How Milk May Contribute to Childhood Obesity

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We've known that breastfed infants may be protected against obesity later in life for more than 30 years, but why? It may be the formula. Giving infants formula based on cow's milk presents an unusual situation. Cow's milk is designed to put nearly two pounds a day onto a growing calf, 40 times the growth rate of human infants (see Formula for Childhood Obesity).

The perfect food for humans, finely tuned over millions of years, is human breast milk. Remarkably, among all mammalian species, the protein content of human milk is the lowest. The excessive protein content of cow's milk-based formula is thought to be what may be what sets the child up for obesity later in life.

And then, instead of being weaned, we continue to drink milk. The question thus arises as to whether consumption of a growth-promoting substance from another species throughout childhood fundamentally alters processes of human growth and maturation. A study out of Indiana University, for example, found evidence that greater milk intake is associated with an increased risk of premature puberty; girls drinking a lot of milk started to get their periods earlier. Thus, cross-species milk consumption and ingestion into childhood may trigger unintended consequences.

Only human milk allows appropriate metabolic programming and protects against diseases of civilization in later life, whereas consumption of cow's milk and dairy products during adolescence and adulthood is an evolutionarily novel behavior that may have long-term adverse effects on human health.

Teens exposed to dairy proteins such as casein, skim milk, or whey, experienced a significant increase in BMI and waist circumference compared to a control group. In contrast, not a single study funded by the dairy industry found a result unfavorable to milk.

The head of the Obesity Prevention Center at Boston Children's Hospital and the chair of Harvard's nutrition department wrote an editorial recently to the AMA's Pediatrics journal questioning the role of cow's milk in human nutrition. They stated the obvious: humans have no requirement for other animal's milk; in fact, dairy may play a role in certain cancers due to the high levels of reproductive hormones in the U.S. milk supply.


So what's The Best Baby Formula? Click on the link and find out!

More on dairy and infancy:

And in childhood: Childhood Constipation and Cow's Milk and Treating Infant Colic by Changing Mom's Diet

In adolescence: Saving Lives By Treating Acne With Diet

Before conception: Dairy Estrogen and Male Fertility

During pregnancy: Why Do Vegan Women Have 5x Fewer Twins?

And in adulthood:

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: Sergey Novikov © 123RF.com. This image has been modified.

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How Milk May Contribute to Childhood Obesity

How Milk May Contribute to Childhood Obesity.jpeg

We've known that breastfed infants may be protected against obesity later in life for more than 30 years, but why? It may be the formula. Giving infants formula based on cow's milk presents an unusual situation. Cow's milk is designed to put nearly two pounds a day onto a growing calf, 40 times the growth rate of human infants (see Formula for Childhood Obesity).

The perfect food for humans, finely tuned over millions of years, is human breast milk. Remarkably, among all mammalian species, the protein content of human milk is the lowest. The excessive protein content of cow's milk-based formula is thought to be what may be what sets the child up for obesity later in life.

And then, instead of being weaned, we continue to drink milk. The question thus arises as to whether consumption of a growth-promoting substance from another species throughout childhood fundamentally alters processes of human growth and maturation. A study out of Indiana University, for example, found evidence that greater milk intake is associated with an increased risk of premature puberty; girls drinking a lot of milk started to get their periods earlier. Thus, cross-species milk consumption and ingestion into childhood may trigger unintended consequences.

Only human milk allows appropriate metabolic programming and protects against diseases of civilization in later life, whereas consumption of cow's milk and dairy products during adolescence and adulthood is an evolutionarily novel behavior that may have long-term adverse effects on human health.

Teens exposed to dairy proteins such as casein, skim milk, or whey, experienced a significant increase in BMI and waist circumference compared to a control group. In contrast, not a single study funded by the dairy industry found a result unfavorable to milk.

The head of the Obesity Prevention Center at Boston Children's Hospital and the chair of Harvard's nutrition department wrote an editorial recently to the AMA's Pediatrics journal questioning the role of cow's milk in human nutrition. They stated the obvious: humans have no requirement for other animal's milk; in fact, dairy may play a role in certain cancers due to the high levels of reproductive hormones in the U.S. milk supply.


So what's The Best Baby Formula? Click on the link and find out!

More on dairy and infancy:

And in childhood: Childhood Constipation and Cow's Milk and Treating Infant Colic by Changing Mom's Diet

In adolescence: Saving Lives By Treating Acne With Diet

Before conception: Dairy Estrogen and Male Fertility

During pregnancy: Why Do Vegan Women Have 5x Fewer Twins?

And in adulthood:

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: Sergey Novikov © 123RF.com. This image has been modified.

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How Fruits and Vegetables Can Prevent Asthma

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-Michael Greger, M.D.

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

Image Credit: EdTech Stanford University School of Medicine / Flickr

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How Contaminated Are Our Children?

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In a study highlighted in my video, California Childen Are Contaminated, researchers analyzed the diets of California children ages two through seven to determine the cancer and non-cancer health effects from food contaminant exposures. It turns out food may be the primary route of exposure to toxic heavy metals, persistent pollutants, and pesticides. "Though food-borne toxic contaminants are a concern for all ages, they are of greatest concern for children, who are disproportionately impacted because they're still developing and have greater intake of food and fluids relative to their weight. Pediatric problems that have been linked to preventable environmental toxin exposures include cancer, asthma, lead poisoning, neurobehavioral disorders, learning and developmental disabilities, and birth defects."

The good news is that changing one's diet can change one's exposure. Quoting from the study, "A diet high in fish and animal products, for example, results in greater exposure to persistent pollutants like DDT and dioxins and heavy metals than does a plant-based diet because these compounds bioaccumulate up the food chain." Plants are at the bottom of the food chain. The sample of California kids, however, was not eating a plant-based diet. Cancer benchmark levels were exceeded by all 364 children for arsenic, the banned pesticide dieldrin, a metabolite of DDT called DDE, and dioxins.

Children exceeded safety levels by a greater margin than adults. This is especially of concern for children because all of these compounds are suspected endocrine disruptors and thus may impact normal development. Cancer risk ratios were exceeded by over a factor of 100 for both arsenic and dioxins.

Which foods were the worse? For preschoolers, the number one food source of arsenic was poultry, though for their parents, it was tuna. The number one source of lead was dairy, and for mercury it was seafood. And the number one source of the banned pesticides and dioxins was dairy. (See Preventing Parkinson's Disease With Diet.)

The researchers also recommended children should eat lower quantities of chips, cereal, crackers, and other crispy carbs to reduce acrylamide intake.

The California study didn't split up the groups by gender, but a similar study in Europe found that men had higher levels of some of these pollutants than women. For example, levels of the banned pesticide chlordane were higher in men, but women who never breastfed were right up there alongside men, with the lowest levels found in women who breastfed over 12 months. Therefore, it is likely that the lactation-related reduction in blood pollutant levels partly explains the lower body burdens among women compared with men. So cows can lower their levels by giving some to us, then we can pass it along to our children.

What non-cancer effects might some of these pollutants have? They can affect our immune system. Studies clearly demonstrate the "ability of dioxins and related compounds to have a long-lasting and deleterious impact on immune function." This manifests as increased incidences of respiratory infections, ear infections, cough, and sore throat. At first, most of the data was for during infancy, but now we have follow-up studies showing that the immunosuppressive effects of these toxins may persist into early childhood, so we should try to reduce our exposure as much as possible. Because these pollutants accumulate in animal fat, consuming a plant-based diet-decreasing meat, dairy, and fish consumption-may reduce exposure for children and adults alike.

These findings should come as no surprise to those who saw my video Pollutants in California Breast Tissue. For an overview see CDC Report on Environmental Chemical Exposure and President's Cancer Panel Report on Environmental Risk.

Pollutant exposure may affect the ability to have children in the first place (Male Fertility and Diet and Meat Hormones & Female Infertility). Such a delay, though, may allow one an opportunity to reduce one's toxic burden through dietary change (Hair Testing for Mercury Before Considering Pregnancy and How Long to Detox From Fish Before Pregnancy?).

During pregnancy, pollutants can be transferred directly (DDT in Umbilical Cord Blood), and after pregnancy through breastfeeding (The Wrong Way to Detox). Once our kids are contaminated, How Fast Can Children Detoxify from PCBs? The chemicals have implications for older children too: Protein, Puberty, and Pollutants.

Seafood is not the only source of toxic heavy metals. See:

Videos on primary food sources of other industrial pollutants include:

There are some things we can eat, though, to counteract some of the toxins:

-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: Kevin Krejci / Flickr

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How to Reduce Exposure to Alkylphenols Through Your Diet

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Alkylphenols are industrial chemicals that are found in hair products, spermicides, cleaning products and detergents. They are considered endocrine disruptors. For more information on alkylphenols, check out my video Alkylphenol Endocrine Disruptors and Allergies.

Concern about alkylphenols first surfaced decades ago when a group at Tufts observed an excessive proliferation of human breast cancer cells in certain types of plastic containers, something that would normally only be seen if the cells were exposed to some type of estrogen. They identified an alkylphenol leaching from the plastic as the culprit, having "estrogen-like properties when tested in the human breast tumor cells." Excessive proliferation of human breast cancer cells is never good, so countries in Europe started banning and restricting the use of these chemicals. However, the U.S. EPA has been slow to respond.

A half million tons of alkylphenols continue to spew out into the environment every year, so much so that now that they come down in the rain and then accumulate up the food chain.

One study, highlighted in my video, Dietary Sources of Alkylphenol Endocrine Disruptors, examined the Japanese food supply to find out which foods had these potentially allergy-exacerbating endocrine disruptors. The researchers found that chicken and fish had the highest levels. Water animals and birds concentrate these compounds to levels several thousands of times greater than those in the environment because these are fat-soluble chemicals. "Therefore, they can easily contaminate foods of animal origin, which are thought to represent the most important source of human exposure to many organic pollutants," not just the alkylphenols. Another research group also found that fish was the worst.

Which kind of fish? Anchovies, mackerel, salmon and cod seem to have the highest levels. In fact, salmon was the only food found contaminated with nonylphenol diethoxylate, which is even more potent than regular nonylphenol. The levels of contamination in fish were at the concentrations that start to make breast cancer cells go crazy in vitro.

These findings are consistent with the fact that seafood consumption has been associated with severe asthma, current and severe rhinoconjunctivitis, (seasonal pollen allergies), and current and severe eczema (an allergic-type disease of the skin) in adolescent populations around the globe.

If these synthetic xenoestrogens are playing a role, what about natural phytoestrogens, such as those found in soy foods? It turns out that in patients with asthma, consumption of a diet with moderate to high amounts of soy phytoestrogens is associated with better lung function and better asthma control. If anything then, it's these chemical pollutants, which come down in the rain, contaminate the soil, the plants, and then concentrate up the food chain in the fat of animals. We're now the animals at the top of the food chain, like the polar bear or bald eagle, building up higher levels of these synthetic xenoestrogens.

Thankfully, there aren't many cannibals around anymore. However, there is one group that continues to feed off human tissues--babies (See The Wrong Way to Detox). Alkylphenols have been found to concentrate in human breast milk, particularly in women who eat fish. The highest levels of these endocrine-disrupting pollutants were recorded in milk samples from mothers who said they ate fish at least twice a week, consistent with the fact that seafood consumption represents an important source of alkylphenol intake. Even these "slightly elevated levels of endocrine disruptors in the milk of mothers with a seafood-rich diet may be associated with adverse effects on neurological development, fetal and postnatal growth, and memory functions on breastfed infants, because these contaminants may interfere with the endocrine [hormonal] system."

Since these toxins concentrate in fat, the highest concentrations may be found in straight animal fat, such as chicken fat, lard, tallow, or fish oil. Consumption of fish oil capsules and processed fish products has been associated with alkylphenol concentration in mothers' milk, again due to bioaccumulation up the food chain. And then we recycle the leftover remains of farm animals into farm animal feed, so the levels can get higher and higher in animal products.

As one commentator noted, while these pollutants do contaminate human milk, they also contaminate cow's milk--humans and cows live in the same polluted world. In fact, infant formula was found to be over five times more contaminated, so breast is still best, absolutely. But these kinds of studies are important in order to provide good suggestions for food choices to nursing mothers to prevent excess exposure to these pollutants in their infants.

We can kind of cut out the middlefish and move lower down the food chain in hopes of decreasing our exposure to industrial toxins.

Endocrine disruptors have also been linked to conditions such as male infertility (Male Fertility and Diet and Xenoestrogens and Sperm Counts) and early onset of puberty (Protein, Puberty, and Pollutants and Xenoestrogens and Early Puberty).

What other industrial pollutants build up in the aquatic fish chain? See, for example:

Farmed Fish vs. Wild Caught. Which is worse?

How Long to Detox from Fish Before Pregnancy? If it's too late, How Fast Can Children Detoxify from PCBs?

-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: Andrea Pokrzywinski / Flickr

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What to Eat to Reduce Our Toxic Exposure

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It is not very common that a single molecule attracts enough interest to merit international scientific conferences of its own. "Ah receptor," however, "belongs to the rare elite of such molecules." Ah receptors are an important factor in how our immune system works. For background, see my video, The Broccoli Receptor: Our First Line of Defense. The latest conference offered "new reports about the way plant-derived compounds in our diet are necessary for a fully functioning immune system of the gut." One study in particular out of the journal Nature, "expanded our understanding of how diet impacts immunity and health by showing that a plant-derived nutrient profoundly shapes the capacity for intestinal immune defense." And intestinal defense not only protects us against the pathogens we may ingest, but also against toxic chemicals.

We're constantly exposed to a wide range of toxins, from such sources as cigarette smoke, exhaust fumes, furnace gases, cooked meat and fish, cow's milk, and even mother's milk (because of what mothers themselves are exposed to) as seen in my video Counteracting the Effects of Dioxins Through Diet. Many of these pollutants exert their toxic effects through the Ah receptor system. For example, dioxins invade the body mainly through the diet (where we get more than 90% of our exposure) as it concentrates through the food chain, presenting a serious health concern. But there are phytonutrients in fruits, vegetables, tea, red wine, and beans that block the effects of dioxins at levels close to what we find in people's bloodstream. Just three apples or about a tablespoon of red onion a day may cut dioxin toxicity in half. And the half-life of these phytonutrients in the body is only about 25 hours, so we have to keep eating these health-promoting foods day after day.

At first we just thought that it was only cruciferous vegetables that could dock in these receptors and fend off toxins, but does that make evolutionary sense? As Lora V. Hooper from the Howard Hughes Medical Institute notes, "Given the variety and flexibility of most mammalian diets, a specific dependence on cruciferous vegetables for optimal intestinal immune function would seem overly restrictive. Rather, it seems likely that many other foods contain compounds with similar immune-stimulatory properties."

Indeed, "the search for foods containing similar immunomodulatory compounds has begun." We now know that a wide variety of natural plant compounds can counteract the chemical pollution to which we're all exposed. There is actually one animal product that has also been shown to potentially block the cancer-causing effects of dioxins: camel urine. Camel urine--but not cow urine--was found to inhibit the effects of a known carcinogenic chemical. Importantly, the researchers emphasize that virgin camel urine showed the highest degree of inhibition, performing better than pregnant camel urine, for example. So the next time our kids don't want to eat their fruits and veggies, we can just say, "It's either that, or camel pee."

I report different mechanisms but similar outcomes in Plants vs. Pesticides and Eating Green to Prevent Cancer. So this all suggests a double benefit of eating lower on the food chain, since it would also entail lower exposure to toxic contaminants in the first place (Industrial Pollutants in Vegans).

How Chemically Contaminated Are We? Check out the CDC Report on Environmental Chemical Exposure. Where are dioxins found so we can avoid them in the first place? See Dioxins in the Food 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, More Than an Apple a Day, and From Table to Able.

Images thanks to Feliciano Guimaraes / Flickr

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Breast Cancer and Wine

 

 

 

 

 

 

 

 

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After diagnosis, women with breast cancer may cut their risk of dying nearly in half by just instituting simple, modest lifestyle changes—5 or more servings of fruits and veggies a day and walking 30 minutes a day, 6 days a week. But what about preventing breast cancer in the first place?

If we follow the advice of the official dietary guidelines for cancer prevention, does it actually reduce our risk of cancer? If we manage our weight, eat more plant foods, less animal foods, less alcohol and breastfeed, based on the largest prospective study on diet and cancer in history, we may significantly lower our risk of breast cancer, endometrial cancer, colorectal cancer, lung cancer, kidney cancer, stomach cancer, oral cancer, liver cancer, esophageal cancer, and all cancers combined.

Of all the recommendations, the “eat mostly foods of plant origin” appeared the most powerful. For example, a study in the UK found that in just one year in Britain there were 14,902 excess cases of cancer caused by something participants were exposed to 10 years earlier. What was that something that ended up causing thousands of cancers?  

Deficient intake of fruit and vegetables.

If that was instead, some chemical spill causing 14,000 cancers, people would be up in arms to ban it—but instead when that killer carcinogen is not eating their “fruit and veg” (as the Brits would say), it hardly gets anyone’s attention.

What if we throw in smoking, too? Researchers created a healthy lifestyle index, defined by four things: 1) exercise;  2) a dietary shift away from the standard American diet high in meat, dairy, fat, and sugar towards a more prudent dietary pattern—for instance more green and yellow vegetables, beans, and fruits;  3) avoidance of tobacco; and 4) avoidance of alcohol. Young women scoring higher on those four things cut their odds of getting breast cancer in half, older women cut their odds of breast cancer by 80%!

We’ve covered how even light drinking can increase breast cancer risk (see my video Breast Cancer and Alcohol: How Much is Safe?), but for women who refuse to eliminate alcohol, which is less carcinogenic: red wine or white? Some studies, outlined in my four minute video, Breast Cancer Risk: Red Wine vs. White Wine, actually suggest less or even no risk from red wine, and we may have just figured out why. Remember how mushrooms were the vegetable best able to suppress the activity of aromatase, the enzyme used by breast tumors to produce its own estrogen? (from my video Vegetables Versus Breast Cancer). Well, if we run the same human placenta experiments with fruit, strawberries get the silver, but grapes get the gold.

For more on the aromatase story, see:

But what kind of grapes? The wimpy green grapes used to make white wine barely worked compared to those used for making red.  Bottom line: “red wine may serve as a nutritional aromatase inhibitor, which may ameliorate the elevated breast cancer risk associated with alcohol intake.” But why accept any elevated risk? Just eat whole grapes! And if you do, choose ones with seeds if you can, as they may work even better. More on grapes in Fat Burning Via Flavonoids and Best Fruit Juice.

Wasn’t there a study that found that fruits and vegetables weren’t protective against cancer, though? See my video on the EPIC Study.

What if you already have breast cancer? Well, Cancer Prevention and Treatment May Be the Same Thing, but I do have a few studies on breast cancer survival and 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 and More Than an Apple a Day.

Image credit: TonalLuminosity / Flickr

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