Benefits of Oatmeal for Fatty Liver Disease

Benefits of Oatmeal for Fatty Liver Disease.jpeg

If oatmeal is so powerful that it can clear up some of the ravages of chemotherapy just applied to the skin (see my video Oatmeal Lotion for Chemotherapy-Induced Rash), what might it do if we actually ate it? Oats are reported to possess varied drug-like activities like lowering blood cholesterol and blood sugar, boosting our immune system, anticancer, antioxidant, and anti-atherosclerosis activites, in addition to being a topical anti-inflammatory, and reprtedly may also be useful in controlling childhood asthma and body weight.

Whole-grain intake in general is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain, as shown in my video Can Oatmeal Help Fatty Liver Disease?. All of the cohort studies on type 2 diabetes and heart disease show whole grain intake is associated with lower risk.

Researchers have observed the same for obesity--consistently less weight gain for those who consumed a few servings of whole grains every day. All the forward-looking population studies demonstrate that a higher intake of whole grains is associated with lower body mass index and body weight gain. However, these results do not clarify whether whole grain consumption is simply a marker of a healthier lifestyle or a factor favoring lower body weight.

For example, high whole grain consumers--those who eat whole wheat, brown rice, and oatmeal for breakfast--tend to be more physically active, smoke less, and consume more fruit, vegetables, and dietary fiber than those that instead reach for fruit loops. Statistically, one can control these factors, effectively comparing nonsmokers to nonsmokers with similar exercise and diet as most of the studies did, and they still found whole grains to be protective via a variety of mechanisms.

For example, in terms of helping with weight control, the soluble fiber of oatmeal forms a gel in the stomach, delaying stomach emptying, making one feel full for a longer period. It seems plausible that whole grain intake does indeed offer direct benefits, but only results of randomized controlled intervention studies can provide direct evidence of cause and effect. In other words, the evidence is clear that oatmeal consumers have lower rates of disease, but that's not the same as proving that if we start eating more oatmeal, our risk will drop. To know that, we need an interventional trial, ideally a blinded study where you give half the people oatmeal, and the other half fake placebo oatmeal that looks and tastes like oatmeal, to see if it actually works. And that's what we finally got--a double-blinded randomized trial of overweight and obese men and women. Almost 90% of the real oatmeal-treated subjects had reduced body weight, compared to no weight loss in the control group. They saw a slimmer waist on average, a 20 point drop in cholesterol, and an improvement in liver function.

Nonalcoholic fatty liver disease, meaning a fatty liver caused by excess food rather than excess drink, is now the most common cause of liver disease in the United States, and can lead in rare cases to cirrhosis of the liver, cancer of the liver, and death. Theoretically, whole grains could help prevent and treat fatty liver disease, but this is the first time it had been put to the test. A follow-up study in 2014 confirmed these findings of a protective role of whole grains, but refined grains was associated with increased risk. So one would not expect to get such wonderful results from wonder bread.

How can you make your oatmeal even healthier? See Antioxidants in a Pinch.

Whole Grains May Work As Well As Drugs for hypertension, but refined grain intake may linked with high blood pressure and diseases like diabetes. But If White Rice is Linked to Diabetes, What About China?.

More on keeping the liver healthy in videos like:

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: Sally Plank / Flickr. This image has been modified.

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Benefits of Oatmeal for Fatty Liver Disease

Benefits of Oatmeal for Fatty Liver Disease.jpeg

If oatmeal is so powerful that it can clear up some of the ravages of chemotherapy just applied to the skin (see my video Oatmeal Lotion for Chemotherapy-Induced Rash), what might it do if we actually ate it? Oats are reported to possess varied drug-like activities like lowering blood cholesterol and blood sugar, boosting our immune system, anticancer, antioxidant, and anti-atherosclerosis activites, in addition to being a topical anti-inflammatory, and reprtedly may also be useful in controlling childhood asthma and body weight.

Whole-grain intake in general is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain, as shown in my video Can Oatmeal Help Fatty Liver Disease?. All of the cohort studies on type 2 diabetes and heart disease show whole grain intake is associated with lower risk.

Researchers have observed the same for obesity--consistently less weight gain for those who consumed a few servings of whole grains every day. All the forward-looking population studies demonstrate that a higher intake of whole grains is associated with lower body mass index and body weight gain. However, these results do not clarify whether whole grain consumption is simply a marker of a healthier lifestyle or a factor favoring lower body weight.

For example, high whole grain consumers--those who eat whole wheat, brown rice, and oatmeal for breakfast--tend to be more physically active, smoke less, and consume more fruit, vegetables, and dietary fiber than those that instead reach for fruit loops. Statistically, one can control these factors, effectively comparing nonsmokers to nonsmokers with similar exercise and diet as most of the studies did, and they still found whole grains to be protective via a variety of mechanisms.

For example, in terms of helping with weight control, the soluble fiber of oatmeal forms a gel in the stomach, delaying stomach emptying, making one feel full for a longer period. It seems plausible that whole grain intake does indeed offer direct benefits, but only results of randomized controlled intervention studies can provide direct evidence of cause and effect. In other words, the evidence is clear that oatmeal consumers have lower rates of disease, but that's not the same as proving that if we start eating more oatmeal, our risk will drop. To know that, we need an interventional trial, ideally a blinded study where you give half the people oatmeal, and the other half fake placebo oatmeal that looks and tastes like oatmeal, to see if it actually works. And that's what we finally got--a double-blinded randomized trial of overweight and obese men and women. Almost 90% of the real oatmeal-treated subjects had reduced body weight, compared to no weight loss in the control group. They saw a slimmer waist on average, a 20 point drop in cholesterol, and an improvement in liver function.

Nonalcoholic fatty liver disease, meaning a fatty liver caused by excess food rather than excess drink, is now the most common cause of liver disease in the United States, and can lead in rare cases to cirrhosis of the liver, cancer of the liver, and death. Theoretically, whole grains could help prevent and treat fatty liver disease, but this is the first time it had been put to the test. A follow-up study in 2014 confirmed these findings of a protective role of whole grains, but refined grains was associated with increased risk. So one would not expect to get such wonderful results from wonder bread.

How can you make your oatmeal even healthier? See Antioxidants in a Pinch.

Whole Grains May Work As Well As Drugs for hypertension, but refined grain intake may linked with high blood pressure and diseases like diabetes. But If White Rice is Linked to Diabetes, What About China?.

More on keeping the liver healthy in videos like:

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: Sally Plank / Flickr. This image has been modified.

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Children’s Supplements Found Contaminated With Pollutants

NF-May19 PCBs in Children's Fish Oil Supplements.jpeg

A number of case-control studies have found that giving kids cod liver oil supplements may increase their risk of asthma later in life. Case-control studies are done by asking about past behavior in cases (those with asthma) versus controls (those without asthma) to see if certain past behaviors are more likely among the disease group. The problem is that asking people to remember what they were doing years ago, when most people can't remember what they had for breakfast last week, is unreliable. When interpreting the results from case-control studies, we also can't rule out something called reverse causation. Maybe cod liver oil doesn't lead to asthma, but asthma led to the use of cod liver oil.

It would therefore be nice to see a cohort study. In a cohort study, researchers would take people without asthma and follow them over time to see if those taking cod liver oil are more likely to develop it. Because people without the disease and their diets are followed over time, cohort studies bypass the problems of recall bias and reverse causation.

In 2013, we finally got one such study. 17,000 people free of asthma were followed over 11 years. Researchers knew who was taking cod liver oil and who wasn't, and then sat back and watched to see who got asthma over the subsequent 11 years. The researchers found that cod liver oil intake was indeed significantly associated with the development of asthma. They thought it might be the excessive vitamin A in the cod liver oil that was causing the problem, but there are also a number of substances in fish oil we may not want our children exposed to.

Researchers from Philadelphia University, highlighted in my video PCBs in Children's Fish Oil Supplements, recently looked at 13 over-the-counter children's dietary supplements containing fish oil to assess potential exposure to PCBs, toxic industrial pollutants that have contaminated our oceans. PCBs were detected in all products. Could we just stick to the supplements made from small, short-lived fish like anchovies instead of big predator fish like tuna to reduce the impact of biomagnification? Or use purified fish oils? No, the researchers found no significant difference in PCB levels whether the supplements were labeled as molecularly distilled or how high up the food chain the fish were.

The researchers concluded that while children's dietary supplements containing the long-chain omega-3's from fish oils may claim to benefit young consumers, "daily ingestion of these products may provide a vector for contaminant exposure that may off-set the positive health effects." What positive health benefits are they talking about?

Researchers publishing in the journal, Early Human Development, found that infants given DHA-fortified formula may have better development of their eyes and brains compared to infants getting non DHA-fortified formula. What was the source of the DHA? Not fish, but algae-derived DHA. In that way we can get the benefits of omega 3's without the contaminant risks. But of course, breast milk is the gold standard, significantly better than either of the formula fed infants. So the best source of omega-3's is mom.

It's bad enough when supplement manufacturers exploit adults when they're sick and vulnerable with pills that are often useless or worse, but taking advantage of our parental drive to do what's best for our children with contaminated products that may make them sick, makes me sick.

More on supplements in:

And speaking of which, Is Fish Oil Just Snake Oil?

Also check out these videos on fish oil and DHA: Omega-3's and the Eskimo Fish Tale and Should We Take EPA and DHA Omega-3 For Our Heart?

What about omega 3's for our child's growing brain? See my video Mercury vs. Omega-3s for Brain Development

We can also be exposed to PCBs in food. See Food Sources of PCB Chemical Pollutants.

More on the polluted aquatic food chain in:

What can we do to lower the risk of childhood asthma and other allergic-type diseases? See:

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: Lars Plougmann / Flickr

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Gluten Sensitivity Put to the Test

NF-Feb18 Is Gluten Sensitivity Real?.jpeg

In 1980, researchers in England reported a series of women with no evidence of celiac disease (the autoimmune disorder associated with gluten intolerance), who nevertheless resolved their chronic diarrhea on a gluten-free diet. The medical profession was skeptical at the time that non-celiac gluten sensitivity existed, and even 30 years later, such patients were commonly referred to psychiatrists. Psychological testing of such patients, however, found no evidence that they were suffering from any kind of psychosomatic hysteria.

The medical profession has a history of dismissing diseases as all in people's heads--post-traumatic stress disorder, ulcerative colitis, migraines, ulcers, asthma, Parkinson's disease, and multiple sclerosis. Despite resistance from the prevailing medical community at the time, these health problems have subsequently been confirmed to be credible physiologically-based disorders rather than psychologically-based confabulations.

On the flipside, the internet is rife with unsubstantiated claims about gluten free diets, which has spilled over into the popular press to make gluten the diet villain du jour, with claims like "17 million Americans are gluten sensitive." However, it must be remembered that the gluten-free food industry is a big business. When literally billions are at stake, it's hard to trust anybody. As always, it's best to stick to the science.

What sort of evidence do we have for the existence of a condition presumed to be so widespread? Not much. The evidence base for such claims has been unfortunately very thin because we haven't had randomized controlled trials demonstrating that the entity even exists. The gold-standard for confirming non-celiac gluten sensitivity requires a gluten-free diet, followed by a double-blind, randomized, placebo-controlled food challenge. For example, give people a muffin and don't tell them if it's gluten-free or gluten-filled--to control for placebo effects--and see what happens. The reason this is necessary is because when you actually do this, a number of quote-unquote "gluten-sensitive" patients don't react at all to disguised gluten and instead react to the gluten-free placebo.

We never had that level of evidence until 2011, when a double-blind, randomized placebo-controlled trial was published, which tested to see if patients complaining of irritable bowel symptoms who claimed they felt better on a gluten free diet--despite not having celiac disease--actually could tell if they were given gluten containing bread and muffins or gluten-free bread and muffins.

Subjects started out gluten-free and symptom-free for two weeks and then were challenged with the bread and muffins. In my video, Is Gluten Sensitivity Real?, you can see what happened to the 15 patients who got the placebo, meaning they started out on a gluten-free diet and continued on a gluten-free diet. They got worse. Just the thought that they may be eating something that was bad for them made them feel crampy and bloated. This is what's called the nocebo effect. The placebo effect is when you give someone something useless and they feel better; the nocebo effect is when you give someone something harmless and they feel worse. On the other hand, the small group that got the actual gluten, felt even worse still. The researchers concluded that non-celiac gluten intolerance may therefore indeed exist.

It was a small study, though, and even though the researchers claimed the gluten-free bread and muffins were indistinguishable, maybe at some level the patients could tell which was which. So in 2012, researchers in Italy took 920 patients that had been diagnosed with non-celiac gluten sensitivity and put them to the test with a double-blinded wheat challenge by giving them capsules filled with wheat flour or filled with placebo powder. More than two-thirds failed the test, such as getting worse on the placebo or better on the wheat. But of those that passed, there was a clear benefit to staying on the wheat-free diet. The researchers concluded that their findings confirmed the existence of a non-celiac wheat sensitivity. Note I said "wheat sensitivity," not "gluten sensitivity."

Gluten itself may not be causing gut symptoms at all. Most people with wheat sensitivity have a variety of other food sensitivities. Two thirds are sensitive to cow's milk protein, and many are sensitive to eggs. If we put people on a diet low in common triggers of irritable bowel symptoms, and then challenge them with gluten, there's no effect. We find the same increase in symptoms with high gluten, low gluten, or no gluten diets, calling into question the very existence of non-celiac gluten sensitivity.

Interestingly, despite being informed that avoiding gluten didn't seem to do a thing for their gut symptoms, many participants opted to continue following a gluten-free diet as they subjectively described "feeling better." So researchers wondered if avoiding gluten might improve the mood of those with wheat sensitivity. Indeed, short-term exposure to gluten appeared to induce feelings of depression in these patients. Whether non-celiac gluten sensitivity is a disease of the mind or the gut, it is no longer a condition that can be dismissed.


More than 10,000 articles have been published on gluten in medical journals--intimidating even for me! Combined with the multi-billion dollar financial interests on both sides, it makes for a difficult task. But I think I did it! This is the first of a 3-part series summarizing the best available science on gluten. Also check out: Gluten-Free Diets: Separating the Wheat from the Chat and How to Diagnose Gluten Intolerance.

Why this apparent increase in food sensitivities in recent decades? It could be because of pollutant exposure (see Alkylphenol Endocrine Disruptors and Allergies and Dietary Sources of Alkylphenol Endocrine Disruptors).

What can we do about preventing so-called atopic diseases (like allergies, asthma, and eczema)? See my videos Preventing Allergies in Adulthood and Preventing Allergies in Childhood. The weirdest example of an emerging food sensitivity may be the tick-bite related meat allergy story I review in Alpha Gal and the Lone Star Tick and Tick Bites, Meat Allergies, and Chronic Urticaria.

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: Guillaume Paumier / Flickr

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A Simple Yet Neglected Cure for Childhood Constipation

NF-Feb11 Childhood Constipation and Cow's Milk.jpeg

Back in the 1950s, it was suggested that some cases of constipation among children might be due to the consumption of cow's milk. But it wasn't until 40 years later that it was finally put to the test. We used to think that most chronic constipation in infants and young children was all in their head--they were "anal retentive"--or had some intestinal disorder, but a group of Italian researchers studied 27 consecutive infants who showed up in their pediatric gastroenterology clinic with chronic "idiopathic constipation" (meaning they had no idea what was causing it), and tried removing cow's milk protein from their diet.

Within three days on a cow's milk protein-free diet, 21 out of the 27 children were cured. There were clinical relapsea during two subsequent cow milk challenges, meaning when they tried giving the children back some cow's milk, the constipation reappeared within 24 to 48 hours. The subjects came back after a month and stayed cured, and their eczema and wheezing went away, too! The researchers concluded that many cases of chronic constipation in young children--more than three quarters it seemed, may be due to an underlying cow's milk protein allergy.

Chronic constipation is a common problem in children, for which fiber and laxatives are prescribed. If those don't work, several laxatives at progressively higher dosages can be used, and that still may not work. Five years later, a considerable number of kids are still suffering. In fact, chronic constipation may even extend into adulthood. To cure the disease in just a few days by eliminating cow's milk was a real breakthrough.

But it was an open trial, meaning not blinded or placebo-controlled. We didn't have such a trial until a landmark study was published in the New England Journal of Medicine--a double-blind, crossover study, comparing cow's milk and soy milk. The study enrolled 65 kids suffering from chronic constipation, all previously treated unsuccessfully with laxatives; 49 had anal fissures and inflammation and swelling. The researchers gave them either cow's milk or soy milk for two weeks and then switched it around.

In two thirds of the children, constipation resolved while they were receiving soy milk, and the anal fissures and pain were cured. None of the children receiving cow's milk had a positive response. In the 44 responders, the relation with cow's milk protein hypersensitivity was confirmed in all cases by a double-blind challenge with cow's milk. All those lesions, including the most severe anal fissures, disappeared on a cow's milk-free diet, yet reappeared within days after the reintroduction of cow's milk back into their diets.

This may explain why children drinking more than a cup of milk a day may have eight times the odds of developing anal fissures. Cutting out milk may help cure anal fissures in adults, too. Cow's milk may also be a major contributor to recurrent diaper rash as well.

Why does removing cow's milk treat these conditions? Studies that have looked at biopsy tissue samples in patients with chronic constipation because of cow's milk protein hypersensitivity have found signs of rectal inflammation, suggesting that cow's milk protein was inducing an inflammatory response.

Studies from around the world have subsequently confirmed these findings, curing up to 80 percent of kids' constipation by switching to soy milk or rice milk. A common problem with the studies, though, is when they switched kids from cow's milk to non-dairy milk, the kids could still have been eating other dairy products. That is, they didn't control the background diet...until recently. A 2013 study (highlighted in my video, Childhood Constipation and Cow's Milk, got constipated kids off all dairy products and 100 percent were cured, compared with 68 percent in the New England Journal study.

Isn't this amazing? I just kept thinking, "why didn't I learn this in medical school?" Is the dairy lobby so persuasive that a cheap, simple, safe, life-changing intervention like this remains buried?

Until now!

If you appreciate learning what your child's pediatrician probably never did, please consider making a donation to the 501c3 nonprofit charity that keeps this website going. I don't make a penny off the site, but it does require substantial server and logistics costs.

Make sure to check out tomorrow's video: Treating Infant Colic by Changing Mom's Diet.

Avoiding dairy may be important for infant health too. Watch my 3-part video series:

Then the effects on adolescents and beyond:

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: Melissa Wiese / Flickr

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How Plants Can be Both Safer and More Effective

NF-Sep10 Magic Bullets vs. Promiscuous plants.jpg

During the last decade, the drug industry has followed an assumption that a single drug hitting a single target was the "rational" way to design drugs. We're learning that Mother Nature may be a bit too complicated for that. "Strategies for targeting single genes or proteins ignore a very important fact that most, if not all diseases, involve a sophisticated network system." For example, one little family of immune molecules involves about 50 different keys fitting into about 20 different locks, often acting with redundancy, making selection of an appropriate drug to antagonize one key or one lock ineffective in the long run. A whole list of agents has been developed to target a specific molecule for the treatment of inflammatory bowel disease, for example, but they have all flopped. That's why drug companies are now working on so-called "promiscuous" drugs that try to affect multiple pathways simultaneously.

Meanwhile, since ancient times, natural agents derived from plants--fruits, vegetables, spices, beans, and grains--have been preferred as potential therapeutics for most chronic diseases, not only because of their safety, affordability, and long-term use, but also "for their ability to target multiple cell signaling pathways, a therapeutic virtue." (See Magic Bullets vs. Promiscuous Plants).

One example of a successful promiscuous plant-based drug is aspirin. It doesn't just target inflammation and offer pain relief, but can act as a blood thinner and help prevent preeclampsia and even some types of cancer. Curcumin is another hopeful plant-based medicine. Aspirin is an extract of the willow tree bark (and is present in other fruits and vegetables); curcumin is an extract of turmeric root. It's so anti-inflammatory that it may even work through the skin--a traditional use was to wrap sprains and injuries with turmeric soaked poultices, a use that continues to this day. Curcumin is so anti-inflammatory that it can help counter the effects of mustard gas.

In a petri dish, curcumin extinguishes the response of spleen cells to an inflammatory cytokine. Promising effects have also been observed in patients with a variety of inflammatory diseases. One of the great things about curcumin is that it also appears to be very safe. One of the reasons may be that despite its powerful pharmacological effects, the same pathway promiscuity that may account for its effectiveness may act synergistically to neutralize side-effects. For example, turmeric has been traditionally used as a bronchodilator to open airways in conditions like asthma. Many of the adrenaline-like drugs that do the same thing can raise blood pressure. The reason turmeric doesn't may be because it has different components with opposing activities, such as calcium channel-blocking effects that may actually lower blood pressure, and so the side effects may cancel each other out.

This strength in promiscuity, though, is also a weakness. The U.S. Food and Drug Administration has been reluctant to approve plant extracts, which by definition are composed of mixtures of different compounds. It's a Catch-22. One drug, one chemical, one mechanism of action and you can patent it, get FDA approval, and make a billion off it, but it may not work very well. On the other hand, there might be a safe, natural alternative that works better, but industry and the government may not be interested.

However, there is hope on the horizon. The FDA approved a green tea ointment as a prescription drug for the treatment of genital warts (See Treating Genital Warts with Green Tea), making it the first prescription plant approved in the United States. If you think that's neat, check out Treating Gorlin Syndrome With Green Tea.

So have drug companies abandoned their model and started pouring money into plants? No. "Having discovered that so-called magic bullet has been largely unsuccessful, they just propose creating non-selective drugs. Instead of magic bullets, magic shotguns."

I go into more detail about the Catch-22 in my last video Plants as Intellectual Property - Patently Wrong?

Aspirin isn't just found in willow tree bark, but throughout the plant kingdom, including fruits and vegetables. See: Aspirin Levels in Plant Foods.

My video Power Plants shows how plant foods are not to be underestimated.

More on turmeric curcumin and inflammation here:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my videos for free by clicking here and watch my full 2012 - 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Shu / Flickr

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Using Diet to Treat Asthma and Eczema

NF-Jul9 Treating Asthma and Eczema with Plant Based Diets.jpg

I previously discussed the power of fruits and vegetables to help prevent and treat asthma and allergies. If adding a few more servings of fruits and vegetables may help asthma, what about a diet centered around plants? Twenty patients with allergic eczema were placed on a vegetarian diet. At the end of two months, their disease scores, which covered both subjective and objective signs and symptoms, were cut in half, similar to what we might see using one of our most powerful drugs. The drug works much quicker, within about two weeks, but since drugs can often include dangerous side effects the dietary option is more attractive. This was no ordinary vegetarian diet, however. This was an in-patient study using an extremely calorically-restricted diet--the subjects were practically half fasting. Therefore, we don't know which component was responsible for the therapeutic effect.

What about using a more conventional plant-based diet against a different allergic disease, asthma? In Sweden, there was an active health movement that claimed that a vegan diet could improve or cure asthma. This was a bold claim, so in order to test this, a group of orthopedic surgeons at Linköping University Hospital followed a series of patients who were treated with a vegan regimen for one year. (This study is highlighted in my video, Treating Asthma and Eczema with Plant-Based Diets.) Participants had to be willing to go completely plant-based, and they had to have physician-verified asthma of at least a year's duration that wasn't getting better or was getting worse despite the best medical therapies available.

The researchers found quite a sick group to follow. The thirty-five patients had long-established, hospital-verified bronchial asthma for an average duration of a dozen years. Of the 35 patients, 20 had been admitted to the hospital for acute asthmatic attacks during the last two years. Of these, one patient had received acute infusion therapy (emergency IV drugs) a total of 23 times during this period and another patient claimed he had been to the hospital 100 times during his disease and on every occasion had evidently required such treatments. One patient even had a cardiac arrest during an asthma attack and had been brought back to life on a ventilator. These were some pretty serious cases.

The patients were on up to eight different asthma medicines when they started, with an average of four and a half drugs, and were still not getting better. Twenty of the 35 were constantly using cortisone, which is a powerful steroid used in serious cases. These were all fairly advanced cases of the disease, more severe than the vegan practitioners were used to.

Eleven couldn't stick to the diet for a year, but of the 24 that did, 71% reported improvement at four months and 92% at one year. These were folks that had not improved at all over the previous year. Concurrently with this improvement, the patients greatly reduced their consumption of medicine. Four had completely given up their medication altogether, and only two weren't able to at least drop their dose. They went from an average of 4.5 drugs down to 1.2, and some were able to get off cortisone.

Some subjects said that their improvement was so considerable they felt like "they had a new life." One nurse had difficulty at work because most of her co-workers were smokers, but after the plant-based regimen she could withstand the secondhand smoke without getting an attack and could tolerate other asthma triggers. Others reported the same thing. Whereas previously they could only live in a clean environment and felt more or less isolated in their homes, they could now go out without getting asthmatic attacks.

The researchers didn't find only subjective improvements. They also found a significant improvement in a number of clinical variables, most importantly in measures of lung function, vital capacity, forced expiratory volume, and physical working capacity, as well as significant drops in sed rate (a marker of inflammation) and IgE (allergy associated antibodies).

The study started out with 35 patients who had suffered from serious asthma for an average of 12 years, all receiving long-term medication, with 20 using cortisone, who were "subjected to vegan food for a year," and, in almost all cases, medication was withdrawn or reduced, and asthma symptoms were significantly reduced.

Despite the improved lung function tests and lab values, the placebo effect can't be discounted since there was no blinded control group. However, the nice thing about a healthy diet is that there are only good side effects. The subjects' cholesterol significantly improved, their blood pressures got better, and they lost 18 pounds. From a medical standpoint, I say why not give it a try?

If you missed the first three videos of this 4-part series here are the links:

More on eczema and diet can be found in my videos:

There are a number of other conditions plant-based diets have been found to be effective in treating:

-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: KristyFaith / Flickr

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Treating Asthma With Plants vs. Pills

NF-July7 Treating Asthma with Plants vs. Supplements.jpg

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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How Fruits and Vegetables Can Treat Asthma

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In my video Preventing Asthma With Fruits and Vegetables, I highlighted an international study of asthma and allergies involving more than a million kids. The study found a consistent inverse relationship between prevalence rates of asthma, allergies, and eczema and the intake of plants, starch, grains, and vegetables. Researchers speculated "over a decade ago that if these findings could be generalized, and if the average daily consumption of these foods increased, an important decrease in symptom prevalence could be achieved." No need to speculate any more, though, because plants were finally put to the test.

Researchers have proposed that "by eating fewer fruits and vegetables, the susceptibility to potentially harmful inhaled substances of the population as a whole may be increased because of the reduction in antioxidant defenses of the lungs." The thin lining of fluid that forms the interface between our respiratory tract and the external environment is our first line of defense against oxidative damage. Oxidative damage is important in asthma, contributing to airway contraction, excessive mucous production, and hypersensitivity. Antioxidants protect against oxidative stress, so our lung lining contains a range of antioxidants our body makes itself, as well as those obtained from our diet, particularly from fruits and vegetables.

We can even quantify the level of oxidative stress in people by measuring the level of oxidation products in their exhaled breath, which drops as we start eating more fruits and vegetables, and drops further as we combine more plants with fewer animal foods.

Do those with asthma really have lower levels of antioxidants than people without asthma? Compared to healthy controls, subjects with asthma had lower whole blood levels of total carotenoids and lower levels of each of the individual phytonutrients they measured: cryptoxanthin, lycopene, lutein, alpha-carotene and beta-carotene compared to healthy controls.

Therefore, they posit, "the accumulating evidence does suggest that diet has an influence in modulating the response of the lung to inhaled allergens and irritants. However, it is possible that the reduced carotenoid levels in asthma are a result of increased utilization in the presence of excess free radicals." So it's like a chicken-or-the-egg phenomenon.

We know antioxidant-rich diets have been associated with reduced asthma prevalence. However, direct evidence that altering intake of antioxidant-rich foods actually affects asthma was lacking, until now.

There are two ways to test the effects of fruits and vegetables on asthma. Add fruits and vegetables to people's diets and see if their asthma improves, or take asthmatics and remove fruits and vegetables from their diets and see if they get worse.

The first such study of its kind, highlighted in my video, Treating Asthma With Fruits and Vegetables, placed subjects with asthma on a low antioxidant diet. After just a matter of days, there was a significant worsening of lung function and asthma control. The researchers conclude that "This finding is highly significant for subjects with asthma, as it indicates that omitting antioxidant-rich foods from the diet, for even a short time frame, will have a detrimental effect on asthma symptoms."

Ironically, the low antioxidant diet consumed by subjects, where they were restricted to one serving of fruit and up to two servings of vegetables per day, is typical of Western diets. In other words, the low antioxidant diet they used to worsen people's asthma, crippling their lung function, was just like the standard American diet.

As about "half the population usually consumes a diet with an intake of fruit and vegetables equivalent to that in the study diet or less, it appears likely that this dietary pattern, which must be considered suboptimal for lung health, may have a significant impact on asthma management, indicating the potential for typical Western dietary patterns to contribute to a worsening of lung function and asthma control."

Within just days, cutting down fruit and vegetable intake can impair lung function, but does adding fruits and vegetables help with asthma? That was the second phase of the study.

Asthmatics on the standard American diet had about a 40% chance of relapsing into an asthma exacerbation within three months. However, put them on seven servings of fruits and vegetables a day instead of three, and we cut their exacerbation rate in half, down to 20%. Imagine if there were a drug that could work as powerfully as a few fruits and vegetables.

If manipulating antioxidant intake by increasing fruit and vegetable intake can so powerfully reduce asthma exacerbation rates, why not just take antioxidant pills instead? I cover that in my video Treating Asthma With Plants vs. Supplements?

And if a few extra servings of fruits and vegetables can make that kind of difference, what about a whole diet composed of plants? Check out Treating Asthma and Eczema With Plant-Based Diets.

What else might antioxidant-rich diets help with? See:

How many antioxidants should we shoot for? See:

Where are antioxidants found the most?

-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: Pacific Northwest Agricultural Safety and Health Center / Flickr

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How Fruits and Vegetables Can Prevent Asthma

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Asthma is the most common chronic disease in children and the prevalence is increasing around the world. Despite this, most research dollars are spent on adult chronic disease. "One might ask," a group of researchers posited "whether this is because our politicians and senior administrators feel themselves to be more likely to suffer from the latter, and thus ignore allergic diseases as they mostly impact children and young adults" - who don't vote.

An enormous study about asthma and allergies in childhood, highlighted in my video, Preventing Asthma with Fruits and Vegetables, was published that includes more than a million children in nearly a hundred countries, making it the most comprehensive survey of asthma and allergies ever undertaken. The researchers found striking worldwide variations in the prevalence and severity of asthma, allergies, and eczema--a 20 to 60-fold difference in prevalence of symptoms of asthma, allergic runny nose, and atopic eczema around the world. The large variability suggests a crucial role of local characteristics that are determining the differences in prevalence between one place and another.

What kind of environmental factors? Why does the prevalence of itchy eyes and runny noses range anywhere from 1% in India, for example, and up to 45% of kids elsewhere? There were some associations with regional air pollution and smoking rates, but the most significant associations were with diet. Adolescents showed a consistent pattern of decreases in symptoms of wheeze (current and severe), allergic rhinoconjunctivitis, and atopic eczema with increases in per capita consumption of plant foods. The more their calories and protein came from plant sources, the less allergies they tended to have.

In general, there seems to be an association between an increase in asthma prevalence and a decrease in consumption of fresh fruits, green vegetables, and other dietary sources of antioxidants, helping to explain why the prevalence of asthma and respiratory symptoms are lower in populations with high intake of foods of plant origin. High intakes of fat and sodium, and low intakes of fiber and carbohydrates, are linked with asthma, while traditional and vegetarian diets are associated with lower rates. For example, if we look closer within India, in a study of more than 100,000 people, "those who consumed meat (daily or occasionally) were more likely to report asthma than those who were strictly vegetarian." This also meant avoiding eggs.

Eggs have been associated (along with soft drink consumption) with increased risk of respiratory symptoms and asthma in schoolchildren. On the other hand, consumptions of soy foods and fruits were associated with reduced risk of respiratory symptoms. In fact, removing eggs and dairy from the diet may improve lung function in asthmatic children in as little as eight weeks. Therefore, it may be a combination of eating fewer animal foods and more plants.

High vegetable intake, for example, has been found protective in children, potentially cutting the odds of allergic asthma in half. And fruit has also shown a consistent protective association for current and severe wheeze and runny nose in adolescents, and for current and severe asthma, allergies, and eczema in children.

Why is this? I've talked about the endocrine-disrupting industrial pollutants (see Dietary Sources of Alkylphenol Endocrine Disruptors) building up in the meat supply that may increase the risk of allergic disease, but the increase in asthma may be a combination of both a more toxic environment and a more susceptible population. One review notes that, "The dietary changes which have occurred over recent years may have led to a reduction in these natural antioxidant defenses, resulting in a shift of the antioxidant status of the whole population and leading to increased susceptibility to oxidant attack and airway inflammation."

In adults, for example, the risk of airway hyper-reactivity may increase seven-fold among those with the lowest intake of vitamin C from plant foods, while those with the lowest intake of saturated fats may have a 10-fold protection, presumably because of saturated fat's role in triggering inflammation.

The protective effect of plant-based food may also be mediated through effects on intestinal microflora. It turns out that differences in the indigenous intestinal flora might affect the development and priming of the immune system in early childhood. Kids with allergies, for example, tend to be less likely to harbor lactobacilli, the good bacteria that's found in fermented foods, and naturally on many fruits and vegetables. Lactobacillus probiotics may actually help with childhood asthma, which may help explain why children raised on largely organic vegetarian diets may have a lower prevalence of allergic reactions. Infants raised this way tend to have more good lactobacilli in their guts compared to controls, though they were also more likely to have been born naturally, breastfed longer, and not been given antibiotics, so we can't really tell if it's the diet until we put it to the test (See Treating Asthma with Fruits and Vegetables).

More on preventing allergic diseases can be found in my videos Preventing Childhood Allergies and Preventing Allergies in Adulthood.

More on protecting lung function with fruits and vegetables can be found in Preventing COPD With Diet.

Surprised probiotics can affect immune function? Check out my video Preventing the Common Cold with Probiotics? And if you think that is wild, wait until you see Gut Feelings: Probiotics and Mental Health.

What might be in plants that's so beneficial? See Anti-inflammatory Antioxidants.

What might be in animal products that is harmful to lung function? There are endocrine-disrupting industrial pollutants that build up in the food chain that may be playing a role. See my video Alkylphenol Endocrine Disruptors and Allergies. Also there's an inflammatory omega-6 fatty acid found predominantly in chicken and eggs that may contribute to inflammation as well. See Inflammatory Remarks About Arachidonic Acid.

Choosing fragrance-free personal care products may also help reduce airway reactivity: Throw Household Products Off the Scent.

I compare the efficacy of plants to pills (Treating Asthma With Plants vs. Supplements?) and explore the role an entire diet filled with plants might play in Treating Asthma and Eczema With Plant-Based Diets.

-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: EdTech Stanford University School of Medicine / Flickr

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