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

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

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

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

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

High Blood Pressure: Normal but Not Natural

High Blood Pressure - Normal but Not Natural.jpeg

The most comprehensive and systematic analysis of causes of death ever undertaken allows us to answer questions like, how many lives could we save if people cut back on soda? The answer is 299,521. Soft drinks aren't just bad because they're empty calories. More than just not being a health-promoting item, soda appears to be an actively death-promoting item. Of course, it's not as deadly as processed meats such as bacon, bologna, ham, or hot dogs, which account for about 800,000 deaths every year--killing twice as many women as domestic violence and five times more people than all illegal drugs combined.

On the other hand, eating more whole grains could save 1.7 million lives. And more vegetables could save 1.8 million lives every year. If only we ate more nuts and seeds, we'd save 2 and a half million lives. But fruit is apparently what the world needs most (they didn't look at beans) with 4.9 million lives hanging in the balance every year. The cure is not drugs or vaccines; the cure is fruit. The #1 dietary risk factor for death in the world may be not eating enough fruit.

One reason why plant-based diets can save so many millions is because the #1 killer risk factor in the world is high blood pressure, laying to waste nine million people year after year. In the United States, high blood pressure affects nearly 78 million--that's one in three of us. As we age our pressures get higher and higher, such that by age 60, it strikes more than half of that population. If it affects most of us when we get older, maybe it's less a disease and more just a natural, inevitable consequence of getting older?

No.

We've known for nearly a century that high blood pressure need never occur. Researchers measured the blood pressure of a thousand people in rural Kenya. Up until age 40, the blood pressures of rural Africans were about the same as Europeans and Americans, down around 120's over 80's, but as Westerners age, our pressures creep up such that by age 60 the average person is hypertensive, exceeding 140 over 90. But the pressures of those in rural Africa improved with age; not only did they not develop hypertension, their blood pressures actually got better.

The 140/90 cut-off is arbitrary. Just like studies that show the lower our cholesterol the better--there's really no safe level above about 150--blood pressure studies also support a "lower the better" approach. Even people who start out with blood pressure under 120/80 appear to benefit from blood pressure reduction. The ideal blood pressure, the no-benefit-from-reducing-it-further blood pressure, appears to be 110/70. Is it possible to get blood pressures under 110 over 70? It's not just possible, it can be normal for those eating healthy enough diets (see How Not to Die from High Blood Pressure).

Over two years at a rural Kenyan hospital, 1,800 patients were admitted. How many cases of high blood pressure were found? Zero. Wow. They must have had low rates of heart disease. Actually, they had no rates of heart disease. Not low risk--no risk. Not a single case of arteriosclerosis was found.

Having a "normal" blood pressure may set you up for dying from "normal" causes such as heart attacks and strokes. For more on this concept, see When Low Risk Means High Risk. It's like having a normal cholesterol level (see Optimal Cholesterol Level).

It seems high blood pressure is a choice. Like cavities: Cavities and Coronaries: Our Choice.

Even end-stage malignant hypertension can be reversed with diet (thereby demonstrating it was the diet and not other lifestyle factors that protected traditional plant-based populations). See Kempner Rice Diet: Whipping Us Into Shape.

Flax seeds, hibiscus tea, whole grains, and nitrate-rich vegetables may offer additional protection:

Why not just take the drugs? See The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure. And be sure to check out my summary video, How Not to Die from High Blood Pressure, as well as The Evidence that Salt Raises Blood Pressure.

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

High Blood Pressure: Normal but Not Natural

High Blood Pressure - Normal but Not Natural.jpeg

The most comprehensive and systematic analysis of causes of death ever undertaken allows us to answer questions like, how many lives could we save if people cut back on soda? The answer is 299,521. Soft drinks aren't just bad because they're empty calories. More than just not being a health-promoting item, soda appears to be an actively death-promoting item. Of course, it's not as deadly as processed meats such as bacon, bologna, ham, or hot dogs, which account for about 800,000 deaths every year--killing twice as many women as domestic violence and five times more people than all illegal drugs combined.

On the other hand, eating more whole grains could save 1.7 million lives. And more vegetables could save 1.8 million lives every year. If only we ate more nuts and seeds, we'd save 2 and a half million lives. But fruit is apparently what the world needs most (they didn't look at beans) with 4.9 million lives hanging in the balance every year. The cure is not drugs or vaccines; the cure is fruit. The #1 dietary risk factor for death in the world may be not eating enough fruit.

One reason why plant-based diets can save so many millions is because the #1 killer risk factor in the world is high blood pressure, laying to waste nine million people year after year. In the United States, high blood pressure affects nearly 78 million--that's one in three of us. As we age our pressures get higher and higher, such that by age 60, it strikes more than half of that population. If it affects most of us when we get older, maybe it's less a disease and more just a natural, inevitable consequence of getting older?

No.

We've known for nearly a century that high blood pressure need never occur. Researchers measured the blood pressure of a thousand people in rural Kenya. Up until age 40, the blood pressures of rural Africans were about the same as Europeans and Americans, down around 120's over 80's, but as Westerners age, our pressures creep up such that by age 60 the average person is hypertensive, exceeding 140 over 90. But the pressures of those in rural Africa improved with age; not only did they not develop hypertension, their blood pressures actually got better.

The 140/90 cut-off is arbitrary. Just like studies that show the lower our cholesterol the better--there's really no safe level above about 150--blood pressure studies also support a "lower the better" approach. Even people who start out with blood pressure under 120/80 appear to benefit from blood pressure reduction. The ideal blood pressure, the no-benefit-from-reducing-it-further blood pressure, appears to be 110/70. Is it possible to get blood pressures under 110 over 70? It's not just possible, it can be normal for those eating healthy enough diets (see How Not to Die from High Blood Pressure).

Over two years at a rural Kenyan hospital, 1,800 patients were admitted. How many cases of high blood pressure were found? Zero. Wow. They must have had low rates of heart disease. Actually, they had no rates of heart disease. Not low risk--no risk. Not a single case of arteriosclerosis was found.

Having a "normal" blood pressure may set you up for dying from "normal" causes such as heart attacks and strokes. For more on this concept, see When Low Risk Means High Risk. It's like having a normal cholesterol level (see Optimal Cholesterol Level).

It seems high blood pressure is a choice. Like cavities: Cavities and Coronaries: Our Choice.

Even end-stage malignant hypertension can be reversed with diet (thereby demonstrating it was the diet and not other lifestyle factors that protected traditional plant-based populations). See Kempner Rice Diet: Whipping Us Into Shape.

Flax seeds, hibiscus tea, whole grains, and nitrate-rich vegetables may offer additional protection:

Why not just take the drugs? See The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure. And be sure to check out my summary video, How Not to Die from High Blood Pressure, as well as The Evidence that Salt Raises Blood Pressure.

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 to Prevent a Heart Attack

How to Prevent a Heart Attack.jpeg

In my video Arterial Acne, I described atherosclerotic plaques as inflamed pockets of pus. Our coronary arteries start out healthy, but then the saturated fat, trans fat, and cholesterol in the standard American diet increases the cholesterol in our blood, which accumulates in the artery wall. This triggers an inflammatory response. This so-called fatty streak can then grow into an atherosclerotic plaque, which has the potential to rupture into our artery. If that happens, a blood clot forms, shutting off blood flow to a part of our heart, which can then die off and ultimately kill us.

What causes that final step, the rupture of the plaque? Ten years ago, researchers at Michigan State proposed a mechanism. They noted that when you look at ruptured plaques from autopsies of people who died from heart attacks, they were filled with cholesterol crystals protruding out from the plaque. So, the researchers wondered if maybe all that cholesterol in the plaque gets so supersaturated that it reaches a point where it crystallizes like sugar water forming rock candy. The growing crystals may then burst the plaque open.

To test out this theory they first made a supersaturated solution of cholesterol in a test tube to see if it expanded when it crystallized, and indeed it did-just like how water expands when it crystallizes into ice. In my video Cholesterol Crystals May Tear Through Our Artery Lining, you can see a massive cholesterol crystal shooting out the top of a test tube. Under a microscope, the tips of the cholesterol crystals were sharp jagged needles.

The researchers tried placing a thin membrane over the top of the test tube to see if the cholesterol needles would poke through, and indeed the sharp tips of the cholesterol crystals cut through the membrane. This suggested that the crystallization of supersaturated cholesterol in atherosclerotic plaques could indeed induce the rupture that kills us.

A test tube is one thing, but can you actually see crystals poking out in autopsy specimens? Yes, cholesterol crystals piercing the arterial plaque were found in patients who died with heart attacks, with extensive protrusions of cholesterol crystals into the middle of the artery.

What makes us think it was the crystals that actually burst the plaque? All those studied who died of acute heart attacks had perforating cholesterol crystals sticking out of their plaques, but no crystals were found perforating the arteries of people who had severe atherosclerosis, but died first of other, non-cardiac causes.

This can explain why dramatically lowering cholesterol levels with diet (and drugs, if necessary) can reduce the risk of fatal heart attack, by pulling cholesterol out of the artery wall, and decreasing the risk of crystallizing these cholesterol needles that may pop your plaque.

Given the powerful visuals, my Cholesterol Crystals May Tear Through Our Artery Lining video might be a good one to share with those in your life with heart disease, in hopes that they might reconsider eating artery-clogging diets.

Blocking the First Step of Heart Disease involves keeping our LDL cholesterol low by decreasing our intake of Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. Swapping red meat for white won't do it: Switching From Beef to Chicken and Fish May Not Lower Cholesterol

Does it matter if LDL cholesterol in our blood is small and dense or large and fluffy? See my video Does Cholesterol Size Matter?

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

The Five Most Important Dietary Tweaks

The Five Most Important Dietary Tweaks.jpeg

Generally, adherence to healthy lifestyle patterns has decreased during the last 18 years. Obesity is up, exercise is down, and the number of people eating just five servings of fruits and veggies a day dropped like a rock. And we didn't start out that great to begin with.

Only 3% of Americans at the turn of the 21st century had the following four healthy lifestyle characteristics: not smoking, not overweight, five daily servings of fruits and vegetables, and exercising a half hour a day at least five days a week. Whether people were wealthy or college-educated didn't matter; no sub-group even remotely met clinical or public health recommendations.

Where are people falling down the most? You can see in my video What Percent of Americans Lead Healthy Lifestyles?. If you look at heart disease risk factors, for example, most people don't smoke and about half are exercising. But if we look at the healthy diet score-which is based on things like drinking less than four cups of soda a week-a scale of zero to five, only about 1% of Americans score a four or five. The American Heart Association's aggressive 2020 target to improve that by 20% would bring us up to 1.2%.

Since we've known for decades that advanced coronary artery disease may be present by age 20--with atherosclerosis often even present in young children--it is particularly disturbing that healthy lifestyle choices are declining rather than improving in the U.S.

In terms of life expectancy, the U.S. is down around 27 or 28 out of the 34 OECD free-market democracies. The people of Slovenia live a year longer than citizens of the United States. Why? According to the most rigorous analysis of risk factors ever published, the number one cause of death and disability in the United States is our diet.

It's the food.

According to the Global Burden of Disease study, the worst five things about our diet are: we don't eat enough fruit, we don't eat enough nuts and seeds, we eat too much salt, too much processed meat, and not enough vegetables.

Studies that have looked at diet quality and chronic disease mortality risk found that those scoring higher (e.g. more whole plant foods), reduced the risk of dying prematurely from heart disease, cancer, and all causes of death combined. There is now an overwhelming body of clinical and epidemiological evidence illustrating the dramatic impact of a healthy lifestyle on reducing all-cause mortality and preventing chronic diseases such as coronary heart disease, stroke, diabetes, and cancer.

Why do we eat so poorly? Aren't we scared of dying from these horrible chronic diseases? It's almost as if we're eating as though our future didn't matter. And there's actually data to back that up, from a study entitled Death Row Nutrition.

The growing macabre fascination with speculating about one's ''last meal'' offers a window into one's true consumption desires when one's value of the future is discounted close to zero. In contrast to pop culture anecdotes, a group of Cornell researchers created a catalog of actual last meals-the final food requests of 247 individuals executed in the United States during a recent five-year period. Meat was the most common request. The researchers go out of their way to note that tofu never made the list, and no one asked for a vegetarian meal. In fact, if you compare the last meals to what Americans normally eat, there's not much difference.

If we continue to eat as though they were our last meals, eventually, they will be.


A few years ago I did a video called Nation's Diet in Crisis. It's sad that it doesn't seem like much has changed. How Many Meet the Simple Seven? is another video in which you can see how your own habits stack up.

For more on fruits and veggies and living longer, see Fruits and Longevity: How Many Minutes per Mouthful? Surprised that nuts made the longevity list? See Nuts May Help Prevent Death. What about legumes? See Increased Lifespan from Beans.

The reason public health professionals are so keen on measuring lifestyle characteristics is because modest improvements may have extraordinary effects. See, for example:

Didn't know the beginnings of heart disease may already be present in children? See my video Heart Disease Starts in Childhood. Think that's tragic? Check out Heart Disease May Start in the Womb. Is it too late if we've been eating poorly most of our lives? It's Never Too Late to Start Eating Healthier.

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 to Prevent a Heart Attack

How to Prevent a Heart Attack.jpeg

In my video Arterial Acne, I described atherosclerotic plaques as inflamed pockets of pus. Our coronary arteries start out healthy, but then the saturated fat, trans fat, and cholesterol in the standard American diet increases the cholesterol in our blood, which accumulates in the artery wall. This triggers an inflammatory response. This so-called fatty streak can then grow into an atherosclerotic plaque, which has the potential to rupture into our artery. If that happens, a blood clot forms, shutting off blood flow to a part of our heart, which can then die off and ultimately kill us.

What causes that final step, the rupture of the plaque? Ten years ago, researchers at Michigan State proposed a mechanism. They noted that when you look at ruptured plaques from autopsies of people who died from heart attacks, they were filled with cholesterol crystals protruding out from the plaque. So, the researchers wondered if maybe all that cholesterol in the plaque gets so supersaturated that it reaches a point where it crystallizes like sugar water forming rock candy. The growing crystals may then burst the plaque open.

To test out this theory they first made a supersaturated solution of cholesterol in a test tube to see if it expanded when it crystallized, and indeed it did-just like how water expands when it crystallizes into ice. In my video Cholesterol Crystals May Tear Through Our Artery Lining, you can see a massive cholesterol crystal shooting out the top of a test tube. Under a microscope, the tips of the cholesterol crystals were sharp jagged needles.

The researchers tried placing a thin membrane over the top of the test tube to see if the cholesterol needles would poke through, and indeed the sharp tips of the cholesterol crystals cut through the membrane. This suggested that the crystallization of supersaturated cholesterol in atherosclerotic plaques could indeed induce the rupture that kills us.

A test tube is one thing, but can you actually see crystals poking out in autopsy specimens? Yes, cholesterol crystals piercing the arterial plaque were found in patients who died with heart attacks, with extensive protrusions of cholesterol crystals into the middle of the artery.

What makes us think it was the crystals that actually burst the plaque? All those studied who died of acute heart attacks had perforating cholesterol crystals sticking out of their plaques, but no crystals were found perforating the arteries of people who had severe atherosclerosis, but died first of other, non-cardiac causes.

This can explain why dramatically lowering cholesterol levels with diet (and drugs, if necessary) can reduce the risk of fatal heart attack, by pulling cholesterol out of the artery wall, and decreasing the risk of crystallizing these cholesterol needles that may pop your plaque.

Given the powerful visuals, my Cholesterol Crystals May Tear Through Our Artery Lining video might be a good one to share with those in your life with heart disease, in hopes that they might reconsider eating artery-clogging diets.

Blocking the First Step of Heart Disease involves keeping our LDL cholesterol low by decreasing our intake of Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. Swapping red meat for white won't do it: Switching From Beef to Chicken and Fish May Not Lower Cholesterol

Does it matter if LDL cholesterol in our blood is small and dense or large and fluffy? See my video Does Cholesterol Size Matter?

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.

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The Five Most Important Dietary Tweaks

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Generally, adherence to healthy lifestyle patterns has decreased during the last 18 years. Obesity is up, exercise is down, and the number of people eating just five servings of fruits and veggies a day dropped like a rock. And we didn't start out that great to begin with.

Only 3% of Americans at the turn of the 21st century had the following four healthy lifestyle characteristics: not smoking, not overweight, five daily servings of fruits and vegetables, and exercising a half hour a day at least five days a week. Whether people were wealthy or college-educated didn't matter; no sub-group even remotely met clinical or public health recommendations.

Where are people falling down the most? You can see in my video What Percent of Americans Lead Healthy Lifestyles?. If you look at heart disease risk factors, for example, most people don't smoke and about half are exercising. But if we look at the healthy diet score-which is based on things like drinking less than four cups of soda a week-a scale of zero to five, only about 1% of Americans score a four or five. The American Heart Association's aggressive 2020 target to improve that by 20% would bring us up to 1.2%.

Since we've known for decades that advanced coronary artery disease may be present by age 20--with atherosclerosis often even present in young children--it is particularly disturbing that healthy lifestyle choices are declining rather than improving in the U.S.

In terms of life expectancy, the U.S. is down around 27 or 28 out of the 34 OECD free-market democracies. The people of Slovenia live a year longer than citizens of the United States. Why? According to the most rigorous analysis of risk factors ever published, the number one cause of death and disability in the United States is our diet.

It's the food.

According to the Global Burden of Disease study, the worst five things about our diet are: we don't eat enough fruit, we don't eat enough nuts and seeds, we eat too much salt, too much processed meat, and not enough vegetables.

Studies that have looked at diet quality and chronic disease mortality risk found that those scoring higher (e.g. more whole plant foods), reduced the risk of dying prematurely from heart disease, cancer, and all causes of death combined. There is now an overwhelming body of clinical and epidemiological evidence illustrating the dramatic impact of a healthy lifestyle on reducing all-cause mortality and preventing chronic diseases such as coronary heart disease, stroke, diabetes, and cancer.

Why do we eat so poorly? Aren't we scared of dying from these horrible chronic diseases? It's almost as if we're eating as though our future didn't matter. And there's actually data to back that up, from a study entitled Death Row Nutrition.

The growing macabre fascination with speculating about one's ''last meal'' offers a window into one's true consumption desires when one's value of the future is discounted close to zero. In contrast to pop culture anecdotes, a group of Cornell researchers created a catalog of actual last meals-the final food requests of 247 individuals executed in the United States during a recent five-year period. Meat was the most common request. The researchers go out of their way to note that tofu never made the list, and no one asked for a vegetarian meal. In fact, if you compare the last meals to what Americans normally eat, there's not much difference.

If we continue to eat as though they were our last meals, eventually, they will be.


A few years ago I did a video called Nation's Diet in Crisis. It's sad that it doesn't seem like much has changed. How Many Meet the Simple Seven? is another video in which you can see how your own habits stack up.

For more on fruits and veggies and living longer, see Fruits and Longevity: How Many Minutes per Mouthful? Surprised that nuts made the longevity list? See Nuts May Help Prevent Death. What about legumes? See Increased Lifespan from Beans.

The reason public health professionals are so keen on measuring lifestyle characteristics is because modest improvements may have extraordinary effects. See, for example:

Didn't know the beginnings of heart disease may already be present in children? See my video Heart Disease Starts in Childhood. Think that's tragic? Check out Heart Disease May Start in the Womb. Is it too late if we've been eating poorly most of our lives? It's Never Too Late to Start Eating Healthier.

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.

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How Much Fiber Should You Eat Every Day?

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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.

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