How to Treat Dry Eye Disease Naturally with Diet

Oct 31 Dry Eyes copy.jpeg

One of the most common eye disorders, dry eye disease, causes irritation or discomfort, and can decrease functional vision, sometimes causing a dramatic deterioration in the quality of life. About five million Americans over age 50 suffer from moderate-to-severe dry eyes, and tens of millions more have mild or episodic manifestations of the disease, at a cost of more than $50 billion.

In terms of treatment, there are several drops and drugs that can help. We spend hundreds of millions of dollars on things like artificial tears, but currently there is no therapy available to actually fix the problem. If drugs don't work, doctors can try plugging up the outflow tear ducts, but that can cause complications, such as plugs migrating and eroding into the face, requiring surgical removal. Alternatively, surgeons can just cauterize or stitch up the ducts in the first place.

There has to be a better way.

What about prevention? Dry eyes can be caused by LASIK surgery, affecting about 20-40% of patients six months after the operation. With a million LASIK procedures performed annually, that's a lot of people, and sometimes the long-term symptoms can be severe and disabling.

There's a long list of drugs that can cause it, including antihistamines, decongestants, nearly all the antidepressants, anticonvulsants, antipsychotics, anti-Parkinson's drugs, beta-blockers, and hormone replacement therapy, as well as a few herbal preparations.

In the developing world, vitamin A deficiency can start out as dry eyes and then progress to becoming the leading cause of preventable childhood blindness. Vitamin A deficiency is almost never seen in the developed world, unless you do it intentionally. There was a report in the 1960s of a guy who deliberately ate a vitamin A-deficient diet, living off of bread and lime juice for five years, and his eyes developed vascularization and ulceration of the cornea, which you can see (if you dare) in my Treating Dry Eye Disease with Diet: Just Add Water? video. That was better than what happened to an unfortunate woman who was the member of a cult and tried to live off of brown rice and herbal tea: Her eyes literally melted and collapsed.

There are also a couple case reports of autistic children who refused to eat anything but French fries or menus exclusively comprised of bacon, blueberry muffins, and Kool-Aid, and became vitamin A deficient. A case in the Bronx was written up as vegan diet and vitamin A deficiency, but it had nothing to do with his vegan diet--the kid refused to eat vegetables, consuming only potato chips, puffed rice cereal with non-fortified soymilk, and juice drinks. "His parents lacked particular skill in overcoming the child's tendency to avoid fruits and vegetables."

A plant-based diet may actually be the best thing for patients with dry eye disease, those who wear contact lenses, and those who wish to maximize their tear secretions. People with dry eyes should be advised to lower protein, total fat, and cholesterol intake, and do the following:

  • increase complex carbohydrates;
  • increase vitamin A content (by eating red, orange, yellow, and dark green leafy vegetables);
  • increase zinc and folate intake (by eating whole grains, beans, and raw vegetables, especially spinach);
  • ensure sufficient vitamin B6 and potassium intake (by eating nuts, bananas, and beans);
  • ensure sufficient vitamin C intake (by eating citrus);
  • eliminate alcohol and caffeine;
  • reduce sugar and salt intake; and
  • consume six to eight glasses of water per day.

We know dehydration can cause a dry mouth, but could dehydration cause dry eyes? It may seem kind of obvious, but evidently it was never studied until recently. Is the answer to just drink more water? We know that those suffering from dry eye are comparatively dehydrated, so researchers figured that tear secretion decreases with progressive dehydration just like saliva secretion decreases and gives us a dry mouth. And indeed, as one gets more and more dehydrated, their urine concentrates and so does the tear fluid. But one can reverse that with rehydration, raising the exciting prospect that improving whole-body hydration by getting people to drink more water might bring relief for those with dry eyes. The researchers recommend eight cups of water a day for women and ten cups a day for men.


Find more on the importance of proper hydration in my How Many Glasses of Water Should We Drink a Day?, Does a Drink Of Water Make Children Smarter?, and Can Dehydration Affect Our Mood? videos.

To learn more on other topics related to eye health, check out:

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:

Original Link

How to Treat Dry Eye Disease Naturally with Diet

Oct 31 Dry Eyes copy.jpeg

One of the most common eye disorders, dry eye disease, causes irritation or discomfort, and can decrease functional vision, sometimes causing a dramatic deterioration in the quality of life. About five million Americans over age 50 suffer from moderate-to-severe dry eyes, and tens of millions more have mild or episodic manifestations of the disease, at a cost of more than $50 billion.

In terms of treatment, there are several drops and drugs that can help. We spend hundreds of millions of dollars on things like artificial tears, but currently there is no therapy available to actually fix the problem. If drugs don't work, doctors can try plugging up the outflow tear ducts, but that can cause complications, such as plugs migrating and eroding into the face, requiring surgical removal. Alternatively, surgeons can just cauterize or stitch up the ducts in the first place.

There has to be a better way.

What about prevention? Dry eyes can be caused by LASIK surgery, affecting about 20-40% of patients six months after the operation. With a million LASIK procedures performed annually, that's a lot of people, and sometimes the long-term symptoms can be severe and disabling.

There's a long list of drugs that can cause it, including antihistamines, decongestants, nearly all the antidepressants, anticonvulsants, antipsychotics, anti-Parkinson's drugs, beta-blockers, and hormone replacement therapy, as well as a few herbal preparations.

In the developing world, vitamin A deficiency can start out as dry eyes and then progress to becoming the leading cause of preventable childhood blindness. Vitamin A deficiency is almost never seen in the developed world, unless you do it intentionally. There was a report in the 1960s of a guy who deliberately ate a vitamin A-deficient diet, living off of bread and lime juice for five years, and his eyes developed vascularization and ulceration of the cornea, which you can see (if you dare) in my Treating Dry Eye Disease with Diet: Just Add Water? video. That was better than what happened to an unfortunate woman who was the member of a cult and tried to live off of brown rice and herbal tea: Her eyes literally melted and collapsed.

There are also a couple case reports of autistic children who refused to eat anything but French fries or menus exclusively comprised of bacon, blueberry muffins, and Kool-Aid, and became vitamin A deficient. A case in the Bronx was written up as vegan diet and vitamin A deficiency, but it had nothing to do with his vegan diet--the kid refused to eat vegetables, consuming only potato chips, puffed rice cereal with non-fortified soymilk, and juice drinks. "His parents lacked particular skill in overcoming the child's tendency to avoid fruits and vegetables."

A plant-based diet may actually be the best thing for patients with dry eye disease, those who wear contact lenses, and those who wish to maximize their tear secretions. People with dry eyes should be advised to lower protein, total fat, and cholesterol intake, and do the following:

  • increase complex carbohydrates;
  • increase vitamin A content (by eating red, orange, yellow, and dark green leafy vegetables);
  • increase zinc and folate intake (by eating whole grains, beans, and raw vegetables, especially spinach);
  • ensure sufficient vitamin B6 and potassium intake (by eating nuts, bananas, and beans);
  • ensure sufficient vitamin C intake (by eating citrus);
  • eliminate alcohol and caffeine;
  • reduce sugar and salt intake; and
  • consume six to eight glasses of water per day.

We know dehydration can cause a dry mouth, but could dehydration cause dry eyes? It may seem kind of obvious, but evidently it was never studied until recently. Is the answer to just drink more water? We know that those suffering from dry eye are comparatively dehydrated, so researchers figured that tear secretion decreases with progressive dehydration just like saliva secretion decreases and gives us a dry mouth. And indeed, as one gets more and more dehydrated, their urine concentrates and so does the tear fluid. But one can reverse that with rehydration, raising the exciting prospect that improving whole-body hydration by getting people to drink more water might bring relief for those with dry eyes. The researchers recommend eight cups of water a day for women and ten cups a day for men.


Find more on the importance of proper hydration in my How Many Glasses of Water Should We Drink a Day?, Does a Drink Of Water Make Children Smarter?, and Can Dehydration Affect Our Mood? videos.

To learn more on other topics related to eye health, check out:

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:

Original Link

Choosing to Have a Normal Blood Pressure

Oct 5 Blood Pressure copy.jpeg

For the first 90% of our evolution, humans ate diets containing less than a quarter teaspoon of salt a day. Why? Because we ate mostly plants. Since we went millions of years without salt shakers, our bodies evolved into salt-conserving machines, which served us well until we discovered salt could be used to preserve foods. Without refrigeration, this was a big boon to human civilization. Of course, this may have led to a general rise in blood pressure, but does that matter if the alternative is starving to death since all your food rotted away? But where does that leave us now, when we no longer have to live off pickles and jerky? We are genetically programmed to eat ten times less salt than we do now. Even many "low"-salt diets can be considered high-salt diets. That's why it's critical to understand what the concept of "normal" is when it comes to salt.

As I discuss in my video High Blood Pressure May Be a Choice, having a "normal" salt intake can lead to a "normal" blood pressure, which can help us to die from all the "normal" causes, like heart attacks and strokes.

Doctors used to be taught that a "normal" systolic blood pressure (the top number) is approximately 100 plus age. Babies start out with a blood pressure around 95 over 60, but then as we age that 95 can go to 120 by our 20s, then 140 in our 40s, and keep climbing as we age. (140 is the official cut-off above which one technically has high blood pressure.) That was considered normal, since everyone's blood pressure creeps up as we get older. And if that's normal, then heart attacks and strokes are normal too, since risk starts rising once we start getting above the 100 we had as a baby.

If blood pressures over 100 are associated with disease, maybe they should be considered abnormal. Were these elevated blood pressures caused by our abnormally high salt intake--ten times more than what our bodies were designed to handle? Maybe if we ate a natural amount of salt, our blood pressures would not go up with age and we'd be protected. Of course, to test that theory you'd have to find a population in modern times that doesn't use salt, eat processed food, or go out to eat. For that, you'd have to go deep into the Amazon rainforest.

Meet the Yanomamo people, a no-salt culture with the lowest salt intake ever reported. That is, they have a totally normal-for-our-species salt intake. So, what happens to their blood pressure on a no- or low-salt diet as they age? They start out with a blood pressure of about 100 over 60 and end up with a blood pressure of about 100 over 60. Though theirs is described as a salt-deficient diet, that's like saying they have a diet deficient in Twinkies. They're the ones, it seems, who are eating truly normal salt intakes, which leads to truly normal blood pressures. Those in their 50s have the blood pressure of a 20-year-old. What was the percentage of the population tested with high blood pressure? Zero. However, elsewhere in Brazil, up to 38% of the population may be affected. The Yanomamos probably represent the ultimate human example of the importance of salt on blood pressure.

Of course, there could have been other factors. They didn't drink alcohol, ate a high-fiber and plant-based diet, got lots of exercise, and had no obesity. There are a number of plant-based populations eating little salt who experience no rise of blood pressure with age, but how do we know what exactly is to blame? Ideally, we'd do an interventional trial. Imagine if we took people literally dying from out-of-control high blood pressure (so called malignant hypertension) where you go blind from bleeding into your eyes, your kidneys shut down, and your heart fails, and then we withhold from these patients blood pressure medications so their fate is certain death. Then, what if we put them on a Yanomamo level of salt intake--that is, a normal-for-the-human-species salt intake--and, if instead of dying, they walked away cured of their hypertension? That would pretty much seal the deal.

Enter Dr. Walter Kempner and his rice and fruit diet. Patients started with blood pressures of 210 over 140, which dropped down to 80 over 60. Amazing stuff, but how could he ethically withhold all modern blood pressure medications and treat with diet alone? This was back in the 1940s, and the drugs hadn't been invented yet.

His diet wasn't just extremely low salt, though; it was also strictly plant-based and extremely low in fat, protein, and calories. There is no doubt that Kempner's rice diet achieved remarkable results, and Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure can often be lowered by a low enough salt diet.

Forty years ago, it was acknowledged that the evidence is very good, if not conclusive, that a low enough reduction of salt in the diet would result in the prevention of essential hypertension (the rising of blood pressure as we age) and its disappearance as a major public health problem. It looks like we knew how to stop this four decades ago. During this time, how many people have died? Today, high blood pressure may kill 400,000 Americans every year--causing a thousand unnecessary deaths every day.


I have a whole series of videos on salt, including Sprinkling Doubt: Taking Sodium Skeptics with a Pinch of Salt, The Evidence That Salt Raises Blood Pressure, Shaking the Salt Habit and Sodium & Autoimmune Disease: Rubbing Salt in the Wound.

Canned foods are infamous for their sodium content, but there are no-salt varieties. Learn more with my video Canned Beans or Cooked Beans?. Cutting down on sodium is one of the ways we could be Improving on the Mediterranean Diet. Beyond heart health, reducing salt intake could also help our kidneys (How to Treat Kidney Stones with Diet) but if you cut down on salt, won't everything taste like cardboard? See Changing Our Taste Buds.

For more on hypertension, see How to Prevent High Blood Pressure with Diet, How to Treat High Blood Pressure with Diet, and How Not to Die from High Blood Pressure. What if you already eat healthfully and still can't get your pressures down? Try adding hibiscus tea (Hibiscus Tea vs. Plant-Based Diets for Hypertension) and ground flaxseeds (Flax Seeds for Hypertension) to your diet, and, of course, make sure you're exercising regularly (Longer Life Within Walking Distance).

Dr. Kempner and his rice diet are so fascinating they warrant an entire video series. Check out Kempner Rice Diet: Whipping Us Into Shape, Drugs and the Demise of the Rice Diet, Can Diabetic Retinopathy Be Reversed?, and Can Morbid Obesity be Reversed Through Diet?.

In health,

Michael Greger, M.D.

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

Original Link

Choosing to Have a Normal Blood Pressure

Oct 5 Blood Pressure copy.jpeg

For the first 90% of our evolution, humans ate diets containing less than a quarter teaspoon of salt a day. Why? Because we ate mostly plants. Since we went millions of years without salt shakers, our bodies evolved into salt-conserving machines, which served us well until we discovered salt could be used to preserve foods. Without refrigeration, this was a big boon to human civilization. Of course, this may have led to a general rise in blood pressure, but does that matter if the alternative is starving to death since all your food rotted away? But where does that leave us now, when we no longer have to live off pickles and jerky? We are genetically programmed to eat ten times less salt than we do now. Even many "low"-salt diets can be considered high-salt diets. That's why it's critical to understand what the concept of "normal" is when it comes to salt.

As I discuss in my video High Blood Pressure May Be a Choice, having a "normal" salt intake can lead to a "normal" blood pressure, which can help us to die from all the "normal" causes, like heart attacks and strokes.

Doctors used to be taught that a "normal" systolic blood pressure (the top number) is approximately 100 plus age. Babies start out with a blood pressure around 95 over 60, but then as we age that 95 can go to 120 by our 20s, then 140 in our 40s, and keep climbing as we age. (140 is the official cut-off above which one technically has high blood pressure.) That was considered normal, since everyone's blood pressure creeps up as we get older. And if that's normal, then heart attacks and strokes are normal too, since risk starts rising once we start getting above the 100 we had as a baby.

If blood pressures over 100 are associated with disease, maybe they should be considered abnormal. Were these elevated blood pressures caused by our abnormally high salt intake--ten times more than what our bodies were designed to handle? Maybe if we ate a natural amount of salt, our blood pressures would not go up with age and we'd be protected. Of course, to test that theory you'd have to find a population in modern times that doesn't use salt, eat processed food, or go out to eat. For that, you'd have to go deep into the Amazon rainforest.

Meet the Yanomamo people, a no-salt culture with the lowest salt intake ever reported. That is, they have a totally normal-for-our-species salt intake. So, what happens to their blood pressure on a no- or low-salt diet as they age? They start out with a blood pressure of about 100 over 60 and end up with a blood pressure of about 100 over 60. Though theirs is described as a salt-deficient diet, that's like saying they have a diet deficient in Twinkies. They're the ones, it seems, who are eating truly normal salt intakes, which leads to truly normal blood pressures. Those in their 50s have the blood pressure of a 20-year-old. What was the percentage of the population tested with high blood pressure? Zero. However, elsewhere in Brazil, up to 38% of the population may be affected. The Yanomamos probably represent the ultimate human example of the importance of salt on blood pressure.

Of course, there could have been other factors. They didn't drink alcohol, ate a high-fiber and plant-based diet, got lots of exercise, and had no obesity. There are a number of plant-based populations eating little salt who experience no rise of blood pressure with age, but how do we know what exactly is to blame? Ideally, we'd do an interventional trial. Imagine if we took people literally dying from out-of-control high blood pressure (so called malignant hypertension) where you go blind from bleeding into your eyes, your kidneys shut down, and your heart fails, and then we withhold from these patients blood pressure medications so their fate is certain death. Then, what if we put them on a Yanomamo level of salt intake--that is, a normal-for-the-human-species salt intake--and, if instead of dying, they walked away cured of their hypertension? That would pretty much seal the deal.

Enter Dr. Walter Kempner and his rice and fruit diet. Patients started with blood pressures of 210 over 140, which dropped down to 80 over 60. Amazing stuff, but how could he ethically withhold all modern blood pressure medications and treat with diet alone? This was back in the 1940s, and the drugs hadn't been invented yet.

His diet wasn't just extremely low salt, though; it was also strictly plant-based and extremely low in fat, protein, and calories. There is no doubt that Kempner's rice diet achieved remarkable results, and Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure can often be lowered by a low enough salt diet.

Forty years ago, it was acknowledged that the evidence is very good, if not conclusive, that a low enough reduction of salt in the diet would result in the prevention of essential hypertension (the rising of blood pressure as we age) and its disappearance as a major public health problem. It looks like we knew how to stop this four decades ago. During this time, how many people have died? Today, high blood pressure may kill 400,000 Americans every year--causing a thousand unnecessary deaths every day.


I have a whole series of videos on salt, including Sprinkling Doubt: Taking Sodium Skeptics with a Pinch of Salt, The Evidence That Salt Raises Blood Pressure, Shaking the Salt Habit and Sodium & Autoimmune Disease: Rubbing Salt in the Wound.

Canned foods are infamous for their sodium content, but there are no-salt varieties. Learn more with my video Canned Beans or Cooked Beans?. Cutting down on sodium is one of the ways we could be Improving on the Mediterranean Diet. Beyond heart health, reducing salt intake could also help our kidneys (How to Treat Kidney Stones with Diet) but if you cut down on salt, won't everything taste like cardboard? See Changing Our Taste Buds.

For more on hypertension, see How to Prevent High Blood Pressure with Diet, How to Treat High Blood Pressure with Diet, and How Not to Die from High Blood Pressure. What if you already eat healthfully and still can't get your pressures down? Try adding hibiscus tea (Hibiscus Tea vs. Plant-Based Diets for Hypertension) and ground flaxseeds (Flax Seeds for Hypertension) to your diet, and, of course, make sure you're exercising regularly (Longer Life Within Walking Distance).

Dr. Kempner and his rice diet are so fascinating they warrant an entire video series. Check out Kempner Rice Diet: Whipping Us Into Shape, Drugs and the Demise of the Rice Diet, Can Diabetic Retinopathy Be Reversed?, and Can Morbid Obesity be Reversed Through Diet?.

In health,

Michael Greger, M.D.

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

Original Link

Brown Fat: Losing Weight Through Thermogenesis

Sept 21 Brown Fat Thermo copy.jpeg

During World War I, it was discovered that many of the chemicals for new explosives had toxic or even lethal effects on the workers in the munitions factories. Chemicals such as di-nitro-phenol (DNP) can boost metabolism so much that workers were too often found wandering along the road after work, covered in sweat with temperatures of 106 to 109 degrees Fahrenheit before they died. Even after death, their temperatures kept going up, as if they were having a total body meltdown. At subacute doses, however, workers claimed to have grown thin to a notable extent after several months working with the chemical.

That got some Stanford pharmacologists excited about the "promising metabolic applications" of DNP. Our resting metabolic rate jumps up 30% after one dose of DNP, and therefore, it becomes an actual fat-burning drug. People started losing weight, as you can see in my video Brown Fat: Losing Weight Through Thermogenesis, with no apparent side effects. They felt great... and then thousands of people started going blind and users started dropping dead from hyperpyrexia, fatal fever due to the heat created by the burning fat. Of course, it continued to be sold. Ad copy read:

"Here, at last, is a [weight] reducing remedy that will bring you a figure men admire and women envy, without danger to your health or change in your regular mode of living....No diet, no exercise!"

It did work, but the therapeutic index--the difference between the effective dose and the deadly dose--was razor thin. It was not until thousands suffered irreversible harm that it got pulled from the market and remained unavailable. Unavailable, that is, until it was brought back by the internet for those dying to be thin.

There is, however, a way our body naturally burns fat to create heat. When we're born, we go from a nice tropical 98.6 in our mother's womb straight to room temperature, just when we're still all wet and slimy. As an adaptive mechanism to maintain warmth, the appearance of a unique organ around 150 million years ago allowed mammals to maintain our high body temperatures.

That unique organ is called brown adipose tissue, or BAT, and its role is to consume fat calories by generating heat in response to cold exposure. The white fat in our bellies stores fat, but the brown fat, located up between our shoulder blades, burns fat. BAT is essential for thermogenesis, the creation of heat in newborns, but has been considered unnecessary in adults who have higher metabolic rates and increased muscle mass for shivering to warm us up when we get chilled. We used to think brown tissue just shrank away when we grew up, but, if it was there, then it could potentially make a big difference for how many calories we burn every day.

When PET scans were invented to detect metabolically active tissues like cancer, oncologists kept finding hot spots in the neck and shoulder regions that on CT scans turned out not to be cancer, just fat. Then, some observant radiologists noticed they appeared in patients mostly during the cold winter months. When they looked closer at tissue samples taken from people who had undergone neck surgery, they found it: brown fat in adults.

The common message from a number of studies is that BAT is present and active in adults, and the more we have and the more active it is, the thinner we are. And we can rapidly activate our fat-burning brown fat by exposure to cold temperatures. For example, if you hang out in a cold room for two hours in your undies and put your legs on a block of ice for four minutes every five minutes, you can elicit a marked increase in energy expenditure, thanks to brown fat activation. So, the studies point to a potential "natural" intervention to stimulate energy expenditure: Turn down the heat to burn calories (and reduce the carbon footprint in the process).

Thankfully, for those of us who would rather not lay our bare legs on blocks of ice, our brown fat can also be activated by some food ingredients such as those that are covered in my Boosting Brown Fat Through Diet video.


I briefly touch on the role cold temperatures can play in weight loss in The Ice Diet and talk more about calories in (Nutrient-Dense Approach to Weight Management) and calories out (How Much Exercise to Sustain Weight Loss).

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:

Original Link

Brown Fat: Losing Weight Through Thermogenesis

Sept 21 Brown Fat Thermo copy.jpeg

During World War I, it was discovered that many of the chemicals for new explosives had toxic or even lethal effects on the workers in the munitions factories. Chemicals such as di-nitro-phenol (DNP) can boost metabolism so much that workers were too often found wandering along the road after work, covered in sweat with temperatures of 106 to 109 degrees Fahrenheit before they died. Even after death, their temperatures kept going up, as if they were having a total body meltdown. At subacute doses, however, workers claimed to have grown thin to a notable extent after several months working with the chemical.

That got some Stanford pharmacologists excited about the "promising metabolic applications" of DNP. Our resting metabolic rate jumps up 30% after one dose of DNP, and therefore, it becomes an actual fat-burning drug. People started losing weight, as you can see in my video Brown Fat: Losing Weight Through Thermogenesis, with no apparent side effects. They felt great... and then thousands of people started going blind and users started dropping dead from hyperpyrexia, fatal fever due to the heat created by the burning fat. Of course, it continued to be sold. Ad copy read:

"Here, at last, is a [weight] reducing remedy that will bring you a figure men admire and women envy, without danger to your health or change in your regular mode of living....No diet, no exercise!"

It did work, but the therapeutic index--the difference between the effective dose and the deadly dose--was razor thin. It was not until thousands suffered irreversible harm that it got pulled from the market and remained unavailable. Unavailable, that is, until it was brought back by the internet for those dying to be thin.

There is, however, a way our body naturally burns fat to create heat. When we're born, we go from a nice tropical 98.6 in our mother's womb straight to room temperature, just when we're still all wet and slimy. As an adaptive mechanism to maintain warmth, the appearance of a unique organ around 150 million years ago allowed mammals to maintain our high body temperatures.

That unique organ is called brown adipose tissue, or BAT, and its role is to consume fat calories by generating heat in response to cold exposure. The white fat in our bellies stores fat, but the brown fat, located up between our shoulder blades, burns fat. BAT is essential for thermogenesis, the creation of heat in newborns, but has been considered unnecessary in adults who have higher metabolic rates and increased muscle mass for shivering to warm us up when we get chilled. We used to think brown tissue just shrank away when we grew up, but, if it was there, then it could potentially make a big difference for how many calories we burn every day.

When PET scans were invented to detect metabolically active tissues like cancer, oncologists kept finding hot spots in the neck and shoulder regions that on CT scans turned out not to be cancer, just fat. Then, some observant radiologists noticed they appeared in patients mostly during the cold winter months. When they looked closer at tissue samples taken from people who had undergone neck surgery, they found it: brown fat in adults.

The common message from a number of studies is that BAT is present and active in adults, and the more we have and the more active it is, the thinner we are. And we can rapidly activate our fat-burning brown fat by exposure to cold temperatures. For example, if you hang out in a cold room for two hours in your undies and put your legs on a block of ice for four minutes every five minutes, you can elicit a marked increase in energy expenditure, thanks to brown fat activation. So, the studies point to a potential "natural" intervention to stimulate energy expenditure: Turn down the heat to burn calories (and reduce the carbon footprint in the process).

Thankfully, for those of us who would rather not lay our bare legs on blocks of ice, our brown fat can also be activated by some food ingredients such as those that are covered in my Boosting Brown Fat Through Diet video.


I briefly touch on the role cold temperatures can play in weight loss in The Ice Diet and talk more about calories in (Nutrient-Dense Approach to Weight Management) and calories out (How Much Exercise to Sustain Weight Loss).

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:

Original Link

How Doctors Responded to Being Named a Leading Killer

Sept 19 Doctors copy.jpeg

In my video Why Prevention Is Worth a Ton of Cure, I profiled a paper that added up all the deaths caused by medical care in this country, including the hundred thousand deaths from medication side effects, all the deaths caused by errors, and so on. The author of the paper concluded that the third leading cause of death in America is the American medical system.

What was the medical community's reaction to this revelation? After all, the paper was published in one of the most prestigious medical journals, the Journal of the American Medical Association, and was authored by one of our most prestigious physicians, Barbara Starfield, who literally wrote the book on primary care. When she was asked in an interview what the response was, Starfield replied that her primary care work had been widely embraced, but her findings on how harmful and ineffective healthcare could be received almost no attention.

This inspires the recollection of "the dark dystopia of George Orwell's 1984, where awkward facts are swallowed up by the 'memory hole' as if they had never existed at all." Report after report has come out, and the response has been a deafening silence both in deed and in word, failing to even openly discuss the problem, leading to thousands of additional deaths. We can't just keep putting out reports, we have to actually do something.

As I discuss in my video How Doctors Responded to Being Named a Leading Killer, the first report was published in 1978, suggesting about 120,000 preventable hospital deaths a year. The response? Silence for another 16 years until another scathing reminder was published. If we multiply 120,000 by those 16 years, we get 1.9 million preventable deaths, about which there was near total doctor silence. There was no substantial effort to reduce the number of those deaths. The Institute of Medicine (IOM) then released its landmark study in 1999, asserting that yet another 600,000 patients died during that time when providers could have acted.

Some things have finally changed. Work hour limits were instituted for medical trainees. Interns and residents could no longer be worked more than 80 hours a week, at least on paper, and the shifts couldn't be more than 30 hours long. That may not sound like a big step, but when I started out my internship, I worked 36 hour shifts every three days, 117-hour work weeks.

When interns and residents are forced to pull all-nighters, they make 36% more serious medical errors, five times more diagnostic errors, and have twice as many "attentional failures." That doesn't sound so bad, until you realize that means things like nodding off during surgery.

The patient is supposed to be asleep during surgery, not the surgeon.

Performance is impaired as much as a blood alcohol level that would make it illegal to drive a car--but these overworked interns and residents can still do surgery. No surprise there were 300% more patient deaths. Residents consider themselves lucky if they get through training without killing anyone. Not that the family would ever find out. With rare exceptions, doctors are unaccountable for their actions.

The IOM report did break the silence and prompted widespread promises of change, but what they did not do is act as if they really believed their own findings. If we truly believed that a minimum of 120 people every day were dying preventable deaths in hospitals, we would draw a line in the sand. If an airliner was crashing every day, we'd expect that the FAA would step in and do something. The Institute of Medicine could insistently demand that doctors and hospitals immediately adopt at least a minimum set of preventive practices--for example, bar-coding drugs so there aren't any mix-ups, like they do for even a pack of Tic Tacs at the grocery store. Rather than just going on to write yet another report, they could bluntly warn colleagues they would publicly censure those who resisted implementing these minimum practices, calling for some kind of stringent sanctions.

Instead, we get silence. But not for Barbara Starfield, who is unfortunately no longer with us. Ironically, she may have died from one of the adverse drug reactions she so vociferously warned us about. She was placed on aspirin and the blood-thinner Plavix to keep a stent she had to have placed in her coronary artery from clogging up. She told her cardiologist she was bruising more, bleeding longer, but those side effects are the risks you hope don't outweigh the benefits. Starfield apparently hit her head while swimming and bled into her brain.

The question for me is not whether she should have been on two blood-thinners for that long or even whether she should have had the stent inserted. Instead, I question whether or not she could have outright avoided the heart disease, which is 96% avoidable in women.

The number-one killer of women need almost never happen.


For those curious about my time in medical training, you can read my memoir of sorts, Heart Failure: Diary of a Third Year Medical Student.

It isn't just medical treatment that can be harmful. Even medical diagnosis can be dangerous, as I discuss in my video Cancer Risk From CT Scan Radiation.

And, just as we're (finally) seeing some changes in training protocols, the times, they are a-changin' with the emergence of the field of lifestyle medicine, as I present in several videos, including:

I recently made some videos to give people a closer look at why I believe it's so important for us to take responsibility for our own health. You can see all of them on our new Introductory Videos page.

I'm excited to be part of this revolution in medicine. Please consider joining me by supporting the 501c3 nonprofit organization that keeps NutritionFacts.org alive by making a tax-deductible donation. Thank you so much for helping me help so many others.

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:

Original Link

How Doctors Responded to Being Named a Leading Killer

Sept 19 Doctors copy.jpeg

In my video Why Prevention Is Worth a Ton of Cure, I profiled a paper that added up all the deaths caused by medical care in this country, including the hundred thousand deaths from medication side effects, all the deaths caused by errors, and so on. The author of the paper concluded that the third leading cause of death in America is the American medical system.

What was the medical community's reaction to this revelation? After all, the paper was published in one of the most prestigious medical journals, the Journal of the American Medical Association, and was authored by one of our most prestigious physicians, Barbara Starfield, who literally wrote the book on primary care. When she was asked in an interview what the response was, Starfield replied that her primary care work had been widely embraced, but her findings on how harmful and ineffective healthcare could be received almost no attention.

This inspires the recollection of "the dark dystopia of George Orwell's 1984, where awkward facts are swallowed up by the 'memory hole' as if they had never existed at all." Report after report has come out, and the response has been a deafening silence both in deed and in word, failing to even openly discuss the problem, leading to thousands of additional deaths. We can't just keep putting out reports, we have to actually do something.

As I discuss in my video How Doctors Responded to Being Named a Leading Killer, the first report was published in 1978, suggesting about 120,000 preventable hospital deaths a year. The response? Silence for another 16 years until another scathing reminder was published. If we multiply 120,000 by those 16 years, we get 1.9 million preventable deaths, about which there was near total doctor silence. There was no substantial effort to reduce the number of those deaths. The Institute of Medicine (IOM) then released its landmark study in 1999, asserting that yet another 600,000 patients died during that time when providers could have acted.

Some things have finally changed. Work hour limits were instituted for medical trainees. Interns and residents could no longer be worked more than 80 hours a week, at least on paper, and the shifts couldn't be more than 30 hours long. That may not sound like a big step, but when I started out my internship, I worked 36 hour shifts every three days, 117-hour work weeks.

When interns and residents are forced to pull all-nighters, they make 36% more serious medical errors, five times more diagnostic errors, and have twice as many "attentional failures." That doesn't sound so bad, until you realize that means things like nodding off during surgery.

The patient is supposed to be asleep during surgery, not the surgeon.

Performance is impaired as much as a blood alcohol level that would make it illegal to drive a car--but these overworked interns and residents can still do surgery. No surprise there were 300% more patient deaths. Residents consider themselves lucky if they get through training without killing anyone. Not that the family would ever find out. With rare exceptions, doctors are unaccountable for their actions.

The IOM report did break the silence and prompted widespread promises of change, but what they did not do is act as if they really believed their own findings. If we truly believed that a minimum of 120 people every day were dying preventable deaths in hospitals, we would draw a line in the sand. If an airliner was crashing every day, we'd expect that the FAA would step in and do something. The Institute of Medicine could insistently demand that doctors and hospitals immediately adopt at least a minimum set of preventive practices--for example, bar-coding drugs so there aren't any mix-ups, like they do for even a pack of Tic Tacs at the grocery store. Rather than just going on to write yet another report, they could bluntly warn colleagues they would publicly censure those who resisted implementing these minimum practices, calling for some kind of stringent sanctions.

Instead, we get silence. But not for Barbara Starfield, who is unfortunately no longer with us. Ironically, she may have died from one of the adverse drug reactions she so vociferously warned us about. She was placed on aspirin and the blood-thinner Plavix to keep a stent she had to have placed in her coronary artery from clogging up. She told her cardiologist she was bruising more, bleeding longer, but those side effects are the risks you hope don't outweigh the benefits. Starfield apparently hit her head while swimming and bled into her brain.

The question for me is not whether she should have been on two blood-thinners for that long or even whether she should have had the stent inserted. Instead, I question whether or not she could have outright avoided the heart disease, which is 96% avoidable in women.

The number-one killer of women need almost never happen.


For those curious about my time in medical training, you can read my memoir of sorts, Heart Failure: Diary of a Third Year Medical Student.

It isn't just medical treatment that can be harmful. Even medical diagnosis can be dangerous, as I discuss in my video Cancer Risk From CT Scan Radiation.

And, just as we're (finally) seeing some changes in training protocols, the times, they are a-changin' with the emergence of the field of lifestyle medicine, as I present in several videos, including:

I recently made some videos to give people a closer look at why I believe it's so important for us to take responsibility for our own health. You can see all of them on our new Introductory Videos page.

I'm excited to be part of this revolution in medicine. Please consider joining me by supporting the 501c3 nonprofit organization that keeps NutritionFacts.org alive by making a tax-deductible donation. Thank you so much for helping me help so many others.

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:

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