The Best Diet for Rheumatoid Arthritis

The Best Diet for Rheumatoid Arthritis.jpeg

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting millions. It is characterized by persistent pain, stiffness, and progressive joint destruction leading to crippling deformities, particularly in the hands and feet. What can we do to prevent and treat it?

In my video Why Do Plant-Based Diets Help Rheumatoid Arthritis?, I show a famous 13-month randomized controlled trial of plant-based diets for rheumatoid arthritis where patients were put on a vegan diet for three and a half months and then switched to an egg-free lactovegetarian diet for the remainder of the study. Compared to the control group (who didn't change their diet at all), the plant-based group experienced significant improvements starting within weeks. Their morning stiffness improved within the first month, cutting the number of hours they suffered from joint stiffness in half. Their pain level dropped from 5 out of 10 down to less than 3 out of 10. Disability levels dropped, and subjects reported feeling better; they had greater grip strength, fewer tender joints, less tenderness per joint, and less swelling. They also had a drop in inflammatory markers in their blood, such as sedimentation rate, C-reactive protein, and white blood cell count. As a bonus, they lost about 13 pounds and kept most of that weight off throughout the year.

What does diet have to do with joint disease?

Rheumatoid arthritis is an autoimmune disease, in which our own body attacks the lining of our joints. There's also a different autoimmune disease called rheumatic fever, in which our body attacks our heart. Why would it do that? It appears to be a matter of friendly fire.

Rheumatic fever is caused by strep throat, which is itself caused by a bacterium that has a protein that looks an awful lot like a protein in our heart. When our immune system attacks the strep bacteria, it also attacks our heart valves, triggering an autoimmune attack by "molecular mimicry." The protein on the strep bacteria is mimicking a protein in our heart, so our body gets confused and attacks both. That's why it's critical to treat strep throat early to prevent our heart from getting caught in the crossfire.

Researchers figured that rheumatoid arthritis might be triggered by an infection as well. A clue to where to start looking was the fact that women seem to get it three times more frequently than men. What type of infection do women get more than men? Urinary tract infections (UTIs). So researchers started testing the urine of rheumatoid arthritis sufferers and, lo and behold, found a bacterium called Proteus mirabilis. Not enough to cause symptoms of a UTI, but enough to trigger an immune response. And indeed, there's a molecule in the bacterium that looks an awful lot like one of the molecules in our joints.

The theory is that anti-Proteus antibodies against the bacterial molecule may inadvertently damage our own joint tissues, leading eventually to joint destruction. Therefore, interventions to remove this bacteria from the bodies of patients, with consequent reduction of antibodies against the organism, should lead to a decrease in inflammation.

As we saw in my video Avoiding Chicken to Avoid Bladder Infections, urinary tract infections originate from the fecal flora. The bacteria crawl up from the rectum into the bladder. How might we change the bugs in our colons? By changing our diet.

Some of the first studies published more than 20 years ago to fundamentally shift people's gut flora were done using raw vegan diets, figuring that's about as fundamental a shift from the standard Western diet as possible. Indeed, within days researchers could significantly change subjects' gut flora. When researchers put rheumatoid arthritis sufferers on that kind of diet, they experienced relief, and the greatest improvements were linked to greatest changes in gut flora. The diet was considered so intolerable, though, that half the patients couldn't take it and dropped out, perhaps because they were trying to feed people things like "buckwheat-beetroot cutlets" buttered with a spread made out of almonds and fermented cucumber juice.

Thankfully, regular vegetarian and vegan diets work too, changing the intestinal flora and improving rheumatoid arthritis. However, we didn't specifically have confirmation that plant-based diets brought down anti-Proteus antibodies until 2014. Subjects that responded to the plant-based diet showed a significant drop in anti-Proteus mirabilis antibodies compared to the control group. Maybe it just dropped immune responses across the board? No, antibody levels against other bugs remained the same, so the assumption is that the plant-based diet reduced urinary or gut levels of the bacteria.

A shift from an omnivorous to a vegetarian diet has a profound influence on the composition of urine as well. For example, those eating plant-based had higher levels of lignans in their urine. Up until now, it was thought that they only protected people from getting cancer, but we now know lignans can also have antimicrobial properties. Perhaps they help clear Proteus mirabilis from the system. Either way, these data suggest a new type of therapy for the management of rheumatoid arthritis: anti-Proteus measures including plant-based diets.


I have to admit I had never even heard of Proteus mirabilis. That's why I love doing work--I learn as much as you do!

I explored another unconventional theory as to why plant-based diets are so successful in treating inflammatory arthritis in Potassium and Autoimmune Disease.

There's another foodborne bacteria implicated in human disease, the EXPEC in chicken leading to urinary tract infections--another game-changer: Avoiding Chicken To Avoid Bladder Infections.

I have a bunch of videos on gut flora--the microbiome. They include:

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

The Best Diet for Rheumatoid Arthritis

The Best Diet for Rheumatoid Arthritis.jpeg

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting millions. It is characterized by persistent pain, stiffness, and progressive joint destruction leading to crippling deformities, particularly in the hands and feet. What can we do to prevent and treat it?

In my video Why Do Plant-Based Diets Help Rheumatoid Arthritis?, I show a famous 13-month randomized controlled trial of plant-based diets for rheumatoid arthritis where patients were put on a vegan diet for three and a half months and then switched to an egg-free lactovegetarian diet for the remainder of the study. Compared to the control group (who didn't change their diet at all), the plant-based group experienced significant improvements starting within weeks. Their morning stiffness improved within the first month, cutting the number of hours they suffered from joint stiffness in half. Their pain level dropped from 5 out of 10 down to less than 3 out of 10. Disability levels dropped, and subjects reported feeling better; they had greater grip strength, fewer tender joints, less tenderness per joint, and less swelling. They also had a drop in inflammatory markers in their blood, such as sedimentation rate, C-reactive protein, and white blood cell count. As a bonus, they lost about 13 pounds and kept most of that weight off throughout the year.

What does diet have to do with joint disease?

Rheumatoid arthritis is an autoimmune disease, in which our own body attacks the lining of our joints. There's also a different autoimmune disease called rheumatic fever, in which our body attacks our heart. Why would it do that? It appears to be a matter of friendly fire.

Rheumatic fever is caused by strep throat, which is itself caused by a bacterium that has a protein that looks an awful lot like a protein in our heart. When our immune system attacks the strep bacteria, it also attacks our heart valves, triggering an autoimmune attack by "molecular mimicry." The protein on the strep bacteria is mimicking a protein in our heart, so our body gets confused and attacks both. That's why it's critical to treat strep throat early to prevent our heart from getting caught in the crossfire.

Researchers figured that rheumatoid arthritis might be triggered by an infection as well. A clue to where to start looking was the fact that women seem to get it three times more frequently than men. What type of infection do women get more than men? Urinary tract infections (UTIs). So researchers started testing the urine of rheumatoid arthritis sufferers and, lo and behold, found a bacterium called Proteus mirabilis. Not enough to cause symptoms of a UTI, but enough to trigger an immune response. And indeed, there's a molecule in the bacterium that looks an awful lot like one of the molecules in our joints.

The theory is that anti-Proteus antibodies against the bacterial molecule may inadvertently damage our own joint tissues, leading eventually to joint destruction. Therefore, interventions to remove this bacteria from the bodies of patients, with consequent reduction of antibodies against the organism, should lead to a decrease in inflammation.

As we saw in my video Avoiding Chicken to Avoid Bladder Infections, urinary tract infections originate from the fecal flora. The bacteria crawl up from the rectum into the bladder. How might we change the bugs in our colons? By changing our diet.

Some of the first studies published more than 20 years ago to fundamentally shift people's gut flora were done using raw vegan diets, figuring that's about as fundamental a shift from the standard Western diet as possible. Indeed, within days researchers could significantly change subjects' gut flora. When researchers put rheumatoid arthritis sufferers on that kind of diet, they experienced relief, and the greatest improvements were linked to greatest changes in gut flora. The diet was considered so intolerable, though, that half the patients couldn't take it and dropped out, perhaps because they were trying to feed people things like "buckwheat-beetroot cutlets" buttered with a spread made out of almonds and fermented cucumber juice.

Thankfully, regular vegetarian and vegan diets work too, changing the intestinal flora and improving rheumatoid arthritis. However, we didn't specifically have confirmation that plant-based diets brought down anti-Proteus antibodies until 2014. Subjects that responded to the plant-based diet showed a significant drop in anti-Proteus mirabilis antibodies compared to the control group. Maybe it just dropped immune responses across the board? No, antibody levels against other bugs remained the same, so the assumption is that the plant-based diet reduced urinary or gut levels of the bacteria.

A shift from an omnivorous to a vegetarian diet has a profound influence on the composition of urine as well. For example, those eating plant-based had higher levels of lignans in their urine. Up until now, it was thought that they only protected people from getting cancer, but we now know lignans can also have antimicrobial properties. Perhaps they help clear Proteus mirabilis from the system. Either way, these data suggest a new type of therapy for the management of rheumatoid arthritis: anti-Proteus measures including plant-based diets.


I have to admit I had never even heard of Proteus mirabilis. That's why I love doing work--I learn as much as you do!

I explored another unconventional theory as to why plant-based diets are so successful in treating inflammatory arthritis in Potassium and Autoimmune Disease.

There's another foodborne bacteria implicated in human disease, the EXPEC in chicken leading to urinary tract infections--another game-changer: Avoiding Chicken To Avoid Bladder Infections.

I have a bunch of videos on gut flora--the microbiome. They include:

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

Ciguatera Poisoning & Chronic Fatigue Syndrome

NF-Sept22 Ciguatera Poisoning & Chronic Fatigue Syndrome.jpeg

Ciguatera is one of the most common forms of food poisoning, which occurs after the consumption of fish contaminated with neurotoxins produced by certain microalgae that build up the food chain. Just a few bites can be sufficient to induce the condition. Disturbingly, affected fish looks, smells, and tastes normal, and ciguatoxins are resistant to all forms of cooking. So, there is no straightforward method to predict whether a seafood meal can turn into a ciguatera nightmare.

It literally can cause nightmares; about one in six may experience signs of hallucinatory poisoning: lack of coordination, hallucinations, depression, and nightmares. Most suffer some kind of neurological symptoms such as tingling, numbness, and a burning cold sensation. Sometimes a reversal of temperature sensation occurs, where cold objects feel hot and vice versa. For instance, ciguatera sufferers have reported that a refreshing dive in the ocean actually caused burning pain, or that drinking cool beer felt like too hot coffee.

The toxin may also be apparently sexually transmitted, or as one of my favorite public health bloggers put it, "when hot sex turns cold and painful, blame it on dinner."

As seen in my video Ciguatera Poisoning & Chronic Fatigue Syndrome, the symptoms can persist for months or even years. Ongoing research has shown that people with chronic fatigue syndrome may actually be suffering the long-term effects of this fish food poisoning or a condition called polymyositis, which causes diffuse muscle aches, pains, and inflammation. Some individuals intoxicated by fish consumption 25 years previously experience a recurrence of the main neurological disturbances during periods of overwork, fatigue, or stress. You can still find the toxins stuck in your body decades later.

Recent outbreaks in New York City have drawn attention to the problem. For example, a man ate grouper at a Manhattan restaurant and went from swimming two miles a day to having difficulty walking that lasted for months. But these aren't just rare anecdotes. Ciguatera fish poisoning affects an estimated 15,000 Americans every year, causing hundreds of hospitalizations and even a few deaths. Because the toxins are colorless, odorless, tasteless, and not destroyed by cooking, CDC scientists suggest "education aimed at the prevention of seafood intoxication by avoidance of high-risk fish altogether."

The AMA put out a similar advisory, suggesting that the only way to prevent it is to avoid eating fish like red snapper or grouper, but the problem is that a third of fish sold in the United States is mislabeled, so we don't know what we're getting. Some suggest first feeding a portion of the fish meal to a cat, treating them like a court tester, and if they're okay six hours later, we can dig in -- but this was considered inhumane. But if it's inhumane to feed it to your cat, how is it not inhumane to feed it to other members of the family?

Many more are killed by more conventional food poisoning bugs (Chicken Salmonella Thanks to Meat Industry Lawsuit), but how scary that you can get these toxins stuck in you and ruin your life? Reminds me of my Amnesic Seafood Poisoning video.

Other neurotoxin videos include Preventing Parkinson's Disease With Diet and Essential Tremor and 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--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Image Credit: Pen Waggener / Flickr

Original Link

Preventing and Treating Low Back Pain With Diet

Aug11.jpg

Low back pain became one of the biggest problems for public health systems in the Western world during the second half of the 20th century. The lifetime prevalence of low back pain is reported to be as high as 84 percent, and chronic low back pain is present in about one in five, with one in ten being disabled. It's an epidemic.

Are people just lifting more heavy stuff? No. "[M]echanical factors, such as lifting and carrying, probably do not have a major role in this disease." Atherosclerosis can obstruct the arteries that feed the spine, and this diminished blood flow can result in various back problems. This can be seen on special scans. Check them out in my video, Back in Circulation: The Link Between Sciatica and Cholesterol, where you can see the difference between normal and clogged spinal arteries. I also show what they look like on autopsy, where we can see the openings to the spinal arteries getting squeezed shut by cholesterol-filled plaques.

Now we have MRI imaging that can show the occlusion of spinal arteries in people with back pain and the degeneration of the discs. Researchers showed that patients with long-term lower back pain had constricted blood flow, and those with high cholesterol appeared to suffer with more severe symptoms. Those with narrowed arteries appear about eight and a half times more likely to have suffered from chronic back pain.

Although disc degeneration has multiple causal factors, with genetic, occupational and mechanical influences, alteration in nutrition has been proposed as the final common pathway. This makes sense. The discs in our lower back are the largest "avascular" tissue in the body, meaning our discs don't have any blood vessels. Thus, its nutrition just kind of diffuses in from the margins, making it especially vulnerable to deprivation. Using MRIs, we can measure the effects of impaired blood flow on that diffusion. Because of this vulnerability, discs degenerate far earlier than other musculoskeletal tissues; the first unequivocal findings of degeneration in the discs of the lower spines are seen starting around age 11. Nearly all kids have the beginnings of atherosclerosis by age ten (Heart Disease Starts in Childhood). By the early teen years, we can already see the disks starting to deteriorate. By age 49, 97 percent of the discs of those eating the standard American diet show at least grade-2 degradation.

Cholesterol plaques in the wall of the aorta obliterate the openings of spinal arteries. Structures with precarious nutrient supply, such as the intervertebral discs, may suffer and gradually degenerate, as well as herniate. There is a link not only between cholesterol levels and disc degeneration, but between cholesterol levels and disc herniation.

This compromised blood flow may also damage the nerve roots that come off the spine, causing sciatica. Sciatica is back pain that radiates down the legs, causing additional pain, numbness or weakness, and prolonged disability. Sciatica affects as many as 1 in 20 people. Independent of weight, clinical sciatica may be associated with blood cholesterol levels as well. The nerve roots, which are most commonly associated with sciatic pain, are supplied by some of the arteries most vulnerable to atherosclerotic plaque formation. Obliteration of these arteries by cholesterol buildup results in compromised nutrient supply to the nerve itself. That lack of oxygen to the nerve may play a role in the sciatica nerve crying out in pain. Reduced blood flow also hampers the removal of waste products, such as lactic acid, which can irritate the nerve endings causing pain and deterioration.

Sadly, low back pain is now common in children and adolescents, and getting worse. It's like children now getting disorders like adult-onset diabetes. Teenagers starting out their lives with a chronic disease. That's why it's never too early to start eating healthier.


Just like back pain can be an indicator of clogged arteries, so can erectile dysfunction: Survival of the Firmest: Erectile Dysfunction and Death. Thankfully, the clogs in our arteries can be reversed! See, for example:

In health,
Michael Greger, M.D.

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

Original Link

How to Treat Gout With Diet

NFOct8-Gout treatment with a cherry on top.jpg

The Washington State Fruit Commission, our largest cherry producer, can fund reviews that cherry-pick studies on the anti-inflammatory effects of cherries in a petri dish and animal models. But what we've needed are human studies. For example, if we stuff the human equivalent of up to a thousand cups of cherries down the throats of rats, it appears to have an anti-inflammatory effect, but we could never eat that many. (In fact, if we tried, it could end badly. One poor guy who ate 500 cherries whole--without spitting out the pits--ended up fatally obstructing his colon.)

A decade ago, we didn't have many human studies, but thankfully now we do. A study published in The Journal of Nutrition had men and women eat about 45 cherries a day for a month (I wouldn't mind being part of that study!). The researchers found a 25% drop in C-reactive protein levels (a marker of inflammation), as well as an inflammatory protein with an inelegant acronym RANTES ("Regulated on, Activation, Normal, T cell, Expressed and, Secreted"). Even a month after the study ended there appeared to be residual anti-inflammatory benefit from the cherry fest.

These subjects were all healthy, with low levels of inflammation to begin with, but a follow-up study, highlighted in my video, Gout Treatment with a Cherry on Top, on folks with higher levels found similar results for C-reactive protein and for a number of other markers for chronic inflammatory diseases. Do cherries then help people who actually have a chronic inflammatory disease?

Back in 1950, in an obscure Texas medical journal, "observations made by responsible physicians" suggested that in a dozen patients with gout, eating half a pound of fresh or canned cherries helped prevent flares of gout. But the issue had never seriously been tested, until recently. Gout is an excruciatingly painful inflammatory arthritis caused by the crystallization of uric acid within joints. Based on the National Health and Nutrition Examination Survey 2007-2008, the prevalence of gout in the US is estimated to be 3.9% among US adults, which translates into 8.3 million people.

Hundreds of gout sufferers were studied, and cherry intake was associated with a 35% lower risk of gout attacks, with over half the risk gone at three servings measured over a two day period (about 16 cherries a day). That's the kind of efficacy the researchers saw with a low-purine diet (uric acid is a break-down product of purines). This same research group found that purine intake of animal origin increased the odds for recurrent gout attacks by nearly five-fold. Heavy alcohol consumption isn't a good idea either.

There are some high-purine non-animal foods, like mushrooms and asparagus, but they found no significant link to plant sources of purines. So the researchers recommended eliminating meat and seafood from the diet. This may decrease risk substantially, and adding cherries on top may decrease risk of gout attacks even further. Same thing with the leading drug: allopurinol works, but adding produce appears to work even better.

Often, dietary changes and cherries may be all patients have, as doctors are hesitant to prescribe uric acid-lowering drugs like allopurinol due to rare but serious side-effects.

In addition to fighting inflammation, cherries may also lower uric acid levels. Within five hours of eating a big bowl of cherries, uric acid levels in the blood significantly drop. At the same time, antioxidant levels in the blood go up. So is it just an antioxidant effect? Would other fruit work just as well? No. Researchers tried grapes, strawberries, and kiwi fruit, and none significantly lowered uric acid levels, supporting a specific anti-gout effect of cherries.

There are some new gout drugs out now, costing up to $2,000 per dose and carry a "risk of toxicity that may be avoided by using nonpharmacologic treatments or prevention in the first place." Given the potential harms and high costs, attention ought to be directed to dietary modification, reducing alcohol and meat intake, particularly sardines and organ meats. "If life serves up a bowl of cherries (consumed on a regular basis), the risk of a recurrent gout attack may be meaningfully reduced."

More about the inflammation fighting effects of sweet cherries in my video Anti-inflammatory Life is a Bowl of Cherries.

I've previously mentioned gout and controlling uric acid levels in my videos:

Other foods that may help tamp down inflammation:

In health,
Michael Greger, M.D.

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

Image Credit: Valdemar Fishmen / Flickr

Original Link

Which are More Anti-Inflammatory: Sweet Cherries or Tart Cherries?

NF-Oct6 Anti-inflammatory life is a bowl full of cherries.jpg

Haggis, the national dish of Scotland, is a savory pudding of heart, liver, lungs, and oatmeal traditionally stuffed inside of a stomach. When that stomach goes into our own stomach, our digestive enzymes and stomach acid have no problem digesting it away. How do our bodies digests the stomach lining of a sheep on our plate without digesting our own stomach linings? It's meat and we're meat, so why don't we digest our own stomach every time we eat?

Partly because we have an enzyme called cyclooxygenase (COX) that protects the lining of our stomach. There are two types, COX-1 and COX-2. COX-1 is thought to be the primary protector of our stomach, whereas COX-2 is an enzyme responsible for pain and inflammation. In fact, anti-inflammatory drugs like ibuprofen and naproxen work by inhibiting the COX-2 enzyme. But these are non-selective drugs, so in addition to inhibiting COX-2 they also inhibit COX-1, which is trying to protect our stomach linings. Thus, although drugs like ibuprofen are great at relieving pain and inflammation, they kill thousands every year due to ulcerations through the stomach wall that result in life-threatening bleeding and perforation.

What are the risks on an individual level? On average, one in about 1,200 people who take this class of drugs for at least two months will die as a result. To put this into perspective, we can compare the death rate from anti-inflammatory drug side-effects to the risks associated with some well-known events. For example, it may be safer to go bungee jumping a few hundred times.

What we need is a selective COX-2 inhibitor, inhibiting the pain and inflammation of COX-2 without inhibiting the stomach protection of COX-1. We thought we got it with Vioxx, a blockbuster drug that brought in billions in profits before it started killing tens of thousands of peoples. Internal emails reveal how the drug manufacturer responded to the revelation that they were killing people: They drew up a list of doctors who were trying to warn people to "neutralize" them. If that didn't work, they tried to discredit them (You can see the emails in the video, Anti-inflammatory Life Is a Bowl of Cherries).

We're left then with two options: death from internal bleeding from one type of drug or death from side effects from another type of drug. If only there was some sort of natural COX-2 inhibitor. There is: cherries, which unlike ibuprofen suppress COX-2 more than COX-1.

In videos I did on insomnia and reducing muscle soreness (See Tart Cherries for Insomnia and Reducing Muscle Soreness with Berries), I talked about the benefits of sour cherries, the types of cherries used in baking. But sweet cherries, the kind you eat fresh, seem to be the MVP for COX-2 inhibition. Tart cherries had less of an effect. Regular red sweet cherries (Bing sweet cherries) were shown to have a greater anti-inflammatory activity than tart cherries. This makes sense since we think it may be the anthocyanin phytonutrients, and there are much more in sweet red cherries than in tart, and nearly none in yellow Rainer cherries.

Because fresh cherries have limited availability, what about other cherry products? In terms of anthocyanin phytonutrients, fresh is best, but frozen would appear to be the second-best choice.

Here are two ways I incorporate cherries into my diet:

Other studies in which anti-inflammatory drugs were compared natural dietary remedies include: Turmeric Curcumin and Osteoarthritis and Turmeric Curcumin and Rheumatoid Arthritis.

Anti-inflammatory activity in a test tube is one thing, but can cherries actually be used clinically to treat inflammatory diseases? See Gout Treatment with a Cherry on Top.

In health,
Michael Greger, M.D.

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

Image Credit: Valdemar Fishmen / Flickr

Original Link

How Plants Can be Both Safer and More Effective

NF-Sep10 Magic Bullets vs. Promiscuous plants.jpg

During the last decade, the drug industry has followed an assumption that a single drug hitting a single target was the "rational" way to design drugs. We're learning that Mother Nature may be a bit too complicated for that. "Strategies for targeting single genes or proteins ignore a very important fact that most, if not all diseases, involve a sophisticated network system." For example, one little family of immune molecules involves about 50 different keys fitting into about 20 different locks, often acting with redundancy, making selection of an appropriate drug to antagonize one key or one lock ineffective in the long run. A whole list of agents has been developed to target a specific molecule for the treatment of inflammatory bowel disease, for example, but they have all flopped. That's why drug companies are now working on so-called "promiscuous" drugs that try to affect multiple pathways simultaneously.

Meanwhile, since ancient times, natural agents derived from plants--fruits, vegetables, spices, beans, and grains--have been preferred as potential therapeutics for most chronic diseases, not only because of their safety, affordability, and long-term use, but also "for their ability to target multiple cell signaling pathways, a therapeutic virtue." (See Magic Bullets vs. Promiscuous Plants).

One example of a successful promiscuous plant-based drug is aspirin. It doesn't just target inflammation and offer pain relief, but can act as a blood thinner and help prevent preeclampsia and even some types of cancer. Curcumin is another hopeful plant-based medicine. Aspirin is an extract of the willow tree bark (and is present in other fruits and vegetables); curcumin is an extract of turmeric root. It's so anti-inflammatory that it may even work through the skin--a traditional use was to wrap sprains and injuries with turmeric soaked poultices, a use that continues to this day. Curcumin is so anti-inflammatory that it can help counter the effects of mustard gas.

In a petri dish, curcumin extinguishes the response of spleen cells to an inflammatory cytokine. Promising effects have also been observed in patients with a variety of inflammatory diseases. One of the great things about curcumin is that it also appears to be very safe. One of the reasons may be that despite its powerful pharmacological effects, the same pathway promiscuity that may account for its effectiveness may act synergistically to neutralize side-effects. For example, turmeric has been traditionally used as a bronchodilator to open airways in conditions like asthma. Many of the adrenaline-like drugs that do the same thing can raise blood pressure. The reason turmeric doesn't may be because it has different components with opposing activities, such as calcium channel-blocking effects that may actually lower blood pressure, and so the side effects may cancel each other out.

This strength in promiscuity, though, is also a weakness. The U.S. Food and Drug Administration has been reluctant to approve plant extracts, which by definition are composed of mixtures of different compounds. It's a Catch-22. One drug, one chemical, one mechanism of action and you can patent it, get FDA approval, and make a billion off it, but it may not work very well. On the other hand, there might be a safe, natural alternative that works better, but industry and the government may not be interested.

However, there is hope on the horizon. The FDA approved a green tea ointment as a prescription drug for the treatment of genital warts (See Treating Genital Warts with Green Tea), making it the first prescription plant approved in the United States. If you think that's neat, check out Treating Gorlin Syndrome With Green Tea.

So have drug companies abandoned their model and started pouring money into plants? No. "Having discovered that so-called magic bullet has been largely unsuccessful, they just propose creating non-selective drugs. Instead of magic bullets, magic shotguns."

I go into more detail about the Catch-22 in my last video Plants as Intellectual Property - Patently Wrong?

Aspirin isn't just found in willow tree bark, but throughout the plant kingdom, including fruits and vegetables. See: Aspirin Levels in Plant Foods.

My video Power Plants shows how plant foods are not to be underestimated.

More on turmeric curcumin and inflammation here:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my videos for free by clicking here and watch my full 2012 - 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Shu / Flickr

Original Link

Why Certain Plant Compounds May Mimic Dietary Restriction

NF-Sep3 Xenohormesis- What doesn't kill plants may make us stronger.jpg

A new concept, called xenohormesis, has arisen to explain the mystery of why so many plant molecules interact with and modulate key regulators of our physiology in ways that are beneficial to our health (explained further in my video, Xenohormesis: What Doesn't Kill Plants May Make Us Stronger).

Basically, hormesis is the biological principle of "no pain, no gain." Mild stresses like exercise can trigger a protective response that leads to strengthened defenses in the long run. But instead of exposing ourselves to the stressor to trigger our bodies' defenses and shore up protection against future stressors, why not let plants take the hit? Let the plants get stressed because, incredibly, the stress response molecules in plants may activate the same protective responses in humans. Xenohormesis "explains how environmentally stressed plants produce bioactive compounds that can confer stress resistance and survival benefits to animals that consume them." We can piggyback off of their sophisticated stress response. Indeed, the majority of known health-beneficial effects of edible plants are attributable to the pharmacologically active substances of plants' stress responses.

Hormesis may be why dietary restriction can lead to lifespan extension. The mild stress placed upon the body by not eating enough may activate a wide variety of protective pathways within the body, ramping up anti-inflammatory and antioxidant defenses. Our bodies are preparing themselves for the coming famine they think is about to occur. So is there a way to exploit the benefits of dietary restriction to prevent chronic disease? Obviously, "chronically restricting food intake is not a realistic health strategy for the majority of people--it's hard for most people to even cut food intake 10-20%, [given the powerful evolutionary drive to eat]. A more feasible alternative may be to activate dietary restriction-induced stress response pathways by other means."

In other words, xenohormesis.

If we starve plants, they do the same thing mammals do: activate preservation pathways. So let's let the plant face the adversity to create the molecules that trigger cell stress resistance, alter metabolism, and improve disease resistance, and then just come along and appropriate them for the same uses in our own bodies.

The reason phytonutrients like resveratrol in grapes, curcumin in the spice turmeric, and ECGC in green tea are called "dietary restriction mimetics" is that they mimic the physiological effects of dietary restriction. This may be no coincidence, because the plants produced these compounds to save their own green butts from scarcity. So instead of having to walk around starving all the time, thanks to xenohormesis, we may be able to let the plants bear the brunt and enable us to harness other species' hardships as a means to promote our own health.

If this subject interests you, make sure you see my video where I introduce the topic: Appropriating Plant Defenses.

I previously introduced the concept of hormesis in my videos Enhanced Athletic Recovery Without Undermining Adaptation and Is Liquid Smoke Carcinogenic?

How else might we get the benefits of dietary restriction without starving ourselves? See:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my videos for free by clicking here and watch my full 2012 - 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: KylaBorg / Flickr

Original Link

The Spice That Helps Ease Rheumatoid Arthritis Pain

NF-Jan22 The Spice that Helps Ease Rheumatoid Arthritis Pain.jpg
Accordingto the World Health Organization, "80% of the Earth's inhabitants rely upon the traditional medicine for their primary health-care needs, in part due to high cost of Western pharmaceuticals. Medicines derived from plants have played a pivotal role in the health care of both ancient and modern cultures." One of the prime sources of plant-derived medicines is spices. Turmeric, for example, has been consumed over the centuries around the world. Turmeric is known by different names in different societies--my favorite of which is probably "zard-choobag."

Turmeric is the dried powdered root stalks of the turmeric plant--a member of the ginger family--from which the orangey-yellow pigment curcumin can be extracted. The spice turmeric is what makes curry powder yellow, and curcumin is what makes turmeric yellow. In the video, Turmeric Curcumin and Rheumatoid Arthritis, you can see the molecular structure of curcumin. I always thought it kind of looked like a crab.

In recent years, more than 5,000 articles have been published in the medical literature about curcumin. Many sport impressive looking diagrams suggesting curcumin can benefit a multitude of conditions via a dizzying array of mechanisms. Curcumin was first isolated more than a century ago, but out of the thousands of experiments, just a handful in the 20th century were clinical studies, involving actual human participants. Most of the 5,000 were just in vitro lab studies, which I've resisted covering until the studies moved out of the petri dish and into the person. But since the turn-of-the-century, more than 50 clinical trials have been done, testing curcumin against a variety of human diseases, with 84 more on the way. One such study got my attention.

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that causes progressive destruction of the cartilage and bone of joints. The long-term prognosis of RA is poor, with as much as 80% of patients affected becoming disabled with a reduced life expectancy. There are lots of drugs one can take, but unfortunately they're often associated with severe side effects including blood loss, bone loss and bone marrow suppression, and toxicity to the liver and eyes.

The efficacy of curcumin was first demonstrated over 30 years ago in a double-blind crossover study: curcumin versus phenylbutazone, a powerful anti-inflammatory that is used in race horses. Both groups showed significant improvement in morning stiffness, walking time, and joint swelling, with the complete absence of any side effects from curcumin (which is more than can be said for phenylbutazone, which was pulled from the market three years later after wiping out people's immune systems and their lives).

In the new study, 45 patients diagnosed with rheumatoid arthritis were randomized into three groups: curcumin, the standard of care drug, or both. The primary endpoint was a reduction in disease activity as well as a reduction in joint tenderness and swelling. All three groups got better, but interestingly the curcumin groups showed the highest percentage of improvement, significantly better than those in the drug group. The findings are significant and demonstrate that curcumin alone was not only safe and effective, but surprisingly more effective in alleviating pain compared to the leading drug of choice, all without any adverse side effects. In fact, curcumin appeared protective against drug side effects, given that there were more adverse reactions in the drug group than in the combined drug and curcumin group. In contrast to non-steroidal anti-inflammatory drugs (NSAIDs), curcumin has no gastrointestinal side effects, and may even protect the lining of the stomach.

Hard to appreciate the gorgeous color of fresh turmeric root unless you see it for yourself. You should be able to find it at any large Asian store. I incorporate it into my Natural Nausea Remedy Recipe. The inner color is almost fluorescent!

I'm afraid followers of NutritionFacts.org are going to get sick of turmeric, but there's a load of important new research I felt I needed to cover. So far there's Turmeric Curcumin and Osteoarthritis, Boosting the Bioavailability of Curcumin and Who Shouldn't Consume Curcumin or Turmeric?

I've previously talked about treating autoimmune joint inflammation with diets full of plants in Diet & Rheumatoid Arthritis and Potassium and Autoimmune Disease.

If phenylbutazone sounds vaguely familiar, maybe you read my Q&A Is horse meat safe to eat?

-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 From Table to Able.

Image Credit: David van Horn / Flickr

Original Link

How to Treat Multiple Sclerosis With Diet

NF-July17 Treating Multiple Sclerosis with Diet.jpg

Multiple sclerosis is an unpredictable and frightening degenerative autoimmune inflammatory disease of the central nervous system in which our body attacks our own nerves. It often strikes in the prime of life and can cause symptoms in the brain, such as cognitive impairment; in the eye, such as painful loss of vision; as well as tremors, weakness, loss of bladder control, pain, and fatigue.

The most frequently prescribed drug for multiple sclerosis is interferon beta, which can make one feel lousy and cost $30,000 a year. But hey, it might be worthwhile--if it actually worked. We learned recently that it doesn't seem to prevent or delay long-term disability. That leaves chemo drugs like mitoxantrone that causes irreversible heart damage in one out of every eight people who go on the drug and causes cancer (leukemia) in nearly 1% of people who take it. But MS is no walk in the park either.

If only there was a cheap, simple, safe, side-effect free solution that also just so happened to be the most effective treatment for MS ever prescribed...

Dr. Roy Swank, who we lost recently at age 99, was a distinguished neurologist whose research culminated in over 170 scientific papers. In the video, Treating Multiple Sclerosis with the Swank MS Diet, I highlight a few.

As far back as 1950, we knew there were areas in the world that had a lot of MS--North America, Europe--and other places--Africa and Asia--that hardly had any. And migration studies show that those who move from a high risk area to a low risk area significantly drop their risk, and vice versa. So it seems less genetic and more lifestyle.

Dr. Swank had an idea. As he recounts in an interview with Dr. John McDougall at the ripe young age of 84, "it seemed possible to me that this could be a matter of food, because the further north you go the less vegetarian a life is led and the more people are carnivores, you might say--they spend a lot more time eating meat."

After looking at the multiple sclerosis data from World War II in occupied countries where meat and dairy were rationed, along with his famous study in '52 that found that the frequency of MS related directly to the amount of saturated animal fat consumed daily in different areas of Norway, he concluded that it might be the animal fat that was causing the increased risk. He decided to put it to the test by restricting people's intake of saturated animal fat, most commonly coming from dairy and chicken in the U.S. (See Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero).

In Treating Multiple Sclerosis with the Swank MS Diet, you can see data on his first 47 patients before cutting out about 90% of the saturated fat from their diet and after, showing a decrease in both the frequency and severity of MS attacks. Normally, we're lucky if we can get people to stick to a diet for six months, and so that's why most dietary trials last a year at the most. The first study he published reported results from the first three and a half years.

Then came the five and a half year follow-up in which he added about another 100 patients. Then the seven year follow-up, published in the Annals of Internal Medicine. Then the 20 year follow-up, and then the 34 year follow-up.

How did his patients do? If we can get to people early in their disease, when they're only mildly disabled, and restrict their saturated fat intake, Dr. Swank showed he could stop their disease in 95% of cases--no further disability 34 years later. But if they started slacking on their diet--even years in, their disease could become reactivated. They felt so great that some felt that they could cheat a little bit, since they had their disease so well under control. But eating just eight grams of saturated fat more a day was accompanied by a striking increase in disability and a near tripling of their death rate.

How about a 50 year follow-up! They were able to track down 15 of the original patients that stuck to the diet, now in their 70s and 80s, with multiple sclerosis for over 50 years, and 13 out of 15 were walking around normal in all respects. Conclusion: "This study indicated that, in all probability, MS is caused largely by consumption of saturated animal fat."

Dr. Swank thought it was the sludging of the blood caused by even a single meal of saturated fats that can clog tiny capillaries that feed our nervous system. Diets rich in saturated fat and cholesterol can thicken the blood and make our red cells sticky. A single meal of sausage and eggs can stick our blood cells together like rolls of quarters. And that kind of hyperaggregation can lead to a reduction of blood flow and oxygenation of our tissues. What's in sausage and eggs that may cause so much inflammation? See my video series on endotoxins described in my blog How Does Meat Cause Inflammation?

If we put someone's blood through a machine that sucks out about 90% of the cholesterol in their blood, we can demonstrate an immediate improvement in microcirculation in the heart muscle. But what about the brain?

The eyes are the windows... to our brain. We can visualize--in real-time--changes in blood vessel function in the retina at the back of the eye, which gives us a sense of what's happening further back in the brain. And if we lower the cholesterol level in the blood, we can immediately get a significant improvement in vasodilation--the little veins open wider and let the blood flow.

So yes, it could be the animal fat leading to clogging of our capillaries, but now we know animal fats can have all sorts of other deleterious effects such as inflammation, so who knows what the actual mechanism may be by which cutting animal fat can cut MS progression. Regardless, patients with MS that follow a diet with no more than 10 or 15 grams of saturated fat can expect to survive and thrive to a ripe old age. Of course, cutting out saturated fat completely might be better, given that heart disease is our number one killer.

The bottom line is that the results Dr. Swank published remain "the most effective treatment of multiple sclerosis ever reported in the peer reviewed medical literature." In patients with early stage MS, 95% were without progression of their disease 34 years later after adopting his low saturated fat dietary program. Even patients with initially advanced disease showed significant benefit. To date, no medication or invasive procedure has ever even come close, to demonstrating such success.

Doesn't cost $30,000 dollars; doesn't give you leukemia--and works. Better!

This all begs one big obvious question: If Dr. Swanks results are "so stunningly impressive, why haven't other physicians, neurologists, and centers adopted this method of treatment?" One reason may be that MRI machines weren't invented until the 1970s, decades after Dr. Swank's study began. MRIs are how we track the progress of MS today. We don't have to rely on patients' subjective reports or doctor's clinical judgments, we can see the disease get better or worse right there in black and white.

It's like in the 1970s when Nathan Pritikin appeared to reverse heart disease by the thousands but no one took him seriously until angiography was invented and the likes of Ornish and Esselstyn (see Our Number One Killer Can Be Stopped) could hold up angiographic images, proving conclusively that a plant-based diet could help literally open up arteries.

So what we need is someone to repeat Swank's experiment today with MRI scans every step of the way. And I'm happy to report that exact experiment was just completed by Dr. John McDougall. Dr. Swank was one of Dr. McDougall's heroes, and Dr. McDougall is one of mine. Study enrollment was completed last year and we should have the full results soon.

I touched on this in my live 2013 year-in-review lecture More Than an Apple a Day, but I'm excited to be able to take a deeper dive into this extraordinary story.

Those interested in supporting Dr. McDougall's landmark study (headed by Dr. Dennis Bourdette, M.D. and under the supervision of Dr. Vijayshree Yadav) can donate to his nonprofit McDougall Research & Education Foundation (you can also donate to NutritionFacts.org to help keep us bringing you similarly underreported yet life-saving science).

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live 2012 year-in-review presentation Uprooting the Leading Causes of Death.

Image Credit: Theen Moy / Flickr

Original Link