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Legacy Appendix C - ADVENTIST HEALTH STUDY

LLUMC Legacy: Daring to Care

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Appendix C

ADVENTIST HEALTH STUDY

A number of years ago a group of Seventh-day Adventist scientists decided to subject their fellow church members to scientific evaluation. If the Adventist way of life promotes health as it claims to do, the results should be obvious.

Seventh-day Adventists abstain from smoking, drinking alcoholic beverages, and eating pork. About 50 percent are lacto-ovo- (milk-and-egg-using) vegetarians, and most Adventists do not use coffee, other caffeine-containing drinks, hot condiments, or spices. They do use fruits, nuts, grains, and vegetables abundantly, and are discouraged from eating highly refined foods.

Adventists have been following these dietary practices in varying degrees for more than a century. In general, they have a great interest in health and tend to follow a healthful life-style, believing that they must have a healthy mind to appreciate spiritual concepts.

In 1958 Frank R. Lemon, M.D., and Richard T. Walden, M.D., both on the faculty of the Loma Linda University School of Medicine, began an eight-year study of 50,000 California Adventists. Death rates were compared with the death rates of all California residents. This research project is now referred to as the Adventist Mortality Study.

Life expectancy at age 35 for all causes of death was found to be longer for Seventh-day Adventists than for the California population as a whole (77 years for California women compared to 80 years for Adventist women, and 71 years for California men compared to 77 years for Adventist men)--an average of four-and-a-half-years longer.

With California death rates standardized at 100 percent, the relative death rates among Seventh-day Adventists were: 20 percent for lung cancer; 5 percent for cancer of the mouth, throat, and larynx; 32 percent for bronchitis and emphysema; 28 percent for bladder cancer; 34 percent for esophagus cancer; 13 percent for cirrhosis of the liver; 72 percent for breast cancer; 65 percent for digestive tract cancer; 62 percent for uterus cancer; 66 percent for all other cancer; 55 percent for coronary heart disease; 65 percent for other heart disease; 53 percent for stroke; 55 percent for diabetes; 42 percent for peptic ulcers; and 54 percent for single vehicle traffic accidents.

Why Adventists seldom die from diseases that are strongly related to smoking or drinking is obvious. The scientific literature provides abundant documentation that alcohol and tobacco are strong risk factors for lung cancer, cardiovascular disease and several other diseases. But there is no answer to the question: Why is risk of death from other diseases lower among Adventists? Is it related to less stress or anxiety? Better medical care, heredity or socioeconomic factors or dietary practices?

In 1973 the 100,000 members of the Seventh-day Adventist church in California were asked to participate in the "Adventist Health Study," a planned 15-year study conducted by Loma Linda University and sponsored by the National Cancer Institute of the National Institutes of Health (NIH). Roland Phillips, Dr. PH., began this study which was subsequently taken over by Gary E. Fraser, MB.BCh.B., Ph.D., after Dr. Phillips death. A brief census questionnaire was sent to each Adventist household. A subsequent life-style questionnaire was sent to each adult. All serious illnesses were identified from hospital records and all causes of death were determined during the first six years of follow-up.

Due to the large number of converts (California membership had doubled since the first study) a sizable proportion of members had adopted the Adventist lifestyle relatively late in life. About one half were adult converts who were compared with lifetime Adventists.

The study was complex. It required maintaining accurate records on thousands of people, compiling scattered sources of information, and the passing of ample time for a significant number of diseases and deaths to occur. The resultant data is critically analyzed with the aid of computers.

The study is further complicated by potential longevity increases that may be due to the higher educational levels and occupational status of Seventh-day Adventists. Such a group could have access to better housing, food, and medical care. Better educated people are usually more interested in health. They are better able to seek early diagnosis for more effective treatment. A more responsible attitude about health could significantly reduce the rate of death. These factors plus an interest in preventive health practices could probably have a beneficial effect on the overall longevity of Seventh-day Adventists.

These epidemiological studies have provided a wealth of information which is as yet only partially explored. The project has attracted great interest in scientific circles and is quoted frequently in the scientific literature.

Studies suggest that diet may be a significant factor in explaining the reduced risk of cancer, in addition to the effects of alcohol or tobacco. The percentage of Adventists who follow a vegetarian life-style is significantly different depending on the educational background and place of residence. Fifty-two percent of those with college degrees or post-collegiate training are vegetarians, compared with 34 percent of those who do not have a high school diploma. Fifty-three percent of those who live in rural areas are vegetarians, whereas 38 percent from urban areas are vegetarians.

Heavy meat-eaters use more cheese, eggs, sweets, and chip foods and less vegetables than do vegetarians. They also tend to eat their biggest meal in the evening and to snack between meals. Obesity is much more common among heavy meat-users. To a modest extent vegetarians tend to exercise more vigorously and regularly, to also eat their biggest meal in the morning, and to snack less between meals.

Use or nonuse of meat has been shown to be a rather reliable predictor of the adherence to other health-habits among SDAs. This hypothesis has been confirmed by a health habit index constructed by the research team. Investigators compiled a list of 15 health practices promoted by the Seventh-day Adventist church (adequate rest, regular exercise, vegetarianism, abstinence from smoking, etc.).

Early in 1980 the research team reported that only 21 percent of those who used meat heavily followed 10 or more of these 15 habits, compared to 65 percent of the vegetarians. The Adventist Health Study could also compare Adventists with one life-style to Adventists with different life-styles, due to the fact that Adventists subscribe to a wide variety of dietary and exercise habits. This follow-up study recorded more detail than the older mortality study, and looked for those who had non-fatal as well as fatal cancer and heart attack.

The Adventists who eat higher quantities of red meat, fatty foods, eggs, and coffee could be compared with those who emphasize fruits and vegetables or to those who have a relatively small intake of most foods, thus consuming relatively few calories. The high fat/meat group had a risk of dying almost four times greater than either of the other two dietary patterns in the younger age groups (30 to 50 years) with this advantage remaining discernible and substantial into the 80s.

Consuming of a variety of fruits and vegetables decreases the risk of cancers of the pancreas, colon, lung, and perhaps kidney and stomach. Meat eating appears to increase the risk of bladder and maybe even of colon cancer.

Statistics demonstrate a clear relationship between the consumption of nuts at least five times a week and an almost 50 percent reduction in the risk of coronary heart disease compared to Adventists who ate nuts only once a week, even when adjusted for intake of meat, other dietary habits, past smoking, diabetes, hypertension, exercise, and obesity. A relationship of almost the same significance was shown between eating whole wheat bread and reduced heart disease.

Additional findings include:

• Eating fruit three or more times a week reduced the risk of lung cancer by two-thirds compared with rarely eating fruits. This fact remained the same whether the Adventist had ever smoked or not.

• Eating beans, lentils, peas or raisins, dates, or dried fruits at least three times a week markedly reduced the risk of pancreatic cancer, an uncommon but usually fatal disease.

• Eating flesh foods more than once a week was related to doubling the risk of bladder cancer, regardless of whether the subject previously smoked.

• Men who ate dried fruits three or more times a week decreased their risk of prostate cancer by 40 percent.

• Those who ate whole wheat bread, as opposed to white bread, enjoyed a 40 percent decrease in the risk for a heart attack even when the findings were adjusted for differences in exercise habits, obesity, nut consumption, previous smoking or diabetes.

The ultimate goal of the study was to provide reasons for the better health experience of Adventists, but by comparing the health experience of Adventists with widely different life-styles. Not all adhere to the recommended Adventist health practices to the same degree, a fact which provides great strength to these kinds of studies.

Except for the causes of death strongly related to alcohol or tobacco, Seventh-day Adventists die from basically the same diseases as the general population. However, their age-adjusted mortality rates are low because they tend to die much later in comparison to the general population. Apparently Seventh-day Adventists have less exposure to causative factors, more exposure to protective factors, and so are more resistant to disease.

In 2001 Adventist Health Study-2, directed by Dr. Fraser and funded by the National Cancer Institute of the National Institutes of Health (NIH), started a survey that is hoped to finally include 125,000 Adventists nationwide. It is one of the largest long-term studies in the country. Based on a 594-question survey, the study involves 4,300 congregations and 8,000 volunteers and is projected to last for decades. AHS-2 employs 50 people including 10 senior researchers, four programmers, many research associates, nutritionists, data technicians, and scanner operators. Seven consultants, distinguished professors from leading academic institutions around the country, share their research experience and expertise. The study is projected to clearly portray whether dietary choices and other habits will change a person's risk of developing cancer or heart disease.

Dr. Gary E. Fraser's 371-page book, Diet, Life Expectancy, and Chronic Disease, published by the Oxford University Press and based on previous Adventist Health Studies, summarizes evidence from these and other studies that link diet and vegetarianism to health and life expectancy. It can be purchased at Amazon.com.

According to one of the study's consultants, Dr. Ralph Paffenbarger of Stanford University, "Adventists are a national treasure for health research because of their diversity in diet."1

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