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Tag: sodium

  • Plant-Based Hospital Menus | NutritionFacts.org

    The American Medical Association passed a resolution encouraging hospitals to offer healthy plant-based food options.

    “Globally, 11 million deaths annually are attributable to dietary factors, placing poor diet ahead of any other risk factor for death in the world.” Given that diet is our leading killer, you’d think that nutrition education would be emphasized during medical school and training, but there is a deficiency. A systematic review found that, “despite the centrality of nutrition to a healthy lifestyle, graduating medical students are not supported through their education to provide high-quality, effective nutrition care to patients…”

    It could start in undergrad. What’s more important? Learning about humanity’s leading killer or organic chemistry?

    In medical school, students may average only 19 hours of nutrition out of thousands of hours of instruction, and they aren’t even being taught what’s most useful. How many cases of scurvy and beriberi, diseases of dietary deficiency, will they encounter in clinical practice? In contrast, how many of their future patients will be suffering from dietary excesses—obesity, diabetes, hypertension, and heart disease? Those are probably a little more common than scurvy or beriberi. “Nevertheless, fully 95% of cardiologists [surveyed] believe that their role includes personally providing patients with at least basic nutrition information,” yet not even one in ten feels they have an “expert” grasp on the subject.

    If you look at the clinical guidelines for what we should do for our patients with regard to our number one killer, atherosclerotic cardiovascular disease, all treatment begins with a healthy lifestyle, as shown below and at 1:50 in my video Hospitals with 100-Percent Plant-Based Menus.

    “Yet, how can clinicians put these guidelines into practice without adequate training in nutrition?”

    Less than half of medical schools report teaching any nutrition in clinical practice. In fact, they may be effectively teaching anti-nutrition, as “students typically begin medical school with a greater appreciation for the role of nutrition in health than when they leave.” Below and at 2:36 in my video is a figure entitled “Percentage of Medical Students Indicating that Nutrition is Important to Their Careers.” Upon entry to different medical schools, about three-quarters on average felt that nutrition is important to their careers. Smart bunch. Then, after two years of instruction, they were asked the same question, and the numbers plummeted. In fact, at most schools, it fell to 0%. Instead of being educated, they got de-educated. They had the notion that nutrition is important washed right out of their brains. “Thus, preclinical teaching”— the first two years of medical school—“engenders a loss of a sense of the relevance of the applied discipline of nutrition.”

    Following medical school, during residency, nutrition education is “minimal or, more typically, absent.” “Major updates” were released in 2018 for residency and fellowship training requirements, and there were zero requirements for nutrition. “So you could have an internal medicine graduate who comes out of a terrific program and has learned nothing—literally nothing—about nutrition.”

    “Why is diet not routinely addressed in both medical education and practice already, and what should be done about that?” One of the “reasons for the medical silence in nutrition” is that, “sadly…nutrition takes a back seat…because there are few financial incentives to support it.” What can we do about that? The Food Law and Policy Clinic at Harvard Law School identified a dozen different policy levers at all stages of medical education and the kinds of policy recommendations there could be for the decision-makers, as you can see here and at 3:48 in my video.

    For instance, the government could require doctors working for Veterans Affairs (VA) to get at least some courses in nutrition, or we could put questions about nutrition on the board exams so schools would be pressured to teach it. As we are now, even patients who have just had a heart attack aren’t changing their diet. Doctors may not be telling them to do so, and hospitals may be actively undermining their future with the food they serve.

    The good news is that the American Medical Association (AMA) has passed a resolution encouraging hospitals to offer healthy food options. What a concept! “Our AMA hereby calls on [U.S.] Health Care Facilities to improve the health of patients, staff, and visitors by: (a) providing a variety of healthy food, including plant-based meals, and meals that are low in saturated and trans fat, sodium, and added sugars; (b) eliminating processed meats from menus; and (c) providing and promoting healthy beverages.” Nice!

    “Similarly, in 2018, the State of California mandated the availability of plant-based meals for hospital patients,” and there are hospitals in Gainesville (FL), the Bronx, Manhattan, Denver, and Tampa (FL) that “all provide 100% plant-based meals to their patients on a separate menu and provide educational materials to inpatients to improve education on the role of diet, especially plant-based diets, in chronic illness.”

    Let’s check out some of their menu offerings: How about some lentil Bolognese? Or a cauliflower scramble with baked hash browns for breakfast, mushroom ragu for lunch, and, for supper, white bean stew, salad, and fruit for dessert. (This is the first time a hospital menu has ever made me hungry!)

    The key to these transformations was “having a physician advocate and increasing education of staff and patients on the benefits of eating more plant-based foods.” A single clinician can spark change in a whole system, because science is on their side. “Doctors have a unique position in society” to influence policy at all levels; it’s about time we used it.

    For more on the ingrained ignorance of basic clinical nutrition in medicine, see the related posts below.

    Michael Greger M.D. FACLM

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  • 3-MCPD in Refined Cooking Oils | NutritionFacts.org

    There is another reason to avoid palm oil and question the authenticity of extra-virgin olive oil.

    The most commonly used vegetable oil in the world today is palm oil. Pick up any package of processed food in a box, bag, bottle, or jar, and the odds are it will have palm oil. Palm oil not only contains the primary cholesterol-raising saturated fat found mostly in meat and dairy, but concerns have been raised about its safety, given the finding that it may contain a potentially toxic chemical contaminant known as 3-monochloropropane-1,2-diol, otherwise known as 3-MCPD, which is formed during the heat treatment involved in the refining of vegetable oils. So, these contaminants end up being “widespread in refined vegetable oils and fats and have been detected in vegetable fat-containing products, including infant formulas.”

    Although 3-MCPD has been found in all refined vegetable oils, some are worse than others. The lowest levels of the toxic contaminants were found in canola oil, and the highest levels were in palm oil. Based on the available data, this may result in “a significant amount of human exposure,” especially when used to deep-fry salty foods, like french fries. In fact, just five fries could blow through the tolerable daily intake set by the European Food Safety Authority. If you only eat such foods once in a while, it shouldn’t be a problem, but if you’re eating fries every day or so, this could definitely be a health concern.

    Because the daily upper limit is based on body weight, particularly high exposure values were calculated for infants who were on formula rather than breast milk, since formula is made from refined oils, which—according to the European Food Safety Authority—may present a health risk. Estimated U.S. infant exposures may be three to four times worse.

    If infants don’t get breast milk, “there is basically no alternative to industrially produced infant formula.” As such, the vegetable oil industry needs to find a way to reduce the levels of these contaminants. This is yet another reason that breastfeeding is best whenever possible.

    What can adults do to avoid exposure? Since these chemicals are created in the refining process of oils, what about sticking to unrefined oils? Refined oils have up to 32 times the 3-MCPD compared to their unrefined counterparts, but there is an exception: toasted sesame oil. Sesame oil is unrefined; manufacturers just squeeze the sesame seeds. But, because they are squeezing toasted sesame seeds, the 3-MCPD may have come pre-formed.

    Virgin oils are, by definition, unrefined. They haven’t been deodorized, the process by which most of the 3-MCPD is formed. In fact, that’s how you can discriminate between the various processing grades of olive oil. If your so-called extra virgin olive oil contains MCPD, then it must have been diluted with some refined olive oil. The ease of adulterating extra virgin olive oil, the difficulty of detection, the economic drivers, and the lack of control measures all contribute to extra virgin olive oil’s susceptibility to fraud. How widespread a problem is it?

    Researchers tested 88 bottles labeled as extra virgin olive oil and found that only 33 were found to be authentic. Does it help to stick to the top-selling imported brands of extra virgin olive oil? In that case, 73% of those samples failed. Only about one in four appeared to be genuine, and not a single brand had even half its samples pass the test, as you can see here and at 3:32 in my video 3-MCPD in Refined Cooking Oils.

    Doctor’s Note

    If you missed the previous post where I introduced 3-MCPD, see The Side Effects of 3-MCPD in Bragg’s Liquid Aminos.

    There is no substitute for human breast milk. We understand this may not be possible for adoptive families or those who use surrogates, though. In those cases, look for a nearby milk bank.

    Michael Greger M.D. FACLM

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  • Rates of high blood pressure in children have nearly doubled in 20 years

    (CNN) — Global rates of hypertension, or high blood pressure, in childhood and adolescence have nearly doubled since 2000, putting more kids at risk for poor health later in life.

    “In 2000, about 3.4% of boys and 3% of girls had hypertension. By 2020, those numbers had risen to 6.5% and 5.8% respectively,” said Dr. Peige Song, a researcher from the School of Public Health at Zhejiang University School of Medicine in China. Song is one of the authors of a study describing the findings that published Wednesday in the journal The Lancet Child and Adolescent Health.

    Children who have hypertension could be at greater risk later on of developing heart disease –– the No. 1 cause of death in the United States, said Dr. Mingyu Zhang, assistant professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. He was not involved in the research.

    “The good news is that this is a modifiable risk,” Song said in an email. “With better screening, earlier detection, and a stronger focus on prevention, especially around healthy weight and nutrition, we can intervene before complications arise.”

    High blood pressure in kids can be addressed

    The rise in hypertension in children is likely due to many factors.

    Childhood obesity is a significant risk factor, because it is associated with factors like insulin resistance, inflammation and vascular function, Song said.

    Dietary factors such as consuming high levels of sodium and ultraprocessed food can also contribute to hypertension risk, as well as poor sleep quality, stress and genetic predisposition, she said.

    Many children also get less movement than past generations and spend more time on sedentary activities, like screen use, which may be affecting risk, she said.

    “We are also starting to know that other factors, including environmental pollutants, can contribute,” Zhang added.

    Zhang served as senior author on a previous study that showed a connection between prebirth exposure to chemicals called PFAS — a class of about 15,000 human-made compounds linked to cancers, endocrine-related conditions and developmental issues in children — and childhood hypertension. Short for perfluoroalkyl and polyfluoroalkyl substances, PFAS are sometimes called “forever chemicals” because they don’t fully break down in the environment.

    The biggest takeaway of this research for families is not to assume high blood pressure is only a problem for adults, Song said.

    If you are worried about your child’s risk for obesity or hypertension, pressure, shame and restriction are not the best approaches.

    Instead, focus on increasing healthy behaviors in a happy way, said Jill Castle, a pediatric dietitian in Massachusetts, in a previous CNN article.

    “The goal of the food pillar is really to embrace flexibility with food and to emphasize foods that are highly nutritious and … to allow foods also that might be minimally nutritious within the diet in ways that can be fully enjoyed and flexible,” Castle said.

    Try to prioritize sitting down as a family for meals and avoid labeling foods as “good” or “bad,” said Castle, author of “Kids Thrive at Every Size.”

    “The clean plate club or rewarding with sweets — they might work in the moment, but they don’t do a good job of establishing the self-trust and an intuitive, good relationship with food as kids grow up,” Castle said.

    Masked hypertension in children

    The study didn’t just track rates in the United States. Instead, researchers analyzed data from 96 studies across 21 countries.

    Another important consideration the study team made is how blood pressure differs in and outside the doctor’s office. Some children might have normal blood pressure at home, but a higher reading in the office, while others might have a lower blood pressure in the office than they normally would.

    By including data from both office visits and at-home blood pressure readings, the researchers were able to include hypertension rates that are “masked,” or wouldn’t be caught in a doctor’s visit, Zhang said. Masked hypertension was found to be the most common kind, according to the data.

    “This is important because it means that many children with true hypertension could go undetected if we rely only on office blood pressure readings,” he said.

    The result show that one reading may not be enough, and there may be a need for more scalable solutions for better monitoring and care of hypertension around the world, Song added.

    Madeline Holcombe and CNN

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  • A Healthy, Natural Source of Iodine?  | NutritionFacts.org

    How much nori, dulse, or arame approximates the recommended daily allowance for iodine?

    Dairy milk supplies between a quarter and a half of the daily iodine requirement in the United States, though milk itself has “little native iodine.” The iodine content in cow’s milk is mainly determined by factors like “the application of iodine-containing teat disinfectants,” and the “iodine residues in milk originate mainly from the contamination of the teat surface…” Indeed, the teats of dairy cows are typically sprayed or dipped with betadine-type disinfectants, and the iodine just kind of leaches into their milk, as you can see at 0:35 in my video Friday Favorites: The Healthiest Natural Source of Iodine. 

    Too bad most of the plant-based milks on the market aren’t enriched with iodine, too. Fortified soy milk is probably the healthiest of the plant milks, but even if it were enriched with iodine, what about the effects soy may have on thyroid function? When I searched the medical literature on soy and thyroid, this study popped up: “A Cost-Effective, Easily Available Tofu Model for Training Residents in Ultrasound-Guided Fine Needle Thyroid Nodule Targeting Punctures”—an economical way to train residents to do thyroid biopsies by sticking the ultrasound probe right on top a block of tofu and get to business, as you can see below and at 1:10 in my video. It turns out that our thyroid gland looks a lot like tofu on ultrasound.

    Anyway, “the idea that soya may influence thyroid function originated over eight decades ago when marked thyroid enlargement was seen in rats fed raw soybeans.” (People living in Asian countries have consumed soy foods for centuries, though, “with no perceptible thyrotoxic effects,” which certainly suggests their safety.) The bottom line is that there does not seem to be a problem for people who have normal thyroid function. However, soy foods may inhibit the oral absorption of Synthroid and other thyroid hormone replacement drugs, but so do all foods. That’s why we tell patients to take it on an empty stomach. But you also have to be getting enough iodine, so it may be particularly “important for soy food consumers to make sure their intake of iodine is adequate.”

    What’s the best way to get iodine? For those who use table salt, make sure it’s iodized. “Currently, only 53% of salt sold for use in homes contains iodine, and salt used in processed foods typically is not iodized.” Ideally, we shouldn’t add any salt at all, of course, since it is “a public health hazard.” A paper was titled: “Salt, the Neglected Silent Killer.” Think it’s a little over the top? Dietary salt is the number one dietary risk factor for death on planet Earth, wiping out more than three million people a year, twice as bad as not eating your vegetables, as you can see here and at 2:38 in my video. 

    In that case, what’s the best source of iodine then? Sea vegetables, as you can see below and at 2:50. We can get a little iodine here and there from a whole variety of foods, but the most concentrated source by far is seaweed. We can get up to nearly 2,000 percent of our daily allowance in just a single gram, about the weight of a paperclip. 

    “Given that iodine is extensively stored in the thyroid, it can safely be consumed intermittently,” meaning we don’t have to get it every day, “which makes seaweed use in a range of foods attractive and occasional seaweed intake enough to ensure iodine sufficiency.” However, some seaweed has overly high iodine content, like kelp, and should be used with caution. Too much iodine can cause hyperthyroidism, a hyperactive thyroid gland. A woman presented with a racing heartbeat, insomnia, anxiety, and weight loss, thanks to taking just two tablets containing kelp a day.

    In my last video, I noted how the average urinary iodine level of vegans was less than the ideal levels, but there was one kelp-eating vegan with a urinary concentration over 9,000 mcg/liter. Adequate intake is when you’re peeing out 100 to 199 mcg/liter, and excessive iodine intake is when you break 300 mcg/liter. Clearly, 9,437 mcg/liter is way too much. 
     
    As you can see below and at 3:57 in my video, the recommended average daily intake is 150 mcg per day for non-pregnant, non-breastfeeding adults, and we may want to stay below 600 mcg a day on a day-to-day basis, but a tablespoon of kelp may contain about 2,000 mcg. So, I’d stay away from kelp because it has too much iodine, and I’d also stay away from hijiki because it contains too much arsenic. 

    This can give you an approximate daily allowance of iodine from some common seaweed preparations: two nori sheets, which you can just nibble on them as snacks like I do; one teaspoon of dulse flakes, which you can just sprinkle on anything; one teaspoon of dried arame, which is great to add to soups; or one tablespoon of seaweed salad.

    If iodine is concentrated in marine foods, “this raises the question of how early hominins living in continental areas could have met their iodine requirements.” What do bonobos do? They’re perhaps our closest relatives. During swamp visits, they all forage for aquatic herbs.  

    Doctor’s Note:

    This is the second in a four-video series on thyroid function. If you missed the previous one, check out Are Vegans at Risk for Iodine Deficiency?.

    Coming up are The Best Diet for Hypothyroidism and Hyperthyroidism and Diet for Hypothyroidism: A Natural Treatment for Hashimoto’s Disease.

    What else can seaweed do? See the related posts below.

    Michael Greger M.D. FACLM

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  • Vegans and Iodine Deficiency Risk  | NutritionFacts.org

    Most plant-based milks are not fortified with iodine.

    “Adequate dietary iodine is required for normal thyroid function.” In fact, the two thyroid hormones are named after how many iodine atoms they contain: T3 and T4. “Given that iodine is extensively stored in the thyroid gland itself, it can safely be consumed intermittently,” so we don’t need to consume it every day. However, our overall diet does need a good source of it. Unfortunately, the common sources aren’t particularly health-promoting: iodized salt and dairy foods. (Iodine-based cleansers like betadine are used on cows “to sanitize the udders, resulting in leaching of iodine in the milk.”) Iodine may also be added to cattle feed, and some commercially produced breads contain food additives with iodine.

    If you put people on a paleo-type diet and cut out their dairy and table salt, they can develop an iodine deficiency, even though they double their intake of seafood, which can also be a source of iodine. What about those switching to diets centered around whole plant foods? They also cut down on ice cream and Wonder Bread, and if they aren’t eating anything from the sea, like seaweed or other sea vegetables, they can run into the same problem.

    A three-year-old’s parents reported striving to feed her only the healthiest foods, and her diet included only plant-based, unsalted, and unseasoned foods. She got no unprocessed foods, but she also got no vitamin supplementation, which could be deadly. Without vitamin B12, those on strictly plant-based diets can develop irreversible nerve damage, but in this case, a goiter arose first, due to inadequate iodine intake.

    In another case of “veganism as a cause of iodine-deficient hypothyroidism,” a toddler became ill after weaning. Before weaning, he was fine because his mother kept taking her prenatal vitamins, which fortunately contained iodine.

    Most vegetarians and vegans are apparently unaware of the importance of iodine intake during pregnancy, “for the neurodevelopment of the unborn child, similar to their omnivorous counterparts.” The American Thyroid Association and the American Academy of Pediatrics have recommended that women, even just planning on getting pregnant, should take a daily supplement containing 150 micrograms (mcg) of iodine, yet only 60 percent of prenatal vitamins marketed in the United States contain this essential mineral. So, despite the recommendations, about 40 percent of prenatal vitamins don’t contain it. “Therefore, it is extremely important that women, especially when pregnant, breastfeeding, or planning a pregnancy, read the labels of their multivitamin supplements to ensure that they are receiving an adequate amount of iodine.”

    Women of reproductive age have an average iodine level of 110 mcg/liter, which is fine for nonpregnant individuals, but we’d really like women to get at least 150 mcg/liter during pregnancy. (It’s basically a 24-hour urine test, in which iodine sufficiency is defined as 100 mcg/liter of urine in nonpregnant adults; the average vegan failed to reach this in the largest study done to date, one out of Boston.)

    The recommended average daily intake is 150 mcg per day for most people, which we can get in about a cup and a half of cow’s milk. Regrettably, plant-based milks aren’t typically fortified with iodine and average only about 3 mcg per cup. Although many plant-based milks are fortified with calcium, researchers found in the largest systematic study to date that only 3 out of 47 were fortified with iodine. Those that were fortified had as much as cow’s milk, but those that weren’t fell short, as you can see at 3:30 in my video Are Vegans at Risk for Iodine Deficiency?. 

    Plant-based milk companies brag about enriching their milks with calcium and often vitamins B12, D, and A, but only rarely are attempts made to match iodine content. The only reason cow’s milk has so much is that producers enrich the animals’ feed or it comes dripping off their udders. So, why don’t plant-milk companies add iodine, too? I was told by a food scientist at Silk that my carrageenan video played a role in the company switching to another thickener. Hopefully, Silk will see this video, too, and consider adding iodine, or maybe another company will snatch the opportunity for a market advantage.  

    The researchers conclude that individuals who consume plant-based milks not fortified with iodine may be at risk for iodine deficiency, unless they consume alternative dietary iodine sources, the healthiest of which are sea vegetables, which we’ll cover next.

    Doctor’s Note:

    This is the first in a four-video series on thyroid function. The next three are: 

    For more on iodine, see the related posts below.

    Michael Greger M.D. FACLM

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  • Natural Electrolyte Boost for Your Dog: Keeping Your Best Friend Hydrated and Healthy | Animal Wellness Magazine

    Natural Electrolyte Boost for Your Dog: Keeping Your Best Friend Hydrated and Healthy | Animal Wellness Magazine

    Do you have questions about how to keep your canine companions properly hydrated, especially when it comes to electrolytes? These essential minerals play a crucial role in your dog’s health, regulating everything from muscle function to hydration. But when do dogs need electrolyte replenishment, and how can we do it naturally? 

    When does your dog need electrolyte replenishment?

    Dogs may need extra electrolytes after intense exercise, during hot weather, or when they’re experiencing vomiting or diarrhea. Senior dogs or those with certain health conditions might also benefit from electrolyte support. Always consult your vet if you’re unsure whether your pup needs electrolyte supplementation.

    Water — the foundation of hydration 

    Before we get into specific electrolytes, let’s talk about the basics – water! Ensuring your dog has constant access to fresh, clean water is the first step in maintaining proper hydration and electrolyte balance. Some dogs prefer running water, so a doggy fountain might encourage more drinking.

    Sodium and chloride as a salty duo

    Sodium and chloride are key electrolytes often lost through sweating (yes, dogs do sweat, albeit minimally) and panting. While we don’t want to overdo the sodium, a pinch of sea salt in your dog’s water or food can help replenish these electrolytes naturally. Just remember, moderation is key!

    Potassium lives in bananas

    Potassium is another crucial electrolyte. Luckily, many dogs love bananas, a great natural source of potassium. Other dog-safe, potassium-rich foods include sweet potatoes, pumpkin, and watermelon (seeds removed, of course). These can be offered as occasional treats or mixed into your dog’s regular food.

    Calcium is not just for bones

    While we often think of calcium in terms of bone health, it’s also an important electrolyte. Plain, unsweetened yogurt is a great natural source of calcium that many dogs enjoy. Just be sure your pup isn’t lactose intolerant before offering dairy products.

    Magnesium — your multitasking mineral

    Magnesium plays a role in numerous bodily functions. Pumpkin seeds are a magnesium powerhouse and can be a healthy treat for dogs when unsalted and ground up. Leafy greens like spinach also contain magnesium, but introduce these gradually to avoid digestive upset.

    Coconut water is nature’s sports drink 

    Coconut water is often touted as a natural electrolyte drink for humans, and it can benefit dogs too! It’s rich in potassium, calcium, and magnesium. Just make sure it’s pure coconut water without added sugars or flavors. Offer it in small amounts, especially if it’s new to your dog’s diet.

    Bone broth as a nutrient and electrolyte powerhouse

    Homemade bone broth is not only delicious for dogs but also packed with natural electrolytes and other nutrients. Simmer bones in water with a splash of apple cider vinegar to release the minerals. Let the broth cool, remove and discard the bones, skim off any fat, and offer small amounts to your pup.

    Commercial options when natural isn’t enough

    While natural sources are great, sometimes commercial electrolyte solutions designed for dogs are necessary, especially in cases of severe dehydration or illness. Be sure to speak to your vet before using these products.

    Balance is key

    While replenishing electrolytes naturally in dogs can be beneficial, it’s crucial not to overdo it. Too much of any electrolyte can be harmful. Always introduce new foods gradually and in moderation. If you’re concerned about your dog’s hydration or electrolyte balance, don’t hesitate to consult with your veterinarian.

    Also remember that each dog is unique. Pay attention to your furry friend’s response to different foods and always prioritize their overall health and well-being. 


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

    Animal Wellness

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Michael Greger M.D. FACLM

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  • What About Vegan Junk Food and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    What About Vegan Junk Food and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    Just because you’re eating a vegetarian or vegan diet doesn’t mean you’re eating healthfully.

    “Plant-Based Diets Are Associated with a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults”: This study of a diverse sample of 12,000 Americans found that “progressively increasing the intake of plant foods by reducing the intake of animal foods is associated with benefits on cardiovascular health and mortality.” Still, regarding plant-based diets for cardiovascular disease prevention, “all plant foods are not created equal.” As you can see in the graph below and at 0:40 in my video Vegetarians and Stroke Risk Factors: Vegan Junk Food?, a British study found higher stroke risk in vegetarians. Were they just eating a lot of vegan junk food? 

    “Any diet devoid of animal food sources can be claimed to be a vegetarian [or vegan] diet; thus, it is important to determine” what is being eaten. One of the first things I look at when I’m trying to see how serious a population is about healthy eating is something that is undeniably, uncontroversially bad: soda, aka liquid candy. Anyone drinking straight sugar water doesn’t have health on top of mind.

    A large study was conducted of plant-based eaters in the United States, where people tend to cut down on meat for health reasons far more than for ethics, as you can see in the graph below and at 1:20 in my video.

    Researchers found that flexitarians drink fewer sugary beverages than regular meat eaters, as do pescatarians, vegetarians, and vegans, as you can see below and at 1:30.

    However, in the study from the United Kingdom where the increased stroke risk in vegetarians was found and where people are more likely to go veg or vegan for ethical reasons, researchers found that pescatarians drink less soda, but the vegetarians and vegans drink more, as shown in the graph below and at 1:44. 

    I’m not saying that’s why they had more strokes; it might just give us an idea of how healthfully they were eating. In the UK study, the vegetarian and vegan men and women ate about the same amounts of desserts, cookies, and chocolate, as you can see in the graph below and at 1:53. 

    They also consumed about the same total sugar, as shown below and at 2:02. 

    In the U.S. study, the average non-vegetarian is nearly obese, the vegetarians are a little overweight, and the vegans were the only ideal weight group. In this analysis of the UK study, however, everyone was about the same weight. The meat eaters were lighter than the vegans, as you can see below, and at 2:19 in my video. The EPIC-Oxford study seems to have attracted a particularly “health-conscious” group of meat eaters weighing substantially less than the general population. 

    Let’s look at some specific stroke-related nutrients. Dietary fiber appears to be beneficial for the prevention of cardiovascular disease, including stroke, and it seems the more, the better, as you can see in the graph below and at 2:43 in my video. 

    Based on studies of nearly half a million men and women, there doesn’t seem to be any upper threshold of benefit—so, again, “the more, the better.” At more than 25 grams of soluble fiber and 47 grams of insoluble dietary fiber, you can start seeing a significant drop in associated stroke risk. So, one could consider these values “as the minimal recommendable daily intake of soluble and insoluble fiber…to prevent stroke at a population level.” That’s what you see in people eating diets centered around minimally processed plant foods. Dean Ornish, M.D., got up around there with his whole food, plant-based diet. It might not be as much as we were designed to eat, based on the analyses of fossilized feces, but that’s about where we might expect significantly lower stroke risk, as shown below and at 3:25 in my video. 

    How much were the UK vegetarians getting? 22.1 grams. Now, in the UK, they measure fiber a little differently, so it may be closer to 30 grams, but that’s still not the optimal level for stroke prevention. It’s so little fiber that the vegetarians and vegans only beat out the meat eaters by about one or two bowel movements a week, as you can see below and at 3:48 in my video, suggesting the non-meat eaters were eating lots of processed foods. 

    The vegetarians were only eating about half a serving more of fruits and vegetables. Intake is thought to reduce stroke risk in part because of their potassium content, but the UK vegetarians at higher stroke risk were eating so few greens and beans that they couldn’t even match the meat eaters. The vegetarians (and the meat eaters) weren’t even reaching the recommended minimum daily potassium intake of 4,700 mg a day.

    What about sodium? “The vast majority of the available evidence indicates that elevated salt intake is associated with higher stroke risk…” There is practically a straight-line increase in the risk of dying from a stroke, the more salt you eat, as you can see in the graph below and at 4:29 in my video. 

    Even just lowering sodium intake by a tiny fraction every year could prevent tens of thousands of fatal strokes. “Reducing Sodium Intake to Prevent Stroke: Time for Action, Not Hesitation” was the title of the paper, but the UK vegetarians and vegans appeared to be hesitating, as did the other dietary groups. “All groups exceeded the advised less than 2400 mg daily sodium intake”—and that didn’t even account for salt added to the table! The American Heart Association recommends less than 1,500 mg a day. So, they were all eating a lot of processed foods. It’s no wonder the vegetarians’ blood pressures were only one or two points lower. High blood pressure is perhaps “the single most important potentially modifiable risk factor for stroke.” 

    What evidence do I have that the vegetarians’ and vegans’ stroke risk would go down if they ate more healthfully? Well, in rural Africa, where they were able to nail the fiber intake that our bodies were designed to get by eating so many whole, healthy plant foods—including fruits, vegetables, grains, greens, beans, and protein almost entirely from plant sources—not only was heart disease, our number one killer, “almost non-existent,” but so was stroke. It only surged up from nowhere “with the introduction of salt and refined foods” to their diet. 

    “It is notable that stroke and senile dementia appear to be virtually absent in Kitava, an Oceanic culture [near Australia] whose quasi-vegan traditional diet is very low in salt and very rich in potassium.” They ate fish a few times a week, but the other 95 percent or so of their diet was made up of vegetables, fruits, corn, and beans. They had an apparent absence of stroke, even despite their ridiculously high rates of smoking, 76 percent of men and 80 percent of women. We evolved by eating as little as less than an eighth of a teaspoon of salt a day, and our daily potassium consumption is thought to have been as high as 10,000 mg or so. We went from an unsalted, whole-food diet to eating salty, processed foods depleted of potassium whether we eat meat or not. 

    Caldwell Esselstyn at the Cleveland Clinic tried putting about 200 patients with established cardiovascular disease on a whole food, plant-based diet. Of the 177 who stuck with the diet, only a single patient went on to have a stroke in the subsequent few years, compared to a hundred-fold greater rate of adverse events, including multiple strokes and deaths in those who strayed from the diet. “This is not vegetarianism,” Esselstyn explains. Vegetarians can eat a lot of less-than-ideal foods, “such as milk, cream, butter, cheese, ice cream, and eggs. This new paradigm is exclusively plant-based nutrition.” 

    This entire train of thought—that the reason typical vegetarians don’t have better stroke statistics is because they’re not eating particularly stellar diets—may explain why they don’t have significantly lower stroke rates. However, it still doesn’t explain why they may have higher stroke rates. Even if they’re eating similarly crappy, salty, processed diets, at least they aren’t eating meat, which we know increases stroke risk. There must be something about vegetarian diets that so increases stroke risk that it offsets their inherent advantages. We’ll continue our hunt for the answer next. 

    From a medical standpoint, labels like vegan and vegetarian just tell me what you don’t eat. It’s like identifying yourself as a “No-Twinkie-tarian.” You don’t eat Twinkies? Great, but what’s the rest of your diet like? 

    What are the healthiest foods? Check out my Daily Dozen.

    To catch up on the rest of this series, see related posts below. 

    Michael Greger M.D. FACLM

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  • The Stroke Risk of Vegetarians  | NutritionFacts.org

    The Stroke Risk of Vegetarians  | NutritionFacts.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Michael Greger M.D. FACLM

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

    Corporate Influence and Our Epidemic of Obesity  | NutritionFacts.org

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

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

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

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

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

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

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

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

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

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

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

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

    If the political angle interests you, check out: 

    Michael Greger M.D. FACLM

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  • How Healthy Are Ancient Grains?  | NutritionFacts.org

    How Healthy Are Ancient Grains?  | NutritionFacts.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Michael Greger M.D. FACLM

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  • The Safety of Fasting to Lose Weight  | NutritionFacts.org

    The Safety of Fasting to Lose Weight  | NutritionFacts.org

    Why should fasts lasting longer than 24 hours and particularly for three or more days only be done under the supervision of a health professional and preferably in a live-in clinic? 
     
    Fasting for a week or two can actually interfere with the loss of body fat, as shown at the start of my video Is Fasting for Weight Loss Safe?. But, eventually, after the third week of fasting, fat loss starts to overtake the loss of lean body mass in obese individuals, as seen in the graph below and at 0:14 in my video. Is it safe to go that long without food? 

    Proponents speak of fasting as a cleansing process, but some of what is being purged from our bodies are essential vitamins and minerals. People who are heavy enough can fast up to 382 days without calories, but no one can go even a fraction of that long without vitamins. Scurvy, for example, can be diagnosed within as few as four weeks without any vitamin C. Beriberi, deficiency of thiamine (vitamin B1), may start even earlier in fasting patients. And, once it manifests, it can result in brain damage within days, which can eventually become irreversible.  
     
    Even though fasting patients report problems such as nausea and indigestion after taking supplements, all of the months-long fasting cases I’ve discussed previously were given daily multivitamins and mineral supplementation as necessary. Without supplementation, hunger strikers and those undergoing prolonged fasts for therapeutic or religious purposes (like the Baptist pastor hoping “to enhance his spiritual powers for exorcism”) have ended up paralyzed, become comatose, or worse. 
     
    Nutrient deficiencies aren’t the only risk. After reading about all of the successful reports of massive weight loss from prolonged fasting in the medical literature, one doctor decided to give it a try with his patients. Of the first dozen he tried it on, two died. In retrospect, the two patients who died had started out with heart failure and had been on diuretics. Fasting itself produces pronounced diuresis, meaning loss of water and electrolytes through the urine, so it was the combination of fasting on top of the water pills that likely depleted their potassium and triggered their fatal heart rhythms. The doctor went out of his way to point out that both of the people who died started out “in severe heart failure, complicated by gross obesity; but both had improved greatly whilst undergoing starvation therapy.” That seems like a small consolation since they were both dead within a matter of weeks. 
     
    Not all therapeutic fasting fatalities were complicated by concurrent medication use, though. One researcher writes: “At first he did very well and experienced the usual euphoria…His pulse, blood pressure, and electrolytes remained satisfactory, but in the middle of the third week of treatment, he suddenly collapsed and died. This line of treatment is certainly tempting because it does produce weight loss and the patient feels so much better, but the report of case-fatalities”—the whole part about killing people—“must make it a very suspect line of management.” 
     
    Contrary to the popular notion that the heart muscle is specially spared during fasting, the heart appears to experience similar muscle wasting. This was “described in the victims of the Warsaw ghetto” during World War II in a remarkable series of detailed studies carried out by the ghetto physicians before they themselves succumbed. In a case entitled “Gross Fragmentation of Cardiac Fiber After Therapeutic Starvation for Obesity,” a 20-year-old woman successfully “achieved her ideal weight” after losing 128 pounds by fasting for 30 weeks. “After a breakfast of one egg,” she had a heart attack and died. On autopsy, as you can see below and at 3:44 in my video, the muscle fibers in her heart showed evidence of widespread disintegration. The pathologists suggested that fasting regimens “should no longer be recommended as a safe means of weight reduction.” 
    Breaking the fast appears to be the most dangerous part. After World War II, as many as one out of five starved Japanese prisoners of war tragically died following liberation. Now known as “refeeding syndrome,” multiorgan system failure can result from resuming a regular diet too quickly. This is because there are critical nutrients such as thiamine and phosphorus that are used to metabolize food. Therefore, in the critical refeeding window, if too much food is taken before these nutrients can be replenished, demand may exceed supply. Whatever residual stores you still carry can be driven down even further, with potentially fatal consequences. This is why rescue workers are taught to always give thiamine before food to victims who have been trapped or otherwise unable to eat. Thiamine is responsible for the yellow color of “banana bags,” a term you might have heard used in medical dramas to describe an IV fluid concoction often given to malnourished alcoholics to prevent a similar reaction. (You can see a photo of them below and at 4:53 in my video.) Anyone “with negligible food intake for more than five days” may be at risk of developing refeeding problems. 
    Medically-supervised fasting has gotten much safer now that there are proper refeeding protocols. We now know what warning signs to look for and who shouldn’t be fasting in the first place, such as those who have advanced liver or kidney failure, porphyria, uncontrolled hyperthyroidism, and pregnant and breastfeeding women. The most comprehensive safety analysis of medically supervised, water-only fasting was recently published by the TrueNorth Health Center in California. Out of 768 visits to its facility for fasts up to 41 days, were there any adverse events? There were 5,961 of them! Most of these were mild, known reactions to fasting, such as fatigue, nausea, insomnia, headache, dizziness, upset stomach, and back pain. Only two serious events were reported, and no fatalities. You can see the chart below and at 5:58 in my video. 
    “Fasting periods lasting longer than 24 hr, and particularly those lasting 3 or more days, should be done under the supervision of a physician and preferably in a [live-in] clinic.” In other words, don’t try this at home! This is not just legalistic mumbo-jumbo. For example, normally, your kidneys dive into sodium conservation mode during fasting, but should that response break down, you could rapidly develop an electrolyte abnormality that may only manifest with non-specific symptoms, like fatigue or dizziness, which could easily be dismissed until it’s too late. 
     
    The risks of any therapy must be premised on the severity of the disease. The consequences of obesity are considered so serious that effective therapies could have “considerable acceptable toxicity.” For example, many consider major surgery for obesity to be a justifiable risk, but the keyword is effective. 
     
    Therapeutic fasting for obesity has largely been abandoned by the medical community not only because of its uncertain safety profile but its questionable short- and long-term efficacy. Remember, for a fast that only lasts a week or two, you might be able to lose as much body fat or even more on a low-calorie diet than a no-calorie diet. 
     
    Fasting for a week or two can actually interfere with the loss of body fat. For more background on this, see Is Fasting Beneficial for Weight Loss? and Benefits of Fasting for Weight Loss Put to the Test.
     
    If you’re wondering what the best way to lose weight is, I wrote a whole book about it! Check out How Not to Diet. 
     
    Interested in learning more about fasting? See related videos below. 

    Michael Greger M.D. FACLM

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  • Cutting Table Salt Tied to Lower Heart Disease Risk

    Cutting Table Salt Tied to Lower Heart Disease Risk

    Nov. 28, 2022 – Simply limiting shakes of salt at the table may help lower the risk of heart disease, new research suggests.

    Using less added salt appeared to have the biggest effect on two common kinds of heart disease: heart failure and ischemic heart disease, also known as hardening of the arteries, which slows blood flow to the heart. But the research found that putting such limits on salt did not affect the risk of having a stroke.

    The new research, from the School of Public Health and Tropical Medicine at Tulane University in New Orleans, was published today in the Journal of the American College of Cardiology.

    “Overall, we found that people who don’t shake on a little additional salt to their foods very often had a much lower risk of heart disease events, regardless of lifestyle factors and pre-existing disease,” says co-author Lu Qi, MD, PhD, a professor at Tulane.

    You Don’t Have to Eliminate It Altogether

    That’s good news, because it suggests that just adding less salt to food – not removing it entirely – can make a difference without too big a sacrifice, Qi said in a statement.

    Even those who followed a DASH-style diet to lower their blood pressure further reduced their heart disease risk when they held back the salt at the table, the researchers found.

    DASH stands for Dietary Approaches to Stop Hypertension, and people following it focus on foods rich in protein, calcium, potassium, fiber, and magnesium and avoid foods high in sodium, added sugar, and saturated fat.

    People who didn’t add salt at the table very often and also followed the DASH diet had the lowest heart disease risk of the people studied, the researchers say.

    The researchers found there was an even stronger link between adding salt to foods and heart disease risk when people were current smokers or had a lower social and economic status. 

    Conflicting Results

    There’s already lots of evidence linking high sodium to high blood pressure, which is a major risk factor for cardiovascular disease. But studies looking at the link have had conflicting results because it’s been hard for researchers to find out how much salt people consume over many years. 

    A previous study by the same research team reported that people who added salt to foods more often had a higher risk of dying early from any cause and a lower life expectancy. This study builds on that and focuses on how more added salt over the long term affects heart disease risk.

    For the study, researchers surveyed 176,570 people from the United Kingdom Biobank database who did not have cardiovascular disease at the beginning of the study. They were asked about how often they added salt to their food, not including salt used in cooking. They could answer never/rarely; sometimes; usually; or always. 

    They also were asked if they had made major changes to their diet in the last 5 years and were asked to recall what they ate and drank over the last 24 hours.

    The researchers analyzed heart disease events through medical histories, data on hospital admissions, answers on questionnaires, and death register data.

    Sara Ghoneim, MD, a gastroenterology fellow at the University of Nebraska Medical Center in Omaha, wrote in an editorial that this study is promising for people in both high- and low-income countries.

    “The economic burden of CVD [cardiovascular disease] is considerable and continues to increase in prevalence,” she wrote. 

    Ghoneim pointed out that a drawback of the study is that people were asked to report their own level of salt use and that they came from the database in the United Kingdom, so it’s uncertain whether other populations would have the same results.

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  • 7 Cereals Can No Longer Claim ‘Healthy’ Label Under FDA Rule

    7 Cereals Can No Longer Claim ‘Healthy’ Label Under FDA Rule

    Oct. 13, 2022 — Generations of Americans grew up being told that breakfast cereals like Corn Flakes and Raisin Bran were healthy ways to start their days.

    But now, under new federal guidelines, those cereals and other mainstays of the breakfast table can no longer make that claim.

    The guidance was proposed after the White House Conference on Hunger, Nutrition, and Health, “as well as the release of the related national strategy, which aims to end hunger, improve nutrition and physical activity, reduce diet-related diseases and close disparity gaps by 2030,” the FDA wrote in a press release.

    To be considered “healthy,” foods must meet certain criteria. The FDA used cereal as an example to illustrate how the guidelines affect how food will be presented to consumers.

    For that “healthy” label, cereals need three-fourth ounces of whole grains and no more than 1 gram of saturated fat, 230 milligrams of sodium, and 2.5 grams of added sugars, CNBC reported.

    Here are seven common American brands that don’t meet the “healthy” label standards:

    • Raisin Bran (9 grams of added sugars)
    • Honey Nut Cheerios (12 grams of added sugars)
    • Corn Flakes (300 milligrams of sodium; 4 grams of added sugars)
    • Honey Bunches of Oats, Honey Roasted (8 grams of added sugars)
    • Frosted Mini Wheats (12 grams of added sugars)
    • Life (8 grams of added sugars)
    • Special K (270 milligrams of sodium; 4 grams of added sugars)

    “Nutrition is key to improving our nation’s health,” said Xavier Becerra, Health and Human Services secretary. “Healthy food can lower our risk for chronic disease. But too many people may not know what constitutes healthy food. FDA’s move will help educate more Americans to improve health outcomes, tackle health disparities and save lives.”

     

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  • These 7 Cereals Can No Longer Claim ‘Healthy’ Label Under FDA Rule

    These 7 Cereals Can No Longer Claim ‘Healthy’ Label Under FDA Rule

    Oct. 13, 2022 — Generations of Americans grew up being told that breakfast cereals like Corn Flakes and Raisin Bran were healthy ways to start their days.

    But now, under new federal guidelines, those cereals and other mainstays of the breakfast table can no longer make that claim.

    The guidance was proposed after the White House Conference on Hunger, Nutrition, and Health, “as well as the release of the related national strategy, which aims to end hunger, improve nutrition and physical activity, reduce diet-related diseases and close disparity gaps by 2030,” the FDA wrote in a press release.

    To be considered “healthy,” foods must meet certain criteria. The FDA used cereal as an example to illustrate how the guidelines affect how food will be presented to consumers.

    For that “healthy” label, cereals need three-fourth ounces of whole grains and no more than 1 gram of saturated fat, 230 milligrams of sodium, and 2.5 grams of added sugars, CNBC reported.

    Here are seven common American brands that don’t meet the “healthy” label standards:

    • Raisin Bran (9 grams of added sugars)
    • Honey Nut Cheerios (12 grams of added sugars)
    • Corn Flakes (300 milligrams of sodium; 4 grams of added sugars)
    • Honey Bunches of Oats, Honey Roasted (8 grams of added sugars)
    • Frosted Mini Wheats (12 grams of added sugars)
    • Life (8 grams of added sugars)
    • Special K (270 milligrams of sodium; 4 grams of added sugars)

    “Nutrition is key to improving our nation’s health,” said Xavier Becerra, Health and Human Services secretary. “Healthy food can lower our risk for chronic disease. But too many people may not know what constitutes healthy food. FDA’s move will help educate more Americans to improve health outcomes, tackle health disparities and save lives.”

     

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