Transcript of Interview 5:

S.J.: The Irish medical doctor Denis Burkitt came to some remarkable conclusions after serving for 10 years as a Minister of Health in Uganda. He encountered diseases such as heart attacks and chronic intestinal diseases mainly in people who had sojourned in the West and then returned to Uganda. He came up with a striking quote, “Small stools, large hospitals”. What did he mean by that?

T.C.C.: Well, I knew Denis Burkitt by the way, and as a matter of fact, when he got a rather prestigious award in this country for his life’s work, he invited me down to be his principle speaker at the ceremony. He turned out to be a good friend. Unfortunately, it was just two months before he passed away, but Dennis Burkitt was a very remarkable honest man. I had great respect for him. He traveled, I think, something like 10,000 miles over really back country roads all over Africa trying to find out basically something about disease and how it compared with the West as you indicated, and he used to give these amusing seminars with that quote after showing some pictures of stools and things like that in the West and the rural countryside. What he really meant by it was that when people are consuming the typical western diet, low in fiber high in fat, they’re much more likely to get constipated, compacted. The way he described it was very quite amusing but it was tragically true that the stress and strain with that kind of diet translated into hemorrhoids, translated into constipation, translated into other kinds of western disease such as colon cancer, he thought at least, and in which case you need big hospitals.

In contrast, he told how the people in Africa would step off into the bush and do their business and then back to work, and this was certainly more frequent by considerable amount than what happens with people in the west. In his view, that was the best of medicine, that was the best of health and you didn’t need much in the way of hospitals to take care of that problem.

S.J.: Did your research in China show a relationship of animal based foods to degenerative diseases in addition to cancer?

T.C.C.: No, not really. What we had done was to look at all the disease rates we had, some of which are typical western kinds of disease, some of which are typical diseases found in poor countries which tend to be the infectious kinds of diseases and the diseases that associate with poor public health facilities understandably, and so, we basically learned that the western kind of diseases tended to aggregate together in the same geographic areas and the so called poor country disease aggregated in somewhat different areas. Of course, that suggested to me that there would be some common causes, and of course, our minds can range far and wide as to what these common causes might be. They might be biological, they might be social, they might be economic, they might be this, they might be that, but we had an opportunity to see, in fact, if the biological information we had associated with this group of diseases would amount to anything. It turned out that the western diseases were associated with blood cholesterol which in turn is associated with animal food, to get back to you question. Cholesterol tends to go up with more animal food consumption and it tends to go down with more plant food consumption, so we saw a high correlation between blood cholesterol levels and the consumption of animal based food such as meat, milk and dairy, although they didn’t consume much in the way of dairy, but there were two or three areas that they did and hence the association. In contrast, the blood cholesterol levels were inversely associated with dietary fiber, different kinds of dietary fibers, legumes and the like, and that was really a very powerful observation in my view because the cholesterol levels in China were already very low, as we’ve talked of before, going from somewhere around 80 or 90 mg a deciliter up to about 170 or so. It was within that range as they move from 80 to 170 that we found that as the cholesterol tends to go up it’s highly significantly associated with the consumption of more animal food and less plant food. I know that is kind of a long winded answer but it was an important observation especially since the range of cholesterol that we were considering in this case was already quite low.

S.J.: So did heart disease increase along with cholesterol as a marker?

T.C.C.: Well, heart disease overall in rural China was quite low, and quite frankly, we didn’t really see any significant heart disease when you get below let’s say about 150-160. So there was very little heart disease present in China, and you tended to see it at the higher levels. So that is not enough data to really make too much of that within rural China, but when you compare this range of cholesterol with the extended range you see in the West, of course, we know that blood cholesterol levels are highly associated with heart disease.

S.J.: So in China, the range just didn’t reach anything like the high levels of cholesterol that you see in the west.

T.C.C.: That’s right.

S.J.: And that is why the study didn’t show an increase in heart disease with cholesterol and didn’t show a relationship of animal based food to degenerative diseases in addition to cancer?

T.C.C.: Correct, you are absolutely right.

S.J.: Just because the range of eating animal products didn’t increase enough.

T.C.C.: That is exactly right.

S.J.: Or even when people ate some animal products, they were mainly eating plant based food.

T.C.C.: The range in China was kind of just beginning to penetrate the western range a little bit, but only on the low side, and you don’t see much heart disease there; therefore, from an experimental point of view, it’s hard to see an association. Interestingly, within that same range, I must say, a number of different cancer rates also went up. Others hadn’t made much of that in the past, and I am not sure that it had ever been reported.

S.J.: So cancer might be more susceptible to animal based foods and animal fats.

T.C.C.: Perhaps, or you know whatever it is that people are doing when they start consuming animal based foods.

S.J.: Okay, whatever correlates.

T.C.C.: Yes.

S.J.: So in that regard, couldn’t getting more exercise help to keep the Chinese healthier rather than diet?

T.C.C.: Yes, of course, exercise we know from many different studies, as you know, Sylvester, it’s obviously very good, and we have lots of evidence to show it’s going to help to reduce the risk of these diseases. In China, it was not something that we could look at very carefully because virtually all the Chinese were quite active. The Chinese had a way of segregating people into different groups for experimental purposes in so far as their exercise is concerned ranging from those that were involved in very heavy exercise all the way down to those that were let’s say doing office type work who were presumed to be the people who were doing the least exercise, but even in that case, the Chinese people who supposedly go into the office went to the office on bicycles.

S.J.: So there wasn’t any group in the study that really did no exercising. So you really couldn’t distinguish disease in relationship to exercise since everybody was getting enough exercise to help the immune system for example?

T.C.C.: Exactly. Precisely. It just wasn’t possible to sort of tease out that relationship and have a very careful look at it because everybody was exercising quite a bit.

S.J.: Well, how about the fact that people in third world countries don’t live as long, so they don’t have time to develop degenerative diseases, doesn’t that invalidate the conclusions?

T.C.C.: No, actually, it turns out that the accrued disease rates across different countries are influenced by what proportion of each population is living to be older. Obviously, with population of a higher proportion of older people, they’re going to have more of these kinds of diseases. So in that case, you can’t compare one population with another in that they may differ in age distribution. So what we do in determining statistics is to age adjust, as we say. In other words, we weight each population according to a common base of age of distribution, and in that particular case, then we can compare. So in effect, for example in rural China where the age distribution might be quite different than here, what we’re doing, I think, to put it in the simplest possible words, we’re comparing people within a fairly narrow range like all 50-55 year old people in each society one with another. Now that is fair you see, now we’re just comparing people of the same age bracket and determining what is their risk of getting disease. That is a very different kind of question. Under those circumstances, we can compare different populations by doing that, and incidentally, virtually all data are done that way these days. So in most studies, you will see that it has been done.

S.J.: So do the results of the China study support the relationship of animal based foods to cancer?

T.C.C.: Yes.

S.J.: Even though you don’t know what else it might it might correlate with?

T.C.C.: That is true.

S.J.: You talk about exercise, what about pollution or something like that? Is there anything else that could correlate that would invalidate the results?

T.C.C.: I mean those other factors from some other different kinds of studies you know are proposed from time to time to relate to cancer especially the presence of environment chemicals that are mischievous and bad, but we really didn’t have a chance to measure that kind of thing really. So in exercise, of course, we were limited there too, but we could, of course, look at the relationship between diet and disease rates, and in spite of what those other factors may or may not be doing, it’s clear that diet does have an effect. Incidentally, the effect that we see, again, as we have talked before, is a very broad based effect involving animal foods in general, and that, in turn compares favorably with more discriminating kinds of studies that might be done on selected groups of people in other types of studies.

S.J.: In India, a higher percentage of the population consumes milk products than in China. Do they get cancer more often than the Chinese, do you happen to know?

T.C.C.: No, I don’t know that. I just don’t know what the comparison is between India and China. I do know that in India they’re having a problem with heart disease these days, higher than what otherwise would have been expected I think, especially in regard to the fact that India tends to consume more plant based foods than in China. They have a history and a culture that is rather friendly to consuming vegetarian types of diets, and many Indians are that way, but they’re getting more heart disease than what they want and a lot of this is attributed to the fact that they’re consuming a lot of ghee, you know the dairy fat. They really use a lot of that, and that certainly is contributing to some of it.

S.J.: So if they’re using ghee rather than the whole milk product, the protein part of it, as much, then they would be more susceptible to heart disease than cancer.

T.C.C.: Perhaps.

S.J.: Because of their consumption of dairy.

T.C.C.: Perhaps. There are some studies now going on in India trying to analyze that question more carefully, but I am just not familiar with the results enough to comment.

S.J.: How about throughout the world, do people in areas with higher consumption of milk products also experience higher cancer rates?

T.C.C.: Yes they do. If you plot dairy consumption, which incidentally is only consumed by a minority proportion of the population of the world, but if you compare dairy consumption across different societies and cancer rates, you see more cancer rates, more heart disease, and more diabetes in countries that consume more dairy.

S.J.: And more osteoporosis?

T.C.C.: More osteoporosis too.

S.J.: More hip fractures?

T.C.C.: Exactly. But you know there is another factor in the whole dairy association that should be mentioned. That is, and this is kind of interesting, dairy tends to be consumed obviously in the temperate zones of the world rather than the tropical zones. It’s much more commonly consumed in the temperate zones, and to the extent that dairy is consumed in the tropical zones, it tends to be more fermented and much less is consumed. It turns out cows grow better in colder climates. They don’t accommodate so well in warm climates except for a couple of different breeds, and as you get to the northern climates where cow’s milk is consumed, that is also the region where sunlight exposure is less. Sunlight, of course, produces vitamin D in the skin, and we know now that vitamin D is important in helping to prevent cancer. So there is, at the present time, quite a discussion in literature about the role of the lack of vitamin D being associated with these diseases which tends to coincide with the simultaneous presence of more dairy.

S.J.: Vitamin D would be more associated with osteoporosis rather than cancer?

T.C.C.: Actually, yes, it always has been discussed primarily in context of osteoporosis, but now we know too that vitamin D is important in preventing cancer. Although that is a relationship that has to be considered very carefully ­because it’s really the vitamin D that is transported to the liver in which case it’s metabolized to hydroxy form and then subsequently is stored in the liver also. Then it’s transported again to the kidney where a very tiny, tiny fraction of it’s converted one step further to so called dihydroxy vitamin D, and it’s that form, that latter form that is very, very important in a number of different events in the body, not the least of which tends to prevent the conversion or the transformation of normal cells to cancer cells. So, it’s important to have adequate amounts of the dihydroxy vitamin D. That raises a very fascinating question, how do you make sure you have enough of the so called highly active dihydroxy vitamin D that is being produced in the kidney? Well, the body is another place where nature’s really developed for itself a rather wonderful scenario of reactions to make sure we always have enough of this latter product if we have enough vitamin D in the first place. We can get enough vitamin D if we get adequate exposure to sunshine. But in those situations where people may be restricted; they don’t get enough sunshine, they’re in cities or whatever, they don’t get enough sunshine, they don’t get enough of vitamin D and therefore, they suffer not having enough, and that is what lead to the movement several decades ago of supplementing vitamin D in dairy products especially and now some other foods too. The story gets kind of complicated, but one of the interesting things about dairy and vitamin D that I find interesting is that that dairy obviously is a good source of protein and as we talked before, the protein animal in origin, of course, tends to create a metabolic acidosis decreased in the pH a bit and that metabolic acidosis actually impedes the conversion of the hydroxy form of vitamin D in the liver to the kidney from the dihydroxy that is really needed. So, when one is consuming animal protein based foods it tends to repress the formation of that very important last product of vitamin D which in turn raises the risk for cancer and these other things: osteoporosis and the like. So it’s a really interesting network of reactions that as far as the bottom line is concerned goes back to the consumption of animal protein based foods as being a single factor. So, you go to the northern climates, you get less sunlight, let’s say, you see more cancer and immediately people want to attribute that to the factor that they’re not getting enough sunlight, not enough D, but by the same token, they’re consuming more dairy which in turn is going to negatively impact the vitamin D activity that is there and is limited in the first place. It’s really quite a fascinating story. Fascinating story of how, in this case, the food is interacting with an environmental condition to create together a compromised situation that can lead to cancer.

S.J.: So, actually, the biological science, the biological plausibility is the relationship between D and milk products and the population studies varying. All of these come together to show an even stronger support for the hypothesis that dairy is correlated with cancer.

T.C.C.: Absolutely, I think this is one of the parts of science that I particularly like, looking for that context and to see if, in fact, the observations we may make in a test tube or in a lab or in a single experiment, all of that correlates with other things and to see if it fits so to speak. As in what you just said, especially in reference to dairy, sunlight, vitamin D and cancer, it’s all kind of coming together.

S.J.: I’m looking at a different kind of study. Could you please describe the Physician’s Health Study and the Health Professional Study and the association those studies found from milk products with prostate cancer.

T.C.C.: They did some work obviously on that question and found a relationship specifically in their study between dairy consumption and prostate cancer, but more to the point, I think, really one of the most eminent members of that group, Dr. Ed Giovannucci. Actually, it covers some very nice work not only in sort of formulating hypotheses and explanations of how all this works but concluded after summarizing a number of different studies on the relationship between dairy and prostate cancer that concluded with his colleague, Dr. June Chan, that when you look at all these studies together, dairy is the most significant factor in so far as it’s association with prostate cancer is concerned, and Dr. Giovannucci, in fact, I think, gave a very nice description of possibly how that could work. I liked it because it just made a lot of biological sense. I think he’s correct.

S.J.: Does bovine leukemia virus pose a threat to humans?

T.C.C.: It’s said to by a number of different people. I am just not familiar enough with the data, and I think the data is a bit sparse on this question, but there are some who will argue with me and say no it’s getting pretty strong these days, and they will cite certain evidence to say it is. This is the kind of thing, talking about the transmission of an infectious agent, if you will, from one species to another and then in turn relating that to the presence or the absence of disease. It takes a big study and it takes time to see that kind of thing, but it certainly is a plausible hypothesis. There is no question about that.

S.J.: It’s of interest that it has been supported by a study that the virus crosses species and infects chimpanzees, an animal model of course, very close to humans, and also that a majority of dairy herds are infected and that dairy farmers experience a higher rate of leukemia.

T.C.C.: I have heard of some of those studies. You know maybe more about than I do in this case. That certainly sounds a little alarming, I wouldn’t say necessarily convincing but it certainly is indicative of a real problem here.

S.J.: Whether people have Type 1 or Type 2 diabetes, the excess sugar makes the blood more like molasses than freer flowing normal blood so that the thickened, more viscous blood fluid damages fragile tissues and restricts nutrient and waste flows throughout the body. How can changing diets help diabetics?

T.C.C.: There’s really some very convincing work and it goes back many, many years, back to the 1920s at least, showing that in diabetics, Type 2 diabetics in this case, adult onset insulin independent Diabetes is commonly found in adults. Those individuals when they’re put on a high fiber diet, plant based, can really bring that disease largely under control, and that kind of information has been popping up from time to time for 60-70 years, and now we know from a number of clinics and other studies that the effect is really quite remarkable and convincing.

S.J.: Besides Type 1 diabetes, even multiple sclerosis and other autoimmune disease such as rheumatoid arthritis and lupus are associated with animal products. Does any food stand out as particularly risky?

T.C.C.: This is, first off, looking at the information on those autoimmune diseases, I am intrigued by the fact that those diseases tend to occur in regions of the world where dairy is consumed. They also tend to occur in areas, as we said before, of the world where there is less sunlight. So, I think, it’s very possible, and it’s looking at it very broadly, that dairy has a support and association with a number of these different diseases and people have published on this. Some work in France, I know was published maybe about 15 years ago on that question and earlier about 20 years ago others have published on it, and so, they see these general relationships which certainly raises ones consciousness about the fact that the association between dairy and the presence of these autoimmune diseases is real. Then in the last 10 years, 15 years perhaps at the most, some very good biochemists have begun to tackle this question and have looked at the biochemical events going on in the formation of these kinds of diseases: lupus, MS, we have a model in animals that mimics the MS situation and mimics the lupus situation and also the rheumatoid arthritis situation. These are pretty good models. It’s an autoimmune disease that has been created in such a way that animals can get that disease, and so now they’re beginning to study some of the mechanisms associated with the formation of that disease in these particular animals, and it turns out in that particular case, once again, it’s the vitamin D connection which in turn has the connection to animal protein, in turn has the connection with the dairy, that all supports what we generally see on a population basis. So, it’s too early to really put your finger on it and say ‘okay this is the food that causes one of those diseases necessarily’, but I don’t particularly like to do that anyhow with any disease, any diet-disease connection, but broadly speaking, the dairy connection is getting to be very convincing. In my view, it’s not just the presence of dairy but it’s also perhaps the presence of other animal foods too, and the extent to which those kinds of foods work on one of those autoimmune diseases might, in fact, differ obviously under different circumstances. It may be stronger for one disease than for another disease, but is quite clear that the biochemistry and also the comparative population data that those two groups of that kind of evidence when coupled together, say that dairy has the potential of a really serious problem here as far as those diseases are concerned. There is one other factor in those diseases that we have to take into consideration maybe more so than other diseases, and that is genetic background. It turns out that especially in Type 1 diabetes with children. The children who are likely to be susceptible to these effects we’re talking about, the dairy, etc., there is a subset of children who do appear to have a rather different genetic makeup that can in fact be measured in these people, and so it’s sort of a genetically susceptible subgroup of the population that seem to be susceptible. That is very clear, but it’s not clear how that genetic predisposition is really translated into susceptibility but there is genetic component here, I think, that is probably pretty important.

S.J.: Even without dairy proteins triggering the autoimmune problems?

T.C.C.: That is open to question. I don’t know that.

S.J.: No research has been done in that area?

T.C.C.: There is some research that suggests from what I have seen that genetically susceptible babies, in this case, who don’t go on dairy, don’t get the disease.

S.J.: So you have seen a study?

T.C.C.: Yes, we have seen this kind of thing. It seems to me, I think many would argue we need to see more of this kind of information to really become convinced of that, but of the evidence that I have seen, you see this. So, I think it leads to this notion that we talked about before that all of these biological events whether they’re ­pathological or physiological you know disease or health and these events really are starting with DNA which is the main component of genes. It starts that way and we all have the presence of perhaps the wrong kind of genes on occasion either because we’re born with them or because they’re acquired during our lifetime, and those diseases even though we may have them it turns out we can learn to control their expression, and this is one of the instances I think where this is beginning to play out. Children who have that genetic predisposition and are exposed to dairy are going to be at very much higher risk of getting Type 1 diabetes. That is quite clear, and if they don’t have dairy then they’re much lower risk maybe equivalent to those who are not, in fact, genetically predisposed.

S.J.: It’s a tragic price to pay for wearing a white mustache.

T.C.C.: Yes, it’s especially for the African American race. I mean the African Americans we know as well as the Latin Americans, and this is true for Asians too, but in our continent, I think, the Latin Americans and Hispanics have been probably studied most. In any event, those two ethnic groups have a very high lactose intolerance, and we have known that for a long time. With blacks for example in the United States, the percentage of people who are lactose intolerant is somewhere around 75-85%, with Hispanics it’s probably higher, and unfortunately, you find some black celebrities agreeing to put the mustache on their face, and surely, they don’t know. I don’t believe that they’re obviously aware of this information, but they have been co-opted into the system with money, I’m sure.

S.J.: Particularly counter-productive.

T.C.C.: It’s very counter-productive and obviously in their case they’re not doing their own race any good, let alone other races. The white mustache thing you could say, I guess, is a great marketing tool but that is really all it was, it had nothing to do with health. It was money.

S.J.: I hope the word gets out so that people don’t make the mistake of promoting it any longer.

T.C.C.: Right.

S.J.: Could you describe the work of the medical doctor Joel Fuhrman?

T.C.C.: Yes, Dr. Fuhrman is a productive, interesting physician. He incidentally was a world class ice skater and was in championships, and so, you can say he’s an elite athlete as well. Joel, who I know personally, has become very interested in a couple things. He has become interested in the plant based diet and in even for the most part raw food plant based diet kind of thing. He also has become interested in the idea of fasting, water-only fasting, and he has published a book on each of those things. He has recently also published a book on this kind of diet for youngsters in pediatric age groups. Joel is very much, I mean he and I and Dr. McDougall and many others are in the same camp in general. I think Dr. Fuhrman, if there is a difference between Dr. Fuhrman and myself, it’s that he tends to favor a little more of the nutrient supplements. He’s a little quicker to use those than I would, but he’s a physician and I am not, so, I think it’s something that we have to continue look at, maybe he’s right, but at the present time, I am not quite as enthusiastic for the use of supplements as he is.

S.J.: When does undigested dairy galactose form deposits in the lenses of the eyes forming cataracts?

T.C.C.: I don’t know. It has something to do with lactose metabolism or digestion hydrolysis into its two components. Lactose being a disaccharidant to galactose and glucose, it’s the galactose component that seems to be involved in this, but I, quite frankly, have just forgotten what the details of that galactose pathway is.

S.J.: Well, if people were to eliminate the source of the galactose…

T.C.C.: Yes, of course.

S.J.: Mainly removing the lactose in dairy can…

T.C.C.: Resolve…

S.J. Indeed, ameliorate the problem.

T.C.C.: Yes, absolutely.

S.J.: Many people develop partial blindness due to degeneration of the macula, the tissue that receives light in the eye. One of the main causes of macular degeneration is free radical damage that can be prevented by antioxidants. What roles to free radicals and protective antioxidants play in other diseases?

T.C.C.: I think the free radical idea which was born under obviously controversial conditions,

(I was, in fact, involved in those early discussions myself) is fairly recent, but free radical activity I think is really one of the great areas to think about in terms of disease formation because free radicals are highly oxidative as you know well and highly oxidative reactions can amount to rusting and so in a sense, if we have a lot of free radicals in our body it’s only exacerbating the rusting of our body and aging of our body which is not good and plays a role in cancer, plays a role in heart disease, plays a role in this, plays a role in that. I mean a lot of diseases are exacerbated by the presence of free radicals and the formation of free radicals is in part a natural process but in nature in our bodies the free radicals that can be formed in some of these complex reactions tend to be controlled quite a lot, and so they don’t cause mischief, and one might even argue at low levels maybe they’re doing something worthwhile to simulate our bodies to work in certain ways, but obviously we tend to produce excess free radicals. Then you can ask the question ‘well, how do you get excess free radicals and that kind of damage?’ Well, one way to get excess free radicals not to consume enough of the antioxidants of plants. So, if you don’t consume enough plants, you don’t get enough antioxidants in order to impede the activity of these pro-oxidants or free radicals which is an imbalance of antioxidants and pro-oxidants, and we have some evidence too that animal foods, protein in particular, stimulate the performance of pro-oxidants or free radicals. So it’s coming back to kind of balance between animal and plant foods, but as far as these specific radicals are concerned or specific antioxidants are concerned, we can’t put our finger just on one kind of free radical; there are many different kinds or one kind of antioxidant. It’s a whole family of antioxidants and free radicals that are competing with each other.

S.J.: Do plant antioxidants play a role in tissue repair?

T.C.C.: Well, they should certainly prevent further degradation. As far as repair is concerned, I think if you are talking about damage that already occurred that lead to scar tissue and fibrotic tissue and things like that and that’s what free radical activity can do. If that kind of tissue has been formed, no, I don’t know of any evidence that antioxidants can necessarily repair scar tissue, but it certainly can stop the whole situation right there. There is evidence though, interestingly, that you can have scar tissue, within the cell or between cells or at the tissue level, that can be overgrown; let’s say you put it right and it can be overgrown by normal tissue which would tend to make it look like it’s disappearing. But as far as this specific chemical reaction is concerned of actually repairing that, let’s say converting a fibrotic tissue back to a normal tissue, I am not aware of any evidence that that can actually occur; but maybe that is a moot academic point to some extent because if you are going down the wrong road and you have scar tissue and it’s accumulating and all of a sudden you change your diet, and you say, ‘ok put the brakes on,’ you stop it, and then subsequently, the normal tissue’s encouraged to grow and gradually covers it up.

S.J.: Let’s say that the liver or the kidney has gotten to a large extent dysfunctional but not necrotic; can plant antioxidants help the body repair that tissue?

T.C.C.: I am going to say yes.

S.J.: In sense of increasing functionality and getting themselves more vibrant.

T.C.C.: I am going to say yes but I can’t give you any specific reaction that occurred to me straight off.

S.J.: Without supporting research, the instinct is yes.

T.C.C.: My instinct says yes, but I have to put my critical scientific hat on in this case, and I can’t tell you specific reactions. I have to think about that a little bit.

S.J.: But switching diets to plant based diet could help.

T.C.C.: Oh, yes.

S.J.: Just to eliminate the disease promoter would help?

T.C.C.: That is right.

S.J.: And whatever good phytochemicals that are in plants might also help?

T.C.C.: Sure.

S.J.: So as far as plant antioxidants per se, research is yet to be done. All plants contain protein. Does eating a variety of whole and refined plant based food provide plenty of the essential protein building blocks so that we can make all the proteins we need?

T.C.C.: Absolutely. If we’re consuming a good plant based diet with lots of variety as you have just indicated, meaning the whole foods, the bran layer of cereal grains has protein and that is good, the flour on the inside of the grain does not, not to any significant extent; so we have to eat the whole grains A. B, We should be eating the other portions of the plant, the leafy material is rich in protein, so are the things like I call the flowers and buds of cauliflower. They also have some protein. Of course, one of the richest sources of protein indicates the seeds, the bean, the legumes, especially legumes. There is a plant that is drawing nitrogen from the air, able to convert the nitrogen in the air to organic nitrogen or protein, and so it becomes quite rich. So things like soy, peas and peanuts and things like that and other kind of beans are a good source of protein, lot of protein, plenty of protein.

S.J.: What do you mean when you write ‘the whole is greater than the sum of its parts’?

T.C.C.: Well, it’s one plus one equals four or five or six or ten instead of two. Things work together. Statistically speaking, we talk about interactions. You know you can actually measure interactions at times with this kind of synergy but we do it in a rather simplistic sense, I would argue. In science, we tend to look at A plus B and if you look at them separately it gives you, whatever, some number, but then it turns out the interaction between A and B might add still more; it’s not just an additive thing, it adds still more. So we can dissect out that kind of relationship from a statistical point of view, and we can study it. We see it, and we know it exists. The problem is what do you do when you have got not just A & B, you’ve got a few tens of thousands of A’s and tens of thousands of B’s. and C’s., and D’s, and E’s, and F’s and you know all those interactions are going on. Now talking about the whole is greater than the sum of its parts is, quite frankly, a very substantial statement. It really is. We can see from a larger perspective and this is one of the reasons I get interested in the larger perspective because just allowing for this effect of the whole is greater than the sum of its parts to be expressed is fascinating.

S.J.: Can taking vitamin supplements make up for not eating many veggies?

T.C.C.: It has been a hotly debated topic for quite a number of decades now, essentially two or three decades, much of which have been during my career because vitamin supplements weren’t much used before 20-30 years ago. So that argument has been playing out and debated quite widely. In fact, I was just talking to someone this morning about that very question. There is some evidence, and I have always tended to say, ‘No, they can’t, they just can’t’. These vitamin supplements cannot replace what is in the whole food. But there are a little bit of cracks here and there; maybe. You know where, if a certain food, in theory, is missing all of its water soluble antioxidants such as vitamin C and somehow it got destroyed or whatever happened, and then you dump some vitamin C back in; you might restore a little activity. But this is kind of an academic question, and in large context, in a practical setting, no. There is no point on relying on nutritional supplements when you can get the whole food. Just to mention, as I said, I was just talking this morning to someone and we were comparing some notes and where if you take the whole fruits and vegetables and then look at, your sort of test it you study it, you look at its antioxidant activity in the whole and then let’s say you are looking at the antioxidant activity in terms of its ability to do vitamin C-like work and you get a certain result. Then you look to see how much vitamin C is really there. Can vitamin C account for all that work that was done to create that vitamin C-like response? No way, it turns out that often times that the vitamin C level is only about maybe 1% of the vitamin C that is there that actually ends up causing a vitamin C-like effect. That’s the whole is greater than the sum of its parts, and this guy a professor at Cornell University, Rui Lu who has been doing some of that work with apple skins and grape skins in showing that the effect that is actually produced, a vitamin C-like effect for example, cannot be attributed to just the vitamin C in the fruit peel. It’s quite interesting. I think the question you just asked is one of the more important questions, we all should think about that to realize that the evidence is so far produced. It does really strongly, and I mean strongly, reinforce the idea that eating the whole food is a lot better than trying to take out a single vitamin and put it in a pill or something like that, but I have to say at the same time, maybe there are occasions in the short run when you can take a vitamin supplement you can kind of fill in whatever is missing for a short while but to rely on that is in my view not a risk, it’s pretty much nonsense. It has to be whole food. These supplements are costly, anyhow. It costs us money and then we turn around and for the most part urinate them out anyhow.

S.J.: Dr. Michael Klaper’s Vegan Health Study has found by offering an extensive range of blood tests that many vegans are deficient in DHA. Please comment on the recommendation that he has made that vegans supplement DHA source from algae.

T.C.C.: I just don’t know enough about that information. I know Dr. Klaper quite well and I know that he has been promoting that. DHA is sort of an omega 3 type of product.

J.S.: Long chain omega 3.

T.C.C.: Exactly. We know omega 3’s have a lot of good properties especially in the immune system and immune system function, and I know he has basically proposed and I think he has some clinical evidence to suggest that DHA is good and that vegans aren’t getting enough of that. The only problem now speaking in general about Dr. Klaper’s work, he really is very conscientious and a really wonderful person and very conscientious about working with vegans. He’s doing more work with vegan-type people than anybody I know of, and he’s, of course, an MD, a doctor, and he’s doing this kind of thing. He basically is trying to understand why it is that a certain small fraction of so called vegans don’t seem to behave the right way, as far as disease is concerned. They still maintain fairly high cholesterol levels for example, maybe 5% of them do or maybe more but they seem to be resistant to the kind of benefits that most vegans would get, and so he’s trying to understand something about those so called resistant vegans. Some of us think, and I think he acknowledged this, that those vegans who are not getting all the benefit that they think they otherwise would get may not be aware they’re cheating a bit in their diet. In other words, they might be using foods that are less than whole, get into the sugars and the flours and things like this. In which case, they’re not getting enough of the right, the good kind of stuff. So it may be a plant based diet but it’s not what they really should be eating, and some of us believe that those 5% of the people haven’t quite taken that step yet, and quite frankly, aren’t even quite aware of it themselves. You know that they’re kind of slipping off the wagon. They may be people who are somewhat resistant to change too. That is always a possibility. But here is the interesting thing about these people and Dr. Klaper’s, and I really admire his work and attempt to try to find this out. We need to do more of that kind of work, and that is something. These kinds of questions are here for us to think about, the sort of challenging questions that we don’t know fully the answers to. You know, why a certain small fraction of vegans don’t get all the benefits that others do. I would argue that that is the kind of research that we need to do much more so than trying to find a new drug for a new disease.

S.J.: Based on this kind of extensive range of blood tests to get an overall snapshot.

T.C.C.: Which he’s doing.

S.J.: The laboratory analysis that he’s doing. Also in this study, he has found widespread deficiencies in vitamin B12.

T.C.C.: Yes.

S.J.: But aren’t many Americans whether consuming animal products or not deficient in B-12?

T.C.C.: Yes, that seems to be the case. B-12 seems to be somewhat low. But in a lot of those cases, too, we have to keep in mind deciding whether it’s too low is based in large measure or comparing against the reference standard. You know how much B-12 we think should be there, and based on other examples, sometimes we set these standards to reflect, in this case, a meat eating population, in which case the B-12 is somewhat higher. We set the standard up here, now you go to the vegans, they don’t have as much and you say oh they’re deficient. Well maybe they’re the ones who have the right amount, you see. That was certainly true in the story on cholesterol. It used to be, even in my lifetime in my younger years, 200-300 mg of cholesterol in the blood was considered normal and we in fact, even got to the point, where if people had levels as low as 150 to 160 they were abnormal and they were at risk. So, through the last 30-40 years that range of 200-300 has been changing, and the reason 200-300 was considered normal was only because that was the normal distribution for people eating the western diet.