Saturday, May 31, 2008

Why go against the medical grain?

Here's the story about what led me to first to question and then to condemn the theory that cholesterol causes heart disease.

On August 5, 2002, I finished a cup of coffee sweetened with homemade caramel sauce and set off on a mission to retrieve a species of Hawaiian fern. The hike was strenuous, up a steep grade through mud and three-foot grass that wound itself around the wheel of the wheel-barrel. When my knee started hurting, I figured it would get better later, like it always did. I was wrong. The injury became a life-changing event that would make it impossible for me to walk and threaten my ability to work. After surgery failed and every day I failed to improve, I began to believe there was no hope of recovery.

Fortunately Luke, my husband, had another opinion. He thought there might be some use in learning more about nutrition.

Sure, I thought, everyone has an opinion. I, on the other hand, went to medical school. Hel-l-l-lo-o-o…I took a course on nu-tri-tion. I learned bi-o-chem-is-try. What could anyone possibly tell me? The next day, Luke brought home a book. Had I not been completely immobilized, I may never have bothered opening Andrew Weil’s book Spontaneous Healing and started reading.

It didn’t take long for me to bump into something I’d never heard of before—omega-3 fatty acids. According to Weil, these are a type fats we need to eat, just like vitamins, and that we need to supplement because our diets are deficient. This blew my mind. I’d thought fats were bad. Either he was off base, or my medical education had failed to provide some basic information. Like a kid who gets into the bathtub kicking and screaming and then doesn’t want to get out, I soon couldn’t get enough of these books. In these books [lay more than] weren’t just new information, but hope that I might walk normally again.

I came across an intriguing article entitled Guts and Grease: The Diet of Native Americans which suggested that Native Americans were healthier than their European counterparts because they ate the entire animal. Not just muscle, but all the “guts and grease.”

According to John (Fire) Lame Deer, the eating of guts had evolved into a contest.

"In the old days we used to eat the guts of the buffalo, making a contest of it, two fellows getting hold of a long piece of intestines from opposite ends, starting chewing toward the middle, seeing who can get there first; that’s eating. Those buffalo guts, full of half-fermented, half-digested grass and herbs, you didn’t need any pills and vitamins when you swallowed those."

I liked the voice of authority this Native American assumed, as if he were drawing from a secret well of knowledge. I also liked that the article offered healthy people as evidence instead of experiments on caged lab animals or statistics. At the time, the approach struck me as novel—studying health, to prevent disease. Early European explorers Cabeza de Vaca, Francisco Vaquez de Coronado, and Louis and Clark described Native Americans as fearsome and powerful warriors, able to run down buffalo on foot and keep running after being shot through with an arrow. Photographs taken two hundred years later, in the 1800s, capture the Native American’s broad, balanced bone structure. Presenting a people’s stamina and strength as evidence of a healthy diet seemed reasonable, and it rang true with my own clinical experience in Hawaii. The healthiest family members are, in many cases, the oldest, raised on foods vastly superior to those being fed to their great grand children, foods representative of a far healthier ecosystem, and—according to the studies—many times more nutritionally potent.

Reading the passage about two grown men chewing their way through an animal’s unwashed, fat-encased intestine forever changed the way I remember the spaghetti scene from 101 Dalmations. But it also brought up some serious questions. For one thing, wouldn’t eating buffalo poo make the men ill? And isn’t animal fat supposed to be unhealthy? Two things I learned about nutrition in medical school were that saturated fat raises cholesterol levels, and cholesterol is a known killer. So who was on the right track, the American Medical Association, or John (Fire) Lame Deer? The best dietary stance would be the one most supported by the scientific facts which, thankfully, I had the training to decipher.

And that’s what I did. After six months of research, I’d found that that the available evidence failed to support the AMA’s position, and overwhelmingly sided with that of John (Fire) Lame Deer. After reading every old fashioned cookbook I could get my hands on, and enough biochemistry to understand the essential character of traditional cuisine, I changed everything about the way I eat. And guess what: I got better. Not only did my knee heal, but all aspects of my health—from better mood, to more energy, to fewer colds—took an upturn. Now, I’ve also changed the way I practice medicine, and my patients see the benefits as well.

I ultimately came to understand that the nutrition science I’d learned in medical school was nearly exactly wrong, full of contradictions, and resting on assumptions proved false by researchers in other, related scientific fields. Why is such sloppy, inaccurate science still taught? Because so much medical research is now funded by industries expecting a healthy return on that investment. When research conclusions jeopardize a product line—like the fact that trans fat causes heart attacks—they make their way into textbooks only in the rare case they survive a near impossible journey, swimming against the roaring currents of one or another industry’s profit stream. Those that make it—sometimes decades later—are allowed in only in abbreviated form. These omissions prevented me from learning, for instance, that Canola oil is actually full of trans fat, or that cholesterol lowering pills increase your risk of dying from cancer.

For the past 6 years, Luke and I have been writing a book that covers some of the fascinating things I've learned about health. If you'd like to learn more, click on the link: About the book.

Aloha, and thank you for reading my story!

Catey Shanahan, MD