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

Stomach Stapling Kids

Stomach Stapling Kids.jpeg

Weight loss surgery for children and adolescents is becoming widespread and is being performed in children as young as five years old. Roux-en-Y gastric bypass is the most common type of procedure, in which surgeons cut out nearly the entire stomach, as you can see in my video, Stomach Stapling Kids. Bariatric surgery in pediatric patients does result in weight loss, but also has the potential for serious complications. These include pulmonary embolism, shock, intestinal obstruction, postoperative bleeding, leaking along the staple line, severe malnutrition, and even death at a rate of 0.5%. This means that 1 in 200 kids who go under the knife may die. Infection is identified as the leading cause of death and is most often associated with leaking of intestinal contents into the abdominal cavity.

Sometimes the surgery doesn't work, and you have to go in and do another procedure. If that doesn't work either, you can always try implanting electrodes into patients' brains, a "novel antiobesity strategy" reported in the Journal of Neurosurgery. The concept of deep brain stimulation "since its inception has been that placing an electrode somewhere in the brain could make people eat less." You drill two little holes in the patient's skull, snake in some electrodes a few inches, and then tunnel the wires under the scalp into a pulse generator implanted under the skin on the chest. You evidently can't crank it up past 5 volts because it induces anxiety and nausea. But even without the nausea, people with electrodes stuck in their brains lost an average of about 10 pounds a year.

The childhood obesity epidemic is so tragic. It pains me to see insult piled on injury. Too often, medical treatments can be worse than the disease. See my video, Why Prevention Is Worth a Ton of Cure.

Speaking of prevention, what might be the best diet for our young ones? See:

There are complications associated with gastric bypass in adults, too. See my video The Dangers of Broccoli?.

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: ReSurge International / Flickr. This image has been modified.

Original Link

Stomach Stapling Kids

Stomach Stapling Kids.jpeg

Weight loss surgery for children and adolescents is becoming widespread and is being performed in children as young as five years old. Roux-en-Y gastric bypass is the most common type of procedure, in which surgeons cut out nearly the entire stomach, as you can see in my video, Stomach Stapling Kids. Bariatric surgery in pediatric patients does result in weight loss, but also has the potential for serious complications. These include pulmonary embolism, shock, intestinal obstruction, postoperative bleeding, leaking along the staple line, severe malnutrition, and even death at a rate of 0.5%. This means that 1 in 200 kids who go under the knife may die. Infection is identified as the leading cause of death and is most often associated with leaking of intestinal contents into the abdominal cavity.

Sometimes the surgery doesn't work, and you have to go in and do another procedure. If that doesn't work either, you can always try implanting electrodes into patients' brains, a "novel antiobesity strategy" reported in the Journal of Neurosurgery. The concept of deep brain stimulation "since its inception has been that placing an electrode somewhere in the brain could make people eat less." You drill two little holes in the patient's skull, snake in some electrodes a few inches, and then tunnel the wires under the scalp into a pulse generator implanted under the skin on the chest. You evidently can't crank it up past 5 volts because it induces anxiety and nausea. But even without the nausea, people with electrodes stuck in their brains lost an average of about 10 pounds a year.

The childhood obesity epidemic is so tragic. It pains me to see insult piled on injury. Too often, medical treatments can be worse than the disease. See my video, Why Prevention Is Worth a Ton of Cure.

Speaking of prevention, what might be the best diet for our young ones? See:

There are complications associated with gastric bypass in adults, too. See my video The Dangers of Broccoli?.

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: ReSurge International / Flickr. This image has been modified.

Original Link

Stomach Stapling Kids

Stomach Stapling Kids.jpeg

Weight loss surgery for children and adolescents is becoming widespread and is being performed in children as young as five years old. Roux-en-Y gastric bypass is the most common type of procedure, in which surgeons cut out nearly the entire stomach, as you can see in my video, Stomach Stapling Kids. Bariatric surgery in pediatric patients does result in weight loss, but also has the potential for serious complications. These include pulmonary embolism, shock, intestinal obstruction, postoperative bleeding, leaking along the staple line, severe malnutrition, and even death at a rate of 0.5%. This means that 1 in 200 kids who go under the knife may die. Infection is identified as the leading cause of death and is most often associated with leaking of intestinal contents into the abdominal cavity.

Sometimes the surgery doesn't work, and you have to go in and do another procedure. If that doesn't work either, you can always try implanting electrodes into patients' brains, a "novel antiobesity strategy" reported in the Journal of Neurosurgery. The concept of deep brain stimulation "since its inception has been that placing an electrode somewhere in the brain could make people eat less." You drill two little holes in the patient's skull, snake in some electrodes a few inches, and then tunnel the wires under the scalp into a pulse generator implanted under the skin on the chest. You evidently can't crank it up past 5 volts because it induces anxiety and nausea. But even without the nausea, people with electrodes stuck in their brains lost an average of about 10 pounds a year.

The childhood obesity epidemic is so tragic. It pains me to see insult piled on injury. Too often, medical treatments can be worse than the disease. See my video, Why Prevention Is Worth a Ton of Cure.

Speaking of prevention, what might be the best diet for our young ones? See:

There are complications associated with gastric bypass in adults, too. See my video The Dangers of Broccoli?.

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: ReSurge International / Flickr. This image has been modified.

Original Link

How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That's the topic of How to Treat High Blood Pressure with Diet.

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend lifestyle modification as the first-line treatment. If that doesn't work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What's wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don't treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one's weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it's not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not vegetarian? We've known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I've talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. In rural Africa, the elderly have perfect blood pressure as opposed to hypertension. What both diets share in common is that they're plant-based day-to-day, with meat only eaten on special occasion.

How do we know it's the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low were those eating strictly plant-based diets, coming out about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it "palatable" to the general public.

You can see what they were thinking. Just like drugs never work--unless you actually take them. Diet never work--unless you actually eat them. So what's the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with a compromise diet you can imagine how they were thinking that on a population clae they might be doing more good. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it's time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it's the added plant foods--not the changes in oil, sweets, or dairy--that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we're already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you'd have to eat around 2 pounds a day. Sounds like my kind of medicine, but it's hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don't seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.

The DASH diet is one of the best studied, and it consistently ranks as US News & World Report's #1 diet. It's one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I've talked about the patronizing attitude many doctors have that patients can't handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, 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

How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That's the topic of How to Treat High Blood Pressure with Diet.

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend lifestyle modification as the first-line treatment. If that doesn't work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What's wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don't treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one's weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it's not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not vegetarian? We've known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I've talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. In rural Africa, the elderly have perfect blood pressure as opposed to hypertension. What both diets share in common is that they're plant-based day-to-day, with meat only eaten on special occasion.

How do we know it's the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low were those eating strictly plant-based diets, coming out about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it "palatable" to the general public.

You can see what they were thinking. Just like drugs never work--unless you actually take them. Diet never work--unless you actually eat them. So what's the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with a compromise diet you can imagine how they were thinking that on a population clae they might be doing more good. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it's time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it's the added plant foods--not the changes in oil, sweets, or dairy--that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we're already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you'd have to eat around 2 pounds a day. Sounds like my kind of medicine, but it's hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don't seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.

The DASH diet is one of the best studied, and it consistently ranks as US News & World Report's #1 diet. It's one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I've talked about the patronizing attitude many doctors have that patients can't handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, 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

Solving a Colon Cancer Mystery

Solving-a-Colon-Cancer-Mystery.jpeg

Colorectal cancer is the second leading cause of cancer death in the United States, after lung cancer. The rates of lung cancer around the world vary by a factor of 10. If there was nothing we could do to prevent lung cancer--if it just happened at random--we'd assume that the rates everywhere would be about the same. But since there's such a huge variation in rates, it seems like there's probably some external cause. Indeed, we now know smoking is responsible for 90% of lung cancer cases. If we don't want to die of the number-one cancer killer, we can throw 90% of our risk out the window just by not smoking.

There's an even bigger variation around the world for colon cancer. As discussed in Solving a Colon Cancer Mystery, it appears colon cancer doesn't just happen, something makes it happen. If our lungs can get filled with carcinogens from smoke, maybe our colons are getting filled with carcinogens from food. Researchers from the University of Pittsburgh and the University of Limpopo sought to answer the question, "Why do African Americans get more colon cancer than native Africans?" Why study Africans? Because colon cancer is extremely rare in native African populations, more than 50 times lower than rates of Americans, white or black.

It's the fiber, right? The first to describe the low rates of colon cancer in native Africans, Dr. Denis Burkitt ascribed it to their staple diet traditionally high in whole grains and, consequently, high in fiber content. We seem to get a 10% reduction in risk for every 10 grams of fiber we eat a day. If it's a 1% drop for each gram, and native Africans are eating upwards of 100 grams a day, it could explain why colon cancer is so rare in sub-Saharan Africa.

Wait a second. The modern African diet is highly processed and low in fiber, yet there has been no dramatic increase in colon cancer incidence. Their diet today has such a low fiber content because most populations now depend on commercially produced refined cornmeal. We're not just talking low fiber intake, we're talking United States of America low, down around half the recommended daily allowance. Yet colon disease in Africa is still about 50 times less common than in the United States.

Maybe it's because native Africans are thinner and exercise more? No, they're not, and no, they don't. If anything, their physical activity levels may now be even lower than Americans'. So if they're sedentary like us and eating mostly refined carbs, few whole plant foods, and little fiber like us, why do they have 50 times less colon cancer than we do? There is one difference. The diet of both African Americans and Caucasian Americans is rich in meat, whereas the native Africans' diet is so low in meat and saturated fat they have total cholesterol levels averaging 139 mg/dL, compared to over 200 mg/dL in the United States.

They may not get a lot of fiber anymore, but they continue to minimize meat and animal fat consumption, which supports other evidence indicating the most powerful determinants of colon cancer risk may be meat and animal fat intake levels. So why do Americans get more colon cancer than Africans? Maybe the rarity of colon cancer in Africans is not the fiber, but their low animal product consumption.

Although opinions diverge as to whether cholesterol, animal fat, or animal protein is most responsible for the increased colon cancer risk, given that all three have been proven to have carcinogenic properties, it may not really matter which component is worse, as a diet laden in one is usually laden in the others.

I've previously suggested phytates may play a critical role as well (Phytates for the Prevention of Cancer). Resistant starch may be another player. Since native Africans cool down their corn porridge, some of the starch can crystallize and effectively turn into fiber. (This is the same reason pasta salad and potato salad better feed our gut bacteria than starchy dishes served hot.) I touch on it briefly in Bowel Wars: Hydrogen Sulfide vs. Butyrate. Resistant starch may also help explain Beans and the Second Meal Effect. And for even more, see Resistant Starch & Colon Cancer and Getting Starch to Take the Path of Most Resistance.

Fiber may just be a marker for healthier eating since it's only found concentrated in unprocessed plant foods. So the apparent protection afforded by high fiber diets may derive from whole food plant-based nutrition rather than the fiber itself (so fiber supplements would not be expected to provide the same protection). Here are some videos that found protective associations with higher fiber diets:

What might be in animal products that can raise cancer risk? Here's a smattering:

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: Department of Foreign Affairs and Trade / Flickr. This image has been modified.

Original Link

Solving a Colon Cancer Mystery

Solving-a-Colon-Cancer-Mystery.jpeg

Colorectal cancer is the second leading cause of cancer death in the United States, after lung cancer. The rates of lung cancer around the world vary by a factor of 10. If there was nothing we could do to prevent lung cancer--if it just happened at random--we'd assume that the rates everywhere would be about the same. But since there's such a huge variation in rates, it seems like there's probably some external cause. Indeed, we now know smoking is responsible for 90% of lung cancer cases. If we don't want to die of the number-one cancer killer, we can throw 90% of our risk out the window just by not smoking.

There's an even bigger variation around the world for colon cancer. As discussed in Solving a Colon Cancer Mystery, it appears colon cancer doesn't just happen, something makes it happen. If our lungs can get filled with carcinogens from smoke, maybe our colons are getting filled with carcinogens from food. Researchers from the University of Pittsburgh and the University of Limpopo sought to answer the question, "Why do African Americans get more colon cancer than native Africans?" Why study Africans? Because colon cancer is extremely rare in native African populations, more than 50 times lower than rates of Americans, white or black.

It's the fiber, right? The first to describe the low rates of colon cancer in native Africans, Dr. Denis Burkitt ascribed it to their staple diet traditionally high in whole grains and, consequently, high in fiber content. We seem to get a 10% reduction in risk for every 10 grams of fiber we eat a day. If it's a 1% drop for each gram, and native Africans are eating upwards of 100 grams a day, it could explain why colon cancer is so rare in sub-Saharan Africa.

Wait a second. The modern African diet is highly processed and low in fiber, yet there has been no dramatic increase in colon cancer incidence. Their diet today has such a low fiber content because most populations now depend on commercially produced refined cornmeal. We're not just talking low fiber intake, we're talking United States of America low, down around half the recommended daily allowance. Yet colon disease in Africa is still about 50 times less common than in the United States.

Maybe it's because native Africans are thinner and exercise more? No, they're not, and no, they don't. If anything, their physical activity levels may now be even lower than Americans'. So if they're sedentary like us and eating mostly refined carbs, few whole plant foods, and little fiber like us, why do they have 50 times less colon cancer than we do? There is one difference. The diet of both African Americans and Caucasian Americans is rich in meat, whereas the native Africans' diet is so low in meat and saturated fat they have total cholesterol levels averaging 139 mg/dL, compared to over 200 mg/dL in the United States.

They may not get a lot of fiber anymore, but they continue to minimize meat and animal fat consumption, which supports other evidence indicating the most powerful determinants of colon cancer risk may be meat and animal fat intake levels. So why do Americans get more colon cancer than Africans? Maybe the rarity of colon cancer in Africans is not the fiber, but their low animal product consumption.

Although opinions diverge as to whether cholesterol, animal fat, or animal protein is most responsible for the increased colon cancer risk, given that all three have been proven to have carcinogenic properties, it may not really matter which component is worse, as a diet laden in one is usually laden in the others.

I've previously suggested phytates may play a critical role as well (Phytates for the Prevention of Cancer). Resistant starch may be another player. Since native Africans cool down their corn porridge, some of the starch can crystallize and effectively turn into fiber. (This is the same reason pasta salad and potato salad better feed our gut bacteria than starchy dishes served hot.) I touch on it briefly in Bowel Wars: Hydrogen Sulfide vs. Butyrate. Resistant starch may also help explain Beans and the Second Meal Effect. And for even more, see Resistant Starch & Colon Cancer and Getting Starch to Take the Path of Most Resistance.

Fiber may just be a marker for healthier eating since it's only found concentrated in unprocessed plant foods. So the apparent protection afforded by high fiber diets may derive from whole food plant-based nutrition rather than the fiber itself (so fiber supplements would not be expected to provide the same protection). Here are some videos that found protective associations with higher fiber diets:

What might be in animal products that can raise cancer risk? Here's a smattering:

In health,

Michael Greger, M.D.

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Image Credit: Department of Foreign Affairs and Trade / Flickr. This image has been modified.

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Sushi Worm Parasite

Sushi Worm Parasite.jpeg

There was a report recently of a woman in San Francisco suffering from gnathostomiasis. I had learned about the disease while I was in medical school, but never actually saw a case. Evidently, it's now on the rise. Clinically, the disease commonly presents as "migratory cutaneous swelling" (bumps on the skin that move around). Why? Because there's a worm under there that migrates through the tissues under the skin and causes recurring episodes of migratory swelling or creeping eruptions. The worm's head has rings of little hooks that allow it to burrow through tissue. There is no effective treatment, other than removal of the worm. Since humans are basically dead-end hosts for the larva, they can't develop into mature worms. The symptoms patients experience are due to the organism wandering throughout the body (see Migratory Skin Worms from Sushi).

In addition to burrowing under our skin, it can also crawl into our eyeballs. The 42-year-old woman is described as having a four-year history of migratory swellings on her face, then a little bleeding from the eyelid... and we know where this is going. No problem, though! We can make a little cut, stick in some forceps, locate the worm, and then just pull the sucker right out of the eyeball. If you have any pimples on your face that move around, better to have your doctor grab them before they start swimming around in your eyes.

By far the most serious manifestation is when they get into your brain. As the worm migrates along the nerves, the patient can experience excruciating pain. The condition can lead to paralysis, bleeding in the brain, and finally death. However, in non-cerebral disease, it's the worms that die, though it may take about 12 years.

How do the worms get into our brain, causing so-called neurognathostomiasis? Gnathostoma worms are highly invasive parasites. After you leave the sushi bar, the larvae can penetrate the wall of your intestine. They can then enter the brain through the base of the skull, crawling along the spinal nerves and vessels. They start out in the nerve roots, enter the spinal cord, and then can climb up into the brain. The worm isn't poisonous or anything; it's just the migration of the worm through the body that causes direct mechanical injury because of tearing of nerve tissues.

The bottom line: This diagnosis should be considered in patients who present with nonspecific little lumps and bumps, especially when there is a history of frequent consumption of raw fish.

Thankfully, most raw foodists stick to plants and thereby avoid scenarios like this: A 21-year-old woman experienced acute, severe pain in her mouth immediately after swallowing a raw squid. It seems consuming a squid with "sperm bags and an active ejaculatory apparatus" can result in the "unintended ejection of the sperm bag" and injury to the oral cavity. The researchers conclude that eating raw food, especially living organisms, can be risky. Though some living organisms (plants!) may be substantially less risky than others.

This is like my Tongue Worm in Human Eye or Cheese Mites and Maggots videos. Extremely rare, but extremely fascinating (to me at least!).

There is one parasitic infection that is much more common and a major cause of disability worldwide,though, neurocysticercosis:

I think the only other sushi videos I have are Fecal Contamination of Sushi and Allergenic Fish Worms, though the nori seaweed is good for you (Which Seaweed Is Most Protective Against Breast Cancer? and Avoiding Iodine Deficiency).

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

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