The 10% Solution For A Healthy Life: Acknowledgments, Introduction, A Brief Medical History and Foreword
March 6, 2002
To my doctor Steven Flier, and our mutual explorations of health and well-being
I would like to express my gratitude to many people, among them:
·My wife, Sonya, for having lovingly explored a new way of life with me, not to mention having participated in many enjoyable collaborations on the recipes in this book
·My son, Ethan, and my daughter, Amy, for their patience through hundreds of dinnertime conversations on nutrition and for putting up with some of the less-than-successful culinary experiments
·My mother, Hannah, and my sister, Enid, for, many pleasurable conversations on nutrition and life-style
·Alison Roberts for her wonderfully proficient and exhaustive research and irreplaceable assistance with many aspects of this project
·My medical advisory team-Steven Flier, Robert Bauer, and Peter Kurzweil-for generously contributing their time and expertise, discussing extensively relevant issues, and supplying highly detailed commentaries to review the medical and scientific accuracy of this work
·My editor, Erica Marcus, and the team at Crown: Kim Hertlein, June Bennett-Tantillo, Bill Peabody, Etya Pinker,and Ken Sansone
·Nancy Mulford for her expert assistance with the research, glossary, and food charts
·Warren Stewart for his culinary insights and enhancement of the recipes with flavorful spices and herbs
·Jill Jacobs for her valuable administrative support and ideas
·Don Gonson for his ideas, support, and encouragement
·Aaron Kleiner for hundreds of discussions on nutrition and health
·My readers-Loretta Barrett, Harry George, George Gilder, Don Gonson, Jill Jacobs, George King, M.D., Aaron Kleiner, Ethan Kurzweil, Hannah Kurzweil, Sonya Kurzweil, Erica Marcus, Nancy Mulford, Steve Rabinowitz, Mitch Rabkin, M.D., Alison Roberts, Martin Schneider, Enid Kurzweil Sterling, Warren Stewart, and Laura Viola-for their many valuable comments and criticisms
·And, finally, all of my friends and associates and the many engaging discussions we have had that have helped to shape my perspective on health and well-being versus the “civilized” diet
Medical research has shown that the nutrition, exercise, and other life-style principles described in this book can help control weight and diseases, including heart disease, stroke, cancer, hypertension, and type II diabetes, and reduce the risk factors associated with these diseases.
However, neither the author nor the medical advisers for this book make any representation or warranty of any kind whatsoever regarding the effectiveness or appropriateness of this program, principles, or information for any individual.
· No person should engage in this or any other dietary, exercise, or health program without advice from his or her physician.
· In particular, persons who have or believe they may have a disease, including but not limited to heart disease, cardiovascular disease (such as stroke), hypertension, diabetes, or cancer, or who are taking medication for such conditions, should take particular care to be monitored by a doctor when undertaking this or any other nutritional, life-style, or health program.
Shortly after World War II, the idea that cigarette usage may be damaging to one’s health was controversial. Yet when my father’s doctor suggested that there may be some benefit to cutting down on smoking, my father stopped immediately and never thought about it again. In 1961, he had his first heart attack. It was suggested that he cut down on salt to reduce the strain on his heart, so he simply cut out salt from his diet. In 1970, at the age of 58, he died of heart disease. I was 22, ten years older than my father was when his father died of the same cause.
I carried two feelings that stemmed from my father’s experience. One was the sense of a cloud in my future. The trend, indicated by the only two data points I had, suggested that I might only live to see my own son reach the age of 32. On the other hand, I also had a vague sense of confidence that somehow I would figure out a way to overcome this problem. That latter feeling was typical of my optimistic orientation, but it was nonetheless a strongly held conviction. As it turned out, I had some help along the way.
Thus began my interest in heart disease. I am not a doctor, although I do consider myself to be a scientist and consequently I began to approach this issue from the perspective of the available scientific literature. I tried to engage my doctor in a discussion of the issues, with only limited success. While he talked to me about it to some extent, he clearly had only limited interest in doing so, and, admittedly, I was unusually demanding. Finally, exasperated with my persistent questions, he said, “Look, I just don’t have time for this, I have patients who are dying that I have to attend to.” Not one to be easily put off by attempts to appeal to my sense of guilt, I couldn’t help but wonder whether any of these patients now dying might possibly have benefited from earlier explorations of ways to prevent disease. I decided to change doctors and find one who had an interest in preventive medicine. It also wouldn’t hurt if he had sometime on his hands.
As it turns out, I heard about a new doctor who was just setting up a practice. He had a reputation for a brilliant mind, an engaging curiosity in new medical frontiers, and, most important the willingness to struggle with issues of prevention with his patients. I became Steven Flier’s patient in 1982. It turned out to be a good decision. Just recently, Boston Magazine recognized him as one of the leading physicians in the city.
Most significant, he had the time and the patience to engage in my extensive interrogations on medical issues. One of his early discoveries was that I had a glucose intolerance, an early form of type II diabetes (a major risk factor for heart disease). This only intensified my interest in understanding what was known about heart disease and its prevention.
We decided I should lose about 25 to 40 pounds, so there followed a number of years of largely futile efforts in this direction. I tried numerous diets of various kinds (low-calorie, low-carbohydrate, and others) and while some worked temporarily, I kept gravitating back to the same weight. I began to despair that I didn’t have the willpower to take this vital first step.
In late 1987, on Dr. Flier’s advice, I decided to adopt the recommendations of the American Heart Association and reduce fat intake to 30 percent of calories and cholesterol intake to no more than 300 milligrams per day. This had a modest positive effect. My cholesterol went down from 234 to 193. According to the Framingham Study-a massive longitudinal (long-term) study of more than 5,000 Americans with a view toward understanding the factors underlying heart disease-one can obtain an estimate of one’s risk of heart disease by considering the ratio of total serum (blood) cholesterol to high-density lipoprotein (HDL) cholesterol, the so-called good cholesterol. The lower the ratio, the lower one’s risk. My ratio fell from 8.7 to 6.9, which, according to the Framingham Study, means that my risk fell from 175 percent of “normal” risk to 143 percent of “normal.”1 That’s a shift in the right direction, but not entirely comforting when you consider that “normal” (i.e., average) risk for Americans is a 75 percent chance of a heart attack in one’s lifetime!2
In 1988, I ran across the writings of Nathan Pritikin I had heard of his approach before but had always dismissed it as too radical and too Spartan. Pritikin maintained that by adopting a diet that was very low in fat and cholesterol (specifically 10 percent of calories from fat and 100 milligrams of cholesterol per day), one can obtain dramatic reductions in the risk of heart disease and other diseases. With my heightened interest in preventing heart disease, I decided to take a closer look.
Nathan Pritikin’s own story is interesting.3 In 1957, at the age of 40, he was diagnosed as having coronary insufficiency caused by advanced atherosclerosis. He was prescribed a variety of drugs and told to restrict his mobility. Distressed with these recommendations, he decided instead to examine the scientific literature and discovered extensive evidence that atherosclerosis could be reversed in animals if they were given diets very low in fat and cholesterol. With this and other clues, Pritikin went on to pioneer an approach to treating heart disease using diet and exercise. Using himself as his first test subject, all of his symptoms of heart disease disappeared.
Paradoxically, Pritikin also made a profound mistake in 1957. His doctor had prescribed a series of X-ray treatments to destroy a fungus infection that was causing anal itching. Pritikin was very concerned that the X rays would hit parts of his body that would be damaged by this radiation, but his doctor assured him that it was a safe procedure. Today, we would recognize the procedure as irresponsible, but Pritikin reluctantly went along with the recommendation and underwent the treatment, which involved receiving 220 rads of unfiltered X rays. Two days later, a blood test revealed a seriously elevated white blood cell count, which was subsequently diagnosed as monoclonal macroglobulinemia, a blood disorder caused by excessive radiation and an early stage of leukemia. Twenty-eight years later, Nathan Pritikin died of leukemia. An autopsy revealed that he had the heart and arteries of a young man, completely clear of any signs of heart disease or atherosclerosis.4
I examined Pritikin’s evidence and became impressed with the extensive documentation establishing a link between nutrition and disease. Despite the medical profession’s early resistance to Pritikin’s advocacy of nutrition and other life-style modifications as a treatment for heart disease, there has been increasing interest in this approach in the medical community since Pritikin’s death. Some of the best evidence has been fairly recent, including the first concrete evidence of atherosclerotic reversal in humans brought about entirely by life-style modification.
I discussed what I had read with Dr. Flier and he thought that it made sense. I was still concerned about my ability to undergo such an apparently radical change in my eating habits, given my rather dismal efforts through more than five years of attempted weight loss. Nonetheless, in October of 1988, I decided to give it a try. Since I had found much more moderate changes to be difficult to sustain, I braced myself for a significant discipline. The results were rather surprising.
It turned out to be a lot easier than I had expected. In fact it felt rather natural. I discovered a new world of foods that were very tasty, diverse, and satisfying. I never felt deprived and, unlike my experiences with other “diets” I had been on, I never felt hungry. Gradually my tastes and orientation to food changed and my desire for the higher-fat foods I had been used to went away.
Within 3 months, I had lost 25 pounds. More surprising were the results of my cholesterol test. “I’m stunned” was Dr. Flier’s response, to which he added that he was going to start the diet himself the next day. My total serum cholesterol was now 110. My HDL had also gone up (primarily from increased exercise), so my ratio (of total cholesterol to HDL) was now 2.5. According to the Framingham Study statistics, my risk of heart disease was now only 5 percent of normal (down from an original 175 percent of normal). Altogether, that represented a 97 percent reduction in my risk. Extensive testing also indicated that my glucose intolerance had vanished as well. I went on to lose another 15 pounds to put me at my ideal weight. I felt that the cloud had disappeared.