Transcript of Interview 4:

S.J.: For those who are concerned about cholesterol, high cholesterol, does consuming animal products as well as saturated fats stimulate our production of cholesterol?

T.C.C: Yes it does. Yes, that is an important point I think. We have always been told for many many years now that if you want to reduce your cholesterol level through dietary means, we should be consuming less saturated fat and less cholesterol. Nobody almost ever mentions that we should stop consuming high animal protein and the data shows and has shown for many many years that the level of animal protein being consumed is probably a more significant factor than either saturated fat or dietary cholesterol consumption. Probably more than both of them put together. So, this returns us to the more general statement or idea that just consuming animal based foods gives us higher levels of cholesterol, higher saturated fat, and most importantly, higher levels of animal protein. And we could conclude that in consuming that kind of diet we tend to have less antioxidants, because you are not consuming a plant based diet. That whole constellation of factors is clearly all playing a role far more important than just saturated fat or dietary cholesterol itself.

S.J: How come plant protein and saturated fat don’t stimulate production of cholesterol?

T.C.C.: Why plant protein and saturated fat you said?

S.J.: Either or.

T.C.C.: Plants’ fat is more generally called oils, and are usually less saturated. Although we see some saturated fat in plants, we see much more polyunsaturated fats in plant material. We have known for many years that consuming diets that have a higher ratio of polyunsaturated fats (usually arising from consuming a plant based diet) that a higher ratio of polyunsaturated fats to saturated fat consumption lowers the cholesterol. So when there are more plants, more polyunsaturates there is less cholesterol. So plants don’t tend to have very much saturated fat, but there are a couple of exceptions: coconut oil obviously has quite a lot of saturated fat and a couple of others. You can find some saturated fat in most plants quite frankly, and you can find unsaturated fats and polyunsaturated fats in some animal fats.

S.J.: Mostly there is a big difference between shorter chained saturated fats and longer chained.

T.C.C.: Right. As you know, the chain length of fatty acids is described by the number of carbon units along the chain going anywhere from let’s say three or four carbon units from the simpler short chain fatty acids all the way to 22 to 24 to 26 length. The ones that we have sort of focused on, historically, for the most part in terms of atherosclerosis are the ones that are about 16 carbon units in length or 16,18 or 20 somewhere in that region. Then, further, we tend to make the story look more complicated by talking about the extent to which they’re saturated or unsaturated. So, it’s the 16-18 carbon chain length fatty acids that have commanded most of our attention over the years, but in more recent years, as you indicated, the middle chain, the medium chain fatty acids 12-14 are now being recognized as being probably as significant, if not more so, than the longer chain fatty acids. But, again, that is another wrinkle that helps us to refine our estimates and in the relationships, but there are so many of these kind of additional bits of information. There is the question concerning the total amount of fat in the diet. I would just like to list these as it’s kind of important. I mean, the effect of fat on disease production, whether it’s heart disease or perhaps other disease, in so far as the fat alone is concerned, is related to the total amount of fat being consumed. Secondly, it’s related to the degree of unsaturation, namely how much saturated fat, how much polyunsaturated fat and how much monounsaturated fat like you find in olive oil. So the degree of saturation is important, and also chain length, which we just talked about. Chain length is yet another factor that seems to be significant here, and then there is the question concerning the positioning of these unsaturated bonds in the fatty acid which are usually characterized by where the position is relative to the end of the fatty acid chain and we have referred to them as omega 3’s, omega 6’s and omega 9’s. So, the question concerning omega 3’s and omega 6’s and the ratio thereof is still yet another factor. I just listed a whole bunch of different factors here along with the fats, that all are known to play some role.

S.J.: Can more information be found in your book, The China Study?

T.C.C.: Yes it can be, and it gets pretty complex. You know, looking at all these details, and quite frankly, you know these details become less important when we consume a low fat diet because in a low fat diet these relationships become almost unimportant. It’s one of the arguments for low fat diet. If we’re going to be consuming a high fat diet, then we’re supposed to be picking and choosing things.

S.J.: Additional dietary cholesterol beyond what we make is found only in animal foods, never in plants?

T.C.C.: Yes, cholesterol is never found in plants, only in animal foods.

S.J.: Is it necessary to take cholesterol lowering drugs to clear arteries?

T.C.C.: For the most part, no. I am not a physician, and I think there is some evidence that in people with traditionally very high levels of cholesterol, we know that they can take cholesterol lowering drugs and we can see some decrease in the cholesterol levels. There is no question about that. Cholesterol lowering drugs do lower cholesterol in many instances, but the fact remains that we can also get a lowering of cholesterol, a substantial lowering of cholesterol, by switching our diet from an animal based one to a plant based one. Especially a diet involving whole plant based foods, in which case the importance of these cholesterol lowering drugs is much less. To answer your question, I suspect that there are people who can’t change, refuse to change, or who can’t get their cholesterol levels down even if they do change and they still have these very high cholesterol levels. I can see a case being made for using cholesterol lowering drugs to some extent.

S.J.: Rarely?

T.C.C.: I mean there are certain people who are genetically predisposed to having really high cholesterol. We call them familial hypercholesterolemia: it runs in the family. In those situations, sure, I suppose you can use some artificial means to get it down if you can’t get it down by natural means, but I think getting cholesterol levels down to their appropriate levels by natural means is far, far more important.

S.J.: Could you describe the work of the medical doctor Caldwell Esselstyn that you have touched on already.

T.C.C.: Yes, Dr. Esselstyn is a very eminent physician and surgeon who did virtually all of his practice at the Cleveland Clinic, the famous Cleveland Clinic in Cleveland often rated as #1 in the country for heart disease. Dr. Esselstyn was loaded with awards and a very distinguished career. He did a lot of operations, and finally, in the 1980’s decided that all of his operations for heart surgery and other sorts of issues were not likely to lead to less heart attacks and less heart problems, and so, he decided to organize a study of heart disease patients where he basically changed their diets to a low-fat plant based diet. He did it on the basis of his knowledge at the time, and we didn’t know each other at that time, of course. But in any event, he did this study and started out with 18 patients with advanced heart disease, really seriously with heart disease, who had collectively had 49 coronary events in the previous eight years. They were very sick. He put them on this low-fat, plant based diet. He started them out also on some cholesterol lowering drugs just to make sure that the high cholesterol got down and you could demonstrate that to them. But in any case, he started out these people on that kind of diet, and they stayed with it; mostly because he stayed with them. He met with them frequently, every two weeks I think. He took their cholesterol levels often and really stayed on top of it so he could be assured that they were complying, and so, 20 years later, those 18 patients middle to older age at the time they started, have gone from 49 coronary events in the previous eight years to zero over the next 20. Three people have died but not from coronary disease. His results, I think, are perhaps the most remarkable results of this kind in the medical literature of the last century.

S.J.: I have here some images of coronary angiograms of the distal left anterior descending artery before and after beginning a plant based diet and this is in one of his later patient’s without any cholesterol lowering medication. Could you describe what they show?

T.C.C.: This fellow he followed very closely, one of his colleagues actually at the Cleveland Clinic who I think at the time was about in his middle 40s who developed some difficulties. He just was able to show that, as you said, by simply getting him to change his diet, he saw this rather remarkable change and the arteries started to open up. He did these kinds of angiograms using reasonably sophisticated medical techniques to actually examine his patients. Not only did they get the results that they desired in terms of how they felt, but also with respect to the elimination of the angina pains that they often had. He not only resolved those problems for them in a practical sense, but then he went to much more sophisticated scientifically advanced techniques to show that, in fact, these arteries were absolutely opening up. So, to see in these pictures it’s very visible. You can see an opening of the arteries. There could be a huge increase in blood flow and that can occur pretty fast. He has done this with some friends of mine. Not with respect to the pictures, but he has taken friends of mine who have had angina or other heart problems and put them on this and really has had remarkable results.

S.J.: So, Dr. Esselstyn took patients who were scheduled for bypass surgery and helped them change their diets with the result that they didn’t need bypass surgery any longer.

T.C.C.: Right. Just recently, I obviously can’t use the name of the individual, but it’s a friend of mine I sent to him who had had bypass surgery about 10 years ago, and he’s an older man. He’s 73 now, and as I said about 10 years ago he had bypass surgery because he had heart pains, atherosclerosis and so forth, and he has kind of lived with that over the last 10 years. He tried to change his diet a little bit, not a lot. I told him about it but he only changed a little bit. Well, recently, it got worse. His angina reappeared, and he went to the hospital, a very famous hospital, and they told him they could do an operation on him but they were concerned that if they did he might not survive. It was that advanced. So obviously, he was alarmed. He called me up and I said, ‘Look, you have to do see Dr. Esselstyn, it’s time for you to go see him’, and so he did. I just happened to have visited this man a week ago in his home, and his cholesterol level has dropped down to 110 after changing his diet. His LDL level is down to something like 40. It’s amazing. Of course, he’s pleased. His angina for the most part now is gone, and here was a man really in advanced stages. The doctors still wanted to do bypass surgery on him. They urged him to do that, and he didn’t know if he wanted to do that, especially when they told him he might not survive. That’s when he called me, and so, I said you have an option, you can go do this surgery or you can go see Esselstyn. He went to see Esselstyn and he has gotten these results. He’s been a very prominent man in this town by the way for many years, but I won’t give his name.

S.J.: I believe you showed an image of the angiogram in your book as well as describing more of Dr. Esselstyn’s work in the book, The China Study.

T.C.C.: Yes. I have heard Dr. Esselstyn speak on a number of occasions. We have spoken together at different conferences and other meetings and I just am so impressed, and others are too. Here is a very famous doctor who steps outside of his profession in a sense and did something unusual.

S.J.: Surgery?

T.C.C.: Yes. I also have to tell you something about Dr. Esselstyn. His father before him was a famous doctor. He was the first director of the forerunner organization to the Medicare Program and was appointed by President Kennedy. His wife’s father was a very famous surgeon at the Cleveland Clinic. He was largely given responsibility for bringing under control the radical mastectomy operations they were doing in those days. He kind of stepped outside of the realm of his practice too and took that on. His wife’s grandfather is the founder of the Cleveland Clinic. Dr. Esselstyn is so prominent that one could arguably say that he’s Mr. Cleveland Clinic: the #1 heart hospital in the world. He’s president of his National Society, and he recently had me to speak in grand rounds at the Cleveland Clinic. So, when I was there on the campus, I gave the seminar in the building that’s beautiful, a big building; a real monument to someone. It’s called the Crile Building. It’s named after Esselstyn’s wife’s grandfather who founded the Cleveland Clinic. This man with such prominence, such personal distinction and such, quite frankly, humility as well (some of his colleagues kind of poked fun at him as Dr. Sprouts) just went outside of the realm of his field. He’s a man of great courage. Most importantly, he’s a man with a lot of compassion for his patients, and he got these results. He’s the doctor’s doctor. He’s the physician for the former president of the American Medical Association. He’s the physician for some associates of the Board of Trustees at the Cleveland Clinic. It’s not like they don’t know him. They know him, and if they want to go to a real doctor, they go to him. But you know, I find it so troubling that somehow I give lectures and I ask how many people have heard of Esselstyn and it’s almost no one. It’s shameful.

S.J.: Have other medical doctors besides Dr. Esselstyn stepped beyond the conventional to recommend complementary dietary changes to improve health?

T.C.C.: Yes. There are an increasing number of people who are doing that these days. Probably, Dr. Dean Ornish is best known. He did something similar to Esselstyn but he also used stress management exercise as part of his program, and he would have people come there and do it for a week or two to see what benefits they got. He got some good results also. He published them after one year a fairly short period of time. He certainly has published his technique widely, and so the Ornish diet, in fact, Dean Ornish is known much more than Caldwell Esselstyn although Esselstyn’s work is of longer standing, and I think more dramatic. Then there are people like Dr. John McDougall who has had thousands of patients. I think he most recently told me he almost has had 8,000 patients already run through his program at his clinic where he treats people with this kind of diet for all kind of conditions and gets remarkable results on things like rheumatoid arthritis, diabetes. These kinds of things are resolved pretty cleanly for most people, to say nothing of heart disease and reducing the risk of cancer.

S. J.: Dr. McDougall is also a medical doctor?

T.C.C.: Yes. McDougall is an M.D., and he got his medical degree at one of the big ten schools and then went west and eventually to Hawaii and he started there and he was practicing. At a fairly young age, he had a problem himself. He had a stroke when, I believe, he was 19, and so, he had to come face to face with his own mortality. He got obviously very interested and eventually found that this kind of diet had remarkable effects and has spent most of his life out there vigorously pursuing it and showing remarkable results. Again, often, almost always considered outside of his profession, sadly, when he should be at the core of the profession. He should be leading all the others. There are still others: Dr. Terry Shintani, from Hawaii, a very compassionate, generous, M.D.; he has a law degree, and M.D. and Doctors of Public Health. He does this in Hawaii. He has had a clinic there and is doing something very similar. There are many others, like Dr. Michael Croft. One of the more interesting ones that I have met in recent times is a young man, relatively young man in Oklahoma by the name of Dr. Neal Nedley who finished up his M.D. when he was 23. A very bright guy and married somewhere along the lines a woman who was good at physical therapy. That was her thing, and so together they have been in medicine, and he ended up in a place in Ardmore, Oklahoma where he became quite well known for being just a really good general doctor and internist and now he has turned his attention to using so called lifestyle medicine in his practice where he basically has patients come to him with all kinds of problems. He really gets serious about urging them to try the dietary approach instead of the drug approach, and he’s getting remarkable results. In fact, the results that he has been getting with this kind of diet have had a substantial effect on reducing signs of clinical depression. A lot of patients who come to him with serious problems have real clinical depression, and with this diet, he has had a substantial effect on reducing clinical depression. So he has written a book on it.

In any case, Dr. Nedley and his wife and another woman who had a health food store in Ardmore have now built a new facility. A beautiful facility, it’s like a café, health food store, grocery store, and a beautiful place in the back for holding lectures and cooking demonstrations and things like that. Dr. Nedley has this practice, and he’s actually getting referrals from other doctors to him for what he has been able to achieve. So, he filled up his office with patients. So, now the last thing I have heard, he has three other colleagues who have joined him, other medical doctors. Now they’re a group of four. They can’t keep up with the patient supply. I mean, it’s really working. The results he’s getting with this kind of diet are absolutely brilliant. I see this sort of being the future of medicine in many ways.

S.J.: It’s becoming the case that now that the pathfinders have shown the way in how beneficial this approach of improving diet can be, people are building substantial practices by advocating dietary improvements.

T.C.C.: Good way to put it, and you know that didn’t happen a few short years ago, and I think to some extent a lot of credit needs to be given to Dr. Nedley because of his personal charisma. He’s a very pleasant fellow, and I am sure that a doctor of that kind has a better chance of making this work than others maybe, but he’s also a very competent doctor, and he’s getting results regardless of his personality. He found that, I think the figure that he was giving me was something like half his patients took him seriously and went home and really changed their diet, and that is the half that he worked with to see the results. There was something like another quarter who tried maybe halfheartedly or incompletely, and then there’s always a quarter of the people who don’t want to do it. But in any event, if you get half the people to do it or maybe three quarters of the people to do it, listen carefully and do it and see the results, that is enough. He’s going to get a lot of patients coming to him for that reason. There are other young people, some students in my class have gone on and are starting to do the same thing. My own son is now going into medicine, the one who wrote the book with me, Tom. That is exactly what he wants to do. So I think there is a whole generation of young people that are coming along now and they now know that not only is this information reliable and useful, they’re young enough to start off their careers in this area and make it work. I have to say that is where the real hope is; getting these young people who are into medicine. There is another young woman who was in my class some three years ago now is in Upstate Medical Center in Syracuse and she intends to do the same thing. It’s going to spread with these young people who know how to do it.

S.J.: Milk is meant to grow calves from 60 to 600 pounds or more in under a year. What do you think of the study claiming that dairy milk products can be used to increase the loss of adipose or fat tissue.

T.C.C.: That is a ridiculous claim and it’s also now being challenged officially, legally, and in fact, one of the big dairy companies that was making that claim has withdrawn it. But it went through a period for a few months where we all had to hear about this relationship between dairy and obesity. It was on all the TV shows and radio shows, and the dairy industry spent huge amounts of money and they can put it out there regardless of the evidence, and finally, the Physicians Committee for Responsible Medicine. One particular person on that committee wrote a paper summarizing all the evidence, a former student of mine who has been there as a director of nutrition. She did an excellent job summarizing all of the evidence and it turned out that only about two of those 17 studies were relevant to this question in one way or another; only two of them actually showed an effect. It turned out that both of those studies that showed a beneficial effect of dairy and reduced obesity were done by the same research group and were funded by the dairy industry, but even worse, the study was structured in such a way they did not, in fact, even record baseline calorie intake which is always a consideration. So, there was no way to make the conclusion that they were making. How it got published, I don’t know, but it did, and it was on that basis of extremely flimsy and quite frankly, unreliable evidence that the dairy industry went out and spent millions of dollars to put the story across the land. Of course, they have been challenged now in respect to a lawsuit, and one of the big dairy companies has already conceded, they’re not going to say it anymore. Yet, that story is sad because, quite frankly, they were out there long enough to now cause a lot of people in this country to think that dairy might just be able to reduce obesity in children and dairy is good thing to now put in schools instead of the cokes. That is what all this leads to, even though it’s a false claim. This is a sad commentary on our entire society as far as I am concerned.

S.J.: Well, that the dairy industry could basically pay for the advertising and has connections to get the appearances on shows an promote that thread, a very fragile thread of evidence, evidence in quotes, that really got later disproved so that many people got the idea without hearing about the lawsuit.

T.C.C.: Absolutely, that is my point.

S.J.: And withdrawal of the claim.

T.C.C.: That doesn’t get publicized very likely.

S.J.: What would be a sound strategy for weight loss?

T.C.C.: Quite frankly, from many different perspectives and on the basis of a variety of evidence, the best way to go is just a total dietary and lifestyle change. I am talking about really lots of things working together. Consuming a low fat plant based diet for various biological reasons and biochemical reasons can lead to a reduction in body weight. It may not be the really rapid kind that you get simply by all of a sudden consuming far less calories for a bit of time, but it gradually decreases and decreases in a very healthy manor so that the body begins to adapt and so eventually staying on that one can keep their weight under control, provided, of course that they also add to this some reasonable amount of exercise. That is the lifestyle component and at the same time, if they have a stressful life, trying to keep that a little bit under control so that they’re not in a sense driven to eat more than they should be eating because of their stress which is obviously a relationship. So, it’s a lifestyle thing but the low fat plant based diet is a very good starting place and it probably is the central player in this constellation of diet and lifestyle things. That will lead to a lower body weight that can be sustained. That is the most important part of it. It can be sustained, and in the process, not only do they lose weight, but they lower the risk for just an enormous number of different diseases that tend to be associated with obesity for example.

S.J.: Many years ago, I was 50 pounds heavier with adipose tissue, and I gave up milk products to lower saturated fat intake and cholesterol intake. Well, that seemed to really be the key to allow me to begin losing weight, and that was before I went vegan. Just giving up the milk products, and so, here’s a before and after picture. It has been very gratifying to feel lighter and to be able to get around more readily.

T.C.C.: That is interesting, I also today weigh 45 pounds less than I once did, and I lost much of that, of course I am older and one tends to lose some weight as you get older obviously, but not always. I actually, lost most of this as I really changed my diet too.

S.J.: Now as a vegan it’s very easy to maintain an ideal, for me, weight.

T.C.C.: Absolutely. And also, I suspect you still remain physically active.

S.J.: That’s it.

T.C.C: One of the interesting things about this diet and exercise thing, people sometimes will ask this question, you know, ‘how important is exercise?’ Well, we can’t really quantitate things quite that way, but the two working together is very interesting. The two working together create a result that is greater than the sum of the parts, if you will, and there’s some very interesting physiology and chemistry going on here. If people eat right, a low fat type of diet and taking into consideration calorie intake and so forth, and look at the blood chemistry, this actually leads to a distribution of energy in the body in favor or a greater urge to have physical activity. We did this kind of study in rats, and when switched to a low protein diet, for example, they can actually consume more calories and gain less weight: maintain lower body weight and they can gain excess calories. What happens is that some of those extra calories they consume in a larger fraction actually go off as body heat instead of body fat, and some of it goes off to stimulate them to exercise. So if you offer them a wheel to spin a wheel beside their cage, they actually exercise a lot more, voluntarily exercise.

S.J.: So that is actually contrary to the mythical belief that you need the animal protein to get exercise.

T.C.C.: Absolutely.

S.J.: To have high metabolic activity.

T.C.C.: Absolutely. These are animal experiments, and that is what came about. If you start looking at humans to see how they correspond, we did things with the animals incidentally to find out some interesting things. The animals consuming less protein are consuming more oxygen. This is very interesting. So they ended up having a higher BMR and then of course, they expended more of the calories in two ways. First, they had a little higher BMR, so calories came off as body heat, and secondly, some of these calories were used to stimulate exercise. So you start thinking of this in the context of humans. You know, the same thing is happening, but then on top of it, let’s say you tell the person the other way around. Let’s say they’re way overweight. ‘Why don’t you go exercise?’ So they go exercise, with difficulty usually, but they’re exercising: doing the best they can. As they lose their weight they get stimulated to want to eat differently. Their taste preferences begins to change too. So, the exercise in a sense almost can lead to dietary changes in the right direction, and dietary changes in the right direction can lead to more appropriate exercise patterns.

S.J.: You don’t have to exercise and start off from 0 and go to an hour and a half a day.

T.C.C.: No

S.J.: Just anything, 5 minutes.

T.C.C.: Whatever.

S.J.: 20 minutes, 10 minutes.

T.C.C.: Whatever you can do reasonably comfortably but pushing it just a little bit, staying with it. The two together, it’s truly remarkable.

S.J.: Or break it up, several brief walks several times a day.

T.C.C.: Exactly, and you can also add in some components like being out in the sunshine and making sure you get enough water and enough sleep and so forth and so on. It’s a great formula.

S.J.: Are there any diseases that changing diet wouldn’t help?

T.C.C.: I am sure there are, but I am finding it harder and harder to find such diseases. I mean some of these genetic disorders, you know rare genetic diseases obviously, probably we can’t do much about, maybe.

S.J.: For example?

T.C.C.: I can’t even think of some of the names of them. I think muscular dystrophy for example might be difficult to control through diet. I don’t know that. In animals muscular dystrophic kind of condition can be influenced by diet and maybe it can in humans too, I don’t know.

S.J.: Well would a high animal product diet worsen symptoms, for example?

T.C.C.: It would be my guess yes. That would be my guess.

S.J.: So symptoms could be ameliorated even if the disease could not be reversed entirely?

T.C.C.: I think so.

S.J.: Possibly ameliorated.

T.C.C.: Right. After thinking about this, you know, every disease you once thought was pretty much family oriented or genetically oriented, and then with the passing of time, I think these so called diseases kind of fall by the wayside. You can no longer explain the causation of these diseases that way, and we see more and more evidence that even difficult diseases may be ameliorated as you say or maybe even reversed with appropriate diet, and that is one of the remarkable things about this diet, the diversity of response that is created. A wide spectrum of conditions.

S.J.: How about Alzheimer’s and other forms of dementia?

T.C.C.: Same thing, Alzheimer’s has been associated with meat consumption. It has a very strong relationship.

S.J.: A tight correlation.

T.C.C.: Pretty tight. I mean not so much correlation but was more so called case control studies. Just asking people who had Alzheimer’s or comparable people who did not, same age, same sex and that kind of thing, you could see a substantial increase in risk for those who consume more meat and animal based foods. Even with things like cognitive dysfunction, a little bit of senility if you will that can lead to Alzheimer’s and at least is associated with a higher risk of Alzheimer’s. That too is associated with the ratio of animal to plant based foods being consumed. It wasn’t until we actually did the book that I had an opportunity to go back and look at some of the work of others, particularly in the context of history and it’s really quite remarkable.

S.J.: So with plant based foods one could possibly maintain a high level of mental acuity throughout most of life even until quite elderly?

T.C.C.: Yes.

S.J.: We have spoken about maintaining mental acuity and virility. How about other markers of aging?

T.C.C.: Like aches and pains maybe?

S.J. Sure.

T.C.C.: I just got reaffirmed in some of this talking to a very well known physical fitness guru who works with professional athletes a couple weeks ago as well as a book that I just recently read on hydration. Those two experiences, reading the book about hydration, written by an M.D. by the way, and also meeting this fitness fellow, and at the time that I was talking to him a couple weeks ago, he was actually working with a Russian tennis star, #1 ranked tennis player in the world who was at the Wimbledon. At that time, he was called in to see her because she was competing at a very high level and we were having some discussions, and it turns out that on that basis as well as on a personal basis, hydration is very important, good diet is very important. As far as aches and pains are concerned, as one gets older everyone tends to incur a few more aches and pains of the joints, muscles or whatever, probably not keeping in shape to be honest about it in a large measure. I have found for myself, I do a lot of running and am very active and once in a while I get an ache and pain. I don’t know where it comes from but every time I stop and think about it, I haven’t drunk enough water the previous day, and so I can tell that by other sorts of signs. If I drink enough water, it goes away. I don’t really slip off the wagon as far as my diet is concerned ever really, so I can’t say that. I think that for older age people, we know that rheumatoid arthritis which is an affliction of older people, of course, more than of younger people, that is greatly attenuated by a proper diet. Dr. McDougall has shown this with lots of people. I just ran into somebody last Tuesday night talking in Rochester. A man came up to me at a book signing with almost tears in his eyes and was quite emotional about it. He had somehow gotten a copy of the book somewhere along the line and his 16-year-old daughter had a serious case of rheumatoid arthritis and she was really in a difficult way, and so she started this diet, and he just couldn’t believe the response that she was seeing. As I say, he was really taken by this. Of course, I pointed it out him. And she had quit dairy by the way, and I thought that probably was one of the main things. So, I just told him and he knew this: that Dr. John McDougall had been doing this fairly routinely. So, I wasn’t surprised to hear it but it was really nice to hear that someone so young with that serious of a problem came to the talk. I didn’t speak to her but you know something like rheumatoid arthritis and other kinds of arthritic conditions are the sources of pains, very clearly, and it’s more common in older people, and I think it can largely be controlled on the basis of the evidence that we now have. What else could we think of with old age? We talked about impotence. We talked about mental acuity, blindness; even people get blind for different reasons. So called macular degeneration is the chief cause of blindness among older people. We know that has a close link to diet. Even cataracts, which are not a fatal thing, not even necessarily a cause of blindness for the most part, but they’re common and troublesome. That has a relationship with diet, same fashion. Animal based diet increases the risk for cataracts. Animal based diet increases risk for macular degeneration and blindness.

S.J.: So, if a person is reducing the markers or signs of aging does that mean reducing the processes of aging or many of them?

T.C.C.: Yes, what is age? Aging, obviously, to some extent is rusting away of our body or deterioration of our tissues or loss of function. I mean that is part of life, and a lot of these problems do arise and up and focus in tissue here or there and end up being called a disease of one kind or another. So a lot of these diseases we’re talking about are age related. Obviously, they tend to occur in older people, and can you call these diseases a sign of aging or is aging naturally linked to these diseases? I don’t know how one would, I think to some extent this is sort of a matter of semantics.

S.J.: Maybe the animal based diet increases the rapidity of aging and the plant base slows it down.

T.C.C.: Right.

S.J.: Or even reverses the signs, some of the signs of aging to some extent or to a large extent even in the case of impotence from impotence to virility.

T.C.C.: The way I like to say it these days is this dietary effect, that is, the plant based diet, maintains health and prevents disease simultaneously. Now, it’s a little bit redundant to say it that way because if you are maintaining health you are obviously going to be preventing disease. If you are preventing disease, you are likely to maintain health. I am going to throw something else in here that has nothing to do with prevention of disease; it has to do with what we mentioned before: mental acuity, physical activity. We know from studies of lead athletes that there are lead athletes, and there were Olympic-type athletes who have found that their performance is enhanced when they consume this kind of diet.

S.J.: Especially endurance.

T.C.C.: Endurance, even strength. One of the people who came to my class was a world champion wrestler for four years, a vegan. He was a captain of the American Olympic team in 1992 and was the oldest person to win a medal in wrestling.

A vegan, he later became the executive director of the Olympic boxing team, and had me out to speak to the team because he was so enthused about this that he wanted the whole Olympic team, especially the boxing time which hadn’t been doing very well, to become vegans. You know, there is evidence in the literature going back a long ways, all the way back to the ancient Greeks that elite athleticism as well as just overall physical performance can be enhanced with this kind of diet.