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

Deep Breathing Exercise for Nausea

Deep Breathing Exercise for Nausea.jpeg

One of the most common fears patients express when facing surgery is postoperative nausea, which can range from minor queasiness to protracted periods of vomiting. Feeling sick to one's stomach and throwing up after surgery is a common problem, affecting between a quarter and a half of those placed under general anesthesia, and more than half of those at high risk (women who don't smoke and have a history of motion sickness).

I've explored the science behind treating nausea with ginger (see Natural Nausea Remedy Recipe), but if you're too nauseous to eat, what do you do? Well, people are often sent home with anti-nausea rectal suppositories. Surveys, however, show that cultural and sexual attitudes may make a number of people sensitive to anything involving the rectum. Though the wording of the question researchers asked was, "are you happy to have a drug put in your back passage?" I can imagine many of the respondents thinking "well, maybe I wouldn't so much mind, but wouldn't exactly be happy about it," especially when you're feeling sick and throwing up.

For women who've had a C-section, they might not want to take drugs at all if they're breastfeeding, so researchers decided to put aromatherapy to the test. Research has shown that essential oils of both spearmint and peppermint are effective in reducing nausea and vomiting after chemotherapy, but this was after swallowing them.

Would just the smell of peppermint help with nausea? I explore this in my video Peppermint Aromatherapy for Nausea. Researchers had women take deep whiffs of peppermint extract (like you'd buy at a store) and it seemed to work. Eighty percent of the mint-sniffers felt better within just a few minutes, compared to no improvement in the placebo group who sniffed water with green food coloring, or the control group who didn't sniff anything.

The study was criticized for being small and for not using pure peppermint oil. Peppermint extract is peppermint oil plus alcohol. Maybe it was the smell of alcohol that made people better? And that's actually not too much of a stretch. In 1997, researchers reported a simple, innocuous, and inexpensive treatment for postoperative nausea and vomiting--the smell of isopropyl alcohol, which is what is found in those alcohol wipes, the little prep pads that nurses swab you with before shots. They found that they could just effectively tear one open and wave it under someone's nose and relieve nausea and vomiting in more than 80% of folks after surgery. It has been since shown to work as well as a leading anti-nausea drug, and may even work faster, cutting nausea in half within 10 to 15 minutes, rather than 20 or 25.

So was it the alcohol, the peppermint, or both? Researchers decided to put it to the test. They instructed patients to take three slow, deep breaths, smelling alcohol, peppermint, or nothing. The smell of peppermint cut nausea in half within five minutes, and so did the alcohol. But so did smelling nothing! So maybe it had nothing to do with the scent; maybe it was just the instruction to take slow, deep breaths. That would make it a really cost-effective intervention. Maybe it shouldn't be so surprising, given the proximity of the vomiting and breathing centers within the brain.

And indeed, controlled breathing was found effective with or without any scent. So next time you feel nauseous, inhale deeply through your nose to the count of three, hold your breath to the count of three, and exhale out the mouth to the count of three. Do that three times.

Ironically, the researchers continued to advocate using those nasty smelling alcohol pads even though they themselves showed they weren't any more effective than breathing alone. Why? Since isopropyl alcohol has a readily detectable odor, patients are more likely to think that their post-operation nausea and vomiting is being actively treated when they inhale alcohol vapors rather than just engaging in breathing exercises.


What do you think of still using the alcohol pads even though they were shown to offer no additional benefit? I have a whole video on such questions: The Lie That Heals: Should Doctors Give Placebos?

For those who can swallow, I offer more about powdered ginger in my video Dangerous Advice From Health Food Store Employees.

There's more on aromatherapy here:

What about actually eating the peppermint?

Of course, the best way to avoid postsurgical nausea is to try to avoid surgery in the first place. Those that eat healthy may be less likely to go under the knife. See Say No to Drugs by Saying Yes to More Plants.

In health,
Michael Greger, M.D.

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

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

Original Link

Deep Breathing Exercise for Nausea

Deep Breathing Exercise for Nausea.jpeg

One of the most common fears patients express when facing surgery is postoperative nausea, which can range from minor queasiness to protracted periods of vomiting. Feeling sick to one's stomach and throwing up after surgery is a common problem, affecting between a quarter and a half of those placed under general anesthesia, and more than half of those at high risk (women who don't smoke and have a history of motion sickness).

I've explored the science behind treating nausea with ginger (see Natural Nausea Remedy Recipe), but if you're too nauseous to eat, what do you do? Well, people are often sent home with anti-nausea rectal suppositories. Surveys, however, show that cultural and sexual attitudes may make a number of people sensitive to anything involving the rectum. Though the wording of the question researchers asked was, "are you happy to have a drug put in your back passage?" I can imagine many of the respondents thinking "well, maybe I wouldn't so much mind, but wouldn't exactly be happy about it," especially when you're feeling sick and throwing up.

For women who've had a C-section, they might not want to take drugs at all if they're breastfeeding, so researchers decided to put aromatherapy to the test. Research has shown that essential oils of both spearmint and peppermint are effective in reducing nausea and vomiting after chemotherapy, but this was after swallowing them.

Would just the smell of peppermint help with nausea? I explore this in my video Peppermint Aromatherapy for Nausea. Researchers had women take deep whiffs of peppermint extract (like you'd buy at a store) and it seemed to work. Eighty percent of the mint-sniffers felt better within just a few minutes, compared to no improvement in the placebo group who sniffed water with green food coloring, or the control group who didn't sniff anything.

The study was criticized for being small and for not using pure peppermint oil. Peppermint extract is peppermint oil plus alcohol. Maybe it was the smell of alcohol that made people better? And that's actually not too much of a stretch. In 1997, researchers reported a simple, innocuous, and inexpensive treatment for postoperative nausea and vomiting--the smell of isopropyl alcohol, which is what is found in those alcohol wipes, the little prep pads that nurses swab you with before shots. They found that they could just effectively tear one open and wave it under someone's nose and relieve nausea and vomiting in more than 80% of folks after surgery. It has been since shown to work as well as a leading anti-nausea drug, and may even work faster, cutting nausea in half within 10 to 15 minutes, rather than 20 or 25.

So was it the alcohol, the peppermint, or both? Researchers decided to put it to the test. They instructed patients to take three slow, deep breaths, smelling alcohol, peppermint, or nothing. The smell of peppermint cut nausea in half within five minutes, and so did the alcohol. But so did smelling nothing! So maybe it had nothing to do with the scent; maybe it was just the instruction to take slow, deep breaths. That would make it a really cost-effective intervention. Maybe it shouldn't be so surprising, given the proximity of the vomiting and breathing centers within the brain.

And indeed, controlled breathing was found effective with or without any scent. So next time you feel nauseous, inhale deeply through your nose to the count of three, hold your breath to the count of three, and exhale out the mouth to the count of three. Do that three times.

Ironically, the researchers continued to advocate using those nasty smelling alcohol pads even though they themselves showed they weren't any more effective than breathing alone. Why? Since isopropyl alcohol has a readily detectable odor, patients are more likely to think that their post-operation nausea and vomiting is being actively treated when they inhale alcohol vapors rather than just engaging in breathing exercises.


What do you think of still using the alcohol pads even though they were shown to offer no additional benefit? I have a whole video on such questions: The Lie That Heals: Should Doctors Give Placebos?

For those who can swallow, I offer more about powdered ginger in my video Dangerous Advice From Health Food Store Employees.

There's more on aromatherapy here:

What about actually eating the peppermint?

Of course, the best way to avoid postsurgical nausea is to try to avoid surgery in the first place. Those that eat healthy may be less likely to go under the knife. See Say No to Drugs by Saying Yes to More Plants.

In health,
Michael Greger, M.D.

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

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

Original Link

Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

We've learned that exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression (in my video Exercise vs. Drugs for Depression). But how much is that really saying? How effective are antidepressant drugs in the first place?

A recent meta-analysis sparked huge scientific and public controversy by stating that the placebo effect can explain the apparent clinical benefits of antidepressants. But aren't there thousands of clinical trials providing compelling evidence for antidepressant effectiveness? If a meta-analysis compiles together all the best published research, how could it say they don't work much better than sugar pills?

The key word is "published."

What if a drug company decided only to publish studies that showed a positive effect, but quietly shelved and concealed any studies showing the drug didn't work? If you didn't know any better, you'd look at the published medical literature and think "Wow, this drug is great." And what if all the drug companies did that? To find out if this was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.

According to the published literature, the results of nearly all the trials of antidepressants were positive, meaning they worked. In contrast, FDA analysis of the trial data showed only roughly half of the trials had positive results. In other words, about half the studies showed the drugs didn't work. Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill. Not publishing negative results undermines evidence-based medicine and puts millions of patients at risk for using ineffective or unsafe drugs, and this was the case with these antidepressant drugs.

These revelations hit first in 2008. Prozac, Serzone, Paxil and Effexor worked, but so did sugar pills, and the difference between the drug and placebo was small. That was 2008. Where were we by 2014? Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect. And what's even worse, Freedom of Information Act documents show the FDA knew about it but made an explicit decision to keep this information from the public and from prescribing physicians.

How could drug companies get away with this?

The pharmaceutical industry is considered the most profitable and politically influential industry in the United States, and mental illness can be thought of as the drug industry's golden goose: incurable, common, long term and involving multiple medications. Antidepressant medications are prescribed to 8.7 percent of the U.S. population. It's a multi-billion dollar market.

To summarize, there is a strong therapeutic response to antidepressant medication; it's just that the response to placebo is almost as strong. Indeed, antidepressants offer substantial benefits to millions of people suffering from depression, and to cast them as ineffective is inaccurate. Just because they may not work better than fake pills doesn't mean they don't work. It's like homeopathy--just because it doesn't work better than the sugar pills, doesn't mean that homeopathy doesn't work. The placebo effect is real and powerful.

In one psychopharmacology journal, a psychiatrist funded by the Prozac company defends the drugs stating, "A key issue is disregarded by the naysaying critics. If the patient is benefiting from antidepressant treatment does it matter whether this is being achieved via drug or placebo effects?"

Of course it matters!

Among the side effects of antidepressants are: sexual dysfunction in up to three quarters of people, long-term weight gain, insomnia, nausea and diarrhea. About one in five show withdrawal symptoms when they try to quit. And perhaps more tragically, the drugs may make people more likely to become depressed in the future. Let me say that again: People are more likely to become depressed after treatment by antidepressants than after treatment by other means - including placebo.

So if doctors are willing to give patients placebo-equivalent treatments, maybe it'd be better for them to just lie to patients and give them actual sugar pills. Yes, that involves deception, but isn't that preferable than deception with a side of side effects? See more on this in my video Do Antidepressant Drugs Really Work?

If different treatments are equally effective, then choice should be based on risk and harm, and of all of the available treatments, antidepressant drugs may be among the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed.

Antidepressants may not work better than placebo for mild and moderate depression, but for very severe depression, the drugs do beat out sugar pills. But that's just a small fraction of the people taking these drugs. That means that the vast majority of depressed patients--as many as nine out of ten--are being prescribed medications that have negligible benefits to them.

Too many doctors quickly decide upon a depression diagnosis without necessarily listening to what the patient has to say and end up putting them on antidepressants without considering alternatives. And fortunately, there are effective alternatives. Physical exercise, for example can have lasting effects, and if that turns out to also be a placebo effect, it is at least a placebo with an enviable list of side effects. Whereas side effects of antidepressants include things like sexual dysfunction and insomnia, side effects of exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone and a longer life.


There are other ways meta-analyses can be misleading. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

More on the ethical challenges facing doctors and whether or not to prescribe sugar pills in The Lie That Heals: Should Doctors Give Placebos?

I've used the Freedom of Information Act myself to get access to behind the scenes industry shenanigans. See, for example, what I found out about the egg industry in Who Says Eggs Aren't Healthy or Safe? and Eggs and Cholesterol: Patently False and Misleading Claims.

This isn't the only case of the medical profession overselling the benefits of drugs. See How Smoking in 1956 is Like Eating in 2016, The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure (though if you're worried about your mood they might make you even more depressed!)

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: GraphicStock. This image has been modified.

Original Link

Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

We've learned that exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression (in my video Exercise vs. Drugs for Depression). But how much is that really saying? How effective are antidepressant drugs in the first place?

A recent meta-analysis sparked huge scientific and public controversy by stating that the placebo effect can explain the apparent clinical benefits of antidepressants. But aren't there thousands of clinical trials providing compelling evidence for antidepressant effectiveness? If a meta-analysis compiles together all the best published research, how could it say they don't work much better than sugar pills?

The key word is "published."

What if a drug company decided only to publish studies that showed a positive effect, but quietly shelved and concealed any studies showing the drug didn't work? If you didn't know any better, you'd look at the published medical literature and think "Wow, this drug is great." And what if all the drug companies did that? To find out if this was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.

According to the published literature, the results of nearly all the trials of antidepressants were positive, meaning they worked. In contrast, FDA analysis of the trial data showed only roughly half of the trials had positive results. In other words, about half the studies showed the drugs didn't work. Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill. Not publishing negative results undermines evidence-based medicine and puts millions of patients at risk for using ineffective or unsafe drugs, and this was the case with these antidepressant drugs.

These revelations hit first in 2008. Prozac, Serzone, Paxil and Effexor worked, but so did sugar pills, and the difference between the drug and placebo was small. That was 2008. Where were we by 2014? Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect. And what's even worse, Freedom of Information Act documents show the FDA knew about it but made an explicit decision to keep this information from the public and from prescribing physicians.

How could drug companies get away with this?

The pharmaceutical industry is considered the most profitable and politically influential industry in the United States, and mental illness can be thought of as the drug industry's golden goose: incurable, common, long term and involving multiple medications. Antidepressant medications are prescribed to 8.7 percent of the U.S. population. It's a multi-billion dollar market.

To summarize, there is a strong therapeutic response to antidepressant medication; it's just that the response to placebo is almost as strong. Indeed, antidepressants offer substantial benefits to millions of people suffering from depression, and to cast them as ineffective is inaccurate. Just because they may not work better than fake pills doesn't mean they don't work. It's like homeopathy--just because it doesn't work better than the sugar pills, doesn't mean that homeopathy doesn't work. The placebo effect is real and powerful.

In one psychopharmacology journal, a psychiatrist funded by the Prozac company defends the drugs stating, "A key issue is disregarded by the naysaying critics. If the patient is benefiting from antidepressant treatment does it matter whether this is being achieved via drug or placebo effects?"

Of course it matters!

Among the side effects of antidepressants are: sexual dysfunction in up to three quarters of people, long-term weight gain, insomnia, nausea and diarrhea. About one in five show withdrawal symptoms when they try to quit. And perhaps more tragically, the drugs may make people more likely to become depressed in the future. Let me say that again: People are more likely to become depressed after treatment by antidepressants than after treatment by other means - including placebo.

So if doctors are willing to give patients placebo-equivalent treatments, maybe it'd be better for them to just lie to patients and give them actual sugar pills. Yes, that involves deception, but isn't that preferable than deception with a side of side effects? See more on this in my video Do Antidepressant Drugs Really Work?

If different treatments are equally effective, then choice should be based on risk and harm, and of all of the available treatments, antidepressant drugs may be among the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed.

Antidepressants may not work better than placebo for mild and moderate depression, but for very severe depression, the drugs do beat out sugar pills. But that's just a small fraction of the people taking these drugs. That means that the vast majority of depressed patients--as many as nine out of ten--are being prescribed medications that have negligible benefits to them.

Too many doctors quickly decide upon a depression diagnosis without necessarily listening to what the patient has to say and end up putting them on antidepressants without considering alternatives. And fortunately, there are effective alternatives. Physical exercise, for example can have lasting effects, and if that turns out to also be a placebo effect, it is at least a placebo with an enviable list of side effects. Whereas side effects of antidepressants include things like sexual dysfunction and insomnia, side effects of exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone and a longer life.


There are other ways meta-analyses can be misleading. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

More on the ethical challenges facing doctors and whether or not to prescribe sugar pills in The Lie That Heals: Should Doctors Give Placebos?

I've used the Freedom of Information Act myself to get access to behind the scenes industry shenanigans. See, for example, what I found out about the egg industry in Who Says Eggs Aren't Healthy or Safe? and Eggs and Cholesterol: Patently False and Misleading Claims.

This isn't the only case of the medical profession overselling the benefits of drugs. See How Smoking in 1956 is Like Eating in 2016, The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure (though if you're worried about your mood they might make you even more depressed!)

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: GraphicStock. This image has been modified.

Original Link

Drugs vs. Lifestyle for Preventing Diabetes

NF-Mar8 How to Prevent Prediabetes from turning into Diabetes.jpeg

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

What's the big deal?

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

What can we do to prevent it?

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

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

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

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

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

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

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


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

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

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

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

In health,
Michael Greger, M.D.

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

Image Credit: Heather Aitken / Flickr

Original Link

Cayenne for Irritable Bowel

 

 

 

 

 

 

 

 

Cayenne for Irritable Bowel

Nearly 50 million Americans come down with food poisoning every year. Over a hundred thousand are hospitalized and thousands die every year just because of something they ate. If they had ordered something different on the menu or chosen something else at the grocery store, they or their loved one might be alive today. But in the vast majority of cases, food poisoning manifests itself as little more than a case of “stomach flu”—a few days of pain, vomiting, diarrhea, and then it’s gone. So what’s the big deal?

Well, as described in this recent editorial in the American Journal of Gastroenterology, in many cases, that acute infection can trigger a chronic “postinfectious functional gastrointestinal disorder” that can last for years or even forever. The two most common of which are irritable bowel syndrome and functional dyspepsia (chronic indigestion).

Up to 10% of people stricken with Salmonella, E. coli, or Campylobacter are left with irritable bowel syndrome. The thought is that the "transitory inflammation during the infection leads to subtle but permanent changes in the structure and function of the digestive system," causing the lining of the gut to become hyper-sensitized. How do they determine if someone’s rectum is hypersensitive?

Innovative Japanese researchers developed a device to deliver "repetitive painful rectal distention." Basically, the researchers hooked up a half-quart balloon to a fancy bicycle pump that was lubricated with olive oil, inserted it into the rectum and inflated it until the patients couldn’t stand the pain anymore. As you can see in my video, Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion, those with IBS had a significantly lower pain threshold, significantly less “rectal compliance.”

Healthy people felt the pain where we’d expect to feel the pain with, effectively, a balloon animal up their tush. But many with IBS also experienced abdominal pain, indicating a hypersensitivity of the entire gut wall. Well, if that’s the problem, how can we desensitize the gut?

In my video, Hot Sauce in the Nose for Cluster Headaches?, we learned about the ability of hot pepper compounds to deplete pain fibers of substance P, a neurotransmitter used for transmitting pain. It’s bad enough to have to rub hot peppers up our nose, where do we have to stick them for irritable bowel? Thankfully researchers chose the oral route.

The researchers concluded that “the chronic administration of red pepper powder in IBS patients with enteric-coated pills was significantly more effective than placebo in decreasing the intensity of abdominal pain and bloating, and was considered by the patients more effective than placebo," suggesting a "novel way of dealing with this frequent and distressing functional disease.”

After 48 million cases of annual food poisoning, 10% may end up with IBS. Even more may end up with chronic indigestion. How do peppers work against that? We can’t use whole peppers because then we couldn’t blind a placebo, but if we give capsules of red pepper powder to folks suffering from chronic indigestion—about one and a half teaspoons a day worth—and compare that to an identical-looking sugar pill, within a month their overall symptoms improved, including their stomach pain and their feelings of being bloated. They had less nausea, too. The frequently prescribed drug, Propulsid (cisapride), worked almost as well as the red pepper powder, and was considered generally well tolerated… that is, until it killed people. Propulsid was pulled from the market after causing dozens of deaths.

I explore another natural treatment for IBS in Kiwi Fruit for Irritable Bowel Syndrome.

I’ve covered some of the long-term consequences of food poisoning in videos such as Poultry and Paralysis, Fecal Bacteria Survey, and Amnesic Seafood Poisoning. The meat industry is all over it, though: Check out my videos  Viral Meat Spray and Maggot Meat Spray. Why is it legal to sell meat tainted with our leading foodborne killer? Find out in Salmonella in Chicken & Turkey: Deadly But Not Illegal and  

-Michael Greger, M.D.

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

Image credit: Jennifer C. / Flickr

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