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Tag: Diabetes

  • Coloradans can get updated COVID vaccines, but insurance might not cover the shots

    Anyone 6 months and older who wants a COVID-19 shot in Colorado can now get one, but the vaccine will only be free for those with the right insurance — at least for now.

    Initially, pharmacies couldn’t administer the updated shots in Colorado unless a patient had a prescription. The state allows pharmacists to administer vaccines recommended by the Centers for Disease Control and Prevention’s advisory committee, but not other shots.

    Dr. Ned Calonge, chief medical officer for the state health department, responded by issuing a standing order — essentially, a prescription for every resident – allowing them to get vaccinated at retail pharmacies.

    But that order doesn’t guarantee insurance will cover the shots or that pharmacies will choose to stock them. Last year, fewer than half of people over 65 nationwide received an updated COVID-19 shot, with uptake dropping further in younger age groups, raising questions about whether health care providers will believe demand is high enough to justify buying the vaccine.

    “The standing order provides accessibility. It doesn’t necessarily provide availability,” Calonge said Tuesday.

    The Colorado Division of Insurance issued a draft rule last week that would require state-regulated plans to cover COVID-19 vaccines without out-of-pocket costs for people of any age, assuming the division passes it as written. Insurance cards from state-regulated plans typically have CO-DOI printed in the lower left corner.

    The state’s rule doesn’t apply to federally regulated plans, which account for about 30% of employer-sponsored insurance plans in Colorado, Calonge said. Typically, however, those plans try to offer competitive benefits, since they mostly serve large employers, he said.

    “My hope would be they would want to keep up with other insurers,” he said.

    This isn’t the first time that people on state-regulated plans have had benefits not guaranteed for people with federally regulated insurance.

    Colorado capped the cost of insulin and epinephrine shots to treat severe allergic reactions in state plans, but couldn’t require the same for plans the state doesn’t oversee. In those cases, it offered an “affordability program” requiring manufacturers to supply the medication at a lower cost for people who aren’t covered by the state caps, Medicare or Medicaid.

    At least two Colorado insurers surveyed by The Denver Post said all of their plans will cover COVID-19 vaccines, while others hedged.

    Select Health, which sells Medicare and individual marketplace plans in Colorado, said its plans currently cover COVID-19 vaccines without out-of-pocket costs for everyone. Kaiser Permanente Colorado said in a message to members that it will pay for the shot for anyone 6 months or older.

    Donna Lynne, CEO of Denver Health, said the health system’s insurance arm is waiting on clarification about when it should cover the vaccines. Denver Health Medical Plan offers multiple plan types, some state-regulated and some under federal rules, she said.

    “It’s less of a decision on our part than understanding what the health department and the insurance department are saying,” she said. “You can’t have one insurance company saying they are doing it and one saying they aren’t doing it.”

    Anthem said it considers immunizations “medically necessary” if the American Academy of Pediatrics, American Academy of Family Physicians or the CDC’s vaccine advisory committee has recommended them, but didn’t specify whether it would charge out-of-pocket costs for medically necessary vaccines.

    If those bodies stated that certain people could get a particular vaccine — but not that they should — Anthem would decide about coverage “on an individual basis,” its website said. The other groups have recommended the shots for people over 18 or under 2, with the option for healthy children in between to get a booster if their parents wish.

    The state’s Medicaid program is still waiting for guidance from federal authorities about whose vaccines it can cover, according to the Colorado Department of Health Care Policy and Financing, and Medicare isn’t yet paying for the shots.

    For most of the COVID-19 vaccines’ relatively brief existence, they were free and recommended for everyone 6 months and older. In 2024, the federal government stopped paying for them, which meant uninsured people no longer could be sure they could get the shot without paying.

    Almost all insurance plans still were required to pay for the shots, though, because the CDC’s Advisory Committee on Immunization Practices recommended them.

    In previous years, the committee recommended updated shots within days of the U.S. Food and Drug Administration approving them. In late August, the FDA approved the updated vaccines for people over 65 and those with one of about 30 conditions increasing their risk of severe disease, including asthma, obesity and diabetes.

    Doctors still could prescribe the vaccine “off-label” to healthy people, in the same way that they prescribe adult medications for children when an alternative specifically approved for kids isn’t available.

    This year, however, the committee won’t meet until Thursday, and may not recommend the shots when it does. Secretary of Health and Human Services Robert F. Kennedy Jr. dismissed all of the committee’s members earlier this year and replaced them with new appointees, most of whom oppose COVID-19 vaccines.

    Meg Wingerter

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  • Nearly half of people with diabetes don’t know they have it, new study finds

    (CNN) — When was the last time you had your blood sugar checked? It might be worth looking into, a new study says.

    Forty-four percent of people age 15 and older living with diabetes are undiagnosed, so they don’t know they have it, according to data analysis published Monday in the journal The Lancet Diabetes & Endocrinology.

    The study looked at data from 204 countries and territories from 2000 to 2023 in a systematic review of published literature and surveys. The findings at the global level are for people age 15 and older.

    “The majority of people with diabetes that we report on in the study have type 2 diabetes,” said Lauryn Stafford , the lead author of the study.

    Around 1 in 9 adults live with diabetes worldwide, according to the International Diabetes Foundation. In the United States, 11.6% of Americans have diabetes, according to 2021 data from the American Diabetes Association.

    “We found that 56% of people with diabetes are aware that they have the condition,” said Stafford, a researcher for the Institute for Health Metrics and Evaluation. “Globally, there’s a lot of variation geographically, and also by age. So, generally, higher-income countries were doing better at diagnosing people than low- and middle-income countries.”

    Younger people don’t know they have diabetes

    People under 35 years were much less likely to be diagnosed if they had diabetes than people in middle age or older. Just “20% of young adults with diabetes were aware of their condition,” Stafford said.

    Routine screenings aren’t promoted as much for young adults as for older adults. Many larger organizations, like the American Diabetes Association, suggest annual routine screenings for adults 35 and older.

    “You can survive with elevated glucose levels for many, many years,” Stafford said. “People end up getting diagnosed with diabetes only at the point where they have complications,” which are more common in older adults.

    Depending on how long a person has had diabetes before it’s discovered, the health impacts may vary.

    “Diagnosing diabetes early is important because it allows for timely management to prevent or delay long-term complications such as heart disease, kidney failure, nerve damage, and vision loss,” said Rita Kalyani, chief scientific and medical officer at the American Diabetes Association. She was not involved in the study.

    Around one-third of adults are diagnosed with diabetes later than their earliest symptom, according to a 2018 study.

    What symptoms should you look for?

    “Symptoms of diabetes include increased thirst or hunger, frequent urination, blurry vision, unexpected weight loss, and fatigue. However, in the early stages, most people with diabetes are asymptomatic, which highlights the importance of screening and diagnosis,” said Kalyani, a professor of medicine in the division of endocrinology, diabetes and metabolism at Johns Hopkins University.

    If you experience any of these symptoms or have a history of diabetes in your family, experts recommend you get a glucose screening.

    Globally, in 2023, about 40% of people with treated diabetes were getting optimal results and lowering their blood sugar, said Stafford. That’s why it’s important that future efforts focus on ensuring that more people receive and follow proper treatment post-diagnosis.

    That only 4 in 10 patients were seeing optimal results was surprising, as several well-established treatments, including insulin, Metformin and other drugs like GLP-1s, are available.

    People with diabetes likely also have other health issues, such as hypertension or chronic kidney disease, which can make treatment complex, Stafford added.

    Can you prevent diabetes?

    It depends.

    While there is no known way to prevent type 1 diabetes, there are many ways to prevent the more common form of type 2 diabetes.

    Reducing the amount of red and processed meats you eat can help lower your risk of type 2 diabetes, as previously reported by CNN. You could do this with a Mediterranean diet or by introducing more plant-based foods to your meals.

    In addition, limit the amount of ultraprocessed foods you eat, adding more whole foods, like fruits and nuts, instead.

    Incorporating physical activity into your regular routine can also decrease your risk of developing not only diabetes but also other chronic diseases. Fast walking for at least 15 minutes a day is just one form of exercise you can do.

    “I think, ultimately, if we can also focus more on the risk factors for developing diabetes — preventing people from needing to be diagnosed in the first place — that is also critical,” Stafford said.

    Gina Park and CNN

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  • CVS, Walgreens now require prescriptions for COVID vaccines in Colorado

    People who want to get an updated COVID-19 vaccine at CVS or Walgreens pharmacies in Colorado this fall will need to present a prescription.

    State law allows pharmacists to administer vaccines recommended by the Advisory Committee on Immunization Practices, a group that counsels the director of the Centers for Disease Control and Prevention about who will benefit from which shots.

    In previous years, the committee recommended updated COVID-19 vaccines within days of the U.S. Food and Drug Administration approving them. This year, the committee doesn’t have any meetings scheduled until late September, and may not recommend the shot when it does meet, since Secretary of Health and Human Services Robert F. Kennedy Jr. appointed multiple members with anti-vaccine views after removing all prior appointees in June.

    The lack of a recommendation also means that insurance companies aren’t legally required to pay for the COVID-19 vaccine without out-of-pocket costs. Most private insurers will cover the updated shots this year, though that could change in 2026, according to Reuters.

    Initially, CVS said it couldn’t give the COVID-19 vaccine to anyone in Colorado or 15 other states, because of their ACIP-approval requirement. As of Friday morning, its pharmacies can offer the shots to eligible people who have a prescription, spokeswoman Amy Thibault said.

    As of about 10 a.m. Friday, CVS’s website wouldn’t allow visitors to schedule COVID-19 shots in Colorado.

    Walgreens didn’t respond to questions about its COVID-19 vaccine policy, but its website said patients need a prescription in Colorado. A New York Times reporter found the same in 15 other states.

    The FDA this week recommended the updated shots only for people who are over 65 or have a health condition that puts them at risk for severe disease.

    The listed conditions include:

    • Asthma and other lung diseases
    • Cancer
    • History of stroke or disease in the brain’s blood vessels
    • Chronic kidney disease
    • Liver disease
    • Cystic fibrosis
    • Diabetes (all types)
    • Developmental disabilities, such as Down syndrome
    • Heart problems
    • Mental health conditions, including depression and schizophrenia
    • Dementia
    • Parkinson’s disease
    • Obesity
    • Physical inactivity
    • Current or recent pregnancy
    • Diseases or medications that impair the immune system
    • Smoking

    Meg Wingerter

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  • Why I Don’t Recommend Moringa Leaf Powder  | NutritionFacts.org

    “Clearly, in spite of the widely held ‘belief’ in the health benefits of M. oleifera [moringa], the interest of the international biomedical community in the medicinal potential of this plant has been rather tepid.” In fact, it has been “spectacularly hesitant in exploring its nutritional and medicinal potential. This lukewarm attitude is curious, as other ‘superfoods’ such as garlic and green tea have enjoyed better reception,” but those have more scientific support. There are thousands of human studies on garlic and more than ten thousand on green tea, but only a few hundred on moringa.

    The most promising appears to be moringa’s effects on blood sugar control. Below and at 0:55 in my video The Efficacy and Side Effects of Moringa Leaf Powder, you can see the blood sugar spikes after study participants ate about five control cookies each (top line labeled “a”), compared with cookies containing about two teaspoons of moringa leaf powder into the batter (bottom line labeled “b”). Even with the same amount of sugar and carbohydrates as the control cookies, the moringa-containing cookies resulted in a dampening of the surge in blood sugar.

    Researchers found that drinking just one or two cups of moringa leaf tea before a sugar challenge “suppressed the elevation in blood glucose [sugar] in all cases compared to controls that did not receive the tea initially” and instead drank plain water. As you can see here and at 1:16 in my video, drinking moringa tea with sugar dampened blood sugar spikes after 30 minutes of consumption of the same amount of sugar without moringa tea. It’s no wonder that moringa is used in traditional medicine practice for diabetes, but we don’t really know if it can help until we put it to the test. 
    People with diabetes were given about three-quarters of a teaspoon of moringa leaf powder every day for 12 weeks and had significant improvements in measures of inflammation and long-term blood sugar control. The researchers called it a “quasi-experimental study” because there was no control group. They just took measurements before and after the study participants took moringa powder, and we know that simply being in a dietary study can lead some to eat more healthfully, whether consciously or unconsciously, so we don’t know what effect the moringa itself had. However, even in a moringa study with a control group, it’s not clear if the participants were randomly allocated. The researchers didn’t even specify how much moringa people were given—just that they took “two tablets daily with one tablet each after breakfast and dinner,” but what does “one tablet” mean? There was no significant improvement in this study, but perhaps the participants weren’t given enough moringa. Another study used a tablespoon a day and not only saw a significant drop in fasting blood sugars, but a significant drop in LDL cholesterol as well, as seen below and at 2:27 in my video. 

    Two teaspoons of moringa a day didn’t seem to help, but what about a third, making it a whole tablespoon? Apparently not, since, finally, a randomized, placebo-controlled study using one tablespoon of moringa a day failed to show any benefit on blood sugar control in people with type 2 diabetes.

    So, we’re left with a couple of studies showing potential, but most failing to show benefit. Why not just give moringa a try to see for yourself? That’s a legitimate course of action in the face of conflicting data when we’re talking about safe, simple, side–effect–free solutions, but is moringa safe? Probably not during pregnancy, as “about 80% of women folk” in some areas of the world use it to abort pregnancies, and its effectiveness for that purpose has been confirmed (at least in rats), though breastfeeding women may get a boost of about half a cup in milk production based on six randomized, blinded, placebo-controlled clinical trials.

    Just because moringa has “long been used in traditional medicine” does not in any way prove that the plant is safe to consume. A lot of horribly toxic substances, like mercury and lead, have been used in traditional medical systems the world over, but at least “no major harmful effects of M. oleifera [moringa]…have been reported by the scientific community.” More accurately, “no adverse effects were reported in any of the human studies that have been conducted to date.” In other words, no harmful effects had been reported until now. 

    Stevens-Johnson syndrome (SJS) is probably the most dreaded drug side effect, “a rare but potentially fatal condition characterized by…epidermal detachment and mucous membrane erosions.” In other words, your skin may fall off. Fourteen hours after consuming moringa, a man broke out in a rash. The same thing had happened three months earlier, the last time he had eaten moringa, causing him to suffer “extensive mucocutaneous lesions with blister formation over face, mouth, chest, abdomen, and genitalia.” “This case report suggests that consumption of Moringa leaf is better avoided by individuals who are at risk of developing SJS.” Although it can happen to anyone, HIV is a risk factor.

    My take on moringa is that the evidence of benefit isn’t compelling enough to justify shopping online for something special when you can get healthy vegetables in your local market, like broccoli, which has yet to be implicated in any genital blistering. 

    Michael Greger M.D. FACLM

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  • Is Moringa the Most Nutritious Food?  | NutritionFacts.org

    Does the so-called miracle tree live up to the hype?

    Moringa (Moringa oleifera) is a plant commonly known as the “miracle” tree due to its purported healing powers across a spectrum of diseases. If “miracle” isn’t hyperbolic enough for you, “on the Internet,” it’s also known as “God’s Gift to Man.” Is moringa a miracle or just a mirage? “The enthusiasm for the health benefits of M. oleifera is in dire contrast with the scarcity of strong experimental and clinical evidence supporting them. Fortunately, the chasm is slowly being filled.” There has been a surge in scientific publications on moringa. In just the last ten years, the number of articles is closer to a thousand, as shown here and at 1:02 in my video The Benefits of Moringa: Is It the Most Nutritious Food?.

    What got my attention was the presence of glucosinolates, compounds that boost our liver’s detoxifying enzymes. I thought they were only found in cruciferous vegetables, such as cabbage, broccoli, kale, collards, and cauliflower. Still, it turns out they’re also present in the moringa family, with a potency comparable to broccoli. But rather than mail-ordering exotic moringa powder, why not just eat broccoli?Is there something special about moringa?

    “Moringa oleifera has been described as the most nutritious tree yet discovered,” but who eats trees? Moringa supposedly “contains higher amounts of elemental nutrients than most conventional vegetable sources,” such as featuring 10 times more vitamin A than carrots, 12 times more vitamin C than oranges, 17 times more calcium than milk, 15 times more potassium than bananas, 25 times more iron than spinach, and 9 times more protein than yogurt, as shown here and at 2:08 in my video. 
    Sounds impressive, but first of all, even if this were true, it is relevant for 100 grams of dry moringa leaf, which is about 14 tablespoons, almost a whole cup of leaf powder. Researchers have had trouble getting people to eat even 20 grams, so anything more would likely “result in excessively unpleasant taste, due to the bitterness of the leaves.”

    Secondly, the nutritional claims in these papers are “adapted from Fuglie,” which is evidently a lay publication. If you go to the nutrient database of the U.S. Department of Agriculture, and enter a more reasonable dose, such as the amount that might be in a smoothie, about a tablespoon, for instance, a serving of moringa powder has as much vitamin A as a quarter of one baby carrot and as much vitamin C as one one-hundredth of an orange. So, an orange has as much vitamin C as a hundred tablespoons of moringa. A serving of moringa powder has the calcium of half a cup of milk, the potassium of not fifteen bananas but a quarter of one banana, the iron of a quarter cup of spinach, and the protein of a third of a container of yogurt, as seen below and at 3:15 in my video. So, it may be nutritious, but not off the charts and certainly not what’s commonly touted. So, again, why not just eat broccoli?

    Moringa does seem to have anticancer activity—in a petri dish—against cell lines of breast cancer, lung cancer, skin cancer, and fibrosarcoma, while tending to leave normal cells relatively alone, but there haven’t been any clinical studies. What’s the point in finding out that “Moringa oleifera extract enhances sexual performance in stressed rats,” as one study was titled?

    Studies like “Effect of supplementation of drumstick (Moringa oleifera) and amaranth (Amaranthus tricolor) leaves powder on antioxidant profile and oxidative status among postmenopausal women” started to make things a little interesting. When researchers were testing the effects of a tablespoon of moringa leaf powder once a day for three months on antioxidant status, they saw a drop in oxidative stress, as one might expect from eating any healthy plant food. However, they also saw a drop in fasting blood sugars from prediabetic levels exceeding 100 to more normal levels. Now, that’s interesting. Should we start recommending a daily tablespoon of moringa powder to people with diabetes, or was it just a fluke? I’ll discuss the study “Moringa oleifera and glycemic [blood sugar] control: A review of the current evidence” next.

    Michael Greger M.D. FACLM

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  • Eating to Help Control Cancer Metastasis  | NutritionFacts.org

    Randomized controlled trials show that lowering saturated fat intake can lead to improved breast cancer survival.

    The leading cause of cancer-related death is metastasis. Cancer kills because cancer spreads. The five-year survival rate for women with localized breast cancer is nearly 99 percent, for example, but that falls to only 27 percent in women with metastasized cancer. Yet, “our ability to effectively treat metastatic disease has not changed significantly in the past few decades…” The desperation is evident when there are such papers as “Targeting Metastasis with Snake Toxins: Molecular Mechanisms.”

    We have built-in defenses, natural killer cells that roam the body, killing off budding tumors. But, as I’ve discussed, there’s a fat receptor called CD36 that appears to be essential for cancer cells to spread, and these cancer cells respond to dietary fat intake, but not all fat.

    CD36 is upregulated by palmitic acid, as much as a 50-fold increase within 12 hours of consumption, as shown below and at 1:13 in my video How to Help Control Cancer Metastasis with Diet.

    Palmitic acid is a saturated fat made from palm oil that can be found in junk food, but it is most concentrated in meat and dairy. This may explain why, when looking at breast cancer mortality and dietary fat, “there was no difference in risk of breast-cancer-specific death…for women in the highest versus the lowest category of total fat intake,” but there’s about a 50 percent greater likelihood of dying of breast cancer with higher intake of saturated fat. Researchers conclude: “These meta-analyses have shown that saturated fat intake negatively impacts breast cancer survival.”

    This may also explain why “intake of high-fat dairy, but not low-fat dairy, was related to a higher risk of mortality after breast cancer diagnosis.” If a protein in dairy, like casein, was the problem, skim milk might be even worse, but that wasn’t the case. It’s the saturated butterfat, perhaps because it triggered that cancer-spreading mechanism induced by CD36. Women who consumed one or more daily servings of high-fat dairy had about a 50 percent higher risk of dying from breast cancer.

    We see the same with dairy and its relationship to prostate cancer survival. Researchers found that “drinking high-fat milk increased the risk of dying from prostate cancer by as much as 600% in patients with localized prostate cancer. Low-fat milk was not associated with such an increase in risk.” So, it seems to be the animal fat, rather than the animal protein, and these findings are consistent with analyses from the Health Professionals Follow-up Study (HPFS) and the Physicians’ Health Study (PHS), conducted by Harvard researchers.

    There is even more evidence that the fat receptor CD36 is involved. The “risk of colorectal cancer for meat consumption” increased from a doubling to an octupling—that is, the odds of getting cancer multiplied eightfold for those who carry a specific type of CD36 gene. So, “Is It Time to Give Breast Cancer Patients a Prescription for a Low-Fat Diet?” A cancer diagnosis is often referred to as a ‘teachable moment’ when patients are motivated to make changes to their lifestyle, and so provision of evidence-based guidelines is essential.”

    In a randomized, prospective, multicenter clinical trial, researchers set out “to test the effect of a dietary intervention designed to reduce fat intake in women with resected, early-stage breast cancer,” meaning the women had had their breast cancer surgically removed. As shown below and at 4:02 in my video, the study participants in the dietary intervention group dropped their fat intake from about 30 percent of calories down to 20 percent, reduced their saturated fat intake by about 40 percent, and maintained it for five years. “After approximately 5 years of follow-up, women in the dietary intervention group had a 24% lower risk of relapse”—a 24-percent lower risk of the cancer coming back—“than those in the control group.” 

    That was the WINS study, the Women’s Intervention Nutrition Study. Then there was the Women’s Health Initiative study, where, again, women were randomized to lower their fat intake down to 20 percent of calories, and, again, “those randomized to a low-fat dietary pattern had increased breast cancer overall survival. Meaning: A dietary change may be able to influence breast cancer outcome.” What’s more, not only was their breast cancer survival significantly greater, but the women also experienced a reduction in heart disease and a reduction in diabetes.

    Michael Greger M.D. FACLM

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  • Should We Drink Kombucha  | NutritionFacts.org

    What are the risks versus benefits of drinking kombucha?

    Is Kombucha Tea Good for You? is one of my first videos. It was featured in a blog entry entitled “NutritionFacts.org: the first month,” where I marveled the video had reached nearly 100,000 people. You can see it below and at 0:20 in my video Kombucha’s Side Effects: Is It Bad for You?. I’m honored to say that we now reach more than 100,000 people a day.

    In that first kombucha video, I profiled a report published in the Journal of Intensive Care Medicine of “a case of kombucha tea toxicity” in which a young man ended up in an acidotic coma. The authors concluded, “While Kombucha tea is considered a healthy elixir, the limited evidence currently available raises considerable concern that it may pose serious health risks. Consumption of this tea should be discouraged, as it may be associated with life-threatening lactic acidosis.” And this was just one of several case reports of “serious, and sometimes fatal, hepatic [liver] dysfunction and lactic acidosis within close proximity of ingestion.”

    For example, there were two cases in Iowa of severe metabolic acidosis, including one death. There was also a triggering of a life-threatening autoimmune muscle disease that required emergency surgery and was “probably related to the consumption of a fermented Kombucha beverage.” Another patient presented with shortness of breath, shaking, and a movement disorder “after consumption of tea and no other medications,” and a middle-aged woman complained of xerostomia, dizziness, nausea, vomiting, headache, and neck pain,” and her symptoms recurred on reingestion of the tea. There was another case of severe metabolic lactic acidosis, as well as a case of hepatotoxicity (liver toxicity) that resolved after stopping kombucha.

    Why these sporadic cases? Maybe some unusual toxins developed in a particular batch. I mean, it is a fermented product, so it’s possible there was just some contamination by a bad bug, like the time people smeared kombucha on their skin because they were told it had “magical healing power.” What it had instead was anthrax. So, even though such reports were rare, I concluded ten years ago that we should probably stick to foods that haven’t put people in a coma. But what about its risks versus benefits? Maybe kombucha is worth it. After all, it’s “reputed to cure cancer,” “eliminate wrinkles,” “and even restore gray hair to its original color”—as “marketed by alternative and naturopathic healers throughout the United States.”

    “Currently, kombucha is alternately praised as ‘the ultimate health drink’ or damned as ‘unsafe medicinal tea.’” It’s been “claimed to be a universal wonderful drug…a potion which improves awareness and concentration, slimming, also purifying, regenerating and life extending.” Which is it? Is it “potion or poison?

    Back in the 1920s, 1930s, and 1940s, there were several medical studies conducted by recognized physicians confirming all sorts of beneficial effects, as you can see below and at 2:55 in my video. 

    I couldn’t wait to read them. Dufrense and Farnworth were cited, and when I went to that paper, I saw the same claim, citing Allen 1998. When I went to that source, I saw the citation is for a random kombucha website, as shown below, and at 3:10 in my video. And guess what? That website’s been defunct since 2001, and “much of the Kombucha information” posted came from comments on some mailing list.

    Finally, in 2003, a systematic review of the clinical evidence that had been published was conducted. “The main result of this systematic review, it seems, is the total lack of efficacy data…No clinical studies were found relating to the efficacy of this remedy.” We just have these cautionary tales, these case reports. So, based on these data, it was concluded that the largely undetermined benefits do not outweigh the documented risks of kombucha. It can therefore not be recommended for therapeutic use.” That was back in 2003, though. How about a 2019 systematic review of the empirical evidence of human health benefit?

    “The nonhuman subjects literature claims numerous health benefits of kombucha,” with “nonhuman” meaning mice and rats. We need human clinical trials, yet there is still not a single controlled human study. (I did find one uncontrolled study purporting to show a significant reduction in fasting and after-meal blood sugars among individuals with type 2 diabetes, though, as seen below and at 4:19 in my video.)

    “Nonetheless,” despite no controlled trials, “significant commercial shelf space is now dedicated to kombucha products, and there is widespread belief that the products promote health.” So, we are left with this extreme disparity between science and belief: “There is no convincingly positive clinical evidence at all; the [health] claims for it are as far-reaching as they are implausible; the potential for harm seems considerable. In such extreme cases, healthcare professionals should discourage consumers from using (and paying for) remedies that only seem to benefit those who sell them.”

    Doctor’s Note:

    Friday Favorites: What Are the Best Beverages? Watch the video to find out. 

    Michael Greger M.D. FACLM

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  • Eating with Hypothyroidism and Hyperthyroidism  | NutritionFacts.org

    Is the apparent protection of plant-based diets for thyroid health due to the exclusion of animal foods, the benefits of plant foods, or both?

    Several autoimmune diseases affect the thyroid gland, and Graves’ disease and Hashimoto’s thyroiditis are the most common. Graves’ disease results in hyperthyroidism, an overactive thyroid gland. Though slaughter plants are supposed to remove animals’ thyroid glands as they “shall not be used for human food,” should some neck meat slip in, you can suffer a similar syndrome called Hamburger thyrotoxicosis. That isn’t from your body making too much thyroid hormone, though. Rather, it’s from your body eating too much thyroid hormone. Graves’ disease is much more common, and meat-free diets may be able to help with both diseases, as plant-based diets may be associated with a low prevalence of autoimmune disease in general, as observed, for example, in rural sub-Saharan Africa. Maybe it’s because plants are packed with “high amounts of antioxidants, possible protective factors against autoimmune disease,” or because they’re packed with anti-inflammatory compounds. After all, “consuming whole, plant-based foods is synonymous with an anti-inflammatory diet.” But you don’t know until you put it to the test.

    It turns out that the “exclusion of all animal foods was associated with half the prevalence of hyperthyroidism compared with omnivorous diets. Lacto-ovo [dairy-and-egg] and pesco [fish] vegetarian diets were associated with intermediate protection.” But, for those eating strictly plant-based, there is a 52 percent lower odds of hyperthyroidism.

    As I discuss in my video The Best Diet for Hypothyroidism and Hyperthyroidism, this apparent protection “may be due to the exclusion of animal foods, the [beneficial] effects of plant foods, or both. Animal foods like meat, eggs, and dairy products may contain high oestrogen concentrations, which have been linked to autoimmunity in cell and animal studies.” Or it could be because the decrease in animal protein by excluding animal foods may downregulate IGF-1, which is not just a cancer-promoting growth hormone, but may play a role in autoimmune diseases. The protection could also come from the goodness in plants that may “protect cells against autoimmune processes,” like the polyphenol phytochemicals, such as flavonoids found in plant foods. Maybe it’s because environmental toxins build up in the food chain. For example, fish contaminated with industrial pollutants, like PCBs, are associated with an increased frequency of thyroid disorders.

    But what about the other autoimmune thyroid disease, Hashimoto’s thyroiditis, which, assuming you’re getting enough iodine, is the primary cause of hypothyroidism, an underactive thyroid gland? Graves’ disease wasn’t the only autoimmune disorder that was rare or virtually unknown among those living in rural sub-Saharan Africa, eating near-vegan diets. They also appeared to have less Hashimoto’s.

    There is evidence that those with Hashimoto’s have compromised antioxidant status, but we don’t know if it’s cause or effect. But if you look at the dietary factors associated with blood levels of autoimmune anti-thyroid antibodies, animal fats seem to be associated with higher levels, whereas vegetables and other plant foods are associated with lower levels. So, again, anti-inflammatory diets may be useful. It’s no surprise, as Hashimoto’s is an inflammatory disease—that’s what thyroiditis means: inflammation of the thyroid gland.

    Another possibility is the reduction in intake of methionine, an amino acid concentrated in animal protein, thought to be one reason why “regular consumption of whole-food vegan diets is likely to have a favourable influence on longevity through decreasing the risk of cancer, coronary [heart] disease, and diabetes.” Methionine restriction improves thyroid function in mice, but it has yet to be put to the test for Hashimoto’s in humans.

    If you compare the poop of patients with Hashimoto’s to controls, the condition appears to be related to a clear reduction in the concentration of Prevotella species. Prevotella are good fiber-eating bugs known to enhance anti-inflammatory activities. Decreased Prevotella levels are also something you see in other autoimmune conditions, such as multiple sclerosis and type 1 diabetes. How do you get more Prevotella? Eat more plants. If a vegetarian goes on a diet of meat, eggs, and dairy, within as few as four days, their levels can drop. So, one would expect those eating plant-based diets to have less Hashimoto’s, but in a previous video, I expressed concern about insufficient iodine intake, which could also lead to hypothyroidism. So, which is it? Let’s find out.

    “In conclusion, a vegan diet tended to be associated with lower, not higher, risk of hypothyroid disease.” Why “tended”? The associated protection against hypothyroidism incidence and prevalence studies did not reach statistical significance. It wasn’t just because they were slimmer either. The lower risk existed even after controlling for body weight. So, researchers think it might be because animal products may induce inflammation. The question I have is: If someone who already has Hashimoto’s, what happens if they change their diet? That’s exactly what I’ll explore next.

    This is the third in a four-video series on thyroid function. The first two were Are Vegans at Risk for Iodine Deficiency? and Friday Favorites: The Healthiest Natural Source of Iodine.

    Stay tuned for the final video: Diet for Hypothyroidism: A Natural Treatment for Hashimoto’s Disease. 

    Michael Greger M.D. FACLM

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  • Unbelievable facts

    Unbelievable facts

    In the 5th century BCE, Sushruta, a renowned Indian surgeon, first identified diabetes by observing…

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  • Apple reportedly tested a blood glucose monitoring app

    Apple reportedly tested a blood glucose monitoring app

    Apple is reportedly still working on glucose management — this time through software. Bloomberg’s Mark Gurman says the company tested an app this year for pre-diabetic people, helping them manage their diet and lifestyle. Apple is said not to have plans to launch the app to consumers, but it could play a part in future health products.

    The company reportedly tested the app internally, with employees confirmed through a blood test to be at risk of developing Type 2 diabetes. The subjects “actively monitored their blood sugar via various devices available on the market,” logging corresponding glucose changes. The app would then note correlations between dietary changes and blood sugar levels (for example, “don’t eat the pasta”).

    Gurman says Apple paused the test to focus on other health features. Bloomberg notes that the Apple Health app currently lacks meal tracking, something rival services offer. The publication also says Apple could eventually offer deeper third-party glucose tracking integration into its products.

    The study reportedly wasn’t directly related to Apple’s 15-year quest to offer non-invasive blood glucose monitoring, something that’s seemingly regurgitated in Apple Watch rumors every cycle. The company’s current hardware prototype is reportedly an iPhone-sized wearable device that uses lasers to shoot light into the skin. Gurman claims Apple’s first consumer-facing version — whether in the Apple Watch or some other form — will likely only notify users if they may be pre-diabetic. Providing specific glucose levels would have to come in later iterations.

    Will Shanklin

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  • Treat Type 1 Diabetes with a Plant-Based Diet?  | NutritionFacts.org

    Treat Type 1 Diabetes with a Plant-Based Diet?  | NutritionFacts.org

    Is it possible to reverse type 1 diabetes if caught early enough?

    The International Journal of Disease Reversal and Prevention has already had its share of miraculous disease reversals with a plant-based diet. For instance, one patient began following a whole food, plant-based diet after having two heart attacks in two months. Within months, he experienced no more chest pain, controlled his cholesterol, blood pressure, and blood sugars, and also lost 50 pounds as a nice bonus. Yet, the numbers “do not capture the patient’s transformation from feeling like a ‘dead man walking’ to being in command of his health with a new future and life.” 

    I’ve previously discussed cases of reversing the autoimmune inflammatory disease psoriasis and also talked about lupus nephritis (kidney inflammation). What about type 1 diabetes, an autoimmune disease we didn’t think we could do anything about? In contrast to type 2 diabetes, which is a lifestyle disease that can be prevented and reversed with a healthy enough diet and lifestyle, type 1 diabetes is an autoimmune disease in which our body attacks our pancreas, killing off our insulin-producing cells and condemning us to a life of insulin injections—unless, perhaps, it’s caught early enough. If a healthy enough diet is started early enough, might we be able to reverse the course of type 1 diabetes by blunting that autoimmune inflammation?

    As I discuss in my video Type 1 Diabetes Treatment: A Plant-Based Diet, we know that patients with type 1 diabetes “may be able to reduce insulin requirements and achieve better glycemic [blood sugar] control” with healthier diets. For example, children and teens were randomized to a nutritional intervention in which they increased the whole plant food density of their diet—meaning they ate more whole grains, whole fruits, vegetables, legumes (beans, split peas, chickpeas, and lentils), nuts, and seeds. Researchers found that the more whole plant foods, the better the blood sugar control.

    The fact that more whole fruits were associated “with better glycemic [blood sugar] control has important clinical implications for nutrition education” in those with type 1 diabetes. We should be “educating them on the benefits of fruit intake, and allaying erroneous concerns that fruit may adversely affect blood sugar.”

    The case series in the IJDRP, however, went beyond proposing better control of just their high blood sugars, the symptom of diabetes, but better control of the disease itself, suggesting the anti-inflammatory effects of whole healthy plant foods “may slow or prevent further destruction of the beta cells”—the insulin-producing cells of the pancreas—“if dietary intervention is initiated early enough.” Where did this concept come from?

    A young patient. Immediately following diagnosis of type 1 diabetes at age three, a patient began a vegetable-rich diet and, three years later, “has not yet required insulin therapy…and has experienced a steady decline in autoantibody levels,” which are markers of insulin cell destruction. Another child, who also started eating a healthier diet, but not until several months after diagnosis, maintains a low dose of insulin with good control. And, even if their insulin-producing cells have been utterly destroyed, individuals with type 1 diabetes can still enjoy “dramatically reduced insulin requirements,” reduced inflammation, and reduced cardiovascular risk, which is their number one cause of death over the age of 30. People with type 1 diabetes have 11 to 14 times the risk of death from cardiovascular disease compared to the general population, and it’s already the top killer among the public, so it’s closer to 11 to 14 times more important for those with type 1 diabetes to be on the only diet and lifestyle program ever proven to reverse heart disease in the majority of patients—one centered around whole plant foods. The fact it may also help control the disease itself is just sugar-free icing on the cake.

    All this exciting new research was presented in the first issue of The International Journal of Disease Reversal and Prevention. As a bonus, there’s a companion publication called the Disease Reversal and Prevention Digest. These are for the lay public and are developed with the belief I wholeheartedly share that “everyone has a right to understand the science that could impact their health.” You can go behind the scenes and hear directly from the author of the lupus series, read interviews from luminaries like Dean Ornish, see practical tips from dietitians on making the transition towards a healthier diet, and enjoy recipes. 

    The second issue includes more practical tips, such as how to eat plant-based on a budget, and gives updates on what Dr. Klaper is doing to educate medical students, what Audrey Sanchez from Balanced is doing to help change school lunches, and how Dr. Ostfeld got healthy foods served in a hospital. (What a concept!) And what magazine would be complete without an article to improve your sex life? 

    The journal is free, downloadable at IJDRP.org, and its companion digest, available at diseasereversaldigest.com, carries a subscription fee. I am a proud subscriber.

    Want to learn more about preventing type 1 diabetes in the first place? See the related posts below.

    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

    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.

    Michael Greger M.D. FACLM

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  • Is Marijuana A Diabetic’s Answer To Alcohol

    Is Marijuana A Diabetic’s Answer To Alcohol

    Alcohol and mixers are always a bit a wild card if you are a diabetic, maybe cannabis can help.

    Being a diabetic can be tough and you always must be aware of your blood sugar.  Today, there are programs which monitor the levels and gives alerts if things are too bad. Cocktails and some other alcohol and can be full of sugar, which can play havoc with a body. Additionally, alcohol consumption can worsen diabetes-related medical complications, such as disturbances in fat metabolism, nerve damage, and eye disease. But cannabis, well, that is a different story – and it seems the knowledge it catching on. So is marijuana a diabetes answer to alcohol?

    RELATED: Science Says Medical Marijuana Improves Quality Of Life

    Marijuana use is becoming more common for diabetics. A recent  study estimated that 9% adults with diabetes used cannabis in the last month, a 33.7% increase with nearly half (48.9%) of users were younger than 50 years. Cannabis use is also increasing among Boomer (65 and older), many of whom have diabetes and other chronic conditions.

    Photo by Lepro/Getty Images

    Alcohol consumption is taking a hit as more people consume marijuana. Gen Z is drifting from alcohol and consuming more. California sober has become a trend. The AARP has said cannabis has medical benefits, but what about using it as a full or partial replacement of alcohol? Cannabis is

    For diabetic, drinking alcohol can cause low or high blood sugar, affect diabetes medicines, and cause other possible problems. The liver releases glucose into your blood stream as needed to help keep blood sugar at normal levels. The liver releases glucose into the blood stream help keep blood sugar at normal levels. When drinking alcohol, the liver needs to break down the alcohol. While the liver is processing alcohol, it stops releasing glucose. As a result, blood sugar levels can drop quickly, making a risks for low blood sugar (hypoglycemia).

    RELATED: Biden Administration Puts A Knife Into The Cannabis Industry

    While over indulging is never good, moderate vaping can avoid the sugar and carb intake received from alcohol and especially cocktails. Microdosing has also become popular.

    Two important notes, there needs to be more research on dosage and use. Also, cannabis could use could increase the risk for diabetic ketoacidosis for people with type 1 diabetes. Research showed it was primarily due to worse management of diabetes, including increased intake of high-carb foods and forgetting to take medications.

    Amy Hansen

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  • Can Fasting Be Healing?  | NutritionFacts.org

    Can Fasting Be Healing?  | NutritionFacts.org

    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.

    Michael Greger M.D. FACLM

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  • What’s the Best Weight-Loss and Disease-Prevention Diet?  | NutritionFacts.org

    What’s the Best Weight-Loss and Disease-Prevention Diet?  | NutritionFacts.org

    The most effective diet for weight loss may also be the most healthful.

    Why are vegetarian diets so effective in preventing and treating diabetes? Maybe it is because of the weight loss. As I discuss in my video The Best Diet for Weight Loss and Disease Prevention, those eating more plant-based tend to be significantly slimmer. That isn’t based on looking at a cross-section of the population either. You can perform an interventional trial and put it to the test in a randomized, controlled community-based trial of a whole food, plant-based diet.

    “The key difference between this trial [of plant-based nutrition] and other approaches to weight loss was that participants were informed to eat the WFPB [whole food, plant-based] diet ad libitum and to focus efforts on diet, rather than increasing exercise.” Ad libitum means they could eat as much as they want; there was no calorie counting or portion control. They just ate. It was about improving the quality of the food rather than restricting the quantity of food. In the study, the researchers had participants focus just on a diet rather than exercising more exercise because they wanted to isolate the effects of eating more healthfully.

    So, what happened? At the start of the study, the participants were, on average, obese at nearly 210 pounds (95 kg) with an average height of about 5’5” (165 cm). Three months into the trial, they were down about 18 pounds (8 kg)—without portion restrictions and eating all the healthy foods they wanted. At six months in, they were closer to 26 pounds (12 kg) lighter. You know how these weight-loss trials usually go, though. However, this wasn’t an institutional study where the participants were locked up and fed. In this trial, no meals were provided. The researchers just informed them about the benefits of plant-based eating and encouraged them to eat that way on their own, with their own families, and in their own homes, in their own communities. What you typically see in these “free-living” studies is weight loss at six months, with the weight creeping back or even getting worse by the end of a year. But, in this study, the participants were able to maintain that weight loss all year, as you can see below and at 1:57 in my video.

    What’s more, their cholesterol got better, too, but the claim to fame is that they “achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy [caloric] intake or mandate regular exercise.” That’s worth repeating. A whole food, plant-based diet achieved the greatest weight loss ever recorded at 6 and 12 months compared to any other such intervention published in the medical literature. Now, obviously, with very low-calorie starvation diets, you can drop down to any weight. “However, medically supervised liquid ‘meal replacements’ are not intended for ongoing use”—obviously, they’re just short-term fixes—“and are associated with ‘high costs, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years.’” In contrast, the whole point of whole food, plant-based nutrition is to maximize long-term health and longevity.

    What about low-carb diets? “Studies on the effects of low-carbohydrate diets have shown higher rates of all-cause mortality”—meaning a shorter lifespan—“decreased peripheral flow-mediated dilation [artery function], worsening of coronary artery disease, and increased rates of constipation, headache, halitosis [bad breath], muscle cramps, general weakness, and rash.”

    The point of weight loss is not to fit into a smaller casket. A whole food, plant-based diet is more effective than low-carb diets for weight loss and has the bonus of having all good side effects, such as decreasing the risk of diabetes beyond just weight loss.

    “The lower risk of type 2 diabetes among vegetarians may be explained in part by improved weight status (i.e., lower BMI). However, the lower risk also may be explained by higher amounts of ingested dietary fiber and plant protein, the absence of meat- and egg-derived protein and heme iron, and a lower intake of saturated fat. Most studies report the lowest risk of type 2 diabetes among individuals who adhere to vegan diets. This may be explained by the fact that vegans, in contrast to ovo- and lacto-ovo-vegetarians, do not ingest eggs. Two separate meta-analyses linked egg consumption with a higher risk of type 2 diabetes.”

    Maybe it’s eating lower on the food chain, thereby avoiding the highest levels of persistent organic pollutants, like dioxins, PCBs, and DDT in animal products. Those have been implicated as a diabetes risk factor. Or maybe it has to do with the gut microbiome. With all that fiber in a plant-based diet, it’s no surprise there would be fewer disease-causing bugs and more protective gut flora, which can lead to less inflammation throughout the body that “may be the key feature linking the vegan gut microbiota with protective health effects”—including the metabolic dysfunction you can see in type 2 diabetes.

    The multiplicity of benefits from eating plant-based can help with compliance and family buy-in. “Whereas a household that includes people who do not have diabetes may be unlikely to enthusiastically follow a ‘diabetic diet,’ a low-fat plant-based approach is not disease-specific and has been shown to improve other chronic conditions. While the patient [with diabetes] will likely see improvement in A1C [blood sugar control], a spouse suffering from constipation or high blood pressure may also see improvements, as may children with weight issues,” if you make healthy eating a family affair.

    This is just a taste of my New York Times best-selling book, How Not to Diet. (As with all of my books, all proceeds I received went to charity.) Watch the book trailer. You may also be interested in its companion, The How Not to Diet Cookbook.

    Check out my hour-long Evidence-Based Weight Loss lecture for more. 

    Michael Greger M.D. FACLM

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  • Is Creatine Safe and Efficient for High Homocysteine?  | NutritionFacts.org

    Is Creatine Safe and Efficient for High Homocysteine?  | NutritionFacts.org

    Those on a healthy plant-based diet who have elevated homocysteine levels despite taking sufficient vitamin B12 may want to consider taking a gram a day of contaminant-free creatine.

    The average blood levels of homocysteine in men are about 1.5 points higher than in women, which may be one of the reasons men tend to be at higher risk for cardiovascular disease. Women don’t need to make as much creatine as men since they tend to have less muscle mass. That may help explain “the ‘gender gap’ in homocysteine levels.” If you remember from my previous video and as seen below and at 0:36 in The Efficacy and Safety of Creatine for High Homocysteine, in the process of making creatine, our body produces homocysteine as a by-product. So, for people with stubbornly high homocysteine levels that don’t respond sufficiently to B vitamins, “creatine supplementation may represent a practical strategy for decreasing plasma homocysteine levels”—that is, lowering the level of homocysteine into the normal range. 

    It seemed to work in rats. What about humans? Well, it worked in one study, but it didn’t seem to work in another. It didn’t work in yet another either. And, in another study, homocysteine levels were even driven up. So, this suggestion that taking creatine supplements would lower homocysteine was called into question. 

    However, all those studies were done with non-vegetarians, so they were already effectively supplementing with creatine every day in the form of muscle meat. In that way, researchers were testing higher versus lower supplementation. Those eating strictly plant-based make all their creatine from scratch, so they may be more sensitive to an added creatine source. There weren’t any studies on creatine supplementation in vegans to lower homocysteine until now. 

    Researchers took vegans who were not supplementing their diets with vitamin B12, so some of their homocysteine levels were through the roof. A few were as high as 50 when the ideal is more like under 10, for example. After taking some creatine for a few weeks, all of their homocysteine levels normalized. You can see the before and after in the graph below and at 2:04 in my video. 

    Now, they didn’t normalize, as that would have been a level under 10, but that’s presumably because they weren’t taking any B12. Give vegetarians and vegans vitamin B12 supplements, either dosing daily or once a week, and their levels normalize in a matter of months, as you can see below and at 2:20 in my video. However, the fact that you could bring down homocysteine levels with creatine alone, even without any B12, suggests—to me at least—that if your homocysteine is elevated (above 10) on a plant-based diet despite taking B12 supplements and eating greens and beans to get enough folate, it might be worth experimenting with supplementing with a gram of creatine a day for a few weeks to see if your homocysteine comes down. 

    Why just a single gram? That’s approximately how much non-vegetarians do not have to make themselves; it’s the amount that erased vegetarian discrepancies in blood and muscle, as you can see in the graph below and at 3:01 in my video, and how much has been shown to be safe in the longer term. 

    How safe is it? We can take a bit of comfort in the fact that it’s “one of the world’s best-selling dietary supplements,” with literally billions of servings taken, and the only consistently reported side effect has been weight gain, presumed to be from water retention. The only serious side effects appear to be among those with pre-existing kidney diseases taking whopping doses closer to 20 grams a day. A concern was raised that creatine could potentially form a carcinogen known as N-nitrososarcosine when it hit the acid bath of the stomach, but, when it actually put to the test, researchers found this does not appear to be a problem. 

    Bottom line: Doses of supplemental creatine up to 3 grams a day are “unlikely to pose any risk,” provided “high purity creatine” is used. However, as we all know, dietary supplements in the United States “are not regulated by the US Food and Drug Administration and may contain contaminants or variable quantities of the desired supplement” and may not even contain what’s on the label. We’re talking about “contaminants…that may be generated during the industrial production.” When researchers looked at 33 samples of creatine supplements made in the United States and Europe, they found that they all actually contained creatine, which is nice, but about half exceeded the maximum level recommended by food safety authorities for at least one contaminant. The researchers recommend that “consumers give their preference to products obtained by producers that ensure the highest quality control and certify the maximum amount of contaminants present in their products.” Easier said than done.

    Because of the potential risks, I don’t think people should take creatine supplements willy-nilly, but the potential benefits may exceed the potential risks if, again, you’re on a healthy plant-based diet and taking B12, and your homocysteine levels are still not under 10. In that case, I would suggest giving a gram a day of creatine a trying to see if it brings it down.

    The reason I did this whole video series goes back to “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,” which found that, although the overall cardiovascular risk is lower in vegetarians and vegans combined, they appeared to be at slightly higher stroke risk, as you can see in the graph below and at 5:06 in my video. 

    I went through a list of potential causes, as you can see at 5:11 and below, and arrived at elevated homocysteine. What’s the solution? A regular, reliable source of vitamin B12. The cheapest, easiest method that I personally use is one 2,500 mcg chewable tablet of cyanocobalamin, the most stable source of B12, once a week. (In fact, you can just use 2,000 mcg once a week.) And, again, a backup plan for those doing that but still having elevated homocysteine is an empirical trial of a single gram a day of creatine supplementation, which was shown to improve at least capillary blood flow in those who started out with high homocysteine levels. 

    In sum, plant-based diets appear to “markedly reduce risk” for multiple leading killer diseases—heart disease, type 2 diabetes, and many common types of cancer—but “an increased risk for stroke may represent an ‘Achilles heel.’ Nonetheless, vegans have the potential to achieve a truly exceptional ‘healthspan’ if they face this problem forthrightly by restricting salt intake and taking other practical measures that promote cerebrovascular [brain artery] health…Nonetheless, these considerations do not justify nutritional nihilism. On balance, low-fat vegan diets offer such versatile protection for long-term health that they remain highly recommendable. Most likely, the optimal strategy is to adopt such a [plant-based] diet, along with additional measures—appropriate food choices, exercising training, judicious supplementation [of vitamin B12]—that will mitigate the associated stroke risk.” And try not to huff whipped cream charging canister gas. Leave the “whippets” alone.

    This concludes my series on stroke risk. If you missed any of the other videos, see the related posts below.

    I’m assuming that nearly everyone taking their B12 will have normal homocysteine levels, so these last two videos are just for the rare person who doesn’t. However, those on a healthy plant-based diet with elevated homocysteine levels despite taking sufficient vitamin B12 should consider taking a gram a day of contaminant-free creatine, which should be about a quarter teaspoon.

    Where do you get contaminant-free creatine? Since regulations are so lax, you can’t rely on supplement manufacturers no matter what they say, so I would recommend going directly to the chemical suppliers that sell it to laboratories and guarantee a certain purity. Here are some examples (in alphabetical order) of some of the largest companies where you can get unadulterated creatine: Alfa Aesar, Fisher Scientific, Sigma-Aldrich, and TCI America.

    Michael Greger M.D. FACLM

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Michael Greger M.D. FACLM

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  • Public Health Experts Want the Olympics to Drop Its Oldest Sponsor

    Public Health Experts Want the Olympics to Drop Its Oldest Sponsor

    Since then, every Summer and Winter Olympics has adopted a strict smoke-free policy and, since 2010, a complete tobacco-free policy. Smoking is not permitted at any Paris 2024 venues except in designated areas—a rule that extends to vaping.

    Alcoholic beverage companies are another category of controversial Olympic sponsors, from Molson Brewery at the 1976 Montreal Olympics to Heineken at the 2004 Athens games.

    Though the IOC is partnered with AB InBev, the world’s leading brewer, Corona Cero—a zero-alcohol drink—is the global beer sponsor of the Paris Olympics. The Olympic Committee says this highlights both organizations’ “commitment to responsible consumption and a better world.”

    Efforts like the Kick Big Soda Out of Sport campaign aren’t coming out of nowhere. In the 2012 London Olympics, Coca-Cola’s sponsorship, which featured various promotional activities focused on youth engagement, faced significant backlash. And in 2021, the company’s sponsorship changed; Coca-Cola now has a joint “Olympic Partner,” or TOP, agreement with Mengniu, a Chinese dairy-product company, that makes them the exclusive nonalcoholic beverage sponsors of the Games. (The TOP programme is the Olympics’ highest level of sponsorship.)

    “Coca-Cola gets positively connected with a dairy food company and the ‘health halo’ that comes with that,” says Joe Piggin, senior lecturer in sport Policy at Loughborough University. Therefore, though a joint sponsorship may seem to lessen the significance of Coca-Cola’s funding, strategically this move actually leverages the company’s sponsorship and future longevity.

    From 2021 to 2032 (when their contract is up), the joint sponsors will pay an estimated total of $3 billion to the IOC. Coca-Cola’s 14-person athlete roster was revealed in the lead-up to the 2024 games. The face of this campaign is this image, in which the athletes hold bottles of Coca-Cola’s drinks. Certain athletes hold full-sugar Coca-Cola itself, which has 53 grams of sugar per 500 milliliter—almost double the recommended daily sugar intake for an adult.

    Many of the athletes hold Powerade Original, another of Coca-Cola’s drinks, which contains 5.8 grams of sugar per 600-milliliter bottle, almost 20 percent of the recommended daily intake. (Powerade is also the official drink of the US Olympic team.)

    Experts have said that this marketing strategy mirrors Olympians of the past hawking cigarettes. A recent project by the Centre for the Study of Tobacco and Society investigated this, noting that Harold “Dutch” Smith, a high-diving champion, was quoted in a 1935 Saturday Evening Post ad saying, “Camels don’t get your wind.”

    “If a cigarette company tried to run a commercial on network TV during the Olympics, there would be such an outcry. It [should be] no different for Coca-Cola,” says Lustig. (“The Coca-Cola Company provides a wide range of beverage options that include dairy and juice drinks as well as water, tea, coffee, and sparkling beverages, with many sugar-free options available,” an IOC spokesperson tells WIRED.)

    “We urge sports organizations to stop promoting unhealthy food and drink and work with health experts to create a healthier food environment,” said Zoe Davies, a nutritionist from Action on Sugar, in a statement issued to WIRED.

    Coca-Cola did not respond to WIRED’s request for comment. ”The company has used its front groups to advance the argument that the lack of physical exercise and not its sugary drinks are fueling an obesity crisis,” says researcher Ashka Naik from Corporate Responsibility. However, Coca-Cola has been criticized for its manipulation of science to justify this shifting of blame.

    Experts that WIRED spoke with consistently held that Coca-Cola should be the next Olympic sponsor to go; however, they don’t expect this to happen anytime soon.

    Many experts suggested that a shift shouldn’t be left to the organizations themselves. In order to stop sports organizations from “taking money from ultra-processed food companies,” there must be “public policy measures,” says Lustig. “When there are more votes than dollars, that’s when things will change.”

    Isabel Fraser

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  • Kim ‘training daughter to take over’ as 22-stone tyrant’s health deteriorates

    Kim ‘training daughter to take over’ as 22-stone tyrant’s health deteriorates

    NORTH Korean tyrant Kim Jong-un is grooming his young daughter for the top job after getting morbidly fat again, South Korean spies say.

    It’s believed Kim, 40, is suffering from high-blood pressure and diabetes, weighing a whopping 140kg – or 22st – despite standing at 170cm.

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    Kim has been rolling out his daughter as his health declines, say South Korea spies
    Kim's obesity could contribute to fatal heart problems so he's getting his daughter ready, it's believed

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    Kim’s obesity could contribute to fatal heart problems so he’s getting his daughter ready, it’s believed
    The chubby tyrant is known for his smoking

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    The chubby tyrant is known for his smoking

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    Now he is said to be training his daughter up to take the reins as Supreme Leader – even though she is said to be just 11 years old.

    Kim, a boozy operator also known for his smoking, comes from a bloodline beleaguered by heart issues.

    He took over from his father Kim Jong-il in 2011 when he died from a huge heart attack.

    Prior to that, Kim Il-sung suffered a sudden heart attack in 1994.

    Current-day Kim appeared to have lost a heap of weight around 2021, but South Korea’s chief spy agency believes he’s put it all back on.

    The National Intelligence Service (NIS) revealed to South Korean politicians that he is sending the scales off the charts at 140kg and therefore is at high risk of heart disease.

    The NIS says Kim’s daughter, Kim Ju-ae, could be next in line for the thrown.

    The secretive North Korea hasn’t divulged her official age but the NIS believes she is about 11.

    Although she is yet to be officially designated his successor, she has set tongues wagging since late 2022, attending numerous events alongside her infamous father.

    According to local reports, NIS secretary Park Sun-won said: “Kim Ju-ae is hinted at as a strong successor and is undergoing successor training.”

    Watch as North Korea flies MORE rubbish-filled balloons but the South replies by blasting K-pop songs from loudspeakers

    He added: “How North Korea refers to Kim Ju-ae and what activities she appears in are very significant.

    Intelligence Committee secretary Lee Seong-won said: “Kim Jong-un is extremely obese, weighing 140kg and in his 40s with a body mass index that greatly exceeds the normal level … putting him at high risk for heart disease.”

    “We have determined that he has been showing symptoms of high blood pressure and diabetes since his early 30s.

    “If he does not improve his current health, there is a possibility that he may develop cardiovascular disease, which is a family history, so we are closely monitoring him.”

    Others speculated his heavy drinking and smoking were behind the weight gain.

    Kim decided to keep his 40th birthday celebrations low-key amid rumours of his health battle in January.

    But the Supreme Leader has recently been snapped by state media out in public as North Korea deals with a flood crisis.

    Record-breaking rain lashed the country, leaving thousands stranded and prompting Kim to declare an emergency.

    Pictures showed the leader travelling through flooding in a car, with his puffy face peering out the window inspecting damage.

    Kim kept 40th birthday celebrations under wraps

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    Kim kept 40th birthday celebrations under wrapsCredit: Getty Images
    It's thought that North Korea are testing public reaction to Kim's daughter

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    It’s thought that North Korea are testing public reaction to Kim’s daughter
    She is believed to be just 11 - but if Kim Jong-un keeps getting fatter she'll have to be ready, South Koreans say

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    She is believed to be just 11 – but if Kim Jong-un keeps getting fatter she’ll have to be ready, South Koreans say

    Owen Leonard

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  • More Americans With Diabetes Are Turning to Marijuana – Cannabis Business Executive – Cannabis and Marijuana industry news

    More Americans With Diabetes Are Turning to Marijuana – Cannabis Business Executive – Cannabis and Marijuana industry news





    More Americans With Diabetes Are Turning to Marijuana – Cannabis Business Executive – Cannabis and Marijuana industry news





























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