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Tag: Brain Health

  • What About Homocysteine, Vitamin B12, and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    What About Homocysteine, Vitamin B12, and Vegetarians’ Stroke Risk?  | NutritionFacts.org

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    Not taking vitamin B12 supplements or regularly eating B12-fortified foods may explain the higher stroke risk found among vegetarians.

    Leonardo da Vinci had a stroke. Might his vegetarian diet have been to blame? “His stroke…may have been related to an increase in homocysteine level because of the long duration of his vegetarian diet.” A suboptimal intake of vitamin B12 is common in those eating plant-based diets (unless they take B12 supplements or regularly eat B12-fortified foods) and can lead to an increased level of homocysteine in the blood, which “is accepted as an important risk factor for stroke.”

    “Accepted” may be overstating it as there is still “a great controversy” surrounding the connection between homocysteine and stroke risk. But, as you can see in the graph below and at 0:57 in my video Vegetarians and Stroke Risk Factors: Vitamin B12 and Homocysteine?, those with higher homocysteine levels do seem to have more atherosclerosis in the carotid arteries that lead up to the brain, compared to those with single-digit homocysteine levels, and they also seem to be at higher risk for clotting ischemic strokes in observational studies and, more recently, bleeding hemorrhagic strokes, as well as increased risk of dying from cardiovascular disease and all causes put together. 

    Even more convincing are the genetic data. About 10 percent of the population has a gene that increases homocysteine levels by about 2 points, and they appear to have significantly higher odds of having a stroke. Most convincing would be randomized, double-blind, placebo-controlled trials to prove that lowering homocysteine with B vitamins can lower strokes, and, indeed, that appears to be the case for clotting strokes: Strokes with homocysteine-lowering interventions were more than five times as likely to reduce stroke compared with placebo.

    Ironically, one of the arguments against the role of homocysteine in strokes is that, “assuming that vegetarians have lower vitamin B12 concentrations than meat-eaters and that low vitamin B12 concentrations cause ischaemic stroke, then the incidence of stroke should be increased among vegetarians…but this is not the case.” However, it has never been studied until now.

    As you can see in the graph below and at 2:16 in my video, the EPIC-Oxford study researchers found that vegetarians do appear to be at higher risk.

    And no wonder, as about a quarter of the vegetarians and nearly three-quarters of the vegans studied were vitamin B12-depleted or B12-deficient, as you can see below and at 2:23, and that resulted in extraordinarily high homocysteine levels.

    Why was there so much B12 deficiency? Because only a small minority were taking a dedicated B12 supplement. And, unlike in the United States, B12 fortification of organic foods isn’t allowed in the United Kingdom. So, while U.S. soymilk and other products may be fortified with B12, UK products may not. We don’t see the same problem among U.S. vegans in the Adventist study, presumably because of the B12 fortification of commonly eaten foods in the United States. It may be no coincidence that the only study I was able to find that showed a significantly lower stroke mortality risk among vegetarians was an Adventist study.

    Start eating strictly plant-based without B12-fortified foods or supplements, and B12 deficiency can develop. However, that was only for those not eating sufficient foods fortified with B12. Those eating plant-based who weren’t careful about getting a regular reliable source of B12 had lower B12 levels and, consequently, higher homocysteine levels, as you can see below and at 3:27 in my video.

    The only way to prove vitamin B12 deficiency is a risk factor for cardiovascular disease in vegetarians is to put it to the test. When researchers measured the amount of atherosclerosis in the carotid arteries, the main arteries supplying the brain, “no significant difference” was found between vegetarians and nonvegetarians. They both looked just as bad even though vegetarians tend to have better risk factors, such as lower cholesterol and blood pressure. The researchers suggest that B12 deficiency plays a role, but how do they know? Some measures of artery function weren’t any better either. Again, they surmised that vitamin B12 deficiency was overwhelming the natural plant-based benefits. “The beneficial effects of vegetarian diets on lipids and blood glucose [cholesterol and blood sugars] need to be advocated, and efforts to correct vitamin B12 deficiency in vegetarian diets can never be overestimated.”

    Sometimes vegetarians did even worse. Worse artery wall thickness and worse artery wall function, “raising concern, for the first time, about the vascular health of vegetarians”—more than a decade before the new stroke study. Yes, their B12 was low, and, yes, their homocysteine was high, “suggest[ing] that vitamin B12 deficiency in vegetarians might have adverse effects on their vascular health.” What we need, though, is an interventional study, where participants are given B12 to see if that fixes it, and here we go. The title of this double-blind, placebo-controlled, randomized crossover study gives it away: “Vitamin B-12 Supplementation Improves Arterial Function in Vegetarians with Subnormal Vitamin B-12 Status.” So, compromised vitamin B12 status among those eating more plant-based diets due to not taking B12 supplements or regularly eating vitamin B12-fortified foods may explain the higher stroke risk found among vegetarians.

    Unfortunately, many vegetarians resist taking vitamin B12 supplements due to “misconceptions,” like “hold[ing] on to the old myth that deficiency of this vitamin is rare and occurs only in a small proportion of vegans.” “A common mistake is to think that the presence of dairy products and eggs in the diet, as in LOV [a lacto-ovo vegetarian diet], can still ensure a proper intake [of B12]…despite excluding animal flesh.”

    Now that we may have nailed the cause, maybe “future studies with vegetarians should focus on identifying ways to convince vegetarians to take vitamin B12 supplements to prevent a deficiency routinely.” 

    I have updated my recommendation for B12 supplementation. I now suggest at least 2,000 mcg (µg) of cyanocobalamin once weekly, ideally as a chewable, sublingual, or liquid supplement taken on an empty stomach, or at least 50 mcg daily of supplemental cyanocobalamin. (You needn’t worry about taking too much.) You can also have servings of B12-fortified foods three times a day (at each meal), each containing at least 190% of the Daily Value listed on the nutrition facts label. (Based on the new labeling mandate that started on January 1, 2020, the target is 4.5 mcg three times a day.) Please note, though, that those older than the age of 65 have only one option: to take 1,000 micrograms a day. 

    We started this series on what to eat and not eat for stroke prevention, and whether vegetarians really have a higher stroke risk. Check related posts for the last few videos that looked at specific factors.

    Stay tuned for: 

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    Michael Greger M.D. FACLM

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  • What About Animal Protein and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    What About Animal Protein and Vegetarians’ Stroke Risk?  | NutritionFacts.org

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    Might animal protein-induced increases in the cancer-promoting growth hormone IGF-1 help promote brain artery integrity? 

    In 2014, a study on stroke risk and dietary protein found that greater intake was associated with lower stroke risk and, further, that the animal protein appeared particularly protective. Might that help explain why, as shown in the graph below and at 0:31 in my video Vegetarians and Stroke Risk Factors: Animal Protein?, vegetarians were recently found to have a higher stroke rate than meat eaters?

    Animal protein consumption increases the levels of a cancer-promoting growth hormone in the body known as IGF-1, insulin-like growth factor 1, which “accelerates the progression of precancerous changes to invasive lesions.” High blood concentrations are associated with increased risks of breast, colorectal, lung, and prostate cancers, potentially explaining the association between dairy milk intake and prostate cancer risk, for example. However, there are also IGF-1 receptors on blood vessels, so perhaps IGF-1 promotes cancer and brain artery integrity.

    People who have strokes appear to have lower blood levels of IGF-1, but it could just be a consequence of the stroke rather than the cause. There weren’t any prospective studies over time until 2017 when researchers found that, indeed, higher IGF-1 levels were linked to a lower risk of stroke—but is it cause and effect? In mice, the answer seems to be yes, and in a petri dish, IGF-1 appears to boost the production of elastin, a stretchy protein that helps keep our arteries elastic. As you can see in the graph below and at 1:41 in my video, higher IGF-1 levels are associated with less artery stiffness, but people with acromegaly, like Andre the Giant, those with excessive levels of growth hormones like IGF-1, do not appear to have lower stroke rates, and a more recent study of dietary protein intake and risk of stroke that looked at a dozen studies of more than half a million people (compared to only seven studies with a quarter million in the previous analysis), found no association between dietary protein intake and the risk of stroke. If anything, dietary plant protein intake may decrease the risk of stroke. 

    However, those with high blood pressure who have low IGF-1 levels do appear to be at increased risk of developing atherosclerosis, which is the thickening of the artery walls leading up to the brain, but no such association was found in people with normal blood pressure. So, there may be “a cautionary lesson for vegans” here. Yes, a whole food, plant-based diet “can down-regulate IGF-1 activity” and may slow the human aging process, not to mention reduce the risk of some of the common cancers that plague the Western world. But, “perhaps the ‘take-home’ lesson should be that people who undertake to down-regulate IGF-1 activity [by cutting down on animal protein intake] as a pro-longevity measure should take particular care to control their blood pressure and preserve their cerebrovascular health [the health of the arteries in their brain] – in particular, they should keep salt intake relatively low while insuring an ample intake of potassium” to keep their blood pressures down. So, that means avoiding processed foods and avoiding added salt, and, in terms of potassium-rich foods, eating beans, sweet potatoes, and dark-green leafy vegetables. 

    Might this explain the higher stroke risk found among vegetarians? No—because dairy and egg whites are animal proteins, too. Only vegans have lower IGF-1 levels in both men and women, so low levels of IGF-1 can’t explain why higher rates of stroke were found in vegetarians. Then what is it? I think the best explanation for the mystery is something called homocysteine, which I cover next. 

    If you aren’t familiar with IGF-1, my videos Flashback Friday: Animal Protein Compared to Cigarette Smoking and How Not to Die from Cancer are good primers. 

    Beyond eating a plant-based diet, how else can we lower our blood pressure? Check out the chapter of hypertension in my book How Not to Die at your local public library. 

    This is the eighth video in a 12-part series on vegetarians’ stroke risk. If you missed any of the previous ones, check out the related posts below.

    Coming up, we turn to what I think is actually going on:

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    Michael Greger M.D. FACLM

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  • What About Saturated Fat and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    What About Saturated Fat and Vegetarians’ Stroke Risk?  | NutritionFacts.org

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    How can we explain the drop in stroke risk as the Japanese diet became westernized with more meat and dairy?

    As Japan westernized, the country’s stroke rate plummeted, as you can see in the graph below and at 0:15 in my video Vegetarians and Stroke Risk Factors: Saturated Fat?. 

    Stroke had been a leading cause of death in Japan, but the mortality rate decreased sharply as they moved away from their traditional diets and started eating more like those in the West. Did the consumption of all that extra meat and dairy have a protective effect? After all, their intake of animal fat and animal protein was going up at the same time their stroke rates were going down, as shown below and at 0:35 in my video. 

    Commented a noted Loma Linda cardiology professor, “Protection from stroke by eating animal foods? Surely not!…Many vegetarians, like myself, have almost come to expect the data to indicate that they have an advantage, whatever the disease that is being considered. Thus, it is disquieting to find evidence in a quite different direction for at least one subtype of stroke.” 

    Can dietary saturated fat, like that found in meat and dairy, be beneficial in preventing stroke risk? There appeared to be a protective association—but only in East Asian populations, as you can see below and at 1:11 in my video. 

    High dietary saturated fat was found to be associated with a lower risk of stroke in Japanese but not in non-Japanese. So, what was it about the traditional Japanese diet that the westernization of their eating habits made things better when it came to stroke risk? Well, at the same time, their meat and dairy intake was going up, and their salt intake was going down, as you can see below and at 1:40. 

    The traditional Japanese diet was packed with salt. They had some of the highest salt intakes in the world, about a dozen spoonsful of salt a day. Before refrigeration became widely available, they ate all sorts of salted, pickled, and fermented foods from soy sauce to salted fish. In the areas with twice the salt intake, they had twice the stroke mortality, but when the salt intake dropped, so did the stroke death rates, because when the salt consumption went down, their blood pressure went down, too. High blood pressure is perhaps “the single most important potentially modifiable risk factor for stroke,” so it’s no big mystery why the westernization of the Japanese diet led to a drop in stroke risk.  

    When they abandoned their more traditional diets, their obesity rates went up and so did their diabetes and coronary artery disease, but, as they gave up the insanely high salt intake, their insanely high stroke rates correspondingly fell. 

    Stomach cancer is closely associated with excess salt intake. When you look at their stomach cancer rates, they came down beautifully as they westernized their diets away from salt-preserved foods, as you can see in the graph below and at 2:50 in my video. 

    But, of course, as they started eating more animal foods like dairy, their rates of fatal prostate cancer, for example, shot through the roof. Compared to Japan, the United States has 7 times more deaths from prostate cancer, 5 times more deadly breast cancer, 3 times more colon cancer and lymphoma mortality, and 6 to 12 times the death rate from heart disease, as you can see in the graph below and at 3:15 in my video. Yes, Japanese stroke and stomach cancer rates were higher, but they were also eating up to a quarter cup of salt a day. 

    That would seem to be the most likely explanation, rather than some protective role of animal fat. And, indeed, it was eventually acknowledged in the official Japanese guidelines for the prevention of cardiovascular disease: “Refrain from the consumption of large amounts of fatty meat, animal fat, eggs, and processed foods…”

    Now, one of the Harvard cohorts found a protective association between hemorrhagic strokes and both saturated fat and trans fat, prompting a “sigh of relief…heard throughout the cattle-producing Midwestern states,” even though the researchers concluded that, of course, we all have to cut down on animal fat and trans fat for the heart disease benefit. Looking at another major Harvard cohort, however, they found no such protective association for any kind of stroke, and when they put all the studies together, zero protection was found across the board, as you can see below and at 4:07 in my video. 

    Observational studies have found that higher LDL cholesterol seems to be associated with a lower risk of hemorrhagic stroke, raising the possibility that cholesterol may be “a double-edged sword,” by decreasing the risk of ischemic stroke but increasing the risk of hemorrhagic stroke. But low cholesterol levels in the aged “may be a surrogate for nutritional deficiencies…or a sign of debilitating diseases,” or perhaps the individuals were on a combination of cholesterol-lowering drugs and blood thinners, and that’s why we tend to see more brain bleeds in those with low cholesterol. You don’t know until you put it to the test.

    Researchers put together about two dozen randomized controlled trials and found that the lower your cholesterol, the better when it comes to overall stroke risk, with “no significant increase in hemorrhagic stroke risk with lower achieved low-density lipoprotein [LDL] cholesterol levels.”

    The genetic data appear mixed, with some suggesting a lifetime of elevated LDL would give you a higher hemorrhagic stroke risk, while other data suggest more of that double-edged sword effect. However, with lower cholesterol, “any possible excess of hemorrhagic [bleeding] stroke is greatly outweighed by the protective effect against ischaemic stroke,” the much more common clotting type of stroke, not to mention heart disease. It may be on the order of 18 fewer clotting strokes for every 1 extra bleeding stroke with cholesterol-lowering. 

    Does this explain the increased stroke risk found among vegetarians? Hemorrhagic stroke is the type of stroke that appeared higher in vegetarians, but the cholesterol levels in vegans were even lower, and, if anything, vegans trended towards a higher clotting stroke risk, so it doesn’t make sense. If there is some protective factor in animal foods, it is to be hoped that a diet can be found that still protects against the killer number one, heart disease, without increasing the risk of the killer number five, stroke. But, first, we have to figure out what that factor is, and the hunt continues. 

    Aren’t there studies suggesting that saturated fat isn’t as bad as we used to think? Check out: 

    Just like the traditional Japanese diet had a lot going for it despite having high sodium as the fatal flaw, what might be the Achilles’ heel of plant-based diets when it comes to stroke risk? 

    This is the seventh video in this stroke series. See the related posts below for the others.

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    Michael Greger M.D. FACLM

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  • What About Vegan Junk Food and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    What About Vegan Junk Food and Vegetarians’ Stroke Risk?  | NutritionFacts.org

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    Just because you’re eating a vegetarian or vegan diet doesn’t mean you’re eating healthfully.

    “Plant-Based Diets Are Associated with a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults”: This study of a diverse sample of 12,000 Americans found that “progressively increasing the intake of plant foods by reducing the intake of animal foods is associated with benefits on cardiovascular health and mortality.” Still, regarding plant-based diets for cardiovascular disease prevention, “all plant foods are not created equal.” As you can see in the graph below and at 0:40 in my video Vegetarians and Stroke Risk Factors: Vegan Junk Food?, a British study found higher stroke risk in vegetarians. Were they just eating a lot of vegan junk food? 

    “Any diet devoid of animal food sources can be claimed to be a vegetarian [or vegan] diet; thus, it is important to determine” what is being eaten. One of the first things I look at when I’m trying to see how serious a population is about healthy eating is something that is undeniably, uncontroversially bad: soda, aka liquid candy. Anyone drinking straight sugar water doesn’t have health on top of mind.

    A large study was conducted of plant-based eaters in the United States, where people tend to cut down on meat for health reasons far more than for ethics, as you can see in the graph below and at 1:20 in my video.

    Researchers found that flexitarians drink fewer sugary beverages than regular meat eaters, as do pescatarians, vegetarians, and vegans, as you can see below and at 1:30.

    However, in the study from the United Kingdom where the increased stroke risk in vegetarians was found and where people are more likely to go veg or vegan for ethical reasons, researchers found that pescatarians drink less soda, but the vegetarians and vegans drink more, as shown in the graph below and at 1:44. 

    I’m not saying that’s why they had more strokes; it might just give us an idea of how healthfully they were eating. In the UK study, the vegetarian and vegan men and women ate about the same amounts of desserts, cookies, and chocolate, as you can see in the graph below and at 1:53. 

    They also consumed about the same total sugar, as shown below and at 2:02. 

    In the U.S. study, the average non-vegetarian is nearly obese, the vegetarians are a little overweight, and the vegans were the only ideal weight group. In this analysis of the UK study, however, everyone was about the same weight. The meat eaters were lighter than the vegans, as you can see below, and at 2:19 in my video. The EPIC-Oxford study seems to have attracted a particularly “health-conscious” group of meat eaters weighing substantially less than the general population. 

    Let’s look at some specific stroke-related nutrients. Dietary fiber appears to be beneficial for the prevention of cardiovascular disease, including stroke, and it seems the more, the better, as you can see in the graph below and at 2:43 in my video. 

    Based on studies of nearly half a million men and women, there doesn’t seem to be any upper threshold of benefit—so, again, “the more, the better.” At more than 25 grams of soluble fiber and 47 grams of insoluble dietary fiber, you can start seeing a significant drop in associated stroke risk. So, one could consider these values “as the minimal recommendable daily intake of soluble and insoluble fiber…to prevent stroke at a population level.” That’s what you see in people eating diets centered around minimally processed plant foods. Dean Ornish, M.D., got up around there with his whole food, plant-based diet. It might not be as much as we were designed to eat, based on the analyses of fossilized feces, but that’s about where we might expect significantly lower stroke risk, as shown below and at 3:25 in my video. 

    How much were the UK vegetarians getting? 22.1 grams. Now, in the UK, they measure fiber a little differently, so it may be closer to 30 grams, but that’s still not the optimal level for stroke prevention. It’s so little fiber that the vegetarians and vegans only beat out the meat eaters by about one or two bowel movements a week, as you can see below and at 3:48 in my video, suggesting the non-meat eaters were eating lots of processed foods. 

    The vegetarians were only eating about half a serving more of fruits and vegetables. Intake is thought to reduce stroke risk in part because of their potassium content, but the UK vegetarians at higher stroke risk were eating so few greens and beans that they couldn’t even match the meat eaters. The vegetarians (and the meat eaters) weren’t even reaching the recommended minimum daily potassium intake of 4,700 mg a day.

    What about sodium? “The vast majority of the available evidence indicates that elevated salt intake is associated with higher stroke risk…” There is practically a straight-line increase in the risk of dying from a stroke, the more salt you eat, as you can see in the graph below and at 4:29 in my video. 

    Even just lowering sodium intake by a tiny fraction every year could prevent tens of thousands of fatal strokes. “Reducing Sodium Intake to Prevent Stroke: Time for Action, Not Hesitation” was the title of the paper, but the UK vegetarians and vegans appeared to be hesitating, as did the other dietary groups. “All groups exceeded the advised less than 2400 mg daily sodium intake”—and that didn’t even account for salt added to the table! The American Heart Association recommends less than 1,500 mg a day. So, they were all eating a lot of processed foods. It’s no wonder the vegetarians’ blood pressures were only one or two points lower. High blood pressure is perhaps “the single most important potentially modifiable risk factor for stroke.” 

    What evidence do I have that the vegetarians’ and vegans’ stroke risk would go down if they ate more healthfully? Well, in rural Africa, where they were able to nail the fiber intake that our bodies were designed to get by eating so many whole, healthy plant foods—including fruits, vegetables, grains, greens, beans, and protein almost entirely from plant sources—not only was heart disease, our number one killer, “almost non-existent,” but so was stroke. It only surged up from nowhere “with the introduction of salt and refined foods” to their diet. 

    “It is notable that stroke and senile dementia appear to be virtually absent in Kitava, an Oceanic culture [near Australia] whose quasi-vegan traditional diet is very low in salt and very rich in potassium.” They ate fish a few times a week, but the other 95 percent or so of their diet was made up of vegetables, fruits, corn, and beans. They had an apparent absence of stroke, even despite their ridiculously high rates of smoking, 76 percent of men and 80 percent of women. We evolved by eating as little as less than an eighth of a teaspoon of salt a day, and our daily potassium consumption is thought to have been as high as 10,000 mg or so. We went from an unsalted, whole-food diet to eating salty, processed foods depleted of potassium whether we eat meat or not. 

    Caldwell Esselstyn at the Cleveland Clinic tried putting about 200 patients with established cardiovascular disease on a whole food, plant-based diet. Of the 177 who stuck with the diet, only a single patient went on to have a stroke in the subsequent few years, compared to a hundred-fold greater rate of adverse events, including multiple strokes and deaths in those who strayed from the diet. “This is not vegetarianism,” Esselstyn explains. Vegetarians can eat a lot of less-than-ideal foods, “such as milk, cream, butter, cheese, ice cream, and eggs. This new paradigm is exclusively plant-based nutrition.” 

    This entire train of thought—that the reason typical vegetarians don’t have better stroke statistics is because they’re not eating particularly stellar diets—may explain why they don’t have significantly lower stroke rates. However, it still doesn’t explain why they may have higher stroke rates. Even if they’re eating similarly crappy, salty, processed diets, at least they aren’t eating meat, which we know increases stroke risk. There must be something about vegetarian diets that so increases stroke risk that it offsets their inherent advantages. We’ll continue our hunt for the answer next. 

    From a medical standpoint, labels like vegan and vegetarian just tell me what you don’t eat. It’s like identifying yourself as a “No-Twinkie-tarian.” You don’t eat Twinkies? Great, but what’s the rest of your diet like? 

    What are the healthiest foods? Check out my Daily Dozen.

    To catch up on the rest of this series, see related posts below. 

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    Michael Greger M.D. FACLM

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  • What About Omega-3s and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    What About Omega-3s and Vegetarians’ Stroke Risk?  | NutritionFacts.org

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    Does eating fish or taking fish oil supplements reduce stroke risk? 

    In my last video, we started to explore what might explain the higher stroke risk in vegetarians found in the EPIC-Oxford study. As you can see below and at 0:25 in my video Vegetarians and Stroke Risk Factors: Omega-3s?, vegetarians have a lower risk of heart disease and cardiovascular disease overall, but a higher risk of stroke. We looked into vitamin D levels as a potential mechanism, but that didn’t seem to be the reason. What about long-chain omega-3s, the fish fats like EPA and DHA? 

    Not surprisingly, their levels are found to be “markedly lower in vegetarians and particularly in vegans than in meat-eaters.” They’re about 30 percent lower in vegetarians and more than half as low in vegans, as you can see below and at 0:45 in my video. 

    According to “the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date,” combining 28 randomized controlled trials, stroke has no benefit. There is evidence that taking fish oil “does not reduce heart disease, stroke or death,” or overall mortality, either. This may be because, on the one hand, the omega-3s may be helping, but the mercury in fish may be making things worse. “Balancing the benefits with the contaminant risks of fish consumption has represented a challenge for regulatory agencies and public health professionals.”  

    For example, dietary exposure to polychlorinated biphenyls (PCBs) may be associated with an increased risk of stroke. In one study, for instance, “neither fish nor intake of PCBs was related to stroke risk. However, with adjustment for fish intake,” that is, at the same fish intake, “dietary PCBs were associated with an increased risk of total stroke,” so the PCB pollutants may be masking the fish benefit. If we had a time machine and could go back before the Industrial Revolution and find fish in an unpolluted state, we might find that it is protective against stroke. Still, looking at the EPIC-Oxford study data, if fish were protective, then we might expect that the pescatarians (those who eat fish but no other meat) would have lower numbers of strokes since they would have the fish benefit without the risk from other meat. But, no. That isn’t the reality. So, it doesn’t seem to be the omega-3s either.

    Let’s take a closer look at what the vegetarians are eating.

    When it comes to plant-based diets for cardiovascular disease prevention, all plant foods are not created equal. There are two types of vegetarians—those who do it for their health, and those who do it for ethical reasons, like global warming or animals—and the latter tend to eat different diets. Health vegans tend to eat more fruits and fewer sweets, for instance, and you don’t tend to see them chomping down on vegan donuts, as shown below and at 2:41 in my video. 

    “Concerns about health and costs were primary motivations for [meat] reduction” in the United States. A middle-class American family is four times more likely to reduce meat for health reasons compared to environmental or animal welfare concerns, as you can see in the graph below and at 2:55 in my video. 

    But in the United Kingdom, where the EPIC-Oxford stroke study was done, ethics was the number one reason given for becoming vegetarian or vegan, as you can see in below and at 3:05 in my video.

    We know that “plant-based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality”—a lower risk of dying from all causes put together—“in a general US adult population.” But, that’s only for healthy plant foods. Eating a lot of Wonder Bread, soda, and apple pie isn’t going to do you any favors. “For all types of plant-based diets, however, it is crucial that the choice of plant foods is given careful consideration.” We should choose whole fruits and whole grains over refined grains and avoid trans fats and added sugars. Could it be that the veggie Brits were just eating more chips? We’ll find out next. 

    Another strikeout trying to explain the increased risk. Could it be that the vegetarians were eating particularly unhealthy diets? Labels like vegetarian or vegan just tell me what is not being eaten. You can be vegetarian and consume a lot of unhealthy fare, like french fries, potato chips, and soda. That’s why, as a physician, I prefer the term whole food, plant-based nutrition. That tells me what you do eat. You eat vegetables and follow a diet centered around the healthiest foods out there.

    If you missed the first four videos in this series, see:

     Surprised about the fishy oil findings? Learn more: Is Fish Oil Just Snake Oil? and Omega-3s and the Eskimo Fish Tale. 

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    Michael Greger M.D. FACLM

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  • What About Vitamin D and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    What About Vitamin D and Vegetarians’ Stroke Risk?  | NutritionFacts.org

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    Could the apparent increased stroke risk in vegetarians be reverse causation? And what about vegetarians versus vegans? 

    In the “Risks of Ischaemic Heart Disease and Stroke in Meat Eaters, Fish Eaters, and Vegetarians Over 18 Years of Follow-Up” EPIC-Oxford study, not surprisingly, vegetarian diets were associated with less heart disease—10 fewer cases per 1,000 people per decade compared to meat eaters—but vegetarian diets were associated with three more cases of stroke. So, eating vegetarian appears to lower the risk of cardiovascular disease by 7 overall, but why the extra stroke risk? Could it just be reverse causation?

    When studies have shown higher mortality among those who quit smoking compared to people who continue to smoke, for example, we suspect “reverse causality.” When we see a link between quitting smoking and dying, instead of quitting smoking leading to people dying, it’s more likely that being “affected by some life-threatening condition” led people to quit smoking. It’s the same reason why non-drinkers can appear to have more liver cirrhosis; their failing liver led them to stop drinking. This is the “sick-quitter effect,” and you can see it when people quit meat, too.

    As you can see below and at 1:16 in my video Vegetarians and Stroke Risk Factors: Vitamin D?

    , new vegetarians can appear to have more heart disease than non-vegetarians. Why might an older person all of a sudden start eating vegetarian? Well, they may have just been diagnosed with heart disease, so that may be why there appear to be higher rates for new vegetarians—an example of the sick-quitter effect. To control for that, you can throw out the first five years of data to make sure the diet has a chance to start working. And, indeed, when you do that, the true effect is clear: a significant drop in heart disease risk. 

    So, does that explain the apparent increased stroke risk, too? No, because researchers still found higher stroke risk even after the first five years of data were skipped. What’s going on? Let’s dive deeper into the data to look for clues.

    What happens when you break down the results by type of stroke and type of vegetarian (vegetarian versus vegan)? As you can see below and at 2:09 in my video, there are two main types of strokes—ischemic and hemorrhagic. Most common are ischemic, clotting strokes where an artery in the brain gets clogged off, as opposed to hemorrhagic, or bleeding strokes, where a blood vessel in the brain ruptures. In the United States, for example, it is about 90:10, with nine out of ten strokes the clotting (ischemic) type and one out of ten bleeding (hemorrhagic), the latter being the kind of stroke vegetarians appeared to have significantly more of. Now, statistically, the vegans didn’t have a significantly higher risk of any kind of stroke, but that’s terrible news for vegans. Do vegans have the same stroke risk as meat eaters? What is elevating their stroke risk so much that it’s offsetting all their natural advantages? The same could be said for vegetarians, too. 

    Even though this was the first study of vegetarian stroke incidence, there have been about half a dozen studies on stroke mortality. The various meta-analyses have consistently found significantly lower heart disease risk for vegetarians, but the lower stroke mortality was not statistically significant. Now, there is a new study that can give vegetarians some comfort in the fact that they at least don’t have a higher risk of dying from stroke, but that’s terrible news for vegetarians. Statistically, vegetarians have the same stroke death rate as meat eaters. Again, what’s going on? What is elevating their stroke risk so much that it’s offsetting all their natural advantages?

    Let’s run through a couple of possibilities. As you can see in the graph below and at 3:48 in my video, if you look at the vitamin D levels of vegetarians and vegans, they tend to run consistently lower than meat eaters, and lower vitamin D status is associated with an increased risk of stroke. But who has higher levels of the sunshine vitamin? Those who are running around outside and exercising, so maybe that’s why their stroke risk is better. What we need are randomized studies.

    When you look at people who have been effectively randomized at birth to genetically have lifelong, lower vitamin D levels, you do not see a clear indicator of increased stroke risk, so the link between vitamin D and stroke is probably not cause-and-effect.

    We’ll explore some other possibilities, next.

    So far in this series, we’ve looked at what to eat and what not to eat for stroke prevention, and whether vegetarians do have a higher stroke risk. 

    It may be worth reiterating that vegetarians do not have a higher risk of dying from a stroke, but they do appear to be at higher risk of having a stroke. How is that possible? Meat is a risk factor for stroke, so how could cutting out meat lead to more strokes? There must be something about eating plant-based that so increases stroke risk that it counterbalances the meat-free benefit. Might it be because plant-based eaters don’t eat fish? We turn to omega-3s next. For other videos in this series, see related posts below. 

    There certainly are benefits to vitamin D, though. Here is a sampling of videos where I explore the evidence.

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    Michael Greger M.D. FACLM

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  • The Stroke Risk of Vegetarians  | NutritionFacts.org

    The Stroke Risk of Vegetarians  | NutritionFacts.org

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    The first study in history on the incidence of stroke in vegetarians and vegans suggests they may be at higher risk.

    “When ranked in order of importance, among the interventions available to prevent stroke, the three most important are probably diet, smoking cessation, and blood pressure control.” Most of us these days are doing pretty good about not smoking, but less than half of us exercise enough. And, according to the American Heart Association, only 1 in 1,000 Americans is eating a healthy diet and less than 1 in 10 is even eating a moderately healthy diet, as you can see in the graph below and at 0:41 in my video Do Vegetarians Really Have Higher Stroke Risk?. Why does it matter? It matters because “diet is an important part of stroke prevention. Reducing sodium intake, avoiding egg yolks, limiting the intake of animal flesh (particularly red meat), and increasing the intake of whole grains, fruits, vegetables, and lentils….Like the sugar industry, the meat and egg industries spend hundreds of millions of dollars on propaganda, unfortunately with great success.” 

    The paper goes on to say, “Box 1 provides links to information about the issue.” I was excited to click on the hyperlink for “Box 1” and was so honored to see four links to my videos on egg industry propaganda, as you can see below and at 1:08 in my video. 

    The strongest evidence for stroke protection lies in increasing fruit and vegetable intake, with more uncertainty regarding “the role of whole grains, animal products, and dietary patterns,” such as vegetarian diets. One would expect meat-free diets would do great. Meta-analyses have found that vegetarian diets lower cholesterol and blood pressure, as well as enhance weight loss and blood sugar control, and vegan diets may work even better. All the key biomarkers are going in the right direction. Given this, you may be surprised to learn that there hadn’t been any studies on the incidence of stroke in vegetarians and vegans until now. And if you think that is surprising, wait until you hear the results. 

    “Risks of Ischaemic Heart Disease and Stroke in Meat Eaters, Fish Eaters, and Vegetarians Over 18 Years of Follow-Up: Results from the Prospective EPIC-Oxford Study”: There was less heart disease among vegetarians (by which the researchers meant vegetarians and vegans combined). No surprise. Been there, done that. But there was more stroke, as you can see below, and at 2:14 in my video. 

    An understandable knee-jerk reaction might be: Wait a second, who did this study? Was there a conflict of interest? This is EPIC-Oxford, world-class researchers whose conflicts of interest may be more likely to read: “I am a member of the Vegan Society.”

    What about overadjustment? When the numbers over ten years were crunched, the researchers found 15 strokes for every 1,000 meat eaters, compared to only 9 strokes for every 1,000 vegetarians and vegans, as you can see below and at 2:41 in my video. In that case, how can they say there were more strokes in the vegetarians? This was after adjusting for a variety of factors. The vegetarians were less likely to smoke, for example, so you’d want to cancel that out by adjusting for smoking to effectively compare the stroke risk of nonsmoking vegetarians to nonsmoking meat eaters. If you want to know how a vegetarian diet itself affects stroke rates, you want to cancel out these non-diet-related factors. Sometimes, though, you can overadjust. 

    The sugar industry does this all the time. This is how it works: Imagine you just got a grant from the soda industry to study the effect of soda on the childhood obesity epidemic. What could you possibly do after putting all the studies together to conclude that there was a “near zero” effect of sugary beverage consumption on body weight? Well, since you know that drinking liquid candy can lead to excess calories that can lead to obesity, if you control for calories, if you control for a factor that’s in the causal chain, effectively only comparing soda drinkers who take in the same number of calories as non-soda-drinkers, then you could undermine the soda-to-obesity effect, and that’s exactly what they did. That introduces “over adjustment bias.” Instead of just controlling for some unrelated factor, you control for an intermediate variable on the cause-and-effect pathway between exposure and outcome.

    Overadjustment is how meat and dairy industry-funded researchers have been accused of “obscuring true associations” between saturated fat and cardiovascular disease. We know that saturated fat increases cholesterol, which increases heart disease risk. Therefore, if you control for cholesterol, effectively only comparing saturated fat eaters with the same cholesterol levels as non-saturated-fat eaters, that could undermine the saturated fat-to-heart disease effect.

    Let’s get back to the EPIC-Oxford study. Since vegetarian eating lowers blood pressure and a lowered blood pressure leads to less stroke, controlling for blood pressure would be an overadjustment, effectively only comparing vegetarians to meat eaters with the same low blood pressure. That’s not fair, since lower blood pressure is one of the benefits of vegetarian eating, not some unrelated factor like smoking. So, that would undermine the afforded protection. Did the researchers do that? No. They only adjusted for unrelated factors, like education, socioeconomic class, smoking, exercise, and alcohol. That’s what you want. You want to tease out the effects of a vegetarian diet on stroke risk. You want to try to equalize everything else to tease out the effects of just the dietary choice. And, since the meat eaters in the study were an average of ten years older than the vegetarians, you can see how vegetarians could come out worse after adjusting for that. Since stroke risk can increase exponentially with age, you can see how 9 strokes among 1,000 vegetarians in their 40s could be worse than 15 strokes among 1,000 meat-eaters in their 50s. 

    The fact that vegetarians had greater stroke risk despite their lower blood pressure suggests there’s something about meat-free diets that so increases stroke risk it’s enough to cancel out the blood pressure benefits. But, even if that’s true, you would still want to eat that way. As you can see in the graph below and at 6:16 in my video, stroke is our fifth leading cause of death, whereas heart disease is number one. 

    So, yes, in the study, there were more cases of stroke in vegetarians, but there were fewer cases of heart disease, as you can see below and at 6:29. If there is something increasing stroke risk in vegetarians, it would be nice to know what it is in hopes of figuring out how to get the best of both worlds. This is the question we will turn to next. 

    I called it 21 years ago. There’s an old video of me on YouTube where I air my concerns about stroke risk in vegetarians and vegans. (You can tell it’s from 2003 by my cutting-edge use of advanced whiteboard technology and the fact that I still had hair.) The good news is that I think there’s an easy fix.

    This is the third in a 12-video series on stroke risk. Links to the others are in the related posts below.

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    Michael Greger M.D. FACLM

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  • Eating to Lower Lp(a)  | NutritionFacts.org

    Eating to Lower Lp(a)  | NutritionFacts.org

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    What should we eat—and not eat—to lower the cardiovascular disease risk factor lipoprotein(a)?

    Lipoprotein A, also known as Lp(a), is an independent, genetic, and causal factor for cardiovascular disease and heart attacks. At any level of LDL cholesterol, our risk of heart attack and stroke is two- to three-fold higher when our Lp(a) is elevated. With a high enough Lp(a) level, atherosclerosis continues to progress even if we get our LDL cholesterol way down, which may help explain why so many people continue to have heart attacks and strokes even under treatment for high cholesterol. It’s been suggested that “it would be worthwhile to check Lp(a) levels in a patient who has suffered an event but has no traditional risk factors to explain it.” What’s the point of checking it, though, if there isn’t much we can do about it? “To date, no drug to reduce circulating Lp(a) levels has been approved for clinical use.”

    Some researchers blame our lack of knowledge on the fact that Lp(a) is not found in typical lab animals, like rats and mice. It’s only found in two places in nature: primates and hedgehogs. Hedgehogs? How strange is that? No wonder Lp(a) is “an enigmatic protein that has mystified medical scientists ever since” it was first discovered more than half a century ago. But who needs mice when you have men? The level in our bloodstream is “primarily determined” by genetics. For the longest time, Lp(a) was not thought to be significantly influenced by factors such as diet. Given its similarity to LDL, though, one might assume lifestyle changes, “such as increased physical activity or the adoption of a healthy diet,” would help. “However, the effects of these interventions on Lp(a) concentrations are so far either only marginal or lacking in evidence,” but might that be because they have not tried a plant-based diet yet?

    As I discuss in my video How to Lower Lp(a) with Diet, when it comes to raising LDL cholesterol, we’ve known for years that the trans fats found in meat and dairy are just as bad as the industrially produced trans fats found in partially hydrogenated oil and junk food. But, when it comes to Lp(a), as you can see below and at 2:05 in my video, trans fats from meat and dairy appear to be even worse. 

    Just cutting out meat and following a lacto-ovo vegetarian diet did not appear to help, but, as you can see below and at 2:19 in my video, when study participants were put on a whole food, plant-based diet packed with a dozen servings of fruits and vegetables a day, their Lp(a) levels dropped by 16 percent within four weeks. 

    Of course, in those 30 days, the study subjects also lost about 15 pounds, as you can see below and at 2:28, but weight loss does not appear to affect Lp(a) levels, so you figure that it must have been due to the diet. 

    If you’re already eating a healthy plant-based diet and your Lp(a) levels are still too high, are there any particular foods that can help? As with cholesterol, even if the average total cholesterol of those eating strictly plant-based may be right on target at less than 150, with an LDL under 70, there’s a bell curve with plus or minus 30 points that fall on either side, as you can see below and at 2:45 in my video. 

    Enter the “Portfolio Diet,” which is not only plant-based, but also adds specific cholesterol-lowing foods—so, think nuts, beans, oatmeal, and berries to drag cholesterol down even further. The infographic is below and at 3:11 in my video.  

    What about Lp(a)? Nuts have been put to the test. Two and a half ounces of almonds every day dropped levels, but only by about 8 percent. That is better than another nut study, though, that found no effect at all, as you can see below and at 3:29 in my video. An additional study found “no significant changes,” and researchers reported that subjects in their study “did not experience a change in Lp(a).” Ah, nuts.  

    There is one plant that appears to drop Lp(a) levels by 20 percent, which is enough to take people exceeding the U.S. cut-off down to a more optimum level. And that plant is a fruit: Emblica officinalis, otherwise known as amla or Indian gooseberry. A randomized, double-blind, placebo-controlled study asked smokers before and after the trial about their “mouth hygiene, cough with expectoration, shortness of breath on exertion, loss of appetite, feelings of impending doom, palpitation, sleep deprivation, irritability, heartburn and tiredness,” as well as such objective measurements as their blood count, cholesterol, DNA damage, antioxidant status, and lung function. The amla extract used “showed a significant improvement compared to the placebo group in all the subjective and objective parameters tested with no reports of adverse events.” No side effects at all. That’s unbelievable! No, that’s unbelievable. And indeed, it’s completely not true.  

    Yes, subjective complaints got better in the amla group, but they got better in the placebo group, too, with arbitrary scoring systems and no statistical analysis whatsoever. And, of the two dozen objective measures, only half could be said to reach any kind of before-and-after statistical significance and only three were significant enough to account for the fact that if you measure two dozen things, a few might pop up as positive if only by chance. Any time you see this kind of spin in the abstract, which is sometimes the only part of a study people read, you should suspect some kind of conflict of interest. However, no conflicts of interest were declared by the researchers, but that’s bullsh*t, as the study was funded by the very company selling those amla supplements! Sigh.

    Anyway, one of those three significant findings was the Lp(a), so it might be worth a try in the context of a plant-based diet, which, in addition to helping with weight loss, can dramatically improve blood pressure (even after cutting down on blood pressure medications) and contribute to a 25-point drop in LDL cholesterol. Also, it may contribute to a 30 percent drop in C-reactive protein and significant reductions in other inflammatory markers for “a systemic, cardio-protective effect”—all thanks to this single dietary approach.

    You may be interested in my video on Trans Fat in Meat and Dairy. Did you know that animal products are exempted from the ban? See Banning Trans Fat in Processed Foods but Not Animal Fat.

    For more on amla and what else it can do, check out the related posts below.

    If you missed my previous video on Lp(a), watch Treating High Lp(a)—A Risk Factor for Atherosclerosis. 

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    Michael Greger M.D. FACLM

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  • What Should We Eat?  | NutritionFacts.org

    What Should We Eat?  | NutritionFacts.org

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    Here is a review of reviews on the health effects of animal foods versus plant foods.

    Instead of looking only at individual studies or individual reviews of studies, what if you looked at a review of reviews? In my last video, I covered beverages. As you can see below and at 0:20 in my video Friday Favorites: What Are the Best Foods?, the majority of reviews found some effects either way, finding at least some benefits to tea, coffee, wine, and milk, but not for sweetened beverages, such as soda. As I explored in depth, this approach isn’t perfect. It doesn’t take into account such issues as conflicts of interest and industry funding of studies, but it can offer an interesting bird’s-eye view of what’s out in the medical literature. So, what did the data show for food groups? 

    You’ll note the first thing the authors did was divide everything into plant-based foods or animal-based foods. For the broadest takeaway, we can look at the totals. The vast majority of reviews on whole plant foods show protective or, at the very least, neutral effects, whereas most reviews of animal-based foods identified deleterious health effects or, at best, neutral effects, as you can see at 1:14 in my video. 

    Let’s break these down. As you can see in the graph below and at 1:23, the plant foods consistently rate uniformly well, reflecting the total, but the animal foods vary considerably. If it weren’t for dairy and fish, the total for animal foods would swing almost entirely neutral or negative. 

    I talked about the effects of funding by the dairy industry in my last blog, as well as substitution effects. For instance, those who drink milk may be less likely to drink soda, a beverage even more universally condemned than dairy, so the protective effects may be relative. They may arise not necessarily from what is being consumed, but rather from what is being avoided. This may best explain the fish findings. After all, the prototypical choice is between chicken and fish, not chicken and chickpeas.

    Not a single review found a single protective effect of poultry consumption. Even the soda industry could come up with 14 percent protective effects! But, despite all of the funding from the National Chicken Council and the American Egg Board, chicken, and eggs got big fat goose eggs, as you can see below and at 2:20 in my video. 

    Also, like the calcium in dairy, there are healthful components of fish, such as the long-chain omega-3 fatty acids. Not for heart health, though. In “the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date,” increasing intake of fish oil fats had little or no effect on cardiovascular health. If anything, it was the plant-based omega-3s found in flaxseeds and walnuts that were protective. The long-chain omega-3s are important for brain health. Thankfully, just like there are best-of-both-worlds non-dairy sources of calcium, there are pollutant-free sources of the long-chain omega-3s, EPA, and DHA, as well.

    The bottom line, as you can see below and at 3:04 in my video, is that when it comes to diet-related diseases, such as obesity, type 2 diabetes, mental health, bone health, cardiovascular disease, and cancers, even if you lump together all the animal foods, ignore any industry-funding effects, and just take the existing body of evidence at face value, nine out of ten study compilations show that whole plant foods are, in the very least, not bad.

    However, about eight out of ten of the reviews on animal products show them to be not good, as shown in the graph below and at 3:24 in my video.

    This reminds me of my Flashback Friday: What Are the Healthiest Foods? video, which you may find to be helpful for some broad takeaways.

    If you missed my previous video, check out Friday Favorites: What Are the Best Beverages?.

    The omega-3s video I mentioned is Should Vegans Take DHA to Preserve Brain Function?.

    For more on eggs, see here.

    On fish, go here.

    And, for poultry, see related posts below. 

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    Michael Greger M.D. FACLM

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  • What Should We Drink?  | NutritionFacts.org

    What Should We Drink?  | NutritionFacts.org

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    Here is a review of reviews on the health effects of tea, coffee, milk, wine, and soda.

    If you’ve watched my videos or read my books, you’ve heard me say, time and again, the best available balance of evidence. What does that mean? When making decisions as life-or-death important as what to feed ourselves and our families, it matters less what a single study says, but rather what the totality of peer-reviewed science has to say.

    Individual studies can lead to headlines like “Study Finds No Link Between Secondhand Smoke and Cancer,” but to know if there is a link between secondhand smoke and lung cancer, it would be better to look at a review or meta-analysis that compiles multiple studies. The problem is that some reviews say one thing—for instance, “breathing other people’s tobacco smoke is a cause of lung cancer”—and other reviews say another—such as, the effects of secondhand smoke are insignificant and further such talk may “foster irrational fears.” And, while we’re at it, you can indulge in “active smoking of some 4-5 cigarettes per day” without really worrying about it, so light up!

    Why do review articles on the health effects of secondhand smoke reach such different conclusions? As you can imagine, about 90 percent of reviews written by researchers affiliated with the tobacco industry said it was not harmful, whereas you get the opposite number with independent reviews, as you can see below and at 1:18 in my video Friday Favorites: What Are the Best Beverages?. Reviews written by the tobacco industry–affiliated researchers had 88 times the odds of concluding that secondhand smoke was harmless. It was all part of “a deliberate strategy to use scientific consultants to discredit the science…” In other words, “the strategic and long run antidote to the passive smoking issue…is developing and widely publicizing clear-cut, credible, medical evidence that passive smoking [secondhand smoke] is not harmful to the non-smoker’s health.”

    Can’t we just stick to the independent reviews? The problem is that industry-funded researchers have all sorts of sneaky ways to get out of declaring conflicts of interest, so it can be hard to follow the money. For instance, it was found that “77% failed to disclose the sources of funding” for their research. But, even without knowing who funded what, the majority of reviews still concluded that secondhand smoke was harmful. So, just as a single study may not be as helpful as looking at a compilation of studies on a topic, a single review may not be as useful as a compilation of reviews. In that case, looking at a review of reviews can give us a better sense of where the best available balance of evidence may lie. When it comes to secondhand smoke, it’s probably best not to inhale, as you can see in the graph below and at 2:30 in my video. 

    Wouldn’t it be cool if there were reviews of reviews for different foods and drinks? Voila! Enter “Associations Between Food and Beverage Groups and Major Diet-Related Chronic Diseases: An Exhaustive Review of Pooled/Meta-Analyses and Systematic Reviews.” Let’s start with the drinks. As you can see below and at 2:51 in my video, the findings were classified into three categories: protective, neutral, or deleterious.

    First up: tea versus coffee. As you can see in the graph below and at 2:58, most reviews found both beverages to be protective for whichever condition they were studying, but you can see how this supports my recommendation for tea over coffee. Every cup of coffee is a lost opportunity to drink a cup of green tea, which is even healthier. 

    It’s no surprise that soda sinks to the bottom, as you can see below and at 3:20 in my video, but 14 percent of reviews mentioned the protective effects of drinking soda. What?! Well, most were references to papers like “High Intake of Added Sugar Among Norwegian Children and Adolescents,” a cross-sectional study that found that eighth-grade girls who drank more soda were thinner than girls who drank less. Okay, but that was just a snapshot in time. What do you think is more likely? That the heavier girls were heavier because they drank less soda, or that they drank less sugary soda because they were heavier? Soda abstention may therefore be a consequence of obesity, rather than a cause, yet it gets marked down as having a protective association. 

    Study design flaws may also account for wine numbers, as seen below and at 4:07 in my video. This review of reviews was published in 2014, before the revolution in our understanding of “alcohol’s evaporating health benefits,” suggesting that the “presumed health benefits from ‘moderate’ alcohol use [may have] finally collapsed”—thanks in part to a systematic error of misclassifying former drinkers as if they were lifelong abstainers, as I revealed in a deep dive in a video series on the subject.  

    Sometimes there are unexplainable associations. For example, one of the soft drink studies found that increased soda consumption was associated with a lower risk of certain types of esophageal cancers. Don’t tell me. Was the study funded by Coca-Cola? Indeed. Does that help explain the positive milk studies, as you can see in the graph below and at 5:02 in my video? Were they all just funded by the National Dairy Council? 

    As shown below and at 5:06, even more conflicts of interest have been found among milk studies than soda studies, with industry-funded studies of all such beverages “approximately four to eight times more likely to be favorable to the financial interests of the [study] sponsors than articles without industry-related funding.”

    Funding bias aside, though, there could be legitimate reasons for the protective effects associated with milk consumption. After all, those who drink more milk may drink less soda, which is even worse, so they may come out ahead. It may be more than just relative benefits, though. The soda-cancer link seems a little tenuous and not just because of the study’s financial connection to The Coca-Cola Company. It’s hard to imagine a biologically plausible mechanism, whereas even something as universally condemned as tobacco isn’t universally bad. As I’ve explored before, more than 50 studies have consistently found a protective association between nicotine and Parkinson’s disease. Even secondhand smoke may be protective. Of course, you’d still want to avoid it. Passive secondhand smoke may decrease the risk of Parkinson’s, but it increases the risk of stroke, an even deadlier brain disease, not to mention lung cancer and heart disease, which has killed off millions of Americans since the first Surgeon General’s report was released, as you can see below and at 6:20 in my video. 

    Thankfully, by eating certain vegetables, we may be able to get some of the benefits without the risks, and the same may be true of dairy. As I’ve described before, the consumption of milk is associated with an increased risk of prostate cancer, leading to recommendations suggesting that men may want to cut down or minimize their intake, but milk consumption is also associated with decreased colorectal cancer risk. This appears to be a calcium effect. Thankfully, we may be able to get the best of both worlds by eating high-calcium plant foods, such as greens and beans.  

    What does our review-of-reviews study conclude about such plant-based foods, in comparison to animal-based foods? We’ll find out next.

    Stay tuned for the exhaustive review of meta-analyses and systematic reviews on major diet-related chronic diseases found for food groups in What Are the Best Foods?.

    The alcohol video I mentioned is Is It Better to Drink a Little Alcohol Than None at All?, and the Parkinson’s video is Pepper’s and Parkinson’s: The Benefits of Smoking Without the Risks. I also mentioned my Dairy and Cancer video. 

    What about diet soda? See related posts below. 

    What’s so bad about alcohol? Check out Can Alcohol Cause Cancer? and Do Any Benefits of Alcohol Outweigh the Risks? for more. 

    I’ve also got tons of milk. Check here.

    My recommendations for the best beverages are water, green tea, and hibiscus herbal tea. Learn more in the related posts below.

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    Michael Greger M.D. FACLM

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  • Brain-Boosting Grapes  | NutritionFacts.org

    Brain-Boosting Grapes  | NutritionFacts.org

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    Grape juice and whole grapes are put to the test for brain function, including cognitive decline in early Alzheimer’s.

    In 2010, the first controlled trial was published that examined how the brain responds to grape juice. It helped aged rats, but what about people? “Concord grape juice supplementation improves memory function in older adults with mild cognitive impairment”—or so says the title. The problem is that the study was funded by Welch’s, and, though the authors claim they have no financial interest in the outcome, that seems disingenuous. I mean, do they think Welch’s would ever fund them again if they found grape juice wasn’t good for you? And, indeed, that title is a bit of industry spin. I’m sure that’s what they wanted to find.

    Older adults with memory decline (but not dementia) were randomized into a placebo-controlled, double-blind trial with Concord grape juice versus a similarly looking and tasting Kool-Aid type of drink with the same calories and same sugars. That’s a solid study design. And, berries have those wonderful polyphenol phytonutrients, which have anti-inflammatory and antioxidant properties, so it certainly could help brain function and it did seem to help with verbal learning, as you can see in the graph below and at 1:21 in my video Friday Favorites: Benefits of Grapes for Brain Health.

    The odds you’d get such notable results just by chance are like 1 in 25, whereas the higher recall scores are not considered to be statistically significant, since even if there wasn’t an effect, you might get those kinds of results by chance 1 in every 8 or 10 times you’d run the experiment, as shown in the graph below and at 1:38 in my video. And, by convention, we like at least 1 in 20—a p-value of 0.05 or less—especially if we’re looking at multiple outcomes, which increases the likelihood that something will pop up as a fluke. The bottom line is that we’re less confident in these memory outcomes. If this study hadn’t had industry funding, I imagine it would be titled more accurately. Perhaps “Concord grape juice supplementation improves verbal learning in older adults with mild cognitive impairment”—which is still an important finding, and we have the Welch’s corporation to thank for it. Without industry funding, a study like this might never get done. 

    The findings suggest that drinking grape juice is superior to drinking a grape Kool-Aid type of beverage, not necessarily for helping memory, but maybe for helping with learning. When the study was repeated, though, it did seem to help one measure of memory, but no benefit was found for verbal learning, even when using the same test as before, which calls the previous results into question. So, we’re left uncertain about what effects, if any, grape juice has on the aging brain. 

    What about the brains of middle-aged mothers? The Welch’s-funded researchers noted significant improvements in one measure of memory and driving performance as measured in a fancy driving simulator, suggesting you might be able to stop a dozen yards earlier on the highway after drinking grape juice than if you had instead had a grape Kool-Aid type of drink. I do like how they tried to translate the cognitive effects into more meaningful metrics, but it’s important to acknowledge, as they did, that no effects were found for the majority of cognitive consequences. And, when you study 20 different outcomes, the odds are pretty good that you’d just get a statistically significant result or two by chance, as you can see below and at 3:33 in my video. 

    The latest study involved giving a single dose of a cup of purple grape juice or white grape juice (to which flavor and color had been added to disguise it) to young adults with an average age of 21. In this way, researchers could see if there’s something special about those deep purple polyphenol pigments in Concord grape juice. Their findings? They got the same kind of results: two cognitive measures just reaching statistical significance, but that’s out of seven different outcomes, as you can see below and at 4:12 in my video. So, instead of a p-value of 0.05 as the cut-off for significance, we’d really like to see closer to 0.007, and none hit that. Maybe it’s because they didn’t use whole food like in that blueberry study I profiled before. 

    There was a study that looked at actual grape consumption by utilizing freeze-dried grape powder to capture the whole food (instead of just the juice) versus a sugar-matched placebo. The researchers used PET scans to track changes in brain metabolism associated with early Alzheimer’s in a group of older adults already suffering from mild cognitive decline. Although the changes couldn’t be picked up on neuropsychological testing, in those early-stage Alzheimer’s regions, the placebo group continued to worsen, but the grape group “was spared such decline,” suggesting a protective effect of grapes. You can see these points illustrated in a graph and brain mapping pictures below and from 5:11 in my video. You can see locations where brain metabolism declined after eating six months of placebo grapes (colored red in the video), compared to the level of decline in a brain after six months of eating actual grapes. 

    When commercial entities fund studies, it’s more for marketing purposes than science. That doesn’t necessarily mean the findings are invalid, but you do have to pay special attention to things like the framing of the research question, the experimental methods, statistical analysis, biased interpretation of results, or spin.

    The blueberry video I mentioned is Flashback Friday: Benefits of Blueberries for the Brain. You may also be interested in the Benefits of Blueberries for Mood and Mobility.

    What else might help protect brain function? Check out related posts below.

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    Michael Greger M.D. FACLM

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  • What Part of the Brain Controls Breathing?

    What Part of the Brain Controls Breathing?

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    Breathing. What are the chances you’ve paid attention to it?

    Granted, many of us have when we’re hyperventilating or short of breath. But oftentimes, it’s so automatic that we don’t give it a second thought.

    Additionally, what we also don’t give much thought to is what part of the brain controls breathing. Because why should we?

    “If you stop breathing just for a few minutes, it’s over,” says Niraj Naik, the founder of SOMA Breath® and trainer of Mindvalley’s Breathwork for Life Quest. “So really, we should be paying more attention to our breath.”

    The truth of the matter is, caring about it goes beyond mere curiosity—it’s about unlocking the potential to enhance your well-being, stress management, and overall quality of life. 

    What Part of the Brain Controls Breathing?

    The brainstem controls breathing. Situated at the base of your skull, this part of the brain acts as a bridge between your brain and spinal cord. It’s made up of three main parts:

    • Medulla oblongata: Sends signals through the spinal cord to automatically control your breathing muscles.
    • Pons: Adjusts your breaths to be smooth by fine-tuning inhalation and exhalation.
    • Midbrain: Influences breathing indirectly based on your activity level and alertness.

    So out of these three, what part of the brain controls breathing rate? That would be the medulla oblongata. Its respiratory centers, which are groups of neurons, automatically control the rate and depth of breathing.

    How? By sending signals to the muscles involved, such as the diaphragm and the muscles around the ribs, telling them when to contract and relax.

    What part of the brain controls heart rate and breathing?

    The responsibility of controlling not only breathing but also heart rate goes to the medulla oblongata. It houses specific groups of neurons that are dedicated to keeping your body functioning optimally. 

    For heart rate, there’s the cardiac center, which sends signals to speed up or slow down based on your body’s needs. Take exercise, for instance. The neurons pick up the pace to deliver more oxygen to your muscles.

    The medulla oblongata doesn’t stop there. When it comes to breathing, it contains the respiratory center that ensures your lungs take in the right amount of oxygen and expel carbon dioxide efficiently.

    Additionally, this particular brain region doesn’t work alone. It collaborates closely with the pons to regulate your heart rate in response to your breathing. This seamless integration ensures that when you’re faced with stress or excitement, your breathing and heart rate adjust accordingly, helping you maintain balance.

    And if you ever need to, you can make conscious efforts to adjust with breathing exercises like SOMA Breath® or pranayama breathing.

    Effects of Breathing On the Brain

    “Breathe” is not just another commonsense piece of advice. According to research, it can have great effects on your brain health—different types of breathing can influence thoughts, moods, and behaviors.

    When the breathing rate is increased, it activates the amygdala, a part of the brain that is primarily involved in emotional learning and behavior. So when you breathe rapidly and shallowly, it can trigger feelings like anxiety, anger, or fear.

    On the other hand, if your breathing is slow and deep, like in meditation, it stimulates the vagus nerves, which regulate the respiratory rate. This, then, can turn off the “fight or flight” reflex and relax your brain.

    Learning how to consciously control the breath is easier said than done, but it can have a number of powerful benefits. Breathing calmly may also improve your balance, ability to control your emotions, and stress levels, just to name a few.

    5 Breathing Exercises for Brain Performance

    Humans can go a while without food and water. But how long can you go without breathing?

    “Just a few minutes,” Niraj explains. 

    Understanding what part of the brain controls breathing gives you a window into how your whole body functions. With this knowledge, you can actually take control of your breath. And in doing so, you can also influence your emotions and physical health in surprising ways.

    Here are five simple breathing exercises you can start with:

    1. Pranayama breathing

    With its roots in yoga, pranayama breathing helps you control your breath to calm your mind and body. The idea is that the breathing rhythms help enhance the respiratory system, calming the mind, reducing stress, and improving concentration and overall well-being. 

    Best of all, it’s easy to learn. Here’s how to do it:

    1. Sit in a quiet place where you won’t be disturbed. Keep your back straight and relax your shoulders.
    1. Close your eyes. Take a deep breath in through your nose, filling your lungs fully. Notice how your belly rises.
    1. Slowly breathe out through your nose, emptying your lungs completely. Feel your belly fall.
    1. Keep this deep breathing going. Breathe in slowly, then exhale slowly. Try to make your inhale and exhale the same length.

    Doing this for a few minutes each day can help you feel more relaxed and centered.

    2. SOMA Breath®

    Stemming from pranayama techniques, this unique breathwork focuses on regulating CO2 levels in your body to encourage proper breathing habits. What sets it apart is its use of rhythmic music, aligning your breath with the beat to achieve a state of heart coherence, where inner harmony and balance are realized.

    Here’s how to do it:

    1. Sit comfortably in an upright position, ensuring your back is straight.
    1. Gently point the tip of your tongue to the back of your upper teeth, aligning it towards your third eye to enhance energy flow.
    1. Inhale deeply through your nostrils.
    1. As you exhale, produce a humming sound, directing your awareness to the buzzing sensation at the center of your forehead, the location of your third eye.
    1. Continue this humming for three minutes, focusing on the vibration to stimulate your third eye and enhance the practice.
    1. During the exercise, you can shift your focus to enhance the effect. Look towards your third eye or bring your attention to the tip of your nose while maintaining the humming sound.
    Breathwork expert Niraj Naik showing a breathing exercise

    SOMA Breath® is designed to balance your nervous system, enhance focus, and awaken your inner strength. It’s perfect for a morning routine or a mid-day refresh.

    3. Breathing biohacks

    Juan Pablo Barahona (better known as JuanPa), a renowned transformational leader and energy master, shares a simple yet effective way to use your breath to balance your nervous system in his Ultra Presence Quest on Mindvalley. It’ll help make you feel more relaxed and present.

    Here’s how you can do it:

    1. Start by breathing in and out through your nose very gently, so it’s almost silent.
    1. When you’re feeling calm, fully exhale and then pause, holding your breath.
    1. When you feel the urge to breathe, inhale softly without rushing. Then, exhale all the air out gently.
    1. When you’re ready, hold your breath again, this time a bit longer. Try to extend the hold a little more each time, up to three times.

    This exercise is all about finding balance through gentle breathing. While holding your breath might seem counterintuitive, it can actually help your body switch between alertness and relaxation.

    Studies have shown that slowing down your breath rate (less than 10 breaths per minute) can positively impact your nervous system. This means you can train your body to handle stress better and experience a greater sense of peace in your daily life.

    4. Third Breath Biohack

    The Third Breath Biohack is all about using your breath to help your nervous system chill out. It’s something you can do while walking, running, or doing any kind of movement, according to JuanPa.

    Here’s how to do it:

    1. Walk (or do any kind of movement) naturally, breathing in and out through your nose.
    1. Whenever you’re ready, breathe out all your air and keep walking without taking a breath in. Feel relaxed, even with the stress of not breathing.
    1. Take a breath when you need to, then go back to your gentle nose breathing.
    1. Do it again, holding your breath out longer each time, for three rounds. Try making the last one challenging.

    Doing this exercise, you’ll notice how it changes your walk and how you feel. It teaches your body to be okay with a bit of stress and then to relax again quickly. Plus, it’s a great way to boost your oxygen use and make your nervous system stronger.

    5. The Wim Hof Technique

    Wim Hof, also known as “The Iceman,” is a Dutch extreme athlete known for his ability to withstand freezing temperatures. His method, which he calls the Wim Hof Method, combines cold exposure, breathing techniques, and meditation.

    The breathing part goes like this:

    1. Sit or lie down in a place where you won’t be disturbed.
    1. Start taking deep, short, controlled breaths. Inhale deeply through your nose, filling your lungs, and then exhale unforced through your mouth.
    1. Do this for about 30 cycles. (Each cycle includes a deep breath in and then letting the breath go.)
    1. After the last breath, exhale and hold your breath until you feel the urge to breathe again.
    1. Once you need to breathe again, take a deep breath in and hold it for 15 to 20 seconds.
    1. Exhale. This completes one round.
    1. Do 3 to 4 rounds.

    Practicing this method can boost your immune system, improve concentration, and give you a feeling of increased energy. It’s a powerful tool to strengthen both mind and body resilience.

    Futureproof Your Well-Being

    Breathing may seem like the most natural thing to do, but many of us need help with doing so properly. You can, however, learn to breathe to benefit your brain.

    Head over to Mindvalley and check out the Breathwork for Life Quest with Niraj Naik. This transformational leader will guide you beyond what part of the brain controls breathing to help you better understand the profound impact of it on your health, performance, and well-being.

    As he says in his Quest, “If you master your breath, you can control your state. And when you control your state, you master your life.”

    Welcome in.

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    Tatiana Azman

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  • The Safety of Fasting to Lose Weight  | NutritionFacts.org

    The Safety of Fasting to Lose Weight  | NutritionFacts.org

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    Why should fasts lasting longer than 24 hours and particularly for three or more days only be done under the supervision of a health professional and preferably in a live-in clinic? 
     
    Fasting for a week or two can actually interfere with the loss of body fat, as shown at the start of my video Is Fasting for Weight Loss Safe?. But, eventually, after the third week of fasting, fat loss starts to overtake the loss of lean body mass in obese individuals, as seen in the graph below and at 0:14 in my video. Is it safe to go that long without food? 

    Proponents speak of fasting as a cleansing process, but some of what is being purged from our bodies are essential vitamins and minerals. People who are heavy enough can fast up to 382 days without calories, but no one can go even a fraction of that long without vitamins. Scurvy, for example, can be diagnosed within as few as four weeks without any vitamin C. Beriberi, deficiency of thiamine (vitamin B1), may start even earlier in fasting patients. And, once it manifests, it can result in brain damage within days, which can eventually become irreversible.  
     
    Even though fasting patients report problems such as nausea and indigestion after taking supplements, all of the months-long fasting cases I’ve discussed previously were given daily multivitamins and mineral supplementation as necessary. Without supplementation, hunger strikers and those undergoing prolonged fasts for therapeutic or religious purposes (like the Baptist pastor hoping “to enhance his spiritual powers for exorcism”) have ended up paralyzed, become comatose, or worse. 
     
    Nutrient deficiencies aren’t the only risk. After reading about all of the successful reports of massive weight loss from prolonged fasting in the medical literature, one doctor decided to give it a try with his patients. Of the first dozen he tried it on, two died. In retrospect, the two patients who died had started out with heart failure and had been on diuretics. Fasting itself produces pronounced diuresis, meaning loss of water and electrolytes through the urine, so it was the combination of fasting on top of the water pills that likely depleted their potassium and triggered their fatal heart rhythms. The doctor went out of his way to point out that both of the people who died started out “in severe heart failure, complicated by gross obesity; but both had improved greatly whilst undergoing starvation therapy.” That seems like a small consolation since they were both dead within a matter of weeks. 
     
    Not all therapeutic fasting fatalities were complicated by concurrent medication use, though. One researcher writes: “At first he did very well and experienced the usual euphoria…His pulse, blood pressure, and electrolytes remained satisfactory, but in the middle of the third week of treatment, he suddenly collapsed and died. This line of treatment is certainly tempting because it does produce weight loss and the patient feels so much better, but the report of case-fatalities”—the whole part about killing people—“must make it a very suspect line of management.” 
     
    Contrary to the popular notion that the heart muscle is specially spared during fasting, the heart appears to experience similar muscle wasting. This was “described in the victims of the Warsaw ghetto” during World War II in a remarkable series of detailed studies carried out by the ghetto physicians before they themselves succumbed. In a case entitled “Gross Fragmentation of Cardiac Fiber After Therapeutic Starvation for Obesity,” a 20-year-old woman successfully “achieved her ideal weight” after losing 128 pounds by fasting for 30 weeks. “After a breakfast of one egg,” she had a heart attack and died. On autopsy, as you can see below and at 3:44 in my video, the muscle fibers in her heart showed evidence of widespread disintegration. The pathologists suggested that fasting regimens “should no longer be recommended as a safe means of weight reduction.” 
    Breaking the fast appears to be the most dangerous part. After World War II, as many as one out of five starved Japanese prisoners of war tragically died following liberation. Now known as “refeeding syndrome,” multiorgan system failure can result from resuming a regular diet too quickly. This is because there are critical nutrients such as thiamine and phosphorus that are used to metabolize food. Therefore, in the critical refeeding window, if too much food is taken before these nutrients can be replenished, demand may exceed supply. Whatever residual stores you still carry can be driven down even further, with potentially fatal consequences. This is why rescue workers are taught to always give thiamine before food to victims who have been trapped or otherwise unable to eat. Thiamine is responsible for the yellow color of “banana bags,” a term you might have heard used in medical dramas to describe an IV fluid concoction often given to malnourished alcoholics to prevent a similar reaction. (You can see a photo of them below and at 4:53 in my video.) Anyone “with negligible food intake for more than five days” may be at risk of developing refeeding problems. 
    Medically-supervised fasting has gotten much safer now that there are proper refeeding protocols. We now know what warning signs to look for and who shouldn’t be fasting in the first place, such as those who have advanced liver or kidney failure, porphyria, uncontrolled hyperthyroidism, and pregnant and breastfeeding women. The most comprehensive safety analysis of medically supervised, water-only fasting was recently published by the TrueNorth Health Center in California. Out of 768 visits to its facility for fasts up to 41 days, were there any adverse events? There were 5,961 of them! Most of these were mild, known reactions to fasting, such as fatigue, nausea, insomnia, headache, dizziness, upset stomach, and back pain. Only two serious events were reported, and no fatalities. You can see the chart below and at 5:58 in my video. 
    “Fasting periods lasting longer than 24 hr, and particularly those lasting 3 or more days, should be done under the supervision of a physician and preferably in a [live-in] clinic.” In other words, don’t try this at home! This is not just legalistic mumbo-jumbo. For example, normally, your kidneys dive into sodium conservation mode during fasting, but should that response break down, you could rapidly develop an electrolyte abnormality that may only manifest with non-specific symptoms, like fatigue or dizziness, which could easily be dismissed until it’s too late. 
     
    The risks of any therapy must be premised on the severity of the disease. The consequences of obesity are considered so serious that effective therapies could have “considerable acceptable toxicity.” For example, many consider major surgery for obesity to be a justifiable risk, but the keyword is effective. 
     
    Therapeutic fasting for obesity has largely been abandoned by the medical community not only because of its uncertain safety profile but its questionable short- and long-term efficacy. Remember, for a fast that only lasts a week or two, you might be able to lose as much body fat or even more on a low-calorie diet than a no-calorie diet. 
     
    Fasting for a week or two can actually interfere with the loss of body fat. For more background on this, see Is Fasting Beneficial for Weight Loss? and Benefits of Fasting for Weight Loss Put to the Test.
     
    If you’re wondering what the best way to lose weight is, I wrote a whole book about it! Check out How Not to Diet. 
     
    Interested in learning more about fasting? See related videos below. 

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    Michael Greger M.D. FACLM

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  • Keto Diet to Effectively Fight Cancer?  | NutritionFacts.org

    Keto Diet to Effectively Fight Cancer?  | NutritionFacts.org

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    What does the science say about the clinical use of ketogenic diets for epilepsy and cancer? 

    Blood sugar, also known as blood glucose, is the universal go-to fuel for the cells throughout our bodies. Our brain burns through a quarter pound of sugar a day because “glucose is the preferred metabolic fuel.” We can break down proteins and make glucose from scratch, but most comes from our diet in the form of sugars and starches. If we stop eating carbohydrates (or stop eating altogether), most of our cells switch over to burning fat. Fat has difficulty getting through the blood-brain barrier, though, and our brain has a constant, massive need for fuel. Just that one organ accounts for up to half of our energy needs. Without it, the lights go out…permanently. 

    To make that much sugar from scratch, our body would need to break down about half a pound of protein a day. That means we’d cannibalize ourselves to death within two weeks, but people can fast for months. What’s going on? The answer to the puzzle was discovered in 1967. Harvard researchers famously stuck catheters into the brains of obese subjects who had been fasting for more than a month and discovered that ketones had replaced glucose as the preferred fuel for the brain. Our liver can turn fat into ketones, which can then breach the blood-brain barrier and sustain our brain if we aren’t getting enough carbohydrates. Switching fuels has such an effect on brain activity that it has been used to treat epilepsy since antiquity. 

    In fact, the prescription of fasting for the treatment of epileptic seizures dates back to Hippocrates. In the Bible, even Jesus seems to have concurred. To this day, it’s unclear why switching from blood sugar to ketones as a primary fuel source has such a dampening effect on brain overactivity. How long can one fast? To prolong the fasting therapy, in 1921, a distinguished physician scientist at the Mayo Clinic suggested trying what he called “ketogenic diets,” high-fat diets designed to be so deficient in carbohydrates that they could effectively mimic the fasting state. “Remarkable improvement” was noted the first time it was put to the test, efficacy that was later confirmed in randomized, controlled trials. Ketogenic diets started to fall out of favor in 1938 with the discovery of the anti-seizure drug that would become known as Dilantin, but they’re still being used today as a third- or fourth-line treatment for drug-refractory epilepsy in children. 

    Oddly, the success of ketogenic diets against pediatric epilepsy seems to get conflated by “keto diet” proponents into suggesting a ketogenic diet is beneficial for everyone. Know what else sometimes works for intractable epilepsy? Brain surgery, but I don’t hear people clamoring to get their skulls sawed open. Since when do medical therapies translate into healthy lifestyle choices? Scrambling brain activity with electroshock therapy can be helpful in some cases of major depression, so should we get out the electrodes? Ketogenic diets are also being tested to see if they can slow the growth of certain brain tumors. Even if they work, you know what else can help slow cancer growth? Chemotherapy. So why go keto when you can just go chemo? 

    Promoters of ketogenic diets for cancer are paid by so-called ketone technology companies that offer to send you salted caramel bone broth powder for a hundred bucks a pound or companies that market ketogenic meals and report “extraordinary” anecdotal responses in some cancer patients. But more concrete evidence is simply lacking, and even the theoretical underpinnings may be questionable. A common refrain is that “cancer feeds on sugar.” But all cells feed on sugar. Advocating ketogenic diets for cancer is like saying Hitler breathed air so we should boycott oxygen. 

    Cancer can feed on ketones, too. Ketones have been found to fuel human breast cancer growth and drive metastases in an experimental model, more than doubling tumor growth. Some have even speculated that this may be why breast cancer often metastasizes to the liver, the main site of ketone production. As you can see below and at 4:59 in my video Is Keto an Effective Cancer-Fighting Diet?, if you drip ketones directly onto breast cancer cells in a petri dish, the genes that get turned on and off make for much more aggressive cancer, associated with significantly lower five-year survival in breast cancer patients, as you can see in the following graph and at 5:05 in my video. Researchers are even considering designing ketone-blocking drugs to prevent further cancer growth by halting ketone production.  

    Let’s also think about what eating a ketogenic diet might entail. High animal fat intake may increase the mortality risk among breast cancer survivors and potentially play a role in the development of breast cancer in the first place through oxidative stress, hormone disruption, or inflammation. This applies to men, too. “A strong association” has been found “between saturated fat intake and prostate cancer progression and survival.” Those in the top third of consumption of these kinds of fat-rich animal foods appeared to triple their risk of dying from prostate cancer. This isn’t necessarily fat in general either. No difference has been found in breast cancer death rates based on total fat intake. However saturated fat intake specifically may negatively impact breast cancer survival, increasing the risk of dying from it by 50 percent. There’s a reason the official American Cancer Society and American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline recommend a dietary pattern for breast cancer patients that’s essentially the opposite of a ketogenic diet. It calls for a diet that’s “high in vegetables, fruits, whole grains, and legumes [beans, split peas, chickpeas, and lentils]; low in saturated fats; and limited in alcohol consumption.” 

    “To date, not a single clinical study has shown a measurable benefit from a ketogenic diet in any human cancer.” There are currently at least a dozen trials underway, however, and the hope is that at least some cancer types will respond. Still, even then, that wouldn’t serve as a basis for recommending ketogenic diets for the general population any more than recommending everyone get radiation, surgery, and chemo just for kicks. 

    “Keto” has been the most-searched keyword on NutritionFacts.org for months, and I didn’t have much specific to offer…until now. Check out my other videos on the topic in related videos below. 

     For an overview of my cancer work, watch How Not to Die from Cancer. 

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    Michael Greger M.D. FACLM

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  • How Rush Hour Traffic Can Affect Your Brain

    How Rush Hour Traffic Can Affect Your Brain

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    April 3, 2023 – No one likes to sit in traffic. Now, new research finds that toughing out rush hour may also present significant brain health risks you never knew about. 

    A study from the University of British Columbia found that just minutes of breathing in diesel pollution can reduce your brain performance over a matter of hours. Specifically, the researchers found that this kind of exposure can alter your brain’s default mode network, or DMN. The DMN is made up of connected brain regions that are partly responsible for memory and thought process. This activity, the researchers found, was lower in people who had been exposed to diesel pollution. 

    Disruptions to the brain’s functional connectivity have also been linked to depression. The study does show that brain function will return to normal within hours after diesel pollution exposure stops. But it’s not known exactly how much pollution could cause permanent impairment.

    On another front, research published by the American Academy of Neurology found that a particle matter called PM2.5, found in traffic pollution, can raise your risk of dementia. PM2.5 is made up of particles of pollution that hang in midair. Out of 91 million people analyzed, 5.5 million developed dementia; those who were diagnosed with the disease had more exposure to traffic than those who did not. The researchers also found that the risk of dementia grew by 3% for every single microgram per cubic meter of PM2.5 a person was exposed to. PM2.5 particles are very small and can be inhaled very deeply into your lungs, moving into your brain via your nose. It’s thought that this is how brain cell death may start, and lead to conditions like Alzheimer’s.

    Car exhaust is just one part of traffic that can have a bad effect on your brain. While there’s no way to avoid the potential hazards completely, the good news is that you can learn about ways to lessen your risk and keep your brain healthy on a daily basis.

    What Are the Symptoms of Traffic-Related Brain Problems?

    Any kind of dizziness or mental confusion that you notice specifically after being in traffic should be brought to the attention of your doctor.

    Hearing issues may be a lesser-known, but important, sign of the impact traffic exposure can have on your brain. 

    “Overexposure to traffic noise can lead to tinnitus,” said  Stéphane F. Maison, PhD, an associate professor of otolaryngology/head and neck surgery at Harvard Medical School and principal investigator at Eaton-Peabody Laboratories at Mass General Brigham Massachusetts Eye and Ear in Boston. “This will cause a ringing or buzzing sound in your ear all the time. These symptoms can lead to sleep deprivation, anxiety, and depression.”

    A lesser-known reason for problems with mental skills after hearing traffic noise is hyperacusis. This rare disorder makes exposure to sounds like a car engine unbearably loud. You may get hyperacusis after a head injury, because of a virus, or as a result of conditions like migraine. 

    “Hyperacusis can lead to depression as well,” says Maison. “If you suspect you may have symptoms of either tinnitus or hyperacusis, get a hearing test.”

    Can Traffic Noise Cause or Worsen Mental Health Conditions?

    Yes, experts say – depending on how much noise you’re exposed to. A team of British and German researchers reported that if you are very sensitive to noise, traffic sounds that truly bother you can lead to different forms of mental illness, if you are at risk. Traffic noise may also worsen previously diagnosed mental health conditions. 

    But the way this might occur varies, depending on the person affected. 

    “I don’t think there is a particular length of exposure to road traffic noise which is more annoying,”  said lead study author Stephen Stansfeld, PhD, an emeritus professor of psychiatry at Queen Mary University of London, U.K. “Times of day, for instance; traffic noise in the early morning or late into the night may be more annoying, disturbing time of rest and sleep.”

    Another study found that exposure to transportation noise can lead to a 9% chance of severe anxiety; it’s thought this happens because noises like traffic can stimulate stress hormones in some people. 

    The key to whether these kinds of adverse outcomes can happen appears to be the length of time you’re hearing the traffic. Prolonged commutes – not just a short drive or walk through a congested area – that are continuous appear to be the most impactful.

    “Health effects are more likely with longer duration over time, months and years,” Stansfeld said. 

    How Can I Protect My Brain During My Commute? 

    ”Invest in custom-made earplugs,” suggested Maison. “You can use standard foam earplugs, but they are not comfortable, and so you are less likely to continue to wear them. Custom-made earplugs are very comfortable because they fit inside the exact shape of your ear.” 

    Custom-made earplugs are also available in different sound-blocking levels, which is important so you can still hear what is happening around you. Never block your hearing while driving. 

    Other tips include: 

    • Roll up your windows. It’s the easiest way to avoid breathing in fumes. Also, make sure the air filter in your car is in tip-top shape. 
    • Don’t blast music in your car too loudly. 
    • If you’re stuck in a traffic jam for a long time, turn off your engine to keep excess exhaust from entering your car through vents.
    • If you walk or bike to work, choose a route as far away from busy traffic areas as possible.
    • Avoid sitting near sources of exhaust on public transportation, like a bus.
    • Mask up for your commute, just to be on the safe side.

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  • Caring for Teeth, Gums May Safeguard Aging Brains

    Caring for Teeth, Gums May Safeguard Aging Brains

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    By Cara Murez 

    HealthDay Reporter

    THURSDAY, Feb. 2, 2023 (HealthDay News) — Taking good care of your teeth — brushing, flossing, regular dental checkups — is, of course, important for good health. Now researchers say it’s also vital for brain health.

    While it was already clear that poor dental health could increase stroke and heart disease risk, a new study funds that adults who are genetically prone to have cavities, dentures and missing teeth are also more likely to show signs of declining brain health.
     

    That declining brain health could affect memory and the ability to think clearly and function in life.
     

    “Oral health is a quite easy to modify risk factor. It’s one of the easiest. We just have to take better care of our oral health and it’s not very costly or complicated,” said study co-author Dr. Cyprien Rivier, a postdoctoral fellow in neurology at Yale School of Medicine.

    The study doesn’t demonstrate that dental hygiene actually improves brain health, but this is an area worthy of more research, said Dr. Joseph Broderick, a professor at the University of Cincinnati’s Department of Neurology and Rehabilitation Medicine, and volunteer expert for the American Stroke Association.
     

    Risk factors like smoking and diabetes play a larger role in poor oral health than genetic markers, Broderick noted in a stroke association news release. He was not involved in the research.

    Rivier’s team analyzed the potential link between oral health and brain health using data from the U.K. Biobank. The study included 40,000 adults without stroke history who were assessed between 2014 and 2021.

    Each participant was screened for 105 genetic variants that can predispose someone to dental issues. The investigators also looked at MRI images of the participants’ brains, scanning them for damage in the white matter, white matter hyperintensities and microstructural damage.

    Brain white matter damage could impair memory, balance and mobility, the researchers noted. Microstructural damage would show up as changes to the fine architecture of the brain.
     

    The study found that people with a tendency for cavities, missing teeth and dentures had a 24% increase in the amount of white matter hyperintensities.

    They also had a 43% change in microstructural damage scores visible on their MRIs.

    White matter hyperintensities typically accumulate silently over decades and have been strongly correlated with future stroke risk and future dementia risk, noted Dr. Shyam Prabhakaran, a professor of neurology at the University of Chicago School of Medicine. He was not involved in this study.

    The research “starts to really move the dial towards earlier identifying of those that have poor oral health and then thinking about the public health implications of how do we treat people with that oral health earlier so that we can hopefully modify that and improve oral health,” Prabhakaran said.

    The idea is that would potentially lead to less change in the brain and then less stroke and dementia in the more distant future, he said.

    As for the link between the mouth and brain health, it’s possible that poor oral health creates low-grade inflammation in the body that then affects the lining of the blood vessels, Prabhakaran said. This may lead to cholesterol plaque buildup or micro clots.
     

    Prabhakaran noted that some good research has been done on the impact of infections, including dental infections causing changes in the arteries.

    “Something as simple as taking care of your teeth, brushing your teeth, going to dentists with the frequency that’s recommended, those types of activities are well worth it. They’re more than just cosmetic,” Prabhakaran said.

    Stroke is the fifth leading cause of death in the United States, according to the American Stroke Association. And about 3 in 5 people will develop brain disease during their lifetime, according to the association.

    Rivier said the study results would need to be replicated in a randomized controlled trial before doctors could give specific recommendations. But, of course, there’s no harm in suggesting everyone should take care of their teeth.
     

    “It just adds another layer of incentive,” Rivier said.

    Study limitations include that those in the U.K. Biobank are mostly white people of European ancestry. More research needs to be done in diverse groups, the authors acknowledged.

    The findings will be presented virtually and in Dallas at the American Stroke Association’s international conference, Feb. 8-10. Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

    More information

    The U.S. Centers for Disease Control and Prevention has more on dental health.

     

    SOURCES: Cyprien Rivier, MD, MSc, postdoctoral fellow, neurology, Yale School of Medicine, New Haven, Conn.; Shyam Prabhakaran, MD, MS, professor and chair, Department of Neurology, University of Chicago School of Medicine; Joseph Broderick, MD, professor, University of Cincinnati, Department of Neurology and Rehabilitation Medicine, and director, University of Cincinnati Gardner Neuroscience Institute, Ohio; American Stroke Association International Stroke Conference, Feb. 8-10, 2023, Dallas

     

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  • Berry Good for You: Some Foods Can Strengthen Your Brain

    Berry Good for You: Some Foods Can Strengthen Your Brain

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    By Steven Reinberg 

    HealthDay Reporter

    MONDAY, Nov. 28, 2022 (HealthDay News) — Eating more berries and drinking tea may help slow mental decline as you age, new research suggests.
     

    In a study of more than 900 adults, researchers found that foods like these — containing antioxidant flavonols — delivered brain benefits to older adults. Flavonols are found in fruits like berries, green leafy vegetables, tea and wine.

    For example, people who ate a serving of leafy green vegetables a day slowed their rate of cognitive decline by about 32%, compared with people who didn’t eat any foods with flavonols, said lead researcher Dr. Thomas Holland, an instructor of internal medicine at Rush University Medical Center in Chicago.

    “Flavonols are both anti-inflammatories and antioxidants,” he said. “These foods that contain flavonols destroy free radicals and prevent cell damage. They prevent cell damage in the brain as well as in other organs, such as the heart and vascular system, kidneys, liver, etc.”

    Holland isn’t keen on getting flavonols from supplements. He believes the best way to stock up on flavonols is through diet.

    “You’re going to get a higher diversity of nutrients from foodstuffs,” he said. “I like to maintain supplements as exactly that, supplements. They should supplement a healthy diet.”

    For the study, Holland’s team collected data on 961 adults, average age 81, who did not have dementia. Over an average of seven years, participants completed yearly questionnaires about their diet and took cognitive and memory tests. The tests involved remembering lists of words, recalling numbers and putting them in the correct order.

    Holland cautioned that the study shows an association between higher amounts of flavonols and slower cognitive decline but cannot prove a direct cause-and-effect relationship. Also, people’s recollections of what they ate might not have been completely accurate.

    The researchers found that people who ate the most flavonols, about 15 mg a day (equivalent to about 1 cup of dark leafy greens), had slower memory decline, compared with those who consumed the least, about 5 mg a day. This association remained after taking into account age, sex and smoking.

    The foods that contributed most to slowing mental decline included kale, beans, tea, spinach, broccoli, tomatoes, apples, tea, wine, oranges, pears, olive oil and tomato sauce, the researchers said.

    “Plant foods contain a treasure trove of powerful nutrients that offer significant health benefits,” said Samantha Heller, a senior clinical nutritionist at NYU Langone Health in New York City.

    Flavonoids are just one family of over 5,000 compounds found in plants. “Included in this family are a subgroup called flavonols,” she noted.

    This study focused on the flavonol content in people’s diets and its relationship with cognitive health, but we do not sit down and have a plate of flavonols for breakfast, said Heller, who had no role in the study.

    “We eat foods that contain an array of phytonutrients [healthy plant compounds], such as fiber, vitamins, minerals and plant chemicals, such as flavonols. These phytonutrients work together synergistically, as a team, and this is what boosts the health benefits we derive by eating them,” she said.

    These elements interact with each other in many biological processes — for example, reducing inflammation, supporting the immune system, protecting and repairing cells, and reducing oxidative stress, Heller said.
     

    She stressed that one element in the diet is probably not a magic path to a long and healthy life.

    “Perhaps the people in this study who ate a more plant-based diet saw the greatest cognitive benefits, but this was not assessed. Research suggests that shifting to eating more legumes, vegetables, fruits, nuts and whole grains helps us live longer, healthier lives,” Heller said.

    Holland agreed that flavonols alone aren’t going to keep mental decline at bay. The best path to maintaining physical and mental health, he said, includes a healthy lifestyle complete with a diverse diet of fruits and vegetables, physical activity and cognitive training — challenging yourself each day with learning something new.

    “Also, sleep and stress reduction are all collectively going to be beneficial for overall health,” Holland said. “It’s never too early or too late to start making healthy changes.”

    The report was published online Nov. 22 in the journal Neurology.

    More information

    For more on flavonols, see the American Heart Association.

     

    SOURCES: Thomas Holland, MD, instructor, Department of Internal Medicine, Rush University Medical Center, Chicago; Samantha Heller, MS, RD, CDN, senior clinical nutritionist, NYU Langone Health, New York City; Neurology, Nov. 22, 2022, online

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  • Rick Sharp Alzheimer’s Foundation Announces 3rd Annual ‘Alzheimer’s Day 2020’

    Rick Sharp Alzheimer’s Foundation Announces 3rd Annual ‘Alzheimer’s Day 2020’

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    This year’s event will feature renowned scientists and an opening meditation with special guest Deepak Chopra, M.D.

    Press Release
    –


    updated: Nov 11, 2020


    RICHMOND, Va., November 11, 2020 (Newswire.com)
    –
    The Rick Sharp Alzheimer’s Foundation, named in memory of the late CEO of Circuit City and founder of CarMax, has announced its 3rd annual “Alzheimer’s Day 2020.” While previous events have been held at the University of Richmond and the Science Museum of Virginia, this year’s event will be held virtually. Complimentary registration in advance is required – www.ricksharpalz.org. Previous speakers have included famed researcher Dr. Rudy Tanzi and New York Times best-selling author of “Still Alice” Lisa Genova.

    Panelists will include Dr. John Lazo of the University of Virginia, Dr. Constantine Lykestsos of Johns Hopkins, and Dr. Robert Innis from the National Institute of Mental Health. The evening will include special guest Deepak Chopra. The panel will be moderated by Dr. Catherine Franssen. The panel discussion will include the status of current research, the impact of COVID-19, and brain health.

    Sherry Sharp, founder of the Rick Sharp Alzheimer’s Foundation, said, “Since our inaugural event, we’ve met thousands of people and raised hundreds of thousands of dollars to achieve our goal of curing Alzheimer’s Disease. Together, with your support, we have donated over $2 million and every penny raised goes directly to research.”

    Sherry also serves on the Board of Directors of Cure Alzheimer’s Fund (www.curealz.org).

    For more information about the event and sponsorship opportunities, contact Director of Donor Engagement Carli Nelson at 833.CURE ALZ, Option 1, and/or visit www.ricksharpalz.org.

    About Dr. John Lazo: Dr. Lazo is a professor of Pharmacology and Chemistry at the University of Virginia School of Medicine.

    About Dr. Constantine Lyketsos: Dr. Lyketsos is the Chair of Psychiatry at Johns Hopkins Bayview Medical Center.

    About Dr. Robert Innis: Dr. Innis is Chief of the Molecular Imaging Brand at the National Institute of Mental Health. 

    About Deepak Chopra, M.D.: Chopra is an expert in the field of mind-body healing and a world-renowned speaker and author on the subject of alternative medicine.

    About Dr. Catherine L. Franssen: Dr. Franssen is currently the Scientist in Residence at the Science Museum of Virginia. She is an Associate Professor in the Department of Psychology at Longwood University.

    About the Rick Sharp Alzheimer’s Foundation: Rick Sharp was a business leader, husband, father, and friend to many. For over a decade, he served as the CEO of electronics retailer Circuit City. He went on to found car superstore CarMax, was a founding investor and Chairman of the Board of footwear brand Crocs, and electronics company Flextronics. Shortly after his death at age 67 from Alzheimer’s in 2014, Sherry founded the Rick Sharp Alzheimer’s Foundation. The non-profit focuses on supporting world-class research and increasing ALZ awareness. 100% of all money raised goes to finding a cure.

    Media Inquiries  
    Cara Dickens 
    Rocket Pop Media 
    cara@rocketpopmedia.com 

    Event Inquiries
    Carli Nelson
    Rick Sharp Alzheimer’s Foundation
    carli@ricksharpalz.org

    Source: Rick Sharp Alzheimer’s Foundation

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  • LearningRx Shreveport Has Earned a Board-Certified Cognitive Center Designation

    LearningRx Shreveport Has Earned a Board-Certified Cognitive Center Designation

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    Press Release
    –


    updated: May 14, 2020


    SHREVEPORT, La., May 14, 2020 (Newswire.com)
    –
    ​LearningRx Shreveport is the first LearningRx Center in the nation and the first center of its kind in Louisiana to become a Board Certified Cognitive Center (BCCC), granted by the International Board of Credentialing and Continuing Education Standards (IBCCES).

    The BCCC designation is awarded to organizations whose staff have completed an evidence-based training and certification program focusing on autism, ADHD, anxiety, and dyslexia in school-aged learners. The Shreveport center has shown its team’s dedication to providing the best possible outcomes for everyone they work with by completing the IBCCES program.

    “Though we are proud of our results and the success our clients achieve with the help of our cognitive skills training programs, we know it’s important to hear what others in the scientific community have to say about our Brain Training Center,” said Donesa Walker of LearningRx Shreveport. “We are especially proud to be known as a Board Certified Cognitive Center because we are the best in the business and it is great to achieve the status so that others may know and come to love us as the best in the world at brain training.”

    LearningRx provides clinician-delivered cognitive training to clients who range in age from 5 to 95. Their “brain trainers” sit one-on-one with clients and use a variety of hands-on manipulatives to train cognitive skills including working and long-term memory, visual and auditory processing, reasoning skills, processing speed, and attention.

    “One of the core values that guide our daily performance is ‘excellence,’” reports Kim Hanson, CEO of LearningRx Brain Training. “We strive for excellence in customer service; excellence in program results; and excellence in the training of our team members—the Center owners, directors, and brain trainers who interact with our clients every day.” Hanson adds, “Our partnership with IBCCES allows us to expand that excellence by providing team members with a series of certifications that buoy their leadership abilities and enrich their competencies in ADHD, anxiety, dyslexia, and autism. It’s a win for our team and a win for the children and adults we have the pleasure of helping all over the world.”  

    For more than 20 years, IBCCES has been the industry leader in cognitive disorder training and certification for education, healthcare, and corporate professionals around the globe. IBCCES provides evidence-based training and certification programs created in conjunction with clinical experts and individuals with autism in order to provide professionals serving individuals with cognitive disorders a better understanding of what these disorders are, industry best practices, varied perspectives, and the latest research in these areas.

    “IBBCES is excited to work with an organization that is dedicated to professional development and ensuring inclusion for all of their programs,” said Myron Pincomb, IBCCES Board Chairman.

    ###

    MEDIA CONTACT:

    Meredith Tekin, IBCCES President

    904.508.0135 / 904.434.1534

    meredith@ibcces.org

    ​Donesa Walker, Learning RX Shreveport

    318.797.8523

    d.walker@learningrx.net

     

    Source: IBCCES

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  • 3.14 Academy Has Earned Certified Autism Center™ Designation

    3.14 Academy Has Earned Certified Autism Center™ Designation

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    Press Release
    –


    updated: Mar 11, 2020


    LURAY, Va., March 11, 2020 (Newswire.com)
    –
    3.14 Academy is now a Certified Autism Center™, designated by the International Board of Credentialing and Continuing Education Standards (IBCCES). Staff at the online learning curriculum and support center for parents and children with autism have completed a training and certification program to help them ensure students with autism have the best educational outcomes.

    “At 3.14 Academy, our pledge is to provide high-level knowledge through quality software applications,” said Dr. Celeste Chamberlain, Founder of 3.14 Academy. “Being a certified non-profit through IBCCES shows the families we serve that we take our pledge seriously. It shows we hold ourselves to the highest standards, and our customers deserve no less.”

    The Academy offers STEM learning applications to provide learning through short repetitious games. Learners gain confidence through positive reinforcement and build on those skills in advanced games. Learning videos are also available for both caregivers and students with information from Occupational, Speech and Behavioral therapists. And the Academy also provides additional worksheets that coincide with online applications, as well as a community portal for families to engage with one another to share ideas and information.

    For more than 20 years, IBCCES has been the industry leader in cognitive disorder training and certification for education, healthcare, and corporate professionals around the globe. IBCCES provides evidence-based training and certification programs created in conjunction with clinical and special education experts, along with individuals with autism, in order to provide professionals serving individuals with cognitive disorders a better understanding of what these disorders are, industry best practices, personal perspectives, and the latest research in these areas.

    “IBCCES is excited to announce this designation. Our mission is to provide specialized training and certification so educators can continue to help individuals with autism to flourish,” said Myron Pincomb, IBCCES Board Chairman.

    IBCCES also created CertifiedAutismCenter.com, as a free online resource for parents that lists certified locations and professionals. Each organization listed on the site has met Certified Autism Center™ (CAC) requirements.

    ###

    MEDIA CONTACT:

    Celeste Chamberlain, Founder of 3.14 Academy

    Phone: 703.220.0630

    Email: celeste@314academy.org

    Meredith Tekin, President of IBCCES
    Phone: 904.508.0135 // 904.434.1534
    Email: meredith@ibcces.org

    Source: IBCCES

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