Reversing Diabetic Blindness with Diet

Reversing Diabetic Blindness with Diet.jpeg

Though many reported feeling better on Dr. Walter Kempner's rice and fruit diet, he refused to accept such anecdotal evidence as proof of success. He wanted objective measurements. The most famous were his "eyegrounds photographs," taken with a special camera that allowed one to visualize the back of the eye. In doing so, he proved diet can arrest the bleeding, oozing, and swelling you see in the back of the eye in people with severe kidney, hypertensive, or heart disease. Even more than that, he proved that diet could actually reverse it, something never thought possible.

In my video, Can Diabetic Retinopathy Be Reversed?, you can see before and after images of the back of patients' eyes. He found reversal to such a degree that even those who could no longer distinguish large objects were able to once again read fine print. Dr. Kempner had shown a reversal of blindness with diet.

The results were so dramatic that the head of the department of ophthalmology at Duke, where Kempner worked, was questioned as to whether they were somehow faked. He assured them they were not. In fact, he wrote in one person's chart, "This patient's eyegrounds are improved to an unbelievable degree." Not only had he never seen anything like it, he couldn't remember ever seeing a patient with such advanced disease even being alive 15 months later.

The magnitude of the improvements Kempner got--reversal of end-stage heart and kidney failure--was surprising, simply beyond belief. But as Kempner said as his closing sentence of a presentation before the American College of Physicians, "The important result is not that the change in the course of the disease has been achieved by the rice diet but that the course of the disease can be changed."

Now that we have high blood pressure drugs, we see less hypertensive retinopathy, but we still see a lot of diabetic retinopathy, now the leading cause of blindness in American adults. Even with intensive diabetes treatment--at least three insulin injections a day with the best modern technology has to offer--the best we can offer is usually just a slowing of the progression of the disease.

So, in the 21st century, we slow down your blindness. Yet a half century ago, Kempner proved we could reverse it. Kempner started out using his plant-based rice diet ultra-low in sodium, fat, cholesterol, and protein to reverse kidney and heart failure; he actually assumed the diet would make diabetes worse. He expected a 90% carbohydrate diet would increase insulin requirements, however, the opposite proved to be true. He took the next 100 patients with diabetes who walked through his door who went on the rice diet for at least three months and found their fasting blood sugars dropped despite a drop in the insulin they were taking. What really blew people away was this: Forty-four of the patients had diabetic retinopathy, and, in 30% of the cases, their eyes improved. That's not supposed to happen; diabetic retinopathy had been considered "a sign of irreversible destruction." What does this change mean in real life? Patients went from unable to even read headlines to normal vision.

The remarkable success Dr. Kempner had reversing some of the most dreaded complications of diabetes with his rice and fruit diet was not because of weight loss. The improvements occurred even in those patients who did not lose significant weight, so it must have been something specific about the diet. Maybe it was his total elimination of animal protein, animal fat, and cholesterol? Or perhaps it was his radical reduction in sodium, fat, and protein in general? We don't know.

How do we treat diabetic retinopathy these days? With steroids and other drugs injected straight into the eyeball. If that doesn't work, there's always pan-retinal laser photocoagulation, in which laser burns are etched over nearly the entire retina. Surgeons literally burn out the back of your eye. Why would they do that? The theory is that by killing off most of the retina, the little pieces you leave behind may get more blood flow.

When I see that, along with Kempner's work, I can't help but feel like history has been reversed. It seems as though it should have gone like, "Can you believe 50 years ago the best we had was this barbaric, burn-out-your-socket surgery? Thank goodness we've since learned that through dietary means alone, we can reverse the blindness." But instead of learning, medicine seems to have forgotten.

I documented the extraordinary Kempner story previously in Kempner Rice Diet: Whipping Us Into Shape and Drugs and the Demise of the Rice Diet. The reason I keep coming back to this is not to suggest people should go on such a diet (it is too extreme and potentially dangerous to do without strict medical supervision), but to show the power of dietary change to yield tremendous healing effects.

The best way to prevent diabetic blindness is to prevent or reverse diabetes in the first place. See, for example:

Why wouldn't a diet of white rice make diabetes worse? See If White Rice Is Linked to Diabetes, What About China?

For more on the nitty gritty on what is the actual cause of type 2 diabetes, see:

In health,

Michael Greger, M.D.

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

Image Credit: Community Eye Health / Flickr. This image has been modified.

Original Link

Reversing Diabetic Blindness with Diet

Reversing Diabetic Blindness with Diet.jpeg

Though many reported feeling better on Dr. Walter Kempner's rice and fruit diet, he refused to accept such anecdotal evidence as proof of success. He wanted objective measurements. The most famous were his "eyegrounds photographs," taken with a special camera that allowed one to visualize the back of the eye. In doing so, he proved diet can arrest the bleeding, oozing, and swelling you see in the back of the eye in people with severe kidney, hypertensive, or heart disease. Even more than that, he proved that diet could actually reverse it, something never thought possible.

In my video, Can Diabetic Retinopathy Be Reversed?, you can see before and after images of the back of patients' eyes. He found reversal to such a degree that even those who could no longer distinguish large objects were able to once again read fine print. Dr. Kempner had shown a reversal of blindness with diet.

The results were so dramatic that the head of the department of ophthalmology at Duke, where Kempner worked, was questioned as to whether they were somehow faked. He assured them they were not. In fact, he wrote in one person's chart, "This patient's eyegrounds are improved to an unbelievable degree." Not only had he never seen anything like it, he couldn't remember ever seeing a patient with such advanced disease even being alive 15 months later.

The magnitude of the improvements Kempner got--reversal of end-stage heart and kidney failure--was surprising, simply beyond belief. But as Kempner said as his closing sentence of a presentation before the American College of Physicians, "The important result is not that the change in the course of the disease has been achieved by the rice diet but that the course of the disease can be changed."

Now that we have high blood pressure drugs, we see less hypertensive retinopathy, but we still see a lot of diabetic retinopathy, now the leading cause of blindness in American adults. Even with intensive diabetes treatment--at least three insulin injections a day with the best modern technology has to offer--the best we can offer is usually just a slowing of the progression of the disease.

So, in the 21st century, we slow down your blindness. Yet a half century ago, Kempner proved we could reverse it. Kempner started out using his plant-based rice diet ultra-low in sodium, fat, cholesterol, and protein to reverse kidney and heart failure; he actually assumed the diet would make diabetes worse. He expected a 90% carbohydrate diet would increase insulin requirements, however, the opposite proved to be true. He took the next 100 patients with diabetes who walked through his door who went on the rice diet for at least three months and found their fasting blood sugars dropped despite a drop in the insulin they were taking. What really blew people away was this: Forty-four of the patients had diabetic retinopathy, and, in 30% of the cases, their eyes improved. That's not supposed to happen; diabetic retinopathy had been considered "a sign of irreversible destruction." What does this change mean in real life? Patients went from unable to even read headlines to normal vision.

The remarkable success Dr. Kempner had reversing some of the most dreaded complications of diabetes with his rice and fruit diet was not because of weight loss. The improvements occurred even in those patients who did not lose significant weight, so it must have been something specific about the diet. Maybe it was his total elimination of animal protein, animal fat, and cholesterol? Or perhaps it was his radical reduction in sodium, fat, and protein in general? We don't know.

How do we treat diabetic retinopathy these days? With steroids and other drugs injected straight into the eyeball. If that doesn't work, there's always pan-retinal laser photocoagulation, in which laser burns are etched over nearly the entire retina. Surgeons literally burn out the back of your eye. Why would they do that? The theory is that by killing off most of the retina, the little pieces you leave behind may get more blood flow.

When I see that, along with Kempner's work, I can't help but feel like history has been reversed. It seems as though it should have gone like, "Can you believe 50 years ago the best we had was this barbaric, burn-out-your-socket surgery? Thank goodness we've since learned that through dietary means alone, we can reverse the blindness." But instead of learning, medicine seems to have forgotten.

I documented the extraordinary Kempner story previously in Kempner Rice Diet: Whipping Us Into Shape and Drugs and the Demise of the Rice Diet. The reason I keep coming back to this is not to suggest people should go on such a diet (it is too extreme and potentially dangerous to do without strict medical supervision), but to show the power of dietary change to yield tremendous healing effects.

The best way to prevent diabetic blindness is to prevent or reverse diabetes in the first place. See, for example:

Why wouldn't a diet of white rice make diabetes worse? See If White Rice Is Linked to Diabetes, What About China?

For more on the nitty gritty on what is the actual cause of type 2 diabetes, see:

In health,

Michael Greger, M.D.

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

Image Credit: Community Eye Health / Flickr. This image has been modified.

Original Link

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

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. Image has been modified.

Original Link

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

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. Image has been modified.

Original Link

What Animal Protein Does in Your Colon

What Animal Protein Does in Your Colon.jpeg

There's a take-off of the industry slogan, "Beef: It's What's For Dinner" - "Beef: It's What's Rotting in Your Colon." I saw this on a shirt once with some friends and I was such the party pooper--no pun intended--explaining to everyone that meat is fully digested in the small intestine, and never makes it down into the colon. It's no fun hanging out with biology geeks.

But I was wrong!

It's been estimated that with a typical Western diet, up to 12 grams of protein can escape digestion, and when it reaches the colon, it can be turned into toxic substances like ammonia. This degradation of undigested protein in the colon is called putrefaction, so a little meat can actually end up putrefying in our colon. The problem is that some of the by-products of this putrefaction process can be toxic.

It's generally accepted that carbohydrate fermentation--the fiber and resistant starches that reach our colon--results in beneficial effects because of the generation of short-chain fatty acids like butyrate, whereas protein fermentation is considered detrimental. Protein fermentation mainly occurs in the lower end of colon and results in the production of potentially toxic metabolites. That may be why colorectal cancer and ulcerative colitis tends to happen lower down--because that's where the protein is putrefying.

Probably the simplest strategy to reduce the potential harm of protein fermentation is to reduce dietary protein intake. But the accumulation of these toxic byproducts of protein metabolism may be attenuated by the fermentation of undigested plant matter. In my video, Bowel Wars: Hydrogen Sulfide vs. Butyrate, you can see a study out of Australia showed that if you give people foods containing resistant starch you can block the accumulation of potentially harmful byproducts of protein metabolism. Resistant starch is resistant to small intestine digestion and so it makes it down to our colon where it can feed our good bacteria. Resistant starch is found in cooked beans, split peas, chickpeas, lentils, raw oatmeal, and cooled cooked pasta (like macaroni salad). Apparently, the more starch that ends up in the colon, the less ammonia that is produced.

Of course, there's protein in plants too. The difference is that animal proteins tend to have more sulfur-containing amino acids like methionine, which can be turned into hydrogen sulfide in our colon. Hydrogen sulfide is the rotten egg gas that may play a role in the development of the inflammatory bowel disease, ulcerative colitis (see Preventing Ulcerative Colitis with Diet).

The toxic effects of hydrogen sulfide appear to be a result of blocking the ability of the cells lining our colon from utilizing butyrate, which is what our good bacteria make from the fiber and resistant starch we eat. It's like this constant battle in our colon between the bad metabolites of protein, hydrogen sulfide, and the good metabolites of carbohydrates, butyrate. Using human colon samples, researchers were able to show that the adverse effects of sulfide could be reversed by butyrate. So we can either cut down on meat, eat more plants, or both.

There are two ways hydrogen sulfide can be produced, though. It's mainly present in our large intestine as a result of the breakdown of sulfur-containing proteins, but the rotten egg gas can also be generated from inorganic sulfur preservatives like sulfites and sulfur dioxide.

Sulfur dioxide is used as a preservative in dried fruit, and sulfites are added to wines. We can avoid sulfur additives by reading labels or by just choosing organic, since they're forbidden from organic fruits and beverages by law.

More than 35 years ago, studies started implicating sulfur dioxide preservatives in the exacerbation of asthma. This so-called "sulfite-sensitivity" seems to affect only about 1 in 2,000 people, so I recommended those with asthma avoid it, but otherwise I considered the preservative harmless. I am now not so sure, and advise people to avoid it when possible.

Cabbage family vegetables naturally have some sulfur compounds, but thankfully, after following more than a hundred thousand women for over 25 years, researchers concluded cruciferous vegetables were not associated with elevated colitis risk.

Because of animal protein and processed food intake, the standard American diet may contain five or six times more sulfur than a diet centered around unprocessed plant foods. This may help explain the rarity of inflammatory bowel disease among those eating traditional whole food, plant-based diets.

How could companies just add things like sulfur dioxide to foods without adequate safety testing? See Who Determines if Food Additives are Safe? For other additives that may be a problem, see Titanium Dioxide & Inflammatory Bowel Disease and Is Carrageenan Safe?

More on this epic fermentation battle in our gut in Stool pH and Colon Cancer.

Does the sulfur-containing amino acid methionine sound familiar? You may remember it from such hits as Starving Cancer with Methionine Restriction and Methionine Restriction as a Life Extension Strategy.

These short-chain fatty acids released by our good bacteria when we eat fiber and resistant starches are what may be behind the second meal effect: Beans and the Second Meal Effect.

I mentioned ulcerative colitis. What about the other inflammatory bowel disease Crohn's? See Preventing Crohn's Disease With Diet and Dietary Treatment of Crohn's Disease.

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

What Animal Protein Does in Your Colon

What Animal Protein Does in Your Colon.jpeg

There's a take-off of the industry slogan, "Beef: It's What's For Dinner" - "Beef: It's What's Rotting in Your Colon." I saw this on a shirt once with some friends and I was such the party pooper--no pun intended--explaining to everyone that meat is fully digested in the small intestine, and never makes it down into the colon. It's no fun hanging out with biology geeks.

But I was wrong!

It's been estimated that with a typical Western diet, up to 12 grams of protein can escape digestion, and when it reaches the colon, it can be turned into toxic substances like ammonia. This degradation of undigested protein in the colon is called putrefaction, so a little meat can actually end up putrefying in our colon. The problem is that some of the by-products of this putrefaction process can be toxic.

It's generally accepted that carbohydrate fermentation--the fiber and resistant starches that reach our colon--results in beneficial effects because of the generation of short-chain fatty acids like butyrate, whereas protein fermentation is considered detrimental. Protein fermentation mainly occurs in the lower end of colon and results in the production of potentially toxic metabolites. That may be why colorectal cancer and ulcerative colitis tends to happen lower down--because that's where the protein is putrefying.

Probably the simplest strategy to reduce the potential harm of protein fermentation is to reduce dietary protein intake. But the accumulation of these toxic byproducts of protein metabolism may be attenuated by the fermentation of undigested plant matter. In my video, Bowel Wars: Hydrogen Sulfide vs. Butyrate, you can see a study out of Australia showed that if you give people foods containing resistant starch you can block the accumulation of potentially harmful byproducts of protein metabolism. Resistant starch is resistant to small intestine digestion and so it makes it down to our colon where it can feed our good bacteria. Resistant starch is found in cooked beans, split peas, chickpeas, lentils, raw oatmeal, and cooled cooked pasta (like macaroni salad). Apparently, the more starch that ends up in the colon, the less ammonia that is produced.

Of course, there's protein in plants too. The difference is that animal proteins tend to have more sulfur-containing amino acids like methionine, which can be turned into hydrogen sulfide in our colon. Hydrogen sulfide is the rotten egg gas that may play a role in the development of the inflammatory bowel disease, ulcerative colitis (see Preventing Ulcerative Colitis with Diet).

The toxic effects of hydrogen sulfide appear to be a result of blocking the ability of the cells lining our colon from utilizing butyrate, which is what our good bacteria make from the fiber and resistant starch we eat. It's like this constant battle in our colon between the bad metabolites of protein, hydrogen sulfide, and the good metabolites of carbohydrates, butyrate. Using human colon samples, researchers were able to show that the adverse effects of sulfide could be reversed by butyrate. So we can either cut down on meat, eat more plants, or both.

There are two ways hydrogen sulfide can be produced, though. It's mainly present in our large intestine as a result of the breakdown of sulfur-containing proteins, but the rotten egg gas can also be generated from inorganic sulfur preservatives like sulfites and sulfur dioxide.

Sulfur dioxide is used as a preservative in dried fruit, and sulfites are added to wines. We can avoid sulfur additives by reading labels or by just choosing organic, since they're forbidden from organic fruits and beverages by law.

More than 35 years ago, studies started implicating sulfur dioxide preservatives in the exacerbation of asthma. This so-called "sulfite-sensitivity" seems to affect only about 1 in 2,000 people, so I recommended those with asthma avoid it, but otherwise I considered the preservative harmless. I am now not so sure, and advise people to avoid it when possible.

Cabbage family vegetables naturally have some sulfur compounds, but thankfully, after following more than a hundred thousand women for over 25 years, researchers concluded cruciferous vegetables were not associated with elevated colitis risk.

Because of animal protein and processed food intake, the standard American diet may contain five or six times more sulfur than a diet centered around unprocessed plant foods. This may help explain the rarity of inflammatory bowel disease among those eating traditional whole food, plant-based diets.

How could companies just add things like sulfur dioxide to foods without adequate safety testing? See Who Determines if Food Additives are Safe? For other additives that may be a problem, see Titanium Dioxide & Inflammatory Bowel Disease and Is Carrageenan Safe?

More on this epic fermentation battle in our gut in Stool pH and Colon Cancer.

Does the sulfur-containing amino acid methionine sound familiar? You may remember it from such hits as Starving Cancer with Methionine Restriction and Methionine Restriction as a Life Extension Strategy.

These short-chain fatty acids released by our good bacteria when we eat fiber and resistant starches are what may be behind the second meal effect: Beans and the Second Meal Effect.

I mentioned ulcerative colitis. What about the other inflammatory bowel disease Crohn's? See Preventing Crohn's Disease With Diet and Dietary Treatment of Crohn's Disease.

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

How Milk May Contribute to Childhood Obesity

How Milk May Contribute to Childhood Obesity.jpeg

We've known that breastfed infants may be protected against obesity later in life for more than 30 years, but why? It may be the formula. Giving infants formula based on cow's milk presents an unusual situation. Cow's milk is designed to put nearly two pounds a day onto a growing calf, 40 times the growth rate of human infants (see Formula for Childhood Obesity).

The perfect food for humans, finely tuned over millions of years, is human breast milk. Remarkably, among all mammalian species, the protein content of human milk is the lowest. The excessive protein content of cow's milk-based formula is thought to be what may be what sets the child up for obesity later in life.

And then, instead of being weaned, we continue to drink milk. The question thus arises as to whether consumption of a growth-promoting substance from another species throughout childhood fundamentally alters processes of human growth and maturation. A study out of Indiana University, for example, found evidence that greater milk intake is associated with an increased risk of premature puberty; girls drinking a lot of milk started to get their periods earlier. Thus, cross-species milk consumption and ingestion into childhood may trigger unintended consequences.

Only human milk allows appropriate metabolic programming and protects against diseases of civilization in later life, whereas consumption of cow's milk and dairy products during adolescence and adulthood is an evolutionarily novel behavior that may have long-term adverse effects on human health.

Teens exposed to dairy proteins such as casein, skim milk, or whey, experienced a significant increase in BMI and waist circumference compared to a control group. In contrast, not a single study funded by the dairy industry found a result unfavorable to milk.

The head of the Obesity Prevention Center at Boston Children's Hospital and the chair of Harvard's nutrition department wrote an editorial recently to the AMA's Pediatrics journal questioning the role of cow's milk in human nutrition. They stated the obvious: humans have no requirement for other animal's milk; in fact, dairy may play a role in certain cancers due to the high levels of reproductive hormones in the U.S. milk supply.


So what's The Best Baby Formula? Click on the link and find out!

More on dairy and infancy:

And in childhood: Childhood Constipation and Cow's Milk and Treating Infant Colic by Changing Mom's Diet

In adolescence: Saving Lives By Treating Acne With Diet

Before conception: Dairy Estrogen and Male Fertility

During pregnancy: Why Do Vegan Women Have 5x Fewer Twins?

And in adulthood:

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:

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How Milk May Contribute to Childhood Obesity

How Milk May Contribute to Childhood Obesity.jpeg

We've known that breastfed infants may be protected against obesity later in life for more than 30 years, but why? It may be the formula. Giving infants formula based on cow's milk presents an unusual situation. Cow's milk is designed to put nearly two pounds a day onto a growing calf, 40 times the growth rate of human infants (see Formula for Childhood Obesity).

The perfect food for humans, finely tuned over millions of years, is human breast milk. Remarkably, among all mammalian species, the protein content of human milk is the lowest. The excessive protein content of cow's milk-based formula is thought to be what may be what sets the child up for obesity later in life.

And then, instead of being weaned, we continue to drink milk. The question thus arises as to whether consumption of a growth-promoting substance from another species throughout childhood fundamentally alters processes of human growth and maturation. A study out of Indiana University, for example, found evidence that greater milk intake is associated with an increased risk of premature puberty; girls drinking a lot of milk started to get their periods earlier. Thus, cross-species milk consumption and ingestion into childhood may trigger unintended consequences.

Only human milk allows appropriate metabolic programming and protects against diseases of civilization in later life, whereas consumption of cow's milk and dairy products during adolescence and adulthood is an evolutionarily novel behavior that may have long-term adverse effects on human health.

Teens exposed to dairy proteins such as casein, skim milk, or whey, experienced a significant increase in BMI and waist circumference compared to a control group. In contrast, not a single study funded by the dairy industry found a result unfavorable to milk.

The head of the Obesity Prevention Center at Boston Children's Hospital and the chair of Harvard's nutrition department wrote an editorial recently to the AMA's Pediatrics journal questioning the role of cow's milk in human nutrition. They stated the obvious: humans have no requirement for other animal's milk; in fact, dairy may play a role in certain cancers due to the high levels of reproductive hormones in the U.S. milk supply.


So what's The Best Baby Formula? Click on the link and find out!

More on dairy and infancy:

And in childhood: Childhood Constipation and Cow's Milk and Treating Infant Colic by Changing Mom's Diet

In adolescence: Saving Lives By Treating Acne With Diet

Before conception: Dairy Estrogen and Male Fertility

During pregnancy: Why Do Vegan Women Have 5x Fewer Twins?

And in adulthood:

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: Sergey Novikov © 123RF.com. This image has been modified.

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10 Trouble-Free Techniques to Cut Calories

How to Make Your Calories Count Without Counting Calories

No matter how we approach weight loss, all methods ultimately require the creation of a caloric deficit for results. Nowadays, with the onslaught of food and fitness trackers, calorie apps, step counters, etc., there are myriad ways to calculate and postulate how much energy is coming in and about how much may be going out. Despite these calculations and disciplined approaches to monitoring progress, there are several simple ways to effectively decrease calories consumed without much of an effort; habits you can change in your day to day practice which can support your goals and help you succeed.

Since you can’t out-exercise your diet and what you eat is unquestionably the primary factor in weight loss, here are 10 ways to reduce your intake significantly enough to make a difference:

  1. Hold off on eating the first meal of the day for as long as possible.

    There are no verified rules about how many meals per day are ideal or that eating breakfast helps “jumpstart your metabolism” for the day. Remember that the human body is adapted to survive periods without food (beyond just dinner through breakfast the following morning) and that skipping meals does not, in fact, “slow down” your metabolism. Time without food being digested and absorbed is precious for the body, as it offers energy for the body to repair, recover, and rejuvenate. Unless you are really, really lean, your body has enough fat storage to metabolize for energy in between meals. Pushing off breakfast as long as possible is the perfect way to offer your body rest and an opportunity to start nibbling away at your fat stores. This is why the concept and practice of intermittent fasting has taken off recently in the news. Drink water, sparkling water, black coffee, or any of the infinite varieties of teas without any added sweeteners or creamers. It will keep you satisfied as you stave off hunger until your body is really ready to eat.

  2. Drink tea or coffee straight up.

    Speaking of tea and coffee… If you do enjoy these beverages (as millions or billions of people do around the world), they fit perfectly into a healthy diet for most people. (Of course, if you have cardiac arrhythmias, high blood pressure, reflux, are pregnant, or other specific conditions, this is something to ask your physician about.) And, as I mentioned above, they can keep you going in the morning as you delay your first meal of the day. The only way people get into trouble is by dousing these calorie-free, phytonutrient-containing beverages with addictive sweeteners and calorie-dense creamers. These beverages offer the perfect vehicle for excess sugars, fats, and calories. My favorite Starbucks venti green tea soy latte, for example, contains a whopping 320 calories, 9 grams of fat (6 of which are saturated), and 43 grams of sugar (!). Hence, these are best enjoyed as special occasion treats. I am not going to pretend there is no adjustment necessary when transitioning to clear tea or black coffee, but you can indeed adapt with time (see tip #9). If you have ever made an attempt to lower your salt intake, switch from whole milk to skim milk, or switched from sugar to artificial sweeteners, you have experienced this process. This helps in the morning, when you are avoiding kicking in the digestive process with calories but, if you account for the calories during the day, when you are in fact eating (during the feeding window), you can enjoy tea or coffee with an unsweetened plant milk (or even foamed…a la latte or cappuccino style).

  3. caloriesEat only when foods like a crunchy stalk of celery or crisp apple sound satisfying. 

    The longer you go without food, the better everything seems. Anyone who has gone on a “diet” can attest to this experience…where everything sounds delicious and you can easily end up reading through recipe books for masochistic distraction (well, perhaps that is something only I used to do). Often, most people eat for emotion, stress, convenience, or opportunity. Doing so easily contributes to weight gain. Further, many people experience toxic hunger, a hypoglycemic feeling that may include shakiness, headaches, fatigue, cramps, etc. This is usually due to an unhealthy diet and is a sign that you may need to reevaluate your overall intake. (Again, please see your physician if you are experiencing these symptoms before jumping to conclusions.) True hunger is something that is felt in the throat region and the best test of this is pontificating upon whether eating a crunchy stalk of celery, a crisp apple, or any simple food that may not normally tempt you will actually satisfy you. At that point, eat a healthy, whole food, plant-based meal, including any infinite combination of vegetables, fruits, whole grains, legumes, nuts, seeds, herbs, and spices.

  4. Cook more.

    Eating out is a convenient way to enjoy a delicious meal without spending the time necessary to prepare food at home. And dining at restaurants can indeed fit into a health-promoting lifestyle when done conscientiously and infrequently. However, it is unquestionably more challenging to find food at restaurants that is truly free of ingredients you need to avoid for weight loss and for your health. Oils, salts, sugars, and flours are added in far greater quantities than would be in your own kitchen and calories are almost guaranteed to exceed your goals. Additionally, it is far too alluring to overeat when you are surrounded by access, excess, and hyperpalatable options. On the other side of this is the fact that most of us are busy. Very busy. And cooking is not the first thing you may be eager to do after a long day of work, kids, school, etc. This is compounded by the fact that many people do not feel cozy in the kitchen. I know I didn’t. And it was overwhelming to have to create healthy delicious dishes…particularly once I had kids. But cooking is a priority. Learning just a few dishes can mean massive control over your weight and your long-term health. The trick is to keep it simple. You can go all out and take the amazing Rouxbe Online Professional Plant-Based Cooking School to gain mastery over your kitchen. You can use shortcuts and order plant-based meal kits from places like Chef’d. But, you can also learn some very simple tips and tricks by following some healthy recipes. Here is a collection of some of my favorite recipes and here are all of my favorite cookbooks (and other resources). Batch cooking items like a large pot of rice or other whole grains, soups, stews, and chilis helps because they last several days in the fridge and you can freeze them and defrost as needed for up to a year. Keeping precut vegetables, hummus, tofu/tempeh, and  in the refrigerator; and frozen vegetables, fruits, and whole grains in the freezer; as well as canned beans, jarred marinara sauces and salsas, and whole grains in the pantry; and potatoes, squash, avocados, and fresh fruits on the countertop will enable you to make quick and easy meals with hardly any effort. Some examples of super easy, satisfying, and light dishes include: baked potatoes with salsa and canned beans; frozen stir-fry vegetables sautéed in water or vegetable broth over brown rice; or beans with precut veggies, salsa, and avocado in a bowl or in a whole grain tortilla. In fact, it doesn’t get any easier than these 50 whole food plant-based recipes with 5 ingredients or less.  You will save hundreds or thousands of calories each day that you prepare your meals at home. Keep it simple for sustainable results.

  5. caloriesPrioritize vegetables and fruits.

    Everyone, from the American Institute for Cancer Research to the USDA, agrees that at least half of your plate should come from fruits and vegetables. Forget “5 a day,” new research supports aiming for at least 10 daily servings. Not only do fruits and vegetables provide unparalleled health benefits, but they play a pivotal role in weight loss with their very low calorie density and high satiety factor. Prioritize these food groups every single day to maximize weight loss and help reduce your risk for chronic disease. Aim to eat a huge salad with everything you enjoy mixed in, which could include leafy greens, steamed or roasted vegetables, shredded veggies, slaw, artichoke hearts, potatoes, corn, fresh herbs, beans, lentils, tofu, tempeh, hummus, sun dried tomatoes, onions, sautéed mushrooms, avocado, fruit, cooked whole grains, leftovers from yesterday, etc., etc. Essentially, there is no limit to the creative combinations possible. Here are 40 fun recipes to inspire you. And topping it off with a delicious dressing or sauce, like one of these healthy options, helps you enjoy salads and vegetables even more. Include cooked vegetables, especially leafy greens, each day, using them as a bed to lay the rest of your meal upon or plate them on the side. Whipping up a batch of soup, stew, or chili to enjoy throughout the week is the ultimate fast food. Here are 30 delicious recipes you can try. Experiment with new items to build your repertoire and have fun with them. While eating fruit may be easier for many people to consume, vegetables can be sexy and super delicious as they take center stage on your plate.

  6. caloriesMinimize or eliminate oils. All oils.

    One of the easiest ways to cut out hundreds – or even thousands – of calories each week is to simply cut down on oils. All oils (yes, even olive oil and coconut oil) are 100 percent pure fat, containing 120 calories and 14 grams of fat. One cup of oil contains more than 2000 calories…an entire day’s worth for most people! And just think of how easy it is to drizzle a half cup of oil over a salad, or in the pan to sauté, or to dunk your bread in at a restaurant. Boom. 1000 calories added right there. Further, there is zero fiber and many of the nutrients that started in the olive or soybean are extracted out. Fortunately, it is easy to cook without oil. You can sauté with water, vegetable broth, vinegar, or other liquid; use beans, silken tofu, nuts, or seeds to whip up a creamy dressing; and bake with mashed banana, applesauce or other fruit purees, silken tofu, or mashed avocado. All of these hundreds of options are oil-free and offer examples on how to modify your cooking. Eating out, however, makes it much more challenging to avoid oil. Ask for foods steamed, grilled, baked, or roasted without oil, and use vinegars, salsa, guacamole, lemon or lime juice, or hot sauce as salad dressing.

  7. Focus on your food and shut down all distractions while you eat.

    We make approximately 200 food choices a day, which matters immensely when you consider the fact that diet is the number one cause of early death and disability in the United States. There are many reasons we overeat, mostly due to social pressures and accessibility. But, practicing mindfulness is an excellent way to help avoid overeating. Shut down the television, close your laptop, and put the phone down (a challenge for many of us) while you sit down to a meal. With an emphasis on the word sit. Instead of noshing while standing, walking, driving, or skateboarding, or even just taking bites here and there throughout the day, try to create rituals when eating a meal. While it doesn’t have to include candlelight and background music (although that is a lovely tone to set anytime you’re in the mood), there is a happy middle ground between getting fancy and getting to the bottom of a tub of popcorn without remembering enjoying it. Try tactics like choosing dishware and utensils you love, plating your meal prettily, and putting utensils down between bites to bring in the zen and help you be present.

  8. Chew.

    Although it sounds so simple and perhaps trivial, chewing is a lost art. From the moment food enters your mouth, a cascade of mechanical and biochemical reactions rev up to start the complex digestive process. While there is a host of psychobiological implications of chewing, an incentive to slow down and chew better includes that it may help reduce hunger and food intake.

  9. caloriesTrain your taste buds away from hyperpalatable food.

    Sugar, oil, salt, more sugar, more oil, more salt… Pick your poison, but let there be no doubt that the food industry has masterminded your palate. Extensive science is at play making certain “you really can’t eat just one,” as the goal is to enhance their products for your eating pleasure. Hooking consumers on products in a similar manner used to make the cigarette industry so successful is a motivation of the food industry. There is sugar, oil, and salt in everything from the obvious chips, cookies, and candies to the less obvious breads, dried fruits, and dressings/sauces. Research has found similar neurological and behavioral responses to these highly processed foods as to substances that cause addiction. While there are biological reasons we fall into the “pleasure trap,” and there are powerful pressures at play that exacerbate that biology, it is indeed possible to break the food seduction. One of the best ways to bypass this system is to recalibrate your taste buds by setting a few weeks aside and committing to eating whole, intact foods without exception. This is simple, but not easy. If you are motivated to make it happen, you can move beyond the challenging first few weeks and feel liberated and empowered from thereon forward.

  10. Stop eating at least three hours before bed.

    Similar to holding off on your first meal of the day, ending your feeding window earlier in the evening enables your body to complete the energy-intensive process of digesting and absorbing food. There appears to be circadian explanations for why it is best to stop eating earlier, but there are also behavioral elements, such as decision fatigue, that come into play. Being tired reduces your ability to resist tempting (usually less-than-ideal) foods, no matter how much willpower you may have. Making this choice can become habitual over time and usually requires some scheduling adjustments.

As you may have noticed, there are no recommendations listed above to count calories or fat grams, to cut out carbs, or to exercise harder. This is because the weight loss industry’s loud messaging simply has not worked. It is time that we shift our focus to foods, behaviors, and social pressures in order to ameliorate the issues so many of us struggle with in terms of achieving and sustaining our ideal body weight.

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White Meat May Be as Cholesterol-Raising as Red

White Meat May Be as Cholesterol-Raising as Red.jpeg

In light of recommendations for heart healthy eating from national professional organizations encouraging Americans to limit their intake of meat, the beef industry commissioned and co-wrote a review of randomized controlled trials comparing the effects of beef versus chicken and fish on cholesterol levels published over the last 60 years. They found that the impact of beef consumption on the cholesterol profile of humans is similar to that of fish and/or poultry--meaning that switching from red meat to white meat likely wouldn't make any difference. And that's really no surprise, given how fat we've genetically manipulated chickens to be these days, up to ten times more fat than they had a century ago (see Does Eating Obesity Cause Obesity?).

There are a number of cuts of beef that have less cholesterol-raising saturated fat than chicken (see BOLD Indeed: Beef Lowers Cholesterol?), so it's not so surprising that white meat was found to be no better than red, but the beef industry researchers conclusion was that "therefore you can eat beef as part of a balanced diet to manage your cholesterol."

Think of the Coke versus Pepsi analogy. Coke has less sugar than Pepsi: 15 spoonfuls of sugar per bottle instead of 16. If studies on blood sugar found no difference between drinking Coke versus Pepsi, you wouldn't conclude that "Pepsi may be considered when recommending diets for the management of blood sugars," you'd say they're both equally as bad so we should ideally consume neither.

That's a standard drug industry trick. You don't compare your fancy new drug to the best out there, but to some miserable drug to make yours look better. Note they didn't compare beef to plant proteins, like in this study published in the American Journal of Clinical Nutrition. As I started reading it, though, I was surprised that they found no benefit of switching to a plant protein diet either. What were they eating? You can see the comparison in Switching from Beef to Chicken & Fish May Not Lower Cholesterol.

For breakfast, the plant group got a kidney bean and tomato casserole and a salad, instead of a burger. And for dinner, instead of another burger, the plant protein group just got some boring vegetables. So why was the cholesterol of the plant group as bad as the animal group? They had the plant protein group eating three tablespoons of beef tallow every day--three tablespoons of straight beef fat!

This was part of a series of studies that tried to figure out what was so cholesterol-raising about meat--was it the animal protein or was it the animal fat? So, researchers created fake meat products made to have the same amount of saturated fat and cholesterol by adding extracted animal fats and cholesterol. Who could they get to make such strange concoctions? The Ralston Purina dog food company.

But what's crazy is that even when keeping the saturated animal fat and cholesterol the same (by adding meat fats to the veggie burgers and making the plant group swallow cholesterol pills to equal it out), sometimes they still saw a cholesterol lowering advantage in the plant protein group.

If you switch people from meat to tofu, their cholesterol goes down, but what if you switch them from meat to tofu plus lard? Then their cholesterol may stay the same, though tofu and lard may indeed actually be better than meat, since it may result in less oxidized cholesterol. More on the role of oxidized cholesterol can be found in my videos Does Cholesterol Size Matter? and Arterial Acne.

Just swapping plant protein for animal protein may have advantages, but if you really want to maximize the power of diet to lower cholesterol, you may have to move entirely toward plants. The standard dietary advice to cut down on fatty meat, dairy, and eggs may lower cholesterol 5-10%, but flexitarian or vegetarian diets may drop our levels 10 to 15%, vegan diets 15 to 25%, and healthier vegan diets can cut up to 35%, as seen in this study out of Canada showing a whopping 61 point drop in LDL cholesterol within a matter of weeks.


You thought chicken was a low-fat food? It used to be a century ago, but not anymore. It may even be one of the reasons we're getting fatter as well: Chicken Big: Poultry and Obesity and Infectobesity: Adenovirus 36 and Childhood Obesity.

Isn't protein just protein? How does our body know if it's coming from a plant or an animal? How could it have different effects on cardiovascular risk? See Protein and Heart Disease, another reason why Plant Protein [is] Preferable.

Lowering cholesterol in your blood is as simple as reducing one's intake of three things: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

What about those news stories on the "vindication" of saturated fat? See the sneaky science in The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

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:

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