Music as Medicine

Music as Medicine.jpeg

We've been playing music since the Paleolithic Era, 40,000 years ago. Music as therapy has been documented since at least biblical times. The first music therapy experiment was published in the Journal of the American Medical Association in 1914. As to why he placed a phonograph in the operating room as his patients lay fully conscious and awake during surgery, the surgeon explained it was "a means of calming and distracting my patients from the horror of the situation."

Now that we have anesthesia, music is used to calm nerves before surgery. Normally we use Valium-type drugs like midazolam (sold as Versed), but they can have a variety of side effects, including sometimes even making people more agitated. A study from Sweden sought to determine if relaxing music has a greater anxiety-reducing effect than a standard dose of midazolam. Researchers whipped out some Kenny G, and the music worked significantly better than the drug. Those listening to Mr. G had lower anxiety scores, heart rates, and blood pressures. This is perhaps the first report of any anti-anxiety therapy working not only as good as, but even better than, benzodiazepine drugs. The difference in side effects of relaxing music compared to the drug is obvious: There were none. Soft jazz causes no post-operative hangover. The researchers suggest we should start using music instead of midazolam.

Music may also reduce anxiety and pain in children undergoing minor medical and dental procedures, helping with blood draws and shots. It may even reduce the pain of spinal taps. However, Mozart is evidently powerless against the pain of circumcision.

It doesn't take a randomized controlled trial to demonstrate that listening to music can be relaxing. Tell me something I don't know. Well, if you take someone with a latex allergy and inject their skin with latex, they get a big, red, angry bump. But if you repeat the test after they've been listening to Mozart for 30 minutes, they develop a much smaller bump (as you can see in my video, Music as Medicine). That is, they have less of an allergic reaction. If you think that's wild, get ready for this: Beethoven didn't work. The subjects had the same reaction before and after listening to his music! Schubert, Hayden, and Brahms didn't work either, as all failed to reduce the allergic skin response. The reducing effect on allergic responses may be specific to Mozart.

So Mozart's looking pretty good, but what if he could be suppressing our immune systems in general? That would not be good. The same researchers also injected a chemical that causes reactions in everyone, not just in allergic people. Mozart had no effect. It seems Mozart suppresses only the pathological allergic reaction. If that isn't crazy enough for you, the researchers drew subjects' blood after the music, stuck their white blood cells in a petri dish with a little latex, and measured the allergic antibody response. The white blood cells from those exposed to Mozart had less of an allergic response even outside the body compared to cells taken from Beethoven blood. How cool is that?

Music may even impact our metabolism. This inquiry started with a 2012 study published in the journal Pediatrics, which found the resting energy expenditure (the number of calories burned when just lying around) was lower in preterm infants when researchers piped in Mozart. This may explain why infants exposed to music put on weight faster, so much so they are able to go home earlier.

Gaining weight faster is great for premature babies, but not necessarily for adults. Could listening to music slow our metabolism and contribute to weight gain? Well, one study found no effect on adults. But the researchers used Bach, not Mozart. Bach doesn't cause a drop in energy expenditure in babies either. These data suggest there may be "more a 'Mozart effect' than a universal 'music effect'."

What if we just listen to music of our choice? Does that affect our metabolism? We didn't know... until now. It turns out that listening to music appears to actually increase our metabolic rate, such that we burn an average of 27.6 more calories a day just lying in bed. That's only like six M&M's worth, though, so it's better to use music to get up and start dancing or exercising. Music can not only improve exercise enjoyment but also performance--a way to improve athletic performance that's legal.

Male bodybuilders may be less enthused music's effects. After listening to music for just 30 minutes, testosterone levels drop 14% in young men and go up 21% in young women. Do all kinds of music have this effect or just some types? Thirty minutes of silence had no effect on testosterone levels at all, while a half-hour of Mozart, jazz, pop, or Gregorian chants (no relation :) all suppressed testosterone. What about a half-hour of people's personal favorites? Testosterone levels were cut in half! Testosterone decreased in males under all music conditions, whereas testosterone increased in females. What is going on? Well, in men, testosterone is related to libido, dominance, and aggressiveness, whereas women get a bigger boost in testosterone from cuddling than from sex. So maybe we evolved using music as a way to ensure we all got along, like a melodious cold shower to keep everyone chill.

Is that crazy or what? I'm fascinated by the whole topic. For more, see Music for Anxiety: Mozart vs. Metal.

Sounds are the only sensory-stimulators that can have an effect on us--so can scents! See:

Exposure to industrial pollutants may also affect both allergic diseases and testosterone levels:

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. This image has been modified.

Original Link

Music as Medicine

Music as Medicine.jpeg

We've been playing music since the Paleolithic Era, 40,000 years ago. Music as therapy has been documented since at least biblical times. The first music therapy experiment was published in the Journal of the American Medical Association in 1914. As to why he placed a phonograph in the operating room as his patients lay fully conscious and awake during surgery, the surgeon explained it was "a means of calming and distracting my patients from the horror of the situation."

Now that we have anesthesia, music is used to calm nerves before surgery. Normally we use Valium-type drugs like midazolam (sold as Versed), but they can have a variety of side effects, including sometimes even making people more agitated. A study from Sweden sought to determine if relaxing music has a greater anxiety-reducing effect than a standard dose of midazolam. Researchers whipped out some Kenny G, and the music worked significantly better than the drug. Those listening to Mr. G had lower anxiety scores, heart rates, and blood pressures. This is perhaps the first report of any anti-anxiety therapy working not only as good as, but even better than, benzodiazepine drugs. The difference in side effects of relaxing music compared to the drug is obvious: There were none. Soft jazz causes no post-operative hangover. The researchers suggest we should start using music instead of midazolam.

Music may also reduce anxiety and pain in children undergoing minor medical and dental procedures, helping with blood draws and shots. It may even reduce the pain of spinal taps. However, Mozart is evidently powerless against the pain of circumcision.

It doesn't take a randomized controlled trial to demonstrate that listening to music can be relaxing. Tell me something I don't know. Well, if you take someone with a latex allergy and inject their skin with latex, they get a big, red, angry bump. But if you repeat the test after they've been listening to Mozart for 30 minutes, they develop a much smaller bump (as you can see in my video, Music as Medicine). That is, they have less of an allergic reaction. If you think that's wild, get ready for this: Beethoven didn't work. The subjects had the same reaction before and after listening to his music! Schubert, Hayden, and Brahms didn't work either, as all failed to reduce the allergic skin response. The reducing effect on allergic responses may be specific to Mozart.

So Mozart's looking pretty good, but what if he could be suppressing our immune systems in general? That would not be good. The same researchers also injected a chemical that causes reactions in everyone, not just in allergic people. Mozart had no effect. It seems Mozart suppresses only the pathological allergic reaction. If that isn't crazy enough for you, the researchers drew subjects' blood after the music, stuck their white blood cells in a petri dish with a little latex, and measured the allergic antibody response. The white blood cells from those exposed to Mozart had less of an allergic response even outside the body compared to cells taken from Beethoven blood. How cool is that?

Music may even impact our metabolism. This inquiry started with a 2012 study published in the journal Pediatrics, which found the resting energy expenditure (the number of calories burned when just lying around) was lower in preterm infants when researchers piped in Mozart. This may explain why infants exposed to music put on weight faster, so much so they are able to go home earlier.

Gaining weight faster is great for premature babies, but not necessarily for adults. Could listening to music slow our metabolism and contribute to weight gain? Well, one study found no effect on adults. But the researchers used Bach, not Mozart. Bach doesn't cause a drop in energy expenditure in babies either. These data suggest there may be "more a 'Mozart effect' than a universal 'music effect'."

What if we just listen to music of our choice? Does that affect our metabolism? We didn't know... until now. It turns out that listening to music appears to actually increase our metabolic rate, such that we burn an average of 27.6 more calories a day just lying in bed. That's only like six M&M's worth, though, so it's better to use music to get up and start dancing or exercising. Music can not only improve exercise enjoyment but also performance--a way to improve athletic performance that's legal.

Male bodybuilders may be less enthused music's effects. After listening to music for just 30 minutes, testosterone levels drop 14% in young men and go up 21% in young women. Do all kinds of music have this effect or just some types? Thirty minutes of silence had no effect on testosterone levels at all, while a half-hour of Mozart, jazz, pop, or Gregorian chants (no relation :) all suppressed testosterone. What about a half-hour of people's personal favorites? Testosterone levels were cut in half! Testosterone decreased in males under all music conditions, whereas testosterone increased in females. What is going on? Well, in men, testosterone is related to libido, dominance, and aggressiveness, whereas women get a bigger boost in testosterone from cuddling than from sex. So maybe we evolved using music as a way to ensure we all got along, like a melodious cold shower to keep everyone chill.

Is that crazy or what? I'm fascinated by the whole topic. For more, see Music for Anxiety: Mozart vs. Metal.

Sounds are the only sensory-stimulators that can have an effect on us--so can scents! See:

Exposure to industrial pollutants may also affect both allergic diseases and testosterone levels:

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. This image has been modified.

Original Link

Benefits of Nutritional Yeast to Prevent the Common Cold

Benefits of Nutritional Yeast to Prevent the Common Cold.jpeg

Natural immunomodulators that can help regulate our immune system without side-effects have been sought for centuries, and all the while they've been sitting in the produce aisle. Plants produce thousand of active compounds, many of which modulate our immune system, but we can't forget the fungi (see Boosting Immunity While Reducing Inflammation).

Mushrooms have used for centuries as folk remedies, and for good reason. Some have been shown to boost immune function, so much so that a type of fiber found in shiitake mushrooms is approved for use as adjunct chemotherapy, injected intravenously to help treat a variety of cancers by rallying our immune defenses.

More than 6,000 papers have been published on these so-called beta glucans, but almost all of the data about preventing infections had come from petri dish or lab animal studies, until a few years ago when a series of experiments on athletes showed beneficial effects in marathon runners (see Preserving Immune Function in Athletes With Nutritional Yeast). What about the rest of us? We didn't know... until now.

As I explore in my video, Nutritional Yeast to Prevent the Common Cold, beta glucan fiber found in baker's, brewer's and nutritional yeast helps to maintain our body's defense against pathogens even in nonathletes, according to a double-blind, randomized, placebo-controlled trial. The recurrence of infections with the common cold was reduced by 25% in those that ate the equivalent of about a spoonful of nutritional yeast a day, and had fewer cold-related sleeping difficulties when they did get sick.

What about half a spoonful a day? Still worked! Subjects experienced a big drop in common cold incidence and a reduction in symptoms as well. Why is this? This study found that not only were upper respiratory infection symptoms diminished, but that mood states appeared to improve, for example a significant boost in feelings of "vigor." So the researchers suggest that maybe the yeast fiber is able to counteract the negative effects of stress on the immune system.

In terms of side-effects, two folks reported stomachaches, but they were both in the placebo group.

Unlike antibiotics and antivirals, which are designed to kill the pathogen directly, these yeast compounds instead appear to work by stimulating our immune defenses, and as such don't share the same antibiotic side effects. They stimulate our immune defenses presumably because our body recognizes them as foreign. But if it's treated like an invader, might it trigger an inflammatory response? Turns out these fiber compounds may actually have an anti-inflammatory effect, suggesting nutritional yeast may offer the best of both worlds, boosting the infection fighting side of the immune system while suppressing inflammatory components.

Yeast is high in purines, so those with gout, uric acid kidney stones, and new organ transplant recipients may want to keep their intake to less than a teaspoon a day. But is there any downside for everyone else? In California some packages of nutritional yeast are slapped with prop 65 warning stickers, suggesting there's something in it exceeding cancer or birth defect safety limits. I called around to the companies and it turns out the problem is lead. California state law says a product cannot contain more than half of a microgram of lead per daily serving, so I contacted the six brands I knew about and asked them how much lead was in their products.

KAL originally said "<5 ppm," but when we called back they said "<3 ppm." Even if it's 3, that translates into less than 45 micrograms per serving, nearly a 100 times more than the California limit. But perhaps that's better than Bob's Red Mill or Frontier Coop, who evidently don't test at all. But at least they got back to me. Redstar brand failed to respond to multiple attempts to contact them. Now Foods said they test for lead and claim that at least their recent batches meet the less than a half a microgram California standard. Unfortunately, despite repeated requests they would not provide me with documentation to substantiate their numbers. My favorite response was from Bragg's who sent me the analysis certificate from the lab showing less than 0.01 ppm, which means at most less than half the California standard, which I believe is the most stringent in the world. To put the numbers in context, in determining how much lead manufacturers can put into candy likely to be frequently consumed by small children, the Food and Drug Administration would allow about 2 micrograms a day in the form of lollipops, but as far as I'm concerned the less lead the better.

I was so frustrated by the lack of transparency I decided to test them for lead myself. NutritionFacts.org hired an independent lab to conduct our own tests for lead and shipped out 8 samples of nutritional yeast in their original package. The lab used standard practices for lead testing known as Official Methods of Analysis set by AOAC International. Lab technicians determined the lead values based on California Prop 65 standards. Here are the results from the brands we tested:

Bob's Red Mill - Test report shows no detectable lead (<0.01 ppm).

Bragg - Test report shows no detectable lead (< 0.01 ppm).

Dr. Fuhrman - Test report shows no detectable lead (< 0.01 ppm).

Frontier Coop - Test report shows lead levels at 0.021 ppm. It would take six tablespoons a day (based on the manufacture's listed density) to exceed the California Office of Environmental Health Hazard Assessment Maximum Allowable Dose Level (MADL) for chemicals causing reproductive toxicity.*

KAL - Test report shows lead levels at 0.011 ppm. It would take seven tablespoons a day to exceed the MADL.*

NOW Foods - Test report shows no detectable lead (< 0.01 ppm).

Red Star - Test report shows no detectable lead (< 0.01 ppm).

Whole Foods - Test report shows lead levels at 0.012 ppm. It would take six tablespoons a day to exceed the MADL.*

So what do all those numbers mean? None of the brands tested exceeded California prop 65 standards. No matter what brand, consuming a typical serving (2 tablespoons) per day is still well within safe limits.

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:

* The Maximum Allowable Dose Level for lead as a developmental toxin is 0.5 micrograms a day. How are MADL's calculated? Basically scientists figure out what the "no observable effect level" is, the level at which no birth defects or reproductive toxicity can be found, and then introduce a 1000-fold safety buffer. So for example, let's say there's some chemical that causes birth defects if expectant moms are exposed to two drops of the chemical a day, but there's no evidence that one drop a day is harmful. Do they set the Maximum Allowable Dose Level at one drop? No, they set it at 1/1000th of a drop to account for scientific uncertainty and to err on the side of caution. So by saying six tablespoons a day of nutritional yeast may exceed the MADL is in effect saying that the level of lead found in 6,000 tablespoons of nutritional yeast may cause birth defects. Like mercury, though, as far as I'm concerned the less lead exposure the better. I hope this will inspire companies to do further testing to see if the levels we found were just flukes.

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

Original Link

Benefits of Nutritional Yeast to Prevent the Common Cold

Benefits of Nutritional Yeast to Prevent the Common Cold.jpeg

Natural immunomodulators that can help regulate our immune system without side-effects have been sought for centuries, and all the while they've been sitting in the produce aisle. Plants produce thousand of active compounds, many of which modulate our immune system, but we can't forget the fungi (see Boosting Immunity While Reducing Inflammation).

Mushrooms have used for centuries as folk remedies, and for good reason. Some have been shown to boost immune function, so much so that a type of fiber found in shiitake mushrooms is approved for use as adjunct chemotherapy, injected intravenously to help treat a variety of cancers by rallying our immune defenses.

More than 6,000 papers have been published on these so-called beta glucans, but almost all of the data about preventing infections had come from petri dish or lab animal studies, until a few years ago when a series of experiments on athletes showed beneficial effects in marathon runners (see Preserving Immune Function in Athletes With Nutritional Yeast). What about the rest of us? We didn't know... until now.

As I explore in my video, Nutritional Yeast to Prevent the Common Cold, beta glucan fiber found in baker's, brewer's and nutritional yeast helps to maintain our body's defense against pathogens even in nonathletes, according to a double-blind, randomized, placebo-controlled trial. The recurrence of infections with the common cold was reduced by 25% in those that ate the equivalent of about a spoonful of nutritional yeast a day, and had fewer cold-related sleeping difficulties when they did get sick.

What about half a spoonful a day? Still worked! Subjects experienced a big drop in common cold incidence and a reduction in symptoms as well. Why is this? This study found that not only were upper respiratory infection symptoms diminished, but that mood states appeared to improve, for example a significant boost in feelings of "vigor." So the researchers suggest that maybe the yeast fiber is able to counteract the negative effects of stress on the immune system.

In terms of side-effects, two folks reported stomachaches, but they were both in the placebo group.

Unlike antibiotics and antivirals, which are designed to kill the pathogen directly, these yeast compounds instead appear to work by stimulating our immune defenses, and as such don't share the same antibiotic side effects. They stimulate our immune defenses presumably because our body recognizes them as foreign. But if it's treated like an invader, might it trigger an inflammatory response? Turns out these fiber compounds may actually have an anti-inflammatory effect, suggesting nutritional yeast may offer the best of both worlds, boosting the infection fighting side of the immune system while suppressing inflammatory components.

Yeast is high in purines, so those with gout, uric acid kidney stones, and new organ transplant recipients may want to keep their intake to less than a teaspoon a day. But is there any downside for everyone else? In California some packages of nutritional yeast are slapped with prop 65 warning stickers, suggesting there's something in it exceeding cancer or birth defect safety limits. I called around to the companies and it turns out the problem is lead. California state law says a product cannot contain more than half of a microgram of lead per daily serving, so I contacted the six brands I knew about and asked them how much lead was in their products.

KAL originally said "<5 ppm," but when we called back they said "<3 ppm." Even if it's 3, that translates into less than 45 micrograms per serving, nearly a 100 times more than the California limit. But perhaps that's better than Bob's Red Mill or Frontier Coop, who evidently don't test at all. But at least they got back to me. Redstar brand failed to respond to multiple attempts to contact them. Now Foods said they test for lead and claim that at least their recent batches meet the less than a half a microgram California standard. Unfortunately, despite repeated requests they would not provide me with documentation to substantiate their numbers. My favorite response was from Bragg's who sent me the analysis certificate from the lab showing less than 0.01 ppm, which means at most less than half the California standard, which I believe is the most stringent in the world. To put the numbers in context, in determining how much lead manufacturers can put into candy likely to be frequently consumed by small children, the Food and Drug Administration would allow about 2 micrograms a day in the form of lollipops, but as far as I'm concerned the less lead the better.

I was so frustrated by the lack of transparency I decided to test them for lead myself. NutritionFacts.org hired an independent lab to conduct our own tests for lead and shipped out 8 samples of nutritional yeast in their original package. The lab used standard practices for lead testing known as Official Methods of Analysis set by AOAC International. Lab technicians determined the lead values based on California Prop 65 standards. Here are the results from the brands we tested:

Bob's Red Mill - Test report shows no detectable lead (<0.01 ppm).

Bragg - Test report shows no detectable lead (< 0.01 ppm).

Dr. Fuhrman - Test report shows no detectable lead (< 0.01 ppm).

Frontier Coop - Test report shows lead levels at 0.021 ppm. It would take six tablespoons a day (based on the manufacture's listed density) to exceed the California Office of Environmental Health Hazard Assessment Maximum Allowable Dose Level (MADL) for chemicals causing reproductive toxicity.*

KAL - Test report shows lead levels at 0.011 ppm. It would take seven tablespoons a day to exceed the MADL.*

NOW Foods - Test report shows no detectable lead (< 0.01 ppm).

Red Star - Test report shows no detectable lead (< 0.01 ppm).

Whole Foods - Test report shows lead levels at 0.012 ppm. It would take six tablespoons a day to exceed the MADL.*

So what do all those numbers mean? None of the brands tested exceeded California prop 65 standards. No matter what brand, consuming a typical serving (2 tablespoons) per day is still well within safe limits.

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:

* The Maximum Allowable Dose Level for lead as a developmental toxin is 0.5 micrograms a day. How are MADL's calculated? Basically scientists figure out what the "no observable effect level" is, the level at which no birth defects or reproductive toxicity can be found, and then introduce a 1000-fold safety buffer. So for example, let's say there's some chemical that causes birth defects if expectant moms are exposed to two drops of the chemical a day, but there's no evidence that one drop a day is harmful. Do they set the Maximum Allowable Dose Level at one drop? No, they set it at 1/1000th of a drop to account for scientific uncertainty and to err on the side of caution. So by saying six tablespoons a day of nutritional yeast may exceed the MADL is in effect saying that the level of lead found in 6,000 tablespoons of nutritional yeast may cause birth defects. Like mercury, though, as far as I'm concerned the less lead exposure the better. I hope this will inspire companies to do further testing to see if the levels we found were just flukes.

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

Original Link

Fat is the Cause of Type 2 Diabetes

NF-Nov17 What Causes Insulin Resistance copy.jpg

Studies dating back nearly a century noted a striking finding: If you take young, healthy people and split them up into two groups--half on a fat-rich diet and half on a carbohydrate-rich diet--we find that within just two days, glucose intolerance skyrockets in the fat group. The group that had been shoveling fat in ended up with twice the blood sugar. As the amount of fat in the diet goes up, so does one's blood sugar. Why would eating fat lead to higher blood sugar levels? It would take scientists nearly seven decades to unravel this mystery, but it would end up holding the key to our current understanding of the cause of type 2 diabetes.

The reason athletes carb-load before a race is to build up the fuel supply within their muscles. We break down the starch into glucose in our digestive tract, it circulates as blood glucose (blood sugar) and is taken up by our muscles to be stored and burnt for energy.

Blood sugar, though, is like a vampire. It needs an invitation to come into our cells. That invitation is insulin. Insulin is the key that unlocks the door that lets glucose in the blood enter muscle cells. When insulin attaches to the insulin receptor on the cell, it activates an enzyme, which activates another enzyme, which activates two more enzymes, which finally activates glucose transport (as diagrammed in my video What Causes Insulin Resistance?).

What if there was no insulin? Blood sugar would be stuck in the bloodstream banging on the door to our muscles, unable to get inside. With nowhere to go, sugar levels in the blood would rise and rise. That's what happens in type 1 diabetes: the cells in the pancreas that make insulin get destroyed, and without insulin, sugar in the blood can't get out of the blood into the muscles, and so blood sugar rises. But there's a second way we could end up with high blood sugar.

What if there's enough insulin, but the insulin doesn't work? The key is there, but something's gummed up the lock. This is insulin resistance. Our muscle cells become resistant to the effect of insulin. What's gumming up the locks on our muscle cells? What's preventing insulin from letting glucose in? Tiny droplets of fat inside our muscle cells, so-called intramyocellular lipid.

Fat in the bloodstream can build up inside the muscle cell, creating toxic fatty breakdown products and free radicals that block the insulin signaling process. No matter how much insulin we have in our blood, it's not able to sufficiently open the glucose gates and blood sugar levels build up in the blood. And this can happen within three hours. One hit of fat can start causing insulin resistance, inhibiting blood sugar uptake after just 160 minutes.

This mechanism by which fat induces insulin resistance wasn't known until fancy MRI techniques were developed to see what was happening inside people's muscles as fat was infused into their bloodstream. That's how we found that elevation of fat levels in the blood causes insulin resistance by inhibition of glucose transport into the muscles.

We can also do the opposite experiment. Lower the level of fat in people's blood and the insulin resistance comes right down. If we clear the fat out of the blood, we also clear the sugar out. That explains the finding that on the high fat, ketogenic diet, insulin doesn't work very well. Our bodies become insulin resistant. But as the amount of fat in our diet gets lower and lower, insulin works better and better--a clear demonstration that the sugar tolerance of even healthy individuals can be impaired by administering a low-carb, high-fat diet. We can decrease insulin resistance, however, by decreasing fat intake.

The effect is really dramatic--check out at least the end of my video What Causes Insulin Resistance? to see what happens as dietary fat intake drops.

The most concerning downside of low-carb diets, though, is heart health: Low Carb Diets and Coronary Blood Flow

This is the first of a 3-part series on the cause of type 2 diabetes, so as to better understand dietary interventions to prevent and treat the epidemic. In The Spillover Effect Links Obesity to Diabetes, I talk about how that fat can come either from our diet or excess fat stores, and then in Lipotoxicity: How Saturated Fat Raises Blood Sugar, I show how not all fats are equally to blame.

Here are some of my recent diabetes videos:

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: [Gema Ibarra] © 123RF.com

Original Link

Fat is the Cause of Type 2 Diabetes

NF-Nov17 What Causes Insulin Resistance copy.jpg

Studies dating back nearly a century noted a striking finding: If you take young, healthy people and split them up into two groups--half on a fat-rich diet and half on a carbohydrate-rich diet--we find that within just two days, glucose intolerance skyrockets in the fat group. The group that had been shoveling fat in ended up with twice the blood sugar. As the amount of fat in the diet goes up, so does one's blood sugar. Why would eating fat lead to higher blood sugar levels? It would take scientists nearly seven decades to unravel this mystery, but it would end up holding the key to our current understanding of the cause of type 2 diabetes.

The reason athletes carb-load before a race is to build up the fuel supply within their muscles. We break down the starch into glucose in our digestive tract, it circulates as blood glucose (blood sugar) and is taken up by our muscles to be stored and burnt for energy.

Blood sugar, though, is like a vampire. It needs an invitation to come into our cells. That invitation is insulin. Insulin is the key that unlocks the door that lets glucose in the blood enter muscle cells. When insulin attaches to the insulin receptor on the cell, it activates an enzyme, which activates another enzyme, which activates two more enzymes, which finally activates glucose transport (as diagrammed in my video What Causes Insulin Resistance?).

What if there was no insulin? Blood sugar would be stuck in the bloodstream banging on the door to our muscles, unable to get inside. With nowhere to go, sugar levels in the blood would rise and rise. That's what happens in type 1 diabetes: the cells in the pancreas that make insulin get destroyed, and without insulin, sugar in the blood can't get out of the blood into the muscles, and so blood sugar rises. But there's a second way we could end up with high blood sugar.

What if there's enough insulin, but the insulin doesn't work? The key is there, but something's gummed up the lock. This is insulin resistance. Our muscle cells become resistant to the effect of insulin. What's gumming up the locks on our muscle cells? What's preventing insulin from letting glucose in? Tiny droplets of fat inside our muscle cells, so-called intramyocellular lipid.

Fat in the bloodstream can build up inside the muscle cell, creating toxic fatty breakdown products and free radicals that block the insulin signaling process. No matter how much insulin we have in our blood, it's not able to sufficiently open the glucose gates and blood sugar levels build up in the blood. And this can happen within three hours. One hit of fat can start causing insulin resistance, inhibiting blood sugar uptake after just 160 minutes.

This mechanism by which fat induces insulin resistance wasn't known until fancy MRI techniques were developed to see what was happening inside people's muscles as fat was infused into their bloodstream. That's how we found that elevation of fat levels in the blood causes insulin resistance by inhibition of glucose transport into the muscles.

We can also do the opposite experiment. Lower the level of fat in people's blood and the insulin resistance comes right down. If we clear the fat out of the blood, we also clear the sugar out. That explains the finding that on the high fat, ketogenic diet, insulin doesn't work very well. Our bodies become insulin resistant. But as the amount of fat in our diet gets lower and lower, insulin works better and better--a clear demonstration that the sugar tolerance of even healthy individuals can be impaired by administering a low-carb, high-fat diet. We can decrease insulin resistance, however, by decreasing fat intake.

The effect is really dramatic--check out at least the end of my video What Causes Insulin Resistance? to see what happens as dietary fat intake drops.

The most concerning downside of low-carb diets, though, is heart health: Low Carb Diets and Coronary Blood Flow

This is the first of a 3-part series on the cause of type 2 diabetes, so as to better understand dietary interventions to prevent and treat the epidemic. In The Spillover Effect Links Obesity to Diabetes, I talk about how that fat can come either from our diet or excess fat stores, and then in Lipotoxicity: How Saturated Fat Raises Blood Sugar, I show how not all fats are equally to blame.

Here are some of my recent diabetes videos:

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: [Gema Ibarra] © 123RF.com

Original Link

Can Peppermint Improve Athletic Performance?

NF-Oct20 Enhancing Athletic Performance With Peppermint.jpeg

Ever since smoking was prohibited in night clubs, customers have increasingly noticed other unpleasant smells present in the club--like body odors. So, researchers in Europe thought they'd try to cover them up. The researchers measured the effects of peppermint, for example, on dancing activity and asked people to rate their energy level. They found that with peppermint scent, people felt more cheerful and danced more, and so, concluded the researchers, "environmental fragrancing may be expected to have a positive effects on club revenue." Innovative nightclubs are already inviting "aroma jockeys" to smell the places up.

The business community caught whiff of this and thought maybe peppermint smell would get their secretaries to type faster. And it worked! There was improved performance on clerical tasks associated with the administration of peppermint odor.

In an age where athletic competitions are frequently won or lost by mere hundredths of a second, athletes are continually looking for new ways to excel in their sport. Researchers threw some collegiate athletes onto a treadmill and piped different smell into their nostrils, and those on peppermint reported feeling less fatigued, more vigorous, less frustrated, and felt they performed better. But did they actually perform better? See my video, Enhancing Athletic Performance with Peppermint.

A different study published in the Journal of Sport and Exercise Psychology measured actual performance, and participants were actually able to squeeze out one extra pushup before collapsing and cut almost two seconds off a quarter mile dash with an odorized adhesive strip stuck to their upper lip. Interestingly there was no significant difference in basketball free throws. The researchers think the reason is that free throws actually require some skill, and all the peppermint can do is really improve athlete's motivation.

Unfortunately follow-up studies were not able to replicate these results, showing no beneficial effect of smelling peppermint on athletic performance, so how about eating peppermint? Researchers measured the effects of peppermint on exercise performance before and after ten days of having subjects drink bottles of water with a single drop of peppermint essential oil in them. And all the subjects' performance parameters shot up, churning out 50 percent more work, 20 percent more power, and a 25 percent greater time to exhaustion. Improvements were found across the board in all those physiological parameters, indicating increased respiratory efficiency. They attribute these remarkable results to the peppermint opening up their airways, increasing ventilation and oxygen delivery.

Now, you can overdose on the stuff, but a few drops shouldn't be toxic. Why not get the best of both worls by blending fresh mint leaves in water rather than use the oil?

Sometimes aromatherapy alone may actually help, though:

Beet juice can also enhance athletic performance. See the dozen or so videos in the series starting with Doping With Beet Juice. Other ways healthy food can synergize with exercise:

I use peppermint in my Pink Juice with Green Foam recipe and talk about using the dried in Antioxidants in a Pinch. It can also help reduce IBS symptoms, as seen in Peppermint Oil for Irritable Bowel Syndrome.

Some other tea caveats, though:

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: Cory Denton / Flickr

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Caloric Restriction vs. Plant-Based Diets

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Hundreds of thousands of deaths in the United States every year are attributed to obesity, now overtaking smoking as perhaps the main preventable cause of illness and premature death. In particular, excess body fatness is an important cause of most cancers, according to a meta-analysis of studies done to date. For some cancers, about half of the cases may be attributable to just being overweight or obese.

What's the connection, though? Why do individuals who are obese have increased cancer risk? To answer this question we must consider the biochemical consequences of obesity, like IGF-1; insulin like growth factor one is a cancer-promoting growth hormone associated with a variety of common cancers in adults, as well as children. Kids who got cancer had about four times the levels of IGF-1 circulating in their bloodstream, whereas people growing up with abnormally low levels of IGF-1 don't seem to get cancer at all.

I've talked about this cancer-proofing mutation (See Cancer-Proofing Mutation), the role animal protein intake plays in boosting IGF-1 production from our liver (Protein Intake & IGF-1 Production), which may explain plant-based protection from cancer (The Answer to the Pritikin Puzzle), and how plant-based one has to eat (How Plant-Based to Lower IGF-1?), but our liver is not the only tissue that produced IGF-1, fat cells produce IGF-1 too. That may help explain this "twenty-first century cancer epidemic caused by obesity."

So of course drug companies have come up with a variety of IGF-1 blocking chemo agents, with cute names like figitumamab, but with not-so-cute side effects "such as early fatal toxicities." So perhaps better to lower IGF-1 the natural way, by eating a plant-based diet, as vegan women and men have lower IGF-1 levels. Maybe, though, it's just because they're so skinny. The only dietary group that comes close to the recommended BMI of 21 to 23 were those eating strictly plant-based diets, so maybe it's the weight loss that did it. Maybe we can eat whatever we want as long as we're skinny.

To put that to the test, we'd have to find a group of people that eat meat, but are still as slim as vegans. And that's what researchers did - long-distance endurance runners, running an average of 48 miles a week for 21 years were as slim as vegans. If we run 50,000 miles we too can maintain a BMI of even a raw vegan. So what did they find?

If we look at blood concentrations of cancer risk factors among the groups of study subjects, we see that only the vegans had significantly lower levels of IGF-1. That makes sense given the role animal protein plays in boosting IGF-1 levels.

But the vegan group didn't just eat less animal protein, they ate fewer calories. And in rodents at least, caloric restriction alone reduces IGF-1 levels. So maybe low IGF-1 among vegans isn't due to their slim figures, but maybe the drop in IGF-1 in vegans is effectively due to their unintentional calorie restriction. So we have to compare vegans to people practicing severe calorie restriction.

To do this, the researchers recruited vegans from the St. Louis Vegetarian Society, and went to the Calorie Restriction Society to find folks practicing severe caloric restriction. What did they find?

Only the vegan group got a significant drop in IGF-1. These findings demonstrate that, unlike in rodents, long-term severe caloric restriction in humans does not reduce the level of this cancer-promoting hormone. It's not how many calories we eat, but the protein intake that may be the key determinant of circulating IGF-1 levels in humans, and so reduced protein intake may become an important component of anti-cancer and anti-aging dietary interventions.

That same data set that compared plant eaters to marathon runners was also featured in Hibiscus Tea vs. Plant-Based Diets for Hypertension and Arteries of Vegans vs. Runners.

These studies are highlighted in my video Caloric Restriction vs. Plant-based Diets.

More on the caloric consumption and longevity:

What exactly is IGF-1 and what is the relationship to animal protein consumption?:

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: Heather Hammond / Flickr

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Plant-Based Diets for Hypertension

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Recently, researchers from Taiwan pitted the herbal tea hibiscus against obesity. They gave hibiscus to overweight individuals and reported that subjects showing reduced body weight. However, after 12 weeks on hibiscus subjects only lost about three pounds, only one and a half pounds over placebo. Hibiscus is clearly no magic fix for obesity.

The purported cholesterol-lowering property of hibiscus tea looked a bit more promising. Some older studies suggested as much as an 8% reduction from drinking two cups a day for a month. When all the studies are put together, though, the results are pretty much a wash. This may be because only about 50% of people respond at all to drinking the equivalent of between two to five cups a day, though those that do may get a respectable 12% drop. That's nothing like the 30% one can get within weeks of eating a healthy, plant-based diet, though.

Hibiscus may really shine in treating high blood pressure, a disease affecting a billion people and killing millions. Up until 2010, there wasn't sufficient high quality research to support the use of hibiscus tea to treat hypertension, but there are now randomized double-blind, placebo-controlled studies where hibiscus tea is compared to artificially colored and flavored water that looks and tastes like hibiscus tea, and the tea lowers blood pressure significantly better.

We're still not sure how it works, but hibiscus appears to boost nitric oxide production, which could help our arteries relax and dilate better. Regardless, an updated review acknowledged that the daily consumption of hibiscus tea may indeed significantly lower blood pressures in people with hypertension.

How does hibiscus compare to other blood pressure interventions? The premier clinical trial when it comes to comprehensive lifestyle modification for blood pressure control is the PREMIER Clinical Trial. Realizing that nine out of ten Americans are going to develop hypertension, researchers from John Hopkins randomized 800 men and women with high blood pressure into one of three groups. One was the control group, the so-called "advice only group," where patients were just told to lose weight, cut down on salt, increase exercise and eat healthier. In the two behavioral intervention groups the researchers got serious. Eighteen face-to-face sessions, groups meetings, food diaries, physical activity records, and calorie and sodium intake monitoring. One intervention group just concentrated on exercise; the other included exercise and diet. Researchers pushed the DASH diet, which is high in fruits and vegetables and low in full-fat dairy products and meat. In six months subjects achieved a 4.3 point drop in systolic blood pressure, compared to the control, slightly better than the lifestyle intervention without the diet.

A few points might not sound like a lot--that's like someone going from a blood pressure of 150 over 90 to a blood pressure of 146 over 90--but on a population scale a five point drop in the total number could result in 14% fewer stroke deaths, 9% fewer fatal heart attacks, and 7% fewer deaths every year overall.

A cup of hibiscus tea with each meal didn't just lower blood pressure by three, four, or five points, but by seven points, from an average of 129 down to 122. In fact, tested head-to-head against a leading blood-pressure drug, Captopril, two cups of strong hibiscus tea every morning (five tea bags for the two cups) was as effective in lowering blood pressure as a starting dose of 25mg of captopril taken twice a day.

So hibiscus tea is as good as drugs, without side-effects, and better than diet and exercise? Well, the lifestyle interventions in the PREMIER study were pretty wimpy. As public health experts noted, the PREMIER study was only asking for 30 minutes of exercise a day, whereas the World Health Organization recommends a minimum of an hour a day.

Diet-wise, the lower the animal fat intake, and the more plant sources of protein the PREMIER participants were eating, the better the diet appeared to work. This may explain why vegetarian diets appear to work even better, and the more plant-based, the lower the prevalence of hypertension.

On the DASH diet, subjects cut down on meat, but were still eating it every day, so would qualify as nonvegetarians in the Adventist 2 study (highlighted in my video Hibiscus Tea vs. Plant-Based Diets for Hypertension) which looked at 89,000 Californians. It found that those who only ate meat on a weekly basis had 23% lower rates of high blood pressure. Those who cut out all meat except fish had 38% lower rates. Those eating no meat at all, vegetarians, have less than half the rate. The vegans--cutting out all animal protein and fat--appeared to have thrown three quarters of their risk for this major killer out the window.

One sees the same kind of step-wise drop in diabetes rates as one's diet gets more and more plant-based, and a drop in excess body weight, such that only those eating completely plant-based diets in the Adventist 2 study fell into the ideal weight category. Could that be why those eating plant-based have such great blood pressure? Maybe it's just because they're so skinny. I've previously shown how those eating plant-based just have a fraction of the diabetes risk even at the same weight. but what about hypertension?

The average American has what's called prehypertension, which means the top number of our blood pressure is between 120 and 139. We don't have hypertension yet, which starts at 140, but we may be well on our way. Compare that to the blood pressure of those eating whole food plant-based diets. In one study, those eating plant-based didn't have blood pressures three points lower, four points lower, or even seen points lower, but 28 points lower. However, the group eating the standard American diet was, on average, overweight with a BMI over 26, still better than most Americans, while the vegans were a trim 21--that's 36 pounds lighter.

Maybe the only reason those eating meat, eggs, dairy, and processed junk had such higher blood pressure was because they were overweight. Maybe the diet per se had nothing to do with it?

To solve that riddle we would have to find a group still eating the standard American diet, but as slim as vegans. To find a group that trim, researchers had to use long-distance endurance athletes, who ate the same crappy American diet, but ran an average of 48 miles per week for 21 years. Anyone who runs almost two marathons a week for 20 years can be as slim as a vegan--no matter what they eat!

How did the endurance runners compare to the couch potato vegans? It appears that if we run an average of about a thousand miles every year our blood pressures can rival some couch potato vegans. That doesn't mean we can't do both, but it may be easier to just eat plants.


Those who've been following my work for years have seen how my videos have evolved. In the past, the hibiscus results may have been the whole article or video. But thanks to everyone's support, I've been able to delegate the logistics to staff and concentrate more on the content creation. This allows me to do deeper dives into the literature to put new findings into better context. The posts are a bit longer, but hopefully they're more useful--let me know what you think!

For such a leading killer, hypertension has not gotten the coverage it deserves on NutritionFacts.org. Here's a few videos, with more to come:

So should we all be drinking hibiscus tea every day? This is the first of a four part series on the latest on hibiscus. Stay tuned for the next three:

For another comparison of those running marathons and those eating plants, see: Arteries of Vegans vs. Runners

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: Amy / Flickr

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How to Protect Our Telomeres with Diet

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In my video, Does Meditation Affect Cellular Aging?, I discussed how stress reduction through meditation might be able to lengthen telomeres, the protective caps at the tips of our chromosomes that tend to deplete as we age.

What about exercise? We can't always change our situation in life, but we can always go out for a walk. London researchers studied 2,400 twins, and those who exercised more may have pumped up their telomeres along with their muscles. Apparently it doesn't take much either. The "heavy" exercise group was only averaging about a half-hour a day.

These were mostly folks in their 40's, but does it still work in your 50's? Yes. A study out of South Korea found that people in their 50's who work out three hours a week had longer telomeres.

In my video, Telomeres: Cap It All Off with Diet, you can see the telomere lengths of young healthy regular folk controls at around age 20, and then at age 50. As we'd expect, the older subjects' telomeres were significantly shorter. What about athletes? The young athletes started out in the same boat, with nice, long, young, healthy telomeres capping all their chromosomes. The older athletes, in contrast to the controls, appeared to still have the chromosomes of 20-year-olds. But these were marathon runners, triathletes running 50 miles a week for 35 years.

What was it about the Ornish intervention that so powerfully protected telomeres after just three months? We saw that stress management seems to help, but what about diet and exercise? Was it the plant-based diet, was it the walking 30 minutes a day, or was it just because of the weight loss? In 2013 a study was published that can help us anser just that question.

The researchers took about 400 women and randomized them into four groups: a portion-controlled diet group, an exercise group, a portion controlled diet and exercise group, and a control group for a full year. In the video, you can see a comparison of the length of each group's telomeres. After a year of doing nothing, there was essentially no change in the control group, which is what we'd expect. The exercise group was 45 minutes of moderate-to-vigorous exercise like jogging. After a year of that, they did no better. What about just weight loss? Nothing. The same thing for exercise and weight loss, no significant change either.

So as long as we're eating the same diet, it doesn't appear to matter how small our portions are, or how much weight we lose, or how hard we exercise. After a year, the subjects saw no benefit. On the other hand, the Ornish group on the plant-based diet, who lost the same amount of weight after just three months and exercised less than half as hard, saw significant telomere protection.

It wasn't the weight loss or the exercise: it was the food.

What aspects of a plant-based diet make it so protective? Studies have associated more vegetables and fruit, and less butter, with longer telomeres. From the latest review, foods high in fiber and vitamins are strongly related to longer telomeres. However, the key may be avoiding saturated fat. Swapping just 1% of saturated fat calories in our diet for anything else can add nearly a whole year of aging's worth of length onto our telomeres.

Saturated fats like palmitic acid, the primary saturated fat in salmon, and found in meat, eggs, and dairy in general, can be toxic to cells. This has been demonstrated in heart cells, bone marrow cells, pancreatic cells, and brain cells. The toxic effects on cell death rates happen right around what you'd see in the blood stream of people who eat a lot of animal products. It may not be the saturated fat itself, however, as saturated fat may just be a marker for the increased oxidative stress and inflammation associated with those foods.

With this link to saturated fat, it's no wonder that lifelong low cholesterol levels have been related to longer telomeres and a smaller proportion of short telomeres--in other words, markers of slower biological aging. In fact, there's a rare congenital birth defect called progeria syndrome, where children age 8-10 times faster than normal. It seems associated with a particular inability to handle animal fats.

The good news is that "despite past accumulated injury leading to shorter telomere lengths, current healthy behaviors might help to decrease a person's risk of some of the potential consequences like heart disease." Eating more fruit and vegetables and less meat, and having more support from friends and family, attenuate the association between shorter telomeres and the ravages of aging.

To summarize: inflammation, oxidation, damage and dysfunction are constantly hacking away at our telomeres. At the same time, our antioxidant defenses, healthy diet, exercise and stress reduction are constantly rebuilding them.


I've asked this diet versus exercise question in a few other contexts. See:

Though dietary change appears more impactful, I'm a big fan of walking. See Longer Life Within Walking Distance and for my personal favorite exercise, Standing Up for Your Health.

For more on the role saturated fat may play in disease, see, for example, my videos Heart Disease Starts in Childhood and Treating Multiple Sclerosis with the Swank MS Diet.

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: AJC ajcann.wordpress.com / Flickr

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