What Not to Add to White Rice, Potatoes, or Pasta

What Not to Add to White Rice, Potatoes, or Pasta.jpeg

Rice currently feeds almost half the human population, making it the single most important staple food in the world, but a meta-analysis of seven cohort studies following 350,000 people for up to 20 years found that higher consumption of white rice was associated with a significantly increased risk of type 2 diabetes, especially in Asian populations. They estimated each serving per day of white rice was associated with an 11% increase in risk of diabetes. This could explain why China has almost the same diabetes rates as we do.

Diabetes rates in China are at about 10%; we're at about 11%, despite seven times less obesity in China. Japan has eight times less obesity than we do, yet may have a higher incidence of newly diagnosed diabetes cases than we do--nine per a thousand compared to our eight. They're skinnier and still may have more diabetes. Maybe it's because of all the white rice they eat.

Eating whole fruit is associated with lower risk of diabetes, whereas eating fruit processed into juice may not just be neutral, but actually increases diabetes risk. In the same way, eating whole grains, like whole wheat bread or brown rice is associated with lower risk of diabetes, whereas eating white rice, a processed grain, may not just be neutral, but actually increase diabetes risk.

White rice consumption does not appear to be associated with increased risk of heart attack or stroke, though, which is a relief after an earlier study in China suggested a connection with stroke. But do we want to eat a food that's just neutral regarding some of our leading causes of death, when we can eat whole foods that are associated with lower risk of diabetes, heart attack, stroke, and weight gain?

If the modern diabetes epidemic in China and Japan has been linked to white rice consumption, how can we reconcile that with low diabetes rates just a few decades ago when they ate even more rice? If you look at the Cornell-Oxford-China Project, rural plant-based diets centered around rice were associated with relatively low risk of the so-called diseases of affluence, which includes diabetes. Maybe Asians just genetically don't get the same blood sugar spike when they eat white rice? This is not the case; if anything people of Chinese ethnicity get higher blood sugar spikes.

The rise in these diseases of affluence in China over the last half century has been blamed in part on the tripling of the consumption of animal source foods. The upsurge in diabetes has been most dramatic, and it's mostly just happened over the last decade. That crazy 9.7% diabetes prevalence figure that rivals ours is new--they appeared to have one of the lowest diabetes rates in the world in the year 2000.

So what happened to their diets in the last 20 years or so? Oil consumption went up 20%, pork consumption went up 40%, and rice consumption dropped about 30%. As diabetes rates were skyrocketing, rice consumption was going down, so maybe it's the animal products and junk food that are the problem. Yes, brown rice is better than white rice, but to stop the mounting Asian epidemic, maybe we should focus on removing the cause--the toxic Western diet. That would be consistent with data showing animal protein and fat consumption associated with increased diabetes risk.

But that doesn't explain why the biggest recent studies in Japan and China associate white rice intake with diabetes. One possibility is that animal protein is making the rice worse. If you feed people mashed white potatoes, a high glycemic food like white rice, you can see in my video If White Rice is Linked to Diabetes, What About China? the level of insulin your pancreas has to pump out to keep your blood sugars in check. But what if you added some tuna fish? Tuna doesn't have any carbs, sugar, or starch so it shouldn't make a difference. Or maybe it would even lower the mashed potato spike by lowering the glycemic load of the whole meal? Instead you get twice the insulin spike. This also happens with white flour spaghetti versus white flour spaghetti with meat. The addition of animal protein makes the pancreas work twice as hard.

You can do it with straight sugar water too. If you do a glucose challenge test to test for diabetes, where you drink a certain amount of sugar and add some meat, you get a much bigger spike than without meat. And the more meat you add, the worse it gets. Just adding a little meat to carbs doesn't seem to do much, but once you get up to around a third of a chicken breast's worth, you can elicit a significantly increased surge of insulin. This may help explain why those eating plant-based have such low diabetes rates, because animal protein can markedly potentiate the insulin secretion triggered by carbohydrate ingestion.

The protein exacerbation of the effect of refined carbs could help explain the remarkable results achieved by Dr. Kempner with a don't-try-this-at-home diet composed of mostly white rice and sugar. See my video, Kempner Rice Diet: Whipping Us Into Shape.

Refined grains may also not be good for our blood pressure (see Whole Grains May Work As Well As Drugs).

What should we be eating to best decrease our risk of diabetes? See:

And check out my summary video, How Not to Die from 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:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

What Not to Add to White Rice, Potatoes, or Pasta

What Not to Add to White Rice, Potatoes, or Pasta.jpeg

Rice currently feeds almost half the human population, making it the single most important staple food in the world, but a meta-analysis of seven cohort studies following 350,000 people for up to 20 years found that higher consumption of white rice was associated with a significantly increased risk of type 2 diabetes, especially in Asian populations. They estimated each serving per day of white rice was associated with an 11% increase in risk of diabetes. This could explain why China has almost the same diabetes rates as we do.

Diabetes rates in China are at about 10%; we're at about 11%, despite seven times less obesity in China. Japan has eight times less obesity than we do, yet may have a higher incidence of newly diagnosed diabetes cases than we do--nine per a thousand compared to our eight. They're skinnier and still may have more diabetes. Maybe it's because of all the white rice they eat.

Eating whole fruit is associated with lower risk of diabetes, whereas eating fruit processed into juice may not just be neutral, but actually increases diabetes risk. In the same way, eating whole grains, like whole wheat bread or brown rice is associated with lower risk of diabetes, whereas eating white rice, a processed grain, may not just be neutral, but actually increase diabetes risk.

White rice consumption does not appear to be associated with increased risk of heart attack or stroke, though, which is a relief after an earlier study in China suggested a connection with stroke. But do we want to eat a food that's just neutral regarding some of our leading causes of death, when we can eat whole foods that are associated with lower risk of diabetes, heart attack, stroke, and weight gain?

If the modern diabetes epidemic in China and Japan has been linked to white rice consumption, how can we reconcile that with low diabetes rates just a few decades ago when they ate even more rice? If you look at the Cornell-Oxford-China Project, rural plant-based diets centered around rice were associated with relatively low risk of the so-called diseases of affluence, which includes diabetes. Maybe Asians just genetically don't get the same blood sugar spike when they eat white rice? This is not the case; if anything people of Chinese ethnicity get higher blood sugar spikes.

The rise in these diseases of affluence in China over the last half century has been blamed in part on the tripling of the consumption of animal source foods. The upsurge in diabetes has been most dramatic, and it's mostly just happened over the last decade. That crazy 9.7% diabetes prevalence figure that rivals ours is new--they appeared to have one of the lowest diabetes rates in the world in the year 2000.

So what happened to their diets in the last 20 years or so? Oil consumption went up 20%, pork consumption went up 40%, and rice consumption dropped about 30%. As diabetes rates were skyrocketing, rice consumption was going down, so maybe it's the animal products and junk food that are the problem. Yes, brown rice is better than white rice, but to stop the mounting Asian epidemic, maybe we should focus on removing the cause--the toxic Western diet. That would be consistent with data showing animal protein and fat consumption associated with increased diabetes risk.

But that doesn't explain why the biggest recent studies in Japan and China associate white rice intake with diabetes. One possibility is that animal protein is making the rice worse. If you feed people mashed white potatoes, a high glycemic food like white rice, you can see in my video If White Rice is Linked to Diabetes, What About China? the level of insulin your pancreas has to pump out to keep your blood sugars in check. But what if you added some tuna fish? Tuna doesn't have any carbs, sugar, or starch so it shouldn't make a difference. Or maybe it would even lower the mashed potato spike by lowering the glycemic load of the whole meal? Instead you get twice the insulin spike. This also happens with white flour spaghetti versus white flour spaghetti with meat. The addition of animal protein makes the pancreas work twice as hard.

You can do it with straight sugar water too. If you do a glucose challenge test to test for diabetes, where you drink a certain amount of sugar and add some meat, you get a much bigger spike than without meat. And the more meat you add, the worse it gets. Just adding a little meat to carbs doesn't seem to do much, but once you get up to around a third of a chicken breast's worth, you can elicit a significantly increased surge of insulin. This may help explain why those eating plant-based have such low diabetes rates, because animal protein can markedly potentiate the insulin secretion triggered by carbohydrate ingestion.

The protein exacerbation of the effect of refined carbs could help explain the remarkable results achieved by Dr. Kempner with a don't-try-this-at-home diet composed of mostly white rice and sugar. See my video, Kempner Rice Diet: Whipping Us Into Shape.

Refined grains may also not be good for our blood pressure (see Whole Grains May Work As Well As Drugs).

What should we be eating to best decrease our risk of diabetes? See:

And check out my summary video, How Not to Die from 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:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

What Do All the Blue Zones Have in Common?

Do Flexitarians Live Longer.jpg

What accounts for the benefits of a Mediterranean-style diet? An anatomy of health effects was published, and the single most important component was the high consumption of plant foods. In contrast, fish and seafood consumption, the only animal foods promoted in the Mediterranean diet, did not seem to help.

If you look at four of the major dietary quality scoring systems, which have all been associated with extending lifespan and lowering heart disease and cancer mortality, they all share only four things in common: more fruit, more vegetables, more whole grains and more nuts and beans. They are all built on a common core of a diet rich in plant foods, whereas opposite food patterns, rich in animal foods and poor in plant-based foods (in other words, the Western diet), is associated with higher risks. So we need to optimize the food environment to support whole grains, vegetables, fruit and plant-based proteins.

That's one of the things all the so-called Blue Zones have in common: the longest living populations have not only social support and engagement and daily exercise, but nutritionally they all center their diets around plant foods, reserving meat mostly for special occasions. In fact, the population with perhaps the highest life-expectancy in the world, the California Adventist vegetarians, doesn't eat any meat at all.

So if the primary benefits of the Mediterranean diet are due to all the whole plant foods, what if you went back to the famous PREDIMED study and created a "provegetarian" scoring system? We know vegetarians live longer, but because a pure vegetarian diet might not easily be embraced by many individuals, maybe it would be easier to swallow if we just tell people more plant-based foods and less animal-based foods. But would just moving along the spectrum towards more plants actually enable people to live longer? Researchers thought of this food pattern as a "gentle approach" to vegetarianism, figuring that if it improved survival it would be an easily understandable message for health promotion: more plant foods, less animal foods.

On this scoring system, you get points for eating fruit, vegetables, nuts, grains, beans, olive oil and potatoes, but get docked points for any animal fats, eggs, fish, dairy or any type of meat or meat products. Of course that means you get a higher score the more potato chips and French fries you eat. That's why I prefer the term "whole-food, plant-based diet" since it's defined by what you eat, not by what you don't eat. When I taught at Cornell I had "vegan" students who apparently were trying to live off French fries and beer; vegan does not necessarily mean health-promoting.

But did the provegetarian scoring system work? Regardless of healthy versus unhealthy, if you give points to people for any kind of plant food, processed or not, and detract points for any kind of animal product consumption, people with higher scores live longer. The maximum provegetarian score is 60, but even just scoring 40 or more was associated with a 40 percent drop in mortality. In fact, there were so few deaths in the highest category of adherence to the provegetarian diet, they had to merge the two upper categories for their analysis. This is evidence that simple advice to increase the consumption of plant-derived foods with reductions in the consumption of foods from animal sources confers a survival advantage. You can view the graph in my video Do Flexitarians Live Longer?

The researchers conclude, "this modest change is realistic, affordable, and achievable because a sizable proportion of their population was already eating that way. So one can get significant survival benefit without a radical shift to the exclusive consumption of plant foods, a more gradual and gentle approach which is more easily translatable into public policy." A 41 percent drop in mortality rates in the United States would mean saving the lives of hundreds of thousands of Americans every year.

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

I've done a few videos on the health of so-called semi-vegetarians or flexitarians ("flexible" vegetarians). See how they rate in:

The Provegetarian Score reminds me of the animal to vegetable protein ratio in Prostate Cancer Survival: The A/V Ratio. My favorite dietary quality index is the one in Calculate Your Healthy Eating Score. How do you rate? Even the healthiest among us may be able to continue to push the envelope.

In health,

Michael Greger, M.D.

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

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

What Do All the Blue Zones Have in Common?

Do Flexitarians Live Longer.jpg

What accounts for the benefits of a Mediterranean-style diet? An anatomy of health effects was published, and the single most important component was the high consumption of plant foods. In contrast, fish and seafood consumption, the only animal foods promoted in the Mediterranean diet, did not seem to help.

If you look at four of the major dietary quality scoring systems, which have all been associated with extending lifespan and lowering heart disease and cancer mortality, they all share only four things in common: more fruit, more vegetables, more whole grains and more nuts and beans. They are all built on a common core of a diet rich in plant foods, whereas opposite food patterns, rich in animal foods and poor in plant-based foods (in other words, the Western diet), is associated with higher risks. So we need to optimize the food environment to support whole grains, vegetables, fruit and plant-based proteins.

That's one of the things all the so-called Blue Zones have in common: the longest living populations have not only social support and engagement and daily exercise, but nutritionally they all center their diets around plant foods, reserving meat mostly for special occasions. In fact, the population with perhaps the highest life-expectancy in the world, the California Adventist vegetarians, doesn't eat any meat at all.

So if the primary benefits of the Mediterranean diet are due to all the whole plant foods, what if you went back to the famous PREDIMED study and created a "provegetarian" scoring system? We know vegetarians live longer, but because a pure vegetarian diet might not easily be embraced by many individuals, maybe it would be easier to swallow if we just tell people more plant-based foods and less animal-based foods. But would just moving along the spectrum towards more plants actually enable people to live longer? Researchers thought of this food pattern as a "gentle approach" to vegetarianism, figuring that if it improved survival it would be an easily understandable message for health promotion: more plant foods, less animal foods.

On this scoring system, you get points for eating fruit, vegetables, nuts, grains, beans, olive oil and potatoes, but get docked points for any animal fats, eggs, fish, dairy or any type of meat or meat products. Of course that means you get a higher score the more potato chips and French fries you eat. That's why I prefer the term "whole-food, plant-based diet" since it's defined by what you eat, not by what you don't eat. When I taught at Cornell I had "vegan" students who apparently were trying to live off French fries and beer; vegan does not necessarily mean health-promoting.

But did the provegetarian scoring system work? Regardless of healthy versus unhealthy, if you give points to people for any kind of plant food, processed or not, and detract points for any kind of animal product consumption, people with higher scores live longer. The maximum provegetarian score is 60, but even just scoring 40 or more was associated with a 40 percent drop in mortality. In fact, there were so few deaths in the highest category of adherence to the provegetarian diet, they had to merge the two upper categories for their analysis. This is evidence that simple advice to increase the consumption of plant-derived foods with reductions in the consumption of foods from animal sources confers a survival advantage. You can view the graph in my video Do Flexitarians Live Longer?

The researchers conclude, "this modest change is realistic, affordable, and achievable because a sizable proportion of their population was already eating that way. So one can get significant survival benefit without a radical shift to the exclusive consumption of plant foods, a more gradual and gentle approach which is more easily translatable into public policy." A 41 percent drop in mortality rates in the United States would mean saving the lives of hundreds of thousands of Americans every year.

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

I've done a few videos on the health of so-called semi-vegetarians or flexitarians ("flexible" vegetarians). See how they rate in:

The Provegetarian Score reminds me of the animal to vegetable protein ratio in Prostate Cancer Survival: The A/V Ratio. My favorite dietary quality index is the one in Calculate Your Healthy Eating Score. How do you rate? Even the healthiest among us may be able to continue to push the envelope.

In health,

Michael Greger, M.D.

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

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

The Two Most Active Ingredients of the Mediterranean Diet

Which Parts of the Mediterranean Diet Extended Life.jpg

Olives and nuts are plant foods, and as such, are packed with antioxidants, raising the antioxidant level of our bloodstream resulting in lower fat oxidation and free radical DNA damage, but what's happening inside people's arteries?

Researchers measured the amount of atherosclerotic plaque in the neck arteries going to the brain in folks who for years were eating added nuts, added extra virgin olive oil or neither to their daily diets. In the control group, the plaque got worse, which is what happens when one continues to eat an artery-clogging diet, but there were no significant changes in the added extra virgin olive oil group, and the plaque in the added nut group appeared to get better. The nuts appeared to induce a regression of the disease, or at least a significant delay in the progression. The nut group was still suffering strokes, but only half as many, perhaps because the reduction in plaque height within the arteries on extra nuts was indicating a stabilization of the plaque, rendering them less likely to rupture. You can see these results in my video Which Parts of the Mediterranean Diet Extended Life?

Adding nuts to our diet may also improve endothelial function, boosting the ability of our arteries to dilate naturally by about 30 percent. If you look at the baseline adherence to Mediterranean diet principles and control for things like smoking and exercise, there were only two factors significantly associated with reduced heart attack and stroke risk: more vegetables and more nuts. No significant association with the olive oil, wine, fish or cutting back on soda and cookies. Among the individual components, only increased consumption of vegetables and nuts were related to reduced cardiovascular events.

On the one hand, cutting stroke risk in half just by eating a handful of nuts a day is pretty amazing, but those in the added nut group didn't appear to live any longer overall. This is in contrast to other studies that suggested that frequent nut consumption may extend life. For example, the Harvard health professionals studies, involving a whopping three million person-years of follow-up over decades, found nut consumption associated with fewer deaths from cancer, heart disease, respiratory disease and most importantly fewer deaths overall. This was confirmed by all the other big major prospective studies in a recent review.

So what's going on here with the study showing no longevity benefit from nuts? Did they just not wait long enough? Just because people were randomized to the nut group didn't mean they actually ate more nuts, and those randomized to the other groups didn't necessarily stay away.

If you re-analyze the data comparing the death rates of those who actually ate more nuts to those who actually didn't, nut consumption was indeed associated with significantly reduced risk of death. If you do the same kind of post hoc analysis with olive oil, even with the extra virgin, there is no benefit in terms of living longer. This is consistent with how Ancel Keys, the so-called Father of the Mediterranean diet, viewed olive oil. He thought of its benefit more as a way of just replacing animal fats; anything to get people to eat less lard and butter.

What is the best kind of nut? The greatest benefits were attributed to walnuts, particularly for preventing cancer deaths. Those eating more than three servings of walnuts a week appeared to cut their risk of dying from cancer in half.

Now it's just a matter of communicating the research to the public. All the major cancer groups emphasize a more plant-based diet, remarkably consistent with the World Health Organization guidelines for healthy eating. The far-reaching positive effects of a plant-based diet--including walnuts--may be the most critical message for the public.

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

Think the effects of adding a few nuts to one's daily diet are too good to believe? Check out my video Four Nuts Once a Month. For more on Walnuts and Artery Function check out the video, and for more on nuts and cancer prevention, see Which Nut Fights Cancer Better?

Nuts May Help Prevent Death and so may beans; see Increased Lifespan from Beans. What about Fruits and Longevity: How Many Minutes per Mouthful?

More on protecting ourselves from "brain attacks" in Preventing Strokes with 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:

Image Credit: garlandcannon / Flickr. This image has been modified.

Original Link

The Two Most Active Ingredients of the Mediterranean Diet

Which Parts of the Mediterranean Diet Extended Life.jpg

Olives and nuts are plant foods, and as such, are packed with antioxidants, raising the antioxidant level of our bloodstream resulting in lower fat oxidation and free radical DNA damage, but what's happening inside people's arteries?

Researchers measured the amount of atherosclerotic plaque in the neck arteries going to the brain in folks who for years were eating added nuts, added extra virgin olive oil or neither to their daily diets. In the control group, the plaque got worse, which is what happens when one continues to eat an artery-clogging diet, but there were no significant changes in the added extra virgin olive oil group, and the plaque in the added nut group appeared to get better. The nuts appeared to induce a regression of the disease, or at least a significant delay in the progression. The nut group was still suffering strokes, but only half as many, perhaps because the reduction in plaque height within the arteries on extra nuts was indicating a stabilization of the plaque, rendering them less likely to rupture. You can see these results in my video Which Parts of the Mediterranean Diet Extended Life?

Adding nuts to our diet may also improve endothelial function, boosting the ability of our arteries to dilate naturally by about 30 percent. If you look at the baseline adherence to Mediterranean diet principles and control for things like smoking and exercise, there were only two factors significantly associated with reduced heart attack and stroke risk: more vegetables and more nuts. No significant association with the olive oil, wine, fish or cutting back on soda and cookies. Among the individual components, only increased consumption of vegetables and nuts were related to reduced cardiovascular events.

On the one hand, cutting stroke risk in half just by eating a handful of nuts a day is pretty amazing, but those in the added nut group didn't appear to live any longer overall. This is in contrast to other studies that suggested that frequent nut consumption may extend life. For example, the Harvard health professionals studies, involving a whopping three million person-years of follow-up over decades, found nut consumption associated with fewer deaths from cancer, heart disease, respiratory disease and most importantly fewer deaths overall. This was confirmed by all the other big major prospective studies in a recent review.

So what's going on here with the study showing no longevity benefit from nuts? Did they just not wait long enough? Just because people were randomized to the nut group didn't mean they actually ate more nuts, and those randomized to the other groups didn't necessarily stay away.

If you re-analyze the data comparing the death rates of those who actually ate more nuts to those who actually didn't, nut consumption was indeed associated with significantly reduced risk of death. If you do the same kind of post hoc analysis with olive oil, even with the extra virgin, there is no benefit in terms of living longer. This is consistent with how Ancel Keys, the so-called Father of the Mediterranean diet, viewed olive oil. He thought of its benefit more as a way of just replacing animal fats; anything to get people to eat less lard and butter.

What is the best kind of nut? The greatest benefits were attributed to walnuts, particularly for preventing cancer deaths. Those eating more than three servings of walnuts a week appeared to cut their risk of dying from cancer in half.

Now it's just a matter of communicating the research to the public. All the major cancer groups emphasize a more plant-based diet, remarkably consistent with the World Health Organization guidelines for healthy eating. The far-reaching positive effects of a plant-based diet--including walnuts--may be the most critical message for the public.

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

Think the effects of adding a few nuts to one's daily diet are too good to believe? Check out my video Four Nuts Once a Month. For more on Walnuts and Artery Function check out the video, and for more on nuts and cancer prevention, see Which Nut Fights Cancer Better?

Nuts May Help Prevent Death and so may beans; see Increased Lifespan from Beans. What about Fruits and Longevity: How Many Minutes per Mouthful?

More on protecting ourselves from "brain attacks" in Preventing Strokes with 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:

Image Credit: garlandcannon / Flickr. This image has been modified.

Original Link

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

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

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

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

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

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

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

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

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

For more on the Mediterranean diet, check out:

For more on Dr. Esselstyn's amazing work:

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

In health,

Michael Greger, M.D.

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

Image Credit: wildpixel / Thinkstock. This image has been modified.

Original Link

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

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

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

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

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

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

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

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

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

For more on the Mediterranean diet, check out:

For more on Dr. Esselstyn's amazing work:

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

In health,

Michael Greger, M.D.

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

Image Credit: wildpixel / Thinkstock. This image has been modified.

Original Link

Reducing Glycotoxin Intake to Help Reduce Brain Loss

Reducing Glycotoxin Intake to Prevent Alzheimer's.jpg

Each of us has about six billion miles of DNA. How does our body keep it from getting all tangled up? There are special proteins called histones, which act like spools with DNA as the thread. Enzymes called sirtuins wrap the DNA around the histones and by doing so, silence whatever genes were in that stretch of DNA, hence their name SIRtuins, which stands for silencing information regulator.

Although they were discovered only about a decade ago, the study of sirtuins "has become one of the most promising areas of biomedicine," since they appear to be involved in promoting healthy aging and longevity. Suppression of this key host defense is considered a central feature of Alzheimer's disease, as shown in Reducing Glycotoxin Intake to Prevent Alzheimer's.

Autopsies of Alzheimer's victims reveal that loss of sirtuin activity is closely associated with the accumulation of the plaques and tangles in the brain that are characteristic of Alzheimer's disease. Sirtuin appears to activate pathways that steer the brain away from the formation of plaque and tangle proteins. "Because a decrease in sirtuin activity can clearly have deleterious effects" on nerve health, researchers are trying to come up with drugs to increase sirtuin activity, but why not just prevent its suppression in the first place?

Glycotoxins in our food suppress sirtuin activity, also known as advanced glycation end products, or AGE's. Our modern diet includes excessive AGE's, which can be neurotoxic. High levels in the blood may predict cognitive decline over time. If you measure the urine levels of glycotoxins flowing through the bodies of older adults, those with the highest levels went on to suffer the greatest cognitive decline over the subsequent nine years.

As we age, our brain literally shrinks. In our 60's and 70's, we lose an average of five cubic centimeters of total brain tissue volume every year, but some people lose more than others. Brain atrophy may be reduced in very healthy individuals, and a few people don't lose any brain at all. Normally we lose about 2% of brain volume every year, but that's just the average. Although the average brain loss for folks in their 70's and 80's was 2.1%, some lost more, some lost less, and some men and women lost none at all over a period of four years.

Researchers in Australia provided the first evidence linking AGEs with this kind of cerebral brain loss. So, limiting one's consumption of these compounds may end up having significant public health benefits. Because sirtuin deficiency is both preventable and reversible by dietary AGE reduction, a therapeutic strategy that includes eating less AGE's may offer a new strategy to combat the epidemic of Alzheimer's.

Some glycotoxins are produced internally, particularly in diabetics, but anyone can get them from smoking and eating, particularly foods high in fat and protein cooked at high temperatures. In my video, Avoiding a Sugary Grave, I listed the 15 foods most contaminated with glycotoxins; mostly chicken, but also pork, beef, and fish, which may help explain why those that eat the most meat may have triple the risk of getting dementia compared to long-time vegetarians. Note there are some relatively high fat and protein plant foods such as nuts and soy products, so I no longer recommend toasting nuts and would steer clear from roasted tofu.

I've covered advanced glycation end-products in Glycotoxins, Bacon, Eggs, and Gestational Diabetes During Pregnancy, and Why is Meat a Risk Factor for Diabetes?.

More on slowing brain aging in How to Slow Brain Aging By Two Years.

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

Original Link

Reducing Glycotoxin Intake to Help Reduce Brain Loss

Reducing Glycotoxin Intake to Prevent Alzheimer's.jpg

Each of us has about six billion miles of DNA. How does our body keep it from getting all tangled up? There are special proteins called histones, which act like spools with DNA as the thread. Enzymes called sirtuins wrap the DNA around the histones and by doing so, silence whatever genes were in that stretch of DNA, hence their name SIRtuins, which stands for silencing information regulator.

Although they were discovered only about a decade ago, the study of sirtuins "has become one of the most promising areas of biomedicine," since they appear to be involved in promoting healthy aging and longevity. Suppression of this key host defense is considered a central feature of Alzheimer's disease, as shown in Reducing Glycotoxin Intake to Prevent Alzheimer's.

Autopsies of Alzheimer's victims reveal that loss of sirtuin activity is closely associated with the accumulation of the plaques and tangles in the brain that are characteristic of Alzheimer's disease. Sirtuin appears to activate pathways that steer the brain away from the formation of plaque and tangle proteins. "Because a decrease in sirtuin activity can clearly have deleterious effects" on nerve health, researchers are trying to come up with drugs to increase sirtuin activity, but why not just prevent its suppression in the first place?

Glycotoxins in our food suppress sirtuin activity, also known as advanced glycation end products, or AGE's. Our modern diet includes excessive AGE's, which can be neurotoxic. High levels in the blood may predict cognitive decline over time. If you measure the urine levels of glycotoxins flowing through the bodies of older adults, those with the highest levels went on to suffer the greatest cognitive decline over the subsequent nine years.

As we age, our brain literally shrinks. In our 60's and 70's, we lose an average of five cubic centimeters of total brain tissue volume every year, but some people lose more than others. Brain atrophy may be reduced in very healthy individuals, and a few people don't lose any brain at all. Normally we lose about 2% of brain volume every year, but that's just the average. Although the average brain loss for folks in their 70's and 80's was 2.1%, some lost more, some lost less, and some men and women lost none at all over a period of four years.

Researchers in Australia provided the first evidence linking AGEs with this kind of cerebral brain loss. So, limiting one's consumption of these compounds may end up having significant public health benefits. Because sirtuin deficiency is both preventable and reversible by dietary AGE reduction, a therapeutic strategy that includes eating less AGE's may offer a new strategy to combat the epidemic of Alzheimer's.

Some glycotoxins are produced internally, particularly in diabetics, but anyone can get them from smoking and eating, particularly foods high in fat and protein cooked at high temperatures. In my video, Avoiding a Sugary Grave, I listed the 15 foods most contaminated with glycotoxins; mostly chicken, but also pork, beef, and fish, which may help explain why those that eat the most meat may have triple the risk of getting dementia compared to long-time vegetarians. Note there are some relatively high fat and protein plant foods such as nuts and soy products, so I no longer recommend toasting nuts and would steer clear from roasted tofu.

I've covered advanced glycation end-products in Glycotoxins, Bacon, Eggs, and Gestational Diabetes During Pregnancy, and Why is Meat a Risk Factor for Diabetes?.

More on slowing brain aging in How to Slow Brain Aging By Two Years.

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

Original Link