Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

We've learned that exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression (in my video Exercise vs. Drugs for Depression). But how much is that really saying? How effective are antidepressant drugs in the first place?

A recent meta-analysis sparked huge scientific and public controversy by stating that the placebo effect can explain the apparent clinical benefits of antidepressants. But aren't there thousands of clinical trials providing compelling evidence for antidepressant effectiveness? If a meta-analysis compiles together all the best published research, how could it say they don't work much better than sugar pills?

The key word is "published."

What if a drug company decided only to publish studies that showed a positive effect, but quietly shelved and concealed any studies showing the drug didn't work? If you didn't know any better, you'd look at the published medical literature and think "Wow, this drug is great." And what if all the drug companies did that? To find out if this was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.

According to the published literature, the results of nearly all the trials of antidepressants were positive, meaning they worked. In contrast, FDA analysis of the trial data showed only roughly half of the trials had positive results. In other words, about half the studies showed the drugs didn't work. Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill. Not publishing negative results undermines evidence-based medicine and puts millions of patients at risk for using ineffective or unsafe drugs, and this was the case with these antidepressant drugs.

These revelations hit first in 2008. Prozac, Serzone, Paxil and Effexor worked, but so did sugar pills, and the difference between the drug and placebo was small. That was 2008. Where were we by 2014? Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect. And what's even worse, Freedom of Information Act documents show the FDA knew about it but made an explicit decision to keep this information from the public and from prescribing physicians.

How could drug companies get away with this?

The pharmaceutical industry is considered the most profitable and politically influential industry in the United States, and mental illness can be thought of as the drug industry's golden goose: incurable, common, long term and involving multiple medications. Antidepressant medications are prescribed to 8.7 percent of the U.S. population. It's a multi-billion dollar market.

To summarize, there is a strong therapeutic response to antidepressant medication; it's just that the response to placebo is almost as strong. Indeed, antidepressants offer substantial benefits to millions of people suffering from depression, and to cast them as ineffective is inaccurate. Just because they may not work better than fake pills doesn't mean they don't work. It's like homeopathy--just because it doesn't work better than the sugar pills, doesn't mean that homeopathy doesn't work. The placebo effect is real and powerful.

In one psychopharmacology journal, a psychiatrist funded by the Prozac company defends the drugs stating, "A key issue is disregarded by the naysaying critics. If the patient is benefiting from antidepressant treatment does it matter whether this is being achieved via drug or placebo effects?"

Of course it matters!

Among the side effects of antidepressants are: sexual dysfunction in up to three quarters of people, long-term weight gain, insomnia, nausea and diarrhea. About one in five show withdrawal symptoms when they try to quit. And perhaps more tragically, the drugs may make people more likely to become depressed in the future. Let me say that again: People are more likely to become depressed after treatment by antidepressants than after treatment by other means - including placebo.

So if doctors are willing to give patients placebo-equivalent treatments, maybe it'd be better for them to just lie to patients and give them actual sugar pills. Yes, that involves deception, but isn't that preferable than deception with a side of side effects? See more on this in my video Do Antidepressant Drugs Really Work?

If different treatments are equally effective, then choice should be based on risk and harm, and of all of the available treatments, antidepressant drugs may be among the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed.

Antidepressants may not work better than placebo for mild and moderate depression, but for very severe depression, the drugs do beat out sugar pills. But that's just a small fraction of the people taking these drugs. That means that the vast majority of depressed patients--as many as nine out of ten--are being prescribed medications that have negligible benefits to them.

Too many doctors quickly decide upon a depression diagnosis without necessarily listening to what the patient has to say and end up putting them on antidepressants without considering alternatives. And fortunately, there are effective alternatives. Physical exercise, for example can have lasting effects, and if that turns out to also be a placebo effect, it is at least a placebo with an enviable list of side effects. Whereas side effects of antidepressants include things like sexual dysfunction and insomnia, side effects of exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone and a longer life.


There are other ways meta-analyses can be misleading. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

More on the ethical challenges facing doctors and whether or not to prescribe sugar pills in The Lie That Heals: Should Doctors Give Placebos?

I've used the Freedom of Information Act myself to get access to behind the scenes industry shenanigans. See, for example, what I found out about the egg industry in Who Says Eggs Aren't Healthy or Safe? and Eggs and Cholesterol: Patently False and Misleading Claims.

This isn't the only case of the medical profession overselling the benefits of drugs. See How Smoking in 1956 is Like Eating in 2016, The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure (though if you're worried about your mood they might make you even more depressed!)

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: GraphicStock. This image has been modified.

Original Link

Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

We've learned that exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression (in my video Exercise vs. Drugs for Depression). But how much is that really saying? How effective are antidepressant drugs in the first place?

A recent meta-analysis sparked huge scientific and public controversy by stating that the placebo effect can explain the apparent clinical benefits of antidepressants. But aren't there thousands of clinical trials providing compelling evidence for antidepressant effectiveness? If a meta-analysis compiles together all the best published research, how could it say they don't work much better than sugar pills?

The key word is "published."

What if a drug company decided only to publish studies that showed a positive effect, but quietly shelved and concealed any studies showing the drug didn't work? If you didn't know any better, you'd look at the published medical literature and think "Wow, this drug is great." And what if all the drug companies did that? To find out if this was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.

According to the published literature, the results of nearly all the trials of antidepressants were positive, meaning they worked. In contrast, FDA analysis of the trial data showed only roughly half of the trials had positive results. In other words, about half the studies showed the drugs didn't work. Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill. Not publishing negative results undermines evidence-based medicine and puts millions of patients at risk for using ineffective or unsafe drugs, and this was the case with these antidepressant drugs.

These revelations hit first in 2008. Prozac, Serzone, Paxil and Effexor worked, but so did sugar pills, and the difference between the drug and placebo was small. That was 2008. Where were we by 2014? Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect. And what's even worse, Freedom of Information Act documents show the FDA knew about it but made an explicit decision to keep this information from the public and from prescribing physicians.

How could drug companies get away with this?

The pharmaceutical industry is considered the most profitable and politically influential industry in the United States, and mental illness can be thought of as the drug industry's golden goose: incurable, common, long term and involving multiple medications. Antidepressant medications are prescribed to 8.7 percent of the U.S. population. It's a multi-billion dollar market.

To summarize, there is a strong therapeutic response to antidepressant medication; it's just that the response to placebo is almost as strong. Indeed, antidepressants offer substantial benefits to millions of people suffering from depression, and to cast them as ineffective is inaccurate. Just because they may not work better than fake pills doesn't mean they don't work. It's like homeopathy--just because it doesn't work better than the sugar pills, doesn't mean that homeopathy doesn't work. The placebo effect is real and powerful.

In one psychopharmacology journal, a psychiatrist funded by the Prozac company defends the drugs stating, "A key issue is disregarded by the naysaying critics. If the patient is benefiting from antidepressant treatment does it matter whether this is being achieved via drug or placebo effects?"

Of course it matters!

Among the side effects of antidepressants are: sexual dysfunction in up to three quarters of people, long-term weight gain, insomnia, nausea and diarrhea. About one in five show withdrawal symptoms when they try to quit. And perhaps more tragically, the drugs may make people more likely to become depressed in the future. Let me say that again: People are more likely to become depressed after treatment by antidepressants than after treatment by other means - including placebo.

So if doctors are willing to give patients placebo-equivalent treatments, maybe it'd be better for them to just lie to patients and give them actual sugar pills. Yes, that involves deception, but isn't that preferable than deception with a side of side effects? See more on this in my video Do Antidepressant Drugs Really Work?

If different treatments are equally effective, then choice should be based on risk and harm, and of all of the available treatments, antidepressant drugs may be among the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed.

Antidepressants may not work better than placebo for mild and moderate depression, but for very severe depression, the drugs do beat out sugar pills. But that's just a small fraction of the people taking these drugs. That means that the vast majority of depressed patients--as many as nine out of ten--are being prescribed medications that have negligible benefits to them.

Too many doctors quickly decide upon a depression diagnosis without necessarily listening to what the patient has to say and end up putting them on antidepressants without considering alternatives. And fortunately, there are effective alternatives. Physical exercise, for example can have lasting effects, and if that turns out to also be a placebo effect, it is at least a placebo with an enviable list of side effects. Whereas side effects of antidepressants include things like sexual dysfunction and insomnia, side effects of exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone and a longer life.


There are other ways meta-analyses can be misleading. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

More on the ethical challenges facing doctors and whether or not to prescribe sugar pills in The Lie That Heals: Should Doctors Give Placebos?

I've used the Freedom of Information Act myself to get access to behind the scenes industry shenanigans. See, for example, what I found out about the egg industry in Who Says Eggs Aren't Healthy or Safe? and Eggs and Cholesterol: Patently False and Misleading Claims.

This isn't the only case of the medical profession overselling the benefits of drugs. See How Smoking in 1956 is Like Eating in 2016, The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure (though if you're worried about your mood they might make you even more depressed!)

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: GraphicStock. This image has been modified.

Original Link

Alkylphenol Endocrine Disruptors and Allergies

NF-Apr23 Alkylphenol Endocrine Disruptors and Allergies.jpg

In my video Preventing Childhood Allergies, I noted a study in Japan that found higher maternal intake of meat during pregnancy was significantly associated with about three times the odds of both suspected and physician-diagnosed eczema. The researchers suggest that certain components of meat may affect the fetal immune system. But what about the moms, themselves? A plant-based diet may also help alleviate allergies in adults. See Say No to Drugs by Saying Yes to More Plants and Preventing Allergies in Adulthood.

Seasonal allergies have exploded in Japan in the past few decades, starting with the first reported case in 1964 and now affecting millions every year. We've seen a rising prevalence of allergic diseases around the industrialized world in past decades, but perhaps nothing quite this dramatic.

Some have suggested that profound changes in the Japanese diet may have played a role. Over the latter half of the century total meat, fish, and milk intake rose hundreds of percent in Japan, so researchers decided to look into dietary meat and fat intake and the prevalence of these seasonal pollen allergies. No association with overall fat, but "higher meat intake was significantly associated with an increased prevalence."

Saturated fat wasn't associated with increased prevalence either, so what other constituents in meat may be to blame? The researchers considered the cooked meat carcinogens, the heterocyclic amines, the polycyclic aromatic hydrocarbons, and the nitrosamines.

A new review, highlighted in my video, Alkylphenol Endocrine Disruptors and Allergies, however, raised an intriguing possibility. There's a class of industrial pollutants called alkylphenols, recognized as common toxic endocrine disrupting chemicals that tend to accumulate in the human body and may be associated with allergic diseases. A variety of studies have shown how they may exacerbate allergen-induced inflammation, "suggesting that alkylphenol exposure may influence the onset, progression, and severity of allergic diseases." These toxic xenoestrogens can be found in human breast milk, in our body fat, in our urine, in our bloodstream, and even in the umbilical cord blood going to our babies. How did it get there? Through contaminated food.

It all goes back to a famous study about the reduction of penis size and testosterone levels in alligators living in a contaminated environment. I don't know what you do for a day job, but these researchers observed that a population of juvenile alligators living on one lake in Florida exhibited a "significantly smaller penis size" and lower blood concentrations of testosterone compared to animals on some different lake. The most important difference between the two lakes was that Lake Stubby was fed by relatively polluted waters. They attributed the "short penis phenomenon" to estrogen-mimicking (xenoestrogenic) environmental metabolites of DDT that still pollute our Earth. This seminal work introduced the concept of endocrine disruptors. Environmental xenoestrogens might result in feminization of exposed male animals. And that's just the shriveled tip of the iceberg.

Since then, endocrine-disrupting chemicals have been implicated in the dramatic rise over the last 50 years of diseases like breast cancer, prostate cancer, testicular cancer, diabetes, obesity, and fertility (such as dropping normal sperm counts), genital birth defects such as penile malformations, preterm birth, neurobehavioral disorders in children linked to thyroid disruption, and earlier breast development in young girls. Because genes do not change fast enough to explain these increases, environmental causes must be involved. Since our greatest exposure to the environment is through our gut, it's no surprise that our greatest exposure to these endocrine-disrupting chemicals is through diet.

To find out which foods may contain these alkylphenol endocrine disruptors, check out my video Dietary Sources of Alkylphenol Endocrine Disruptors.

More on endocrine disruptors in:

A different class of chemicals has been found to be associated with smaller penis size in humans. See Chicken Consumption and the Feminization of Male Genitalia.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videoshere 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: Mark Freeth / Flickr

Original Link

How Fatty Foods May Affect Our Love Life

NF-Oct23 Are Fatty Foods Addictive?.jpg

The food industry, like the tobacco companies and other drug lords, has been able to come up with products that tap into the same dopamine reward system that keeps people smoking cigarettes, using marijuana, and eating candy bars (See Are Sugary Foods Addictive?). New research, highlighted in my video Are Fatty Foods Addictive? suggests that fat may have similar effects on the brain. If people are fed yogurt packed with butter fat, within 30 minutes they exhibit the same brain activity as those who just drank sugar water.

People who regularly eat ice cream (sugar and fat) have a deadened dopamine response in their brains in response to drinking a milkshake. It's similar to when drug abusers have to use more and more to get the same high. Frequent ice cream consumption "is related to a reduction in reward-region (pleasure center) responsivity in humans, paralleling the tolerance observed in drug addiction." Once we've so dulled our dopamine response, we may subsequently overeat in an effort to achieve the degree of satisfaction experienced previously, contributing to unhealthy weight gain.

What do fatty and sugary foods have in common? They are energy-dense. It may be less about the number of calories than their concentration. Consumption of a calorie-dilute diet doesn't lead to deadened dopamine responsivity, but a calorie-dense diet with the same number of calories does. It's like the difference between cocaine and crack: same stuff chemically, but by smoking crack cocaine we can deliver a higher dose quicker to our brain.

As an aside, I found it interesting that the control drink in these milkshake studies wasn't just water. They can't use water because our brain actually tastes water on the tongue (who knew!). So instead the researchers had people drink a solution "designed to mimic the natural taste of saliva." Ew!

Anyway, with this new understanding of the neural correlates of food addiction, there have been calls to include obesity as an official mental disorder. After all, both obesity and addiction share the inability to restrain behavior in spite of an awareness of detrimental health consequences, one of the defining criteria of substance abuse. We keep putting crap in our bodies despite the knowledge that we have a problem that is likely caused by the crap, yet we can't stop (a phenomena called the "pleasure trap").

Redefining obesity as an addiction, a psychiatric disease, would be a boon to the drug companies that are already working on a whole bunch of drugs to muck with our brain chemistry. For example, subjects given an opiate blocker (like what's done for people with heroin overdoses to block the effects of the drug) eat significantly less cheese -- it just doesn't do as much for them anymore when their opiate receptors are blocked.

Rather than taking drugs, though, we can prevent the deadening of our pleasure center in the first place by sticking to foods that are naturally calorically dilute, like whole plant foods. This can help bring back our dopamine sensitivity such that we can again derive the same pleasure from the simplest of foods (see Changing Our Taste Buds). And this is not just for people who are obese. When we regularly eat calorie dense animal and junk foods like ice cream, we can blunt our pleasure so that we may overeat to compensate. When our brain down-regulates dopamine receptors to deal with all these jolts of fat and sugar, we may experience less enjoyment from other activities as well.

That's why cocaine addicts may have an impaired neurological capacity to enjoy sex, and why smokers have an impaired ability to respond to positive stimuli. Since these all involve the same dopamine pathways, what we put into our body--what we eat--can affect how we experience all of life's pleasures.

So to live life to the fullest, what should we do? The food industry, according to some addiction specialists, "should be given incentives to develop low calorie foods that are more attractive, palatable and affordable so that people can adhere to diet programs for a long time." No need! Mother Nature beat them to it--that's what the produce aisle is for.

By starting to eat healthfully, we can actually change how things taste. Healthiest means whole plant foods, which tend to be naturally dilute given their water and fiber content. Not only is fiber also calorie-free, but one might think of it as having "negative" calories, given the fermentation of fiber in our bowel into anti-obesity compounds (as well as anti-inflammatory, anti-cancer compounds). For this reason, those eating plant-based diets eat hundreds of fewer calories without even trying. (See my video Nutrient-Dense Approach to Weight Management).

-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.

Images thanks to Burger Austin / Flickr

Original Link

Pistachios May Help Erectile Dysfunction

Pistachios May Help Erectile Dysfunction

Erectile dysfunction is a major cause of decreased quality of life in men—so much so that one early theory suggested that this may explain the link between impotence and heart attacks. Depression is a risk factor for coronary heart disease, and the thought was that men who couldn’t get it up become so depressed that they die of a broken heart.

Now we know that erectile dysfunction and heart disease can be two different manifestations of the exact same root problem, diseased arteries—inflamed, oxidized, cholesterol-clogged blood vessels (See Survival of the Firmest: Erectile Dysfunction and Death). So it’s no wonder that a diet chock-full of anti-inflammatory, antioxidant, cholesterol-lowering plant foods would improve sexual functioning in both men and women, as well as reduce the risk of heart disease (See 50 Shades of Green). A completely plant-based diet can even stop and reverse our number one killer (See One in a Thousand: Ending the Heart Disease Epidemic).

Of all the plant foods individually examined so far, nuts appear most tied to longevity. Just two handfuls a week may extend a woman’s life as much as jogging four hours a week (see What Women Should Eat to Live Longer). So, if nuts reduce the risk of heart disease, might they also help with sexual dysfunction?

In my video, Pistachio Nuts for Erectlie Dysfuntion I outline a study where men eating three to four handfuls of pistachios a day for just three weeks experienced both significant improvement in blood flow through the penis and significantly firmer erections. This is not surprising. Antioxidant-rich foods have a Viagra-like effect of boosting nitric oxide production. (See The Power of NO). Also, the citruline in watermelons helped with erection firmness by boosting arginine, (See Watermelon as Treatment for Erectile Dysfunction), which is what our body makes nitric oxide out of.Pistachios have a bunch of both antioxidants and arginine, which may help explain the improvement in blood flow.

We also know that cholesterol is an important predictor of sexual dysfunction in both men and women (See Cholesterol and Female Sexual Dysfunction), and after just three weeks, those eating pistachios had significant improvements in cholesterol. And like other studies that piled on hundreds of calories of nuts a day, there was no weight gain. (For more on this remarkable effect, see my videos Nuts and Obesity: The Weight of Evidence, Solving the Mystery of the Missing Calories, and Testing the Pistachio Principle). Conclusion: “Just three weeks of pistachios resulted in a significant improvement in erectile function with additional improvement in cholesterol without any side effects.”

Note the two important differences between diet and drugs. Drugs like Viagra just cover up the symptoms of the underlying problem–unhealthy arteries. Eating whole healthy plant foods like nuts actually helps attack the root cause—cholesterol, oxidation, and inflammation—and has only good side effects.

The enzyme that Viagra-like drugs inhibit is found primarily in two places in the body: the erectile tissue of the penis and the retina of the eye. That’s why the FDA encourages people to stop taking drugs like Viagra, and “call a doctor right away if you experience sudden loss of vision.” (Assuming you can still find your phone.)

Though the harms (such as cyanopsia in which everything in our vision suddenly becomes tinted blue) tend to be self-limited and reversible, why risk side-effects at all when the problem can be reversed and cured in the first place, improving the quality and quantity of our lives?

I discuss the epidemic of adverse prescription drug side-effects in my 2012-13 annual review Uprooting the Leading Causes of Death and my new 2013-14 live presentation More Than an Apple a Day: Combating Common Diseases.

In addition to improving penile blood flow, nuts may also help prevent breast cancer (Tree Nuts or Peanuts for Breast Cancer Prevention?), inflammatory diseases (Fighting Inflammation in a Nut Shell), sudden death (How Do Nuts Prevent Sudden Cardiac Death?), and lengthen one's lifespan (Nuts May Help Prevent Death). 

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here.

Image Credit: miss iona lion / Flickr

Original Link

Foods for a Long Life and Love Life

 

 

 

 

 

 

 

 

Foods for a Long Life and Love Life

Motivating patients to change poor lifestyle habits can be extremely difficult. Preventing cardiovascular events such as heart attacks or strokes is a relatively distant benefit, whereas barbecued ribs, cheesecake, or sitting on our butts promises almost instant gratification. Public health experts are now hoping that prevention or improvement of erectile dysfunction could be a more immediate motivator that physicians can use to improve their patients’ lifestyles and in turn their overall cardiovascular health. That’s how doctors can save a life during a clinic visit for erectile dysfunction. (See Survival of the Firmest: Erectile Dysfunction and Death).

We used to think of erectile dysfunction in young men in their 20s and 30s as psychogenic in origin, meaning it’s all in their heads. But now we’re realizing it’s more likely an early sign of vascular disease. But even when the penis heads in the wrong direction, the heart need not follow. Atherosclerosis in both organs can be reversed with lifestyle changes. We know that "a substantial body of knowledge demonstrates that the abundant consumption of vegetables, fruit, and whole grain, and the dietary patterns rich in these foods, convey a markedly lower risk of coronary disease." In a study profiled in my video, 50 Shades of Green, a group of researchers tried putting impotent men on a Mediterranean diet, which includes an abundance of plant-based foods. After two years on the Mediterranean diet, 37% of the men regained normal sexual function. What is it about the diet that appeared to do it? Improvements in erectile function were tied to five things: increased intake of fruits, vegetables, nuts, beans and essentially the ratio of plant fats to animal fats.

Similar benefits were found for women. The same kind of diet significantly improved sexual function, together with a significant reduction of systemic inflammation. As a whole, these findings "suggest that a Mediterranean-style diet may be a safe strategy for amelioration of sexual function" in women with pre-diabetes or diabetes, who found significant improvement in sexual satisfaction on the healthier diet. For more on preventing sexual dysfunction in women in the first place, see Cholesterol and Female Sexual Dysfunction. The improvement in sexual functioning is thought to be because of the anti-inflammatory and antioxidant benefits of plant-based diet.

Check out my related video: Pistachio Nuts for Erectile Dysfunction.

Other benefits of increased fiber intake may include improved bowel function (Bristol Stool Scale) and frequency (Prunes vs. Metamucil vs. Vegan Diet), lower colorectal cancer risk (Stool Size Matters), lower breast cancer risk (Relieving Yourself of Excess Estrogen and Fiber vs. Breast Cancer), lower blood pressure (Whole Grains May Work as Well as Drugs), lower blood cholesterol (How Fiber Lowers Cholesterol), weight loss (Beans and the Second Meal Effect) and a longer lifespan (What Women Should Eat to Live Longer).

A similar Mediterranean diet failed to help fibromyalgia in the short term (see Fibromyalgia vs. Mostly Raw & Mostly Vegetarian Diets), but diets that were even more plant-based were found to be beneficial: Fibromyalgia vs. Vegetarian & Raw Vegan Diets. 

-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: Jon's Pics / Flickr

Original Link

Pills vs. Diet For Erectile Dysfunction

 

 

 

 

 

 

 

 

Don’t Pop Pills For Erectile Dysfunction. Help Your Heart, Instead

Erectile dysfunction is the recurrent or persistent inability to attain and/or maintain an erection in order for satisfactory sexual performance. It is present in up to 30 million men in the U.S. and approximately 100 million men worldwide. The U.S. has less than 8% of the world’s population, yet up to 30% of the impotence? We're #1!

But hey, we’ve got red, white, and blue pills like Viagra. The problem is that the pills just cover up the symptoms of vascular disease and don’t do anything for the underlying pathology. Erectile dysfunction and our #1 killer, coronary artery disease, are just two manifestations of the same disease: inflamed, clogged, and crippled arteries, regardless of which organ it affects (See Survival of the Firmest: Erectile Dysfunction and Death).

Atherosclerosis is considered a systemic disorder that uniformly affects all major blood vessels in the body. Hardening of the arteries can lead to softening of the penis because stiffened arteries can’t relax, open wide, and let the blood flow. Thus erectile dysfunction may just be the flaccid "tip of an iceberg" in terms of a systemic disorder. For two-thirds of men showing up to emergency rooms for the first time with crushing chest pain, their penis had been trying to warn them for years that something was wrong with their circulation.

Why does it hit the penis first? Because the penile arteries in the penis are half the size of the coronary artery in our heart. So the amount of plaque we wouldn’t even feel in the heart could clog half the penile artery, causing symptomatic restriction in blood flow. That’s why erectile dysfunction has been called “penile angina.” In fact, by measuring blood flow in a man’s penis we can predict the results of his cardiac stress test with an accuracy of 80%. Male sexual function is like a penile stress test, a “window into the hearts of men.”

Forty percent of men over age forty have erectile dysfunction. 40 over 40. Men with erection difficulties in their 40s have a 50-fold increased risk of having a cardiac event (like sudden death). I said before that various things increase heart disease risk by 20% or 30%. That’s nearly 5000%, leading the latest review to ask, “is there any risk greater?” That’s because it’s not so much a risk factor for atherosclerosis as atherosclerosis itself. A man "with erectile dysfunction (even if he doesn’t have cardiac symptoms) should be considered a cardiac patient until proven otherwise."

Erectile dysfunction is considered to be a cardiac equivalent; it’s a marker of the coronary artery one likely already has. Thus, there’s more to treating ED than establishing an erect penis; it offers an opportunity for reducing cardiovascular risk. The reason even young men should care about their cholesterol is because it predicts erectile dysfunction later in life, which in turn predicts heart attacks, strokes, and a shortened lifespan.

Thankfully, Our Number One Killer Can Be Stopped. Check out my video on Eliminating the #1 Cause of Death. More background can be found in Arterial Acne and Blocking the First Step of Heart Disease.

Related videos include: 50 Shades of Green and Pistachio Nuts for Erectile Dysfunction.

Previous videos on the subject include:

A similar relationship appears to exist for female sexual function as well. See my video: Cholesterol and Female Sexual Dysfunction.

-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: sea turtle / Flickr

Original Link

Flaxseeds for Diabetes

 

 

 

 

 

 

 

 

Drug companies hope to capitalize on the fact that the consumption of certain plants appears to lower the risk of diabetes by isolating these plants’ active components for use and sale as pharmacological agents. Though not as profitable, why don’t we just eat the plants themselves?

One plant in particular that’s now been tested is flax. We’ve known for 20 years that having ground flax in your stomach can blunt the blood sugar spike from a meal, but it’s never been tested in diabetics–until now. World Health Organization researchers published an open-label study on the effect of flax seed powder supplementation in the management of diabetes.

Diabetic subjects took a tablespoon of ground flax seeds every day for a month, and, compared to the control group, experienced a significant drop in fasting blood sugars, triglycerides, and cholesterol, as well as the most important thing, a drop in A1C level. If one’s sugars are already well controlled, though, there may be no additional benefit.

How does flax help control blood sugars? Flaxseeds may improve insulin sensitivity in glucose intolerant people. After 12 weeks of flax, researchers found a small but significant drop in insulin resistance, perhaps related to the drop in oxidant stress due to the antioxidant qualities of flaxseeds.

The study profiled in my 3-min video Flaxseed vs. Diabetes showing a tablespoon of daily ground flax seeds for a month appears to improve fasting blood sugars, triglycerides, cholesterol, and hemoglobin A1c levels in diabetics was a non-blinded, non-randomized small study. If it was some drug they were testing, I’d never prescribe it based on this one study, but this isn’t a drug. It’s just flaxseeds. There are just good side effects, so even if this study was a fluke or fraud, flaxseeds have other benefits. In the worst case scenario the seed would still end up benefiting patients who aren’t quite ready or able to reverse their diabetes completely with a plant-based diet.

Flaxseeds are calorically dense, but even adding a half cup of ground flax a day may not lead to weight gain. When 4 tablespoons a day were tested for 3 months the flax group ended up with a slimmer waist than the flaxseed oil or control group. Because of the potential of raw flax seeds to interfere with thyroid function at high doses, though, I would only recommend 2 tablespoons a day. And I would not recommend flaxseed supplementation during pregnancy.

The flaxseed study reminds me of the Prunes vs. Metamucil for Constipation one, or any of those talking about various foods that may control blood sugar (Amla Versus Diabetes), weight (Fat Burning Via Flavonoids), cholesterol (Dried Apples Versus Cholesterol), or sexual dysfunction (Watermelon as Treatment for Erectile Dysfunction). Yes, these foods may help, but why not get at the root of the problem and try to reverse the condition altogether with a healthier diet overall?

The three best books on reversing type 2 diabetes with diet are Defeating Diabetes, co-authored by my favorite dietician, Brenda Davis, and from two of my medical mentors: Dr. Neal Barnard’s Program To Reverse Diabetes Now and Dr. Joel Fuhrman’s The End of Diabetes.

-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: Jill A. Brown / Flickr

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