|The Föllinge project – a research project on a plant based diet in the treatment of disease
The Föllinge Project is an evaluation of the effect of a liquid diet and animal product-free diet (totally plant based) in the treatment of bronchial asthma, hypertension (high blood pressure) chronic urinary infection and chronic prostatitis (inflammation of the prostate gland).
Knowledge and education about these matters is the necessary key to improve the unprecedented gigantic health problems of the world today. It is crucial to have a holistic view and not just see the small details when dealing with health. For us who have been dealing with lifestyle and diet for decades a positive result on this kind of therapy is not a surprise. But we like to make the biological truths available to the public, medical staff, politicians and others and thus show what we already know as true; that a shift in the health state of the world is possible. But for this to happen, knowledge and certain changes in society are necessary. Nothing changes by itself. Research similar to the Föllinge project may help to bring knowledge.
The therapy used in this research is, in my opinion, far superior to conventional therapy because it removes the causes of disease. Many health problems are caused by unhealthy diet. Obviously the right therapy is then to correct the diet. The Föllinge project has done this and the result came as a natural and logical consequence. I have chosen to use the term biological medicine which was used by Olav Lindahl and others in Sweden. Biological medicine may be regarded as similar to natural medicine, but with a greater focus on diet and lifestyle. The therapy used in this research is close to natural hygiene and nature cure. Its main focus is diet; however, exercise, fresh air, pure drinking water and positive thinking also play an important role. Having worked at Föllinge and knowing Lilly Johansson well and having seen many “incurable” patients leaving disease and medicines behind and being well familiar with the therapy and lifestyle promoted am dedicated to spead knowledge about this research through lectures and in writing.
For decades the official comments on Lilly’s work characterized it as: spontaneous improvement, imagined recovery, temporary effects, etc.
The initiative for the investigation came from Lilly Johansson who felt the time had come to find scientific evidence that her therapy was beneficial and improved the conditions of many sick people. She is quoted as saying, “One cannot be responsible for withholding all this health from a sick mankind.” She found that many times it was quite easy to help people regain their health, once one knew how, even if they had been unsuccessfully treated for many years by traditional medical practitioners. It is important to note, however, that “quite easy” for Lilly Johansson is the result of a vast knowledge which she possessed, and is far from easy, neither quick to obtain.
To receive a research grant for this kind of diet study was extremely difficult. This was because it was scientifically very difficult to prove that a change in lifestyle cured disease and because the experts thought the idea of diet therapy in the treatment of disease as preposterous.
In the fall 1977 Lilly and Alf Johansson, who were in charge of administering the health center, paid a visit to the ministers for Social Affairs in Sweden. They were accompanied by a medical student by the name of Alf Spångberg, a Member of Parliament, Birgitta Hambraeus, and Professor Olav Lindahl.
The politicians were interested but cautious. They were skeptical of the group’s claims that diseases could disappear through a sound way of living. They wanted scientific evidence to support that claim. The group then asked for research grants and was advised to seek funding through “the Delegation for Social Research” which focused on medical problems but whose funding criteria was also influenced by social and political considerations. A research committee was formed to develop a comprehensive plan for the research project. It included Professor Olav Lindahl, Professor Per-Arne Öckerman, Assistant Professor Åke Stenram, Alf Spångberg MB, Statistician Lars Lindwall, Lilly Johansson and Alf Johansson.
The first grant application was rejected due to objections raised against the planning of the project. The Medical Research Council of Sweden was very critical and the application was summarily rejected. The application was then modified to counter the Research Council’s criticisms and presented again, but was unanimously rejected a second time.
The politicians thought that the ideas of the health movement could be worthy of consideration and a hearing was arranged. About a dozen experts from the fields of statistics, preventive medicine and nutritional research were represented from both opposing sides of biological and conventional medicine.
During the hearing many experts, especially from the field of statistics, concluded that the double-blind study was the only way to rule out the placebo effect as the possible cause of a patient’s improved health. The basic conclusion was that since double blind tests can not be performed on a liquid diet nor even diet as a therapy, it was consequently impossible “from a strictly scientific point of view” to prove that this way of living actually had any therapeutic effect.
In spite of that, however, the opinion of the statistical experts was that if the results were overwhelmingly good and the diseases (which previously had been lengthy and not cured by conventional methods) showed significant and overwhelming improvement, certain conclusions could be drawn even though those conclusions could not be considered as definite scientific evidence.
They acknowledged an improvement produced by diet, if there was a very large after previously showing no improvement whatsoever, or actually worsening after undergoing conventional treatment for a period of at least one year immediately prior to the study.
On request of a figure how great that improvement had to be, Assistant Professor Gunnar Eklund statistician at the National Swedish Board of Health and Welfare stated that an improvement of these patients of about 30 percent would prove that the diet had an effect. (As a comparison Lilly Johansson who had many years of experience in the field guaranteed an improvement of at least 75 percent so this was encouraging.)
It was chiefly through the intervention of the Minister of Social Affairs, Rune Gustavsson, that a grant of SEK 150,000 was obtained. As far as we know, this was the first time any “official” research money was given to this type of research. The original grant request was for the sum of SEK 850,000 and this dramatic reduction from the original proposal resulted in the patients paying their own travel expenses as well as their own health care costs during the two test periods at the center. This was at a cost of SEK 5,000 to the patient.
One very unique measure taken by the Medical Research Council was the appointment of an independent control group consisting of three experts from the Department of Social Medicine at Stockholm University. They were appointed to supervise the investigation and to make an independent evaluation of the patient’s improvement.
It was not possible to carry out the investigation in the way it was planned, partly due to the delay in approval and partly because of the slashed budget. However, part of the planned investigation was carried out with the aid of research grants from “Svenska Journalens läkarmission” (a Swedish periodical), “Hälsokostrådet” (the supervising organ for Swedish health-food questions) as well as from individuals and, of course, the enormous voluntary efforts from the staff at the health center and members of the research group. Last, but not least, we must not forget the efforts of the patients, whose willingness to accept this radically changed way of life for an entire year, plus the significant financial expense to themselves, made the research project possible.
The aim of the present investigation was to verify and, if possible, prove in a strictly scientific manner, or at least show the probability of, the widespread experience within the health movement (discussed above) that existed since a long time, as being credible and true.
The basic question was: “Could patients suffering from chronic serious diseases improve or actually be cured by a therapy consisting of a liquid diet and a special vegetarian diet?” In Sweden, the liquid diet is usually termed “juice fasting” or “raw juice fasting”. At the health center, this consisted of freshly made or frozen juices from fruit, berries and vegetables, including pears, strawberries, blueberries, carrots and various greens. In addition herbal teas, a vegetable broth boiled from fresh vegetables and very small amount of fermented (milksoured) vegetable juice such as sauerkraut juice, were included. It was a standard treatment at the center to be on the strictly liquid diet for one week but this was often prolonged.
The research group willingly admitted that the results given here are “total effects” from which the placebo part cannot be separated. But that placebo could be responsible for very great improvements over 30 percent was rejected even by statistician authorities.
The double-blind technique was rejected in this study since a double-blind test cannot be applied to an investigation dealing with diet or a special way of living. It is not possible to make people believe they eat a standard omnivorous diet when they are in fact eating a special totally vegetarian diet.
Even if one does not consider the problems of the placebo effect, the possibility still remains that certain diseases go into spontaneous remission, the causes of which are unknown. To prove or demonstrate that a given therapy is superior to the natural course, are normally two randomized groups used and then the outcome of each is compared.
Biological medicine has used this type of research for many years and has found that randomized groups are extremely difficult to maintain. This method is conducted in the following way: a large group of patients, all willing to subject themselves to a considerable change in lifestyle are first gathered. Half of the patients are randomized to the treatment and the other half continue with their usual conventional therapy. Such investigations have been performed, but have been extremely difficult to administer.
Interestingly enough, the biggest factor in this method’s lack of success, is that the patients who make up the control group want to be placed in the treatment group instead! Furthermore, if they are not allowed to switch groups, they frequently begin to go on a liquid diet and eat vegetarian food on their own initiative, at which point the control group is lost and the investigation is ruined.
The conclusion was that the only practical solution to this problem is to design a so-called longitudinal superiority test (see Vetenskap och beprövad erfarenhet – Science and empirical experience – by Lars Lindwall and Olov Lindahl, Natur & Kultur 1978) in which, for a certain time prior to the investigation the patient’s condition is constantly registered (spontaneous frequency of recovery).
The treatment then begins at a randomly chosen point of time for each patient. Only patients with long-standing diseases which have shown no spontaneous remission are included in the research.
The research group considered this design equally as scientific as the double-blind study or randomized test method. It may be considered a kind of “partial cross-over test”.
Common statistical methods are used prior to introducing the prescribed therapy to study spontaneous variation or possible remission.
In this respect, the Föllinge investigation is neither better nor worse than corresponding tests performed by conventional medicine.
Naturally, it is impossible to know how the selected patient group for the Föllinge project differs from the nation’s “same diagnosis” patient group as a whole.
Patients were selected in the following way: After discussions in the research group, it was decided to concentrate primarily on those diseases which, according to the experience of biological medicine, were relatively easy to improve with the appropriate therapy.
Bronchial asthma, hypertension, chronic prostatitis and chronic urinary infection were the first to be selected.
The next step was to establish contact with people interested in this kind of therapy. Information was published in health magazines, periodicals and certain daily newspaper. The announcements stated that a research project was to start at Föllinge Health Center and that people suffering from any of the four above diseases, could apply to the center for evaluation as study participants. The center received up to 1,000 calls from interested applicants. From there the center began the screening process. The center sent information to each applicant along with a questionnaire for them to complete. They then stayed in continuous telephone contact with them. Approximately 150 people who fit the following criteria were selected:
Initially the project was planned to include approximately 100 people, however this plan was unfilled for the following reasons:
Information on the approval of the research grants was delayed for periods of up to one year. The research grant was reduced from the original amount of SEK 850,000 to only SEK 150,000.
As time went by, the number of patients significantly declined due to the country’s economic slump in 1978. As a result, many of the patients were simply too poor to afford the treatment, or could not leave their jobs at the specified times, and still others were admitted to the hospital due to health complications.
Upon closer examination of the hospital records, it was found that some patients did not fulfill the criteria for the study.
When the research project finally started, a total of 80 people who fit the criteria were able to participate and were admitted to the Föllinge Health Center. Upon arrival they were thoroughly tested and clinically examined, including laboratory testing.
Only patients with severe chronic diseases were allowed to participate in the study as one of the criteria was that the patient’s health had remained unimproved or deteriorated for one year or longer, just prior to the study’s start date. Because of this, the group was much more difficult to treat than the usual patient at the center. This was especially true for those suffering from asthma.
Previous experiences show that patients suffering from any of these diseases often suffered from a number of other diseases as well. This was the case with this group. Depending on how detailed the diagnosis, participants were often diagnosed with several diseases concurrently. In certain cases, up to ten different diagnoses were given such as: asthma, joint pain, neck pain, migraine, ulcerative colitis, constipation, insomnia, dysphagia, perspiration at night, itching, etc.
In the opinion of the research team, all participants were considered to be in the general category of “invalids”.
To illustrate just how sick the patients in the trial group were, one patient died of coronary insufficiency before he was able to start the program. Some of the patients had been admitted to the hospital as many as eight times during the year prior to the study. One received cortisone drips for severe asthma attacks. One patient had been declared clinically dead from a severe asthma attack with suffocation and had been brought back to life with heart massage. The average length of sickness and receiving various treatments was 11 years, with variations from 1 to 30 years.
However, because of considerable telephone contact during the entire research period, the drop-out rate was very low – only 16 drop outs out of 80 patients (20 percent). Those who left the trial did not differ from the rest of the group in regards to the seriousness of their disease. The patients said the primary reason for not continuing the treatment was due to psycho-social difficulties and pressures. Financially, the expense of the journeys, in-care periods and diet costs were an insurmountable burden to some patients. In many cases there was conflict with other family members concerning diet.
To have two different kinds of foods in a family was found to be expensive and impractical. Some family members and doctors were very suspicious about this new regimen and did not believe it could improve the state of health. Warnings from both family members and physicians were frequently given that their condition could worsen. Below is a sampling of the kind of statements that were made from doctors which further illustrate the type of pressure the patients were under.
One patient died from a coronary infarction at home after a couple of months (he suffered from both severe asthma and chronic coronary heart disease).
CRITERIA FOR IMPROVEMENT
Commonly, objective criteria are considered scientifically more reliable and are more trusted as evidence of improvement than the patient’s own assessment. However the research group placed special importance on the patient’s own observations about improvement or deterioration of their condition. To this end, patients were given questionnaires to monitor and rate their symptoms starting from 6 months before the study began and continuing through the first 21 weeks. Symptoms were rated according to the following scale: symptom free (1), slight symptom (2), moderate symptom (3), strong symptom (4), and severe symptom (5).
The questionnaires were analyzed extensively from 6 months before and during the treatment, using this scale, which is relatively coarse and unrefined, with large intervals between scale markers. Since it was found that very little variation in patient’s symptoms appeared during the 6 months prior to investigation the main evaluation has been made during two weeks before the acceptance and after 21 weeks.
A number of different tests were performed on the patients including a visual acuity test, pulse at rest, blood pressure, respiratory capacity, weight, and working capacity (via use of an exercise bike).
Laboratory tests included hemoglobin, ESR, blood lipids and a number of other laboratory parameters that were able to indicate normal or deteriorated kidney or liver function, etc. The number of different medicaments as well as the cost for them was calculated before and after the treatment and a record maintained.
This table shows that 91 percent of the patients recovered completely or became better after four months of treatment.
If, instead, a simpler parameter is considered, namely the patients’ evaluation of their own condition using a scale of 1 to 5 (symptom free to severe symptoms), during two weeks before acceptance and after 21 weeks, the difference is significant. Fifty-five percent of the patients indicated an improvement of one or two levels on this scale. Forty percent of the patients remained at the same level, while 5 percent stated deterioration.
The difference in results between these two evaluations can be explained by the large distances between the different levels of the scale markers. The same level of the scale can imply certain, though minor, improvements.
The results after one year were even better and show that 94 percent of the patients recovered completely or became better.
Compliance 25-100%, average 83%.
Of the 64 patients, 27 were men and 37 were women. The average age was 49 years, with ages ranging from 28 to 67. The patients had been ill, on average, 11 years before the treatment began. The doctors that treated the patients prior to the research were specialists at a Central Hospital or a University Hospital (in 56 cases), a General Practitioner or Private Physician (in 8 cases). Seven of the 64 patients smoked before the treatment. Twenty-seven consumed smaller amounts and four consumed larger amounts of alcohol. Everyone, naturally, gave this up in connection with the treatment.
After 3½ – 4 years a final evaluation was made. Many had changed addresses, but 60 of the 64 patients were contacted.
*One patient had died of cancer and another had a stroke and became a hemiplegic. Compliance, average 61 %.
Because the patients consumed less medicine, the medical costs were reduced by approximately SEK 60,000 in one year for the entire group.
During the year prior to this treatment the patients were admitted to hospitals on average 1,533 days which, with an average cost of SEK 700 a day, means a total of SEK 1,070,000. During the year after the treatment began, the same patients were admitted to hospitals only 153 days, with a total cost of SEK 100,000.
The savings was almost SEK 1,000,000 in the first year alone. Since the patients then gradually improved, it is probable that the savings for this one little group was considerable in the coming years.
The reduced costs of medication and hospital care stand in stark contrast to the money allocated for the research grant. It also points out how difficult it is to obtain a grant for this kind of research. The hearing experts’ assessment mirrors this latter point.
Let us hope that, confronted with these results, conventional medicine and government authorities will move away from their dogmatically negative view and that society will compensate future patients for treatment in specially qualified health centers and invest more on this type of health care and less on conventional treatment (which often only manipulates symptoms).
Naturally, there will be objections that the subjective improvements are not scientifically stringent or reliable. The plentiful objective improvements that can be seen from the different tests, including laboratory tests, should counteract any such skepticism.
One objection that can be expected is: “Is it any wonder patients feel better when they lose 10 kg in weight?” To this it can be said that: (1) weight reduction under the auspices of conventional medicine has very little success, and (2) if it does succeed, it often causes considerable discomfort for the patients who sometimes say, “I didn’t feel myself again until I was back at my normal weight.” Against this backdrop, the art of making the patients lose weight must be regarded as important although this aspect is not at all well represented by hospitals or among doctors in general. Naturally, the weight reduction is not in itself the main reason for the improvement, but rather only a part of the excellent results of the treatment.
Many patients said that when they became ill, they weighed less than after the treatment, which means that the weight reduction, in their case, could not explain the improvement.
The research group expressed a hope that in the future, the support will be better and the resistance less fanatical when research projects are proposed or grants applied for in this field.
Perhaps these results will stimulate many doctors from the field of conventional medicine to undertake research in the same field. It must be pointed out that it is not sufficient with research alone or resources alone to achieve these kinds of results. Knowledge of the therapy is important as well, if results like those given here are hoped for.
When the results of the investigation became known, a great interest appeared in “how this is done”. Physicians, dietitians, nurses and others wanted to visit the health center, believing that a few days or a week would be enough to achieve all this knowledge.
The research group was of the opinion that a three year education in this field is required, as well as a long practical experience, in order to accomplish these results. Lilly Johansson was keen to start teaching her therapy but never received sufficient support for this.
Many people who think that these results are encouraging want a “Diet sheet” for their particular diseases. But as can be seen from the above discussion, it is not as easy as only prescribing a diet. During the two, two week periods that these people stay at the health center, they will probably have time to learn how to eat more or less correctly, but then further contacts are required as well as frequent discussions and alteration in the instructions before the perfect result can be achieved. This system represents a complete change in the patients’ way of life and for this the patient must have extensive knowledge of the therapy itself. She/he must, above all, know what food is suitable, how it can be obtained or how it should be grown. In general, it can be said that this new way of life includes – apart from a number of individual rules – total abstinence from alcohol, tobacco, coffee, cocoa, tea, chocolate, meat, fish, egg and dairy products and frequently a reduction or a total exclusion of grain. Vegetables must be organically grown and be eaten mainly raw. The drinking water must be spring water or other water of good quality. Chlorinated tap water or water treated with other chemicals is not acceptable.
For many people this way of eating may sound boring but it should be stated that (1) this food is delicious when correctly prepared. Many people who have changed their diet would never go back to “normal foods”. (2) A lot more variety is available and a lot more can be done with this kind of food than the average person can imagine. The average person on this diet would most probably include a higher amount of food items in the diet than the average person on a standard diet. (3) Normally, we like what we are used to; i.e., a person used to a diet consisting of meat, cheese and bread likes that food and a person used to fruit and vegetables likes that. The sense of taste changes when we change the diet. (4) Addictions to refined sugar, tobacco, alcohol, salt, coffee etc. maybe more or less difficult to overcome, but when they are the sense of taste changes.
It is important to establish a healthy way of life in order to stay healthy as long as possible or to become free from a severe and long-lasting disease. In the first case, the regime need not, perhaps, be so “strict”, but in the latter case, often maximal efforts are required to obtain results. Whoever follows these very short instructions cannot count on total disappearance of every possible symptom or disease, but can expect much better health and, provided the disease is not too severe, that some of the symptoms will actually disappear. It must be understood, however, that the changed way of life can be difficult and usually requires help and guidance. For many sick people with a poor digestive system, it is difficult to adapt and tolerate a new and completely different dietary regimen if specific measures are not undertaken.
METHODS OF TREATMENT SUMMARIZED
Lilly and Alf Johansson ceased working at the Föllinge Health Center in 1990 when the center ceased operating.
Today there is no health center operating in accordance with the methods of Lilly Johansson. This is regrettable, considering that many patients thought to be incurable by conventional medical standards, regained their health, through the use of her methods.
Today, in Sweden, the topic of the general deterioration in health for the population as a whole, and the increased expense in health care, is widely discussed in the political arena. The cost of health care is higher than ever before. Still the government doesn’t take the opportunity to improve health or support methods such as the ones used by Lilly Johansson, which could result in a savings of millions.
The following calculation may illustrate just one example: Between 1976 and 1982, 5,500 patients were treated at the health center. If all would have improved their health as much as the research group, and decreased their use of medication and the need for hospital care, the following figures of savings would be valid as of the end of 1983:
Since not all the patients treated at the center were as ill as the research group, it cannot be expected that such great improvement would have been made. However, if only 20% of that sum could have been saved, that would amount to over SEK 73,000,000 in seven years.
Considering these figures and the extent of human suffering, – it must be stated that during the life time of Lilly Johansson, a great deal of knowledge which could have been better used had the authorities been more willing, has been wasted. The health care system could have paid for people to stay at the health center, which works out a lot cheaper than hospitalization.
Support could have been given to educate both the public and professionals about Lilly Johansson’s methods. This would have had a profound effect on the future health and economy of the country. Doubtlessly, there would also have been many positive spin-off effects to this too. .
Could the lack of support from politicians and the medical profession have something to do with the fact that Lilly was basically a self-taught amateur and that many medical doctors, who have many years of studies behind them, would find it embarrassing to admit that an amateur outclassed them with methods supposed to be useless? Have, perhaps, politicians vested interest in pharmaceutical companies, the dairy or meat industry or are they under pressure from them? Or perhaps most of them just don’t care about the health of people. At least it may appear this way when knowledge and resources that could have saved many lives and helped many people to health aren’t being used.
The Föllinge project and other such research provide invaluable knowledge and give reason for change. Instead, the project has been met with silence from both politicians and medical doctors.
Had politicians been at all interested in health they would long ago have made use of this kind of knowledge. The poor state of health in Sweden, and the overload of the health care system may never have become such a major issue as it has today.
The cost of ill-health is one of the great political problems of today and one of the greatest expenses of society.
All politicians ought to have knowledge of the harmfulness of animal products, which at least in the amounts that they are eaten in the west, pose a great health threat. Together with junk foods, they are the leading cause of diseases of civilization (unknown among so called primitive people) and of premature death. This should make politicians’ work towards the end of all subsidizing of these products. Through changing agricultural practices towards production of plant foods, by supporting effective natural healing methods and by promoting and making it easier for everyone to enjoy healthy plant based food in society, health problems would diminish. At the same time it would decrease pollution, save precious natural resources and protect biodiversity.
A second study on four diseases was started but had to be discontinued due to a lack of funds.
Lilly Johansson passed away in 1999 and Professor Olav Lindahl in 1991. Lilly wrote several books, many of them together with Alf Spångberg, M.D.
For further information about laboratory tests refer to professor Lindahl´s book.
Lindahl et al: Vegan regimen with reduced medication in the treatment of bronchial asthma. J. of Asthma 1985;22:45-55.
Lindahl et al: A vegan regimen with reduced medication in the treatment of hypertension. Br J Nutr 1:984. Jul;52(1):11-20.
Lindahl, Olav: Föllingeprojektet 1984
“It is better to be healthy in Jämtland Dialect than sick in Latin”.
“We have to deal, not with diseases, but with wrong living habits. Take away the wrong living habits and the diseases will disappear by themselves.” Are Waerland
“I know of nothing so potent in producing ill-health as improperly constituted food.”Sir Robert McCarrison, M.D.
“Unless the doctors of today become the dietitians of tomorrow, the dietitians of today will become the doctors of tomorrow.”
“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”
“All truth goes through three stages. First it is ridiculed. Then it is violently opposed. Finally, it is accepted as self-evident.”
“The truth is on the way. But it is traveling slowly”
“Quite simply, the more you substitute plant foods for animal foods, the healthier you are likely to be. …. In every respect, vegans appear to enjoy equal or better health in comparison to both vegetarians and non-vegetarians.”
Updated May 2015