How Much Water Should We Drink Every Day?

How Much Water Should We Drink Every Day?.jpeg

More than 2000 years ago Hippocrates (460-377 BCE) said, "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health." What does that mean when it comes to water? Water has been described as a neglected, unappreciated, and under-researched subject, and further complicating the issue, a lot of the papers extolling the need for proper hydration are funded by the bottled water industry.

It turns out the often quoted "drink at least eight glasses of water a day" dictum has little underpinning scientific evidence . Where did that idea come from? The recommendation was traced to a 1921 paper, in which the author measured his own pee and sweat and determined we lose about 3% of our body weight in water a day, or about 8 cups (see How Many Glasses of Water Should We Drink in a Day?). Consequently, for the longest time, water requirement guidelines for humanity were based on just one person.

There is evidence that not drinking enough may be associated with falls and fractures, heat stroke, heart disease, lung disorders, kidney disease, kidney stones, bladder and colon cancer, urinary tract infections, constipation, dry mouth, cavities, decreased immune function and cataract formation. The problem with many of these studies is that low water intake is associated with several unhealthy behaviors, such as low fruit and vegetable intake, more fast-food, less shopping at farmers markets. And who drinks lots of water? People who exercise a lot. No wonder they tend to have lower disease rates!

Only large and expensive randomized trials could settle these questions definitively. Given that water cannot be patented, such trials seem unlikely; who's going to pay for them? We're left with studies that find an association between disease and low water intake. But are people sick because they drink less, or are they drinking less because they're sick? There have been a few large prospective studies in which fluid intake is measured before disease develops. For example, a Harvard study of 48,000 men found that the risk of bladder cancer decreased by 7% for every extra daily cup of fluid we drink. Therefore, a high intake of water--like 8 cups a day--may reduce the risk of bladder cancer by about 50%, potentially saving thousands of lives.

The accompanying editorial commented that strategies to prevent the most prevalent cancers in the West are remarkably straightforward in principle. To prevent lung cancer, quit smoking; to prevent breast cancer, maintain your ideal body weight and exercise; and to prevent skin cancer, stay out of the sun. Now comes this seemingly simple way to reduce the risk of bladder cancer: drink more fluids.

Probably the best evidence we have for a cut off of water intake comes from the Adventist Health Study, in which 20,000 men and women were studied. About one-half were vegetarian, so they were also getting extra water by eating more fruits and vegetables. Those drinking 5 or more glasses of water a day had about half the risk of dying from heart disease compared to those who drank 2 or fewer glasses a day. Like the Harvard study, this protection was found after controlling for other factors such as diet and exercise. These data suggest that it was the water itself that was decreasing risk, perhaps by lowering blood viscosity (blood thickness).

Based on all the best evidence to date, authorities from Europe, the U.S. Institute of Medicine, and the World Health Organization recommend between 2.0 and 2.7 liters (8 to 11 cups) of water a day for women, and 2.5 to 3.7 liters (10 to 15 cups) a day for men. This includes water from all sources, not just beverages. We get about a liter from food and the water our body makes. So this translates into a recommendation for women to drink 4 to 7 cups of water a day and men 6 to 11 cups, assuming only moderate physical activity at moderate ambient temperatures.

We can also get water from all the other drinks we consume, including caffeinated drinks, with the exception of stronger alcoholic drinks like wines and spirits. Beer can leave you with more water than you started with, but wine actively dehydrates you. However, in the cancer and heart disease studies I mentioned above, the benefits were only found with increased water consumption, not other beverages.

I've previously touched on the cognitive benefits of proper hydration here: Does a Drink Of Water Make Children Smarter?

Surprised tea is hydrating? See my video Is Caffeinated Tea Dehydrating?

Surprised that the 8-a-day rested on such flimsy evidence? Unfortunately, so much of what we do in medicine has shaky underpinnings. That's the impetus behind the idea of evidence-based medicine (what a concept!). Ironically, this new movement may itself undermine some of the most effective treatments. See Evidence-Based Medicine or Evidence-Biased?

How else can we reduce our risk of bladder cancer? See Raw Broccoli and Bladder Cancer Survival.

What kind of water? I recommend tap water, which tends to be preferable from a chemical and microbial contamination standpoint. What about buying one of those fancy alkalizing machines? See Alkaline Water: a Scam?

It's so nice to have data on such a fundamental question. We have much to thank the Adventists for. You will see their studies cropping up frequently. See, for example, Plant-Based Diets and Diabetes, The Okinawa Diet: Living to 100, and Evidence-Based Eating.

In health,

Michael Greger, M.D.

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

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

Original Link

How Much Water Should We Drink Every Day?

How Much Water Should We Drink Every Day?.jpeg

More than 2000 years ago Hippocrates (460-377 BCE) said, "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health." What does that mean when it comes to water? Water has been described as a neglected, unappreciated, and under-researched subject, and further complicating the issue, a lot of the papers extolling the need for proper hydration are funded by the bottled water industry.

It turns out the often quoted "drink at least eight glasses of water a day" dictum has little underpinning scientific evidence . Where did that idea come from? The recommendation was traced to a 1921 paper, in which the author measured his own pee and sweat and determined we lose about 3% of our body weight in water a day, or about 8 cups (see How Many Glasses of Water Should We Drink in a Day?). Consequently, for the longest time, water requirement guidelines for humanity were based on just one person.

There is evidence that not drinking enough may be associated with falls and fractures, heat stroke, heart disease, lung disorders, kidney disease, kidney stones, bladder and colon cancer, urinary tract infections, constipation, dry mouth, cavities, decreased immune function and cataract formation. The problem with many of these studies is that low water intake is associated with several unhealthy behaviors, such as low fruit and vegetable intake, more fast-food, less shopping at farmers markets. And who drinks lots of water? People who exercise a lot. No wonder they tend to have lower disease rates!

Only large and expensive randomized trials could settle these questions definitively. Given that water cannot be patented, such trials seem unlikely; who's going to pay for them? We're left with studies that find an association between disease and low water intake. But are people sick because they drink less, or are they drinking less because they're sick? There have been a few large prospective studies in which fluid intake is measured before disease develops. For example, a Harvard study of 48,000 men found that the risk of bladder cancer decreased by 7% for every extra daily cup of fluid we drink. Therefore, a high intake of water--like 8 cups a day--may reduce the risk of bladder cancer by about 50%, potentially saving thousands of lives.

The accompanying editorial commented that strategies to prevent the most prevalent cancers in the West are remarkably straightforward in principle. To prevent lung cancer, quit smoking; to prevent breast cancer, maintain your ideal body weight and exercise; and to prevent skin cancer, stay out of the sun. Now comes this seemingly simple way to reduce the risk of bladder cancer: drink more fluids.

Probably the best evidence we have for a cut off of water intake comes from the Adventist Health Study, in which 20,000 men and women were studied. About one-half were vegetarian, so they were also getting extra water by eating more fruits and vegetables. Those drinking 5 or more glasses of water a day had about half the risk of dying from heart disease compared to those who drank 2 or fewer glasses a day. Like the Harvard study, this protection was found after controlling for other factors such as diet and exercise. These data suggest that it was the water itself that was decreasing risk, perhaps by lowering blood viscosity (blood thickness).

Based on all the best evidence to date, authorities from Europe, the U.S. Institute of Medicine, and the World Health Organization recommend between 2.0 and 2.7 liters (8 to 11 cups) of water a day for women, and 2.5 to 3.7 liters (10 to 15 cups) a day for men. This includes water from all sources, not just beverages. We get about a liter from food and the water our body makes. So this translates into a recommendation for women to drink 4 to 7 cups of water a day and men 6 to 11 cups, assuming only moderate physical activity at moderate ambient temperatures.

We can also get water from all the other drinks we consume, including caffeinated drinks, with the exception of stronger alcoholic drinks like wines and spirits. Beer can leave you with more water than you started with, but wine actively dehydrates you. However, in the cancer and heart disease studies I mentioned above, the benefits were only found with increased water consumption, not other beverages.

I've previously touched on the cognitive benefits of proper hydration here: Does a Drink Of Water Make Children Smarter?

Surprised tea is hydrating? See my video Is Caffeinated Tea Dehydrating?

Surprised that the 8-a-day rested on such flimsy evidence? Unfortunately, so much of what we do in medicine has shaky underpinnings. That's the impetus behind the idea of evidence-based medicine (what a concept!). Ironically, this new movement may itself undermine some of the most effective treatments. See Evidence-Based Medicine or Evidence-Biased?

How else can we reduce our risk of bladder cancer? See Raw Broccoli and Bladder Cancer Survival.

What kind of water? I recommend tap water, which tends to be preferable from a chemical and microbial contamination standpoint. What about buying one of those fancy alkalizing machines? See Alkaline Water: a Scam?

It's so nice to have data on such a fundamental question. We have much to thank the Adventists for. You will see their studies cropping up frequently. See, for example, Plant-Based Diets and Diabetes, The Okinawa Diet: Living to 100, and Evidence-Based Eating.

In health,

Michael Greger, M.D.

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

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

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Which Dietary Factors Affect Breast Cancer Most?

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One of my favorite cancer-specific charities, the American Institute for Cancer Research, lauds the China Study and the documentary Forks Over Knives, with which they share the same bottom-line message: The healthiest diets are those that revolve around whole plant foods.

They then translate that advice into their Ten Recommendations for Cancer Prevention, featured in my video Which Dietary Factors Affect Breast Cancer Most? We now have evidence that those who follow such advice are actually protected against cancer. Breast cancer risk was reduced by 60% in women who met at least five recommendations compared with those who met none. The most important dietary advice was to be as lean as possible within the normal range of body weight, eat mostly foods of plant origin, and limit alcoholic drinks.

What about other cancers? Greater adherence to the AICR dietary guidelines was also associated with significantly less endometrial, colorectal, lung, kidney, stomach, oral, liver, and esophageal cancer. In other words, adherence to dietary recommendations for cancer prevention may lower the risk of developing most types of cancer. The drop in bladder cancer did not reach statistical significance, but a larger follow-up study following 469,000 people for 11 years (the largest to date) found that just a 3% increase in the consumption of animal protein calories was associated with a 15% higher risk of bladder cancer, whereas just a 2% increase in plant protein was associated with a 23% lower risk.

AICR recommendation number ten is that cancer survivors should follow the recommendations for cancer prevention. The same diet that can help prevent cancer in the first place can be used to help save our life after diagnosis. Adherence to the guidelines for cancer prevention was found to be associated with lower mortality among older female cancer survivors, or breast cancer and other cancers in general.

A cancer diagnosis is considered a teachable moment to get people eating and living healthier. Oncologists revel at the growth in the number of cancer survivors in this country, now ten million strong and growing. It's great that those with cancer are living longer, but even better to prevent it in the first place so we can all live longer. Not only does adherence to the guidelines lower cancer risk, but extends our lifespan because the guidelines are also significantly associated with a lower hazard of dying from heart disease and respiratory disease, suggesting that following the recommendations could "significantly increase longevity."

Just like eating to prevent cancer helps to prevent heart disease, eating to protect our heart helps prevent cancer. It sounds self-evident, but adherence to a healthy lifestyle is therefore associated with a lower risk of mortality overall. And the more healthy behaviors we have, the longer we get to live. Such factors included not smoking, walking every day, or eating green leafy vegetables almost daily.

To help differentiate the effects of diet from other lifestyle behaviors like smoking and drinking on cancer incidence, Adventists were recently compared to Baptists. Both discourage alcohol and tobacco, but the Adventists go further, encouraging a reduction of meat. In general, the Adventists had lower cancer hazard rates than the Baptists, and within Adventist populations, the vegetarians did even better, and those eating the most plants, did the best.

Why do plant-based diets appear to lower the risk of cancer? A number of fascinating mechanisms:

Specific to breast cancer:

Though plant-based beverages may be harmful: Breast Cancer and Alcohol: How Much Is Safe?

In terms of foods associated with breast cancer survival, see:

In health,
Michael Greger, M.D.

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

Image Credit: [Lev Kropotov] © 123RF.com

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Topical Application of Turmeric Curcumin for Cancer

NF-Oct27 Topical application for turmeric curcumin for cancer .jpg
In my video, Turmeric Curcumin and Colon Cancer, I talked about a study where researchers showed that, by taking curcumin, the yellow pigment in the spices turmeric and curry powder, those at high risk for colon cancer could cut down on precancerous and even pre-precancerous lesions, in effect reversing cancer progression. Are there other high risk lesions we can try spicing up?

How about giving turmeric extracts to people who just had bladder cancer taken out? Or to those who have an early stage of squamous cell carcinoma skin cancer caused by arsenic exposure, or early stage cervical cancer, or precancerous lesions in the mouth or stomach? Researchers did this, and in about a quarter of the patients, the lesions started to get better. One out of the two bladder cancer survivors, two out of seven patients with precancerous mouth lesions, one out of six patients with precancerous stomach lesions, one out of four early stage cervical cancer cases, and two out of six patients with early stage skin cancer, all without any noticeable side-effects.

One of the reasons turmeric curcumin may work in some cancers better than others, or in some people better than others, is differences in bioavailability. Megadoses were given, yet just a tiny amount ended up in the bloodstream. If we're treating skin cancer, though, why not just put the curcumin directly on the skin?

I've talked about what turmeric compounds can do to cancer cells in a petri dish. In the video, Topical Application of Turmeric Curcumin for Cancer, you can see some before and after pics. Cervical cancer cells are laid to waste as more and more curcumin is added, and normal cells are unharmed. But to make it to the cervix, curcumin must be absorbed (though a vaginal cream has been invented).

A variety of delivery methods have been devised, including oral, intra-abdominal, intramuscular, under-the-skin injections, straight into the veins or the arteries, on the skin, up the bladder, in the nose, breathed like an inhaler, up where the sun don't shine, or straight into the spinal column, bone marrow, the tumor itself, or implanted somehow. Taken orally, some curcumin does actually get into the tissues. We can measure the amount of curcumin absorbed into the wall of the intestine by examining biopsies and surgical specimens taken after a curcumin regimen. It makes sense to take turmeric orally to try to fight colon cancer, but if we have cancer erupting on our skin why not just rub it on directly?

That's what one group of researchers did. They took some turmeric from the store, made a tincture out of it, dried it, put it in Vaseline, and then had cancer patients rub it on their cancer three times a day. What kind of cancer can you get at with a finger? These were folks with cancers of the mouth, breast, skin, vulva, and elsewhere. Isn't breast cancer under the surface? Not always. Advanced breast cancer can ulcerate right through the skin. The subjects were all people with recurrent ulcerating tumors that had failed to respond to surgery, radiation, and chemo. These open cancers can stink, itch, and ooze, and there was nothing else medicine had to offer. So they rubbed some turmeric ointment to see what happened. It produced remarkable relief. A reduction in smell was noted in 90% of the cases, even in extensively ulcerated cases of breast cancer, and a reduction in itching in almost all cases as well. For example, treatment relieved severe itching in two of the vulva cancer patients. Most of the lesions dried up, and in many cases this relief lasted for months, all from just rubbing on the harmless spice turmeric, which the researchers describe as "an indigenous drug ... highly effective in reducing smell, itching and exudate." The effect of this so-called drug is remarkable. And that "drug" is just some edible spice used in curries for centuries.

More on what this golden spice can do in:

There are ways of Boosting the Bioavailability of Curcumin to get it into our blood stream.

Some should be cautious about turmeric use, though. See Who Shouldn't Consume Curcumin or Turmeric?

-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: Andrea Kirkby / Flickr

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Why are Cancer Rates so Low in India?

NF-May5 Back to Our Roots- Curry and Cancer.jpg

It is estimated that many tumors start around the age of 20. However, detection of cancer is normally around the age of 50 or later. Thus, it takes cancer decades to incubate. Why does it take so long? Recent studies indicate that in any given type of cancer, hundreds of different genes must be modified to change a normal cell into a cancer cell. Although cancers are characterized by the dysregulation of cell signaling pathways at multiple steps, most current anticancer therapies involve the modulation of a single target. Chemotherapy has gotten incredibly specific, but the ineffectiveness, lack of safety, and high cost of these monotargeted therapies has led to real disappointment, and drug companies are now trying to develop chemo drugs that take a multitargeted approach.

Many plant-based products, however, accomplish multitargeting naturally and are inexpensive and safe compared to drugs. However, because drug companies are not usually able to secure intellectual property rights to plants, the development of plant-based anticancer therapies has not been prioritized. They may work (and work better for all we know), and they may be safer, or even fully risk free.

If we were going to choose one plant-based product to start testing, we might choose curcumin, the pigment in the spice turmeric (the reason curry powder looks yellow). Before we start throwing money at research, we might want to ask some basic questions, like "Do populations that eat a lot of turmeric have lower cancer rates?" The incidence of cancer does appear to be significantly lower in regions where turmeric is heavily consumed. Population-based data indicate that some extremely common cancers in the Western world are much less prevalent in regions where turmeric is widely consumed in the diet.

For example, "overall cancer rates are much lower in India than in western countries." U.S. men get 23 times more prostate cancer than men in India. Americans get between 8 and 14 times the rate of melanoma, 10 to 11 times more colorectal cancer, 9 times more endometrial cancer, 7 to 17 times more lung cancer, 7 to 8 times more bladder cancer, 5 times more breast cancer, and 9 to 12 times more kidney cancer. This is not mere 5, 10, or 20 percent more, but 5, 10, or 20 times more. Hundreds of percent more breast cancer, thousands of percent more prostate cancer--differences even greater than some of those found in the China Study.

The researchers in this study, highlighted in my video Back to Our Roots: Curry and Cancer, conclude: "Because Indians account for one-sixth of the world's population, and have some of the highest spice consumption in the world, epidemiological studies in this country have great potential for improving our understanding of the relationship between diet and cancer. The lower rates of cancer may, of course, not be due to higher spice intake. Several dietary factors may contribute to the low overall rate of cancer in India. Among them are a "relatively low intake of meat and a mostly plant-based diet, in addition to the high intake of spices." Forty percent of Indians are vegetarians, and even the ones that do eat meat don't eat a lot. And it's not only what they don't eat, but what they do. India is one of the largest producers and consumers of fresh fruits and vegetables, and Indians eat a lot of pulses (legumes), such as beans, chickpeas, and lentils. They also eat a wide variety of spices in addition to turmeric that constitute, by weight, the most antioxidant-packed class of foods in the world.

Population studies can't prove a correlation between dietary turmeric and decreased cancer risk, but they can certainly inspire a bunch of research. So far, curcumin has been tested against a variety of human cancers, including colorectal cancer, pancreatic cancer, breast, prostate, multiple myeloma, lung cancer, and head and neck cancer, for both prevention and treatment. For more information on turmeric and curcumin, check out Carcinogen Blocking Effects of Turmeric Curcumin and Turmeric Curcumin Reprogramming Cancer Cell Death.

I'm working on another dozen or so videos on this amazing spice. This is what I have so far:

Amla, dried Indian gooseberry powder, is another promising dietary addition:

I add amla to my Pink Juice with Green Foam recipe. Not all natural products from India are safe, though. See, for example, my video Some Ayurvedic Medicine Worse than Lead Paint Exposure.

More on the antioxidant concentration in spices in general in Antioxidants in a Pinch. Why do antioxidants matter? See Food Antioxidants and Cancer and Food Antioxidants, Stroke, and Heart Disease.

Which fruits and vegetables might be best? See #1 Anticancer Vegetable and Best Fruits for Cancer Prevention.

-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: peddhapati / Flickr

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Who Should be Careful About Curcumin?

NF-Feb5 Who Shouldn't Consume Curcumin or Turmeric?.jpg

Following flax and wheatgrass, turmeric is the third best-selling botanical dietary supplement, racking up $12 million in sales. Currently, sales are increasing at a rate of 20%.

"Curcumin is a natural plant product extracted from the turmeric root and is used commonly as a food additive popular for its pleasant mild aroma and exotic yellow color. It is widely considered unlikely to cause side effects." However, just because something is natural doesn't mean it's not toxic. Strychnine is natural; cyanide is natural. Lead, mercury and plutonium are all elements--can't get more natural than that! But turmeric is just a plant. Surely plants can't be dangerous? Tell that to Socrates.

"In considering the validity of the widely accepted notion that complementary and alternative medicine is a safer approach to therapy, we must remind ourselves and our patients that a therapy that exerts a biologic effect is, by definition, a drug and can have toxicity." It cannot be assumed that diet-derived agents will be innocuous when administered as pharmaceutical formulations at doses likely to exceed those consumed in the diet.

Traditional Indian diets may include as much as a teaspoon of turmeric a day. Doses of turmeric that have been used in human studies range from less than just a 16th of a teaspoon a day to two tablespoons a day for over a month. On the other hand, the curcumin trials have used up to the amount found in cups of the spice, around 100 times more than what curry lovers have been eating for centuries.

Studies have yet to show overt serious side effects in the short-term. However, if we combine high dose curcumin with black pepper, resulting in a 2000% boost in bioavailability (See Boosting the Bioavailability of Curcumin), it could be like consuming the equivalent of 29 cups of turmeric a day. That kind of intake could bring peak blood levels to the range where you start seeing some significant DNA damage in vitro.

So just incorporating turmeric into your cooking may be better than taking curcumin supplements, especially during pregnancy. The only other contraindication cited in the most recent review on curcumin was the potential to trigger gallbladder pain in individuals with gallstones.

If anything, curcumin may help protect liver function and help prevent gallstones by acting as a cholecystokinetic agent, meaning that it facilitates the pumping action of the gallbladder to keep the bile from stagnating. In one study, profiled in my video, Who Shouldn't Consume Turmeric or Curcmin?, researchers gave people a small dose of curcumin, about the amount found in a quarter teaspoon of turmeric and, using ultrasound, were able to visualize the gallbladder squeezing down in response, with an average change in volume of about 29%. Optimally, though we want to squeeze it in half. So the researchers repeated the experiment with different doses. It took about 40 milligrams to get a 50% contraction, or about a third of a teaspoon of turmeric every day.

On one hand that's great--totally doable. On the other hand, that's some incredibly powerful stuff! What if you had a gallbladder obstruction? What if you had a stone blocking your bile duct? If you eat something that makes your gallbladder squeeze so much, it could cause pain. So patients with biliary tract obstruction should be careful about consuming curcumin. For everyone else, these results suggest that curcumin can effectively "induce the gallbladder to empty and thereby reduce the risk of gallstone formation and ultimately even gallbladder cancer."

Too much turmeric, though, may increase the risk of kidney stones. As I mentioned in Oxalates in Cinnamon, turmeric is high in soluble oxalates which can bind to calcium and form insoluble calcium oxalate, which is responsible for approximately 75% of all kidney stones. "The consumption of even moderate amounts of turmeric would therefore not be recommended for people with a tendency to form kidney stones." Such folks should restrict the consumption of total dietary oxalate to less than 40 to 50 mg/day, which means no more than at most a teaspoon of turmeric. Those with gout, for example, are by definition, it appears, at high risk for kidney stones, and so if their doctor wanted to treat gout inflammation with high dose turmeric, he or she might consider curcumin supplements, because to reach high levels of curcumin in turmeric form would incur too much of an oxalate load.

If we are going to take a supplement, how do we choose? The latest review recommends purchasing from Western suppliers that follow recommended Good Manufacturing Practices, which may decrease the likelihood of buying an adulterated product.

I previously discussed the role spices play in squelching inflammation and free radicals in Which Spices Fight Inflammation? and Spicing Up DNA Protection. Then out of the lab into the clinic with attempts to test the ability of turmeric extracts to treat joint inflammation with Turmeric Curcumin and Rheumatoid Arthritis and Turmeric Curcumin and Osteoarthritis.

I wish there was more science on wheatgrass. I just had that one unhelpful anecdote in my video How Much Broccoli Is Too Much? There is good science on flax though. See:

More on gallbladder health can be found in my video Cholesterol Gallstones. And those who are susceptible to kidney stones should try to alkalinize their urine by eating lots of dark green leafy vegetables. See Testing Your Diet with Pee & Purple Cabbage.

Based on this new science on turmeric (lots more to come!), I now try to include it in my family's daily diet.

-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: sean dreilinger / Flickr

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Cancer and the Animal-to-Plant Protein Ratio

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It is now eight years since the famous Ornish study was published, suggesting that 12 months on a strictly plant-based diet could reverse the progression of prostate cancer. For those unfamiliar with that landmark Ornish study, see Cancer Reversal Through Diet?, which the Pritikin Foundation followed up on with Ex Vivo Cancer Proliferation Bioassay.

Wait a second. How were they able to get a group of older men to go vegan for a year? They home delivered prepared meals to their doors, I guess figuring men are so lazy they'll just eat whatever is put in front of them.

But what about out in the real world? Realizing that we can't even get most men with cancer to eat a measly five servings of fruits and veggies, in a study profiled in my video, Prostate Cancer Survival: The A/V Ratio, researchers settled on just trying to change their A to V ratio--the ratio of animal to vegetable proteins--and indeed were successful in cutting this ratio by at least half, from about two to one animal to plant, to kind of half vegan, one to one.

How'd the men do? Their cancer appeared to slow down. The average PSA doubling time (an estimate of how fast the tumor may be doubling in size) in the "half vegan" group slowed from 21 months to 58 months. So the cancer kept growing, but with a part-time plant-based diet they were able to slow down the tumor's expansion. What Ornish got, though, was an apparent reversal in cancer growth--the PSA didn't just rise slower, it trended down, which could be an indication of tumor shrinkage. So the ideal A to V ratio may be closer to zero.

If there's just no way grandpa's going vegan, and we just have half-measures, which might be the worst A and the best V? Eggs and poultry may be the worst, respectively doubling and potentially quadrupling the risk of cancer progression in a study out of Harvard. Twice the risk eating less than a single egg a day and up to quadruple the risk eating less than a single daily serving of chicken or turkey.

And if we could only add one thing to our diet, what would it be? Cruciferous vegetables. Less than a single serving a day of either broccoli, Brussels sprouts, cabbage, cauliflower, or kale may cut the risk of cancer progression (defined as the cancer coming back, spreading to the bone, or death) by more than half.

The animal to plant ratio might be useful for cancer prevention as well. For example, in the largest study ever performed on diet and bladder cancer, just a 3% increase in the consumption of animal protein was associated with a 15% higher risk of bladder cancer, whereas a 2% increase in plant protein intake was associated with a 23% lower risk. Even little changes in our diets can have significant effects.

What else might help men with prostate cancer? See Flaxseed vs. Prostate Cancer and Saturated Fat & Cancer Progression. What about preventing it in the first place? See:

Poultry and eggs may be related to cancer risk in a variety of ways:

Crucifers may also help with other cancers. See:

Breast cancer is highlighted in my video Breast Cancer Survival Vegetable.

-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 and More Than an Apple a Day.

Image Credit: Greg Habermann / Flickr

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A Low Methionine Diet May Help Starve Cancer Cells

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When designing an antibiotic, we can't create a drug that destroys DNA because that's something that both humans and bacteria share in common. It would kill bacteria, but it might kill us, too. Instead, many antibiotics work by attacking bacterial cell walls, which is something bacteria have that we don't.

Similarly, antifungals can attack the unique cell walls of fungus. Pesticides can work by attacking the special exoskeleton of insects. But fighting cancer is harder because cancer cells are our own cells. So fighting cancer comes down to trying to find and exploit differences between cancer cells and normal cells.

Forty years ago, a landmark paper was published showing for the first time that many human cancers have what's called "absolute methionine dependency," meaning that if we try to grow cells in a Petri dish without giving them the amino acid methionine, normal cells thrive, but without methionine, cancer cells die. Normal breast cells grow no matter what, with or without methionine, but cancer cells need that added methionine to grow.

What does cancer do with the methionine? Tumors use it to generate gaseous sulfur-containing compounds that, interestingly, can be detected by specially trained diagnostic dogs. There are mole-sniffing dogs that can pick out skin cancer. There are breath-sniffing dogs that can pick out people with lung cancer. Pee-sniffing dogs that can diagnose bladder cancer and--you guessed it--fart-sniffing dogs for colorectal cancer. Doctors can now bring their lab to the lab!

It gives a whole new meaning to the term pet scan :)

Methionine dependency is not just present in cancer cell lines in a Petri dish. Fresh tumors taken from patients show that many cancers appear to have a biochemical defect that makes them dependent on methionine, including some tumors of the colon, breast, ovary, prostate, and skin. Pharmaceutical companies are fighting to be the first to come out with a drug that decreases methionine levels. But since methionine is sourced mainly from food, a better strategy may be to lower methionine levels by lowering methionine intake, eliminating high methionine foods to control cancer growth as well as improve our lifespan (see Methionine Restriction as a Life-Extension Strategy).

Here's the thinking: smoking cessation, consumption of diets rich in plants, and other lifestyle measures can prevent the majority of cancers. Unfortunately, people don't do them, and as a result hundreds of thousands of Americans develop metastatic cancer each year. Chemotherapy cures only a few types of metastatic cancer. Unfortunately, the vast majority of common metastatic cancers, such as breast, prostate, colon, and lung, are lethal. We therefore desperately need novel treatment strategies for metastatic cancer, and dietary methionine restriction may be one such strategy.

So, where is methionine found? In my video, Starving Cancer with Methionine Restriction, you can see a graph of foods with their respective methionine levels. Chicken and fish have the highest levels. Milk, red meat, and eggs have less, but if we really want to stick with lower methionine foods, fruits, nuts, veggies, grains, and beans are the best. In other words, "In humans, methionine restriction may be achieved using a predominately vegan diet."

There are also compounds in animal products that may actually stimulate tumor growth. See, for example, How Tumors Use Meat to Grow: Xeno-Autoantibodies. Animal protein may also boost levels of the cancer-promoting hormone IGF-1 (The Answer to the Pritikin Puzzle). Combined, this could all help explain why plants and plant-based diets have been found effective in potentially reversing some cancer processes. See Cancer Reversal Through Diet?, Strawberries versus Esophageal Cancer, and Black Raspberries versus Oral Cancer.

So why isn't every oncologist prescribing a low-methionine diet? One researcher notes that "Despite many promising preclinical and clinical studies in recent years, dietary methionine restriction and other dietary approaches to cancer treatment have not yet gained wide clinical application. Most clinicians and investigators are probably unfamiliar with nutritional approaches to cancer." That's an understatement! "Many others may consider amino acid restriction as an 'old idea,' since it has been examined for several decades. However, many good ideas remain latent for decades if not centuries before they prove valuable in the clinic....With the proper development, dietary methionine restriction, either alone or in combination with other treatments, may prove to have a major impact on patients with cancer."

Why might the medical profession be so resistant to therapies proven to be effective? The Tomato Effect may be partially to blame.

In my video, Anti-Angiogenesis: Cutting Off Tumor Supply Lines, researchers come to the same plant-based conclusion from a different perspective, starving cancers of their blood supply.

-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 and More Than an Apple a Day.

Image Credit: PNNL - Pacific Northwest National Laboratory / Flickr

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