income Increases Animal-Based Foods ? The “Protein Gap” • In the 1960’s and 1970’s, it was constantly asserted that there was a “protein gap” in the developing world. • M. Autret of the Food and Agriculture Organization (FAO) of the United Nations reported a very strong association (correlation) between the consumption of animal-based foods and annual income, and he implied causation. What else could explain the association (correlation)?

19. Annual Income Increases Animal-Based Foods A More Realistic Explanation!

20. Philippine Connection • In 1967, while on the faculty at Virginia Tech, Dr. T. Colin Campbell began working on a ten-year project in the Philippines (funded by the U.S. Agency for International Development) to improve childhood nutrition among the poor. • Ultimately, 110 nutrition “mothercraft” self-help education centers were established around the country, focussed on educating mothers of malnourished children about healthy “local” foods. • The aim was to make sure that children of the poor were getting as much protein as possible, since there was a perceived “protein gap” in the developing world.

21. Protein and Cancer? • Part of this project involved investigating the high prevalence of liver cancer, usually an adult disease, in Filipino children. It was thought to be caused by aflatoxin, a mould found in peanuts and corn, which is one of the most potent carcinogens known. • “Children who ate the highest-protein diets were the ones most likely to get liver cancer. They were the children of the wealthiest families.”Campbell TC and Campbell TM (2006) The China Study. Dallas, Texas: Benbella Books, p.5

22. The Indian Study • One group of rats was given aflatoxin and then fed diets of 20% protein. The other group was also given aflatoxin and then fed diets of only 5% protein. • Every single animal fed a 20% protein diet got liver cancer or its precursor lesions. • Not a single animal fed a 5% protein diet got liver cancer or its precursor lesions. • 100% versus 0%? This seldom occurs in biological sciences. It was a very provocative finding! Madhavan TV and Gopalan C (1968) The effect of dietary protein on carcinogenesis of aflatoxin. Arch Path 85:133-7.

23. Three Stages of Cancer • Initiation - A carcinogen enters a cell and is converted by cellular enzymes to highly reactive products that bind to the cell’s DNA, forming carcinogen-DNA complexes (adducts) that are often repaired. If not repaired before the cell divides, the “daughter cells” will have this new genetic defect (mutation). This occurs quickly and is usually irreversible. It represents a potential for cancer. • Promotion - Some factors (promoters) may act to increase the growth and multiplication of these mutant cells over a longer period of time, while other factors (anti-promoters) work against this. • Progression - Large foci (clusters of mutant cells) progress in the growth and may wander from their initial site (metastasize).

24. The Promotion Stage • Many animal studies have shown that nutrition may be far more important in controlling the cancer promotion stage than the dose of the initiating carcinogen.O’Connor TP, Roebuck BD and Campbell TC (1985) Dietary intervention during the post-dosing phase of L-azaserine-induced preneoplastic lesions. Journal of the National Cancer Institute 75:955-957 (cover article). • Nutrients (esp. casein) from animal-based foods increased tumour development while nutrients from plant-based foods decreased tumour development.Hawrylewicz EJ, Huang HH et al. (1982) Enhancement of the 7,12-dimethylbenz(a) anthracene (DMBA)mammary tumorigenesis by high dietary protein in rats.” Nutr. Reps. Int. 26:793-806.

25. What about the type of protein? • What protein consistently and strongly promoted cancer? Casein (87% of cow’s milk protein) promoted all stages of the cancer process. • What type of protein did not promote cancer, even at high levels of intake? The safe proteins were from plants, including wheat and soy.

26. Protein Excesses? • Peer-reviewed biochemical research, funded by the National Institutes of Health, the American Cancer Society and the American Institute for Cancer Research, resulted in dozens of articles published in some of the best scientific journals. The results were shocking… “Low protein diets inhibited the initiation of cancer by aflatoxin, regardless of how much of this carcinogen was administered …In fact, dietary protein proved to be so powerful in its effect that we could turn on and turn off cancer growth simply by changing the level consumed.”The China Study, p.6

27. The Human Question • So far, most of this research had involved laboratory studies performed on animals: rats and mice. • Would similar results be found with humans?

29. ‘The China Study’ Scientific Team • Dr. T. Colin Campbell was Project Director; • Dr. Junshi Chen, deputy director of China’s premier diet & health research laboratory; • Dr. Junyao Li, one of the authors of the China Cancer Atlas Survey and a key scientist in China’s Academy of Medical Sciences; • Dr. Richard Peto of Oxford University, one of the leading epidemiologists in the world, who has been knighted for his work.Campbell TC and Campbell TM (2006) The China Study.Dallas, Texas: Benbella Books.

30. Findings of the China Study • The largest and most comprehensive study of human diet, lifestyle and disease in the history of biomedical research was organized through Cornell University, Oxford University and the Chinese Academy of Preventive Medicine, and involved 367 variables taken from questionnaires, blood tests, urine samples and 3-day diet inventories taken from 6500 adults from 65 Chinese counties. • Called “the Grand Prix of epidemiology” by the New York Times, it produced more than 8,000 statistically significant correlations between various dietary factors and disease. • People who ate the most animal-based foods got the most chronic disease. • People who ate the most plant-based foods were the healthiest.

31. Disease Groupings in the China Study (from The China Study, p. 76)

32. Rural Chinese versus U.S. Diets(normalized for a body mass of 65 kg) (age-standardized rates from The China Study, p. 74)

33. From Underfed to Overfed • In the year 2000, for the first time in human history, the number of overweight people in the world rivalled the number of underweight people. (While the world's underfed population had declined slightly since 1980 to 1.1 billion, the number of overweight people had surged to 1.1 billion.) Both the overweight and the underweight suffer from malnutrition. • "Often, nations have simply traded hunger for obesity, and diseases of poverty for diseases of excess.”Worldwatch (2000)Underfed and Overfed: The Global Epidemic of Malnutrition. Paper #150: Worldwatch Institute, Washington, DC.

34. Countries: “Developing” to “Developed” Major trends usually occur during this shift: • increased longevity (life expectancy at birth) e.g. Canada 81.23, U.S. 78.11, Philippines 71.09CIA World Fact Bookhttps://www.cia.gov/library/publications/the-world-factbook/ • improved sanitation and drinking water • improved access to high quality medical care • decrease in amount of daily physical activity • shift from a plant-based diet to an animal-based diet • increase in levels of obesity • nutrient deficiencies & infectious diseases give way to chronic sedentary and degenerative diseases of excess

35. Diseases of Affluence • hypoglycemia • hyperglycemia • type II diabetes • high blood pressure • coronary artery disease • strokes • autoimmune diseases(e.g. rheumatoid arthritis, gout, bursitis, neuritis, and some sciatica) • osteoporosis • many cancers

36. Cancer in China • Counties with the highest incidence of some cancers had rates more than 100 times greater than counties with the lowest rates of those cancers. (In the U.S., cancer rates in one area are never more than about 3 times higher than in the lowest incidence areas.) • Since 87% of China’s population is the same ethnic group (the Han), why is there such a variation in the rates of cancer? It had to be due to environmental factors like poor nutrition, lack of exercise and unhealthy living environments. • (Some U.S. scientists had already estimated that genetics only determines about 2-3% of the total cancer risk.)Doll R and Peto R (1981) The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst 66:1192-1265.

37. Blood Cholesterol & Cancer • Blood cholesterol levels in rural China were far lower than expected (measured in mg/dL):Av. Rural ChinaAv. U.S.Minimal Safety (assumed) 127 215 150 • As levels dropped from 170 to 90, there were associated decreases in cancers of the liver and colon (p<0.01), and rectum, male lung, adult leukemia and adult brain (p<0.5). • NOTE:This correlation even at very low levels is surprising, due to a statistical phenomenon. Real relationships between 2 variables sometimes cannot be seen when the range of data is limited!

41. Breast Cancer • The American death rate from breast cancer was 5 times higher than the rural Chinese rate. In fact, from an international perspective, breast cancer can clearly be seen as a disease of affluence that is highly related to animal fat (and, possibly just by association, animal protein). Carroll KK, Braden LM et al. (1986) Fat and cancer. Cancer 58:1818-25 • This finding has been confirmed many times since then.

42. Carroll KK, Braden Lm et al. (1986)Fat and cancer. Cancer 58:1818-25

43. Carroll KK, Braden Lm et al. (1986)Fat and cancer. Cancer 58:1818-25

44. Carroll KK, Braden Lm et al. (1986)Fat and cancer. Cancer 58:1818-25

45. Colorectal Cancer • A major American Cancer Society study finds people who reported the highest consumption of red and processed meat had a significantly higher risk of colorectal cancer than those who reported the least consumption. The study of nearly 150,000 Americans, the largest and most comprehensive to date, adds substantially to previous evidence linking highest consumption of red and processed meat to intestinal cancer. Chao et al. (2005) Meat Consumption and Risk of Colorectal Cancer. JAMA (Journal of the American Medical Association) 293: 172-182.

46. A Major Recent Study! • “Red and processed meat intakes were associated with modest increases in total mortality, cancer mortality, and cardiovascular disease mortality.”Sinha R, Cross AJ et al. (2009) Meat Intake and Mortality: A Prospective Study of Over Half a Million People. Archives of Internal Medicine 169(6), 562-571.

47. Nitrites and Nitrosamines • Sodium nitrite:A meat preservative used since the 1920’s, it kills bacteria, colours meat pink and adds to the taste. • Nitrosamines:A family of chemicals of which at least 17 are “reasonably anticipated to be human carcinogens.”National Toxicology Program (2001) Ninth report on carcinogens, revised January 2001. Washington, DC: U.S Dept of Health and Human Services.http://ntp.niehs.nih.gov/index.cfm?objectid=72016262-BDB7-CEBA-FA60E922B18C2540

49. Value of a Plant-Based Diet • “Recent scientific findings are suggesting that diets largely based on plant foods, such as some vegetarian, Mediterranean, or rural Asian diets, could best prevent nutrient deficiencies as well as diet-related chronic diseases. These diets contain no or very little meat.” • Diets largely based on plant foods, such as well-balanced vegetarian diets, could best prevent nutrient deficiencies as well as diet-related chronic diseases.Sabaté, Joan (2003) The contribution of vegetarian diets to health and disease: a paradigm shift? American Journal of Clinical Nutrition, Vol. 78, No. 3, 502S-507S.

50. 1960’s Perspective from Sabaté, Joan (2003)