A Dietary Treatment for Irritable Bowel Syndrome

A Dietary Treatment for Irritable Bowel Syndrome.jpeg

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don't seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we're trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There's got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That's where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I've talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There's actually a way to harness the placebo effect without lying to patients, though. We tell them it's a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked "placebo pills" "take 2 pills twice daily." I kid you not.

Lo and behold, it worked! That's how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won't cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one's bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don't yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It's never been tested, but one might assume it wouldn't be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that "are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events." Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer's.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

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. This image has been modified.

Original Link

A Dietary Treatment for Irritable Bowel Syndrome

A Dietary Treatment for Irritable Bowel Syndrome.jpeg

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don't seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we're trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There's got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That's where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I've talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There's actually a way to harness the placebo effect without lying to patients, though. We tell them it's a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked "placebo pills" "take 2 pills twice daily." I kid you not.

Lo and behold, it worked! That's how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won't cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one's bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don't yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It's never been tested, but one might assume it wouldn't be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that "are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events." Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer's.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

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. This image has been modified.

Original Link

A Dietary Treatment for Irritable Bowel Syndrome

A Dietary Treatment for Irritable Bowel Syndrome.jpeg

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don't seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we're trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There's got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That's where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I've talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There's actually a way to harness the placebo effect without lying to patients, though. We tell them it's a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked "placebo pills" "take 2 pills twice daily." I kid you not.

Lo and behold, it worked! That's how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won't cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one's bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don't yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It's never been tested, but one might assume it wouldn't be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that "are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events." Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer's.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

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. This image has been modified.

Original Link

Reversing Diabetic Blindness with Diet

Reversing Diabetic Blindness with Diet.jpeg

Though many reported feeling better on Dr. Walter Kempner's rice and fruit diet, he refused to accept such anecdotal evidence as proof of success. He wanted objective measurements. The most famous were his "eyegrounds photographs," taken with a special camera that allowed one to visualize the back of the eye. In doing so, he proved diet can arrest the bleeding, oozing, and swelling you see in the back of the eye in people with severe kidney, hypertensive, or heart disease. Even more than that, he proved that diet could actually reverse it, something never thought possible.

In my video, Can Diabetic Retinopathy Be Reversed?, you can see before and after images of the back of patients' eyes. He found reversal to such a degree that even those who could no longer distinguish large objects were able to once again read fine print. Dr. Kempner had shown a reversal of blindness with diet.

The results were so dramatic that the head of the department of ophthalmology at Duke, where Kempner worked, was questioned as to whether they were somehow faked. He assured them they were not. In fact, he wrote in one person's chart, "This patient's eyegrounds are improved to an unbelievable degree." Not only had he never seen anything like it, he couldn't remember ever seeing a patient with such advanced disease even being alive 15 months later.

The magnitude of the improvements Kempner got--reversal of end-stage heart and kidney failure--was surprising, simply beyond belief. But as Kempner said as his closing sentence of a presentation before the American College of Physicians, "The important result is not that the change in the course of the disease has been achieved by the rice diet but that the course of the disease can be changed."

Now that we have high blood pressure drugs, we see less hypertensive retinopathy, but we still see a lot of diabetic retinopathy, now the leading cause of blindness in American adults. Even with intensive diabetes treatment--at least three insulin injections a day with the best modern technology has to offer--the best we can offer is usually just a slowing of the progression of the disease.

So, in the 21st century, we slow down your blindness. Yet a half century ago, Kempner proved we could reverse it. Kempner started out using his plant-based rice diet ultra-low in sodium, fat, cholesterol, and protein to reverse kidney and heart failure; he actually assumed the diet would make diabetes worse. He expected a 90% carbohydrate diet would increase insulin requirements, however, the opposite proved to be true. He took the next 100 patients with diabetes who walked through his door who went on the rice diet for at least three months and found their fasting blood sugars dropped despite a drop in the insulin they were taking. What really blew people away was this: Forty-four of the patients had diabetic retinopathy, and, in 30% of the cases, their eyes improved. That's not supposed to happen; diabetic retinopathy had been considered "a sign of irreversible destruction." What does this change mean in real life? Patients went from unable to even read headlines to normal vision.

The remarkable success Dr. Kempner had reversing some of the most dreaded complications of diabetes with his rice and fruit diet was not because of weight loss. The improvements occurred even in those patients who did not lose significant weight, so it must have been something specific about the diet. Maybe it was his total elimination of animal protein, animal fat, and cholesterol? Or perhaps it was his radical reduction in sodium, fat, and protein in general? We don't know.

How do we treat diabetic retinopathy these days? With steroids and other drugs injected straight into the eyeball. If that doesn't work, there's always pan-retinal laser photocoagulation, in which laser burns are etched over nearly the entire retina. Surgeons literally burn out the back of your eye. Why would they do that? The theory is that by killing off most of the retina, the little pieces you leave behind may get more blood flow.

When I see that, along with Kempner's work, I can't help but feel like history has been reversed. It seems as though it should have gone like, "Can you believe 50 years ago the best we had was this barbaric, burn-out-your-socket surgery? Thank goodness we've since learned that through dietary means alone, we can reverse the blindness." But instead of learning, medicine seems to have forgotten.

I documented the extraordinary Kempner story previously in Kempner Rice Diet: Whipping Us Into Shape and Drugs and the Demise of the Rice Diet. The reason I keep coming back to this is not to suggest people should go on such a diet (it is too extreme and potentially dangerous to do without strict medical supervision), but to show the power of dietary change to yield tremendous healing effects.

The best way to prevent diabetic blindness is to prevent or reverse diabetes in the first place. See, for example:

Why wouldn't a diet of white rice make diabetes worse? See If White Rice Is Linked to Diabetes, What About China?

For more on the nitty gritty on what is the actual cause of type 2 diabetes, see:

In health,

Michael Greger, M.D.

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

Image Credit: Community Eye Health / Flickr. This image has been modified.

Original Link

Reversing Diabetic Blindness with Diet

Reversing Diabetic Blindness with Diet.jpeg

Though many reported feeling better on Dr. Walter Kempner's rice and fruit diet, he refused to accept such anecdotal evidence as proof of success. He wanted objective measurements. The most famous were his "eyegrounds photographs," taken with a special camera that allowed one to visualize the back of the eye. In doing so, he proved diet can arrest the bleeding, oozing, and swelling you see in the back of the eye in people with severe kidney, hypertensive, or heart disease. Even more than that, he proved that diet could actually reverse it, something never thought possible.

In my video, Can Diabetic Retinopathy Be Reversed?, you can see before and after images of the back of patients' eyes. He found reversal to such a degree that even those who could no longer distinguish large objects were able to once again read fine print. Dr. Kempner had shown a reversal of blindness with diet.

The results were so dramatic that the head of the department of ophthalmology at Duke, where Kempner worked, was questioned as to whether they were somehow faked. He assured them they were not. In fact, he wrote in one person's chart, "This patient's eyegrounds are improved to an unbelievable degree." Not only had he never seen anything like it, he couldn't remember ever seeing a patient with such advanced disease even being alive 15 months later.

The magnitude of the improvements Kempner got--reversal of end-stage heart and kidney failure--was surprising, simply beyond belief. But as Kempner said as his closing sentence of a presentation before the American College of Physicians, "The important result is not that the change in the course of the disease has been achieved by the rice diet but that the course of the disease can be changed."

Now that we have high blood pressure drugs, we see less hypertensive retinopathy, but we still see a lot of diabetic retinopathy, now the leading cause of blindness in American adults. Even with intensive diabetes treatment--at least three insulin injections a day with the best modern technology has to offer--the best we can offer is usually just a slowing of the progression of the disease.

So, in the 21st century, we slow down your blindness. Yet a half century ago, Kempner proved we could reverse it. Kempner started out using his plant-based rice diet ultra-low in sodium, fat, cholesterol, and protein to reverse kidney and heart failure; he actually assumed the diet would make diabetes worse. He expected a 90% carbohydrate diet would increase insulin requirements, however, the opposite proved to be true. He took the next 100 patients with diabetes who walked through his door who went on the rice diet for at least three months and found their fasting blood sugars dropped despite a drop in the insulin they were taking. What really blew people away was this: Forty-four of the patients had diabetic retinopathy, and, in 30% of the cases, their eyes improved. That's not supposed to happen; diabetic retinopathy had been considered "a sign of irreversible destruction." What does this change mean in real life? Patients went from unable to even read headlines to normal vision.

The remarkable success Dr. Kempner had reversing some of the most dreaded complications of diabetes with his rice and fruit diet was not because of weight loss. The improvements occurred even in those patients who did not lose significant weight, so it must have been something specific about the diet. Maybe it was his total elimination of animal protein, animal fat, and cholesterol? Or perhaps it was his radical reduction in sodium, fat, and protein in general? We don't know.

How do we treat diabetic retinopathy these days? With steroids and other drugs injected straight into the eyeball. If that doesn't work, there's always pan-retinal laser photocoagulation, in which laser burns are etched over nearly the entire retina. Surgeons literally burn out the back of your eye. Why would they do that? The theory is that by killing off most of the retina, the little pieces you leave behind may get more blood flow.

When I see that, along with Kempner's work, I can't help but feel like history has been reversed. It seems as though it should have gone like, "Can you believe 50 years ago the best we had was this barbaric, burn-out-your-socket surgery? Thank goodness we've since learned that through dietary means alone, we can reverse the blindness." But instead of learning, medicine seems to have forgotten.

I documented the extraordinary Kempner story previously in Kempner Rice Diet: Whipping Us Into Shape and Drugs and the Demise of the Rice Diet. The reason I keep coming back to this is not to suggest people should go on such a diet (it is too extreme and potentially dangerous to do without strict medical supervision), but to show the power of dietary change to yield tremendous healing effects.

The best way to prevent diabetic blindness is to prevent or reverse diabetes in the first place. See, for example:

Why wouldn't a diet of white rice make diabetes worse? See If White Rice Is Linked to Diabetes, What About China?

For more on the nitty gritty on what is the actual cause of type 2 diabetes, see:

In health,

Michael Greger, M.D.

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

Image Credit: Community Eye Health / Flickr. This image has been modified.

Original Link

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

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. Image has been modified.

Original Link

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

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. Image has been modified.

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Introducing the Kempner Rice Diet

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

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

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

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

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

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

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

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

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

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

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


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

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

For more on Kempner's work, see:

In health,
Michael Greger, M.D.

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

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No More Than a Quart a Day of Hibiscus Tea

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Over the counter antacids are probably the most important source for human aluminum exposure in terms of dose. For example, Maalox, taken as directed, can exceed the daily safety limit more than 100-fold, and nowhere on the label does it say to not take it with acidic beverages such as fruit juice. Washing an antacid down with orange juice can increase aluminum absorption 8-fold, and citric acid-the acid found naturally concentrated in lemon and limes--is even worse.

Just as sour fruits can enhance the absorption of iron (a good thing), the same mechanism they may enhance the absorption of aluminum (a bad thing). This raises the question of what happens when one adds lemon juice to tea? Previously, I concluded that the amount of aluminum in tea is not a problem for most people because it's not very absorbable (See Is There Too Much Aluminum in Tea?). What if we add lemon? Researchers publishing in the journal Food and Chemical Toxicology found no difference between tea with lemon, tea without lemon, or no tea at all in terms of the amount of aluminum in the bloodstream, suggesting that tea drinking does not significantly contribute to aluminum getting inside the body.

The researchers used black tea, green tea, white tea, oolong tea, but what about the "red zinger" herbal tea, hibiscus? The reason hibiscus tea is called "sour tea" is because it has natural acids in it like citric acid. Might these acids boost the absorption of any hibiscus's aluminum? While a greater percentage of aluminum gets from the hibiscus into the tea water than from the other teas, there's less aluminum overall.

The real question is whether the aluminum then gets from the tea water into our bodies. We don't have that data, so to be on the safe side we should assume the worst: that hibiscus tea aluminum, unlike green and black tea aluminum, is completely absorbable. In that case, based on this data and the World Health Organization weekly safety limit, we may not want to drink more than 15 cups of hibiscus tea a day, (based on someone who's about 150 pounds). If you have a 75 pound 10-year-old, a half-gallon a day may theoretically be too much. Recent, more extensive testing highlighted in my video, How Much Hibiscus Tea is Too Much?, suggests that levels may reach level twice as high. Therefore, to be safe, no more than about two quarts a day for adults, or one quart a day for kids or pregnant women. Hibiscus tea should be completely avoided by infants under six months--who should only be getting breast milk--as well as kids with kidney failure, who can't efficiently excrete it.

There is also a concern about the impressive manganese level in hibiscus tea. Manganese is an essential trace mineral, a vital component of some of our most important antioxidant enzymes, but we probably only need about two to five milligrams a day. Four cups of hibiscus tea can have as much as 17 milligrams, with an average of about ten. Is that a problem?

One study from the University of Wisconsin found that women given 15 milligrams of manganese a day for four months, saw, if anything, an improvement in their anti-inflammatory, anti-oxidant enzyme activity. Another study using 20 milligrams a day similarly showed no adverse short-term effects, and importantly showed that the retention of dietary manganese is regulated. Our bodies aren't stupid; if we take in too much manganese, we decrease the absorption and increases the excretion. Even though tea drinkers may get ten times the manganese load (10 or 20 milligrams a day) the levels in their blood are essentially identical. There is little evidence that dietary manganese poses a risk.

These studies were conducted with regular tea, though, so we don't know about the absorption from hibiscus. To err on the side of caution we should probably not routinely exceed the reference dose of ten milligrams per day, or about a quart a day for adults and a half-quart for a 75 pound child.

I've actually changed my consumption. Given the benefits of the stuff, I was using it as a substitute for drinking water, drinking around two quarts a day. I was also blending the hibiscus petals in, not throwing them away, effectively doubling the aluminum content, and increasing manganese concentrations by about 30%. So given this data I've cut back to no more than a quart of filtered hibiscus tea a day.

Lemon can actually boost the antioxidant content of green and white tea. See Green Tea vs. White. For a comparison of their cancer-fighting effects in vitro, Antimutagenic Activity of Green Versus White Tea.

Before that I covered another potential downside of sour tea consumption in Protecting Teeth From Hibiscus Tea, and before that a reason we should all consider drinking it in: Hibiscus Tea vs. Plant-Based Diets for Hypertension.

For more on the iron absorption effect, see my video Risks Associated with Iron Supplements.

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: mararie / Flickr

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Aluminum Levels in Tea

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While aluminum is the third most abundant element on Earth, it may not be good for our brain, something we learned studying foundry workers exposed to particularly high levels. Although the role of aluminum in the development of brain diseases like Alzheimer's is controversial, to be prudent, steps should probably be taken to lessen our exposure to this metal.

There are a number of aluminum-containing drugs on the market (like antacids, which have the highest levels), though aluminum compounds are also added to processed foods such as anti-caking agents in pancake mix, melting agents in American cheese, meat binders, gravy thickeners, rising agents in some baking powders and dye-binders in candy. Therefore, it's better to stick to unprocessed, natural foods. Also, if you cook those natural foods in an aluminum pot, a significant amount of aluminum can leach into the food (compared to cooking in stainless steel).

When researchers tried the same experiment with tea, they got a few milligrams of aluminum regardless of what type of pot they used, suggesting that aluminum was in the tea itself. Indeed, back in the 1950's researchers noticed that tea plants tended to suck up aluminum from the soil. But it's the dose that makes the poison. According to the World Health Organization, the provisional tolerable weekly intake--our best guess at a safety limit for aluminum--is two mg per healthy kilogram of body weight per week, which is nearly a milligram per pound. Someone who weighs around 150 pounds probably shouldn't ingest more than around 20 mg of aluminum per day.

Up to a fifth of aluminum intake may come from beverages, so what we drink probably shouldn't contribute more than about four mg a day, the amount found in about five cups of green, black, or oolong tea. So should we not drink more than five cups of tea a day?

It's not what you eat or drink, it's what you absorb. If we just measured how much aluminum was in tea, it would seem as though a couple cups could double aluminum intake for the day. But if we measure the level of aluminum in people's bodies after they drink tea, it doesn't go up. This suggests that the bioavailability of aluminum in tea is low, possibly because most of the extractable aluminum in brewed tea is strongly bound to large phytonutrients that are not easily absorbed, so the aluminum just passes right through us without actually getting into our bodies. Probably more than 90 percent of the aluminum in tea is bound up.

One study out of Singapore, highlighted in my video, Is There Too Much Aluminum in Tea? did show a large spike in aluminum excretion through the urine after drinking tea compared to water. The only way for something to get from our mouth to our bladder is to first be absorbed into our bloodstream. But the researchers weren't comparing the same quantity of tea to water. They had the study subject chug down about eight and a half cups of tea, or drink water at their leisure. Therefore, the tea drinkers peed a lot more, so the aluminum content cup-for-cup was no different for tea versus water. This suggests that gross aluminum absorption from tea is unlikely and that only a little aluminum is potentially available for absorption.

So although as few as four cups of tea could provide 100 percent of our daily aluminum limit, the percentage available for absorption in the intestine may be less than 10 percent. It is therefore unlikely that moderate amounts of tea drinking can have any harmful effects--for people with normal aluminum excretion. Tea may not, however, be a good beverage for children with kidney failure, since they can't get rid of aluminum as efficiently. For most people, though, tea shouldn't be a problem.

On a special note, if you drink tea out of a can, buy undented cans. The aluminum in dented cans can leach into the liquid, boosting aluminum levels by a factor of eight while sitting on store shelves for a year.

What about the levels and absorbability of the aluminum in my other favorite type of tea? Find out in my video, How Much Hibiscus Tea is Too Much?

The tea plant also sucks up fluoride. So much so that heavy tea drinking can stain the teeth of children. See my video Childhood Tea Drinking May Increase Fluorosis Risk.

Why should we go out of our way to drink tea? See:

Is Caffeinated Tea Dehydrating? Find out by watching the video!

For more on metals in our food supply, 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: Toshiyuki IMAI / Flickr

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