BY GARY E. FRASER AND TERRY L. BUTLER

DVENTISM IS UNUSUAL, THOUGH not unique, among modern religious movements in giving personal health a prominent place in its tradition and doctrine. Yet it makes perfect sense that a loving Creator-God should make provision for His people to maximize their productivity and potential by sensible living. We believe that God has done so in both ancient and modern times. Adventists have been and still are His ambassadors in this respect.

During the more than 140 years of our church's history, Adventists have contributed much to both the popular and scientific understanding of healthful living, and this progress continues. The Battle Creek Sanitarium, the Kellogg food industry, Dr. Harry Miller and palatable soy milk, the Five-Day plan to stop smoking, the modern food industries associated with the Adventist Church, and the scientific study of Adventist health are quite well known and appreciated. The world is a different and better place because of these efforts.

Yet in recent decades the demographics of the church have changed significantly. The endeavors noted above have largely been in the United States, Australasia, or Europe (although Harry Miller's primary focus was on China). What does an Adventist understanding of health mean to the large and growing number of Adventists in Asia, Central and South America, or Africa? In some of these regions the major diseases differ markedly from those in the industrialized world, even as globalization tends to decrease our lifestyle differences. Some of these regions are dreadfully afflicted with HIV/AIDS, but with few exceptions, most people still die of other infectious diseases, cancer, or heart disease.

As many persons in developing nations aspire to the standard of living of those in the developed world, characterized by overconsumption and little physical activity, cancer and heart disease become the major killers that they are in the Western world. During the past 30 years mortality from heart and related diseases has risen dramatically in economically undeveloped countries. At present these countries account for more of such deaths than countries in the developed world, and this trend is predicted to increase rapidly.1 Similarly, cancer is an increasing problem in Asia, Africa, and elsewhere in developing nations. The kinds of cancer often differ some from those usually seen in Western countries, but their impact on the population is no less terrible.

Heart disease and cancers of the breast, prostate, and colon are common in most parts of the world. The major studies conducted in the United States by Adventist researchers have provided much useful information about these diseases, as well as longevity, and there is no reason to believe that the findings will not be useful to those living elsewhere. The human genome project has been particularly enlightening by demonstrating that the different human ethnic groups differ very little in their genetic makeup, and most people will probably react to different lifestyles in quite predictable ways.

Analyses from two large studies of the health and dietary causes of disease in American Adventists over the past 40 years have produced many different details but also some common themes. California Adventists are a researcher's dream: many are vegetarian (about 50 percent), but others are decidedly not. Thus we can make strong comparisons between different kinds of Adventists and measure how frequently each group suffers from heart disease and cancer, and how long they live.

Vegetarian Adventists usually do better than the nonvegetarians. We must remember that this may or may not have to do with the lack of meat in the vegetarian group. The vegetarians also eat more fruits, vegetables, nuts, and commercial meat substitutes; use whole-grain rather than white bread, margarine rather than butter; and are much less likely to drink coffee or alcohol. It is possible that it is these factors that are changing the risk of some diseases rather than the absence of meat. More detailed analyses can often sort this out.

Vegetarian Adventists have only about half as much heart disease as nonvegetarian Adventists. Actually, the vegetarian advantage is much greater than this in younger and middle-aged Adventists, but rather less in the elderly. This is no surprise, as vegetarians have lower levels of blood cholesterol and lower blood pressures, and are less likely to be overweight. The evidence for these matters is strong and comes from a number of other vegetarian groups as well as Adventist vegetarians. Vegetarian Adventists also have less diabetes, probably in large part because of their lower body weights. Insulin does not work properly in overweight people, and this puts a strain on the pancreas, trying to keep up the high insulin demand.

More detailed analyses strongly suggest that in the case of heart disease it is the meat itself, in part at least, that increases risk in the nonvegetarians. Our work and that of others also make it clear that nut consumption decreases risk of heart attack, as nuts decrease levels of the bad LDL blood cholesterol. Nonvegetarian Adventists eat fewer nuts, so this has an additional effect to increase their risk. In a similar way nonvegetarians are more likely to eat white bread than whole-grain breads, and whole grains decrease risk, probably because of the fiber that they contain, as well as other chemicals that reduce levels of blood cholesterol.

Cancer of the large bowel was about one third less frequent in the vegetarian Adventists than in nonvegetarian Adventists, and the risk became greater with increased consumption of meat. Other studies have also suggested that meat consumption increases risk of this cancer. Among Adventists, those who ate more beans had a reduced risk of this cancer. As usual, it would add to our confidence in this result to see it confirmed by other good studies. Even so, as beans are excellent and tasty sources of fiber and protein, they can be included in a good diet easily with no known risks and the probability of benefits.

Another distressingly common cancer of men in many parts of the world is cancer of the prostate. In the U.S., among men who are age 60 or older and who do not have diagnosed prostate cancer, about 15 percent will develop it over the next seven years alone, although most of these cancers will be slow growing.2 Unfortunately, these cancers will sometimes unpredictably "break loose" and spread aggressively to other parts of the body. Interestingly, prostate cancer is much less common in Asia. We do not know which of the many lifestyle differences between Asians and the Western cultures may be responsible, but some focus has been placed on soy beans as a common component of many Asian, but not Western, diets.

In the U.S. very few other populations eat as much soy as Adventists (mainly through commercial vegetarian meats). Thus Adventists are a unique resource for investigating the effects of soy on health. Soy is known to reduce blood cholesterol, but also contains isoflavones that may have subtle and possibly helpful effects to suppress cancer cells and retard their growth. In fact, in Adventist men who drank at least one cup of soy milk each day, the risk of prostate cancer was only 30-40 percent that of nonsoy-drinking men.

Interestingly, one other food that may be protective against prostate cancer is tomatoes. Perhaps this is because they contain lycopene, the red carotenoid that gives them their color and is also an antioxidant. More evidence would be helpful, but again, it seems that there is no downside to eating tomatoes when they are available. It is likely that they will protect against this, and, in our study, also ovarian cancer in women. Risk of ovarian cancer among those eating tomatoes at least five times each week was about 50-60 percent lower than among those who ate few tomatoes, according to our study.

Another striking feature of our research has been the observation that California Adventists are presently probably the longest-living formally described population in the world. The vegetarian Adventist men live 9.4 years longer than other California men, and vegetarian Adventist women live 6.2 years longer than other California women. These very large differences will probably take the general population 50 years to make up, just considering the gradually increasing longevity of most populations. A 50-year advance on others is a very nice bonus! But it is a bonus that is in fact available to all. More detailed analysis has shown that among Adventists differences in diet, exercise, body weight, and past smoking can readily account for 9-10 years of extra life. Hence, these factors may explain most of the Adventist advantage.

It has been well known for 20 years that people who attend church regularly live longer and have less heart disease. This is in no sense confined to Adventists, but our data does show the same phenomenon. It is probably not the hard pew that accounts for this reduction in risk. Most likely this is a marker for other psychological and social effects of being religious. The details are not yet well understood. A thoughtful person may wonder if church attendance is just a marker for good living. In fact, it appears to be more than this, because after we adjust for differences in diet, exercise, body weight, etc., there still remains an important effect that can apparently be ascribed to the church attendance and religious factors. We plan to explore this further in future studies.

In our previous studies Adventists in California had a 31 percent lower risk of developing any cancer when compared to other Californians. Such a large deficit is not the result of chance, but is a real difference. Although we do not fully understand the reasons for this, for some of the cancers there are a number of clues. It seems that meat often increases risk, and fruits, beans, tomatoes, soy, and certain other vegetables decrease risk. Each kind of cancer is relatively uncommon, and to study cancer of a particular bodily organ needs very large studies. Thus we are very fortunate to recently have received funds to establish a huge study of Adventists that reaches right across the U.S. A primary focus of this new research will be on the diet-cancer link.

Although enrollment has been slower and recruitment more difficult than we had anticipated, we are grateful that already 70,000 are fully enrolled. We anticipate that finally at least 100,000 North American Adventists will be part of Adventist Health Study-2 (AHS-2) when we finish enrolling in about 18 months. This will be one of the largest diet-chronic disease studies in the world and will surely produce many important answers, both because of the size of the study and the special attributes of the Adventist population.

Thus this movement can continue to play an important part in improving the world's health. Would an international study of Adventist health make sense? Certainly, its time may come.

In summary, what Adventists received more than 140 years ago was indeed a remarkable gift that is increasingly being validated by science. There are more than 300 peer-reviewed scientific papers in the medical literature on Adventist health, summarized in the recent book by Dr. Fraser, Diet, Life Expectancy, and Chronic Disease: Studies of Seventh-day Adventists and Other Vegetarians, Oxford University Press, 2003.

We have a responsibility to share this part of the "good news" with others, but even more important, to use it in our own lives. Members in many of the divisions in the Adventist Church have not grasped the value of the health message as clearly as those in the North American and South Pacific Divisions, perhaps for historical reasons. As Adventists in developing countries become more affluent (and as Adventists, we do become more affluent) and potentially adopt more Western eating habits, the Adventist health message, interpreted and sometimes clarified by modern scientific methods, must take on a new relevance and urgency.

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1 K. S. Reddy and S. Yusuf, "Emerging Epidemic of Cardiovascular Disease in Developing Countries," Circulation 97 (1998): 596-601.
2 I. M. Thompson, D. K. Pauler, P. J. Goodman, et al., "Prevalence of Prostate cancer among men With a prostate-specific antigen level <4.0 ng per Milliliter," New England Journal of Medicine 350 (2004): 2239-2246.

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Dr. Gary E. Fraser and Dr. Terry L. Butler are members of the faculty at the School of Public Health, Loma Linda University. They are the director and a primary researcher respectively of the Adventist Health Study now under way.