From The New England Journal of Medicine
I recently listened to a presentation by Dr. Mervyn Hardinge, founding dean and professor emeritus at Loma Linda University's School of Public Health. With candor and humor, he eloquently reviewed the history of modern vegetarianism by recounting his experiences with this then-tenuous subject when he was a student in the 1940s. He recalled an incident that occurred while he was studying food technology at the Massachusetts Institute of Technology: an associate professor spent an entire class denouncing vegetarianism. The professor closed his tirade with what he thought was some seasoned wisdom. "And it is easy to recognize a vegetarian," he said. "They are bleary-eyed, sallow-skinned, and mentally dull." Hardinge could no longer restrain himself. "Sir," he responded with raised hand, "I have been a lifelong vegetarian, and it appears as though your generalization doesn't apply to me." After much laughter and foot stomping from the rest of the class, the now red-faced professor responded apologetically, "I have just learned a most important lesson of knowing when to keep my mouth shut!" Hardinge concluded his presentation with a personal observation: "In my lifetime, vegetarianism has passed through three periods -- there was a time when it was ridiculed, then tolerated, and finally accepted and advocated." Fraser's book will surely buttress the accumulating evidence in favor of vegetarianism as a healthful dietary option. He collates the results of decades of published research on vegetarian populations, leaving the reader in little doubt that such a choice of lifestyle is indeed health promoting. True to its title, the book methodically addresses the ways in which a vegetarian diet may positively influence both longevity and vulnerability to diseases such as obesity, diabetes, rheumatoid arthritis, various cancers, and heart disease. He convincingly demonstrates that not only do vegetarians live longer than nonvegetarians, but they also probably enjoy a better quality of life. And if readers are not familiar with entropy values and the squaring of survival curves, they will be after they have read this section. So, does the book assume expertise in nutritional epidemiology? No, although a healthy appreciation of biostatistics would be a distinct advantage to the reader. Pithy chapter summaries, a glossary, and a moderate use of tables and graphs ensure that even neophytes in this research discipline should be able to appreciate the fundamental findings. This book will have a strong appeal to a wide range of health professionals who are interested in areas such as preventive cardiology, nutrition, cancer prevention, health education and promotion, "wellness" and lifestyle interventions, public health, and epidemiology. The population on which many of the reported studies are based is the members of the Seventh-Day Adventist Church. What makes this group interesting to study is that its members engage in minimal use of tobacco and alcohol yet have wide variation in their dietary and exercise habits. Consequently, Fraser and the contributing authors also deal specifically with the influence of psychosocial factors, including religiousness, on health outcomes. There are useful chapters on changes in health-related behavior and making the transition to a vegetarian diet. Unlike the zealous health reformers of the past, such as the Reverend Sylvester Graham, Fraser does not mind using conservative scientific language. In touting the advantages of a plant-centered diet, he makes no secret of wanting the evidence to speak for itself, but no more than that. Thus, words such as "possible," "may," "might," "modest," "borderline significance," "further research needed," and other qualifiers punctuate the text. The limitations of the book are related to the limitations of the original studies. For example, the relation between diet and osteoporosis is not covered. This and other areas may well be under consideration for inclusion in the redesigned edition of the Adventist Health Study to which Fraser alludes.
Robert H. Granger, Dr. P.H., M.P.H.Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
"This book is...for all those who wish to use diet to treat chronic disease. It can be read with enjoyment from cover to cover, but will be returned to frequently as a reference work to browse through chapters on specific topics. It is a book which stands to benefit the health of all readers, be they physician, medical student, or patient." --The Lancet
"Fraser's book will surely buttress the accumulating evidence in favor of vegetarianism as a healthful dietary option. He convincingly demonstrates that not only do vegetarians live longer than non-vegetarians, but they also probably enjoy a better quality of life. This book will have strong appeal to a wide range of health professionals who are interested in areas such as preventive cardiology, nutrition, cancer prevention, health education and promotion, 'wellness' and lifestyle interventions, public health, and epidemiology." - The New England Journal of Medicine
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