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Tag: Heart Disease

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

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

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

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

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

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

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

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

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

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

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

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

    We’ll explore some other possibilities, next.

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

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

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

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    Michael Greger M.D. FACLM

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  • The Stroke Risk of Vegetarians  | NutritionFacts.org

    The Stroke Risk of Vegetarians  | NutritionFacts.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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    Michael Greger M.D. FACLM

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

    Eating to Lower Lp(a)  | NutritionFacts.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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    Michael Greger M.D. FACLM

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  • How to Treat High Lp(a), an Atherosclerosis Risk Factor  | NutritionFacts.org

    How to Treat High Lp(a), an Atherosclerosis Risk Factor  | NutritionFacts.org

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    What could help explain severe coronary disease in someone with a healthy lifestyle who is considered to be at low cardiovascular disease risk? A young man ended up in the ER after a heart attack and was ultimately found to have severe coronary artery disease. Given his age, blood pressure, and cholesterol, his ten-year risk of a heart attack should have only been about 2 percent, but he had a high lipoprotein(a), also known as Lp(a). In fact, it was markedly high at 80 mg/dL, which may help explain it. You can see the same in women: a 27-year-old with a heart attack with a high Lp(a). What is Lp(a), and what can we do about it? 

    As I discuss in my video Treating High Lp(a): A Risk Factor for Atherosclerosis, Lp(a) is an “underestimated cardiovascular risk factor.” It causes coronary artery disease, heart attacks, strokes, peripheral arterial disease, calcified aortic valve disease, and heart failure. And these can occur in people who don’t even have high cholesterol—because Lp(a) is cholesterol, as you can see below and at 1:15 in my video. It’s an LDL cholesterol molecule linked to another protein, which, like LDL, transfers cholesterol into the lining of our arteries, contributing to the inflammation in atherosclerotic plaques. But “this increased risk caused by Lp(a) has not yet gained recognition by practicing physicians.” 

    “The main reason for the limited clinical use of Lp(a) is the lack of effective and specific therapies to lower Lp(a) plasma levels.” Because “Lp(a) concentrations are approximately 90% genetically determined,” the conventional thinking has been you’re just kind of born with higher or lower levels and there isn’t much you can do about it. Even if that were the case, though, you might still want to know about it. If it were high, for instance, that would be all the more reason to make sure all the other risk factors that you do have more control over are as good as possible. It may help you quit smoking, for example, and motivate you to do everything you can to lower your LDL cholesterol as much as possible.  

    Lp(a) levels in the blood can vary a thousand-fold between individuals, “from less than 0.1 mg/dL to as high as 387 mg/dL.” You can see a graph of the odds of heart disease at different levels in the graph below and at 2:20 in my video. Less than 20 mg/dL is probably optimal, with greater than 30 to 50 mg/dL considered to be elevated. Even when the more conservative threshold of greater than 50 mg/dL is used, that describes about 10 to 30 percent of the global population, an estimated 1.4 billion people. So, if we’re in the one in five people with elevated levels, what can we do about it? 

    The way we know that Lp(a) causes atherosclerosis is that we can put it to the ultimate test. There is something called apheresis, which is essentially like a dialysis machine where they can take out your blood, wash out some of the Lp(a), and give your blood back to you. And when you do that, you can reverse the progression of the disease. As you can see in the graph below and at 3:06 in my video, atherosclerosis continues to get worse in the control group, but it gets better in the apheresis group. This is great for proving the role of Lp(a), but it has limited clinical application, given the “cost, limited access to centers, and the time commitment required for biweekly sessions of 2 to 4 h each.” 

    It causes a big drop in blood levels, but they quickly creep back up, so you have to keep going in, as you can see in the graph below and at 3:26 in my video, costing more than $50,000 a year. 

    There has to be a better way. We’ll explore the role diet can play, next.  

    I’ve been wanting to do videos about Lp(a), but there just wasn’t much we could do about it until now. So, how do we lower Lp(a) with diet? Stay tuned for the exciting conclusion in my next video.

    What can we do to minimize heart disease risk? My video How Not to Die from Heart Disease is a good starting point. 

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    Michael Greger M.D. FACLM

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

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

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

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

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

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

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    The chubby tyrant is known for his smoking

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Kim kept 40th birthday celebrations under wraps

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

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

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

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    Owen Leonard

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  • One Positive Sleep Habit Can Be Doubly Good

    One Positive Sleep Habit Can Be Doubly Good

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    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.

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    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.

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    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.”

    ___

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

    ___

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

    ___

    Follow Seth Borenstein on X at @borenbears

    ______

    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

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

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

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

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

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

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

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

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

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

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

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

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

    For more on eggs, see here.

    On fish, go here.

    And, for poultry, see related posts below. 

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    Michael Greger M.D. FACLM

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

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

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    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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    What about diet soda? See related posts below. 

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

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

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

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    Michael Greger M.D. FACLM

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  • 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

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    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.

    ___

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

    ___

    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

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    Ancient types of wheat, like kamut, are put to the test for inflammation, blood sugar, and cholesterol control. 

    The number one killer in the United States and around the world is what we eat. As you can see in the graph below and at 0:15 in my video Friday Favorites: Are Ancient Grains Healthier?, our diet kills millions more than tobacco. What are the five most important things we can do to improve our diets, based on the single most comprehensive global study of the health impact of nutrition? Eat less salt, eat more nuts, eat more non-starchy vegetables, eat more fruit, and, finally, eat more whole grains. 
    Any particular type of whole grains? What about so-called ancient grains? Are they any better than modern varieties? For instance, what about kamut, described as “mummy wheat” and supposedly unearthed from an Egyptian tomb?

    After WWII, the wheat industry selected particularly high-yielding varieties for pasta and bread. Over the past few years, though, some of the more ancient grains—“defined as those species that have remained unchanged over the last hundred years” despite agricultural revolutions—have been reintroduced to the market.

    As you can see below and at 1:13 in my video, nutritionally, kamut and einkorn wheat, which is the oldest wheat, have more eyesight-improving yellow carotenoid pigments, such as lutein and zeaxanthin, compared to modern bread and pastry wheat, because the pigments have been bred out of the bread intentionally. People want their white bread white, but modern pasta flour (durum wheat) maintains much of that yellow nutritional hue. 

    As you can see in the graph below and at 1:41 in my video, modern wheat may have less lutein, but it tends to have more vitamin E, as seen in the graph below and at 1:45. Based on straight vitamin and mineral concentrations, it’s pretty much a wash. Both modern and primitive kinds of wheat have a lot of each, but primitive wheats do have more antioxidant capacity, likely due to their greater polyphenol content, as you can see in the graph below and at 2:00 in my video. To know if that makes any difference, though, we have to put it to the test. 

    If you expose human liver cells to digested bread made out of ancient grains (kamut and spelt), heritage kinds of wheat, or modern strains, then expose the cells to an inflammatory stimulus, the modern wheat strains seem less able to suppress the inflammation, as you can see in the graphs below and at 2:09 in my video. The investigators conclude that even though these different grains seem to be very similar nutritionally, they appear to exert different effects on human cells, “confirming the potential health benefits of ancient grains.” 
    That was in a petri dish, though. What about people? If ancient kinds of wheat are better at suppressing inflammation, what if you took people with irritable bowel syndrome (IBS) and randomized them to receive six weeks of wheat products made out of modern wheat or ancient wheat—in this case, kamut? Same amount of wheat, just different types. If there is no difference between the wheats, there’d be no difference in people’s symptoms, right? But, when study participants in the control group were switched to the ancient wheat kamut, they experienced less abdominal pain, less frequent pain, less bloating, more satisfaction with stool consistency, and less interference with their quality of life, compared to the modern wheat. So, after switching to the ancient wheat, they had “a significant global improvement in the extent and severity of symptoms related to IBS…”

    What about liver inflammation? The liver function of those with nonalcoholic fatty liver disease randomized to eat kamut improved, compared to those eating the same amount of regular wheat, suggesting kamut is superior, as you can see below and at 3:47 in my video.

    People with diabetes, had better cholesterol and better insulin sensitivity on the same ancient grain, as shown below and at 3:57.

    And those with heart disease? They had better blood sugar control and better cholesterol, as shown below and at 4:03. 

    And, people without overt heart disease had better artery function, as you can see below and at 4:06 in my video.

    The bottom line is that findings derived from human studies suggest that ancient wheat products are more anti-inflammatory and may improve things like blood sugar control and cholesterol. “Given that the overall number of human interventional trials conducted to date are numerically insufficient, it is not possible to definitively conclude that ancient wheat varieties are superior to all commercial, modern wheat counterparts in reducing chronic disease risk.” However, the best available data do suggest they’re better for us.  

    Regardless of what type of wheat you may eat, a word to the wise: Don’t eat the plastic bread-bag clip. A 45-year-old man presented with bloody stools, and his CT scan showed the offending piece of plastic from his bag of bread, as you can see below and at 4:53 in my video. When the patient was questioned, he “admitted to habitually eating quickly without chewing properly.” 

    Whole grains—ideally intact ones and ancient and modern varieties alike—are an integral part of my Daily Dozen checklist, the healthiest of healthy things I encourage everyone to try to fit into their daily routines.  

    Whole grains are especially good for our microbiome. Learn more in the related posts below.  What about gluten? Also, see the related posts below. 

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    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

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    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. 

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    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

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    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. 

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    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

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    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. 

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    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

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    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.

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    Michael Greger M.D. FACLM

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  • Fighting Inflammation with Flaxseeds  | NutritionFacts.org

    Fighting Inflammation with Flaxseeds  | NutritionFacts.org

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    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.

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    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

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    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.

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    Lentheus Chaney

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

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

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    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. 



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    Michael Greger M.D. FACLM

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  • Flavonoid Benefits from Apple Peels  | NutritionFacts.org

    Flavonoid Benefits from Apple Peels  | NutritionFacts.org

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    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.

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    Michael Greger M.D. FACLM

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