Choosing to Have a Normal Blood Pressure

Oct 5 Blood Pressure copy.jpeg

For the first 90% of our evolution, humans ate diets containing less than a quarter teaspoon of salt a day. Why? Because we ate mostly plants. Since we went millions of years without salt shakers, our bodies evolved into salt-conserving machines, which served us well until we discovered salt could be used to preserve foods. Without refrigeration, this was a big boon to human civilization. Of course, this may have led to a general rise in blood pressure, but does that matter if the alternative is starving to death since all your food rotted away? But where does that leave us now, when we no longer have to live off pickles and jerky? We are genetically programmed to eat ten times less salt than we do now. Even many "low"-salt diets can be considered high-salt diets. That's why it's critical to understand what the concept of "normal" is when it comes to salt.

As I discuss in my video High Blood Pressure May Be a Choice, having a "normal" salt intake can lead to a "normal" blood pressure, which can help us to die from all the "normal" causes, like heart attacks and strokes.

Doctors used to be taught that a "normal" systolic blood pressure (the top number) is approximately 100 plus age. Babies start out with a blood pressure around 95 over 60, but then as we age that 95 can go to 120 by our 20s, then 140 in our 40s, and keep climbing as we age. (140 is the official cut-off above which one technically has high blood pressure.) That was considered normal, since everyone's blood pressure creeps up as we get older. And if that's normal, then heart attacks and strokes are normal too, since risk starts rising once we start getting above the 100 we had as a baby.

If blood pressures over 100 are associated with disease, maybe they should be considered abnormal. Were these elevated blood pressures caused by our abnormally high salt intake--ten times more than what our bodies were designed to handle? Maybe if we ate a natural amount of salt, our blood pressures would not go up with age and we'd be protected. Of course, to test that theory you'd have to find a population in modern times that doesn't use salt, eat processed food, or go out to eat. For that, you'd have to go deep into the Amazon rainforest.

Meet the Yanomamo people, a no-salt culture with the lowest salt intake ever reported. That is, they have a totally normal-for-our-species salt intake. So, what happens to their blood pressure on a no- or low-salt diet as they age? They start out with a blood pressure of about 100 over 60 and end up with a blood pressure of about 100 over 60. Though theirs is described as a salt-deficient diet, that's like saying they have a diet deficient in Twinkies. They're the ones, it seems, who are eating truly normal salt intakes, which leads to truly normal blood pressures. Those in their 50s have the blood pressure of a 20-year-old. What was the percentage of the population tested with high blood pressure? Zero. However, elsewhere in Brazil, up to 38% of the population may be affected. The Yanomamos probably represent the ultimate human example of the importance of salt on blood pressure.

Of course, there could have been other factors. They didn't drink alcohol, ate a high-fiber and plant-based diet, got lots of exercise, and had no obesity. There are a number of plant-based populations eating little salt who experience no rise of blood pressure with age, but how do we know what exactly is to blame? Ideally, we'd do an interventional trial. Imagine if we took people literally dying from out-of-control high blood pressure (so called malignant hypertension) where you go blind from bleeding into your eyes, your kidneys shut down, and your heart fails, and then we withhold from these patients blood pressure medications so their fate is certain death. Then, what if we put them on a Yanomamo level of salt intake--that is, a normal-for-the-human-species salt intake--and, if instead of dying, they walked away cured of their hypertension? That would pretty much seal the deal.

Enter Dr. Walter Kempner and his rice and fruit diet. Patients started with blood pressures of 210 over 140, which dropped down to 80 over 60. Amazing stuff, but how could he ethically withhold all modern blood pressure medications and treat with diet alone? This was back in the 1940s, and the drugs hadn't been invented yet.

His diet wasn't just extremely low salt, though; it was also strictly plant-based and extremely low in fat, protein, and calories. There is no doubt that Kempner's rice diet achieved remarkable results, and Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure can often be lowered by a low enough salt diet.

Forty years ago, it was acknowledged that the evidence is very good, if not conclusive, that a low enough reduction of salt in the diet would result in the prevention of essential hypertension (the rising of blood pressure as we age) and its disappearance as a major public health problem. It looks like we knew how to stop this four decades ago. During this time, how many people have died? Today, high blood pressure may kill 400,000 Americans every year--causing a thousand unnecessary deaths every day.


I have a whole series of videos on salt, including Sprinkling Doubt: Taking Sodium Skeptics with a Pinch of Salt, The Evidence That Salt Raises Blood Pressure, Shaking the Salt Habit and Sodium & Autoimmune Disease: Rubbing Salt in the Wound.

Canned foods are infamous for their sodium content, but there are no-salt varieties. Learn more with my video Canned Beans or Cooked Beans?. Cutting down on sodium is one of the ways we could be Improving on the Mediterranean Diet. Beyond heart health, reducing salt intake could also help our kidneys (How to Treat Kidney Stones with Diet) but if you cut down on salt, won't everything taste like cardboard? See Changing Our Taste Buds.

For more on hypertension, see How to Prevent High Blood Pressure with Diet, How to Treat High Blood Pressure with Diet, and How Not to Die from High Blood Pressure. What if you already eat healthfully and still can't get your pressures down? Try adding hibiscus tea (Hibiscus Tea vs. Plant-Based Diets for Hypertension) and ground flaxseeds (Flax Seeds for Hypertension) to your diet, and, of course, make sure you're exercising regularly (Longer Life Within Walking Distance).

Dr. Kempner and his rice diet are so fascinating they warrant an entire video series. Check out Kempner Rice Diet: Whipping Us Into Shape, Drugs and the Demise of the Rice Diet, Can Diabetic Retinopathy Be Reversed?, and Can Morbid Obesity be Reversed Through 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:

Original Link

Choosing to Have a Normal Blood Pressure

Oct 5 Blood Pressure copy.jpeg

For the first 90% of our evolution, humans ate diets containing less than a quarter teaspoon of salt a day. Why? Because we ate mostly plants. Since we went millions of years without salt shakers, our bodies evolved into salt-conserving machines, which served us well until we discovered salt could be used to preserve foods. Without refrigeration, this was a big boon to human civilization. Of course, this may have led to a general rise in blood pressure, but does that matter if the alternative is starving to death since all your food rotted away? But where does that leave us now, when we no longer have to live off pickles and jerky? We are genetically programmed to eat ten times less salt than we do now. Even many "low"-salt diets can be considered high-salt diets. That's why it's critical to understand what the concept of "normal" is when it comes to salt.

As I discuss in my video High Blood Pressure May Be a Choice, having a "normal" salt intake can lead to a "normal" blood pressure, which can help us to die from all the "normal" causes, like heart attacks and strokes.

Doctors used to be taught that a "normal" systolic blood pressure (the top number) is approximately 100 plus age. Babies start out with a blood pressure around 95 over 60, but then as we age that 95 can go to 120 by our 20s, then 140 in our 40s, and keep climbing as we age. (140 is the official cut-off above which one technically has high blood pressure.) That was considered normal, since everyone's blood pressure creeps up as we get older. And if that's normal, then heart attacks and strokes are normal too, since risk starts rising once we start getting above the 100 we had as a baby.

If blood pressures over 100 are associated with disease, maybe they should be considered abnormal. Were these elevated blood pressures caused by our abnormally high salt intake--ten times more than what our bodies were designed to handle? Maybe if we ate a natural amount of salt, our blood pressures would not go up with age and we'd be protected. Of course, to test that theory you'd have to find a population in modern times that doesn't use salt, eat processed food, or go out to eat. For that, you'd have to go deep into the Amazon rainforest.

Meet the Yanomamo people, a no-salt culture with the lowest salt intake ever reported. That is, they have a totally normal-for-our-species salt intake. So, what happens to their blood pressure on a no- or low-salt diet as they age? They start out with a blood pressure of about 100 over 60 and end up with a blood pressure of about 100 over 60. Though theirs is described as a salt-deficient diet, that's like saying they have a diet deficient in Twinkies. They're the ones, it seems, who are eating truly normal salt intakes, which leads to truly normal blood pressures. Those in their 50s have the blood pressure of a 20-year-old. What was the percentage of the population tested with high blood pressure? Zero. However, elsewhere in Brazil, up to 38% of the population may be affected. The Yanomamos probably represent the ultimate human example of the importance of salt on blood pressure.

Of course, there could have been other factors. They didn't drink alcohol, ate a high-fiber and plant-based diet, got lots of exercise, and had no obesity. There are a number of plant-based populations eating little salt who experience no rise of blood pressure with age, but how do we know what exactly is to blame? Ideally, we'd do an interventional trial. Imagine if we took people literally dying from out-of-control high blood pressure (so called malignant hypertension) where you go blind from bleeding into your eyes, your kidneys shut down, and your heart fails, and then we withhold from these patients blood pressure medications so their fate is certain death. Then, what if we put them on a Yanomamo level of salt intake--that is, a normal-for-the-human-species salt intake--and, if instead of dying, they walked away cured of their hypertension? That would pretty much seal the deal.

Enter Dr. Walter Kempner and his rice and fruit diet. Patients started with blood pressures of 210 over 140, which dropped down to 80 over 60. Amazing stuff, but how could he ethically withhold all modern blood pressure medications and treat with diet alone? This was back in the 1940s, and the drugs hadn't been invented yet.

His diet wasn't just extremely low salt, though; it was also strictly plant-based and extremely low in fat, protein, and calories. There is no doubt that Kempner's rice diet achieved remarkable results, and Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure can often be lowered by a low enough salt diet.

Forty years ago, it was acknowledged that the evidence is very good, if not conclusive, that a low enough reduction of salt in the diet would result in the prevention of essential hypertension (the rising of blood pressure as we age) and its disappearance as a major public health problem. It looks like we knew how to stop this four decades ago. During this time, how many people have died? Today, high blood pressure may kill 400,000 Americans every year--causing a thousand unnecessary deaths every day.


I have a whole series of videos on salt, including Sprinkling Doubt: Taking Sodium Skeptics with a Pinch of Salt, The Evidence That Salt Raises Blood Pressure, Shaking the Salt Habit and Sodium & Autoimmune Disease: Rubbing Salt in the Wound.

Canned foods are infamous for their sodium content, but there are no-salt varieties. Learn more with my video Canned Beans or Cooked Beans?. Cutting down on sodium is one of the ways we could be Improving on the Mediterranean Diet. Beyond heart health, reducing salt intake could also help our kidneys (How to Treat Kidney Stones with Diet) but if you cut down on salt, won't everything taste like cardboard? See Changing Our Taste Buds.

For more on hypertension, see How to Prevent High Blood Pressure with Diet, How to Treat High Blood Pressure with Diet, and How Not to Die from High Blood Pressure. What if you already eat healthfully and still can't get your pressures down? Try adding hibiscus tea (Hibiscus Tea vs. Plant-Based Diets for Hypertension) and ground flaxseeds (Flax Seeds for Hypertension) to your diet, and, of course, make sure you're exercising regularly (Longer Life Within Walking Distance).

Dr. Kempner and his rice diet are so fascinating they warrant an entire video series. Check out Kempner Rice Diet: Whipping Us Into Shape, Drugs and the Demise of the Rice Diet, Can Diabetic Retinopathy Be Reversed?, and Can Morbid Obesity be Reversed Through 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:

Original Link

Brown Fat: Losing Weight Through Thermogenesis

Sept 21 Brown Fat Thermo copy.jpeg

During World War I, it was discovered that many of the chemicals for new explosives had toxic or even lethal effects on the workers in the munitions factories. Chemicals such as di-nitro-phenol (DNP) can boost metabolism so much that workers were too often found wandering along the road after work, covered in sweat with temperatures of 106 to 109 degrees Fahrenheit before they died. Even after death, their temperatures kept going up, as if they were having a total body meltdown. At subacute doses, however, workers claimed to have grown thin to a notable extent after several months working with the chemical.

That got some Stanford pharmacologists excited about the "promising metabolic applications" of DNP. Our resting metabolic rate jumps up 30% after one dose of DNP, and therefore, it becomes an actual fat-burning drug. People started losing weight, as you can see in my video Brown Fat: Losing Weight Through Thermogenesis, with no apparent side effects. They felt great... and then thousands of people started going blind and users started dropping dead from hyperpyrexia, fatal fever due to the heat created by the burning fat. Of course, it continued to be sold. Ad copy read:

"Here, at last, is a [weight] reducing remedy that will bring you a figure men admire and women envy, without danger to your health or change in your regular mode of living....No diet, no exercise!"

It did work, but the therapeutic index--the difference between the effective dose and the deadly dose--was razor thin. It was not until thousands suffered irreversible harm that it got pulled from the market and remained unavailable. Unavailable, that is, until it was brought back by the internet for those dying to be thin.

There is, however, a way our body naturally burns fat to create heat. When we're born, we go from a nice tropical 98.6 in our mother's womb straight to room temperature, just when we're still all wet and slimy. As an adaptive mechanism to maintain warmth, the appearance of a unique organ around 150 million years ago allowed mammals to maintain our high body temperatures.

That unique organ is called brown adipose tissue, or BAT, and its role is to consume fat calories by generating heat in response to cold exposure. The white fat in our bellies stores fat, but the brown fat, located up between our shoulder blades, burns fat. BAT is essential for thermogenesis, the creation of heat in newborns, but has been considered unnecessary in adults who have higher metabolic rates and increased muscle mass for shivering to warm us up when we get chilled. We used to think brown tissue just shrank away when we grew up, but, if it was there, then it could potentially make a big difference for how many calories we burn every day.

When PET scans were invented to detect metabolically active tissues like cancer, oncologists kept finding hot spots in the neck and shoulder regions that on CT scans turned out not to be cancer, just fat. Then, some observant radiologists noticed they appeared in patients mostly during the cold winter months. When they looked closer at tissue samples taken from people who had undergone neck surgery, they found it: brown fat in adults.

The common message from a number of studies is that BAT is present and active in adults, and the more we have and the more active it is, the thinner we are. And we can rapidly activate our fat-burning brown fat by exposure to cold temperatures. For example, if you hang out in a cold room for two hours in your undies and put your legs on a block of ice for four minutes every five minutes, you can elicit a marked increase in energy expenditure, thanks to brown fat activation. So, the studies point to a potential "natural" intervention to stimulate energy expenditure: Turn down the heat to burn calories (and reduce the carbon footprint in the process).

Thankfully, for those of us who would rather not lay our bare legs on blocks of ice, our brown fat can also be activated by some food ingredients such as those that are covered in my Boosting Brown Fat Through Diet video.


I briefly touch on the role cold temperatures can play in weight loss in The Ice Diet and talk more about calories in (Nutrient-Dense Approach to Weight Management) and calories out (How Much Exercise to Sustain Weight Loss).

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:

Original Link

Brown Fat: Losing Weight Through Thermogenesis

Sept 21 Brown Fat Thermo copy.jpeg

During World War I, it was discovered that many of the chemicals for new explosives had toxic or even lethal effects on the workers in the munitions factories. Chemicals such as di-nitro-phenol (DNP) can boost metabolism so much that workers were too often found wandering along the road after work, covered in sweat with temperatures of 106 to 109 degrees Fahrenheit before they died. Even after death, their temperatures kept going up, as if they were having a total body meltdown. At subacute doses, however, workers claimed to have grown thin to a notable extent after several months working with the chemical.

That got some Stanford pharmacologists excited about the "promising metabolic applications" of DNP. Our resting metabolic rate jumps up 30% after one dose of DNP, and therefore, it becomes an actual fat-burning drug. People started losing weight, as you can see in my video Brown Fat: Losing Weight Through Thermogenesis, with no apparent side effects. They felt great... and then thousands of people started going blind and users started dropping dead from hyperpyrexia, fatal fever due to the heat created by the burning fat. Of course, it continued to be sold. Ad copy read:

"Here, at last, is a [weight] reducing remedy that will bring you a figure men admire and women envy, without danger to your health or change in your regular mode of living....No diet, no exercise!"

It did work, but the therapeutic index--the difference between the effective dose and the deadly dose--was razor thin. It was not until thousands suffered irreversible harm that it got pulled from the market and remained unavailable. Unavailable, that is, until it was brought back by the internet for those dying to be thin.

There is, however, a way our body naturally burns fat to create heat. When we're born, we go from a nice tropical 98.6 in our mother's womb straight to room temperature, just when we're still all wet and slimy. As an adaptive mechanism to maintain warmth, the appearance of a unique organ around 150 million years ago allowed mammals to maintain our high body temperatures.

That unique organ is called brown adipose tissue, or BAT, and its role is to consume fat calories by generating heat in response to cold exposure. The white fat in our bellies stores fat, but the brown fat, located up between our shoulder blades, burns fat. BAT is essential for thermogenesis, the creation of heat in newborns, but has been considered unnecessary in adults who have higher metabolic rates and increased muscle mass for shivering to warm us up when we get chilled. We used to think brown tissue just shrank away when we grew up, but, if it was there, then it could potentially make a big difference for how many calories we burn every day.

When PET scans were invented to detect metabolically active tissues like cancer, oncologists kept finding hot spots in the neck and shoulder regions that on CT scans turned out not to be cancer, just fat. Then, some observant radiologists noticed they appeared in patients mostly during the cold winter months. When they looked closer at tissue samples taken from people who had undergone neck surgery, they found it: brown fat in adults.

The common message from a number of studies is that BAT is present and active in adults, and the more we have and the more active it is, the thinner we are. And we can rapidly activate our fat-burning brown fat by exposure to cold temperatures. For example, if you hang out in a cold room for two hours in your undies and put your legs on a block of ice for four minutes every five minutes, you can elicit a marked increase in energy expenditure, thanks to brown fat activation. So, the studies point to a potential "natural" intervention to stimulate energy expenditure: Turn down the heat to burn calories (and reduce the carbon footprint in the process).

Thankfully, for those of us who would rather not lay our bare legs on blocks of ice, our brown fat can also be activated by some food ingredients such as those that are covered in my Boosting Brown Fat Through Diet video.


I briefly touch on the role cold temperatures can play in weight loss in The Ice Diet and talk more about calories in (Nutrient-Dense Approach to Weight Management) and calories out (How Much Exercise to Sustain Weight Loss).

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:

Original Link

Reversing Diabetic Blindness with Diet

Reversing Diabetic Blindness with Diet.jpeg

Though many reported feeling better on Dr. Walter Kempner's rice and fruit diet, he refused to accept such anecdotal evidence as proof of success. He wanted objective measurements. The most famous were his "eyegrounds photographs," taken with a special camera that allowed one to visualize the back of the eye. In doing so, he proved diet can arrest the bleeding, oozing, and swelling you see in the back of the eye in people with severe kidney, hypertensive, or heart disease. Even more than that, he proved that diet could actually reverse it, something never thought possible.

In my video, Can Diabetic Retinopathy Be Reversed?, you can see before and after images of the back of patients' eyes. He found reversal to such a degree that even those who could no longer distinguish large objects were able to once again read fine print. Dr. Kempner had shown a reversal of blindness with diet.

The results were so dramatic that the head of the department of ophthalmology at Duke, where Kempner worked, was questioned as to whether they were somehow faked. He assured them they were not. In fact, he wrote in one person's chart, "This patient's eyegrounds are improved to an unbelievable degree." Not only had he never seen anything like it, he couldn't remember ever seeing a patient with such advanced disease even being alive 15 months later.

The magnitude of the improvements Kempner got--reversal of end-stage heart and kidney failure--was surprising, simply beyond belief. But as Kempner said as his closing sentence of a presentation before the American College of Physicians, "The important result is not that the change in the course of the disease has been achieved by the rice diet but that the course of the disease can be changed."

Now that we have high blood pressure drugs, we see less hypertensive retinopathy, but we still see a lot of diabetic retinopathy, now the leading cause of blindness in American adults. Even with intensive diabetes treatment--at least three insulin injections a day with the best modern technology has to offer--the best we can offer is usually just a slowing of the progression of the disease.

So, in the 21st century, we slow down your blindness. Yet a half century ago, Kempner proved we could reverse it. Kempner started out using his plant-based rice diet ultra-low in sodium, fat, cholesterol, and protein to reverse kidney and heart failure; he actually assumed the diet would make diabetes worse. He expected a 90% carbohydrate diet would increase insulin requirements, however, the opposite proved to be true. He took the next 100 patients with diabetes who walked through his door who went on the rice diet for at least three months and found their fasting blood sugars dropped despite a drop in the insulin they were taking. What really blew people away was this: Forty-four of the patients had diabetic retinopathy, and, in 30% of the cases, their eyes improved. That's not supposed to happen; diabetic retinopathy had been considered "a sign of irreversible destruction." What does this change mean in real life? Patients went from unable to even read headlines to normal vision.

The remarkable success Dr. Kempner had reversing some of the most dreaded complications of diabetes with his rice and fruit diet was not because of weight loss. The improvements occurred even in those patients who did not lose significant weight, so it must have been something specific about the diet. Maybe it was his total elimination of animal protein, animal fat, and cholesterol? Or perhaps it was his radical reduction in sodium, fat, and protein in general? We don't know.

How do we treat diabetic retinopathy these days? With steroids and other drugs injected straight into the eyeball. If that doesn't work, there's always pan-retinal laser photocoagulation, in which laser burns are etched over nearly the entire retina. Surgeons literally burn out the back of your eye. Why would they do that? The theory is that by killing off most of the retina, the little pieces you leave behind may get more blood flow.

When I see that, along with Kempner's work, I can't help but feel like history has been reversed. It seems as though it should have gone like, "Can you believe 50 years ago the best we had was this barbaric, burn-out-your-socket surgery? Thank goodness we've since learned that through dietary means alone, we can reverse the blindness." But instead of learning, medicine seems to have forgotten.

I documented the extraordinary Kempner story previously in Kempner Rice Diet: Whipping Us Into Shape and Drugs and the Demise of the Rice Diet. The reason I keep coming back to this is not to suggest people should go on such a diet (it is too extreme and potentially dangerous to do without strict medical supervision), but to show the power of dietary change to yield tremendous healing effects.

The best way to prevent diabetic blindness is to prevent or reverse diabetes in the first place. See, for example:

Why wouldn't a diet of white rice make diabetes worse? See If White Rice Is Linked to Diabetes, What About China?

For more on the nitty gritty on what is the actual cause of type 2 diabetes, see:

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: Community Eye Health / Flickr. This image has been modified.

Original Link

Reversing Diabetic Blindness with Diet

Reversing Diabetic Blindness with Diet.jpeg

Though many reported feeling better on Dr. Walter Kempner's rice and fruit diet, he refused to accept such anecdotal evidence as proof of success. He wanted objective measurements. The most famous were his "eyegrounds photographs," taken with a special camera that allowed one to visualize the back of the eye. In doing so, he proved diet can arrest the bleeding, oozing, and swelling you see in the back of the eye in people with severe kidney, hypertensive, or heart disease. Even more than that, he proved that diet could actually reverse it, something never thought possible.

In my video, Can Diabetic Retinopathy Be Reversed?, you can see before and after images of the back of patients' eyes. He found reversal to such a degree that even those who could no longer distinguish large objects were able to once again read fine print. Dr. Kempner had shown a reversal of blindness with diet.

The results were so dramatic that the head of the department of ophthalmology at Duke, where Kempner worked, was questioned as to whether they were somehow faked. He assured them they were not. In fact, he wrote in one person's chart, "This patient's eyegrounds are improved to an unbelievable degree." Not only had he never seen anything like it, he couldn't remember ever seeing a patient with such advanced disease even being alive 15 months later.

The magnitude of the improvements Kempner got--reversal of end-stage heart and kidney failure--was surprising, simply beyond belief. But as Kempner said as his closing sentence of a presentation before the American College of Physicians, "The important result is not that the change in the course of the disease has been achieved by the rice diet but that the course of the disease can be changed."

Now that we have high blood pressure drugs, we see less hypertensive retinopathy, but we still see a lot of diabetic retinopathy, now the leading cause of blindness in American adults. Even with intensive diabetes treatment--at least three insulin injections a day with the best modern technology has to offer--the best we can offer is usually just a slowing of the progression of the disease.

So, in the 21st century, we slow down your blindness. Yet a half century ago, Kempner proved we could reverse it. Kempner started out using his plant-based rice diet ultra-low in sodium, fat, cholesterol, and protein to reverse kidney and heart failure; he actually assumed the diet would make diabetes worse. He expected a 90% carbohydrate diet would increase insulin requirements, however, the opposite proved to be true. He took the next 100 patients with diabetes who walked through his door who went on the rice diet for at least three months and found their fasting blood sugars dropped despite a drop in the insulin they were taking. What really blew people away was this: Forty-four of the patients had diabetic retinopathy, and, in 30% of the cases, their eyes improved. That's not supposed to happen; diabetic retinopathy had been considered "a sign of irreversible destruction." What does this change mean in real life? Patients went from unable to even read headlines to normal vision.

The remarkable success Dr. Kempner had reversing some of the most dreaded complications of diabetes with his rice and fruit diet was not because of weight loss. The improvements occurred even in those patients who did not lose significant weight, so it must have been something specific about the diet. Maybe it was his total elimination of animal protein, animal fat, and cholesterol? Or perhaps it was his radical reduction in sodium, fat, and protein in general? We don't know.

How do we treat diabetic retinopathy these days? With steroids and other drugs injected straight into the eyeball. If that doesn't work, there's always pan-retinal laser photocoagulation, in which laser burns are etched over nearly the entire retina. Surgeons literally burn out the back of your eye. Why would they do that? The theory is that by killing off most of the retina, the little pieces you leave behind may get more blood flow.

When I see that, along with Kempner's work, I can't help but feel like history has been reversed. It seems as though it should have gone like, "Can you believe 50 years ago the best we had was this barbaric, burn-out-your-socket surgery? Thank goodness we've since learned that through dietary means alone, we can reverse the blindness." But instead of learning, medicine seems to have forgotten.

I documented the extraordinary Kempner story previously in Kempner Rice Diet: Whipping Us Into Shape and Drugs and the Demise of the Rice Diet. The reason I keep coming back to this is not to suggest people should go on such a diet (it is too extreme and potentially dangerous to do without strict medical supervision), but to show the power of dietary change to yield tremendous healing effects.

The best way to prevent diabetic blindness is to prevent or reverse diabetes in the first place. See, for example:

Why wouldn't a diet of white rice make diabetes worse? See If White Rice Is Linked to Diabetes, What About China?

For more on the nitty gritty on what is the actual cause of type 2 diabetes, see:

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: Community Eye Health / Flickr. This image has been modified.

Original Link

Introducing the Kempner Rice Diet

Aug16-2.jpg

Franklin Delano Roosevelt brought us through the Great Depression and World War II. Who knows how history would have been different had he not died in his fourth term as President from a massive stroke. In the following days and months, we learned that Roosevelt had suffered from severe high blood pressure for years. In spite of this, he was on no medications or other treatments. The reason for the lack of treatment is stark and simple: there were none. The state of the art at that time was death. Death, from so-called malignant hypertension--out-of-control high blood pressure--for which, it was thought, there was no remedy. But they were wrong. There was Dr. Walter Kempner and his rice-fruit diet.

A physician-scientist, Kempner trained with the best, fled Nazi Germany and set up shop at Duke, where he began treating malignant hypertension patients with a radical diet consisting of only white rice and fruit, with strikingly favorable results: a rapid reduction in blood pressure, rapid improvement in kidney failure, eye pressure, heart failure and other manifestations of this previously fatal illness.

He figured that if a low salt diet helped with blood pressure, a low protein diet helped with kidney function, and a low fat and cholesterol diet helped the heart, why not take it to its logical conclusion and design a no-salt, no cholesterol diet of almost pure carbohydrate. So, he designed a diet with less sodium than any low-sodium diet, less protein than any low-protein diet, and less cholesterol and fat than any other low-fat diet.

His hope was that it would just stop progression of the disease. Instead, something miraculous happened. In about two-thirds of cases, the disease reversed. There were reversals of heart failure, reversals of eye damage, and reversals of kidney failure. At the time, this was effectively a terminal disease where people just had a few months to live, but with Kempner's rice diet, they got better. In my video Kempner Rice Diet: Whipping Us Into Shape, you can see before and after pictures of the back of people's eyes. They started out swollen, bloody and leaking and then were nearly normal in a matter of months.

After being effectively cured by the diet over many months, many patients could then relax the diet to a more conventional plant-based diet and go on to live a normal, active life. The rice diet may actually drop blood pressures too low, so we have to add back other foods to bring the pressures back up to normal.

An editorial in the New England Journal of Medicine described Kempner's results as "little short of miraculous." Practically speaking, there's probably no more effective diet for obese cardiac patients. The problem, though, is that most physicians lack the extraordinary persuasive powers required to keep the patient eating such a restricted diet.

When Dr. Caldwell Esselstyn presented his study results demonstrating in some cases reversal of near end-stage heart disease with a whole food plant-based diet, the Chair of Cleveland Clinic cardiology department asked, "How can we expect patients to stay on a strict diet like this when we can't even get them to quit smoking?" Just like penicillin drugs don't work at all unless we take them, plant-based diets don't work unless we actually eat them.

The answer may be that the physician must have a zealous belief in the diet and must convey that passion to the patients. For Kempner, to keep his patients on the rice diet, he "brow-beat, yelled at, and castigated them when he caught them straying." And he didn't just browbeat them; he sometimes actually beat them. It came out in a lawsuit in which a former patient sued Dr. Kempner, claiming that he had literally whipped her and other patients to motivate them to stick to the diet.

Reminds me of the famous diabetes physician back in the 1800s, Arnoldo Cantani, who knew the remedy for diabetes was not in the drugstore, but rather the kitchen. To ensure compliance, if necessary, he would lock a patient up in a room for six weeks.

Thankfully, in terms of personality, Dr. Esselstyn is the opposite of Dr. Kempner. He is polite, soft-spoken, gentle and able to keep his patients on track without whipping them. And last but not least, Esselstyn walks the talk, following the diet himself, whereas Kempner died of a heart attack (though at the age of 94). Kempner's work continues on in Durham, where they continue a relaxed version of the diet, allowing actual vegetables.

A year before Roosevelt died, Kempner had already published his miraculous results. It seems highly likely that had the rice diet been "provided to President Roosevelt a year before his death, his disease might have been controlled before his fatal stroke, and that this fatal event could have been averted."


For those unfamiliar with Dr. Esselstyn's work, check out:

Kempner was a lifestyle medicine pioneer. What's lifestyle medicine? See, for example:

For more on Kempner's work, see:

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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Drugs vs. Lifestyle for Preventing Diabetes

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In just one decade, the number of people with diabetes has more than doubled. According to the Center for Disease Control and Prevention, by 2050, one out of every three of us may have diabetes.

What's the big deal?

Well, the "consequences of diabetes are legion." Diabetes is the number one cause of adult-onset blindness, the number one cause of kidney failure, and the number one cause of surgical amputations.

What can we do to prevent it?

The onset of Type 2 diabetes is gradual, with most individuals progressing through a state of prediabetes, a condition now striking approximately one in three Americans, but only about one in ten even knows they have it. Since current methods of treating diabetes remain inadequate, prevention is preferable, but what works better: lifestyle changes or drugs? We didn't know until a landmark study, highlighted in my video, How to Prevent Prediabetes from Turning into Diabetes, was published in the New England Journal of Medicine.

Thousands were randomized to get a double dose of the leading anti-diabetes drug, or diet and exercise. The drug, metformin, is probably the safest diabetes drug there is. It causes diarrhea in about half, makes one in four nauseous, about one in ten suffer from asthenia (physical weakness and fatigue), but only about 1 in 67,000 are killed by the drug every year.

And the drug worked. Compared to placebo, in terms of the percentage of people developing diabetes within the four-year study period, fewer people in the drug group developed diabetes.

But diet and exercise alone worked better. The lifestyle intervention reduced diabetes incidence by 58 percent, compared to only 31 percent with the drug. The lifestyle intervention was significantly more effective than the drug, and had fewer side-effects. More than three quarters of those on the drug reported gastrointestinal symptoms, though there was more muscle soreness reported in the lifestyle group, on account of them actually exercising.

That's what other studies have subsequently found: non-drug approaches superior to drug-based approaches for diabetes prevention. And the average 50 percent or so drop in risk was just for those instructing people to improve their diet and lifestyle, whether or not they actually did it.

In one of the most famous diabetes prevention studies, 500 people with prediabetes were randomized into a lifestyle intervention or control group. During the trial, the risk of diabetes was reduced by that same 50-60 percent, but only a fraction of the patients met the modest goals. Even in the lifestyle intervention group, only about a quarter were able to eat enough fiber, meaning whole, plant foods, and cut down on enough saturated fat, which in North America is mostly dairy, dessert, chicken and pork. But they did better than the control group, and fewer of them developed diabetes because of it. But what if you looked just at the folks that actually made the lifestyle changes? They had zero diabetes--none of them got diabetes. That's effectively a 100 percent drop in risk.

I often hear the diet and exercise intervention described as 60 percent effective. That's still nearly twice as effective as the drug, but what the other study really showed it may be more like 100 percent in people who actually do it. So is diet and exercise 100 percent effective or only 60 percent effective? On a population scale, since so many people won't actually do it, it may only be 60 percent effective. But on an individual level, if you want to know what are the chances you won't get diabetes if you change your lifestyle, then the 100 percent answer is more accurate. Lifestyle interventions only work when we do them. Kale is only healthy if it actually gets into our mouth. It's not healthy just sitting on the shelf.


How about preventing prediabetes in the first place? See Preventing Prediabetes By Eating More and my video How to Prevent Prediabetes in Children.

Some things we may want to avoid can be found in my videos Eggs and Diabetes and Fish and Diabetes.

And what if we already have the disease? See Diabetics Should Take Their Pulses and my live presentation From Table to Able: Combating Disabling Diseases with Diet.

What if you don't have time for exercise? Check out Standing Up for Your Health.

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, and Food as Medicine.

Image Credit: Heather Aitken / Flickr

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How to Prevent Childhood Obesity and Diabetes

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Thirty years ago, virtually all diabetes in young individuals was thought to be autoimmune Type 1 diabetes, but since the mid-90s, we started to see an increase in Type 2 diabetes among youth, particularly in the United States. Indeed, "the term adult onset diabetes has now been scrapped and replaced with 'Type 2' because children as young as eight are now developing the disease." And the effects can be just as devastating. A 15-year follow-up of children diagnosed with Type 2 diabetes found an alarming rate in young adults of blindness, amputation, kidney failure and death in young adulthood.

Why the dramatic rise in childhood diabetes? The dramatic rise in childhood diabetes is due to the dramatic rise in childhood obesity. During the past 30 years, the number of children diagnosed as being overweight has increased by more than 100 percent. Once an obese child reaches age six, it's likely they'll stay that way. And even if they don't, being overweight in our youth predicts adult disease and death regardless of adult body weight.

Being an overweight teen may predict disease risk 55 years later, including twice the risk of dying from heart attack, more cancer, gout, and arthritis. In fact being overweight as a teen "was a more powerful predictor of these risks then being overweight in adulthood." This underscores the importance of focusing on preventing childhood obesity.

How do we do it? From the official American Academy of Pediatrics clinical practice guidelines: the problem appears to be kids eating too much fat and added sugar, and not eating enough fruits and vegetables.

Doctors, at every occasion beginning soon after a child's birth, should endeavor to give sound advice regarding nutrition and growth so that obesity and its complications may be curtailed. What might sound advice sound like?

The chair of the nutrition department at Loma Linda published a review suggesting not eating meat at all might be an effective strategy. Population studies have consistently shown that vegetarians are thinner than comparable non-vegetarians.

In the largest such study to date (highlighted in my video How to Prevent Prediabetes in Children), a body mass index over 30 is considered obese, 25 to 30 overweight, and under 25 an ideal weight. The non-vegetarians were up at 28.8, showing the average meat-eater in the U.S. is significantly overweight. As one gets more and more plant-based, the average BMI drops. But even the average vegetarian in the U.S. is overweight. The only dietary group that was, on average, ideal weight were those eating strictly plant-based. It comes out to be about a 30-pound difference between average vegans and meat-eaters.

In school-aged children, the consumption of animal foods (meats, dairy, or eggs) is associated with an increased risk of being overweight, whereas plant-based equivalents like veggie burgers, veggie dogs, and veggie cold cuts were not. The whole plant foods like grains, beans, and nuts were found to be protective.

This may be because plant-based diets are low in energy density and high in starch, fiber, and water, which may increase feelings of fullness and resting energy expenditure, meaning resting metabolic rate. Eating plant-based appears to boost metabolism, such that you just burn more calories at rest. However, we're not sure how much of the benefits are due to increased consumption of plant foods versus decreased consumption of meat.

"Plant-based diets should be encouraged and promoted for optimal health. Local, national and international food policies are warranted to support social marketing messages and to reduce the social, cultural, economic and political forces that make it difficult to promote such diets." For example, although the advice to consume a plant-based diet is sound, questions arise concerning the relatively high price of produce.

We could reduce the burden of childhood obesity and prevent further spread of the disease, but we need to ensure that plant foods are affordable and accessible to children of all income levels. Getting diabetes in childhood cuts about 20 years of their life. What parent wouldn't go to the ends of the Earth to add decades to their children's lives? Fruits and vegetables may not fit on the Dollar Menu, but our kids are worth it.

We make life and death decisions at the grocery store buying food for our family. It's never too early to start our kids off on the right foot. See my video Heart Disease Starts in Childhood.

And healthy doesn't have to mean more expensive. Check out Eating Healthy on a Budget.

For some tips on getting our kids to eat their vegetables, see my videos Tricks to Get Kids to Eat Healthier at School and Tricks to Get Kids to Eat Healthier at Home.

Once one has prediabetes, there's a way to prevent it from progressing further. See my video How to Prevent Prediabetes from Turning into Diabetes.

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: DAVID Swift / Flickr

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Dr. Greger’s 2015 Live Year-in-Review Presentation

Food as Medicine

View my new live presentation here: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet

Every year I scour the world's scholarly literature on clinical nutrition, pulling together what I find to be the most interesting, practical, and groundbreaking science on how to best feed ourselves and our families. I start with the thousands of papers published annually on nutrition (27,000 this year--a new record!) and, thanks to a crack team of volunteers (and now staff!), I'm able to whittle those down (to a mere 8,000 this year). They are then downloaded, categorized, read, analyzed, and churned into the few hundred short videos. This allows me to post new videos and articles every day, year-round, to NutritionFacts.org. This certainly makes the site unique. There's no other science-based source for free daily updates on the latest discoveries in nutrition. The problem is that the amount of information can be overwhelming.

Currently I have more than a thousand videos covering 1,931 nutrition topics. Where do you even begin? Many have expressed their appreciation for the breadth of material, but asked that I try to distill it into a coherent summary of how best to use diet to prevent and treat chronic disease. I took this feedback to heart and in 2012 developed Uprooting the Leading Causes of Death, which explored the role diet may play in preventing, arresting, and even reversing our top 15 killers. Not only did it rise to become one of the Top 10 Most Popular Videos of 2012, it remains my single most viewed video to date, watched over a million times (NutritionFacts.org is now up to more than 1.5 million hits a month!).

In 2013 I developed the sequel, More Than an Apple a Day, in which I explored the role diet could play in treating some of our most common conditions. I presented it around the country and it ended up #1 on our Top 10 Most Popular Videos of 2013. Then in 2014 I premiered the sequel-sequel, From Table to Able, in which I explored the role diet could play in treating some of our most disabling diseases, landing #1 on our Top 10 Most Popular Videos of 2014.

Every year I wonder how I'm going to top the year before. Knowing how popular these live presentations can be and hearing all the stories from folks about what a powerful impact they can have on people's lives, I put my all into this new 2015 one. I spent more time putting together this presentation than any other in my life. It took me an entire month, and when you see it I think you'll appreciate why.

This year, I'm honored to bring you Food as Medicine, in which I go through our most dreaded diseases--but that's not even the best part! I'm really proud of what I put together for the ending. I spend the last 20 minutes or so (starting at 56:22) going through a thought experiment that I'm hoping everyone will find compelling. I think it may be my best presentation ever. You be the judge.

You can watch it at no cost online, but it is also available on DVD through my website or on Amazon. If you want to share copies with others, I have a five for $40 special (enter coupon code 5FOR40FAM). All proceeds from the sales of all my books, DVDs, downloads, and presentations go to the 501c3 nonprofit charity that keeps NutritionFacts.org free for all, for all time. If you want to support this initiative to educate millions about eradicating dietary diseases, please consider making a donation.

After you've watched the new presentation, make sure you're subscribed to get my video updates daily, weekly, or monthly to stay on top of all the latest.

-Michael Greger

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