How to Prevent Ulcerative Colitis with Diet

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What has driven the dramatic increase in prevalence of the inflammatory bowel disease Crohn's disease in societies that rapidly westernized--a disease practically unknown just a century ago? What has changed in our internal and external environment that has led to the appearance of this horrible disease?

Japan suffered one of the most dramatic increases, and out of all the changing dietary components, animal protein appeared to be the strongest factor. There was an exponential increase in newly diagnosed Crohn's patients and daily animal protein intake, whereas the greater the vegetable protein, the fewer the cases of Crohn's, which is consistent with data showing a more plant-based diet may be successful in both preventing and treating Crohn's disease (See Preventing Crohn's Disease With Diet and Dietary Treatment of Crohn's Disease). But what about other inflammatory bowel diseases?

In the largest study of its kind, shown in my video Preventing Ulcerative Colitis with Diet, 60,000 people were followed for more than a decade. Researchers found that high total protein intake--specifically animal protein--was associated with a significantly increased risk of the other big inflammatory bowel disease, ulcerative colitis. It wasn't just protein in general, but the "association between high protein intake and inflammatory bowel disease risk was restricted to animal protein."Since World War II, animal protein intake has increased not only in Japan but also in all developed countries. This increase in animal protein consumption is thought to explain some of the increased incidence of inflammatory bowel disease in the second half of the 20th century.

Other studies found this as well, but why? What's the difference between animal protein and plant protein? Animal proteins tend to have more sulfur containing amino acids like methionine, which bacteria in our gut can turn into the toxic rotten egg smell gas, hydrogen sulfide. Emerging evidence suggests that sulfur compounds may play a role in the development of ulcerative colitis, a chronic inflammatory disease of the colon and rectum characterized by bloody diarrhea.

The first hint as to the importance of our gut flora was in the 1970's when "analysis of stools showed that their bulk was made up of mostly bacteria, not undigested material." We're pushing out trillions of bacteria a day and they just keep multiplying and multiplying. They do wonderful things for us like create the protective compound, butyrate, from the fiber we eat, but unfortunately, the bacteria may also elaborate toxic products from food residues such as hydrogen sulfide "in response to a high-meat diet."

Hydrogen sulfide is a bacterially derived cell poison that has been implicated in ulcerative colitis. We had always assumed that sulfide generation in the colon is driven by dietary components such as sulfur-containing amino acids, but we didn't know for sure until a study from Cambridge was published. Researchers had folks eat five different diets each with escalating meat contents from vegetarian all the way up to a steak each day. They found that the more meat one ate, the more sulfide; ten times more meat meant ten times more sulfide. They concluded that "dietary protein from meat is an important substrate for sulfide generation by bacteria in the human large intestine."

Hydrogen sulfide can then act as a free radical and damage our DNA at concentrations way below what our poor colon lining is exposed to on a routine basis, which may help explain why diets higher in meat and lower in fiber may produce so-called "fecal water" that causes about twice as much DNA damage. Fecal water is like when researchers make a tea from someone's stool.

The biology of sulfur in the human gut has escaped serious attention until recently. Previously it was just thought of as the rotten egg smell in malodorous gas, but the increase in sulfur compounds in response to a supplement of animal protein is not only of interest in the field of flatology--that is, the formal study of farts--but may also be of importance in the development of ulcerative colitis.

I have several videos on our microbiome, including:

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: illustrator © 123RF.com. This image has been modified.

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Improving Employee Diets Could Save Companies Millions

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

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

Original Link

Improving Employee Diets Could Save Companies Millions

Plant-Based Workplace Intervention.jpg

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

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

Original Link

The Natural Human Diet

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Our epidemics of dietary disease have prompted a great deal of research into what humans are meant to eat for optimal health. In 1985, an influential article highlighted in my video The Problem With the Paleo Diet Argument was published proposing that our chronic diseases stem from a disconnect between what our bodies ate while evolving during the Stone Age (about 2 million years ago) and what we're stuffing our face with today. The proposal advocated for a return towards a hunter-gatherer type diet of lean meat, fruits, vegetables, and nuts.

It's reasonable to assume our nutritional requirements were established in the prehistoric past. However, the question of which prehistoric past we should emulate remains. Why just the last 2 million? We've been evolving for about 20 million years since our last common great ape ancestor, during which our nutrient requirements and digestive physiology were set down. Therefore our hunter-gatherer days at the tail end probably had little effect. What were we eating for the first 90% of our evolution? What the rest of the great apes ended up eating--95 percent or more plants.

This may explain why we're so susceptible to heart disease. For most of human evolution, cholesterol may have been virtually absent from the diet. No bacon, butter, or trans fats; and massive amounts of fiber, which pulls cholesterol from the body. This could have been a problem since our body needs a certain amount of cholesterol, but our bodies evolve not only to make cholesterol, but also to preserve it and recycle it.

If we think of the human body as a cholesterol-conserving machine, then plop it into the modern world of bacon, eggs, cheese, chicken, pork, and pastry; it's no wonder artery-clogging heart disease is our #1 cause of death. What used to be adaptive for 90% of our evolution--holding on to cholesterol at all costs since we weren't getting much in our diet--is today maladaptive, a liability leading to the clogging of our arteries. Our bodies just can't handle it.

As the editor-in-chief of the American Journal of Cardiology noted 25 years ago, no matter how much fat and cholesterol carnivores eat, they do not develop atherosclerosis. We can feed a dog 500 eggs worth of cholesterol and they just wag their tail; a dog's body is used to eating and getting rid of excess cholesterol. Conversely, within months a fraction of that cholesterol can start clogging the arteries of animals adapted to eating a more plant-based diet.

Even if our bodies were designed by natural selection to eat mostly fruit, greens and seeds for 90% of our evolution, why didn't we better adapt to meat-eating in the last 10%, during the Paleolithic? We've had nearly 2 million years to get used to all that extra saturated fat and cholesterol. If a lifetime of eating like that clogs up nearly everyone's arteries, why didn't the genes of those who got heart attacks die off and get replaced by those that could live to a ripe old age with clean arteries regardless of what they ate? Because most didn't survive into old age.

Most prehistoric peoples didn't live long enough to get heart attacks. When the average life expectancy is 25 years old, then the genes that get passed along are those that can live to reproductive age by any means necessary, and that means not dying of starvation. The more calories in food, the better. Eating lots of bone marrow and brains, human or otherwise, would have a selective advantage (as would discovering a time machine stash of Twinkies for that matter!). If we only have to live long enough to get our kids to puberty to pass along our genes, then we don't have to evolve any protections against the ravages of chronic disease.

To find a population nearly free of chronic disease in old age, we don't have to go back a million years. In the 20th century, networks of missionary hospitals in rural Africa found coronary artery disease virtually absent, and not just heart disease, but high blood pressure, stroke, diabetes, common cancers, and more. In a sense, these populations in rural China and Africa were eating the type of diet we've been eating for 90% of the last 20 million years, a diet almost exclusively of plant foods.

How do we know it was their diet and not something else? In the 25 year update to their original paleo paper, the authors tried to clarify that they did not then and do not now propose that people adopt a particular diet just based on what our ancient ancestors ate. Dietary recommendations must be put to the test. That's why the pioneering research from Pritikin, Ornish, and Esselstyn is so important, showing that plant-based diets can not only stop heart disease but have been proven to reverse it in the majority of patients. Indeed, it's the only diet that ever has.

For more on the absence of Western diseases in plant-based rural populations, see for example:

I've touched on "paleo" diets in the past:

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: Nathan Rupert / Flickr

Original Link

The Natural Human Diet

NF-Nov15 The Problem with the Paleo Diet Argument copy.jpg

Our epidemics of dietary disease have prompted a great deal of research into what humans are meant to eat for optimal health. In 1985, an influential article highlighted in my video The Problem With the Paleo Diet Argument was published proposing that our chronic diseases stem from a disconnect between what our bodies ate while evolving during the Stone Age (about 2 million years ago) and what we're stuffing our face with today. The proposal advocated for a return towards a hunter-gatherer type diet of lean meat, fruits, vegetables, and nuts.

It's reasonable to assume our nutritional requirements were established in the prehistoric past. However, the question of which prehistoric past we should emulate remains. Why just the last 2 million? We've been evolving for about 20 million years since our last common great ape ancestor, during which our nutrient requirements and digestive physiology were set down. Therefore our hunter-gatherer days at the tail end probably had little effect. What were we eating for the first 90% of our evolution? What the rest of the great apes ended up eating--95 percent or more plants.

This may explain why we're so susceptible to heart disease. For most of human evolution, cholesterol may have been virtually absent from the diet. No bacon, butter, or trans fats; and massive amounts of fiber, which pulls cholesterol from the body. This could have been a problem since our body needs a certain amount of cholesterol, but our bodies evolve not only to make cholesterol, but also to preserve it and recycle it.

If we think of the human body as a cholesterol-conserving machine, then plop it into the modern world of bacon, eggs, cheese, chicken, pork, and pastry; it's no wonder artery-clogging heart disease is our #1 cause of death. What used to be adaptive for 90% of our evolution--holding on to cholesterol at all costs since we weren't getting much in our diet--is today maladaptive, a liability leading to the clogging of our arteries. Our bodies just can't handle it.

As the editor-in-chief of the American Journal of Cardiology noted 25 years ago, no matter how much fat and cholesterol carnivores eat, they do not develop atherosclerosis. We can feed a dog 500 eggs worth of cholesterol and they just wag their tail; a dog's body is used to eating and getting rid of excess cholesterol. Conversely, within months a fraction of that cholesterol can start clogging the arteries of animals adapted to eating a more plant-based diet.

Even if our bodies were designed by natural selection to eat mostly fruit, greens and seeds for 90% of our evolution, why didn't we better adapt to meat-eating in the last 10%, during the Paleolithic? We've had nearly 2 million years to get used to all that extra saturated fat and cholesterol. If a lifetime of eating like that clogs up nearly everyone's arteries, why didn't the genes of those who got heart attacks die off and get replaced by those that could live to a ripe old age with clean arteries regardless of what they ate? Because most didn't survive into old age.

Most prehistoric peoples didn't live long enough to get heart attacks. When the average life expectancy is 25 years old, then the genes that get passed along are those that can live to reproductive age by any means necessary, and that means not dying of starvation. The more calories in food, the better. Eating lots of bone marrow and brains, human or otherwise, would have a selective advantage (as would discovering a time machine stash of Twinkies for that matter!). If we only have to live long enough to get our kids to puberty to pass along our genes, then we don't have to evolve any protections against the ravages of chronic disease.

To find a population nearly free of chronic disease in old age, we don't have to go back a million years. In the 20th century, networks of missionary hospitals in rural Africa found coronary artery disease virtually absent, and not just heart disease, but high blood pressure, stroke, diabetes, common cancers, and more. In a sense, these populations in rural China and Africa were eating the type of diet we've been eating for 90% of the last 20 million years, a diet almost exclusively of plant foods.

How do we know it was their diet and not something else? In the 25 year update to their original paleo paper, the authors tried to clarify that they did not then and do not now propose that people adopt a particular diet just based on what our ancient ancestors ate. Dietary recommendations must be put to the test. That's why the pioneering research from Pritikin, Ornish, and Esselstyn is so important, showing that plant-based diets can not only stop heart disease but have been proven to reverse it in the majority of patients. Indeed, it's the only diet that ever has.

For more on the absence of Western diseases in plant-based rural populations, see for example:

I've touched on "paleo" diets in the past:

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: Nathan Rupert / Flickr

Original Link

How May Eating Plants Help Prevent Alzheimer’s Disease?

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Intake of saturated fats and added sugars, two of the primary components of a modern Western diet, is linked with the development of Alzheimer's disease. There has been a global shift in dietary composition, from traditional diets high in starches and fiber, to what has been termed the Western diet, high in fat and sugar, low in whole, plant foods. What's so great about fruits and vegetables?

Plant-derived foods contain thousands of compounds with antioxidant properties, some of which can traverse the blood-brain barrier and may have neuroprotective effects by assisting with antioxidant defense. There's this concept of "brain rust," that neurodegenerative diseases arise from excess oxidative stress. But Nature has gifted humankind with a plethora of plants--fruits, vegetables, and nuts, and the diverse array of bioactive nutrients present in these natural products may play a pivotal role in prevention and one day, perhaps, even the cure of various neurodegenerative diseases, such as Alzheimer's disease.

Accumulated evidence suggests that naturally occurring plant compounds may potentially hinder neurodegeneration, and even improve memory and cognitive function, as I've shared in my videos Preventing Alzheimer's Disease with Plants and How to Slow Brain Aging By Two Years) and treating Alzheimer's with spices such as saffron or turmeric (See Saffron for the Treatment of Alzheimer's and Treating Alzheimer's with Turmeric).

Vegetables may be particularly protective, in part because of certain compounds we eat that concentrate in the brain, found in dark green leafy vegetables, the consumption of which are associated with lower rates of age-related cognitive decline.

Yet when you look at systemic reviews on what we can do to prevent cognitive decline, you'll see conclusions like this: "The current literature does not provide adequate evidence to make recommendations for interventions." The same is said for Alzheimer's, "Currently, insufficient evidence exists to draw firm conclusions on the association of any modifiable factors with risk of Alzheimer's disease." Doctors cite the lack of randomized controlled trials (RCTs) as the basis for their conclusions. RCTs are the gold standard used to test new medicines. This is where researchers randomize people into two groups, half get the drug and half don't, to control for confounding factors. The highest level of evidence is necessary because drugs may kill a hundred thousand Americans every year - not medication errors or illicit drugs, just regular, FDA-approved prescription drugs, making medication alone the sixth leading cause of death in the United States. So, you better make absolutely sure the benefits of new drugs outweigh the often life-threatening risks.

But we're talking about diet and exercise--the side effects are all good, so we don't need the same level of rigorous evidence to prescribe them.

A "modest proposal" was published recently in the Journal of Alzheimer's Disease, an editorial calling for a longitudinal study of dementia prevention. They agreed that definitive evidence for the effectiveness of dementia prevention methods was lacking, so we need large-scaled randomized trials. They suggested we start with 10,000 healthy volunteers in their 20's and split them into five groups. There's evidence, for example, that traumatic brain injury is a risk factor for Alzheimer's, because people with head injuries appear more likely to get the disease, but it's never been put to the test. So, they say, let's take two thousand people and beat half of them in the head with baseball bats, and the other half we'll use Styrofoam bats as a control. Afterall, until we have randomized controls, how can't physicians recommend patients not get hit in the head? They go further saying we should probably chain a thousand people to a treadmill for 40 years, and a thousand people to a couch before recommending exercise. A thousand will be forced to do crossword puzzles; another thousand forced to watch Jerry Springer reruns, lots of meat and dairy or not prescribed for another group for the next 40 years, and we can hook a thousand folks on four packs a day just to be sure.

We help our patients to quit smoking despite the fact that there's not a single randomized controlled trial where they held people down and piped smoke into their lungs for a few decades. It is time to realize that the ultimate study in regard to lifestyle and cognitive health cannot be done. Yet the absence of definitive evidence should not restrict physicians from making reasonable recommendations based on the evidence that is available.

I've discussed how drug-centric approaches to evidence-based medicine may neglect some of the most convincing data: Evidence-Based Medicine or Evidence-Biased?

To see how and why I built NutritionFacts.org on evidence-based principles, see my recent introductory videos:

A sampling of some of my Alzheimer's videos:

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: Michael Heim / 123rf

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How to Mitigate and Prevent Crohn’s Disease with Diet

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Crohn's disease is an autoimmune disorder that affects more than a million Americans. It is an inflammatory bowel disease in which the body attacks the intestines. There is currently no known cure for Crohn's disease; current research focuses on controlling symptoms. There is no definitive medical or surgical therapy. The best we have is a plant-based diet, which has afforded the best relapse prevention to date.

Researchers got the idea to try a plant-based diet because diets rich in animal protein and animal fat have been found to cause a decrease in beneficial bacteria in the intestine. So, researchers designed a semi-vegetarian diet to counter that, and 100 percent of subjects stayed in remission the first year and 92 percent the second year. These results are far better than those obtained by current drugs, including new "biological agents" that can cost $40,000 a year, and can cause progressive multifocal leukoencephalopathy, a disabling and deadly brain disease. And a healthy diet appears to work better.

But what about preventing Crohn's disease in the first place? A systematic review of the scientific literature on dietary intake and the risk of developing inflammatory bowel disease found that a high intake of fats and meat was associated with an increased risk of Crohn's disease as well as ulcerative colitis, whereas high fiber and fruit intakes were associated with decreased risk of Crohn's.

These results were supported more recently by the Harvard Nurse's Health Study. Data revealed that long-term intake of dietary fiber, particularly from fruit, was associated with lower risk of Crohn's disease. Women who fell into in the highest long-term fiber consumption group had a 40 percent reduced risk, leading the accompanying editorial to conclude, "advocating for a high-fiber diet may ultimately reduce the incidence of Crohn's disease."

The irony is that the highest fiber group wasn't even eating the official recommended daily minimum of fiber intake. Apparently, even just being less fiber deficient has a wide range of benefits, including a significant reduction in the risk of developing Crohn's disease, but why? The authors suggest it's because "fiber plays a vital role in the maintenance of our intestinal barrier function."

Our skin keeps the outside world outside, and so does the lining of our gut, but in Crohn's disease, this barrier function is impaired. You can see this under an electron microscope as shown in my video Preventing Crohn's Disease With Diet. The tight junctions between the intestinal cells have all sorts of little holes and breaks. The thought is that the increase in prevalence of inflammatory bowel diseases may be that dietary changes lead to the breakdown of our intestinal barrier, potentially allowing the penetration of bacteria into our gut wall, which our body then attacks, triggering the inflammation.

We know fiber acts as a prebiotic in our colon (large intestine), feeding our good bacteria, but what does fiber do in our small intestine where Crohn's often starts? We didn't know, until a landmark study was published. Researchers wanted to find out what could stop Crohn's associated invasive bacteria from tunneling into the gut wall. They found the invasion is inhibited by the presence of certain soluble plant fibers, such as from plantains and broccoli at the kinds of concentrations one might expect after eating them. They wondered if that may explain why plantain-loving populations have lower levels of inflammatory bowel disease. But, the researchers also found that there was something in processed foods that facilitated the invasion of the bacteria. Polysorbate 80 was one of them, found predominantly in ice cream, but also found in Crisco, Cool Whip, condiments, cottage cheese--you just have to read the labels.

What about maltodextrin, which is found in artificial sweeteners like Splenda, snack foods, salad dressings, and fiber supplements? Maltodextrin markedly enhanced the ability of the bacteria to glob onto our intestinal cells, though other additives. Carboxy-methyl cellulose and xanthan gum appeared to have no adverse effects.

This may all help solve the mystery of the increasing prevalence of Crohn's disease in developed nations, where we're eating less fiber-containing whole plant foods and more processed foods. What we need now are interventional studies to see if boosting fiber intake and avoiding these food additives can be effective in preventing and treating Crohn's disease. But until then, what do we tell people? The available evidence points to a diet low in animal fat, with lots of soluble fiber containing plant foods, and avoiding processed fatty foods that contain these emulsifiers. We also want to make sure we're not ingesting traces of dishwashing detergent, which could have the same effect, so make sure to rinse your dishes well. Researchers found that some people wash dishes and then just leave them to dry without rinsing, which is probably not a good idea. We don't currently have studies that show that avoiding polysorbate 80 and rinsing dishes well actually helps. Nevertheless, advice based on 'best available evidence' is better than no advice at all.

Here's a video about using a more plant-based diet to reduce the risk of relapses: Dietary Treatment of Crohn's Disease.

I get a lot of questions about additives like polysorbate 80. I'm glad I was finally able to do a blog about it. Here are some videos on some others:

If you, like me, used to think all fiber was good for was helping with bowel regularity you'll be amazed! See for example, Dr. Burkitt's F-Word 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: Graphic Stock

Original Link

What to Eat to Protect Against Kidney Cancer

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58,000 Americans are diagnosed with kidney cancer every year, and 13,000 die. And the numbers have been going up. Approximately 4 percent of cases are hereditary, but what about the other 96 percent? The only accepted risk factor has been tobacco use, but cigarette smoking has been declining.

Nitrosamines are one of the most potent carcinogens in cigarette smoke. One hot dog has as many nitrosamines and nitrosamides as five cigarettes. And these carcinogens are also found in fresh meat as well: beef, chicken and pork. So even though smoking rates have dropped, perhaps the rise in kidney cancer over the last few decades may have something to do with meat consumption. But would kidney cancer just be related to the processed meats like bacon, sausage, hot dogs and cold cuts that have nitrate and nitrite additives, or fresh meat as well?

The NIH-AARP study featured in my video Can Diet Protect Against Kidney Cancer? is the largest prospective study on diet and health ever performed--about 500,000 followed for nine years. In addition to examining nitrate and nitrite intake from processed meat, they also looked at intake from other sources such as fresh meat, eggs and dairy. Nitrite from animal sources, not just processed meats, was associated with an increased risk of kidney cancer, and total intake of nitrate and nitrite from processed meat sources was also associated with kidney cancer risk. The researchers found no associations with nitrate or nitrite intake from plant sources, but nitrates from processed meat was associated with cancer.

When meat producers advertise their bacon or lunch meat as "uncured," this means no nitrites or nitrates added. But if you look at the small print you'll see something like, "except for celery juice." That's just a sneaky way to add nitrites. Processed meat producers ferment the nitrates in celery to create nitrites, then add it to the meat; a practice even the industry admits "may be viewed as incorrect at best or deceptive at worst."

But that same fermentation of nitrates to nitrites can happen thanks to bacteria on our tongue when we eat vegetables. So why are nitrates and nitrites from vegetables on our tongue harmless, but nitrates and nitrites from vegetables in meat linked to cancer? The actual carcinogens are not nitrites, but nitrosamines and nitrosamides. In our stomach, to turn nitrites into nitros-amines, and nitros-amides we need amines and amides, which are concentrated in animal products. And vitamin C and other antioxidants in plant foods block the formation of these carcinogens in our stomach. That's why we can safely benefit from the nitrates in vegetables without the cancer risk. In fact some of the highest nitrate vegetables like arugula, kale, and collards are associated with decreased risk of kidney cancer. The more plants, it appears, the better.

Plant-based diets and fiber-rich diets are recommended to prevent cancer directly, as well as chronic conditions associated with kidney cancer, such as obesity, high blood pressure and diabetes. It's similar to sodium intake and kidney cancer. Sodium intake increases kidney disease risk, but that's not just because sodium intake increases blood pressure. It appears the salt is associated with increased cancer risk even independently of hypertension. What about plant-based diets? Turns out the protective association remains even in people who are not obese and have normal blood pressure. So overall, plant-based and fiber-rich diets appear to do both: decrease cancer risk directly and indirectly.

I briefly address kidney health in Preventing Kidney Failure Through Diet and Treating Kidney Failure Through Diet, but have a whole series of more in-depth videos dealing with various kidney issues.

More on the fascinating nitrate/nitrite story in my 17-part series about improving athletic performance with nitrate-rich vegetables such as beets and arugula. Here are a few short highlights:

More on carcinogens caused by cooking meat in videos like:

In health,
Michael Greger, M.D.

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

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What About All the Sugar in Fruit?

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If the fructose in sugar and high fructose corn syrup has been considered "alcohol without the buzz" in terms of the potential to inflict liver damage, what about the source of natural fructose, fruit?

If you compare the effects of a diet restricting fructose from both added sugars and fruit to one just restricting fructose from added sugars, the diet that kept the fruit did better. People lost more weight with the extra fruit present than if all fructose was restricted. Only industrial, not fruit fructose intake, was associated with declining liver function and high blood pressure. Fructose from added sugars was associated with hypertension; fructose from natural fruits is not.

If we have people drink a glass of water with three tablespoons of table sugar in it, which is like a can of soda, they get a big spike in blood sugar within the first hour (as you can see in my video If Fructose is Bad, What About Fruit?). Our body freaks out and releases so much insulin we actually overshoot, and by the second hour we're relatively hypoglycemic, dropping our blood sugar below where they were when we started out fasting. In response, our body dumps fat into our blood stream as if we're starving, because our blood sugars just dropped so low so suddenly.

What if you eat blended berries in addition to the sugar? They have sugars of their own in them, in fact an additional tablespoon of sugar worth, so the blood sugar spike should be worse, right?

Not only is there no additional blood sugar spike, there was no hypoglycemic dip afterwards. Blood sugar just went up and down without that overshoot and without the surge of fat into the blood.

This difference may be attributed to the semisolid consistency of the berry meals, which may have decreased the rate of stomach emptying compared with just guzzling sugar water. In addition, the soluble fiber in the berries has a gelling effect in our intestines that slows the release of sugars. To test to see if it was the fiber, researchers repeated the experiment with berry juice that had all the sugar but none of the fiber. A clear difference was observed early on in the blood sugar insulin responses. At the 15-minute mark, the blood sugar spike was significantly reduced by the berry meals, but not by the juices, but the rest of the beneficial responses were almost the same between the juice and the whole fruit, suggesting that fiber may just be part of it. It turns out there are fruit phytonutrients that inhibit the transportation of sugars through the intestinal wall into our blood stream. Phytonutrients in foods like apples and strawberries can block some of the uptake of sugars by the cells lining our intestines.

Adding berries can actually blunt the insulin spike from high glycemic foods. For example, white bread creates a big insulin spike within two hours after eating it. Eat that same white bread with some berries, though, and we're able to blunt the spike. So, even though we've effectively added more sugars in the form of berries, there's less of an insulin spike, which has a variety of potential short and long-term benefits. So if you're going to make pancakes, make sure they're blueberry pancakes.

Surprised about the juice results? Me too! More on juice:

A few videos I have on industrial sugars:

How else can we blunt the glycemic spike?

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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How to Optimize the “Whole” in a Whole Food, Plant-Based Diet

Food can feel complicated. But it really doesn’t need to be. Keeping it simple and as close to nature as possible is all that is necessary. An optimal diet that reduces risk for disease is based on whole plant foods which are recognizable and enjoyed in their most intact form, avoiding animal products and processed foods. But what is a processed food, exactly? Clearly, Twinkies, Skittles, and fluorescent colored energy drinks would fit the bill of being highly processed. But what about something less obvious…such as a green smoothie, pasta, or plant-based yogurt?

From a diced onion and juiced carrot to refined sugar and artificially-colored corn chip, there is a whole lot of gray area in between when defining processed foods. Especially when you consider that processing includes all sorts of transformations that can be done on food, including grating, mincing, chopping, blending, boiling, baking, blanching, chargrilling, canning, pickling, extracting, changing the chemical or physical structure, etc., etc. The list goes on and on.

With many–but not all–of these alterations, there may be implications, such as these:

  • Nutrients can become lost. From the moment a plant is plucked from the Earth, nutrients start to degrade. Even from the time between when food is harvested to the time it ends up in your kitchen–let alone on your plate–significant losses occur. Cooking foods causes further leaching of certain nutrients and refining a whole grain significantly reduces fiber, protein, and other key nutrients.
  • Unhealthy or potentially harmful substances can be added in. On most food production lines, preservatives, artificial colors, (artificial) sweeteners, artificial flavors, stabilizers, thickeners, and other ingredients are added into the original food for myriad survival reasons. Even using high temperatures to cook potato or grain products can promote byproducts such as acrylamide formation.
  • Olives versus Olive OilNutrients can be concentrated. There is an increase in vitamins, minerals, antioxidants, and phytochemicals when blending and juicing fruits and vegetables (however, this may also reduce fiber and satiety). Further, a dramatic enhancement of fat and calories is found in olive oil as compared to whole olives or carbohydrates from sugar beets as compared to table sugar when refined (however, this reduces fiber and most other nutrients).
  • Satiety can decrease. When fiber is reduced, many health benefits are minimized and satiety is often also slighted.
  • Caloric densityCalories can increase. Taking out fiber or water leaves room for more calories. Highly processed foods such as sugars and oil contain the most calorically dense foods of all. But even dried fruit increases caloric density as water is removed.
  • Enzymes can become activated. Certain foods are best eaten raw or even sprouted, to protect their disease-fighting phytochemicals and to enhance nutrient absorption. For example, allicin in garlic protects against cancer and is only activated when cut or crushed based on the enzyme allinase. Similarly, sprouting seeds significantly improves their nutritional benefits.
  • Cravings may be enhanced. Highly processed foods have been shown to provoke  physiological responses similar to addictive drugs.

Here is a graphic to help illustrate the journey foods can take from its original state to a more processed version of itself: 

Calorie Nutrient Density

Here are 5 ways to optimize the “whole” in your whole food, plant-based diet:

  1. Fill at least half of your plate (or bowl) with raw or lightly cooked vegetables and fruits.
    • Include at least half of your diet from raw foods to benefit from their original nutritional profile.
    • Include cooked foods as well to incorporate the benefits that take place with cooking certain nutrients, such as carotenoids.
    • Drink soups and stews to make sure you retain any nutrients lost in the cooking broth.
  2. Minimize or avoid oils and refined sweeteners.
  3. Choose whole grains over refined grains as often as possible.
  4. When purchasing food with a label:
    • Focus exclusively on the ingredient list.
    • Aim for the fewest ingredients possible.
    • Completely recognizable and pronounceable ingredients.
    • ignore misleading marketing on the front of the package;
    • Avoid artificial flavors/sweeteners/colors, preservatives, stabilizers, thickeners.
  5. Prioritize The 6 Daily 3’s: 3 servings of legumes, leafy green vegetables, other-colored vegetables, fruits, nuts and seeds, and exercise.

6 Daily 3's Web Sized

Ultimately, it all lies on a spectrum…

Spectrum

 

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