Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

We've learned that exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression (in my video Exercise vs. Drugs for Depression). But how much is that really saying? How effective are antidepressant drugs in the first place?

A recent meta-analysis sparked huge scientific and public controversy by stating that the placebo effect can explain the apparent clinical benefits of antidepressants. But aren't there thousands of clinical trials providing compelling evidence for antidepressant effectiveness? If a meta-analysis compiles together all the best published research, how could it say they don't work much better than sugar pills?

The key word is "published."

What if a drug company decided only to publish studies that showed a positive effect, but quietly shelved and concealed any studies showing the drug didn't work? If you didn't know any better, you'd look at the published medical literature and think "Wow, this drug is great." And what if all the drug companies did that? To find out if this was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.

According to the published literature, the results of nearly all the trials of antidepressants were positive, meaning they worked. In contrast, FDA analysis of the trial data showed only roughly half of the trials had positive results. In other words, about half the studies showed the drugs didn't work. Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill. Not publishing negative results undermines evidence-based medicine and puts millions of patients at risk for using ineffective or unsafe drugs, and this was the case with these antidepressant drugs.

These revelations hit first in 2008. Prozac, Serzone, Paxil and Effexor worked, but so did sugar pills, and the difference between the drug and placebo was small. That was 2008. Where were we by 2014? Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect. And what's even worse, Freedom of Information Act documents show the FDA knew about it but made an explicit decision to keep this information from the public and from prescribing physicians.

How could drug companies get away with this?

The pharmaceutical industry is considered the most profitable and politically influential industry in the United States, and mental illness can be thought of as the drug industry's golden goose: incurable, common, long term and involving multiple medications. Antidepressant medications are prescribed to 8.7 percent of the U.S. population. It's a multi-billion dollar market.

To summarize, there is a strong therapeutic response to antidepressant medication; it's just that the response to placebo is almost as strong. Indeed, antidepressants offer substantial benefits to millions of people suffering from depression, and to cast them as ineffective is inaccurate. Just because they may not work better than fake pills doesn't mean they don't work. It's like homeopathy--just because it doesn't work better than the sugar pills, doesn't mean that homeopathy doesn't work. The placebo effect is real and powerful.

In one psychopharmacology journal, a psychiatrist funded by the Prozac company defends the drugs stating, "A key issue is disregarded by the naysaying critics. If the patient is benefiting from antidepressant treatment does it matter whether this is being achieved via drug or placebo effects?"

Of course it matters!

Among the side effects of antidepressants are: sexual dysfunction in up to three quarters of people, long-term weight gain, insomnia, nausea and diarrhea. About one in five show withdrawal symptoms when they try to quit. And perhaps more tragically, the drugs may make people more likely to become depressed in the future. Let me say that again: People are more likely to become depressed after treatment by antidepressants than after treatment by other means - including placebo.

So if doctors are willing to give patients placebo-equivalent treatments, maybe it'd be better for them to just lie to patients and give them actual sugar pills. Yes, that involves deception, but isn't that preferable than deception with a side of side effects? See more on this in my video Do Antidepressant Drugs Really Work?

If different treatments are equally effective, then choice should be based on risk and harm, and of all of the available treatments, antidepressant drugs may be among the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed.

Antidepressants may not work better than placebo for mild and moderate depression, but for very severe depression, the drugs do beat out sugar pills. But that's just a small fraction of the people taking these drugs. That means that the vast majority of depressed patients--as many as nine out of ten--are being prescribed medications that have negligible benefits to them.

Too many doctors quickly decide upon a depression diagnosis without necessarily listening to what the patient has to say and end up putting them on antidepressants without considering alternatives. And fortunately, there are effective alternatives. Physical exercise, for example can have lasting effects, and if that turns out to also be a placebo effect, it is at least a placebo with an enviable list of side effects. Whereas side effects of antidepressants include things like sexual dysfunction and insomnia, side effects of exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone and a longer life.


There are other ways meta-analyses can be misleading. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

More on the ethical challenges facing doctors and whether or not to prescribe sugar pills in The Lie That Heals: Should Doctors Give Placebos?

I've used the Freedom of Information Act myself to get access to behind the scenes industry shenanigans. See, for example, what I found out about the egg industry in Who Says Eggs Aren't Healthy or Safe? and Eggs and Cholesterol: Patently False and Misleading Claims.

This isn't the only case of the medical profession overselling the benefits of drugs. See How Smoking in 1956 is Like Eating in 2016, The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure (though if you're worried about your mood they might make you even more depressed!)

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: GraphicStock. This image has been modified.

Original Link

Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

We've learned that exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression (in my video Exercise vs. Drugs for Depression). But how much is that really saying? How effective are antidepressant drugs in the first place?

A recent meta-analysis sparked huge scientific and public controversy by stating that the placebo effect can explain the apparent clinical benefits of antidepressants. But aren't there thousands of clinical trials providing compelling evidence for antidepressant effectiveness? If a meta-analysis compiles together all the best published research, how could it say they don't work much better than sugar pills?

The key word is "published."

What if a drug company decided only to publish studies that showed a positive effect, but quietly shelved and concealed any studies showing the drug didn't work? If you didn't know any better, you'd look at the published medical literature and think "Wow, this drug is great." And what if all the drug companies did that? To find out if this was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.

According to the published literature, the results of nearly all the trials of antidepressants were positive, meaning they worked. In contrast, FDA analysis of the trial data showed only roughly half of the trials had positive results. In other words, about half the studies showed the drugs didn't work. Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill. Not publishing negative results undermines evidence-based medicine and puts millions of patients at risk for using ineffective or unsafe drugs, and this was the case with these antidepressant drugs.

These revelations hit first in 2008. Prozac, Serzone, Paxil and Effexor worked, but so did sugar pills, and the difference between the drug and placebo was small. That was 2008. Where were we by 2014? Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect. And what's even worse, Freedom of Information Act documents show the FDA knew about it but made an explicit decision to keep this information from the public and from prescribing physicians.

How could drug companies get away with this?

The pharmaceutical industry is considered the most profitable and politically influential industry in the United States, and mental illness can be thought of as the drug industry's golden goose: incurable, common, long term and involving multiple medications. Antidepressant medications are prescribed to 8.7 percent of the U.S. population. It's a multi-billion dollar market.

To summarize, there is a strong therapeutic response to antidepressant medication; it's just that the response to placebo is almost as strong. Indeed, antidepressants offer substantial benefits to millions of people suffering from depression, and to cast them as ineffective is inaccurate. Just because they may not work better than fake pills doesn't mean they don't work. It's like homeopathy--just because it doesn't work better than the sugar pills, doesn't mean that homeopathy doesn't work. The placebo effect is real and powerful.

In one psychopharmacology journal, a psychiatrist funded by the Prozac company defends the drugs stating, "A key issue is disregarded by the naysaying critics. If the patient is benefiting from antidepressant treatment does it matter whether this is being achieved via drug or placebo effects?"

Of course it matters!

Among the side effects of antidepressants are: sexual dysfunction in up to three quarters of people, long-term weight gain, insomnia, nausea and diarrhea. About one in five show withdrawal symptoms when they try to quit. And perhaps more tragically, the drugs may make people more likely to become depressed in the future. Let me say that again: People are more likely to become depressed after treatment by antidepressants than after treatment by other means - including placebo.

So if doctors are willing to give patients placebo-equivalent treatments, maybe it'd be better for them to just lie to patients and give them actual sugar pills. Yes, that involves deception, but isn't that preferable than deception with a side of side effects? See more on this in my video Do Antidepressant Drugs Really Work?

If different treatments are equally effective, then choice should be based on risk and harm, and of all of the available treatments, antidepressant drugs may be among the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed.

Antidepressants may not work better than placebo for mild and moderate depression, but for very severe depression, the drugs do beat out sugar pills. But that's just a small fraction of the people taking these drugs. That means that the vast majority of depressed patients--as many as nine out of ten--are being prescribed medications that have negligible benefits to them.

Too many doctors quickly decide upon a depression diagnosis without necessarily listening to what the patient has to say and end up putting them on antidepressants without considering alternatives. And fortunately, there are effective alternatives. Physical exercise, for example can have lasting effects, and if that turns out to also be a placebo effect, it is at least a placebo with an enviable list of side effects. Whereas side effects of antidepressants include things like sexual dysfunction and insomnia, side effects of exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone and a longer life.


There are other ways meta-analyses can be misleading. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

More on the ethical challenges facing doctors and whether or not to prescribe sugar pills in The Lie That Heals: Should Doctors Give Placebos?

I've used the Freedom of Information Act myself to get access to behind the scenes industry shenanigans. See, for example, what I found out about the egg industry in Who Says Eggs Aren't Healthy or Safe? and Eggs and Cholesterol: Patently False and Misleading Claims.

This isn't the only case of the medical profession overselling the benefits of drugs. See How Smoking in 1956 is Like Eating in 2016, The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure (though if you're worried about your mood they might make you even more depressed!)

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: GraphicStock. This image has been modified.

Original Link

Exercise as a Treatment for Depression

 Exercise vs. Drugs for Depression.jpg

We've known for decades that even a single bout of exercise can elevate our mood, but could it be enough to be used as a treatment for major depression?

We've known that physical activity has been associated with decreased symptoms of depression. For example, if you look at a cross-section of 8,000 people across the country, those that exercised regularly were less likely to have a major depression diagnosis. That's just a snapshot in time, though. In that study, the researcher openly acknowledges this may be a case of reverse causation. Maybe exercise didn't cut down on depression, maybe depression cut down on exercise. The reason depression may be associated with low physical activity is that people may feel too lousy to get out of bed. What we've needed was an interventional study where you take people who are already depressed and randomize them into an exercise intervention.

That is what researchers from Duke University Medical Center did. They randomized men and women over age 50 with major depression to two groups: one who did an aerobic exercise program for four months and another that took an antidepressant drug called Zoloft. In my video Exercise vs. Drugs for Depression you can see a graph of their changes. Before exercise, their Hamilton Depression scores were up around 18 (anything over seven is considered depressed). Within four months, the drug group came down to normal, which are exactly what the drugs are supposed to do. What about the exercise-only group, though? Exercise had the same powerful effect.

The researchers concluded that an exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons, given that they've shown that a group program of aerobic exercise is a feasible and effective treatment for depression, at least for older people.

Not so fast, though.

A "group program?" They had the exercise group folks come in three times a week for a group class. Maybe the only reason the exercise group got better is because they were forced to get out of bed and interact with people--maybe it was the social stimulation and had nothing to do with the actual exercise? Before you could definitively say that exercise can work as well as drugs, what we would need to see is the same study, but with an additional group who exercised alone with no extra social interaction. And those same Duke researchers did just that,

They created the largest exercise trial of patients with major depression conducted to date, and not just including older folks, but other adults as well with three different treatment groups this time: a home exercise group in addition to the supervised group exercise and the drug group as before.

And they all worked about just as well in terms of forcing the depression into remission. So we can say with confidence that exercise is comparable to antidepressant medication in the treatment of patients with major depressive disorder.

Putting all the best studies together, researchers indicate that exercise at least has a moderate antidepressant effect, and at best, exercise has a large effect on reductions in depression symptoms and could be categorized as a very useful and powerful intervention. Unfortunately, while studies support the use of exercise as a treatment for depression, exercise is rarely prescribed as a treatment for this common and debilitating problem.

Exercise may compare favorably to antidepressant medications as a first-line treatment for mild to moderate depression, but how much is that really saying? How effective are antidepressant drugs in the first place? Check out my video Do Antidepressant Drugs Really Work?

For dietary interventions that may improve mood, see:

Exercise can also help with ADHD (Treating ADHD Without Stimulants) and improve immunity (Preserving Immune Function in Athletes With Nutritional Yeast), not to mention extend our lives (Longer Life Within Walking Distance). But what we eat matters: Paleo Diets May Negate Benefits of Exercise.

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

Exercise as a Treatment for Depression

 Exercise vs. Drugs for Depression.jpg

We've known for decades that even a single bout of exercise can elevate our mood, but could it be enough to be used as a treatment for major depression?

We've known that physical activity has been associated with decreased symptoms of depression. For example, if you look at a cross-section of 8,000 people across the country, those that exercised regularly were less likely to have a major depression diagnosis. That's just a snapshot in time, though. In that study, the researcher openly acknowledges this may be a case of reverse causation. Maybe exercise didn't cut down on depression, maybe depression cut down on exercise. The reason depression may be associated with low physical activity is that people may feel too lousy to get out of bed. What we've needed was an interventional study where you take people who are already depressed and randomize them into an exercise intervention.

That is what researchers from Duke University Medical Center did. They randomized men and women over age 50 with major depression to two groups: one who did an aerobic exercise program for four months and another that took an antidepressant drug called Zoloft. In my video Exercise vs. Drugs for Depression you can see a graph of their changes. Before exercise, their Hamilton Depression scores were up around 18 (anything over seven is considered depressed). Within four months, the drug group came down to normal, which are exactly what the drugs are supposed to do. What about the exercise-only group, though? Exercise had the same powerful effect.

The researchers concluded that an exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons, given that they've shown that a group program of aerobic exercise is a feasible and effective treatment for depression, at least for older people.

Not so fast, though.

A "group program?" They had the exercise group folks come in three times a week for a group class. Maybe the only reason the exercise group got better is because they were forced to get out of bed and interact with people--maybe it was the social stimulation and had nothing to do with the actual exercise? Before you could definitively say that exercise can work as well as drugs, what we would need to see is the same study, but with an additional group who exercised alone with no extra social interaction. And those same Duke researchers did just that,

They created the largest exercise trial of patients with major depression conducted to date, and not just including older folks, but other adults as well with three different treatment groups this time: a home exercise group in addition to the supervised group exercise and the drug group as before.

And they all worked about just as well in terms of forcing the depression into remission. So we can say with confidence that exercise is comparable to antidepressant medication in the treatment of patients with major depressive disorder.

Putting all the best studies together, researchers indicate that exercise at least has a moderate antidepressant effect, and at best, exercise has a large effect on reductions in depression symptoms and could be categorized as a very useful and powerful intervention. Unfortunately, while studies support the use of exercise as a treatment for depression, exercise is rarely prescribed as a treatment for this common and debilitating problem.

Exercise may compare favorably to antidepressant medications as a first-line treatment for mild to moderate depression, but how much is that really saying? How effective are antidepressant drugs in the first place? Check out my video Do Antidepressant Drugs Really Work?

For dietary interventions that may improve mood, see:

Exercise can also help with ADHD (Treating ADHD Without Stimulants) and improve immunity (Preserving Immune Function in Athletes With Nutritional Yeast), not to mention extend our lives (Longer Life Within Walking Distance). But what we eat matters: Paleo Diets May Negate Benefits of Exercise.

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

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

Ciguatera Poisoning & Chronic Fatigue Syndrome

NF-Sept22 Ciguatera Poisoning & Chronic Fatigue Syndrome.jpeg

Ciguatera is one of the most common forms of food poisoning, which occurs after the consumption of fish contaminated with neurotoxins produced by certain microalgae that build up the food chain. Just a few bites can be sufficient to induce the condition. Disturbingly, affected fish looks, smells, and tastes normal, and ciguatoxins are resistant to all forms of cooking. So, there is no straightforward method to predict whether a seafood meal can turn into a ciguatera nightmare.

It literally can cause nightmares; about one in six may experience signs of hallucinatory poisoning: lack of coordination, hallucinations, depression, and nightmares. Most suffer some kind of neurological symptoms such as tingling, numbness, and a burning cold sensation. Sometimes a reversal of temperature sensation occurs, where cold objects feel hot and vice versa. For instance, ciguatera sufferers have reported that a refreshing dive in the ocean actually caused burning pain, or that drinking cool beer felt like too hot coffee.

The toxin may also be apparently sexually transmitted, or as one of my favorite public health bloggers put it, "when hot sex turns cold and painful, blame it on dinner."

As seen in my video Ciguatera Poisoning & Chronic Fatigue Syndrome, the symptoms can persist for months or even years. Ongoing research has shown that people with chronic fatigue syndrome may actually be suffering the long-term effects of this fish food poisoning or a condition called polymyositis, which causes diffuse muscle aches, pains, and inflammation. Some individuals intoxicated by fish consumption 25 years previously experience a recurrence of the main neurological disturbances during periods of overwork, fatigue, or stress. You can still find the toxins stuck in your body decades later.

Recent outbreaks in New York City have drawn attention to the problem. For example, a man ate grouper at a Manhattan restaurant and went from swimming two miles a day to having difficulty walking that lasted for months. But these aren't just rare anecdotes. Ciguatera fish poisoning affects an estimated 15,000 Americans every year, causing hundreds of hospitalizations and even a few deaths. Because the toxins are colorless, odorless, tasteless, and not destroyed by cooking, CDC scientists suggest "education aimed at the prevention of seafood intoxication by avoidance of high-risk fish altogether."

The AMA put out a similar advisory, suggesting that the only way to prevent it is to avoid eating fish like red snapper or grouper, but the problem is that a third of fish sold in the United States is mislabeled, so we don't know what we're getting. Some suggest first feeding a portion of the fish meal to a cat, treating them like a court tester, and if they're okay six hours later, we can dig in -- but this was considered inhumane. But if it's inhumane to feed it to your cat, how is it not inhumane to feed it to other members of the family?

Many more are killed by more conventional food poisoning bugs (Chicken Salmonella Thanks to Meat Industry Lawsuit), but how scary that you can get these toxins stuck in you and ruin your life? Reminds me of my Amnesic Seafood Poisoning video.

Other neurotoxin videos include Preventing Parkinson's Disease With Diet and Essential Tremor and Diet.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Image Credit: Pen Waggener / Flickr

Original Link

Side-Effects of Aspartame on the Brain

NF-Sept1 Aspartame and the Brain.jpeg

The National Institutes of Health AARP study of hundreds of thousands of Americans followed for years found that frequent consumption of sweetened beverages, especially diet drinks, may increase depression risk among older adults. Whether soda, fruit-flavored drinks, or iced tea, those artificially sweetened drinks appeared to carry higher risk. There was a benefit in coffee drinkers compared to non-drinkers, but if they added sugar, much of the benefits appeared to disappear, and if they added Equal or Sweet-and-Low, the risk appeared to go up.

Various effects of artificial sweeteners, including neurological effects, have been suspected. For example, aspartame--the chemical in Equal and Nutrasweet--may modulate brain neurotransmitters such as dopamine and serotonin, although data have been controversial and inconsistent. Scientific opinions range from "safe under all conditions" to "unsafe at any dose." The controversy started in the 80's soon after aspartame was approved. Researchers at the Mass College of Pharmacy and MIT noted:

"given the very large number of Americans routinely exposed, if only 1% of the 100,000,000 Americans thought to consume aspartame ever exceed the sweetener's acceptable daily intake, and if only 1% of this group happen coincidentally to have an underlying disease that makes their brains vulnerable to the effects, then the number of people who might manifest adverse brain reactions attributable to aspartame could still be about 10,000, a number on the same order as the number of brain and nerve-related consumer complaints already registered with the FDA before they stopped accepting further reports on adverse reactions to the sweetener."

Those with a history of depression might be especially vulnerable. Researchers at Case Western designed a study I highlighted in my video Aspartame and the Brain to ascertain whether individuals with mood disorders are particularly vulnerable to adverse effects of aspartame. Although they had planned on recruiting 40 patients with depression and 40 controls, the project was halted early by the Institutional Review Board for safety reasons because of the severity of reactions to aspartame within the group of patients with a history of depression.

It was decided that it was unethical to continue to expose people to the stuff.

Normally when we study a drug or a food, the company donates the product to the researchers because they're proud of the benefits or safety of their product. But the Nutrasweet company refused to even sell it to these researchers. The researchers managed to get their hands on some, and within a week there were significantly more adverse effects reported in the aspartame group than in the placebo group. They concluded that individuals with mood disorders may be particularly sensitive to aspartame, and therefore its use in this population should be discouraged.

In a review of the direct and indirect cellular effects of aspartame on the brain, it was noted that there are reports of aspartame causing neurological and behavioral disturbances in sensitive individuals, such as headaches, insomnia and seizures. The researchers go even further and propose that excessive aspartame ingestion might be involved in the development of certain mental disorders and also in compromised learning and emotional functioning. They conclude that "due to all the adverse effects caused by aspartame, it is suggested that serious further testing and research be undertaken to eliminate any and all controversies," to which someone responded in the journal that "there really is no controversy," arguing that aspartame was conclusively toxic.

But what do they mean by excessive ingestion? The latest study on the neuro-behavioral effects of aspartame consumption put people on a high aspartame diet compared to a low aspartame diet. But even the high dose at 25 mg/kg was only half the adequate daily intake set by the FDA. The FDA says one can safely consume 50mg a day, but after just eight days on half of that, participants had more irritable mood, exhibited more depression, and performed worse on certain brain function tests. And these weren't people with a pre-existing history of mental illness; these were just regular people. The researchers concluded that "given that the higher intake level tested here was well below the maximum acceptable daily intake level [40mg in Europe, 50mg here] careful consideration is warranted when consuming food products that may affect neurobehavioral health."

Easier said than done, since it's found in more than 6,000 foods, apparently making artificial sweeteners "impossible to completely eradicate from daily exposure." While that may be true for the great majority of Americans, it's only because they elect to eat processed foods. If we stick to whole foods, we don't even have to read the ingredients lists, because the healthiest foods in the supermarket are label-free, they don't even have ingredients lists--produce!

I've previously touched on artificial sweeteners before:

The healthiest caloric sweeteners are blackstrap molasses and date sugar (whole dried powdered dates). The least toxic low-calorie sweetener is probably erythritol (Erythritol May Be a Sweet Antioxidant).

Coffee may decrease suicide and cancer risk (Preventing Liver Cancer with Coffee? and Coffee and Cancer) but may impair blood flow to the heart (Coffee and Artery Function).

Other ways to improve mood include:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

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Preventing Alzheimer’s with Lifestyle Changes

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It's safe to say that Alzheimer's disease research is in a "state of crisis." For the past two decades, over 73,000 research articles have been published, averaging 100 papers per day, yet little clinical progress has been made. The reason a cure may be impossible is because lost cognitive functions in Alzheimer's disease patients are due to fatally damaged neuronal networks, and dead nerve cells cannot be brought back to life. Consequently, replacement with new brain cells--even if it were technically possible, cannot be done without creating a new personal identity. One may live, but is it really a cure if their personality is lost forever?

Developing drugs that try to clear out the plaques from advanced degenerated brain tissue therefore makes about as much sense as bulldozing tombstones from graveyards in an attempt to raise the dead. Even if drug companies figured out how to further disease progression, many Alzheimer's victims might not choose to live without being able to recognize family, friends, or themselves in a mirror.

Thus, prevention of Alzheimer's seems to be the key. Alzheimer's disease, like heart attacks or strokes, need to be prevented by controlling vascular risk factors like high blood pressure and cholesterol, controlling what's called "chronic brain hypoperfusion," the lack of adequate blood flow to the brain over the years before the onset of Alzheimer's disease. This means a healthy diet, physical exercise and mental exercise.

In the video, Preventing Alzheimer's Disease with Lifestyle Changes, you can see a visual of the potential number of Alzheimer's cases that could be prevented every year in the United States if we could just reduce diabetes rates 10 percent or 25 percent, since diabetes is a risk factor for Alzheimer's. And so is high blood pressure, depression, not exercising your body, smoking, and not exercising your brain. Altogether, a small reduction in all of these risk factors could potentially prevent hundreds of thousands of devastated families.

If modifiable factors such as diet were found conclusively to modulate the risk of Alzheimer's disease to the degree suggested by this research, then we would all indeed rejoice at the implications.

My mom's mom died of Alzheimer's. It is worth preventing at all costs.

Up to half of Alzheimer's cases may be attributable to just those seven risk factors, and that's not even including diet, because there were so many dietary factors that they couldn't fit them into their model. What role does diet play? That's the subject of my video, Preventing Alzheimer's Disease with Diet.

So far these are some of the videos I've done on dementia prevention and treatment:

In health,
Michael Greger, M.D.

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

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Can Turmeric Help with Alzheimer’s?

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The spice turmeric may help prevent Alzheimer's disease (See Preventing Alzheimer's with Turmeric), but what about treating Alzheimer's disease with turmeric? An exciting case series was published in 2012 (highlighted in my video, Treating Alzheimer's with Turmeric): three Alzheimer's patients were treated with turmeric, and their symptoms improved.

In case number one, an 83-year-old woman started losing her memory and feeling disoriented. She started having problems taking care of herself, wandering aimlessly and became incontinent. After taking a teaspoon of turmeric per day however, her agitation, apathy, anxiety and irritability were relieved and she had less accidents. Furthermore, she began to laugh again, sing again, and knit again. After taking turmeric for more than a year, she came to recognize her family and now lives a peaceful life without a significant behavioral or psychological symptom of dementia.

Case number two was similar, but with the additional symptoms of hallucinations, delusions and depression, which were relieved by turmeric. She began to recognize her family again and now lives in a peacefully serene manner. And the third case, similar as well, included an improvement in cognition.

Researchers concluded that this was the first demonstration of turmeric as an effective and safe "drug" for the treatment of the behavioral and psychological symptoms of dementia in Alzheimer's patients. They call it a drug, but it's just a spice you can walk into any grocery store and buy for a few bucks. They were giving people like a teaspoon a day, which comes out to be about 15 cents.

Two trials using curcumin supplements rather than turmeric, however, failed to show a benefit. Curcumin is just one of hundreds of phytochemicals found in turmeric. Concentrated into pill form at up to 40 times the dose, no evidence of efficacy was found. Why didn't they get the same dramatic results we saw in the three case reports? Well, those three cases may have been total flukes, but on the other hand, turmeric, the whole food, may be greater than the sum of its parts.

There is a long list of compounds that have been isolated from turmeric, and it's possible that each component plays a distinct role in making it useful against Alzheimer's disease. Hence, researchers suggested that a mixture of compounds might better represent turmeric in its medicinal value better than curcumin alone. But why concoct some artificial mixture when Mother Nature already did it for us with turmeric? Because you can't patent the spice. And if you can't patent it, how are you going to charge more than 15 cents?

I've previously addressed the thorny issue of patenting natural plant remedies in my video: Plants as Intellectual Property - Patently Wrong?

The whole-greater-than-the-sum-of-its-parts theme is one that comes up over and over:

What else might the cheap, easily available spice turmeric do? It may help fight arthritis (Turmeric Curcumin and Rheumatoid Arthritis and Turmeric Curcumin and Osteoarthritis) and cancer:

But it's not for everyone: Who Shouldn't Consume Curcumin or Turmeric?

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 Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Steven Jackson / Flickr

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