Lipotoxicity: How Saturated Fat Raises Blood Sugar

NF-Nov24 Lipotoxicity How Saturated Fat Raises Blood Sugar copy.jpg

The reason those eating plant-based diets have less fat buildup in their muscle cells and less insulin resistance may be because saturated fats appear to impair blood sugar control the most.

The association between fat and insulin resistance is now widely accepted. Insulin resistance is due to so-called ectopic fat accumulation, the buildup of fat in places it's not supposed to be, like within our muscle cells. But not all fats affect the muscles the same. The type of fat, saturated vs. unsaturated, is critical. Saturated fats like palmitate, found mostly in meat, dairy and eggs, cause insulin resistance, but oleate, found mostly in nuts, olives and avocados may actually improve insulin sensitivity.

What makes saturated fat bad? Saturated fat causes more toxic breakdown products and mitochondrial dysfunction, and increases oxidative stress, free radicals and inflammation, establishing a vicious cycle of events in which saturated fat induces free radicals, causes dysfunction in the little power plants within our muscle cells (mitochondria), which then causes an increase in free radical production and an impairment of insulin signaling. I explain this in my video Lipotoxicity: How Saturated Fat Raises Blood Sugar.

Fat cells filled with saturated fat activate an inflammatory response to a far greater extent. This increased inflammation from saturated fat has been demonstrated to raise insulin resistance through free radical production. Saturated fat also has been shown to have a direct effect on skeletal muscle insulin resistance. Accumulation of saturated fat increases the amount of diacyl-glycerol in the muscles, which has been demonstrated to have a potent effect on muscle insulin resistance. You can take muscle biopsies from people and correlate the saturated fat buildup in their muscles with insulin resistance.

While monounsaturated fats are more likely to be detoxified or safely stored away, saturated fats create those toxic breakdown products like ceramide that causes lipotoxicity. Lipo- meaning fat, as in liposuction. This fat toxicity in our muscles is a well-known concept in the explanation of trigger for insulin resistance.

I've talked about the role saturated and trans fats contribute to the progression of other diseases, like autoimmune diseases, cancer and heart disease, but they can also cause insulin resistance, the underlying cause of prediabetes and type 2 diabetes. In the human diet, saturated fats are derived from animal sources while trans fats originate in meat and milk in addition to partially hydrogenated and refined vegetable oils.

That's why experimentally shifting people from animal fats to plant fats can improve insulin sensitivity. In a study done by Swedish researchers, insulin sensitivity was impaired on the diet with added butterfat, but not on the diet with added olive fat.

We know prolonged exposure of our muscles to high levels of fat leads to severe insulin resistance, with saturated fats demonstrated to be the worst, but they don't just lead to inhibition of insulin signaling, the activation of inflammatory pathways and the increase in free radicals, they also cause an alteration in gene expression. This can lead to a suppression of key mitochondrial enzymes like carnitine palmitoyltransferase, which finally solves the mystery of why those eating vegetarian have a 60 percent higher expression of that fat burning enzyme. They're eating less saturated fat.

So do those eating plant-based diets have less fat clogging their muscles and less insulin resistance too? There hasn't been any data available regarding the insulin sensitivity or inside muscle cell fat of those eating vegan or vegetarian... until now. Researchers at the Imperial College of London compared the insulin resistance and muscle fat of vegans versus omnivores. Those eating plant-based diets have the unfair advantage of being much slimmer, so they found omnivores who were as skinny as vegans to see if plant-based diets had a direct benefit, as opposed to indirectly pulling fat out of the muscles by helping people lose weight in general.

They found significantly less fat trapped in the muscle cells of vegans compared to omnivores at the same body weight, better insulin sensitivity, better blood sugar levels, better insulin levels and, excitingly, significantly improved beta-cell function (the cells in the pancreas that make the insulin). They conclude that eating plant-based is not only expected to be cardioprotective, helping prevent our #1 killer, heart disease, but that plant-based diets are beta-cell protective as well, helping also to prevent our seventh leading cause of death, diabetes.

This is the third of a three-part series, starting with What Causes Insulin Resistance? and The Spillover Effect Links Obesity to Diabetes.

Even if saturated fat weren't associated with heart disease, its effects on pancreatic function and insulin resistance in the muscles would be enough to warrant avoiding it. Despite popular press accounts, saturated fat intake remains the primary modifiable determinant of LDL cholesterol, the #1 risk factor for our #1 killer-heart disease. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

How low should we shoot for in terms of saturated fat intake? As low as possible, according to the U.S. National Academies of Science Institute of Medicine: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

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: Andrew Malone / Flickr

Original Link

Lipotoxicity: How Saturated Fat Raises Blood Sugar

NF-Nov24 Lipotoxicity How Saturated Fat Raises Blood Sugar copy.jpg

The reason those eating plant-based diets have less fat buildup in their muscle cells and less insulin resistance may be because saturated fats appear to impair blood sugar control the most.

The association between fat and insulin resistance is now widely accepted. Insulin resistance is due to so-called ectopic fat accumulation, the buildup of fat in places it's not supposed to be, like within our muscle cells. But not all fats affect the muscles the same. The type of fat, saturated vs. unsaturated, is critical. Saturated fats like palmitate, found mostly in meat, dairy and eggs, cause insulin resistance, but oleate, found mostly in nuts, olives and avocados may actually improve insulin sensitivity.

What makes saturated fat bad? Saturated fat causes more toxic breakdown products and mitochondrial dysfunction, and increases oxidative stress, free radicals and inflammation, establishing a vicious cycle of events in which saturated fat induces free radicals, causes dysfunction in the little power plants within our muscle cells (mitochondria), which then causes an increase in free radical production and an impairment of insulin signaling. I explain this in my video Lipotoxicity: How Saturated Fat Raises Blood Sugar.

Fat cells filled with saturated fat activate an inflammatory response to a far greater extent. This increased inflammation from saturated fat has been demonstrated to raise insulin resistance through free radical production. Saturated fat also has been shown to have a direct effect on skeletal muscle insulin resistance. Accumulation of saturated fat increases the amount of diacyl-glycerol in the muscles, which has been demonstrated to have a potent effect on muscle insulin resistance. You can take muscle biopsies from people and correlate the saturated fat buildup in their muscles with insulin resistance.

While monounsaturated fats are more likely to be detoxified or safely stored away, saturated fats create those toxic breakdown products like ceramide that causes lipotoxicity. Lipo- meaning fat, as in liposuction. This fat toxicity in our muscles is a well-known concept in the explanation of trigger for insulin resistance.

I've talked about the role saturated and trans fats contribute to the progression of other diseases, like autoimmune diseases, cancer and heart disease, but they can also cause insulin resistance, the underlying cause of prediabetes and type 2 diabetes. In the human diet, saturated fats are derived from animal sources while trans fats originate in meat and milk in addition to partially hydrogenated and refined vegetable oils.

That's why experimentally shifting people from animal fats to plant fats can improve insulin sensitivity. In a study done by Swedish researchers, insulin sensitivity was impaired on the diet with added butterfat, but not on the diet with added olive fat.

We know prolonged exposure of our muscles to high levels of fat leads to severe insulin resistance, with saturated fats demonstrated to be the worst, but they don't just lead to inhibition of insulin signaling, the activation of inflammatory pathways and the increase in free radicals, they also cause an alteration in gene expression. This can lead to a suppression of key mitochondrial enzymes like carnitine palmitoyltransferase, which finally solves the mystery of why those eating vegetarian have a 60 percent higher expression of that fat burning enzyme. They're eating less saturated fat.

So do those eating plant-based diets have less fat clogging their muscles and less insulin resistance too? There hasn't been any data available regarding the insulin sensitivity or inside muscle cell fat of those eating vegan or vegetarian... until now. Researchers at the Imperial College of London compared the insulin resistance and muscle fat of vegans versus omnivores. Those eating plant-based diets have the unfair advantage of being much slimmer, so they found omnivores who were as skinny as vegans to see if plant-based diets had a direct benefit, as opposed to indirectly pulling fat out of the muscles by helping people lose weight in general.

They found significantly less fat trapped in the muscle cells of vegans compared to omnivores at the same body weight, better insulin sensitivity, better blood sugar levels, better insulin levels and, excitingly, significantly improved beta-cell function (the cells in the pancreas that make the insulin). They conclude that eating plant-based is not only expected to be cardioprotective, helping prevent our #1 killer, heart disease, but that plant-based diets are beta-cell protective as well, helping also to prevent our seventh leading cause of death, diabetes.

This is the third of a three-part series, starting with What Causes Insulin Resistance? and The Spillover Effect Links Obesity to Diabetes.

Even if saturated fat weren't associated with heart disease, its effects on pancreatic function and insulin resistance in the muscles would be enough to warrant avoiding it. Despite popular press accounts, saturated fat intake remains the primary modifiable determinant of LDL cholesterol, the #1 risk factor for our #1 killer-heart disease. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

How low should we shoot for in terms of saturated fat intake? As low as possible, according to the U.S. National Academies of Science Institute of Medicine: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

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: Andrew Malone / Flickr

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How to Mitigate and Prevent Crohn’s Disease with Diet

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Crohn's disease is an autoimmune disorder that affects more than a million Americans. It is an inflammatory bowel disease in which the body attacks the intestines. There is currently no known cure for Crohn's disease; current research focuses on controlling symptoms. There is no definitive medical or surgical therapy. The best we have is a plant-based diet, which has afforded the best relapse prevention to date.

Researchers got the idea to try a plant-based diet because diets rich in animal protein and animal fat have been found to cause a decrease in beneficial bacteria in the intestine. So, researchers designed a semi-vegetarian diet to counter that, and 100 percent of subjects stayed in remission the first year and 92 percent the second year. These results are far better than those obtained by current drugs, including new "biological agents" that can cost $40,000 a year, and can cause progressive multifocal leukoencephalopathy, a disabling and deadly brain disease. And a healthy diet appears to work better.

But what about preventing Crohn's disease in the first place? A systematic review of the scientific literature on dietary intake and the risk of developing inflammatory bowel disease found that a high intake of fats and meat was associated with an increased risk of Crohn's disease as well as ulcerative colitis, whereas high fiber and fruit intakes were associated with decreased risk of Crohn's.

These results were supported more recently by the Harvard Nurse's Health Study. Data revealed that long-term intake of dietary fiber, particularly from fruit, was associated with lower risk of Crohn's disease. Women who fell into in the highest long-term fiber consumption group had a 40 percent reduced risk, leading the accompanying editorial to conclude, "advocating for a high-fiber diet may ultimately reduce the incidence of Crohn's disease."

The irony is that the highest fiber group wasn't even eating the official recommended daily minimum of fiber intake. Apparently, even just being less fiber deficient has a wide range of benefits, including a significant reduction in the risk of developing Crohn's disease, but why? The authors suggest it's because "fiber plays a vital role in the maintenance of our intestinal barrier function."

Our skin keeps the outside world outside, and so does the lining of our gut, but in Crohn's disease, this barrier function is impaired. You can see this under an electron microscope as shown in my video Preventing Crohn's Disease With Diet. The tight junctions between the intestinal cells have all sorts of little holes and breaks. The thought is that the increase in prevalence of inflammatory bowel diseases may be that dietary changes lead to the breakdown of our intestinal barrier, potentially allowing the penetration of bacteria into our gut wall, which our body then attacks, triggering the inflammation.

We know fiber acts as a prebiotic in our colon (large intestine), feeding our good bacteria, but what does fiber do in our small intestine where Crohn's often starts? We didn't know, until a landmark study was published. Researchers wanted to find out what could stop Crohn's associated invasive bacteria from tunneling into the gut wall. They found the invasion is inhibited by the presence of certain soluble plant fibers, such as from plantains and broccoli at the kinds of concentrations one might expect after eating them. They wondered if that may explain why plantain-loving populations have lower levels of inflammatory bowel disease. But, the researchers also found that there was something in processed foods that facilitated the invasion of the bacteria. Polysorbate 80 was one of them, found predominantly in ice cream, but also found in Crisco, Cool Whip, condiments, cottage cheese--you just have to read the labels.

What about maltodextrin, which is found in artificial sweeteners like Splenda, snack foods, salad dressings, and fiber supplements? Maltodextrin markedly enhanced the ability of the bacteria to glob onto our intestinal cells, though other additives. Carboxy-methyl cellulose and xanthan gum appeared to have no adverse effects.

This may all help solve the mystery of the increasing prevalence of Crohn's disease in developed nations, where we're eating less fiber-containing whole plant foods and more processed foods. What we need now are interventional studies to see if boosting fiber intake and avoiding these food additives can be effective in preventing and treating Crohn's disease. But until then, what do we tell people? The available evidence points to a diet low in animal fat, with lots of soluble fiber containing plant foods, and avoiding processed fatty foods that contain these emulsifiers. We also want to make sure we're not ingesting traces of dishwashing detergent, which could have the same effect, so make sure to rinse your dishes well. Researchers found that some people wash dishes and then just leave them to dry without rinsing, which is probably not a good idea. We don't currently have studies that show that avoiding polysorbate 80 and rinsing dishes well actually helps. Nevertheless, advice based on 'best available evidence' is better than no advice at all.

Here's a video about using a more plant-based diet to reduce the risk of relapses: Dietary Treatment of Crohn's Disease.

I get a lot of questions about additives like polysorbate 80. I'm glad I was finally able to do a blog about it. Here are some videos on some others:

If you, like me, used to think all fiber was good for was helping with bowel regularity you'll be amazed! See for example, Dr. Burkitt's F-Word 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--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: Graphic Stock

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How to Prevent Childhood Obesity and Diabetes

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Thirty years ago, virtually all diabetes in young individuals was thought to be autoimmune Type 1 diabetes, but since the mid-90s, we started to see an increase in Type 2 diabetes among youth, particularly in the United States. Indeed, "the term adult onset diabetes has now been scrapped and replaced with 'Type 2' because children as young as eight are now developing the disease." And the effects can be just as devastating. A 15-year follow-up of children diagnosed with Type 2 diabetes found an alarming rate in young adults of blindness, amputation, kidney failure and death in young adulthood.

Why the dramatic rise in childhood diabetes? The dramatic rise in childhood diabetes is due to the dramatic rise in childhood obesity. During the past 30 years, the number of children diagnosed as being overweight has increased by more than 100 percent. Once an obese child reaches age six, it's likely they'll stay that way. And even if they don't, being overweight in our youth predicts adult disease and death regardless of adult body weight.

Being an overweight teen may predict disease risk 55 years later, including twice the risk of dying from heart attack, more cancer, gout, and arthritis. In fact being overweight as a teen "was a more powerful predictor of these risks then being overweight in adulthood." This underscores the importance of focusing on preventing childhood obesity.

How do we do it? From the official American Academy of Pediatrics clinical practice guidelines: the problem appears to be kids eating too much fat and added sugar, and not eating enough fruits and vegetables.

Doctors, at every occasion beginning soon after a child's birth, should endeavor to give sound advice regarding nutrition and growth so that obesity and its complications may be curtailed. What might sound advice sound like?

The chair of the nutrition department at Loma Linda published a review suggesting not eating meat at all might be an effective strategy. Population studies have consistently shown that vegetarians are thinner than comparable non-vegetarians.

In the largest such study to date (highlighted in my video How to Prevent Prediabetes in Children), a body mass index over 30 is considered obese, 25 to 30 overweight, and under 25 an ideal weight. The non-vegetarians were up at 28.8, showing the average meat-eater in the U.S. is significantly overweight. As one gets more and more plant-based, the average BMI drops. But even the average vegetarian in the U.S. is overweight. The only dietary group that was, on average, ideal weight were those eating strictly plant-based. It comes out to be about a 30-pound difference between average vegans and meat-eaters.

In school-aged children, the consumption of animal foods (meats, dairy, or eggs) is associated with an increased risk of being overweight, whereas plant-based equivalents like veggie burgers, veggie dogs, and veggie cold cuts were not. The whole plant foods like grains, beans, and nuts were found to be protective.

This may be because plant-based diets are low in energy density and high in starch, fiber, and water, which may increase feelings of fullness and resting energy expenditure, meaning resting metabolic rate. Eating plant-based appears to boost metabolism, such that you just burn more calories at rest. However, we're not sure how much of the benefits are due to increased consumption of plant foods versus decreased consumption of meat.

"Plant-based diets should be encouraged and promoted for optimal health. Local, national and international food policies are warranted to support social marketing messages and to reduce the social, cultural, economic and political forces that make it difficult to promote such diets." For example, although the advice to consume a plant-based diet is sound, questions arise concerning the relatively high price of produce.

We could reduce the burden of childhood obesity and prevent further spread of the disease, but we need to ensure that plant foods are affordable and accessible to children of all income levels. Getting diabetes in childhood cuts about 20 years of their life. What parent wouldn't go to the ends of the Earth to add decades to their children's lives? Fruits and vegetables may not fit on the Dollar Menu, but our kids are worth it.

We make life and death decisions at the grocery store buying food for our family. It's never too early to start our kids off on the right foot. See my video Heart Disease Starts in Childhood.

And healthy doesn't have to mean more expensive. Check out Eating Healthy on a Budget.

For some tips on getting our kids to eat their vegetables, see my videos Tricks to Get Kids to Eat Healthier at School and Tricks to Get Kids to Eat Healthier at Home.

Once one has prediabetes, there's a way to prevent it from progressing further. See my video How to Prevent Prediabetes from Turning into Diabetes.

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: DAVID Swift / Flickr

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What To Do if You Suspect Gluten Problems

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Symptoms of gluten sensitivity include irritable bowel type symptoms such as bloating, abdominal pain, and changes in bowel habits, as well as systemic manifestations such as brain fog, headache, fatigue, depression, joint and muscle aches, numbness in the extremities, skin rash, or anemia. I previously discussed why people who suspect they might be gluten sensitive should not go on a gluten-free diet. But if that's true, what should they do?

The first thing is a formal evaluation for celiac disease, which currently involves blood tests and a small intestinal biopsy. If the evaluation is positive, then a gluten-free diet is necessary. If it's negative, it's best to try a healthier diet with more fruits, vegetables, whole grains and beans while avoiding processed junk. In the past, a gluten-free diet had many benefits over the traditional American diet because it required increasing fruit and vegetable intake--so no wonder people felt better eating gluten-free: no more unhealthy bread products, no more fast food restaurants. Now, there is just as much gluten-free junk out there.

If a healthy diet doesn't help, then the next step is to try ruling out other causes of chronic gastrointestinal distress. In a study of 84 people who claim gluten causes them adverse reactions (they're referred to in the literature as"PWAWGs," People Who Avoid Wheat and/or Gluten), highlighted in my video, How to Diagnose Gluten Intolerance, about a third didn't appear to have gluten sensitivity at all. Instead, they either had an overgrowth of bacteria in their small intestine, were fructose or lactose intolerant, or had a neuromuscular disorder like gastroparesis or pelvic floor dysfunction. Only if those are also ruled out, would I suggest people suffering from chronic suspicious symptoms try a gluten-free diet. If symptoms improve, stick with it and maybe re-challenge with gluten periodically.

Unlike the treatment for celiac disease, a gluten-free diet for gluten sensitivity is ideal not only to prevent serious complications from an autoimmune reaction, but to resolve symptoms and try to improve a patient's quality of life. However, a gluten-free diet itself can also reduce quality of life, so it's a matter of trying to continually strike the balance. For example, gluten-free foods can be expensive, averaging about triple the cost. Most people would benefit from buying an extra bunch of kale or blueberries instead.

No current data suggests that that general population should maintain a gluten-free lifestyle, but for those with celiac disease, a wheat allergy, or a sensitivity diagnosis, gluten-free diets can be a lifesaver.

For more on gluten, check out Is Gluten Sensitivity Real? and Gluten-Free Diets: Separating the Wheat from the Chat.

Some food strategies that may help with irritable bowel symptoms are covered in a few of my previous videos, such as Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

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: Jeremy Segrott/ Flickr

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Hives from Tick Bite-Induced Meat Allergies

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In a previous video Alpha Gal and the Lone Star Tick, I started talking about a tick bite-induced meat allergy, called Alpha-Gal, that is unlike any other food allergy we know. The most interesting feature of the reactions may be that first symptoms can occur hours after eating meat. Normally, an allergic reaction to a bee sting, for example, happens within minutes. With this meat allergy, we could have a piece of bacon for breakfast and our throat wouldn't start closing off until the afternoon. Because the cause and effect are temporarily separated, we often blame other factors, such as what we ate for lunch, or we just call it "spontaneous" or "idiopathic" anaphylaxis, which is just doctor-speak for "we have no idea what the cause is."

The delay likely occurs because the alpha-gal is probably absorbed along with the fat in meat, given that the allergic reaction occurring four to five hours after meat ingestion corresponds to the peak absorption time of fatty acids from the intestinal tract.

What makes the allergy even more difficult to diagnose is that the majority of victims experience only occasional overt reactions, despite regular meat consumption. Fattier meats, like pork rinds, may provoke episodes more consistently and severely, but still don't trigger a reaction every time.

Tick bite-induced meat allergy is on the rise. Ten years ago we didn't even know this thing existed, but now in tick-ridden states as many as 20% of the population have these anti-meat allergic antibodies (See Tick Bites, Meat Allergies, and Chronic Urticaria). And more and more people are coming in affected, though probably no more than 10% who test positive go on to experience hives or serious allergic reaction to meat.

We're also seeing it more and more in kids. Researchers in Virginia have found that it is not uncommon, though identification of the allergy may not be straightforward. Unlike in adults, who frequently present with systemic reactions, the majority of children with this syndrome present with just skin manifestations, such as hives. However, this doesn't mean it's not serious. In fact, nearly half the kids ended up in the ER, and about 1 in 12 needed to be hospitalized.

Up to a quarter of the population breaks out in hives at some time in their lives, but some children can be affected for weeks or months. It can be triggered by infections, foods, drugs, parasites, or be autoimmune, but in a large subset of cases we don't know what the trigger is, and so, call it chronic "idiopathic" urticaria. It's a common thing pediatricians see. The only cure is avoiding and eliminating whatever is triggering it, but in three quarters of cases we have no clue.

We now know that many children who had been diagnosed with mysterious hives or allergic reactions and may have been specifically told that the reactions were not a result of a food allergy, may have actually been suffering from anti-gal meat allergies. The serious nature of the reactions and the rising frequency of allergic swelling and hives across all age groups underscore the importance of identifying what's going on, and physicians should keep this new diagnosis in mind.

Allergies to meat might be more common than previously thought, as much as 2% of the population (which would mean millions of people). But to put this in context, Americans are much more likely to suffer an anaphylactic reaction due to seafood, tick bite or not, no matter where they live. A national survey of emergency rooms found shellfish was by far the most frequently implicated food, and unlike many other allergies, kids don't tend to outgrow fish and shellfish allergies.

Some fish allergies are actually allergies not to the fish, but to worms in the fish, like anisakis, which are found particularly in cod, anchovies, and squid. Exposure to these parasites in fish, living or dead, is a widespread problem. In fact, we can even have an allergic reaction to the parasitic fish worm when we eat chickens that were fed on fishmeal. This is one of the ways someone who's allergic to fish could get triggered by chicken.

Because of these worms, researchers recommend that people stop eating seafood and sushi altogether, because besides inducing allergenic reactions, the worms may cause a leaky gut syndrome, which often is unrecognized and can predispose someone to other, more important pathologies than just being itchy all over.

I previously covered anisakis in Allergenic Fish Worms and other allergenic parasite reactions in Chronic Headaches and Pork Tapeworms.

The worms might not the only thing increasing allergies in fish. See:

I also did a 4-part series on allergies in general if anyone's interested:

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: Meredith P. / Flickr

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How a Tick Bite Can Lead to Food Allergies

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In the beginning, Aristotle defined two forms of life on planet Earth: plants and animals. Two thousand years later, the light microscope was invented and we discovered tiny, single-celled organisms like amoebas. Then, the electron microscope was invented and we discovered bacteria. Finally, in 1969, biologists recognized fungi as a separate category, and we've had at least five kingdoms of life ever since.

In my video, Higher Quality May Mean Higher Risk, I talk about the potential downsides of consuming proteins from within our own kingdom, such as the impact our fellow animal proteins can have on boosting our liver's production of a cancer-promoting hormone called IGF-1.

In Eating Outside Our Kingdom, I talked about other potential advantages of preferably dipping into the plant and mushroom kingdoms for dinner, not only from a food safety perspective (we're more likely to get infected by animal pathogens than Dutch Elm Disease), but because of the potential for cross-reactivity between animal and human proteins. Our immune system is more likely to get confused between a chicken leg and our own legs than it is with a banana, so there may be less potential to trigger an autoimmune reaction, like degenerative brain diseases or inflammatory arthritis (See Diet & Rheumatoid Arthritis). In attacking some foreign animal meat protein, some of our own similarly composed tissues may get caught in the crossfire.

It's not just proteins. If you remember the Neu5Gc story (see Inflammatory Meat Molecule Neu5GC), sialic acid in other animals may cause inflammation in our arteries (see Nonhuman Molecules Lining Our Arteries) and help breast tumors and other human cancers to grow (see How Tumors Use Meat to Grow: Xeno-Autoantibodies). Now a new twist has been added to the story.

The reason Neu5Gc triggers inflammation is because humans lost the ability to make it two million years ago, and so when our body is exposed to it through animal products, it's treated as a foreign molecule, causing inflammation. But there's also another oligosaccharide called alpha-gal that humans, chimps, and apes lost the ability to make 20 million years ago, but is still made by a variety of animals, including many animals we eat.

Anti-gal antibodies may be involved in a number of detrimental processes that may result in allergic, autoimmune, and autoimmune-like diseases, such as auto-immune thyroid disorders. We see higher levels of anti-gal antibodies in Crohn's disease victims. These antibodies even react against about half of human breast tumors, and we can find them in atherosclerotic plaques in people's necks. However, those are all mostly speculative risks. We do know that alpha-gal is a major obstacle to transplanting pig organs into people, like kidneys, because our bodies reject alpha-gal as foreign. In fact, alpha-gal is thought to be the major target for human anti-pig antibodies.

It's interesting that if we look at those that abstain from pork for whatever reason, they have fewer swine-specific immune cells in their bloodstream. Researchers speculate that oral intake of pork could ferry swine molecules into the bloodstream via gut-infiltrating lymphocytes to prime the immune response. So we can have an allergic reaction to eating pig kidneys too, but such severe meat allergies were considered rare, until an unusual report surfaced. First described in 2009, the report included details on 24 cases of meat allergies triggered by tick bites.

Within a year, it was obvious that the cases should be counted in hundreds rather than dozens. By 2012, there were thousands of cases across a large area of the southern and eastern U.S., and new cases are now popping up in several countries around the world.

The culprit, the lone star tick, so-called because females have a white spot on their back, are famous for causing Masters' disease, a disease similar to Lyme syndrome, also known as STARI (southern tick associated rash illness). But thanks to the lone star tick steadily expanding its range (even as far as Long Island, NY), it's not necessarily just so Southern any more.

What is the relevance of tick bites to the production of allergy-causing anti-meat antibodies to alpha-gal? Good question. What we know is that if you get bitten by one of these ticks, you can develop an allergy to meat (See Alpha Gal and the Lone Star Tick). This appears to be the first example of a response to an external parasite giving rise to an important form of food allergy. We don't know the exact mechanism, but it may be because there's something in the tick saliva that's cross-reacting with alpha-gal, or because the tick is injecting you with animal allergens from its last meal.

What role may these tick-bite induced allergies play in the development of chronic hives and other allergic skin reactions in children? See Tick Bites, Meat Allergies, and Chronic Urticaria.

Here's some videos unearthing the IGF-1 story:

Neu5Gc is what opened up this whole can of worms:

I wonder if alpha gal is playing a role in the improvements in arthritis and Crohn's on plant-based diets: Dietary Treatment of Crohn's Disease and Diet & Rheumatoid Arthritis.

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: USGS Bee Inventory and Monitoring Lab / Flickr

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What is ‘Meat Glue’?

NF-Apr16 What is

The so-called "meat glue enzyme" transglutaminase is used by the meat industry to add value to meat by gluing together smaller scraps into a larger chunk. And it's not just used to make fake steak--the American Meat Institute estimates that it's used in about "eight million pounds of meat every year in the United States." Transglutaminase can be used to cross-link pieces of any type of meat, fish, or meat product, and hence can be used to produce large chunks of virtually intact looking meat or fish out of small meat or fish cuttings. When researchers actually tested for transglutaminase in 20 samples of meat from the supermarket, they found meat glue in only two of the samples--in a sample of salmon and a sample of turkey (See Is Meat Glue Safe?)

Where does meat glue come from? For decades, the sole commercial source of transglutaminase was from the livers of guinea pigs. Now it can be sourced much cheaper. However, the future of meat glue remains uncertain because of "communication difficulties."

One of the reasons the industry uses meat glue enzymes is because, "restructured meat can be made from underutilized portions of the carcasses." For example, you can get away with adding up to 5% tendons to beef, and some people can't tell the difference.

This has raised food safety concerns. There is a "risk that otherwise discarded leftovers of questionable microbial quality could find their way into the reconstituted meat."

One can actually take a microscope and see introduced E. coli O157:H7 along the glue lines where meat pieces were enzymatically attached, which shows that the restructuring process can translocate fecal matter surface contamination into the interior of the meat.

Furthermore, people who have problems with gluten may develop problems when ingesting meat treated with the meat glue enzyme, since it functions as an auto-antigen capable of inducing an autoimmune reaction. (Many gluten reactions may not actually be to gluten, though. See my video Is Gluten Sensitivity Real? and most need not worry about gluten sensitivity. See my video Is Gluten Bad For You?).

Some meat additives, however, may actually improve food safety. See Meat Additives to Diminish Toxicity, Viral Meat Spray and Maggot Meat Spray.

More on E. coli O157:H7 in my video, Meat May Exceed Daily Allowance of Irony. For those interested in the politics of this "Jack-in-the-Box" strain, see my blogs E. coli O145 Ban Opposed by Meat Industry and Supreme Court case: meat industry sues to keep downed animals in food supply. From a population perspective, the E. coli in chicken is more of a concern. See my video Avoiding Chicken To Avoid Bladder Infections.

-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: Wheeler Cowperthwaite / Flickr

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The Spice That Helps Ease Rheumatoid Arthritis Pain

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Accordingto the World Health Organization, "80% of the Earth's inhabitants rely upon the traditional medicine for their primary health-care needs, in part due to high cost of Western pharmaceuticals. Medicines derived from plants have played a pivotal role in the health care of both ancient and modern cultures." One of the prime sources of plant-derived medicines is spices. Turmeric, for example, has been consumed over the centuries around the world. Turmeric is known by different names in different societies--my favorite of which is probably "zard-choobag."

Turmeric is the dried powdered root stalks of the turmeric plant--a member of the ginger family--from which the orangey-yellow pigment curcumin can be extracted. The spice turmeric is what makes curry powder yellow, and curcumin is what makes turmeric yellow. In the video, Turmeric Curcumin and Rheumatoid Arthritis, you can see the molecular structure of curcumin. I always thought it kind of looked like a crab.

In recent years, more than 5,000 articles have been published in the medical literature about curcumin. Many sport impressive looking diagrams suggesting curcumin can benefit a multitude of conditions via a dizzying array of mechanisms. Curcumin was first isolated more than a century ago, but out of the thousands of experiments, just a handful in the 20th century were clinical studies, involving actual human participants. Most of the 5,000 were just in vitro lab studies, which I've resisted covering until the studies moved out of the petri dish and into the person. But since the turn-of-the-century, more than 50 clinical trials have been done, testing curcumin against a variety of human diseases, with 84 more on the way. One such study got my attention.

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that causes progressive destruction of the cartilage and bone of joints. The long-term prognosis of RA is poor, with as much as 80% of patients affected becoming disabled with a reduced life expectancy. There are lots of drugs one can take, but unfortunately they're often associated with severe side effects including blood loss, bone loss and bone marrow suppression, and toxicity to the liver and eyes.

The efficacy of curcumin was first demonstrated over 30 years ago in a double-blind crossover study: curcumin versus phenylbutazone, a powerful anti-inflammatory that is used in race horses. Both groups showed significant improvement in morning stiffness, walking time, and joint swelling, with the complete absence of any side effects from curcumin (which is more than can be said for phenylbutazone, which was pulled from the market three years later after wiping out people's immune systems and their lives).

In the new study, 45 patients diagnosed with rheumatoid arthritis were randomized into three groups: curcumin, the standard of care drug, or both. The primary endpoint was a reduction in disease activity as well as a reduction in joint tenderness and swelling. All three groups got better, but interestingly the curcumin groups showed the highest percentage of improvement, significantly better than those in the drug group. The findings are significant and demonstrate that curcumin alone was not only safe and effective, but surprisingly more effective in alleviating pain compared to the leading drug of choice, all without any adverse side effects. In fact, curcumin appeared protective against drug side effects, given that there were more adverse reactions in the drug group than in the combined drug and curcumin group. In contrast to non-steroidal anti-inflammatory drugs (NSAIDs), curcumin has no gastrointestinal side effects, and may even protect the lining of the stomach.

Hard to appreciate the gorgeous color of fresh turmeric root unless you see it for yourself. You should be able to find it at any large Asian store. I incorporate it into my Natural Nausea Remedy Recipe. The inner color is almost fluorescent!

I'm afraid followers of NutritionFacts.org are going to get sick of turmeric, but there's a load of important new research I felt I needed to cover. So far there's Turmeric Curcumin and Osteoarthritis, Boosting the Bioavailability of Curcumin and Who Shouldn't Consume Curcumin or Turmeric?

I've previously talked about treating autoimmune joint inflammation with diets full of plants in Diet & Rheumatoid Arthritis and Potassium and Autoimmune Disease.

If phenylbutazone sounds vaguely familiar, maybe you read my Q&A Is horse meat safe to eat?

-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: David van Horn / Flickr

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The Top Four Anti-Inflammatory Spices

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Once in a while I come across a study that's so juicy I have to do a whole video about it (Which Spices Fight Inflammation?).

A group of researchers at the University of Florida, Gainesville and Pennsylvania State set up a brilliant experiment. We've known that ounce per ounce, herbs and spices have some of the greatest antioxidant activities known. But that's only ever been tested in a test tube. Before we can ask if an herb or spice has real health benefits, it is first necessary to determine whether it is bioavailable -- whether the active ingredients are even absorbed. This had never been done, until now.

The researchers could have taken the easy route and just measured the change in antioxidant level in one's bloodstream before and after consumption, but the assumption that the appearance of antioxidant activity in the blood is an indication of bioavailability has a weakness. Maybe more gets absorbed than we think but doesn't show up on antioxidant tests because it gets bound up to proteins or cells. So the researchers attempted to measure physiological changes in the blood. They were interested in whether absorbed compounds would be able to protect white blood cells from an oxidative or inflammatory injury--whether herb and spice consumption would protect the strands of our DNA from breaking when attacked by free radicals. I cover the DNA findings in my video, Spicing Up DNA Protection. They also wondered if the consumption might alter cellular inflammatory responses in the presence of a physiologically relevant inflammatory insult. What does this all mean?

The researchers took a bunch of people and had each of them eat different types of spices for a week. There were many truly unique things about this study, but one was that the quantity of spices that study subjects consumed was based on the usual levels of consumption in actual food. For example, the oregano group was given a half teaspoon a day--a practical quantity that people might actually eat once in a while. At the end of the week, they drew blood from the dozen or so people they had adding, for example, black pepper to their diets that week, and compared the effects of their blood to the effects of the blood of the dozen subjects on cayenne, or cinnamon, or cloves, or cumin. They had about ten different groups of people eating about ten different spices. Then they dripped their plasma (the liquid fraction of their blood) onto human white blood cells in a Petri dish that had been exposed to an inflammatory insult. The researchers wanted to pick something really inflammatory, so they chose oxidized cholesterol (which is what we'd get in our bloodstream after eating something like fried chicken. If oxidized cholesterol is a new concept for you, please check out its role in heart disease progression in my video Arterial Acne). So they jabbed the white blood cells with oxidized cholesterol and measured how much tumor necrosis factor (TNF) they produced in response.

TNF is a powerful inflammatory cytokine, infamous for the role it plays in autoimmune attacks like inflammatory bowel disease. Compared to the blood of those who ate no spices for a week, black pepper was unable to significantly dampen the inflammatory response. What about any of the other spices? The following significantly stifled the inflammatory response:

  • cloves
  • ginger
  • rosemary
  • turmeric

And remember, they weren't dripping the spices themselves on these human white blood cells, but the blood of those who ate the spices. So the results represents what might happen when cells in our body are exposed to the levels of spices that circulate in our bloodstream after normal daily consumption--not megadoses in some pill. Just the amount that makes our spaghetti sauce, pumpkin pie, or curry sauce taste good.

There are drugs that can do the same thing. Tumor necrosis factors are such major mediators of inflammation and inflammation-related diseases that there are TNF-blocking drugs on the market for the treatment of inflammatory diseases such as osteoarthritis, inflammatory bowel disease, psoriasis, and ankylosing spondylitis, which collectively rake in more than $20 billion a year ($15,000-$20,000 per person per year). At that price, the side effects better be hugs and rainbows. But no, the drugs carry a so-called "black box warning" because they can cause things like cancer and heart failure. If only there was a cheaper, safer solution.

The spice curcumin, the yellow pigment in turmeric, is substantially cheaper and safer, but does it work outside of a test tube? There's evidence that it may help in all of the diseases for which TNF blockers are currently being used. So with health-care costs and safety being such major issues, this golden spice turmeric may help provide the solution.

See Antioxidants in a Pinch and How to Reach the Antioxidant RDA to see the extent to which even small amounts of spices can affect one's antioxidant intake.

Another elegant series of "ex vivo" experiments exploring the cancer fighting power of lifestyle changes can be seen in the videos starting with Ex Vivo Cancer Proliferation Bioassay.

Mushrooms (Boosting Immunity While Reducing Inflammation), nuts (Fighting Inflammation in a Nut Shell), and purple potatoes (Anti-Inflammatory Effects of Purple Potatoes) may also reduce inflammation (along with plant foods in general, see Anti-Inflammatory Antioxidants and Aspirin Levels in Plant Foods). In fact so well that plant-based diets can be used to treat inflammatory conditions. See, for example, Dietary Treatment of Crohn's Disease, Diet & Rheumatoid Arthritis, and Potassium and Autoimmune Disease. Animal products on the other hand may increase inflammation through a variety of mechanisms, including endotoxins (How Does Meat Cause Inflammation?), arachidonic acid (Chicken, Eggs, and Inflammation), and Neu5Gc (The Inflammatory Meat Molecule Neu5Gc).

-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: jo-marshall (was Jo-h) / Flickr

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