Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

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

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

The key word is "published."

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was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.

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 Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill.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

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 Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect.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

How could drug companies get away with this?

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

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

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

Of course it matters!

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

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

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

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

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


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

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

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

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

In health,

Michael Greger, M.D.

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

Image Credit: GraphicStock. This image has been modified.

Original Link

Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

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

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

The key word is "published."

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

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

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

How could drug companies get away with this?

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

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

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

Of course it matters!

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

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

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

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

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


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

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

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

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

In health,

Michael Greger, M.D.

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

Image Credit: GraphicStock. This image has been modified.

Original Link

Peeks Behind the Egg Industry Curtain

NF-Mar19 Who Says Eggs Aren't Healthy or Safe?.jpg

The American Egg Board is a promotional marketing board appointed by the U.S. government whose mission is to "increase demand for egg and egg products on behalf of U.S. egg producers." If an individual egg company wants to run an ad campaign, they can say pretty much whatever they want. But if an egg corporation wants to dip into the 10 million dollars the American Egg Board sets aside for advertising every year, because the board is overseen by the federal government, corporations are not allowed to lie with those funds. This leads to quite revealing exchanges between egg corporations that want to use that money and the USDA on what egg companies can and cannot say about eggs.

Thanks to the Freedom of Information Act I was able to get my hands on some of those emails. Of course a lot of what I got were pages with nearly all of the text blacked out (you can see these in my video, Who Says Eggs Aren't Healthy or Safe?). But I did find some illuminating correspondence. For example, one email shows an egg company trying to put out a brochure on healthy snacking for kids. But because of existing laws against false and misleading advertising, the head of the USDA's poultry research and promotion programs reminds the company that eggs or egg products cannot be couched as being healthy or nutritious. "The words nutritious and healthy carry certain connotations, and because eggs have the amount of cholesterol they do, plus the fact that they're not low in fat, [the words healthy and nutritious] are problematic." This is the United States Department of Agriculture saying this!

However, the USDA official helpfully suggests, "I believe you can say something that's just as strong if not stronger, that is 'naturally nutrient-dense.'" Why can we say eggs are nutrient-dense but not nutritious? Because there's no legal definition of nutrient-dense. We can say Twinkies and Coca Cola are nutrient dense, but legally, we can't say something is nutritious unless it's actually... nutritious.

For example, the egg industry wanted to run an ad calling eggs a nutritional powerhouse that aids in weight loss. The USDA had to remind the industry that they can't portray eggs as a diet food because of the fat and cholesterol content. In fact, eggs have nearly twice the calories of anything that can be called "low-calorie."

"Nutritional powerhouse" can't be used either. Fine, the industry said, they'll move to plan B, and headline the ad "Egg-ceptional Nutrition." They couldn't say that either because, again, given the saturated fat and cholesterol you can't legally call eggs nutritious. So the headline ended up as, "Find true satisfaction," and instead of weight loss they had to go with "can reduce hunger." The USDA congratulated them on their cleverness. Yes, a food that when eaten can reduce hunger--what a concept!

They can't even say eggs are "relatively" low in calories. Can't say eggs are low in saturated fat--they're not. Can't say they're relatively low in fat, they're not. Can't even call them a rich source of protein, because, according to the USDA, they're not.

It's illegal to advertise that eggs pack a nutritional wallop, or that they have a high nutritional content. Eggs have so much cholesterol, we can't even say they "contribute nutritionally." Can't say eggs are "healthful," certainly can't say they're "healthy." Can't even say eggs contribute "healthful components."

Since we can't say eggs are a healthy start to the day, the USDA suggests a "satisfying start." Egg corporations can't call eggs a healthy ingredient, but they can call eggs a "recognizable" ingredient. Can't truthfully say eggs are good for us, either. By law, according to the USDA, the egg industry "needs to steer clear of words like 'healthy' or 'nutritious.'"

For a food to be labeled "healthy" under FDA rules, it has to be low in saturated fat (eggs fail that criteria) and have less than 90mg of cholesterol per serving (even half an egg fails that test). For the same reason we can't tout ice cream for strong bones, we can't say eggs are healthy because they exceed the threshold for cholesterol.

Egg corporations aren't even allowed to say things like "Eggs are an important part of a well balanced, healthy diet" on an egg carton because it would be considered misleading according to the USDA's National Egg Supervisor, since eggs contain significant amounts of fat and cholesterol and therefore can contribute to the leading killer in the United States, heart disease.

The industry can't afford to tell the truth about the eggs, or even the hens that lay them. The industry crams five to ten birds in cages the size of a file cabinet their whole lives, but when providing footage to the media, the American Egg Board instructs, "do not show multiple birds in cages--they look too crowded and open us up to activist criticism."

Not only is the industry barred from saying eggs are healthy, they can't even refer to eggs as safe because more than a hundred thousand Americans are food poisoned by Salmonella from eggs every year.

The egg board's response to this egg-borne epidemic is that Salmonella is a naturally occurring bacterium. An internal egg industry memo didn't think that should necessarily be the key message, fearing that "it may be counterproductive by implying there is no avoiding Salmonella in eggs aside from avoiding eggs altogether."

The food poisoning risk is why the American Egg Board can't even mention anything but eggs cooked hard and dry. No soft-boiled, no over-easy, no sunny-side up--because of the Salmonella risk. The American Egg Board's own research showed that the sunny-side up cooking method should be considered "unsafe."

In light of bird flu viruses, both the white and yolk must be cooked firm. The VP of marketing for the Egg Board complained to the USDA saying they'd "really like to not have to dictate that the yolks are firm," and cites a Washington Post article saying runny yolks may be safe for everyone except pregnant women, infants, elderly, or those with chronic disease. It turns out it was a misquote--eggs can't be considered safe for anyone.

Instead of safe, they can call eggs "fresh," the USDA marketing service helpfully suggests. But they can't call eggs safe, and they can't say eggs are "safe to eat." They can't even mention safety at all.

Wait a second, not only can eggs not be called healthy they can't even be called safe? Says who? Says the United States Department of Agriculture.

For more peeks behind the egg industry curtain see:

-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: U.S. Department of Agriculture / Flickr

Original Link

How Avoiding Eggs Could Help You Avoid Diabetes

NF-NovWhat You Need to Know About Preventing Heart Disease.jpg

Type 2 diabetes is becoming a global pandemic. We know the consumption of eggs is related to the development of some other chronic diseases, what about diabetes? There appears to be a stepwise increase in risk as more and more eggs are consumed. One study found that eating just a single egg a week increased the odds of diabetes by 76%. Two eggs a week doubled the odds, and an egg a day tripled the odds.

Recent studies, profiled in my video Eggs and Diabetes, have confirmed the link. In 2009, Harvard researchers found that a single egg a day or more was associated with an increased risk of Type 2 diabetes in men and women. This finding has since been confirmed in Asia in 2011 and in Europe in 2012. Reducing egg consumption should start early in life, though, as it appears once we get into our 70s, it may be too late.

For those with diabetes, eggs may then hasten our death. Eating one egg or more a day appears to shorten anyone's lifespan, but may be even worse for those with diabetes, potentially doubling all-cause mortality, meaning egg-eating diabetics seem to live particularly short lives.

This is not good news for the egg industry. From a transcript of a closed meeting I got through the Freedom of Information Act, one egg industry advisor said, "Given the rate at which obesity and incidence of type II diabetes is growing in the US, any association between dietary cholesterol and type II diabetes could be a 'showstopper' that could overshadow the positive attributes in eggs."

More Freedom of Information Act insights into the egg industry can be found in:

Flax seeds may help control blood sugars (Flaxseeds for Diabetes) as well as Indian gooseberries (Amla Versus Diabetes), but our best bet may be a diet composed entirely of plants (How to Prevent Diabetes and How to Treat Diabetes).

-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 and More Than an Apple a Day, and From Table to Able.

Image Credit: Lif / Flickr

Original Link

Why the Egg-Cancer Link?

NF-Aug21 Why the Egg Cancer-link?.jpg

Two million men in the U.S. are living with prostate cancer -- but that's better than dying from prostate cancer. Catch it when it's localized and the five-year survival is practically guaranteed, but once it really starts spreading, chances drop to one in three. "Thus, identification of modifiable factors that affect the progression of prostate cancer is something that deserves study," noted Dr. Erin Richard and colleagues at Harvard. So, they took more than a thousand men with early stage prostate cancer and followed them for a couple years to see if there was anything in their diet associated with a resurgence of the cancer, such as spreading to the bone.

Compared to men who hardly ate any eggs, men who ate even less than a single egg a day had a significant 2-fold increased risk of prostate cancer progression. The only thing worse was poultry consumption, with up to four times the risk of progression among high-risk men. They think it might be the cooked meat carcinogens that for some reason build up more in chicken and turkey muscle than in other meats. For more on these so-called heterocyclic amines, see my videos: Heterocyclic Amines in Eggs, Cheese, and Creatine?, Estrogenic Cooked Meat Carcinogens, and PhIP: The Three Strikes Breast Carcinogen.

But what about the eggs? Why would less than once-a-day egg consumption double the risk of cancer progression? "A plausible mechanism that may explain the association between eggs and prostate cancer progression is high dietary choline," the researchers suggested. Egg consumption is a determinant of how much choline you have in your blood, and higher blood choline has been associated with a greater risk of getting prostate cancer in the first place. So the choline in eggs may both increase one's risk of getting it and having it spread.

Studies have associated choline consumption not just with getting cancer and spreading cancer, but also with significantly increased risk of dying from it. Those who ate the most had a 70% increased risk of lethal prostate cancer. Another recent study found that men who consumed two and a half or more eggs per week -- that's just like one egg every three days -- had an 81 percent increased risk of lethal prostate cancer.

Maybe that's why meat, milk, and eggs have all been associated with advanced prostate cancer--because of the choline. Choline is so concentrated in cancer cells that doctors can follow choline uptake to track the spread of cancer throughout the body. But why may dietary choline increase the risk of lethal prostate cancer? Dietary choline is converted in the gut to trimethylamine (see my video Carnitine, Choline, Cancer and Cholesterol: The TMAO Connection), so the Harvard researchers speculated that the TMAO from the high dietary choline intake may increase inflammation, which may promote progression of prostate cancer to a lethal disease.

In one of my videos, Eggs and Choline: Something Fishy, I talked about what trimethylamine might do to one's body odor.

In the New England Journal of Medicine, the same Cleveland Clinic research team that did the famous study on carnitine repeated the study, but instead of feeding people a steak, they fed people some hard-boiled eggs. Just as they suspected, a similar spike in that toxic TMAO. So it's not just red meat. And the link between TMAO levels in the blood and strokes, heart attacks, and death was seen even in low-risk groups like those with low-risk cholesterol levels. Thus, because of the choline, eating eggs may increase our risk regardless of what our cholesterol is.

It's ironic that the choline content of eggs is something the egg industry actually boasts about. And the industry is aware of the cancer data. Through the Freedom of Information Act, I was able to get my hands on an email (which you can view in my video, Eggs, Choline, and Cancer) from the executive director of the industry's Egg Nutrition Center to an American Egg Board executive talking about how choline may be a culprit in promoting cancer progression. "Certainly worth keeping in mind," he said, "as we continue to promote choline as another good reason to consume eggs."

With regard to the prevention of prostate cancer progression, chicken and eggs may be the worst foods to eat, but what might be the best? See my video Prostate Cancer Survival: The A/V Ratio.

To prevent prostate cancer in the first place, see videos such as:

What about reversing cancer progression? See Dr. Ornish's work Cancer Reversal Through Diet?, followed up by the Pritikin Foundation: Ex Vivo Cancer Proliferation Bioassay. Flax may help as well (Flaxseed vs. Prostate Cancer).

-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: Christopher Craig / Flickr

Original Link

How Eggs Can Impact Body Odor

NF-Aug14 How Eggs Can Impact Body Odor.jpg

I previously lampooned the egg industry PR campaign that tried to promote eggs as a source of eyesight-saving nutrients such as lutein, by noting that a single spoonful of spinach had as much as nine eggs (see Egg Industry Blind Spot). The reason we'll only hear that egg industry claim on websites and TV shows, and never in an ad or on an egg carton, is because there are laws against false and misleading advertising that don't allow the industry to say eggs contain lutein because there's such an insignificant amount.

In an email I retrieved through the Freedom of Information Act (you can see the email in my video Eggs and Choline: Something Fishy), the head of the USDA's poultry research and promotion programs reminded the egg industry that they can't mention lutein in an egg ad. They can't say it helps people with macular degeneration, and can't even talk about how good lutein is for us since "eggs have such a wee amount, and given eggs' fat and cholesterol content this is a nonstarter for anything but PR." So for public relations, companies can lie through your teeth, but there are laws covering truthfulness in ads.

The industry can't say eggs are a source of omega 3s, iron, or folate either. They can't even honestly call eggs a rich source of protein. The USDA Agriculture Marketing Service suggested that the egg industry instead boast about the choline content of eggs, one of only two nutrients that eggs are actually rich in, besides cholesterol.

So the egg industry switched gears. A priority objective of the American Egg Board became "to make choline out to be an urgent problem and eggs the solution." They outlined how they could partner with a physician's group and write an "advertorial." They developed a number of them for nutrition journals. An advertorial is an advertisement parading as an objective editorial. They sent letters out to doctors arguing that "inadequate intake of choline has tremendous public health implications." So forget about the cholesterol--the "elephant-in-the-room," as the industry calls it--and focus on this conjured epidemic of choline deficiency.

People actually get about twice the choline they need and, in fact, too much choline can be the real problem. For one thing, too much choline can give breath, urine, sweat, saliva, and vaginal secretions an odor resembling rotten fish. Millions of Americans have a genetic defect that causes a fishy body odor and might benefit from a low-choline diet, since choline is converted in our gut into the fishy compound trimethylamine (TMA). Individuals oozing trimethylamine often become vegans because reducing the ingestion of dietary animal products rich in lipids decreases TMA production and the associated noxious odor. The other 99 percent of us, though, can turn the fishy choline compound into trimethylamine oxide, which is 100 times less stinky. We used to think extra choline was harmless for the 99 percent, but not anymore.

Researchers at the Cleveland Clinic found that dietary choline (after it is converted in our gut to trimethylamine and oxidized in our liver to form trimethylamine oxide) may contribute to plaque build-up in people's arteries. This may set us up for heart disease, stroke, and death. Which foods is choline predominantly found in? Eggs, milk, liver, red meat, poultry and fish.

The good news is that this may mean a new approach to prevent or treat heart disease, the most obvious of which would be to limit dietary choline intake. But if that means decreasing egg, meat and dairy consumption, then the new approach sounds an awful lot like the old approach - adopting a plant-based diet.

Choline may be one of the reasons people following the Atkins diet are at increased risk of heart disease whereas a more plant-based diet like Ornish's can instead reverse our number one killer (see Low Carb Diets and Coronary Blood Flow). This new research adds choline to the list of dietary culprits with the potential to increase the risk of heart disease, making eggs a double whammy--the most concentrated common source of both choline and cholesterol.

I previously did a more in depth dive into the choline issue in Carnitine, Choline, Cancer and Cholesterol: The TMAO Connection.

More on eggs and cholesterol in Egg Cholesterol in the Diet and Avoiding Cholesterol Is a No Brainer.

More Freedom of Information Act finds in Eggs and Cholesterol: Patently False and Misleading Claims, Eggs vs. Cigarettes in Atherosclerosis, and probably my favorite, Who Says Eggs Aren't Healthy or Safe?

What else might make one smell fishy? See Bacterial Vaginosis and Diet.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my 2012-2013 live year-in-review presentation Uprooting the Leading Causes of Death.

Image Credit: Shannara00 / Flickr

Original Link

Egg Industry Caught Making False Claims

 

 

 

 

 

 

 

 

Egg Industry Caught Making False Claims

On the basis of concerns from the American Heart Association and consumer groups, the Federal Trade Commission carried out successful legal action—upheld by the Supreme Court—to compel the egg industry to cease and desist from false and misleading advertising that eggs had no harmful effects on health.

Over the years, cholesterol concerns resulted in severe economic loss through a reduction in egg consumption, so the egg industry created a “National Commission on Egg Nutrition” to combat the public health warnings with ads that said things like “There is no scientific evidence whatsoever that eating eggs in any way increases the risk of heart attack.” The U.S. Court of Appeals found such outright deception patently false and misleading.

Even the tobacco industry wasn’t that brazen, trying only to introduce the element of doubt, arguing that the relationship between smoking and health remains an open question. In contrast, the egg ads made seven claims, each of which was determined by the courts to be blatantly false. The Court determined the egg industry ads were "false, misleading, and deceptive." Legal scholars note that, like Big Tobacco, the egg industry did more than just espouse one side of a genuine controversy, but flatly denied the existence of scientific evidence.

Over the last 36 years, the American Egg Board has spent hundreds of millions of dollars to convince people eggs are not going to kill them—and it’s working. From one of their internal strategy documents that I was able to get a hold of: “In combination with aggressive nutrition science and public relations efforts, research shows that the advertising has been effective in decreasing consumers concerns over eggs and cholesterol/heart health.”

Currently, they’re targeting moms. Their approach is to “surround moms wherever they are.” They pay integration fees for egg product placement in TV shows. To integrate eggs into The Biggest Loser, for example, could be a million dollars, according to their internal documents. Getting some kids storytime reading program to integrate eggs may only take half a million, though. The American Egg Board keeps track of who is, and is not, a “friend-of-eggs.” They even pay scientists $1500 to sit and answer questions like, “What studies can help disassociate eggs from cardiovascular disease?”

From the beginning, their arch nemesis was the American Heart Association, with whom they fought a major battle over cholesterol. In documents retrieved through the Freedom of Information Act featured in my 6-min video Eggs and Cholesterol: Patently False and Misleading Claims, you can see even the USDA repeatedly chastises the egg industry for misrepresenting the American Heart Association position. In a draft letter to magazine editors, the egg industry tried to say that the “American Heart Association changed its recommendations to approve an egg a day in 2000 and eventually eliminated its number restrictions on eggs in 2002,” to which the head of USDA’s poultry research and promotion programs had to explain that the “change” in 2000 wasn’t a change at all. Nothing in the guidelines or recommendations was changed. What happened was that in response to a question posed by someone planted in the audience, Heart Association reps acknowledged that even though eggs are among the most concentrated source of cholesterol in the diet, an individual egg has under 300mg of cholesterol and could technically fit under the 300 mg daily limit. In 2002, they eliminated the specific mention of eggs for consistency sake, but the American Heart Association insists that they haven’t changed their position and continue to warn consumers about eggs.

The guidelines on the AHA website at the time explained that since one egg has 213 and the limit for people with normal cholesterol is 300 you could fit an egg in if you cut down on all other animal products. If you have an egg for breakfast, for example, and some coffee, some skinless turkey breast for lunch, etc., you could end up at over 500 by the end of the day, nearly twice the recommended limit. So if you are going to eat an egg, the Heart Association instructed, we would need to "substitute vegetables for some of the meat, drink our coffee black, and watch for hidden eggs in baked goods." Furthermore, the limit for folks with high cholesterol is 200mg a day, which may not even allow a single egg a day.

This is how the senior director of nutrition education at the American Egg Board’s Egg Nutrition Center characterized the American Heart Association guidelines: “Maybe I’m being overly sensitive, but this reads like: ‘If you insist on having those deadly high cholesterol eggs your penalty will be to eat vegetables and you can’t even have the yummy steak and creamy coffee you love. Really it’s not worth eating eggs. Oh, and if you think you’ll be able to enjoy some delicious baked goods, forget it, the deadly eggs are there too!’”

I shared some of my other Freedom of Information Act finds in my other egg videos, Eggs vs. Cigarettes in Atherosclerosis, and my personal favorite, Who Says Eggs Aren’t Healthy or Safe?

I’ve also explored the presence of carcinogenic chemicals in eggs (Heterocyclic Amines in Eggs, Cheese, and Creatine?), carcinogenic viruses (Carcinogenic Retrovirus Found in Eggs), industrial pollutants (Food Sources of Perfluorochemicals and Food Sources of PCB Chemical Pollutants), the egg-borne annual epidemic of Salmonella (Total Recall), arachidonic acid (Chicken, Eggs, and Inflammation), misleading claims about eyesight nutrients (Egg Industry Blind Spot), and, of course, cholesterol (Egg Cholesterol in the Diet and What Women Should Eat to Live Longer).

To my surprise, though, eggs are actually not the most concentrated dietary source of cholesterol. See Avoiding Cholesterol Is a No Brainer.

-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 and More Than an Apple a Day.

Image credit: Nick Wheeler/ Flickr

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