Plant-Based Diets as the Nutritional Equivalent of Quitting Smoking

The Best Kept Secret in Medicine.jpeg

Despite the most widely accepted and well-established chronic disease practice guidelines uniformly calling for lifestyle change as the first line of therapy, doctors often don't follow these recommendations. As seen in my video, The Best Kept Secret in Medicine, lifestyle interventions are not only safer and cheaper but often more effective in reducing heart disease and failure, hypertension, stroke, cancer, diabetes, and deaths from all causes than nearly any other medical intervention.

"Some useful lessons may come from the war on tobacco," Dr. Neal Barnard wrote in the American Medical Association's ethics journal. When he stopped smoking himself in the 1980s, the lung cancer death rate was peaking in the United States. As the prevalence of smoking dropped, so have lung cancer rates. No longer were doctors telling patients to "[g]ive your throat a vacation" by smoking a fresh cigarette. Doctors realized they were "more effective at counseling patients to quit smoking if they no longer had tobacco stains on their own fingers." "In other words, doctors went from being bystanders--or even enablers--to leading the fight against smoking." And today, says Dr. Barnard, "Plant-based diets are the nutritional equivalent of quitting smoking."

From an editorial in the journal Alternative Therapies in Health and Medicine: "If we were to gather the world's top nutrition scientists and experts (free from food industry influence), there would be very little debate about the essential properties of good nutrition. Unfortunately, most doctors are nutritionally illiterate. And worse, they don't know how to use the most powerful medicine available to them: food."

Physician advice matters. When doctors told patients to improve their diets by cutting down on meat, dairy, and fried foods, patients were more likely to make dietary changes. It may work even better if doctors practice what they preach. Researchers at Emory University randomized patients to watch one of two videos. In one video, a physician briefly mentioned her personal dietary and exercise practices and visible on her desk were both a bike helmet and an apple. In the other video, she did not discuss her personal healthy practices, and the helmet and apple were missing. In both videos, the doctor advised the patients to cut down on meat, not usually have meat for breakfast, and have no meats for lunch or dinner at least half the time. In the disclosure video, the physician related that she herself had successfully cut down on meat. Perhaps not surprisingly, patients rated that physician to be more believable and motivating. Physicians who walk the walk--literally--and have healthier eating habits not only tend to counsel more about exercise and diet, but have been found to seem more credible or motivating when they do so.

It may also make them better doctors. A randomized controlled intervention to clean up doctors' diets, called the Promoting Health by Self Experience (PHASE) trial, found that healthcare providers' personal lifestyles were correlated directly with their clinical performance. Healthcare providers' improved wellbeing and lifestyle cascaded to the patients and clinics, suggesting an additional strategy to achieve successful health promotion.

Are you ready for the best kept secret in medicine? Given the right conditions, the body can heal itself. For example, treating cardiovascular disease with appropriate dietary changes is good medicine, reducing mortality without any adverse effects. We should keep doing research, certainly, but educating physicians and patients alike about the existing knowledge regarding the power of nutrition as medicine may be the best investment we can make.

Of course, to advise patients about nutrition, physicians first have to educate themselves, as it is unlikely they received formal nutrition education during their medical training:

For more on the power of healthy living, see:

In health,

Michael Greger, M.D.

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

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

Original Link

Plant-Based Diets as the Nutritional Equivalent of Quitting Smoking

The Best Kept Secret in Medicine.jpeg

Despite the most widely accepted and well-established chronic disease practice guidelines uniformly calling for lifestyle change as the first line of therapy, doctors often don't follow these recommendations. As seen in my video, The Best Kept Secret in Medicine, lifestyle interventions are not only safer and cheaper but often more effective in reducing heart disease and failure, hypertension, stroke, cancer, diabetes, and deaths from all causes than nearly any other medical intervention.

"Some useful lessons may come from the war on tobacco," Dr. Neal Barnard wrote in the American Medical Association's ethics journal. When he stopped smoking himself in the 1980s, the lung cancer death rate was peaking in the United States. As the prevalence of smoking dropped, so have lung cancer rates. No longer were doctors telling patients to "[g]ive your throat a vacation" by smoking a fresh cigarette. Doctors realized they were "more effective at counseling patients to quit smoking if they no longer had tobacco stains on their own fingers." "In other words, doctors went from being bystanders--or even enablers--to leading the fight against smoking." And today, says Dr. Barnard, "Plant-based diets are the nutritional equivalent of quitting smoking."

From an editorial in the journal Alternative Therapies in Health and Medicine: "If we were to gather the world's top nutrition scientists and experts (free from food industry influence), there would be very little debate about the essential properties of good nutrition. Unfortunately, most doctors are nutritionally illiterate. And worse, they don't know how to use the most powerful medicine available to them: food."

Physician advice matters. When doctors told patients to improve their diets by cutting down on meat, dairy, and fried foods, patients were more likely to make dietary changes. It may work even better if doctors practice what they preach. Researchers at Emory University randomized patients to watch one of two videos. In one video, a physician briefly mentioned her personal dietary and exercise practices and visible on her desk were both a bike helmet and an apple. In the other video, she did not discuss her personal healthy practices, and the helmet and apple were missing. In both videos, the doctor advised the patients to cut down on meat, not usually have meat for breakfast, and have no meats for lunch or dinner at least half the time. In the disclosure video, the physician related that she herself had successfully cut down on meat. Perhaps not surprisingly, patients rated that physician to be more believable and motivating. Physicians who walk the walk--literally--and have healthier eating habits not only tend to counsel more about exercise and diet, but have been found to seem more credible or motivating when they do so.

It may also make them better doctors. A randomized controlled intervention to clean up doctors' diets, called the Promoting Health by Self Experience (PHASE) trial, found that healthcare providers' personal lifestyles were correlated directly with their clinical performance. Healthcare providers' improved wellbeing and lifestyle cascaded to the patients and clinics, suggesting an additional strategy to achieve successful health promotion.

Are you ready for the best kept secret in medicine? Given the right conditions, the body can heal itself. For example, treating cardiovascular disease with appropriate dietary changes is good medicine, reducing mortality without any adverse effects. We should keep doing research, certainly, but educating physicians and patients alike about the existing knowledge regarding the power of nutrition as medicine may be the best investment we can make.

Of course, to advise patients about nutrition, physicians first have to educate themselves, as it is unlikely they received formal nutrition education during their medical training:

For more on the power of healthy living, see:

In health,

Michael Greger, M.D.

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

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

Original Link

Should Cancer Patients Avoid Raw Fruits and Vegetables?

Should Cancer Patients Avoid Raw Fruits and Vegetables?.jpeg

Back in the 1960s, a patient isolator unit was developed for cancer patients undergoing chemotherapy. Because our immune system cells were often caught in the friendly fire, up to 50% of cancer patients died of infections before they could even complete the chemo because their immune systems had become so compromised. So, a bubble boy-like contraption was developed. The patient was shaved, dipped in disinfectant, rinsed off with alcohol, rubbed with antibiotic ointment into every orifice, and placed on a rotating regimen of a dozen of the most powerful antibiotics they had. Procedures were performed through plastic sleeves on the sides of the unit, and everything in and out had to be sterilized and passed through airlocks. So, the patient wasn't allowed any fresh fruits or vegetables.

People went crazy cooped up in these bubble-like units, with 38% even experiencing hallucinations. Fifteen years later the results were in: it simply didn't work. People were still dying at the same rate, so the whole thing was scrapped--except the diet. The airlocks and alcohol baths were abandoned, but they continued to make sure no one got to eat a salad.

Neutrophils are white blood cells that serve as our front line of defense. When we're immunocompromised and don't have enough neutrophils, we're called "neutropenic." So, the chemotherapy patients were put on a so-called neutropenic diet without any fresh fruits and vegetables. The problem is there's a glaring lack of evidence that such a neutropenic diet actually helps (see my video Is a Neutropenic Diet Necessary for Cancer Patients?).

Ironically, the neutropenic diet is the one remaining component of those patient isolator unit protocols that's still practiced, yet it has the least evidence supporting its use. Why? The rationale is: there are bacteria in salads, bacteria cause infections, immunocompromised patients are at increased risk for infections, and therefore, no salad. What's more, they were actually glad there aren't any studies on this because it could be way too risky to give a cancer patient an apple or something. So, its continued use seems to be based on a ''better safe than sorry'' philosophy.

The problem is that kids diagnosed with cancer are already low in dietary antioxidants, so the last thing we should do is tell them they can't have any fresh fruit or veggies. In addition to the lack of clinical evidence for this neutropenic diet, there may be some drawbacks. Restricting fruits and vegetables may even increase the risk of infection and compromise their nutritional status.

So, are neutropenic diets for cancer patients "reasonable prudence" or "clinical superstition"? Starting in the 1990s, there was a resurgence of research when greater importance was placed on the need to "support clinical practice with evidence."

What a concept!

Three randomized controlled trials were published, and not one supported the neutropenic diet. In the biggest study, an all-cooked diet was compared to one that allowed raw fruits and veggies, and there was no difference in infection and death rates. As a result of the study, the principal investigator at the MD Anderson Cancer Center described how their practice has changed and now everyone is allowed to eat their vegetables--a far cry from "please don't eat the salads" 31 years earlier.

Today, neither the Food and Drug Administration, the Centers for Disease Control and Prevention, nor the American Cancer Society support the neutropenic diet. The real danger comes from pathogenic food-poisoning bacteria like Campylobacter, Salmonella, and E. coli. So we still have to keep patients away from risky foods like undercooked eggs, meat, dairy, and sprouts. At this point, though, there really shouldn't be a debate about whether cancer patients should be on a neutropenic diet. Nevertheless, many institutions still tell cancer patients they shouldn't eat fresh fruits and veggies. According to the latest survey, more than half of pediatric cancer doctors continue to prescribe these diets, though it's quite variable even among those at the same institution.

Why are doctors still reluctant to move away from the neutropenic diet? There are several reasons why physicians may be hesitant to incorporate evidence-based medicine into their practices. They may have limited time to review the literature. They'd like to dig deep into studies, but simply don't have the time to look at the evidence. Hmm, if only there was a website... :)

Bone marrow transplants are the final frontier. Sometimes it's our immune system itself that is cancerous, such as in leukemia or lymphoma. In these cases, the immune system is wiped out on purpose to rebuild it from scratch. So, inherent in the procedure is a profound immunodeficiency for which a neutropenic diet is often recommended. This has also had never been tested--until now.

Not only did it not work, a strict neutropenic diet was actually associated with an increased risk for infection, maybe because you don't get the good bugs from fruits and vegetables crowding out the bad guys in the gut. So not only was the neutropenic diet found to be unbeneficial; there was a suggestion that it has the potential to be harmful. This wouldn't be the first time an intervention strategy made good sense theoretically, but, when put to the test, was ultimately ineffective.

Unfortunately, there's an inertia in medicine that can result in medical practice that is at odds with the available evidence. Sometimes this disconnect can have devastating consequences. See, for example, Evidence-Based Medicine or Evidence-Biased? and The Tomato Effect.

The reason it is so important to straighten out the neutropenic diet myth is that fruits and vegetables may actually improve cancer survival:

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

Original Link

Should Cancer Patients Avoid Raw Fruits and Vegetables?

Should Cancer Patients Avoid Raw Fruits and Vegetables?.jpeg

Back in the 1960s, a patient isolator unit was developed for cancer patients undergoing chemotherapy. Because our immune system cells were often caught in the friendly fire, up to 50% of cancer patients died of infections before they could even complete the chemo because their immune systems had become so compromised. So, a bubble boy-like contraption was developed. The patient was shaved, dipped in disinfectant, rinsed off with alcohol, rubbed with antibiotic ointment into every orifice, and placed on a rotating regimen of a dozen of the most powerful antibiotics they had. Procedures were performed through plastic sleeves on the sides of the unit, and everything in and out had to be sterilized and passed through airlocks. So, the patient wasn't allowed any fresh fruits or vegetables.

People went crazy cooped up in these bubble-like units, with 38% even experiencing hallucinations. Fifteen years later the results were in: it simply didn't work. People were still dying at the same rate, so the whole thing was scrapped--except the diet. The airlocks and alcohol baths were abandoned, but they continued to make sure no one got to eat a salad.

Neutrophils are white blood cells that serve as our front line of defense. When we're immunocompromised and don't have enough neutrophils, we're called "neutropenic." So, the chemotherapy patients were put on a so-called neutropenic diet without any fresh fruits and vegetables. The problem is there's a glaring lack of evidence that such a neutropenic diet actually helps (see my video Is a Neutropenic Diet Necessary for Cancer Patients?).

Ironically, the neutropenic diet is the one remaining component of those patient isolator unit protocols that's still practiced, yet it has the least evidence supporting its use. Why? The rationale is: there are bacteria in salads, bacteria cause infections, immunocompromised patients are at increased risk for infections, and therefore, no salad. What's more, they were actually glad there aren't any studies on this because it could be way too risky to give a cancer patient an apple or something. So, its continued use seems to be based on a ''better safe than sorry'' philosophy.

The problem is that kids diagnosed with cancer are already low in dietary antioxidants, so the last thing we should do is tell them they can't have any fresh fruit or veggies. In addition to the lack of clinical evidence for this neutropenic diet, there may be some drawbacks. Restricting fruits and vegetables may even increase the risk of infection and compromise their nutritional status.

So, are neutropenic diets for cancer patients "reasonable prudence" or "clinical superstition"? Starting in the 1990s, there was a resurgence of research when greater importance was placed on the need to "support clinical practice with evidence."

What a concept!

Three randomized controlled trials were published, and not one supported the neutropenic diet. In the biggest study, an all-cooked diet was compared to one that allowed raw fruits and veggies, and there was no difference in infection and death rates. As a result of the study, the principal investigator at the MD Anderson Cancer Center described how their practice has changed and now everyone is allowed to eat their vegetables--a far cry from "please don't eat the salads" 31 years earlier.

Today, neither the Food and Drug Administration, the Centers for Disease Control and Prevention, nor the American Cancer Society support the neutropenic diet. The real danger comes from pathogenic food-poisoning bacteria like Campylobacter, Salmonella, and E. coli. So we still have to keep patients away from risky foods like undercooked eggs, meat, dairy, and sprouts. At this point, though, there really shouldn't be a debate about whether cancer patients should be on a neutropenic diet. Nevertheless, many institutions still tell cancer patients they shouldn't eat fresh fruits and veggies. According to the latest survey, more than half of pediatric cancer doctors continue to prescribe these diets, though it's quite variable even among those at the same institution.

Why are doctors still reluctant to move away from the neutropenic diet? There are several reasons why physicians may be hesitant to incorporate evidence-based medicine into their practices. They may have limited time to review the literature. They'd like to dig deep into studies, but simply don't have the time to look at the evidence. Hmm, if only there was a website... :)

Bone marrow transplants are the final frontier. Sometimes it's our immune system itself that is cancerous, such as in leukemia or lymphoma. In these cases, the immune system is wiped out on purpose to rebuild it from scratch. So, inherent in the procedure is a profound immunodeficiency for which a neutropenic diet is often recommended. This has also had never been tested--until now.

Not only did it not work, a strict neutropenic diet was actually associated with an increased risk for infection, maybe because you don't get the good bugs from fruits and vegetables crowding out the bad guys in the gut. So not only was the neutropenic diet found to be unbeneficial; there was a suggestion that it has the potential to be harmful. This wouldn't be the first time an intervention strategy made good sense theoretically, but, when put to the test, was ultimately ineffective.

Unfortunately, there's an inertia in medicine that can result in medical practice that is at odds with the available evidence. Sometimes this disconnect can have devastating consequences. See, for example, Evidence-Based Medicine or Evidence-Biased? and The Tomato Effect.

The reason it is so important to straighten out the neutropenic diet myth is that fruits and vegetables may actually improve cancer survival:

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

Original Link

How Much Nutrition Education Do Doctors Get?

How Much Nutrition Education Do Doctors Get?.jpeg

In the United States, most deaths are preventable and related to nutrition. Given that the number-one cause of death and the number-one cause of disability in this country is diet, surely nutrition is the number-one subject taught in medical school, right? Sadly, that is not the case.

As shown in my video, Physician's May Be Missing Their Most Important Tool, a group of prominent physicians wrote in 2014 that "nutrition receives little attention in medical practice" and "the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training." They note this is particularly shocking since it has been proven that a whole foods, plant-based diet low in animal products and refined carbohydrates can reverse coronary heart disease--our number-one killer--and provide potent protection against other leading causes fof death such as cancer and type 2 diabetes.

So, how has medical education been affected by this knowledge? Medical students are still getting less than 20 hours of nutrition education over 4 years, and even most of that has limited clinical relevance. Thirty years ago, only 37 percent of medical schools had a single course in nutrition. According to the most recent national survey, that number has since dropped to 27 percent. And it gets even worse after students graduate.

According to the official list of all the requirements for those specializing in cardiology, Fellows must perform at least 50 stress tests, participate in at least 100 catheterizations, and so on. But nowhere in the 34-page list of requirements is there any mention of nutrition. Maybe they leave that to the primary care physicians? No. In the official 35-page list of requirements for internal medicine doctors, once again, nutrition doesn't get even a single mention.

There are no requirements for nutrition before medical school either. Instead, aspiring doctors need to take courses like calculus, organic chemistry, and physics. Most of these common pre-med requirements are irrelevant to the practice of medicine and are primarily used to "weed out" students. Shouldn't we be weeding out based on skills a physician actually uses? An important paper published in the Archives of Internal Medicine states: "The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course...[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician."

How about requiring a course in nutrition instead of calculus, or ethics instead of physics?

Despite the neglect of nutrition in medical education, physicians are considered by the public to be among the most trusted sources for information related to nutrition. But if doctors don't know what they're talking about, they could actually be contributing to diet-related disease. If we're going to stop the prevailing trend of chronic illness in the United States, physicians need to become part of the solution.

There's still a lot to learn about the optimal diet, but we don't need a single additional study to take nutrition education seriously right now. It's health care's low-hanging fruit. While we've had the necessary knowledge for some time, what we've been lacking is the will to put that knowledge into practice. If we emphasized the powerful role of nutrition, we could dramatically reduce suffering and needless death.

Take, for example, the "Million Hearts" initiative. More than 2 million Americans have a heart attack or stroke each year. In 2011, U.S. federal, state, and local government agencies launched the Million Hearts initiative to prevent 1 million of the 10 million heart attacks and strokes that will occur in the next 5 years. "But why stop at a million?" a doctor asked in the American Journal of Cardiology. Already, we possess all the information needed to eradicate atherosclerotic disease, which is our number-one killer while being virtually nonexistent in populations who consume plant-based diets. Some of the world's most renowned cardiovascular pathologists have stated we just need to get our cholesterol low enough in order to not only prevent--but also reverse--the disease in more than 80% of patients. We can open up arteries without drugs and surgery, and stabilize or improve blood flow in 99% of those who choose to eat healthily and clean up their bad habits. We can essentially eliminate our risk of having a heart attack even in the most advanced cases of heart disease.

Despite this, medical students aren't even taught these concepts while they're in school. Instead, the focus is on cutting people open, which frequently provides only symptomatic relief because we're not treating the actual cause of the disease. Fixing medical education is the solution to this travesty. Knowledge of nutrition can help doctors eradicate the world's leading killer.

I've previously addressed how Doctors Tend to Know Less Than They Think About Nutrition, which is no surprise given most medical schools in the United States fail to provide even a bare minimum of nutrition training (see Medical School Nutrition Education), with mainstream medical associations even actively lobbying against additional nutrition training.

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

Original Link

How Much Nutrition Education Do Doctors Get?

How Much Nutrition Education Do Doctors Get?.jpeg

In the United States, most deaths are preventable and related to nutrition. Given that the number-one cause of death and the number-one cause of disability in this country is diet, surely nutrition is the number-one subject taught in medical school, right? Sadly, that is not the case.

As shown in my video, Physician's May Be Missing Their Most Important Tool, a group of prominent physicians wrote in 2014 that "nutrition receives little attention in medical practice" and "the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training." They note this is particularly shocking since it has been proven that a whole foods, plant-based diet low in animal products and refined carbohydrates can reverse coronary heart disease--our number-one killer--and provide potent protection against other leading causes fof death such as cancer and type 2 diabetes.

So, how has medical education been affected by this knowledge? Medical students are still getting less than 20 hours of nutrition education over 4 years, and even most of that has limited clinical relevance. Thirty years ago, only 37 percent of medical schools had a single course in nutrition. According to the most recent national survey, that number has since dropped to 27 percent. And it gets even worse after students graduate.

According to the official list of all the requirements for those specializing in cardiology, Fellows must perform at least 50 stress tests, participate in at least 100 catheterizations, and so on. But nowhere in the 34-page list of requirements is there any mention of nutrition. Maybe they leave that to the primary care physicians? No. In the official 35-page list of requirements for internal medicine doctors, once again, nutrition doesn't get even a single mention.

There are no requirements for nutrition before medical school either. Instead, aspiring doctors need to take courses like calculus, organic chemistry, and physics. Most of these common pre-med requirements are irrelevant to the practice of medicine and are primarily used to "weed out" students. Shouldn't we be weeding out based on skills a physician actually uses? An important paper published in the Archives of Internal Medicine states: "The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course...[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician."

How about requiring a course in nutrition instead of calculus, or ethics instead of physics?

Despite the neglect of nutrition in medical education, physicians are considered by the public to be among the most trusted sources for information related to nutrition. But if doctors don't know what they're talking about, they could actually be contributing to diet-related disease. If we're going to stop the prevailing trend of chronic illness in the United States, physicians need to become part of the solution.

There's still a lot to learn about the optimal diet, but we don't need a single additional study to take nutrition education seriously right now. It's health care's low-hanging fruit. While we've had the necessary knowledge for some time, what we've been lacking is the will to put that knowledge into practice. If we emphasized the powerful role of nutrition, we could dramatically reduce suffering and needless death.

Take, for example, the "Million Hearts" initiative. More than 2 million Americans have a heart attack or stroke each year. In 2011, U.S. federal, state, and local government agencies launched the Million Hearts initiative to prevent 1 million of the 10 million heart attacks and strokes that will occur in the next 5 years. "But why stop at a million?" a doctor asked in the American Journal of Cardiology. Already, we possess all the information needed to eradicate atherosclerotic disease, which is our number-one killer while being virtually nonexistent in populations who consume plant-based diets. Some of the world's most renowned cardiovascular pathologists have stated we just need to get our cholesterol low enough in order to not only prevent--but also reverse--the disease in more than 80% of patients. We can open up arteries without drugs and surgery, and stabilize or improve blood flow in 99% of those who choose to eat healthily and clean up their bad habits. We can essentially eliminate our risk of having a heart attack even in the most advanced cases of heart disease.

Despite this, medical students aren't even taught these concepts while they're in school. Instead, the focus is on cutting people open, which frequently provides only symptomatic relief because we're not treating the actual cause of the disease. Fixing medical education is the solution to this travesty. Knowledge of nutrition can help doctors eradicate the world's leading killer.

I've previously addressed how Doctors Tend to Know Less Than They Think About Nutrition, which is no surprise given most medical schools in the United States fail to provide even a bare minimum of nutrition training (see Medical School Nutrition Education), with mainstream medical associations even actively lobbying against additional nutrition training.

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

Original Link

Medical Care: The Third Leading Cause of Death

NF-Nov10 Why Prevention is Worth.jpg

An ounce of prevention is worth a pound of cure, but a pound isn't that heavy. Why change our diet and lifestyle when we can just wait and let modern medicine fix us up? In my video The Actual Benefit of Diet vs. Drugs, I noted that patients tend to wildly overestimate the ability of cancer screening and cholesterol-lowering medications to prevent disease. Surveyed patients report they were told the truth about how little they'd benefit, 90% said they wouldn't even bother.

The reason we should eat healthier, rather than just counting on a medical technofix, is that we may hold this same overconfidence for treatment, too. In a massive study of more than 200,000 trials, researchers discovered that pills and procedures can certainly help, but genuine, very large effects with extensive support from substantial evidence appear to be rare in medicine. Further, large benefits for mortality--making people live significantly longer--are almost entirely nonexistent. Modern medicine is great for acute conditions--broken bones and curing infections--but for chronic disease, our leading causes of death and disability, we don't have much to offer. In fact, we sometimes do more harm than good.

In my Uprooting the Leading Causes of Death presentation, I noted that side-effects from prescription drugs kill an estimated 100,000 Americans every year, making medical care the sixth leading cause of death in the United States. There are another 7,000 deaths from getting the wrong medicine by mistake and 20,000 deaths from other errors in hospitals. Hospitals are dangerous places. An additional 99,000 of us die from hospital-acquired infections. But can we really blame doctors for those deaths, though? We can when they don't wash their hands.

We've known since the 1840's that the best way to prevent hospital-acquired infections is through handwashing, yet compliance rates among healthcare workers rarely exceeds 50%, and doctors are the worst, as highlighted in my video Why Prevention is Worth a Ton of Cure. Even in a medical intensive care unit with a "contact precautions" sign, signaling a particularly high risk patient, less than a quarter of doctors were found to wash their hands. Many physicians greeted the horrendous mortality data due to medical error with disbelief and concern that the information would undermine public trust. But if doctors still won't even wash their hands, how much trust do we deserve?

We could go in for a simple operation and come out with a life-threatening infection, or not come out at all. 12,000 more die from surgeries that were unnecessary in the first place. For those keeping score, that's 225,000 people dead from iatrogenic ("relating to medical care") causes. And that's mostly just for patients in a hospital. In an outpatient setting, side-effects from prescription drugs send millions to the hospital and result in perhaps 199,000 additional deaths. This is not including all those non-fatally injured (such as the case where doctors accidentally amputated the tip of a man's penis. Oops).

These estimates are on the low end. The Institute of Medicine estimated that deaths from medical errors may kill up to 98,000 Americans. That would bump us up to 284,000 dead. Even if we use the lower estimate, the medical profession constitutes the third leading cause of death in the United States. It goes heart disease, cancer, then... me.

One respondent pointed out that it was misleading to call medicine the third leading cause of death since many of those we kill also had heart disease or cancer. It's not like doctors are out there gunning down healthy people. Only people on medications are killed by medication errors or side-effects. You have to be in the hospital to be killed by a hospital error.

To which I respond: Exactly.

That's why lifestyle medicine is so important. The most common reasons people are on drugs and in hospitals is for diseases that can be prevented with a healthy diet and lifestyle. The best way to avoid the adverse effects of medical care is to not get sick in the first place.

For more background on how scandalous our handwashing history has been, see my Q&A: What about Semmelweis and medicine's shameful handwashing history? It's truly an unbelievable story.

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: Portal PBH / Flickr

Original Link

How Well Do Cholesterol-Lowering Drugs Actually Work?

NF-Nov8 The Actual Benefit  copy.jpg

One of the reasons people may undervalue diet and lifestyle changes is an overconfidence in the ability of pills and procedures to prevent disease. For example, people tend to wildly overestimate the power of things like mammograms and colonoscopies to prevent deaths from breast and bowel cancer, or the power of drugs like Fosamax to prevent hip fractures, or the power of cholesterol drugs to prevent fatal heart attacks. Patients believe statin drugs like Lipitor are about 100 times more effective than they actually are in preventing heart attacks. Studies show most people wouldn't take multiple blood pressure medications if they knew the truth.

For most people, the chance of benefit is normally less than 5 percent over five years for cholesterol, blood pressure, and blood thinning drugs. Patients don't want to take drugs unless they have at least a one in five chance--even those who just had a heart attack. It's no wonder, then, that doctors seldom share these figures. Informing patients of the percentage chance of benefit from preventive drug strategies would likely substantially reduce the likelihood that patients would agree to take the drugs every day for the rest of their lives.

For the individual, this is unlikely to be detrimental; after all, there's a 95 percent chance it won't do anything for them. But for the population at large, it would make a difference, so doctors and drug companies oversell the benefits by conveniently not mentioning how tiny they actually are, knowing most patients wouldn't take them if doctors divulged the truth. To practice non-lifestyle medicine is to practice deceptive medicine.

The best that cholesterol-lowering statin drugs appear to do is an absolute risk reduction of 3.1 percent over six years. If Dr. Esselstyn's work can be replicated in a randomized, controlled trial, then a whole foods plant-based diet will have been shown to work twenty times better, an absolute risk reduction of 60 percent after less than four years. In Esselstyn's study, 99.4 percent of high-risk patients that stuck with the diet avoided major cardiac events, such as death from heart attack.

When we have to decide whether we want to go diet versus drugs, we're not making a choice between eating healthy to prevent a heart attack or taking a pill to prevent a heart attack. Because in 97 percent of cases in the near-term, pills don't do anything. We're risking side effects for nothing, whereas if we treat the underlying root cause of the disease by eating a healthy, cholesterol-free diet, we may even reverse the progression of the disease, as seen in my video The Actual Benefit of Diet vs. Drugs.

If we stop eating an artery-clogging diet, our bodies can start dissolving that plaque away, opening up arteries in some cases without drugs or surgery. A healthy whole food plant-based diet by itself may work 20 times better than drugs to combat our #1 killer.

Now that's something doctors may want to tell their patients.

Yes, an ounce of prevention is worth a pound of cure, but a pound isn't that heavy--why change our diet and lifestyle when we can just wait and let modern medicine fix us up? Turns out we overestimate the efficacy of treatment as well, the subject of my video Why Prevention is Worth a Ton of Cure.

Sometimes preventive medicine procedures can even be harmful. See Cancer Risk From CT Scan Radiation and Do Dental X-Rays Cause Brain Tumors?

I've previously noted how an honest physician-patient interaction might go in Fully Consensual Heart Disease Treatment, Optimal Diet: Just Give it To Me Straight, Doc and Disclosing Conflicts of Interest in Medical Research. What should we be saying? See: What Diet Should Physician's Recommend?

So why don't more doctors do it? See Barriers to Heart Disease Prevention and Find Out If Your Doctor Takes Drug Company Money.

More on Dr. Esselstyn's heart disease reversal study in: Evidence-Based Medicine or Evidence-Biased?

Of course then there's just the brute force method: Kempner Rice Diet: Whipping Us Into Shape.

In health,

Michael Greger, M.D.

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

Image Credit: [akz] © 123RF.com

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Do You Meet the Simple Seven?

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

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

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

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

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

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

So What Diet Should Physicians Recommend? Watch the video!

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

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

In health,

-Michael Greger, M.D.

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

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How to Treat Prediabetes with Diet

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For people with prediabetes, lifestyle modification is considered "the cornerstone of diabetes prevention." Diet-wise, this means individuals with prediabetes or diabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. Too many of us consume a diet with too many solid fats and added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.

Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, and the official standards of care for the American Diabetes Association. Dietary strategies include reducing intake of fat and increasing intake of fiber (meaning unrefined plant foods, including whole grains).

The recommendation to consume more whole grains is based on research showing that eating lots of whole grains is associated with reduced risk of developing type 2 diabetes. New research even suggests that whole grains may protect against prediabetes in the first place.

According to the American Diabetes Association's official standards of care (which you can see in my video Lifestyle Medicine Is the Standard of Care for Prediabetes), dietary recommendations should focus on reducing saturated fat, cholesterol and trans fat intake (meat, dairy, eggs and junk food). Recommendations should also focus on increasing omega 3's, soluble fiber and phytosterols, all three of which can be found together in flax seeds; an efficient, but still uncommon, intervention for prediabetes. In one study, about two tablespoons of ground flax seed a day decreased insulin resistance (the hallmark of the disease).

If the standards of care for all the major diabetes groups say that lifestyle is the preferred treatment for prediabetes because it's safe and highly effective, why don't more doctors do it? Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about one in three patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.

It may be because doctors aren't getting paid to do it. Why haven't reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns.

"The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?"

How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education "has not changed since 1910."


I hope my work is helping to fill the gap that medical professionals are not getting during training about preventing and treating chronic disease. That's actually how this all started. I would make trips to Countway at the beginning of every month in medical school to read all the new journal issues. I felt I had a duty to my patients to stay on top of the literature. But hey, since I'm doing so much work, might as well share it! So what started as an email newsletter morphed into a medical school speaking tour into a DVD series and then now all online for everyone.

For more on preventing and treating prediabetes/diabetes, see:

For more on lifestyle medicine:

And for insight into the sad state of nutrition in medical training, Doctors Know Less Than They Think About Nutrition and Medical School Nutrition Training.

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: Alden Chadwick / Flickr

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