On Thursday, Jan 17, 2013, a friend wrote me:
On Sunday, January 20, 2013, I responded as follows. I've added paragraph headings so it's easier to navigate.
The First Big Milestone
The Second Big Milestone
The Second Big Milestone, For Me
Leaving The Safe Zone
The Third Big Milestone: Emotional Stability, Empathy, Social Development
The Secret Of Success
The Secret Of Failure
This past year has seen one of the most incredible developments of my life.
I'll describe this like a case study, in narrations of increasing detail.
This is a long post that I've made easy to stop reading at any point, without losing the big picture.
Case Study: Saving A Whole Family's Quality Of Life In Weeks Through Food
I dropped my cholesterol over 50 points in 5 weeks, gave dad a brighter future, and improved our health just by eating more vegetables, and enjoyed it for 10 months and counting.
Before dad's heart attack, family and I thought we knew how to eat and live for optimal health. He is a retired medal-winning national athlete, almost underweight, low cholesterol (160 mg/dL at the time), ate lots of vegetables, avoided too much meat and unnecessary fat, and mum used only extra virgin cold-pressed olive oil in their cooking.
Dad's shocking November 2009 heart attack at age 67 shattered my family's hope for the future and reminded us of my uncle's death from ischemic heart disease at age 40, just weeks after being passed a clean bill of health from the local National Heart Center after a battery of tests, including stress testing, and leaving behind three young children.
Granted, my extended family is not very healthy, with obesity, heart disease, diabetes and gout finding its way to various members, but dad had been something of a health zealot and shining example up to this point.
Yet, when I arrived in Singapore next to his hospital bed, it saddened me deeply to find him in the state he was in. He had lost hope in the future and did not even have an opinion about his medical condition - I could see that he had given up on life when he did not even ask questions of the cardiologist, simply accepting, even welcoming, one short-term medical procedure after another, including two drug-eluting stents, almost had a third inserted, and a pacemaker to boot. Shockingly, two out of three of the most critical coronary arteries were blocked, one 90% and the other 99%. When I tried to share my latest research, he did not want to hear it. He did not want to talk about his condition. Understandably, dad's heart attack had convinced him that everything he had believed in about how one's health destiny is in one's own control had been proven wrong in a single instant that dreadful November morning at 5am, Friday the 13th.
Dad is an important part of me, and it was obvious that if I couldn't help my own father, my situation would be far worse, without a doubt. My cholesterol level was 192 mg/dL, and I was only slightly over half my dad's age. I was something of a direct opposite to dad. Married to computers as a child long before I met my wife, I had embraced a sedentary lifestyle. I was diagnosed with borderline high cholesterol as a teenager, long before the advent of the statin family of cholesterol-lowering drugs, something I am now thankful for, as you will see below. I had developed multiple environmental allergies by 12 years of age, and received major maxillofacial surgery to treat their side-effects by age 14, which resulted in irreversible changes to the structure of my nose that came back to haunt me over 15 years later as chronically narrowed and blocked airways.
Not surprisingly, my productivity began going rapidly downhill several years ago, and I was diagnosed with sleep hypopnea at age 34. Understandably, I have something of a love-hate relationship with doctors, and friends consider it unlikely that I would accept the trouble and expense of going for a sleep study. The turning point came when I brought my wife along to see the allergist in her private practice, and later learned that she had pleaded with her to do something about my health. I had been chronically tired at home, having to pull long hours at work just to catch up with the Joneses of performance, not even having the energy to play with my daughter. The allergist explained to me that if I did not do something about my health, and soon, I was on my way to waking up tired as usual one morning to find my marriage beyond help.
Yet not a single medical professional had correctly diagnosed my allergies to cats, dogs and dust mites when I lived in the tropics in a family that, at one point, had kept 8 cats! Not until, that is, I saw this Google doctor that took the time and trouble to explain my history to me, guided my research, and revealed the truth about my past. But my trust of doctors was already eroded far beyond restoration from my life experiences. Heart disease had been high on my consciousness. Prior attempts to control my own cholesterol with diet and lifestyle had at most resulted in a 20-30 mg/dL reduction. I had even tried going (ovo-lacto) vegetarian at one point, but the headaches eventually got to me, and I had to go back to meat. Eventually, the chest pains that awakened me in the middle of the night, even before my dad's heart attack, had alerted me that something was wrong, despite what the doctors said about my excellent apparent cardiovascular and lung health indicators, and I had by this time already put a fair bit of time into researching the disease. Yet most of the information I found was TBU - true but useless.
Following my dad's heart attack, I pursued the subject with renewed interest and desperation, keeping a gruesome schedule of full-time and over-time research during a combination of leave of absence, vacation time and family leave, determined to save my family, enlisting the help of some of my friends.
I was blown away when I finally discovered the startling truth from Dr Caldwell Esselstyn of the Cleveland Clinic, one of the leading heart centers in the US: heart disease could be prevented and even reversed through diet, in many cases even without exercise. I had heard about such fads when researching the subject before, but this time, I was staring at peer reviewed scientific literature in the face, backed by 20 year longitudinal studies - the longest of their kind. And Esselstyn wasn't the only one. All the Dean Ornishes, John McDougalls, Joel Fuhrmans, Neal Barnards and Francine Kaufmans of the world, despite their superficial differences, were saying the same thing at the core: not only heart disease, but also diabetes and obesity, all the diseases that were killing my family, could not only be prevented, but also reversed, in many cases through dietary changes alone. And every single one of them had thousands of real patients to show for it.
I learned that medical science had known about these scientific findings relating diet to the diseases of affluence for decades, but finding no money to be made, it was neglected by industry. Doctors who attempted to call out specific health benefits of such diets were once labeled quacks, and branded as naturopaths together with a dozen other pseudo-sciences. I was both elated and furious, realizing that all the pain in my extended family over decades past had been completely unnecessary.
Further, these were not austere changes, but involved no calorie counting, no meal planning, no food diaries, eating whenever and however much one wanted, and more than before. The key lay in how the food was prepared, and the broad categories from which to choose the most nutritious foods from, covering every known and every unknown nutrient. And there were hundreds of recipes supporting these ways of eating.
Then I focussed on getting the message through to dad. It took no less than three weeks of constant opportunity-seeking and careful conversation to finally get the message through, and then he opened up to the body of knowledge I had found. we resolved to put our newfound knowledge to the test. And our results were more spectacular and more swift than any could have dreamed. Within 5 weeks of embracing a new way of eating, I dropped my total blood cholesterol from 192 to 138 mg/dL. Then I returned to work, and in a few more weeks, it had fallen further to 126 mg/dL. In addition, my LDL fell from 131 mg/dL to 93, and finally to 73 mg/dL. Within two months, I had eliminated multiple risk factors for having the disease. Then in 6 months, I discovered that my chronic cough had disappeared, and I don't remember when it had left me. After 8 months, I began to notice an increase in my tolerance for sleep debt. My insomnia still remains, but at least I am now better able to cope with it. I now understand that exercise may be the solution for that, and am just beginning to introduce it.
Dad's results are no less spectacular, but it will be impossible to tell how much was due to exercise and how much to medications. From 160, his total blood cholesterol plummeted to less than 100 mg/dL, and his cardiologist halved his cholesterol lowering medication to 10 mg/day. At these levels, we know from Esselstyn's studies that heart disease begins to reverse itself, and we will know in 2-3 years to what extent it has reversed. We also know that, as the months go by, dad's chances of a second heart attack will begin to stem more from the stents than from the disease itself - from sudden thrombosis (blood clotting) due to the damage the stents have done to his endothelium, which in the case of drug-eluting stents, can take over 3 years to heal. For this reason, he will have to continue on anti-clotting drugs and, as a result of their side-effects, on digestive medication too.
In addition, my wife and daughter, though skeptics at first, eventually began to follow gradually, and at least for my daughter, the benefits to her quality of life and development were likewise swift and undeniable. But I should let them speak for themselves.
Long Version With Supplementary Content
Before dad's heart attack, I thought I knew how to eat healthy. More vegetables, less red meat, more fish and white meat, less fat, more protein, less sugar and salt, less bad oils, more good healthy oils, etc. Dad ate even more carefully than me. A retired national athlete, almost underweight, thin and lanky, lots of vegetables, less meat, low salt, almost twice my age but with blood cholesterol levels over 30 points below mine.
With one coronary artery 99% blocked and the other 90% blocked, he had been surviving for years with only a fraction of healthy blood flow to the heart, and no-one had known about it. All those years of competitive endurance training out in the sun paid off. But it didn't pay off long enough, and he eventually succumbed.
The heart attack shattered our worlds. I began to question everything we knew about nutrition, and researched frantically as he lay in hospital. I discovered, for instance, that the drug-eluting stents they inserted just hours after his attack would not reduce his chances of suffering a second heart attack. That once the drugs wore off the stents in 1-2 years, the risk of a sudden blood clot due to the damaged caused by the stents increases 40%. That unless he diligently continued his coctail of 6-7 different medications for two years without ever missing a dose, that clot could happen much sooner. I began to lose hope, thinking that life was beyond our control. I began to wonder how the heck this kind of treatment could end up getting approved by the FDA and the AMA. But what's far worse is he had already lost hope in the future. He didn't want to hear what I had found, didn't want to question the doctors, just accepted whatever they were going to do. It was as if when his heart was starved, his spirit had also been crushed. One by one, our relatives had fallen victim to this and related diseases, and now, he, too, had lost the battle despite his utmost efforts.
Then another Googler suggested I research Caldwell Esselstyn's work at the Cleveland Clinic, one of the top heart centers in the US. It introduced me to a body of scientific research and medical practice that begun in the 1970s by Dean Ornish demonstrating that, in most people, coronary artery disease can be reversed through dietary and lifestyle intervention. And it wasn't austere intervention, like the carbohydrate-restriction diets or the stressful caloric restriction experiments we often here about. Some of Esselstyn's patients survived 20 years longer than their cardiologists predicted, while also eating as much as they wanted and as often as they wanted, and with no instructions whatsoever in the way of exercise - just dietary changes alone. The trick lay in what they ate. And he had demonstrated irrefutable evidence of halting or reversing the disease in the way of MRI scans and angiograms.
Astonishingly - and this particular finding still amazes me today - in as little as three weeks, his patients' blood vessels regained their ability to dilate despite the arterial plaque - enabling blood flow around existing blockages. As a result, many of his patients saw a reduction in their chest pains (angina) within 6 weeks.
What was even more appealing to me was that a relatively simple measure - blood cholesterol profile - was typically only a weak predictor of heart disease risk at levels that we consider "normal" in developed countries and developing world cities, but once lowered below 150 mg/dL of blood, it became a very strong anti-predictor. That is, epidemiological studies had proven again and again over many decades that coronary artery disease is not just reduced, it is totally eliminated when total blood cholesterol is consistently below 150 mg/dL, and when low density lipoprotein (often called the "bad cholesterol") - is also below 80 mg/dL, when achieved using whole, natural plant-based foods, not necessarily cutting out all animal products.
So this is all well and good, but sorry to say, those cholesterol levels are practically unheard of and impossible to accomplish, right? Well, it turned out that is exactly what Esselstyn achieved himself, in 1983, and then with his over a dozen middle-aged and elderly patients in 1984, then day after day, year after year, for 20 years thereafter. Granted, some were also on cholesterol lowering medication, but many of them eventually got off their medications altogether. They not only survived, they thrived - previously bedridden patients began jogging and traveling the world. And he did this for more than those 18 - he had other patients not included in his 20 year study.
But now the only question was, would it work for me? We had our doubts. You see, heart disease runs in the family. An uncle died at 40 from a heart attack. Grandmothers, uncles, aunts, grand-uncles and grand-aunts, everyone in the family seems to have the disease. But then I looked at the statistics, and it made me strangely happy. I learned my family was no different from yours, or anyone's for that matter.
In fact, 50% of Americans will die of coronary artery disease, and two-thirds to three quarters will silently or not-so-silently suffer some form of the cardiovascular diseases. Over 600,000 Americans die of heart disease alone, and from the so-called "diseases of affluence" - heart disease, cancer, obesity, diabetes, ischemic stroke - roughly a million and a half annually. This is huge. Men over 40 have a 50/50 lifetime chance of dying from a heart attack, as do post-menopausal women. Americans have a 45% lifetime chance of cancer. Yet these diseases occur disproportionately in developed and metropolitan areas, and are conspicuously rare or absent in rural developing regions. These numbers may look like bad news to you, but to me, it was music to my ears. It meant that if my genes are defective, then in all likelihood, so are the genes of three quarters of human beings - so are yours.
You see, it meant that heart disease in fact didn't run in my family. No, not really, it wasn't just our problem, it was everyone's problem. And that dad wouldn't have gotten a heart attack, if only we'd known about Esselstyn's work sooner. Dozens of migrant studies over the last several decades showed again and again that the disease has less to do with families and genes than previously thought. It meant we could save my immediate family by changing our diet and lifestyle factors and then work outwards through friends, family, coworkers, etc to rescue the healthcare system and eventually save the world. And so that's exactly what I set about to do.
And as if that wasn't enough, many of Esselstyn's patients achieved results in 3-6 weeks. So we said, we could try this and in 6 weeks we'd know if it works for us. I mean, one of us already had a heart attack, and the other is probably already halfway there - what did we have to lose? We looked at what exactly those dietary changes entailed, and it was remarkably simple. No animal products, no processed foods, no extracted oils.
This appeared difficult on the surface. No animal products, bummer. No processed foods, royal bummer. But no extracted oils? How was anyone supposed to cook? So it turns out, Esselstyn had already anticipated this, and included over 150 recipes, all without oil, from vegan jambalaya to tacos to pizza, in the second half of his book. I showed it to my wife and mum, and they got to work testing out the recipes. It turns out you can create many delicious new taste sensations by using water, steam and heat on various combinations of fruits, leaf, stem and root vegetables, fungi, beans and legumes, nuts and seeds, and various spices. And there are tons more kinds of plants than there are animals in the produce section, and so... next time you're at the produce section, go do the math. But no salt, no sugar, no refined flour, etc - no processed foods.
So one day we were both happily eating meat, salt, oil, cookies, whatever, and the next, both of us went Esselstyn. 5 weeks later, my total blood cholesterol level had plummeted over 50 points - from 192 mg/dL to 138 - and LDL was no longer in the danger zone above 130. This included a period of two weeks when I had to cook my own meals because in-laws were afraid to cook this way, so I began setting a silent example for them. One of them had severe heart disease too, but what puzzles me is that they never got it and never asked. It was analogous to the cocaine addict who doesn't want to ask why life is going downhill, because of course, it just can't be the drugs. I began to suspect that oil and meat are not just bad for us, they're addictive, they change the way we think and perceive the world.
And what about dad's results? Plus the cholesterol lowering medication, it was down below 100, and his dose of that medication had to be halved in the end. He could never get off, because of those danged stents that were now getting in the way of a total recovery.
Was that all? No. By the 8th week mine had fallen further to 126, well in the "unheard of" and "impossible" range. The question then became, how long will it remain below 150? By all indications, 9 months and counting...
Did I lose my enjoyment of food? Initially, yes. But not anymore. Two things changed. One, I learned to cook, and without oil - simple recipes. Two, my taste buds became remarkably sensitive. Now I can taste something with salt or oil added, and it turns me off. But you give me the high quality ingredients we source in our cafes, and I can taste the difference.
It's actually pretty remarkable. I can now tell the difference blindfolded between the nuttiness of a spinach leaf and the mild sweetness of french spinach, or the characteristic taste of the red orach spinach. As you might tell, a whole new world of vegetables opened up, taste sensations I never knew existed. The herbiness of fennel, the moist crunchiness of white and red-ringed chioggia beet. But this didn't happen overnight, it happened gradually over time, as my taste evolved. I learned to experience the richness of the world underneath all the salt and oil and fat that low quality ingredients need in order to make regular prepared foods addictive - so addictive that we forget what the real underlying food is supposed to taste like anymore.
This approach to eating has allowed me to break free of that. Doug Lisle explains in his book, The Pleasure Trap, that it takes 3-4 days for taste receptors to recover from the maladaptation to high fat, high salt, high refined carbohydrate foods, and 3-4 weeks for dopamine receptors to recover, and likens our addiction to unnatural processed food to cocaine addiction, except the latter takes 17 years for dopamine receptors to recover.
Actually there was a third change too, as my taste buds recovered. I developed new favorite foods. Or should I say, old favorite foods. These were foods I had loved as a child, but sugar, salt and oil had caused me to forget them. I fell in love - again - with sweet potatoes, oatmeal, grapes, raw cashews and almonds and new favorites like macadamias and walnuts, shiitakes, and so on.
Can I eat like this in the Google cafes? Most certainly, or almost. I get to enjoy the salad bars. As you might have guessed, quite a lot, and I'm actually very relieved that almost every cafe has a great salad bar. Only some of the salad items have oil, most don't. The only thing I miss is the oil-free prepared foods I eat at home, but I get to enjoy that back home, so it works out. I just find it a little sad that coworkers who want to try this will get the wrong impression, because they will miss out on the rich world of lentil stews, bean soups, whole food plant-based ice cream and popsicles, oil-free vegan pizzas and other delicacies, right when they need it most - during the first few weeks of their transition, before the flavors from whole, natural foods alone are sufficient to stimulate their dopamine receptors without the added fat, salt and sugar that the commercial food industry has accustomed them to.
Do I suffer from deficiencies? Initially, vitamin D. But vitamin D takes months to fall precipitously, so I was probably already vitamin D insufficient before I turned vegan, like 50% of californians are anyway, meat or no. So get yours tested. The problem is, the best way to get D is to run around in the sun and not bathe for a while so it gets absorbed from surface oils through the skin, and even us Californians just don't run around in the sun and not bathe long enough. Except those blessed enough to lack the ability to smell human sweat, but I'm not one of them, so... Anyway, I fixed that over 6 weeks with a low-dose D supplement (600 IU daily) and UVB sun exposure, so my D level is in the optimal range now.
Another thing one runs into is B12 deficiency. That, too, takes months to fall, and the B12 supplement I take about once or twice weekly has kept it steady smack in the middle of the normal range. Other than that, nothing. I get everything else I need from the whole, natural, unprocessed food I eat. At one point, I was worried about the EPA and DHA I wasn't getting from fish, so I even had a fatty acid profile done at Google, and no deficiencies there either. This is important - over long periods, fatty acid deficiencies have been associated with auto-immune and neural degenerative diseases, and allergies. So I'm glad I got that out of the way.
But how could that be? Aren't I missing the fat from oil? Well, no. As it turns out, romaine lettuce - or most leaves for that matter - is 11-15% calories from fat. So you can eat lettuce all day and still end up with a diet comprising 11% or more calories from fat. Add nuts, seeds, avocados, etc and it only gets higher - like I said, no measurements, eat as much as you want, as often as you want, whatever you feel like, from all categories fruits, vegetables, nuts, seeds, beans, legumes, mushrooms - and you can end up with as much fat as you could possibly want.
Won't I die from too little protein? No. Take spinach, weighing in at only 107 calories per pound. A third's from protein. That's the same as a beef steak, except half the calories of spinach are carbohydrate, while the steak is 2/3 fat, mostly saturated. Go figure, which is better for you.
Am I crazy or what, munching on spinach? So, some of you have seen me doing this, like a cow or a horse, or giraffe. Like I said, I didn't always enjoy munching leaves like that. My taste evolved. Along the way, I started mixing salads. Then I started blending fruits and nuts and carrot juice with the leaves, and still do, 2/3 pound of leaves (and since September, a full pound) every morning before I do anything else. And it tastes pretty good - I was surprised the first time I did this, how I couldn't taste the leaves because it was overpowered by the far stronger flavors of the fruit. At some point along the way I discovered I'd begun actually enjoying the leaves, especially romaine and spinach, oh - and the french spinach, absolutely godly - and that's when I turned into a giraffe.
Do I use salad dressings? No. But I don't have to not use them. It's just my choice, I just like the taste of raw nuts and seeds and cooked Japanese sweet potatoes and sliced fruit in my salads. Those who want results in 3 or 6 weeks can still use dressings if they want, just without the oil. You see, just a tablespoon of even olive or rice oil is still a tablespoon of fat, and weighing in at 120 calories, it means you'll eat over a pound less spinach or four entire cups less broccoli or whatever that particular day. Now, that's a lot less greens just for that tablespoon of olive oil, and by removing those greens, your health may well begin deteriorating again.
And a little background just so you understand how significant that is. It's becoming more and more evident from the research on phytochemicals over the last two decades - and that research is still going on - that blood cholesterol is only a marker of what you're eating and what you're not eating. The cholesterol your liver makes is itself not the only factor that has to do with your health outcomes. In fact, it's possible that for some diseases of affluence cholesterol may not even be involved at all. It might simply be a correlate, a sign that you're probably also consuming lots of other compounds in your diet, like the thousands or tens or hundreds of thousands of phytochemicals including carotenoids, tocopherols, polyphenols, peroxidoxins, glutathione, phytosterols, enzymatic anti-oxidants, etc - and more are still being discovered every day.
What I'm saying is, it may be what you're eating, plus what you're not eating, or both, that determines your level of protection from these diseases. And by eating that one tablespoon of olive oil, boy you've no idea what else you've just given up for that day, because you're not going to hunger it any more, so you just ain't going to eat it. Because the oil is so calorically dense, and it's already been exposed to the atmosphere, it's just not the same as what you'd get from the raw nuts and seeds, along with all the other nutrition that's been stripped from the oils.
And so I put this to the test. I tried taking 1-2 ounces of nuts and seeds daily for a month. Then I increased that to 3-4 ounces a day. And my cholesterol level increased - by just two points - 137 to 139 mg/dL. But hidden inside that 2 point increase was a 7 point drop in LDL, plus a 9 point increase in HDL, the so-called "good cholesterol." Which is even better for me. And so replacing the oil with raw nuts and seeds was way better for me than taking the oil and meat - which had taken my original cholesterol level way up there in the 190s. I'll probably never know which one affected it more, the meat or the oil, but I don't have to, and don't want to any more.
What about Google 15, eating all that food? So this part gets interesting. Most people know me as thin. But I actually put on 15 or 20 pounds over the years at Google, and I did notice a change in the fit of my clothing over time. So yes, Google 15 did get me, it's just less noticeable because of my body shape, or height, or something. But I didn't think I needed to lose weight. And so I didn't try to. In fact, I tried to do the opposite. When I changed my diet, I said, I'd better eat as much as I can or I'll become a skeleton. And so that's just what I did - gorge myself every meal I could. Some of you will have noticed the stacks of 3, or 4 or sometimes 5 plates I carry for lunch. I mean, with the new smaller plates, I'm going to just starve to death. I actually mean it. While eating all those multiple plates of food, I actually lost those 20 pounds and then some. But my weight seems to have since stabilized. And this agrees with the experience of many patients of the Esselstyns and the McDougalls and the Fuhrmans and the Ornishes of the world. Once people learn how to pick and choose the right ingredients to make the dishes, and the right dishes to make the meals, they end up eating more in order to stay full - and losing weight despite all their best efforts, until things reach a new equilibrium. It's almost like we're artificially and reversibly swollen, and as we improve the nutritional quality of our food, the swelling subsides and our enjoyment of food increases.
So what I'm saying is, once you've figured out the right categories of foods to eat, there're really no artificial limits worth imposing on yourself any more, and your cravings and appetites become a good thing to follow. It's like your food just turned into medicine, and the more you eat the better off you are. And then when you learn to make the right food - the food that's good for you - taste great too, combined with your heightened sense of taste, that's what allows you to enjoy your food, and more kinds of food, as well as just more food, better than you could before.
And there's more to this, like the story of my wife and daughter, but that's another story...