Whitewash, by Joseph Keon

In this book-length indictment of the use of cow’s milk for human consumption, Keon leaves no stone unturned. Exhaustively, he offers us information on why cow’s milk is not good for humans, either children or adults; on contamination of milk products; on how the calcium in milk does not do a body good, in fact it weakens bones; on the association of dairy products with a myriad of human diseases; on the environmental effects of dairy farming (and a brief synopsis of the agonies of being a milk cow); and finally, on how to give up dairy products and lead a healthier life.

There is much good here, and I recommend having this book on your reference shelf. However, be careful with how you use the information. Keon is generally careful about making connections between dairy consumption and human health, for example, by saying milk “may” cause this or that disease or have an effect on it, when he is not certain that studies have made the connection conclusive.  At times, though, the sources he cites are not credible. For example, he makes connections between dairy consumption, vaccines, and autism, citing various studies by Andrew Wakefield that have since been discredited. He should have known of this discrediting and either found other, better sources (I am not aware there are any) or mentioned the cloud hanging over Dr. Wakefield. 

He also sometimes uses second- or third-hand information. For example, a reference to a Consumer Reports statement comes from an article in a newspaper rather than directly from Consumer Reports.  

To his credit, most sources are direct. Also to his credit, Keon does an admirable job describing the mechanisms by which our bodies handle different food products or contaminants. To me the descriptions sounded believable. However, Keon is not a doctor or scientist. He is a “wellness expert, nutrition and fitness expert”. Frankly, these are not titles that inspire confidence in me. There are no governmental standards for what a nutritionist or fitness expert must learn, and the various “wellness experts” around town are all self-described. This does not mean that a non-professional cannot write a good book about milk. He’s clearly knowledgable and understands a great deal about the human body, but the few issues raised above suggest to me that he would have done well to coordinate the writing of this book with a medical doctor or appropriate scientist. 

The book contains a wealth of supplementary information, from the cited sources to a separate “recommended reading” section. It therefore rates a place on any health-conscious person’s reference shelf.

The Obesity Myth, by Paul Campos

“I have a glandular problem,” sneers the unattractive, heavy, odoriferous mother of a serial killer in the television series Bones.

Here you have a rather typical, if overdone, version of a fat person as shown on television or in the movies. If she's fat there is something fundamentally wrong with her. She's unlikeable, she smells, she blames a condition or others for her fat. She's morally bankrupt.

A more sympathetic version is Bridget Jones as played by Renee Zellweger in the movie Bridget Jones's Diary. She's a little “thick”. I don't think “heavy” or “fat” apply here. In fact, the actress gained weight to play the part but she is still an average weight in this movie – just fat in comparison to other movie actresses. But the story here is a cinderella one in which the glam guy goes for her even though she's fat. Which she isn't, really, but let's play along.

Fat people don't get the title roles except in unusual circumstances, like Cracker (British version, with Robbie Coltrane, incredible actor) and Murder One (another terrific show in which the lead, the charismatic Daniel Benzali, is a mite chubby (and bald)). Fat people don't get asked on dates, except by so-called BBW-lovers. Fat people don't get promoted. And fat people are the butt of major jokes, some of which are full-length movies.

The cultural disgust with large persons is grounded in myths about what large people represent. The disgust isn't because thin people are concerned that fat people are unhealthy. However, the medical community has jumped wholeheartedly on that bandwagon. A day doesn't go by when we don't see an article somewhere that points out the “fact” that because they are fatter, this generation is going to die sooner than their parents.

In the Obesity Myth, Paul Campos sets the record straight. And does so with a passion often absent from medical nonfiction, along with a healthy dose of humor.

Early on, though, he makes a note in passing that he was fat and now he's not, and he'll explain later. He makes the comment to underline the fact that he knows what it is to be fat. I appreciate that but at the same time I found myself wondering as I made my way through, just what will he reveal about himself later? Is he going to reveal some sort of super diet after all??

Fortunately, he does redeem himself later, through his honesty and insight into himself. He can write passionately about the pain and frustration with the diet industry because he is, as much as any of the rest of us who obsess about weight, a victim. Even knowing the facts does not change what we want for ourselves. It turns out that this personal section, for me, is the best part of the book, because it brings it home.

But first, what are those facts? Campos tells us more than once (and a good thing, too; some facts bear repeating):

* It is healthier (from a mortality standpoint) to be 75 pounds overweight than 5 pounds underweight, if you are moderately active. Moderately active translates to four or five brisk 1/2-hour walks per week. I have read elsewhere that the difference is two hours of moderate exercise per week, which is comparable.
* Two persons of the same weight and height can respond to the same food in entirely different ways. In one experiment, 16 persons were “overfed” by 1,000 calories per day, six days a week, for eight weeks. Their activities and food intake were strictly controlled. Their caloric burning capacity was measured. The experimenters discovered a huge range in energy expenditure: from 0 calories to 692. In other words, some subjects burned 692 more calories per day than others, while engaging in similar physical activities and eating the same amount and type of food.
* Dieting is the problem, not the solution. Persons who go on calorie-restricted diets lose weight, then regain it, and gain more. The more often they diet the more they ultimately gain. There are few exceptions. (The exceptions are interesting and a little scary; read more about them in this book.) Although many feel virtuous when dieting, feeling hungry is not good for your body.
* There is no difference in mortality between persons of average weight and persons of higher weight in terms of overall health, when you control for levels of activity and type of food they eat. Shockingly, even the standard claims that fat persons are more likely to develop heart disease and type 2 diabetes are not supported by the facts. The association between fat and heart disease actually is a connection between those who have gone on calorie-restricted diets and heart problems. Those at the same weights who never dieted do not exhibit these heart problems.

Weight itself is not a problem for mortality. If there is no “healthy weight”, then (thin persons can be unhealthier than fat ones, for instance), there can be no “overweight”. The only time weight is a factor is when it is so extreme that it makes the person essentially immobile.

Why then do so many of us believe fat people are unhealthy? We can all point to relatives who lived long and satisfied lives in spite of being large. We all know many thin persons who are unhealthy. It is true that being fat usually limits our ability to move as well as we'd like, take part in some activities we might otherwise enjoy. Why – admit it – are you thinking right now that I am making excuses for myself??

I struggle with that last. As a vegan I know that I am seen as an example of a group of people who eat differently than most other Americans. I feel an obligation to be seen as healthy and well, and I know that to many I do not appear to be, mainly because I'm fat.

Campos phrases it differently. He answers the charge, “You are giving people permission to be fat” with the countercharge: “As opposed to what: not giving people permission to be fat?” and then points out just how well that approach has worked in the last 100 years. It is just that approach that has taken us here, ironically. Stigmatize, attack, accuse people of being lazy, immoral, dirty, ignorant, lacking in willpower, and what happens? Eventually they believe it. In spite of evidence to the contrary, often evidence anyone can see. And it is incredibly difficult to change the way you think about yourself when you've had so much help over the years.

There are no absolute answers here, no roadmap to a brighter future. The forces that have brought us to this place are larger than we are. Campos does help us see beyond “common knowledge” and suggests that we replace myth with reality. We need more books of this caliber on this subject.

How Doctors Think, by Jerome Groopman, M.D.

A terrific book. Groopman takes on the task of figuring out how doctors make decisions about treatment. He finds that the majority of medical mistakes come from certain types of thinking patterns that doctors fall into. He offers simple suggestions to both doctor and patient to help the doctors break out of these patterns in particular cases.

Patients and doctors can benefit most by understanding the "three As", as they were termed by one reader:

• anchoring

• attribution

• availability

"Anchoring" is seizing on a set of symptoms, making a snap diagnosis and not looking further

"Attribution" is making assumptions about a patient because of certain patient attributes - old, young, complainer, whatever. In an episode of House the patient was a hugely obese man who insisted that the doctors look past his weight for what was wrong with him. Turns out he was right; the diagnosis was bad but had nothing to do with his weight.

"Availability" is the tendency to remember, in a flash, similar cases and assign the present case to the same group. For example, if the doctor has been treating a number of people with abdominal pains and they all had acid reflux he might jump to that assumption in a similar case because the diagnosis is "available" - frequently used, easy to call on.

I am sure I haven't described these as well as I could. What is critical for patients is to ask some meaningful questions when they feel the diagnosis may not be right for some reason. Here are the questions Dr. Groopman suggests:

"What else could it be?" - this question can break the physician away from a snap diagnosis.

"Could two things be going on at once?" In other words, might there be two problems instead of one?

"Is there anything in my history or the tests that seem to be at odds with the diagnosis?" Sometimes doctors see symptoms that "don't fit" but simply label them "atypical". This question brings those symptoms to the front.

I want to give a copy of this book to the doctor I have seen a few times, the doctor I am starting to consider my primary physician. I think all doctors should read it, and in the case of my doctor I suspect he actually would. It's a great resource, written compassionately and clearly, that does not condemn doctors; instead it can help them be better than they are.

Overdosed America: The Broken Promise of American Medicine, by John Abramson

You may have suspected it. In spite of the incredible expense poured into our health care system we aren't any healthier. Here, then, is the proof confirming your suspicions and the why.

Near the end of the book Abramson, a long-time family doctor who has an extensive background in statistics, epidemiology, and health policy, puts it simply: the bad news is that many of our celebrated advances in medicine, including new drugs, medical procedures, and sophisticated equipment, do not perform as well as older treatments and cost a great deal more. The good news is the same! If we knew what really works, based on unbiased well-designed studies, we would not need to use expensive treatments, equipment, or drugs nearly as often as we do, and we'd be better for it. In other words, our health care costs would drop and our health would improve.

Our health care system has gone so far astray that in comparisons with other developed countries the U.S. pays twice as much for abysmal results. And it really is not an accident. And it isn't because we eat too much fried food (although, of course, we do have to take responsibility for choices within our power). Read this book and find out for yourself. It's easy to read, clearly written, easy to understand. And so important. I would like every one of our political leaders to have a copy.

The Secret History of the War on Cancer, by Devra Davis

The book I and likely many others have been waiting for. The book that asks why the focus on cancer has so much been on cure and so little on prevention. The book that asks why we know so little about the environmental basis for cancers.

Davis, an epidemiologist, actually thought of this book many years ago, but was persuaded to set the idea aside or risk her own career. Now that she is established and at less risk she has laid it all out for us: it is no accident that we don't know much about the environmental causes of cancer.

Yet it wasn't always so. Davis points out that in the early part of this century, into the 1930s, a great deal was already known about how substances like asbestos and professions like coal mining are directly linked to cancer. Even more astonishing, companies that made or mined cancer-causing agents freely admitted the connection. And much of what we believe is new information about many chemicals was known then. So why were we in the dark for so long?

The scene has changed. Hiding behind "trade secrets", companies routinely deny any knowledge of the harm their products do, even when their own investigators have proven otherwise. Most significantly, the industries responsible for so much cancer - through their pollution of the air, the water, our food, our land - have learned an effective way to delay any real action: they sow the seeds of doubt. We saw it in the tobacco companies. We see it now in the global warming deniers. They give the impression that they are all over this, that they want the answers as much as we do - to prove it, they fund "further studies". But of course nothing can be done until those studies are complete.

And they have it easy. In this world, nobody is safe from man-made contamination of the environment. It is impossible to determine without a doubt exactly which product or exposure caused cancer in a particular person. Worse, courts have tightened the burden of proof requirements so that a plaintiff has to show overwhelming evidence of causation by a particular agent. It's easy for the accused to point out that we live in a chemical soup so who can honestly claim this or that exposure was the one that caused the cancer?

Davis lays out the case against the corporations and the colluding government agencies with compelling evidence. She further calls for an end to "further study". We know enough, she said. The time to act is long overdue. I can only hope enough people with power hear her.

book rating: 9 out of 10

Rethinking Thin, by Gina Kolata

Why are some people fat? Why do they stay fat or regain weight after losing it?

In Rethinking Thin, Kolata doesn't have the absolute answer to those questions but she takes us a lot farther than most. We've all heard various "facts" about obesity and dieting over the years, so often that many of us don't question their truth. Kolata asks different questions and gets surprising answers from controlled studies, which she summarizes here. Her investigation is hung on a frame: the story of real people who are subjects in a two-year study that compares two different types of diets: Atkins and a standard low-fat alternative.

Do you want to know which diet comes out ahead? That's the wrong question and Kolata knows it. The fact that huge research centers spend all their time on this type study is one indication of how the so-called science of weight loss has failed us.

When I was working in various offices my co-workers invariably included many who wanted to lose weight. These people kept looking for the right diet, and those who were succeeding in losing weight would dispense advice about how they did it. During part of that time I had been "successful" and was managing to maintain a healthy weight, so people would ask me for advice too. One thing I knew: it is possible to lose weight many different ways. The real problem is keeping it off. And on that front I had no magic answers. I only said that for now I was managing, I was keeping on top of it, my mind was in the right place, but I had no idea why or whether that would remain so. I have since "slid". I have regained much of that weight, and it happened much as a balloon once filled with air more easily takes air the second time.

A few interesting facts:

* when naturally thin people force themselves to gain weight (or gain weight because of some unusual situation) and fat people lose weight and both groups weigh the same (lower for the fat, higher for the thin) it takes fewer calories for the fat people to maintain the same weight as the thin.

* normal people who are forced to lose weight (like in a concentration camp or in a controlled study in the military) they become obsessed with food. They dream of recipes, they buy kitchen equipment. When they get freed to eat as they like again they eat enormous amounts, much more than they would have if they had never dieted.

* hunger is a drive that is far harder to resist for a fat person than a thin one. It is totally distracting and almost impossible to resist.

* there does appear to be a "set point" for most of us. Usually we waver somewhere within 30 pounds of that set point, regardless of how we eat. Thin people who say they maintain their weight with constant vigilance, that if they gave in to their urges they would become huge, are actually not correct; they would gain maybe ten pounds, maybe a bit more, and then stop, and it would not be difficult to go back to where they were. I have long noticed that the diet companies are clever to focus on those who are naturally thin who might have gained five pounds over a holiday - these folks won't have a problem losing the weight or keeping it off.

* some people are born without a hormone - I think it's a hormone - that regulates food intake. They are always hungry and gain weight rapidly and will eat anything. There are examples in the book of some who have been helped by regular injections of this chemical, and the help has been amazing. There was an episode on House recently that featured a young woman who had always been fat. House actually found a medical condition that explained it, and when corrected she lost that weight. There are, in other words, some medical conditions that do cause people to gain weight.

* fat people really do have more fat cells than thin people. When we fatties lose weight we do not lose fat cells. Instead, they become starved, wanting to be filled again.

* when sodas were removed and healthier foods added to cafeterias and increased exercise required in some studied schools, these changes made no statistical difference in body mass of the students.

* here's a kicker: people who are very thin or very fat have a mortality rate higher than the normal. Those who are overweight but not in the "morbidly obese" category actually have the edge on living longer. Fat people do experience medical conditions, like diabetes or arthritis, that are more debilitating than thin people, but statistically these diseases do not affect longevity. In other words, obesity is not as dangerous as you thought.

Kolata suggests that perhaps we are all born with a certain possible top weight. Because of the food available to us, many of us have reached higher weights than ever before. She concludes that it takes an enormous amount of so-called willpower to stay on a rigorous diet and exercise program for a long period, and that it takes a great deal more will for a fattie than a thinny, given that it takes fewer calories to maintain the same level in the fattie and that hunger is a more powerful drive in the fattie.

I read somewhere else that it is possible to change the set point, through regular exercise. I managed to keep weight off and to exercise regularly for a long time but that did not save me ultimately. When I was forced to rest because of an injury I seemed to have a brief "grace period", when I could maintain my weight, but then the pounds started creeping back on again. And now that I am fat again and faced with debilitating arthritis I am finding it much more difficult to get in enough exercise to cause a reduction in pounds.

This book is important for sorting out what's true and what isn't, what we know and what we don't. It is a quick read, interesting and informative, and perhaps most importantly it skewers the weight-loss industry. The folks who are getting rich off our heavy backs, who find it in their best interest not to tell us the truth.

I am hoping that further research into the areas that matter will take place and that someone like Kolata will let us know about it.

book rating: 4.5 out of 5