BY GARY E. FRASER AND TERRY BUTLER

F YOU WERE BROUGHT UP IN AN ADVENTIST home, it is probably part of your life story to be a careful eater and to believe that a meatless diet is healthier. Even if your compliance was less than perfect, the ideal was clear. Such is the power of early life experiences.

Our non-Adventist neighbors have not had this advantage. And in an age of scientific "proof" our society is unlikely to be persuaded by the writings of a nineteenth-century author, even if she did have health insights that were far ahead of her time. Vegetarians have been around for thousands of years, but it is only quite recently that one rationale for their diet has been better health, as compared to animals' rights or religious beliefs.

One way to make our health message vibrant and clearly relevant again is to respond to twenty-first-century expectations and provide the scientific evidence. The Adventist experience over the past 140 years is a marvelous "natural experiment" that begs study. What is less commonly understood is that Adventists provide other natural advantages for research seeking to link diet to the risk of disease. This is why investigators at Loma Linda University have received highly competitive funding from federal and other resources for more than 45 years to do such work.

Adventists vary widely in their eating habits. Yet similarities in other areas of their lifestyles make for easy comparisons between the health experience of a vegan Adventist and a hamburger/fries Adventist. That's right; without the participation of nonvegetarian Adventists this research would hardly be possible.

Past Findings
What does past evidence show? Are the previous conclusions of benefit real? It takes a book to do justice to this question,* but here are a few recent results.

California Adventists have only half the risk of heart attack as other Californians. In Figure 1 the horizontal line represents the non-Adventist experience. At all the ages measured in this analysis, the rate of heart attack was much less for both male and female Adventists. Benefits are especially apparent in younger and middle-aged Adventists, in whom the risks are an extraordinary one third or less those of a non-Adventist. Vegetarian Adventists had lower risks yet.

Another major fear for many people is cancer. As compared to other Californians, Adventists again have strikingly lower risks of many cancers, as indicated in Figure 2, in which the value of 1.0 represents the risk of a non-Adventist. The risks for Adventists are nearly always lower--often by a lot.

You may notice a few cancers missing from Figure 2. In no case is there evidence that a cancer is more frequent in Adventists or vegetarians. But there are a few in which the risk is not clearly lower (lymphoma, leukemia, brain cancer, uterine cancer), and the jury is still out for prostate cancer, concerning which there are other research complications. The apparent slight excess of prostate cancer in Adventist men is easily compatible with a chance result, and may be the result of earlier diagnosis in Adventists because of their good medical care and preventive orientation. So more work is necessary. As potent a factor as diet seems to be, it is unreasonable to expect it to affect all diseases.

Adventist men in California live an amazing 7.3 years longer than non-Adventist men, and the advantage for Adventist women is 4.4 years. The equivalent figures for vegetarian Adventists are 9.5 and 6.6 years for men and women, respectively. Moreover, there is every reason to suspect that most of these extra years are accompanied by a good quality of life. We are now seeking firm evidence of this. It will take the general population 40 to 50 years to catch up with the current Adventist life expectancy at present rates of increased longevity. It is interesting that life expectancy in Adventists also appears to be increasing over the years, even with our initial advantage.

Putting Off the Inevitable
So what do Adventists die from? The answer is simple: from essentially the same causes as everyone else. But whether we consider heart disease, cancer, stroke, pneumonia, flu, diabetes, etc., the striking difference is that deaths from all these causes occur much later than in the general population.

For example, although about 38 percent of both Adventist and non-Adventist women die of heart disease, on average this occurs at age 83 years in non-Adventists, at age 87 years in Adventist women as a whole, and at 92 years in Adventist women who are more careful with their lifestyle.

The broad range of Adventist diet has allowed studies of Adventists to be the first to strongly suggest that nuts and whole grains reduce risk of heart attack; that meat increases the risk of heart attack and several cancers; and that tomatoes, legumes, and fruits reduce the risk of cancer. Because of this, and also based on the evidence from subsequent similar studies of non-Adventists, the dietary recommendations of the American Heart Association and the American Cancer Society are moving closer and closer to the positions that Adventists have promoted for so long.

We can be proud to have had an important part in this process. However, despite these recommendations most Americans have made only minor changes in eating habits. Obesity is a national epidemic. Did you know that vegetarian Adventists are on average 13 pounds lighter at the same height than nonvegetarian Adventists? We have learned a lot from previous research, but when it comes to the effects of specific foods on risk of disease, the evidence is still very sketchy and controversial. Much more research is necessary, and this will come only from studies that gather a great deal of detail about the diets of a very large number of people.

Participants Needed
Our new federally funded study of 125,000 Adventists (AHS-2) addresses these needs. As we collect data on heart attacks and particular cancers during the next four years, the large number of subjects in the study ensures that our results will become more precise and trustworthy. We will be in the same league as the famous Nurses' Health Study (directed by Harvard University), the very large AARP study of retired Americans, and the EPIC study in Europe. Adventists have the great opportunity to be the key players contributing in a way that only a handful of other studies will do anywhere in the world.

Adventists have a proud health heritage: the famous Battle Creek Sanitarium, which pioneered the production of soy foods; the Five-Day Plan to Stop Smoking; world-class clinical institutions, such as Loma Linda University Medical Center; and the Sanitarium Health Food Company, a commercial producer of health foods for entire nations, are some examples of activities and institutions that are world-class.

Please join us in the latest of these opportunities to improve the health of the world's population (see the enrollment card in this issue). We are thankful for the 50,000 members who have already joined AHS-2. This is by now the largest study of Adventists ever. However, over the next two years we need at least this many again to partner with us. We believe that this is another facet of God's work.

The marvelous good advice given to Adventists more than 140 years ago was not for us alone. Help us share it with others. You can make an important contribution, no matter what your health status, even if you are overweight, nonvegetarian, or not in perfect health. The beauty of this research program is that all contribute equally.

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*Gary E. Fraser, Diet, Life Expectancy and Chronic Disease, Studies of Seventh-day Adventists and Other Vegetarians (New York: Oxford University Press, 2003).

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Gary E. Fraser, M.D., Ph.D., and Terry Butler, Dr.P.H., are director and associate director (respectively) of the Adventist Health Study-2, Loma Linda University.