Authored by Dr. Michael Greger, Care2
"The majority of U.S. fatalities are avoidable and linked to dietary choices." The Global Burden of Disease study—the most thorough assessment of risk factors ever conducted, backed by the Bill and Melinda Gates Foundation—reveals that what we eat is now the leading cause of death and disability in America, pushing tobacco smoking into second place. Cigarettes currently claim roughly half a million American lives annually, while poor nutrition accounts for hundreds of thousands more.
If the majority of mortality and morbidity is avoidable and stems from diet, then nutrition should undoubtedly be the primary focus in medical education and the main subject physicians discuss with patients—correct? Why does such a gap exist between scientific evidence and actual medical practice?
Consider a mental exercise. Picture yourself as a cigarette smoker during the 1950s. Back then, the typical annual cigarette consumption per person reached roughly 4,000 sticks. Reflect on that number. In that era, the average U.S. citizen lit up half a pack daily.
The video embedded below displays a collection of 1950s cigarette advertisements featuring Hollywood celebrities, top athletes, and even Santa Claus endorsing smoking. The takeaway was unmistakable: to remain fit and slim, you had to smoke. Print ads also promoted hot dogs as a way to stay lean, and urged consuming plenty of sugar to keep both slender and trim. One particular ad went so far as to assert that sugar was less fattening than apples. Apples! Meanwhile, an internal tobacco industry memo noted, "Apples connote goodness and freshness and we see many possibilities for our youth-oriented cigarette with this flavor."
Those 1950s advertisements communicated that, beyond keeping "fit," "slender," and "protecting against throat irritation," you could smoke "for digestion's sake." One ad for Philip Morris stated, "No curative power is claimed for Philip Morris, but—an ounce of prevention is worth a pound of cure." Following that logic, better safe than sorry—so you'd better smoke. Much like eating, smoking became a family activity. Marlboro commercials depicted infants with speech bubbles reading, "Gee, Mommy, you sure enjoy your Marlboro," "You're darn tootin my dad smokes Marlboro…he knows a good thing," and "Just one question, Mom…can you afford not to smoke Marlboro?" Another 1950s ad showcased a picture-perfect nuclear family: the father receiving cartons of cigarettes from his adoring children—a boy and a girl, naturally—while even the family dog holds a carton as his devoted wife looks on.
One tobacco firm used the slogan "Blow in her face and she'll follow you anywhere," while another declared, "No woman ever says no to Winchester." Cigarettes were marketed as "so round, so firm, so fully packed." And John Wayne himself smoked them—until lung cancer claimed his life.
In those days, even the Flintstones were depicted smoking, and doctors were no exception. That's not to imply there was no debate within the medical community. Some advertisements featured physicians smoking Camels, while others showed them preferring Lucky Strikes—so opinions differed. Indeed, "eminent doctors…on high and impartial medical authority…call for Philip Morris." Even "leading nose and throat specialists" could not agree on which cigarette was gentler on the throat. Perhaps it's safest to rely on science, as another ad boasted, "more scientists…smoke Kent…" This shouldn't be rocket science—yet even rocket scientists had their preferred Viceroys for "the man who thinks for himself."
Can you fathom why the American Medical Association (AMA) "went on record as withholding endorsement of the Surgeon General's Report on Smoking and Health, which documented the important role of cigarettes in…lung cancer"? A ten-million-dollar "gift from the tobacco companies" might have played a role. Yet why didn't more individual physicians raise their voices? A handful of courageous, forward-thinking doctors wrote to medical journals then—just as some do now—opposing industries that claim millions of lives. But why weren't there more?
Perhaps the reason is that "the majority of physicians themselves smoked cigarettes," mirroring how today most doctors still consume foods that fuel our epidemics of diet-related illnesses. What was the AMA's slogan at the time? Everything "in moderation." The organization declared that "[e]xtensive scientific studies have proved that smoking in moderation" is acceptable.
Consuming the Standard American Diet nowadays is akin to being a cigarette smoker in the 1950s. Smoking was ubiquitous then—now consider the meals we serve to hospital patients even today.
We don't need to wait for society to align with scientific evidence. Medical change often requires an entire generation. The older cohort of smoking doctors and medical educators eventually passes away, replaced by a new wave—but how many patients must perish during that transition?
Discover the findings of a study on the effects of a 10-day sugar-free diet on the human body.
I attempt to address the question that occurs to nearly everyone who begins exploring lifestyle medicine: "Hold on. If this is accurate, why didn't my physician inform me?" For instance, if our leading cause of death can be reversed through dietary changes, why isn't it headline news, included in every medical curriculum, proclaimed from every peak by health organizations, and incorporated into official government dietary recommendations?
