Type 2 diabetes is a major risk factor for heart disease.  Consequently, historically, physicians have prescribed aggressive drug treatments to lower the risk of heart disease among patients with Type 2 diabetes.  Typically, these drugs include medications that lower blood pressure, blood cholesterol, and serum triglycerides.   However, results from three substantial studies (especially, in terms of sample size) presented at the annual meeting of the American College of Cardiology in Atlanta this past Sunday, Mar 14, indicated that some of the most widely prescribed medications to reduce the risk of  heart disease in Type 2 diabetics appeared not to provide much protection to patients at all, and in some cases, such therapy may even be doing harm.

Data for these conclusions come from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial.  This was a three-part study launched a decade ago to investigate whether aggressively lowering 3 key risk factors for heart disease, i.e., blood sugar, cholesterol, and blood pressure – would reduce heart disease risk in patients with diabetes or pre-diabetes.  Interestingly, 2 years ago, the blood-sugar lowering arm of the study was terminated when patients who drastically reduced glucose levels suffered a higher overall mortality rate as compared to those not receiving such therapy.

RESULTS - IN A NUTSHELL

• Results of the two remaining arms of the trial (One, in which patients received aggressive treatment to lower blood pressure, and the other, in which they received statins to reduce blood cholesterol as well as other medications to reduce triglycerides) indicated that aggressive drug treatment did little to reduce the risk of diabetics developing heart disease.  These study arms had 4,700 and 5,500 patients each – a factor, that gives substantial weight to these findings.  These findings were published online in the New England Journal of Medicine.
• In addition to the above, results of two other related large studies that measured effects of aggressive blood pressure and blood sugar reduction were also published online.  Results of these studies also indicated no benefit of aggressive blood pressure & blood sugar lowering treatments in reducing the risk of heart disease.

WHAT ARE PHYSICIANS (AND PATIENTS) TO MAKE OF THESE RESULTS?

In light of the results from the above statistically large, prospective studies, many researchers and physicians appear to be in a quandary regarding how best to incorporate these results into recommendations for practice.  At first glance, to most researchers who are directly involved with the studies, these results appear counterintuitive.

My first comment (as an epidemiologist) is that large-scale studies that investigate several complex factors simultaneously always have to face up to the challenge of “teasing out” the many subtle relationships that are present among the variables under study.  If that sounds too esoteric, here is a simple way to understand it — Patient histories, exercise levels, diet(s), stress levels, and other factors are ALL relevant to disease outcomes.  Thus, it is difficult, if not impossible, to arrive at a standard set of recommendations that are universally applicable.  For example, in one of the studies under discussion, it appeared that older patients with more advanced disease benefited less from drugs than younger or newly diagnosed patients.   Such nuances only come to surface with very specific examination of the study data.  It is thus possible that some of these very complex associations among study variables may become clearer as the data is investigated further in the future. 

My second comment is a much more practical one.  Whether or not aggressive drug treatment lowers heart disease risk in Type 2 diabetics may be up for discussion and discourse, but what immediate advice is imminently relevant to Type 2 diabetics…AND, incidentally, is not subject to prolonged debate?   The answer – It is the straightforward advice of improving their diet, their exercise patterns and their stress levels.  Why?  Because there is a safety factor “built-in” in positive lifestyle and nutritional changes that is nearly always absent in treatment with drugs; and especially so, in the case of “aggressive” treatments with drugs – as these very substantial studies have amply testified.

THE BOTTOM LINE – COMING FULL CIRCLE

Speaking generally – certainly, drugs can be beneficial, and even life-saving, especially in numerous acute situations.  But, the weight – both of experience and research - suggests that drugs alone are seldom the complete answer, especially when dealing with complex chronic diseases.  Rather, it is nearly always the case that most patients can benefit from nutritional and lifestyle modifications in tandem with drug use, and often, even utilize such modifications as stand-alone therapies when they are implemented under professional guidance.

In the aftermath of the (counter-intuitive) results of the studies under discussion, numerous researchers and physicians are now anticipating a move toward the “re-introduction” of nutritional and lifestyle modifications as perhaps a useful primary mode of treatment for diabetics, after all.  But, one question remains –  Did we really have to wait for the results of these studies to “re-introduce” patients to the idea of sensible eating & living?   Is it not intuitive to introduce patients to the merits of correct nutritional and behavioral choices – irrespective of whether these choices accompany drug use (as needed/indicated)?  

We appear to have come full circle.   The most basic and intuitive of all choices - that of seeking and maintaining quality in the foods we eat, and moderation in the lives we live – is now ratified by hard science.  How much more proof do we need to believe that how we eat and live matters?   This day, and how you  live it matters, after all.  Make a start.

Heart disease, Diabetes, Obesity, Cancer – It is no secret that at present, the U.S. is mired in an unprecedented epidemic of these and other deadly chronic diseases.  But, how serious is the situation really?  The answer: 1 in 3 individuals in the U.S. currently have one or more forms of cardiovascular disease; nearly 70 million of our population is clinically obese (not just overweight)  and more than 2 out of every 5 individuals in the U.S. now face a lifetime risk of cancer.   These numbers represent us; They tell the story of how we are doing individually with our health, and collectively as a nation.   And, frankly, how we are doing does not look good.

So, what is the remedy for the health and chronic disease crisis that appears to be overwhelming our nation?  Are the answers to be found only in better insurance policies, adding more money into the System, and/or in better medical technology?  I believe not.  Rather, I believe that the time is ripe for another strategy – one that appears to have been universally overlooked.  And, that strategy is: Education.  But, it is not ordinary education I am talking about here.  Rather,  I am talking about education that will help the average individual arrive at lasting knowledge & clarity with respect to the critical choices that have a profound effect on one’s health.   Why bother with education of the kind I am describing?

Simple.  In his book, The Omnivore’s Dilemma, Michael Pollan accurately observes that we live in times in which most anyone with a medical degree and enough resources can topple the existing “food pyramid.”  Incidentally, the precise contents and design of the “food pyramid” themselves are often the final product of political battles that are fought every few years by multiple groups that have a stake in it.  Add to this, the ubiquitous presence and perpetual entry of new “diet” books on the market - and it is little surprise that the average person is overwhelmed with confusion and anxiety about how best to eat to achieve the simple objective of sound, long-term health.

Given the above, the question arises: Is it possible to arrive at  final answers with respect to our basic food and heath-related choices?  And, my answer is a resounding, Yes!  Notwithstanding all the factors mentioned in the previous paragraph, I believe that not only are knowledge and clarity possible with respect to knowing how to eat; they are the pre-requisite conditions for creating health.  Knowledge and clarity ARE the antidote to anxiety.  And, arriving at clarity alone  is worth the study and struggle that a good scientist endures.

Today, we do have the benefit of greater knowledge vis-a-vis which food/health-related choices can serve us best in the long run, but the benefit of such knowledge seldom reaches the average person.   As a research scientist who has been studying health, nutrition, and medicine for nearly 20 years now, I remember that from my earliest days of study, I was obsessed with the quest for knowledge, which in turn leads to clarity.  Even today, I find that the most important thing I can teach an audience is not just “what to eat,” but how to discern objectively whether what I, or any another scientist/speaker is sharing with them, is accurate.  It should be obvious why this is so crucial, but to really spell it out, here is why:  A good researcher is after the truth.  Period.  He/she is not after an agenda, profit or sales.  Further, a good researcher invests in learning and teaching about OBJECTIVE CRITERIA that can help anyone arrive at the truth.

In our Western world of nearly infinite food choices, I believe that education regarding optimal choices that can promote health is now absolutely crucial to help us turn the tide of the avalanche of chronic diseases that is falling upon us.  And yes, the choices recommended by any scientist must necessarily be grounded in objectivity, NOT opinion.  We arrive at such objectivity by relying on a body of corroborative scientific research, and further, by evaluating the observational evidence passed down to us over the centuries.  And, of vital interest, both research and observational evidence tell us that certain foods and ways of eating ARE INDEED better than others.

What then, are these foods and ways of eating?  The answer to that question will be addressed in a book that I am completing now, and that will be available on the market later this year.  In the meantime, in the next few weeks, I will write periodically on some of the most ideal food and health choices you can make with respect to achieving and maintaining good, sound health.  Stay tuned for that, and remember – When it comes to your health, there is simply no investment more worthy, and no time better spent than that utilized in truly educating yourself.

In several previous posts, I have cited statistics and trends with respect to heart disease, diabetes, cancer, and other chronic diseases that are currently rampant in the Western nations.   Historically, in the US and other Western nations, we have relied primarily on prescription drugs to address these and other chronic diseases.   But, is that strategy still viable?  Let’s consider the following.

Data suggests that in 2005, the total number of prescriptions purchased in the United States was 3.6 billion and in 2006, the average number of retail prescriptions per head was 12.4 (1)  In the United Kingdom, on average, people aged 60 and over received 42.4 items per head in 2007, compared to 22.3 items in 1997 – indicating that the average number of prescription items dispensed to older people doubled in a decade in that country (2).  Research from Medco Health Solutions Inc. (a company that manages prescription benefits for 1 in 5 Americans) indicates that prescription drug use is on the rise not just among Seniors.  In fact, the biggest jump in the use of chronic medications is in the 20-44 year-old age group – adults in the prime of life who are already on the committed path of drugs “for life” for conditions such as Depression, Diabetes, Asthma and ADD (Attention Deficit Disorder), amongst others. 

Economist Paul Zane Pilzer (Author, The New Wellness Revolution, 2^nd Edition, Wiley, 2007) has an interesting perspective on this rise in the use of prescription drugs.  In one of his recent articles, he stated that prescription drugs were first developed by individuals such as Dr. Jonas Salk and Dr. Alexander Fleming – physicians who developed the polio vaccine and antibiotics such as penicillin.  These agents either prevented disease from occurring in the first place or cured acute disease relatively quickly.  According to Pilzer, however, today about 95% of prescription drugs are “maintenance drugs” – that is, these drugs do not prevent disease, but treat only disease symptoms, and for most individuals (once they are on them) are designed to be taken “for life.”  In spite of these traits, the world’s five top-selling prescription drugs (Lipitor, Zocor, Nexium, Prevacid, and Zoloft) presently account for more than $25 billion in sales in the United States alone (3). 

TOUGH QUESTIONS THAT MUST BE ANSWERED

In light of the general rise in chronic disease rates (i.e. the rise in new cases of diabetes, heart disease, etc.) in the US and the West, even in the face of an astronomical rise in the use of prescription drugs, the question inevitably arises:  If we are so well medicated in the West, why are we still so sick?  If prescription drugs alone are the answer to our problems, then why are rates of diseases such as heart disease, diabetes, cancer, and many other conditions generally on the rise?  

My answer to the above (apparent conundrum) is that one of the main reasons why chronic disease rates are on the rise in the Western nations is because we are grossly failing to address the fundamental root causes of these diseases to the extent it is possible to do so, given our current state of knowledge.   I am not against the use of prescription drugs.  I believe that they can be, and often are, life-saving especially in acute situations.  However, I am against their excessive use,  and abuse,  in situations that evidence indicates should be – and can be – ameliorated far more safely with simple nutritional and lifestyle changes.  While I believe that there is certainly a right and proper place for the use of prescription drugs, the numbers cited above clearly indicate that our reliance on drugs has become way out of hand.  In light of these numbers, I am obliged to confirm Paul Pilzer’s conclusion that of the millions of individuals on “maintenance drugs,” few should be taking them “for life.”  Rather, these individuals should be working with competent health professionals to improve their diet and lifestyle to address and overcome the underlying causes of their condition, whenever it is possible to do so.

GETTING TO CAUSES, AND TO LASTING SOLUTIONS

In upcoming posts, I will outline some of the key causes that have made conditions such as obesity, diabetes, heart disease, and cancer nearly synonymous with living in the West, or in Western-style nations.  But as daunting as they may seem, these problems have solutions.  Through research and time-tested evidence, we have the knowledge today to affect powerfully the prevention of many of these diseases and conditions.  If we fail to use this knowledge, we will have made poor use not only of decades of diligent research, but also of our own ability to affect positively and benevolently the state of our health and consequently, the course of our lives.

NOTES

(1) US Prescription Drug Trends

(2) UK Prescription Drug Statistics for Seniors

(3) Pilzer, Paul Zane – From the article, “A Perfect Storm.”  Success from Home (Magazine) Vol1, Issue 6.

Astronomically high health care costs in the U.S. have been a matter of ongoing concern for some time now.  The debates surrounding the question of  how best to control these costs have often shed more heat than light on this issue, which is indeed one of the most volatile of all in the health-care arena today.  Why?  Perhaps one reason there is more heat than light on this issue is that hard numbers continue to testify to the steadily rising rates of deadly chronic diseases in the U.S. (as well as the West in general).  As a consequence, not only current but also projected increases in disease rates for certain conditions overwhelm even “smart moves” to bring health-care costs under control.  A University of Chicago study published in the December 2009 issue of Diabetes Care serves to prove this point perfectly. 

According to this new study, in the next 25 years – i.e. By 2034, the number of Americans with diabetes will nearly double to 44.1 million, and the costs of treating these individuals will triple – rising from $113 billion annually to $336 billion.  As staggering as these numbers may seem, what is truly disturbing about them is that the researchers projecting them consider these predictions “very conservative” for the following reasons:

• These numbers do not account for the rapidly growing population of overweight children and teenagers – all of whom represent a high risk group for developing diabetes.
• They do not factor in immigration or the rising population of ethnic minorities that suffer diabetes at higher rates than the US population as a whole.
• Prior estimates from studies vis-a-vis the rise in diabetes in the population have previously predicted dramatic rates of increase of this disease in the US – but in each case, the acutal number of diabetes cases have ended up being larger than the estimates.

A TRUE CONUNDRUM OR ARE WE MISSING THE BOAT?

As a researcher, I am continuously face-to-face with emerging chronic disease statistics; As a speaker on chronic disease prevention and controlling health-care costs, I am continuously in touch with everyday people (both lay and academic) as well as those in the Corporate world dealing with staggering health-care challenges.  The obvious facts that emerge, from both rigorous academic research and my real-life interactions with those dealing with diabetes, are simply these:

1.  About 90% of individuals with diabetes have type 2 diabetes – a condition that develops over a period of time. 

2.  The most common (and preventable) risk factor for type 2 diabetes is simply being overweight.

3.  Research suggests unequivocally that nutritional and lifestyle changes – when followed diligently – can lower the risk of diabetes by 58%, even without medication.

4.  Most people – when they are made aware of how truly difficult and deadly a condition chronic diabetes can be – are motivated to take better care of themselves to make the necessary lifestyle changes to prevent or even reverse this condition.

HEALTH-CARE COSTS CANNOT BE CONTROLLED WITHOUT ADDRESSING PRIMARY CAUSES

Diabetes, and several other preventable chronic diseases, will continue to remain unresolvable conundrums in the US and the West until we become willing to acknowledge and address the true underlying Primary Causes of such conditions.  In the case of diabetes, I believe there are primarily three reasons why numbers for this condition continue to rise in the US:

1)  A re-active approach to treating diabetes after it occurs, rather than a pro-active approach to preventing it in the first place to the extent it is possible to do so;

2)  Widespread use of Industrialized and highly processed foods as foundational foods among the large majority of the population, combined with high stress and largely sedentary lifestyles for most people; and

3)  A lack of systematic utilization of gains made in epidemiological nutritional research (that indeed does constructively bring to surface the Primary Causes of diabetes) for the practical effect of improving health, both individually and socially.  

A one-line summary of the 3 reasons above would be that we (both as individuals and as “A System”) are at present not fully utilizing or taking advantage of the scientific knowledge we do have to pro-actively prevent diabetes.  Type 2 diabetes is one of the most preventable of major chronic diseases.  While it is true that we may not be able to slash ALL costs related to diabetes-care through pro-active prevention efforts, the reality nevertheless remains that if want to see solid, long-term results – both in controlling costs and improving our health – we have no choice but to addressing the Primary Causes of this disease.

THE BOTTOM LINE

Needless to say, addressing the causes of diabetes is an extensive topic – one that will be addressed in my upcoming book.  For now, please refer to another recent post on the issue of addressing Primary Causes.  The bottom line message of the current post and the one you are being referred to is this – Lasting solutions to the chronic disease crisis in the US lie in addressing the underlying and ongoing true causes of disease in the population.  Anything short of doing so is “band-aid” therapy – guaranteed both to increase disease and health-care costs in the long run, regardless of who pays or how.

Cardiovascular disease, cancer, and diabetes may indeed be listed in any database as the top three killer diseases in the West.  But, as one studies research carefully, it starts to become evident that these diseases are in fact NOT the Primary Causes of death; rather they represent what may be called the Secondary Causes of death in the vast majority of cases.   What does this mean?  In simple language, this means that if someone dies of a heart attack and we consequently conclude that the cause of death was heart disease – we are engaging in what may be called “circular reasoning.”   The REAL question we must ask and answer is this:  What was the Primay Cause or Causes of the heart disease in the individual who died?  What caused heart disease to happen in the first place?  And the same questions must be asked for cancer, diabetes, and other diseases.  Why do this?

Here is the answer to the above question:  There is mounting evidence to indicate that the vast majority of the actual causes of death (what I am here referring to as Primary Causes) are factors that are often well within our control.  In 1993, a publication in The Journal of the American Medical Association (JAMA) concluded that of the more than 2 million deaths that occurred each year in the U.S. (around that time), more than half – or greater than one million -were occurring prematurely as a result of 10 specific behaviors that included the following:

• Tobacco use
• Poor diet
• Lack of physical activity
• Alcohol abuse
• Exposure to infectious agents
• Expsoure to toxins
• Unsafe sex
• Unsafe driving
• Illicit drug use

Of the one million deaths due to the above causes, more than half a million deaths were accounted for by the top three causes alone, i.e., tobacco use (smoking), being physically inactive, and eating poorly.

Since 1993, other scientific publications have appeared that have ratified the link between a poor diet, sedentary behavior and premature death.  In 2000, another paper published in JAMA by the Centers for Disease Control indicated that tobacco use still remained the leading cause of death accounting for greater than 400,000 deaths that year.  Another 350,000 deaths were attributed that same year to the combination of eating badly and being inactive.   The question is: Does the link between the causes listed above and premature death still hold today?

Indeed it does.  In 2008, researchers from Harvard published a paper in The British Medical Journal entitled, “Combined impact of lifestyle factors on mortality: prospective cohort study in U.S. women.”  This study followed 80,000 women between the ages of 34 and 59 for more than 24 years.  During that period, there were 9,000 deaths in this cohort – of which nearly 2,000 were attributed to heart disease, and 4,500 to cancer.  But again, these could be called the Secondary Causes of death.  What were the Primary Causes?   In studying this sample, researchers found that 5 specific behavioral risk factors were the underyling actual causes of premature disease and death in these women.  The 5 factors were these:

• Smoking
• Inadequate physical activity
• Poor diet quality
• Weight gain/obesity
• Alcohol intake outside of the recommended light to moderate range

Investigators concluded that the combination of the above 5 risk factors increased the overall risk of death more than four-fold in their sample; increased risk of cancer death by more than three-fold, and increased the risk of cardiovascular death more than eight times!   These results can be restated as follows:  The combination of not smoking, being physically active, eating sensibly and well, drinking within recommended guidelines, and maintaining a close to optimal weight is associated with a markedly lower mortality that is equivalent to a nearly 90% reduction in risk of death from heart disease, a 2/3rd or 66% reduction in the risk of cancer, and greater than 75% reduction in risk of death from any cause. 

These numbers suggest that while it is true that we may not have absolute or 100% control over our destinies vis-a-vis our health, we are decidedly far from helpless.  Indeed, it might not be an exagerration to say that what we are able to do with what we already know to influence the state of our health positively far exceeds any major medical breakthrough we may make tomorrow.  This is not an argument against the benefit(s) of future medical research; rather, it is a call to action to energize ourselves to do all we can with what we already know.

At present, greater than two-thirds of Americans (165 million plus) are overweight, of which 30% are clinically obese.  Similar trends are occurring all across other Western and Westernized nations.   As an example, the World Health Organization recently stated that by 2010, 76% of men and 67% of women will be overweight in Australia.  These numbers are equivalent to roughly three-quarters of the entire Australian population!   There is no disputing the fact that overweight and obesity are closely related to heart disease, diabetes, and even certain cancers.  Consequently, rates of these diseases are expected to be  high wherever people are overweight or obese.   Today, any way we look at it, the majority of those living in the West or in the Westernized world are sick.  We are mired in an epidemic of overweight, obesity, and deadly chronic diseases.

So, what is our way out of this quagmire?  Perhaps one way out is for us to start by clearly stating and distinguishing Primary from Secondary Causes of both illness and death.  Is doing so really that essential?  Yes, it is.  Establishing and understanding the Primary Causes of disease is crucial to coming to terms with how much influence we truly have over disease and the state of our health.  In the great majority of cases, heart disease, cancer, and diabetes don’t just “happen” to us.  We are not completely helpless against these diseases.   The reality is that we can exert tremendous influence over the state of our health as well as the quality and the duration of our lives.  That statement is not mere opinion; it is a research-based fact.  

Now, it is true that with our poor diets, our stress-filled hurried lifestyles, and our sedentary habits, many of us who live in the U.S. or other Western nation have been our own worst enemies for a long time.  But, I am convinced that if we decide to, we can just as easily be our own best friends.  Don’t you think its time?

Notes

Combined Impact of Lifestyle Factors on Mortality: Prospective Cohort Study in U.S. Women

1.  WHOLE GRAINS EQUAL LESS HEART DISEASE:  Several studies have helped us to understand and confirm the connection between whole grain consumption and reduced rates of heart disease.  Studies published in the Journal of the American Medical Association (JAMA) and the American Journal of Clinical Nutrition (AJCN) in 1999 reported that women in the Nurses’ Health Study who ate the most whole grain foods ( an average of 2.5 servings a day), were 30% less likely to develop heart disease than women eating the fewest (about 1 serving a week).  It is estimated that eating a bowl of breakfast cereal that contains about 5 grams of fiber cuts the chance of heart disease by about one-third.  These results are ratified by other high quality epidemiologic studies as well.

2.  REGULAR WHOLE GRAIN CONSUMPTION SIGNIFICANTLY REDUCES THE RISK OF DEVELOPING TYPE 2 DIABETES:  Epidemiologic research unequivocally suggests that whole grain consumption is fundamental to keeping the body’s blood sugar levels in the ideal range.  Harvard’s Nurses’ Health Study as well as the Health Professionals Follow-Up Study confirmed that those who ate the most cereal fiber from grains (about 7.5 grams per day – which translates to approximately a bowl of oatmeal and 2 slices of whole grain bread) were 30% less likely to develop Type 2 diabetes as compared to those who ate the least grain fiber (less than 2.5 grams per day).  Conversely, the consumption of a combination of low cereal fiber and a high sugar load (from white bread, colas, white rice, etc.) more than doubled the risk of developing Type 2 diabetes.

3.  WHOLE GRAINS HELP WARD OFF MANY CANCERS:  Meta-analyses (several “pooled” analyses) of many epidemiologic studies suggest clearly that whole-grain consumption reduces the risk of developing several cancers  including stomach, colon, mouth, gall-bladder, and ovarian cancer(s).  The pathways through which whole grains protect against all these conditions are not fully understood, but research suggests that the many components of whole grains such as B-vitamins, phytoestrogens, fiber, etc. may all be involved in offering protection against several cancers.

4.  WHOLE GRAINS CAN HELP ALLEVIATE DIFFICULT MENOPAUSAL SYMPTOMS:  For most women, one of the central problems associated with menopause is the fluctuation in estrogen levels that occurs during this stage of life, and the simultaneous bone-loss that often occurs.  Research suggests that fortification of the diet during this time with high quality calcium and magnesium rich foods can help blunt bone-loss, relieve symptoms such as head-aches, and also regulate blood pressure levels.  The bran layer of many whole grains contains essential minerals such as calcium, magnesium, copper, selenium, and manganese – all of which play crucial roles in maintaining metabolic and hormonal health.  Women going through menopause should therefore pay especially close attention to the regular consumption of whole grains.

PUTTING IT INTO PRACTICE

The points made above ought to motivate us all to make a more concerted effort to include a variety of whole grains in our meals.  But, old habits often die hard, and most Americans are hard-wired to eating refined foods.  Here are 5 simple suggestions that will help you make a jump-start on improving your whole grain consumption:

1.  THINK BREAKFAST:  Always start the day with a whole-grain based breakfast.  You can have a bowl of cold whole-grain cereal or a hot cereal made with a mixture of whole grains.  Numerous varieties are now available in whole-foods stores.  Look for oats that have been steel-cut (rather than instant or quick oats) and/or other cereal mixes that contain whole wheat, barley, oats, or whole rye meal.

2.  SNACK ON WHOLE GRAIN-BASED FOODS:  A small lunch or snack can easily consist of a whole-wheat pita pocket with roasted red pepper (or other) hummus, avocado slices, and fresh lettuce/watercress/other greens.  Also, look for 100% whole grain crackers and try them with a little organic goat cheese or freshly made hummus  – Delicious and Nutritious!

3.  TRY HIGH QUALITY, WHOLE GRAIN PASTA:  Do you think that whole  grain pasta tastes too heavy?  Here are a couple of ideas – Try whole-wheat thin spaghetti or angel-hair pasta  rather than “regular” spaghetti, and occasionally, try some of the imported Italian brands.  The thinner versions of the pasta lighten the taste of the whole wheat, and for now, there appears to be a broader selection of these foods in the imported brands. 

4.  LOOK FOR 100% WHOLE GRAIN BREADS:  With more customers asking for whole foods, American grocery stores are adding newer varieties of whole grain breads regularly.  However, it can take a while to decipher the labels on breads.  Whenever possible, buy breads that contain 100% stone-ground whole wheat or other grain flours (as the first ingredient), and look for varieties that are NOT loaded with enriched flour.

5.  STRETCH AND EXPLORE UNFAMILIAR GRAINS!:  There is a whole world of fabulous whole grains out there - Sadly, most individuals in the West are not familiar with them.   Growing up in India, I was exceptionally fortunate to learn how to use what (at that time) seemed like a nearly infinite variety of grains that were used in unimaginably delicious ways.  Consequently, one of my passions is to share that wealth of knowledge with my Western friends and audiences.  As both a passionate chef as well as a research-scientist, I see this knowledge as being of a kind that simply must be shared. 

I’ll conclude this post with a question that I have been asked more often than I can remember: “I want to eat whole grains, but, what exists past whole wheat flour?”  To begin with, a treasure of grains such as whole barley, millet, rye, an unending variety of lentil flours, and combinations of lentil and whole grain flours used for making uncommonly delicious flat breads.  All of these foods provide an unparalleled bounty of taste and health.  I am aware that manyof these foods may be alien to most in the West, but this is a treasure worth learning about and tapping into.   In both my upcoming book, as well as in future posts, I will write frequently on the subject of whole foods.  So, stay tuned for fabulous, one-of-a-kind mouth-watering whole foods recipes from around the globe, as well as other ideas on how to use whole grains and whole foods for creating a lifetime of  vibrant health. 

Until then, Bon Appétit!

In the West, and in the nations generally perceived to be “Western”  (U.S., Most of Europe, Australia/NZ), we find that we are at present faced with a more or less common set of chronic diseases; Heart disease, diabetes, obesity, and certain cancers being the most prominant.  Interestingly, we now also find that nations that have relatively recently undergone “Westernization” (economically speaking) such as China, India, Ireland, and others, are faced with…guess what?  — Explodingly high rates of the same chronic diseases; Heart disease, diabetes, obesity, and (increasingly) certain cancers again being the most prominant.   What is the connection here?  What if we could identify and address the factor(s) that have been contributing to high rates of chronic diseases in the West, and now increasingly Globally? 

Research suggests that ONE factor that is common in the genesis of numerous chronic diseases is the consumption of processed, refined, and denatured foods.  Here is what I see to be the crux of the problem, for those in either the West or in the ”Westernizing” nations:

1.  People in the West have historically been unfamiliar with certain whole foods that are powerhouses of nutrition and have uncommon ability to create health; Thus, the common question:  What exists past whole wheat flour, please?  The answer:  A LOT!   Whole rye, whole barley, whole millet, whole spelt, whole lentil flour(s), lentil flour flat breads — these are the foods that have traditionally been used down the centuries across the rest of the globe.  Sadly, these health-packed foods are alien to most in the West, and are not common to the Western vocabulary.

2.  On the other hand, people in the East and in other parts othe world have historically been deeply familiar with the grains and flours I have mentioned above, as well as with a plethora of other health-generating Whole Foods.  But, those across the globe who in recent years have adapted to their new “Westernized” lives as a result of rapid Industrialization, have now all but given up these traditional foods.  They too are now mass consumers of the “fast-food” culture — burgers, pizzas, and shakes rule the day, along with sedentary, stress-filled lifestyles.

So,  let’s get to the point — Why write on Whole Foods? 

1.  To let the Western audience(s) know and learn about the treasures that exist past Whole Wheat Flour, and how to use them greatly to improve their chances of preventing chronic diseases, AND

2. To urge those around the rest of the world who have already turned their backs on Whole Foods, or are in the process of doing so, to reverse or correct course in order to bypass the many dangers ahead.

The perspective of utilizing Whole Foods for creating health must not be dismissed as one that is overly simplistic.  There is overwhelming evidence to lead us to conclude that the majority of “Western” (and now increasingly, Global) diseases are conditions that are primarily related to nutritional, lifestyle, and metabolic causes.  And, a very simple, yet potent way both to prevent and improve outcomes for these diseases is to start by consuming Whole Foods.  In doing so, we are focusing directly on remediating one of the most key contributing causes of the Western and Global chronic disease epidemic.

….Now, here is the treat you are in for over the coming weeks.  Not only will you learn about new Whole Foods, you will also learn about  mouth-watering ways to enjoy them.  I will share some traditional recipes from around the globe that I have labored over the years both to collect and perfect, and I will share how scientific research ratifies the use of these foods for long term health and wellness.   

I will continue to write articles and opinion pieces on other topics as well; However, you can look for posts related to Whole Foods under the Category: Whole Foods Series. 

STAY TUNED – You can’t afford not to!

1.  In your considered opinion, does food have anything to do with how or why so many people develop heart disease/ high blood pressure/cancer/diabetes/ (fill in the blank)?

2.  Does food have anything to do with the prospects of preventing these conditions?

Now, it seems ironic to me, that even in our present time in which solid epidemiological research has indisputably established the link between diet and health, there are still millions of people out there who are uncertain and tenuous about whether this link is truly real.  Due to the fact that this topic is very broad, I am deliberately going to restrict this discussion to a few simple truths for the purpose of this post.  Let us momentarily consider some of the facts.

It is no secret that today, the West (especially the United States, most of Europe, and Australia) is mired in an epidemic of obesity, diabetes, heart disease, and several (predominant) cancers.  Interestingly, this was not always the case.  A careful study of the progression of disease rates in the West reveals that chronic disease rates skyrocketed in the West in close correspondence with the transition from largely agrarian to largely industrialized methods of food production.  The mass inundation of the supermarket shelves with processed and packaged foods, especially post World War II (and especially in the U.S.), marked a phenomenal change in people’s eating habits, and with that, a literally phenomenal change in the state of their health as well.  Whereas at one time, food was produced by one’s own physical labor and was a source first of sustenance, and then of pleasure; this principle became fully reversed with the advent of commercial and industrialized foods.  Now, it became more about pleasure first, and then sustenance (if at all).  Refined, over-processed, over-salted, over-sweetened and trans-fat laden foods came to rule the supermarket shelves, and then our taste buds.  Even the quality of eggs, meats and dairy suffered, as the goals and objectives of “efficient” corporate mass production took precedence over that of maintaining the purity and nutritive ability of food.   This has gone on now for several decades, up to our present time.   And now, to all this, we have (albeit unwillingly) added new health destroying variables.  Ask most anyone, and they will tell you — Stress and fatigue seem to rule the day; a daily 8 hour shift on the computer occurs with alarming regularity, whereas daily exercise is irregular at best; sleep is elusive and usually averages less than 6 hours a night; the sit-down farm fresh meal, either for lunch or dinner, is a distant pipe-dream of  the past, whereas the “techno-protein bar” on-the-go  is the dominant reality of the lunch hour, and the home-cooked dinner is a rare treat, hardly the daily norm.

Thus far we have talked about the “West” in general and about nations generally perceived to be Western.  Now, let’s take a look at the state of health in nations that have relatively recently undergone Westernization in terms of their socio-economic structure.  Two particular and especially salient examples in this category are China and India, and each of these two nations has in recent years seen a truly astronomic rise in rates of obesity, diabetes and heart disease.   Interestingly, the rise in chronic disease rates in both China and India (especially in the metropolitan areas) corresponds exactly with their large-scale abandonment of traditional, sustainably produced whole foods, and their adoption of Western-style mass produced processed foods.  For example, it  is no longer “trendy” in India to make lentils and brown rice with a side of fresh, local vegetables and home-made fresh yogurt for dinner; It is now infinitely more exciting to order “Western” foods for the lunch or dinner meal — hot dogs, burgers, pizza and the like.  How do I know?  I have been there.  These are the new foods there; these are the new items of excitement.  

But, the excitement won’t last…and neither should it.  The World Health Organization recently estimated that by 2010, 60% – or more than half – of the world’s cardiac patients will be from the Indian subcontinent alone, giving India the dubious distinction of being the country with the highest rate of heart disease in the world.  It is interesting, isn’t it, to note that this was once a nation with some of the longest-lived people on the planet?  The same was also true for China, for Okinawa…and the list goes on.

It is said that those who refuse to learn the bitter lessons of history are doomed to endure repeating them.  And, the lessons of history in this case are simply these:  Locally produced, traditional whole foods (whole grains, freshly picked vegetables, fresh fruits, fresh eggs and meats, pure pressed nut and seed oils and other similar foods) both nourish and sustain people, and have done so for centuries.  In addition, sustainable agriculture preserves the health of the soil, which in turn literally gives life to the food and thus to people, and often a sense of community as well.  But, wherever and whenever people turn their backs on the soil, and chase after the latest and greatest “fast-” or “techno-food” of the day, they chase after a dangerous illusion — one that costs them their vitality and, all too often, even their very lives.   And these are the facts, not mere opinion — neither mine nor someone else’s.  The numbers establish the truth.

So, does food have anything to do with being sick or staying well?  Well, the numbers tell us that the West is sick, and the newly “Westernizing” nations (especially with respect to food and lifestyle) are already sick, and rapidly getting sicker.  The food experiments of the U.S., Europe, Australia, China, India, Okinawa, and other nations as well, all testify that those who have no clue where their breakfast, lunch or dinner come from are the sickest of all.  Conversely, those who either produce their own food or, at the very least, prepare their own meals from fresh, local foods seem to be beneficiaries of uncommonly long lives and a true joie-de-vivre.  Add to this, the fact that substantial research convincingly tells us that with careful attention to the foods we eat and with regular exercise, nearly 70% of certain cancers and 80% of heart attacks are preventable, and the question arises: how much more proof do we really need to believe that what we eat matters?

Let’s sum this up.   For those still haunted by whether food really matters, here are the formal answers to the two questions posed at the beginning of this post:

1.  Yes, modern denatured, over-processed, commercially prepared, and mass-produced industrialized foods have a lot to do with both how and why so many people develop one or more chronic diseases.

2.  Yes, locally and sustainably produced, un-tampered, whole foods have a lot to do with our prospects of preventing these conditions.

While food is not the only factor in the genesis of disease and other factors such as genetic or environmental exposures may play a role in both the genesis of disease or the prevention of it, nonetheless both time-tested and epidemiological evidence bear out that what we eat and how we produce what we eat are fundamental to our well-being and to our very existence.

You see, in any land where nearly every meal is processed, preserved, pre-packaged, frozen, or microwavable; where a myriad of foods are specifically designed to be eaten on-the-go; and where the average adult has neither seen nor can even recognize a kernel of real wheat, rye or barley — health seldom reigns.