This post was originally published at Science-Based Medicine. –PalMD

Earlier this week, my colleague Dr. Gorski explored a common theme in alternative medicine: the idea that all disease is preventable.  This implies that all disease has a discrete cause and that individual behavior can mitigate this cause.

If biology worked this way, my job as an internist would be very different.   Many people would love to believe that life is this predictable, and that they have that much control over their health, but they don’t.  Most disease represents the interaction of environment and genetics, and you can’t change your genes (with a few exceptions, of course).

It’s natural to want to be able to exert an impossible level of control over your health, but when unscrupulous charlatans (redundant redundancy alert!) play on these beliefs and fears, they can cause, rather than prevent problems.

Which brings us yet again to the Huffington Post.  Yet another Promiser of Big Promises is telling us why we’re sick and what to do about it, without the benefit of actual truth or science.  Dr. Joel Fuhrman starts by frightening us, but the reassures us:

The American diet causes disease.

[…]

You cannot escape from the biological law of cause and effect — food choices are the most significant cause of disease and premature death. We cannot win the war on these diseases by putting more money into medical interventions or drugs. We must unleash the disease-fighting artillery in our own kitchens.

Well, there is no “biological law of cause and effect”.  There is biology, there is medical science, but no “law”.  The best lies are built on truth, and contain both fear and hope.  It’s true that Americans are suffering from obesity and diseases associated with obesity.  It’s obvious that diet has something to do with this.  And as every primary care physician knows, lifestyle change are an important part of preventing and treating these diseases.

But real doctors also know that we will never “win the war on these diseases.”  Biology is indifferent to our desires.  We all get sick, we all die.  We have learned to moderate this in some cases, but we will never “win”.  Anyone who tells you otherwise is trying to sell you something.

And Joel is trying to sell you something.  Like most so-called medical writers at HuffPo, he links directly to his website, where he sells all sorts of miracles.  In the usual whirlwind of internal contradiction that is alternative medicine, he at once denigrates the progress possible with science-based medicine, while at the same time inventing his own “science”.  This is what I found particularly interesting about this particular brand of fake medicine.  Rather than appealing to unseen forces such as qi or “water memory”, Joel goes straight for what Michael Pollan calls “nutritionism”.   He invents what he calls his “health equation”: Health = Nutrients / Calories (H = N / C).

In real equations, it’s important to define ones terms, and in this case the big undefinable is “health”.  Since this can’t be quantified in any real way, this is nothing more than a parlor trick.

But like all medicine shows, this one needs more than just some fancy equations.  Joel explains that he is sharing with you a secret that “they” don’t want you to know:

Doesn’t every American have the right to know they don’t have to suffer a heart attack or a stroke? They can protect themselves. They could choose otherwise, but shouldn’t they be informed of the most effective lifestyle to protect against cancer? Should they just be given drugs for diabetes, cholesterol, blood pressure and more or should they know they have the opportunity for a complete non-drug recovery?

Or maybe people have the right to know that they cannot control every aspect of their health, and that if they cannot make necessary lifestyle changes, they should not be “punished” by being denied access to life-saving medications.  Not everyone has “the opportunity for a non-drug recovery”.  As physicians, our job is to use the best available evidence to help all of our patients.  It is not to dispense false promises, fake science, and a heaping portion of blame to those who don’t do everything we tell them to.

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1. #### James Sweet

/  September 9, 2010

And people will swallow this hook-line-and-sinker, because the following phrase from Dr. Fuhrman is so close to being accurate:

food choices are the most significant cause of disease and premature death

I count four words that need to be added to make it an accurate statement:

In the West, food choices are the most significant preventable cause of disease and premature death

That’s probably true, though I suppose its arguable depending on how you define your terms and your metrics.

People have probably heard some variant of the accurate version of that statement repeated dozens of times from reliable authorities. Most people won’t notice that Dr. Fuhrman’s deletion of a few key words saps all the truth out of it…

2. #### Benton Jackson

/  September 9, 2010

“Health = Nutrients / Calories (H = N / C).”

So, does this mean if you starve yourself, you’ll have infinite health?

• #### Snarkyxanf

/  October 3, 2010

No, but it does imply that Health is measured in units of grams per Joule.

This is confirmed by the fact that rocks posses very few joules per gram, and correspondingly have extremely long (boring) existences.

3. #### Caro

/  September 9, 2010

@Benton Jackson: Not necessarily, if the amount of nutrients also approaches zero (as they would during starvation), we’ll have to use l’Hôpital’s rule to find the true limit of the function, since 0/0 is an indeterminate form 😛

On topic, though, victim blaming like this what I consider to be the most pernicious part of the So-Called Alternative Medicine industry. Wrap it up in fancy paper and call it “The Secret” or anything else, it’s tough enough being sick already without being labelled a defective person for being sick. Guilt on top of dealing with being sick will never make anyone feel any better.

• #### James Sweet

/  September 10, 2010

Hmmm, good point. Thinking about $$\lim_{C \to 0} \frac{N}{C}$$, it occurs to me… If you hold constant the ratio of different foods while only modifying the amount, you could express N as a function of C. If we let $$f_D(C)$$ be the function to compute N for a given diet D, we can see that it must necessarily be true that $$f_D(C) = k_DC$$ — because if the ratio of foods is the same, the nutrients just scale as a function of how much you eat, right?

So $$H = \frac{N}{C} = \frac{f_D(C)}{C} = \frac{k_DC}{C} = k_D$$. That’s right, for a given diet D, $$H = k_D$$ regardless of how much food you actually eat. A bold claim!

• #### Luna_the_cat

/  September 18, 2010

Off-topic, but I have to ask — what do you use to get the math notation into a comment?

• #### PalMD

/  September 18, 2010

It’s Latex. I’ve never used it, so you have to google it.

• #### Luna_the_cat

/  September 18, 2010

I’m familiar in a passing way with LaTEX, I just didn’t realise I could embed it into comments!

::goes away enlightened::

4. #### jre

/  September 10, 2010

Once upon a time, I tried to leave a comment at HuffPo, only to learn that (a) you have to register, and (b) even after you’ve jumped through the hoops, your comment will be quickly moderated out of existence if it contradicts the party line. Life’s too short.

God bless you for becoming a HuffPost superuser, so the rest of us can ignore the latest baloney, safe in the knowledge that you’ve got this one. Way to take one for the team, PalMD!

5. #### User38983

/  September 11, 2010

Your argument is generally correct. However, I think Dr. Fuhrman is an exception to the type of Doctors your warn about.

First of all, he does not sell anything ‘strange.’

He sells, by US standards, mild multivitamins and Vitamin Supplements (in tiny amounts). He doesn’t sell megadoses, etc. He sell vinegars and salad dressings, too: hardly sneaky products promising instant health.

His scientific ‘formula ‘is meant as an aid to understand, not a formula by which measurements might be made.

Here’s my problem with your post: Nothing – and I mean NOTHING – Joel Fuhrman, Medical Doctor, publishes is scientifically incorrect – it is interpretation.

But, nothing he recommends is DANGEROUS!! NOTHING.

He does NOT promise that diet will cure cancer, etc. But, most people with type 2 diabetes can control it 100% with diet.

He recommends that people exercise and eat salads, vegetables, fruits, nuts/seeds, beans, and small amount of animal products (if they want).

THAT’S IT.

I’ll repeat:

He recommends that people exercise and eat salads, vegetables, fruits, nuts/seeds, beans, and small amount of animal products (if they want).

He does NOT subscribe to Veganism, Raw Foodism, or any other political prescription for eating.

He even warns that people might still need Vitamin D, DHA, etc – which are hardly outlandish. He doesn’t recommend ACAI or anything exotic because he understands blueberries and such are just at good.

In fact, the ONLY objection other Doctors really have is the idea that people can’t follow his diet in the west – because, in their minds, it’s too strict.

I am not using my name but I think you should CHALLENGE Dr. Fuhrman to a debate. I assume that he’d accept.

I feel you are so used to pointing out real charlatans (and good for you) that some times you hit a wrong target.

Dr. Fuhrman’s idea of eating is the best of the planet (for some people – maybe most westerners)

• #### PalMD

/  September 11, 2010

Sorry, I’m feeling less cranky now.

You’ve missed the basic point. Lifestyle modification, including dietary modification is not always enough to treat our most common and problematic diseases. And even when it could have a significant impact, many patients cannot/will not make the necessary changes.

When a patient cannot quit smoking, exercise more, eat better, should I punish them by withholding life-saving medications?

From a factual standpoint, I’d like to see you support your assertion that most type II diabetes can be controlled with diet.

6. #### PalMD

/  September 11, 2010

“I’ll repeat…”

HAHAHAHAHAHA!!!

7. #### User38983

/  September 11, 2010

I thought I was being polite.

I took time to write my opinion. Perhaps my analysis and opinion are wrong.

I hope you aren’t as arrogant to your patients, but I suspect you may be. I hope not . . .

8. #### hydropsyche

/  September 11, 2010

As someone with inflammatory arthritis, so many people who are supposed to be my friends have all but implied that they are not at risk for diseases like mine because they are vegetarian/exercise a whole lot/take the right supplements. I’ve heard it referred to as Medical Puritanism (was that on SBM?) and it seems to be so true. The idea that we deserve the health we have because we are a good/bad person has become a cornerstone of self-righteous American culture.

• #### OleanderTea

/  September 13, 2010

Exactly so. Medical Puritanism is a problem in many doctor-patient interactions, whether or not said doctor is a wackaloon or not. In recent interaction with a new PCP, he blamed my asthma flare-up on my weight, rather than the gallons of ragweed pollen in the air. He was taken aback when I told him that I’ve been asthmatic since I was two years old and slightly *underweight*. Ditto migraines — I had a doctor tell me that migraine disease is more common in overweight women. I pointed out that a) 60% of Americans are too fat, and that the overlap could well be circumstantial, and b) that the five preventatives I’d tried were the culprit in the weight gain.

Damned if you do…

• #### Karen

/  October 3, 2010

Oh wait — I’m a vegetarian who exercises. I’m in the clear! Whew. I’d pump my fist in victory if I could fully extend my arm. Maybe I just need more flaxseed oil or something.

9. #### Sam Knox

/  September 12, 2010

This is my first and, as it turns out, last visit.

I agree with “User38993”.

You come across as kind of a dick.

The literature showing an association between the consumption of refined carbohydrates and Type II diabetes is voluminous, although I’m not surprised you are unfamiliar with it, and if diet can be implicated in the onset of the condition, it follows that diet might be used to treat it.

Do you remember when you sold out?

10. #### PalMD

/  September 12, 2010

It’s amazing how we supposedly speak the same language, and yet you seem to not be able to comprehend simply constructed sentences.

11. #### Rodentrancher

/  September 12, 2010

The great thing about the blame-the-patient game the alt-medies love is that there’s always SOMETHING they can find that’s the patient’s fault.

A vegan, thin, non-smoking, non-drinking, exercise-fanatic acquaintance was recently diagnosed with RA. She was told by one alt-med wackjobs that if she’d just eat fish and take the right supplements she’d be cured. I guess her RA was caused by being a strict vegan 😛

There’s ALWAYS something.

12. #### Jordan

/  September 13, 2010

I agree with User38983.

Pretty sure I recognize you as a commenter on Respectful Insolence, a blog that I frequent myself. I was incredibly worried that Dr. Fuhrman had posted a blog entry on Huffington Post because you and I know that it is a den of pseudoscience and quackery. I’m a fan of his on Facebook and immediately responded to his post that he had begun a blog there to ask him if he didn’t see a conflict between the science-based medicine and diet recommendations that he provides appearing in a den of wackaloons. Unfortunately, I got no response. I knew that everything that he was going to say would be attacked by people that have rigorous science standards and require a literal interpretation of everything that was said. Unfortunately, this article is written for the lay person, not for scientists.

This, for Joel, is an introductory puff piece that just gets across his basic message.

Firstly, I wouldn’t call him an alt-med practitioner. Even his mailing list articles that he sends are entirely cited to the respective journals and articles, and they are actual science journals, not invented for the purpose of furthering some agenda. I’ve never seen him promote any form of woo. Yes, he sells supplements and food on his website but it is all created with the latest in nutritional science in mind (respect given to things like vitamin A, E and folic acid). I double-check every single article that he quotes to ensure that he isn’t just quoting things out of context to suit some goal. He actually genuinely cares about getting people healthier.

His philosophy at this point is that the first step in treating anyone for illness is to redesign their diet with health promoting foods, basically a reversal of the food pyramid from the FDA. From that point medications are reduced or eliminated if possible. Yes, the way people eat affects their health and when people eat poorly it reflects in their health. There are factors beyond our control like genetics and our environment. He knows this fact. It is too bad your first exposure to his work is this article and not his books.

My only problem with his writings is the use of the word toxins as a catch-all phrase or buzz word, as we know a word bandied about far too often and usually not in the correct context. It’s a word few people understand correctly.

Referring to him as an unscrupulous charlatan is entirely unwarranted. He is not a big ‘promiser of promises’, if anything all he does is provide the most recent nutritional science and shows people that certain ways of eating are proven to put you, statistically, into a place where your chances of contracting heart disease, type 2 diabetes, and other preventable diseases are significantly diminished. He usually makes no absolutist statements about health, he does not make guarantees about anything. I read his writing with the same scrutiny that you employ but I know how to parse what he is saying. He will say the word ‘disease’ but he’s referring to things that we know, that we have proven scientifically, to respond in specific ways to diet. Like lowering your intake of salt reducing your chances of experiencing hemorragic stroke. I know that when you read it, you are taking it to mean ALL disease. The problem being that we both know of alt-med practitioners, holistic healers and homeopaths that are ACTUALLY using that word literally with grandiose claims of superdoses of Vitamin D preventing viruses, disease, etc. or even acting as vaccinations.

“But real doctors also know that we will never “win the war on these diseases.””

Ad hominem attack thrown in for good measure I guess. The man’s been practicing for years and assisting people make positive woo-free changes in their lifestyles. You’re drawing a conclusion based upon your interpretation of what he means by ‘disease’ as is used casually by alt-med or holistic doctors. You would not get his meaning of the term disease from this article and that is unfortunate. He’s talking about preventable diseases that we know respond to dietary changes. Your quack alarm is ringing and it’s entirely understandable given the way that he has written this article.

“And even when it could have a significant impact, many patients cannot/will not make the necessary changes.

When a patient cannot quit smoking, exercise more, eat better, should I punish them by withholding life-saving medications?”

This is just a piss poor attitude and one I hope you don’t carry this brand of thinking into your eventual practice. Will you always begin with a new patient assuming that they are not going to make radical changes to their diet? Do you assume you cannot help them move towards that? Should you not arm yourself with the latest in nutritional science to go along with whatever medication you feel is necessary? Is it not better to use constant medication, like statins, as a last resort and not a first resort if possible?

Maybe Dr. Fuhrman just magically attracts people that are willing to change their lifestyle. One of the most tragic problems with health in this country is the attitude you are presenting. In your mind you’ve already lost the battle. Drastic changes in a person’s eating style or lifestyle are almost always delivered at the point of a sword; disease has already struck and people need to now change and need someone responsible that is going to provide them with a healthier lifestyle and medication. You ask the poster a ridiculous question which seems to imply that Fuhrman would deny a patient medication or punish them in some way. Entirely untrue and kind of shameful.

In the battle against cancer, heart disease and diabetes Dr. Joel Fuhrman is one of the good guys. Maybe you should go to his practice as part of your internship and spend a few weeks there. He does regularly accept interns. Find out more about him. For example, he has a kitchen right in his office and shows people during their visits how to prepare healthy foods based upon his “nutritarian” eating style. I’ve never heard of another doctor that cooks the food and lets them taste it for themselves on-site to help show them that they can eat healthy and still have it be tasty and fulfilling. There is a lot more here than meets the eye and this single article simply doesn’t say enough about his methodology or his accomplishments with patients.

Don’t write him off because of this article, I know it was terribly written but you could learn a lot from his approach to health.

I find a lot of people immediately discredit anyone stepping away from the FDA food pyramid because it doesn’t coincide with what they want to eat. That’s fine, but refrain from the demonizing that goes on in this article response. A lot of the people on the original thread from ‘science-based medicine’ also just fly off the handle and dismiss everything that he says because of his goofy formula. How easy is it to prove that formula wrong? It’s not a scientific or mathematical formula. It’s something easy to remember for the lay person to remember to guide them in their food choices.

Look at the responses from people over there – Fuhrman never claims anywhere that if you follow his eating style you’ll be in perfect health. They are inventing these claims in their minds because so many of the alt-med community DO make those claims with a straight face. He just produces this article in an obtuse, generalized way and people are falling all over themselves to find one issue in it that they can easily falsify and dismiss everything else that he has done. That’s enough justification for them to continue on their merry way. I understand the mentality. His article is so fucking frustrating to me because now he is watering down the message too much to appeal to a wider audience.

I’m a nutritarian first and a vegan second for both health and ethical reasons. Before I found him I didn’t really have a place to go for good advice about how to eat vegan and still be healthy. If I didn’t look at his research and the articles that he cites critically I would fall prey to a lot of woo. There’s no magic here, just nutritional science. Unfortunately, you don’t get much of it from this article and I think it’s a crime that people that love science and evidence will immediately dismiss him because of this piece.

If I ever find him promoting any kind of woo I’ll immediately re-evaluate him and let him know personally how I feel about his responsibility to truth and science. It seems like he wants to get the message out there to as many people as possible, sacrificing better writing for catchier writing. It’s unfortunate but if you want to reach the most people at this point it’s the nature of the beast. The people that will ignore him because of this article probably number only in the hundreds instead of the thousands that will have the spark ignited for more information and a healthier lifestyle. Maybe now he considers this negligible. I’m not sure but he still hasn’t lost me.

Rodentrancher – Interesting to see you delighting in an acquaintances misfortune in such a way. Some people that eat vegan diets do not get enough omega fatty acids, or too much 6 instead of 3. Furhman isn’t an alt-med wackjob either. Who decided that the RA was caused by the vegan diet? The alt-med wackjob? I thought they weren’t trustworthy? Get your story straight so you can get the most out of your gloating.

A lot of doctors recommend fish or fish oils when they want people consuming omega 3’s for whatever reason. The fact that you can get the omega 3 DHA from algae-based sources instead of consuming it after it’s been filtered into a fish never even enters the conversation.

13. #### Ann

/  September 13, 2010

I agree with User38983 & Jordan – and I think you are really barking up the wrong tree here.

Please read Dr. Fuhrmann’s books, and the medical studies he cites that back up his work, before you dismiss his advice.

He is very clear that you cannot prevent ALL disease by eating properly, but he also lays out which that you can achieve A LOT through proper nutrition and fasting (and he always encourages you to work in tandem with a physician).

Once you have read his work – and engaged the science (not the equation he uses to illustrate an idea) – feel free to comment. Until then, I don’t think I’ll be back.

14. #### red rabbit

/  September 14, 2010

Wow, it’s gonna suck to be some of these folks in 30 years, after their genes catch up to them. How will they cope?

I have patients who are thin, who exercise, who eat right (and who always have), and who still have type II diabetes which requires medication and insulin to control. Sometimes you can do everything right, and still not be awesomely healthy.

Don’t get me wrong, I do have patients who prefer medication to lifestyle change. But by and large, the population I see would do anything to avoid insulin, which includes see a dietician, get into an exercise programme, lose weight, change jobs…. and some people still need insulin.

Ditto cardiac disease. Ditto lung cancer.

There is a genetic and a stochastic element to most illness. Some people *really do* draw the short straw, and despite best efforts, they need people like Pal. You could be one of them, Sam, so lighten the hell up already.

15. #### Paul Surovell

/  September 14, 2010

Dr. Fuhrman has a theory about the relationship between health and nutrition that is based on scientific research. His formula can be understood in this fashion:

Health = Nutrition / Calories where each person requires (approximately) a fixed number of calories per day to function. The level depends on the lifestyle and level of activity.

So with Calories a constant, if we cross multiply, our equation becomes:

H x C = N which means that as one’s nutritional intake increases, one’s health increases.

A corollary to the theorem is that the way to achieve maximum nutritional intake is to follow a diet which contains large volumes of the most “nutrient-dense” foods, primarily vegetables, but especially dark green leafy vegetables (kale, collards, watercress, spinach, etc.). As a rule of thumb, Dr. Fuhrman recommends one pound of cooked and one pound of raw vegetables a day. Other staples in the Fuhrman diet are raw fruit, beans (including peas and lentils) and nuts and seeds.

In order to maximize nutritional intake Dr. Fuhrman recommends low levels of starchy foods, oils and sugars, which are high in calories and low in nutrients.

His diet also minimizes processed foods such as veggie burgies and veggie hotdogs which are usually high in salt and relatively low in nutrients compared with unprocessed foods.

He also recommends elimination of added salt. You can eat animal products on his diet but in small amounts.

Along with the diet, Dr. Furhman recommends at least 30 minutes of exercise each day. He’s a former skating champion and very well versed in athletics and sports.

Dr. Fuhrman is very definite that heart disease and diabetes (type 2) can be eliminated if one follows his program strictly. There are several other conditions where he’s had great success with his diet. However, he recognizes the need for medication and surgery in many situations and if someone has high cholesterol and they don’t want to eliminate it through diet and exercise, Fuhrman would say they should take a statin, which he recognizes will lower the risk of heart disease.

He also recognizes rare individual cases where his diet may not be effective and where medical intervention may be necessary.

Bottom line — what’s wrong with a program that recommends optimizing one’s health by optimizing their nutritional intake and incorporating a regular exercise routine?

• #### Paul Surovell

/  September 14, 2010

To clarify the second-to-last paragraph — the phrase “rare individual cases” refers to individuals with heart disease and diabetes who do not respond to his program.

• #### Luna_the_cat

/  September 18, 2010

Look up the Graham Diet (if you don’t know where to start, try “history of the Graham cracker”), and substitute “ill health” for “carnal urges” and “masturbation.”

America has a long history of health-food nuttiness (yes, pun intended). The problem is that sensible advice on diet is taken to the level of evangelism, prescribed for everyone, and failure to follow this advice then taken as a personal failing and the reason (justifiable or not) for all and any bad health. You want an example of that, just look how many commenters showed up here claiming that Type II diabetes could be prevented/100% managed by diet alone — which is absolutely medically unjustifiable to claim. Diet helps, no doubt about that. Diet was the only thing that diabetics had to fall back on before the understanding and availability of insulin, and strict regulation of diet kept them alive for years longer than would have otherwise been the case. But since the advent of insulin, the average lifespan of Type II diabetics has leapt by decades, even against those who kept to strict diets.

So there’s the problem, the unjustifiable “Big Promises” which go beyond sensible advice. Something can be based on very sound science, and still be taken to a degree of ridiculousness.

As for where are all the other doctors advising healthy diets — all over the place. I would say, possibly every single medical professional I’ve run acoss, except for a few of the older ones who’ve simply given up saying these things because nobody ever seems to act on it. I find it amazing and disheartening how they vanish into invisibility and inaudibility in people’s perceptions, and it’s not until some popular figure claims to be telling people something the establishment supposedly doesn’t want you to know that people pay any attention, and then it’s only to accuse the establishment of not saying what it’s been saying for years.

• #### Karen

/  October 3, 2010

Please forgive me, but I tend not to trust any Diet that has some dude’s name in it. It’s usually named to be trademarked, which bodes ill for its intent.

• #### Dianne

/  October 4, 2010

Dr. Fuhrman is very definite that heart disease and diabetes (type 2) can be eliminated if one follows his program strictly.

He may be “very definite” but what is his evidence? Indeed, I have doubts about the whole “diet causes type II DM” paradigm. Consider the following: Type II DM has a strong twin concordance (nearly 100%, IIRC, but I may not). That suggests a strong genetic component. OTOH, it has been noted that people with abnormal glucose tolerance reduce their risk of progressing to DM (or at least delay progression) if they lose weight. That suggests that diet is a major player. However, there is one further point to consider: Insulin stimulates hunger. And type II DM is a disease of relative, not absolute, insulin lack. The absolute insulin level in a type II diabetic is high. Maybe the reason that people who lose weight are less likely to progress to DM is that they have lower insulin levels and so aren’t as hungry and are more able to lose weight. In short, I’d like to see trials of diet in DM controlled for insulin level at baseline. And maybe see changes in insulin during the trial to see if a less calorically dense diet might help decrease insulin levels as well as normalizing blood glucose. There are a lot of unknowns still in DM and a simplistic approach like “just follow my diet and you’ll be fine” isn’t likely to succeed.

16. #### Phil Weinstein

/  September 14, 2010

Does there exist ONE disease for which there would be no benefit to having had a commitment to excellent nutrition?

Dr. Joel Fuhrman isn’t writing for doctor-lawyers, who haven’t themselves done a great job conveying to the rest of us the most important conclusions from good current health and nutrition science. “H=N/C” (phyto-nutrient density) is an abstraction to characterize just ONE OF SEVERAL important risk factors which Dr. Fuhrman identifies.

Sure, most doctors are firemen. But does every medical doctor need to focus on treating mainly the final stages of disease? I’m an adult, and I very much appreciate being reminded that the medical emergency has already started — for each and every one of us.

Dr. Fuhrman comes across as a scientist rather than as a lawyer. Fundamental to “nutritarianism” is accommodation of emerging health and nutrition science. But the basic ideas of “nutritarianism” (by the way, not trademarked by Fuhrman) are well supported by large scale evidence, and have been characterized in great detail.

And how many physicians are standing in front of a camera to teach us how to buy and prepare vegetables and fruits? That’s real Surgeon General material, in my book.

• #### Chris

/  September 19, 2010

Have you ever tried to learn to cook yourself? Who would you go to, a surgeon or a chef? A surgeon usually has a full time job cutting into people, not veggies (oh, and fixing things, then sewing them up). Also, did you know there is a whole section in bookstores just for cookbooks? Plus there is the Food Network, which has many videos online. You might want to try it.

By the way, eating healthy will do nothing for my son’s hypertrophic cardiomyopathy. And it won’t do anything for many of the people with Type 1 Diabetes. And not a thing for infectious diseases like pertussis, measles, malaria, dengue fever, etc.

Here is a list of things of “SEVERAL important risk factors which Dr. Fuhrman” missed:
1) genetics
2) environmental factors
3) infections

17. #### daedalus2u

/  September 19, 2010

There are some infections that starvation improves the course of. I think that is why people usually lose their appetite when they are sick.

but some it does not.

http://jn.nutrition.org/cgi/content/full/136/5/1141

Look at reference 1 in this last citation.

Correcting anemia in end stage kidney failure patients to a normal hemoglobin level increases the death rate over raising it to a lower level.

• #### PalMD

/  September 19, 2010

A brief correction: correcting Hb in chronic kidney disease to a target level of > 13 may increase the risk of serious adverse events. Latest guidelines recommend target level of 11-12.

The main benefit to correcting Hb in CKD is quality of life rather than mortality.

18. #### daedalus2u

/  September 20, 2010

The paper I was remembering is this one.

http://www.nejm.org/doi/full/10.1056/NEJM199808273390903

which may be out of date. I was just trying to point out that a state of “anemia” may be more “healthy” than a state of non-anemia (depending on the criteria used which need to be measured by clinical trials because until we measure such things we don’t really know) and a simplistic “more nutrition is better” can fail.

19. #### PalMD

/  September 20, 2010

Other similar studies you may be interested in have to do with blood transfusion in critically ill patients.

20. #### daedalus2u

/  September 20, 2010

Yes, I have seen them, and the effect of hemoglobin levels in pregnancy are quite interesting. I am pretty sure it relates to NO; all the diseases associated with anemia are low NO-type diseases and that lowering hemoglobin levels are an adaptive response to low NO (Epo expression is mediate through NO controlled pathways, high NO produces Epo which increases hemoglobin which decreases NO).

Hemoglobin is the sink for NO, and in cases of prompt anemia, the NO concentration goes up (at constant NO production it is the product of [NO] times [hemoglobin] that remains constant (production =destruction)). You can see NO levels go up in exhaled air during loss of hemoglobin.

I suspect that anemia during sepsis would reduce multiple organ failure because the NO production rate would not need to be so high to get NO levels sufficient to suppress biofilm formation in the vasculature. I suspect that is where the anemia of pregnancy comes from, that some degree of anemia reduces death a little bit from puerperal fever.

21. #### Zuska

/  October 21, 2010

Wow, I guess it was totally my fault when I had that migraine that gave me that stroke. I guess this is why people are always asking me what I did that caused the stroke. They want to know how I sinned.

Fuck you, Furhmanites.

• Ars longa vita brevis