Food Over Medicine: The Conversation That Could Save Your Life



GM: Pam, here’s my nearly all-inclusive list of the various causes of diseases: diet and lifestyle, the environment, genes, stress, psychological factors, and pathogens. Let’s review the many maladies plaguing our population and examine the cause for each. Let’s start with heart disease.

PP: Definitely diet and lifestyle.

GM: Does genetics play any role?

PP: With very few people. I can say the same with regard to any condition that we would label chronic and degenerative. You have genetic predisposition, but those genes are switched on by diet and lifestyle choices. You’re going to have, in any practice setting, 2 to 3 percent of the population whose cholesterol levels, no matter how much they clean up their diet and lifestyle, won’t get down to ideal levels. Or perhaps they’re salt-sensitive and an adjustment in salt intake is needed to get their blood pressure down, and sometimes even that doesn’t work. We see a very tiny percentage of people who honestly have been dealt a bad hand. But the good news is that you can say to the new person coming in that the chances are outrageously high that your body is going to respond positively to this diet and lifestyle that we’re going to show you and that it’s well worth doing.

GM: I’m someone with heart disease and hypercholesterolemia rampant in my family, and yet I lowered my cholesterol levels when I finally got the diet exactly right.

PP: Yeah, most people have had it drilled into them that it’s familial; I tell them that there’s no question that you have genetic predisposition. As I think I’ve mentioned to you, women in my family have rheumatoid arthritis and they’re fat. I’m positive that it would not take me, at my age, but a year or two to eat my way into rheumatoid arthritis and obesity, if I choose to do so. But I’m not going to switch on those bad genes with my diet.

GM: How about strokes?

PP: Definitely diet and lifestyle. There are times when there is a structural abnormality that will cause somebody to develop a blood clot. That’s fairly rare; again, it’s diet and lifestyle that’s going to cause your risk of stroke to go up. Stroke is an outcome of atherosclerosis, just like heart disease.

GM: High blood pressure?

PP: Diet and lifestyle most of the time. The causes are similar to heart disease and stroke.

GM: Cancer?

PP: Diet and lifestyle, above all. Two lifestyle factors are significant: obviously, cigarettes profoundly increase the risk of many cancers, not just lung cancer, and alcohol increases the risk of many cancers, not just liver cancer. There’s a role that stress plays, but it may not be what people think. I don’t think stress causes cancer, just as I don’t think it causes heart disease. I think that stress often causes people to become even less diligent about taking care of themselves; that’s its role in disease-promotion. As your stress levels increase, you may exercise less, eat more junk food, or turn to alcohol, and that’s how you end up with cancer.

GM: What about the environmental factor for cancer?

PP: The environment is often responsible for cancer initiation, but not usually promotion; it’s diet that promotes the cancer. There are some types of cancer, however, that are purely environmental. For example, I had a good friend die of lung cancer who never smoked. However, he owned a plastics factory. He used to spend a lot of time on the factory floor, of course, and this was at a time when environmental regulations were a lot more lax. That’s probably what caused his lung cancer. That would be a case of an environmental cause, but it’s an atypical case. And you also have to consider the degree of exposure. My friend’s exposure was massive and daily, as opposed to our exposure to chemical carcinogens and air pollution, which is not as massive as people might believe. I think that that’s a minor factor for most people.

There is an area where environment and diet overlap concerning carcinogens—pesticides and toxins in our food. The most important thing to know about toxins is that they are concentrated in the fatty tissues of animals and become more concentrated as you move up the food chain. Fish have levels of heavy metals, pesticides, and other toxins that are often off the charts. As a general rule, you’ll find far less pesticide exposure in plant foods and you can wash some of it off, or avoid it altogether if you eat plants grown organically. But even the Environmental Working Group, one of the most active in trying to change farming practices, states on its website that the benefits of eating fruits and vegetables far outweigh any exposure to pesticides in those foods.

GM: Type 1 and type 2 diabetes?

PP: Type 2 diabetes is definitely brought on by diet and lifestyle. For type 1 diabetes, there are a number of causes, but a major one is dairy products through the mechanism known as molecular mimicry.123 Some other causes can be viruses and infections, and genetics is definitely a factor as well. In other words, we know that not all children who consume cow’s milk develop juvenile diabetes, so there has to be some genetic predisposition that actually causes that to happen. Of course, we don’t know which kids are genetically susceptible, so when we feed almost every child in the country cow’s milk, some of them will get juvenile diabetes. The better option would be to never give cow’s milk to infants and toddlers.

GM: So I take it you’re an advocate for breast-feeding.

PP: I am. Dr. John McDougall says that if he were surgeon general, he would make formula available only by prescription. I’m not sure I’d go that far, but I do think we need to educate all moms-to-be that infants do best with breast milk, and there are many negative consequences of formula feeding, including compromised immunity and increased risk for many diseases, such as asthma4 and Crohn’s disease.5

GM: If somebody has the genetic predisposition to type 1 and he never consumes dairy, might the gene still express itself?

PP: It could, if exposed to the right virus or some types of infection.

GM: What do we know about the cause of Alzheimer’s?

PP: Alzheimer’s is a cardiovascular disease, very much related to diet and lifestyle.6

GM: Now that’s not generally accepted wisdom, is it?

PP: No, it’s not. I think the general wisdom about the etiology of most diseases comes down to genes, bad luck, and we don’t know.

GM: Most mainstream doctors would concede that diet and lifestyle play a major role in heart disease, but they wouldn’t say that about Alzheimer’s.

PP: True. But their own medical journals, if they would take the time to read them, have shown that taking statin drugs can improve symptoms in early-stage Alzheimer’s patients.7 That tells me that there’s a connection. The other thing is that the brain is the biggest user of glucose, oxygen, and water, so it only makes sense that if you narrow blood vessels to the brain, you’re going to impair its supply of those essential substances.

GM: What about the fact that with Alzheimer’s, there’s an amyloid plaque that forms that resembles the plaque found in people who have Creutzfeldt-Jakob disease (CJD), the human form of mad cow disease?

PP: Yes, and there’s a theory, which Howard Lyman has talked about, that some people being diagnosed with Alzheimer’s actually have CJD.8 Alzheimer’s is rarely present in plant-eating populations; it’s a disease of the Western diet. It’s a vascular disease that is most prevalent in the populations, like ours, that eat the most meat.9

GM: What’s the cause of osteoporosis?

PP: Well, first of all, osteoporosis is a mythical disease much of the time.

GM: It’s mythical?

PP: To the extent that it actually exists, it’s principally a diet and lifestyle disease, or it’s drug-induced. For example, taking steroids can cause osteoporosis. Another thing that happens is people with celiac disease and gastrointestinal disorders often have osteoporosis because they are not absorbing nutrients from foods, including calcium and other nutrients, needed to build bones. But the vast majority of the time, the diagnosis of osteoporosis is fictitious.

GM: Well, could you explain that? We have millions of Americans believing they have osteoporosis and taking drugs for it. Have they imagined it? What’s going on?

PP: No, they haven’t imagined it; their doctors have helped them arrive at this conclusion. Years and years ago, osteoporosis would be diagnosed if somebody would have a fracture or broken bone for no apparent reason; maybe they wouldn’t even know they had a fracture—they would just experience pain. Some type of X-ray or imaging would show that the cause of the pain was a fracture. Without the evidence of any impact or memory of falling down or anything else, they would consider a diagnosis of osteoporosis. They used to put you on this scanning device that was very expensive and very large. They would do a whole-body scan that would show porous bones in the skeleton and would give you a firm diagnosis. You actually saw bones that would be porous and poorly formed.

This changed after Merck developed a terrible drug called Fosamax to treat osteoporosis. It doesn’t really work and has been linked to all kinds of side effects, including fractures to the thighbone10—the very sort of thing you’d think it would help prevent—and osteonecrosis (bone death) of the jaw.11 But in the beginning, the problem was that there weren’t enough people being diagnosed with osteoporosis. So Merck hired a marketing expert to change that. A conference was convened in Rome in 1992, sponsored by drug companies, during which medical experts, if you want to call them that, got together and redefined the diagnostic criteria for osteoporosis. It would henceforth be the loss of bone mineral density that would be the diagnostic criteria.12

The problem with that is that all people lose bone mineral density as they age, particularly women. Women have very strong skeletons because they need strong bones for childbearing; when we’re past our childbearing years, we lose bone density. I’m not planning on carrying any more children, so my bones don’t have to be as strong as they were when I was twenty-eight. Merck succeeded in developing diagnostic criteria that would eventually include everybody. In a process called disease-mongering, the definition of a disease is expanded so that more and more people will qualify and get treatment. The other thing that happened at this meeting was that they picked an arbitrary amount of bone mineral density loss that was not based on any science. The question came up: What about people on the other side of the arbitrary line who aren’t yet qualified for osteoporosis but are getting close? So they made up the mythical disease called osteopenia. Merck, being the ever-accommodating company, actually developed a lower dose of Fosamax to treat those people who had the mythical condition that was considered a precursor to the even worse mythical condition.

GM: So osteopenia is simply less loss of bone mineral density than osteoporosis?

PP: Yes. Osteopenia is a stepping-stone. You’re told, once you’re diagnosed with this mythical disease, that if you don’t do something about it, you’re going to progress to the next level of mythical disease.

GM: So there are no symptoms? Osteopenia is merely a way station, like purgatory?

PP: Except that I think there’s probably more scientific proof of purgatory.

GM: But don’t we live in a nation of elderly people falling down and fracturing themselves? Is that just natural or is something wrong?

PP: Well, first of all, let me make what sounds like an obvious, asinine statement: the number-one cause of fractures is falling. But why do people fall? They fall because they’re frail, on drugs, or have poor balance and coordination. People who haven’t exercised become frail. My mother hasn’t exercised since 1956, so it’s not surprising that she’s terribly frail. Of course, we’re further frightened by the idea that once these falls happen and bones are broken, these people often become bedridden and then die; we’re told it’s the hip fracture that killed them. Well, it isn’t the fracture that killed them; it’s the poor health and the drugs they were taking that caused the fall in the first place. They’re fracturing bones because of the trajectory of the fall in many instances. I’m not saying that nobody has osteoporosis; we see people in here who have it, but I’m saying the vast majority of people who think they have it, don’t. These Dexa scans to determine bone density are very unreliable.13 Many, many health agencies in other countries have said that there’s no relationship between bone mineral density and fracture risk and that the Dexa scan tells us nothing.

GM: But you do acknowledge that some people have osteoporosis, meaning some people have very low bone density?

PP: Right.

GM: And is the cause related to diet, or is it just genetics?

PP: First, it’s lifestyle as it relates to exercise, or the lack thereof. It can also be diet related as it pertains to developing a GI disorder, like inflammatory bowel diseases, where you’re not absorbing nutrients. The other cause is a condition called metabolic acidosis, in which you eat animal foods, highly processed foods, or foods with a high sulfur content—animal protein is highly sulfuric—and these sulfur compounds increase the acid load in the body, necessitating the withdrawal of calcium from the bones in order for the body to maintain proper pH.

GM: And the calcium is eliminated through the process of urination?

PP: Yes, you literally pee out your calcium. People drink milk because it allegedly builds strong bones due to its calcium, but in fact the high sulfuric protein content of milk winds up costing the body calcium; that’s why the highest rates of osteoporosis are in countries with the highest dairy intake.14

GM: Have there been any studies that have proved this dynamic of metabolic acidosis?

PP: Yes, absolutely.15161718 A meta-analysis of eighteen separate studies published on bone health found that fourteen of them, or about 78 percent, supported the idea that low-acid eating improves bone health.19 So the preponderance of the evidence shows that eating animal foods causes the body to use calcium drawn from the bones to buffer the acid in order for the body to maintain blood pH within a very narrow range. We can measure how much calcium somebody takes in; it’s quantifiable. We can also measure how much you urinate; that’s also quantifiable. If you’re excreting more than you’re taking in, it’s coming from somewhere.

GM: What brings on acid reflux?

PP: Diet and lifestyle. It’s related to several things, but one is weight. Overweight people tend to have acid reflux because the sheer force of their weight sometimes weakens the esophageal sphincter, particularly when they are lying down. Overeating is another cause. Eating large meals that expand the stomach way beyond its capacity contributes to it. Constipation also contributes to it because all that straining pushes the diaphragm up and puts pressure on the esophageal sphincter. Certain foods, which would include alcohol, caffeine, and foods high in fat, tend to aggravate acid reflux. What’s amazing is that within a fairly short period of time, there’s generally relief from acid reflux as soon as people stop eating a terrible diet.

GM: Let’s move on to multiple sclerosis (MS). Genes or diet or something else?

PP: MS is definitely diet, particularly saturated fat and dairy intake. Lifestyle can also be a factor in terms of stress, which can exacerbate MS, but diet is the primary culprit.

GM: MS can actually be caused by diet?

PP: Yes, absolutely.

GM: Where is the evidence for that?

PP: Even as far back as the 1940s, there was evidence that diet played a role. For example, in areas of the world where fat consumption was higher (more than one hundred grams per day), the incidence of multiple sclerosis was higher, too. In areas where fat consumption was less than fifty grams per day, the incidence of multiple sclerosis was lower.20 Studies in Norway confirmed this: in areas of the country where fat consumption was higher, the incidence of MS was higher, and saturated fat was the most harmful.21 But I think the most compelling evidence we have comes from Dr. Roy Swank, who developed a theory sixty years ago stating that there were certain causes of multiple sclerosis, one of which was poor diet that eventually compromised the blood/brain barrier and the intestinal barrier. It would take a long time to explain the mechanism of action, but the bottom line for him was to test his theory by placing thirty-four patients on a low-fat diet, very low saturated fat. The results were astounding.22

Some of Dr. Swank’s patients were compliant and others were not. He categorized his patients based on their fat consumption—“good dieters” consumed less than twenty grams per day of saturated fat; “bad dieters” consumed more than twenty grams per day. Patients in the group consuming less than twenty grams of saturated fat per day fared significantly better than the group eating more saturated fat. For those who ate a low-saturated fat diet, “about 95% […] remained only mildly disabled for approximately 30 years.” Eighty percent of the patients who consumed more saturated fat died of MS.23 Dr. Swank published several articles in medical journals documenting his results.24,2526 He duplicated those results on thousands of additional patients and showed that patients on a low-fat diet with a minimal amount of animal foods basically remained asymptomatic. The exacerbation rate—exacerbations are what they call these flare-ups that MS patients experience—went down by 95 percent and stayed that way in compliant patients.

GM: Dr. McDougall is doing a similar study now.

PP: He is. His diet—and I learned about diet and MS from Dr. McDougall—is a little bit different from Dr. Swank’s: no animal foods, no low-fat dairy, no oils. According to Dr. McDougall, Dr. Swank acknowledged before he died that the inclusion of oils had no therapeutic value. He thought it might make people more compliant on the diet, but he didn’t attribute his success to the inclusion of oil. So Dr. McDougall’s diet is lower in fat. And the results are even better. It’s amazing, and we see that here, too. It’s complete regression of the disease, so much so that I would call it a reversal of the disease, especially in patients who adopt the diet in the early stages of the disease. People say, “How can you make that claim?” Well, there are two things that are common to MS patients: an intolerance of heat and a lack of stamina or endurance. We have Wellness Forum members with MS who are doing bike rides for three hundred miles, taking hot yoga classes in a 105 degree room. They don’t take any drugs and have absolutely no symptoms. At this point in time we would pronounce them former MS patients.

GM: So they have no symptoms?

PP: None.

GM: Is there any marker for the disease other than its symptoms?

PP: In the early stages, no. That’s what makes diagnosis really difficult. Most patients start with what we call “relapsing-remitting MS,” which means that they get symptoms and then they go away. Then a few weeks later they get symptoms and then they go away and the symptoms change. The doctors will say, “I can’t find anything wrong with you,” and sometimes send them to a psychiatrist. They’ll even take spinal taps; nothing shows anything so “maybe you’ve got a mental problem,” they are told. Doctors send them to a psychiatrist instead of telling them to improve their diet. They can go for a really long time without a firm diagnosis. Eventually you can see, through proper imaging, what looks like plaques or lesions in different areas of the central nervous system. There are some tests, a flicker fusion vision test, and some various tests you can do to test reflexes that sometimes give you a pretty definitive diagnosis, but in the early stages, there is no definitive diagnosis.

GM: What about influenza? Does it have any cause other than contagion?

PP: Well, it is contagious, but whether or not you get it, and how severe it is, depends upon your health status. About five years ago, one of the most virulent strains of flu ran through Columbus, Ohio, that I can remember in my entire life. It was heinous. I belong to a lot of groups, and people were missing work for three weeks at a time; we were having meetings with half of the people there. One school closed for a couple days because there were so many kids sick. It was bad. And at first, none of us got sick here at The Wellness Forum, even though we’re exposed to sick people every day in this office. Then one day I woke up around four in the morning (I’m an early riser), and I was as sick as a dog. I was sick for maybe four or five hours, and then it went away. I was just tired, so I took a nice nap and came into the office around one or two and made it a short day. By the next day, I was back to normal.

Well, sure enough, the next day Gary, our general manager, woke up with the flu. He had it for about four or five hours, came in later in the afternoon, and was fine afterward. One by one, it cycled through the office. We all actually got it, but nobody missed more than a half a day of work because of it. I think many times I don’t get what’s going around because I’m a very uninviting host for disease. And if I do get it, or somebody around here gets something, it’s usually a nonevent. Nobody here misses work much for anything, and we’re exposed to more sickness than most people.

GM: My old man died of Parkinson’s. Is it genetic?

PP: Even if there are some genetic predispositions to it, and there may well be, I think that definitely diet and lifestyle play a significant role. Chemical exposure may be involved as well; we just don’t know. The sad part is that by the time somebody has full-blown Parkinson’s, we don’t usually see diet and lifestyle reversing it. What we do see is that it’ll stop or slow its progression, which can be a blessing for the person who has Parkinson’s and anybody caring for that person, but we don’t normally see the regression that you see in MS and some of these other conditions.

GM: Have you been able to slow or stop its progression?

PP: Both, depending on how bad our clients are when they become members and start eating a plant-based diet. Sometimes we get people in such late stages that all we can do is slow it. Again, it’s not the way I wish it were, but it’s better than nothing. As these people degenerate, they lose their ability to communicate, or to do anything for themselves; they become tremendous burdens on their families, so even a minor reduction in the rate of its progression can make a big difference.

GM: Rheumatoid arthritis?

PP: It’s almost always diet and lifestyle related, and is particularly related to the consumption of animal foods.

GM: And that’s not commonly accepted wisdom, either?

PP: Oh, no. The conventional wisdom is wrong, but as I said, it’s not easy to change the conventional wisdom of people in this country, including health professionals.

GM: Does genetics play a role in rheumatoid arthritis?

PP: Yes. Genetics can make you predisposed. I am positive I am predisposed. I am positive I could make myself have it in a very short time, particularly at my current age. But I don’t eat like my mother, my grandmother, or the other members of my family who have this dreadful disease.

GM: What are the causes of asthma?

PP: Well, there are a lot of things that can cause asthma. There are environmental triggers and dietary triggers for sure, dairy being one of the most common.2728 Dehydration is a factor;29 a lot of kids are not very good water drinkers, so that has an impact. Poor GI health contributes; people who have screwed-up GI tracts often have respiratory disorders, including allergies and asthma. We see a lot of asthma in children, which is related to many factors, including poor gut ecology due to constipation; treatment with antibiotics; and, in some situations, even vaccinations. Their guts are not very healthy and their immune systems are overstimulated. The overuse of antibiotics due to chronic infection compromises the health of their GI tracts and contributes to it as well. Respiratory toxins aggravate the situation.

Asthma tends to get better in kids if you take the dairy out of the diet, get the kid drinking enough water, put him or her on a program of dietary excellence (a whole foods, plant-based diet), and add some probiotic supplements. Generally speaking, it improves to the point where they often don’t even have to use an inhaler for exercise. In older people who’ve had it for a long time, it takes longer to get better, but they follow the same protocol with the addition of supplements like quercetin. I recommend sea salt as a natural antihistamine. I don’t recommend against salt consumption for most people, as you know, so we recommend sea salt as an antihistamine, more so in adults than kids.

GM: So how does the salt work—how much do people have to consume?

PP: We use it therapeutically; how it is used and the dose depend on the age of the individual.

Even in those cases where asthma or environmental allergies don’t entirely go away, with a change in diet, people can become a lot more comfortable and reduce their dependence on antihistamines and medications.

GM: It isn’t very intuitive that the GI tract would have something to do with a respiratory disease.

PP: There are a number of connections between asthma and GI function, including reflux and beneficial bacteria in the GI tract. Reflux contributes to asthma, because the acid is inhaled through the back of the throat, burns the bronchial tubes, and causes symptoms of asthma.3031

Beneficial bacteria in the GI tract are very important in regulating immune function. It is compromised by taking antibiotics, steroids, and other drugs, as well as by constipation and inflammatory bowel diseases. When enough beneficial bacteria are destroyed, leaky gut can result, allowing whole-food particles to enter the bloodstream, leading to compromised or overactive immunity, allergic responses to foods, and systemic inflammation. An overactive immune system and systemic inflammation can contribute to the development of asthma.

GM: What causes gallstones?

PP: It’s definitely diet related. Gallstones are made of cholesterol in nearly all cases. People end up with gallstones from eating a high-fat, animal-protein diet. Unfortunately, one problem we have in medicine today is the overriding view by a lot of doctors that body parts are disposable. “Oh, if it’s bothering you, we’ll just take it out.”

GM: So the gallbladder goes.

PP: The gallbladder goes, or maybe the spleen or the appendix go. I happen to think we have these body parts for a reason and we should work hard to preserve them. Unless the disease has progressed to the place where it’s horrific, most people who change to the diet we’re promoting would experience relief from the pain associated with gallstones and gallbladder disease. As long as they’re compliant, they’re fine. I’ve had members who say, “I eat one high-fat meal and I’m miserable,” and I tell them, “Good, that’s a good way to keep you on the straight and narrow. We don’t have to worry so much about you because you have an instant adverse effect from straying.”

It’s not unusual, of course, for people to have their gallbladder removed. Then they continue their dietary habits and find out they’re still just as uncomfortable because all of the fat and animal protein that they’re eating is so detrimental to their health. They’re usually fairly distressed to find out that some of their discomfort is coming from bile acids dripping right into the colon, which is why they still feel nauseous and sick. And the presence of bile acids in the colon increases their risk of colon cancer substantially. They were promised instantaneous relief from their discomfort; however, they end up with long-term increased risk of colon cancer and no relief from their symptoms.32 I would say that that probably happens 35 or 40 percent of the time following gallbladder removal.

GM: So having your gallbladder removed increases your risk of colon cancer?

PP: Yes. And we all acknowledge that there are situations where the gallbladder is just so diseased that you have to take it out, but doctors tend to be really cavalier about removing body parts. I think it’s always worthwhile to see if a change in diet, if somebody’s willing to do it, affects the situation. Sometimes it happens so quickly—I’m talking about a matter of days—that someone calls his doctor and says, “That surgery I had scheduled for next Friday? I don’t need to do it now because I’m feeling much better.”

GM: Have you had Wellness Forum members who did that?

PP: Yes. I’ve also had members who have had their gallbladder taken out. The unfortunate reality is that what we want as human beings, from both the doctor’s perspective and the patient’s perspective, is resolution. The doctor and the patient want it resolved, and there’s something satisfying about just taking it out. The disease is gone. It’s over with, and we can just put it behind us. That’s not really the case, but that’s the perception a lot of people have that lead them to engage in, or consent to, risky medical practices.

GM: So if somebody has a diseased gallbladder, riddled with gallstones, and then he adopts the correct diet, will those gallstones just dissolve?

PP: Sometimes they will, but usually they just stop causing problems. If the gallstones get caught in the duct, that’s when you may have to do something surgically, but not always.

GM: And what about kidney stones?

PP: Well, that’s the result of several factors. The first is increased calcium concentration, which comes about from the high calcium intake that people in this country have been convinced is necessary. We have a lot of people taking calcium supplements and, of course, consuming cow’s milk. The other cause of high calcium levels is the release of calcium from the bones to buffer acidity, the metabolic acidosis that results from consuming a lot of protein, fat, refined foods, caffeine, alcohol, etc. Combine the high calcium levels with dehydration, and our poor little kidneys are forced to concentrate more and more waste with less and less fluid. You can end up with some kidney stones. They can become a thing of the past, even for people who have a lot of them, if they just start drinking enough filtered water every day and eating a healthy, whole foods, plant-based diet.

GM: How many glasses of filtered water?

PP: I like for people to drink sixty-four ounces of water a day as a base. That’s for adults. Children should drink half their weight in ounces. And then you have to compensate for activities. Yesterday I ran, went to the gym, taught a hot yoga class, and then took a hot sweatbox class, so I probably had three gallons of water to compensate.

I’ve heard people insist that if you eat the right diet, you don’t need to drink water. I disagree. We need to remember that thirst is not an adequate or reliable indicator of the need for water. There are a couple of reasons for that. One is that we salivate when we eat, which disguises the thirst response. The second is that our bodies adapt to dehydration. Eventually, just as if you don’t eat long enough, you don’t feel hungry anymore, if you don’t drink water for a long enough time, you learn to live with dehydration and not necessarily feel thirsty. As evidence, consider the number of people who end up hospitalized for dehydration every year, in perfectly ordinary circumstances, when they could easily have reached for a drink of water.

One of the smartest people I know runs a multimillion-dollar company here in Columbus. A couple of years ago, at a meeting in New York, he passed out on the floor. They took him to the hospital; he was just dehydrated. Now, I’m sure that if this very smart, educated, wealthy guy thought that he was thirsty, he would have reached for something to drink. To insist that all of this would just be remedied if we would drink just when we’re thirsty and not worry about it the rest of the time is to miss the lesson in incidences like this, which are not uncommon.

GM: Food poisoning is obviously a dietary issue, but is there one type of diet that makes you less likely to get food poisoning than another?

PP: One way you can avoid food poisoning is to avoid chicken, fish, pork, beef, and the other foods that are more likely to give you food poisoning. The second thing is that healthy people, even exposed to a pathogen, often don’t have any response to it. So if you’ve got really well-established colonies of beneficial bacteria in your system, even exposure to a pathogen may not make any difference. Generally, food poisoning results from consuming animal foods, with some rare exceptions like the one that happened a few years ago when spinach was contaminated by animals near the farm. The spinach was not the cause of the food poisoning; it was the nearby environmental abusers, like cattle ranches, causing the food poisoning.

GM: Yeah, it always bugs me when the news media reports some scare, like E. coli in lettuce, without noting animal agriculture as a likely cause. They make it sound like it’s normal, like some lettuce from a bad seed just grows into pathological lettuce.

PP: I have no idea what they’re thinking, but our best defense in any case remains maintaining colonies of beneficial bacteria, while limiting or eliminating the animal foods that generally expose us to the harmful bacteria.

GM: Does eating soy yogurt help a person get those healthy bacteria? How do you get the healthy bacteria?

PP: Well, first of all, you’re born with it. You acquire it during vaginal delivery.33 One problem we have is the overuse of Caesarean deliveries, most of them unnecessary. The baby’s normal way of acquiring beneficial bacteria, which is moving through the birth canal, isn’t happening as frequently, so the baby is acquiring bacteria from the hospital environment, which impairs the child.

Another way that the baby develops beneficial bacteria is through breast-feeding.34 So a Caesarean-born, bottle-fed baby has an automatic disadvantage. That child is at a disadvantage for the rest of her life. That doesn’t mean bad things are going to happen; it means they are more likely to happen. But let’s just say that a baby is vaginally born, is breast-fed, and has healthy bacteria. That child will be fine unless she does something to destroy it, like take antibiotics or birth control pills, develop constipation, irritable bowel or inflammatory bowel conditions, or celiac disease. Those kinds of conditions impact the beneficial bacteria in the GI tract. If you’ve had any of those things happen, you need to take strong, pharmaceutical-grade probiotics in order to fix it.

GM: Well, most Americans have taken an antibiotic now and then.

PP: Right, and this is something I get angry about. One hundred percent of all doctors surveyed will tell you that taking an antibiotic destroys beneficial bacteria. Yet in any metropolitan area, you can count on one hand the number of doctors who put their patients on probiotics to compensate for the destruction of the antibiotic regimen. We have a lot of folks out there who have taken not just one antibiotic regimen but twenty-five or thirty of them in their lifetime and never fixed the damage. They need good pharmaceutical-grade probiotics. You’re not going to replenish a destroyed colony by eating yogurt of any type. There aren’t enough of the critters in the yogurt to establish the colonies. Eating soy yogurt may help a little; people claim benefits from consuming probiotic-laced products, but they don’t really grow colonies. You get some temporary relief from the symptoms, but you don’t resolve the underlying issue.

Having a healthy colony of beneficial bacteria is crucial for your immune function, your ability to absorb nutrients from food, and your ability to keep the intestinal barrier healthy so that partially digested food and other pathogens and bacteria don’t get into the bloodstream.

GM: And these pharmaceutical-grade probiotics, can you get them in health food stores?

PP: You can get better ones from a doctor or another knowledgeable practitioner. A lot of the best companies don’t sell their products in health food stores for a couple of reasons. First of all, some people can hurt themselves with these products. For example, if a person with active Crohn’s disease walked into a store, bought a really strong product, and took it home, he might end up in the hospital as a result of taking it. It could increase their diarrhea considerably, and a Crohn’s patient definitely doesn’t need more diarrhea. I found that the best probiotics manufacturers sell their products through practitioners rather than through health food stores.

GM: Let’s discuss the causes of irritable bowel syndrome, ulcerative colitis, and Crohn’s disease.

PP: Absolutely diet and lifestyle. For some people, there’s also a psychological component in the case of irritable bowel; while the syndrome is biological in nature, there is some evidence that it can be brought about by psychological factors.35

There are two ways in which our thoughts and emotions can impact GI health. The first is that we actually have a nervous system in our GI tract called the enteric nervous system that operates independent of our autonomic and central nervous systems. This is what causes you to have a “gut feeling” about something. This is what causes you to have diarrhea or a stomach ache in response to stress or something of that nature. Butterflies in your stomach are your enteric nervous system acting up a bit. Also, there are certain psychological profiles of people who are more inclined to develop and maintain irritable bowel, even when you do all the right things to fix it. They continue to have it, sometimes because they get secondary gain from hanging on to the disease. Some of these people had trauma or were rewarded for sickness as children. They got excused from going to school if they had a tummy ache. Or they got excused from dinner and were given ice cream instead. So some people learn secondary gain from using gastrointestinal disorders of an undefined nature and those people grow up sometimes to have irritable bowel syndrome. There’s a little bit more of a complex causation with irritable bowel than with other ailments. On the other hand, I can say with a great deal of confidence that inflammatory bowel diseases are at base the result of diet and lifestyle choices.

GM: Is dairy one of the main culprits?

PP: Dairy is a big culprit. Animal foods are also a culprit, as are high-gluten foods: barley, rye, oats, and wheat.

GM: Now you’re talking about good, healthy, vegan foods that could cause trouble.

PP: Nuts are good foods, too, but if you go into anaphylactic shock when you eat them, you wouldn’t say they’re particularly good for you. High-gluten foods are really deadly for these people. They have to maintain complete abstinence from barley, rye, oats, and wheat in order to maintain the complete remission from their disease. The good news is that people with inflammatory bowel diseases who follow the dietary recommendations we give them—a low-fat, plant-based diet, which is phased in over time—achieve excellent results.36

GM: And that’s the next malady I was going to ask you about: celiac disease.

PP: Celiac disease has a genetic predisposition. I don’t think somebody eats her way into celiac disease. There is some evidence that a virus or precipitating events can contribute to it. You have to do a couple of things to recover from celiac disease. One is to stop consuming any gluten; you eliminate any exposure to gluten at all, including tiny amounts of gluten as an ingredient in soy sauce and things of that nature. You have to be very diligent about it. You also take probiotics to restore the beneficial bacteria that’s been destroyed. Many people have been undiagnosed for years, so they present with considerable destruction to the GI tract. If they spend a long time taking a high-grade probiotic product, they can restore their health if they eat the right diet and abstain from all gluten products.

GM: Do you advocate blood tests to determine if someone has celiac disease?

PP: The blood test is not always definitive. The most definitive test is to take a biopsy and look at the tissue; if all the little villi are destroyed, then the person is a celiac patient. But I don’t think we have to go that far. If someone has a family history of celiac disease and has gotten better since giving up gluten, that’s enough evidence in many cases. Somebody asked me during a class why doctors subject these patients to a lot of these tests. I said, “Well, some people show up with a very big disadvantage when they arrive in a doctor’s office or a hospital; it’s called “good insurance.” One of the worst things you can have if you’re at a facility where they like to do testing is good insurance. If they know it’s going to be paid for, they’ll subject you to as much of it as can possibly be arranged.

GM: We haven’t talked about one of the leading causes of death in America, which is iatrogenic death, or death caused by medical treatment.

PP: The numbers are astounding.

GM: And when I research it, I see wildly varying estimates. Wikipedia comes up with a figure of 225,000 deaths per year; critics of the American medical system will estimate more like 800,000 or 900,000 deaths per year.

PP: Dr. T. Colin Campbell and Dr. McDougall are among those critics.

GM: It’s obviously hard to know exactly what the correct figure is because so many people, especially older people, whose death may be brought on by a medication, never have that fact determined in court, and their death certificates don’t reflect that cause.

PP: Well, I think the problem’s getting worse. I can just tell you from my own experience, people who join The Wellness Forum are often as sick from medical care as they are from whatever was ailing them when they first started receiving medical care. Or they were perfectly healthy people who were treated for mythical diseases like osteoporosis or carcinoma in situ and become sick patients as the result of being treated for diseases they never had. In terms of what the actual numbers are, the most reliable numbers I’ve seen come from sources like Shannon Brownlee’s book, Overtreated,37 a well-referenced book on the topic. Even the Journal of the American Medical Association has published articles showing that between 230,000 and 284,000 deaths per year result from medical treatment. This does not include adverse effects from medication that result in sickness or disability, which are estimated to result in 116 million extra physician visits, 77 million extra prescriptions, 17 million emergency department visits, 8 million hospitalizations, 3 million long-term admissions, 199,000 additional deaths, and $77 billion in extra costs (equivalent to the total cost of taking care of patients with diabetes).38 It’s generally accepted that dying from medical treatment is the third- or fourth-leading cause of death in this country; at least a few hundred thousand or potentially more people die every year directly as a result of the treatment that they receive.

Now, I’ll mitigate that frightening statistic somewhat. Some of the people who die from medical treatment were really sick and decrepit when they entered the hospital; while they received treatment that may have been useless and may have sped up their death, they were going to die anyway. That said, there’s still an atrocious amount of death from medical treatment arising from the treatment of conditions that patients don’t really have. From overmedication or unnecessary surgery. From suicides brought on by useless antidepressant and antianxiety drugs. Overall, it’s certainly one of the leading causes of death in the country. That’s why Dr. McDougall says, “Stay away from doctors; they’ll kill you.”

GM: Pam, having reviewed now a significant list of diseases and ailments, what’s revealed to me is the sweeping and I’d say revolutionary nature of your work. Under standard medical care, a very sick patient presenting with heart disease, diabetes, high blood pressure, acid reflux, and irritable bowel syndrome would spend his days shuttling between his cardiologist, gastroenterologist, and otolaryngologist, getting different medications or interventions for each condition. Then he’d have to hope that his medications don’t interact in a dangerous way. He’d find himself on a slippery slope to doom. And there are millions of Americans who live that way, if you could call it living. Now, you would argue that all these conditions are essentially expressions of the same disease that is the Western diet, and that the remedy for all the conditions is essentially the same: a low-fat, plant-based diet. With this diet, it’s quite possible no medications would be needed at all, for almost any condition.

PP: That’s exactly right.

GM: Unfortunately, there are only a few places in America that take this very simple and comprehensive approach to disease, most notably Dr. McDougall’s practice in Santa Rosa, California, and your own Wellness Forum based in Columbus, Ohio.

PP: That’s why we need to get the word out.

GM: Since food is actually the leading cause of disease, let’s get very specific now about different types of food. What’s wrong, for example, with fish?

PP: There’s a misperception that fish is a healthier form of animal food when, in fact, it’s actually higher in fat than many animal foods. The misperception causes people to replace red meat with fish and feel that they have improved their health when they really haven’t. If they eat too much fish, they may have actually made things worse because of the high fat content.

GM: But we’ve heard so often that it’s healthy fat; it’s full of omega fatty acids.

PP: I think that there isn’t any such thing as healthy fat beyond a certain percentage in the diet. The idea is to eat a very low-fat diet: 15 percent at the upper end and 9 to 11 percent at the lower end for people who have coronary artery disease, obesity, and certain other conditions. So when more than 50 percent of the calories in salmon are from fat, you can’t eat a whole lot of that and keep yourself within that range.

GM: Is the fat from fish better than the fat from beef?

PP: If you’re crossing that 15 percent line, I don’t think it makes any difference at all. And while many claim that fish is somehow protective, there have been some interesting studies on Japanese men that show that the more fish they eat, the higher the incidence of prostate cancer.39 At a certain point, you cross that threshold in terms of the allowable amounts of animal protein and fat; fish becomes just another flesh food, and bad things start to happen. There are also the dangers presented by mercury and other toxins in fish. At the end of the day, the source of that animal fat and protein doesn’t make much difference; it doesn’t matter if you’re getting it from eggs, fish, chicken, turkey, pork—it’s really all the same thing.

GM: We’ve all heard studies reported in the news that fish allegedly protects the heart. My theory is that when they do these studies and they compare fish eaters to beef eaters, it’s possible that salmon is marginally less bad for the heart than beef. People have better outcomes in terms of sudden cardiac death with fish than beef, but they’ve never done a study comparing fish eaters to vegans.

PP: Right. But there’s another complication, too. There are some studies that show that eating fish and or taking fish oil capsules will raise HDL, or “good cholesterol,” levels, which is one reason it’s touted as being protective. But that doesn’t make any difference. In other words, we don’t really have any evidence showing that higher HDL levels are the key to better cardiovascular health. And, in fact, two drugs never made it to market, very promising drugs, not by my definition, but by the definition of drug companies and the traditional cardiology profession. These two drugs, dalcetrapib, which was developed by Roche, and torcetrapib, which was developed by Pfizer, were designed to elevate HDL cholesterol; both did that quite well. The one little problem was that the people with the higher HDL levels were dying off faster than the people with lower HDL levels, so those drugs never came to market. The concern with the ratio of HDL to LDL is completely misplaced.40

GM: So have doctors across America misunderstood this, or have they all been misled? How did this happen?

PP: It’s a fundamental misunderstanding about the role of HDL, which is to help to clear the bad cholesterol from the bloodstream. As your LDL levels ratchet down, which they do on a low-fat, plant-based diet, the need for HDL will also ratchet down. If you look at populations like the Tarahumara of northwestern Mexico, who typically have very, very low cholesterol levels, they also have low HDL levels. I love Dr. Caldwell Esselstyn’s line; he says “the HDL levels of the Tarahumara Indians would make the average cardiologist in the United States apoplectic.” Why? Because they would be certain that it would be deadly. We’re talking about HDL levels in the range of fourteen to twenty-four milligrams per deciliters, which is very, very low.41 The Tarahumara eat a plant-based diet centered around corn and have a low incidence of heart disease.

GM: We’ve talked about fish. What do you think about chicken?

PP: I sometimes refer to the strategy of replacing one bad food with another as rearranging the deck chairs on the Titanic. Chicken is just another animal food, and a particularly filthy one at that. It’s another food that has a face and a mother, which is how we define animal food around here. The same detrimental effect that we would expect to experience by consuming too much beef in our diets, we’ll see with too much chicken in the diet. We’ve got to stop imagining that there’s some animal out there that’s really healthy to consume. We’ve got to understand that if animal foods are consumed more than two to three times per week, and even that may be too much for some people, we’re going to have problems; it really doesn’t much matter what animal we pick. Chicken, even white meat chicken, is high in fat. Again, it’s extraordinarily difficult if this is going to be part of the daily fare to keep fat consumption in line.

And it’s not just the excessive fat that’s a problem. There’s no fiber. There are no phytochemicals and antioxidants. When people develop cancer, what really is going on, on a certain level, is that cancer promoters have outnumbered the anticancer agents in the diet. We have to consider the anticancer properties of food, the phytochemicals like indole-3-carbinol that we see in, for example, cruciferous vegetables. Well, chicken doesn’t contain those, or any other antioxidants. It offers absolutely no protection, and that’s why I say if it rises above the level of condiment in the diet, it’s deadly. There are no “better” animal foods. When we start talking about grass-fed beef and organic beef and organic chicken and those sorts of things, we’re still talking about a product that has no fiber, no phytochemicals, no antioxidants, and is high in fat. Yes, we avoid some of the hormones, steroids, and antibiotics that are given to conventionally raised animals, but the amino acid chains that make up those animal foods are exactly the same, and they’re just as cancer promoting at a certain concentration in the diet. All the evidence points in the same direction: you should not consume much of this stuff, or any of it at all. My preference is none at all.

GM: I like to look at it this way: carbohydrate is the most efficient fuel for the human body.

PP: Right. And when the body is forced to use fat or protein for fuel, it’ll do it, but it’s a very cumbersome process; it’s very stressful and quite toxic to the body to do that.

GM: So we know that carbohydrate is the natural fuel for the human body and we know that fiber is necessary and health promoting to the human body. Yet we look at these flesh foods and they have no fiber and no carbohydrates. It strikes me as a clue that they’re not human foods.

PP: Right. These are not the foods we were designed to live on. Our intestinal tracts are long. We need a lot of fiber to push food through the system, and the primary enzyme that’s secreted in your saliva is amylase, which is an enzyme that breaks down starch. We could anatomically take a little tour through the digestive system, starting with what happens when food enters the mouth, and make a strong case for our design being geared toward consuming plant food.

GM: Which brings us to another high-fat, high-protein, zero-fiber, low-carbohydrate animal food: dairy.

PP: I think that’s the most toxic of all. When I give lectures, I get asked, “If I were going to do one thing and one thing only, what would you suggest I do?” Well, one change alone won’t do the trick if you’re eating the standard American diet. But if you’re going to make an important first step that would improve your health, get the dairy out of the diet. Dairy products have no upside. On the downside, dairy proteins have been linked to asthma, allergies, chronic constipation, chronic ear infections in children,4243 multiple sclerosis,44 autoimmune diseases, breast cancer, prostate cancer,45 and osteoporosis.46 The likelihood that a genetically susceptible child consuming dairy products will develop juvenile diabetes is actually greater than the likelihood of a smoker developing lung cancer.47,48,49 That’s kind of hard to wrap your arms around when you think about it, particularly since our government actually promotes the consumption of dairy products by children.

GM: People who follow the federal dietary guidelines, the ever-changing pyramids and plates that the United States Department of Agriculture (USDA) spends untold millions revising, believe they’re eating a balanced diet. Are they so wrong in believing that their diet of fruit and vegetables and grains on the one hand, and dairy and eggs and meat on the other hand, is at least balanced?

PP: Only in the sense that it can lead to a balanced need for various types of medical interventions. Here’s something I’ve observed: a family of four people sits down to eat dinner in a restaurant and there’s absolutely nothing on the table they’re eating that I would put in my mouth. You have one person eating a cheeseburger and fries. The next is eating chicken and cheese quesadillas. And the next one is having a spinach quiche. The last one is having a turkey sandwich. They’re all drinking sodas and lemonade. This is the whole family’s dinner. It would probably be heartily endorsed by the USDA and there’s not a single worthwhile, nutritious thing on the table. They just have no idea that the meal they just spent fifty or sixty bucks on is worth nothing nutritionally. “Oh, cheese is good for your bones, the chicken is lower in fat than the beef, and the fries must be better because they’re housemade. Oh, and it’s Diet Coke.” They use all this ridiculous criteria to justify the choice of these foods and believe that they’re doing reasonably well, but it’s all just horrible.

GM: Beyond animal foods, there are other sins in the standard American diet.

PP: There’s the fat content in general, but what makes it really horrendous are the oils; people cook with oils, packaged foods and baked goods contain oil, salad dressings are full of oil, and restaurants overuse it. So people consume enormous amounts of oil and fat in the diet. And enormous amounts of plain junk foods.

GM: What about sugar and sweets?

PP: Well, I always tell people that we can’t vilify individual constituents because it’s the pattern that makes the difference, but sugar is just empty calories and is also addictive. I don’t know very many people—I can think of a handful—who can be around sweets without eating them. I personally don’t like those people. I’m very envious of them because if it’s in front of me, I want to eat it. Dr. Neal Barnard, in his book Breaking the Food Seduction, writes that there are studies that have shown that the effect of sugar on the dopamine receptors of the brain is very similar to the effect of drugs like heroin and cocaine on those dopamine receptors. Most people don’t understand when they buy this stuff at the store that it has a highly addictive quality and that they’re going to want more and more of it.

Not only do sweets not provide any nutritive value, and one could argue that they’re destructive to health in terms of elevating blood sugar levels and suppressing immune function, but they displace healthy foods in the diet. If someone eats eight hundred calories’ worth of cookies and brownies in a day, that’s eight hundred calories that aren’t going into sweet potatoes and vegetables and rice and other foods that would actually have some protective value.

The other thing to remember is that these refined sugary foods elevate triglycerides. And triglycerides are blood fats waiting to cause mischief. Triglycerides and cholesterol will go down when you get rid of all that refined and processed sugar-filled stuff.

GM: Now, is there anything wrong with buying a box of crackers, whether it’s something like Ritz crackers, or even crackers you might see in a health food store made with whole wheat flour and organic sesame seeds and so forth?

PP: There’s definitely something wrong with the Ritz crackers. The top ingredients for your regular, store-bought cracker brands, the ones that most people would know about, are sugar, white flour, and some type of fat. This is just absolutely junk food. There’s no nutritive value to it; you don’t want to buy it. When it comes to crackers in a health food store, you can find a few that don’t contain oil. However, any type of processed food like that is going to be calorie-dense. You really don’t want to be filling your diet with calorie-dense food.

I don’t completely abstain from eating crackers, but they’re not a staple of my diet. I like fat-free hummus; I use it for vegetable wraps, but I also like to eat it as a dip. Now most people would dip crackers in it; I dip mushroom slices, sliced cucumbers, carrots, and things like that in the hummus. They’re much better for you than crackers. If I were having a party this weekend, I might have some crackers, but I’m working alone this weekend, so I’ll be dipping my mushroom slices in the hummus.

GM: Okay, let’s talk about fatty plant foods. Let’s assume you’re eating these foods in their whole state. Avocado—anything wrong with that?

PP: Well, there’s nothing wrong with any of these foods for a relatively healthy person. Avocados, nuts, seeds, olives—I love them. What I tell people is that they don’t want to be going out of their way to consume them, though, because they can end up eating a diet that’s quite high in fat with those foods. Our Chef Del is a good example. On a totally vegan diet, he ate himself to 475 pounds.

GM: What the heck was he eating?

PP: High-fat plant foods, fried food, baked goods … Del used to eat lots of avocados and almonds by the handful. Now he’s lost half of himself. I want to make that clear; he’s done a great job since he’s been here. So my rule is that I eat these fatty plant foods when they occur in a dish, but I don’t go out of my way to eat them. A restaurant near my house makes black bean wraps and the chef puts slices of avocado in them; I eat that. We have a dish here called vegetable byriani that has almonds in it; I eat that. But I don’t buy avocados at the store and put them on all of my salads. Nor do I have a bag of almonds at my house to nosh on because these are densely caloric, high-protein, high-fat foods. I tell everybody I could easily be a three-hundred-pound vegan. I’m at a healthy weight because I minimize this kind of stuff in the diet.

GM: What about coconut? I’ll go into a health food store and there will be all these raw desserts, these supposedly healthy alternative desserts. However, they have so much coconut in them that they’ll have eighteen grams of saturated fat. Is coconut as unhealthy as it appears to be?

PP: Absolutely. It’s full of saturated fat. Now, having said that, I love it. If you told me I could never have coconut again, I might have to end my life. So I don’t want to give it up, but I’m very clear that it’s a treat. Raw food desserts and raw food dishes in general are very high in fat. They often accomplish the textures they desire by using really high-fat foods.

This issue of food-versus-treat is something we just have to drive home. On the one hand, we certainly don’t want people to think they’re making a sixty-year commitment to never having dessert, birthday cake, or wedding cake, etc.; that’s not going to fly. Nor do we want people stressing out thinking they blew the diet. That’s a bad idea. On the other hand, this stuff can’t be part of the daily fare. We need to make the whole foods our daily fare and make the treats occasional. And this is something that people get into all the time: “Well, what do you mean by occasional?” And I tell them it should be situational. Do we have a reason for having this item that is not part of the daily fare? If you graduate first in your class, a glass of champagne is okay. But today’s Tuesday, it’s a pretty normal day, we’re not celebrating anything around here, so I think we ought to just eat our beans and rice and vegetables.

GM: On the subject of plant foods that you have to watch your intake of, what about dried fruit?

PP: There are two issues with dried fruit: First, it’s high in calories. You can sit down and eat half a bag of dried apricots pretty easily. Just think about how many calories you consumed. It’s like eating three dozen apricots, which you would never do. Second, you have to make sure the dried fruits you’re buying aren’t adulterated. There are lots of sulfites, coloring agents, and sugar in many dried fruit products. Any time you buy cranberries that taste good right out of the package, you know that they’ve had sugar added to them because cranberries are actually sour. Be careful when you buy dried fruits; you don’t want to be eating a lot of that stuff. Again, I’ll eat it when it’s in a dish. Del makes a great salad here that has raisins in it, or I’ll put raisins on my oatmeal every so often. But I’m not eating handfuls of dried bananas, dried apples, dried pineapples, that kind of stuff.

GM: How about fruit juice?

PP: Never.

GM: Okay, what’s wrong with fruit juice?

PP: It’s concentrated calories and sugar. Instead of drinking apple juice, eat apples; instead of orange juice, eat oranges.

GM: What about salt?

PP: Well, now we get into a contentious issue. Salt restriction is one of those things that became part of the conventional wisdom; we’ve been told it’s necessary for people to restrict salt in order to have normal blood pressure.

Early in my career, I heard Dr. McDougall buck the establishment by saying that salt restriction is not only inadvisable but may be detrimental. I got curious about it, so I reviewed the studies that had shown that salt restriction was beneficial; the difficulty was that salt restriction is usually accompanied with other dietary changes. The famous DASH (Dietary Approaches to Stop Hypertension) diet, promoted by the USDA to lower hypertension, is probably the best example of this. The participants of the DASH study were eating more fruits and vegetables, less animal foods, higher fiber, and less salt.50 I don’t think we can attribute the improvement in their health to the salt restriction alone, when people were making so many other changes to their diet at the same time. I just really could not find a lot of clear evidence that salt restriction was important. On the other hand, according to the 2007 National Health and Nutrition Examination Survey, which included almost one hundred million adults, people who eat more salt have a lower risk of death from heart attack and stroke.51 There are many populations on the planet that eat a lot more salt than we do that enjoy great cardiovascular health.

GM: Is Japan one of those?

PP: Japan is one of those, yes. And parts of China.

We’ve used salt to cure and flavor food for centuries. I don’t think we can attribute our current epidemic of hypertension to salt. The bottom line is this: when you adopt the diet that we recommend, your consumption of salt is going to ratchet down quite a bit because you’re not going to be eating processed meats and as much packaged foods as you were before. And another very important thing is going to happen, too—your consumption of other minerals and nutrients like potassium will go up. I think that one of the issues is the ratio of salt to other nutrients, particularly potassium, in the diet, so you’re going to experience salt reduction. Also, if you salt your food at the table instead of in the cooking process, you’re going to use less salt, and I think that’s a good idea. In any given year, we end up with half a dozen people here who have to restrict because they really have some salt sensitivity; their blood pressure goes up when they eat salt, and it goes down when they don’t.

GM: So you’re not denying that that relationship could exist?

PP: Oh, it does exist. But as public policy, what we’re doing is restricting millions of people to try to help a handful who need the restriction.

GM: Aren’t we salt-restricting millions of people primarily because of their blood pressure?

PP: Well, yes, but they don’t need to be restricted.52 In other words, if they lost weight and they ate a plant-based diet without salt restriction, their blood pressure would come down naturally, without restricting it overtly. If you look at the mechanism of action for high blood pressure, a lot of it is related to damage to the endothelial tissue. If the endothelial cells can’t produce nitric oxide, which is a vasodilator, the vessels start to close a little bit. Add in a little arterial plaque and the lumen in the vessels start to narrow even more; essentially, you’re trying to force more blood through narrower arteries. That’s the recipe for high blood pressure. Well, when you put people on a low-fat, plant-based diet, the plaque deposits stop forming and the narrowing of the lumen of the blood vessels isn’t happening anymore. We stop assaulting the endothelial tissue and it starts to regenerate; it begins to produce nitric oxide and opens up those blood vessels. It’s amazing, over a period of time, how many people will have their blood pressure return to normal. Add in some exercise and take off a few pounds and most people will be able to get their blood pressure down without salt restriction.

I want to mention one thing. This is not my idea—it’s a Dr. McDougall idea that’s worth sharing, and there’s a considerable amount of evidence in the medical journals to support it.53 Remember that our object is to encourage people to eat starchy foods and vegetables. And if salting the broccoli makes them eat a lot of it then, by gosh, let’s put some salt on it. I don’t want the vast majority of people who aren’t salt sensitive to think they’re cheating because they put salt on their broccoli and rice.

GM: What about the meat analogs: the tofu hot dogs and the Gardein meats and so forth?

PP: Well, some of them are pretty clean. Using tempeh to give spaghetti sauce the texture of something with ground meat in it, if it’s a clean tempeh product, like the ones we make at Wellness Forum Foods, I don’t have any problem with that. I do it; we do it here. What I have a problem with is these highly processed meat analogs that are just garbage food, like the tofu hot dogs and the fake pepperoni. Once in a while, it’s not a problem. People invite me, say, to a Memorial Day picnic and they say, “Pam, we’ve got veggie burgers for you.” They may be overly processed veggie burgers, but it’s Memorial Day and people are being nice. I’m not going to die from eating a veggie burger that isn’t clean. It’s only when this kind of garbage infiltrates the daily diet that you don’t really end up with the health improvement that you’re looking for. These fake meats are transitional foods and treats. If you’ve got to feed your kids some tofu hot dogs to get them through the transitional period, that’s fine. However, if you’re still doing it two years later, you’re just postponing making some serious health improvements.

GM: How do you feel about the raw food diet?

PP: That’s a complicated question. What typically happens to people who adopt a raw food diet is that they do really well for a while because of all of the things that they eliminate. Many people who start a raw food diet come from eating some version of a terrible diet, so they feel really great. But then, even with the meat and the dairy out of their diet, they start to feel badly. The biggest reason they feel badly is that they can’t get enough calories from eating only raw foods, or they have difficulty doing so. When they begin to feel the impact of the calorie deficiency, they start to increase their calorie count by eating nuts and oils and things of that nature. Then they start to get sick.

There are some people who are able to maintain a raw food diet well. Not everybody gets it wrong, but most people don’t do it well and end up worse off as a result. I think the bigger issue is that we really don’t have any evidence that shows that a raw food diet is better than a diet that includes cooked food. One of my philosophical issues around raw food is that what we’re asking people to do is a big enough change all by itself, without adding layers of difficulty to it that are unnecessary. Often I find that these added layers of difficulty attract a lot of attention at the expense of things that are much more important. I think it’s much more important to deal with fat in the diet, for example, than to eat all raw food. It requires an involved discussion about the effort that it takes to do the raw diet right and to teach people how to dehydrate foods and all that sort of thing; I don’t see that it’s worth it.

GM: I look at it this way: there are two important goals in nutrition. One is to obtain nutrients and the other is to avoid poisons or deleterious substances. Now, if you eat a lot of raw greens, vegetables, and salads, you get a lot of nutrients, which is a positive. You want to have a healthy complement of raw foods in your diet. Then if we add to these some rice, potato, or other plant food that requires cooking, there’s no downside. We’re not getting any poisons. We’re not getting something that’s high in fat or full of toxins or has animal protein or anything else. I just can’t see the case for abstaining from healthy, cooked foods that satisfy our appetites, as long as we’re getting our full complement of nutrient-dense raw foods.

PP: I agree with that. We want people to eat lots of salads and raw foods. But the extreme idea that you try to live on only raw foods doesn’t play out really well in real life. We need those cooked foods, those cooked starchy foods, because otherwise it’s difficult for the diet to be calorically adequate.

One fun dining adventure that I enjoy in many cities is to sample raw food restaurants. There are many in Los Angeles, and I’ve had the pleasure of dining in some of them. The food is just phenomenal at some of these places but—and this is a big but that could lead to a big butt—it’s also very high in fat. If I ate at those restaurants every day, I’d be a three-hundred-pound vegan.

The whole idea of adopting a health-promoting diet is not to separate yourself from the rest of humanity and make it impossible to interact with the rest of the world. That’s a terrible outcome, in my opinion. The emphasis on eating only raw food, and food combining, and a lot of other ideas that are circulating, make it harder and harder for a person to be out among the rest of the world. I don’t want to stop going to family gatherings and book club, or any of the other things that I do that involve interactions and meals with other people. I don’t want to adopt some eating style that’s incompatible with the way the rest of the world lives. I can eat the plant-based diet we’ve discussed here; I can practice dietary excellence anywhere I go. I can’t practice raw food-ism and food combining and a lot of these other extreme things every place I go.

GM: How do you feel about the macrobiotic diet?

PP: Well, that’s interesting. There’s some evidence that the macrobiotic diet is helpful for resolving cancer. We don’t really have a lot of studies that point in that direction, but we have a lot of stories, enough that I think if somebody wanted to do a study on macrobiotic diets and cancer, it could be justified from a funding standpoint. It’ll never happen because the drug companies will never let it happen, but I’ve read enough about it to believe there’s something to it.

One thing that’s misunderstood is that the macrobiotic diet isn’t just a diet; it’s a lifestyle, too. The people who have succeeded with it have not only adhered to the dietary principles but they’ve done a lot of the other things that are recommended in terms of the way they live their lives. I think if you’re going to do macrobiotics, you’re going to have to incorporate the whole program to get the benefit.

The macrobiotic diet can be difficult in terms of food preparation; it takes a lot of time. What we don’t know is if it’s the specific combination of foods that are included that’s causing the positive effect, or if it’s simply the elimination of some of the bad foods that’s causing the positive effect. In other words, do we really have to do all of this, or can we get the same results from just eating a plant-based diet? I’d love to see a study with leukemia patients comparing a macrobiotic diet to our Wellness Forum plan to see if there truly is a difference between the two. Will that ever happen? No, not in this country.

GM: I lived in Boston in 1983 in a vegetarian group house near one of Michio Kushi’s macrobiotic schools (Kushi founded the Kushi Institute). Whenever we advertised for a new roommate, a lot of his students would come and interview with us to see if they wanted to live in our house. They would always ask the same question: “Do you eat vegetables that grow at night?” I would say, “I don’t know. I never get up to watch.”

Is there anything to this “nightshade vegetable” thing? Apparently potatoes and eggplants and I’m not sure what else grow at night; is there any basis for concern about that?

PP: No, not generally. There are some patients with arthritis—it’s a very small minority—who seem to do better without nightshade vegetables. I think you bring up a great example of what I was just talking about. That’s a layer of difficulty added to eating a macrobiotic diet, and we just don’t have any research to show that added level of restriction and difficulty is necessary most of the time. I’d love to see it studied someday; maybe I will live long enough to see the right types of studies done about diet in this country, but right now we just don’t have the evidence for it.

GM: Speaking of potatoes, what’s the best way to prepare a potato? Baked potato, boiled potato? Do you eat the skin, do you not eat the skin?

PP: I always eat the skin. I love potato skins. Boiled, baked, steamed—those are the ways I usually have them. But it’s not necessary to eat the skin if you don’t want to.

GM: Now what about a glass of wine in the evening? Anything wrong with that?

PP: Every evening is a big deal. Alcohol is not beneficial for health. The several studies that have shown that occasional drinkers are healthier than abstainers have not, I think, accounted for the fact that many abstainers are abstainers because of health conditions. I don’t see a benefit from drinking, but I don’t want to take the enjoyment out of life. I know some real purists, and they’re a pain in the butt to be around. I don’t want to be one of them. It doesn’t attract people to our way of life. I enjoy an occasional cocktail and I don’t discourage our members from doing so unless they have a condition like pancreatitis or hepatitis C. I think the average person can certainly drink some alcohol, but not every day.

GM: What do you say to those who believe that a daily glass of red wine explains the so-called French Paradox? They manage to eat a fatty, animal-based diet with less heart disease than Americans.

PP: First of all, the incidence of heart disease and cancer in France is very high.54 It’s lower than the United States, but it’s still very high. I wouldn’t be attracted to that type of risk profile. Second, the French, as well as other populations in Europe that eat similar diets, eat an enormous amount of legumes, fresh vegetables, whole grains, and fruit. The people who truly abide by this diet are not overweight. And while they eat plenty of animal foods, they eat much smaller portions than we do in America. I’ve spent a lot of time in Europe; I’ve eaten the Mediterranean diet in Europe, so I know what I’m speaking about.

Having said that, their disease rates are still high. To the extent that their health is better than ours, it’s not because of the red wine or olive oil; it’s because of the entire way they live their life, which includes more walking and more physical activity. It’s their pattern of diet and lifestyle that is somewhat protective, not red wine and olive oil, and in any case they’re not as healthy as is sometimes reported. What happens here is that people look at various diets and they read about the Mediterranean diet and say, “I like the red wine and olive oil,” and they extract that and add that to the American diet, only to make things worse.

GM: Chocolate has been in the news lately because of studies that allegedly show that it’s very good for the heart. That seems to be too good to be true.

PP: And it is. The danger would be people thinking they can continue to eat the fatty Western diet and then protect themselves with fatty chocolate bars. The study that was in the news recently was a meta-analysis of seven studies. Only five of the seven showed some benefit. Even the researchers issued a caution about how to interpret the results because chocolate is high in fat and calories; even they did not interpret their own study as a mandate to begin eating chocolate as a preventive tool.55 If there’s some legitimate good news here, it’s that if you’re in good health and practicing a low-fat, plant-based diet, you can treat yourself occasionally to some chocolate without worry.

GM: What about coffee?

PP: Coffee has been a little vilified. There’s no question that caffeine is a drug. As with alcohol, if you abuse it, you’re going to have problems. I used to be a caffeine abuser, so I can speak to that from extreme personal experience. It used to take three pots of coffee a day to keep me going. I don’t think the occasional cup of coffee is a dealbreaker. When people who are completely compliant with the diet say that a cup of coffee in the morning is something they want to do, I’m not going to make an issue out of it. To do so would be choosing the wrong battle. But when I see people drinking coffee all day long to stay awake and masking symptoms of fatigue, which should signal to them that they’re overworking themselves and that their body is exhausted, I’ll make an issue of that.

GM: I’m pleased to say that I’ve had only one cup of coffee in my life.

PP: How’d you manage that?

GM: Well, I was a seventeen-year-old high school student and visited the college I would ultimately attend, New College in Sarasota, Florida. Somebody told me that there would be a coffee klatch in the evening at the home of Professor Peggy Bates, so I went there to meet the students and some professors. Dr. Bates said to me, in front of everyone, “Glen, do you drink coffee?” Well, I never drank coffee growing up; it had never occurred to me to try it. But now I was going to college, joining the grown-ups, and I didn’t want to make a fool of myself, so I had to think on my feet.

I said, “I don’t know.”

She said, “Well, Glen, would you like to try a cup?”

I said, “Sure.”

So she gave me my first cup of coffee. And I drank a few sips. It tasted like mud. It was the worst tasting drink I’d ever experienced. I couldn’t imagine that people actually drank this crap. So I never had coffee again.

Cut to twenty years later. My old literature professor was retiring, and I flew back to Sarasota to speak at his retirement dinner. I’m hanging around the campus and I meet a young woman from China who is a new student at the college. She tells me she’s studying international relations with Dr. Bates. I say, “Oh, is she still here? How’s she doing?”

She says, “Great. She’s just the greatest professor. But she makes the worst friggin’ coffee.”