Book Review: "Eat to Beat Disease" by Dr. William Li

Dr. William Li is a physician and research scientist at his institute, the Angiogenesis Foundation in Massachusetts.

Eat to Beat Disease:
The New Science of How Your Body Can Heal Itself 

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!

From Eat to Beat Disease.

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..

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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