High Blood Pressure: Normal but Not Natural

High Blood Pressure - Normal but Not Natural.jpeg

The most comprehensive and systematic analysis of causes of death ever undertaken allows us to answer questions like, how many lives could we save if people cut back on soda? The answer is 299,521. Soft drinks aren't just bad because they're empty calories. More than just not being a health-promoting item, soda appears to be an actively death-promoting item. Of course, it's not as deadly as processed meats such as bacon, bologna, ham, or hot dogs, which account for about 800,000 deaths every year--killing twice as many women as domestic violence and five times more people than all illegal drugs combined.

On the other hand, eating more whole grains could save 1.7 million lives. And more vegetables could save 1.8 million lives every year. If only we ate more nuts and seeds, we'd save 2 and a half million lives. But fruit is apparently what the world needs most (they didn't look at beans) with 4.9 million lives hanging in the balance every year. The cure is not drugs or vaccines; the cure is fruit. The #1 dietary risk factor for death in the world may be not eating enough fruit.

One reason why plant-based diets can save so many millions is because the #1 killer risk factor in the world is high blood pressure, laying to waste nine million people year after year. In the United States, high blood pressure affects nearly 78 million--that's one in three of us. As we age our pressures get higher and higher, such that by age 60, it strikes more than half of that population. If it affects most of us when we get older, maybe it's less a disease and more just a natural, inevitable consequence of getting older?

No.

We've known for nearly a century that high blood pressure need never occur. Researchers measured the blood pressure of a thousand people in rural Kenya. Up until age 40, the blood pressures of rural Africans were about the same as Europeans and Americans, down around 120's over 80's, but as Westerners age, our pressures creep up such that by age 60 the average person is hypertensive, exceeding 140 over 90. But the pressures of those in rural Africa improved with age; not only did they not develop hypertension, their blood pressures actually got better.

The 140/90 cut-off is arbitrary. Just like studies that show the lower our cholesterol the better--there's really no safe level above about 150--blood pressure studies also support a "lower the better" approach. Even people who start out with blood pressure under 120/80 appear to benefit from blood pressure reduction. The ideal blood pressure, the no-benefit-from-reducing-it-further blood pressure, appears to be 110/70. Is it possible to get blood pressures under 110 over 70? It's not just possible, it can be normal for those eating healthy enough diets (see How Not to Die from High Blood Pressure).

Over two years at a rural Kenyan hospital, 1,800 patients were admitted. How many cases of high blood pressure were found? Zero. Wow. They must have had low rates of heart disease. Actually, they had no rates of heart disease. Not low risk--no risk. Not a single case of arteriosclerosis was found.

Having a "normal" blood pressure may set you up for dying from "normal" causes such as heart attacks and strokes. For more on this concept, see When Low Risk Means High Risk. It's like having a normal cholesterol level (see Optimal Cholesterol Level).

It seems high blood pressure is a choice. Like cavities: Cavities and Coronaries: Our Choice.

Even end-stage malignant hypertension can be reversed with diet (thereby demonstrating it was the diet and not other lifestyle factors that protected traditional plant-based populations). See Kempner Rice Diet: Whipping Us Into Shape.

Flax seeds, hibiscus tea, whole grains, and nitrate-rich vegetables may offer additional protection:

Why not just take the drugs? See The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure. And be sure to check out my summary video, How Not to Die from High Blood Pressure, as well as The Evidence that Salt Raises Blood Pressure.

In health,

Michael Greger, M.D.

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

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

Original Link

High Blood Pressure: Normal but Not Natural

High Blood Pressure - Normal but Not Natural.jpeg

The most comprehensive and systematic analysis of causes of death ever undertaken allows us to answer questions like, how many lives could we save if people cut back on soda? The answer is 299,521. Soft drinks aren't just bad because they're empty calories. More than just not being a health-promoting item, soda appears to be an actively death-promoting item. Of course, it's not as deadly as processed meats such as bacon, bologna, ham, or hot dogs, which account for about 800,000 deaths every year--killing twice as many women as domestic violence and five times more people than all illegal drugs combined.

On the other hand, eating more whole grains could save 1.7 million lives. And more vegetables could save 1.8 million lives every year. If only we ate more nuts and seeds, we'd save 2 and a half million lives. But fruit is apparently what the world needs most (they didn't look at beans) with 4.9 million lives hanging in the balance every year. The cure is not drugs or vaccines; the cure is fruit. The #1 dietary risk factor for death in the world may be not eating enough fruit.

One reason why plant-based diets can save so many millions is because the #1 killer risk factor in the world is high blood pressure, laying to waste nine million people year after year. In the United States, high blood pressure affects nearly 78 million--that's one in three of us. As we age our pressures get higher and higher, such that by age 60, it strikes more than half of that population. If it affects most of us when we get older, maybe it's less a disease and more just a natural, inevitable consequence of getting older?

No.

We've known for nearly a century that high blood pressure need never occur. Researchers measured the blood pressure of a thousand people in rural Kenya. Up until age 40, the blood pressures of rural Africans were about the same as Europeans and Americans, down around 120's over 80's, but as Westerners age, our pressures creep up such that by age 60 the average person is hypertensive, exceeding 140 over 90. But the pressures of those in rural Africa improved with age; not only did they not develop hypertension, their blood pressures actually got better.

The 140/90 cut-off is arbitrary. Just like studies that show the lower our cholesterol the better--there's really no safe level above about 150--blood pressure studies also support a "lower the better" approach. Even people who start out with blood pressure under 120/80 appear to benefit from blood pressure reduction. The ideal blood pressure, the no-benefit-from-reducing-it-further blood pressure, appears to be 110/70. Is it possible to get blood pressures under 110 over 70? It's not just possible, it can be normal for those eating healthy enough diets (see How Not to Die from High Blood Pressure).

Over two years at a rural Kenyan hospital, 1,800 patients were admitted. How many cases of high blood pressure were found? Zero. Wow. They must have had low rates of heart disease. Actually, they had no rates of heart disease. Not low risk--no risk. Not a single case of arteriosclerosis was found.

Having a "normal" blood pressure may set you up for dying from "normal" causes such as heart attacks and strokes. For more on this concept, see When Low Risk Means High Risk. It's like having a normal cholesterol level (see Optimal Cholesterol Level).

It seems high blood pressure is a choice. Like cavities: Cavities and Coronaries: Our Choice.

Even end-stage malignant hypertension can be reversed with diet (thereby demonstrating it was the diet and not other lifestyle factors that protected traditional plant-based populations). See Kempner Rice Diet: Whipping Us Into Shape.

Flax seeds, hibiscus tea, whole grains, and nitrate-rich vegetables may offer additional protection:

Why not just take the drugs? See The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure. And be sure to check out my summary video, How Not to Die from High Blood Pressure, as well as The Evidence that Salt Raises Blood Pressure.

In health,

Michael Greger, M.D.

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

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

Original Link

Antioxidant- and Folate-Rich Foods for Depression

Antioxidant- and Folate-Rich Foods for Depression.jpeg

According to the Centers for Disease Control and Prevention, the rates of all of our top 10 killers have fallen or stabilized except for one, suicide. As shown in my video, Antioxidants & Depression, accumulating evidence indicates that free radicals may play important roles in the development of various neuropsychiatric disorders including major depression, a common cause of suicide.

In a study of nearly 300,000 Canadians, for example, greater fruit and vegetable consumption was associated with lower odds of depression, psychological distress, self-reported mood and anxiety disorders and poor perceived mental health. They conclude that since a healthy diet comprised of a high intake of fruits and vegetables is rich in anti-oxidants, it may consequently dampen the detrimental effects of oxidative stress on mental health.

But that study was based on asking how many fruits and veggies people ate. Maybe people were just telling the researchers what they thought they wanted to hear. What if you actually measure the levels of carotenoid phytonutrients in people's bloodstreams? The same relationship is found. Testing nearly 2000 people across the United States, researchers found that a higher total blood carotenoid level was indeed associated with a lower likelihood of elevated depressive symptoms, and there appeared to be a dose-response relationship, meaning the higher the levels, the better people felt.

Lycopene, the red pigment predominantly found in tomatoes (but also present in watermelon, pink grapefruit, guava and papaya) is the most powerful carotenoid antioxidant. In a test tube, it's about 100 times more effective at quenching free radicals than a more familiar antioxidant like vitamin E.

Do people who eat more tomatoes have less depression, then? Apparently so. A study of about a thousand older men and women found that those who ate the most tomato products had only about half the odds of depression. The researchers conclude that a tomato-rich diet may have a beneficial effect on the prevention of depressive symptoms.

Higher consumption of fruits and vegetables has been found to lead to a lower risk of developing depression, but if it's the antioxidants can't we just take an antioxidant pill? No.

Only food sources of antioxidants were protectively associated with depression. Not antioxidants from dietary supplements. Although plant foods and food-derived phytochemicals have been associated with health benefits, antioxidants from dietary supplements appear to be less beneficial and may, in fact, be detrimental to health. This may indicate that the form and delivery of the antioxidants are important. Alternatively, the observed associations may be due not to antioxidants but rather to other dietary factors, such as folate, that also occur in plant-rich diets.

In a study of thousands of middle-aged office workers, eating lots of processed food was found to be a risk factor for at least mild to moderate depression five years later, whereas a whole food pattern was found to be protective. Yes, it could be because of the high content of antioxidants in fruits and vegetables but could also be the folate in greens and beans, as some studies have suggested an increased risk of depression in folks who may not have been eating enough.

Low folate levels in the blood are associated with depression, but since most of the early studies were cross-sectional, meaning a snapshot in time, we didn't know if the low folate led to depression or the depression led to low folate. Maybe when you have the blues you don't want to eat the greens.

But since then a number of cohort studies were published, following people over time. They show that a low dietary intake of folate may indeed be a risk factor for severe depression, as much as a threefold higher risk. Note this is for dietary folate intake, not folic acid supplements; those with higher levels were actually eating healthy foods. If you give people folic acid pills they don't seem to work. This may be because folate is found in dark green leafy vegetables like spinach, whereas folic acid is the oxidized synthetic compound used in food fortification and dietary supplements because it's more shelf-stable. It may have different effects on the body as I previously explored in Can Folic Acid Be Harmful?

These kinds of findings point to the importance of antioxidant food sources rather than dietary supplements. But there was an interesting study giving people high dose vitamin C. In contrast to the placebo group, those given vitamin C experienced a decrease in depression scores and also greater FSI. What is FSI? Frequency of Sexual Intercourse.

Evidently, high dose vitamin C improves mood and intercourse frequency, but only in sexual partners that don't live with one another. In the placebo group, those not living together had sex about once a week, and those living together a little higher, once every five days, with no big change on vitamin C. But for those not living together, on vitamin C? Every other day! The differential effect for non-cohabitants suggests that the mechanism is not a peripheral one, meaning outside the brain, but a central one--some psychological change which motivates the person to venture forth to have intercourse. The mild antidepressant effect they found was unrelated to cohabitation or frequency, so it does not appear that the depression scores improved just because of the improved FSI.

For more mental health video, see:

Anything else we can do to enhance our sexual health and attractiveness? 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 / Flickr. This image has been modified.

Original Link

Antioxidant- and Folate-Rich Foods for Depression

Antioxidant- and Folate-Rich Foods for Depression.jpeg

According to the Centers for Disease Control and Prevention, the rates of all of our top 10 killers have fallen or stabilized except for one, suicide. As shown in my video, Antioxidants & Depression, accumulating evidence indicates that free radicals may play important roles in the development of various neuropsychiatric disorders including major depression, a common cause of suicide.

In a study of nearly 300,000 Canadians, for example, greater fruit and vegetable consumption was associated with lower odds of depression, psychological distress, self-reported mood and anxiety disorders and poor perceived mental health. They conclude that since a healthy diet comprised of a high intake of fruits and vegetables is rich in anti-oxidants, it may consequently dampen the detrimental effects of oxidative stress on mental health.

But that study was based on asking how many fruits and veggies people ate. Maybe people were just telling the researchers what they thought they wanted to hear. What if you actually measure the levels of carotenoid phytonutrients in people's bloodstreams? The same relationship is found. Testing nearly 2000 people across the United States, researchers found that a higher total blood carotenoid level was indeed associated with a lower likelihood of elevated depressive symptoms, and there appeared to be a dose-response relationship, meaning the higher the levels, the better people felt.

Lycopene, the red pigment predominantly found in tomatoes (but also present in watermelon, pink grapefruit, guava and papaya) is the most powerful carotenoid antioxidant. In a test tube, it's about 100 times more effective at quenching free radicals than a more familiar antioxidant like vitamin E.

Do people who eat more tomatoes have less depression, then? Apparently so. A study of about a thousand older men and women found that those who ate the most tomato products had only about half the odds of depression. The researchers conclude that a tomato-rich diet may have a beneficial effect on the prevention of depressive symptoms.

Higher consumption of fruits and vegetables has been found to lead to a lower risk of developing depression, but if it's the antioxidants can't we just take an antioxidant pill? No.

Only food sources of antioxidants were protectively associated with depression. Not antioxidants from dietary supplements. Although plant foods and food-derived phytochemicals have been associated with health benefits, antioxidants from dietary supplements appear to be less beneficial and may, in fact, be detrimental to health. This may indicate that the form and delivery of the antioxidants are important. Alternatively, the observed associations may be due not to antioxidants but rather to other dietary factors, such as folate, that also occur in plant-rich diets.

In a study of thousands of middle-aged office workers, eating lots of processed food was found to be a risk factor for at least mild to moderate depression five years later, whereas a whole food pattern was found to be protective. Yes, it could be because of the high content of antioxidants in fruits and vegetables but could also be the folate in greens and beans, as some studies have suggested an increased risk of depression in folks who may not have been eating enough.

Low folate levels in the blood are associated with depression, but since most of the early studies were cross-sectional, meaning a snapshot in time, we didn't know if the low folate led to depression or the depression led to low folate. Maybe when you have the blues you don't want to eat the greens.

But since then a number of cohort studies were published, following people over time. They show that a low dietary intake of folate may indeed be a risk factor for severe depression, as much as a threefold higher risk. Note this is for dietary folate intake, not folic acid supplements; those with higher levels were actually eating healthy foods. If you give people folic acid pills they don't seem to work. This may be because folate is found in dark green leafy vegetables like spinach, whereas folic acid is the oxidized synthetic compound used in food fortification and dietary supplements because it's more shelf-stable. It may have different effects on the body as I previously explored in Can Folic Acid Be Harmful?

These kinds of findings point to the importance of antioxidant food sources rather than dietary supplements. But there was an interesting study giving people high dose vitamin C. In contrast to the placebo group, those given vitamin C experienced a decrease in depression scores and also greater FSI. What is FSI? Frequency of Sexual Intercourse.

Evidently, high dose vitamin C improves mood and intercourse frequency, but only in sexual partners that don't live with one another. In the placebo group, those not living together had sex about once a week, and those living together a little higher, once every five days, with no big change on vitamin C. But for those not living together, on vitamin C? Every other day! The differential effect for non-cohabitants suggests that the mechanism is not a peripheral one, meaning outside the brain, but a central one--some psychological change which motivates the person to venture forth to have intercourse. The mild antidepressant effect they found was unrelated to cohabitation or frequency, so it does not appear that the depression scores improved just because of the improved FSI.

For more mental health video, see:

Anything else we can do to enhance our sexual health and attractiveness? 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 / Flickr. This image has been modified.

Original Link

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.

Original Link

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.

Original Link

What’s the Mediterranean Diet’s Secret?

Why Was Heart Disease Rare in the Mediterranean?.jpg

The Mediterranean Diet is an "in" topic nowadays in both the medical literature and the lay media. As one researcher put it, "Uncritical laudatory coverage is common, but specifics are hard to come by: What is it? Where did it come from? Why is it good? Merits are rarely detailed; possible downsides are never mentioned." So, let's dig in....

After World War II, the government of Greece asked the Rockefeller foundation to come in and assess the situation. Impressed by the low rates of heart disease in the region, nutrition scientist Ancel Keys--after which "K" rations were named--initiated his famous seven countries study. In this study, he found the rate of fatal heart disease on the Greek isle of Crete was 20 times lower than in the United States. They also had the lowest cancer rates and fewest deaths overall. What were they eating? Their diets were more than 90% plant-based, which may explain why coronary heart disease was such a rarity. A rarity, that is, except for a small class of rich people whose diet differed from that of the general population--they ate meat every day instead of every week or two.

So, the heart of the Mediterranean diet is mainly plant-based, and low in meat and dairy, which Keys considered the "major villains in the diet" because of their saturated fat content. Unfortunately, no one is really eating the traditional Mediterranean diet anymore, even in the Mediterranean. The prevalence of coronary heart disease skyrocketed by an order of magnitude within a few decades in Crete, blamed on the increased consumption of meat and cheese at the expense of plant foods.

Everyone is talking about the Mediterranean diet, but few do it properly. People think of pizza or spaghetti with meat sauce, but while "Italian restaurants brag about the healthy measuring in diet, they serve a travesty of it." If no one's really eating this way anymore, how do you study it?

Researchers came up with a variety of Mediterranean diet adherence scoring systems to see if people who are eating more Mediterranean-ish do better. You get maximum points the more plant foods you eat, and effectively you get points deducted by eating just a single serving of meat or dairy a day. So it's no surprise those that eat relatively higher on the scale have a lower risk of heart disease, cancer, and death overall. After all, the Mediterranean diet can be considered to be a "near vegetarian" diet. "As such, it should be expected to produce the well-established health benefits of vegetarian diets." That is, less heart disease, cancer, death, and inflammation; improved arterial function; a lower risk of developing type 2 diabetes; a reduced risk for stroke, depression, and cognitive impairment.

How might it work? I've talked about the elegant studies showing that those who eat plant-based diets have more plant-based compounds, like aspirin, circulating within their systems. Polyphenol phytonutrients in plant foods are associated with a significantly lower risk of dying. Magnesium consumption is also associated with a significantly lower risk of dying, and is found in dark green leafy vegetables, as well as fruits, beans, nuts, soy, and whole grains.

Heme iron, on the other hand--the iron found in blood and muscle--acts as a pro-oxidant and appears to increase the risk of diabetes, whereas plant-based, non-heme iron appears safe. Similarly, with heart disease, animal-based iron was found to significantly increase the risk of coronary heart disease, our number one killer, but not plant-based iron. The Mediterranean diet is protective compared to the Standard American Diet--no question--but any diet rich in whole plant foods and low in animal-fat consumption could be expected to confer protection against many of our leading killers.

Here are some more videos on the Mediterranean Diet:

For more information on heme iron, see Risk Associated With Iron Supplements.

More on magnesium is found in How Do Nuts Prevent Sudden Cardiac Death? and Mineral of the Year--Magnesium.

And more on polyphenols can be seen in videos like How to Slow Brain Aging by Two Years and Juicing Removes More Than Just Fiber.

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: Couleur / Pixabay. This image has been modified.

Original Link

What’s the Mediterranean Diet’s Secret?

Why Was Heart Disease Rare in the Mediterranean?.jpg

The Mediterranean Diet is an "in" topic nowadays in both the medical literature and the lay media. As one researcher put it, "Uncritical laudatory coverage is common, but specifics are hard to come by: What is it? Where did it come from? Why is it good? Merits are rarely detailed; possible downsides are never mentioned." So, let's dig in....

After World War II, the government of Greece asked the Rockefeller foundation to come in and assess the situation. Impressed by the low rates of heart disease in the region, nutrition scientist Ancel Keys--after which "K" rations were named--initiated his famous seven countries study. In this study, he found the rate of fatal heart disease on the Greek isle of Crete was 20 times lower than in the United States. They also had the lowest cancer rates and fewest deaths overall. What were they eating? Their diets were more than 90% plant-based, which may explain why coronary heart disease was such a rarity. A rarity, that is, except for a small class of rich people whose diet differed from that of the general population--they ate meat every day instead of every week or two.

So, the heart of the Mediterranean diet is mainly plant-based, and low in meat and dairy, which Keys considered the "major villains in the diet" because of their saturated fat content. Unfortunately, no one is really eating the traditional Mediterranean diet anymore, even in the Mediterranean. The prevalence of coronary heart disease skyrocketed by an order of magnitude within a few decades in Crete, blamed on the increased consumption of meat and cheese at the expense of plant foods.

Everyone is talking about the Mediterranean diet, but few do it properly. People think of pizza or spaghetti with meat sauce, but while "Italian restaurants brag about the healthy measuring in diet, they serve a travesty of it." If no one's really eating this way anymore, how do you study it?

Researchers came up with a variety of Mediterranean diet adherence scoring systems to see if people who are eating more Mediterranean-ish do better. You get maximum points the more plant foods you eat, and effectively you get points deducted by eating just a single serving of meat or dairy a day. So it's no surprise those that eat relatively higher on the scale have a lower risk of heart disease, cancer, and death overall. After all, the Mediterranean diet can be considered to be a "near vegetarian" diet. "As such, it should be expected to produce the well-established health benefits of vegetarian diets." That is, less heart disease, cancer, death, and inflammation; improved arterial function; a lower risk of developing type 2 diabetes; a reduced risk for stroke, depression, and cognitive impairment.

How might it work? I've talked about the elegant studies showing that those who eat plant-based diets have more plant-based compounds, like aspirin, circulating within their systems. Polyphenol phytonutrients in plant foods are associated with a significantly lower risk of dying. Magnesium consumption is also associated with a significantly lower risk of dying, and is found in dark green leafy vegetables, as well as fruits, beans, nuts, soy, and whole grains.

Heme iron, on the other hand--the iron found in blood and muscle--acts as a pro-oxidant and appears to increase the risk of diabetes, whereas plant-based, non-heme iron appears safe. Similarly, with heart disease, animal-based iron was found to significantly increase the risk of coronary heart disease, our number one killer, but not plant-based iron. The Mediterranean diet is protective compared to the Standard American Diet--no question--but any diet rich in whole plant foods and low in animal-fat consumption could be expected to confer protection against many of our leading killers.

Here are some more videos on the Mediterranean Diet:

For more information on heme iron, see Risk Associated With Iron Supplements.

More on magnesium is found in How Do Nuts Prevent Sudden Cardiac Death? and Mineral of the Year--Magnesium.

And more on polyphenols can be seen in videos like How to Slow Brain Aging by Two Years and Juicing Removes More Than Just Fiber.

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: Couleur / Pixabay. This image has been modified.

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The Natural Human Diet

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

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

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

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

Image Credit: Nathan Rupert / Flickr

Original Link

The Natural Human Diet

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

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

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

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

Image Credit: Nathan Rupert / Flickr

Original Link