Best Foods for Acid Reflux

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Gastroesophageal reflux disease (GERD) is one of the most common disorders of the digestive tract. The two most typical symptoms are heartburn and regurgitation of stomach contents into the back of the throat, but GERD is not just burning pain and a sour taste in your mouth. It causes millions of doctor visits and hospitalizations every year in the United States. The most feared complication is cancer.

You start out with a normal esophagus. If the acid keeps creeping up, your esophagus can get inflamed and result in esophagitis. Esophagitis can transform into Barrett's esophagus, a precancerous condition which can then turn into adenocarcinoma (a type of cancer). To prevent all that, we need to prevent the acid reflux in the first place.

In the last three decades, the incidence of this cancer in the US has increased six-fold, an increase greater than that of melanoma, breast, or prostate cancer. This is because acid reflux is on the rise. In the United States, we're up to about 1 in 4 people suffering at least weekly heartburn and/or acid regurgitation, compared to around 5% in Asia. This suggests that dietary factors may play a role.

In general, high fat intake is associated with increased risk, whereas high fiber foods appear to be protective. The reason fat intake may be associated with GERD symptoms and erosive esophagitis is because when we eat fatty foods, the sphincter at the top of the stomach that's supposed to keep the food down becomes relaxed, so more acid can creep up into the esophagus. In my video Diet & GERD Acid Reflux Heartburn, you can see a study in which researchers fed volunteers a high-fat meal--a McDonald's sausage and egg McMuffin--compared to a low-fat meal (McDonald's hot cakes), and there was significantly more acid squirted up in the esophagus after the high-fat meal.

In terms of later stages of disease progression, over the last twenty years 45 studies have been published in the association between diet and Barrett's esophagus and esophageal cancer. In general, they found that meat and high-fat meals appeared to increase cancer risk. Different meats were associated with cancers in different locations, thoughj. Red meat was more associated with cancer in the esophagus, whereas poultry was more associated with cancer at the top of the stomach. Plant-based sources of protein, such as beans and nuts, were associated with a significantly decreased risk of cancer.

Those eating the most antioxidant-rich foods have half the odds of esophageal cancer, while there is practically no reduction in risk among those who used antioxidant vitamin supplements, such as vitamin C or E pills. The most protective produce may be red-orange vegetables, dark green leafies, berries, apples, and citrus. The benefit may come from more than just eating plants. Eating healthy foods crowds out less healthy foods, so it may be a combination of both.

Based on a study of 3,000 people, the consumption of non-vegetarian foods (including eggs) was an independent predictor of GERD. Egg yolks cause an increase in the hormone cholecystokinin, which may overly relax the sphincter that separates the esophagus from the stomach. The same hormone is increased by meat, which may help explain why plant-based diets appear to be a protective factor for reflux esophagitis.

Researchers found that those eating meat had twice the odds of reflux-induced esophageal inflammation. Therefore, plant-based diets may offer protection, though it's uncertain whether it's attributable to the absence of meat in the diet or the increased consumption of healthy foods. Those eating vegetarian consume greater amounts of fruits and vegetables containing innumerable phytochemicals, dietary fiber, and antioxidants. They also restrict their consumption of animal sources of food, which tend to be fattier and can thus relax that sphincter and aggravate reflux.

GERD is common; its burdens are enormous. It relapses frequently and can cause bleeding, strictures, and a deadly cancer. The mainstay of treatment is proton pump inhibitor drugs, which rake in billions of dollars. We spend four billion dollars on Nexium alone, three billion on Prevacid, two billion on Protonix, one billion on Aciphex. These drugs can cause nutrient deficiencies and increase the risk for pneumonia, food poisoning, and bone fractures. Thus, it is important to find correctable risk factors and correct them. Known correctable risk factors have been things like obesity, smoking and alcohol consumption. Until recently, though, there hadn't been studies on specifically what to eat and what to avoid, but now we have other correctable factors to help prevent this disease.

For more on GERD, see: Diet & Hiatal Hernia, Coffee & Mortality, and Club Soda for Stomach Pain & Constipation.

I also have a video about esophageal cancer, detailing the extraordinary reversal of the kinds of precancerous changes that lead to the devastating condition--with nothing but strawberries: Strawberries versus Esophageal Cancer.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: PDPics / Pixabay. Image has been modified.

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Best Foods for Acid Reflux

Best Foods for Acid Reflux.jpeg

Gastroesophageal reflux disease (GERD) is one of the most common disorders of the digestive tract. The two most typical symptoms are heartburn and regurgitation of stomach contents into the back of the throat, but GERD is not just burning pain and a sour taste in your mouth. It causes millions of doctor visits and hospitalizations every year in the United States. The most feared complication is cancer.

You start out with a normal esophagus. If the acid keeps creeping up, your esophagus can get inflamed and result in esophagitis. Esophagitis can transform into Barrett's esophagus, a precancerous condition which can then turn into adenocarcinoma (a type of cancer). To prevent all that, we need to prevent the acid reflux in the first place.

In the last three decades, the incidence of this cancer in the US has increased six-fold, an increase greater than that of melanoma, breast, or prostate cancer. This is because acid reflux is on the rise. In the United States, we're up to about 1 in 4 people suffering at least weekly heartburn and/or acid regurgitation, compared to around 5% in Asia. This suggests that dietary factors may play a role.

In general, high fat intake is associated with increased risk, whereas high fiber foods appear to be protective. The reason fat intake may be associated with GERD symptoms and erosive esophagitis is because when we eat fatty foods, the sphincter at the top of the stomach that's supposed to keep the food down becomes relaxed, so more acid can creep up into the esophagus. In my video Diet & GERD Acid Reflux Heartburn, you can see a study in which researchers fed volunteers a high-fat meal--a McDonald's sausage and egg McMuffin--compared to a low-fat meal (McDonald's hot cakes), and there was significantly more acid squirted up in the esophagus after the high-fat meal.

In terms of later stages of disease progression, over the last twenty years 45 studies have been published in the association between diet and Barrett's esophagus and esophageal cancer. In general, they found that meat and high-fat meals appeared to increase cancer risk. Different meats were associated with cancers in different locations, thoughj. Red meat was more associated with cancer in the esophagus, whereas poultry was more associated with cancer at the top of the stomach. Plant-based sources of protein, such as beans and nuts, were associated with a significantly decreased risk of cancer.

Those eating the most antioxidant-rich foods have half the odds of esophageal cancer, while there is practically no reduction in risk among those who used antioxidant vitamin supplements, such as vitamin C or E pills. The most protective produce may be red-orange vegetables, dark green leafies, berries, apples, and citrus. The benefit may come from more than just eating plants. Eating healthy foods crowds out less healthy foods, so it may be a combination of both.

Based on a study of 3,000 people, the consumption of non-vegetarian foods (including eggs) was an independent predictor of GERD. Egg yolks cause an increase in the hormone cholecystokinin, which may overly relax the sphincter that separates the esophagus from the stomach. The same hormone is increased by meat, which may help explain why plant-based diets appear to be a protective factor for reflux esophagitis.

Researchers found that those eating meat had twice the odds of reflux-induced esophageal inflammation. Therefore, plant-based diets may offer protection, though it's uncertain whether it's attributable to the absence of meat in the diet or the increased consumption of healthy foods. Those eating vegetarian consume greater amounts of fruits and vegetables containing innumerable phytochemicals, dietary fiber, and antioxidants. They also restrict their consumption of animal sources of food, which tend to be fattier and can thus relax that sphincter and aggravate reflux.

GERD is common; its burdens are enormous. It relapses frequently and can cause bleeding, strictures, and a deadly cancer. The mainstay of treatment is proton pump inhibitor drugs, which rake in billions of dollars. We spend four billion dollars on Nexium alone, three billion on Prevacid, two billion on Protonix, one billion on Aciphex. These drugs can cause nutrient deficiencies and increase the risk for pneumonia, food poisoning, and bone fractures. Thus, it is important to find correctable risk factors and correct them. Known correctable risk factors have been things like obesity, smoking and alcohol consumption. Until recently, though, there hadn't been studies on specifically what to eat and what to avoid, but now we have other correctable factors to help prevent this disease.

For more on GERD, see: Diet & Hiatal Hernia, Coffee & Mortality, and Club Soda for Stomach Pain & Constipation.

I also have a video about esophageal cancer, detailing the extraordinary reversal of the kinds of precancerous changes that lead to the devastating condition--with nothing but strawberries: Strawberries versus Esophageal Cancer.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: PDPics / Pixabay. Image has been modified.

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Paleo Diet May Undermine Benefit of CrossFit Exercise

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Much of the low-carb and paleo reasoning revolves around insulin. To quote a paleo blogger, "carbohydrates increase insulin, the root of all evil when it comes to dieting and health." So the logic follows that because carbs increase insulin, we should stick mostly to meat, which is fat and protein with no carbs, so no increase in insulin, right?

Wrong.

We've known for half a century that if you give someone just a steak: no carbs, no sugar, no starch; their insulin goes up. Carbs make our insulin go up, but so does protein.

In 1997 an insulin index of foods was published, ranking 38 foods to determine which stimulates higher insulin levels. Researchers compared a large apple and all its sugar, a cup of oatmeal packed with carbs, a cup and a half of white flour pasta, a big bun-less burger with no carbs at all, to half of a salmon fillet. As you can see in the graph in my video Paleo Diets May Negate Benefits of Exercise, the meat produced the highest insulin levels.

Researchers only looked at beef and fish, but subsequent data showed that that there's no significant difference between the insulin spike from beef, chicken, or pork--they're all just as high. Thus, protein and fat rich foods may induce substantial insulin secretion. In fact, meat protein causes as much insulin release as pure sugar.

So, based on the insulin logic, if low-carbers and paleo folks really believed insulin to be the root of all evil, then they would be eating big bowls of spaghetti day in and day out before they would ever consume meat.

They are correct in believing that having hyperinsulinemia, high levels of insulin in the blood like type 2 diabetics have, is not a good thing, and may increase cancer risk. But if low-carb and paleo dieters stuck to their own insulin theory, then they would be out telling everyone to start eating plant-based. Vegetarians have significantly lower insulin levels even at the same weight as omnivores. This is true for ovo-lacto-vegetarians, lacto-vegetarians, and vegans. Meat-eaters have up to 50% higher insulin levels.

Researchers from the University of Memphis put a variety of people on a vegan diet (men, women, younger folks, older folks, skinny and fat) and their insulin levels dropped significantly within just three weeks. And then, just by adding egg whites back to their diet, their insulin production rose 60% within four days.

In a study out of MIT, researchers doubled participants' carbohydrate intake, and their insulin levels went down. Why? Because the researchers weren't feeding people jellybeans and sugar cookies, they were feeding people whole, plant foods, lots of whole grains, beans, fruits, and vegetables.

What if we put someone on a very-low carb diet, like an Atkins diet? Low carb advocates such as Dr. Westman assumed that it would lower insulin levels. Dr. Westman is the author of the new Atkins books, after Dr. Atkins died obese with, according to the medical examiner, a history of heart attack, congestive heart failure, and hypertension. But, Dr. Westman was wrong in his assumption. There are no significant drop in insulin levels on very low-carb diets. Instead, there is a significant rise in LDL cholesterol levels, the number one risk factor for our number one killer, heart disease.

Atkins is an easy target though. No matter how many "new" Atkins diets that come out, it's still old news. What about the paleo diet? The paleo movement gets a lot of things right. They tell people to ditch dairy and doughnuts, eat lots of fruits, nuts, and vegetables, and cut out a lot of processed junk food. But a new study published in the International Journal of Exercise Science is pretty concerning. Researchers took young healthy people, put them on a Paleolithic diet along with a CrossFit-based, high-intensity circuit training exercise program.

If you lose enough weight exercising, you can temporarily drop our cholesterol levels no matter what you eat. You can see that with stomach stapling surgery, tuberculosis, chemotherapy, a cocaine habit, etc. Just losing weight by any means can lower cholesterol, which makes the results of the Paleo/Crossfit study all the more troubling. After ten weeks of hardcore workouts and weight loss, the participants' LDL cholesterol still went up. And it was even worse for those who started out the healthiest. Those starting out with excellent LDL's (under 70), had a 20% elevation in LDL cholesterol, and their HDL dropped. Exercise is supposed to boost our good cholesterol, not lower it.

The paleo diet's deleterious impact on blood fats was not only significant, but substantial enough to counteract the improvements commonly seen with improved fitness and body composition. Exercise is supposed to make things better.

On the other hand, if we put people instead on a plant-based diet and a modest exercise program, mostly just walking-based; within three weeks their bad cholesterol can drop 20% and their insulin levels 30%, despite a 75-80% carbohydrate diet, whereas the paleo diets appeared to "negate the positive effects of exercise."

I touched on paleo diets before in Paleolithic Lessons, and I featured a guest blog on the subject: Will The Real Paleo Diet Please Stand Up?

but my favorite paleo videos are probably The Problem With the Paleo Diet Argument and Lose Two Pounds in One Sitting: Taking the Mioscenic Route.

I wrote a book on low carb diets in general (now available free full-text online) and touched on it in Atkins Diet: Trouble Keeping It Up and Low Carb Diets and Coronary Blood Flow.

And if you're thinking, but what about the size of the cholesterol, small and dense versus large and fluffy? Please see my video Does Cholesterol Size Matter?

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Image Credit: Vincent Lit / Flickr

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What About All the Sugar in Fruit?

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If the fructose in sugar and high fructose corn syrup has been considered "alcohol without the buzz" in terms of the potential to inflict liver damage, what about the source of natural fructose, fruit?

If you compare the effects of a diet restricting fructose from both added sugars and fruit to one just restricting fructose from added sugars, the diet that kept the fruit did better. People lost more weight with the extra fruit present than if all fructose was restricted. Only industrial, not fruit fructose intake, was associated with declining liver function and high blood pressure. Fructose from added sugars was associated with hypertension; fructose from natural fruits is not.

If we have people drink a glass of water with three tablespoons of table sugar in it, which is like a can of soda, they get a big spike in blood sugar within the first hour (as you can see in my video If Fructose is Bad, What About Fruit?). Our body freaks out and releases so much insulin we actually overshoot, and by the second hour we're relatively hypoglycemic, dropping our blood sugar below where they were when we started out fasting. In response, our body dumps fat into our blood stream as if we're starving, because our blood sugars just dropped so low so suddenly.

What if you eat blended berries in addition to the sugar? They have sugars of their own in them, in fact an additional tablespoon of sugar worth, so the blood sugar spike should be worse, right?

Not only is there no additional blood sugar spike, there was no hypoglycemic dip afterwards. Blood sugar just went up and down without that overshoot and without the surge of fat into the blood.

This difference may be attributed to the semisolid consistency of the berry meals, which may have decreased the rate of stomach emptying compared with just guzzling sugar water. In addition, the soluble fiber in the berries has a gelling effect in our intestines that slows the release of sugars. To test to see if it was the fiber, researchers repeated the experiment with berry juice that had all the sugar but none of the fiber. A clear difference was observed early on in the blood sugar insulin responses. At the 15-minute mark, the blood sugar spike was significantly reduced by the berry meals, but not by the juices, but the rest of the beneficial responses were almost the same between the juice and the whole fruit, suggesting that fiber may just be part of it. It turns out there are fruit phytonutrients that inhibit the transportation of sugars through the intestinal wall into our blood stream. Phytonutrients in foods like apples and strawberries can block some of the uptake of sugars by the cells lining our intestines.

Adding berries can actually blunt the insulin spike from high glycemic foods. For example, white bread creates a big insulin spike within two hours after eating it. Eat that same white bread with some berries, though, and we're able to blunt the spike. So, even though we've effectively added more sugars in the form of berries, there's less of an insulin spike, which has a variety of potential short and long-term benefits. So if you're going to make pancakes, make sure they're blueberry pancakes.

Surprised about the juice results? Me too! More on juice:

A few videos I have on industrial sugars:

How else can we blunt the glycemic spike?

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

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How Much Added Sugar is Too Much?

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In 1776, at the time of the American Revolution, Americans consumed about four pounds of sugar per person each year. By 1850, this had risen to 20 pounds, and by 1994 to 120 pounds. Now we're closer to 160 (See How Much Added Sugar is Too Much?). Half of table sugar is fructose, taking up about 10 percent of our diet. This is not from eating apples, but rather the fact that we're each guzzling the equivalent of 16-ounce soft drink every day; that's about 50 gallons a year.

Even researchers paid by the likes of the Dr. Pepper Snapple Group and The Coca Cola Company acknowledge that sugar is empty calories, containing "no essential micronutrients, and therefore if we're trying to reduce calorie intake, reducing sugar consumption is obviously the place to start." Concern has been raised, though, that sugar calories may be worst than just empty.

A growing body of scientific evidence suggests that "the fructose added to foods and beverages in the form of table sugar and high fructose corn syrup in large enough amounts can trigger processes that lead to liver toxicity and other chronic diseases."

Fructose hones in like a laser beam on the liver, and like alcohol, fructose can increase the fat in the liver. The increase in non-alcoholic fatty liver disease is one of the most remarkable medical developments over the past three decades--the emergence of fatty liver inflammation as a public health problem here and around the globe.

These may not be messages that the sugar industry or beverage makers want to hear. In response, the director-general of the industry front group, the World Sugar Research Organization, replied, "Overconsumption of anything is harmful, including water and air." Yes, he compared the overconsumption of sugar to breathing too much.

Under American Heart Association's new sugar guidelines, most American women should consume no more than 100 calories per day from added sugars, and most American men should eat or drink no more than 150. That means one can of soda could take us over the top for the day. The new draft guidelines from the World Health Organization suggests we could benefit from restricting added sugars to under 5 percent of calories. That's about six spoonfuls of added sugar. I don't know why they don't just recommend zero as optimal, but you can get a sense of how radical their proposal is given that we consume an average of 12-18 spoonfuls a day right now.

This underscores why a whole foods, plant-based diet is preferable to a plant-based diet that includes processed junk.

I've touched on the harm of refined sugars before in:

For healthful alternatives in baking, see The Healthiest Sweetener, and for beverages, Erythritol May Be a Sweet Antioxidant.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Adam Engelhart / Flickr

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Why Smoothies are Better Than Juicing

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Studies such as a recent Harvard School of Public Health investigation found that the consumption of whole fruits is associated with a significantly lower risk of type 2 diabetes, whereas fruit juice consumption is associated with a higher risk, highlighting the dramatic difference between eating whole fruits and drinking fruit juice. Cholesterol serves as another example. If we eat apples, our cholesterol drops. On the other hand, if we drink apple juice, our cholesterol may actually go up a little. Leaving just a little of the fiber behind--as in cloudy apple juice--was found to add back in some of the benefit.

We used to think of fiber as just a bulking agent that helps with bowel regularity. We now know fiber is digestible by our gut bacteria, which make short chain fatty acids (SCFAs) out of it. SCFAs have a number of health promoting effects, such as inhibiting the growth of bad bacteria and increasing mineral absorption. For example, experimentally infused into the rectum of the human body, SCFAs can stimulate calcium absorption, so much so that we can improve the bone mineral density of teenagers just by giving them the fiber naturally found in foods like onions, asparagus, and bananas.

Our good bacteria also uses fiber to maintain normal bowel structure and function, preventing or alleviating diarrhea, stimulating colonic blood flow up to five-fold, and increasing fluid and electrolyte uptake. The major fuel for the cells that line our colon is butyrate, which our good bacteria make from fiber. We feed them, and they feed us right back.

If the only difference between fruit and fruit juice is fiber, why can't the juice industry just add some fiber back to the juice? The reason is because we remove a lot more than fiber when we juice fruits and vegetables. We also lose all the nutrients that are bound to the fiber.

In the 1980's, a study (highlighted in my video, Juicing Removes More Than Just Fiber) found a discrepancy in the amount of fiber in carob using two different methods. A gap of 21.5 percent was identified not as fiber but as nonextractable polyphenols, a class of phytonutrients thought to have an array of health-promoting effects. Some of the effects associated with the intake of dietary fiber in plants may actually be due to the presence of these polyphenols.

Nonextractable polyphenols, usually ignored, are the major part of dietary polyphenols. Most polyphenol phytonutrients in plants are stuck to the fiber. These so-called missing polyphenols make it down to our colon, are liberated by our friendly flora and can then get absorbed into our system. The phytonutrients in fruit and vegetable juice may just be the tip of the iceberg.

For those that like drinking their fruits and vegetables, these findings suggest that smoothies may be preferable. I can imagine people who eat really healthy thinking they get so much fiber from their regular diet that they need not concern themselves with the loss from juicing. But we may be losing more than we think.

For those that like drinking their fruits and vegetables, this suggests smoothies are preferable. I can imagine people who eat really healthy thinking they get so much fiber from their regular diet that they need not concern themselves with the loss from juicing, but they may be losing more than they think.

Why are polyphenol phytonutrients important? See, for example, my video How to Slow Brain Aging by Two Years

Not that fiber isn't important in its own right. Check out:

For more on smoothies, check out:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Craig Sunter / Flickr

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Apple Crisp

This apple crisp is a perfect “anytime” dessert. I like to use Granny Smith apples because they soften nicely but still retain their shape. However, others may be used as well, such as a Gala, Fuji, or Pink Lady. Using a mix of apples is also fun. Print Apple Crisp Prep time:  30 mins Cook time:  30 mins...

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Treating Asthma With Plants vs. Pills

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In my video Treating Asthma With Fruits and Vegetables, I highlighted a landmark study on manipulating antioxidant intake in asthma. The study found that just a few extra fruits and vegetables a day can powerfully reduce asthma exacerbation rates. If the antioxidants in the plants are ameliorating asthma, then why can't we take antioxidant pills instead? Because antioxidant pills don't appear to work.

Studies using antioxidant supplements on respiratory or allergic diseases have mostly shown no beneficial effects. This discrepancy between data relating to fruit and vegetable intake compared with those using antioxidant supplements may indicate the importance of the whole food, rather than individual components. For example, in the Harvard Nurse's Health Study, women who got the most vitamin E from their diet appeared to be at half the risk for asthma, (which may help explain why nut consumption is associated with significantly lower rates of wheezing), but vitamin E supplements did not appear to help.

Men who eat a lot of apples appear to have superior lung function, as do kids who eat fresh fruit every day, as measured by FEV1 (basically how much air you can forcibly blow out in one second). The more fruit, salad, and green vegetables kids ate, the greater their lung function appeared.

Researchers are "cautious about concluding which nutrient might be responsible." There's vitamin C in fruits, salads, and green vegetables, but there are lots of other antioxidants, such as "vitamin P," a term used to describe polyphenol phytonutrients found in grapes, flax seeds, beans, berries, broccoli, apples, citrus, herbs, tea, and soy. Polyphenol phytonutrients can directly bind to allergenic proteins and render them hypoallergenic, allowing them to slip under our body's radar. If this first line of defense fails, polyphenols can also inhibit the activation of the allergic response and prevent the ensuing inflammation, and so may not only work for prevention, but for treatment as well.

Most of the available evidence is weak, though, in terms of using supplements containing isolated phytonutrients to treat allergic diseases. We could just give people fruits and vegetables to eat, but then we couldn't perform a double-blind study to see if they work better than placebo. Some researchers decided to use pills containing plant food extracts. Plant extracts are kind of a middle ground. They are better than isolated plant chemicals, but are not as complete as whole foods. Still, since we can put whole foods in a capsule, we can compare the extracts to fake sugar pills that look and feel the same to see if they have an effect.

The first trial involved giving people extracts of apple skins. I've talked about the Japan's big cedar allergy problem before (See Alkylphenol Endocrine Disruptors and Allergies), so apple extract pills were given every day for a few months starting right before pollen season started. The results were pretty disappointing. They found maybe a little less sneezing, but the extract didn't seem to help their stuffy noses or itchy eyes.

What about a tomato extract? A randomized, double-blind, placebo-controlled eight-week trial was performed on perennial allergic rhinitis, this time not for seasonal pollen, but for year-round allergies to things like dust-mites. There are lots of drugs out there, but you may have to take them every day year-round, so how about some tomato pills instead? After oral administration of tomato extract for eight weeks, there was a significant improvement of total nasal symptom scores, combined sneezing, runny nose and nasal obstruction, with no apparent adverse effects.

Would whole tomatoes work even better? If only researchers would design an experiment directly comparing phytonutrient supplements to actual fruits and vegetables head-to-head against asthma, but such a study had never been done... until now. The same amazing study, highlighted in my video, Treating Asthma with Plants vs. Supplements?, that compared the seven-fruit-and-vegetables-a-day diet to the three-fruit-and-vegetables-a-day diet, after completion of its first phase, commenced a parallel, randomized, controlled supplementation trial with capsules of tomato extract, which boosted the power of five tomatoes in one little pill, and the study subjects were given three pills a day.

Who did better, the group that ate seven servings of actual fruits and vegetables a day, or the group that ate three servings a day but also took 15 supposed serving equivalents in pill form? The pills didn't help at all. Improvements in lung function and asthma control were evident only after increased fruit and vegetable intake, which suggests that whole-food interventions are most effective. Both the supplements and increased fruit and vegetable intake were effective methods for increasing carotenoid concentrations in the bloodstream, but who cares? Clinical improvements--getting better from disease--were evident only as a result of an increase in plant, not pill, consumption. The results provide further evidence that whole-food approaches should be used to achieve maximum efficacy of antioxidant interventions.

And if this is what a few more plants can do, what might a whole diet composed of plants accomplish? See Treating Asthma and Eczema with Plant-Based Diets.

I also dealt with preventing asthma in the first place: Preventing Asthma With Fruits and Vegetables.

The theme of whole foods being more efficacious than supplements seems to come up over and over again. See for example:

More on "vitamin P" in How to Slow Brain Aging by Two Years.

The anti-inflammatory effects of nuts may explain the Harvard Nurse's Health Study finding: Fighting Inflammation in a Nut Shell.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Image Credit: Mike Mozart / Flickr

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Living Longer by Reducing Leucine Intake

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Many studies have shown that calorie restriction, without malnutrition, can increase lifespan and lower the risk of age-related diseases, such as cancer.

However, for many people, calorie restriction clearly has its drawbacks. In the classic Minnesota Starvation Study, many of the volunteers suffered a preoccupation with food, constant hunger, binge eating, and lots of emotional and psychological issues. Even researchers who study caloric restriction rarely practice it. There's got to be a better way to suppress the aging engine enzyme, TOR (see Why Do We Age? for more on TOR).

That's why researchers were so excited about rapamycin, a drug that inhibits TOR, thinking it could be caloric restriction in a pill. But like any drug, it a long list of potentially serious side effects. There's got to be a better way.

The breakthrough came when scientists discovered that the benefits of dietary restriction may be coming not from restricting calories, but from restricting protein intake (See my video Caloric Restriction vs. Animal Protein Restriction). If we look at the first comprehensive, comparative meta-analysis of dietary restriction, "the proportion of protein intake was more important for life extension than the degree of caloric restriction." In fact, just "reducing protein without any changes in calorie level have been shown to have similar effects as caloric restriction."

That's good news. Protein restriction is much less difficult to maintain than dietary restriction, and it may even be more powerful because it suppresses both TOR and IGF-1, the two pathways thought responsible for the dramatic longevity and health benefits of caloric restriction.

Some proteins are worse than others. One amino acid in particular, leucine, appears to exert the greatest effect on TOR. In fact, just cutting down on leucine may be nearly as effective as cutting down on all protein. Where is leucine found? Predominantly animal foods: eggs, dairy, and meat (including chicken and fish). Plant foods, such as fruits, vegetables, grains, and beans, have much less.

"In general, lower leucine levels are only reached by restriction of animal proteins." To reach the leucine intake provided by dairy or meat, we'd have to eat nine pounds of cabbage--about four big heads--or 100 apples. These calculations exemplify the extreme differences in leucine amounts provided by a conventional diet in comparison to a plant-based diet. The functional role of leucine in regulating TOR activity may help explain the extraordinary results reported in the Cornell-Oxford-China Study, "since quasi-vegan diets of modest protein content tend to be relatively low in leucine."

This may also help explain the longevity of populations like the Okinawa Japanese, who have about half our mortality rate. The traditional Okinawan diet is only about 10% protein, and practically no cholesterol, because they ate almost exclusively plants. Less than one percent of their diet was fish, meat, eggs, and dairy - the equivalent of one serving of meat a month and one egg every two months. Their longevity is surpassed only by vegetarian Adventists in California, who have perhaps the highest life expectancy of any formally studied population in history.

This reminds of the study I profiled in The Benefits of Caloric Restriction Without the Actual Restricting.

Methionine is another amino acid that may be associated with aging. See Methionine Restriction as a Life Extension Strategy to find out which foods to avoid in that case. Both leucine and methionine content may be additional reasons why Plant Protein is Preferable.

Other reasons why those eating plant-based diets may live longer:

This all may help explain the results of Harvard's Meat and Mortality Studies.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Image Credit: hslo / Flickr

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Add Beans, Berries, and Greens to More Meals

NF-Dec11 The Case for Adding Berries to More Meals.jpg

After we eat, our bodies create free radicals in the process of breaking down our food. That's why we need to eat antioxidant-rich foods with every meal to counteract this oxidation caused by metabolism. We can't just have berries on our oatmeal in the morning to meet our Minimum Recommended Daily Allowance of Antioxidants and call it a day. Each and every meal should contain high antioxidant foods, which means that each and every meal should contain whole plant foods. Antioxidant rich foods originate from the plant kingdom, due to the thousands of different natural antioxidant compounds naturally created by the plants we eat.

Consuming fruits--which are high in phenolic phytonutrients--increases the antioxidant capacity of the blood. When fruits are consumed along with high fat and refined carbohydrate "pro-oxidant and pro-inflammatory" meals, they may help counterbalance their negative effects. Given the content and availability of fat and sugars in the Western diet, regular consumption of phenolic-rich foods, particularly in conjunction with meals, appears to be a prudent strategy to maintain oxidative balance and health.

And of all fruits, berries may be the best source of phytonutrients. In the video, How to Reach the Antioxidant "RDA", you can see an example of the spike in oxidation caused by a Mediterranean meal of pasta, tomato sauce, olive oil, and fried fish. Obviously, given the spike of oxidation, there were not enough tomatoes. Add a glass of red wine, which contains berry phytonutrients from grapes, and we can bring down, but not blunt completely, the level of oxidation. So the meal needs even more plants.

In a study I profile in the video, researchers gave subjects standard breakfast items, resulting in lots of oxidized cholesterol in their bloodstream one to six hours after the meal. But all it took was a cup of strawberries with that same breakfast to at least keep the meal from contributing to further oxidation. In my Food Antioxidants and Cancer video, you can see a comparison of breakfast with berries versus breakfast without.

If we don't consume high-antioxidant plants with breakfast, by lunch we'll already be in oxidative debt. Let's say we ate a standard American breakfast at 6 a.m. If we didn't eat that cup of strawberries with breakfast, by the time lunch rolls around we'd already be starting out in the hyper-oxidized state, and lunch could just make things worse. Since western eating patterns include eating multiple meals a day, including snacks, one can only speculate on the level of biological unrest.

If we have some berries for breakfast, at least we'd be starting out at baseline for lunch. This acute protection is likely due to the antioxidant effects of the strawberry phytonutrients. What if, by lunch, we could be even better than baseline? How about our meals actually improving our antioxidant status?

If, for example, we eat a big bunch of red grapes with our meal, the antioxidant level of our bloodstream goes up and our bodies are in positive antioxidant balance for a few hours. We get the same result after eating enough blueberries. And imagine if in these ensuing hours before our next meal we were sipping green tea, hibiscus tea or even whole cranberries? (See Pink Juice with Green Foam). We'd have a nice antioxidant surplus all day long.

One group of researchers conclude: "These data provide an interesting perspective for advising individuals on food choice when consuming a moderate- to high-fat meal is unavoidable." (Unavoidable? So what, if we're locked in a fast food joint or something?) They suggest chasing whatever we're forced to eat with some berries. Reminds me of those studies I've talked about suggesting that smokers should eat lots of kale and broccoli to reduce the oxidative damage to their DNA. Of course, they could also just not smoke.

In a single day, the systemic stress of all the fat in our blood and "redox imbalance" (being in a mild pro-oxidant state after meals) may seem trivial. Over time, however, these daily insults can lead to problems such as heart disease, contributing to the hundreds of thousands of deaths a year (See The Power of NO).

I strive to eat berries every day and so should everyone. If we are going to drink wine, red is preferable (See Breast Cancer Risk: Red Wine vs. White Wine).

See how quickly stress can eat our antioxidants in: Antioxidant Level Dynamics.

I used a similar meal-components technique to illustrate the potent antioxidant power of spices. See Antioxidants in a Pinch.

All fruits and veggies aren't the same. I make this point in different ways in videos like Which Fruit Fights Cancer Better? and Anti-Inflammatory Antioxidants.

I have a series of videos on which foods have the most antioxidants. See Antioxidant Content of 3,139 Foods and Antioxidant Power of Plant Foods Versus Animal Foods. Note these are measured based on test tube tests. There are more sophisticated ways to measure antioxidant activity. See Anti Up on the Veggies.

What's the cheapest common source of whole food antioxidants? See Superfood Bargains for a dollar per dollar comparison. What's the cheapest uncommon source? See Dragon's Blood.

Are there diminishing returns to getting too many antioxidants? See Maxing Out on Antioxidants.

So if we have that bowl of berries in the morning to meet our minimum daily antioxidant needs can we just call it a day?. Hint: the title of my follow-up video is: Antioxidant Rich Foods With Every Meal.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Image Credit: Vegan Feast Catering / Flickr

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