Dr. William Li is a physician and research
scientist at his institute, the Angiogenesis Foundation
in Massachusetts.
I recently had the opportunity to
interview him with DavidGornoski, and in preparation for that read
his
book.
“EAT
TO BEAT DISEASE shows you how to integrate the foods you already love into
any diet or health plan to activate your body’s health defense systems —Angiogenesis, Regeneration, the Microbiome, DNA
Protection, and Immunity —to fight cancer, cardiovascular disease,
diabetes, neurodegenerative disease, autoimmune disease, and other debilitating
conditions.”
Introduction
It’s an interesting book, and a bit different from any I’ve
seen before, in that he starts from what he says are the five functions essential for health and
repair: Angiogenesis, Regeneration, the Microbiome, DNA Protection, and
Immunity, and then backs into foods that support those functions. This leads to
his 5 x 5 x 5 “framework” for eating better. It’s not meant to be a strict
program of eating, but is a series of guidelines to pick better foods in your
day-to-day life, while allowing for flexibility and not requiring perfect
behavior. Aside from the list of foods, it’s also not complicated.
He starts from a presumption which should be self-evident,
that medicine has made many advances, “But, despite all of the success, the
sobering fact is that the rates of new disease are skyrocketing.”
He attributes this, correctly I think, to our diet, and to
Medicine’s lack of attention to it:
“Not many doctors know how to
discuss a healthy diet with their patients. This is through no fault of the
individual doctors, but rather a side effect of how little nutrition education
they receive. According to David Eisenberg, a professor at the Harvard T.H.
Chan School of Public Health, only one in five medical schools in the United
States requires medical students to take a nutrition course. On average,
medical schools offer a mere nineteen hours of coursework in nutrition, and
there are few postgraduate continuing education classes on nutrition for
doctors already in practice.”
Being at root a physician of the vascular system, he starts
there (which of course allows him to look at every system in the body, since
all depend on the vascular system to some extent). Angiogenesis is the process
of the body growing new blood vessels. Surprisingly, this takes place
regularly, and is involved in wound healing (good), and atherosclerosis,
cancer, and blindness; and is an area in which Dr. Li is a pioneer.
“The goal of an angiopreventive
diet is to keep the body’s angiogenesis defense system in a healthy state of balance.
This sometimes becomes a point of confusion among Western-trained doctors,
because balance is not typically part of their lexicon for disease treatment.
Balance is a more familiar concept in Ayurvedic and traditional Chinese
medicine, in which the focus is on balance for preventive health. Health is
viewed in those systems as the presence of balanced systems in body and mind.”
Lack of balance leads to dysregulation, where the homeostatic
systems that are supposed to keep things in balance (within reason) get out of
order, leading to the chronic diseases.
It’s an approach I whole-heartedly agree with.
The book is presented logically, in an easy-to-follow
manner. He goes through each “5” of the framework, so the first five chapters
cover the topics mentioned above (angiogenesis, etc), and so on.
He offers a suggestion of surviving in the kitchen, and a
bunch of recipes. You have to like a book about food where this is the first
recipe!
Background
Li seems to approach this with a strong “plant-based” (aka vegan) view. (“Vegan” appears in the text nine times, and “plant-based” 32, “paleo” appears eight times, "red meat" appears 13 times (mostly negatively), and “carnivore” does not appear at all.) However, while I think it is fair to say that Li is biased in that direction, or at least influenced by that school of thought; he is open-minded. He is somewhat critical of the Paleo diet (calling it an
“elimination” diet, a critique he does not level the vegan or vegetarian diets
he discusses, but he also describes the success of Loren Cordain’s autoimmune
protocol, a Paleo-based diet geared towards reducing autoimmune disease. He
expresses some concerns (unfounded, I think) about the ketogenic diet, but also
describes some successes of that diet for treating cancer.
“Glioblastoma was used to study the
ketogenic effect, in part because of the importance of cancer stem cells in
this disease. Even if this cancer is successfully removed or treated initially,
the glioblastoma stem cells help it return aggressively. Avoiding added sugar
and adhering to a ketogenic diet are strategies that may be helpful in fighting
brain tumors.”
Many of the papers he cites or discusses start with an
assumption that a plant-based diet is optimally healthy, and even those that he
has authored himself make this claim:
“A plant-based diet is increasingly becoming recognized as a
healthier alternative to a diet laden with meat.... We suggest that a shift
toward a plant-based diet may confer protective effects against atherosclerotic
CAD by increasing endothelial protective factors in the circulation while
reducing factors that are injurious to endothelial cells.” (Tuso
et al., 2015)
Another paper contrasts a “plant-based” diet to a Western
diet (Fotsis
et al., 1993), and that’s a comparison where the PB diet will win (in the short
term, at least) as nothing seems worse than a Western diet.
But this is not a vegan or plant-based diet book, by any
means.
“Because the 5 × 5 × 5 is a
framework, not a prescription, it is adaptable to whatever diet plan you’re
currently following, whether it’s Paleo, Whole30, Ornish, low-carb,
plant-based, gluten-free, allergen-free, or ketogenic—and it’s easy to adopt if
you don’t follow a plan at all.”
Many of the foods he recommends as part of his list of prescribed
foods are indeed fish, but the only meat is dark chicken. He does not proscribe
red meat, although he certainly discourages it.
Pros and Cons
Ultimately the cons to this approach are quibbles. The pro
is that it’s a flexible, relatively easy-to-follow diet plan that you can
overlay on whatever you are currently doing. Adding foods that are healthy—and
it’s fair to say they are all healthy, and he includes beer and wine in
moderation—will make any diet better, so even if you are on a junk-food Modern
American Diet your diet will improve.
“For the 5 × 5 × 5 framework you
first create your own personalized preferred food list (PFL) based on foods you
actually enjoy. You create your list from the master list of all of the foods
that follow.”
It’s a long list, so I won’t reproduce it here, but the sections
are:
-
Fruits
- Vegetables
- Legumes/fungi
- Nuts, seeds, whole grains, bread
- Seafood
- Meat
- Dairy
- Spices/herbs
- Oil
- Sweets
- Beverages
Three sections only contain one item, and these sections tell you the most about this framework: Meat is only dark chicken, Oil is only
extra-virgin olive oil (EVOO), and Sweets are only dark chocolate.
He obviously doesn’t like red meat, and
recommends dark chicken, along with lots of cheeses, because of the vitamin K2—which
is what your body needs, not the vitamin K found in vegetables. K2 is thought
to be important to vascular health. He does recommend not eating the chicken
fat. Li is not a fan of organ meats, although he does recommend oysters, the liver of the ocean.
Recommending only EVOO is due to Li not being a fan of omega-6
seed oils. While this is a major pro in my view, it’s also a con, as he doesn’t
explicitly say so.
Instead, one must read between the lines:
“Tilapia has a high unhealthy ratio
of omega-6 to omega-3 PUFAs, making it a less desirable fish from a health
perspective.”
And:
“There was no cancer-risk-reducing
benefit seen with seed oils.
And:
“For cancer protection, researchers
have found that the higher the overall intake of marine omega-3 in the diet,
the greater the benefit. In contrast, higher omega-6 PUFA consumption in
relation to omega-3 PUFA (the omega 6:3 ratio), which comes from vegetable oil,
for example, is linked to unhealthy inflammation and an increased risk of
disease.”
I fully agree with those ideas, but I would have been
helpful if he had been more explicit. (I asked him about this in the interview,
he was quite explicit there.)
And by recommending only dark chocolate for your sweets,
what I do personally, he is recommending against too much added sugar,
something he discusses at length in the book.
I would have liked to have seen a similar discussion of
omega-6 fats, which I think are a much bigger health issue than sugar.
His recommendations on meat are unfortunately not
well-founded in science, unfortunately. He is concerned that meat can increase
the production of TMAO, a chemical which is often cited in the vegan literature
as a reason not to eat meat. However, “Among food groups, TMAO directly
correlated with the intake of fish, vegetables, and whole-grain products, but
not meat, processed meat, and dairy products,” which is from a paper titled, “Plasma
TMAO increase after healthy diets: results from 2 randomized controlled trials
with dietary fish, polyphenols, and whole-grain cereals” (Costabile
et al., 2021). Li’s diet is indeed a healthy one, and it will indeed raise your
TMAO. Fish is the single biggest source of TMAO production. It’s not a reason
to avoid Li’s framework, or red meat. The biggest issue with red meat
consumption that I’m aware of is when it is consumed with high levels of
omega-6 fats (Guéraud et al., 2015; Pierre et al., 2003),
which, happily, Li steers his readers away from.
Quibbles aside, if you follow Li’s framework, and increase
your consumption of fruits, vegetables, fish, dairy, and avoid seed oils and
sugar, you will surely improve the quality of your diet immeasurably.
Conclusion
When David suggested interviewing Dr. Li, it was at
the suggestion of his listeners. Frankly, I was rather dreading it, as it
pretty quickly became apparent that he was on the plant-based side of things as I did my initial research.
So I was quite happily surprised when I went through his
book, and in speaking to him. While we have some disagreements, it’s a
well-founded book that takes a reasonable approach to nutrition, and is more
cognizant of the science behind a lot of the issues in the Modern American Diet
than, say, the Dietary Guidelines.
I’d recommend this book to anyone that is looking to fix
their diet for the first time, as it’s a good introduction to some basic
principles of diet and health, or to someone who is simply looking to expand
their understanding of what makes a healthy diet, and is looking for a more
holistic view. From either perspective he has a better approach than a typical physician with little interest or training in the subject. The advantage of Li’s background in vascular health is that he starts from a
holistic view, and thus makes a series of very practical recommendations.
The recommendations in Li's book reminds me of both a traditional Japanese diet,
with its emphasis on fish and vegetables, while avoiding fat and sugar; and also of Dr. Terry Wahls’
excellent Minding My Mitochondria (Wahls,
2010), also heavily focused on plant nutrients and from a vegetarian
background.
I recommend Eat to Beat
Disease, it’s a helpful addition to a happily burgeoning literature of how diet can
improve health..
References
Costabile,
G., Vetrani, C., Bozzetto, L., Giacco, R., Bresciani, L., Del Rio, D.,
Vitale, M., Della Pepa, G., Brighenti, F., Riccardi, G., Rivellese, A. A.,
& Annuzzi, G. (2021). Plasma TMAO increase after healthy diets: Results
from 2 randomized controlled trials with dietary fish, polyphenols, and whole-grain
cereals. The American Journal of Clinical Nutrition, nqab188.
https://doi.org/10.1093/ajcn/nqab188
Fotsis, T., Pepper, M., Adlercreutz, H., Fleischmann,
G., Hase, T., Montesano, R., & Schweigerer, L. (1993). Genistein, a
dietary-derived inhibitor of in vitro angiogenesis. Proceedings of the
National Academy of Sciences, 90(7), 2690–2694.
https://doi.org/10.1073/pnas.90.7.2690
Guéraud, F., Taché, S., Steghens, J.-P., Milkovic, L.,
Borovic-Sunjic, S., Zarkovic, N., Gaultier, E., Naud, N., Héliès-Toussaint, C.,
Pierre, F., & Priymenko, N. (2015). Dietary polyunsaturated fatty acids and
heme iron induce oxidative stress biomarkers and a cancer promoting environment
in the colon of rats. Free Radical Biology and Medicine, 83,
192–200. https://doi.org/10.1016/j.freeradbiomed.2015.02.023
Pierre, F., Taché, S., Petit, C. R., Van Der Meer, R.,
& Corpet, D. E. (2003). Meat and cancer: Haemoglobin and haemin in a
low-calcium diet promote colorectal carcinogenesis at the aberrant crypt stage
in rats. Carcinogenesis, 24(10), 1683–1690.
https://doi.org/10.1093/carcin/bgg130
Tuso, P., Stoll, S. R., & Li, W. W. (2015). A
plant-based diet, atherogenesis, and coronary artery disease prevention. The
Permanente Journal, 19(1), 62–67. https://doi.org/10.7812/TPP/14-036
Wahls, T. L. (2010). Minding My Mitochondria 2nd
Edition: How I overcame secondary progressive multiple sclerosis (MS) and got
out of my wheelchair. (2nd edition). TZ Press. https://amzn.to/3v6G03s
