What Do All the Blue Zones Have in Common?

Do Flexitarians Live Longer.jpg

What accounts for the benefits of a Mediterranean-style diet? An anatomy of health effects was published, and the single most important component was the high consumption of plant foods. In contrast, fish and seafood consumption, the only animal foods promoted in the Mediterranean diet, did not seem to help.

If you look at four of the major dietary quality scoring systems, which have all been associated with extending lifespan and lowering heart disease and cancer mortality, they all share only four things in common: more fruit, more vegetables, more whole grains and more nuts and beans. They are all built on a common core of a diet rich in plant foods, whereas opposite food patterns, rich in animal foods and poor in plant-based foods (in other words, the Western diet), is associated with higher risks. So we need to optimize the food environment to support whole grains, vegetables, fruit and plant-based proteins.

That's one of the things all the so-called Blue Zones have in common: the longest living populations have not only social support and engagement and daily exercise, but nutritionally they all center their diets around plant foods, reserving meat mostly for special occasions. In fact, the population with perhaps the highest life-expectancy in the world, the California Adventist vegetarians, doesn't eat any meat at all.

So if the primary benefits of the Mediterranean diet are due to all the whole plant foods, what if you went back to the famous PREDIMED study and created a "provegetarian" scoring system? We know vegetarians live longer, but because a pure vegetarian diet might not easily be embraced by many individuals, maybe it would be easier to swallow if we just tell people more plant-based foods and less animal-based foods. But would just moving along the spectrum towards more plants actually enable people to live longer? Researchers thought of this food pattern as a "gentle approach" to vegetarianism, figuring that if it improved survival it would be an easily understandable message for health promotion: more plant foods, less animal foods.

On this scoring system, you get points for eating fruit, vegetables, nuts, grains, beans, olive oil and potatoes, but get docked points for any animal fats, eggs, fish, dairy or any type of meat or meat products. Of course that means you get a higher score the more potato chips and French fries you eat. That's why I prefer the term "whole-food, plant-based diet" since it's defined by what you eat, not by what you don't eat. When I taught at Cornell I had "vegan" students who apparently were trying to live off French fries and beer; vegan does not necessarily mean health-promoting.

But did the provegetarian scoring system work? Regardless of healthy versus unhealthy, if you give points to people for any kind of plant food, processed or not, and detract points for any kind of animal product consumption, people with higher scores live longer. The maximum provegetarian score is 60, but even just scoring 40 or more was associated with a 40 percent drop in mortality. In fact, there were so few deaths in the highest category of adherence to the provegetarian diet, they had to merge the two upper categories for their analysis. This is evidence that simple advice to increase the consumption of plant-derived foods with reductions in the consumption of foods from animal sources confers a survival advantage. You can view the graph in my video Do Flexitarians Live Longer?

The researchers conclude, "this modest change is realistic, affordable, and achievable because a sizable proportion of their population was already eating that way. So one can get significant survival benefit without a radical shift to the exclusive consumption of plant foods, a more gradual and gentle approach which is more easily translatable into public policy." A 41 percent drop in mortality rates in the United States would mean saving the lives of hundreds of thousands of Americans every year.

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

I've done a few videos on the health of so-called semi-vegetarians or flexitarians ("flexible" vegetarians). See how they rate in:

The Provegetarian Score reminds me of the animal to vegetable protein ratio in Prostate Cancer Survival: The A/V Ratio. My favorite dietary quality index is the one in Calculate Your Healthy Eating Score. How do you rate? Even the healthiest among us may be able to continue to push the envelope.

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 Do All the Blue Zones Have in Common?

Do Flexitarians Live Longer.jpg

What accounts for the benefits of a Mediterranean-style diet? An anatomy of health effects was published, and the single most important component was the high consumption of plant foods. In contrast, fish and seafood consumption, the only animal foods promoted in the Mediterranean diet, did not seem to help.

If you look at four of the major dietary quality scoring systems, which have all been associated with extending lifespan and lowering heart disease and cancer mortality, they all share only four things in common: more fruit, more vegetables, more whole grains and more nuts and beans. They are all built on a common core of a diet rich in plant foods, whereas opposite food patterns, rich in animal foods and poor in plant-based foods (in other words, the Western diet), is associated with higher risks. So we need to optimize the food environment to support whole grains, vegetables, fruit and plant-based proteins.

That's one of the things all the so-called Blue Zones have in common: the longest living populations have not only social support and engagement and daily exercise, but nutritionally they all center their diets around plant foods, reserving meat mostly for special occasions. In fact, the population with perhaps the highest life-expectancy in the world, the California Adventist vegetarians, doesn't eat any meat at all.

So if the primary benefits of the Mediterranean diet are due to all the whole plant foods, what if you went back to the famous PREDIMED study and created a "provegetarian" scoring system? We know vegetarians live longer, but because a pure vegetarian diet might not easily be embraced by many individuals, maybe it would be easier to swallow if we just tell people more plant-based foods and less animal-based foods. But would just moving along the spectrum towards more plants actually enable people to live longer? Researchers thought of this food pattern as a "gentle approach" to vegetarianism, figuring that if it improved survival it would be an easily understandable message for health promotion: more plant foods, less animal foods.

On this scoring system, you get points for eating fruit, vegetables, nuts, grains, beans, olive oil and potatoes, but get docked points for any animal fats, eggs, fish, dairy or any type of meat or meat products. Of course that means you get a higher score the more potato chips and French fries you eat. That's why I prefer the term "whole-food, plant-based diet" since it's defined by what you eat, not by what you don't eat. When I taught at Cornell I had "vegan" students who apparently were trying to live off French fries and beer; vegan does not necessarily mean health-promoting.

But did the provegetarian scoring system work? Regardless of healthy versus unhealthy, if you give points to people for any kind of plant food, processed or not, and detract points for any kind of animal product consumption, people with higher scores live longer. The maximum provegetarian score is 60, but even just scoring 40 or more was associated with a 40 percent drop in mortality. In fact, there were so few deaths in the highest category of adherence to the provegetarian diet, they had to merge the two upper categories for their analysis. This is evidence that simple advice to increase the consumption of plant-derived foods with reductions in the consumption of foods from animal sources confers a survival advantage. You can view the graph in my video Do Flexitarians Live Longer?

The researchers conclude, "this modest change is realistic, affordable, and achievable because a sizable proportion of their population was already eating that way. So one can get significant survival benefit without a radical shift to the exclusive consumption of plant foods, a more gradual and gentle approach which is more easily translatable into public policy." A 41 percent drop in mortality rates in the United States would mean saving the lives of hundreds of thousands of Americans every year.

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

I've done a few videos on the health of so-called semi-vegetarians or flexitarians ("flexible" vegetarians). See how they rate in:

The Provegetarian Score reminds me of the animal to vegetable protein ratio in Prostate Cancer Survival: The A/V Ratio. My favorite dietary quality index is the one in Calculate Your Healthy Eating Score. How do you rate? Even the healthiest among us may be able to continue to push the envelope.

In health,

Michael Greger, M.D.

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

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

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Reversal of Chronic Disease Risk Even Late in Life

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A hundred years ago, the New York Times reported on a rather sophisticated study for the time: 4,600 cases of cancer appearing over a seven year period, suggesting that the increased consumption of animal foods was to blame. A century later, the latest review on the subjects concluded that mortality from all causes put together, ischemic heart disease, circulatory, and cerebrovascular diseases was significantly lower in those eating meat-free diets, in addition to less cancer and diabetes.

I'm surprised they found such significant results given that people in these studies typically didn't stop eating meat until late in life. For example, in the largest study done up until recently, up to a third of subjects ate vegetarian for less than five years, yet they still ended up with lower rates of heart disease whether they were under 60 or over 60, normal weight or overweight, used to smoke or never smoked; those that had stopped eating meat had lower risk, suggesting that decades of higher risk dietary behavior could be reversed within just years of eating healthier.

If you look at countries that switched from eating traditional, more plant-based diets to more Westernized diets, it may take 20 years for cancer rates to shoot up. It takes decades for most tumors to grow. For example, if you look at Asia, their dietary shift was accompanied by a remarkable increase in mortality rates of breast, colon, and prostate cancers. The same thing can be shown with migration studies. Men moving from rural China to the U.S. experience a dramatic increase in cancer risk, but tumors take time to grow.

So it's remarkable to me that after most of a lifetime eating the standard Western diet, one can turn it around and reverse chronic disease risk with a healthier diet, even late in the game... as discussed in my video, Never Too Late to Start Eating Healthier.

So, "should we all start eating vegetarian?" asked an editorial that accompanied the results from the largest study ever published on Americans eating plant-based diets, which found vegetarian diets to be associated with lower all-cause mortality, meaning those who started eating vegetarian live, on average, longer lives. This analysis included so-called semi-vegetarians, who ate meat at least once a month (but no more than once a week), so it's not yet clear how harmful eating meat a few times a month is. What we can all agree on, though, is that we should limit our intake of junk food and animal fat, and eat more fruits and vegetables. Most authorities will also agree that diets should include whole grains, beans, and nuts. Instead of fighting over whose diet is the best, it's time to acknowledge these common features of diets associated with less disease, and instead focus our attention on helping patients avoid the intense commercial pressures to eat otherwise.

How amazing the human body is if we just treat it right! For more on lifestyle medicine, see:

So please don't allow the perfect to become the enemy of the good. Any movement we can make towards improving our diet can help. Though the earlier the better: See Heart Disease Starts in Childhood and Back in Circulation: Sciatica and Cholesterol.

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: victorpr / 123RF

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Are Raisins a Good Snack Choice?

NF-Oct13 Are Raisins Good Snacks for Kids.jpeg

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

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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.

Image Credit: Reisek / Flickr

Original Link

The Saturated Fat Studies: Buttering Up the Public

NF-Sept29 The Saturated Fat Studies Buttering Up the Public.jpeg

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.

Image Credit: Johnathan Nightingale / Flickr

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How to Mitigate and Prevent Crohn’s Disease with Diet

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Crohn's disease is an autoimmune disorder that affects more than a million Americans. It is an inflammatory bowel disease in which the body attacks the intestines. There is currently no known cure for Crohn's disease; current research focuses on controlling symptoms. There is no definitive medical or surgical therapy. The best we have is a plant-based diet, which has afforded the best relapse prevention to date.

Researchers got the idea to try a plant-based diet because diets rich in animal protein and animal fat have been found to cause a decrease in beneficial bacteria in the intestine. So, researchers designed a semi-vegetarian diet to counter that, and 100 percent of subjects stayed in remission the first year and 92 percent the second year. These results are far better than those obtained by current drugs, including new "biological agents" that can cost $40,000 a year, and can cause progressive multifocal leukoencephalopathy, a disabling and deadly brain disease. And a healthy diet appears to work better.

But what about preventing Crohn's disease in the first place? A systematic review of the scientific literature on dietary intake and the risk of developing inflammatory bowel disease found that a high intake of fats and meat was associated with an increased risk of Crohn's disease as well as ulcerative colitis, whereas high fiber and fruit intakes were associated with decreased risk of Crohn's.

These results were supported more recently by the Harvard Nurse's Health Study. Data revealed that long-term intake of dietary fiber, particularly from fruit, was associated with lower risk of Crohn's disease. Women who fell into in the highest long-term fiber consumption group had a 40 percent reduced risk, leading the accompanying editorial to conclude, "advocating for a high-fiber diet may ultimately reduce the incidence of Crohn's disease."

The irony is that the highest fiber group wasn't even eating the official recommended daily minimum of fiber intake. Apparently, even just being less fiber deficient has a wide range of benefits, including a significant reduction in the risk of developing Crohn's disease, but why? The authors suggest it's because "fiber plays a vital role in the maintenance of our intestinal barrier function."

Our skin keeps the outside world outside, and so does the lining of our gut, but in Crohn's disease, this barrier function is impaired. You can see this under an electron microscope as shown in my video Preventing Crohn's Disease With Diet. The tight junctions between the intestinal cells have all sorts of little holes and breaks. The thought is that the increase in prevalence of inflammatory bowel diseases may be that dietary changes lead to the breakdown of our intestinal barrier, potentially allowing the penetration of bacteria into our gut wall, which our body then attacks, triggering the inflammation.

We know fiber acts as a prebiotic in our colon (large intestine), feeding our good bacteria, but what does fiber do in our small intestine where Crohn's often starts? We didn't know, until a landmark study was published. Researchers wanted to find out what could stop Crohn's associated invasive bacteria from tunneling into the gut wall. They found the invasion is inhibited by the presence of certain soluble plant fibers, such as from plantains and broccoli at the kinds of concentrations one might expect after eating them. They wondered if that may explain why plantain-loving populations have lower levels of inflammatory bowel disease. But, the researchers also found that there was something in processed foods that facilitated the invasion of the bacteria. Polysorbate 80 was one of them, found predominantly in ice cream, but also found in Crisco, Cool Whip, condiments, cottage cheese--you just have to read the labels.

What about maltodextrin, which is found in artificial sweeteners like Splenda, snack foods, salad dressings, and fiber supplements? Maltodextrin markedly enhanced the ability of the bacteria to glob onto our intestinal cells, though other additives. Carboxy-methyl cellulose and xanthan gum appeared to have no adverse effects.

This may all help solve the mystery of the increasing prevalence of Crohn's disease in developed nations, where we're eating less fiber-containing whole plant foods and more processed foods. What we need now are interventional studies to see if boosting fiber intake and avoiding these food additives can be effective in preventing and treating Crohn's disease. But until then, what do we tell people? The available evidence points to a diet low in animal fat, with lots of soluble fiber containing plant foods, and avoiding processed fatty foods that contain these emulsifiers. We also want to make sure we're not ingesting traces of dishwashing detergent, which could have the same effect, so make sure to rinse your dishes well. Researchers found that some people wash dishes and then just leave them to dry without rinsing, which is probably not a good idea. We don't currently have studies that show that avoiding polysorbate 80 and rinsing dishes well actually helps. Nevertheless, advice based on 'best available evidence' is better than no advice at all.

Here's a video about using a more plant-based diet to reduce the risk of relapses: Dietary Treatment of Crohn's Disease.

I get a lot of questions about additives like polysorbate 80. I'm glad I was finally able to do a blog about it. Here are some videos on some others:

If you, like me, used to think all fiber was good for was helping with bowel regularity you'll be amazed! See for example, Dr. Burkitt's F-Word Diet.

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: Graphic Stock

Original Link

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?

Wrong.

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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How Big Food Twists the Science

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Just like mosquitos are the vectors of spread for malaria, a landmark article published last year in one of the most prestigious medical journals, Lancet, described large food corporations as the vectors of spread for chronic disease. Unlike "infectious disease epidemics, however, these corporate disease vectors implement sophisticated campaigns to undermine public health interventions." Most mosquitoes don't have as good PR firms.

A key message was that "alcohol and ultra-processed food and drink industries use similar strategies as the tobacco industry to undermine effective public health policies and programs." What they mean by ultra-processed is things like burgers, frozen meals, chicken nuggets, fish sticks, potato chips, doughnuts and soda pop.

But how is the food industry like the tobacco industry? The "first strategy is to bias research findings." For example, Philip Morris implemented the Whitecoat project to hire doctors to publish ghost-written studies purporting to negate links between secondhand smoke and harm, publishing biased cherry-picked scientific reports to deny harm and suppress health information. In my video Food Industry-Funded Research Bias, you can see the actual industry memo describing the Whitecoat Project, designed to reverse the scientific "misconception" that secondhand smoke is harmful.

Similarly, funding from these large food corporations biases research. Studies show systematic bias from industry funding, so we get the same kind of tactics--supplying misinformation, use of supposedly conflicting evidence and hiding negative data.

The same scientists-for-hire that downplayed the risks of secondhand smoke are the same hired by the likes of the National Confectioner's Association to say candy cigarettes are A-OK as well. Of course, they declared "no conflict of interest."

The similarities between strategies used by the tobacco, alcohol, and food and drink corporations are unsurprising in view of the flow of people, funds and activities across these industries, which also have histories of joint ownership--like Philip Morris owned both Kraft and Miller Brewing.

So what's their strategy? As a former FDA commissioner described:

"The tobacco industry's strategy was embodied in a script written by the lawyers. Every tobacco company executive in the public eye was told to learn the script backwards and forwards, no deviation was allowed. The basic premise was simple-- smoking had not been proven to cause cancer. Not proven, not proven, not proven--this would be stated insistently and repeatedly. Inject a thin wedge of doubt, create controversy, never deviate from the prepared line. It was a simple plan and it worked."

Internal industry memos make this explicit, stating "doubt is our product, since it is the best means of competing with the body of fact that exists in the mind of the general public." The internal industry memos list objective number one as "to set aside in the minds of millions the false conviction that cigarette smoking causes lung cancer and other diseases; a conviction based on fanatical assumptions, fallacious rumors, unsupported claims and the unscientific statements and conjectures of publicity-seeking opportunists... [We need] to lift the cigarette from the cancer identification as quickly as possible, and to establish--once and for all--that no scientific evidence has ever been produced, presented or submitted to prove conclusively that cigarette smoking causes cancer," similar to what's now coming out from the food industry, from the same folks that brought us smoke and candy.

This is part of a series of "political" blogs which includes my video, Collaboration with the New Vectors of Disease. Why don't I just "stick to the science"? When there are billions of dollars at stake, the body of evidence can be skewed and manipulated. Funders can determine which studies are performed, how they're performed and whether or not they get published at all. That's why I think it's important to take a broader view to account for the ways the scientific method can be perverted for profit.

Here are some examples:

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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Fast Food Restaurants in Children’s Hospitals

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The food industry spends billions on advertising. Promotion costs for individual candy bars can run in the tens of millions. McDonald's alone spends a billion dollars on advertising every year. Such figures dwarf the National Cancer Institute's million dollar annual investment promoting fruit and vegetable consumption or the 1.5 million spent on cholesterol education. That McBillion goes a long way.

Children's food preferences are being molded by McDonald's even before they learn to tie their shoelaces. By the early age of three to five years, preschoolers preferred the taste of foods and drinks if they thought they were from McDonald's. This was true even for carrots--baby carrots placed in a bag with McDonald's logo reportedly tasted better. And if they get sick, children can continue to eat McDonald's in the hospital.

Nearly 1 in 3 children's hospitals have a fast food restaurant inside, leading parents to have more positive perceptions of the healthiness of McDonald's food (See Hospitals Selling Sickness). They can also just buy the naming rights altogether: The Ronald McDonald Children's Hospital, for example. In teaching hospitals, though, Krispy Kreme tops the list. Hospitals may wish to revisit the idea of serving high-calorie fast food in the very place where they also care for the most seriously ill.

This is reminiscent of the fight against tobacco back in the 1980's when public health advocates made radical suggestions, such as not selling cigarettes in hospitals. By working to make our hospitals ultimately smoke-free, we become part of a global campaign to completely eliminate the tobacco scourge. The task is difficult, but so was eradicating smallpox. Maybe it's time to stop selling sickness in hospitals.

For more on health entities appeasing the junk food industry, see my video Collaboration With the New Vectors of Disease. Even the Academy of Nutrition and Dietetics, the registered dietitian organization, has quite the shady history which I document near the end of my 2014 annual review presentation From Table to Able.

Even cynical me was surprised by my profession's hostility towards nutrition. 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 Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: davef3138 / Flickr

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