Benefits of Nuts for Stroke Prevention

PREDIMED - Does Eating Nuts Prevent Strokes.jpg

In the PREDIMED study, from the Spanish "PREvencio ́n con DIeta MEDiterranea," a whopping 7,447 patients were randomized into three groups. These were folks at high risk for a heart attack, about half were obese, diabetic and most had high blood pressure and high cholesterol, but they had not yet had their first heart attack or stroke. A third were told to eat a Mediterranean diet and given a free quart of extra virgin olive oil every week. The second group were told to eat a Mediterranean diet and given a half pound of free nuts every week, and the last third were told to follow the American Heart Association guidelines and reduce their fat intake. No portion control or exercise advice was given, and they were followed for about five years. The results were published in the New England Journal of Medicine.

The first thing you do when you look at a diet intervention trial is see what the groups actually ended up eating, which can be very different from what they were told to eat. For example, the so-called low-fat group started out at 39 percent of calories from fat, and ended up getting 37 percent of calories from fat, which is high fat even compared to the Standard American Diet which comes in at 33 percent, something the researchers plainly acknowledged. In fact, the control group didn't change much at all over the years, so can be thought of as the what-if-you-don't-do-anything group, which is still an important control group to have. Though the two Mediterranean diet groups didn't get much more Mediterranean. You can see the charts in my video PREDIMED: Does Eating Nuts Prevent Strokes?

The two Mediterranean groups were told to eat more fruits and vegetables, for example, and less meat and dairy, but didn't accomplish any of those compared to control. The biggest changes recorded were, not surprisingly, in the consumption of the freebies. The group that got a free jug of extra-virgin olive oil delivered to their home every week really did start increasing their consumption, in part by replacing some of the refined olive oil they had been using. And those that got a half pound of free nuts sent to them every week for four years straight did start eating more nuts.

Basically the researchers designed a study to test two different Mediterranean diets versus a low fat diet, but ended up studying something very different. In essence, they studied what happens when thousands of people switch from consuming about three tablespoons of olive oil a day (half virgin) to four tablespoons of all virgin, compared to thousands of people who all the sudden go from eating about a half an ounce of nuts a day to a whole ounce, compared to thousands of people who don't make much of a change at all. It may not have been what they were hoping for, but these are important research questions in and of themselves.

With no significant differences in meat and dairy intake, there were no significant differences in saturated fat or cholesterol intake, so no surprise there was no significant differences in their blood cholesterol levels, and so no difference in their subsequent number of heart attacks. In the five or so years the study ran, there were 37 heart attacks in the olive oil group, 31 in the nut group and 38 in the neither group. No significant difference. Same with dying from a heart attack or stroke or from any cause--but, those in the olive oil and especially the nut group had significantly fewer strokes. All three groups were eating stroke-promoting diets; some people in all three groups had strokes after eating these diets for years, and so ideally we'd choose diets that can stop or reverse the disease process, but the diet with added extra virgin olive oil caused about a third fewer strokes, and adding nuts seemed to cut their stroke risk nearly in half. If this worked as well in the general population, in the U.S. alone that would mean preventing 89,000 strokes a year. That's would be like ten strokes an hour around the clock prevented simply by adding half an ounce of nuts to one's daily diet.

Here are some of my previous videos on the Mediterranean diet:

The PREDIMED study got a bad rap because of how it was reported, but it's an extraordinary trial that continues to churn out useful results.

More on nuts in:

But what about nuts and weight gain? See Nuts and Obesity: The Weight of Evidence .

For videos on olive oil, see Extra Virgin Olive Oil vs. Nuts and Olive Oil & Artery Function.

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

Benefits of Nuts for Stroke Prevention

PREDIMED - Does Eating Nuts Prevent Strokes.jpg

In the PREDIMED study, from the Spanish "PREvencio ́n con DIeta MEDiterranea," a whopping 7,447 patients were randomized into three groups. These were folks at high risk for a heart attack, about half were obese, diabetic and most had high blood pressure and high cholesterol, but they had not yet had their first heart attack or stroke. A third were told to eat a Mediterranean diet and given a free quart of extra virgin olive oil every week. The second group were told to eat a Mediterranean diet and given a half pound of free nuts every week, and the last third were told to follow the American Heart Association guidelines and reduce their fat intake. No portion control or exercise advice was given, and they were followed for about five years. The results were published in the New England Journal of Medicine.

The first thing you do when you look at a diet intervention trial is see what the groups actually ended up eating, which can be very different from what they were told to eat. For example, the so-called low-fat group started out at 39 percent of calories from fat, and ended up getting 37 percent of calories from fat, which is high fat even compared to the Standard American Diet which comes in at 33 percent, something the researchers plainly acknowledged. In fact, the control group didn't change much at all over the years, so can be thought of as the what-if-you-don't-do-anything group, which is still an important control group to have. Though the two Mediterranean diet groups didn't get much more Mediterranean. You can see the charts in my video PREDIMED: Does Eating Nuts Prevent Strokes?

The two Mediterranean groups were told to eat more fruits and vegetables, for example, and less meat and dairy, but didn't accomplish any of those compared to control. The biggest changes recorded were, not surprisingly, in the consumption of the freebies. The group that got a free jug of extra-virgin olive oil delivered to their home every week really did start increasing their consumption, in part by replacing some of the refined olive oil they had been using. And those that got a half pound of free nuts sent to them every week for four years straight did start eating more nuts.

Basically the researchers designed a study to test two different Mediterranean diets versus a low fat diet, but ended up studying something very different. In essence, they studied what happens when thousands of people switch from consuming about three tablespoons of olive oil a day (half virgin) to four tablespoons of all virgin, compared to thousands of people who all the sudden go from eating about a half an ounce of nuts a day to a whole ounce, compared to thousands of people who don't make much of a change at all. It may not have been what they were hoping for, but these are important research questions in and of themselves.

With no significant differences in meat and dairy intake, there were no significant differences in saturated fat or cholesterol intake, so no surprise there was no significant differences in their blood cholesterol levels, and so no difference in their subsequent number of heart attacks. In the five or so years the study ran, there were 37 heart attacks in the olive oil group, 31 in the nut group and 38 in the neither group. No significant difference. Same with dying from a heart attack or stroke or from any cause--but, those in the olive oil and especially the nut group had significantly fewer strokes. All three groups were eating stroke-promoting diets; some people in all three groups had strokes after eating these diets for years, and so ideally we'd choose diets that can stop or reverse the disease process, but the diet with added extra virgin olive oil caused about a third fewer strokes, and adding nuts seemed to cut their stroke risk nearly in half. If this worked as well in the general population, in the U.S. alone that would mean preventing 89,000 strokes a year. That's would be like ten strokes an hour around the clock prevented simply by adding half an ounce of nuts to one's daily diet.

Here are some of my previous videos on the Mediterranean diet:

The PREDIMED study got a bad rap because of how it was reported, but it's an extraordinary trial that continues to churn out useful results.

More on nuts in:

But what about nuts and weight gain? See Nuts and Obesity: The Weight of Evidence .

For videos on olive oil, see Extra Virgin Olive Oil vs. Nuts and Olive Oil & Artery Function.

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 Mediterranean Diet or a Whole Food Plant-Based Diet?

The Mediterranean Diet or a Whole Food Plant-Based Diet.jpg

Recent studies have shown that higher Mediterranean diet adherence scores are associated with a significant reduction of the risk of death, heart disease, cancer, and brain disease. The problem with population studies like these is that people who eat healthier may also live healthier, and so how do we know it's their diet? I examine this in The Mediterranean Diet or a Whole Food Plant-Based Diet?.

As the American Heart Association position states, "Before advising people to follow a Mediterranean diet, we need more studies to find out whether the diet itself or other lifestyle factors account for the lower deaths from heart disease." How do you do that? There are ways you can control for obvious things like smoking and exercise--which many of the studies did--but ideally you'd do an interventional trial, the gold standard of nutritional science. You change people's diets while trying to keep everything else the same and see what happens.

We got that kind of trial 20 years ago with the famous Lyon Diet Heart Study where about 600 folks who had just had their first heart attack were randomized into two groups. The control group received no dietary advice, apart whatever their doctors were telling them, while the experimental group was told to eat more of a Mediterranean-type diet, supplemented with a canola-oil based spread to give them the plant-based omega-3's they'd normally be getting from weeds and walnuts if they actually lived on a Greek isle in the 1950's.

The Mediterranean diet group did end up taking some of the dietary advice to heart. They ate more bread, more fruit, less deli meat, less meat in general, and less butter and cream; other than that, no significant changes in diet were reported in terms of wine, olive oil, or fish consumption. So, they ate less saturated fat and cholesterol, more plant-based omega 3's, but didn't have huge dietary changes. Even so, at the end of about four years, 44 individuals from the control group had a second heart attack, either fatal or nonfatal, but only 14 suffered another attack in the group that changed their diet. So they went from having a 4% chance of having a heart attack every year down to 1%.

A cynic might say that while there was less death and disease, the Mediterranean diet continued to feed their heart disease, so much so that 14 of them suffered new heart attacks while on the diet. Yes, their disease progressed a lot less than the regular diet group (about four times less), but what if there was a diet that could stop or reverse heart disease?

Dr. Caldwell Esselstyn and colleagues at the Cleveland Clinic recently published a case series of 198 consecutive patients with cardiovascular disease counseled to switch to a diet composed entirely of whole plant foods. Of the 198, 177 stuck to the diet, whereas the other 21 fell off the wagon, setting up kind of a natural experiment. What happened to the 21? This was such a sick group of patients that more than half suffered from either a fatal heart attack or needed angioplasty or a heart transplant. In that same time period of about four years, of the 177 that stuck to the plant-based diet, only one had a major event as a result of worsening disease. As Dean Ornish noted in his response to the latest trial, "a Mediterranean diet is better than what most people are consuming"...but even better may be a diet based on whole plant foods.

Dr. Esselstyn's was not a randomized trial, so it can't be directly compared to the Lyon study, and it included very determined patients. Not everyone is willing to dramatically change their diets, even if it may literally be a matter of life or death. In which case, rather than doing nothing, eating a more Mediterranean-type diet may cut risk for heart attack survivors by about two-thirds. Cutting 99% of risk would be better if Esselstyn's results were replicated in a controlled trial, but even a 70% drop in risk could save tens of thousands of lives every year.

For more on the Mediterranean diet, check out:

For more on Dr. Esselstyn's amazing work:

If the short-chain plant-based omega-3s in flax seeds and walnuts appear so beneficial, what about the long-chain omega-3's found in fish and fish oil? There are pros and cons. See, for example, Mercury vs. Omega-3s for Brain Development, Is Fish Oil Just Snake Oil?, and Omega-3's and the Eskimo Fish Tale.

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: wildpixel / Thinkstock. This image has been modified.

Original Link

The Mediterranean Diet or a Whole Food Plant-Based Diet?

The Mediterranean Diet or a Whole Food Plant-Based Diet.jpg

Recent studies have shown that higher Mediterranean diet adherence scores are associated with a significant reduction of the risk of death, heart disease, cancer, and brain disease. The problem with population studies like these is that people who eat healthier may also live healthier, and so how do we know it's their diet? I examine this in The Mediterranean Diet or a Whole Food Plant-Based Diet?.

As the American Heart Association position states, "Before advising people to follow a Mediterranean diet, we need more studies to find out whether the diet itself or other lifestyle factors account for the lower deaths from heart disease." How do you do that? There are ways you can control for obvious things like smoking and exercise--which many of the studies did--but ideally you'd do an interventional trial, the gold standard of nutritional science. You change people's diets while trying to keep everything else the same and see what happens.

We got that kind of trial 20 years ago with the famous Lyon Diet Heart Study where about 600 folks who had just had their first heart attack were randomized into two groups. The control group received no dietary advice, apart whatever their doctors were telling them, while the experimental group was told to eat more of a Mediterranean-type diet, supplemented with a canola-oil based spread to give them the plant-based omega-3's they'd normally be getting from weeds and walnuts if they actually lived on a Greek isle in the 1950's.

The Mediterranean diet group did end up taking some of the dietary advice to heart. They ate more bread, more fruit, less deli meat, less meat in general, and less butter and cream; other than that, no significant changes in diet were reported in terms of wine, olive oil, or fish consumption. So, they ate less saturated fat and cholesterol, more plant-based omega 3's, but didn't have huge dietary changes. Even so, at the end of about four years, 44 individuals from the control group had a second heart attack, either fatal or nonfatal, but only 14 suffered another attack in the group that changed their diet. So they went from having a 4% chance of having a heart attack every year down to 1%.

A cynic might say that while there was less death and disease, the Mediterranean diet continued to feed their heart disease, so much so that 14 of them suffered new heart attacks while on the diet. Yes, their disease progressed a lot less than the regular diet group (about four times less), but what if there was a diet that could stop or reverse heart disease?

Dr. Caldwell Esselstyn and colleagues at the Cleveland Clinic recently published a case series of 198 consecutive patients with cardiovascular disease counseled to switch to a diet composed entirely of whole plant foods. Of the 198, 177 stuck to the diet, whereas the other 21 fell off the wagon, setting up kind of a natural experiment. What happened to the 21? This was such a sick group of patients that more than half suffered from either a fatal heart attack or needed angioplasty or a heart transplant. In that same time period of about four years, of the 177 that stuck to the plant-based diet, only one had a major event as a result of worsening disease. As Dean Ornish noted in his response to the latest trial, "a Mediterranean diet is better than what most people are consuming"...but even better may be a diet based on whole plant foods.

Dr. Esselstyn's was not a randomized trial, so it can't be directly compared to the Lyon study, and it included very determined patients. Not everyone is willing to dramatically change their diets, even if it may literally be a matter of life or death. In which case, rather than doing nothing, eating a more Mediterranean-type diet may cut risk for heart attack survivors by about two-thirds. Cutting 99% of risk would be better if Esselstyn's results were replicated in a controlled trial, but even a 70% drop in risk could save tens of thousands of lives every year.

For more on the Mediterranean diet, check out:

For more on Dr. Esselstyn's amazing work:

If the short-chain plant-based omega-3s in flax seeds and walnuts appear so beneficial, what about the long-chain omega-3's found in fish and fish oil? There are pros and cons. See, for example, Mercury vs. Omega-3s for Brain Development, Is Fish Oil Just Snake Oil?, and Omega-3's and the Eskimo Fish Tale.

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: wildpixel / Thinkstock. This image has been modified.

Original Link

What’s the Mediterranean Diet’s Secret?

Why Was Heart Disease Rare in the Mediterranean?.jpg

The Mediterranean Diet is an "in" topic nowadays in both the medical literature and the lay media. As one researcher put it, "Uncritical laudatory coverage is common, but specifics are hard to come by: What is it? Where did it come from? Why is it good? Merits are rarely detailed; possible downsides are never mentioned." So, let's dig in....

After World War II, the government of Greece asked the Rockefeller foundation to come in and assess the situation. Impressed by the low rates of heart disease in the region, nutrition scientist Ancel Keys--after which "K" rations were named--initiated his famous seven countries study. In this study, he found the rate of fatal heart disease on the Greek isle of Crete was 20 times lower than in the United States. They also had the lowest cancer rates and fewest deaths overall. What were they eating? Their diets were more than 90% plant-based, which may explain why coronary heart disease was such a rarity. A rarity, that is, except for a small class of rich people whose diet differed from that of the general population--they ate meat every day instead of every week or two.

So, the heart of the Mediterranean diet is mainly plant-based, and low in meat and dairy, which Keys considered the "major villains in the diet" because of their saturated fat content. Unfortunately, no one is really eating the traditional Mediterranean diet anymore, even in the Mediterranean. The prevalence of coronary heart disease skyrocketed by an order of magnitude within a few decades in Crete, blamed on the increased consumption of meat and cheese at the expense of plant foods.

Everyone is talking about the Mediterranean diet, but few do it properly. People think of pizza or spaghetti with meat sauce, but while "Italian restaurants brag about the healthy measuring in diet, they serve a travesty of it." If no one's really eating this way anymore, how do you study it?

Researchers came up with a variety of Mediterranean diet adherence scoring systems to see if people who are eating more Mediterranean-ish do better. You get maximum points the more plant foods you eat, and effectively you get points deducted by eating just a single serving of meat or dairy a day. So it's no surprise those that eat relatively higher on the scale have a lower risk of heart disease, cancer, and death overall. After all, the Mediterranean diet can be considered to be a "near vegetarian" diet. "As such, it should be expected to produce the well-established health benefits of vegetarian diets." That is, less heart disease, cancer, death, and inflammation; improved arterial function; a lower risk of developing type 2 diabetes; a reduced risk for stroke, depression, and cognitive impairment.

How might it work? I've talked about the elegant studies showing that those who eat plant-based diets have more plant-based compounds, like aspirin, circulating within their systems. Polyphenol phytonutrients in plant foods are associated with a significantly lower risk of dying. Magnesium consumption is also associated with a significantly lower risk of dying, and is found in dark green leafy vegetables, as well as fruits, beans, nuts, soy, and whole grains.

Heme iron, on the other hand--the iron found in blood and muscle--acts as a pro-oxidant and appears to increase the risk of diabetes, whereas plant-based, non-heme iron appears safe. Similarly, with heart disease, animal-based iron was found to significantly increase the risk of coronary heart disease, our number one killer, but not plant-based iron. The Mediterranean diet is protective compared to the Standard American Diet--no question--but any diet rich in whole plant foods and low in animal-fat consumption could be expected to confer protection against many of our leading killers.

Here are some more videos on the Mediterranean Diet:

For more information on heme iron, see Risk Associated With Iron Supplements.

More on magnesium is found in How Do Nuts Prevent Sudden Cardiac Death? and Mineral of the Year--Magnesium.

And more on polyphenols can be seen in videos like How to Slow Brain Aging by Two Years and Juicing Removes More Than Just Fiber.

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: Couleur / Pixabay. This image has been modified.

Original Link

What’s the Mediterranean Diet’s Secret?

Why Was Heart Disease Rare in the Mediterranean?.jpg

The Mediterranean Diet is an "in" topic nowadays in both the medical literature and the lay media. As one researcher put it, "Uncritical laudatory coverage is common, but specifics are hard to come by: What is it? Where did it come from? Why is it good? Merits are rarely detailed; possible downsides are never mentioned." So, let's dig in....

After World War II, the government of Greece asked the Rockefeller foundation to come in and assess the situation. Impressed by the low rates of heart disease in the region, nutrition scientist Ancel Keys--after which "K" rations were named--initiated his famous seven countries study. In this study, he found the rate of fatal heart disease on the Greek isle of Crete was 20 times lower than in the United States. They also had the lowest cancer rates and fewest deaths overall. What were they eating? Their diets were more than 90% plant-based, which may explain why coronary heart disease was such a rarity. A rarity, that is, except for a small class of rich people whose diet differed from that of the general population--they ate meat every day instead of every week or two.

So, the heart of the Mediterranean diet is mainly plant-based, and low in meat and dairy, which Keys considered the "major villains in the diet" because of their saturated fat content. Unfortunately, no one is really eating the traditional Mediterranean diet anymore, even in the Mediterranean. The prevalence of coronary heart disease skyrocketed by an order of magnitude within a few decades in Crete, blamed on the increased consumption of meat and cheese at the expense of plant foods.

Everyone is talking about the Mediterranean diet, but few do it properly. People think of pizza or spaghetti with meat sauce, but while "Italian restaurants brag about the healthy measuring in diet, they serve a travesty of it." If no one's really eating this way anymore, how do you study it?

Researchers came up with a variety of Mediterranean diet adherence scoring systems to see if people who are eating more Mediterranean-ish do better. You get maximum points the more plant foods you eat, and effectively you get points deducted by eating just a single serving of meat or dairy a day. So it's no surprise those that eat relatively higher on the scale have a lower risk of heart disease, cancer, and death overall. After all, the Mediterranean diet can be considered to be a "near vegetarian" diet. "As such, it should be expected to produce the well-established health benefits of vegetarian diets." That is, less heart disease, cancer, death, and inflammation; improved arterial function; a lower risk of developing type 2 diabetes; a reduced risk for stroke, depression, and cognitive impairment.

How might it work? I've talked about the elegant studies showing that those who eat plant-based diets have more plant-based compounds, like aspirin, circulating within their systems. Polyphenol phytonutrients in plant foods are associated with a significantly lower risk of dying. Magnesium consumption is also associated with a significantly lower risk of dying, and is found in dark green leafy vegetables, as well as fruits, beans, nuts, soy, and whole grains.

Heme iron, on the other hand--the iron found in blood and muscle--acts as a pro-oxidant and appears to increase the risk of diabetes, whereas plant-based, non-heme iron appears safe. Similarly, with heart disease, animal-based iron was found to significantly increase the risk of coronary heart disease, our number one killer, but not plant-based iron. The Mediterranean diet is protective compared to the Standard American Diet--no question--but any diet rich in whole plant foods and low in animal-fat consumption could be expected to confer protection against many of our leading killers.

Here are some more videos on the Mediterranean Diet:

For more information on heme iron, see Risk Associated With Iron Supplements.

More on magnesium is found in How Do Nuts Prevent Sudden Cardiac Death? and Mineral of the Year--Magnesium.

And more on polyphenols can be seen in videos like How to Slow Brain Aging by Two Years and Juicing Removes More Than Just Fiber.

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: Couleur / Pixabay. This image has been modified.

Original Link

Improving Employee Diets Could Save Companies Millions

Plant-Based Workplace Intervention.jpg

The food, alcohol, and tobacco industries have been blamed for "manufacturing epidemics" of chronic disease, but they're just trying to sell more product like everyone else. And so if that means distorting science, creating front groups, compromising scientists, blocking public health policies... they're just trying to protect their business.

It's not about customer satisfaction, but shareholder satisfaction. How else could we have tobacco companies, for example, "continuing to produce products that kill one in two of their most loyal customers?"

Civil society organizations concerned with public health have earned a reputation for being "anti-industry," but the issue is not industry, but that sector of industry whose products are harmful to public health. We like the broccoli industry. In fact, the corporate world might end up leading the lifestyle medicine revolution.

As shown in my video, Plant-Based Workplace Intervention, the annual cost attributable to obesity alone among full-time employees is estimated at 70 billion dollars, primarily because obese employees are not as productive on the job. Having healthy employees is good for the bottom-line. Every dollar spent on wellness programs may offer a $3 return on investment. And if you track the market performance of companies that strive to nurture a culture of health, they appear to outperform their competition.

That's why companies like GEICO are exploring workplace dietary interventions (see my video, Slimming the Gecko). The remarkable success at GEICO headquarters led to an expansion of the program at corporate offices across the country, with test sites from San Diego to Macon, Georgia. Given that previous workplace studies have found that workers who ate a lot of animal protein had nearly five times the odds of obesity, whereas those that ate mostly plant protein appeared protected, obese and diabetic employees were asked to follow a plant-based diet of whole grains, vegetables, beans, and fruit while avoiding meat, dairy, and eggs. Compliance wasn't great. Fewer than half really got their animal product consumption down, but there were definitely improvements such as significant reductions in saturated fat, an increase in protective nutrients, and even noted weight loss, lower blood cholesterol levers, and better blood sugar control in diabetics.

And this was with no calorie counting, no portion control, and no exercise component. The weight reduction appears to result from feeling fuller earlier, due to higher dietary fiber intake. The difference in weight loss could also be the result of an increase in the thermic effect of food, allowing a small extra edge for weight loss in the vegan group. Those eating plant-based diets tend to burn off more calories in heat.

Eating plants appears to boost metabolism. This may be due to increased insulin sensitivity in cells, allowing cells to metabolize carbohydrates more quickly rather than storing them as body fat. "As a result, vegan diets have been shown to increase postprandial calorie burn by about 16%, up to three hours after consuming a meal."

Imagine how much money companies that self-insure their employees could save! See, for example:

Find out more on some of the potential downsides of corporate influence in videos like

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: Ryan McGuire / Pixabay. This image has been modified.

Original Link

Improving Employee Diets Could Save Companies Millions

Plant-Based Workplace Intervention.jpg

The food, alcohol, and tobacco industries have been blamed for "manufacturing epidemics" of chronic disease, but they're just trying to sell more product like everyone else. And so if that means distorting science, creating front groups, compromising scientists, blocking public health policies... they're just trying to protect their business.

It's not about customer satisfaction, but shareholder satisfaction. How else could we have tobacco companies, for example, "continuing to produce products that kill one in two of their most loyal customers?"

Civil society organizations concerned with public health have earned a reputation for being "anti-industry," but the issue is not industry, but that sector of industry whose products are harmful to public health. We like the broccoli industry. In fact, the corporate world might end up leading the lifestyle medicine revolution.

As shown in my video, Plant-Based Workplace Intervention, the annual cost attributable to obesity alone among full-time employees is estimated at 70 billion dollars, primarily because obese employees are not as productive on the job. Having healthy employees is good for the bottom-line. Every dollar spent on wellness programs may offer a $3 return on investment. And if you track the market performance of companies that strive to nurture a culture of health, they appear to outperform their competition.

That's why companies like GEICO are exploring workplace dietary interventions (see my video, Slimming the Gecko). The remarkable success at GEICO headquarters led to an expansion of the program at corporate offices across the country, with test sites from San Diego to Macon, Georgia. Given that previous workplace studies have found that workers who ate a lot of animal protein had nearly five times the odds of obesity, whereas those that ate mostly plant protein appeared protected, obese and diabetic employees were asked to follow a plant-based diet of whole grains, vegetables, beans, and fruit while avoiding meat, dairy, and eggs. Compliance wasn't great. Fewer than half really got their animal product consumption down, but there were definitely improvements such as significant reductions in saturated fat, an increase in protective nutrients, and even noted weight loss, lower blood cholesterol levers, and better blood sugar control in diabetics.

And this was with no calorie counting, no portion control, and no exercise component. The weight reduction appears to result from feeling fuller earlier, due to higher dietary fiber intake. The difference in weight loss could also be the result of an increase in the thermic effect of food, allowing a small extra edge for weight loss in the vegan group. Those eating plant-based diets tend to burn off more calories in heat.

Eating plants appears to boost metabolism. This may be due to increased insulin sensitivity in cells, allowing cells to metabolize carbohydrates more quickly rather than storing them as body fat. "As a result, vegan diets have been shown to increase postprandial calorie burn by about 16%, up to three hours after consuming a meal."

Imagine how much money companies that self-insure their employees could save! See, for example:

Find out more on some of the potential downsides of corporate influence in videos like

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: Ryan McGuire / Pixabay. This image has been modified.

Original Link

Lipotoxicity: How Saturated Fat Raises Blood Sugar

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

Image Credit: Andrew Malone / Flickr

Original Link

Lipotoxicity: How Saturated Fat Raises Blood Sugar

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

Image Credit: Andrew Malone / Flickr

Original Link