Coronary Artery Disease: Genes, Drugs, and the Agricultural Connection

  • Ole Færgeman
Elsevier: 2003. 152 pp. £50, $50

We can prevent coronary artery disease (CAD), says Ole Færgeman, professor of preventive cardiology at the University of Aarhus in Denmark. All we have to do is stop smoking cigarettes and stop eating the meat and milk of large domesticated land mammals. As Færgeman argues in this intriguing, provocative and sometimes maddening book, “producing huge numbers of animals for human food is at the core of the problems of agriculture, medicine, and global food security”. If we fail to grasp the evils of animal agriculture, it is because “the love of milk has been etched into our genome”, the “medico-industrial complex” promotes disease treatment rather than prevention, and powerful agricultural interests profit from our love of meat and dairy foods.

Never mind that agriculture brought us stability and abundant calories. It also brought vitamin and mineral deficiencies (due to a lack of food diversity), infectious diseases (acquired from animals), and poverty (from dependence and low wages). Agriculture is “the most environmentally destructive of all human activities”, wasting nitrogen — which causes “hypoxia in the sea as well as in the human heart muscle” — eroding soil, and is so inefficient that only 10% of the energy in fertilizer, tillage and transport is converted to food. “A doctor's prescription for a better environment would be to lower the number of livestock... As a side-effect, it would reduce heart disease.”

Before dismissing such contentions as absurdly exaggerated, ponder Færgeman's initial questions. When did CAD become an important cause of mortality, and why? How well do we understand its response to dietary factors? Why do we prefer to fund research on the genetics of CAD rather than its behavioural determinants? How does evidence-based medicine affect our understanding of the social, political and agricultural causes of CAD? And how can we answer such questions when research is so often sponsored by self-interested industries?

Færgeman brings plenty of clinical experience to bear on these issues. He has witnessed the effects of saturated animal fat on blood cholesterol levels, of blood cholesterol on plaque formation, and of plaque rupture on coronary thrombosis. Epidemiological studies “clinch the arguments”: populations consuming food from land mammals have higher rates of CAD but live longer when they replace beef and butter with fruits, vegetables, nuts and fish. Plant-based diets not only lower blood cholesterol but also protect against arterial inflammation, endothelial malfunction and disturbances of heart rhythm. Drugs help, but they address symptoms, not causes. Genetics matters, but not much: possessing the wrong genes rarely causes CAD unless people also eat meat and drink milk.

I am guessing that Færgeman is not a vegan, but such statements make him sound like one. The book's startling cover image, derived from Nordic myth, depicts a rather well-endowed man suckling milk from a cow. Adults, he says, are not supposed to drink milk. Evolution ensures that infants wean; most people lose the ability to digest lactose (milk sugar) after early childhood. The rare persistence of lactase in certain populations is “perhaps the most important single genetic determinant of risk of coronary artery disease”. If people fight evolution by continuing to drink milk, it is because the medico-industrial complex labels lactase “deficiency” as a genetic disorder and the dairy industry has convinced us that its products are essential.

I am at a loss to decide whether Færgeman would make a lively or tedious dinner companion. He writes well, but digresses. Along with matters clearly germane to CAD, he discusses theories of biological complexity, Danish history, the career of Tycho Brahe, Prozac, psychological debriefings, gallstone surgery, anaesthesiology and the fractal coastline of California. Such digressions slow the pace and detract from the core arguments, which are much more fun. He rails against the politics of medicine, the influence of corporations on universities and the limitations of science in answering questions about behaviour and health. He worries about how science is corrupted by the meat, dairy, tobacco and pharmaceutical industries and how evidence-based medicine is inadequate to deal with the environmental causes of disease. He agrees that clinical trials make good science but regrets that they leave few resources for studying the political, societal and agricultural context of disease.

Alas, Færgeman offers few solutions to these problems. Unless we change our ways, he warns, the unwise will continue to succumb to CAD, and agriculture will continue to determine the need for cardiologists and heart surgeons. Governments should integrate health and agricultural policies, researchers should study social determinants of disease, and universities should remain independent of corporate influence. It's up to us, he says, to “develop the political will to ... protect nature and to promote human health and sanity”. Yes, but how? This book is about policy, not dietary practices or political advocacy, and Færgeman leaves us on our own to work out how to apply his important lessons.