Flax Seeds Can Have Profound Effect on Hypertension

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

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How Turmeric Can Help Combat the Effects of Sitting

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The average American spends most of their waking life sitting down, which is associated with an increased risk of death even among people who go to the gym after work and exercise regularly. Doing lots of sitting may double our risk of diabetes and heart disease while significantly shortening our lifespan, even at the highest levels of physical activity. Sitting six or more hours a day may increase mortality rates even among those running or swimming an hour a day, every day, seven days a week. Why though? I examine this in Turmeric Cucumin vs. Exercise for Artery Function.

One factor may be endothelial dysfunction, the inability of the inner lining of our blood vessels to relax our arteries normally in response to blood flow. Just like our muscles atrophy if we don't use them, when it comes to arterial function, it's 'use it or lose it' as well. Increased blood flow promotes a healthy endothelium. The cells lining our arteries can actually sense the sheer force of the blood flowing past. That flow is what maintains the stability and integrity of the inner lining of our arteries. Without that constant tugging flow, it may help set us up for heart disease.

We actually have some data now suggesting that treadmill desks may improve the health of office workers without affecting work performance, and walking may be preferable to standing in terms of clearing fat from our bloodstream, which can play a role in endothelial dysfunction.

What if our office can't accommodate a standing or walking desk? Within an hour of sitting, blood starts pooling and blood flow starts to stagnate, so the more we can take breaks the better. Preliminary evidence from observational and interventional studies suggests that regular interruptions in sitting time can be beneficial. And it doesn't have to be long. Breaks could be as short as one minute and not necessarily entail exercise, just something like taking out the trash during commercials may be beneficial.

I've talked about the effects of different diets on endothelial function (See Eggs and Arterial Function, Walnuts and Arterial Function, Vinegar and Artery Function, and Dark Chocolate and Artery Function) and how certain foods in particular--nuts and green tea--are beneficial for endothelial health. Recently, researchers tried out curcumin, the yellow pigment in the spice turmeric.

They showed that regular ingestion of curcumin or up to an hour a day of aerobic exercise training significantly improved endothelial function. And the magnitude of improvement in endothelial function was the same. So does that mean we can just be a couch potato as long as we eat curried potatoes? No, the combination of curcumin and exercise appears to work even better than either alone.

I'm on my third treadmill desk motor, after burning out two. The 2nd one lasted 7,000 miles, though. Could have walked back and forth across the country! I do about 17 miles a day. More on treadmill desks in Standing Up for Your Health.

Amazing how much beneficial just simple walking can be: Longer Life Within Walking Distance

More exercise versus diet comparisons in Is it the Diet, the Exercise, or Both? and How Much Exercise to Sustain Weight Loss.

For more on turmeric and exercise see Heart of Gold: Turmeric vs Exercise.

Who Shouldn't Consume Curcumin or Turmeric? See the video! :)

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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What About Eating Just a Little Meat?

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As you can see in my video, Plant-Based Diets and Diabetes, we've known for decades that a plant-based diet may be protective against diabetes. Studies going back half a century found that those eating meat one or more days a week had significantly higher rates of diabetes, and the more frequently meat was eaten, the more frequent the disease. And this is after controlling for weight, so even at the same weight, those eating more plant-based had but a fraction of the diabetes rates. If anything, vegetarians should have had more diabetes just because they appear to live so much longer, so they had more time to develop these kinds of chronic diseases; but no, apparently lower rates of death and disease.

Fast forward 50 years to the Adventist-2 study, looking at 89,000 people, and we see a stepwise drop in the rates of diabetes as one eats more and more plant-based, down to a 78% lower prevalence among those eating strictly plant-based. Protection building incrementally as one moved from eating meat daily, to eating meat weekly, to just fish, to no meat, and then to no eggs and dairy either. Followed over time, vegetarian diets were associated with a substantially lower incidence of diabetes, indicating the potential of these diets to stem the current diabetes epidemic.

We see the same step-wise drop in rates of another leading killer, high blood pressure. The greater the proportion of plant foods, the lower the rates of hypertension, and the same with excess body fat. The only dietary group not on average overweight were those eating diets composed exclusively of plant foods, but again there was the same incremental drop with fewer and fewer animal products. This suggests that it's not black and white, not all or nothing, any steps we can make along this spectrum of eating healthier may accrue significant benefits.

What about eating a really healthy diet with just a little meat? Is it better to eat none at all? We have new insight last year from Taiwan. Asian diets in general tend to be lower in meat and higher in plant foods compared with Western diet, but whether a diet completely avoiding meat and fish would further extend the protective effect of a plant-based diet wasn't known, until now.

Traditionally, Asian populations have had low rates of diabetes, but a diabetes epidemic has since emerged, and appears to coincide with increased meat, animal protein, and animal fat consumption, but the Westernization of Asian diets also brought along a lot of fast food and junk, and so these researchers at the national university didn't want to just compare those eating vegetarian to typical meateaters. So, they compared Bhuddist vegetarians to Bhuddist non-vegetarians, eating traditional Asian diets. Even the omnivores were eating a predominantly plant-based diet, consuming little meat and fish, with the women eating the equivalent of about a single serving a week, and men eating a serving every few days. That's just 8% of the meat intake in the U.S., 3% for the women. The question: is it better to eat 3% or 0%?

Again, both groups were eating healthy; zero soda consumption, for example, in any group. Despite the similarities in their diet, and after controlling for weight, family history, exercise, and smoking, the men eating vegetarian had just half the rates of diabetes, and the vegetarian women just a quarter of the rates. So even in a population consuming a really plant-based diet with little meat and fish, true vegetarians who completely avoided animal flesh, while eating more healthy plant foods, have lower odds for prediabetes and diabetes after accounting for other risk factors. They wanted to break it up into vegan versus ovo-lacto like in the Adventist-2 study, but they couldn't because there were no cases at all of diabetes found within the vegan group.

More on preventing and treating this terrible disease:

The reason I keep going back to that Adventist-2 study is that it's not only the biggest study of those eating plant based diets in North America, but the largest such study anywhere anytime. We owe those investigators a great debt (not to mention the 96,741 participants!). One thing I'm happy my tax dollars are going towards (via the National Cancer Institute and National Institutes of Health). More from the Adventists in Caloric Restriction vs. Animal Protein Restriction.

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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Do You Meet the Simple Seven?

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In public health school, you learn there are three levels of preventive medicine. Primary prevention would be like trying to prevent someone at risk for heart disease from getting his or her first heart attack. Secondary prevention is when you already have the disease and are trying to prevent your second heart attack, and tertiary prevention is like cardiac rehab, where you're just trying to reduce the complication rates. A fourth level was suggested in 2000, quaternary prevention, trying to reduce the damage from all the drugs and surgery from the first three levels. But people seem to forget about a fifth concept, introduced by the World Health Organization back in 1978, termed primordial prevention, which is being embraced by the American Heart Association's 2020 strategic impact goals.

Primordial prevention was conceived as a strategy to prevent whole societies from experiencing epidemics of the risk factors. The corresponding strategy at the individual level is to prevent the development of risk factors. Instead of trying to prevent someone with high cholesterol from getting a heart attack, why not prevent them from getting high cholesterol in the first place?

So the American Heart Association came up with the simple seven, featured in my video, How Many Meet the Simple Seven?. These health behaviors or factors include not smoking, not being overweight, being "very active" (defined as walking at least 22 minutes a day), eating a few fruits and veggies, having below average cholesterol, normal blood pressure, and normal blood sugars.

Their goal was to reduce heart disease deaths by 20% by 2020. Why so modest an aim? An improvement of 25% was deemed "unrealistic," and 15% was considered insufficient, so they decided on 20. If 90% of risk can be thrown out the window by engaging in simple lifestyle modifications, why is just 25% considered unrealistic? To understand, one must realize just how bad our diets have gotten.

The most common reason patients give for not complying with a cholesterol-lowering diet may be the presumption that they're already eating healthy and so don't need to change. But if you look at the status of cardiovascular health in U.S. adults, only about 1% of Americans have a bare minimum of healthy eating behaviors, such as five-a-day fruits and veggies, eating beans, whole grains, drinking less than three cans of soda a week, etc. What percentage of Americans hit all seven of the simple seven? 14,000 men and women were surveyed, and most had two or three, but hardly any had all seven simple health components. Just how low a prevalence was having seven out of seven? Only about 1 out of 2,000 Americans had all seen factors intact. And the one they were missing the most was diet.

Unfortunately unhealthy behaviors extend into the medical profession. Just like smoking doctors are less likely to tell their patients to stop smoking, and couch potato docs are less likely to push exercise, or things like more fruits and vegetables; we need to role-model healthy behavior. This greatly enhances our credibility and effectiveness. Gone are the days of traditional authority when the fat physician, dropping cigarette ash down his gravy-stained vest, could credibly prescribe a change in behavior.

So What Diet Should Physicians Recommend? Watch the video!

Lifestyle medicine, the use of diet and lifestyle changes to prevent and treat disease, cannot only be cheaper and safer, but also more effective. See, for example:

I've previously noted just how sad the Standard American Diet is in Nation's Diet in Crisis. See how you compare: Calculate Your Healthy Eating Score.

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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How to Design Saturated Fat Studies to Hide the Truth

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Where do the international consensus guidelines to dramatically lower saturated fat consumption come from? (I show the list in my video, The Saturated Fat Studies: Buttering Up the Public). They came from literally hundreds of metabolic ward experiments, which means you don't just ask people to change their diets, you essentially lock them in a room--for weeks if necessary--and have total control over their diet. You can then experimentally change the level of saturated fat consumed by subjects however you want to, and see the corresponding change in their cholesterol levels. And the results are so consistent that you can create an equation, the famous Hegsted Equation, where you can predict how much their cholesterol will go up based on how much saturated fat you give them. So if you want your LDL cholesterol to go up 50 points, all you have to do is eat something like 30% of your calories in saturated fat. When you plug the numbers in, the change in cholesterol shoots up as predicted. The experiments match the predictions. You can do it at home with one of those home cholesterol testing kits, eat a stick of butter every day, and watch your cholesterol climb.

These ward experiments were done in 1965; meaning we've known for 50 years that even if you keep calorie intake the same, increases in saturated fat intake are associated with highly significant increases in LDL bad cholesterol. Your good cholesterol goes up a bit too, but that increase is smaller than the increase in bad, which would translate into increased heart disease risk.

So if you feed vegetarians meat even just once a day, their cholesterol jumps nearly 20% within a month. To prevent heart disease, we need a total cholesterol under 150, which these vegetarians were, but then even just eating meat once a day, and their cholesterol shot up 19%. The good news is that within just two weeks of returning to their meat-free diet, their cholesterol dropped back down into the safe range. Note that their HDL good cholesterol hardly moved at all, so their ratio went from low risk of heart attack to high risk in a matter of weeks with just one meat-containing meal a day. And indeed randomized clinical trials show that dietary saturated fat reduction doesn't just appear to reduce cholesterol levels, but also reduces the risk of subsequent cardiovascular events like heart attacks.

So we have randomized clinical trials, controlled interventional experiments--our most robust forms of evidence--no wonder there's a scientific consensus to decrease saturated fat intake! You'll note, though, that the Y-axis in these studies seen in my video The Saturated Fat Studies: Set Up to Fail is not cholesterol, but change in cholesterol. That's because everyone's set-point is different. Two people eating the same diet with the same amount of saturated fat can have very different cholesterol levels. One person can eat ten chicken nuggets a day and have an LDL cholesterol of 90; another person eating ten a day could start out with an LDL of 120. It depends on your genes. But while our genetics may be different, our biology is the same, meaning the rise and drop in cholesterol is the same for everyone. So if both folks cut out the nuggets, the 90 might drop to 85, whereas the 120 would drop to 115. Wherever we start, we can lower our cholesterol by eating less saturated fat, but if I just know your saturated fat intake--how many nuggets you eat, I can't tell you what your starting cholesterol is. All I can say with certainty is that if you eat less, your cholesterol will likely improve.

But because of this extreme "interindividual variation"--this wide variability in baseline cholesterol levels for any given saturated fat intake--if you take a cross-section of the population, you can find no statistical correlation between saturated fat intake and cholesterol levels, because it's not like everyone who eats a certain set amount of saturated fat is going to have over a certain cholesterol. So there are three ways you could study diet and cholesterol levels: controlled feeding experiments, free-living dietary change experiments, or cross-sectional observations of large populations. As we know, there is a clear and strong relationship between change in diet and change in serum cholesterol in the interventional designs, but because of that individual variability, in cross-sectional designs, you can get zero correlation. In fact, if you do the math, that's what you'd expect you'd get. In statistical parlance, one would say that a cross-sectional study doesn't have the power for detecting such a relationship. Thus because of that variability, these kinds of observational studies would seem an inappropriate method to study this particular relationship. So since diet and serum cholesterol have a zero correlation cross-sectionally, an observational study of the relationship between diet and coronary heart disease incidence will suffer from the same difficulties. So again, if you do the math, observational studies would unavoidably show nearly no correlation between saturated fat and heart disease. These prospective studies can be valuable for other diseases, but the appropriate design demonstrating or refuting the role of diet and coronary heart disease is a dietary change experiment.

And those dietary change experiments have been done; they implicate saturated fat, hence the lower saturated guidelines from basically every major medical authority. In fact, if we lower saturated fat enough, we may be able to reverse heart disease, opening up arteries without drugs or surgery. So with this knowledge, how would the meat and dairy industry prove otherwise? They use the observational studies that mathematically would be unable to show any correlation.

All they need now is a friendly researcher, such as Ronald M. Krauss, who has been funded by the National Dairy Council since 1989, also the National Cattleman's Beef Association, as well as the Atkins Foundation. Then they just combine all the observational studies that don't have the power to provide significant evidence, and not surprisingly, as published in their 2010 meta-analysis, no significant evidence was found.

The 2010 meta-analysis was basically just repackaged for 2014, using the same and similar studies. As the Chair of Harvard's nutrition department put it, their conclusions regarding the type of fat being unimportant are seriously misleading and should be disregarded, going as far as suggesting the paper be retracted, even after the authors corrected a half dozen different errors.

It's not as though they falsified or fabricated data--they didn't have to. They knew beforehand the limitations of observational studies, they knew they'd get the "right" result and so they published it, helping to "neutralize the negative impact of milk and meat fat by regulators and medical professionals." And it's working, according to the dairy industry, as perceptions about saturated fat in the scientific community are changing. They even go so far to say this is a welcome message to consumers, who may be tired of hearing what they shouldn't eat. They don't need to convince consumers, just confuse them. Confusion can easily be misused by the food industry to promote their interests.

It's like that infamous tobacco industry memo that read, "Doubt is our product since it's the best means of competing with the body of fact that exist in the mind of the general public." They don't have to convince the public that smoking is healthy to get people to keep consuming their products. They just need to establish a controversy. Conflicting messages in nutrition cause people to become so frustrated and confused they may just throw their hands up in the air and eat whatever is put in front of them, which is exactly what saturated fat suppliers want, but at what cost to the public's health?

If that "Doubt is our product" memo sounded familiar, I also featured it in my Food Industry Funded Research Bias video. More on how industries can design deceptive studies in BOLD Indeed: Beef Lowers Cholesterol? and How the Egg Board Designs Misleading Studies.

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 Saturated Fat Studies: Buttering Up the Public

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Time magazine's cover exhorting people to eat butter could be viewed as a desperate attempt to revive dwindling print sales, but they claimed to be reporting on real science--a systematic review and meta-analysis published in a prestigious journal that concluded that current evidence does not clearly support cardiovascular guidelines that encourage cutting down on saturated fat, like the kind found in meat and dairy products like butter.

No wonder it got so much press, since reducing saturated fat intake is a major focus of most dietary recommendations worldwide, aiming to prevent chronic diseases including coronary heart disease. So, to quote the Center for Science in the Public Interest, "What gives? Evidently, shaky science...and a mission by the global dairy industry to boost sales."

They interviewed an academic insider, who noted that some researchers are intent on showing saturated fat does not cause heart disease, which can be seen in my video The Saturated Fat Studies: Buttering Up the Public. In 2008, the global dairy industry held a meeting where they decided that one of their main priorities was to "neutralize the negative impact of milk fat by regulators and medical professionals." And when they want to do something, they get it done. So they set up a major, well-funded campaign to come up with proof that saturated fat does not cause heart disease. They assembled scientists who were sympathetic to the dairy industry, provided them with funding, encouraged them to put out statements on milk fat and heart disease, and arranged to have them speak at scientific meetings. And the scientific publications we've seen emerging since the Mexico meeting have done just what they set out to do.

During this meeting, the dairy industry discussed what is the key barrier to increasing worldwide demand for dairy. There's global warming issues and other milks competing out there, but number one on the list is the "Negative messages and intense pressure to reduce saturated fats by governments and non- governmental organizations." In short, the negative messages are outweighing the positive, so indeed, their number one priority is to neutralize the negative image of milk fat among regulators and health professionals as related to heart disease.

So if we are the dairy industry, how are we going to do it? Imagine we work for Big Butter. We've got quite the challenge ahead of us. If we look at recommendations from around the globe, there is a global scientific consensus to limit saturated fat intake with most authoritative bodies recommending getting saturated fat at least under 10% of calories, with the prestigious U.S. Institute of Medicine and the European Food Safety Authority recommending to push saturated fat consumption down as low as possible.

The latest guidelines from the American Heart Association and the American College of Cardiology recommend reducing trans fat intake, giving it their strongest A-grade level of evidence. And they say the same same for reducing saturated fat intake. Since saturated and trans fats are found in the same place, meat and dairy, cutting down on foods with saturated fat will have the additional benefit of lowering trans fat intake. They recommend pushing saturated fat intake down to 5 or 6%. People don't realize how small that is. One KFC chicken breast could take us over the top. Or, two pats of butter and two cubes of cheese and we're done for the day--no more dairy, meat, or eggs. That'd be about 200 calories, so they are in effect saying 90% of our diet should be free of saturated fat-containing foods. That's like the American Heart Association saying, "two meals a week can be packed with meat, dairy, and junk, but the entire rest of the week should be unprocessed plant-foods." That's how stringent the new recommendations are.

So this poses a problem for Big Cheese and Chicken. The top contributors of cholesterol-raising saturated fat is cheese, ice cream, chicken, non-ice cream desserts like cake and pie, and then pork. So what are these industries to do? See The Saturated Fat Studies: Set Up to Fail.

For those unfamiliar with Trans Fat in Meat and Dairy (and refined vegetable oils), that's why I made a video about it.

The U.S. National Academy of Sciences Institute of Medicine "as low as possible" position, echoed by the European Food Safety Authority, is described in my video: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

What happened when a country tried to put the lower saturated fat guidance into practice? See the remarkable results in Dietary Guidelines: From Dairies to Berries.

Don't think the dietary guidelines process could be undermined by underhanded corporate tactics? Sad but true:

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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Which Dietary Factors Affect Breast Cancer Most?


One of my favorite cancer-specific charities, the American Institute for Cancer Research, lauds the China Study and the documentary Forks Over Knives, with which they share the same bottom-line message: The healthiest diets are those that revolve around whole plant foods.

They then translate that advice into their Ten Recommendations for Cancer Prevention, featured in my video Which Dietary Factors Affect Breast Cancer Most? We now have evidence that those who follow such advice are actually protected against cancer. Breast cancer risk was reduced by 60% in women who met at least five recommendations compared with those who met none. The most important dietary advice was to be as lean as possible within the normal range of body weight, eat mostly foods of plant origin, and limit alcoholic drinks.

What about other cancers? Greater adherence to the AICR dietary guidelines was also associated with significantly less endometrial, colorectal, lung, kidney, stomach, oral, liver, and esophageal cancer. In other words, adherence to dietary recommendations for cancer prevention may lower the risk of developing most types of cancer. The drop in bladder cancer did not reach statistical significance, but a larger follow-up study following 469,000 people for 11 years (the largest to date) found that just a 3% increase in the consumption of animal protein calories was associated with a 15% higher risk of bladder cancer, whereas just a 2% increase in plant protein was associated with a 23% lower risk.

AICR recommendation number ten is that cancer survivors should follow the recommendations for cancer prevention. The same diet that can help prevent cancer in the first place can be used to help save our life after diagnosis. Adherence to the guidelines for cancer prevention was found to be associated with lower mortality among older female cancer survivors, or breast cancer and other cancers in general.

A cancer diagnosis is considered a teachable moment to get people eating and living healthier. Oncologists revel at the growth in the number of cancer survivors in this country, now ten million strong and growing. It's great that those with cancer are living longer, but even better to prevent it in the first place so we can all live longer. Not only does adherence to the guidelines lower cancer risk, but extends our lifespan because the guidelines are also significantly associated with a lower hazard of dying from heart disease and respiratory disease, suggesting that following the recommendations could "significantly increase longevity."

Just like eating to prevent cancer helps to prevent heart disease, eating to protect our heart helps prevent cancer. It sounds self-evident, but adherence to a healthy lifestyle is therefore associated with a lower risk of mortality overall. And the more healthy behaviors we have, the longer we get to live. Such factors included not smoking, walking every day, or eating green leafy vegetables almost daily.

To help differentiate the effects of diet from other lifestyle behaviors like smoking and drinking on cancer incidence, Adventists were recently compared to Baptists. Both discourage alcohol and tobacco, but the Adventists go further, encouraging a reduction of meat. In general, the Adventists had lower cancer hazard rates than the Baptists, and within Adventist populations, the vegetarians did even better, and those eating the most plants, did the best.

Why do plant-based diets appear to lower the risk of cancer? A number of fascinating mechanisms:

Specific to breast cancer:

Though plant-based beverages may be harmful: Breast Cancer and Alcohol: How Much Is Safe?

In terms of foods associated with breast cancer survival, 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--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.

Image Credit: MesserWoland

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Paleo Diet May Undermine Benefit of CrossFit Exercise

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Much of the low-carb and paleo reasoning revolves around insulin. To quote a paleo blogger, "carbohydrates increase insulin, the root of all evil when it comes to dieting and health." So the logic follows that because carbs increase insulin, we should stick mostly to meat, which is fat and protein with no carbs, so no increase in insulin, right?


We've known for half a century that if you give someone just a steak: no carbs, no sugar, no starch; their insulin goes up. Carbs make our insulin go up, but so does protein.

In 1997 an insulin index of foods was published, ranking 38 foods to determine which stimulates higher insulin levels. Researchers compared a large apple and all its sugar, a cup of oatmeal packed with carbs, a cup and a half of white flour pasta, a big bun-less burger with no carbs at all, to half of a salmon fillet. As you can see in the graph in my video Paleo Diets May Negate Benefits of Exercise, the meat produced the highest insulin levels.

Researchers only looked at beef and fish, but subsequent data showed that that there's no significant difference between the insulin spike from beef, chicken, or pork--they're all just as high. Thus, protein and fat rich foods may induce substantial insulin secretion. In fact, meat protein causes as much insulin release as pure sugar.

So, based on the insulin logic, if low-carbers and paleo folks really believed insulin to be the root of all evil, then they would be eating big bowls of spaghetti day in and day out before they would ever consume meat.

They are correct in believing that having hyperinsulinemia, high levels of insulin in the blood like type 2 diabetics have, is not a good thing, and may increase cancer risk. But if low-carb and paleo dieters stuck to their own insulin theory, then they would be out telling everyone to start eating plant-based. Vegetarians have significantly lower insulin levels even at the same weight as omnivores. This is true for ovo-lacto-vegetarians, lacto-vegetarians, and vegans. Meat-eaters have up to 50% higher insulin levels.

Researchers from the University of Memphis put a variety of people on a vegan diet (men, women, younger folks, older folks, skinny and fat) and their insulin levels dropped significantly within just three weeks. And then, just by adding egg whites back to their diet, their insulin production rose 60% within four days.

In a study out of MIT, researchers doubled participants' carbohydrate intake, and their insulin levels went down. Why? Because the researchers weren't feeding people jellybeans and sugar cookies, they were feeding people whole, plant foods, lots of whole grains, beans, fruits, and vegetables.

What if we put someone on a very-low carb diet, like an Atkins diet? Low carb advocates such as Dr. Westman assumed that it would lower insulin levels. Dr. Westman is the author of the new Atkins books, after Dr. Atkins died obese with, according to the medical examiner, a history of heart attack, congestive heart failure, and hypertension. But, Dr. Westman was wrong in his assumption. There are no significant drop in insulin levels on very low-carb diets. Instead, there is a significant rise in LDL cholesterol levels, the number one risk factor for our number one killer, heart disease.

Atkins is an easy target though. No matter how many "new" Atkins diets that come out, it's still old news. What about the paleo diet? The paleo movement gets a lot of things right. They tell people to ditch dairy and doughnuts, eat lots of fruits, nuts, and vegetables, and cut out a lot of processed junk food. But a new study published in the International Journal of Exercise Science is pretty concerning. Researchers took young healthy people, put them on a Paleolithic diet along with a CrossFit-based, high-intensity circuit training exercise program.

If you lose enough weight exercising, you can temporarily drop our cholesterol levels no matter what you eat. You can see that with stomach stapling surgery, tuberculosis, chemotherapy, a cocaine habit, etc. Just losing weight by any means can lower cholesterol, which makes the results of the Paleo/Crossfit study all the more troubling. After ten weeks of hardcore workouts and weight loss, the participants' LDL cholesterol still went up. And it was even worse for those who started out the healthiest. Those starting out with excellent LDL's (under 70), had a 20% elevation in LDL cholesterol, and their HDL dropped. Exercise is supposed to boost our good cholesterol, not lower it.

The paleo diet's deleterious impact on blood fats was not only significant, but substantial enough to counteract the improvements commonly seen with improved fitness and body composition. Exercise is supposed to make things better.

On the other hand, if we put people instead on a plant-based diet and a modest exercise program, mostly just walking-based; within three weeks their bad cholesterol can drop 20% and their insulin levels 30%, despite a 75-80% carbohydrate diet, whereas the paleo diets appeared to "negate the positive effects of exercise."

I touched on paleo diets before in Paleolithic Lessons, and I featured a guest blog on the subject: Will The Real Paleo Diet Please Stand Up?

but my favorite paleo videos are probably The Problem With the Paleo Diet Argument and Lose Two Pounds in One Sitting: Taking the Mioscenic Route.

I wrote a book on low carb diets in general (now available free full-text online) and touched on it in Atkins Diet: Trouble Keeping It Up and Low Carb Diets and Coronary Blood Flow.

And if you're thinking, but what about the size of the cholesterol, small and dense versus large and fluffy? Please see my video Does Cholesterol Size Matter?

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.

Image Credit: Vincent Lit / Flickr

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The Role of Caffeine in Artery Function


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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Introducing the Kempner Rice Diet


Franklin Delano Roosevelt brought us through the Great Depression and World War II. Who knows how history would have been different had he not died in his fourth term as President from a massive stroke. In the following days and months, we learned that Roosevelt had suffered from severe high blood pressure for years. In spite of this, he was on no medications or other treatments. The reason for the lack of treatment is stark and simple: there were none. The state of the art at that time was death. Death, from so-called malignant hypertension--out-of-control high blood pressure--for which, it was thought, there was no remedy. But they were wrong. There was Dr. Walter Kempner and his rice-fruit diet.

A physician-scientist, Kempner trained with the best, fled Nazi Germany and set up shop at Duke, where he began treating malignant hypertension patients with a radical diet consisting of only white rice and fruit, with strikingly favorable results: a rapid reduction in blood pressure, rapid improvement in kidney failure, eye pressure, heart failure and other manifestations of this previously fatal illness.

He figured that if a low salt diet helped with blood pressure, a low protein diet helped with kidney function, and a low fat and cholesterol diet helped the heart, why not take it to its logical conclusion and design a no-salt, no cholesterol diet of almost pure carbohydrate. So, he designed a diet with less sodium than any low-sodium diet, less protein than any low-protein diet, and less cholesterol and fat than any other low-fat diet.

His hope was that it would just stop progression of the disease. Instead, something miraculous happened. In about two-thirds of cases, the disease reversed. There were reversals of heart failure, reversals of eye damage, and reversals of kidney failure. At the time, this was effectively a terminal disease where people just had a few months to live, but with Kempner's rice diet, they got better. In my video Kempner Rice Diet: Whipping Us Into Shape, you can see before and after pictures of the back of people's eyes. They started out swollen, bloody and leaking and then were nearly normal in a matter of months.

After being effectively cured by the diet over many months, many patients could then relax the diet to a more conventional plant-based diet and go on to live a normal, active life. The rice diet may actually drop blood pressures too low, so we have to add back other foods to bring the pressures back up to normal.

An editorial in the New England Journal of Medicine described Kempner's results as "little short of miraculous." Practically speaking, there's probably no more effective diet for obese cardiac patients. The problem, though, is that most physicians lack the extraordinary persuasive powers required to keep the patient eating such a restricted diet.

When Dr. Caldwell Esselstyn presented his study results demonstrating in some cases reversal of near end-stage heart disease with a whole food plant-based diet, the Chair of Cleveland Clinic cardiology department asked, "How can we expect patients to stay on a strict diet like this when we can't even get them to quit smoking?" Just like penicillin drugs don't work at all unless we take them, plant-based diets don't work unless we actually eat them.

The answer may be that the physician must have a zealous belief in the diet and must convey that passion to the patients. For Kempner, to keep his patients on the rice diet, he "brow-beat, yelled at, and castigated them when he caught them straying." And he didn't just browbeat them; he sometimes actually beat them. It came out in a lawsuit in which a former patient sued Dr. Kempner, claiming that he had literally whipped her and other patients to motivate them to stick to the diet.

Reminds me of the famous diabetes physician back in the 1800s, Arnoldo Cantani, who knew the remedy for diabetes was not in the drugstore, but rather the kitchen. To ensure compliance, if necessary, he would lock a patient up in a room for six weeks.

Thankfully, in terms of personality, Dr. Esselstyn is the opposite of Dr. Kempner. He is polite, soft-spoken, gentle and able to keep his patients on track without whipping them. And last but not least, Esselstyn walks the talk, following the diet himself, whereas Kempner died of a heart attack (though at the age of 94). Kempner's work continues on in Durham, where they continue a relaxed version of the diet, allowing actual vegetables.

A year before Roosevelt died, Kempner had already published his miraculous results. It seems highly likely that had the rice diet been "provided to President Roosevelt a year before his death, his disease might have been controlled before his fatal stroke, and that this fatal event could have been averted."

For those unfamiliar with Dr. Esselstyn's work, check out:

Kempner was a lifestyle medicine pioneer. What's lifestyle medicine? See, for example:

For more on Kempner's work, 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--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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