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.

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Flax Seeds Can Have Profound Effect on Hypertension

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A recent article in the journal, Meat Science, acknowledged that a sector of the population perceives meat as a food that is detrimental to their health because of studies associating meat consumption with heart disease and cancer. So, the article continues, meat consumers may look for healthier food alternatives as a means to maintain good health, which represents a good opportunity for the meat industry to develop some new products. The industry felt that natural foods could be added to meat to reach those health-oriented consumers by boosting antioxidants levels, for example. Foods like flax seeds and tomatoes are healthy, associated with reduced risks of cancer and cardiovascular disease. So by making flax-y tomato burgers, they figure they can reduce saturated fat intake and maybe eat less sugar somehow. Wouldn't it be easier to just cut out the middle-cow and eat flax seeds ourselves?

Flax seeds have been described as a "miraculous defense against some critical maladies." I'm a fan of flax, but this title seemed a bit over-exuberant; I figured something just got lost in translation, but then I found a prospective, double-blinded, placebo-controlled, randomized trial--you know how hard that is in a nutrition study? For drugs, it's easy: you have two identical looking pills, one's active, one's placebo, and until the end of the study, neither the researcher nor the patient has any idea which is which, hence "double blind." But people tend to notice what they're eating. So how did they sneak a quarter cup of ground flax seeds into half of the people's diets without them knowing? They created all these various flax or placebo containing foods, and even added bran and molasses to match the color and texture, so it was all a big secret until six months later when they broke the code to see who ate which.

Why test it on hypertension? Because having a systolic blood pressure over 115--that's the top number--may be the single most important determinant for death in the world today. If you take a bunch of older folks, most of them on an array of blood pressure pills, and don't improve their diet at all, despite the drugs, they may start out on average hypertensive and stay hypertensive six months later. But those who were unknowingly eating ground flaxseeds every day, dropped their systolic blood pressure about ten points, and their diastolic, the lower number, by about seven points. That might not sound like a lot, but a drop like that could cut stroke risk 46 percent and heart disease 29 percent, and that ten point drop in the top number could have a similar effect on strokes and heart attacks. And for those that started out over 140, they got a 15-point drop.

In summary, flaxseed induced one of the most potent antihypertensive effects ever achieved by a dietary intervention. In other words, the magnitude of this decrease in blood pressure demonstrated by dietary flaxseed, is as good or better than other nutritional interventions and comparable to many drugs, which can have serious side effects. And they're not exaggerating about the comparable to drugs bit. The flax dropped systolic and diastolic up to 15 and 7. Compare that to powerful ACE inhibitors like Vasotec, which may only drop pressures five and two, and calcium channel blockers like Norvasc or Cardizem which drop pressures eight and three. Side effects of these drugs include a large list of serious medical issues, as seen in my video Flax Seeds for Hypertension, compared to the side effect of flax seeds, "its pleasant nutty flavor."

During the six-month trial there were strokes and heart attacks in both groups, though. Even if the flax seeds can cut risk in half, any avoidable risk is unacceptable. Isn't high blood pressure just inevitable as we get older? No - the prevalence of hypertension does increase dramatically with age, but not for everyone. People who eat more plant-based diets or keep their salt intake low enough tend not to exhibit any change in blood pressure with advancing age. It's always better to prevent the disease in the first place.

And that's not all flax can do. Check out:

Hibiscus tea may help with high blood pressure as well: Hibiscus Tea vs. Plant-Based Diets for Hypertension

Diet can also play an important role in preventing heart disease (How Not to Die from Heart Disease and One in a Thousand: Ending the Heart Disease Epidemic) and diabetes (How Not to Die from Diabetes and Plant-Based Diets and Diabetes). In some cases diet can even reverse some of the worst ravages of high blood pressure: How Not to Die from High Blood Pressure and Kempner Rice Diet: Whipping Us Into Shape.

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: Veganbaking.net / Flickr

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Introducing the Kempner Rice Diet

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Franklin Delano Roosevelt brought us through the Great Depression and World War II. Who knows how history would have been different had he not died in his fourth term as President from a massive stroke. In the following days and months, we learned that Roosevelt had suffered from severe high blood pressure for years. In spite of this, he was on no medications or other treatments. The reason for the lack of treatment is stark and simple: there were none. The state of the art at that time was death. Death, from so-called malignant hypertension--out-of-control high blood pressure--for which, it was thought, there was no remedy. But they were wrong. There was Dr. Walter Kempner and his rice-fruit diet.

A physician-scientist, Kempner trained with the best, fled Nazi Germany and set up shop at Duke, where he began treating malignant hypertension patients with a radical diet consisting of only white rice and fruit, with strikingly favorable results: a rapid reduction in blood pressure, rapid improvement in kidney failure, eye pressure, heart failure and other manifestations of this previously fatal illness.

He figured that if a low salt diet helped with blood pressure, a low protein diet helped with kidney function, and a low fat and cholesterol diet helped the heart, why not take it to its logical conclusion and design a no-salt, no cholesterol diet of almost pure carbohydrate. So, he designed a diet with less sodium than any low-sodium diet, less protein than any low-protein diet, and less cholesterol and fat than any other low-fat diet.

His hope was that it would just stop progression of the disease. Instead, something miraculous happened. In about two-thirds of cases, the disease reversed. There were reversals of heart failure, reversals of eye damage, and reversals of kidney failure. At the time, this was effectively a terminal disease where people just had a few months to live, but with Kempner's rice diet, they got better. In my video Kempner Rice Diet: Whipping Us Into Shape, you can see before and after pictures of the back of people's eyes. They started out swollen, bloody and leaking and then were nearly normal in a matter of months.

After being effectively cured by the diet over many months, many patients could then relax the diet to a more conventional plant-based diet and go on to live a normal, active life. The rice diet may actually drop blood pressures too low, so we have to add back other foods to bring the pressures back up to normal.

An editorial in the New England Journal of Medicine described Kempner's results as "little short of miraculous." Practically speaking, there's probably no more effective diet for obese cardiac patients. The problem, though, is that most physicians lack the extraordinary persuasive powers required to keep the patient eating such a restricted diet.

When Dr. Caldwell Esselstyn presented his study results demonstrating in some cases reversal of near end-stage heart disease with a whole food plant-based diet, the Chair of Cleveland Clinic cardiology department asked, "How can we expect patients to stay on a strict diet like this when we can't even get them to quit smoking?" Just like penicillin drugs don't work at all unless we take them, plant-based diets don't work unless we actually eat them.

The answer may be that the physician must have a zealous belief in the diet and must convey that passion to the patients. For Kempner, to keep his patients on the rice diet, he "brow-beat, yelled at, and castigated them when he caught them straying." And he didn't just browbeat them; he sometimes actually beat them. It came out in a lawsuit in which a former patient sued Dr. Kempner, claiming that he had literally whipped her and other patients to motivate them to stick to the diet.

Reminds me of the famous diabetes physician back in the 1800s, Arnoldo Cantani, who knew the remedy for diabetes was not in the drugstore, but rather the kitchen. To ensure compliance, if necessary, he would lock a patient up in a room for six weeks.

Thankfully, in terms of personality, Dr. Esselstyn is the opposite of Dr. Kempner. He is polite, soft-spoken, gentle and able to keep his patients on track without whipping them. And last but not least, Esselstyn walks the talk, following the diet himself, whereas Kempner died of a heart attack (though at the age of 94). Kempner's work continues on in Durham, where they continue a relaxed version of the diet, allowing actual vegetables.

A year before Roosevelt died, Kempner had already published his miraculous results. It seems highly likely that had the rice diet been "provided to President Roosevelt a year before his death, his disease might have been controlled before his fatal stroke, and that this fatal event could have been averted."


For those unfamiliar with Dr. Esselstyn's work, check out:

Kempner was a lifestyle medicine pioneer. What's lifestyle medicine? See, for example:

For more on Kempner's work, 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--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Original Link

Plant-Based Diets for Hypertension

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Recently, researchers from Taiwan pitted the herbal tea hibiscus against obesity. They gave hibiscus to overweight individuals and reported that subjects showing reduced body weight. However, after 12 weeks on hibiscus subjects only lost about three pounds, only one and a half pounds over placebo. Hibiscus is clearly no magic fix for obesity.

The purported cholesterol-lowering property of hibiscus tea looked a bit more promising. Some older studies suggested as much as an 8% reduction from drinking two cups a day for a month. When all the studies are put together, though, the results are pretty much a wash. This may be because only about 50% of people respond at all to drinking the equivalent of between two to five cups a day, though those that do may get a respectable 12% drop. That's nothing like the 30% one can get within weeks of eating a healthy, plant-based diet, though.

Hibiscus may really shine in treating high blood pressure, a disease affecting a billion people and killing millions. Up until 2010, there wasn't sufficient high quality research to support the use of hibiscus tea to treat hypertension, but there are now randomized double-blind, placebo-controlled studies where hibiscus tea is compared to artificially colored and flavored water that looks and tastes like hibiscus tea, and the tea lowers blood pressure significantly better.

We're still not sure how it works, but hibiscus appears to boost nitric oxide production, which could help our arteries relax and dilate better. Regardless, an updated review acknowledged that the daily consumption of hibiscus tea may indeed significantly lower blood pressures in people with hypertension.

How does hibiscus compare to other blood pressure interventions? The premier clinical trial when it comes to comprehensive lifestyle modification for blood pressure control is the PREMIER Clinical Trial. Realizing that nine out of ten Americans are going to develop hypertension, researchers from John Hopkins randomized 800 men and women with high blood pressure into one of three groups. One was the control group, the so-called "advice only group," where patients were just told to lose weight, cut down on salt, increase exercise and eat healthier. In the two behavioral intervention groups the researchers got serious. Eighteen face-to-face sessions, groups meetings, food diaries, physical activity records, and calorie and sodium intake monitoring. One intervention group just concentrated on exercise; the other included exercise and diet. Researchers pushed the DASH diet, which is high in fruits and vegetables and low in full-fat dairy products and meat. In six months subjects achieved a 4.3 point drop in systolic blood pressure, compared to the control, slightly better than the lifestyle intervention without the diet.

A few points might not sound like a lot--that's like someone going from a blood pressure of 150 over 90 to a blood pressure of 146 over 90--but on a population scale a five point drop in the total number could result in 14% fewer stroke deaths, 9% fewer fatal heart attacks, and 7% fewer deaths every year overall.

A cup of hibiscus tea with each meal didn't just lower blood pressure by three, four, or five points, but by seven points, from an average of 129 down to 122. In fact, tested head-to-head against a leading blood-pressure drug, Captopril, two cups of strong hibiscus tea every morning (five tea bags for the two cups) was as effective in lowering blood pressure as a starting dose of 25mg of captopril taken twice a day.

So hibiscus tea is as good as drugs, without side-effects, and better than diet and exercise? Well, the lifestyle interventions in the PREMIER study were pretty wimpy. As public health experts noted, the PREMIER study was only asking for 30 minutes of exercise a day, whereas the World Health Organization recommends a minimum of an hour a day.

Diet-wise, the lower the animal fat intake, and the more plant sources of protein the PREMIER participants were eating, the better the diet appeared to work. This may explain why vegetarian diets appear to work even better, and the more plant-based, the lower the prevalence of hypertension.

On the DASH diet, subjects cut down on meat, but were still eating it every day, so would qualify as nonvegetarians in the Adventist 2 study (highlighted in my video Hibiscus Tea vs. Plant-Based Diets for Hypertension) which looked at 89,000 Californians. It found that those who only ate meat on a weekly basis had 23% lower rates of high blood pressure. Those who cut out all meat except fish had 38% lower rates. Those eating no meat at all, vegetarians, have less than half the rate. The vegans--cutting out all animal protein and fat--appeared to have thrown three quarters of their risk for this major killer out the window.

One sees the same kind of step-wise drop in diabetes rates as one's diet gets more and more plant-based, and a drop in excess body weight, such that only those eating completely plant-based diets in the Adventist 2 study fell into the ideal weight category. Could that be why those eating plant-based have such great blood pressure? Maybe it's just because they're so skinny. I've previously shown how those eating plant-based just have a fraction of the diabetes risk even at the same weight. but what about hypertension?

The average American has what's called prehypertension, which means the top number of our blood pressure is between 120 and 139. We don't have hypertension yet, which starts at 140, but we may be well on our way. Compare that to the blood pressure of those eating whole food plant-based diets. In one study, those eating plant-based didn't have blood pressures three points lower, four points lower, or even seen points lower, but 28 points lower. However, the group eating the standard American diet was, on average, overweight with a BMI over 26, still better than most Americans, while the vegans were a trim 21--that's 36 pounds lighter.

Maybe the only reason those eating meat, eggs, dairy, and processed junk had such higher blood pressure was because they were overweight. Maybe the diet per se had nothing to do with it?

To solve that riddle we would have to find a group still eating the standard American diet, but as slim as vegans. To find a group that trim, researchers had to use long-distance endurance athletes, who ate the same crappy American diet, but ran an average of 48 miles per week for 21 years. Anyone who runs almost two marathons a week for 20 years can be as slim as a vegan--no matter what they eat!

How did the endurance runners compare to the couch potato vegans? It appears that if we run an average of about a thousand miles every year our blood pressures can rival some couch potato vegans. That doesn't mean we can't do both, but it may be easier to just eat plants.


Those who've been following my work for years have seen how my videos have evolved. In the past, the hibiscus results may have been the whole article or video. But thanks to everyone's support, I've been able to delegate the logistics to staff and concentrate more on the content creation. This allows me to do deeper dives into the literature to put new findings into better context. The posts are a bit longer, but hopefully they're more useful--let me know what you think!

For such a leading killer, hypertension has not gotten the coverage it deserves on NutritionFacts.org. Here's a few videos, with more to come:

So should we all be drinking hibiscus tea every day? This is the first of a four part series on the latest on hibiscus. Stay tuned for the next three:

For another comparison of those running marathons and those eating plants, see: Arteries of Vegans vs. Runners

In health,
Michael Greger, M.D.

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

Image Credit: Amy / Flickr

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When Charities Collaborate With the Food Industry

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When the history of the world's attempt to address obesity is written, one researcher writes, "the greatest failure may be collaboration with and appeasement of the food industry." For instance, Yum! Brands, who owns Kentucky Fried Chicken, linked up with a leading U.S. breast cancer charity, to sell pink buckets of fried chicken.

Save the Children, an organization aiming to positively change the lives of children, was initially a staunch supporter of soda taxes. Recently, however, the organization withdrew its support, saying that support of the soda taxes did not fit the way Save the Children works. Perhaps it is only a coincidence that it was seeking a grant from Coca-Cola and had accepted a $5 million grant from Pepsi.

Through these partnerships, the food industry seeks to emphasize that inactivity -- not the promotion and consumption of its calorie-rich products -- is the prime cause of obesity. But studies showing that obesity is rising even in areas where people are exercising more are most likely explained by the fact that the rate of physical activity levels are being outstripped by our eating activity levels. We can outrun our mouths.

As stated by researcher, Bruce Neal, from the University of Sydney (highlighted in my video, Collaboration with the New Vectors of Disease), "The message is plain - the primary driver of the obesity epidemic in the United States is now the food supply, and interventions targeting physical activity are not going to resolve it. So, while physical activity is good regardless, it will not address most of the burden of ill health caused by obesity. That is going to require a new focus on the root cause of the problem--the American diet."

This researcher adds, "At the heart of the 'energy in' side of the obesity problem is the food and beverage industry. Put simply, the enormous commercial success enjoyed by the food industry is now causing what promises to be one of the greatest public health disasters of our time. As fast as we rid the world of the microbial causes of pestilence and famine, they are replaced by new vectors of disease in the form of trans-national food corporations that market salt, fat, sugar, and calories in unprecedented quantities. So policy makers should work on pricing strategies that subsidize the cost of healthier foods."

First, we need to shift relative prices to make it more expensive to consume animal products compared to fruit, vegetables and beans. Second, we need to increase demand for plant foods, which is not as easy given the hundreds of billions of dollars in annual subsidies - our tax payer dollars going to make animal products artificially cheap.

Dr. Bruce Neal then concludes, "The food industry will rail against the 'nanny state' and fight tooth and nail for its right to market a range of options to responsible individuals able to make choices for themselves-it's the American way. For context though, these arguments are no different to those used by the tobacco industry, which also markets habituating unhealthy products in pursuit of profit. In the case of tobacco, the American people have agreed that controls must be applied to limit the harms caused. Poor diet is now responsible for an even greater burden of disease than tobacco, and food companies must be controlled in the same way if the harms are to be reduced. As unpalatable as this may be, the food industry would do well to strengthen their public health conscience, given that consumers are always going to need their goods, something that cannot be said for the tobacco industry." You hear that a lot in public health circles, how we have to work with the companies, because unlike tobacco, we have to eat. But just like yes, we need to breath, but we don't need to breathe smoke, yes we need to eat, but we don't need to eat junk.

Is it our physical activity or eating activity? See Diet vs. Exercise for Weight Loss and How Much Exercise to Sustain Weight Loss?

I touched on the pink buckets of KFC in my video Breast Cancer Survival, Butterfat, and Chicken.

For more on the idea of subsidizing healthy foods or at least stopping tax money to supporting junk, check out my video Taxpayer Subsidies for Unhealthy Foods.

It's sad when non-profits collaborate with companies that contribute to suffering, but seems particularly egregious when the Registered Dietitian group does it. See Academy of Nutrition and Dietetics Conflicts of Interest.

In health,
Michael Greger, M.D.

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

Image Credit: Rafael Edwards / Flickr

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Don’t Forget Fiber

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The famous surgeon Denis Burkitt is better known for his discovery of a childhood cancer now known as Burkitt's lymphoma than for his 1979 international bestseller, Don't Forget the Fibre in Your Diet.

Anyone asked to list the twenty or more most important advances in health made in the last few decades would be likely to include none of what Dr. Burkitt considered to be among the most significant. What was the number one most important advance in health according to one of the most famous medical figures of the 20th century? The discovery that "Many of the major and commonest diseases in modern Western culture are universally rare in third-world communities, were uncommon even in the United States until after World War l" yet are now common in anyone following the Western lifestyle. So it's not genetics--they're lifestyle diseases (See Dr. Burkitt's F-Word Diet). This means they must potentially be preventable.

Those eating the standard American diet have very high levels of a long list of diseases--such as heart disease and colon cancer--that were similar to the rates of disease in the ruling white class in apartheid Africa. Conversely, the rates in the Bantu population were very low. These native Africans ate the same three sister diets of many Native Americans, a plant-based diet centered around corn, beans, and squash. In fact, it was reported that cancer was so seldom seen in American Indians a century ago they were considered practically immune to cancer--and heart disease. What are "very low" rates? 1300 Bantus were autopsied over five years in a Bantu hospital and maybe one case of ischemic heart disease, the West's number one killer.

The Bantu's rates of heart and intestinal disease is similar to poor Indians, whereas wealthier Indians who ate more animal and refined foods were closer to those in Japan--unless they moved to the U.S. and started living like us. You find similar trends for the other so-called Western diseases, which Burkitt thought were related to the major dietary changes that followed the lndustrial Revolution: a reduction in healthy whole plant foods--the source of starch and fiber-and a great increase in consumption of animal fats, salt, and sugar. His theory was that it was the fiber. He believed all of these major diseases may be caused by a diet deficient in whole plant foods, the only natural source of fiber.

Fiber? In a survey of 2,000 Americans, over 95% of graduate school-educated participants and health care providers weren't even aware of the daily recommended fiber intake. Doctors don't even know. How much fiber should we shoot for? The Institute of Medicine recommends 38 grams for men 50 years and younger and 30 grams for men over 50 years. Women 50 years and younger should get 25 and those older than 50 should get 21 grams. But these levels are just the minimum. I recommend we look to our evolutionary past for more clues on fiber intake. See my video Paleolithic Lessons.

One analogy Dr. Burkitt used is this: "If a floor is flooded as a result of a dripping tap, it is of little use to mop up the floor unless the tap is turned off. The water from the tap represents the cause of disease, the flooded floor the diseases filling our hospital beds. Medical students learn far more about methods of floor mopping than about turning off taps, and doctors who are specialists in mops and brushes can earn infinitely more than those dedicated to shutting off taps." And the drug companies is more than happy to sell us rolls of paper towels, so patients can buy a new roll every day for the rest of their lives. To paraphrase Ogden Nash: modern medicine is making great progress, but just headed in the wrong direction.

How do we know that diet was the critical factor? Because when we place people stricken with these diseases on plant-based diets, their disease can be reversed (Our Number One Killer Can Be Stopped). In fact it was the work of Burkitt and others in Africa that led to the disease reversal work of pioneers like Nathan Pritikin (Engineering a Cure).

More on fiber:

And for more of the scoop on poop:

-Michael Greger, M.D.

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

Image Credit: Rachel Hathaway / Flickr

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Why Go SOS-Free?

You have heard of “gluten-free,” “sugar-free” and “fat-free,” but what about “SOS-free?” An SOS-free diet simply means that no refined salt, oil or sugar has been added to the food (during preparation, cooking or afterwards). “Going SOS-free” continues to catch on as more people strive to reduce or eliminate salt, oil and sugar in their […]

The post Why Go SOS-Free? appeared first on Straight Up Food.

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Want to be Healthier? Change Your Taste Buds

NF-June24 Want to Be Healthier? Change Your Taste Buds.jpg

How can we overcome our built-in hunger drives for salt, sugar, and fat? We now have evidence showing that if we go a few weeks cutting down on junk food and animal products, our tastes start to change. We may actually be able to taste fat--just like we taste sweet, sour, and salty--and people on low fat diets start liking low fat foods more and high fat foods less.

Our tongues appear to become more sensitive to fat if we eat less of it. And the more sensitive our tongues become, the less butter, meat, dairy, and eggs study subjects ate. We also get a blunted taste for fat if we eat too much. This diminished fat sensitivity has been linked to eating more calories; more fat; more dairy, meat, and eggs; and becoming fatter ourselves. And this change in sensation, this numbing of our ability to taste fat, can happen within just a few weeks.

In my video, Changing Our Taste Buds, you can see when researchers put people on a low-salt diet, over the ensuing weeks, study subjects like the taste of salt-free soup more and more, and the taste of salty soup less and less. Our tastes physically change. If we let them salt their own soup to taste, they add less and less the longer they're on the diet. By the end, soup tastes just as salty with half the salt. For those who've been on sodium restricted diets, regularly salted foods taste too salty and they actually prefer less salty food. That's why it's important for doctors to explain to patients that a low-salt diet will gradually become more palatable as their taste for salt diminishes. The longer we eat healthier foods, the better they taste.

That's why I've always encouraged my patients to think of healthy eating as an experiment. I ask them to give it three weeks. The hope is by then they feel so much better (not only physically, but in the knowledge that they don't have to be on medications for chronic diseases the rest of their lives after all!--see Say No to Drugs by Saying Yes to More Plants) and their taste sensitivity has been boosted such that whole foods-as-grown regain their natural deliciousness.

To see how a healthy diet can make you feel, check out the Physicians Committee for Responsible Medicine's 21-Day Kickstart program at http://www.21daykickstart.org/.

-Michael Greger, M.D.

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

Image Credit: M Glasgow / Flickr

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Which Seaweed to Help Prevent Breast Cancer?

 

 

 

 

 

 

 

 

Which Seaweed is Protective Against Cancer?

Sushi lovers, rejoice. Nori seaweed may favorably alter estrogen metabolism by modulating women’s gut flora, resulting in decreased breast cancer risk.

As traditional East Asian diets have westernized, breast cancer rates have risen. Some researchers have linked this to a quadrupling of animal product consumption. In my video Which Seaweed Is Most Protective Against Breast Cancer, you can see the breast cancer rate of Japanese women living in Japan. Within 10 years of immigrating to the United States, their risk increases, and if they hang around long enough, their risk goes up even more, although it is still somewhat lower than the U.S. national average. This may be because of some of the dietary habits they carry with them—soy and green tea consumption, perhaps eating more mushrooms and seaweed.

We’ve known for over a decade that in vitro (in a Petri dish) seaweed broth is effective at clearing cancer cells. In the video, you can see three different types of human breast cancer exposed to either a widely used chemotherapy drug or a sea vegetable. The seaweed worked better. And unlike the chemo, it didn’t hurt normal, non-cancerous breast cells. What about outside of the test tube, in people?

Well, a population study comparing women with breast cancer to women without found that consuming a single sheet of nori a day may cut a woman’s odds of breast cancer in half. We think it’s because seaweed favorably alters estrogen metabolism, likely due to modulating women’s gut bacteria. The more seaweed we eat, the less estrogen we have in our system, which may lower breast cancer risk.

The breast cancer protection may be because of all the fiber in sea vegetables, or because seaweed may block the enzyme that undermines our body’s attempt to flush out excess hormones. Or seaweed may somehow interfere with estrogen binding to estrogen receptors. Whatever the cause, to effectively lower their estrogen levels, Asian women may be able to get away with about one sheet of nori a day, but American women are physically so much larger that it may take closer to two. There are lots of yummy seaweed snacks out there to make it a tasty experience—just try to get some low-fat, low-sodium ones. They’re just like kale chips, munchies made out of dark green leafy vegetables—can’t beat that!

For more on lowering breast cancer through diet:

The seaweed used fresh in seaweed salads, wakame, unfortunately did not appear to reduce breast cancer risk. Wakame consumption has, however, been found to lower blood pressure in hypertensives (people with high blood pressure). Just two teaspoons of seaweed salad a day for a month dropped people’s blood pressure 14 points, and two months of wakame was associated with up to a two inch skinnier waistline.

As I’ve mentioned before, I’d recommend avoiding hijike, which tends to have too much arsenic (see Avoiding Iodine Deficiency), and kelp, which tends to have too much iodine (see Too Much Iodine Can Be as Bad as Too Little). In fact, too much seaweed of any type may actually increase our risk for thyroid cancer because of the amount of iodine we’d be taking in, but there does not appear to be any increased risk at the levels of consumption I’m talking about, like a sheet of nori every day. And a study of seaweed eaters in California actually found decreased risk, but, again, we’re talking a modest level of intake.

I’ve frequently talked about the benefits of dietary diversity, eating different families of fruits and vegetables, eating different parts of individual plants—such as beets and beet greens. If we just stick to land plants, though, we’re missing out on all the plants from the other 70% of planet earth. Sea vegetables have phytonutrients found nowhere else, special types of fiber, and unique carotenoids and polysaccharides, and various polyphenol defense compounds, each of which may have anti-cancer properties. I encourage everyone to try experimenting until you find a sea vegetable you like, even if that means just sprinkling some powdered dulse on your food. More on the importance of dietary diversity in Garden Variety Anti-Inflammation, Apples and Oranges: Dietary Diversity, and Constructing a Cognitive Portfolio.

For more on some of the other protective dietary components in the diets of Japanese women, check out Why Do Asian Women Have Less Breast Cancer? and Breast Cancer Survival and Soy.

And if you enjoy anti-cancer comparison videos, make sure to also check out Which Fruit Fights Cancer Better? and #1 Anticancer Vegetable.

-Michael Greger, M.D.

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

Image Credit: srsldy / Flickr

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