Music as Medicine

Music as Medicine.jpeg

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

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

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

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

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

Original Link

Music as Medicine

Music as Medicine.jpeg

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

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

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

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

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

Original Link

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.

Original Link

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.

Original Link

How Much Fiber Should You Eat Every Day?

How Much Fiber Should You Eat Every Day.jpeg

High dietary fiber intake may help prevent strokes. The belief that dietary fiber intake is protectively associated with certain diseases was postulated 40 years ago and then enormously fueled and kept alive by a great body of science since. Today it is generally believed that eating lots of fiber-rich foods helps prevent obesity, diabetes, and cardiovascular diseases such as stroke.

Strokes are the second most common cause of death worldwide. Moreover, stroke is a leading cause of disability, and so preventing strokes in the first place--what's called primary prevention--should therefore, be a key public health priority (see How to Prevent a Stroke).

The best observational studies to date found that fiber appears to significantly protect against the risk of stroke. Different strokes for different folks, depending, evidently, on how much fiber they ate. Notably, increasing fiber just seven grams a day was associated with a 7% reduction in stroke risk. And seven grams is easy, that's like a serving of whole grain pasta with tomato sauce and an apple.

What's the mechanism? Maybe it's that fiber helps lower cholesterol and blood sugar levels. Or it could just be that those eating more fiber are just eating more vegetables, or fewer calories, or less meat and fat, or improving digestion, all of which may slim us down and lower our blood pressure and the amount of inflammation in our bodies. Does it really matter, though? As Dr. Burkitt commented on the biblical passage, "A man scatters seed on the land--the seed sprouts and opens--how, he does not know," the farmer doesn't wait to find out. Had the farmer postponed his sowing until he understood seed germination, he would not have lasted very long. So yes, let's keep trying to figure out why fiber is protective, but in the meanwhile, we should be increasing our intake of fiber, which is to say increasing our intake of whole plant foods.

It's never too early to start eating healthier. Strokes are one of many complications of arterial stiffness. Though our first stroke might not happen until our 50's, our arteries may have been stiffening for decades leading up to it. Hundreds of kids were followed for 24 years, from age 13 in through 36 and researchers found that lower intake of fiber during a young age was associated with stiffening of the arteries leading up to the brain. Even by age 13, they could see differences in arterial stiffness depending on diet. Fiber intake is important at any age.

Again, it doesn't take much. One extra apple a day or an extra quarter cup of broccoli might translate into meaningful differences in arterial stiffness in adulthood. If you really don't want a stroke, we should try to get 25 grams a day of soluble fiber (found concentrated in beans, oats, nuts, and berries) and 47 grams a day of insoluble fiber (concentrated in whole grains). One would have to eat an extraordinarily healthy diet to get that much, yet these cut-off values could be considered as the minimum recommended daily intake of soluble and insoluble fiber to prevent stroke. The researchers admit these are higher than those commonly and arbitrarily proposed as "adequate" levels by scientific societies, but should we care about what authorities think is practical? They should just share the best scienceand let us make up our own minds.

Someone funded by Kellogg's wrote in to complain that in practice, such fiber intakes are "unachievable" and that the message should just be the more, the better--like maybe just have a bowl of cereal or something.

The real Dr. Kellogg was actually one of our most famous physicians, credited for being one of the first to sound the alarm about smoking, and who may have been the first American physician to have recognized the field of nutrition as a science. He would be rolling in his grave today if he knew what his family's company had become.


More on preventing strokes can be found here:

More on the wonders of fiber in:

It really is never too early to start eating healthier. See, for example, Heart Disease Starts in Childhood, How to Prevent Prediabetes in Children, Heart Disease May Start in the Womb, and Should All Children Have their Cholesterol Checked?

In health,

Michael Greger, M.D.

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

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

Original Link

How Much Fiber Should You Eat Every Day?

How Much Fiber Should You Eat Every Day.jpeg

High dietary fiber intake may help prevent strokes. The belief that dietary fiber intake is protectively associated with certain diseases was postulated 40 years ago and then enormously fueled and kept alive by a great body of science since. Today it is generally believed that eating lots of fiber-rich foods helps prevent obesity, diabetes, and cardiovascular diseases such as stroke.

Strokes are the second most common cause of death worldwide. Moreover, stroke is a leading cause of disability, and so preventing strokes in the first place--what's called primary prevention--should therefore, be a key public health priority (see How to Prevent a Stroke).

The best observational studies to date found that fiber appears to significantly protect against the risk of stroke. Different strokes for different folks, depending, evidently, on how much fiber they ate. Notably, increasing fiber just seven grams a day was associated with a 7% reduction in stroke risk. And seven grams is easy, that's like a serving of whole grain pasta with tomato sauce and an apple.

What's the mechanism? Maybe it's that fiber helps lower cholesterol and blood sugar levels. Or it could just be that those eating more fiber are just eating more vegetables, or fewer calories, or less meat and fat, or improving digestion, all of which may slim us down and lower our blood pressure and the amount of inflammation in our bodies. Does it really matter, though? As Dr. Burkitt commented on the biblical passage, "A man scatters seed on the land--the seed sprouts and opens--how, he does not know," the farmer doesn't wait to find out. Had the farmer postponed his sowing until he understood seed germination, he would not have lasted very long. So yes, let's keep trying to figure out why fiber is protective, but in the meanwhile, we should be increasing our intake of fiber, which is to say increasing our intake of whole plant foods.

It's never too early to start eating healthier. Strokes are one of many complications of arterial stiffness. Though our first stroke might not happen until our 50's, our arteries may have been stiffening for decades leading up to it. Hundreds of kids were followed for 24 years, from age 13 in through 36 and researchers found that lower intake of fiber during a young age was associated with stiffening of the arteries leading up to the brain. Even by age 13, they could see differences in arterial stiffness depending on diet. Fiber intake is important at any age.

Again, it doesn't take much. One extra apple a day or an extra quarter cup of broccoli might translate into meaningful differences in arterial stiffness in adulthood. If you really don't want a stroke, we should try to get 25 grams a day of soluble fiber (found concentrated in beans, oats, nuts, and berries) and 47 grams a day of insoluble fiber (concentrated in whole grains). One would have to eat an extraordinarily healthy diet to get that much, yet these cut-off values could be considered as the minimum recommended daily intake of soluble and insoluble fiber to prevent stroke. The researchers admit these are higher than those commonly and arbitrarily proposed as "adequate" levels by scientific societies, but should we care about what authorities think is practical? They should just share the best scienceand let us make up our own minds.

Someone funded by Kellogg's wrote in to complain that in practice, such fiber intakes are "unachievable" and that the message should just be the more, the better--like maybe just have a bowl of cereal or something.

The real Dr. Kellogg was actually one of our most famous physicians, credited for being one of the first to sound the alarm about smoking, and who may have been the first American physician to have recognized the field of nutrition as a science. He would be rolling in his grave today if he knew what his family's company had become.


More on preventing strokes can be found here:

More on the wonders of fiber in:

It really is never too early to start eating healthier. See, for example, Heart Disease Starts in Childhood, How to Prevent Prediabetes in Children, Heart Disease May Start in the Womb, and Should All Children Have their Cholesterol Checked?

In health,

Michael Greger, M.D.

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

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

Original Link

How Much Fiber Should You Eat Every Day?

How Much Fiber Should You Eat Every Day.jpeg

High dietary fiber intake may help prevent strokes. The belief that dietary fiber intake is protectively associated with certain diseases was postulated 40 years ago and then enormously fueled and kept alive by a great body of science since. Today it is generally believed that eating lots of fiber-rich foods helps prevent obesity, diabetes, and cardiovascular diseases such as stroke.

Strokes are the second most common cause of death worldwide. Moreover, stroke is a leading cause of disability, and so preventing strokes in the first place--what's called primary prevention--should therefore, be a key public health priority (see How to Prevent a Stroke).

The best observational studies to date found that fiber appears to significantly protect against the risk of stroke. Different strokes for different folks, depending, evidently, on how much fiber they ate. Notably, increasing fiber just seven grams a day was associated with a 7% reduction in stroke risk. And seven grams is easy, that's like a serving of whole grain pasta with tomato sauce and an apple.

What's the mechanism? Maybe it's that fiber helps lower cholesterol and blood sugar levels. Or it could just be that those eating more fiber are just eating more vegetables, or fewer calories, or less meat and fat, or improving digestion, all of which may slim us down and lower our blood pressure and the amount of inflammation in our bodies. Does it really matter, though? As Dr. Burkitt commented on the biblical passage, "A man scatters seed on the land--the seed sprouts and opens--how, he does not know," the farmer doesn't wait to find out. Had the farmer postponed his sowing until he understood seed germination, he would not have lasted very long. So yes, let's keep trying to figure out why fiber is protective, but in the meanwhile, we should be increasing our intake of fiber, which is to say increasing our intake of whole plant foods.

It's never too early to start eating healthier. Strokes are one of many complications of arterial stiffness. Though our first stroke might not happen until our 50's, our arteries may have been stiffening for decades leading up to it. Hundreds of kids were followed for 24 years, from age 13 in through 36 and researchers found that lower intake of fiber during a young age was associated with stiffening of the arteries leading up to the brain. Even by age 13, they could see differences in arterial stiffness depending on diet. Fiber intake is important at any age.

Again, it doesn't take much. One extra apple a day or an extra quarter cup of broccoli might translate into meaningful differences in arterial stiffness in adulthood. If you really don't want a stroke, we should try to get 25 grams a day of soluble fiber (found concentrated in beans, oats, nuts, and berries) and 47 grams a day of insoluble fiber (concentrated in whole grains). One would have to eat an extraordinarily healthy diet to get that much, yet these cut-off values could be considered as the minimum recommended daily intake of soluble and insoluble fiber to prevent stroke. The researchers admit these are higher than those commonly and arbitrarily proposed as "adequate" levels by scientific societies, but should we care about what authorities think is practical? They should just share the best scienceand let us make up our own minds.

Someone funded by Kellogg's wrote in to complain that in practice, such fiber intakes are "unachievable" and that the message should just be the more, the better--like maybe just have a bowl of cereal or something.

The real Dr. Kellogg was actually one of our most famous physicians, credited for being one of the first to sound the alarm about smoking, and who may have been the first American physician to have recognized the field of nutrition as a science. He would be rolling in his grave today if he knew what his family's company had become.


More on preventing strokes can be found here:

More on the wonders of fiber in:

It really is never too early to start eating healthier. See, for example, Heart Disease Starts in Childhood, How to Prevent Prediabetes in Children, Heart Disease May Start in the Womb, and Should All Children Have their Cholesterol Checked?

In health,

Michael Greger, M.D.

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

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

Original Link

How Exactly Does Type 2 Diabetes Develop?

How Exactly Does Type 2 Diabetes Develop.jpeg

Insulin resistance is the cause of both prediabetes and type 2 diabetes. OkK, so what is the cause of insulin resistance? Insulin resistance is now accepted to be closely associated with the accumulation of fat within our muscle cells. This fat toxicity inside of our muscles is a major factor in the cause of insulin resistance and type 2 diabetes, as it interferes with the action of insulin. I've explored how fat makes our muscles insulin resistant (see What Causes Insulin Resistance?), how that fat can come from the fat we eat or the fat we wear (see The Spillover Effect Links Obesity to Diabetes), and how not all fats are the same (see Lipotoxicity: How Saturated Fat Raises Blood Sugar). It's the type of fat found predominantly in animal fats, relative to plant fats, that appears to be especially deleterious with respect to fat-induced insulin insensitivity. But this insulin resistance in our muscles starts years before diabetes is diagnosed.

In my video, Diabetes as a Disease of Fat Toxicity, you can see that insulin resistance starts over a decade before diabetes is actually diagnosed, as blood sugar levels slowly start creeping up. And then, all of the sudden, the pancreas conks out, and blood sugars skyrocket. What could underlie this relatively rapid failure of insulin secretion?

At first, the pancreas pumps out more and more insulin, trying to overcome the fat-induced insulin resistance in the muscles, and high insulin levels can lead to the accumulation of fat in the liver, called fatty liver disease. Before diagnosis of type 2 diabetes, there is a long silent scream from the liver. As fat builds up in our liver, it also becomes resistant to insulin.

Normally, the liver is constantly producing blood sugar to keep our brain alive between meals. As soon as we eat breakfast, though, the insulin released to deal with the meal normally turns off liver glucose production, which makes sense since we don't need it anymore. But when our liver is filled with fat, it becomes insulin resistant like our muscles, and doesn't respond to the breakfast signal; it keeps pumping out blood sugar all day long on top of whatever we eat. Then the pancreas pumps out even more insulin to deal with the high sugars, and our liver gets fatter and fatter. That's one of the twin vicious cycles of diabetes. Fatty muscles, in the context of too many calories, leads to a fatty liver, which leads to an even fattier liver. This is all still before we have diabetes.

Fatty liver can be deadly. The liver starts trying to offload the fat by dumping it back into the bloodstream in the form of something called VLDL, and that starts building up in the cells in the pancreas that produce the insulin in the first place. Now we know how diabetes develops: fatty muscles lead to a fatty liver, which leads to a fatty pancreas. It is now clear that type 2 diabetes is a condition of excess fat inside our organs, whether we're obese or not.

The only thing that was keeping us from diabetes-unchecked skyrocketing blood sugars-is that the pancreas was working overtime pumping out extra insulin to overcome insulin resistance. But as the so-called islet or Beta cells in the pancreas are killed off by the fatty buildup, insulin production starts to fail, and we're left with the worst of both worlds: insulin resistance combined with a failing pancreas. Unable to then overcome the resistance, blood sugar levels go up and up, and boom: type 2 diabetes.

This has implications for cancer as well. Obesity leads to insulin resistance and our blood sugars start to go up, so our pancreas starts pumping out more insulin to try to force more sugar into our muscles, and eventually the fat spills over into the pancreas, killing off the insulin-producing cells. Then we develop diabetes, in which case we may have to start injecting insulin at high levels to overcome the insulin-resistance, and these high insulin levels promote cancer. That's one of the reasons we think obese women get more breast cancer. It all traces back to fat getting into our muscle cells, causing insulin resistance: fat from our stomach (obesity) or fat going into our stomach (saturated fats in our diet).

Now it should make sense why the American Diabetes Association recommends reduced intake of dietary fat as a strategy for reducing the risk for developing diabetes.


The reason I'm going into all this detail is that I'm hoping to empower both those suffering from the disease and those treating sufferers so as to better understand dietary interventions to prevent and treat the epidemic.

Here are some videos on prevention:

And here are some on treatment:

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: Nephron. This image has been modified.

Original Link

How Exactly Does Type 2 Diabetes Develop?

How Exactly Does Type 2 Diabetes Develop.jpeg

Insulin resistance is the cause of both prediabetes and type 2 diabetes. OkK, so what is the cause of insulin resistance? Insulin resistance is now accepted to be closely associated with the accumulation of fat within our muscle cells. This fat toxicity inside of our muscles is a major factor in the cause of insulin resistance and type 2 diabetes, as it interferes with the action of insulin. I've explored how fat makes our muscles insulin resistant (see What Causes Insulin Resistance?), how that fat can come from the fat we eat or the fat we wear (see The Spillover Effect Links Obesity to Diabetes), and how not all fats are the same (see Lipotoxicity: How Saturated Fat Raises Blood Sugar). It's the type of fat found predominantly in animal fats, relative to plant fats, that appears to be especially deleterious with respect to fat-induced insulin insensitivity. But this insulin resistance in our muscles starts years before diabetes is diagnosed.

In my video, Diabetes as a Disease of Fat Toxicity, you can see that insulin resistance starts over a decade before diabetes is actually diagnosed, as blood sugar levels slowly start creeping up. And then, all of the sudden, the pancreas conks out, and blood sugars skyrocket. What could underlie this relatively rapid failure of insulin secretion?

At first, the pancreas pumps out more and more insulin, trying to overcome the fat-induced insulin resistance in the muscles, and high insulin levels can lead to the accumulation of fat in the liver, called fatty liver disease. Before diagnosis of type 2 diabetes, there is a long silent scream from the liver. As fat builds up in our liver, it also becomes resistant to insulin.

Normally, the liver is constantly producing blood sugar to keep our brain alive between meals. As soon as we eat breakfast, though, the insulin released to deal with the meal normally turns off liver glucose production, which makes sense since we don't need it anymore. But when our liver is filled with fat, it becomes insulin resistant like our muscles, and doesn't respond to the breakfast signal; it keeps pumping out blood sugar all day long on top of whatever we eat. Then the pancreas pumps out even more insulin to deal with the high sugars, and our liver gets fatter and fatter. That's one of the twin vicious cycles of diabetes. Fatty muscles, in the context of too many calories, leads to a fatty liver, which leads to an even fattier liver. This is all still before we have diabetes.

Fatty liver can be deadly. The liver starts trying to offload the fat by dumping it back into the bloodstream in the form of something called VLDL, and that starts building up in the cells in the pancreas that produce the insulin in the first place. Now we know how diabetes develops: fatty muscles lead to a fatty liver, which leads to a fatty pancreas. It is now clear that type 2 diabetes is a condition of excess fat inside our organs, whether we're obese or not.

The only thing that was keeping us from diabetes-unchecked skyrocketing blood sugars-is that the pancreas was working overtime pumping out extra insulin to overcome insulin resistance. But as the so-called islet or Beta cells in the pancreas are killed off by the fatty buildup, insulin production starts to fail, and we're left with the worst of both worlds: insulin resistance combined with a failing pancreas. Unable to then overcome the resistance, blood sugar levels go up and up, and boom: type 2 diabetes.

This has implications for cancer as well. Obesity leads to insulin resistance and our blood sugars start to go up, so our pancreas starts pumping out more insulin to try to force more sugar into our muscles, and eventually the fat spills over into the pancreas, killing off the insulin-producing cells. Then we develop diabetes, in which case we may have to start injecting insulin at high levels to overcome the insulin-resistance, and these high insulin levels promote cancer. That's one of the reasons we think obese women get more breast cancer. It all traces back to fat getting into our muscle cells, causing insulin resistance: fat from our stomach (obesity) or fat going into our stomach (saturated fats in our diet).

Now it should make sense why the American Diabetes Association recommends reduced intake of dietary fat as a strategy for reducing the risk for developing diabetes.


The reason I'm going into all this detail is that I'm hoping to empower both those suffering from the disease and those treating sufferers so as to better understand dietary interventions to prevent and treat the epidemic.

Here are some videos on prevention:

And here are some on treatment:

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: Nephron. This image has been modified.

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10 Trouble-Free Techniques to Cut Calories

How to Make Your Calories Count Without Counting Calories

No matter how we approach weight loss, all methods ultimately require the creation of a caloric deficit for results. Nowadays, with the onslaught of food and fitness trackers, calorie apps, step counters, etc., there are myriad ways to calculate and postulate how much energy is coming in and about how much may be going out. Despite these calculations and disciplined approaches to monitoring progress, there are several simple ways to effectively decrease calories consumed without much of an effort; habits you can change in your day to day practice which can support your goals and help you succeed.

Since you can’t out-exercise your diet and what you eat is unquestionably the primary factor in weight loss, here are 10 ways to reduce your intake significantly enough to make a difference:

  1. Hold off on eating the first meal of the day for as long as possible.

    There are no verified rules about how many meals per day are ideal or that eating breakfast helps “jumpstart your metabolism” for the day. Remember that the human body is adapted to survive periods without food (beyond just dinner through breakfast the following morning) and that skipping meals does not, in fact, “slow down” your metabolism. Time without food being digested and absorbed is precious for the body, as it offers energy for the body to repair, recover, and rejuvenate. Unless you are really, really lean, your body has enough fat storage to metabolize for energy in between meals. Pushing off breakfast as long as possible is the perfect way to offer your body rest and an opportunity to start nibbling away at your fat stores. This is why the concept and practice of intermittent fasting has taken off recently in the news. Drink water, sparkling water, black coffee, or any of the infinite varieties of teas without any added sweeteners or creamers. It will keep you satisfied as you stave off hunger until your body is really ready to eat.

  2. Drink tea or coffee straight up.

    Speaking of tea and coffee… If you do enjoy these beverages (as millions or billions of people do around the world), they fit perfectly into a healthy diet for most people. (Of course, if you have cardiac arrhythmias, high blood pressure, reflux, are pregnant, or other specific conditions, this is something to ask your physician about.) And, as I mentioned above, they can keep you going in the morning as you delay your first meal of the day. The only way people get into trouble is by dousing these calorie-free, phytonutrient-containing beverages with addictive sweeteners and calorie-dense creamers. These beverages offer the perfect vehicle for excess sugars, fats, and calories. My favorite Starbucks venti green tea soy latte, for example, contains a whopping 320 calories, 9 grams of fat (6 of which are saturated), and 43 grams of sugar (!). Hence, these are best enjoyed as special occasion treats. I am not going to pretend there is no adjustment necessary when transitioning to clear tea or black coffee, but you can indeed adapt with time (see tip #9). If you have ever made an attempt to lower your salt intake, switch from whole milk to skim milk, or switched from sugar to artificial sweeteners, you have experienced this process. This helps in the morning, when you are avoiding kicking in the digestive process with calories but, if you account for the calories during the day, when you are in fact eating (during the feeding window), you can enjoy tea or coffee with an unsweetened plant milk (or even foamed…a la latte or cappuccino style).

  3. caloriesEat only when foods like a crunchy stalk of celery or crisp apple sound satisfying. 

    The longer you go without food, the better everything seems. Anyone who has gone on a “diet” can attest to this experience…where everything sounds delicious and you can easily end up reading through recipe books for masochistic distraction (well, perhaps that is something only I used to do). Often, most people eat for emotion, stress, convenience, or opportunity. Doing so easily contributes to weight gain. Further, many people experience toxic hunger, a hypoglycemic feeling that may include shakiness, headaches, fatigue, cramps, etc. This is usually due to an unhealthy diet and is a sign that you may need to reevaluate your overall intake. (Again, please see your physician if you are experiencing these symptoms before jumping to conclusions.) True hunger is something that is felt in the throat region and the best test of this is pontificating upon whether eating a crunchy stalk of celery, a crisp apple, or any simple food that may not normally tempt you will actually satisfy you. At that point, eat a healthy, whole food, plant-based meal, including any infinite combination of vegetables, fruits, whole grains, legumes, nuts, seeds, herbs, and spices.

  4. Cook more.

    Eating out is a convenient way to enjoy a delicious meal without spending the time necessary to prepare food at home. And dining at restaurants can indeed fit into a health-promoting lifestyle when done conscientiously and infrequently. However, it is unquestionably more challenging to find food at restaurants that is truly free of ingredients you need to avoid for weight loss and for your health. Oils, salts, sugars, and flours are added in far greater quantities than would be in your own kitchen and calories are almost guaranteed to exceed your goals. Additionally, it is far too alluring to overeat when you are surrounded by access, excess, and hyperpalatable options. On the other side of this is the fact that most of us are busy. Very busy. And cooking is not the first thing you may be eager to do after a long day of work, kids, school, etc. This is compounded by the fact that many people do not feel cozy in the kitchen. I know I didn’t. And it was overwhelming to have to create healthy delicious dishes…particularly once I had kids. But cooking is a priority. Learning just a few dishes can mean massive control over your weight and your long-term health. The trick is to keep it simple. You can go all out and take the amazing Rouxbe Online Professional Plant-Based Cooking School to gain mastery over your kitchen. You can use shortcuts and order plant-based meal kits from places like Chef’d. But, you can also learn some very simple tips and tricks by following some healthy recipes. Here is a collection of some of my favorite recipes and here are all of my favorite cookbooks (and other resources). Batch cooking items like a large pot of rice or other whole grains, soups, stews, and chilis helps because they last several days in the fridge and you can freeze them and defrost as needed for up to a year. Keeping precut vegetables, hummus, tofu/tempeh, and  in the refrigerator; and frozen vegetables, fruits, and whole grains in the freezer; as well as canned beans, jarred marinara sauces and salsas, and whole grains in the pantry; and potatoes, squash, avocados, and fresh fruits on the countertop will enable you to make quick and easy meals with hardly any effort. Some examples of super easy, satisfying, and light dishes include: baked potatoes with salsa and canned beans; frozen stir-fry vegetables sautéed in water or vegetable broth over brown rice; or beans with precut veggies, salsa, and avocado in a bowl or in a whole grain tortilla. In fact, it doesn’t get any easier than these 50 whole food plant-based recipes with 5 ingredients or less.  You will save hundreds or thousands of calories each day that you prepare your meals at home. Keep it simple for sustainable results.

  5. caloriesPrioritize vegetables and fruits.

    Everyone, from the American Institute for Cancer Research to the USDA, agrees that at least half of your plate should come from fruits and vegetables. Forget “5 a day,” new research supports aiming for at least 10 daily servings. Not only do fruits and vegetables provide unparalleled health benefits, but they play a pivotal role in weight loss with their very low calorie density and high satiety factor. Prioritize these food groups every single day to maximize weight loss and help reduce your risk for chronic disease. Aim to eat a huge salad with everything you enjoy mixed in, which could include leafy greens, steamed or roasted vegetables, shredded veggies, slaw, artichoke hearts, potatoes, corn, fresh herbs, beans, lentils, tofu, tempeh, hummus, sun dried tomatoes, onions, sautéed mushrooms, avocado, fruit, cooked whole grains, leftovers from yesterday, etc., etc. Essentially, there is no limit to the creative combinations possible. Here are 40 fun recipes to inspire you. And topping it off with a delicious dressing or sauce, like one of these healthy options, helps you enjoy salads and vegetables even more. Include cooked vegetables, especially leafy greens, each day, using them as a bed to lay the rest of your meal upon or plate them on the side. Whipping up a batch of soup, stew, or chili to enjoy throughout the week is the ultimate fast food. Here are 30 delicious recipes you can try. Experiment with new items to build your repertoire and have fun with them. While eating fruit may be easier for many people to consume, vegetables can be sexy and super delicious as they take center stage on your plate.

  6. caloriesMinimize or eliminate oils. All oils.

    One of the easiest ways to cut out hundreds – or even thousands – of calories each week is to simply cut down on oils. All oils (yes, even olive oil and coconut oil) are 100 percent pure fat, containing 120 calories and 14 grams of fat. One cup of oil contains more than 2000 calories…an entire day’s worth for most people! And just think of how easy it is to drizzle a half cup of oil over a salad, or in the pan to sauté, or to dunk your bread in at a restaurant. Boom. 1000 calories added right there. Further, there is zero fiber and many of the nutrients that started in the olive or soybean are extracted out. Fortunately, it is easy to cook without oil. You can sauté with water, vegetable broth, vinegar, or other liquid; use beans, silken tofu, nuts, or seeds to whip up a creamy dressing; and bake with mashed banana, applesauce or other fruit purees, silken tofu, or mashed avocado. All of these hundreds of options are oil-free and offer examples on how to modify your cooking. Eating out, however, makes it much more challenging to avoid oil. Ask for foods steamed, grilled, baked, or roasted without oil, and use vinegars, salsa, guacamole, lemon or lime juice, or hot sauce as salad dressing.

  7. Focus on your food and shut down all distractions while you eat.

    We make approximately 200 food choices a day, which matters immensely when you consider the fact that diet is the number one cause of early death and disability in the United States. There are many reasons we overeat, mostly due to social pressures and accessibility. But, practicing mindfulness is an excellent way to help avoid overeating. Shut down the television, close your laptop, and put the phone down (a challenge for many of us) while you sit down to a meal. With an emphasis on the word sit. Instead of noshing while standing, walking, driving, or skateboarding, or even just taking bites here and there throughout the day, try to create rituals when eating a meal. While it doesn’t have to include candlelight and background music (although that is a lovely tone to set anytime you’re in the mood), there is a happy middle ground between getting fancy and getting to the bottom of a tub of popcorn without remembering enjoying it. Try tactics like choosing dishware and utensils you love, plating your meal prettily, and putting utensils down between bites to bring in the zen and help you be present.

  8. Chew.

    Although it sounds so simple and perhaps trivial, chewing is a lost art. From the moment food enters your mouth, a cascade of mechanical and biochemical reactions rev up to start the complex digestive process. While there is a host of psychobiological implications of chewing, an incentive to slow down and chew better includes that it may help reduce hunger and food intake.

  9. caloriesTrain your taste buds away from hyperpalatable food.

    Sugar, oil, salt, more sugar, more oil, more salt… Pick your poison, but let there be no doubt that the food industry has masterminded your palate. Extensive science is at play making certain “you really can’t eat just one,” as the goal is to enhance their products for your eating pleasure. Hooking consumers on products in a similar manner used to make the cigarette industry so successful is a motivation of the food industry. There is sugar, oil, and salt in everything from the obvious chips, cookies, and candies to the less obvious breads, dried fruits, and dressings/sauces. Research has found similar neurological and behavioral responses to these highly processed foods as to substances that cause addiction. While there are biological reasons we fall into the “pleasure trap,” and there are powerful pressures at play that exacerbate that biology, it is indeed possible to break the food seduction. One of the best ways to bypass this system is to recalibrate your taste buds by setting a few weeks aside and committing to eating whole, intact foods without exception. This is simple, but not easy. If you are motivated to make it happen, you can move beyond the challenging first few weeks and feel liberated and empowered from thereon forward.

  10. Stop eating at least three hours before bed.

    Similar to holding off on your first meal of the day, ending your feeding window earlier in the evening enables your body to complete the energy-intensive process of digesting and absorbing food. There appears to be circadian explanations for why it is best to stop eating earlier, but there are also behavioral elements, such as decision fatigue, that come into play. Being tired reduces your ability to resist tempting (usually less-than-ideal) foods, no matter how much willpower you may have. Making this choice can become habitual over time and usually requires some scheduling adjustments.

As you may have noticed, there are no recommendations listed above to count calories or fat grams, to cut out carbs, or to exercise harder. This is because the weight loss industry’s loud messaging simply has not worked. It is time that we shift our focus to foods, behaviors, and social pressures in order to ameliorate the issues so many of us struggle with in terms of achieving and sustaining our ideal body weight.

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