Monday, November 29, 2010

Death or Lentils

Disclaimer: What follows is not intended as a polemic against the vegan movement. Not that it’s any of my business what other people choose to eat and why, but it seems to me that at least two of the most common reasons cited for becoming vegetarian or vegan – not abiding by the suffering of sentient creatures, and supporting more sustainable ways to produce food for everyone – are compelling and worthy of anyone’s consideration, including mine. What I want to comment on here are some narrow and specific rhetorical strands in the arguments in favour of ‘virtuous’ diets and lifestyles, and how they fit within contemporary ideology and the discourse about mortality. Regular readers of this blog will be broadly aware of where I’m coming from; others, I hope, won’t take offence where none is meant. 

When I asked Joe what made him decide to change, he responded very simply. “We believed you”.

(Caldwell Esselstyn)

Dr. Caldwell Esselstyn thinks he knows the cause of heart disease, and how to cure it. He might know how to prevent several of the most common types of cancer, too. It’s all in the diet. Renounce meat, eggs and dairy. Say goodbye to nuts and oils. Eat to live.

His contention, simply put, is that all the foods just mentioned injure the endothelial cells and impair their ability to produce nitric oxide, a compound whose several regulatory effects are fundamental for the prevention of heart disease. While the basis for this hypothesis is epidemiological – based on observations of populations in certain times and places who ate almost solely plant-based foods and lived free of heart disease – the effects on the endothelium of different foods can be readily observed by means of the brachial artery tourniquet test (or BART), informing the dietary prescriptions I just outlined. Besides oil, nuts and avocados, animal products are forbidden then not on ethical grounds but because of their harmful effects, which can be measured literally as they pass our lips.

I am not equipped to evaluate any of these expert claims. I might note with a degree of suspicion that the praise for Esselstyn’s book comes mostly from authors of other books of very similar bent, such as T. Colin Campbell’s The China Study, Dean Ornish’s Dr Dean Ornish’s Program for Reversing Heart Disease, Oz and Roizen’s You: The Owner’s Manual and others. I might also note that the BART test is mentioned on the Net almost exclusively in discussions regarding these books. Mindful of the methodological criticism for The China Study, I might suspend my judgment until Esselstyn’s Prevent and Reverse Heart Disease is subject to the same scrutiny, or the results of his research begin to be replicated elsewhere and on a greater number of patients. That being said, some aspects of the prescription fit in with what we know about the lower incidence of heart disease amongst people who eat primarily or exclusively plant-based foods, so it’s not a question for the lay person of having to take it entirely on faith. Yet faith comes into it precisely because of the language in which the diet is presented and marketed, employing rhetoric that we are accustomed to hear from our spiritual leaders.

Let’s start with the title of Esselstyn’s first chapter: Eating to live. To live longer and free of disease is a reasonable aspiration and we may wish to judge the contribution of medicine to society according to whether it can deliver on this front and do so equitably. By offering a dietary as opposed to a pharmacological cure, Esselstyn empowers his patients to be their own healers, which strikes us instinctively as a good thing. The move also takes power and control away from pharmaceutical companies – another highly desirable outcome. But if agency rests with us, how are we to choose the correct course of action? After all Esselstyn’s cure (the italics are his) is one amongst many; Robert Atkins, for one, had a radically different prescription.

The fabulously named nutrition expert Marion Nestle has written convincingly in Food Politics about the successful efforts of various commercial interests to interfere with or complicate the advice by the US authorities on what a healthy diet should consist of. She contends that this advice hasn’t appreciably changed over the last several decades – to eat a varied diet, in moderation, and with an emphasis on plant-based foods. But you can’t sell that. For one thing, it is not new. For another, it is not sufficiently prescriptive. Esselstyn knows you need to be sterner. He blurts it right out: moderation kills. Why eat something that you know will hurt you, even in small doses? Isn’t that tantamount to taking a poison? You wouldn’t have a few cigarettes reasoning that you might develop just a small lung cancer, or take a little bit of cocaine  – he said in his recent interview with Kim Hill. And if the comparison with drugs strikes you as retrograde or strident, remember that the aim is 'eating to live'. That is the endgame: to preserve yourself, to save yourself. It is not about morals, unless you chose to regard living a long and healthy life as a moral imperative.

Now consider Esselstyn’s core audience: heart disease sufferers, people who are painfully aware of their shortened life expectancy. He promises them that they will live. For how long? It doesn’t matter. If you had had a couple of heart attacks, wouldn’t just the prospect of eventually dying of something else seem like immortality? And it is precisely what this is, an immortality. When Esselstyn says that ‘[n]o one escapes in the end’ he doesn’t mean that you will at some point die regardless of how well you eat, but on the contrary that ‘eventually the traditional western diet guarantees some form of disease in all of us’. Our lifestyle is corrupt, and that’s what kills us. It is not time, it is not life itself.

As for Esselstyn, well, Esselstyn is God: ‘I am uncompromising. I am authoritative. But as I always tell my patients, I am a caring presence.’ His objective is to ward off evil, to ‘annihilate heart disease’. And Esselstyn’s patients are the saved. All the participants in his twenty-six year study have been cured of heart disease, except for one. He tells Kim Hill that he visited this patient at his home, looked into his fridge and cupboards. Let’s just say he was disappointed by what he found there. The prescription hadn’t been followed to the letter. Yet it is very simple. It goes like this. ‘You may not eat anything with a mother or a face’. Not because it is wrong, but because it hurts you. Also: ‘You must not consume oil of any kind—not a drop’. These are god-like commandments, regular thou-shalt-nots – except the Bible for one is in fact more flexible, limiting dietary prohibitions for the most part to certain times of the week or the year.

I find the image of the forbidden drop of oil quite arresting. What is this deadly substance that can corrupt the body in the most minute quantities? This is where the medical-scientific project appears to veer into a quasi-neurosis, and everyday practices that are in other respects progressive develop disquieting vocabularies of othering and revulsion. Christchurch researcher Annie Potts coined recently one such word, vegansexual, to describe vegans who wouldn’t have sex with meat-eaters. Here’s what some of the respondents to her study, entitled ‘Cruelty-Free Consumption in New Zealand’, had to say:

I couldn’t think of kissing lips that allow dead animal pieces to pass between them. [49, vegan, Auckland]

I believe we are what we consume so I really struggle with bodily fluids, especially sexually. [34, vegan, Christchurch]

I would not want to be intimate with someone whose body is literally made up from the bodies of others who have died for their sustenance. Non-vegetarian bodies smell different to me —they are, after all, literally sustained through carcasses—the murdered flesh of others. [55, ovo-vegetarian, Auckland]

There is a convergence in these ways of conceptualising nutrition and the body, a yearning to make oneself morally deserving of being healthy, free from contagion. Consider again Esselstyn’s instruction not to eat things with ‘a mother or a face’: even when it is intended as a prophylactic measure, it is spoken in the cryptic language of the mystics, as if to promise a safety that is neither bodily nor moral, but rather symbolic and spiritual. Another immortality, one of the very few kinds that remain available to us; one that doesn’t require literal, conscious belief, yet informs how we relate to our bodies, to public health and to the attendant politics, amidst regular calls to exclude drinkers or the obese from public hospitals, or make provisions contingent to how well you have behaved, to whether you mended your ways and started to exercise.

As I pick up in the weeks to come where I left off long ago, and resume the discussion of other contemporary approaches to immortality that are mediated by engineering and computer science, I’ll be confronted by ideas that I find in many respects more seductive than those of the healthy lifestyle movements, and I’ll have to dig deeper to summon the necessary scepticism. It might help in those moments to think of my father. After his first heart attack, Dad had to undergo regular check ups, and if this or that doctor happened to praise him for his exceptionally low cholesterol he would sometimes respond: ‘One of these days I’ll make a very healthy corpse’. I take it to mean that he wasn’t fooled, and that he didn’t expect to be saved. To eat a little better so that he could live a little longer, hopefully, yes, but nothing beyond that – he let no higher power or greater virtue creep into his secular worldview. And not everything that passed through his lips was part of the cure.

The quotations from Dr. Esselstyn that are not indicated as belonging to his interview with Kim Hill on Radio New Zealand National of November 27th, 2010, come from chapter one of his book, Prevent and Reverse Heart Disease, which is excerpted here.

Dr. Annie Potts' survey, entitled 'Cruelty-Free Consumption in New Zealand: A National Report on the Perspectives and Experiences of Vegetarians & Other Ethical Consumers', was published by the University of Canterbury in 2007 and is availabe in PDF here.

On the darker undertones of the idea that we are what we consume, I commend this brief recent post at Uninterpretative.

Update: Proving himself once again a man far, far ahead of his time, Philip Challinor warned us of the danger posed by the treacherous lentil all the way back in 2005.

Update 2: M. Jansen has supplied in the comments the link to a very solid-sounding critique of Esselstyn's work by Harriett Hall on the Science-Based Medicine blog.