Things have changed. Gluten-rich Wheatlet, a breakfast cereal, was preferable to oatmeal, said its advertisement in this day’s Daily News in 1895. Oatmeal was starchy, and many people could not eat it. Anyone could eat Wheatlet.
— Museum of Old Newbury
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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Just because you’re eating a vegetarian or vegan diet doesn’t mean you’re eating healthfully.
“Plant-Based Diets Are Associated with a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults”: This study of a diverse sample of 12,000 Americans found that “progressively increasing the intake of plant foods by reducing the intake of animal foods is associated with benefits on cardiovascular health and mortality.” Still, regarding plant-based diets for cardiovascular disease prevention, “all plant foods are not created equal.” As you can see in the graph below and at 0:40 in my video Vegetarians and Stroke Risk Factors: Vegan Junk Food?, a British study found higher stroke risk in vegetarians. Were they just eating a lot of vegan junk food?
“Any diet devoid of animal food sources can be claimed to be a vegetarian [or vegan] diet; thus, it is important to determine” what is being eaten. One of the first things I look at when I’m trying to see how serious a population is about healthy eating is something that is undeniably, uncontroversially bad: soda, aka liquid candy. Anyone drinking straight sugar water doesn’t have health on top of mind.
A large study was conducted of plant-based eaters in the United States, where people tend to cut down on meat for health reasons far more than for ethics, as you can see in the graph below and at 1:20 in my video.
Researchers found that flexitarians drink fewer sugary beverages than regular meat eaters, as do pescatarians, vegetarians, and vegans, as you can see below and at 1:30.
However, in the study from the United Kingdom where the increased stroke risk in vegetarians was found and where people are more likely to go veg or vegan for ethical reasons, researchers found that pescatarians drink less soda, but the vegetarians and vegans drink more, as shown in the graph below and at 1:44.
I’m not saying that’s why they had more strokes; it might just give us an idea of how healthfully they were eating. In the UK study, the vegetarian and vegan men and women ate about the same amounts of desserts, cookies, and chocolate, as you can see in the graph below and at 1:53.
They also consumed about the same total sugar, as shown below and at 2:02.
In the U.S. study, the average non-vegetarian is nearly obese, the vegetarians are a little overweight, and the vegans were the only ideal weight group. In this analysis of the UK study, however, everyone was about the same weight. The meat eaters were lighter than the vegans, as you can see below, and at 2:19 in my video. The EPIC-Oxford study seems to have attracted a particularly “health-conscious” group of meat eaters weighing substantially less than the general population.
Let’s look at some specific stroke-related nutrients. Dietary fiber appears to be beneficial for the prevention of cardiovascular disease, including stroke, and it seems the more, the better, as you can see in the graph below and at 2:43 in my video.
Based on studies of nearly half a million men and women, there doesn’t seem to be any upper threshold of benefit—so, again, “the more, the better.” At more than 25 grams of soluble fiber and 47 grams of insoluble dietary fiber, you can start seeing a significant drop in associated stroke risk. So, one could consider these values “as the minimal recommendable daily intake of soluble and insoluble fiber…to prevent stroke at a population level.” That’s what you see in people eating diets centered around minimally processed plant foods. Dean Ornish, M.D., got up around there with his whole food, plant-based diet. It might not be as much as we were designed to eat, based on the analyses of fossilized feces, but that’s about where we might expect significantly lower stroke risk, as shown below and at 3:25 in my video.
How much were the UK vegetarians getting? 22.1 grams. Now, in the UK, they measure fiber a little differently, so it may be closer to 30 grams, but that’s still not the optimal level for stroke prevention. It’s so little fiber that the vegetarians and vegans only beat out the meat eaters by about one or two bowel movements a week, as you can see below and at 3:48 in my video, suggesting the non-meat eaters were eating lots of processed foods.
The vegetarians were only eating about half a serving more of fruits and vegetables. Intake is thought to reduce stroke risk in part because of their potassium content, but the UK vegetarians at higher stroke risk were eating so few greens and beans that they couldn’t even match the meat eaters. The vegetarians (and the meat eaters) weren’t even reaching the recommended minimum daily potassium intake of 4,700 mg a day.
What about sodium? “The vast majority of the available evidence indicates that elevated salt intake is associated with higher stroke risk…” There is practically a straight-line increase in the risk of dying from a stroke, the more salt you eat, as you can see in the graph below and at 4:29 in my video.
Even just lowering sodium intake by a tiny fraction every year could prevent tens of thousands of fatal strokes. “Reducing Sodium Intake to Prevent Stroke: Time for Action, Not Hesitation” was the title of the paper, but the UK vegetarians and vegans appeared to be hesitating, as did the other dietary groups. “All groups exceeded the advised less than 2400 mg daily sodium intake”—and that didn’t even account for salt added to the table! The American Heart Association recommends less than 1,500 mg a day. So, they were all eating a lot of processed foods. It’s no wonder the vegetarians’ blood pressures were only one or two points lower. High blood pressure is perhaps “the single most important potentially modifiable risk factor for stroke.”
What evidence do I have that the vegetarians’ and vegans’ stroke risk would go down if they ate more healthfully? Well, in rural Africa, where they were able to nail the fiber intake that our bodies were designed to get by eating so many whole, healthy plant foods—including fruits, vegetables, grains, greens, beans, and protein almost entirely from plant sources—not only was heart disease, our number one killer, “almost non-existent,” but so was stroke. It only surged up from nowhere “with the introduction of salt and refined foods” to their diet.
“It is notable that stroke and senile dementia appear to be virtually absent in Kitava, an Oceanic culture [near Australia] whose quasi-vegan traditional diet is very low in salt and very rich in potassium.” They ate fish a few times a week, but the other 95 percent or so of their diet was made up of vegetables, fruits, corn, and beans. They had an apparent absence of stroke, even despite their ridiculously high rates of smoking, 76 percent of men and 80 percent of women. We evolved by eating as little as less than an eighth of a teaspoon of salt a day, and our daily potassium consumption is thought to have been as high as 10,000 mg or so. We went from an unsalted, whole-food diet to eating salty, processed foods depleted of potassium whether we eat meat or not.
Caldwell Esselstyn at the Cleveland Clinic tried putting about 200 patients with established cardiovascular disease on a whole food, plant-based diet. Of the 177 who stuck with the diet, only a single patient went on to have a stroke in the subsequent few years, compared to a hundred-fold greater rate of adverse events, including multiple strokes and deaths in those who strayed from the diet. “This is not vegetarianism,” Esselstyn explains. Vegetarians can eat a lot of less-than-ideal foods, “such as milk, cream, butter, cheese, ice cream, and eggs. This new paradigm is exclusively plant-based nutrition.”
This entire train of thought—that the reason typical vegetarians don’t have better stroke statistics is because they’re not eating particularly stellar diets—may explain why they don’t have significantly lower stroke rates. However, it still doesn’t explain why they may have higher stroke rates. Even if they’re eating similarly crappy, salty, processed diets, at least they aren’t eating meat, which we know increases stroke risk. There must be something about vegetarian diets that so increases stroke risk that it offsets their inherent advantages. We’ll continue our hunt for the answer next.
From a medical standpoint, labels like vegan and vegetarian just tell me what you don’t eat. It’s like identifying yourself as a “No-Twinkie-tarian.” You don’t eat Twinkies? Great, but what’s the rest of your diet like?
What are the healthiest foods? Check out my Daily Dozen.
To catch up on the rest of this series, see related posts below.
Michael Greger M.D. FACLM
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Does eating fish or taking fish oil supplements reduce stroke risk?
In my last video, we started to explore what might explain the higher stroke risk in vegetarians found in the EPIC-Oxford study. As you can see below and at 0:25 in my video Vegetarians and Stroke Risk Factors: Omega-3s?, vegetarians have a lower risk of heart disease and cardiovascular disease overall, but a higher risk of stroke. We looked into vitamin D levels as a potential mechanism, but that didn’t seem to be the reason. What about long-chain omega-3s, the fish fats like EPA and DHA?
Not surprisingly, their levels are found to be “markedly lower in vegetarians and particularly in vegans than in meat-eaters.” They’re about 30 percent lower in vegetarians and more than half as low in vegans, as you can see below and at 0:45 in my video.
According to “the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date,” combining 28 randomized controlled trials, stroke has no benefit. There is evidence that taking fish oil “does not reduce heart disease, stroke or death,” or overall mortality, either. This may be because, on the one hand, the omega-3s may be helping, but the mercury in fish may be making things worse. “Balancing the benefits with the contaminant risks of fish consumption has represented a challenge for regulatory agencies and public health professionals.”
For example, dietary exposure to polychlorinated biphenyls (PCBs) may be associated with an increased risk of stroke. In one study, for instance, “neither fish nor intake of PCBs was related to stroke risk. However, with adjustment for fish intake,” that is, at the same fish intake, “dietary PCBs were associated with an increased risk of total stroke,” so the PCB pollutants may be masking the fish benefit. If we had a time machine and could go back before the Industrial Revolution and find fish in an unpolluted state, we might find that it is protective against stroke. Still, looking at the EPIC-Oxford study data, if fish were protective, then we might expect that the pescatarians (those who eat fish but no other meat) would have lower numbers of strokes since they would have the fish benefit without the risk from other meat. But, no. That isn’t the reality. So, it doesn’t seem to be the omega-3s either.
Let’s take a closer look at what the vegetarians are eating.
When it comes to plant-based diets for cardiovascular disease prevention, all plant foods are not created equal. There are two types of vegetarians—those who do it for their health, and those who do it for ethical reasons, like global warming or animals—and the latter tend to eat different diets. Health vegans tend to eat more fruits and fewer sweets, for instance, and you don’t tend to see them chomping down on vegan donuts, as shown below and at 2:41 in my video.
“Concerns about health and costs were primary motivations for [meat] reduction” in the United States. A middle-class American family is four times more likely to reduce meat for health reasons compared to environmental or animal welfare concerns, as you can see in the graph below and at 2:55 in my video.
But in the United Kingdom, where the EPIC-Oxford stroke study was done, ethics was the number one reason given for becoming vegetarian or vegan, as you can see in below and at 3:05 in my video.
We know that “plant-based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality”—a lower risk of dying from all causes put together—“in a general US adult population.” But, that’s only for healthy plant foods. Eating a lot of Wonder Bread, soda, and apple pie isn’t going to do you any favors. “For all types of plant-based diets, however, it is crucial that the choice of plant foods is given careful consideration.” We should choose whole fruits and whole grains over refined grains and avoid trans fats and added sugars. Could it be that the veggie Brits were just eating more chips? We’ll find out next.
Another strikeout trying to explain the increased risk. Could it be that the vegetarians were eating particularly unhealthy diets? Labels like vegetarian or vegan just tell me what is not being eaten. You can be vegetarian and consume a lot of unhealthy fare, like french fries, potato chips, and soda. That’s why, as a physician, I prefer the term whole food, plant-based nutrition. That tells me what you do eat. You eat vegetables and follow a diet centered around the healthiest foods out there.
If you missed the first four videos in this series, see:
Surprised about the fishy oil findings? Learn more: Is Fish Oil Just Snake Oil? and Omega-3s and the Eskimo Fish Tale.
Michael Greger M.D. FACLM
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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.
Michael Greger M.D. FACLM
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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?.
Michael Greger M.D. FACLM
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Plant-based diets are put to the test for treating migraine headaches.
Headaches are one of the top five reasons people end up in emergency rooms and one of the leading reasons people see their doctors in general. One way to try to prevent them is to identify their triggers and avoid them. Common triggers for migraines include stress, smoking, hunger, sleep issues, certain foods (like chocolate, cheese, and alcohol), your menstrual cycle, or certain weather patterns (like high humidity).
In terms of dietary treatments, the so-called Father of Modern Medicine, William Osler suggested trying a “strict vegetable diet.” After all, the nerve inflammation associated with migraines “may be reduced by a vegan diet as many plant foods are high in anti-inflammatory compounds and antioxidants, and likewise, meat products have been reported to have inflammatory properties.” It wasn’t put to the test, though, for another 117 years.
As I discuss in my video Friday Favorites: Foods That Help Headache and Migraine Relief, among study participants given a placebo supplement, half said they got better, while the other half said they didn’t. But, when put on a strictly plant-based diet, they did much better, experiencing a significant drop in the severity of their pain, as you can see in the graph below and at 1:08 in my video.
Now, “it is possible that the pain-reducing effects of the vegan diet may be, at least in part, due to weight reduction.” The study participants lost about nine more pounds when they were on the plant-based diet for a month, as shown below, and at 1:22.
Even just lowering the fat content of the diet may help. Those placed on a month of consuming less than 30 daily grams of fat (for instance, less than two tablespoons of oil all day), experienced “statistically significant decreases in headache frequency, intensity, duration, and medication intake”—a six-fold decrease in the frequency and intensity, as you can see below and at 1:44 in my video. They went from three migraine attacks every two weeks down to just one a month. And, by “low fat,” the researchers didn’t mean SnackWell’s; they meant more fruits, vegetables, and beans. Before the food industry co-opted and corrupted the term, eating “low fat” meant eating an apple, for example, not Kellogg’s Apple Jacks.
Now, they were on a low-fat diet—about 10 percent fat for someone eating 2,500 calories a day. What about just less than 20 percent fat compared to a more normal diet that’s still relatively lower fat than average? As you can see below and at 2:22 in my video, the researchers saw the same significant drops in headache frequency and severity, including a five-fold drop in attacks of severe pain. Since the intervention involved at least a halving of intake of saturated fat, which is mostly found in meat, dairy, and junk, the researchers concluded that reduced consumption of saturated fat may help control migraine attacks—but it isn’t necessarily something they’re getting less of. There are compounds “present in Live green real veggies” that might bind to a migraine-triggering peptide known as calcitonin gene-related peptide, CGRP.
Drug companies have been trying to come up with something that binds to CGRP, but the drugs have failed to be effective. They’re also toxic, which is a problem we don’t have with cabbage, as you can see below and at 3:01 in my video.
Green vegetables also have magnesium. Found throughout the food supply but most concentrated in green leafy vegetables, beans, nuts, seeds, and whole grains, magnesium is the central atom to chlorophyll, as shown below and at 3:15. So, you can see how much magnesium foods have in the produce aisle by the intensity of their green color. Although magnesium supplements do not appear to decrease migraine severity, they may reduce the number of attacks you get in the first place. You can ask your doctor about starting 600 mg of magnesium dicitrate every day, but note that magnesium supplements can cause adverse effects, such as diarrhea, so I recommend getting it the way nature intended—in the form of real food, not supplements.
Any foods that may be particularly helpful? You may recall that I’ve talked about ground ginger. What about caffeine? Indeed, combining caffeine with over-the-counter painkillers, like Tylenol, aspirin, or ibuprofen, may boost their efficacy, at doses of about 130 mg for tension-type headaches and 100 mg for migraines. That’s about what you might expect to get in three cups of tea, as you can see below, and at 4:00 in my video. (I believe it is just a coincidence that the principal investigator of this study was named Lipton.)
Please note that you can overdo it. If you take kids and teens with headaches who were drinking 1.5 liters of cola a day and cut the soda, you can cure 90 percent of them. However, this may be a cola effect rather than a caffeine effect.
And, finally, one plant food that may not be the best idea is the Carolina Reaper, the hottest chili pepper in the world. It’s so mind-numbingly hot it can clamp off the arteries in your brain, as seen below and at 4:41 in my video, and you can end up with a “thunderclap headache,” like the 34-year-old man who ate the world’s hottest pepper and ended up in the emergency room. Why am I not surprised it was a man?
I’ve previously covered ginger and topical lavender for migraines. Saffron may help relieve PMS symptoms, including headaches. A more exotic way a plant-based diet can prevent headaches is by helping to keep tapeworms out of your brain.
Though hot peppers can indeed trigger headaches, they may also be used to treat them. Check out my video on relieving cluster headaches with hot sauce.
Michael Greger M.D. FACLM
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Ancient types of wheat, like kamut, are put to the test for inflammation, blood sugar, and cholesterol control.
The number one killer in the United States and around the world is what we eat. As you can see in the graph below and at 0:15 in my video Friday Favorites: Are Ancient Grains Healthier?, our diet kills millions more than tobacco. What are the five most important things we can do to improve our diets, based on the single most comprehensive global study of the health impact of nutrition? Eat less salt, eat more nuts, eat more non-starchy vegetables, eat more fruit, and, finally, eat more whole grains.
Any particular type of whole grains? What about so-called ancient grains? Are they any better than modern varieties? For instance, what about kamut, described as “mummy wheat” and supposedly unearthed from an Egyptian tomb?
After WWII, the wheat industry selected particularly high-yielding varieties for pasta and bread. Over the past few years, though, some of the more ancient grains—“defined as those species that have remained unchanged over the last hundred years” despite agricultural revolutions—have been reintroduced to the market.
As you can see below and at 1:13 in my video, nutritionally, kamut and einkorn wheat, which is the oldest wheat, have more eyesight-improving yellow carotenoid pigments, such as lutein and zeaxanthin, compared to modern bread and pastry wheat, because the pigments have been bred out of the bread intentionally. People want their white bread white, but modern pasta flour (durum wheat) maintains much of that yellow nutritional hue.
As you can see in the graph below and at 1:41 in my video, modern wheat may have less lutein, but it tends to have more vitamin E, as seen in the graph below and at 1:45. Based on straight vitamin and mineral concentrations, it’s pretty much a wash. Both modern and primitive kinds of wheat have a lot of each, but primitive wheats do have more antioxidant capacity, likely due to their greater polyphenol content, as you can see in the graph below and at 2:00 in my video. To know if that makes any difference, though, we have to put it to the test.
If you expose human liver cells to digested bread made out of ancient grains (kamut and spelt), heritage kinds of wheat, or modern strains, then expose the cells to an inflammatory stimulus, the modern wheat strains seem less able to suppress the inflammation, as you can see in the graphs below and at 2:09 in my video. The investigators conclude that even though these different grains seem to be very similar nutritionally, they appear to exert different effects on human cells, “confirming the potential health benefits of ancient grains.” 
That was in a petri dish, though. What about people? If ancient kinds of wheat are better at suppressing inflammation, what if you took people with irritable bowel syndrome (IBS) and randomized them to receive six weeks of wheat products made out of modern wheat or ancient wheat—in this case, kamut? Same amount of wheat, just different types. If there is no difference between the wheats, there’d be no difference in people’s symptoms, right? But, when study participants in the control group were switched to the ancient wheat kamut, they experienced less abdominal pain, less frequent pain, less bloating, more satisfaction with stool consistency, and less interference with their quality of life, compared to the modern wheat. So, after switching to the ancient wheat, they had “a significant global improvement in the extent and severity of symptoms related to IBS…”
What about liver inflammation? The liver function of those with nonalcoholic fatty liver disease randomized to eat kamut improved, compared to those eating the same amount of regular wheat, suggesting kamut is superior, as you can see below and at 3:47 in my video.
People with diabetes, had better cholesterol and better insulin sensitivity on the same ancient grain, as shown below and at 3:57.
And those with heart disease? They had better blood sugar control and better cholesterol, as shown below and at 4:03.
And, people without overt heart disease had better artery function, as you can see below and at 4:06 in my video.
The bottom line is that findings derived from human studies suggest that ancient wheat products are more anti-inflammatory and may improve things like blood sugar control and cholesterol. “Given that the overall number of human interventional trials conducted to date are numerically insufficient, it is not possible to definitively conclude that ancient wheat varieties are superior to all commercial, modern wheat counterparts in reducing chronic disease risk.” However, the best available data do suggest they’re better for us.
Regardless of what type of wheat you may eat, a word to the wise: Don’t eat the plastic bread-bag clip. A 45-year-old man presented with bloody stools, and his CT scan showed the offending piece of plastic from his bag of bread, as you can see below and at 4:53 in my video. When the patient was questioned, he “admitted to habitually eating quickly without chewing properly.”
Whole grains—ideally intact ones and ancient and modern varieties alike—are an integral part of my Daily Dozen checklist, the healthiest of healthy things I encourage everyone to try to fit into their daily routines.
Whole grains are especially good for our microbiome. Learn more in the related posts below. What about gluten? Also, see the related posts below.
Michael Greger M.D. FACLM
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On the anniversary of Putin’s aggression, however, uncertainty and irritation were undisguised in Kyiv. Ukrainians wanted to know why Western sanctions on Russia are not working, and why Moscow keeps getting components for its missiles from Western companies. Why Ukrainians have to keep asking for weapons; and why the U.S. is not pushing through the crucial new aid package for Ukraine.
“We are very grateful for the support of the United States, but unfortunately, when I turn to the Democrats for support, they tell me to go to the Republicans. And the Republicans say to go to the Democrats,” Ukrainian MP Oleksandra Ustinova said at a separate Kyiv conference on Saturday. “We are grateful for the European support, but we cannot win without the USA. We need the supply of anti-aircraft defenses and continued assistance.”
“Why don’t you give us what we ask for? Our priorities are air defense and missiles. We need long-range missiles,” Ustinova added.
U.S. Congressman Jim Costa explained to the conference that Americans, and even members of Congress, still need to be educated on how the war in Ukraine affects them and why a Ukrainian victory is in America’s best interests.
“I believe that we must, and that is why we will decide on an additional aid package for Ukraine. It is difficult and unattractive. But I believe that over the next few weeks, the US response will be a beacon to protect our security and democratic values,” Costa said.
The West is afraid of Russia, Oleksiy Danilov, Ukraine’s security and defense council secretary, told the Saturday conference.
“The West does not know what to do with Russia and therefore it does not allow us to win. Russians constantly blackmail and intimidate the West. However, if you are afraid of a dog, it will bite you,” he said.
“And now you are losing not only to autocratic Russia but also to the rest of the autocracies in the world,” Danilov added.
Veronika Melkozerova
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Polish farmers ended a blockade of a Poland-Ukraine border crossing after reaching an agreement with Warsaw that met their demands, defusing a dispute that had become an early test of the new government of Prime Minister Donald Tusk.
Newly appointed Polish Agriculture Minister Czesław Siekierski signed the deal with Polish farmers blockading the Medyka-Shehyni border crossing with Ukraine late Saturday. The protest — which started over a month ago — was called off on December 24 following an agreement with the government, but it resumed on Wednesday amid farmers’ mistrust over the deal.
Farmers accused the new Polish government of failing to defend them against Ukrainian grain imports, but also demanded a series of financial support measures. Saturday’s deal finally implemented those financial demands — which include launching corn production subsidies, maintaining agricultural taxes at 2023 levels and increasing preferential liquidity loans — but didn’t include restrictions on Ukraine imports.
The measures “will be implemented after the legislative process is completed and acceptance by the European Commission is obtained,” the Polish Agriculture Ministry said.
Despite calling off the blockade, protesting farmers said that the “most important” demand now is “to limit the inflow of goods from Ukraine.” EU Agriculture Commissioner Janusz Wojciechowski told Polish media on Friday that he would demand an EU-wide restriction on items like sugar, eggs and poultry from Ukraine.
“These imports are growing in a way that threatens the competitiveness of the EU sector, including Polish poultry and sugar production,” he said. The Polish commissioner has already clashed with other members of the European Commission over full trade liberalization with Ukraine, which the EU executive is expected to recommend as early as next week.
“Ukraine is such a country that they just want to take, take, take, and give nothing back,” Roman Kondrów, one of the protest leaders, told POLITICO by phone on Thursday, warning about the risks of allowing the country to join the EU without restrictions.
In the meantime, Polish truckers are continuing to protest as they want the government to end an EU-Ukraine agreement that liberalized road transport rules in an effort to help the Ukrainian economy, crippled by the Russian invasion.
Underpinning the narratives of both groups are doomsday scenarios about the impact on Poland of Ukraine one day becoming a member of the EU. At a summit in December, EU leaders agreed to open accession talks with Ukraine.
PAULA ANDRéS
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What are the effects of ketogenic diets on nutrient sufficiency, gut flora, and heart disease risk?
Given the decades of experience using ketogenic diets to treat certain cases of pediatric epilepsy, a body of safety data has accumulated. Nutrient deficiencies would seem to be the obvious issue. Inadequate intake of 17 micronutrients, vitamins, and minerals has been documented in those on strict ketogenic diets, as you can see in the graph below and at 0:14 in my video Are Keto Diets Safe?.
Dieting is a particularly important time to make sure you’re meeting all of your essential nutrient requirements, since you may be taking in less food. Ketogenic diets tend to be so nutritionally vacuous that one assessment estimated that you’d have to eat more than 37,000 calories a day to get a sufficient daily intake of all essential vitamins and minerals, as you can see in the graph below and at 0:39 in my video.
That is one of the advantages of more plant-based approaches. As the editor-in-chief of the Journal of the American Dietetic Association put it, “What could be more nutrient-dense than a vegetarian diet?” Choosing a healthy diet may be easier than eating more than 37,000 daily calories, which is like putting 50 sticks of butter in your morning coffee.
We aren’t just talking about not reaching your daily allowances either. Children have gotten scurvy on ketogenic diets, and some have even died from selenium deficiency, which can cause sudden cardiac death. The vitamin and mineral deficiencies can be solved with supplements, but what about the paucity of prebiotics, the dozens of types of fiber, and resistant starches found concentrated in whole grains and beans that you’d miss out on?
Not surprisingly, constipation is very common on keto diets. As I’ve reviewed before, starving our microbial self of prebiotics can have a whole array of negative consequences. Ketogenic diets have been shown to “reduce the species richness and diversity of intestinal microbiota,” our gut flora. Microbiome changes can be detected within 24 hours of switching to a high-fat, low-fiber diet. A lack of fiber starves our good gut bacteria. We used to think that dietary fat itself was nearly all absorbed in the small intestine, but based on studies using radioactive tracers, we now know that about 7 percent of the saturated fat in a fat-rich meal can make it down to the colon. This may result in “detrimental changes” in our gut microbiome, as well as weight gain, increased leaky gut, and pro-inflammatory changes. For example, there may be a drop in beneficial Bifidobacteria and a decrease in overall short-chain fatty acid production, both of which would be expected to increase the risk of gastrointestinal disorders.
Striking at the heart of the matter, what might all of that saturated fat be doing to our heart? If you look at low-carbohydrate diets and all-cause mortality, those who eat lower-carb diets suffer “a significantly higher risk of all-cause mortality,” meaning they live, on average, significantly shorter lives. However, from a heart-disease perspective, it matters if it’s animal fat or plant fat. Based on the famous Harvard cohorts, eating more of an animal-based, low-carb diet was associated with higher death rates from cardiovascular disease and a 50 percent higher risk of dying from a heart attack or stroke, but no such association was found for lower-carb diets based on plant sources.
And it wasn’t just Harvard. Other researchers have also found that “low-carbohydrate dietary patterns favoring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favored plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain bread, were associated with lower mortality…”
Cholesterol production in the body is directly correlated to body weight, as you can see in the graph below and at 3:50 in my video.
Every pound of weight loss by nearly any means is associated with about a one-point drop in cholesterol levels in the blood. But if we put people on very-low-carb ketogenic diets, the beneficial effect on LDL bad cholesterol is blunted or even completely neutralized. Counterbalancing changes in LDL or HDL (what we used to think of as good cholesterol) are not considered sufficient to offset this risk. You don’t have to wait until cholesterol builds up in your arteries to have adverse effects either; within three hours of eating a meal high in saturated fat, you can see a significant impairment of artery function. Even with a dozen pounds of weight loss, artery function worsens on a ketogenic diet instead of getting better, which appears to be the case with low-carb diets in general.
For more on keto diets, check out my video series here.
And, to learn more about your microbiome, see the related videos below.
Michael Greger M.D. FACLM
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What does the science say about the clinical use of ketogenic diets for epilepsy and cancer?
Blood sugar, also known as blood glucose, is the universal go-to fuel for the cells throughout our bodies. Our brain burns through a quarter pound of sugar a day because “glucose is the preferred metabolic fuel.” We can break down proteins and make glucose from scratch, but most comes from our diet in the form of sugars and starches. If we stop eating carbohydrates (or stop eating altogether), most of our cells switch over to burning fat. Fat has difficulty getting through the blood-brain barrier, though, and our brain has a constant, massive need for fuel. Just that one organ accounts for up to half of our energy needs. Without it, the lights go out…permanently.
To make that much sugar from scratch, our body would need to break down about half a pound of protein a day. That means we’d cannibalize ourselves to death within two weeks, but people can fast for months. What’s going on? The answer to the puzzle was discovered in 1967. Harvard researchers famously stuck catheters into the brains of obese subjects who had been fasting for more than a month and discovered that ketones had replaced glucose as the preferred fuel for the brain. Our liver can turn fat into ketones, which can then breach the blood-brain barrier and sustain our brain if we aren’t getting enough carbohydrates. Switching fuels has such an effect on brain activity that it has been used to treat epilepsy since antiquity.
In fact, the prescription of fasting for the treatment of epileptic seizures dates back to Hippocrates. In the Bible, even Jesus seems to have concurred. To this day, it’s unclear why switching from blood sugar to ketones as a primary fuel source has such a dampening effect on brain overactivity. How long can one fast? To prolong the fasting therapy, in 1921, a distinguished physician scientist at the Mayo Clinic suggested trying what he called “ketogenic diets,” high-fat diets designed to be so deficient in carbohydrates that they could effectively mimic the fasting state. “Remarkable improvement” was noted the first time it was put to the test, efficacy that was later confirmed in randomized, controlled trials. Ketogenic diets started to fall out of favor in 1938 with the discovery of the anti-seizure drug that would become known as Dilantin, but they’re still being used today as a third- or fourth-line treatment for drug-refractory epilepsy in children.
Oddly, the success of ketogenic diets against pediatric epilepsy seems to get conflated by “keto diet” proponents into suggesting a ketogenic diet is beneficial for everyone. Know what else sometimes works for intractable epilepsy? Brain surgery, but I don’t hear people clamoring to get their skulls sawed open. Since when do medical therapies translate into healthy lifestyle choices? Scrambling brain activity with electroshock therapy can be helpful in some cases of major depression, so should we get out the electrodes? Ketogenic diets are also being tested to see if they can slow the growth of certain brain tumors. Even if they work, you know what else can help slow cancer growth? Chemotherapy. So why go keto when you can just go chemo?
Promoters of ketogenic diets for cancer are paid by so-called ketone technology companies that offer to send you salted caramel bone broth powder for a hundred bucks a pound or companies that market ketogenic meals and report “extraordinary” anecdotal responses in some cancer patients. But more concrete evidence is simply lacking, and even the theoretical underpinnings may be questionable. A common refrain is that “cancer feeds on sugar.” But all cells feed on sugar. Advocating ketogenic diets for cancer is like saying Hitler breathed air so we should boycott oxygen.
Cancer can feed on ketones, too. Ketones have been found to fuel human breast cancer growth and drive metastases in an experimental model, more than doubling tumor growth. Some have even speculated that this may be why breast cancer often metastasizes to the liver, the main site of ketone production. As you can see below and at 4:59 in my video Is Keto an Effective Cancer-Fighting Diet?, if you drip ketones directly onto breast cancer cells in a petri dish, the genes that get turned on and off make for much more aggressive cancer, associated with significantly lower five-year survival in breast cancer patients, as you can see in the following graph and at 5:05 in my video. Researchers are even considering designing ketone-blocking drugs to prevent further cancer growth by halting ketone production.
Let’s also think about what eating a ketogenic diet might entail. High animal fat intake may increase the mortality risk among breast cancer survivors and potentially play a role in the development of breast cancer in the first place through oxidative stress, hormone disruption, or inflammation. This applies to men, too. “A strong association” has been found “between saturated fat intake and prostate cancer progression and survival.” Those in the top third of consumption of these kinds of fat-rich animal foods appeared to triple their risk of dying from prostate cancer. This isn’t necessarily fat in general either. No difference has been found in breast cancer death rates based on total fat intake. However saturated fat intake specifically may negatively impact breast cancer survival, increasing the risk of dying from it by 50 percent. There’s a reason the official American Cancer Society and American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline recommend a dietary pattern for breast cancer patients that’s essentially the opposite of a ketogenic diet. It calls for a diet that’s “high in vegetables, fruits, whole grains, and legumes [beans, split peas, chickpeas, and lentils]; low in saturated fats; and limited in alcohol consumption.”
“To date, not a single clinical study has shown a measurable benefit from a ketogenic diet in any human cancer.” There are currently at least a dozen trials underway, however, and the hope is that at least some cancer types will respond. Still, even then, that wouldn’t serve as a basis for recommending ketogenic diets for the general population any more than recommending everyone get radiation, surgery, and chemo just for kicks.
“Keto” has been the most-searched keyword on NutritionFacts.org for months, and I didn’t have much specific to offer…until now. Check out my other videos on the topic in related videos below.
For an overview of my cancer work, watch How Not to Die from Cancer.
Michael Greger M.D. FACLM
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WARSAW — After eight years of rule by the nationalist Law and Justice (PiS) party, Polish voters on Sunday chose change — giving three opposition democratic parties enough seats to form a new government.
So now is the way clear to bring Poland back into the European mainstream after dallying as an illiberal democracy?
Not so fast.
The country’s likely ruling coalition faces years of very hard political graft to undo the changes wrought by PiS since 2015.
Here are five main takeaways from an election that will shake Poland and Europe.
The final result puts PiS in first place, with 35.4 percent, according to a preliminary vote count, and 194 seats, but that’s too few for a majority in the 460-member lower house of parliament.
“We will definitely try to build a parliamentary majority,” said Prime Minister Mateusz Morawiecki.
The first move belongs to President Andrzej Duda, a former PiS member who has always been loyal to the party. He has said that presidents traditionally choose the leader of the largest party to try to form a government, but if PiS really is a no-hoper, Duda could delay the formation of a stable government.
Under the Polish constitution, the president has to call a new parliamentary session within 30 days of the election. He then has 14 days to nominate a candidate for prime minister; once named, the nominee has 14 days to win a vote of confidence in parliament.
If that fails, parliament then chooses a nominee for PM.
That means if Duda sticks with PiS, it could be mid-December before the three opposition parties — Civic Coalition, the Third Way and the Left — get a chance to form a government. Together, they have 248 seats in the new legislature.
There are already voices calling on the opposition to short-circuit that by striking a coalition deal with the signatures of at least 231 MPs, demonstrating to Duda that they have a lock on forming a government.
Once in power, the opposition will find that ruling isn’t easy.
What unites the three is their distaste for PiS, but their programs differ markedly.
Civic Coalition, the largest party under the leadership of Donald Tusk, a former prime minister and European Council president, is part of the center-right European People’s Party in the European Parliament. But it also contains smaller parties from different groupings like the Greens.
The Third Way is a coalition of two parties — Poland 2050, founded by TV host Szymon Hołownia, and the Polish People’s Party (PSL), the country’s oldest political force representing the peasantry. Poland 2050 is part of Renew while PSL is in the EPP. The grouping skews center right, which means it’s likely to clash with the Left on issues like loosening draconian abortion laws.
The Left is in turn an amalgamation of three small groupings whose leaders have often been at daggers drawn.
A non-PiS government will have a very difficult time passing legislation as it will not have the three-fifths of parliamentary votes needed to override Duda’s veto; his term ends in 2025.
The new administration’s first job will be cleaning PiS appointees out of controling positions in government, the media and state-controlled corporations. Poland has a long tradition of governments rewarding loyalists with cushy jobs, but PiS took it to an extreme not seen since communist times.
Most of those people face dismissal.
“We will fire all members of supervisory boards and boards of directors. We will conduct new recruitment in transparent competitions, in which competence, not family and party connections, will be decisive,” says the Civic Coalition electoral program.
“We’ll end the rule of the fat cats in state companies,” says the Left’s program.
The immediate market reaction was positive, with energy company Orlen up more than 8 percent on the Warsaw Stock Exchange on Monday, and the biggest bank, PKO BP, up over 11 percent.
Poland’s state media became PiS’s propaganda arm — along with a chain of newspapers bought by state-controlled refiner Orlen — hammering Tusk as the traitorous “Herr Tusk” more loyal to Germany than Poland. Not a lot of people in the media are likely to survive what’s coming, if the new government succeeds in its goal of shutting down the National Media Council — a body stuffed with PiS loyalists that manages public media.
But losing a job isn’t the worst of what’s awaiting many.
When Tusk’s party last won power from a short-lived PiS government in 2007, the winners treated their political rivals with kid gloves and hardly anyone was prosecuted. This time the gloves are off.
In its political program, Civic Coalition promises to prosecute anyone for “breaking the constitution and rule of law.”
It aims at Duda, Morawiecki, PiS leader Jarosław Kaczyński and Justice Minister Zbigniew Ziobro, Central Bank Governor Adam Glapiński for mismanaging the fight against inflation, and Orlen CEO Daniel Obajtek for heading a controversial buyout that saw the sale of part of a large refinery to foreign interests.
Expect prosecutors to track down the numerous scandals that have hit PiS over the years — from the government of former Prime Minister Beata Szydło refusing to publish verdicts issued by the Constitutional Tribunal, to Duda refusing to swear in properly elected judges to the tribunal.
There are also dodgy contracts issued during the panicky early phase of the COVID pandemic, millions spent on a 2020 election by mail that had not been approved by parliament, state companies setting up funds that poured money into PiS-backed projects, a bribes-for-visas scandal, and many more.
Many people with corporate jobs kicked back part of their salaries to PiS. Additionally, state-controlled companies directed a torrent of advertising money to often niche pro-government newspapers while neglecting larger independent media.
All of those transactions are likely to be examined and — if found to be against the interests of the corporation and its shareholders — could result in criminal charges.
The coalition promises to “hold responsible” people “guilty of civil service crimes.”
Tusk is a Brussels animal — he spent five years there as European Council president and was also chief of the European People’s party.
PiS’s departure marks a sea change with the EU — which spent eight years tangling with Warsaw over radical changes to the judicial system aimed at bringing judges under tighter political control.
The European Commission moved to end Poland’s voting rights as an EU member under a so-called Article 7 procedure, blocked the payout of €36 billion in loans and grants from the bloc’s pandemic recovery fund, sued Poland at the Court of Justice of the EU, while the European Parliament passed resolutions decrying Warsaw’s backsliding on democratic principles.
“The day after the election, I will go and unblock the money,” Tusk vowed before the vote.
Although Tusk said all that’s required is “a little goodwill and competence,” it’s going to be tougher than he’s letting on. The PiS government tried to unlock the money by passing a partial rollback of its judicial reforms, but they’re stuck in the PiS-controlled Constitutional Tribunal. Passing any new law will require Duda’s signature and without that, Commission President Ursula von der Leyen doesn’t have the legal basis to acknowledge that Poland has met the milestones it needs to achieve to get the money.
“Perhaps the strategy of Tusk will be to try to reopen the negotiation on the milestones and kind of striking a new deal with the European Commission,” said Jakub Jaraczewski, a research coordinator for Democracy Reporting International, a Berlin-based NGO.
PiS made a lot of enemies — and the new government will try to undo that damage.
Relations with Berlin have been foul, with Kaczyński pounding the German government for wanting to undermine Polish independence and accusing Berlin of aiming to strike a deal with Moscow “because it is in their economic interest as well as that of their national character: the pursuit of domination at any cost.” Kaczyński and other PiS politicians have also constantly harried Germany for not coming clean about wartime atrocities against Poland.
Tusk has been careful not to touch that issue for fear of harming his party’s electoral chances, but he’s historically had good relations with Berlin — although Poland, no matter under which government, is a big and often prickly country that’s not an easy partner.
Tusk blamed PiS for the downturn in relations with Ukraine after the Polish government restricted Ukrainian grain imports not to annoy Polish farmers and to say it would not send more weapons to Kyiv. Tusk called it “stabbing a political knife in Ukraine’s back, while the battles on the frontline are being decided.”
While Brussels, Berlin and Kyiv will be breathing a sigh of relief at the change of direction in Warsaw, things are likely to be a little more tense in Budapest. Poland and Hungary had a mutual defense pact, blocking the needed unanimity in the European Council to move on the Article 7 procedure.
Without Kaczyński to protect him, Hungarian PM Viktor Orbán is much more exposed. There are other populists in Europe, like Italy’s Giorgia Meloni and Robert Fico, who looks likely to take over in Slovakia, but they don’t face Article 7 procedures and their countries have tight relations with the EU — making it difficult to see why they’d risk that to go out on a limb to save Orbán.
Paola Tamma contributed reporting.
This article has been updated with the final election results.
Jan Cienski
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KYIV — Ukraine has hammered Russia’s Black Sea fleet so hard that Moscow is shifting much of it away from Crimea, allowing Kyiv to reopen its ports to grain vessels despite Russia’s blockade threats.
“As of today, Russia is dispersing its fleet, fearing more attacks on its ships. Some units are relocating to the port of Novorossiysk. They try not to visit Sevastopol so often because they don’t feel safe there anymore,” Ukrainian navy spokesperson Dmytro Pletenchuk told POLITICO.
Ukraine unleashed a series of carefully planned attacks against the fleet and parts of its crucial infrastructure in recent weeks — destroying key air defense systems, landing commandos on Crimea, and pounding the fleet’s base in Sevastopol in an attack that heavily damaged a submarine and a missile carrier and put the fleet’s dry dock out of commission.
The coup de grâce was a missile attack on the fleet’s headquarters in downtown Sevastopol.
Ukrainian forces also control drilling rigs in the Black Sea as well as Zmiiniy Island — the famous island where Ukrainian forces said: “Russian warship, go fuck yourself” in the early days of the war.
That’s made naval operations in the western part of the Black Sea perilous for Russia, allowing grain ships to dock at Ukrainian ports with much less fear of being stopped and boarded by the Russians.
“Now ships and boats of the Black Sea fleet of the Russian Federation do not actually sail in the direction of the territorial sea of Ukraine. From time to time, they appear on the coast of Crimea, but not closer. They do not dare to go beyond the Tarkhankut Peninsula,” Natalia Humeniuk of Ukraine’s Army Operational Command South, told Ukrainian television on Wednesday, referring to the point that marks the westernmost extremity of Crimea into the Black Sea.
She said Russian warships had been pushed back at least 100 nautical miles from the coast controlled by Ukraine.
That’s allowed Kyiv to restart grain exports from three Black Sea ports — reopening a route that the Kremlin had tried to throttle after pulling out of the U.N.-negotiated grain deal in July.
An official with the Ukrainian Armed Forces Command South, who was granted anonymity due to the sensitivity of the issue, said the Ukrainian military counted at least 10 Russian Black Sea fleet vessels that used to be based in Crimea and have now shifted east to the Russian port of Novorossiysk.
“They stopped being there all the time,” Pletenchuk said.
While cargo ships are again sailing to Ukrainian ports, Humeniuk warned that the threat isn’t over.
Although Russian warships have made themselves scarce, Russian planes are still flying over the sea. Russian forces frequently bomb Zmiiniy Island and attack cities and towns on the Black Sea coast of Ukraine with drones.
There is also the danger that Russia may lay mines to block sea routes, British intelligence said on Wednesday.
But for the moment, the situation on the Black Sea is a huge embarrassment for the Kremlin, as its second-largest naval force has been humbled by a country with almost no navy.
The Black Sea fleet has been a bone contention between Ukraine and Russia since the collapse of the Soviet Union. Moscow had a special arrangement with Kyiv to keep basing the fleet in Sevastopol, and concern over those basing rights was one of the reasons Russian President Vladimir Putin gave for his illegal annexation of Crimea in 2014.
The challenge to the fleet also endangers Russia’s hold on Crimea, said Volodymyr Zablotskiy, a Ukrainian military and naval expert.
“Without Crimea, this expansion fleet will not be viable, and the capabilities of the Kremlin and the region will be limited. These are the strategic consequences of our future de-occupation of the peninsula,” he said. “It is the fleet that enables the logistics of the Russian forces in this direction. And the key to it is the possession of Sevastopol.”
Veronika Melkozerova
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The West’s united front on Ukraine is showing more cracks than ever — and Kyiv has little choice but to grin and bear it.
More than 500 days into Russia’s full-scale invasion, Republican lawmakers in Washington DC on Saturday derailed an effort to unleash a major tranche of aid for the war-torn country.
Coming just nine days after Ukrainian President Volodymyr Zelenskyy visited Washington to plead for continued support, the blockage underscored a hardening of attitudes among congressional Republicans who want to end Washington’s assistance for Kyiv.
At the same time as Republicans were voting ‘no’ on Capitol Hill, voters in Slovakia elected a pro-Russian prime minister, Robert Fico, who vows not to send a “single round” of ammunition to Ukraine, and looks set to team up with Hungarian Prime Minister Viktor Orbàn to oppose further European support for Kyiv. Poland, once the most dependable of Kyiv’s allies, made the shock announcement on September 20 that it would no longer send weapons.
These warning signs don’t amount to a profound policy shift in Washington or Brussels. U.S. President Joe Biden has vowed to stand by Ukraine despite the budget fiasco. And most European leaders remain staunchly supportive of Ukraine, with some €50 billion in continued support for the country due to be signed off in coming months, according to two EU diplomats who were granted anonymity to talk about the non-public deliberations.
Asked to comment on the fact that the U.S. stopgap bill lacks any funding for Ukraine, White House press secretary Karine Jean-Pierre said: “The president has built a coalition of more than 50 countries to provide aid to support Ukraine … There is very strong international coalition behind Ukraine and if Putin thinks he can outlast us, he’s wrong.”
Josep Borrell, the EU’s top diplomat, said he was “sure” the decision to block funding would be reconsidered. “We’ll continue to be on your side,” he told reporters in Kyiv Monday when asked how the U.S. budget shortfall would affect Ukraine.
Ukrainian politicians — who’ve faced criticism from the United States and United Kingdom for appearing insufficiently “grateful” for Western aid — sounded similarly upbeat. “We’re working with both sides of the Congress to ensure it doesn’t repeat again, under any circumstances,” said Foreign Minister Dmytro Kuleba, appearing next to Borrell.
But despite these attempts to put a positive spin on the situation, open criticism of aid among senior Western politicians — coupled with Elon Musk’s online attacks against Ukrainian President Volodymyr Zelenskyy — sends a chilling message to Kyiv.
The message that the U.S. and Europe will stick with Kyiv — no matter what — is starting to ring hollow.
Ukraine remains heavily dependent on Western support not just to fuel its battle against Russia, but also to keep its public administration ticking over. According to its projected budget for 2024, Ukraine expects to receive $42.8 billion from international donors in the coming year, a big chunk of which would come from the United States. In June, Ukraine’s finance minister, Serhiy Marchenko, told POLITICO that the U.S. should “step in and at least provide us mid-term relief.”
Asked whether the holdup on Capitol Hill now leaves Kyiv with a budget shortfall, a spokesperson for Marchenko declined to comment.
Europe is also worried about what to expect from Washington. While most EU countries agree on supporting Ukraine, aid for Kyiv is tied to a broader review of the EU’s long-term budget on which there is no agreement. And since all EU27 countries need to back the deal, it may prove difficult to pass by year-end, which is when the EU’s current support for Ukraine runs out.
“There is not much political discussion on the financial support for Ukraine. That is not the difficult piece of the puzzle. But the puzzle overall is very hard, that no one dares to predict anything,” said an EU diplomat who asked not to be named to discuss the confidential budget talks.
Indeed, Hungary’s Orbán has already said he’s not prepared to finance Ukraine unless it reviews its treatment of Hungarian minorities living in the country. Although critics describe this stance as a tactical veto meant to unlock funds that Brussels is withholding from Budapest over a separate rule-of-law dispute, Orbán may use the election of his like-minded Slovakian peer to toughen his negotiating tactics.
“Member states remain broadly supportive of aid for Ukraine,” said a second EU diplomat. “Of course the big elephant in the room is, ‘What if this is the precursor to the U.S. just abandoning Ukraine?’ While it’s in the back of everyone’s minds, I just don’t think that’s going to happen now or anytime soon.”
Amid uncertainty about whether Ukraine will be able to finance its budget and keep its war effort going, Ukrainian officials are trying hard to put on a brave face and appear thankful. Speaking to POLITICO last week, Ukrainian Prime Minister Denys Shmyhal insisted on his “gratitude” toward Poland, an ally that has been locked in a dispute with Kyiv over grain exports, and has now vowed not to send any more weapons.
“I would like to express the words of gratitude to the Polish nation and all Polish families for the support that they have given and have provided to Ukrainian refugees,” he said.
Gregorio Sorgi and Suzanne Lynch contributed reporting in Brussels and Eun Kim in Washington DC.
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Warsaw has stopped supplying weapons to Kyiv and is focusing on arming itself instead, Polish Prime Minister Mateusz Morawiecki said Wednesday, amid a dispute over Ukraine’s agricultural exports.
“We are no longer transferring weapons to Ukraine, because we are now arming Poland with more modern weapons,” Morawiecki said in an appearance on Polish television channel Polsat, according to European Pravda. “If you don’t want to be on the defensive, you have to have something to defend yourself with,” he added, insisting, though, that the move wouldn’t endanger Ukraine’s security.
Morawiecki’s terse comments came as tensions escalated between Kyiv and the EU over the past week, after the European Commission moved to allow Ukrainian grain sales across the bloc, ending restrictions on grain imports which five eastern EU countries originally sought to protect their farmers from competition.
Poland, Hungary and Slovakia responded to the Commission’s move by imposing unilateral bans on Ukrainian grain imports, in apparent violation of the EU’s internal market rules. Kyiv struck back by filing lawsuits against the three countries at the World Trade Organization.
Ukrainian President Volodymyr Zelenskyy on Tuesday took a thinly veiled swipe at those imposing grain bans, telling the U.N. General Assembly: “It is alarming to see how some in Europe, some of our friends in Europe, play out solidarity in a political theater — making a thriller from the grain. They may seem to play their own role but in fact they are helping set the stage to a Moscow actor.”
While Zelenskyy didn’t specifically name-check Poland, Warsaw summoned Kyiv’s ambassador to the foreign ministry in response.
Morawiecki also delivered a “warning” to “Ukraine’s authorities,” earlier telling Polsat, “if they are to escalate the conflict like that, we will add additional products to the ban on imports into Poland. Ukrainian authorities do not understand the degree to which Poland’s farming industry has been destabilized.”
Poland is in the midst of a high-stakes campaign ahead of an election next month, with the right-wing Law and Justice government battling for reelection. While Warsaw initially threw its weight behind the campaign to help Kyiv fend off Russia’s attempted invasion, that full-throated support has waned as the consequences of supporting Ukraine for its own farmers have become more evident.
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WARSAW — Ukrainian President Volodymyr Zelenskyy tried to rebuild bridges with Poland late on Saturday, seeking to take the sting out of a political dispute with Warsaw by giving awards to two Polish humanitarian volunteers on his way back from a trip to the U.S. and Canada.
Although Poland was a die-hard ally of Ukraine in the early days of the Russian invasion, the conservative, nationalist government of the Law and Justice (PiS) party has taken an unexpectedly hard line against its war-torn neighbor in the past days, largely for reasons related to the impending election on October 15.
In order to protect Polish farmers — crucial to the ruling party’s electoral prospects next month — Warsaw has blocked agricultural imports from Ukraine, in a protectionist move that Kyiv says is illegal and has referred to the World Trade Organization. Amid this dispute over food products, Warsaw made the shock announcement it would no longer send arms to Ukrainian forces fighting the Russians.
Over recent days, Zelenskyy has been keen to avoid venturing into Polish electoral politics, but has instead tried to play up the importance of direct relations between ordinary Poles and Ukrainians. In that vein, Marcin Przydacz, head of the office of international policy at the presidency, told the Onet news platform that Zelenskyy had simply visited Poland in transit on his way home to Kyiv and had not met politicians.
Instead, Zelenskyy presented decorations to two Poles involved in helping Ukraine. Zelenskyy said journalist Bianka Zalewska from the U.S.-owned television network TVN had helped provide humanitarian aid to Ukrainians and transport wounded children to Polish hospitals. Combat medic Damian Duda had gathered teams to treat wounded soldiers near the front line and set up a fund to assist medics and provide them with training, he said.
“I would like to thank all of Poland for their invaluable support and solidarity, which helps to defend the freedom of our entire Europe!” Zelenskyy said on X, the platform formerly known as Twitter.
Duda explained to Onet that he was awarded the presidential order “For Meritorious Service” Third Class for his work since 2014 as a battlefield medic.
“I work in the Ukrainian trenches, saving Ukrainian soldiers,” he said. “I was there until the end [of the Ukrainian defense] in Bakhmut, in Soledar, in Zaporizhzhia,” he said. “Our work is voluntary, our work is cost-free and I am glad that risking our lives to help another human being has been noticed by President Zelenskyy,” the medic said.
Kamil Turecki is a journalist with Poland’s Onet, a sister publication of POLITICO, also owned by Axel Springer.
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Ukraine has filed lawsuits against Poland, Hungary and Slovakia at the World Trade Organization (WTO) over their decision to ban grain imports, in a row that has split the EU and could hurt Kyiv’s prospects of joining the bloc.
“It is fundamentally important for us to prove that individual member states cannot ban the import of Ukrainian goods. That is why we are filing lawsuits against them in the WTO,” First Deputy Prime Minister and Minister of Economy of Ukraine Yuliya Svyridenko said in a statement.
Svyridenko added that the lawsuits, together with pressure from the European Commission and other member countries, “will help restore normal trade between Ukraine and neighboring countries, as well as show solidarity between us.”
The decision comes after the three countries rebelled against a European Commission decision last Friday to end temporary import restrictions — implemented in the spring in an attempt to mitigate a supply glut — and once again allow Ukrainian grain sales across the EU.
The bans by the three central European countries are intended to protect their farmers from a surge in exports from grain superpower Ukraine, following Russia’s blockade of Ukrainian ports on the Black Sea.
“We hope that these states will lift their restrictions and we will not have to clarify the relationship in the courts for a long time,” Svyridenko said.
NEW DELHI — The G20 endorsed language in support of Ukraine’s territorial integrity, but the group of the world’s biggest economies weakened a previous stance that directly blamed Russia for the war in Ukraine.
The joint communiqué for the G20 summit in India stated that all countries should “refrain from action against the territorial integrity and sovereignty or political independence of any state.” That language was unchanged from a draft first reported by POLITICO on Saturday.
The wording, which Western countries wanted in order to signal a continued anger at Russian President Vladimir Putin’s invasion of Ukraine, could also appease Moscow’s complaints that attacks inside Russia have escalated since Kyiv launched its counteroffensive. Russian Foreign Minister Sergey Lavrov was deeply involved in the weeks of negotiations leading to the final version.
But the joint statement didn’t include a direct condemnation of Russia’s invasion of Ukraine, which a G20 statement in Bali last November did. Some officials contend that a shift was the only way to get buy-in from some of the group’s more Moscow-friendly members — let alone the fact that Russia is also in the bloc.
Critics argued that U.S. President Joe Biden could have gotten more. Svitlana Romanko, founder and director of the pro-Ukraine group Razom We Stand, called the communiqué “weak” and “cowardly by not even mentioning Russia or its ongoing war crimes.”
But some G20 members say it reflected a fair compromise. “It is a fact that this is today a very polarizing issue and there are multiple views on this,” Indian External Affairs Minister Subrahmanyam Jaishankar said Saturday, referring to Ukraine. “Bali was a year ago, the situation was different. Many things have happened since then.”
There’s further language in the declaration that Western officials could herald as victories. It references adherence to the United Nations charter, which stipulates that no country can threaten another’s territory and sovereignty by force — a key demand of the U.S. and the EU in the run-up to the G20 summit. And it also calls for the “full, timely and effective implementation” of the Black Sea Grain Initiative which has stalled after Russia pulled out during the summer.
British Prime Minister Rishi Sunak has already touted the document as a “good and strong outcome.”
“What you’ll see in the communique is strong language, highlighting the impact of the war on food prices and food security, calling on Russia to re-enter the Black Sea grain initiative to allow exports to leave that part of the world and help feed millions of the most vulnerable people as well as the communique recognizing the principles of the U.N. charter respecting territorial integrity,” he said.
Eleni Courea contributed to this report.
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Ukraine is threatening to take Brussels and EU member countries to the World Trade Organization if they fail to lift restrictions on its agricultural exports to the bloc this month.
The country’s grain exports — its main trade commodity — are currently banned from the markets of Poland, Hungary and three other EU countries under a deal struck with the European Commission earlier this year to protect farmers from an influx of cheaper produce from their war-torn neighbor.
The glut, triggered by Russia’s invasion of Ukraine and its blockade of the country’s traditional Black Sea export routes, has driven a wedge between Ukraine and the EU’s eastern frontline states which have been among the strongest backers of Kyiv’s military fightback.
The restrictions, already extended once, are due to expire on September 15. Amid speculation that Commission President Ursula von der Leyen will let them lapse, Poland and Hungary have threatened to impose their own unilateral import bans, in violation of the bloc’s common trade rules.
“With full respect and gratitude to Poland, in case of introduction of any bans after [September 15], Ukraine will bring the case against Poland and the EU to the World Trade Organization,” Taras Kachka, Ukraine’s deputy economy minister, told POLITICO.
Kyiv has argued that the restrictions violate the EU-Ukraine free-trade agreement from 2014.
Kachka’s comments backed up a warning this week from Igor Zhovka, a senior aide to President Volodymyr Zelenskyy. If Brussels fails to act against the countries that violate the trade agreement, Kyiv “reserves the choice of legal mechanisms on how to respond,” Zhovka told Interfax-Ukraine.
The Ukrainian foreign ministry said Kyiv reserved the right to initiate arbitration proceedings under its association agreement with the EU, or to apply to the WTO.
“We do not intend to retaliate immediately given the spirit of friendship and solidarity between Ukraine and the EU,” explained Kachka. But, he added, the systemic threat to Ukrainian interests “forces us to bring this case to the WTO.”
Russia’s war of aggression and partial occupation has cut Ukraine’s grain production in half, compared to before the war, while Moscow’s withdrawal in July from a U.N.-brokered deal allowing safe passage for some seaborne exports has raised concerns that EU-backed export corridors won’t be able to cope.
The bloc’s agriculture commissioner, Janusz Wojciechowski, struggled to explain to European lawmakers at a hearing on Thursday how Brussels would handle the situation after September 15.
Wojciechowski, who is Polish, also appeared to sympathize with the right-wing government in Warsaw, which has latched on to the fight over Ukrainian grain as a campaign issue ahead of mid-October general elections in which it is seeking an unprecedented third term.
The curbs should be extended at least until the end of the year; otherwise “we will have a huge crisis again in the five frontline member states,” Wojciechowski said, adding that this was his personal position and not that of the EU executive.
The Commission’s decision in April to restrict imports to the five countries, which came with a €100 million aid package, met widespread disapproval from other EU governments and European lawmakers for undermining the integrity of the bloc’s single market.
Kachka, in written comments sent in response to questions from POLITICO, said there was no evidence of price deviations or a significant increase in grain supplies that would justify extending the import restrictions. Kyiv had engaged in “constructive cooperation” with the Commission, the five member states, as well as Moldova, a key transit hub for Ukrainian exports to the EU.
“We got a lot of support for ensuring better transit of the goods through the territory of neighboring member states, including Poland and Hungary,” Kachka said. “During [the] last two months we significantly advanced cooperation with Romania on transportation of goods from Ukraine.”
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