How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That's the topic of How to Treat High Blood Pressure with Diet.

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend lifestyle modification as the first-line treatment. If that doesn't work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What's wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don't treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one's weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it's not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not vegetarian? We've known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I've talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. In rural Africa, the elderly have perfect blood pressure as opposed to hypertension. What both diets share in common is that they're plant-based day-to-day, with meat only eaten on special occasion.

How do we know it's the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low were those eating strictly plant-based diets, coming out about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it "palatable" to the general public.

You can see what they were thinking. Just like drugs never work--unless you actually take them. Diet never work--unless you actually eat them. So what's the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with a compromise diet you can imagine how they were thinking that on a population clae they might be doing more good. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it's time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it's the added plant foods--not the changes in oil, sweets, or dairy--that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we're already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you'd have to eat around 2 pounds a day. Sounds like my kind of medicine, but it's hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don't seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.

The DASH diet is one of the best studied, and it consistently ranks as US News & World Report's #1 diet. It's one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I've talked about the patronizing attitude many doctors have that patients can't handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, see:

In health,

Michael Greger, M.D.

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

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

Original Link

How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That's the topic of How to Treat High Blood Pressure with Diet.

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend lifestyle modification as the first-line treatment. If that doesn't work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What's wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don't treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one's weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it's not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not vegetarian? We've known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I've talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. In rural Africa, the elderly have perfect blood pressure as opposed to hypertension. What both diets share in common is that they're plant-based day-to-day, with meat only eaten on special occasion.

How do we know it's the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low were those eating strictly plant-based diets, coming out about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it "palatable" to the general public.

You can see what they were thinking. Just like drugs never work--unless you actually take them. Diet never work--unless you actually eat them. So what's the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with a compromise diet you can imagine how they were thinking that on a population clae they might be doing more good. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it's time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it's the added plant foods--not the changes in oil, sweets, or dairy--that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we're already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you'd have to eat around 2 pounds a day. Sounds like my kind of medicine, but it's hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don't seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.

The DASH diet is one of the best studied, and it consistently ranks as US News & World Report's #1 diet. It's one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I've talked about the patronizing attitude many doctors have that patients can't handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, see:

In health,

Michael Greger, M.D.

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

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

Original Link

Flax Seeds Can Have Profound Effect on Hypertension

NF-Nov1 Flax Seeds for Hypertension copy.jpg

A recent article in the journal, Meat Science, acknowledged that a sector of the population perceives meat as a food that is detrimental to their health because of studies associating meat consumption with heart disease and cancer. So, the article continues, meat consumers may look for healthier food alternatives as a means to maintain good health, which represents a good opportunity for the meat industry to develop some new products. The industry felt that natural foods could be added to meat to reach those health-oriented consumers by boosting antioxidants levels, for example. Foods like flax seeds and tomatoes are healthy, associated with reduced risks of cancer and cardiovascular disease. So by making flax-y tomato burgers, they figure they can reduce saturated fat intake and maybe eat less sugar somehow. Wouldn't it be easier to just cut out the middle-cow and eat flax seeds ourselves?

Flax seeds have been described as a "miraculous defense against some critical maladies." I'm a fan of flax, but this title seemed a bit over-exuberant; I figured something just got lost in translation, but then I found a prospective, double-blinded, placebo-controlled, randomized trial--you know how hard that is in a nutrition study? For drugs, it's easy: you have two identical looking pills, one's active, one's placebo, and until the end of the study, neither the researcher nor the patient has any idea which is which, hence "double blind." But people tend to notice what they're eating. So how did they sneak a quarter cup of ground flax seeds into half of the people's diets without them knowing? They created all these various flax or placebo containing foods, and even added bran and molasses to match the color and texture, so it was all a big secret until six months later when they broke the code to see who ate which.

Why test it on hypertension? Because having a systolic blood pressure over 115--that's the top number--may be the single most important determinant for death in the world today. If you take a bunch of older folks, most of them on an array of blood pressure pills, and don't improve their diet at all, despite the drugs, they may start out on average hypertensive and stay hypertensive six months later. But those who were unknowingly eating ground flaxseeds every day, dropped their systolic blood pressure about ten points, and their diastolic, the lower number, by about seven points. That might not sound like a lot, but a drop like that could cut stroke risk 46 percent and heart disease 29 percent, and that ten point drop in the top number could have a similar effect on strokes and heart attacks. And for those that started out over 140, they got a 15-point drop.

In summary, flaxseed induced one of the most potent antihypertensive effects ever achieved by a dietary intervention. In other words, the magnitude of this decrease in blood pressure demonstrated by dietary flaxseed, is as good or better than other nutritional interventions and comparable to many drugs, which can have serious side effects. And they're not exaggerating about the comparable to drugs bit. The flax dropped systolic and diastolic up to 15 and 7. Compare that to powerful ACE inhibitors like Vasotec, which may only drop pressures five and two, and calcium channel blockers like Norvasc or Cardizem which drop pressures eight and three. Side effects of these drugs include a large list of serious medical issues, as seen in my video Flax Seeds for Hypertension, compared to the side effect of flax seeds, "its pleasant nutty flavor."

During the six-month trial there were strokes and heart attacks in both groups, though. Even if the flax seeds can cut risk in half, any avoidable risk is unacceptable. Isn't high blood pressure just inevitable as we get older? No - the prevalence of hypertension does increase dramatically with age, but not for everyone. People who eat more plant-based diets or keep their salt intake low enough tend not to exhibit any change in blood pressure with advancing age. It's always better to prevent the disease in the first place.

And that's not all flax can do. Check out:

Hibiscus tea may help with high blood pressure as well: Hibiscus Tea vs. Plant-Based Diets for Hypertension

Diet can also play an important role in preventing heart disease (How Not to Die from Heart Disease and One in a Thousand: Ending the Heart Disease Epidemic) and diabetes (How Not to Die from Diabetes and Plant-Based Diets and Diabetes). In some cases diet can even reverse some of the worst ravages of high blood pressure: How Not to Die from High Blood Pressure and Kempner Rice Diet: Whipping Us Into Shape.

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: Veganbaking.net / Flickr

Original Link

Preventing Breast Cancer with Flax Seeds

NF-May24 Can Flax Seeds Help Prevent Breast Cancer?.jpeg

I've previously discussed the role of dietary lignans in the reduction of breast cancer risk and improvement in breast cancer survival, based on studies that showed that women with breast cancer who ate the most lignans appeared to live longer (Flaxseeds & Breast Cancer Survival: Epidemiological Evidence and Flaxseeds & Breast Cancer Survival: Clinical Evidence). However, lignans are found throughout the plant kingdom--in seeds, whole grains, vegetables, fruits, berries--so how do we know lignans aren't merely a marker for the intake of unrefined plant foods? For example, those who eat lots of plants--vegetarians--have about eight times the lignan intake than omnivores.

In a petri dish, lignans have been shown to both have direct anticancer growth activity against human breast cancer cells and to prevent cancer cell migration. But it wasn't until 2005 that it was put to the test in people. Researchers from the University of Toronto conducted a randomized double-blind placebo-controlled clinical trial (as seen in my video, Can Flax Seeds Help Prevent Breast Cancer?) of flaxseeds, the world's most concentrated source of lignans in breast cancer patients. The researchers found that flax appears to have the potential to reduce human breast tumor growth in just a matter of weeks. Therefore, I started recommending ground flax seeds to breast cancer patients.

Can lignans also help prevent breast cancer in the first place? High lignan intake is associated with reduced breast cancer risk, but again lignan intake may just be saying an indicator of high plant food intake in general. So researchers from the University of Kansas gave women at high risk for breast cancer a teaspoon of ground flaxseeds a day for a year, and found on average a drop in precancerous changes in the breast.

What about women who regularly eat flax seeds? Outside of an experimental setting, there just weren't a lot of women eating flax seeds regularly to study--until now. Matching 3,000 women with breast cancer to 3,000 women without, a study published in Cancer Causes and Control found that consumption of flaxseed (and of flax bread) was associated with a 20-30 percent reduction in breast cancer risk. The researchers note that, as flaxseeds are packed with lignans, only a small daily serving of flaxseed is required to attain the level of lignan intake associated with a reduction in breast cancer risk. Researchers concluded: "As it appears that most women do not consume flaxseed and that small amounts may be associated with reduced breast cancer risk, interventions to increase the prevalence of flaxseed consumption might be considered."

The latest review summarizes the association between flax and decreased risk of breast cancer, better mental health, and lower mortality among breast cancer patients. The only other study of flax and brain health I'm aware of was an exploration of 100 commonly used drugs and supplements on cognition in older adults, which found that flax is one of the few things that appears to help.

How else may flaxseeds aid in preventing and treating breast cancer? There's an inflammatory molecule called interleukin-1, which may help tumors feed, grow, and invade. Our bodies therefore produce an interkeukin-1 receptor antagonist, binding to the IL-1 receptor and blocking the action of IL-1. The activity of this protective inhibitor can be boosted with the drug tamoxifen--or by eating flax seed. In premenopausal women, the proinflammatory profile of interleukin-1 can be counteracted by a dietary addition of a few spoonfuls of ground flax. One month of flax may be able to increase the anti-inflammatory inhibitor levels by over 50 percent, better even than the drug.

Yes, having one's ovaries removed may reduce breast cancer risk as much as 60 percent, but at the cost of severe side-effects. The drug tamoxifen may reduce the incidence of breast cancer by more than 40 percent, but may induce other severe side effects such as uterine cancer and blood clots. That's why less toxic (even safe!) breast cancer preventive strategies such as dietary modifications need to be developed. These lignan phytoestrogens in flaxseeds may be one successful route given the data showing reduced breast cancer risk and improved overall survival.

Lignans are not a magic bullet to prevent breast cancer--we can't just sprinkle some flax on your bacon cheeseburger--but as a part of a healthy diet and life-style, they might help to reduce breast cancer risk in the general population.

Flaxseeds may also help fight hormone-mediated cancers in men. See Flaxseed vs. Prostate Cancer and Was It the Flaxseed, Fat Restriction, or Both?

What else can these puppies do? See:

I have another 100+ videos on breast cancer if you want to become an expert and help take care of yourself and/or the women in your life. Here's a few recent ones to get you started:

In health,
Michael Greger, M.D.

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

Image Credit: Alisha Vargas / Flickr

Original Link

How to Treat Prediabetes with Diet

NF-May3 Lifestyle Medicine Is the Standard of Care for Prediabetes.jpeg

For people with prediabetes, lifestyle modification is considered "the cornerstone of diabetes prevention." Diet-wise, this means individuals with prediabetes or diabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. Too many of us consume a diet with too many solid fats and added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.

Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, and the official standards of care for the American Diabetes Association. Dietary strategies include reducing intake of fat and increasing intake of fiber (meaning unrefined plant foods, including whole grains).

The recommendation to consume more whole grains is based on research showing that eating lots of whole grains is associated with reduced risk of developing type 2 diabetes. New research even suggests that whole grains may protect against prediabetes in the first place.

According to the American Diabetes Association's official standards of care (which you can see in my video Lifestyle Medicine Is the Standard of Care for Prediabetes), dietary recommendations should focus on reducing saturated fat, cholesterol and trans fat intake (meat, dairy, eggs and junk food). Recommendations should also focus on increasing omega 3's, soluble fiber and phytosterols, all three of which can be found together in flax seeds; an efficient, but still uncommon, intervention for prediabetes. In one study, about two tablespoons of ground flax seed a day decreased insulin resistance (the hallmark of the disease).

If the standards of care for all the major diabetes groups say that lifestyle is the preferred treatment for prediabetes because it's safe and highly effective, why don't more doctors do it? Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about one in three patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.

It may be because doctors aren't getting paid to do it. Why haven't reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns.

"The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?"

How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education "has not changed since 1910."


I hope my work is helping to fill the gap that medical professionals are not getting during training about preventing and treating chronic disease. That's actually how this all started. I would make trips to Countway at the beginning of every month in medical school to read all the new journal issues. I felt I had a duty to my patients to stay on top of the literature. But hey, since I'm doing so much work, might as well share it! So what started as an email newsletter morphed into a medical school speaking tour into a DVD series and then now all online for everyone.

For more on preventing and treating prediabetes/diabetes, see:

For more on lifestyle medicine:

And for insight into the sad state of nutrition in medical training, Doctors Know Less Than They Think About Nutrition and Medical School Nutrition Training.

In health,
Michael Greger, M.D.

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

Image Credit: Alden Chadwick / Flickr

Original Link

How to Treat Prediabetes with Diet

NF-May3 Lifestyle Medicine Is the Standard of Care for Prediabetes.jpeg

For people with prediabetes, lifestyle modification is considered "the cornerstone of diabetes prevention." Diet-wise, this means individuals with prediabetes or diabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. Too many of us consume a diet with too many solid fats and added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.

Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, and the official standards of care for the American Diabetes Association. Dietary strategies include reducing intake of fat and increasing intake of fiber (meaning unrefined plant foods, including whole grains).

The recommendation to consume more whole grains is based on research showing that eating lots of whole grains is associated with reduced risk of developing type 2 diabetes. New research even suggests that whole grains may protect against prediabetes in the first place.

According to the American Diabetes Association's official standards of care (which you can see in my video Lifestyle Medicine Is the Standard of Care for Prediabetes), dietary recommendations should focus on reducing saturated fat, cholesterol and trans fat intake (meat, dairy, eggs and junk food). Recommendations should also focus on increasing omega 3's, soluble fiber and phytosterols, all three of which can be found together in flax seeds; an efficient, but still uncommon, intervention for prediabetes. In one study, about two tablespoons of ground flax seed a day decreased insulin resistance (the hallmark of the disease).

If the standards of care for all the major diabetes groups say that lifestyle is the preferred treatment for prediabetes because it's safe and highly effective, why don't more doctors do it? Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about one in three patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.

It may be because doctors aren't getting paid to do it. Why haven't reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns.

"The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?"

How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education "has not changed since 1910."


I hope my work is helping to fill the gap that medical professionals are not getting during training about preventing and treating chronic disease. That's actually how this all started. I would make trips to Countway at the beginning of every month in medical school to read all the new journal issues. I felt I had a duty to my patients to stay on top of the literature. But hey, since I'm doing so much work, might as well share it! So what started as an email newsletter morphed into a medical school speaking tour into a DVD series and then now all online for everyone.

For more on preventing and treating prediabetes/diabetes, see:

For more on lifestyle medicine:

And for insight into the sad state of nutrition in medical training, Doctors Know Less Than They Think About Nutrition and Medical School Nutrition Training.

In health,
Michael Greger, M.D.

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

Image Credit: Alden Chadwick / Flickr

Original Link

Breast Cancer Cells Feed on Cholesterol

NF-Jul14 Cholesterol Feeds Breast Cancer Cells.jpg

One in eight American women will be diagnosed with breast cancer in her lifetime. There are a number of compounds in plant foods that may protect against breast cancer by a variety of mechanisms. I've talked about the benefits of broccoli, flaxseeds, and soy foods before (See Breast Cancer Survival Vegetable, Flaxseeds & Breast Cancer Prevention, and Breast Cancer Survival and Soy) but a recent German study reported something new. The researchers found that sunflower and pumpkin seeds were associated with reduced breast cancer risk. They initially chalked the association up to the lignans in the seeds (See Breast Cancer Survival and Lignan Intake), but their lignan lead didn't pan out. Maybe it's the phytosterols found concentrated in seeds? (See Optimal Phytosterol Source).

There is evidence that phytosterols may be anticancer nutrients and play a role in reducing breast cancer risk. I thought phytosterols just lowered cholesterol? (See How Phytosterols Lower Cholesterol) What does cancer have to do with cholesterol?

Increasing evidence demonstrates the role that cholesterol may play in the development and progression of breast cancer. Cancer feeds on cholesterol. Transformed cells take up LDL, so-called "bad" cholesterol, and it's capable of stimulating the growth of human breast cancer cells in a petri dish.

The ability to accumulate fat and cholesterol may enable cancer cells to take advantage of people eating high fat and high cholesterol diets and at least partially explain the benefit of a low-fat diet on lowering human breast cancer recurrence. Although the data has been mixed, the largest study to date (highlighted in my video, Cholesterol Feeds Breast Cancer Cells) found a 17% increased breast cancer risk in women who had a total cholesterol over 240 compared to women whose cholesterol was under 160. However, the researchers could not rule out that there may be something else in cholesterol-raising foods that's increasing breast cancer risk.

Tumors suck up so much cholesterol that LDL has been considered a vehicle for delivering antitumor drugs to cancer cells. Since cancer feeds on cholesterol, maybe we could stuff some chemo into it like a Trojan horse poison pill?

The uptake of LDL into tumors may be why people's cholesterol levels drop low after they get cancer--the tumor is eating it up. In fact, patient survival may be lowest when cholesterol uptake is highest. "High LDL receptor content in breast cancer tissue seems to indicate a poor prognosis, [suggesting] that breast tumors rich in LDL receptors may grow rapidly [in the body]." We've known about this for decades. You can tell that wass an old study because, when it was published in the '80s, only 1 in 11 American women got breast cancer.

If cholesterol increases breast cancer risk, what about the use of cholesterol-lowering drugs? See Statin Cholesterol Drugs and Invasive Breast Cancer.

More videos on broccoli and soy's protective effects against breast cancer:

Some I didn't mention include:

-Michael Greger, M.D.

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

Image Credit: Andrew Bennett / Flickr

Original Link

Treating Asthma With Plants vs. Pills

NF-July7 Treating Asthma with Plants vs. Supplements.jpg

In my video Treating Asthma With Fruits and Vegetables, I highlighted a landmark study on manipulating antioxidant intake in asthma. The study found that just a few extra fruits and vegetables a day can powerfully reduce asthma exacerbation rates. If the antioxidants in the plants are ameliorating asthma, then why can't we take antioxidant pills instead? Because antioxidant pills don't appear to work.

Studies using antioxidant supplements on respiratory or allergic diseases have mostly shown no beneficial effects. This discrepancy between data relating to fruit and vegetable intake compared with those using antioxidant supplements may indicate the importance of the whole food, rather than individual components. For example, in the Harvard Nurse's Health Study, women who got the most vitamin E from their diet appeared to be at half the risk for asthma, (which may help explain why nut consumption is associated with significantly lower rates of wheezing), but vitamin E supplements did not appear to help.

Men who eat a lot of apples appear to have superior lung function, as do kids who eat fresh fruit every day, as measured by FEV1 (basically how much air you can forcibly blow out in one second). The more fruit, salad, and green vegetables kids ate, the greater their lung function appeared.

Researchers are "cautious about concluding which nutrient might be responsible." There's vitamin C in fruits, salads, and green vegetables, but there are lots of other antioxidants, such as "vitamin P," a term used to describe polyphenol phytonutrients found in grapes, flax seeds, beans, berries, broccoli, apples, citrus, herbs, tea, and soy. Polyphenol phytonutrients can directly bind to allergenic proteins and render them hypoallergenic, allowing them to slip under our body's radar. If this first line of defense fails, polyphenols can also inhibit the activation of the allergic response and prevent the ensuing inflammation, and so may not only work for prevention, but for treatment as well.

Most of the available evidence is weak, though, in terms of using supplements containing isolated phytonutrients to treat allergic diseases. We could just give people fruits and vegetables to eat, but then we couldn't perform a double-blind study to see if they work better than placebo. Some researchers decided to use pills containing plant food extracts. Plant extracts are kind of a middle ground. They are better than isolated plant chemicals, but are not as complete as whole foods. Still, since we can put whole foods in a capsule, we can compare the extracts to fake sugar pills that look and feel the same to see if they have an effect.

The first trial involved giving people extracts of apple skins. I've talked about the Japan's big cedar allergy problem before (See Alkylphenol Endocrine Disruptors and Allergies), so apple extract pills were given every day for a few months starting right before pollen season started. The results were pretty disappointing. They found maybe a little less sneezing, but the extract didn't seem to help their stuffy noses or itchy eyes.

What about a tomato extract? A randomized, double-blind, placebo-controlled eight-week trial was performed on perennial allergic rhinitis, this time not for seasonal pollen, but for year-round allergies to things like dust-mites. There are lots of drugs out there, but you may have to take them every day year-round, so how about some tomato pills instead? After oral administration of tomato extract for eight weeks, there was a significant improvement of total nasal symptom scores, combined sneezing, runny nose and nasal obstruction, with no apparent adverse effects.

Would whole tomatoes work even better? If only researchers would design an experiment directly comparing phytonutrient supplements to actual fruits and vegetables head-to-head against asthma, but such a study had never been done... until now. The same amazing study, highlighted in my video, Treating Asthma with Plants vs. Supplements?, that compared the seven-fruit-and-vegetables-a-day diet to the three-fruit-and-vegetables-a-day diet, after completion of its first phase, commenced a parallel, randomized, controlled supplementation trial with capsules of tomato extract, which boosted the power of five tomatoes in one little pill, and the study subjects were given three pills a day.

Who did better, the group that ate seven servings of actual fruits and vegetables a day, or the group that ate three servings a day but also took 15 supposed serving equivalents in pill form? The pills didn't help at all. Improvements in lung function and asthma control were evident only after increased fruit and vegetable intake, which suggests that whole-food interventions are most effective. Both the supplements and increased fruit and vegetable intake were effective methods for increasing carotenoid concentrations in the bloodstream, but who cares? Clinical improvements--getting better from disease--were evident only as a result of an increase in plant, not pill, consumption. The results provide further evidence that whole-food approaches should be used to achieve maximum efficacy of antioxidant interventions.

And if this is what a few more plants can do, what might a whole diet composed of plants accomplish? See Treating Asthma and Eczema with Plant-Based Diets.

I also dealt with preventing asthma in the first place: Preventing Asthma With Fruits and Vegetables.

The theme of whole foods being more efficacious than supplements seems to come up over and over again. See for example:

More on "vitamin P" in How to Slow Brain Aging by Two Years.

The anti-inflammatory effects of nuts may explain the Harvard Nurse's Health Study finding: Fighting Inflammation in a Nut Shell.

-Michael Greger, M.D.

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

Image Credit: Mike Mozart / Flickr

Original Link

Who Should be Careful About Curcumin?

NF-Feb5 Who Shouldn't Consume Curcumin or Turmeric?.jpg

Following flax and wheatgrass, turmeric is the third best-selling botanical dietary supplement, racking up $12 million in sales. Currently, sales are increasing at a rate of 20%.

"Curcumin is a natural plant product extracted from the turmeric root and is used commonly as a food additive popular for its pleasant mild aroma and exotic yellow color. It is widely considered unlikely to cause side effects." However, just because something is natural doesn't mean it's not toxic. Strychnine is natural; cyanide is natural. Lead, mercury and plutonium are all elements--can't get more natural than that! But turmeric is just a plant. Surely plants can't be dangerous? Tell that to Socrates.

"In considering the validity of the widely accepted notion that complementary and alternative medicine is a safer approach to therapy, we must remind ourselves and our patients that a therapy that exerts a biologic effect is, by definition, a drug and can have toxicity." It cannot be assumed that diet-derived agents will be innocuous when administered as pharmaceutical formulations at doses likely to exceed those consumed in the diet.

Traditional Indian diets may include as much as a teaspoon of turmeric a day. Doses of turmeric that have been used in human studies range from less than just a 16th of a teaspoon a day to two tablespoons a day for over a month. On the other hand, the curcumin trials have used up to the amount found in cups of the spice, around 100 times more than what curry lovers have been eating for centuries.

Studies have yet to show overt serious side effects in the short-term. However, if we combine high dose curcumin with black pepper, resulting in a 2000% boost in bioavailability (See Boosting the Bioavailability of Curcumin), it could be like consuming the equivalent of 29 cups of turmeric a day. That kind of intake could bring peak blood levels to the range where you start seeing some significant DNA damage in vitro.

So just incorporating turmeric into your cooking may be better than taking curcumin supplements, especially during pregnancy. The only other contraindication cited in the most recent review on curcumin was the potential to trigger gallbladder pain in individuals with gallstones.

If anything, curcumin may help protect liver function and help prevent gallstones by acting as a cholecystokinetic agent, meaning that it facilitates the pumping action of the gallbladder to keep the bile from stagnating. In one study, profiled in my video, Who Shouldn't Consume Turmeric or Curcmin?, researchers gave people a small dose of curcumin, about the amount found in a quarter teaspoon of turmeric and, using ultrasound, were able to visualize the gallbladder squeezing down in response, with an average change in volume of about 29%. Optimally, though we want to squeeze it in half. So the researchers repeated the experiment with different doses. It took about 40 milligrams to get a 50% contraction, or about a third of a teaspoon of turmeric every day.

On one hand that's great--totally doable. On the other hand, that's some incredibly powerful stuff! What if you had a gallbladder obstruction? What if you had a stone blocking your bile duct? If you eat something that makes your gallbladder squeeze so much, it could cause pain. So patients with biliary tract obstruction should be careful about consuming curcumin. For everyone else, these results suggest that curcumin can effectively "induce the gallbladder to empty and thereby reduce the risk of gallstone formation and ultimately even gallbladder cancer."

Too much turmeric, though, may increase the risk of kidney stones. As I mentioned in Oxalates in Cinnamon, turmeric is high in soluble oxalates which can bind to calcium and form insoluble calcium oxalate, which is responsible for approximately 75% of all kidney stones. "The consumption of even moderate amounts of turmeric would therefore not be recommended for people with a tendency to form kidney stones." Such folks should restrict the consumption of total dietary oxalate to less than 40 to 50 mg/day, which means no more than at most a teaspoon of turmeric. Those with gout, for example, are by definition, it appears, at high risk for kidney stones, and so if their doctor wanted to treat gout inflammation with high dose turmeric, he or she might consider curcumin supplements, because to reach high levels of curcumin in turmeric form would incur too much of an oxalate load.

If we are going to take a supplement, how do we choose? The latest review recommends purchasing from Western suppliers that follow recommended Good Manufacturing Practices, which may decrease the likelihood of buying an adulterated product.

I previously discussed the role spices play in squelching inflammation and free radicals in Which Spices Fight Inflammation? and Spicing Up DNA Protection. Then out of the lab into the clinic with attempts to test the ability of turmeric extracts to treat joint inflammation with Turmeric Curcumin and Rheumatoid Arthritis and Turmeric Curcumin and Osteoarthritis.

I wish there was more science on wheatgrass. I just had that one unhelpful anecdote in my video How Much Broccoli Is Too Much? There is good science on flax though. See:

More on gallbladder health can be found in my video Cholesterol Gallstones. And those who are susceptible to kidney stones should try to alkalinize their urine by eating lots of dark green leafy vegetables. See Testing Your Diet with Pee & Purple Cabbage.

Based on this new science on turmeric (lots more to come!), I now try to include it in my family's daily diet.

-Michael Greger, M.D

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

Image Credit: sean dreilinger / Flickr

Original Link

How Important Is It to Eat Breakfast?

Healthy Breakfast Ideas for Busy People

Skipping breakfast is tempting for time management, especially if you're still sleepy, worried about arriving at a meeting on time, or getting children dressed and out the door with homework in tow. Yet years of research with both adults and children in the U.S., Europe, and Australia show that eating breakfast is important for health and energy levels. When apple on books_small.jpgyou look at your productivity across the whole day, eating soon after getting up is a worthwhile investment of effort.

WHAT DOES THE EVIDENCE SHOW?

Hungry children do not perform as well in school as their classmates who have breakfast. Eating before school starts leads to improved academic results, better classroom behavior, and a lower tendency to be sick later in the day. Based on this research, the Federal government has established the subsidized School Breakfast Program to help assure that students start the day with food, regardless of their family circumstances.

Skipping breakfast is associated with a greater risk of being overweight or obese in both children and adults. People who skip breakfast are more likely to crave higher-calorie foods later in the day. Those who eat breakfast tend to burn more calories and be more physically active before lunch.

Studies have found other health risks of not eating breakfast include:

  • Increased cardiac risk factors, such as hypertension and high cholesterol
  • Greater likelihood of developing type 2 diabetes

Why is eating breakfast so important? Researchers don't have a definitive answer, but the basics of human biology suggest a possible solution to this puzzle. Under ordinary circumstances, glucose (a type of sugar) is the only energy source your brain uses. If you are fasting or not eating enough carbohydrates, the brain develops a limited ability to use ketones (acids made when you use fat for energy).

However, your brain always runs most effectively on and always requires some glucose. Red blood cells, which carry oxygen to every cell in the body, are powered exclusively by glucose and have no ability to burn any other fuel.

When you have not eaten in several hours, the glucose from your last meal will be used up, yet you cannot live without this essential energy source. What's your body to do?

Click here to find out how your body makes sure you have the needed glucose, plus tips for plant-healthy, convenient breakfasts

Original Link