What to Eat to Protect Against Kidney Cancer

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58,000 Americans are diagnosed with kidney cancer every year, and 13,000 die. And the numbers have been going up. Approximately 4 percent of cases are hereditary, but what about the other 96 percent? The only accepted risk factor has been tobacco use, but cigarette smoking has been declining.

Nitrosamines are one of the most potent carcinogens in cigarette smoke. One hot dog has as many nitrosamines and nitrosamides as five cigarettes. And these carcinogens are also found in fresh meat as well: beef, chicken and pork. So even though smoking rates have dropped, perhaps the rise in kidney cancer over the last few decades may have something to do with meat consumption. But would kidney cancer just be related to the processed meats like bacon, sausage, hot dogs and cold cuts that have nitrate and nitrite additives, or fresh meat as well?

The NIH-AARP study featured in my video Can Diet Protect Against Kidney Cancer? is the largest prospective study on diet and health ever performed--about 500,000 followed for nine years. In addition to examining nitrate and nitrite intake from processed meat, they also looked at intake from other sources such as fresh meat, eggs and dairy. Nitrite from animal sources, not just processed meats, was associated with an increased risk of kidney cancer, and total intake of nitrate and nitrite from processed meat sources was also associated with kidney cancer risk. The researchers found no associations with nitrate or nitrite intake from plant sources, but nitrates from processed meat was associated with cancer.

When meat producers advertise their bacon or lunch meat as "uncured," this means no nitrites or nitrates added. But if you look at the small print you'll see something like, "except for celery juice." That's just a sneaky way to add nitrites. Processed meat producers ferment the nitrates in celery to create nitrites, then add it to the meat; a practice even the industry admits "may be viewed as incorrect at best or deceptive at worst."

But that same fermentation of nitrates to nitrites can happen thanks to bacteria on our tongue when we eat vegetables. So why are nitrates and nitrites from vegetables on our tongue harmless, but nitrates and nitrites from vegetables in meat linked to cancer? The actual carcinogens are not nitrites, but nitrosamines and nitrosamides. In our stomach, to turn nitrites into nitros-amines, and nitros-amides we need amines and amides, which are concentrated in animal products. And vitamin C and other antioxidants in plant foods block the formation of these carcinogens in our stomach. That's why we can safely benefit from the nitrates in vegetables without the cancer risk. In fact some of the highest nitrate vegetables like arugula, kale, and collards are associated with decreased risk of kidney cancer. The more plants, it appears, the better.

Plant-based diets and fiber-rich diets are recommended to prevent cancer directly, as well as chronic conditions associated with kidney cancer, such as obesity, high blood pressure and diabetes. It's similar to sodium intake and kidney cancer. Sodium intake increases kidney disease risk, but that's not just because sodium intake increases blood pressure. It appears the salt is associated with increased cancer risk even independently of hypertension. What about plant-based diets? Turns out the protective association remains even in people who are not obese and have normal blood pressure. So overall, plant-based and fiber-rich diets appear to do both: decrease cancer risk directly and indirectly.

I briefly address kidney health in Preventing Kidney Failure Through Diet and Treating Kidney Failure Through Diet, but have a whole series of more in-depth videos dealing with various kidney issues.

More on the fascinating nitrate/nitrite story in my 17-part series about improving athletic performance with nitrate-rich vegetables such as beets and arugula. Here are a few short highlights:

More on carcinogens caused by cooking meat in videos like:

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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Drugs vs. Lifestyle for Preventing Diabetes

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In just one decade, the number of people with diabetes has more than doubled. According to the Center for Disease Control and Prevention, by 2050, one out of every three of us may have diabetes.

What's the big deal?

Well, the "consequences of diabetes are legion." Diabetes is the number one cause of adult-onset blindness, the number one cause of kidney failure, and the number one cause of surgical amputations.

What can we do to prevent it?

The onset of Type 2 diabetes is gradual, with most individuals progressing through a state of prediabetes, a condition now striking approximately one in three Americans, but only about one in ten even knows they have it. Since current methods of treating diabetes remain inadequate, prevention is preferable, but what works better: lifestyle changes or drugs? We didn't know until a landmark study, highlighted in my video, How to Prevent Prediabetes from Turning into Diabetes, was published in the New England Journal of Medicine.

Thousands were randomized to get a double dose of the leading anti-diabetes drug, or diet and exercise. The drug, metformin, is probably the safest diabetes drug there is. It causes diarrhea in about half, makes one in four nauseous, about one in ten suffer from asthenia (physical weakness and fatigue), but only about 1 in 67,000 are killed by the drug every year.

And the drug worked. Compared to placebo, in terms of the percentage of people developing diabetes within the four-year study period, fewer people in the drug group developed diabetes.

But diet and exercise alone worked better. The lifestyle intervention reduced diabetes incidence by 58 percent, compared to only 31 percent with the drug. The lifestyle intervention was significantly more effective than the drug, and had fewer side-effects. More than three quarters of those on the drug reported gastrointestinal symptoms, though there was more muscle soreness reported in the lifestyle group, on account of them actually exercising.

That's what other studies have subsequently found: non-drug approaches superior to drug-based approaches for diabetes prevention. And the average 50 percent or so drop in risk was just for those instructing people to improve their diet and lifestyle, whether or not they actually did it.

In one of the most famous diabetes prevention studies, 500 people with prediabetes were randomized into a lifestyle intervention or control group. During the trial, the risk of diabetes was reduced by that same 50-60 percent, but only a fraction of the patients met the modest goals. Even in the lifestyle intervention group, only about a quarter were able to eat enough fiber, meaning whole, plant foods, and cut down on enough saturated fat, which in North America is mostly dairy, dessert, chicken and pork. But they did better than the control group, and fewer of them developed diabetes because of it. But what if you looked just at the folks that actually made the lifestyle changes? They had zero diabetes--none of them got diabetes. That's effectively a 100 percent drop in risk.

I often hear the diet and exercise intervention described as 60 percent effective. That's still nearly twice as effective as the drug, but what the other study really showed it may be more like 100 percent in people who actually do it. So is diet and exercise 100 percent effective or only 60 percent effective? On a population scale, since so many people won't actually do it, it may only be 60 percent effective. But on an individual level, if you want to know what are the chances you won't get diabetes if you change your lifestyle, then the 100 percent answer is more accurate. Lifestyle interventions only work when we do them. Kale is only healthy if it actually gets into our mouth. It's not healthy just sitting on the shelf.


How about preventing prediabetes in the first place? See Preventing Prediabetes By Eating More and my video How to Prevent Prediabetes in Children.

Some things we may want to avoid can be found in my videos Eggs and Diabetes and Fish and Diabetes.

And what if we already have the disease? See Diabetics Should Take Their Pulses and my live presentation From Table to Able: Combating Disabling Diseases with Diet.

What if you don't have time for exercise? Check out Standing Up for Your Health.

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, and Food as Medicine.

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How to Prevent Childhood Obesity and Diabetes

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Thirty years ago, virtually all diabetes in young individuals was thought to be autoimmune Type 1 diabetes, but since the mid-90s, we started to see an increase in Type 2 diabetes among youth, particularly in the United States. Indeed, "the term adult onset diabetes has now been scrapped and replaced with 'Type 2' because children as young as eight are now developing the disease." And the effects can be just as devastating. A 15-year follow-up of children diagnosed with Type 2 diabetes found an alarming rate in young adults of blindness, amputation, kidney failure and death in young adulthood.

Why the dramatic rise in childhood diabetes? The dramatic rise in childhood diabetes is due to the dramatic rise in childhood obesity. During the past 30 years, the number of children diagnosed as being overweight has increased by more than 100 percent. Once an obese child reaches age six, it's likely they'll stay that way. And even if they don't, being overweight in our youth predicts adult disease and death regardless of adult body weight.

Being an overweight teen may predict disease risk 55 years later, including twice the risk of dying from heart attack, more cancer, gout, and arthritis. In fact being overweight as a teen "was a more powerful predictor of these risks then being overweight in adulthood." This underscores the importance of focusing on preventing childhood obesity.

How do we do it? From the official American Academy of Pediatrics clinical practice guidelines: the problem appears to be kids eating too much fat and added sugar, and not eating enough fruits and vegetables.

Doctors, at every occasion beginning soon after a child's birth, should endeavor to give sound advice regarding nutrition and growth so that obesity and its complications may be curtailed. What might sound advice sound like?

The chair of the nutrition department at Loma Linda published a review suggesting not eating meat at all might be an effective strategy. Population studies have consistently shown that vegetarians are thinner than comparable non-vegetarians.

In the largest such study to date (highlighted in my video How to Prevent Prediabetes in Children), a body mass index over 30 is considered obese, 25 to 30 overweight, and under 25 an ideal weight. The non-vegetarians were up at 28.8, showing the average meat-eater in the U.S. is significantly overweight. As one gets more and more plant-based, the average BMI drops. But even the average vegetarian in the U.S. is overweight. The only dietary group that was, on average, ideal weight were those eating strictly plant-based. It comes out to be about a 30-pound difference between average vegans and meat-eaters.

In school-aged children, the consumption of animal foods (meats, dairy, or eggs) is associated with an increased risk of being overweight, whereas plant-based equivalents like veggie burgers, veggie dogs, and veggie cold cuts were not. The whole plant foods like grains, beans, and nuts were found to be protective.

This may be because plant-based diets are low in energy density and high in starch, fiber, and water, which may increase feelings of fullness and resting energy expenditure, meaning resting metabolic rate. Eating plant-based appears to boost metabolism, such that you just burn more calories at rest. However, we're not sure how much of the benefits are due to increased consumption of plant foods versus decreased consumption of meat.

"Plant-based diets should be encouraged and promoted for optimal health. Local, national and international food policies are warranted to support social marketing messages and to reduce the social, cultural, economic and political forces that make it difficult to promote such diets." For example, although the advice to consume a plant-based diet is sound, questions arise concerning the relatively high price of produce.

We could reduce the burden of childhood obesity and prevent further spread of the disease, but we need to ensure that plant foods are affordable and accessible to children of all income levels. Getting diabetes in childhood cuts about 20 years of their life. What parent wouldn't go to the ends of the Earth to add decades to their children's lives? Fruits and vegetables may not fit on the Dollar Menu, but our kids are worth it.

We make life and death decisions at the grocery store buying food for our family. It's never too early to start our kids off on the right foot. See my video Heart Disease Starts in Childhood.

And healthy doesn't have to mean more expensive. Check out Eating Healthy on a Budget.

For some tips on getting our kids to eat their vegetables, see my videos Tricks to Get Kids to Eat Healthier at School and Tricks to Get Kids to Eat Healthier at Home.

Once one has prediabetes, there's a way to prevent it from progressing further. See my video How to Prevent Prediabetes from Turning into Diabetes.

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.

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How a Tick Bite Can Lead to Food Allergies

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In the beginning, Aristotle defined two forms of life on planet Earth: plants and animals. Two thousand years later, the light microscope was invented and we discovered tiny, single-celled organisms like amoebas. Then, the electron microscope was invented and we discovered bacteria. Finally, in 1969, biologists recognized fungi as a separate category, and we've had at least five kingdoms of life ever since.

In my video, Higher Quality May Mean Higher Risk, I talk about the potential downsides of consuming proteins from within our own kingdom, such as the impact our fellow animal proteins can have on boosting our liver's production of a cancer-promoting hormone called IGF-1.

In Eating Outside Our Kingdom, I talked about other potential advantages of preferably dipping into the plant and mushroom kingdoms for dinner, not only from a food safety perspective (we're more likely to get infected by animal pathogens than Dutch Elm Disease), but because of the potential for cross-reactivity between animal and human proteins. Our immune system is more likely to get confused between a chicken leg and our own legs than it is with a banana, so there may be less potential to trigger an autoimmune reaction, like degenerative brain diseases or inflammatory arthritis (See Diet & Rheumatoid Arthritis). In attacking some foreign animal meat protein, some of our own similarly composed tissues may get caught in the crossfire.

It's not just proteins. If you remember the Neu5Gc story (see Inflammatory Meat Molecule Neu5GC), sialic acid in other animals may cause inflammation in our arteries (see Nonhuman Molecules Lining Our Arteries) and help breast tumors and other human cancers to grow (see How Tumors Use Meat to Grow: Xeno-Autoantibodies). Now a new twist has been added to the story.

The reason Neu5Gc triggers inflammation is because humans lost the ability to make it two million years ago, and so when our body is exposed to it through animal products, it's treated as a foreign molecule, causing inflammation. But there's also another oligosaccharide called alpha-gal that humans, chimps, and apes lost the ability to make 20 million years ago, but is still made by a variety of animals, including many animals we eat.

Anti-gal antibodies may be involved in a number of detrimental processes that may result in allergic, autoimmune, and autoimmune-like diseases, such as auto-immune thyroid disorders. We see higher levels of anti-gal antibodies in Crohn's disease victims. These antibodies even react against about half of human breast tumors, and we can find them in atherosclerotic plaques in people's necks. However, those are all mostly speculative risks. We do know that alpha-gal is a major obstacle to transplanting pig organs into people, like kidneys, because our bodies reject alpha-gal as foreign. In fact, alpha-gal is thought to be the major target for human anti-pig antibodies.

It's interesting that if we look at those that abstain from pork for whatever reason, they have fewer swine-specific immune cells in their bloodstream. Researchers speculate that oral intake of pork could ferry swine molecules into the bloodstream via gut-infiltrating lymphocytes to prime the immune response. So we can have an allergic reaction to eating pig kidneys too, but such severe meat allergies were considered rare, until an unusual report surfaced. First described in 2009, the report included details on 24 cases of meat allergies triggered by tick bites.

Within a year, it was obvious that the cases should be counted in hundreds rather than dozens. By 2012, there were thousands of cases across a large area of the southern and eastern U.S., and new cases are now popping up in several countries around the world.

The culprit, the lone star tick, so-called because females have a white spot on their back, are famous for causing Masters' disease, a disease similar to Lyme syndrome, also known as STARI (southern tick associated rash illness). But thanks to the lone star tick steadily expanding its range (even as far as Long Island, NY), it's not necessarily just so Southern any more.

What is the relevance of tick bites to the production of allergy-causing anti-meat antibodies to alpha-gal? Good question. What we know is that if you get bitten by one of these ticks, you can develop an allergy to meat (See Alpha Gal and the Lone Star Tick). This appears to be the first example of a response to an external parasite giving rise to an important form of food allergy. We don't know the exact mechanism, but it may be because there's something in the tick saliva that's cross-reacting with alpha-gal, or because the tick is injecting you with animal allergens from its last meal.

What role may these tick-bite induced allergies play in the development of chronic hives and other allergic skin reactions in children? See Tick Bites, Meat Allergies, and Chronic Urticaria.

Here's some videos unearthing the IGF-1 story:

Neu5Gc is what opened up this whole can of worms:

I wonder if alpha gal is playing a role in the improvements in arthritis and Crohn's on plant-based diets: Dietary Treatment of Crohn's Disease and Diet & Rheumatoid Arthritis.

In health,
Michael Greger, M.D.

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

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Using Diet to Treat Asthma and Eczema

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I previously discussed the power of fruits and vegetables to help prevent and treat asthma and allergies. If adding a few more servings of fruits and vegetables may help asthma, what about a diet centered around plants? Twenty patients with allergic eczema were placed on a vegetarian diet. At the end of two months, their disease scores, which covered both subjective and objective signs and symptoms, were cut in half, similar to what we might see using one of our most powerful drugs. The drug works much quicker, within about two weeks, but since drugs can often include dangerous side effects the dietary option is more attractive. This was no ordinary vegetarian diet, however. This was an in-patient study using an extremely calorically-restricted diet--the subjects were practically half fasting. Therefore, we don't know which component was responsible for the therapeutic effect.

What about using a more conventional plant-based diet against a different allergic disease, asthma? In Sweden, there was an active health movement that claimed that a vegan diet could improve or cure asthma. This was a bold claim, so in order to test this, a group of orthopedic surgeons at Linköping University Hospital followed a series of patients who were treated with a vegan regimen for one year. (This study is highlighted in my video, Treating Asthma and Eczema with Plant-Based Diets.) Participants had to be willing to go completely plant-based, and they had to have physician-verified asthma of at least a year's duration that wasn't getting better or was getting worse despite the best medical therapies available.

The researchers found quite a sick group to follow. The thirty-five patients had long-established, hospital-verified bronchial asthma for an average duration of a dozen years. Of the 35 patients, 20 had been admitted to the hospital for acute asthmatic attacks during the last two years. Of these, one patient had received acute infusion therapy (emergency IV drugs) a total of 23 times during this period and another patient claimed he had been to the hospital 100 times during his disease and on every occasion had evidently required such treatments. One patient even had a cardiac arrest during an asthma attack and had been brought back to life on a ventilator. These were some pretty serious cases.

The patients were on up to eight different asthma medicines when they started, with an average of four and a half drugs, and were still not getting better. Twenty of the 35 were constantly using cortisone, which is a powerful steroid used in serious cases. These were all fairly advanced cases of the disease, more severe than the vegan practitioners were used to.

Eleven couldn't stick to the diet for a year, but of the 24 that did, 71% reported improvement at four months and 92% at one year. These were folks that had not improved at all over the previous year. Concurrently with this improvement, the patients greatly reduced their consumption of medicine. Four had completely given up their medication altogether, and only two weren't able to at least drop their dose. They went from an average of 4.5 drugs down to 1.2, and some were able to get off cortisone.

Some subjects said that their improvement was so considerable they felt like "they had a new life." One nurse had difficulty at work because most of her co-workers were smokers, but after the plant-based regimen she could withstand the secondhand smoke without getting an attack and could tolerate other asthma triggers. Others reported the same thing. Whereas previously they could only live in a clean environment and felt more or less isolated in their homes, they could now go out without getting asthmatic attacks.

The researchers didn't find only subjective improvements. They also found a significant improvement in a number of clinical variables, most importantly in measures of lung function, vital capacity, forced expiratory volume, and physical working capacity, as well as significant drops in sed rate (a marker of inflammation) and IgE (allergy associated antibodies).

The study started out with 35 patients who had suffered from serious asthma for an average of 12 years, all receiving long-term medication, with 20 using cortisone, who were "subjected to vegan food for a year," and, in almost all cases, medication was withdrawn or reduced, and asthma symptoms were significantly reduced.

Despite the improved lung function tests and lab values, the placebo effect can't be discounted since there was no blinded control group. However, the nice thing about a healthy diet is that there are only good side effects. The subjects' cholesterol significantly improved, their blood pressures got better, and they lost 18 pounds. From a medical standpoint, I say why not give it a try?

If you missed the first three videos of this 4-part series here are the links:

More on eczema and diet can be found in my videos:

There are a number of other conditions plant-based diets have been found to be effective in treating:

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

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Understanding Lifestyle Medicine From the Heart

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I talk a lot about numbers and statistics, but as the Director of Yale's Prevention Research Center Dr. David Katz put it in an editorial in the American Journal of Health Promotion, to reach doctors, our fellow colleagues, maybe we need to "put a human face on it all."

We have known, for at least a decade that the "leading causes of both premature death and persistent misery in our society are chronic diseases that are, in turn, attributable to the use of our feet (exercise), forks (diet), and fingers (cigarette smoking). Feet, forks, and fingers are the master levels of medical destiny for not just thousands of people on any one occasion but the medical destiny of millions upon millions year after year."

We as doctors, as a medical profession have known--Ornish published his landmark study 25 years ago (See Our Number One Killer Can Be Stopped). "We have known, but we have not managed to care," writes Dr. Katz. "At least not care deeply enough to turn what we know into what we routinely do." Were we to do so, we might be able to eliminate most heart disease, strokes, diabetes, and cancer.

But saving millions of lives is just a number. He asks doctors to:

"forget the bland statistics of public health, and ask yourself if you love someone who has suffered a heart attack, stroke, cancer, or diabetes....Now imagine their faces, whisper their names. Recall what it felt like to get the news. And while at it, imagine the faces of others like you and me imagining beloved faces. Now imagine if eight out of ten of us wistfully reflecting on intimate love and loss, on personal anguish, never got that dreadful news because it never happened. Mom did not get cancer; dad did not have a heart attack; grandpa did not have a stroke; sister, brother, aunt, and uncle did not lose a limb or kidney or eyes to diabetes. We are all intimately linked, in a network of personal tragedy that need never have occurred."

Which leads to what he is asking doctors to do about it: put a face on public health every chance you get. "When talking about heart disease and its prevention--or cancer or diabetes--ask your audience to see in their mind's eye the face of a loved one affected by that condition. Then imagine that loved one among the 80% who need never have succumbed if what we knew as doctors were what we do."

"Invoke the mind's eye," he advises, and "then bring a tear to it." (See Convincing Doctors to Embrace Lifestyle Medicine).

I think I've only profiled one other editorial (Ornish's Convergence of Evidence), but this one really struck me, so much so I used it to close out my live presentation, More Than an Apple a Day: Combating Common Diseases.

Why don't more doctors practice lifestyle medicine? Two theories are offered in The Tomato Effect and Lifestyle Medicine: Treating the Causes of Disease.

For more on the power of our day-to-day choices, see:

-Michael Greger, M.D.

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

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Who Should be Careful About Curcumin?

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Following flax and wheatgrass, turmeric is the third best-selling botanical dietary supplement, racking up $12 million in sales. Currently, sales are increasing at a rate of 20%.

"Curcumin is a natural plant product extracted from the turmeric root and is used commonly as a food additive popular for its pleasant mild aroma and exotic yellow color. It is widely considered unlikely to cause side effects." However, just because something is natural doesn't mean it's not toxic. Strychnine is natural; cyanide is natural. Lead, mercury and plutonium are all elements--can't get more natural than that! But turmeric is just a plant. Surely plants can't be dangerous? Tell that to Socrates.

"In considering the validity of the widely accepted notion that complementary and alternative medicine is a safer approach to therapy, we must remind ourselves and our patients that a therapy that exerts a biologic effect is, by definition, a drug and can have toxicity." It cannot be assumed that diet-derived agents will be innocuous when administered as pharmaceutical formulations at doses likely to exceed those consumed in the diet.

Traditional Indian diets may include as much as a teaspoon of turmeric a day. Doses of turmeric that have been used in human studies range from less than just a 16th of a teaspoon a day to two tablespoons a day for over a month. On the other hand, the curcumin trials have used up to the amount found in cups of the spice, around 100 times more than what curry lovers have been eating for centuries.

Studies have yet to show overt serious side effects in the short-term. However, if we combine high dose curcumin with black pepper, resulting in a 2000% boost in bioavailability (See Boosting the Bioavailability of Curcumin), it could be like consuming the equivalent of 29 cups of turmeric a day. That kind of intake could bring peak blood levels to the range where you start seeing some significant DNA damage in vitro.

So just incorporating turmeric into your cooking may be better than taking curcumin supplements, especially during pregnancy. The only other contraindication cited in the most recent review on curcumin was the potential to trigger gallbladder pain in individuals with gallstones.

If anything, curcumin may help protect liver function and help prevent gallstones by acting as a cholecystokinetic agent, meaning that it facilitates the pumping action of the gallbladder to keep the bile from stagnating. In one study, profiled in my video, Who Shouldn't Consume Turmeric or Curcmin?, researchers gave people a small dose of curcumin, about the amount found in a quarter teaspoon of turmeric and, using ultrasound, were able to visualize the gallbladder squeezing down in response, with an average change in volume of about 29%. Optimally, though we want to squeeze it in half. So the researchers repeated the experiment with different doses. It took about 40 milligrams to get a 50% contraction, or about a third of a teaspoon of turmeric every day.

On one hand that's great--totally doable. On the other hand, that's some incredibly powerful stuff! What if you had a gallbladder obstruction? What if you had a stone blocking your bile duct? If you eat something that makes your gallbladder squeeze so much, it could cause pain. So patients with biliary tract obstruction should be careful about consuming curcumin. For everyone else, these results suggest that curcumin can effectively "induce the gallbladder to empty and thereby reduce the risk of gallstone formation and ultimately even gallbladder cancer."

Too much turmeric, though, may increase the risk of kidney stones. As I mentioned in Oxalates in Cinnamon, turmeric is high in soluble oxalates which can bind to calcium and form insoluble calcium oxalate, which is responsible for approximately 75% of all kidney stones. "The consumption of even moderate amounts of turmeric would therefore not be recommended for people with a tendency to form kidney stones." Such folks should restrict the consumption of total dietary oxalate to less than 40 to 50 mg/day, which means no more than at most a teaspoon of turmeric. Those with gout, for example, are by definition, it appears, at high risk for kidney stones, and so if their doctor wanted to treat gout inflammation with high dose turmeric, he or she might consider curcumin supplements, because to reach high levels of curcumin in turmeric form would incur too much of an oxalate load.

If we are going to take a supplement, how do we choose? The latest review recommends purchasing from Western suppliers that follow recommended Good Manufacturing Practices, which may decrease the likelihood of buying an adulterated product.

I previously discussed the role spices play in squelching inflammation and free radicals in Which Spices Fight Inflammation? and Spicing Up DNA Protection. Then out of the lab into the clinic with attempts to test the ability of turmeric extracts to treat joint inflammation with Turmeric Curcumin and Rheumatoid Arthritis and Turmeric Curcumin and Osteoarthritis.

I wish there was more science on wheatgrass. I just had that one unhelpful anecdote in my video How Much Broccoli Is Too Much? There is good science on flax though. See:

More on gallbladder health can be found in my video Cholesterol Gallstones. And those who are susceptible to kidney stones should try to alkalinize their urine by eating lots of dark green leafy vegetables. See Testing Your Diet with Pee & Purple Cabbage.

Based on this new science on turmeric (lots more to come!), I now try to include it in my family's daily diet.

-Michael Greger, M.D

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

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The Vitamin Everyone on a Plant-Based Diet Needs

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A new study from China found that compared to omnivores, those who ate egg-free and meat-free diets had all the typical benefits of eating more plant-based: lower body mass index, lower blood pressure, lower triglyceride, lower total cholesterol, lower bad cholesterol, less free radical damage, etc. Having said that, if those on plant-based diets don't get enough vitamin B12, levels of an artery-damaging compound called homocysteine can start to rise in the bloodstream and may counteract some of the benefits of healthy eating.

In a study profiled in my video, Vitamin B12 Necessary for Arterial Health, a group of Taiwanese researchers found that the arteries of vegetarians were just as stiff as the omnivores and both had the same level of thickening in their carotid arteries, presumably because of the elevated homocysteine levels. The researchers concluded:

"The negative findings of these studies should not be considered as evidence of neutral cardiovascular effects of vegetarianism, but do indicate an urgent need for modification of vegan diets through vitamin B12 fortification or supplementation. Vitamin B12 deficiency is a very serious problem leading ultimately to anemia, neuropsychiatric disorders, irreversible nerve damage, and high levels of artery-damaging homocysteine in the blood. Prudent vegans should include sources of vitamin B12 in their diets."

One study of vegetarians whose B12 levels were really hurting found that they had even thicker, more dysfunctional arteries than omnivores. How do we know B12 was to blame? Because once they were given B12 supplements they got better. Their arterial lining started to shrink back, and the proper functioning of their arteries returned.

Without B12 fortified foods or B12 supplements, omnivores who were switched to a vegan diet developed vitamin B12 deficiency. Yes, it may take our blood levels dropping down to around 150 picomoles per liter to develop classic signs of B12 deficiency, like anemia or spinal cord degeneration, but way before that, we may start getting increased risk of cognitive deficits and brain shrinkage, stroke, depression, and nerve and bone damage. The rise in homocysteine may attenuate the beneficial effects of a vegetarian diet on cardiovascular health. The researchers concluded that while the beneficial effects of vegetarian diets on cholesterol and blood sugars "need to be advocated, but at the same time efforts to correct vitamin B12 deficiency in vegetarian diets can never be overestimated."

I have dozens of videos on B12. For a quick cut-to-the-chase see my Q&A What is the best way to get vitamin B12? and for some context Vegan B12 deficiency: putting it into perspective. Vitamin B12 supplementation with fortified foods or supplements is critical on a plant-based diet.

-Michael Greger, M.D

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

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How Avoiding Eggs Could Help You Avoid Diabetes

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

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

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

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

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

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

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death and More Than an Apple a Day, and From Table to Able.

Image Credit: Lif / Flickr

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What Do Meat Purge and Cola Have in Common?

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In my video, Treating Kidney Failure Through Diet, I profiled research suggesting that the use of a plant-based diet for patients with kidney failure would be beneficial. An important function of our kidneys is to filter out excess phosphorus from our bloodstream, so a decline in kidney function can lead to the build-up of phosphorus in our bodies. This in turn can cause something called metastatic calcification, where our heart valves and muscles and other parts of the body can buildup mineral deposits, eventually potentially resulting in bad things like skin necrosis, gangrene, and amputations. Therefore, controlling dietary phosphorus intake is the lynchpin of successful prevention of metastatic calcification. While both plant foods and animal foods have phosphorus, our bodies seem better able to handle phosphorus excretion from plants, so a plant-based diet may help protect against this dreadful condition.

However, we're beginning to realize that absorbing too much phosphorus isn't good for anyone, even those with healthy kidneys. Having high levels in our blood has been found to be an independent predictor of heart attacks and mortality in the general population, increasing the risk not only of kidney failure, but also of heart failure, heart attacks, coronary death, and overall death. Dietary intake of phosphate is an important matter not just for persons with kidney disease, but for everybody. It's thought to cause damage to blood vessels, to accelerate the aging process, and even, potentially, to hurt our bones by contributing to osteoporosis via a disruption of hormonal regulation. The estimated average requirement of phosphorus is less than 600 mg a day, but the estimated average intake in the United States is nearly twice that. How do we stay away from too much of the stuff?

In the video, Phosphate Additives in Meat Purge and Cola, we can see the different levels of phosphorus in different foods. It looks like many plant foods have as much phosphorus as many animal foods. So why are plant-based diets so effective in treating kidney failure patients? Because most of the phosphorus in plant foods is found in the form of phytic acid, which we can't digest. Therefore, while plant and animal foods may have similar phosphate contents, the amount that is bioavailable differs. In plant foods, the bioavailability of phosphates is usually less than 50%, while the bioavailability of most animal products is up around 75%.

So when we adjust for how much actually gets into our system, plant foods are significantly better. It's like the absorption of heme and non-heme iron: our bodies can protect themselves from absorbing too much plant-based iron, but can't stop excess muscle and blood-based (heme) iron from animals slipping through the intestinal wall (see my video Risk Associated With Iron Supplements).

The worst kind of phosphorus is in the form of phosphate additives (which are absorbed nearly 100%) that are added, for example, to cola drinks. Why is phosphate added to cola? Without the added phosphate, so many glycotoxins would be produced that the beverage would turn pitch black (see my video on Glycotoxins). Thus, cola drinks owe their brown color to phosphate.

Phosphate additives play an especially important role in the meat industry, where they are used as preservatives for the same reason: to enhance a meat product's color. Just like the dairy industry adds aluminum to cheese, the meat and poultry industries "enhance" their products by injecting them with phosphates. If one looks at meat industry trade journals and can get past all the macabre ads for "head dropping robots for the kill floor," you'll see all ad after ad for injection machines. Why? Because of "increased profitability." Enhanced meats have better color and less "purge."

Purge is a term used to describe the liquid that seeps from flesh as it ages. Many consumers find this unattractive, so the industry views phosphate injection as a win-win. When chicken is injected with phosphates, the "consumer benefits through the perception of enhanced quality," and the processor benefits from increased yield because they just pump it up with water and they sell it by the pound. The problem is that it can boost phosphorus levels in meat nearly 70%, a "real and insidious danger" not only for kidney patients, but for us all.

Another toxic addition to alter the color of meat is arsenic-containing drugs fed directly to chickens (see my video Arsenic in Chicken). Carbon monoxide is used to keep red meat red, anthoxanthins keep salmon pink (Artificial Coloring in Fish) and titanium dioxide is used to whiten processed foods (Titanium Dioxide & Inflammatory Bowel Disease). I'm amazed by the risks the food industry will take to alter food cosmetically (more on this in Artificial Food Colors and ADHD).

There are other harmful additives in soda as well (Is Sodium Benzoate Harmful? and Diet Soda and Preterm Birth).

What else is in poultry purge (chicken "juice")? Find out in my video, Phosphate Additives in Chicken.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Images thanks to Michael Scheltgen / Flickr

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