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  • Keeping Better Score of Your Diet | NutritionFacts.org

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    How can you get a perfect diet score?

    How do you rate the quality of people’s diets? Well, “what could be more nutrient-dense than a vegetarian diet?” Indeed, if you compare the quality of vegetarian diets with non-vegetarian diets, the more plant-based diets do tend to win out, and the higher diet quality in vegetarian diets may help explain greater improvements in health outcomes. However, vegetarians appear to have a higher intake of refined grains, eating more foods like white rice and white bread that have been stripped of much of their nutrition. So, just because you’re eating a vegetarian diet doesn’t mean you’re necessarily eating as healthfully as possible.

    Those familiar with the science know the primary health importance of eating whole plant foods. So, how about a scoring system that simply adds up how many cups of fruits, vegetables, whole grains, beans, chickpeas, split peas, and lentils, and how many ounces of nuts and seeds per 1,000 calories (with or without counting white potatoes)? Looking only at the total intake of whole plant foods doesn’t mean you aren’t also stuffing donuts into your mouth. So, you could imagine proportional intake measures, based on calories or weight, to determine the proportion of your diet that’s whole plant foods. In that case, you’d get docked points if you eat things like animal-derived foods—meat, dairy, or eggs—or added sugars and fats.

    My favorite proportional intake measure is McCarty’s “phytochemical index,” which I’ve profiled previously. I love it because of its sheer simplicity, “defined as the percent of dietary calories derived from foods rich in phytochemicals.” It assigns a score from 0 to 100, based on the percentage of your calories that are derived from foods rich in phytochemicals, which are biologically active substances naturally found in plants that may be contributing to many of the health benefits obtained from eating whole plant foods. “Monitoring phytochemical intake in the clinical setting could have great utility” in helping people optimize their diet for optimal health and disease prevention. However, quantifying phytochemicals in foods or tissue samples is impractical, laborious, and expensive. But this concept of a phytochemical index score could be a simple alternative method to monitor phytochemical intake.

    Theoretically, a whole food, plant-based or vegan diet that excluded refined grains, white potatoes, hard liquors, added oils, and added sugars could achieve a perfect score of 100. Lamentably, most Americans’ diets today might be lucky to score just 20. What’s going on? In 1998, our shopping baskets were filled with about 20% whole plant foods; more recently, that has actually shrunk, as you can see below and at 2:49 in my video Plant-Based Eating Score Put to the Test.

    Wouldn’t it be interesting if researchers used this phytochemical index to try to correlate it with health outcomes? That’s exactly what they did. We know that studies have demonstrated that vegetarian diets have a protective association with weight and body mass index. For instance, a meta-analysis of five dozen studies has shown that vegetarians had significantly lower weight and BMI compared with non-vegetarians. And even more studies show that high intakes of fruits, vegetables, whole grains, and legumes may be protective regardless of meat consumption. So, researchers wanted to use an index that gave points for whole plant foods. They used the phytochemical index and, as you may recall from an earlier video, tracked people’s weight over a few years, using a scale of 0 to 100 to simply reflect what percentage of a person’s diet is whole plant foods. And even though the healthiest-eating tier only averaged a score of about 40, which meant the bulk of their diet was still made up of processed foods and animal products, just making whole plant foods a substantial portion of the diet may help prevent weight gain and decrease body fat. So, it’s not all or nothing. Any steps we can take to increase our whole plant food intake may be beneficial.

    Many more studies have since been performed, with most pointing in the same direction for a variety of health outcomes—indicating, for instance, higher healthy plant intake is associated with about a third of the odds of abdominal obesity and significantly lower odds of high triglycerides. So, the index may be “a useful dietary target for weight loss,” where there is less focus on calorie intake and more on increasing consumption of these high-nutrient, lower-calorie foods over time. Other studies also suggest the same is true for childhood obesity.

    Even at the same weight, with the same amount of belly fat, those eating plant-based diets tend to have higher insulin sensitivity, meaning the insulin they make works better in their body, perhaps thanks to the compounds in plants that alleviate inflammation and quench free radicals. Indeed, the odds of hyperinsulinemia—an indicator of insulin resistance—were progressively lower with greater plant consumption. No wonder researchers found 91% lower odds of prediabetes for people getting more than half their calories from healthy plant foods.

    They also found significantly lower odds of metabolic syndrome and high blood pressure. There were only about half the odds of being diagnosed with hypertension over a three-year period among those eating more healthy plants. Even mental health may be impacted—about 80% less depression, 2/3 less anxiety, and 70% less psychological distress, as you can see below and at 5:15 in my video.

    Is there a link between the dietary phytochemical index and benign breast diseases, such as fibrocystic diseases, fatty necrosis, ductal ectasia, and all sorts of benign tumors? Yes—70% lower odds were observed in those with the highest scores. But what about breast cancer? A higher intake of healthy plant foods was indeed associated with a lower risk of breast cancer, even after controlling for a long list of other factors. And not just by a little bit. Eating twice the proportion of plants compared to the standard American diet was linked to more than 90% lower odds of breast cancer.

    Doctor’s Note

    You can learn more about the phytochemical index in Calculate Your Healthy Eating Score.

    If you’re worried about protein, check out Flashback Friday: Do Vegetarians Get Enough Protein?

    It doesn’t have to be all or nothing, though. Do Flexitarians Live Longer?

    For more on plant-based junk, check out Friday Favorites: Is Vegan Food Always Healthy?.

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    Michael Greger M.D. FACLM

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  • Snowstorms, Cannabis And Some Interesting Tidbits

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    Snowstorms, cannabis and some interesting tidbits examining cold weather, cannabis versus alcohol, and unexpected winter facts.

    Much of the country is in the grip of a serious cold weather storm, the kind rattling windows, shutting down highways, and sending people searching for extra blankets and something warm to take the edge off. When temperatures plunge well below normal, daily routines change quickly. People stay indoors, move less, eat differently, and often rethink what they drink or consume to get through the freeze. Their is renewed curiosity around marijuana in cold weather, especially how it compares to alcohol and whether it can actually help you feel warmer.  Read on for snowstorms, cannabis and some interesting tidbits.

    RELATED: Should Dogs Wear A Coat in Cold Snowy Weather

    One of the biggest myths of winter is alcohol keeps you warm. While a stiff drink can create a temporary sensation of heat, it actually causes blood vessels near the skin to dilate. That pulls warmth away from your core and increases heat loss, which can be dangerous in extreme cold. Cannabis works differently. THC does not raise body temperature, but it can change how the body perceives cold by altering sensory signals and relaxing muscles to keep them from tensing up in low temperatures. Many people report feeling more comfortable, calmer, and less aware of the chill after using cannabis, without the same physiological risks associated with alcohol in freezing conditions.

    Certain forms of cannabis may be better suited for winter storms than others. Edibles and tinctures provide longer-lasting effects, which can be appealing during long nights indoors. Flower and vape products act faster, which some people prefer when coming in from the cold. Strains promoting body relaxation and mild euphoria are often favored during cold snaps, while overly stimulating varieties may feel less cozy when you are trying to stay warm and settled.

    Cold weather itself brings some interesting and well-documented side effects. For one, the body tends to burn more calories when temperatures drop. Staying warm requires energy, and mild cold exposure can slightly increase calorie expenditure as the body works to maintain its core temperature. That does not mean winter weather is a weight loss plan, but it does explain why people often feel hungrier during cold spells.

    There is also a long-standing statistical trend showing more babies are born about nine months after major winter storms and prolonged cold periods. When people are snowed in, travel is limited, and social calendars clear, time spent at home increases. Historically, this has translated into noticeable baby booms following harsh winters.

    RELATED: Can CBD Save Your Skin From Cold Weather

    Another cold weather tidbit is how it affects sleep and mood. Shorter days and less sunlight can disrupt circadian rhythms, contributing to winter blues. Cannabis, particularly products  supporting relaxation and sleep, is sometimes used by adults to help unwind during long, dark evenings. Again, moderation matters, especially when cold weather already encourages inactivity.

    As the country rides out this intense cold weather storm, it is clear winter changes more than just the thermostat. It influences what people consume, how they cope, and even what shows up in the data months later. Cannabis is increasingly part of the seasonal conversation, offering a different option than alcohol for those looking to feel a little more comfortable while waiting for warmer days to return.

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    Sarah Johns

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  • Lose Weight with Cumin and Saffron?  | NutritionFacts.org

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    The spice cumin can work as well as orlistat, the “anal leakage” obesity drug.

    In my video Friday Favorites: Benefits of Black Cumin for Weight Loss, I discussed how a total of 17 randomized controlled trials showed that the simple spice could reduce cholesterol and triglyceride levels. And its side effects? A weight-loss effect.

    Saffron is another spice found to be effective for treating a major cause of suffering—depression, in this study, with a side effect of decreased appetite. Indeed, when put to the test in a randomized, double-blind, placebo-controlled trial, saffron was found to lead to significant weight loss, five pounds more than placebo, and an extra inch off the waist in eight weeks. The dose of saffron used in the study was the equivalent of drinking a cup of tea made from a large pinch of saffron threads.

    Suspecting the active ingredient might be crocin, the pigment in saffron that accounts for its crimson color, as shown here and at 0:59 in my video Friday Favorites: Benefits of Cumin and Saffron for Weight Loss, researchers also tried giving people just the purified pigment.

    That also led to weight loss, but it didn’t do as well as the full saffron extract and only beat the placebo by two pounds and half an inch off the waist. The mechanism appeared to be appetite suppression, as the crocin group ended up averaging about 80 fewer calories a day, whereas the full saffron group consumed an average of 170 fewer daily calories, as you can see below and at 1:21 in my video.

    A similar study looked specifically at snacking frequency. The researchers thought that the mood-boosting effects of saffron might cut down on stress-related eating. Indeed, eight weeks of a saffron extract halved snack intake, compared to a placebo. There was also a slight but statistically significant weight loss of about two pounds, as you can see here and at 1:41 in my video, which is pretty remarkable, given that tiny doses were utilized—about 100 milligrams, which is equivalent to about an eighth of a teaspoon of the spice.

    The problem is that saffron is the most expensive spice in the world. It’s composed of delicate threads sticking out of the saffron crocus flower. Each flower produces only a few threads, so about 50,000 flowers are needed to make a single pound of spice. That’s enough flowers to cover a football field. So, that pinch of saffron could cost a dollar a day.

    That’s why, in my 21 Tweaks to accelerate weight loss in How Not to Diet, I include black cumin, instead of saffron, as you can see here and at 2:30 in my video. And, at a quarter teaspoon a day, the daily dose of black cumin would only cost three cents.

    What about just regular cumin? Used in cuisines around the world from Tex-Mex to South Asian, cumin is the second most popular spice on Earth after black pepper. It is one of the oldest cultivated plants with a range of purported medicinal uses, but only recently has it been put to the test for weight loss. Those randomized to a half teaspoon at both lunch and dinner over three months lost about four more pounds and an extra inch off their waist. The spice was found to be comparable to the obesity drug known as orlistat.

    If you remember, orlistat is the “anal leakage” drug sold under the brand names Alli and Xenical. The drug company apparently prefers the term “faecal spotting” to describe the rectal discharge it causes, though. The drug company’s website offered some helpful tips, including: “It’s probably a smart idea to wear dark pants, and bring a change of clothes with you to work.” You know, just in case their drug causes you to poop in your pants at the office.

    I think I’ll stick with the cumin, thank you very much.

    Doctor’s Note

    The video on black cumin that I mentioned is Friday Favorites: Benefits of Black Cumin Seed (Nigella Sativa) for Weight Loss.

    My other videos on saffron are in the related posts below.

    For an in-depth dive into weight loss, see my book How Not to Diet. 

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    Michael Greger M.D. FACLM

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  • Taking Advantage of Sensory-Specific Satiety  | NutritionFacts.org

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    How can we use sensory-specific satiety to our advantage?

    When we eat the same foods over and over, we become habituated to them and end up liking them less. That’s why the “10th bite of chocolate, for example, is desired less than the first bite.” We have a built-in biological drive to keep changing up our foods so we’ll be more likely to hit all our nutritional requirements. The drive is so powerful that even “imagined consumption reduces actual consumption.” When study participants imagined again and again that they were eating cheese and were then given actual cheese, they ate less of it than those who repeatedly imagined eating that food fewer times, imagined eating a different food (such as candy), or did not imagine eating the food at all.

    Ironically, habituation may be one of the reasons fad “mono diets,” like the cabbage soup diet, the oatmeal diet, or meal replacement shakes, can actually result in better adherence and lower hunger ratings compared to less restrictive diets.

    In the landmark study “A Satiety Index of Common Foods,” in which dozens of foods were put to the test, boiled potatoes were found to be the most satiating food. Two hundred and forty calories of boiled potatoes were found to be more satisfying in terms of quelling hunger than the same number of calories of any other food tested. In fact, no other food even came close, as you can see below and at 1:14 in my video Exploiting Sensory-Specific Satiety for Weight Loss.

    No doubt the low calorie density of potatoes plays a role. In order to consume 240 calories, nearly one pound of potatoes must be eaten, compared to just a few cookies, and even more apples, grapes, and oranges must be consumed. Each fruit was about 40 percent less satiating than potatoes, though, as shown here and at 1:45 in my video. So, an all-potato diet would probably take the gold—the Yukon gold—for the most bland, monotonous, and satiating diet.

    A mono diet, where only one food is eaten, is the poster child for unsustainability—and thank goodness for that. Over time, they can lead to serious nutrient deficiencies, such as blindness from vitamin A deficiency in the case of white potatoes.

    The satiating power of potatoes can still be brought to bear, though. Boiled potatoes beat out rice and pasta in terms of a satiating side dish, cutting as many as about 200 calories of intake off a meal. Compared to boiled and mashed potatoes, fried french fries or even baked fries do not appear to have the same satiating impact.

    To exploit habituation for weight loss while maintaining nutrient abundance, we could limit the variety of unhealthy foods we eat while expanding the variety of healthy foods. In that way, we can simultaneously take advantage of the appetite-suppressing effects of monotony while diversifying our fruit and vegetable portfolio. Studies have shown that a greater variety of calorie-dense foods, like sweets and snacks, is associated with excess body fat, but a greater variety of vegetables appears protective. When presented with a greater variety of fruit, offered a greater variety of vegetables, or given a greater variety of vegetable seasonings, people may consume a greater quantity, crowding out less healthy options.

    The first 20 years of the official Dietary Guidelines for Americans recommended generally eating “a variety of foods.” In the new millennium, they started getting more precise, specifying a diversity of healthier foods, as seen below and at 3:30 in my video. 

    A pair of Harvard and New York University dietitians concluded in their paper “Dietary Variety: An Overlooked Strategy for Obesity and Chronic Disease Control”: “Choose and prepare a greater variety of plant-based foods,” recognizing that a greater variety of less healthy options could be counterproductive.

    So, how can we respond to industry attempts to lure us into temptation by turning our natural biological drives against us? Should we never eat really delicious food? No, but it may help to recognize the effects hyperpalatable foods can have on hijacking our appetites and undermining our body’s better judgment. We can also use some of those same primitive impulses to our advantage by minimizing our choices of the bad and diversifying our choices of the good. In How Not to Diet, I call this “Meatball Monotony and Veggie Variety.” Try picking out a new fruit or vegetable every time you shop.

    In my own family’s home, we always have a wide array of healthy snacks on hand to entice the finickiest of tastes. The contrasting collage of colors and shapes in fruit baskets and vegetable platters beat out boring bowls of a single fruit because they make you want to mix it up and try a little of each. And with different healthy dipping sauces, the possibilities are endless.

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    Michael Greger M.D. FACLM

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  • Dietary Diversity and Overeating  | NutritionFacts.org

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    Big Food uses our hard-wired drive for dietary diversity against us.

    How did we evolve to solve the daunting task of selecting a diet that supplies all the essential nutrients? Dietary diversity. By eating a variety of foods, we increase our chances of hitting all the bases. If we only ate for pleasure, we might just stick with our favorite food to the exclusion of all others, but we have an innate tendency to switch things up.

    Researchers found that study participants ended up eating more calories when provided with three different yogurt flavors than just one, even if that one is the chosen favorite. So, variation can trump sensation. They don’t call it the spice of life for nothing.

    It appears to be something we’re born with. Studies on newly weaned infants dating back nearly a century show that babies naturally choose a variety of foods even over their preferred food. This tendency seems to be driven by a phenomenon known as sensory-specific satiety.

    Researchers found that, “within 2 minutes after eating the test meal, the pleasantness of the taste, smell, texture, and appearance of the eaten food decreased significantly more than for the uneaten foods.” Think about how the first bite of chocolate tastes better than the last bite. Our body tires of the same sensations and seeks out novelty by rekindling our appetite every time we’re presented with new foods. This helps explain the “dessert effect,” where we can be stuffed to the gills but gain a second wind when dessert arrives. What was adaptive for our ancient ancestors to maintain nutritional adequacy may be maladaptive in the age of obesity.

    When study participants ate a “varied four-course meal,” they consumed 60 percent more calories than those given the same food for each course. It’s not only that we get bored; our body has a different physiological reaction.

    As you can see below and at 2:13 in my video How Variation Can Trump Sensation and Lead to Overeating, researchers gave people a squirt of lemon juice, and their salivary glands responded with a squirt of saliva. But when they were given lemon juice ten times in a row, they salivated less and less each time. When they got the same amount of lime juice, though, their salivation jumped right back up. We’re hard-wired to respond differently to new foods. 
    Whether foods are on the same plate, are at the same meal, or are even eaten on subsequent days, the greater the variety, the more we tend to eat. When kids had the same mac and cheese dinner five days in a row, they ended up eating hundreds fewer calories by the fifth day, compared to kids who got a variety of different meals, as you can see below and at 2:35 in my video.

    Even just switching the shape of food can lead to overeating. When kids had a second bowl of mac and cheese, they ate significantly more when the noodles were changed from elbow macaroni to spirals. People allegedly eat up to 77 percent more M&Ms if they’re presented with ten different colors instead of seven, even though all the colors taste the same. “Thus, it is clear that the greater the differences between foods, the greater the enhancement of intake,” the greater the effect. Alternating between sweet and savory foods can have a particularly appetite-stimulating effect. Do you see how, in this way, adding a diet soda, for instance, to a fast-food meal can lead to overconsumption?

    The staggering array of modern food choices may be one of the factors conspiring to undermine our appetite control. There are now tens of thousands of different foods being sold.

    The so-called supermarket diet is one of the most successful ways to make rats fat. Researchers tried high-calorie food pellets, but the rats just ate less to compensate. So, they “therefore used a more extreme diet…[and] fed rats an assortment of palatable foods purchased at a nearby supermarket,” including such fare as cookies, candy, bacon, and cheese, and the animals ballooned. The human equivalent to maximize experimental weight gain has been dubbed the cafeteria diet.

    It’s kind of the opposite of the original food dispensing device I’ve talked about before. Instead of all-you-can-eat bland liquid, researchers offered free all-you-can-eat access to elaborate vending machines stocked with 40 trays with a dizzying array of foods, like pastries and French fries. Participants found it impossible to maintain energy balance, consistently consuming more than 120 percent of their calorie requirements.

    Our understanding of sensory-specific satiety can be used to help people gain weight, but how can we use it to our advantage? For example, would limiting the variety of unhealthy snacks help people lose weight? Two randomized controlled trials made the attempt and failed to show significantly more weight loss in the reduced variety diet, but they also failed to get people to make much of a dent in their diets. Just cutting down on one or two snack types seems insufficient to make much of a difference, as seen below and at 4:44 in my video. A more drastic change may be needed, which we’ll cover next.

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    Michael Greger M.D. FACLM

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  • Hijacking Our Appetites  | NutritionFacts.org

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    I debunk the myth of protein as the most satiating macronutrient.

    The importance of satiety is underscored by a rare genetic condition known as Prader-Willi syndrome. Children with the disorder are born with impaired signaling between their digestive system and their brain, so they don’t know when they’re full. “Because no sensation of satiety tells them to stop eating or alerts their body to throw up, they can accidentally consume enough in a single binge to fatally rupture their stomach.” Without satiety, food can be “a death sentence.”

    Protein is often described as the most satiating macronutrient. People tend to report feeling fuller after eating a protein-rich meal, compared to a carbohydrate- or fat-rich one. The question is: Does that feeling of fullness last? From a weight-loss standpoint, satiety ratings only matter if they end up cutting down on subsequent calorie intake, and even a review funded by the meat, dairy, and egg industries acknowledges that this does not seem to be the case for protein. Hours later, protein consumed earlier doesn’t tend to end up cutting calories later on.

    Fiber-rich foods, on the other hand, can suppress appetite and reduce subsequent meal intake more than ten hours after consumption—even the next day—because their site of action is 20 feet down in the lower intestine. Remember the ileal brake from my Evidence-Based Weight Loss lecture? When researchers secretly infused nutrients into the end of the small intestine, study participants spontaneously ate as many as hundreds fewer calories at a meal. Our brain gets the signal that we are full, from head to tail.

    We were built for gluttony. “It is a wonderful instinct, developed over millions of years, for times of scarcity.” Stumbling across a rare bounty, those who could fill themselves the most to build up the greatest reserves would be more likely to pass along their genes. So, we are hard-wired not just to eat until our stomach is full, but until our entire digestive tract is occupied. Only when our brain senses food all the way down at the end does our appetite fully dial down.

    Fiber-depleted foods get rapidly absorbed early on, though, so much of it never makes it down to the lower gut. As such, if our diet is low in fiber, no wonder we’re constantly hungry and overeating; our brain keeps waiting for the food that never arrives. That’s why people who even undergo stomach-stapling surgeries that leave them with a tiny two-tablespoon-sized stomach pouch can still eat enough to regain most of the weight they initially lost. Without sufficient fiber, transporting nutrients down our digestive tract, we may never be fully satiated. But, as I described in my last video, one of the most successful experimental weight-loss interventions ever reported in the medical literature involved no fiber at all, as you can see here and at 2:47 in my video Foods Designed to Hijack Our Appetites.

    At first glance, it might seem obvious that removing the pleasurable aspects of eating would cause people to eat less, but remember, that’s not what happened. The lean participants continued to eat the same amount, taking in thousands of calories a day of the bland goop. Only those who were obese went from eating thousands of calories a day down to hundreds, as shown below and at 3:22 in my video. And, again, this happened inadvertently without them apparently even feeling a difference. Only after eating was disconnected from the reward was the body able to start rapidly reining in the weight.

    We appear to have two separate appetite control systems: “the homeostatic and hedonic pathways.” The homeostatic pathway maintains our calorie balance by making us hungry when energy reserves are low and abolishes our appetite when energy reserves are high. “In contrast, hedonic or reward-based regulation can override the homeostatic pathway” in the face of highly palatable foods. This makes total sense from an evolutionary standpoint. In the rare situations in our ancestral history when we’d stumble across some calorie-dense food, like a cache of unguarded honey, it would make sense for our hedonic drive to jump into the driver’s seat to consume the scarce commodity. Even if we didn’t need the extra calories at the time, our body wouldn’t want us to pass up that rare opportunity. Such opportunities aren’t so rare anymore, though. With sugary, fatty foods around every corner, our hedonic drive may end up in perpetual control, overwhelming the intuitive wisdom of our bodies.

    So, what’s the answer? Never eat really tasty food? No, but it may help to recognize the effects hyperpalatable foods can have on hijacking our appetites and undermining our body’s better judgment.

    Ironically, some researchers have suggested a counterbalancing evolutionary strategy for combating the lure of artificially concentrated calories. Just as pleasure can overrule our appetite regulation, so can pain. “Conditioned food aversions” are when we avoid foods that made us sick in the past. That may just seem like common sense, but it is actually a deep-seated evolutionary drive that can defy rationality. Even if we know for a fact a particular food was not the cause of an episode of nausea and vomiting, our body can inextricably tie the two together. This happens, for example, with cancer patients undergoing chemotherapy. Consoling themselves with a favorite treat before treatment can lead to an aversion to their favorite food if their body tries to connect the dots. That’s why oncologists may advise the “scapegoat strategy” of only eating foods before treatment that you are okay with, never wanting to eat again.

    Researchers have experimented with inducing food aversions by having people taste something before spinning them in a rotating chair to cause motion sickness. Eureka! A group of psychologists suggested: “A possible strategy for encouraging people to eat less unhealthy food is to make them sick of the food, by making them sick from the food.” What about using disgust to promote eating more healthfully? Children as young as two-and-a-half years old will throw out a piece of previously preferred candy scooped out of the bottom of a clean toilet.

    Thankfully, there’s a way to exploit our instinctual drives without resorting to revulsion, aversion, or bland food, which we’ll explore next.

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    Michael Greger M.D. FACLM

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  • Lose 200 Lbs Without Feeling Hungry  | NutritionFacts.org

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    I dive into one of the most fascinating series of studies I’ve ever come across.

    Anyone can lose weight by eating less food. Anyone can be starved thin. Starvation diets are rarely sustainable, though, since hunger pangs drive us to eat. We feel unsatisfied and unsatiated on low-calorie diets. We do have some level of voluntary control, of course, but our deep-seated instinctual drives may win out in the end.

    For example, we can consciously hold our breath. Try it right now. How long can you go before your body’s self-preservation mechanisms take over and overwhelm your deliberate intent not to breathe? Our body has our best interests at heart and is too smart to allow us to suffocate ourselves—or starve ourselves, for that matter. If our body were really that smart, though, how could it let us become obese? Why doesn’t our body realize when we’re too heavy and allow us the leeway to slim down? Maybe our body is very aware and actively trying to help, but we’re somehow undermining those efforts. How could we test this theory to see if that’s true?

    So many variables go into choosing what we eat and how much. “The eating process involves an intricate mixture of physiologic, psychologic, cultural, and esthetic considerations.” To strip all that away and stick just to the physiologic variable, Columbia University researchers designed a series of famous experiments using a “food dispensing device.” The term “food” is used very loosely here. As you can see at 2:02 in my video 200-Pound Weight Loss Without Hunger, the researchers’ feeding machine was a tube hooked up to a pump that delivered a mouthful of bland liquid formula every time a button was pushed. Research participants were instructed to eat as much or as little as they wanted at any time. In this way, eating was reduced to just the rudimentary hunger drive. Without the usual trappings of “sociability,” meal ceremony, and the pleasures of the palate, how much would people be driven to eat? 
    Put a normal-weight person in this scenario, and something remarkable happens. Day after day, week after week, with nothing more than their hunger to guide them, they eat exactly as much as they need, perfectly maintaining their weight, as shown below and at 2:36 in my video.

    They needed about 3,000 calories a day, and that’s just how much they unknowingly gave themselves. Their body just intuitively seemed to know how many times to press that button, as seen here and at 2:48 in my video.

    Put a person with obesity in that same scenario, and something even more remarkable happens. Driven by hunger alone, with the enjoyment of eating stripped away, they wildly undershoot, giving themselves a mere 275 calories a day, total. They could eat as much as they wanted, but they just weren’t hungry. It’s as if their body knew how massively overweight they were, so it dialed down their natural hunger drive to almost nothing. One participant started the study at 400 pounds and steadily lost weight. After 252 days of sipping the bland liquid, he lost 200 pounds, as you can see here and at 3:35 in my video.

    This groundbreaking discovery was initially interpreted to mean that obesity is not caused by some sort of metabolic disturbance that drives people to overeat. In fact, the study suggested quite the opposite. Instead, overeating appeared to be a function of the meaning people attached to food, “aside from its use as fuel,” whether as a source of pleasure or perhaps as relief from boredom or stress. In this way, obesity seemed more psychological than physical. Subsequent experiments with the feeding machine, though, flipped such conceptions on their head once again.

    When researchers covertly doubled the calorie concentration of the formula given to lean study participants, they unconsciously cut their consumption in half to continue to perfectly maintain their weight, as seen here and at 4:24 in my video. Their body somehow detected the change in calorie load and sent signals to the brain to press the button half as often to compensate. Amazing!

    When the same was done with people with obesity, though, nothing changed. They continued to drastically undereat just as much as before. Their body seems incapable of detecting or reacting to the change in calorie load, suggesting a physiological inability to regulate intake, as shown below and at 4:40 in my video. 
    Might the brains of persons with obesity somehow be insensitive to internal satiety signals? We don’t know if it’s cause or effect. Maybe that’s why they’re obese in the first place, or maybe the body knows how obese it is and shuts down its hunger drive regardless of the calorie concentration. Indeed, the participants with obesity continued to steadily lose weight eating out of the machine, regardless of the calorie concentration and the food being dispensed, as you can see here and at 5:19 in my video. 
    It would be interesting to see if they regained the ability to respond to changing calorie intake once they reached their ideal weight. Regardless, what can we apply from these remarkable studies to facilitate weight loss out in the real world? We’ll explore just that question next.

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    Michael Greger M.D. FACLM

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  • Boosting BDNF Levels in Our Brain to Treat Depression  | NutritionFacts.org

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    We can raise BDNF levels in our brain by fasting and exercising, as well as by eating and avoiding certain foods.

    There is accumulating evidence that brain-derived neurotrophic factor (BDNF) may be playing a role in human depression. BDNF controls the growth of new nerve cells. “So, low levels of this peptide could lead to an atrophy of specific brain areas such as the amygdala and the hippocampus, as it has been observed among depressed patients.” That may be one of the reasons that exercise is so good for our brains. Start an hour-a-day exercise regimen, and, within three months, there can be a quadrupling of BDNF release from our brain, as seen below and at 0:35 in my video How to Boost Brain BDNF Levels for Depression Treatment.

    This makes sense. Any time we were desperate to catch prey (or desperate not to become prey ourselves), we needed to be cognitively sharp. So, when we’re fasting, exercising, or in a negative calorie balance, our brain starts churning out BDNF to make sure we’re firing on all cylinders. Of course, Big Pharma is eager to create drugs to mimic this effect, but is there any way to boost BDNF naturally? Yes, I just said it: fasting and exercising. Is there anything we can add to our diet to boost BDNF?

    Higher intakes of dietary flavonoids appear to be protectively associated with symptoms of depression. The Harvard Nurses’ Health Study followed tens of thousands of women for years and found that those who were consuming the most flavonoids appeared to reduce their risk of becoming depressed. Flavonoids occur naturally in plants, so there’s a substantial amount in a variety of healthy foods. But how do we know the benefits are from the flavonoids and not just from eating more healthfully in general? We put it to the test.

    Some fruits and vegetables have more flavonoids than others. As shown below and at 1:51 in my video, apples have more than apricots, plums more than peaches, red cabbage more than white, and kale more than cucumbers. Researchers randomized people into one of three groups: more high-flavonoid fruits and vegetables, more low-flavonoid fruits and vegetables, or no extra fruits and vegetables at all. After 18 weeks, only the high-flavonoid group got a significant boost in BDNF levels, which corresponded with an improvement in cognitive performance. The BDNF boost may help explain why each additional daily serving of fruits or vegetables is associated with a 3 percent decrease in the risk of depression. 

    What’s more, as seen here and at 2:27 in my video, a teaspoon a day of the spice turmeric may boost BNDF levels by more than 50 percent within a month. This is consistent with the other randomized controlled trials that have so far been done. 

    Nuts may help, too. In the PREDIMED study, where people were randomized to receive weekly batches of nuts or extra-virgin olive oil, the nut group lowered their risk of having low BDNF levels by 78 percent, as shown below and at 2:46.

    And BDNF is not implicated only in depression, but schizophrenia. When individuals with schizophrenia underwent a 12-week exercise program, they got a significant boost in their BDNF levels, which led the researchers to “suggest that exercise-induced modulation of BDNF may play an important role in developing non-pharmacological treatment for chronic schizophrenic patients.”

    What about schizophrenia symptoms? Thirty individuals with schizophrenia were randomized to ramp up to 40 minutes of aerobic exercise three times a week or not, and there did appear to be an improvement in psychiatric symptoms, such as hallucinations, as well as an increase in their quality of life, with exercise. In fact, researchers could actually visualize what happened in their brains. Loss of brain volume in a certain region appears to be a feature of schizophrenia, but 30 minutes of exercise, three times a week, resulted in an increase of up to 20 percent in the size of that region within three months, as seen here and at 3:46 in my video. 

    Caloric restriction may also increase BDNF levels in people with schizophrenia. So, researchers didn’t just have study participants eat less, but more healthfully, too—less saturated fat and sugar, and more fruits and veggies. The study was like the Soviet fasting trials for schizophrenia that reported truly unbelievable results, supposedly restoring people to function, and described fasting as “an unparalleled achievement in the treatment of schizophrenia”—but part of the problem is that the diagnostic system the Soviets used is completely different than ours, making any results hard to interpret. There was a subgroup that seemed to correspond to the Western definition, but they still reported 40 to 60 percent improvement rates from fasting, but fasting wasn’t all they did. After the participants fasted for up to a month, they were put on a meat- and egg-free diet. So, when the researchers reported these remarkable effects even years later, they were for those individuals who stuck with the meat- and egg-free diet. Evidently, the closer the diet was followed, the better the effect, and those who broke the diet relapsed. The researchers noted: “Not all patients can remain vegetarian, but they must not take meat for at least six months, and then in very small portions.” We know from randomized controlled trials that simply eschewing meat and eggs can improve mental states within just two weeks, so it’s hard to know what role fasting itself played in the reported improvements.

    A single high-fat meal can drop BDNF levels within hours of consumption, and we can prove it’s the fat itself by seeing the same result after injecting fat straight into our veins. Perhaps that helps explain why increased consumption of saturated fats in a high-fat diet may contribute to brain dysfunction—that is, neurodegenerative diseases, long-term memory loss, and cognitive impairment. It may also help explain why the standard American diet has been linked to a higher risk of depression, as dietary factors modulate the levels of brain-derived neurotrophic factor.

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    Michael Greger M.D. FACLM

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  • Boosting Your Metabolism Safely  | NutritionFacts.org

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    If you drink two cups of water, the adrenal hormone noradrenaline can surge in your bloodstream, similar to the response of smoking a few cigarettes or having a few cups of coffee.

    Given the 60 percent surge in noradrenaline within minutes of drinking just two cups of water, as shown in the graph below and at 0:13 in my video What Is the Safest Metabolism Booster?, might one be able to get the weight-loss benefits of noradrenaline-releasing drugs like ephedra—without the risks? You don’t know until you put it to the test. Published in the Journal of the Endocrine Society, the results were described as “uniquely spectacular.” Researchers found that drinking two cups of water increased the metabolic rate of men and women by 30 percent. The increase started within ten minutes and reached a maximum within an hour. In the 90 minutes after drinking one tall glass of water, the study participants burned about an extra 25 calories (100 kJ). Do that four times throughout the day, and you could eliminate 100 additional calories (400 kJ). That’s more than if you had taken ephedra! You’d trim off more calories drinking water than taking weight-loss doses of the banned substance ephedrine (the active component of ephedra) three times a day. And we’re just talking about plain, cheap, safe, and legal tap water.

    Using the Ten-Calorie Rule I’ve explained previously, drinking that much water could make us lose ten pounds over time unless we somehow compensated by eating more or moving less. Concluded one research team, “In essence, water drinking provides negative calories.

    A similar effect was found in overweight and obese children. Drinking about two cups of water led to a 25 percent increase in metabolic rate within 24 minutes, and it lasted at least 66 minutes, until the experiment ended. So, just getting the recommended daily “adequate intake” of water—about 7 cups (1.7 L) a day for children aged 4 through 8, and for ages 9 through 13, 8 cups (2.1 L) for girls and 10 cups (2.4 L) for boys, as shown below and at 1:45 in my video—may offer more than just hydration benefits. 

    Not all research teams were able to replicate these findings, though. For example, one found an increase of only about 10 to 20 percent, while another found only a 5 percent increase, and yet another team found effectively none at all. What we care about, though, is weight loss. The proof is in the pudding. Let’s test the waters, shall we?

    Some researchers suggest that the “increase in metabolic rate with water drinking could be systematically applied in the prevention of weight gain….” Talk about a safe, simple, side-effect-free solution. It’s free in every sense. Drug companies may spend billions of dollars getting a new drug to market. Surely a little could be spared to test something that, at the very least, couldn’t hurt. That’s the problem, though. Drinking water is a “cost-free intervention.”

    There are observational studies suggesting that those who drink four or more cups (1 L) of water a day, for example, appear to lose more weight, independent of confounding factors, such as drinking less soda or exercising more. What happens when you put it to the test?

    In 2013, “Effect of ‘Water Induced Thermogenesis’ on Body Weight, Body Mass Index and Body Composition of Overweight Subjects” was published. Fifty “overweight girls”—who were actually women, aged 18 to 23—“were instructed to drink 500 ml [2 cups] of water, three times a day, half an hour before breakfast, lunch, and dinner, which was over and above their daily water intake” and without otherwise changing their diets or physical activity. The result? They lost an average of three pounds (1.4 kg) in eight weeks. What happened to those in the control group? There was no control group, a fatal flaw for any weight-loss study due to the “Hawthorne effect,” where just knowing you’re being watched and weighed may subtly affect your behavior. Of course, we’re just talking about drinking water. With no downsides, why not give it a try? I’d feel more confident if there were some randomized, controlled trials to really put it to the test. Thankfully, there are!

    I hate it when the title ruins the suspense. “Water Consumption Increases Weight Loss During a Hypocaloric Diet Intervention in Middle-Aged and Older Adults.” Overweight and obese men and women randomized to two cups of water before each meal lost nearly five pounds more body fat in 12 weeks than those in the control group, as shown below and at 4:08 in my video. Both groups were put on the same calorie-restricted diet, but the one with the added water lost weight 44 percent faster.

    A similar randomized controlled trial found that about 1 in 4 in the water group lost more than 5 percent of their body weight compared to only 1 in 20 in the control group. The average weight-loss difference was only about three pounds (1.3 kg), but those who claimed to have actually complied with the three-times-a-day instructions lost about eight more pounds (4.3 kg) compared to those who only drank the extra water once a day or less. This is comparable to commercial weight-loss programs, like Weight Watchers, and all the participants did was drink some extra water. 

    The video I mentioned is The New Calories per Pound of Weight Loss Rule.

    If you missed my previous video, see The Effect of Drinking Water on Adrenal Hormones.

    For all the specifics, check out Optimizing Water Intake to Lose Weight, coming up next. 

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    Michael Greger M.D. FACLM

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  • The Largest Study on Fasting in the World  | NutritionFacts.org

    The Largest Study on Fasting in the World  | NutritionFacts.org

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    The Buchinger-modified fasting program is put to the test.

    A century ago, fasting—“starvation, as a therapeutic measure”—was described as “the ideal measure for the human hog…” (Fat shaming is not a new invention in the medical literature.) I’ve covered fasting for weight loss extensively in a nine-video series, but what about all the other purported benefits? I also have a video series on fasting for hypertension, but what about psoriasis, eczema, type 2 diabetes, lupus, metabolic disorder, rheumatoid arthritis, other autoimmune disorders, depression, and anxiety? Why hasn’t it been tested more?

    One difficulty with fasting research is: What do you mean by fasting? When I think of fasting, I think of water-only fasting, but, in Europe, they tend to practice “modified therapeutic fasting,” also known as Buchinger fasting, which is more like a very low-calorie juice fasting with some vegetable broth. Some forms of fasting may not even cut calories at all. As you can see below and at 1:09 in my video The World’s Largest Fasting Study, Ramadan fasting, for example, is when devout Muslims abstain from food and drink from sunrise to sunset, yet, interestingly, they end up eating the same amount—or even more food—overall.

    The largest study on fasting to date was published in 2019. More than a thousand individuals were put through a modified fast, cutting daily intake down to about ten cups of water, a cup of fruit juice, and a cup of vegetable soup. They reported very few side effects. In contrast, the latest water-only fasting data from a study that involved half as many people reported nearly 6,000 adverse effects. Now, the modified fasting study did seem to try to undercount adverse effects by only counting reported symptoms if they were repeated three times. However, adverse effects like nausea, feeling faint, upset stomach, vomiting, or palpitations were “observed only in single cases,” whereas the water-only fasting study reported about 100 to 200 of each, as you can see below and at 2:05 in my video. What about the benefits though?

    In the modified fasting study, participants self-reported improvements in physical and emotional well-being, along with a surprising lack of hunger. What’s more, the vast majority of those who came in with a pre-existing health complaint reported feeling better, with less than 10 percent stating that their condition worsened, as you can see in the graph below and at 2:24 in my video. 

    However, the study participants didn’t just fast; they also engaged in a lifestyle program, which included being on a plant-based diet before and after the modified fast. If only the researchers had had some study participants follow the healthier, plant-based diet without the fast to tease out fasting’s effects. Oh, but they did! About a thousand individuals fasted for a week on the same juice and vegetable soup regimen and others followed a normocaloric (normal calorie) vegetarian diet.

    As you can see below and at 2:54 in my video, both groups experienced significant increases in both physical and mental quality of life, and, interestingly, there was no significant difference between the groups.

    In terms of their major health complaints—including rheumatoid arthritis; chronic pain syndromes, like osteoarthritis, fibromyalgia, and back pain; inflammatory and irritable bowel disease; chronic pulmonary diseases; and migraine and chronic tension-type headaches—the fasting group appeared to have an edge, but both groups did well, with about 80 percent reporting improvements in their condition and only about 4 percent reporting feeling worse, as you can see below and at 3:25 in my video. 

    Now, this was not a randomized study; people chose which treatment they wanted to follow. So, maybe, for example, those choosing fasting were sicker or something. Also, the improvements in quality of life and disease status were all subjective self-reporting, which is ripe for placebo effects. There was no do-nothing control group, and the response rates to the follow-up quality of life surveys were only about 60 to 70 percent, which also could have biased the results. But extended benefits are certainly possible, given they all tended to improve their diets, as you can see below and at 4:00 in my video.

    They ate more fruits and vegetables, and less meats and sweets, and therein may lie the secret. “Principally, the experience of fasting may support motivation for lifestyle change. Most fasters experience clarity of mind and feel a ‘letting go’ of past actions and experiences and thus may develop a more positive attitude toward the future.”

    As a consensus panel of fasting experts concluded, “Nutritional therapy (theory and practice) is a vital and integral component of fasting. After the fasting therapy and refeeding period, nutrition should follow the recommendations/concepts of a…plant-based whole-food diet…”

    If you missed the previous video, check out The Benefits of Fasting for Healing.

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    Michael Greger M.D. FACLM

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  • Can Fasting Be Healing?  | NutritionFacts.org

    Can Fasting Be Healing?  | NutritionFacts.org

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    Where did the idea of therapeutic fasting come from?

    The story of life on Earth is a story of starvation. Ash from massive volcanoes and asteroids blocked out the sun, which killed the plants, which then killed almost everything else. As Darwin pointed out: “Thus, from the war of nature, from famine and death, the most exalted object which we are capable of conceiving” arose—namely, us.

    “Among apes, humans are particularly well adapted to prolonged fasting.” Evolving in a context of scarcity is believed to have shaped “our exceptional ability to store large amounts of energy [calories] when food is available.” Of course, nowadays, our ability to easily pack on pounds is leading to modern diseases, like obesity and type 2 diabetes. But, without the ability to store so much body fat, we may not have made it to tell the tale.

    Scarcity wasn’t just caused by the asteroids millions of years ago. “All of Upper Egypt was dying of hunger,” reads an inscription on an Egyptian tomb from about 4,000 years ago, “to such a degree that everyone had come to eating his children…” Just hundreds of years ago, “[p]arents killed their children and children killed parents” and ate them, and “the bodies of executed criminals were eagerly snatched from the gallows.” Hunger wiped out as many as two-thirds of the population of Italy and one-third of the population of Paris. So, we don’t have to go back to ancient history. “Even the most secure and affluent populations of today need only trace their history back a short distance to find evidence of famines that would have impinged on their forebears.” For example, there have been nearly 200 famines in Britain over the last 2,000 years.

    Now, we tend to be suffering from too much food, which carries its problems, but “what about the consequences of not ever starving?” This was a question raised nearly 60 years ago. If our physiology is so well-tuned to periodic starvation, by eliminating that, might we be harming our overall well-being? We just didn’t know.

    The lack of research in the area of starvation was attributed to the “difficulty of securing willing human subjects.” So, what little we had may have come from unwilling subjects. Physicians within the Warsaw Ghetto made detailed accounts before they succumbed, and Irish Republican Army prisoners in Northern Ireland starved themselves to death after hunger striking up to 73 days. However, starvation isn’t necessarily the same as fasting, an issue raised in medical journals more than a century ago. “Starvation is normally a forced, mentally stressful, and chronic condition, whereas [therapeutic] fasting is voluntary, limited in duration, and usually practiced by people in adequate nutritional state”—that is, individuals who start with adequate nutrition.

    Therapeutic fasting? Where did we get this idea of fasting therapy? “Fasting for medical purpose”? As I discuss in my video The Benefits of Fasting for Healing, it may have originally arisen out of the observation that when people get acutely ill, they tend to lose their appetite, so maybe there’s something in the wisdom of our body to stop eating. That’s presumably where the whole “starve a fever” folklore came from.

    There was a sense that “fasting affords physiologic rest” for the body—not just for the digestive tract, but throughout—allowing the body to concentrate on healing. It was evidently “an open secret” that veterinarians used to hospitalize dogs with “various dyspeptic and metabolic ailments” only to fast them back to health. So, the theory went, maybe it might work for people, too.

    Beyond just freeing up all the resources that would normally be used for nutrient digestion and storage, there’s a concept that, during fasting, our cells switch over to some sort of protection mode. Why would fasting reduce free radical “oxidative damage and inflammation, optimize energy metabolism, and bolster cellular protection”? It’s the “that which doesn’t kill us makes us stronger” concept known as hormesis. That’s kind of the opposite of the “let the body rest” theory. It’s more like “let the body stress.” The stress of fasting may steel the body against other stresses coming our way. This was demonstrated perhaps most starkly in a set of cringe-worthy experiments in which mice were blasted with Hiroshima-level gamma radiation sufficient to kill 50 percent within two weeks, but of the mice who had first been intermittently fasted for six weeks before, not a single one died, as you can see in the graph below and at 4:33 in my video.

    It’s these kinds of dramatic data that led to extraordinary claims like therapeutic fasting could drive half of all doctors out of business. You don’t know until you put it to the test, and we’ll explore that next.

    There’s been an explosion in research interest in fasting over the last few years. Stay tuned for The World’s Largest Fasting Study.

    Due to my work on How Not to Diet, I have discussed several studies in videos that are already available to you on fasting and weight loss. Check out the related posts below.

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    Michael Greger M.D. FACLM

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  • Dogs and Cats Thrive on Lean Meats. Try These Two Today! | Animal Wellness Magazine

    Dogs and Cats Thrive on Lean Meats. Try These Two Today! | Animal Wellness Magazine

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    Lean meats for dogs and cats are good for their health, encourage picky eaters, support healthy digestion, and have many other benefits.

    Pet parents are always on the lookout for the best food and treats for their dogs and cats, and no matter what you choose, lean meats should be on the menu. With a lower fat content than other proteins, lean meats have myriad benefits for health, digestion, weight management, and more. And the best part is dogs and cats love them! If you’re on the hunt for a healthy, delicious, irresistible treat for your fur baby, here’s why you should try lean meats for dogs and cats.

    An Excellent Source of High-Quality Protein

    Protein is one of the most important components of your dog’s or cat’s diet. Lean meat is a wise choice because it’s rich in high-quality protein. Dogs and cats need protein to build and repair tissues, maintain muscle mass, and support overall growth and development.

    They’re Packed with Nutrients

    Lean meats include elk, venison, and other novel proteins, which all contain different nutrients and amino acids. By feeding a variety of lean meats, you can ensure a complete and balanced diet.

    Lean Meats for Dogs and Cats Can Help with Weight Management

    Lean meats are lower in fat than others, so they have fewer calories and a higher protein-to-fat ratio. This can help with weight management and is perfect for animals on a low-fat diet.

    High Digestibility Is Great for Animals with Sensitive Stomachs

    Fatty foods can cause digestive upset, especially in dogs and cats with sensitive stomachs. Lean meats tend to be more digestible, so they’re less likely to upset the stomach. They’re also easier to metabolize, so your dog or cat will absorb the nutrients more readily.

    Lean Meats Taste Great!

    Do you have trouble finding food your dog or cat will eat or treats they actually find enticing? Picky eaters can be a challenge, but lean meats are highly palatable and can encourage them to eat and maintain their appetite. What’s more, many lean meats are novel proteins, so your dog or cat will be more likely to chow down on the new flavors!

    Try Elk and Venison Treats from Shades of Gray

    Shades of Gray Indigenous Pet Treats specializes in premium lean meats and novel proteins, including humanely raised venison and elk, the cream of the crop of lean meats! Rich in vitamin B12, iron, zinc, and omega-3 fatty acids, their venison and elk rolls, toppers, strips, and treats are made with single ingredients and contain no corn, soy, wheat, antibiotics, additives, or preservatives. These superior treats are ideal for animals with allergies, dietary restrictions, and weight management needs, as well as any pet parent who wants to spoil their dog or cat with the highest-quality lean-meat treats available!


    Animal Wellness is North America’s top natural health and lifestyle magazine for dogs and cats, with a readership of over one million every year. AW features articles by some of the most renowned experts in the pet industry, with topics ranging from diet and health related issues, to articles on training, fitness and emotional well being.

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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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  • Eat Quinoa and Lower Triglycerides? | NutritionFacts.org

    Eat Quinoa and Lower Triglycerides? | NutritionFacts.org

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    How do the nutrition and health effects of quinoa compare to other whole grains?

    “Approximately 90% of the world’s calories are provided by less than one percent of the known 250,000 edible plant species.” The big three are wheat, corn, and rice, and our reliance on them may be unsustainable, given the ongoing climate crisis. This has spurred new interest in “underutilized crops,” like quinoa, which might do better with drought and heat.

    Quinoa has only recently been introduced into the Northern Hemisphere, but humans have been eating quinoa for more than 7,000 years. Is there any truth to its “superfood” designation, or is it all just marketing hooey?

    Quinoa is a “pseudograin,” since the plant it comes from isn’t a type of grass. “Botanically speaking quinoa is an achene, a seed-like fruit with a hard coat,” and it has a lot of vitamins and minerals, but so do all whole grains. It also has a lot of protein. As you can see below and in a series of graphs starting at 1:05 in my video Benefits of Quinoa for Lowering Triglycerides, quinoa has more protein than other grains, but since when do we need more protein? Fiber is what we’re sorely lacking, and its fiber content is relatively modest, compared to barley or rye. Quinoa is pretty strong on folate and vitamin E, though, and it leads the pack on magnesium, iron, and zinc. So, it is nutritious, but when I think superfood, I think of something with some sort of special clinical benefit. Broccoli is a superfood, strawberries are a superfood, and so is garlic, but quinoa? Consumer demand is up, thanks in part to “perceived health benefits,” and it has all sorts of purported benefits in lab animals, but there have been very few human studies. 

    The first trial was a before-and-after study of quinoa granola bars that showed drops in triglycerides and cholesterol, as you can see below and at 1:53 in my video, but it didn’t have a control group, so we don’t know how much of that would have happened without the quinoa. The kind of study I want to see is a randomized controlled trial. When researchers gave participants about a cup of cooked quinoa every day for 12 weeks, they experienced a 36 percent drop in their triglycerides. That’s comparable to what one gets with triglyceride-lowering drugs or high-dose fish oil supplements.

    Which is better, regular quinoa or red quinoa? As you can see in the graph below and at 2:22 in my video, the red variety has about twice the antioxidant power, leading the investigators to conclude that red quinoa “might…contribute significantly to the management and/or prevention of degenerative diseases associated with free radical damage,” but it’s never been put to the test. 

    What about black quinoa? Both red and black quinoa appear to be equally antioxidant-rich, both beating out the more conventional white variety, as you can see in the graph below and at 2:46 in my video. 

    The only caveat I could find is to inform your doctor before your next colonoscopy or else they might mistake quinoa for parasites. As reported in a paper, a “colonoscopy revealed numerous egg-like tan-yellow ovoid objects, 2 to 3 mm in diameter, of unclear cause,” but they were just undigested quinoa.

    For more on the superfoods I mentioned, check the related posts below.

    Isn’t fish oil important to heart health? Find out in my video Is Fish Oil Just Snake Oil?.

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    Michael Greger M.D. FACLM

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  • Obesity and a Toxic Food Environment  | NutritionFacts.org

    Obesity and a Toxic Food Environment  | NutritionFacts.org

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    Implausible explanations for the obesity epidemic serve the needs of food manufacturers and marketers more than public health and an interest in truth. 

    When it comes to uncovering the root causes of the obesity epidemic, there appears to be manufactured confusion, “with major studies reasserting that the causes of obesity are ‘extremely complex’ and ‘fiendishly hard to untangle,’” but having just reviewed the literature, it doesn’t seem like much of a mystery to me.

    It’s the food.

    Attempts at obfuscation—rolling out hosts of “implausible explanations,” like sedentary lifestyles or lack of self-discipline—cater to food manufacturers and marketers more than the public’s health and our interest in the truth. “When asked about the role of restaurants in contributing to the obesity problem, Steven Anderson, president of the National Restaurant Association stated, “Just because we have electricity doesn’t mean you have to electrocute yourself.” Yes, but Big Food is effectively attaching electrodes to shock and awe the reward centers in our brains to undermine our self-control.

    It is hard to eat healthfully against the headwind of such strong evolutionary forces. No matter what our level of nutrition knowledge, in the face of pepperoni pizza, “our genes scream, ‘Eat it now!’” Anyone who doubts the power of basic biological drives should see how long they can go without blinking or breathing. Any conscious decision to hold your breath is soon overcome by the compulsion to breathe. In medicine, shortness of breath is sometimes even referred to as “air hunger.” The battle of the bulge is a battle against biology, so obesity is not some moral failing. It’s not gluttony or sloth. It is a natural, “normal response, by normal people, to an abnormal situation”—the unnatural ubiquity of calorie-dense, sugary, and fatty foods.

    The sea of excess calories we are now floating in (and some of us are drowning in) has been referred to as a “toxic food environment.” This helps direct focus away from the individual and towards the societal forces at work, such as the fact that the average child is blasted with 10,000 commercials for food a year. Or maybe I should say ads for pseudo food, as 95 percent are for “candy, fast food, soft drinks [aka liquid candy], and sugared cereals [aka breakfast candy].”

    Wait a second, though. If weight gain is just a natural reaction to the easy availability of mountains of cheap, yummy calories, then why isn’t everyone fat? As you can see below and at 2:41 in my video The Role of the Toxic Food Environment in the Obesity Epidemic, in a certain sense, most everyone is. It’s been estimated that more than 90 percent of American adults are “overfat,” defined as having “excess body fat sufficient to impair health.” This can occur even “in those who are normal-weight and non-obese, often due to excess abdominal fat.

    However, even if you look just at the numbers on the scale, being overweight is the norm. If you look at the bell curve and input the latest data, more than 70 percent of us are overweight. A little less than one-third of us is normal weight, on one side of the curve, and more than a third is on the other side, so overweight that we’re obese. You can see in the graph below and at 3:20 in my video.

    If the food is to blame, though, why doesn’t everyone get fat? That’s like asking if cigarettes are really to blame, why don’t all smokers get lung cancer? This is where genetic predispositions and other exposures can weigh in to tip the scales. Different people are born with a different susceptibility to cancer, but that doesn’t mean smoking doesn’t play a critical role in exploding whatever inherent risk you have. It’s the same with obesity and our toxic food environment. It’s like the firearm analogy: Genes may load the gun, but diet pulls the trigger. We can try to switch the safety back on with smoking cessation and a healthier diet.

    What happened when two dozen study participants were given the same number of excess calories? They all gained weight, but some gained more than others. Overfeeding the same 1,000 calories a day, 6 days a week for 100 days, caused weight gains ranging from about 9 pounds up to 29 pounds. The same 84,000 extra calories caused different amounts of weight gain. Some people are just more genetically susceptible. The reason we suspect genetics is that the 24 people in the study were 12 sets of identical twins, and the variation in weight gain between each of them was about a third less. As you can see in the graph below and at 4:41 in my video, a similar study with weight loss from exercise found a similar result. So, yes, genetics play a role, but that just means some people have to work harder than others. Ideally, inheriting a predisposition for extra weight gain shouldn’t give a reason for resignation, but rather motivation to put in the extra effort to unseal your fate. 

    Advances in processing and packaging, combined with government policies and food subsidy handouts that fostered cheap inputs for the “food industrial complex,” led to a glut of ready-to-eat, ready-to-heat, ready-to-drink hyperpalatable, hyperprofitable products. To help assuage impatient investors, marketing became even more pervasive and persuasive. All these factors conspired to create unfettered access to copious, convenient, low-cost, high-calorie foods often willfully engineered with chemical additives to make them hyperstimulatingly sweet or savory, yet only weakly satiating. 

    As we all sink deeper into a quicksand of calories, more and more mental energy is required to swim upstream against the constant “bombardment of advertising” and 24/7 panopticons of tempting treats. There’s so much food flooding the market now that much of it ends up in the trash. Food waste has progressively increased by about 50 percent since the 1970s. Perhaps better in the landfills, though, than filling up our stomachs. Too many of these cheap, fattening foods prioritize shelf life over human life.

    But dead people don’t eat. Don’t food companies have a vested interest in keeping their consumers healthy? Such naiveté reveals a fundamental misunderstanding of the system. A public company’s primary responsibility is to reap returns for its investors. “How else could we have tobacco companies, who are consummate marketers, continuing to produce products that kill one in two of their most loyal customers?” It’s not about customer satisfaction, but shareholder satisfaction. The customer always comes second.

    Just as weight gain may be a perfectly natural reaction to an obesogenic food environment, governments and businesses are simply responding normally to the political and economic realities of our system. Can you think of a single major industry that would benefit from people eating more healthfully? “Certainly not the agriculture, food product, grocery, restaurant, diet, or drug industries,” wrote emeritus professor Marion Nestle in a Science editorial when she was chair of nutrition at New York University. “All flourish when people eat more, and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating.”

    If part of the problem is cheap tasty convenience, is hard-to-find food that’s gross and expensive the solution? Or might there be a way to get the best of all worlds—easy, healthy, delicious, satisfying meals that help you lose weight? That’s the central question of my book How Not to Diet. Check it out for free at your local library.

    This is it—the final video in this 11-part series. If you missed any of the others, see the related posts below. 

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    Michael Greger M.D. FACLM

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  • Corporate Influence and Our Epidemic of Obesity  | NutritionFacts.org

    Corporate Influence and Our Epidemic of Obesity  | NutritionFacts.org

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    Like the tobacco industry adding extra nicotine to cigarettes, the food industry employs taste engineers to accomplish a similar goal of maximizing the irresistibility of its products. 

    The plague of tobacco deaths wasn’t due just to the mass manufacturing and marketing of cheap cigarettes. Tobacco companies actively sought to make their products even more crave-able by spraying sheets of tobacco with nicotine and additives like ammonia to provide “a bigger nicotine ‘kick.’” Similarly, taste engineers are hired by the food industry to maximize product irresistibility.

    Taste is the leading factor in food choice. “Sugar, fat, and salt have been called the three points of the compass” to produce “superstimulating” and “hyper palatability” to tempt people into impulsive buys and compulsive consumption. Foods are intentionally designed to hook into our evolutionary triggers and breach whatever biological barriers help “keep consumption within reasonable limits.”

    Big Food is big business. The processed food industry alone brings in more than $2 trillion a year. That affords them the economic might to manipulate not only taste profiles, but public policy and scientific inquiry, too. The food, alcohol, and tobacco industries have all used similar unsavory tactics: blocking health regulations, co-opting professional organizations, creating front groups, and distorting the science. The common “corporate playbook” shouldn’t be surprising, given the common corporate threads. At one time, for example, tobacco giant Philip Morris owned both Kraft and Miller Brewing.

    As you can see below and at 1:45 in my video The Role of Corporate Influence in the Obesity Epidemic, in a single year, the food industry spent more than $50 million to hire hundreds of lobbyists to influence legislation. Most of these lobbyists were “revolvers,” former federal employees in the revolving door between industry and its regulators, who could push corporate interests from the inside, only to be rewarded with cushy lobbying jobs after their “public service.” In the following year, the industry acquired a new weapon—a stick to go along with all those carrots. On January 21, 2010, the Supreme Court’s five-to-four Citizen’s United ruling permitted corporations to spend unlimited amounts of money on campaign ads to trash anyone who dared stand against them. No wonder our elected officials have so thoroughly shrunk from the fight, leaving us largely with a government of Big Food, by Big Food, and for Big Food. 

    Globally, a similar dynamic exists. Weak tea calls from the public health community for voluntary standards are met not only with vicious fights against meaningful change but also massive transnational trade and foreign investment deals that “cement the protection of their [food industry] profits” into the laws of the lands.

    The corrupting commercial influence extends to medical associations. Reminiscent of the “just what the doctor ordered” cigarette ads of yesteryear, as you can see below and at 3:05 in my video, the American Academy of Family Physicians accepted millions from The Coca-Cola Company to “develop consumer education content on beverages and sweeteners.” 

    On the front line, fake grassroots “Astroturf” groups are used to mask the corporate message. RJ Reynolds created Get Government Off Our Back (memorably acronymed GGOOB), “a front group created by the tobacco industry to fight regulation,” for instance. Americans Against Food Taxes may as just as well be called “Food Industry Against Food Taxes.” The power of front group formation is enough to bind bitter corporate rivals; the Sugar Association and the Corn Refiners Association linked arms with the National Confectioners Association to partner with Americans for Food and Beverage Choice.

    Using another tried-and-true tobacco tactic, research front groups can be used to subvert the scientific process by shaping or suppressing the science that deviates from the corporate agenda. Take the trans fat story. Food manufacturers have not only “long denied that trans fats were associated with disease,” but actively “worked to limit research on trans fats” and “discredit potentially damaging findings.”

    At what cost? The global death toll from foods high in trans fat, saturated fat, salt, and sugar is at 14 million lost lives every year. The inability of countries around the world to turn the tide on obesity “is not a failure of individual will-power. This is a failure of political will to take on big business,” said the Director-General of the World Health Organization. “It is a failure of political will to take on the powerful food and soda industries.” She ended her keynote address before the National Academy of Medicine entitled “Obesity and Diabetes: The Slow-Motion Disaster” with these words: “The interests of the public must be prioritized over those of corporations.”

    Are you mad yet? To sum up my answer to the question underlying my What Triggered the Obesity Epidemic? webinar, it’s the food. I close next with my wrap-up video: The Role of the Toxic Food Environment in the Obesity Epidemic. 

    This was part of an 11-part series. See the related posts below.

    If the political angle interests you, check out: 

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    Michael Greger M.D. FACLM

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  • Should We Take Any Responsibility for the Obesity Epidemic?  | NutritionFacts.org

    Should We Take Any Responsibility for the Obesity Epidemic?  | NutritionFacts.org

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    The power of the “eat more” food environment can overcome our conscious controls.

    Food and beverage companies frame body weight as “a matter of personal choice.” Even when we aren’t distracted, the power of the “eat more” food environment may sometimes overcome our conscious controls of overeating. One look around the room at a dietician convention can tell you that even nutrition professionals are vulnerable to the aggressively marketed ubiquity of tasty, cheap, convenient calories. This suggests there are aspects of our eating behaviors “that defy personal insight or are below individual awareness,” flying below the radar of conscious awareness. Appetite physiologists call the result of these subconscious actions “passive overconsumption.”

    Remember that brain scan study where the thought of a milkshake lit up the same reward pathways in the brain as substance abuse? That was triggered just by a picture of a milkshake. Dopamine gets released, cravings get activated, and we’re motivated to eat. Intellectually, we know it’s just an image, but our lizard brain sees survival. It’s just a reflexive response over which we have little control, which is why marketers ensure there are pictures of milkshakes and their equivalents everywhere.

    As I discuss in my video The Role of Personal Responsibility in the Obesity Epidemic, maintaining a balance between calories in and calories out feels like a series of voluntary acts under conscious control, but it may be more akin to bodily functions, such as blinking, breathing, coughing, swallowing, or sleeping. You can try to will yourself power over any of these, but by and large, they just happen automatically, driven by ancient scripts.

    Not only are food ads ubiquitous, but so is the food. The types of establishments selling food products expanded dramatically in the 1970s and 1980s. Now, you can find candy and snacks at the checkout counters of “gasoline stations, building material outlets, auto parts stores, drug stores, and home furnishing stores” and more. The largest food retailer in the United States is Wal-Mart. You can get that jolt of “dopamine and the associated artificially induced feelings of hunger in modern society” around every turn. Every day, we run the gauntlet.

    It’s also become “socially acceptable to eat food at any time of day and anywhere—in cars, in your hand, on the street—places where eating had never been acceptable.” We’ve become a snacking society. Vending machines are everywhere. Daily eating episodes seem to have gone up by about a quarter since the late 1970s, increasing from about four to five occasions a day, potentially accounting for twice the calorie increase attributed to increasing portion sizes. Snacks and beverages alone could account for the bulk of the calorie surplus implicated in the obesity epidemic.

    And think of the children. Here we are trying to do the best for our kids, role-modeling healthy habits and feeding them healthy foods, but then they venture out into a veritable tornado of junky food and manipulative messages. A commentary in The New England Journal of Medicine asked: “But why should Mr. and Ms. G.’s efforts to protect their children from life-threatening illness be undermined by massive marketing campaigns from the manufacturers of junk food?” Pediatricians are now encouraged to have the “French Fry Discussion” with parents at the 12-month well-child visit instead of waiting until their kids are two—though even that may be too late. As you can see below and at 3:35 in my video, two-thirds of infants are being fed junk food by their first birthday. 

    Dr. David Katz may have said it best in the Harvard Health Policy Review: “Those who contend that parental or personal responsibility should carry the day despite these environmental temptations might consider the implications of generalizing the principle. Perhaps children should be encouraged, but not required, to attend school and tempted each morning by alternatives, such as buses to the circus, zoo, or beach.” 

    It may be helpful to take a step back and think of what’s at stake here. We aren’t just talking about being manipulated into buying a different brand of toothpaste. The obesity pandemic has resulted in millions of deaths and untold suffering. If you aren’t mad yet, brace yourself for my next video: The Role of Corporate Influence in the Obesity Epidemic.

    This is the ninth video in my 11-part series. If you missed any of the previous ones, see the related posts below.

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    Michael Greger M.D. FACLM

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  • Are Food Ads Making Us Obese?  | NutritionFacts.org

    Are Food Ads Making Us Obese?  | NutritionFacts.org

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    We all like to think we make important life decisions, like what to eat, consciously and rationally, but if that were the case, we wouldn’t be in the midst of an obesity epidemic.

    The opening words of the Institute of Medicine’s report on the potential threat posed by food ads were: “Marketing works.” Certainly, there is a “large number of well-conducted randomized experiments” I could go through with you that “have shown that exposure to marketing—especially, but not only, advertising—changes people’s eating behavior. Marketing causes people to choose to eat more.” But, what do you need to know beyond the fact that the industry spends tens of billions of dollars a year on it? To get people to drink its brown sugar water, do you think Coca-Cola would spend a penny more than it thought it had to? It’s like when my medical colleagues accept “drug lunches” from pharmaceutical representatives and take offense that I would suggest it might affect their prescribing practices. Do they really think drug companies are in the business of giving away free money for nothing? They wouldn’t do it if it didn’t work. 

    To give you a sense of marketing’s insidious nature, let me share an interesting piece of research published in the world’s leading scientific journal: “In-Store Music Affects Product Choice” documented an experiment in which French accordion music or German Bierkeller music was played on alternate days in the wine section of a grocery store. As you can see below and at 1:27 in my video The Role of Food Advertisements in the Obesity Epidemic, on the days the French music played in the background, people were three times more likely to buy French wine, and on German music days, shoppers were about three times more likely to buy German wine. And it wasn’t a difference of just a few percent; it was a complete three-fold reversal. Despite the dramatic effect, when shoppers were approached afterward, the vast majority of them denied the music had influence on their choice. 

    Most of our day-to-day behavior does not appear to be dictated by careful, considered deliberations, even if we’d like to think that were the case. Rather, we tend to make more automatic, impulsive decisions triggered by unconscious cues or habitual patterns, especially when we are “under stress, tired, or preoccupied. This unconscious part of our brain is estimated to function and guide our behaviors at least 95% of the time.” This is the arena where marketing manipulations do most of their dirty work. 

    The part of our brain that governs conscious awareness may only be able to process about 50 bits of information per second, which is roughly equivalent to a short tweet. Our entire cognitive capacity, on the other hand, is estimated to process more than 10 million bits per second. Because we’re only able to purposefully process a limited amount of information at a time, if we’re distracted or otherwise unable to concentrate, our decisions can become even more impulsive. An elegant illustration of this “cognitive overload” effect was provided from an experiment involving fruit salad and chocolate cake.

    Before calls could be made at the touch of a button or the sound of our voice, the seven-digit span of phone numbers in the United States was based in part on the longest sequence most people can recall on the fly. We only seem to be able to hold about seven chunks of information (plus or minus two) in our immediate short-term memory. The study’s setup: Randomize people to memorize either a seven-digit number or a two-digit number to be recalled in another room down the hall. On the way, offer them the choice of a fruit salad or a piece of chocolate cake. Memorizing a two-digit number is easy and presumably takes few cognitive resources. As you can see in the graph below and at 3:52 in my video, under the two-digit condition, most study participants chose fruit salad. Faced with the same decision, most of those trying to keep seven digits in their heads just went for the cake. 

    This can play out in the real world by potentiating the effect of advertising. Have people watch a TV show with commercials for unhealthy snacks, and, no surprise, they eat more unhealthy snacks compared to those exposed to non-food ads. Or maybe that is a surprise. We all like to think we’re in control and not so easily manipulated. The kicker, though, is that we may be even more susceptible the less we pay attention. Randomize people to the same two-digit or seven-digit memorization task during the TV show, and the snack-attack effect was magnified among those who were more preoccupied. How many of us have the TV on in the background or multi-task during commercial breaks? Research suggests that may make us even more impressionable to the subversion of our better judgment. 

    There’s an irony in all of this. Calls for restrictions on marketing are often resisted by invoking the banner of freedom. What does that even mean in this context, when research shows how easily our free choices can be influenced without our conscious control? A senior policy researcher at the RAND Corporation even went as far as to suggest that, given the dire health consequences of our unhealthy eating habits, “the marketing techniques of which we are unaware should be considered in the same light as the invisible carcinogens and toxins in the air and water that can poison us without our awareness.”

    Given the role marketing can play even when we least suspect it, what is the role of personal responsibility in the obesity epidemic? That’s the subject of my next video.

    We are winding down this series on obesity, with three videos remaining: 

     If you missed any of the previous videos, see the related posts below. 

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    Michael Greger M.D. FACLM

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  • Marketing Takes Off and Obesity Soars  | NutritionFacts.org

    Marketing Takes Off and Obesity Soars  | NutritionFacts.org

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    The unprecedented rise in the power, scope, and sophistication of food marketing starting around 1980 aligns well with the blastoff slope of the obesity epidemic.

    In the 1970s, the U.S. government went from just subsidizing some of the worst foods to paying companies to make more of them: “Congress passed laws reversing long-standing farm policies aimed at protecting prices by limiting production” and started giving payouts in proportion to output. Extra calories started pouring into the food supply.

    Then Jack Welch gave a speech. In 1981, the CEO of General Electric effectively launched the “shareholder value movement,” reorienting the primary goal of corporations towards maximizing short-term returns for investors. This placed extraordinary pressure from Wall Street on food companies to post increasing profit growth every quarter to boost their share price. There was already a glut of calories on the market and now they had to sell even more.

    This placed food and beverage CEOs in an impossible bind. It’s not like they’re rubbing their sticky hands together at the thought of luring more Hansels and Gretels to their doom in their houses of candy. Food giants couldn’t do the right thing even if they wanted. They are beholden to investors. If they stopped marketing to kids or tried to sell healthier food or did anything else that could jeopardize their quarterly profit growth, Wall Street would demand a change in management. Healthy eating is bad for business. It’s not some grand conspiracy; it’s not even anyone’s fault. It’s just how the system works.

    As I discuss in my video The Role of Marketing in the Obesity Epidemic, given the constant demands for corporate growth and rapid returns in an already oversaturated marketplace, the food industry needed to get people to eat more. Like the tobacco industry before them, it turned to the ad makers. The food industry spends about $10 billion a year on advertising and around another $20 billion on other forms of marketing, such as trade shows, consumer promotions, incentives, and supermarket “slotting fees.” Food and beverage companies purchase shelf space from supermarkets to prominently display their most profitable products. They pay supermarkets. The practice is also known as “cliffing,” because companies “force suppliers to bid against each other for shelf space with the loser pushed ‘over the cliff.’” With slotting fees costing up to $20,000 per item, per retailer, and per city, you can imagine what types of foods get the special treatment. Hint: It ain’t broccoli.

    To get a sense of what kind of products merit prime shelf real estate, look no further than the checkout aisle. “Merchandising the power categories on every lane is critical,” reads a trade publication on the “best practices for superior checkout merchandising.” It was referring to candy bars and beverages. Just a 1 percent power category boost in sales could earn a store an extra $15,000 a year. It’s not that publicly traded companies don’t care about their customers’ health. They might, but like most of the leading grocery store chains, their “primary fiduciary responsibility is to increase profits” above other considerations.

    For instance, tens of millions of dollars are spent annually advertising a single brand of candy bar. McDonald’s alone may spend billions a year. Now, “the food industry is the biggest spender on advertising of any major sector of the economy.”

    “Reagan-era deregulatory policies removed limits on television marketing of food products to children.” Now, the average child may see more than 10,000 TV food ads a year, and that’s on top of “the marketing content online, in print, at school, at the movies, in video games, or at school,” or even on their phones. “Nearly all food marketing to children worldwide promotes products that can adversely affect their health.”

    Besides the massive early exposure and ubiquity, food marketing has become “highly sophisticated. With the help of child psychologists, companies began to understand the factors that unconsciously influenced sales. They found out, for example, how to influence children and get them to manipulate their parents.” Packaging was designed to best attract a child’s attention, and then those products are placed at their eye level in the store. You know those mirrored bubbles in the ceilings of supermarkets? They aren’t just for shoplifters. Closed-circuit cameras and GPS-like devices on shopping carts are used to strategize how best to guide shoppers toward the market’s most profitable products. Behavioral psychology is widely applied to increase impulse buying, and eye movement tracking technologies are utilized.

    The “unprecedented expansion in the scope, power, and ubiquity of food marketing…coincided with an unprecedented expansion in food consumption in predictable ways.” Some techniques have “skyrocket[ed] from essentially zero to multi-billion-dollar industries” since the 1980s, including “product placement, in-school advertising, event sponsorships.” This led one noted economist to conclude that “the most compelling single interpretation of the admittedly incomplete data we have is that the large increase in obesity is due to marketing.” Yes, innovations in manufacturing and political maneuvering led to a food supply bursting at the seams with close to 4,000 calories a day for us all, but it’s the advances in marketing manipulations that try to peddle that surplus into our mouths. 

    I think the natural reaction to the suggestion of the power of marketing is: I’m too smart to fall for that. Marketing works on other people, but I can see through it. But that’s what everyone thinks! For a splash of cold water to shake us all out of this delusion, I next bring you some data: The Role of Food Advertisements in the Obesity Epidemic. 

    Also, for both the role of marketing and food advertisements, check out Friday Favorites: The Role of Marketing and Food Advertisements in the Obesity Epidemic.

    This is the seventh in an 11-video series. If you missed any of the first six, check out the related posts below. 

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    Michael Greger M.D. FACLM

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  • Do Taxpayer Subsidies Play a Role in the Obesity Epidemic?  | NutritionFacts.org

    Do Taxpayer Subsidies Play a Role in the Obesity Epidemic?  | NutritionFacts.org

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    Why are U.S. taxpayers giving billions of dollars to support the likes of the sugar and meat industries?

    The rise in calorie surplus sufficient to explain the obesity epidemic was less a change in food quantity than in food quality. Access to cheap, high-calorie, low-quality convenience foods exploded, and the federal government very much played a role in making this happen. U.S. taxpayers give billions of dollars in subsidies to prop up the likes of the sugar industry, the corn industry and its high-fructose syrup, and the production of soybeans, about half of which is processed into vegetable oil and the other half is used as cheap feed to help make dollar-menu meat. You can see a table of subsidy recipients below and at 0:49 in my video The Role of Taxpayer Subsidies in the Obesity Epidemic. Why do taxpayers give nearly a quarter of a billion dollars a year to the sorghum industry? When was the last time you sat down to some sorghum? It’s almost all fed to cattle and other livestock. “We have created a food price structure that favors relatively animal source foods, sweets, and fats”—animal products, sugars, and oils.

    The Farm Bill started out as an emergency measure during the Great Depression of the 1930s to protect small farmers but was weaponized by Big Ag into a cash cow with pork barrel politics—including said producers of beef and pork. From 1970 to 1994, global beef prices dropped by more than 60 percent. And, if it weren’t for taxpayers “sweetening the pot” with billions of dollars a year, high-fructose corn syrup would cost the soda industry about 12 percent more. Then we hand Big Soda billions more through the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamps Program, to give sugary drinks to low-income individuals. Why is chicken so cheap? After one Farm Bill, corn and soy were subsidized below the cost of production for cheap animal fodder. We effectively handed the poultry and pork industries about $10 billion each. That’s not chicken feed—or rather, it is! 

    This is changing what we eat. 

    As you can see below and at 2:03 in my video, thanks in part to subsidies, dairy, meats, sweets, eggs, oils, and soda were all getting relatively cheaper compared to the overall consumer food price index as the obesity epidemic took off, whereas the relative cost of fresh fruits and vegetables doubled. This may help explain why, during about the same period, the percentage of Americans getting five servings of fruits and vegetables a day dropped from 42 percent to 26 percent. Why not just subsidize produce instead? Because that’s not where the money is. 

    “To understand what is shaping our foodscape today, it is important to understand the significance of differential profit.” Whole foods or minimally processed foods, such as canned beans or tomato paste, are what the food business refers to as “commodities.” They have such slim profit margins that “some are typically sold at or below cost, as ‘loss leaders,’ to attract customers to the store” in the hopes that they’ll also buy the “value-added” products. Some of the most profitable products for producers and vendors alike are the ultra-processed, fatty, sugary, and salty concoctions of artificially flavored, artificially colored, and artificially cheap ingredients—thanks to taxpayer subsidies. 

    Different foods reap different returns. Measured in “profit per square foot of selling space” in the supermarket, confectionaries like candy bars consistently rank among the most lucrative. The markups are the only healthy thing about them. Fried snacks like potato chips and corn chips are also highly profitable. PepsiCo’s subsidiary Frito-Lay brags that while its products represented only about 1 percent of total supermarket sales, they may account for more than 10 percent of operating profits for supermarkets and 40 percent of profit growth. 

    It’s no surprise, then, that the entire system is geared towards garbage. The rise in the calorie supply wasn’t just more food but a different kind of food. There’s a dumb dichotomy about the drivers of the obesity epidemic: Is it the sugar or the fat? They’re both highly subsidized, and they both took off. As you can see below and at 4:29 and 4:35 in my video, along with a significant rise in refined grain products that is difficult to quantify, the rise in obesity was accompanied by about a 20 percent increase in per capita pounds of added sugars and a 38 percent increase in added fats. 

     

    More than half of all calories consumed by most adults in the United States were found to originate from these subsidized foods, and they appear to be worse off for it. Those eating the most had significantly higher levels of chronic disease risk factors, including elevated cholesterol, inflammation, and body weight. 

    If it really were a government of, by, and for the people, we’d be subsidizing healthy foods, if anything, to make fruits and vegetables cheap or even free. Instead, our tax dollars are shoveled to the likes of the sugar industry or to livestock feed to make cheap, fast-food meat. 

    Speaking of sorghum, I had never had it before and it’s delicious! In fact, I wish I had discovered it before How Not to Diet was published. I now add sorghum and finger millet to my BROL bowl which used to just include purple barley groats, rye groats, oat groats, and black lentils, so the acronym has become an unpronounceable BROLMS. Anyway, sorghum is a great rice substitute for those who saw my rice and arsenic video series and were as convinced as I am that we need to diversify our grains. 

    We now turn to marketing. After all of the taxpayer-subsidized glut of calories in the market, the food industry had to find a way to get it into people’s mouths. So, next: The Role of Marketing in the Obesity Epidemic. 

    We’re about halfway through this series on the obesity epidemic. If you missed any so far, check out the related videos below.

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    Michael Greger M.D. FACLM

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