EAT FOR LIFE

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EATFOR LIFEThe Breakthrough Nutrient-Rich Programfor Longevity, Disease Reversal, andSustained Weight LossJoel Fuhrman, MD

This book is dedicated to all people suffering with serious medical issues who were never informed that they could recovertheir health with nutritional excellence. The lack of informationhas denied them their inalienable rights.This book contains advice and information relating to health care. It should be used to supplementrather than replace the advice of your doctor or another trained health professional. If you know orsuspect you have a health problem, it is recommended that you seek your physician’s advice beforeembarking on any medical program or treatment. All efforts have been made to assure the accuracyof the information contained in this book as of the date of publication. This publisher and the authordisclaim liability for any medical outcomes that may occur as a result of applying the methodssuggested in this book.eat for life. Copyright 2020 by Joel Fuhrman, MD. All rights reserved. Printed in the United Statesof America. No part of this book may be used or reproduced in any manner whatsoever withoutwritten permission except in the case of brief quotations embodied in critical articles and reviews. Forinformation, address HarperCollins Publishers, 195 Broadway, New York, NY 10007.HarperCollins books may be purchased for educational, business, or sales promotional use. Forinformation, please email the Special Markets Department at SPsales@harpercollins.com.fir st ed i ti o nDesigned by Kris Tobiassen of Matchbook DigitalLibrary of Congress Cataloging-in-Publication Data is available upon request.ISBN 978-0-06-224931-920 21 22 23 24  LSC  10 9 8 7 6 5 4 3 2 1

NEVER PUT ON WEIGHT RAPIDLY, AS IT PROMOTESACCUMULATION OF VISCERAL FAT.AbdominalMuscle LayerSubcutaneous Fat—fat external to theabdominal wallVisceral Fat—fat inside theabdominal wall, surroundingthe internal organs1

Food Consumption Data: How Most People EatSource: US Department of Agriculture. Economic Research Service. Food Availability(per Capita) Data System. r-capita-data-system/. Last updated 26Aug 2019.2

Nutrient IQ Scores Based on Typical Serving SizesServing NutrientSize IQ Score*Kale, cooked. 1 cup. 112Collards, cooked. 1 cup. 112Mustard greens, cooked. 1 cup. 112Turnip greens, cooked. 1 cup. 112Watercress, cooked. 1 cup. 112Arugula, cooked. 1 cup. 112Swiss chard, cooked. 1 cup. 112Bok choy. 1 cup. 90Broccoli. 1 cup. 90Broccoli rabe. 1 cup. 90Brussels sprouts. 1 cup. 90Cauliflower. 1 cup. 90Cabbage. 1 cup. 90Kohlrabi. 1 cup. 90Radishes. 1 cup. 90Turnips. 1 cup. 90Endive, cooked. 1 cup.82Escarole, cooked. 1 cup.82Spinach, cooked. 1 cup.82Arugula, raw. 1 cup.79Collard greens, raw. 1 cup.79Kale, raw. 1 cup.79Mustard greens, raw. 1 cup.79Turnip greens, raw. 1 cup.79Watercress, raw. 1 cup.79Asparagus. 1 cup. 64Artichoke.1 item. 64Cucumber. 1 cup. 64Endive, raw.2 cups. 64Escarole, raw.2 cups. 64Fennel. 1 cup. 64Green beans. 1 cup. 64Green pepper. 1 cup. 64Okra. 1 cup. 64Romaine orother lettuces.2 cups. 64Snap peas. 1 cup. 64Snow peas. 1 cup. 64Spinach, raw.2 cups. 64Zucchini. 1 cup. 64Bean sprouts. 1 cup. 60Eggplant. 1 cup. 60Mushrooms, cooked. ¼ cup. 60Onions, raw. ¼ cup. 60Radicchio. 1 cup. 60Red pepper. 1 cup. 60Tomatoes. 1 cup. 60Tomato sauce or pastasauce, low sodium. 1 cup. 60Yellow squash. 1 cup. 60Beans, lentils, orsplit peas, cooked. ½ cup.52Edamame. ½ cup.52Lima beans, cooked. ½ cup.52Bean pasta, cooked. 1 cup.52Serving NutrientSize IQ Score*Tempeh. 1 cup.45Beets. 1 cup.45Carrots. 1 cup.45Corn. 1 cup.45Green peas. 1 cup.45Parsnips. 1 cup.45Pumpkin. 1 cup.45Rutabaga. 1 cup.45Sweet potato. 1 cup.45Winter squash (butternut,acorn, spaghetti). 1 cup.45Blackberries. ½ cup.45Blueberries. ½ cup.45Raspberries. ½ cup.45Strawberries. ½ cup.45Cranberries, fresh. ½ cup.45Gooseberries. ½ cup.45Goji berries. ¼ cup.45Walnuts. ¼ cup.45Cherries.2/3 cup.41Chia, flax, or hempseeds.2 Tbs.41Pomegranate, juice orkernels. ¼ cup. 37Sunflower, pumpkin,or sesame seeds. ¼ cup.34Onions, cooked. ¼ cup. 30Cashews, almonds, pistachios,pecans, hazelnuts, orBrazil nuts. ¼ cup.26Pine nuts. ¼ cup.26Barley, cooked. 1 cup.26Buckwheat, cooked. 1 cup.26Farro, cooked. 1 cup.26Steel cut oats, cooked. 1 cup.26Teff, cooked. 1 cup.26Wild rice, cooked. 1 cup.26Quinoa, cooked. 1 cup.26Turmeric, ground.1 tsp.25Avocado. ¼ cup.23Vegetable juice, 100%vegetable. 1 cup.22Apricots, fresh. 2 items.19Figs, fresh. 2 items.19Grapefruit. 1 cup.19Grapes. 1 cup.19Kiwi. 2 items.19Kumquats.4 items.19Mango. 1 cup.19Melons (watermelon, honeydew,cantaloupe). 1 cup.19Orange.1 item.19Papaya. 1 cup.19Peaches or nectarines.1 item.19Pears.1 item.193

Serving NutrientSize IQ Score*Pineapple. 1 cup.19Plums. 2 items.19Tangerines orclementines. 2 items.19Old-fashioned oats,cooked. 1 cup.19Tofu. 1 cup.15Soy, hemp, or almondmilk, unsweetened. 1 cup.15Green tea. 1 cup.15Cashew or almondbutter. 1 Tbs.13Sunflower butter. 1 Tbs.13Sesame seed butter(tahini). 1 Tbs.13White potatoes. 1 cup.12Celery. ½ cup.11Iceberg lettuce.2 cups.11Apple.1 item.11Banana.1 item.11Peanuts. ¼ cup.11Cold cereals, made fromwhole grains or nuts,no added sugar. 1 cup.11Basil, fresh.2 Tbs. 10Dill, fresh.2 Tbs. 10Parsley, fresh.2 Tbs. 10Cilantro, fresh.2 Tbs. 10Gingerroot, fresh. 1 Tbs. 10Cinnamon, ground.1 tsp. 10Orange juice, 100% fruit. 1 cup. 7Salmon, wild.4 oz. 7Apricots, dried. ¼ cup. 7Coconut, dried. ¼ cup. 7Dates. ¼ cup. 7Figs, dried. ¼ cup. 7Raisins. ¼ cup. 7100% whole grainbread, wraps, or pita.1 item. 7Brown rice, cooked. 1 cup. 7Pasta, whole wheat,cooked. 1 cup. 7Cocoa powder,unsweetened.2 Tbs. 7Dark chocolate,85–100% cocoa.1.5 oz. 7Dark chocolate,65–80% cocoa.1.5 oz. 6Peanut butter. 1 Tbs. 6Salmon, farmed.4 oz. 5Lower-mercury seafood(scallops, clams, mussels,oysters, shrimp, lobster, tilapia,mackerel, cod, flounder, haddock,crawfish, catfish, black sea bass,hake, sole, squid,sardines).4 oz. 5Serving NutrientSize IQ Score*Cold cereals made from100% whole grains, 15 g sugar/serving. 1 cup. 5Plain yogurt, fat-free orlow-fat, no addedsugar. 6 oz. 5Milk, skim or 1%. 1 cup. 5Eggs.1 item. 4Higher-mercury seafood(tuna, shark, swordfish,grouper, red snapper,mahi mahi, halibut,orange roughy).4 oz. 4Couscous, cooked. 1 cup. 4Quick or instant oats,cooked. 1 cup. 4Black tea. 1 cup. 4Poultry.4 oz. 3Plain yogurt, full-fat,no added sugar. 6 oz. 3Milk, 2% or whole. 1 cup. 3Cheese. 2 oz. 2Coffee. 1 cup. 2Whole wheat breadproducts, not 100%whole grain. 0White bread products.0White pasta.0White rice.0Cold cereals, not 100%whole grain.0Beef, pork, lamb.0Hotdogs, sausage.0Cold cuts.0Dried meat products (jerky).0Yogurt with added sugar.0Frozen yogurt.0Ice cream.0Pizza.0French fries.0Potato, corn, or other chips.0Crackers.0Milk chocolate ordark chocolate 65%cocoa.0Cookies, pie, cake.0Apple or grape juice.0Carbonated drinks.0Energy drinks.0Note: Unless indicated, vegetable scoresare for either raw or cooked vegetables.*The Nutrient IQ Scores are for adultmen. Women should multiply scores by1.2, and children younger than 12 shouldmultiply scores by 1.75.4

Note: Mushrooms contain natural aromatase inhibitors and suppress estrogen productionin breast tissue, radically reducing the risk of breast cancer. Mushrooms also containangiogenesis inhibitors.5

Calories inBloodstreamFast food(oil and white flour)Slow food(beans and nuts)Hours: 01623

Cancer Cases Attributable to ObesityOvaryGallbladderRectumEsophageal adenocarcinomaPancreasColonKidneyCorpus uteriBreast (postmenopausal)05k10k15k20k25k30kNumber of cases (North America, 2012)Source: World Health Organization. International Agency for Research on Cancer.“Cancer Attributable to Obesity.” https://gco.iarc.fr/causes/obesity/home.enhances appetite. This perpetuates the vicious cycle of overeating,inflammation, and more insulin resistance—promoting disease andtype 2 diabetes.THE MICROBIOME AND INSULIN METABOLISMAny discussion of the cause and repair of altered glucose and insulinmetabolism would not be complete without addressing the microbial composition of the gut—or the gut’s microbiome. The beta-cells ofthe pancreas are also prone to toxicity from proinflammatory foods,increasing their destruction and the development of type 2 diabetes.That is, a poor diet with more animal products and processed foodsand less colored plant food favors a proinflammatory microbiome,which also contributes to insulin resistance. An unfavorable microbial composition is another source of low-grade inflammation fromboth trimethylamine oxide (TMAO) and endotoxemia from excessgram-negative bacteria.7

Glycemic Load of Common FoodsGlycemicIndexGlycemicIndexWhite potato. 29White rice. 26White pasta. 21Chocolate cake. 20Corn.18Sweet potato.14Grapes.14Rolled oats. 13Whole wheat. 11Mango. 11Lentils.9Apples.9Kiwi.8Green peas.8Butternut squash.8Kidney beans.6Black beans.6Watermelon.6Oranges.4Cashews.2Strawberries. 1Sources: Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemicindex and glycemic load values: 2008. Diabetes Care. 2008;31(12):2281–83; Foster-PowellK, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values:2002. Am J Clin Nutr. 2002;76(1):5–56.8

Resistant starch is satiating, yet its calories do not get absorbedwell. It also promotes health and weight loss by other mechanisms,such as Encouraging the growth of beneficial bacteria, which reduceintestinal pH, bile acids, and ammonia Producing, when fermented by bacteria, short-chain fatty acidsthat reduce body fat storage Reducing the glycemic effect of other foods, even when eaten atseparate mealsResistant Starch (%)Resistant Starch (%) Fiber (%)Black beans.27 . 70Navy beans. 26 . 62Lentils. 25 . 59Split peas. 25 . 58Corn. 25 . 45Brown rice. 15 . . 20Rolled oats.7 . 17Whole wheat flour.2 .14Pasta.3 . 9Potato.3 . 5Source: Bednar GE, Patil AR, Murray SM et al. Starch and fiber fractions in selected food andfeed ingredients affect their small intestinal digestibility and fermentability and their largebowel fermentability in vitro in a canine model. J Nutr. 2001;131(2):276–86.9

As an example, a two-group controlled trial encouraged one group toincrease legume intake by 1 cup a day and another to increase theirintake of whole grains by the same amount. A clear benefit occurredfor adding more whole grain, but more dramatic benefits occurred forthe addition of beans, as noted in the chart below.27Whole Grain GroupBean GroupFiber increase (g/1,000 cal). 1.9. 10.0Glycemic load reduction.–5. –48HbA1c (%).–0.3.–0.5Body weight (lb).–4.4. –5.7Fasting glucose (mg/dL).–7.–9Triglycerides (mg/dL).–9. –21Cholesterol (mg/dL).–2.–9Systolic blood pressure (mm Hg). 0.–4Diastolic blood pressure (mm Hg). 0.–310

Animal Protein Intake and Risk of Cancer MortalityRisk ofcancermortality54321Low proteinModerate proteinHigh protein4.1%9.5%18.3%Percent animal proteinSource: Levine ME, Suarez JA, Brandhorst S et al. Low protein intake Is associated with amajor reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not olderpopulation. Cell Metab. 2014;19(3):407–17.11

AgeAverage Serum IGF-1 1 85–90The European Prospective Investigation into Cancer and Nutrition(EPIC) study reported average serum IGF-1 levels of approximately210 ng/mL, suggesting that this is a typical level for adults on a Western or SAD diet.6212

Protein Content of Selected FoodsPlant-Based ProductGrams ofServing Protein/SizeServingPlant-Based ProductGrams ofServing Protein/SizeServingOats, uncooked. ½ cup.5.3Flaxseeds, ground. ¼ cup. 5.1Corn. 1 cup. 5.1Brazil nuts. ¼ cup. 4.8Walnuts. ¼ cup. 4.6Pine nuts, regular. ¼ cup. 4.6White rice, cooked. 1 cup. 4.4Whole wheat bread.1 slice. 4.0Broccoli, cooked. 1 cup.3.7Kale, cooked. 1 cup.3.5Macadamia nuts. ¼ cup.2.7Pecans. ¼ cup.2.5White potato, baked. 1 cup.2.4French fries. 2.5 oz.2.4Romaine lettuce.2 cups.1.2.Pea protein powder.1 oz.22.1Pumpkin proteinpowder.1 oz. 18.7Edamame. 1 cup. 18.5Lentils, cooked.1 cup. 18.0Tempeh. ½ cup. 16.8Soy protein powder.1 oz. 15.8Kidney beans, cooked. 1 cup. 15.3Black beans, cooked. 1 cup. 15.2Bean pasta, cooked. 1 cup. 14.7Chickpeas, cooked. 1 cup. 14.5Hemp protein powder.1 oz. 12.8Hemp seeds. ¼ cup. 12.6Tofu, firm. ½ cup. 11.2Pine nuts,Mediterranean. ¼ cup.10.6Pumpkin seeds. ¼ cup.9.7Peanuts. ¼ cup.8.9Chia seeds. ¼ cup.8.6Wheat germ. ¼ cup.8.2Quinoa, cooked. 1 cup.8.1Almonds. ¼ cup. 7.6Sunflower seeds. ¼ cup. 7.3Pasta, whole wheat,cooked. 1 cup.7.0Peas, frozen. 1 cup.7.0Sesame seeds. ¼ cup. 6.4Pistachio nuts. ¼ cup.6.2Cashews. ¼ cup.6.2Spinach, uncooked. 1 cup.5.3Animal ProductsWhey protein powder.1 oz.21.1Chicken, white,cooked.2 oz.17.6Ground beef, 85%,cooked. 2 oz. 14.7Salmon, cooked. 2 oz.14.4Steak, porterhouse,cooked. 2 oz. 14.1Yogurt, plain, low-fat. 4 oz. 11.9Eggs.1.6.2Milk, nonfat. ½ cup.4.1Milk, whole. ½ cup.3.8Ice cream, vanilla. ½ cup.2.313

Insufficient Intake of Vitamins and Minerals in the USVitamin CVitamin KVitamin Athe lonCalciumeasesMagnesiumconsuVitamin Enuts, aVitamin Din thesOu020%40%60%80%Percent of Americans meeting recommendationsSource: Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements:where do Americans get their nutrients? J Nutr. 2011;141:1847–54.humawe seciencyand nthe DNis equexposugreensDNA tAsVitamin Kminermulti v(Shortage)(Survival)(Longevity)Blood coagulationBone mineralizationArterial elasticity14

Omega-3 Index in VegansNumber ofparticipants35302520151050% 5% 0% 5% 0% 5% 0% 5% 0% 5% 0% 5% 0% 5%2. –2. –3. –3. –4. –4. –5. –5. –6. –6. –7. –7. –8. –8.–1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0My more than thirty years of clinical experience treating veganswho have some failure to thrive on a vegan diet has repeatedlydemonstrated individuals whose lack of DHA and EPA resulted in anepisode of depression or anxiolytic depression. These observationsare consistent with studies demonstrating that patients with depression commonly have lower EPA and DHA levels.29 DHA deficiency indepressed patients relative to healthy control subjects is linked toanxiety and depression. The low omega-3 fatty acid status commonlyobserved in patients with major depressive disorder may reduce theeffectiveness of some antidepressants.30 Supplementation with DHAand EPA, especially EPA, has been shown to be helpful for people whoare depressed.31Other common deficiencies might additively increase depression risk. Low vitamin D (also found in fish), best measured with a25-hydroxy vitamin D blood test, can also exacerbate the risks ofdementia and depression and has been associated with diminishedglobal cognitive function and greater decline over a four-year period.In one study, patients with 25-hydroxy vitamin D values higherthan 30 ng/mL showed insignificant decline, those with levels of 20to 29 ng/mL showed moderate decline, and those with levels lessthan 20 ng/mL showed severe decline. These findings were matchedalmost perfectly in another study as well.3215

16

Glyphosate Use in US Agriculture, 1974–2014Glyphosate use 250,000Thousands of pounds200,000150,000100,00050,000074 82 90 995 00 05 010 012 01419 191221920 20 2Source: Benbrook CM. Trends in glyphosate herbicide use in the United States and globally.Environ Sci Eur. 2016;28:3.17

18

Carotenoids and LifespanRelative risk of death 1.5(All causes)1.31.10.9 1.011.01–1.321.33–1.75 1.75Serum total carotenoids (µmol/L)Source: Shardell MD, Alley DE, Hicks GE et al. Low-serum carotenoid concentrationsand carotenoid interactions predict mortality in US adults: the Third National Health andNutrition Examination Survey. Nutr Res. 2011;31:178–89.19

Foods with FlavonoidsClassFlavonoidFood SourceAnthocyanidins/anthocyaninsCyanidin, delphinidin,malvidin, pelargonidin,peonidin, petunidinBerries, grapes, redonions, red cabbage,eggplant, black beansFlavan-3-olsCatechinsGreen tea, cocoa,grapes, berries,apples, apricots,soybeansProanthocyanidinsApples, cranberries,cocoa, grapes, pecans,pistachios, stonefruits, cinnamonFlavanonesEriodictyol, hesperetin,naringenin, naringinCitrus fruitsFlavonesApigenin, luteolin,baicalein, chrysin,vitexin, orientinParsley, celery,peppers, thyme,oreganoFlavonolsQuercetin, myricetin,kaempferol,isorhamnetin,rutin, tiliroside,aromadendrin,silymarin, silybinOnions, scallions,cruciferousvegetables,blueberries, tea,saffron, cranberries,asparagus, coriander,endive, fennel,ginger, okra, peppers,radishes, beans,buckwheatIsoflavonesDaidzein, genistein,glyciteinSoybeansSources: “Flavonoids.” Oregon State University, Linus Pauling Institute, MicronutrientInformation Center. ytochemicals /flavonoids. Last updated Nov 2015; Alkhalidy H, Wang Y, Liu D. Dietary flavonoids in theprevention of T2D: an overview. Nutrients. 2018 Mar 31;10(4):E438; Panche AN, Diwan AD,Chandra SR. Flavonoids: an overview. J Nutr Sci. 2016 Dec 29;5:e47.20

Common Nrf2 ActivatorsAllicin/diallyl sulfide(garlic)108Cruciferousvegetables /isothiocyanates117Luteolin (celery,peppers, oregano,parsley)131Resveratrol (grapes)118DHA and EPA132Ellagic acid(berries andpomegranates)110AcaiSoy isoflavones133Goji berries111Cocoa122Flavonoid classes:flavanols, s112Lycopene(tomatoes)123Berry ns(berries)109Quercetin114119Curcumin120Black currants134LuteinButyrate (producedby gut bacteriafrom dietary fiberand granates125Carnosic acid(rosemary, sage,other herbs)127EGCG(epigallocatechingallate) (greentea)115Zinc128Sulforaphane(broccoli / broccolisprouts)116Apigenin (celery,parsley,chamomile)129Naringenin (citrusfruits)130Tocopherols(vitamin E)136Cinnamon137Rosmarinic acidand carnosol(rosemary)138Zerumbone (ginger)139Ursolic acid (applepeel)140Chlorogenic acid(coffee, apples,apricots, chiaseeds)141The isothiocyanates in green cruciferous vegetables, such as sulforaphane, are among the most protective phytonutrients—and areparticularly effective in activating Nrf2.142 Once activated by sulforaphane, Nrf2 suppresses the activity of adhesion molecules on theendothelial cell surface to prevent binding of inflammatory cells,therefore halting atherosclerotic plaque development.143 Multiplestudies have shown that sulforaphane or other isothiocyanates, byactivating Nrf2, block inflammatory gene expression and oxidativestress in human endothelial cells.144 Sulforaphane also helps maintain the integrity of the blood-brain barrier, which is crucial for properbrain function, via activation of Nrf2.14521

Colorectal Cancers Increasing in Young Adults (age 50)Age-adjusted ratePer 100,000population9876542000 2002 2004 2006 2008 2010 2012 2014Sources: Siegel RL, Fedewa SA, Anderson WF et al. Colorectal cancer incidence patterns inthe United States, 1974–2013. J Natl Cancer Inst. 2017 Aug 1;109(8); National Cancer Institute.Surveillance, Epidemiology, and End Results (SEER) Program. https://www.seer.cancer.gov.22

Cruciferous Vegetables and Longevity:Study of 134,796 Chinese AdultsReduced risk 25%of death20%15%10%5%031g61g88g123g187gAverage grams of cruciferous vegetables consumed dailySource: Zhang X, Shu XO, Xiang YB et al. Cruciferous vegetable consumption is associatedwith a reduced risk of total and cardiovascular disease mortality. Am J Clin Nutr.2011;94(1):240–46.A Cruciferous Plant Cell23

Increase in Olive Oil Consumption, 1995–2018Millions of 52020Sources: US Department of Agriculture, Economic Research Service. Oil Crops Yearbook2019. earbook/. Last updated 20 August2019; Ash M, Dohlman E. “Oil Crops Year in Review: US Soybean Demand Powered byRecord 2006/07 Supply.” June 2008. ok-06-18-2008 Special Report.pdf.24

Withdrawal from Eating Highly Processed FoodsNumber reportingwithdrawal ings151050Days 2–3Days 6–7Weeks 3–4Months 3–5Source: Adapted from Schulte EM, Smeal JK, Lewis J, Gearhardt AN. Development of thehighly processed food withdrawal scale. Appetite. 2018 Dec 1;131:148–54.25

ADD FLAVOR—BY REDUCING SALTThe natural flavor of food—without added salt—is an acquired taste.Gradually, your taste preferences should change and you will learn toprefer food without salt. Be creative and use other flavoring agents,such as herbs, spices, onion, roasted and raw garlic, lemon or limejuice, vinegar, or lemon pepper. Experiment with fresh herbs instead ofthe dried versions. Fresh mint, cilantro

Sources: Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008. Diabetes Care. 2008;31(12):2281–83; Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr. 2002;76(

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