Evidence-Based Nutrition

NF-Jan12 Evidence-Based Medicine or Evidence-Biased?.jpg

Dr. Esselstyn's landmark study, demonstrating that even advanced triple vessel coronary artery disease could be reversed with a plant-based diet, has been criticized for being such a small study. But the reason we're used to seeing large studies is that they typically show such small effects. Drug manufacturers may need to study 7,000 people in order to show a barely statistically significant 15% drop in ischemic events in a subsample of patients. Esselstyn achieved a 100% drop in those who stuck to his diet, all the more compelling considering that those 18 participants experienced 49 coronary events (like heart attacks) in the eight years before they went on the diet. These patients were the sickest of the sick, most of whom having already failed surgical intervention. When the effects are so dramatic, how many people do you need?

Before 1885, a symptomatic rabies infection was a death sentence, until little Joseph Meister became the first to receive Pasteur's experimental rabies vaccine. The results of this and one other case were so dramatic compared with previous experience that the new treatment was accepted with a sample size of two. That is, the results were so compelling that no randomized controlled trial was necessary. Having been infected by a rabid dog, would you be willing to participate in a randomized controlled trial, when being in the control group had a certainty of a ''most awful death''? Sadly, such a question is not entirely rhetorical.

In the 1970's, a revolutionary treatment for babies with immature lungs called "extracorporeal membranous oxygenation" (ECMO), transformed immature lung mortality from 80% dead to 80% alive nearly overnight. The standard therapy caused damage to infants' lungs and was a major cause of morbidity and mortality in infants. ECMO is much gentler on babies' lungs, "providing life support while allowing the lungs to 'rest.'"

Despite their dramatic success, the researchers who developed ECMO felt forced to perform a randomized controlled trial. They didn't want to; they knew they'd be condemning babies to death. They felt compelled to perform such a trial because their claim that ECMO worked would, they judged, carry little weight amongst their medical colleagues unless supported by a randomized controlled trial. Therefore, at Harvard's Children's Hospital, 39 infants were randomized to either get ECMO or conventional medical therapy. The researchers decided ahead of time to stop the trial after the 4th death so as not to kill too many babies. And that's what they did. The study was halted after the fourth conventional medical therapy death, at which point nine out of nine ECMO babies had survived. Imagine being the parent to one of those four children.

Similarly, imagine being the child of a parent who died other conventional medical or surgical therapy for heart disease.

In her paper "How evidence-based medicine biases physicians against nutrition," Laurie Endicott Thomas reminds us that medical students in the United States are taught very little about nutrition (See Evidence-Based Medicine or Evidence-Biased?). Worse yet, according to Thomas, their training actually biases them against the studies that show the power of dietary approaches to managing disease by encouraging them to ignore any information that does not come from a double-blind, randomized controlled trial. Yet humans cannot be blinded to a dietary intervention--we tend to notice what we're eating--and, as a result, physicians are biased in favor of drug treatments and against dietary interventions for the management of chronic disease.

Evidence-based medicine is a good thing. However, Thomas points out that the medical profession may be focusing too much on one type of evidence to the exclusion of all others. Unfortunately, this approach can easily degenerate into "ignoring-most-of-the-truly-important-evidence" based medicine.

Heart disease is a perfect example. On healthy enough plant based diets, our number one cause of death may simply cease to exist. The Cornell-Oxford-China Study showed that even small amounts of animal-based food was associated with a small, but measurable increase in the risk of some chronic diseases. In other words, "the causal relationship between dietary patterns and coronary artery disease was already well established before Dean Ornish and Caldwell Esselstyn undertook their clinical studies." The value of their studies was not so much in providing evidence that such a dietary change would be effective, but in showing that "physicians can persuade their patients to make such changes," and in "providing interesting data on the speed and magnitude of the change in severe atherosclerotic lesions as a result of dietary therapy."

Therefore, any complaints that these studies were small or unblinded are simply irrelevant. Because the evidence of the role of diet in causing atherosclerosis is already so overwhelming, "assigning a patient to a control group eating the standard American diet could be considered a violation of research ethics."

Evidence of the value of plant-based diets for managing chronic disease has been available in the medical literature for decades. Walter Kempner at Duke University, John McDougall, the Physician's Committee for Responsible Medicine, Nathan Pritikin, and Denis Burkitt all warned us that the standard Western diet is the standard cause of death and disability in the Western world. Yet physicians, especially in the US, are still busily manning the ambulances at the bottom of the cliff instead of building fences at the top.

If you're not familiar with Dr. Esselstyn's work, I touch on it in:

Sadly, medical students learn little about these powerful tools:

If you haven't heard of Pritikin, I introduce him here: Engineering a Cure

An intro to Dr. Ornish: Convergence of Evidence

Dr. Burkitt: Dr. Burkitt's F-Word Diet

The Cornell-Oxford-China Study: China Study on Sudden Cardiac Death

Dr. Walter Kempner: Kempner Rice Diet: Whipping Us Into Shape

-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: clement127 / Flickr

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Dr. Greger’s 2015 Live Year-in-Review Presentation

Food as Medicine

View my new live presentation here: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet

Every year I scour the world's scholarly literature on clinical nutrition, pulling together what I find to be the most interesting, practical, and groundbreaking science on how to best feed ourselves and our families. I start with the thousands of papers published annually on nutrition (27,000 this year--a new record!) and, thanks to a crack team of volunteers (and now staff!), I'm able to whittle those down (to a mere 8,000 this year). They are then downloaded, categorized, read, analyzed, and churned into the few hundred short videos. This allows me to post new videos and articles every day, year-round, to NutritionFacts.org. This certainly makes the site unique. There's no other science-based source for free daily updates on the latest discoveries in nutrition. The problem is that the amount of information can be overwhelming.

Currently I have more than a thousand videos covering 1,931 nutrition topics. Where do you even begin? Many have expressed their appreciation for the breadth of material, but asked that I try to distill it into a coherent summary of how best to use diet to prevent and treat chronic disease. I took this feedback to heart and in 2012 developed Uprooting the Leading Causes of Death, which explored the role diet may play in preventing, arresting, and even reversing our top 15 killers. Not only did it rise to become one of the Top 10 Most Popular Videos of 2012, it remains my single most viewed video to date, watched over a million times (NutritionFacts.org is now up to more than 1.5 million hits a month!).

In 2013 I developed the sequel, More Than an Apple a Day, in which I explored the role diet could play in treating some of our most common conditions. I presented it around the country and it ended up #1 on our Top 10 Most Popular Videos of 2013. Then in 2014 I premiered the sequel-sequel, From Table to Able, in which I explored the role diet could play in treating some of our most disabling diseases, landing #1 on our Top 10 Most Popular Videos of 2014.

Every year I wonder how I'm going to top the year before. Knowing how popular these live presentations can be and hearing all the stories from folks about what a powerful impact they can have on people's lives, I put my all into this new 2015 one. I spent more time putting together this presentation than any other in my life. It took me an entire month, and when you see it I think you'll appreciate why.

This year, I'm honored to bring you Food as Medicine, in which I go through our most dreaded diseases--but that's not even the best part! I'm really proud of what I put together for the ending. I spend the last 20 minutes or so (starting at 56:22) going through a thought experiment that I'm hoping everyone will find compelling. I think it may be my best presentation ever. You be the judge.

You can watch it at no cost online, but it is also available on DVD through my website or on Amazon. If you want to share copies with others, I have a five for $40 special (enter coupon code 5FOR40FAM). All proceeds from the sales of all my books, DVDs, downloads, and presentations go to the 501c3 nonprofit charity that keeps NutritionFacts.org free for all, for all time. If you want to support this initiative to educate millions about eradicating dietary diseases, please consider making a donation.

After you've watched the new presentation, make sure you're subscribed to get my video updates daily, weekly, or monthly to stay on top of all the latest.

-Michael Greger

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Kickstart Your Heart Health this February, Little Rock!

It's been less than a month, but Kickstart Your Health Little Rock has already made huge strides in helping our city get healthy and feel good! Now, it's still not too late to sign up for the free and fun 21-day healthy challenge that began Feb. 1. But first let me share with you some of the health-inspiring events that have happened around town in the past few weeks.

It all started on Jan. 7, when Physicians Committee president Neal Barnard, M.D., whose nonprofit organization developed Kickstart, joined me for several TV interviews to let everyone know about the Kickstart and invite them to a screening of the documentary Forks Over Knives, which examines the power of plant-based foods to combat chronic disease.

Later that day, Dr. Barnard, my husband, Jason Beck, M.D., and I joined Mayor Mark Stodola as he presented a proclamation supporting the Kickstart program.


The powerfully worded proclamation didn't merely recognize the Kickstart--it urged citizens to actively get involved in improving their health and well-being: "The Office of the Mayor encourages residents, businesses, and health care professionals to participate in the Kickstart Your Health Little Rock initiative by attending a public event, pledging to change your diet, or encouraging your school or business to get on board."

The next day, more than 300 people attended a standing-room-only screening of Forks Over Knives. Following the screening, Dr. Barnard, local cardiovascular surgeon Dr. C.D. Williams, and my husband and I led a lively panel discussion for attendees who wanted to learn more about how they could improve their health with a plant-based diet.

Dr. Barnard delivered free lectures at local hospitals and the Arkansas Department of Health during his visit as well. And after an unprecedented response from an article about the Kickstart Your Health Little Rock initiative in the Arkansas Democrat Gazette on January 19th, I was humbled to witness all 40 seats in the free Food For Life Kickstart Your Health 6-class series I'm teaching become reserved literally overnight (with even more Little Rock citizens on the waiting list)!

What's next? The free online 21-Day Kickstart began Feb. 1, but it isn't too late to join! You can still sign up today at KickstartLittleRock.org, and you'll begin receiving daily e-mails on Feb. 1 that give you access to an online nutrition program with a 21-day meal plan, recipes, cooking videos, and nutrition tips (and it is free even if you don't live in Little Rock).

Why February? February is American Heart Month, and Feb. 6 is National Wear Red Day--which specifically focuses on heart disease in women. Heart disease is the No. 1 cause of death for both men and women in America.

Here in Arkansas, we have the fifth highest heart disease death rate and the highest stroke death rate in the nation. Currently, the state has about 200,000 heart disease cases. In just 15 years, we'll have more than 800,000. According to the Arkansas Department of Health, total hospital charges in Arkansas for cardiovascular disease in 2009 totaled over $2.1 billion dollars. With these staggering statistics, how can we not afford to Kickstart Little Rock?

American Heart Month is an ideal time to start improving these statistics. Plant-based diets--the science behind the Kickstart--have been shown to prevent and reverse heart disease.

Don't wait a minute longer to take control of your heart health! Do it for yourself, your family, and your friends. Go to KickstartLittleRock.org and sign up today. Together, we're going to make Little Rock the healthiest city in the U.S.A.

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What is Actually in Chicken Nuggets?

NF-Nov18 What is Actually in Chicken Nuggets?.jpg

In a scathing expose of the USDA's new meat inspection program, the Washington Post quoted a representative from the meat inspectors union, who said:

"pig processing lines may be moving too quickly to catch tainted meat... Tremendous amounts of fecal matter remain on the carcasses. Not small bits, but chunks."

What about the other white meat?

In the video, Autopsy of Chicken Nuggets, you can see an infographic the Physician's Committee for Responsible Medicine created to highlight what they consider to be the five worst contaminants in chicken products. In their investigation of retail chicken products in ten U.S. cities, they found fecal contamination in about half the chicken they bought at the store. But with all the focus on what's in chicken products, we may have lost sight on what may be missing--such as actual chicken.

Researchers from the University of Mississippi Medical Center and the Baptist Medical Center recently published an "autopsy" of chicken nuggets in the American Journal of Medicine. The purpose was to determine the contents of chicken nuggets from two national food chains. Because chicken nuggets are popular among children, the researchers thought that parents should know more about what they may be feeding to their kids.

The nugget from the first restaurant was composed of approximately 50% skeletal muscle, with the remainder composed primarily of fat, blood vessels and nerves, and generous quantities of skin or gut lining and associated supportive tissue. The nugget from the second restaurant was composed of approximately 40% skeletal muscle with lots of other tissues, including bone.

"I was floored," said the lead investigator. "I had read what other reports have said is in them and I didn't believe it. I was astonished actually seeing it under the microscope." I profile some of those other pathology reports in my videos What's in a Burger? and What Is Really in Hot Dogs?

The researchers concluded that since actual chicken meat was not the predominant component of either nugget, the term "chicken" nugget was really a misnomer.

If we're going to eat something chicken-ish that isn't chicken meat, why not truly boneless chicken: Chicken vs. Veggie Chicken.

More on fecal contamination of chicken in Fecal Bacteria Survey, of fish in Fecal Contamination of Sushi, and of pork in Yersinia in Pork. How can that be legal? See Salmonella in Chicken & Turkey: Deadly But Not Illegal.

More on the preservatives in chicken in Phosphate Additives in Meat Purge and Cola and antibiotic contamination in Drug Residues in Meat.

Estrogenic Cooked Meat Carcinogens also build up in poultry in particular, something the Physicians Committee also tested for previously: Fast Food Tested for Carcinogens.

-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: Jacob Enos / Flickr

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