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Tag: Heart Disease

  • One Positive Sleep Habit Can Be Doubly Good

    One Positive Sleep Habit Can Be Doubly Good

    Millions struggle with not being able to sleep.  There are a few things you do to help with your sleep habits – and this one could have a double positive impact.

    Snuggling in bed and falling into a deep sleep is so satisfying. Nothing like waking up and feeling great…but for millions it is sometimes a nightmare. Almost 40% of adults not getting enough sleep and some  55 to 75 million Canadians and Americans have  ongoing, sleep disorders. But this one positive sleep habit  can be doubly good for you.

    Routines are key to sleep for most people. Science says the body operates better on a schedule. So deviling habits around sleep can lead to a more successful result.  Lack of sleep can not only cause including poor concentration, reduced reaction times and altered mood, but also heart issues.

    RELATED: Sleeping Less Than 5 Hours A Night May Increase Your Risk Of This

    A study reported in the  European Heart Journal—Digital Health, anaylized over 88,000 adults for a period of six years, trying to get an understanding of the relationship between sleep and heart health. Researchers were able to access information about the subject’s lifestyle, demographics, physical activity, and health.

    After accounting for a variety of factors like lifestyle, stress, gender, and more, the study found that there was a 12% increase in heart disease amongst people who went to bed between the hours of 11 and 11:59 PM. This percentage increased to 25% when people went to bed past midnight. Women seemed to be affected more by these times when compared to men, experiencing higher risks.

    Study co-author David Plans explained in a statement how circadian rhythms worked and why our bedtime could play an important part in our heart health. “While we cannot conclude causation from our study, the results suggest that early or late bedtimes may be more likely to disrupt the body clock, with adverse consequences for cardiovascular health,” he said.

    Sleeping Too Little May Increase This Group's Risk Of Dementia
    Photo by Bruno Aguirre via Unsplash

    RELATED: 3 Tricks That Can Help You Understand Your Sleep

    Heart disease is the leading cause of death for most people in America, thus a prominent concern for most of us. It’s influenced by internal factors like cholesterol levels and blood pressure, but also by outside forces, like smoking, and, apparently, your sleep habits.

    While the results are not conclusive and don’t suggest sleeping in earlier you’ll be cutting your risk of heart disease, they do imply that there’s a connection between good sleep and heart health.

    Amy Hansen

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  • How does heat kill? It confuses your brain. It shuts down your organs. It overworks your heart.

    How does heat kill? It confuses your brain. It shuts down your organs. It overworks your heart.

    As temperatures and humidity soar outside, what’s happening inside the human body can become a life-or-death battle decided by just a few degrees.

    The critical danger point outdoors for illness and death from relentless heat is several degrees lower than experts once thought, say researchers who put people in hot boxes to see what happens to them.

    With much of the United States, Mexico, India and the Middle East suffering through blistering heat waves, worsened by human-caused climate change, several doctors, physiologists and other experts explained to The Associated Press what happens to the human body in such heat.

    The body’s resting core temperature is typically about 98.6 degrees Fahrenheit (37 degrees Celsius).

    That’s only 7 degrees (4 Celsius) away from catastrophe in the form of heatstroke, said Ollie Jay, a professor of heat and health at the University of Sydney in Australia, where he runs the thermoergonomics laboratory.

    Dr. Neil Gandhi, emergency medicine director at Houston Methodist Hospital, said during heat waves anyone who comes in with a fever of 102 or higher and no clear source of infection will be looked at for heat exhaustion or the more severe heatstroke.

    “We routinely will see core temperatures greater than 104, 105 degrees during some of the heat episodes,” Gandhi said. Another degree or three and such a patient is at high risk of death, he said.

    Heat kills in three main ways, Jay said. The usual first suspect is heatstroke — critical increases in body temperature that cause organs to fail.

    When inner body temperature gets too hot, the body redirects blood flow toward the skin to cool down, Jay said. But that diverts blood and oxygen away from the stomach and intestines, and can allow toxins normally confined to the gut area to leak into circulation.

    “That sets off a cascade of effects,” Jay said. “Clotting around the body and multiple organ failure and, ultimately, death.”

    But the bigger killer in heat is the strain on the heart, especially for people who have cardiovascular disease, Jay said.

    It again starts with blood rushing to the skin to help shed core heat. That causes blood pressure to drop. The heart responds by trying to pump more blood to keep you from passing out.

    “You’re asking the heart to do a lot more work than it usually has to do,” Jay said. For someone with a heart condition “it’s like running for a bus with dodgy (hamstring). Something’s going to give.”

    The third main way is dangerous dehydration. As people sweat, they lose liquids to a point that can severely stress kidneys, Jay said.

    Many people may not realize their danger, Houston’s Gandhi said.

    Dehydration can progress into shock, causing organs to shut down from lack of blood, oxygen and nutrients, leading to seizures and death, said Dr. Renee Salas, a Harvard University professor of public health and an emergency room physician at Massachusetts General Hospital.

    “Dehydration can be very dangerous and even deadly for everyone if it gets bad enough — but it is especially dangerous for those with medical conditions and on certain medications,” Salas said.

    Dehydration also reduces blood flow and magnifies cardiac problems, Jay said.

    Heat also affects the brain. It can cause a person to have confusion, or trouble thinking, several doctors said.

    “One of the first symptoms you’re getting into trouble with the heat is if you get confused,” said University of Washington public health and climate professor Kris Ebi. That’s little help as a symptom because the person suffering from the heat is unlikely to recognize it, she said. And it becomes a bigger problem as people age.

    One of the classic definitions of heat stroke is a core body temperature of 104 degrees “coupled with cognitive dysfunction,” said Pennsylvania State University physiology professor W. Larry Kenney.

    Some scientists use a complicated outside temperature measurement called wet bulb globe temperature, which takes into account humidity, solar radiation and wind. In the past, it was thought that a wet-bulb reading of 95 Fahrenheit (35 Celsius) was the point when the body started having trouble, said Kenney, who also runs a hot box lab and has done nearly 600 tests with volunteers.

    His tests show the wet-bulb danger point is closer to 87 (30.5 Celsius). That’s a figure that has started to appear in the Middle East, he said.

    And that’s just for young healthy people. For older people, the danger point is a wet bulb temperature of 82 (28 degrees Celsius), he said.

    “Humid heat waves kill a lot more people than dry heat waves,” Kenney said.

    When Kenney tested young and old people in dry heat, young volunteers could function until 125.6 degrees (52 degrees Celsius), while the elderly had to stop at 109.4 (43 degrees Celsius). With high or moderate humidity, the people could not function at nearly as high a temperature, he said.

    “Humidity impacts the ability of sweat to evaporate,” Jay said.

    Heatstroke is an emergency, and medical workers try to cool a victim down within 30 minutes, Salas said.

    The best way: Cold water immersion. Basically, “you drop them in a water bucket,” Salas said.

    But those aren’t always around. So emergency rooms pump patients with cool fluids intravenously, spray them with misters, put ice packs in armpits and groins and place them on a chilling mat with cold water running inside it.

    Sometimes it doesn’t work.

    “We call it the silent killer because it’s not this kind of visually dramatic event,” Jay said. “It’s insidious. It’s hidden.”

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    This story has corrected to “humidity,” rather than “temperature” in a mention of how people’s function is affected by humidity.

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    Read more of AP’s climate coverage at http://www.apnews.com/climate-and-environment

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    Follow Seth Borenstein on X at @borenbears

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    The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

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  • What Should We Eat?  | NutritionFacts.org

    What Should We Eat?  | NutritionFacts.org

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

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

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

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

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

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

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

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

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

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

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

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

    For more on eggs, see here.

    On fish, go here.

    And, for poultry, see related posts below. 

    Michael Greger M.D. FACLM

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  • Plastic surgeon charged in death of wife who went into cardiac arrest

    Plastic surgeon charged in death of wife who went into cardiac arrest

    PENSACOLA, Fla. — A plastic surgeon in the Florida Panhandle was charged with his wife’s death after she suffered a cardiac arrest and died days after he performed after-hours procedures on her in his clinic last year, authorities said.

    Benjamin Brown was arrested Monday on a charge of manslaughter by culpable negligence, which is a second-degree felony. He was released from the Santa Rosa County Jail after posting a $50,000 bond.

    His defense attorney said Tuesday that Benjamin Brown intended to plead not guilty. An arraignment was scheduled for next month.

    “Dr. Brown intends to plead not guilty and vigorously fight the allegations against him in court,” defense attorney Barry Beroset said in a phone call.

    Brown’s wife, Hillary Brown, went into cardiac arrest in November while her husband was performing procedures on her at his clinic in the Pensacola area, according to the Santa Rosa County Sheriff’s Office. She was taken to a hospital and died a week later, the sheriff’s office said.

    Last month, the Florida Department of Health filed an administrative complaint before the state Board of Medicine, seeking penalties against Brown up to the revocation or suspension of his license. The complaint involved his wife’s case and other cases.

    Unsupervised by her husband or any other health care practitioner, Hillary Brown prepared her own local anesthesia and filled intravenous bags for the procedures which included arm liposuction, lip injections and an ear adjustment, according to the Department of Health complaint.

    She also ingested several pills, including a sedative, pain killer and antibiotic, before falling into a sedated state, though the consumption of those pills wasn’t documented, the complaint said.

    “The minimum prevailing professional standard of care requires that physicians not permit a patient to prepare medication for use in their own surgery,” the complaint said.

    During the procedures, Hillary Brown’s feet began twitching and she told her husband that her vision was starting to blur and that she saw “orange.” Benjamin Brown injected more lidocaine, an anesthetic, into her face. The Department of Health said she became unresponsive and had a seizure.

    A medical assistant asked Benjamin Brown if they should call 911, and he said “no,” according to the complaint. Over the next 10 or 20 minutes, the medical assistant repeated her question about whether they should call for paramedics, and he said, “no” or “wait,” the complaint said.

    When Hillary Brown’s breathing became shallow and her pulse and blood oxygen levels became low, after about 10 to 20 minutes, Benjamin Brown told his assistants to call 911 and he began performing resuscitation efforts on her, the complaint said.

    However, a medical assistant told a sheriff’s office investigator that she made the decision to call 911, not Benjamin Brown. Emergency room doctors at the hospital where Hillary Brown was transported later told the investigator that they treated her for lidocaine toxicity, according to a sheriff’s office report.

    Also last month, the Department of Health issued an emergency order restricting Benjamin Brown’s license to performing procedures only at a hospital under the supervision of another physician. His wife had given injections and performed laser treatment on patients even though she wasn’t a licensed health care practitioner, the order said.

    Addressing the procedures involving his wife last November, the order noted that muscle twitches and blurred vision are early signs of lidocaine toxicity. The order described Benjamin Brown’s treatment of his wife as “careless and haphazard.”

    “The level of disregard that Dr. Brown paid to patient safety, even when the patient was his wife, indicates that Dr. Brown is unwilling or incapable of providing the appropriate level of care his future patients,” the order said.

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  • What Should We Drink?  | NutritionFacts.org

    What Should We Drink?  | NutritionFacts.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    What about diet soda? See related posts below. 

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

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

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

    Michael Greger M.D. FACLM

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  • Teen died from eating spicy chip in social media challenge, autopsy report concludes

    Teen died from eating spicy chip in social media challenge, autopsy report concludes

    BOSTON — A Massachusetts teen who participated in a spicy tortilla chip challenge on social media died from eating a large quantity of chile pepper extract and also had a congenital heart defect, according to autopsy results obtained by The Associated Press.

    Harris Wolobah, a 10th grader from the city of Worcester, died on Sept. 1, 2023, after eating the chip manufactured by Paqui, a Texas-based subsidiary of the Hershey Co.

    Paqui pulled the product from store shelves shortly after Harris’ death. The Associated Press sent an email seeking comment to Hershey on Thursday.

    A phone number listed for Harris’ family was disconnected. The Associated Press left messages seeking comment with family friends.

    Harris died of cardiopulmonary arrest “in the setting of recent ingestion of food substance with high capsaicin concentration,” according to the autopsy from the Chief Office of the Medical Examiner. Capsaicin is the component that gives chile peppers their heat.

    The autopsy also said that Harris had cardiomegaly, meaning an enlarged heart, and a congenital defect described as “myocardial bridging of the left anterior descending coronary artery.”

    A myocardial bridge occurs when a segment of a major artery of the heart runs within the heart muscle instead of on its surface, according to Dr. James Udelson, chief of cardiology at Tufts Medical Center.

    “It is possible that with significant stimulation of the heart, the muscle beyond the bridge suddenly had abnormal blood flow (‘ischemia’) and could have been a cause of a severe arrhythmia,” Udelson told the AP in an email. “There have been reports of acute toxicity with capsaicin causing ischemia of the heart muscle.”

    Large doses of capsaicin can increase how the heart squeezes, putting extra pressure on the artery, noted Dr. Syed Haider, a cardiologist at MedStar Washington Hospital Center.

    But while the autopsy results suggest that a heart defect probably made Harris more vulnerable to the negative effects of the chile pepper extract, people without underlying risk factors can also experience serious heart problems from ingesting large amounts of capsaicin, Haider said.

    Udelson and Haider both spoke in general terms; neither was involved in Harris’ case.

    The cause of Harris’ death was determined on Feb. 27, and a death certificate was released to the Worcester city clerk’s office on March 5, according to Elaine Driscoll, a spokesperson for the Massachusetts Executive Office of Public Safety and Security. The state only released the cause and manner of death. Officials will not release a full report, which is not considered part of the public record, she said.

    The Paqui chip, sold individually for about $10, came wrapped in foil in a coffin-shaped box containing the warning that it was intended for the “vengeful pleasure of intense heat and pain.” The warning noted that the chip was for adult consumption only, and should be kept out of the reach of children.

    Despite the warning, children had no problem buying the chips, and there had been reports from around the country of teens who got sick after taking part in the chip-eating challenge. Among them were three California high school students who were taken to a hospital and seven students in Minnesota who were treated by paramedics after taking part in the challenge in 2022.

    The challenge called for participants to eat the Paqui chip and then see how long they could go without consuming other food and water. Sales of the chip seemed largely driven by people posting videos on social media of them or their friends taking the challenge. They showed people, including children, unwrapping the packaging, eating the chips and then reacting to the heat. Some videos showed people gagging, coughing and begging for water.

    Spicy food challenges have been around for years. From local chile pepper eating contests to restaurant walls of fame for those who finished extra hot dishes, people around the world have been daring each other to eat especially fiery foods, with some experts pointing to the internal rush of competition and risk-taking.

    A YouTube series called “Hot Ones” rose to internet fame several years ago with videos of celebrities’ reactions to eating spicy wings. Meanwhile, restaurants nationwide have offered in-person challenges — from Buffalo Wild Wings’ “Blazin’ Challenge” to the “Hell Challenge” of Wing King in Las Vegas. In both challenges, patrons over 18 can attempt to eat a certain amount of wings doused in extra hot sauce in limited time without drinking or eating other food. Chile pepper eating contests are also regularly hosted around the world.

    Extremely spicy products created and marketed solely for the challenges — and possible internet fame — represent a more recent phenomenon exacerbated by social media.

    Harris’ death spurred warnings from Massachusetts authorities and physicians, who cautioned that eating such spicy foods can have unintended consequences. Since the chip fad emerged, poison control centers have warned that the concentrated amount could cause allergic reactions, trouble breathing, irregular heartbeats and even heart attacks or strokes.

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    This story has been edited to conform to AP style: chile, instead of chili.

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    AP Medical Writer Lauran Neergaard in Washington and AP Business Writer Dee-Ann Durbin in Detroit contributed to this report.

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  • How Healthy Are Ancient Grains?  | NutritionFacts.org

    How Healthy Are Ancient Grains?  | NutritionFacts.org

    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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  • Circadian Rhythms and Our Blood Sugar Levels  | NutritionFacts.org

    Circadian Rhythms and Our Blood Sugar Levels  | NutritionFacts.org

    The same meal eaten at the wrong time of day can double blood sugar. 

    We’ve known for more than half a century that our glucose tolerance—the ability of our body to keep our blood sugars under control—declines as the day goes on. As you can see in the graph below and at 0:25 in my video How Circadian Rhythms Affect Blood Sugar Levels, if you hook yourself up to an IV and drip sugar water into your vein at a steady pace throughout the day, your blood sugars will start to go up at about 8:00 pm, even though you haven’t eaten anything and the infusion rate didn’t change.

    The same amount of sugar is going into your system every minute, but your ability to handle it deteriorates in the evening before bouncing right back in the morning. A meal eaten at 8:00 pm can cause twice the blood sugar response as an identical meal eaten at 8:00 am, as shown in the graph below and at 0:51 in my video. It’s as if you ate twice as much. Your body just isn’t expecting you to be eating when it’s dark outside. Our species may have only discovered how to use fire about a quarter million years ago. We just weren’t built for 24-hour diners. 

    One of the tests for diabetes is called the glucose tolerance test, which sees how fast our body can clear sugar from our bloodstream. You swig down a cup of water with about four and a half tablespoons of regular corn syrup mixed in, then have your blood sugar measured two hours later. By that point, your blood sugar should be under 140 mg/dL. Between 140 and 199 is considered to be a sign of prediabetes, and 200 and up is a sign of full-blown diabetes, as you can see in the graph below and at 1:37 in my video. 

    The circadian rhythm of glucose tolerance is so powerful that a person can test normal in the morning but as a prediabetic later in the day. Prediabetics who average 163 mg/dL at 7:00 am may test out as frank diabetics at over 200 mg/dL at 7:00 pm, as you can see in the graph below and at 1:53 in my video. 

    Choosing lower glycemic foods may help promote weight loss, but timing is critical. Due to this circadian pattern in glucose tolerance, a low-glycemic food at night can cause a higher blood sugar spike than a high-glycemic food eaten in the morning, as you can see below and at 2:05 in my video.

    We’re so metabolically crippled at night that researchers found that eating a bowl of All Bran cereal at 8:00 pm caused as high a blood sugar spike as eating Rice Krispies at 8:00 am, as you can see in the graph below and at 2:23 in my video.

    High glycemic foods at night would seem to represent the worst of both worlds. So, if you’re going to eat refined grains and sugary junk, it might be less detrimental in the morning, as you can see in the graph below and at 2:32 in my video.  

    The drop in glucose tolerance over the day could therefore help explain the weight-loss benefits of frontloading calories towards the beginning of the day. Even just taking lunch earlier versus later may make a difference, as you can see in the graph below and at 2:48 in my video.

    People randomized to eat a large lunch at 4:30 pm suffered a 46 percent greater blood sugar response compared to an identical meal eaten just a few hours earlier at 1:00 pm. A meal at 7:00 am can cause 37 percent lower blood sugars than an identical meal at 1:00 pm, as you can see below, and at 3:04 in my video.

    Now, there doesn’t seem to be any difference between a meal at 8:00 pm and the same meal at midnight; they both seem to be too late, as you can see below, and at 3:15 in my video.

    But, eating that late, at midnight or even 11:00 pm, can so disrupt your circadian rhythm that it can mess up your metabolism the next morning, resulting in significantly higher blood sugars after breakfast, compared to eating the same dinner at 6:00 pm the evening before, as shown in the graph below and at 3:32 in my video.

    So, these revelations of chronobiology bring the breakfast debate full circle. Skipping breakfast not only generally fails to cause weight loss, but it worsens overall daily blood sugar control in both diabetic individuals and people who are not diabetic, as you can see in the graph below and at 3:44 in my video.

    Below and at 3:53, you can see a graph showing how the breakfast skippers have higher blood sugars even while they’re sleeping 20 hours later. This may help explain why those who skip breakfast appear to be at higher risk of developing type 2 diabetes in the first place. 

    Breakfast skippers also tend to have higher rates of heart disease, as well as having higher rates of atherosclerosis, in general. Is this just because “skipping breakfast tends to cluster with other unhealthy choices, including smoking” and sicklier eating habits overall? The link between skipping breakfast and heart disease—even premature death in general—seems to survive attempts to control for these confounding factors, but you don’t really know until you put it to the test.

    Does skipping breakfast lead to higher cholesterol, for example? Yes, researchers found a significant rise in LDL (bad) cholesterol in study participants randomized to skip breakfast; they were about 10 points higher within just two weeks, as you can see below and at 4:45 in my video.

    The Israeli study with the caloric distribution of 700 calories for breakfast, 500 for lunch, and 200 for dinner that I’ve discussed previously found that the triglycerides of the king-prince-pauper group (those eating more at breakfast versus dinner) got significantly better—a 60-point drop—while those of the pauper-prince-king group got significantly worse (a 26-point rise). So, consuming more calories in the morning relative to the evening may actually have a triple benefit: more weight loss, better blood sugar control, and lower heart disease risk, as you can see below and at 5:18 in my video. 

    If you’re going to skip any meal, whether you’re practicing intermittent fasting or time-restricted feeding (where you try to fit all of your food intake into a certain time window each day), it may be safer and more effective to skip dinner rather than breakfast.

    I’m back with the next installment of the chronobiology series! I previously explored eating breakfast for weight loss (Is Breakfast the Most Important Meal for Weight Loss? and Is Skipping Breakfast Better for Weight Loss?), introduced chronobiology (How Circadian Rhythms Can Control Your Health and Weight), and looked at the science on eating more in the mornings than the evenings (Eat More Calories in the Morning to Lose Weight, Breakfast Like a King, Lunch Like a Prince, Dinner Like a Pauper, and Eat More Calories in the Morning Than the Evening).

    Next, you’ll see How to Sync Your Central Circadian Clock to Your Peripheral Clocks.

    The series will wrap up in the next couple of weeks. See videos and blogs in related posts below.

    Note: The Israeli 700/500/200 study that I mentioned is detailed in the Breakfast Like a King, Lunch Like a Prince, Dinner Like a Pauper video if you want to know more. Also, check the corresponding blog in related posts. 

    Michael Greger M.D. FACLM

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  • A King’s Breakfast, a Prince’s Lunch, and a Pauper’s Dinner  | NutritionFacts.org

    A King’s Breakfast, a Prince’s Lunch, and a Pauper’s Dinner  | NutritionFacts.org

    Harness the power of your circadian rhythms for weight loss by making breakfast or lunch your main meal of the day.

    In my last chronobiology video, we learned that calories eaten at breakfast are significantly less fattening than the same number of calories eaten at dinner, as you can see at 0:14 in my video Breakfast Like a King, Lunch Like a Prince, Dinner Like a Pauper, but who eats just one meal a day? 

    What about simply shifting our daily distribution of calories to earlier in the day? Israeli researchers randomized overweight and obese women into one of two isocaloric groups, meaning each group was given the same number of total calories. One group got a 700-calorie breakfast, a 500-calorie lunch, and a 200-calorie dinner, and the other group got the opposite—200 calories for breakfast, 500 for lunch, and 700 for dinner. Since all of the study participants were eating the same number of calories overall, the king-prince-pauper group should have lost the same amount of weight as the pauper-prince-king group, right? But, no. As you can see in the graph below and at 1:01 in my video, the bigger breakfast group lost more than twice as much weight, in addition to slimming about an extra two inches off their waistline. By the end of the 12-week study, the king-prince-pauper group lost 11 more pounds than the bigger dinner group, dropping 19 pounds compared to only 8 pounds lost by the pauper-prince-king group—despite eating the same number of calories. That’s the power of chronobiology, the power of our circadian rhythm. 

    What was the caloric distribution of the king-prince-pauper group getting 700 calories at breakfast, 500 at lunch, and 200 at dinner? They got 50 percent of calories at breakfast, 36 percent at lunch, and only 14 percent of calories at dinner, which is pretty skewed. What about 20 percent for dinner instead? A 50% – 30% – 20% spread, compared to 20% – 30% – 50%?

    Again, the bigger breakfast group experienced “dramatically increased” weight loss, a difference of about nine pounds in eight weeks with no significant difference in overall caloric intake or physical activity between the groups, as shown in the graph below and at 1:57 in my video. 

    Instead of 80 percent of calories consumed at breakfast and lunch, what about 70 percent compared to 55 percent? Researchers randomized overweight “homemakers” to eat 70 percent of their calories at breakfast, a morning snack, and lunch, leaving 30 percent for an afternoon snack and dinner, or a more balanced 55 percent from the time they woke up through lunch. In both cases, only a minority of calories were eaten for dinner, as you can see below, and at 2:25 in my video. Was there any difference between eating 70 percent of calories through lunch versus only 55 percent? Yes, those eating more calories earlier in the day had significantly more weight loss and slimming. 

    Concluded the researchers: “Stories about food and nutrition are in the news on an almost daily basis, but information can sometimes be confusing and contradictory. Clear messages should be proposed to reach the greatest number of people. One clear communication from physicians could be ‘If you want to lose weight, eat more in the morning than in the evening.’” 

    Even just telling people to eat their main meal at lunch rather than dinner may help. Despite comparable caloric intakes, participants in a weight-loss program randomized to get advice to make lunch their main meal beat out those who instead were told to make dinner their main meal.

    The proverb “Eat breakfast like a king, lunch like a prince, and dinner like a pauper” evidently has another variant: “Eat breakfast yourself, share lunch with a friend, and give dinner away to your enemy.” I wouldn’t go that far, but there does appear to be a metabolic benefit to frontloading the bulk of your calories earlier in the day.

    The evidence isn’t completely consistent, though. A review of dietary pattern studies questioned whether reducing evening intake would facilitate weight loss, citing a study that showed the evening-weighted group did better than the heavy-morning-meal group. Perhaps that was because the morning meal group was given “chocolate, cookies, cake, ice cream, chocolate mousse or donuts” for breakfast. So, chronobiology can be trumped by a junk-food methodology. Overall, the what is still more important than the when. Caloric timing may be used to accelerate weight loss, but it doesn’t substitute for a healthy diet. When he said there was a time for every purpose under heaven, Ecclesiastes probably wasn’t talking about donuts.

    When I heard about this, what I wanted to know was how. Why does our body store less food as fat in the morning? I explore the mechanism in my next video, Eat More Calories in the Morning Than the Evening.

    This is the fifth video in an 11-part series on chronobiology. If you missed the first four, check out the related posts below. 

    Michael Greger M.D. FACLM

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  • Lose Weight by Eating More in the Morning  | NutritionFacts.org

    Lose Weight by Eating More in the Morning  | NutritionFacts.org

    A calorie is not a calorie. It isn’t only what you eat, but when you eat.

    Mice are nocturnal creatures. They eat during the night and sleep during the day. However, if you only feed mice during the day, they gain more weight than if they were fed a similar amount of calories at night. Same food and about the same amount of food, but different weight outcomes, as you can see in the graph below and at 0:18 in my video Eat More Calories in the Morning to Lose Weight, suggesting that eating at the “wrong” time may lead to disproportionate weight gain. In humans, the wrong time would presumably mean eating at night. 

    Recommendations for weight management often include advice to limit nighttime food consumption, but this was largely anecdotal until it was first studied experimentally in 2013. Researchers instructed a group of young men not to eat after 7:00 pm for two weeks. Compared to a control period during which they continued their regular habits, they ended up about two pounds lighter after the night-eating restriction. This is not surprising, given that dietary records show the study participants inadvertently ate fewer calories during that time. To see if timing has metabolic effects beyond just foreclosing eating opportunities, you’d have to force people to eat the same amount of the same food, but at different times of the day. The U.S. Army stepped forward to carry out just such an investigation.

    In their first set of experiments, Army researchers had people eat a single meal a day either as breakfast or dinner. The results clearly showed the breakfast group lost more weight, as you can see in the graph below and at 1:35 in my video. When study participants ate only once a day at dinner, their weight didn’t change much, but when they ate once a day at breakfast, they lost about two pounds a week. 

    Similar to the night-eating restriction study, this is to be expected, given that people tend to be hungrier in the evening. Think about it. If you went nine hours without eating during the day, you’d be famished, but people go nine hours without eating overnight all the time and don’t wake up ravenous. There is a natural circadian rhythm to hunger that peaks around 8:00 pm and drops to its lowest level around 8:00 am, as you can see in the graph below and at 2:09 in my video. That may be why breakfast is typically the smallest meal of the day. 

    The circadian rhythm of our appetite isn’t just behavioral, but biological, too. It’s not just that we’re hungrier in the evening because we’ve been running around all day. If you stayed up all night and slept all day, you’d still be hungriest when you woke up that evening. To untangle the factors, scientists used what’s called a “forced desynchrony” protocol. Study participants stayed in a room without windows in constant, unchanging, dim light and slept in staggered 20-hour cycles to totally scramble them up. This went on for more than a week, so the subjects ended up eating and sleeping at different times throughout all phases of the day. Then, the researchers could see if cyclical phenomena are truly based on internal clocks or just a consequence of what you happen to be doing at the time.  

    For instance, there is a daily swing in our core body temperature, blood pressure, hormone production, digestion, immune activity, and almost everything else, but let’s use temperature as an example. As you can see in the graph below and at 3:21 in my video, our body temperature usually bottoms out around 4:00 am, dropping from 98.6°F (37°C) down to more like 97.6°F (36.4°C). Is this just because our body cools down as we sleep? No. By keeping people awake and busy for 24 hours straight, it can be shown experimentally that it happens at about the same time no matter what. It’s part of our circadian rhythm, just like our appetite. It makes sense, then, if you are only eating one meal per day and want to lose weight, you’d want to eat in the morning when your hunger hormones are at their lowest level. 

    Sounds reasonable, but it starts to get weird.

    The Army scientists repeated the experiment, but this time, they had the participants eat exactly 2,000 calories either as breakfast or as dinner, taking appetite out of the picture. The subjects weren’t allowed to exercise either. Same number of calories, so the same change in weight, right? No. As you can see in the graph below and at 4:18 in my video, the breakfast-only group still lost about two pounds a week compared to the dinner-only group. Two pounds of weight loss eating the same number of calories. That’s why this concept of chronobiology, meal timing—when to eat—is so important. 

    Isn’t that wild? Two pounds of weight loss a week eating the same number of calories! That was a pretty extreme study, though. What about just shifting a greater percentage of calories to earlier in the day? That’s the subject of my next video: Breakfast Like a King, Lunch Like a Prince, Dinner Like a Pauper. First, let’s take a break from chronobiology to look at the Benefits of Garlic for Fighting Cancer and the Common Cold. Then, we’ll resume checking other videos in the related posts below.

    If you missed the first three videos in this extended series, also check out related posts below. 

    Michael Greger M.D. FACLM

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  • The Pros of Garlic Powder for Heart Disease  | NutritionFacts.org

    The Pros of Garlic Powder for Heart Disease  | NutritionFacts.org

    See what a penny a day’s worth of garlic powder can do.

    In ancient Greece, “the Art of Medicine was divided into three parts”: cures through diet, cures through drugs, and cures through surgery. Garlic, Hippocrates wrote, was one such medicinal food, but that was to treat a nonexistent entity called “displacement of the womb,” so ancient wisdom can only go so far.

    Those who eat more than a clove of garlic a day do seem to have better artery function than those who eat less than that, but you don’t know if it’s cause-and-effect until you put it to the test. 

    As I discuss in my video Benefits of Garlic Powder for Heart Disease, heart disease patients were randomized to receive either garlic powder or placebo tablets two times a day for three months. Those lucky enough to be in the garlic group got a significant boost in their artery function—a 50 percent increase in function from taking only 800 mg of garlic powder a day. That’s just a quarter teaspoon of garlic powder. A 50 percent increase in artery function for less than a penny daily!

    If regular, plain old garlic powder can do that, what about those fancy Kyolic® aged garlic extract supplements? They can be 30 times more expensive and don’t work at all. After four weeks, there was zero significant improvement. It’s hard to improve on Mother Nature.

    Garlic powder can improve the function of our arteries, but what about the structure of our arteries? Dozens of studies on garlic all compiled together show that garlic can reduce cholesterol levels in the blood by more than 16 points. So, might garlic powder actually be able to slow the progression of atherosclerosis? Researchers studied a garlic powder tablet versus a placebo for three months. As you can see below and at 1:42 in my video, the placebo group got worse, which is what tends to happen. Eat the same artery-clogging diet, and your arteries continue to clog. However, the progression of the disease appeared to slow and even stall in the garlic group. 

    Of course, it would be nice to see the thickening of the artery wall reverse, but, for that, one might have to add more plants than just garlic to one’s diet. Still, though, that same quarter teaspoon of a simple spice available everywhere may be considered as an adjunct treatment for atherosclerosis, the number one killer of both men and women in the United States and around much of the world.

    What about garlic for high blood pressure? A systematic review and meta-analysis of randomized controlled trials “demonstrated that garlic has a statistically significant and clinically meaningful effect” on both systolic and diastolic blood pressures, reducing the top number by nearly seven and the bottom number by about five. That may not sound like a lot, but reducing diastolic blood pressure (the bottom number) by five points can reduce the risk of stroke by about a third and heart disease by 25 percent, as you can see in the graph below and at 2:38 in my video. 

    “Plant-based medicine provides beneficial effects, alongside with only minimal or no complications”—that is, little or no side effects—“and compared to other medicine are relatively cost-effective.” I’d say so, at as little as a penny per day.

    What else can garlic do? See related posts below.

    Here’s a tasty, garlicky recipe from The How Not to Die Cookbook: Garlic Caesar Salad Dressing. 

    Of course, the best way to treat heart disease is to simply get rid of it by treating the underlying cause. See How Not to Die from Heart Disease.

    Michael Greger M.D. FACLM

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  • Fighting Inflammation with Flaxseeds  | NutritionFacts.org

    Fighting Inflammation with Flaxseeds  | NutritionFacts.org

    Elevated levels of pro-inflammatory, aging-associated oxylipins can be normalized by eating ground flaxseed. 

    I previously explored the “Potent Antihypertensive Effect of Dietary Flaxseed in Hypertensive Patients” study in my video Flaxseeds for Hypertension. That was a double-blind, randomized, placebo-controlled trial where researchers disguised ground flaxseed in baked goods versus flax-free placebo muffins and saw an extraordinary drop in high blood pressure. As you can imagine, the flaxseed industry was overjoyed, praising the “impressive” findings, as was I. After all, high blood pressure is “the single largest risk factor” for death in the world. Yes, we give people medications, lots and lots of medications, but most people don’t take them. Nine out of ten people take less than 80 percent of their prescribed blood pressure pills. 
     
    It’s not difficult to understand why. “Patients are asked to follow an inconvenient and potentially costly regimen, which will likely have a detrimental effect on health-related quality of life, to treat a mostly asymptomatic condition that commonly does not cause problems for many years.” So, they may feel worse instead of better, due to the side effects. Then, some think the answer is to give them even more drugs to counteract the effects of the first drugs, like giving men Viagra to counteract the erectile dysfunction caused by their blood pressure pills. 
     
    How about using a dietary strategy instead, especially if it can be just as effective? And, indeed, the drop in blood pressure the researchers saw in the flaxseed study “was greater than the average decrease observed with the standard dose of anti-hypertensive medications.” Flaxseeds are cheaper, too, compared to even single medications, and most patients are on multiple drugs. Plus, flaxseeds have good side effects beyond their anti-hypertensive actions. Taking tablespoons of flaxseed a day is a lot of fiber for people living off of cheeseburgers and milkshakes their whole lives, and your gut bacteria may need a little time to adjust to the new bounty. So, those who start with low-fiber diets may want to take it a little slow with the flaxseeds at first. 
     
    Not all studies have shown significant blood pressure–lowering effects, though. There have been more than a dozen trials by now, involving more than a thousand subjects. And, yes, when you put them all together, overall, there were “significant reductions in both SBP and DBP”—systolic blood pressure (the upper number) and diastolic blood pressure (the lower number)—“following supplementation with various flaxseed products.” But none was as dramatic as what the researchers had found in that six-month trial. The longer trials tended to show better results, and some of the trials just used flaxseed oil or some kind of flaxseed extract. We think this is because the whole is greater than the sum of its parts. “Each of the components of interest within flaxseed, ALA, lignans, fiber, and peptides”—the omega-3s, the cancer-fighting lignans, all the soluble fiber, and the plant proteins, for instance—“all contribute towards BP reduction.” Okay, but how? Why? What is the mechanism? 
     
    Some common blood-pressure medications like Norvasc or Procardia work in part by reducing the ability of the heart to contract or by slowing down the heart. So, might it be that’s how flaxseeds work, too? But, no. In my video Benefits of Flaxseeds for Inflammation, I profile the “Dietary Flaxseed Reduces Central Aortic Blood Pressure Without Cardiac Involvement but Through Changes in Plasma Oxylipins” study. What are oxylipins? 
     
    “Oxylipins are a group of fatty acid metabolites” involved in inflammation and, as a result, have been implicated in many pro-inflammatory conditions, including aging and cardiovascular disease. “The best-characterized oxylipins about cardiovascular disease are derived from the w-6 fatty acid arachidonic acid,” a long-chain omega-6 fatty acid. These are found preformed in animal products, particularly chicken and eggs, and can be made inside the body from junky oils rich in omega-6, such as cottonseed oil, as noted below and at 3:49 in my video. But, as this study is titled, “Elevated levels of pro-inflammatory oxylipins in older subjects are normalized by flaxseed consumption.” 

    That’s how we think flaxseed consumption reduces blood pressure in patients with hypertension: by inhibiting the enzyme that makes these pro-inflammatory oxylipins. I’ll spare you from acronym overload, but eating flaxseeds inhibits the activity of the enzyme that makes these pro-inflammatory oxylipins, called leukotoxin diols, which in turn may lower blood pressure. “Identifying the biological mechanism adds confidence to the antihypertensive actions of dietary flaxseed,” but that’s not all oxylipins do. Oxylipins may also play a role in the aging process. However, we may be able to “beneficially disrupt these biological changes associated with inflammation and aging” with a nutritional intervention like flaxseed. Older adults around age 50 have higher levels of this arachidonic acid–derived oxylipin compared to younger adults around age 20, as you can see in the graph below and at 4:56 in my video. “These elevated concentrations of pro-inflammatory oxylipins in the older age group…may…explain the higher levels of inflammation in older versus younger individuals.” As we get older, we’re more likely to be stricken with inflammatory conditions like arthritis. So, this “elevation of pro-inflammatory oxylipins…may predispose individuals to chronic disease conditions.”

    What if you took those older adults and gave them muffins, like the ones with ground flaxseed? That’s just what a group of researchers did. Four weeks later, the subjects’ levels dropped down to like 20-year-olds’ levels, as seen in the graph below and at 5:32 in my video, “demonstrating that a potential therapeutic strategy to correct the deleterious pro-inflammatory oxylipin profile is via a dietary supplementation with flaxseed.”

    What about flax and cancer? See the related posts below. 

    I also have a video on diabetes: Flaxseeds vs. Diabetes. 

    If you’re interested in weight loss, see Benefits of Flaxseed Meal for Weight Loss. 

    What about the cyanide content of flax? I answered that in Friday Favorites: How Well Does Cooking Destroy the Cyanide in Flaxseeds and Should We Be Concerned About It?.

    What else can help fight inflammation? Check out in related posts below.

    Michael Greger M.D. FACLM

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  • 5 Questions I Asked After Two Heart Attacks

    5 Questions I Asked After Two Heart Attacks

    Photos courtesy of Lentheus Chaney

    February is national Heart Month

    As the surgical technician rolled my hospital bed into the frigid operating room, my uneasiness grew, and my mind raced with questions about how and why this was happening again. 

    Within a four-month period, doctors placed four stents to restore proper blood flow to my heart. This procedure was more intense than the previous; this time my right arm felt like it was on fire, and I could feel the heart catheter inching its way from my right wrist to the left side of my chest. All I could do was lie still and pray to survive this unexpected diagnosis of heart disease.

    Although death rates within the county I was living in were improving, it didn’t make me feel any better. My cardiologist could not explain why I had experienced another cardiac event in such a short time. The uncertainty took an emotional toll on me, making it difficult to sleep for fear of not waking up.

    Lentheus Chaney

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  • How Safe Is Alternate-Day Intermittent Fasting?  | NutritionFacts.org

    How Safe Is Alternate-Day Intermittent Fasting?  | NutritionFacts.org


    Eating every other day can raise your cholesterol. 
     
    Are there any downsides to fasting every other day? For example, might go all day without eating impair your ability to think clearly? Surprisingly, as I discuss in my video Is Alternate-Day Intermittent Fasting Safe?, the results appear to be “equivocal.” Some studies show no measurable effects and the ones that do fail to agree on which cognitive domains are affected. Might the cycles of fasting and feasting cause eating disorder–type behaviors, like bingeing? So far, no harmful psychological effects have been found. In fact, there may be some benefit. However, the studies that have put it to the test specifically excluded those with a documented history of eating disorders, for whom the effects may differ. 
     
    What about bone health? No change in bone mineral density was noted after six months of alternate-day fasting despite about 16 pounds of weight loss, which would typically result in a dip in bone mass. However, the researchers did not note any skeletal changes in the control group either, and they lost a similar amount of weight using continuous caloric restriction. They suggested this is because both groups tended to be “more physically active than the average obese American,” getting about 1,000 to 2,000 more steps a day. 
     
    Proponents of intermittent fasting suggest it can better protect lean body mass, but most of the intermittent trials have employed less accurate methods of body composition analysis, whereas the majority of continuous caloric restriction trials used “vastly more accurate techniques.” So, to date, it is not clear if there’s a difference in lean mass preservation. 
     
    Improvements in blood pressure and triglycerides have been noted on intermittent fasting regimens, though this is presumed to be due to the reduction in body fat since the effect appears to be “dependent on the amount of weight lost.” Alternate-day fasting can improve artery function, too, as you can see in the graph below and at 1:55 in my video, though it does depend on what you’re eating on the non-fasting day. For study participants randomized to an alternate-day diet high in saturated fat, their artery function worsened despite a ten-pound weight loss, whereas it improved, as expected, in the lower-fat group. The decline in artery function was presumed to be because of the pro-inflammatory nature of saturated fat. 

    A concern has been raised about the effects of alternate-day fasting on cholesterol. After 24 hours without food, LDL cholesterol may temporarily bump up, but this is presumably because so much fat is being released into the system by the fast. As you can see in the graph below and at 2:33 in my video, an immediate negative effect on carbohydrate tolerance may stem from the same phenomenon—the repeated elevations of free fat floating around in the bloodstream. After a few weeks, though, LDL levels start to drop as the weight comes off. However, results from the largest and longest trial of alternate-day fasting have given me pause. 


    A hundred obese men and women were randomized into one of three groups: alternate-day modified fasting (25 percent of their baseline calories on fasting days and 125 percent calories on eating days), continuous, daily caloric restriction (75 percent of baseline), or a control group instructed to maintain their regular diet. So, for those going into the trial eating 2,000 calories a day, they would continue to eat 2,000 calories a day in the control group. The calorie-restriction group would get 1,500 calories every day, and the intermittent-restriction group would alternate between 500 calories a day and 2,500 calories the next. 
     
    As you can see in the graph below and at 3:32 in my video, with the same overall, average, prescribed calorie cutting in the two weight-loss groups, they both lost about the same amount of weight, but, surprisingly, the cholesterol effects were different. In the continuous calorie-restriction group, the LDL levels dropped as expected compared to the control group as the pounds came off. 

    But, in the alternate-day modified fasting group, they didn’t, as you can see below, and at 3:55 in my video. At the end of the year, the LDL cholesterol in the intermittent fasting group ended up being 10 percent higher than in the constant calorie-restriction group—despite the same loss of body fat. Given that LDL cholesterol is a prime causal risk factor for heart disease, our number one killer—or is even the prime risk factor—this strikes a significant blow against alternate-day fasting. If you want to try it anyway, I would advise you to have your cholesterol monitored to make sure it comes down with your weight. 


    If you’re diabetic, you must talk with your physician about medication adjustment for any changes in diet, including fasting of any duration. Even with proactive medication reduction, advice to immediately break the fast should sugars drop too low, and weekly medical supervision, people with type 2 diabetes who fasted for even just two days a week were twice as likely to suffer from hypoglycemic episodes compared to an unfasted control group. We still don’t know the best way to tweak blood sugar medications to prevent blood sugar from dropping too low on fasting days. 
     
    Even fasting for just one day can significantly slow the clearance of some drugs (like the blood-thinning drug Coumadin) or increase the clearance of others (like caffeine). Fasting for 36 hours can cut your caffeine buzz by 20 percent. So, consultation with your medical professional before fasting is an especially good idea for anyone on any kind of medication. 

    If you missed it, check out Alternate-Day Intermittent Fasting Put to the Test. 
     
    So, with ambiguous cognitive, lean mass, and bone effects, plus these cholesterol findings, I wouldn’t suggest alternate-day fasting for weight loss, but dropping pounds isn’t the only thing this way of eating is purported to do. Check out Does Intermittent Fasting Increase Human Life Expectancy?. 
     
    For other types of intermittent fasting, total fasting, and more on fasting, check out the related videos below. 





    Michael Greger M.D. FACLM

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  • Flavonoid Benefits from Apple Peels  | NutritionFacts.org

    Flavonoid Benefits from Apple Peels  | NutritionFacts.org

    Peeled apples are pitted head-to-head against unpeeled apples (and spinach) in a test of artery function. 

    Regularly eating apples may contribute to a lower risk of dying prematurely. “Moderate apple consumption,” meaning one or two apples a week, “was associated with a 20% lower risk of all-cause mortality”—that is, dying from all causes put together—“whereas those who ate an apple a day had a 35% lower risk of all-cause mortality compared with women with low apple consumption.” 
     
    You’ll often hear me talking about a lower or higher risk of mortality, but what does that mean? Isn’t the risk of dying 100 percent for everyone, eventually? As you can see in my graph below and at 0:40 in my video Friday Favorites: For Flavonoid Benefits, Don’t Peel Apples, I present some survival curves to help you visualize these concepts. For example, if you follow thousands of older women over time, nearly half succumb over a period of 15 years, but that half includes those who rarely, if ever, ate apples—less than 20 apples a year. Instead, those averaging more like half a small apple a day lived longer; over the same time period, closer to 40 percent or so of them died. And, those who ate one small apple or about a quarter of a large apple a day survived even longer. 

    Why is that the case? It seems to be less the apple of one’s eye than the apple of one’s arteries. Even a fraction of an apple a day is associated with 24 percent lower odds of having severe major artery calcifications, a marker of vascular disease. You may think that’s an obvious benefit since apples are fruits and fruits are healthy, but the effect was not found for pears, oranges, or bananas. 
     
    Both of these studies were done on women, but a similar effect (with apples and onions) was found for men. We think it’s because of the flavonoids, naturally occurring phytonutrients concentrated in apples. As you can see below and at 2:02 in my video, they’re thought to improve artery function and lower blood pressure, leading to improvements in blood flow throughout the body and brain, thereby decreasing the risk of heart disease and strokes. You don’t know, though, until you put it to the test.


    When I first saw a paper on testing flavonoid-rich apples, I assumed they had selectively bred or genetically engineered a special apple. But, no. The high-flavonoid apple was just an apple with its peel, compared to the low-flavonoid apple, which was the exact same apple with its peel removed. After eating the apples, flavonoid levels in the bloodstream shot up over the next three hours in the unpeeled apple group, compared to the peeled group, as you can see below, and at 2:36 in my video. This coincided with significantly improved artery function in the unpeeled apple group compared to the peeled one. The researchers concluded that “the lower risk of CVD [cardiovascular disease] with higher apple consumption is most likely due to the high concentration of flavonoids in the skin which improve endothelial [arterial] function”—though, it could be anything in the peel. All we know is that apple peels are particularly good for us, improving artery function and lowering blood pressure. 
    Even compared to spinach? As you can see in the graph below and at 3:14 in my video, if you give someone about three-quarters of a cup of cooked spinach, their blood pressure drops within two to three hours. If you instead eat an apple with some extra peel thrown in, you get a similar effect. The researchers concluded that apples and spinach almost immediately improve artery function and lower blood pressure. 
    What’s nice about these results is that we’re talking about whole foods, not some supplement or extract. So, easily, “this could be translated into a natural and low-cost method of reducing the cardiovascular risk profile of the general population.” 

    For more about apples, see the topic page and check out the related videos below. 

    What about dried apples? See Dried Apples vs. Cholesterol. What about apple cider vinegar? Check out Flashback Friday: Does Apple Cider Vinegar Help with Weight Loss?. And what about apples going head-to-head with açai berries? See The Antioxidant Effects of Açai vs. Apples.

    Michael Greger M.D. FACLM

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  • Some mosquitoes like it hot

    Some mosquitoes like it hot

    Newswise — Certain populations of mosquitoes are more heat tolerant and better equipped to survive heat waves than others, according to new research from Washington University in St. Louis.

    This is bad news in a world where vector-borne diseases are an increasingly global health concern. Most models that scientists use to estimate vector-borne disease risk currently assume that mosquito heat tolerances do not vary. As a result, these models may underestimate mosquitoes’ ability to spread diseases in a warming world.

    Researchers led by Katie M. Westby, a senior scientist at Tyson Research Center, Washington University’s environmental field station, conducted a new study that measured the critical thermal maximum (CTmax), an organism’s upper thermal tolerance limit, of eight populations of the globally invasive tiger mosquito, Aedes albopictus. The tiger mosquito is a known vector for many viruses including West Nile, chikungunya and dengue.

    “We found significant differences across populations for both adults and larvae, and these differences were more pronounced for adults,” Westby said. The new study is published Jan. 8 in Frontiers in Ecology and Evolution.

    Westby’s team sampled mosquitoes from eight different populations spanning four climate zones across the eastern United States, including mosquitoes from locations in New Orleans; St. Augustine, Fla.; Huntsville, Ala.; Stillwater, Okla.; St. Louis; Urbana, Ill.; College Park, Md.; and Allegheny County, Pa.

    The scientists collected eggs in the wild and raised larvae from the different geographic locations to adult stages in the lab, tending the mosquito populations separately as they continued to breed and grow. The scientists then used adults and larvae from subsequent generations of these captive-raised mosquitoes in trials to determine CTmax values, ramping up air and water temperatures at a rate of 1 degree Celsius per minute using established research protocols.

    The team then tested the relationship between climatic variables measured near each population source and the CTmax of adults and larvae. The scientists found significant differences among the mosquito populations.

    The differences did not appear to follow a simple latitudinal or temperature-dependent pattern, but there were some important trends. Mosquito populations from locations with higher precipitation had higher CTmax values. Overall, the results reveal that mean and maximum seasonal temperatures, relative humidity and annual precipitation may all be important climatic factors in determining CTmax.

    “Larvae had significantly higher thermal limits than adults, and this likely results from different selection pressures for terrestrial adults and aquatic larvae,” said Benjamin Orlinick, first author of the paper and a former undergraduate research fellow at Tyson Research Center. “It appears that adult Ae. albopictus are experiencing temperatures closer to their CTmax than larvae, possibly explaining why there are more differences among adult populations.”

    “The overall trend is for increased heat tolerance with increasing precipitation,” Westby said. “It could be that wetter climates allow mosquitoes to endure hotter temperatures due to decreases in desiccation, as humidity and temperature are known to interact and influence mosquito survival.”

    Little is known about how different vector populations, like those of this kind of mosquito, are adapted to their local climate, nor the potential for vectors to adapt to a rapidly changing climate. This study is one of the few to consider the upper limits of survivability in high temperatures — akin to heat waves — as opposed to the limits imposed by cold winters.

    “Standing genetic variation in heat tolerance is necessary for organisms to adapt to higher temperatures,” Westby said. “That’s why it was important for us to experimentally determine if this mosquito exhibits variation before we can begin to test how, or if, it will adapt to a warmer world.”

    Future research in the lab aims to determine the upper limits that mosquitoes will seek out hosts for blood meals in the field, where they spend the hottest parts of the day when temperatures get above those thresholds, and if they are already adapting to higher temperatures. “Determining this is key to understanding how climate change will impact disease transmission in the real world,” Westby said. “Mosquitoes in the wild experience fluctuating daily temperatures and humidity that we cannot fully replicate in the lab.”

    Washington University in St. Louis

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  • Keto Diets and Diabetes  | NutritionFacts.org

    Keto Diets and Diabetes  | NutritionFacts.org

    Ketogenic diets are put to the test for diabetes reversal. 
     
    As you can see at the start of my video Does a Ketogenic Diet Help Diabetes or Make It Worse?, ketogenic diets can lower blood sugars better than conventional diets. So much so, in fact, that there is a keto product company that claims ketogenic diets can “reverse” diabetes. However, they are confusing the symptom (high blood sugars) with the disease (carbohydrate intolerance). People with diabetes can’t properly handle carbohydrates, and this manifests as high blood sugars. Clearly, if you stick to eating mostly fat, your blood sugars will stay low, but you may be actually making the underlying disease worse at the same time. 
     
    We’ve known for nearly a century that if you put people on a ketogenic diet, their carbohydrate intolerance can skyrocket within just two days. Below and at 0:46 in my video, you can see a graph from the study showing the blood sugar response two days after eating sugar. On a high-carb diet, blood sugar response is about 90 mg/dL. But, the blood sugar response to the same amount of sugar after a high-fat diet is about 190 mg/dL, nearly double. The intolerance to carbohydrates skyrocketed on a high-fat diet. 

    After one week on an 80 percent fat diet, you can quintuple your blood sugar spike in reaction to the same carb load compared to a week on a low-fat diet, as you can see in the graph below and at 1:12 in my video. 

    Even a single day of excessive dietary fat intake can do it, as you can see in the graph below and at 1:26 in my video. If you’re going in for a diabetes test, having a fatty dinner the night before can adversely affect your results. Just one meal high in saturated fat can make carbohydrate intolerance, the cause of diabetes, worse within four hours. 


    Given enough weight loss by any means, whether from cholera or bariatric surgery, type 2 diabetes can be reversed, but a keto diet for diabetes may not just be papering over the cracks, but actively throwing fuel on the fire. 
     
    I’ve been trying to think of a good metaphor. It’s easy to come up with things that just treat the symptoms without helping the underlying disease, like giving someone with pneumonia aspirin for their fever instead of antibiotics. However, a keto diet for diabetes is worse than that because it may treat the symptoms while actively worsening the disease. It may be more like curing the fever by throwing that pneumonia patient out into a snow bank or “curing” your amputated finger by amputating your hand. One of the co-founders of masteringdiabetes.org suggested it’s like a CEO who makes their bad bottom line look better by borrowing tons of cash. The outward numbers look better, but on the inside, the company is just digging itself into a bigger hole. 
     
    Do you remember The Club, that popular car anti-theft device that attaches to the steering wheel and locks it in place so the steering column can only turn a few inches? Imagine you’re in a car at the top of a hill with the steering wheel locked. Then, the car starts rolling down the hill. What do you do? Imagine there’s also something stuck under your brake pedal. The keto-diet equivalent response to this situation is who cares if you’re barreling down into traffic with a locked steering wheel and no brakes—just stick to really straight deserted roads without any stop signs or traffic lights. If you do that, problem solved! The longer you go, the more speed you’ll pick up. If you should hit a dietary bump in the road or start to veer off the path, the consequences could get more and more disastrous over time. However, if you stick to the keto straight and narrow, you’ll be a-okay! In contrast, the non-keto response would be to just unlock the steering wheel and dislodge whatever’s under your brake. In other words, fix the underlying problem instead of just whistling past—and then into—the graveyard. 
     
    The reason keto proponents claim they can “reverse” diabetes is they can successfully wean type 2 diabetics off their insulin. That’s like faith-healing someone out of the need for a wheelchair by making them stay in bed the rest of their life. No need for a wheelchair if you never move. Their carbohydrate intolerance isn’t gone. Their diabetes isn’t gone. In fact, it could be just as bad or even worse. Type 2 diabetes is reversed when you are weaned off insulin while eating a normal diet like everyone else. Then and only then do you not have diabetes anymore. A true diabetes reversal diet, as you can see below and at 4:58 in my video, is practically the opposite of a ketogenic diet: getting diabetics off their insulin within a matter of weeks by eating more than 300 grams of carbs a day! 
    The irony doesn’t stop there. One of the reasons people with diabetes suffer such nerve and artery damage is due to an inflammatory metabolic toxin known as methylglyoxal, which forms at high blood sugar levels. Methylglyoxal is the most potent creator of advanced glycation end products (AGEs), which are implicated in degenerative diseases—from Alzheimer’s and cataracts to kidney disease and strokes, as you can see below and at 5:31 in my video. 

    You get AGEs in your body from two sources: You can eat them preformed in your diet or make them internally from methylglyoxal if you have high blood sugar levels. On a keto diet, one would expect high exposure to preformed AGEs, since they’re found concentrated in animal-derived foods high in fat and protein, but we would expect less internal, new formation due to presumably low levels of methylglyoxal, given lower blood sugars from not eating carbs. Dartmouth researchers were surprised to find more methylglyoxal! As shown in the graph below and at 6:11 in my video, a few weeks on the Atkins diet led to a significant increase in methylglyoxal levels. Those in active ketosis did even worse, doubling the level of this glycotoxin in their bloodstream. 

    It turns out that high sugars may not be the only way to create this toxin, as you can see below and at 6:24 in my video. One of the ketones you make on a ketogenic diet is acetone (known for its starring role in nail polish remover). Acetone does more than just make keto dieters fail breathalyzer tests, “feel queasy and light-headed, and develop what’s been described as ‘rotten apple breath.’” Acetone can oxidize in the blood to form acetol, which may be a precursor for methylglyoxal.

    That may be why keto dieters can end up with levels of this glycotoxin as high as those with out-of-control diabetes, which can cause the nerve damage and blood vessel damage you see in diabetics. That’s another way keto dieters can end up with a heart attack. The irony of treating diabetes with a ketogenic diet may extend beyond just making the underlying diabetes worse, but by mimicking some of the disease’s dire consequences. 

    This is part of a seven-video series on keto, which you can find in related videos below.

    I also recently tackled diabetes.

    Michael Greger M.D. FACLM

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  • Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

    Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

    Ketogenic diets have been found to undermine exercise efforts and lead to muscle shrinkage and bone loss. 
     
    An official International Society of Sports Nutrition position paper covering keto diets notes the “ergolytic effect” of keto diets on both high- and low-intensity workouts. Ergolytic is the opposite of ergogenic. Ergogenic means performance-boosting, whereas ergolytic means performance-impairing. 
     
    For nonathletes, ketosis may also undermine exercise efforts. Ketosis was correlated with increased feelings of “perceived exercise effort” and “also significantly correlated to feelings of ‘fatigue’ and to ‘total mood disturbance,’” during physical activity. “Together, these data suggest that the ability and desire to maintain sustained exercise might be adversely impacted in individuals adhering to ketogenic diets for weight loss.” 
     
    You may recall that I’ve previously discussed that shrinkage of measured muscle mass among CrossFit trainees has been reported. So, a ketogenic diet may not just blunt the performance of endurance athletes, but their strength training as well. As I discuss in my video Keto Diets: Muscle Growth and Bone Density, study participants performed eight weeks of the battery of standard upper and lower body training protocols, like bench presses, pull-ups, squats, and deadlifts, and there was no surprise. You boost muscle mass—unless you’re on a keto diet, in which case there was no significant change in muscle mass after all that effort. Those randomized to a non-ketogenic diet added about three pounds of muscle mass, whereas the same amount of weight lifting on the keto diet tended to subtract muscle mass by about 3.5 ounces on average. How else could you do eight weeks of weight training and not gain a single ounce of muscle on a ketogenic diet? Even keto diet advocates call bodybuilding on a ketogenic diet an “oxymoron.” 
     
    What about bone loss? Sadly, bone fractures are one of the side effects that disproportionately plague children placed on ketogenic diets, along with slowed growth and kidney stones. Ketogenic diets may cause a steady rate of bone loss as measured in the spine, presumed to be because ketones are acidic, so keto diets can put people in what’s called a “chronic acidotic state.” 
     
    Some of the case reports of children on keto diets are truly heart-wrenching. One nine-year-old girl seemed to get it all, including osteoporosis, bone fractures, and kidney stones, then she got pancreatitis and died. Pancreatitis can be triggered by having too much fat in your blood. As you can see in the graph below and at 2:48 in my video, a single high-fat meal can cause a quintupling of the spike in triglycerides in your bloodstream within hours of consumption, which can put you at risk for inflammation of the pancreas.  

    The young girl had a rare genetic disorder called glucose transporter deficiency syndrome. She was born with a defect in ferrying blood sugar into her brain. That can result in daily seizures starting in infancy, but a ketogenic diet can be used as a way to sneak fuel into the brain, which makes a keto diet a godsend for the 1 in 90,000 families stricken with this disorder.

    As with anything in medicine, it’s all about risks versus benefits. As many as 30 percent of patients with epilepsy don’t respond to anti-seizure drugs. Unfortunately, the alternatives aren’t pretty and can include brain surgery that implants deep electrodes through the skull or even removes a lobe of your brain. This can obviously lead to serious side effects, but so can having seizures every day. If a ketogenic diet can help with seizures, the pros can far outweigh the cons. For those just choosing a diet to lose weight, though, the cost-benefit analysis would really seem to go the other way. Thankfully, you don’t need to mortgage your long-term health for short-term weight loss. We can get the best of both worlds by choosing a healthy diet, as I discussed in my video Flashback Friday: The Weight Loss Program That Got Better with Time.
     
    Remember the study that showed the weight loss was nearly identical in those who had been told to eat the low-carb Atkins diet for a year and those told to eat the low-fat Ornish diet, as seen below and at 4:18 in my video? The authors concluded, “This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.” That seems like terrible advice. 

    There are regimens out there like “The Last Chance Diet which consisted of a low-calorie liquid formula made from leftover byproducts from a slaughterhouse [that] was linked to approximately 60 deaths from cardiovascular-related events.” An ensuing failed lawsuit from one widower laid the precedent for the First Amendment protection for those who produce deadly diet books. 

    It’s possible to construct a healthy low-carb diet or an unhealthy low-fat one—a diet of cotton candy would be zero fat—but the health effects of a typical low-carb ketogenic diet like Atkins are vastly different from a low-fat plant-based diet like Ornish’s. As you can see in the graph below and at 5:26 in my video, they would have diametrically opposed effects on cardiovascular risk factors in theory, based on the fiber, saturated fat, and cholesterol contents of their representative meal plans. 

    And when actually put to the test, low-carb diets were found to impair artery function. Over time, blood flow to the heart muscle itself is improved on an Ornish-style diet and diminished on a low-carb one, as shown below and at 5:44 in my video. Heart disease tends to progress on typical weight-loss diets and actively worsens on low-carb diets, but it may be reversed by an Ornish-style diet. Given that heart disease is the number one killer of men and women, “recommending any diet that a patient will adhere to in order to lose weight” seems irresponsible. Why not tell people to smoke? Cigarettes can cause weight loss, too, as can tuberculosis and a meth habit. The goal of weight loss is not to lighten the load for your pallbearers. 

     
    For more on keto diets, see my videos on the topic. Interested in enhancing athletic performance? Check out the related videos below. 

    Michael Greger M.D. FACLM

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  • USC's Bronny James returns to full-contact practice for 1st time since cardiac arrest

    USC's Bronny James returns to full-contact practice for 1st time since cardiac arrest

    Bronny James has returned to full-contact practice for the first time since suffering cardiac arrest in July, paving the way for the son of Los Angeles Lakers superstar LeBron James to make his college debut for Southern California

    ByBETH HARRIS AP sports writer

    December 7, 2023, 7:21 PM

    Southern California guard Bronny James warms up before an NCAA college basketball game against Gonzaga Saturday, Dec. 2, 2023, in Las Vegas. (AP Photo/Sam Morris)

    The Associated Press

    LOS ANGELES — Bronny James returned to full-contact basketball practice on Thursday for the first time since suffering cardiac arrest in July, paving the way for the son of Los Angeles Lakers superstar LeBron James to make his college debut with Southern California.

    The Trojans host Long Beach State on Sunday.

    “It’ll be a determination how he feels personally and our doctors and trainers and our strength coach, but all indication is he feels great and he looks good,” USC coach Andy Enfield said after practice.

    James would come off the bench and be on a minutes restriction in his debut, Enfield said.

    The elder James has said he would attend his son’s first game regardless of whether the Lakers were playing the same day. The Lakers are off Sunday.

    ___

    Get poll alerts and updates on AP Top 25 basketball throughout the season. Sign up here

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    AP college basketball: https://apnews.com/hub/ap-top-25-college-basketball-poll and https://apnews.com/hub/college-basketball

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  • The Safety of Keto Diets  | NutritionFacts.org

    The Safety of Keto Diets  | NutritionFacts.org

    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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