What we can achieve through “ART therapy” is to “rectangularize” life’s joumey. It is an optimistic long-range view of health for the US population I would like to share, with thanks to Dr. James Fries and Dr. Lawrence Crapo, authors of Vitality and Aging,7 for some of the following concepts.
Most survival curves show a simple exponential decay. Data from 1840–1980 reveal that our life ex pectancy has greatly increased (Figure 1), but the life span of our species remains stable. It has remained the same for >100,000 years. Of 10,000 persons who survive to 85 years of age, one will make it to 100 years old. During the past 140 years, however, the right tail of the curve has shifted to become more rectangular. If premature deaths were prevented, 95% of all deaths would occur between the ages of 77 and 93 (Figure 2).
Significant reduction of deaths in the young and from infectious disease have shifted the curve to the right. We need to overcome chronic diseases if we are to shift the curve much farther to the right. Without chronic diseases and trauma, “natural deaths” would occur more often. For example: (1) an 88-year-old neighbor has not seemed to be himself in recent months and, one night, dies quietly in his sleep; (2) an 85-year-old schoolteacher who has always seemed fragile, contracts an upper respiratory infection during winter flu season, and dies within 3 days; (3) a 103- year-old retired industrial chief executive officer falls, breaks his humerus, contracts pneumonia, and dies 3 days later.
We can all think of similar examples from our practices. The point is that society’s expenditure on health care is significantly lessened as survival curves become more rectangular (Figure 3). Youthful vigor is maintained up until the final brief illness, which does not require–and perhaps does not merit–expensive heroic intervention. I am reminded of an 80-year-old man whose daughter believed him to be too old for the recommended coronary bypass surgery. I was asked to intervene with arrest and reversal nutrition therapy, which he embraced and which eliminated his angina. He celebrated his 91St birthday in April.
We have learned sadly and expensively that treat ment of disease will not be effective in shifting the curve. Despite coronary artery bypass surgery, anglo plasty, stenting, and atherectomy, the epidemic of coronary atherosclerosis continues unabated. Dr. John Bailar succinctly summarized the futility of the bil lions spent on chronic disease–specifically can cer–in a May 1997 New England Journal of Medi cine editorial: “Cancer Undefeated.”8 Likewise, hip replacement for osteoporotic fractures, lung reduction surgery for emphysema, liver transplantation for alcoholic cirrhosis, drugs for obesity (which can cause brain dysfunction, diarrhea, vitamin deficiency, and irreversible cardiac injury), and fad diets that cause sudden death have not been the answer. Antihyperten sive medication may accelerate atherosclerosis and promote cancer, sudden cardiac death, or impotence. Hypoglycemic agents can be helpful, but they do not eliminate the complications of diabetes.
Medical treatment is not an effective way to ap proach this national health problem, and it does noth ing for the unsuspecting who are about to become the next victims of the disease. Only through preventive strategies can we eliminate and delay chronic disease.
It appears that the 20th century has been a great step backward in nutrition. Millions of years of evo lution have not designed our species to consume t~e modem Western diet. This conference has defined the need for plant-based nutrition, not only to prevent atherosclerosis, but also to decrease our risk of cancer and of many other chronic diseases.
We have strong evidence-based research showing that dietary change can eliminate, not only atheroscle rosis, but other “Western” diseases as well. Breast cancer was rare in Japan in the 1950s, when the Japanese diet was <15% fat. Kenya, with a similarly low-fat diet, has a breast cancer prevalence 20 times lower than that in the United States. Prostate cancer was rare in Japan in the 1950s and has since been strongly correlated with dietary fat.9 Colon and rectal cancer rates are also linked directly to fat intake. A similar relation is seen for type 2 diabetes. The Pima Indians of the southwestern United States were healthy and nondiabetic on their native diet of grains, beans, and vegetables; since adopting a high-fat West ern diet, one-third have become diabetic. We can see that, like cirrhosis, emphysema, and obesity, diseases such as coronary artery disease and type 2 diabetes can be controlled through education and personal life style changes. Technology is not the answer.