Four Ways to Improve on the Mediterranean Diet

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The traditional Mediterranean diet can be considered mainly, but not exclusively, as a plant-based diet, and certainly not a whole foods, plant-based diet. Olive oil and wine can be considered essentially fruit juices. Even if one is eating a "vegiterranean diet," an entirely plant-based version, there are a number of problematic nutritional aspects that are rarely talked about. For example, the Mediterranean diet includes lots of white bread, white pasta and not a lot of whole grains.

In an anatomy of the health effects of the Mediterranean diet, the single most important component was the high consumption of plant foods. In contrast, high cereal consumption, meaning high grain consumption, did not appear to help. This may be because most grains that modern Mediterranean dieters eat are refined, like white bread, whereas the traditional Mediterranean diet was characterized by unprocessed cereals--in other words, whole grains. And while whole grains have been associated with lower risk of diabetes, heart disease and cancer, refined grain may increase the risk of diabetes, obesity, heart disease and other chronic diseases. In the PREDIMED study, those who ate the most white bread--but not whole grain bread--gained significant weight.

Alcohol may also be a problem. As a plant-centered diet, adherence to a Mediterranean diet is associated with lower cancer risk, but does not appear to lower breast cancer risk. With all the fruits, veggies, nuts, seeds, beans and low saturated fat content, you'd assume there would be lower breast cancer risk, but alcohol is a known breast carcinogen, even in moderate amounts. When researchers created a special adapted version of the Mediterranean diet score that excluded alcohol, the diet does indeed appear to reduce breast cancer risk.

The wonderful grape phytonutrients in red wine can improve our arterial function such that if you drink nonalcoholic red wine (wine with the alcohol removed), you get a significant boost in endothelial function--the ability of our arteries to relax and dilate normally, increasing blood flow. If you drink the same red wine with alcohol, it abolishes the beneficial effect and counteracts the benefit of the grape phytonutrients. So, it would be better just to eat grapes. You can find more information about this in my video Improving on the Mediterranean Diet.

Similarly, there are components of extra virgin olive oil--the antioxidant phytonutrients, that may help endothelial function, but when consumed as oil, (even extra virgin olive oil), it may impair arterial function. So even if white bread dipped in olive oil is the very symbol of the Mediterranean diet, we can modernize it by removing oils and refined grains.

Another important, albeit frequently ignored issue in the modern Mediterranean diet is sodium intake. Despite evidence linking salt intake to high blood pressure, heart disease and strokes, dietary salt intake in the U.S. is on the rise. Right now, Americans get about seven to ten grams a day, mostly from processed foods. If we were to decrease that just by three grams every year, we could possibly save tens of thousands of people from having a heart attack, prevent tens of thousands of strokes, and tens of thousands of deaths. There is a common misperception that only certain people should reduce their salt intake and that for the vast majority of the population, salt reduction is unnecessary, but in reality, the opposite is true.

There is much we can learn from the traditional Mediterranean diet. A defining characteristic of the Mediterranean diet is an abundance of plant foods, but one thing that seems to have fallen by the wayside. No main Mediterranean meal is replete without lots of greens, a key part of not only a good Mediterranean diet, but of any good diet.

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

I touch more on whole grains in How Many Meet the Simple Seven? and Whole Grains May Work As Well As Drugs.

More on breast cancer and alcohol in Breast Cancer and Alcohol: How Much Is Safe?, Preventing Skin Cancer From the Inside Out, and Breast Cancer Risk: Red Wine v. White Wine.

I've touched on olive oil in the other videos in this Mediterranean diet series, but also have an older video Extra Virgin Olive Oil vs. Nuts and more recently, Olive Oil & Artery Function.

More on sodium in Dietary Guidelines: With a Grain of Big Salt, Big Salt - Getting to the Meat of the Matter, and Can Diet Protect Against Kidney Cancer? But what if without salt everything tastes like cardboard? Not to worry! See Changing Our Taste Buds.

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.

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Four Ways to Improve on the Mediterranean Diet

Improving on the Mediterranean Diet.jpg

The traditional Mediterranean diet can be considered mainly, but not exclusively, as a plant-based diet, and certainly not a whole foods, plant-based diet. Olive oil and wine can be considered essentially fruit juices. Even if one is eating a "vegiterranean diet," an entirely plant-based version, there are a number of problematic nutritional aspects that are rarely talked about. For example, the Mediterranean diet includes lots of white bread, white pasta and not a lot of whole grains.

In an anatomy of the health effects of the Mediterranean diet, the single most important component was the high consumption of plant foods. In contrast, high cereal consumption, meaning high grain consumption, did not appear to help. This may be because most grains that modern Mediterranean dieters eat are refined, like white bread, whereas the traditional Mediterranean diet was characterized by unprocessed cereals--in other words, whole grains. And while whole grains have been associated with lower risk of diabetes, heart disease and cancer, refined grain may increase the risk of diabetes, obesity, heart disease and other chronic diseases. In the PREDIMED study, those who ate the most white bread--but not whole grain bread--gained significant weight.

Alcohol may also be a problem. As a plant-centered diet, adherence to a Mediterranean diet is associated with lower cancer risk, but does not appear to lower breast cancer risk. With all the fruits, veggies, nuts, seeds, beans and low saturated fat content, you'd assume there would be lower breast cancer risk, but alcohol is a known breast carcinogen, even in moderate amounts. When researchers created a special adapted version of the Mediterranean diet score that excluded alcohol, the diet does indeed appear to reduce breast cancer risk.

The wonderful grape phytonutrients in red wine can improve our arterial function such that if you drink nonalcoholic red wine (wine with the alcohol removed), you get a significant boost in endothelial function--the ability of our arteries to relax and dilate normally, increasing blood flow. If you drink the same red wine with alcohol, it abolishes the beneficial effect and counteracts the benefit of the grape phytonutrients. So, it would be better just to eat grapes. You can find more information about this in my video Improving on the Mediterranean Diet.

Similarly, there are components of extra virgin olive oil--the antioxidant phytonutrients, that may help endothelial function, but when consumed as oil, (even extra virgin olive oil), it may impair arterial function. So even if white bread dipped in olive oil is the very symbol of the Mediterranean diet, we can modernize it by removing oils and refined grains.

Another important, albeit frequently ignored issue in the modern Mediterranean diet is sodium intake. Despite evidence linking salt intake to high blood pressure, heart disease and strokes, dietary salt intake in the U.S. is on the rise. Right now, Americans get about seven to ten grams a day, mostly from processed foods. If we were to decrease that just by three grams every year, we could possibly save tens of thousands of people from having a heart attack, prevent tens of thousands of strokes, and tens of thousands of deaths. There is a common misperception that only certain people should reduce their salt intake and that for the vast majority of the population, salt reduction is unnecessary, but in reality, the opposite is true.

There is much we can learn from the traditional Mediterranean diet. A defining characteristic of the Mediterranean diet is an abundance of plant foods, but one thing that seems to have fallen by the wayside. No main Mediterranean meal is replete without lots of greens, a key part of not only a good Mediterranean diet, but of any good diet.

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

I touch more on whole grains in How Many Meet the Simple Seven? and Whole Grains May Work As Well As Drugs.

More on breast cancer and alcohol in Breast Cancer and Alcohol: How Much Is Safe?, Preventing Skin Cancer From the Inside Out, and Breast Cancer Risk: Red Wine v. White Wine.

I've touched on olive oil in the other videos in this Mediterranean diet series, but also have an older video Extra Virgin Olive Oil vs. Nuts and more recently, Olive Oil & Artery Function.

More on sodium in Dietary Guidelines: With a Grain of Big Salt, Big Salt - Getting to the Meat of the Matter, and Can Diet Protect Against Kidney Cancer? But what if without salt everything tastes like cardboard? Not to worry! See Changing Our Taste Buds.

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.

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Are Raisins a Good Snack Choice?

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Raisins, like all fruits, have a variety of health benefits, but dried fruit is higher in calories per serving than fresh, so might they contribute to weight gain? A study done by the University of Connecticut helped set people's minds at ease. Men and women were assigned to consume a cup of raisins a day for six weeks and were able to successfully offset the consumption of other foods in their diets such that they experienced no significant change in weight or waist circumference. What about in kids? I explore that in the video, Are Raisins Good Snacks for Kids?.

Leave it to the California Raisin Marketing Board to dream up a study titled, "An after-school snack of raisins lowers cumulative food intake in young children." Sounds good, right? They compared raisins to potato chips and chocolate chip cookies. They gave kids raisins, grapes, chips or cookies and said they could eat as much as they wanted and surprise surprise kids ate less fruit and more junk, but I guess naming the paper "Kids Prefer Cookies" would not have garnered the same kind of sponsor approval.

This reminds me of another study they did showing that regular consumption of raisins may reduce blood sugar levels... compared to fudge cookies and Oreos. Another study showed raisins caused less of a blood sugar spike than Coca-cola and candy bars. Though you can tell it was not funded by Big Raisin by their conclusion, "whether the general public should be advised to snack on fruit rather than on candy bars requires further debate and investigation."

Comparing raisins to chips and cookies was similarly unhelpful. Luckily, a less biased study was published by researchers at the University of Toronto. Nine to eleven year old boys and girls were told to eat all the grapes or raisins they wanted 30 minutes before a meal in which they could eat all the pizza they wanted. If you just gave them the meal, no snack, they ate 837 calories worth of pizza. If you gave them all-you-can-eat grapes before the meal, they ate 128 calories of grapes, but that seemed to fill them up a bit, so they ended up eating less pizza. But because they ate the snack and the meal they ended up getting more calories over all. Still, grape calories are better than pizza calories, but when given raisins instead, they ate even more snack calories, but the raisins were evidently so satiating that they ate so much less pizza that they ate fewer calories over all.

Now I know as parents there's a concern that if our kids eat snacks it might spoil their dinner, but when the snacks are fruit and the meal is a pepperoni and three cheese pizza, the more we can ruin their appetite, the better.

Raisin marketers aren't the only one's trying game the scientific method. Check out:

How to help get our kids to eat their fruits and veggies:

More dried fruit studies (my fave is dried mango):

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

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The Role of Caffeine in Artery Function

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There are dietary guidelines for food, but what about for beverages? A Beverage Guidance Panel was "assembled to provide guidance on the relative health and nutritional benefits and risks of various beverage categories." They ranked them from one to six, and water was ranked number one.

Soda ranked last at number six. Whole milk was grouped with beer, with a recommendation for zero ounces a day, in part out of concern for links between milk and prostate cancer, as well as aggressive ovarian cancer due to IGF-1. Number two on the list, though, after water, was tea and coffee, preferably without creamer or sweetener.

Even without creamer, though, lots of unfiltered coffee can raise cholesterol, but the cholesterol-raising compounds are trapped by the paper filter in brewed coffee, so filtered coffee is probably better.

But about ten years ago, a study was published on the effects of coffee on endothelial function, the function of our arteries. I profile this study in my video Coffee and Artery Function, showing that within 30 minutes of drinking a cup of coffee there was a significant drop in the ability of our arteries to dilate, whereas decaf did not seem to have a significant effect. This was the first study to demonstrate an acute unfavorable effect on arterial function of caffeinated coffee, but one cup of decaf didn't seem to affect performance. And two cups of decaf appeared to have a beneficial effect. So maybe it's a "battle between caffeine and antioxidants." Something in caffeinated coffee appears to be hurting arterial function, whereas something in decaf appears to be helping.

It's similar to red wine. De-alcoholized red wine significantly improves arterial function, as there are grape components trying to help, but the presence of alcohol counteracts and erases the benefit.

Drinking really high antioxidant coffee, by preparing it Greek style for example (where we actually drink the grounds), coffee drinkers may actually be at an advantage

It might not be the caffeine in caffeinated coffee that appears to be harmful, though. In a randomized, double-blind, placebo-controlled, cross-over study, researchers found that caffeine alone--about two and a half cups of coffee worth--significantly improved arterial function in both people with and without heart disease.

Coffee contains more than a thousand different compounds other than caffeine, many of which are also removed by the decaffeination process, so there must be something else in the coffee bean that's causing the problem. In fact, caffeine may even enhance the repair of the fragile inner lining of our arteries by enhancing the migration of our endothelial progenitor cells, the stem cells that patch up potholes in our artery walls.

But how might we get the potential benefit of caffeine without the risky compounds in caffeinated coffee? Tea consumption enhances artery function, and there are substantial beneficial effects of both green tea and black tea. Instead of other components in tea leaves undermining caffeine's potential benefits, they appear to boost the benefit in healthy individuals, as well as heart disease patients, reversing some of their arterial dysfunction, both immediately and long-term.

All the measurements in the studies I've talked about so far were done on the brachial artery, the main artery in the arm (just because it's easier to get to). What we care about, though, is blood flow to the heart. And caffeine appears to impair blood flow to our heart muscle during exercise even in healthy folks, but especially in those with heart disease. Thankfully caffeine in tea form appears to have the opposite effect, significantly improving coronary blood flow, suggesting that tea consumption has a beneficial effect on coronary circulation, though the addition of milk may undermine the protective effects.

I'm fascinated by how complicated such a simple question can get. The take-home is that water is the healthiest beverage, followed by tea.

The effects of coffee on cancer risk are more salutary:

I've previously covered Walnuts and Artery Function and Dark Chocolate and Artery Function. Stay tuned for a few more coming up further exploring the effects of tea, olive oil, and plant-based diets on our lovely endothelium.

Low Carb Diets and Coronary Blood Flow is one of the few other studies I've done that measured blood flow within the coronary arteries themselves. For more background on the brachial artery test, see my video The Power of NO.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

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Why Smoothies are Better Than Juicing

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Studies such as a recent Harvard School of Public Health investigation found that the consumption of whole fruits is associated with a significantly lower risk of type 2 diabetes, whereas fruit juice consumption is associated with a higher risk, highlighting the dramatic difference between eating whole fruits and drinking fruit juice. Cholesterol serves as another example. If we eat apples, our cholesterol drops. On the other hand, if we drink apple juice, our cholesterol may actually go up a little. Leaving just a little of the fiber behind--as in cloudy apple juice--was found to add back in some of the benefit.

We used to think of fiber as just a bulking agent that helps with bowel regularity. We now know fiber is digestible by our gut bacteria, which make short chain fatty acids (SCFAs) out of it. SCFAs have a number of health promoting effects, such as inhibiting the growth of bad bacteria and increasing mineral absorption. For example, experimentally infused into the rectum of the human body, SCFAs can stimulate calcium absorption, so much so that we can improve the bone mineral density of teenagers just by giving them the fiber naturally found in foods like onions, asparagus, and bananas.

Our good bacteria also uses fiber to maintain normal bowel structure and function, preventing or alleviating diarrhea, stimulating colonic blood flow up to five-fold, and increasing fluid and electrolyte uptake. The major fuel for the cells that line our colon is butyrate, which our good bacteria make from fiber. We feed them, and they feed us right back.

If the only difference between fruit and fruit juice is fiber, why can't the juice industry just add some fiber back to the juice? The reason is because we remove a lot more than fiber when we juice fruits and vegetables. We also lose all the nutrients that are bound to the fiber.

In the 1980's, a study (highlighted in my video, Juicing Removes More Than Just Fiber) found a discrepancy in the amount of fiber in carob using two different methods. A gap of 21.5 percent was identified not as fiber but as nonextractable polyphenols, a class of phytonutrients thought to have an array of health-promoting effects. Some of the effects associated with the intake of dietary fiber in plants may actually be due to the presence of these polyphenols.

Nonextractable polyphenols, usually ignored, are the major part of dietary polyphenols. Most polyphenol phytonutrients in plants are stuck to the fiber. These so-called missing polyphenols make it down to our colon, are liberated by our friendly flora and can then get absorbed into our system. The phytonutrients in fruit and vegetable juice may just be the tip of the iceberg.

For those that like drinking their fruits and vegetables, these findings suggest that smoothies may be preferable. I can imagine people who eat really healthy thinking they get so much fiber from their regular diet that they need not concern themselves with the loss from juicing. But we may be losing more than we think.

For those that like drinking their fruits and vegetables, this suggests smoothies are preferable. I can imagine people who eat really healthy thinking they get so much fiber from their regular diet that they need not concern themselves with the loss from juicing, but they may be losing more than they think.

Why are polyphenol phytonutrients important? See, for example, my video How to Slow Brain Aging by Two Years

Not that fiber isn't important in its own right. Check out:

For more on smoothies, check out:

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: Craig Sunter / Flickr

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How to Suppress the Aging Enzyme TOR

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Over the last decade, more than 5,000 papers have been published about TOR, an engine-of-aging enzyme inhibited by the drug rapamycin. (What is TOR? Check out my videos Why Do We Age? and Caloric Restriction vs. Animal Protein Restriction.) Rapamycin has been used experimentally to extend lifespan, but is already in use clinically to prevent the rejection of kidney transplants. Patients who received rapamycin due to renal transplantation had a peculiar "side effect," a decrease in cancer incidence. In a set of 15 patients who had biopsy proven Kaposi's sarcoma (a cancer that often affects the skin), all cutaneous sarcoma lesions disappeared in all patients within three months after starting rapamycin therapy.

TOR functions as a master regulator of cellular growth and proliferation. For example, TOR is upregulated in nearly 100% of advanced human prostate cancers (See Prevent Cancer From Going on TOR). So, reductions in cancerous lesions after rapamycin therapy make sense. TOR may also be why dairy consumption has been found to be a major dietary risk factor for prostate cancer. We used to think it was just the hormones in milk, but maybe prostate cancer initiation and progression is also promoted by cow's milk stimulation of TOR.

Our understanding of mammalian milk has changed from a simple food to a "species-specific endocrine signaling system," which activates TOR, promoting cell growth and proliferation and suppressing our body's internal housecleaning mechanisms. Normally, milk-mediated TOR stimulation is restricted only to infancy where we really need that constant signal to our cells to grow and divide. So from an evolutionary perspective, "the persistent 'abuse' of the growth-promoting signaling system of cow's milk by drinking milk over our entire life span may maintain the most important hallmark of cancer biology, sustained proliferative signaling."

TOR appears to play a role in breast cancer, too. Higher TOR expression has been noted in breast cancer tumors, associated with more aggressive disease, and lower survival rate among breast cancer patients. Altered TOR expression could explain why women hospitalized for anorexia may end up with only half the risk of breast cancer. Severe caloric restriction in humans may confer protection from invasive breast cancer by suppressing TOR activation.

We don't have to starve ourselves to suppress TOR; just reducing animal protein intake can attenuate overall TOR activity. Moreover, diets emphasizing plants, especially cruciferous vegetables, have both decreased TOR activation from animal proteins and provide natural plant-derived inhibitors of TOR found in broccoli, green tea, soy, turmeric, and grapes, along with other fruits and vegetables such as onions, strawberries, blueberries, mangoes and the skin of cucumbers.

The downregulation of TOR may be one reason why plant-based in general are associated with lower risk for many cancers. "Are we finally on the threshold of being able to fundamentally alter human aging and age-related disease?" asks researchers in the journal Nature. Only time will tell, but if the pace and direction of recent progress are any indication, the next 5,000 studies on TOR should prove very interesting indeed.

More on dairy and prostate cancer in Prostate Cancer and Organic Milk vs. Almond Milk.

This story continues in my video: Saving Lives By Treating Acne With 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, From Table to Able, and Food as Medicine.

Image Credit: Grempz / Flickr

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How to Treat Gout With Diet

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The Washington State Fruit Commission, our largest cherry producer, can fund reviews that cherry-pick studies on the anti-inflammatory effects of cherries in a petri dish and animal models. But what we've needed are human studies. For example, if we stuff the human equivalent of up to a thousand cups of cherries down the throats of rats, it appears to have an anti-inflammatory effect, but we could never eat that many. (In fact, if we tried, it could end badly. One poor guy who ate 500 cherries whole--without spitting out the pits--ended up fatally obstructing his colon.)

A decade ago, we didn't have many human studies, but thankfully now we do. A study published in The Journal of Nutrition had men and women eat about 45 cherries a day for a month (I wouldn't mind being part of that study!). The researchers found a 25% drop in C-reactive protein levels (a marker of inflammation), as well as an inflammatory protein with an inelegant acronym RANTES ("Regulated on, Activation, Normal, T cell, Expressed and, Secreted"). Even a month after the study ended there appeared to be residual anti-inflammatory benefit from the cherry fest.

These subjects were all healthy, with low levels of inflammation to begin with, but a follow-up study, highlighted in my video, Gout Treatment with a Cherry on Top, on folks with higher levels found similar results for C-reactive protein and for a number of other markers for chronic inflammatory diseases. Do cherries then help people who actually have a chronic inflammatory disease?

Back in 1950, in an obscure Texas medical journal, "observations made by responsible physicians" suggested that in a dozen patients with gout, eating half a pound of fresh or canned cherries helped prevent flares of gout. But the issue had never seriously been tested, until recently. Gout is an excruciatingly painful inflammatory arthritis caused by the crystallization of uric acid within joints. Based on the National Health and Nutrition Examination Survey 2007-2008, the prevalence of gout in the US is estimated to be 3.9% among US adults, which translates into 8.3 million people.

Hundreds of gout sufferers were studied, and cherry intake was associated with a 35% lower risk of gout attacks, with over half the risk gone at three servings measured over a two day period (about 16 cherries a day). That's the kind of efficacy the researchers saw with a low-purine diet (uric acid is a break-down product of purines). This same research group found that purine intake of animal origin increased the odds for recurrent gout attacks by nearly five-fold. Heavy alcohol consumption isn't a good idea either.

There are some high-purine non-animal foods, like mushrooms and asparagus, but they found no significant link to plant sources of purines. So the researchers recommended eliminating meat and seafood from the diet. This may decrease risk substantially, and adding cherries on top may decrease risk of gout attacks even further. Same thing with the leading drug: allopurinol works, but adding produce appears to work even better.

Often, dietary changes and cherries may be all patients have, as doctors are hesitant to prescribe uric acid-lowering drugs like allopurinol due to rare but serious side-effects.

In addition to fighting inflammation, cherries may also lower uric acid levels. Within five hours of eating a big bowl of cherries, uric acid levels in the blood significantly drop. At the same time, antioxidant levels in the blood go up. So is it just an antioxidant effect? Would other fruit work just as well? No. Researchers tried grapes, strawberries, and kiwi fruit, and none significantly lowered uric acid levels, supporting a specific anti-gout effect of cherries.

There are some new gout drugs out now, costing up to $2,000 per dose and carry a "risk of toxicity that may be avoided by using nonpharmacologic treatments or prevention in the first place." Given the potential harms and high costs, attention ought to be directed to dietary modification, reducing alcohol and meat intake, particularly sardines and organ meats. "If life serves up a bowl of cherries (consumed on a regular basis), the risk of a recurrent gout attack may be meaningfully reduced."

More about the inflammation fighting effects of sweet cherries in my video Anti-inflammatory Life is a Bowl of Cherries.

I've previously mentioned gout and controlling uric acid levels in my videos:

Other foods that may help tamp down inflammation:

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: Valdemar Fishmen / Flickr

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Why Certain Plant Compounds May Mimic Dietary Restriction

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A new concept, called xenohormesis, has arisen to explain the mystery of why so many plant molecules interact with and modulate key regulators of our physiology in ways that are beneficial to our health (explained further in my video, Xenohormesis: What Doesn't Kill Plants May Make Us Stronger).

Basically, hormesis is the biological principle of "no pain, no gain." Mild stresses like exercise can trigger a protective response that leads to strengthened defenses in the long run. But instead of exposing ourselves to the stressor to trigger our bodies' defenses and shore up protection against future stressors, why not let plants take the hit? Let the plants get stressed because, incredibly, the stress response molecules in plants may activate the same protective responses in humans. Xenohormesis "explains how environmentally stressed plants produce bioactive compounds that can confer stress resistance and survival benefits to animals that consume them." We can piggyback off of their sophisticated stress response. Indeed, the majority of known health-beneficial effects of edible plants are attributable to the pharmacologically active substances of plants' stress responses.

Hormesis may be why dietary restriction can lead to lifespan extension. The mild stress placed upon the body by not eating enough may activate a wide variety of protective pathways within the body, ramping up anti-inflammatory and antioxidant defenses. Our bodies are preparing themselves for the coming famine they think is about to occur. So is there a way to exploit the benefits of dietary restriction to prevent chronic disease? Obviously, "chronically restricting food intake is not a realistic health strategy for the majority of people--it's hard for most people to even cut food intake 10-20%, [given the powerful evolutionary drive to eat]. A more feasible alternative may be to activate dietary restriction-induced stress response pathways by other means."

In other words, xenohormesis.

If we starve plants, they do the same thing mammals do: activate preservation pathways. So let's let the plant face the adversity to create the molecules that trigger cell stress resistance, alter metabolism, and improve disease resistance, and then just come along and appropriate them for the same uses in our own bodies.

The reason phytonutrients like resveratrol in grapes, curcumin in the spice turmeric, and ECGC in green tea are called "dietary restriction mimetics" is that they mimic the physiological effects of dietary restriction. This may be no coincidence, because the plants produced these compounds to save their own green butts from scarcity. So instead of having to walk around starving all the time, thanks to xenohormesis, we may be able to let the plants bear the brunt and enable us to harness other species' hardships as a means to promote our own health.

If this subject interests you, make sure you see my video where I introduce the topic: Appropriating Plant Defenses.

I previously introduced the concept of hormesis in my videos Enhanced Athletic Recovery Without Undermining Adaptation and Is Liquid Smoke Carcinogenic?

How else might we get the benefits of dietary restriction without starving ourselves? See:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my videos for free by clicking here and watch my full 2012 - 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: KylaBorg / Flickr

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How Humans Benefit From Stressed Plants

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Plants live the ultimate sedentary lifestyle--most of us usually think of plants more as objects than as organisms. Because plants can't move, they've had to evolve a whole other way to escape threats to their well-being. Plants can "sense and respond dynamically to all sorts of stimuli: chemical concentrations in the air and soil, water, touch, motion, vibration, pathogens, predators, and, of course, light." How do they respond? Biochemically. They manufacture, from scratch, a dizzying array of compounds to deal with specific threats.

If we get too hot, we can move into the shade. If plants get too hot, they're stuck--they are the shade! As a result, "the complexity of the plant stress response humbles that of animals. Plants and their stress response have been evolving for almost a billion years." And in that time they've created a whole chemistry lab of protective substances, some of which can induce similarly protective responses in those of us who eat them.

The "best grapes in terms of health benefit often grow in relatively dry, sun-exposed, infertile soil. Similarly, drought-stressed strawberries have more antioxidants and phytonutrients. Indeed, commonly consumed foods like lettuce and fruits can be nutritionally enhanced by cold stress, light stress, water deficit, or nutrient deficit stress." Why are stressed plants often the healthiest?

Studies (such as those highlighted in my video, Appropriating Plant Defenses) suggest that plants and animals largely share the same molecular pathways in order to respond to stress, so it's conceivable that a molecule produced in plants can also be effective in people. Plants have DNA; humans have DNA. The UV rays in sunlight can damage the DNA in plants in the same way it can damage our DNA (by creating free radicals). Plants figured out how to cook up all these complex antioxidants, and instead of reinventing the wheel, animals can just expropriate those antioxidants from plants and commandeer them for the same purpose.

We get attacked by bacteria; plants get attacked by bacteria. When a particular fungus is getting muscled in on by bacteria, it creates a molecule called penicillin--provided free for us.

When plants get infected, they produce aspirin (See Aspirin Levels in Plant Foods), which can come in handy when we get infected. Plants heal wounds; we heal wounds, using similar fatty-acid signaling systems. It is "increasingly evident that plants and animals differ less than we thought in how we respond to stimuli, sharing elements of fatty acid, protein, steroidal, neurotransmitter, free radical, nitric oxide, and even plant growth hormone signaling systems." So in a sense, we're just opening up nature's drug store when we pull out the crisper in our fridge.

This whole co-evolution concept reminds me of Human Neurotransmitters In Plants and The Broccoli Receptor: Our First Line of Defense.

More on the power of plants in Power Plants.

Some of the wilder things that Phytochemicals: The Nutrition Facts Missing from the Label can do are explored in:

We evolved eating a lot of plants: Paleolithic Lessons.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my videos for free by clicking here and watch my full 2012 - 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

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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

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