Does Rye Bread Protect Against Cancer?

Sept 14 Rye Bread copy.jpeg

Previously, I've explored the beneficial effects of flaxseeds on prostate cancer (Flaxseeds vs. Prostate Cancer), as well as breast cancer prevention and survival (Flaxseeds & Breast Cancer Prevention and Breast Cancer Survival & Lignan Intake). The cancer-fighting effect of flaxseeds is thought to be because of the lignans, which are cancer-fighting plant compounds found in red wine, whole grains, greens (cruciferous vegetables), and especially sesame seeds and flaxseeds, the most concentrated source on Earth. But this is based on per unit weight. People eat a lot more grains than seeds. Of the grains people eat, the highest concentration of lignans is found in rye. So, can rye intake decrease the risk of cancer? Theoretically yes, but unlike flaxseeds, it's never been directly put to the test... until now.

In my video Does Rye Bread Protect Against Cancer?, I discuss the evidence that does exist. If you measure the levels of lignans in the bloodstream of women living in a region where they eat lots of rye, the odds of breast cancer in women with the highest levels do seem to be just half that of women with the lowest levels. But lignans are also found in tea and berries, so we couldn't be sure where the protection is coming from. To get around this, researchers decided to measure alkylresorcinol metabolites, a class of phytonutrients relatively unique to whole grains.

Researchers collected urine from women with breast cancer and women without, and the women with breast cancer had significantly lower levels compared to those without. This suggests that women at risk for breast cancer consume significantly lower amounts of whole grains like rye. But if we follow older women in their 50s through 60s, the intake of whole grain products was not associated with risk of breast cancer. A similar result was found in older men for prostate cancer. Is it just too late at that point?

We know from data on dairy that diet in our early life may be important in the development of prostate cancer, particularly around puberty when the prostate grows and matures. If you look at what men were drinking in adolescence, daily milk consumption appeared to triple their risk of advanced prostate cancer later in life. (Learn more about milk and prostate cancer in my video Prostate Cancer and Organic Milk vs. Almond Milk.) So, researchers looked at daily rye bread consumption during adolescence.

Those who consumed rye bread daily as kids did appear to only have half the odds of advanced prostate cancer. This is consistent with immigrant studies suggesting that the first two decades of life may be most important for setting the pattern for cancer development in later life. These findings are certainly important for how we should feed our kids, but if we're already middle-aged, is it too late to change course? To answer this question, researchers in Sweden put it to the test.

Researchers took men with prostate cancer and split them into two groups. One group got lots of rye bread, while the other got lots of high-fiber, but low-lignan, wheat bread. There's been some indirect evidence that rye may be active against prostate cancer--like lower cancer rates in regions with high rye consumption--but it had never been directly investigated... until this study. Biopsies were taken from the subjects' tumors before and after three weeks of bread eating, and the number of cancer cells that were dying off were counted. Though there was no change in the cancer cell clearance of the control bread group, there was a 180% increase in the number of cancer cells being killed off in the rye group. A follow-up study lasting 6 weeks found a 14% decrease in PSA levels, a cancer marker suggesting a shrinkage of the tumor.

The researchers note they used very high rye bread intakes, and it remains to be tested if more normal intake levels would have effects that are of clinical importance. As a sadly typical American, my lack of intimate familiarity of the metric system did not flag the "485 grams" of rye bread a day as far out of the ordinary, but that translates to 15 slices! Rather than eating a loaf a day, the same amount of lignans can be found in a single teaspoon of ground flaxseeds.


I've created several videos on flaxseeds for both breast cancer prevention and treatment, including Flaxseeds & Breast Cancer Prevention, Breast Cancer Survival and Lignan Intake, Flaxseeds & Breast Cancer Survival Epidemiological Evidence, and Flaxseeds & Breast Cancer Survival: Clinical Evidence.

What's more, flaxseeds may help with cyclical breast pain (Flaxseeds for Breast Pain), prostate cancer (Flaxseed vs. Prostate Cancer), diabetes (Flaxseeds vs. Diabetes), and hypertension (Flaxseeds for Hypertension).

And if you're wondering Which Are Better: Chia Seeds or Flaxseeds?, get the answer in the video!

The wonders of whole grains are also discussed in Whole Grains May Work as Well as Drugs, Can Oatmeal Reverse Heart Disease?, and Can Oatmeal Help Fatty Liver 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:

Original Link

Does Rye Bread Protect Against Cancer?

Sept 14 Rye Bread copy.jpeg

Previously, I've explored the beneficial effects of flaxseeds on prostate cancer (Flaxseeds vs. Prostate Cancer), as well as breast cancer prevention and survival (Flaxseeds & Breast Cancer Prevention and Breast Cancer Survival & Lignan Intake). The cancer-fighting effect of flaxseeds is thought to be because of the lignans, which are cancer-fighting plant compounds found in red wine, whole grains, greens (cruciferous vegetables), and especially sesame seeds and flaxseeds, the most concentrated source on Earth. But this is based on per unit weight. People eat a lot more grains than seeds. Of the grains people eat, the highest concentration of lignans is found in rye. So, can rye intake decrease the risk of cancer? Theoretically yes, but unlike flaxseeds, it's never been directly put to the test... until now.

In my video Does Rye Bread Protect Against Cancer?, I discuss the evidence that does exist. If you measure the levels of lignans in the bloodstream of women living in a region where they eat lots of rye, the odds of breast cancer in women with the highest levels do seem to be just half that of women with the lowest levels. But lignans are also found in tea and berries, so we couldn't be sure where the protection is coming from. To get around this, researchers decided to measure alkylresorcinol metabolites, a class of phytonutrients relatively unique to whole grains.

Researchers collected urine from women with breast cancer and women without, and the women with breast cancer had significantly lower levels compared to those without. This suggests that women at risk for breast cancer consume significantly lower amounts of whole grains like rye. But if we follow older women in their 50s through 60s, the intake of whole grain products was not associated with risk of breast cancer. A similar result was found in older men for prostate cancer. Is it just too late at that point?

We know from data on dairy that diet in our early life may be important in the development of prostate cancer, particularly around puberty when the prostate grows and matures. If you look at what men were drinking in adolescence, daily milk consumption appeared to triple their risk of advanced prostate cancer later in life. (Learn more about milk and prostate cancer in my video Prostate Cancer and Organic Milk vs. Almond Milk.) So, researchers looked at daily rye bread consumption during adolescence.

Those who consumed rye bread daily as kids did appear to only have half the odds of advanced prostate cancer. This is consistent with immigrant studies suggesting that the first two decades of life may be most important for setting the pattern for cancer development in later life. These findings are certainly important for how we should feed our kids, but if we're already middle-aged, is it too late to change course? To answer this question, researchers in Sweden put it to the test.

Researchers took men with prostate cancer and split them into two groups. One group got lots of rye bread, while the other got lots of high-fiber, but low-lignan, wheat bread. There's been some indirect evidence that rye may be active against prostate cancer--like lower cancer rates in regions with high rye consumption--but it had never been directly investigated... until this study. Biopsies were taken from the subjects' tumors before and after three weeks of bread eating, and the number of cancer cells that were dying off were counted. Though there was no change in the cancer cell clearance of the control bread group, there was a 180% increase in the number of cancer cells being killed off in the rye group. A follow-up study lasting 6 weeks found a 14% decrease in PSA levels, a cancer marker suggesting a shrinkage of the tumor.

The researchers note they used very high rye bread intakes, and it remains to be tested if more normal intake levels would have effects that are of clinical importance. As a sadly typical American, my lack of intimate familiarity of the metric system did not flag the "485 grams" of rye bread a day as far out of the ordinary, but that translates to 15 slices! Rather than eating a loaf a day, the same amount of lignans can be found in a single teaspoon of ground flaxseeds.


I've created several videos on flaxseeds for both breast cancer prevention and treatment, including Flaxseeds & Breast Cancer Prevention, Breast Cancer Survival and Lignan Intake, Flaxseeds & Breast Cancer Survival Epidemiological Evidence, and Flaxseeds & Breast Cancer Survival: Clinical Evidence.

What's more, flaxseeds may help with cyclical breast pain (Flaxseeds for Breast Pain), prostate cancer (Flaxseed vs. Prostate Cancer), diabetes (Flaxseeds vs. Diabetes), and hypertension (Flaxseeds for Hypertension).

And if you're wondering Which Are Better: Chia Seeds or Flaxseeds?, get the answer in the video!

The wonders of whole grains are also discussed in Whole Grains May Work as Well as Drugs, Can Oatmeal Reverse Heart Disease?, and Can Oatmeal Help Fatty Liver 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:

Original Link

Fish Consumption and Suicide

Sept 12 Fish Consumption copy.jpeg

Depression is a serious and common mental disorder responsible for the majority of suicides. As I've covered in Antioxidants & Depression, intake of fruits, vegetables, and naturally occurring antioxidants have been found to be protectively associated with depression. Therefore, researchers have considered that "it may be possible to prevent depression or to lessen its negative effects through dietary intervention."

But not so fast. Cross-sectional studies are snapshots in time, so we don't know "whether a poor dietary pattern precedes the development of depression or if depression causes poor dietary intake." Depression and even treatments for depression can affect appetite and dietary intake. Maybe people who feel crappier just eat crappier, instead of the other way around.

What we need is a prospective study (a study performed over time) where we start out with people who are not depressed and follow them for several years. In 2012, we got just such a study, which ran over six years. As you'll see in my video Fish Consumption and Suicide, those with higher carotenoid levels in their bloodstream, which is considered a good indicator of fruit and vegetable intake, had a 28% lower risk of becoming depressed within that time. The researchers conclude that having low blood levels of those healthy phytonutrients may predict the development of new depressive symptoms. What about suicide?

Worldwide, a million people kill themselves every year. Of all European countries, Greece appears to have the lowest rates of suicide. It may be the balmy weather, but it may also have something to do with their diet. Ten thousand people were followed for years, and those following a more Mediterranean diet pattern were less likely to be diagnosed with depression. What was it about the diet that was protective? It wasn't the red wine or fish; it was the fruit, nuts, beans, and effectively higher plant to animal fat ratio that appeared protective. Conversely, significant adverse trends were observed for dairy and meat consumption.

A similar protective dietary pattern was found in Japan. A high intake of vegetables, fruits, mushrooms, and soy products was associated with a decreased prevalence of depressive symptoms. The healthy dietary pattern was not characterized by a high intake of seafood. Similar results were found in a study of 100,000 Japanese men and women followed for up to 10 years. There was no evidence of a protective role of higher fish consumption or the long-chain omega 3s EPA and DHA against suicide. In fact, they found a significantly increased risk of suicide among male nondrinkers with high seafood omega 3 intake. This may have been by chance, but a similar result was found in the Mediterranean. High baseline fish consumption with an increase in consumption were associated with an increased risk of mental disorders.

One possible explanation could be the mercury content of fish. Could an accumulation of mercury compounds in the body increase the risk of depression? We know that mercury in fish can cause neurological damage, associated with increased risk of Alzheimer's disease, memory loss, and autism, but also depression. Therefore, "the increased risk of suicide among persons with a high fish intake might also be attributable to the harmful effects of mercury in fish."

Large Harvard University cohort studies found similar results. Hundreds of thousands were followed for up to 20 years, and no evidence was found that taking fish oil or eating fish lowered risk of suicide. There was even a trend towards higher suicide mortality.

What about fish consumption for the treatment of depression? When we put together all the trials done to date, neither the EPA nor DHA long-chain omega-3s appears more effective than sugar pills. We used to think omega-3 supplementation was useful, but several recent studies have tipped the balance the other way. It seems that "[n]early all of the treatment efficacy observed in the published literature may be attributable to publication bias," meaning the trials that showed no benefit tended not to get published at all. So, all doctors saw were a bunch of positive studies, but only because a bunch of the negative ones were buried.

This reminds me of my Is Fish Oil Just Snake Oil? video. Just like we thought omega-3 supplementation could help with mood, we also thought it could help with heart health, but the balance of evidence has decidedly shifted. I still recommend the consumption of pollutant-free sources of preformed long-chain omega 3s for cognitive health and explain my rationale in Should We Take DHA Supplements to Boost Brain Function? and Should Vegans Take DHA to Preserve Brain Function?


For more on the neurotoxic nature of mercury-contaminated seafood, see:

What can we do to help our mood? See:

What about antidepressant drugs? Sometimes they can be absolutely life-saving, but other times they may actually do more harm than good. See my controversial video Do Antidepressant Drugs Really Work?.

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:

Original Link

Fish Consumption and Suicide

Sept 12 Fish Consumption copy.jpeg

Depression is a serious and common mental disorder responsible for the majority of suicides. As I've covered in Antioxidants & Depression, intake of fruits, vegetables, and naturally occurring antioxidants have been found to be protectively associated with depression. Therefore, researchers have considered that "it may be possible to prevent depression or to lessen its negative effects through dietary intervention."

But not so fast. Cross-sectional studies are snapshots in time, so we don't know "whether a poor dietary pattern precedes the development of depression or if depression causes poor dietary intake." Depression and even treatments for depression can affect appetite and dietary intake. Maybe people who feel crappier just eat crappier, instead of the other way around.

What we need is a prospective study (a study performed over time) where we start out with people who are not depressed and follow them for several years. In 2012, we got just such a study, which ran over six years. As you'll see in my video Fish Consumption and Suicide, those with higher carotenoid levels in their bloodstream, which is considered a good indicator of fruit and vegetable intake, had a 28% lower risk of becoming depressed within that time. The researchers conclude that having low blood levels of those healthy phytonutrients may predict the development of new depressive symptoms. What about suicide?

Worldwide, a million people kill themselves every year. Of all European countries, Greece appears to have the lowest rates of suicide. It may be the balmy weather, but it may also have something to do with their diet. Ten thousand people were followed for years, and those following a more Mediterranean diet pattern were less likely to be diagnosed with depression. What was it about the diet that was protective? It wasn't the red wine or fish; it was the fruit, nuts, beans, and effectively higher plant to animal fat ratio that appeared protective. Conversely, significant adverse trends were observed for dairy and meat consumption.

A similar protective dietary pattern was found in Japan. A high intake of vegetables, fruits, mushrooms, and soy products was associated with a decreased prevalence of depressive symptoms. The healthy dietary pattern was not characterized by a high intake of seafood. Similar results were found in a study of 100,000 Japanese men and women followed for up to 10 years. There was no evidence of a protective role of higher fish consumption or the long-chain omega 3s EPA and DHA against suicide. In fact, they found a significantly increased risk of suicide among male nondrinkers with high seafood omega 3 intake. This may have been by chance, but a similar result was found in the Mediterranean. High baseline fish consumption with an increase in consumption were associated with an increased risk of mental disorders.

One possible explanation could be the mercury content of fish. Could an accumulation of mercury compounds in the body increase the risk of depression? We know that mercury in fish can cause neurological damage, associated with increased risk of Alzheimer's disease, memory loss, and autism, but also depression. Therefore, "the increased risk of suicide among persons with a high fish intake might also be attributable to the harmful effects of mercury in fish."

Large Harvard University cohort studies found similar results. Hundreds of thousands were followed for up to 20 years, and no evidence was found that taking fish oil or eating fish lowered risk of suicide. There was even a trend towards higher suicide mortality.

What about fish consumption for the treatment of depression? When we put together all the trials done to date, neither the EPA nor DHA long-chain omega-3s appears more effective than sugar pills. We used to think omega-3 supplementation was useful, but several recent studies have tipped the balance the other way. It seems that "[n]early all of the treatment efficacy observed in the published literature may be attributable to publication bias," meaning the trials that showed no benefit tended not to get published at all. So, all doctors saw were a bunch of positive studies, but only because a bunch of the negative ones were buried.

This reminds me of my Is Fish Oil Just Snake Oil? video. Just like we thought omega-3 supplementation could help with mood, we also thought it could help with heart health, but the balance of evidence has decidedly shifted. I still recommend the consumption of pollutant-free sources of preformed long-chain omega 3s for cognitive health and explain my rationale in Should We Take DHA Supplements to Boost Brain Function? and Should Vegans Take DHA to Preserve Brain Function?


For more on the neurotoxic nature of mercury-contaminated seafood, see:

What can we do to help our mood? See:

What about antidepressant drugs? Sometimes they can be absolutely life-saving, but other times they may actually do more harm than good. See my controversial video Do Antidepressant Drugs Really Work?.

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:

Original Link

Fish Consumption and Suicide

Sept 12 Fish Consumption copy.jpeg

Depression is a serious and common mental disorder responsible for the majority of suicides. As I've covered in Antioxidants & Depression, intake of fruits, vegetables, and naturally occurring antioxidants have been found to be protectively associated with depression. Therefore, researchers have considered that "it may be possible to prevent depression or to lessen its negative effects through dietary intervention."

But not so fast. Cross-sectional studies are snapshots in time, so we don't know "whether a poor dietary pattern precedes the development of depression or if depression causes poor dietary intake." Depression and even treatments for depression can affect appetite and dietary intake. Maybe people who feel crappier just eat crappier, instead of the other way around.

What we need is a prospective study (a study performed over time) where we start out with people who are not depressed and follow them for several years. In 2012, we got just such a study, which ran over six years. As you'll see in my video Fish Consumption and Suicide, those with higher carotenoid levels in their bloodstream, which is considered a good indicator of fruit and vegetable intake, had a 28% lower risk of becoming depressed within that time. The researchers conclude that having low blood levels of those healthy phytonutrients may predict the development of new depressive symptoms. What about suicide?

Worldwide, a million people kill themselves every year. Of all European countries, Greece appears to have the lowest rates of suicide. It may be the balmy weather, but it may also have something to do with their diet. Ten thousand people were followed for years, and those following a more Mediterranean diet pattern were less likely to be diagnosed with depression. What was it about the diet that was protective? It wasn't the red wine or fish; it was the fruit, nuts, beans, and effectively higher plant to animal fat ratio that appeared protective. Conversely, significant adverse trends were observed for dairy and meat consumption.

A similar protective dietary pattern was found in Japan. A high intake of vegetables, fruits, mushrooms, and soy products was associated with a decreased prevalence of depressive symptoms. The healthy dietary pattern was not characterized by a high intake of seafood. Similar results were found in a study of 100,000 Japanese men and women followed for up to 10 years. There was no evidence of a protective role of higher fish consumption or the long-chain omega 3s EPA and DHA against suicide. In fact, they found a significantly increased risk of suicide among male nondrinkers with high seafood omega 3 intake. This may have been by chance, but a similar result was found in the Mediterranean. High baseline fish consumption with an increase in consumption were associated with an increased risk of mental disorders.

One possible explanation could be the mercury content of fish. Could an accumulation of mercury compounds in the body increase the risk of depression? We know that mercury in fish can cause neurological damage, associated with increased risk of Alzheimer's disease, memory loss, and autism, but also depression. Therefore, "the increased risk of suicide among persons with a high fish intake might also be attributable to the harmful effects of mercury in fish."

Large Harvard University cohort studies found similar results. Hundreds of thousands were followed for up to 20 years, and no evidence was found that taking fish oil or eating fish lowered risk of suicide. There was even a trend towards higher suicide mortality.

What about fish consumption for the treatment of depression? When we put together all the trials done to date, neither the EPA nor DHA long-chain omega-3s appears more effective than sugar pills. We used to think omega-3 supplementation was useful, but several recent studies have tipped the balance the other way. It seems that "[n]early all of the treatment efficacy observed in the published literature may be attributable to publication bias," meaning the trials that showed no benefit tended not to get published at all. So, all doctors saw were a bunch of positive studies, but only because a bunch of the negative ones were buried.

This reminds me of my Is Fish Oil Just Snake Oil? video. Just like we thought omega-3 supplementation could help with mood, we also thought it could help with heart health, but the balance of evidence has decidedly shifted. I still recommend the consumption of pollutant-free sources of preformed long-chain omega 3s for cognitive health and explain my rationale in Should We Take DHA Supplements to Boost Brain Function? and Should Vegans Take DHA to Preserve Brain Function?


For more on the neurotoxic nature of mercury-contaminated seafood, see:

What can we do to help our mood? See:

What about antidepressant drugs? Sometimes they can be absolutely life-saving, but other times they may actually do more harm than good. See my controversial video Do Antidepressant Drugs Really Work?.

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:

Original Link

How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

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

Original Link

How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In health,

Michael Greger, M.D.

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

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

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Four Ways to Improve on the Mediterranean Diet

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The traditional Mediterranean diet can be considered mainly, but not exclusively, as a plant-based diet, and certainly not a whole foods, plant-based diet. Olive oil and wine can be considered essentially fruit juices. Even if one is eating a "vegiterranean diet," an entirely plant-based version, there are a number of problematic nutritional aspects that are rarely talked about. For example, the Mediterranean diet includes lots of white bread, white pasta and not a lot of whole grains.

In an anatomy of the health effects of the Mediterranean diet, the single most important component was the high consumption of plant foods. In contrast, high cereal consumption, meaning high grain consumption, did not appear to help. This may be because most grains that modern Mediterranean dieters eat are refined, like white bread, whereas the traditional Mediterranean diet was characterized by unprocessed cereals--in other words, whole grains. And while whole grains have been associated with lower risk of diabetes, heart disease and cancer, refined grain may increase the risk of diabetes, obesity, heart disease and other chronic diseases. In the PREDIMED study, those who ate the most white bread--but not whole grain bread--gained significant weight.

Alcohol may also be a problem. As a plant-centered diet, adherence to a Mediterranean diet is associated with lower cancer risk, but does not appear to lower breast cancer risk. With all the fruits, veggies, nuts, seeds, beans and low saturated fat content, you'd assume there would be lower breast cancer risk, but alcohol is a known breast carcinogen, even in moderate amounts. When researchers created a special adapted version of the Mediterranean diet score that excluded alcohol, the diet does indeed appear to reduce breast cancer risk.

The wonderful grape phytonutrients in red wine can improve our arterial function such that if you drink nonalcoholic red wine (wine with the alcohol removed), you get a significant boost in endothelial function--the ability of our arteries to relax and dilate normally, increasing blood flow. If you drink the same red wine with alcohol, it abolishes the beneficial effect and counteracts the benefit of the grape phytonutrients. So, it would be better just to eat grapes. You can find more information about this in my video Improving on the Mediterranean Diet.

Similarly, there are components of extra virgin olive oil--the antioxidant phytonutrients, that may help endothelial function, but when consumed as oil, (even extra virgin olive oil), it may impair arterial function. So even if white bread dipped in olive oil is the very symbol of the Mediterranean diet, we can modernize it by removing oils and refined grains.

Another important, albeit frequently ignored issue in the modern Mediterranean diet is sodium intake. Despite evidence linking salt intake to high blood pressure, heart disease and strokes, dietary salt intake in the U.S. is on the rise. Right now, Americans get about seven to ten grams a day, mostly from processed foods. If we were to decrease that just by three grams every year, we could possibly save tens of thousands of people from having a heart attack, prevent tens of thousands of strokes, and tens of thousands of deaths. There is a common misperception that only certain people should reduce their salt intake and that for the vast majority of the population, salt reduction is unnecessary, but in reality, the opposite is true.

There is much we can learn from the traditional Mediterranean diet. A defining characteristic of the Mediterranean diet is an abundance of plant foods, but one thing that seems to have fallen by the wayside. No main Mediterranean meal is replete without lots of greens, a key part of not only a good Mediterranean diet, but of any good diet.

Here are some of my previous videos on the Mediterranean diet:

I touch more on whole grains in How Many Meet the Simple Seven? and Whole Grains May Work As Well As Drugs.

More on breast cancer and alcohol in Breast Cancer and Alcohol: How Much Is Safe?, Preventing Skin Cancer From the Inside Out, and Breast Cancer Risk: Red Wine v. White Wine.

I've touched on olive oil in the other videos in this Mediterranean diet series, but also have an older video Extra Virgin Olive Oil vs. Nuts and more recently, Olive Oil & Artery Function.

More on sodium in Dietary Guidelines: With a Grain of Big Salt, Big Salt - Getting to the Meat of the Matter, and Can Diet Protect Against Kidney Cancer? But what if without salt everything tastes like cardboard? Not to worry! See Changing Our Taste Buds.

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

Four Ways to Improve on the Mediterranean Diet

Improving on the Mediterranean Diet.jpg

The traditional Mediterranean diet can be considered mainly, but not exclusively, as a plant-based diet, and certainly not a whole foods, plant-based diet. Olive oil and wine can be considered essentially fruit juices. Even if one is eating a "vegiterranean diet," an entirely plant-based version, there are a number of problematic nutritional aspects that are rarely talked about. For example, the Mediterranean diet includes lots of white bread, white pasta and not a lot of whole grains.

In an anatomy of the health effects of the Mediterranean diet, the single most important component was the high consumption of plant foods. In contrast, high cereal consumption, meaning high grain consumption, did not appear to help. This may be because most grains that modern Mediterranean dieters eat are refined, like white bread, whereas the traditional Mediterranean diet was characterized by unprocessed cereals--in other words, whole grains. And while whole grains have been associated with lower risk of diabetes, heart disease and cancer, refined grain may increase the risk of diabetes, obesity, heart disease and other chronic diseases. In the PREDIMED study, those who ate the most white bread--but not whole grain bread--gained significant weight.

Alcohol may also be a problem. As a plant-centered diet, adherence to a Mediterranean diet is associated with lower cancer risk, but does not appear to lower breast cancer risk. With all the fruits, veggies, nuts, seeds, beans and low saturated fat content, you'd assume there would be lower breast cancer risk, but alcohol is a known breast carcinogen, even in moderate amounts. When researchers created a special adapted version of the Mediterranean diet score that excluded alcohol, the diet does indeed appear to reduce breast cancer risk.

The wonderful grape phytonutrients in red wine can improve our arterial function such that if you drink nonalcoholic red wine (wine with the alcohol removed), you get a significant boost in endothelial function--the ability of our arteries to relax and dilate normally, increasing blood flow. If you drink the same red wine with alcohol, it abolishes the beneficial effect and counteracts the benefit of the grape phytonutrients. So, it would be better just to eat grapes. You can find more information about this in my video Improving on the Mediterranean Diet.

Similarly, there are components of extra virgin olive oil--the antioxidant phytonutrients, that may help endothelial function, but when consumed as oil, (even extra virgin olive oil), it may impair arterial function. So even if white bread dipped in olive oil is the very symbol of the Mediterranean diet, we can modernize it by removing oils and refined grains.

Another important, albeit frequently ignored issue in the modern Mediterranean diet is sodium intake. Despite evidence linking salt intake to high blood pressure, heart disease and strokes, dietary salt intake in the U.S. is on the rise. Right now, Americans get about seven to ten grams a day, mostly from processed foods. If we were to decrease that just by three grams every year, we could possibly save tens of thousands of people from having a heart attack, prevent tens of thousands of strokes, and tens of thousands of deaths. There is a common misperception that only certain people should reduce their salt intake and that for the vast majority of the population, salt reduction is unnecessary, but in reality, the opposite is true.

There is much we can learn from the traditional Mediterranean diet. A defining characteristic of the Mediterranean diet is an abundance of plant foods, but one thing that seems to have fallen by the wayside. No main Mediterranean meal is replete without lots of greens, a key part of not only a good Mediterranean diet, but of any good diet.

Here are some of my previous videos on the Mediterranean diet:

I touch more on whole grains in How Many Meet the Simple Seven? and Whole Grains May Work As Well As Drugs.

More on breast cancer and alcohol in Breast Cancer and Alcohol: How Much Is Safe?, Preventing Skin Cancer From the Inside Out, and Breast Cancer Risk: Red Wine v. White Wine.

I've touched on olive oil in the other videos in this Mediterranean diet series, but also have an older video Extra Virgin Olive Oil vs. Nuts and more recently, Olive Oil & Artery Function.

More on sodium in Dietary Guidelines: With a Grain of Big Salt, Big Salt - Getting to the Meat of the Matter, and Can Diet Protect Against Kidney Cancer? But what if without salt everything tastes like cardboard? Not to worry! See Changing Our Taste Buds.

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 Role of Caffeine in Artery Function

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There are dietary guidelines for food, but what about for beverages? A Beverage Guidance Panel was "assembled to provide guidance on the relative health and nutritional benefits and risks of various beverage categories." They ranked them from one to six, and water was ranked number one.

Soda ranked last at number six. Whole milk was grouped with beer, with a recommendation for zero ounces a day, in part out of concern for links between milk and prostate cancer, as well as aggressive ovarian cancer due to IGF-1. Number two on the list, though, after water, was tea and coffee, preferably without creamer or sweetener.

Even without creamer, though, lots of unfiltered coffee can raise cholesterol, but the cholesterol-raising compounds are trapped by the paper filter in brewed coffee, so filtered coffee is probably better.

But about ten years ago, a study was published on the effects of coffee on endothelial function, the function of our arteries. I profile this study in my video Coffee and Artery Function, showing that within 30 minutes of drinking a cup of coffee there was a significant drop in the ability of our arteries to dilate, whereas decaf did not seem to have a significant effect. This was the first study to demonstrate an acute unfavorable effect on arterial function of caffeinated coffee, but one cup of decaf didn't seem to affect performance. And two cups of decaf appeared to have a beneficial effect. So maybe it's a "battle between caffeine and antioxidants." Something in caffeinated coffee appears to be hurting arterial function, whereas something in decaf appears to be helping.

It's similar to red wine. De-alcoholized red wine significantly improves arterial function, as there are grape components trying to help, but the presence of alcohol counteracts and erases the benefit.

Drinking really high antioxidant coffee, by preparing it Greek style for example (where we actually drink the grounds), coffee drinkers may actually be at an advantage

It might not be the caffeine in caffeinated coffee that appears to be harmful, though. In a randomized, double-blind, placebo-controlled, cross-over study, researchers found that caffeine alone--about two and a half cups of coffee worth--significantly improved arterial function in both people with and without heart disease.

Coffee contains more than a thousand different compounds other than caffeine, many of which are also removed by the decaffeination process, so there must be something else in the coffee bean that's causing the problem. In fact, caffeine may even enhance the repair of the fragile inner lining of our arteries by enhancing the migration of our endothelial progenitor cells, the stem cells that patch up potholes in our artery walls.

But how might we get the potential benefit of caffeine without the risky compounds in caffeinated coffee? Tea consumption enhances artery function, and there are substantial beneficial effects of both green tea and black tea. Instead of other components in tea leaves undermining caffeine's potential benefits, they appear to boost the benefit in healthy individuals, as well as heart disease patients, reversing some of their arterial dysfunction, both immediately and long-term.

All the measurements in the studies I've talked about so far were done on the brachial artery, the main artery in the arm (just because it's easier to get to). What we care about, though, is blood flow to the heart. And caffeine appears to impair blood flow to our heart muscle during exercise even in healthy folks, but especially in those with heart disease. Thankfully caffeine in tea form appears to have the opposite effect, significantly improving coronary blood flow, suggesting that tea consumption has a beneficial effect on coronary circulation, though the addition of milk may undermine the protective effects.

I'm fascinated by how complicated such a simple question can get. The take-home is that water is the healthiest beverage, followed by tea.

The effects of coffee on cancer risk are more salutary:

I've previously covered Walnuts and Artery Function and Dark Chocolate and Artery Function. Stay tuned for a few more coming up further exploring the effects of tea, olive oil, and plant-based diets on our lovely endothelium.

Low Carb Diets and Coronary Blood Flow is one of the few other studies I've done that measured blood flow within the coronary arteries themselves. For more background on the brachial artery test, see my video The Power of NO.

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.

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