A Dietary Treatment for Irritable Bowel Syndrome

A Dietary Treatment for Irritable Bowel Syndrome.jpeg

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don't seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we're trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There's got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That's where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I've talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There's actually a way to harness the placebo effect without lying to patients, though. We tell them it's a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked "placebo pills" "take 2 pills twice daily." I kid you not.

Lo and behold, it worked! That's how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won't cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one's bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don't yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It's never been tested, but one might assume it wouldn't be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that "are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events." Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer's.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

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

A Dietary Treatment for Irritable Bowel Syndrome

A Dietary Treatment for Irritable Bowel Syndrome.jpeg

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don't seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we're trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There's got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That's where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I've talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There's actually a way to harness the placebo effect without lying to patients, though. We tell them it's a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked "placebo pills" "take 2 pills twice daily." I kid you not.

Lo and behold, it worked! That's how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won't cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one's bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don't yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It's never been tested, but one might assume it wouldn't be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that "are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events." Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer's.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

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

A Dietary Treatment for Irritable Bowel Syndrome

A Dietary Treatment for Irritable Bowel Syndrome.jpeg

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don't seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we're trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There's got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That's where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I've talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There's actually a way to harness the placebo effect without lying to patients, though. We tell them it's a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked "placebo pills" "take 2 pills twice daily." I kid you not.

Lo and behold, it worked! That's how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won't cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one's bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don't yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It's never been tested, but one might assume it wouldn't be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that "are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events." Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer's.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

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

Foods that Affect Testosterone Levels

Foods that Affect Testosterone Levels.jpeg

A number of studies suggest that exposure to industrial pollutants may affect sexual function, for example, loss of libido, sexual dysfunction, and impotence. This may be due to effects on testosterone levels. In a study of men who ate a lot of contaminated fish, an elevation in PCB levels in the blood was associated with a lower concentration of testosterone levels. These pollutants are found predominantly in fish, but also meat and dairy. The lowest levels are found in plants (see Dietary Pollutants May Affect Testosterone Levels).

Testosterone doesn't just play a role in the determination of secondary sex characteristics like facial hair at puberty. It also regulates normal sexual functioning and the overall physical and psychological well-being of adult men. Abnormally low levels of testosterone can lead to decreased physical endurance and memory capacity, loss of libido, drop in sperm count, loss of bone density, obesity, and depression.

Endocrine-disrupting compounds that build up in fish may be able to mimic or block hormone receptors, or alter rates of synthesis or breakdown of sex steroid hormones. In children, these pollutants may actually impair sexual development. Boys who are exposed may grow up with smaller penises (although only by about two-thirds of an inch shorter at most). Researchers have tried exposing cells from aborted fetal human penises to these kinds of dietary pollutants, and gene expression related to genital development is indeed affected at real-life exposure levels. We're not sure if the effects on penis length are due to the pro-estrogenic effects of the toxins, though, or the anti-testosterone effects.

You've heard of save the whales? Well, male reproductive organs may be at risk from environmental hazards as well.

I previously addressed how we discovered the endocrine disruptor phenomenon in Alkylphenol Endocrine Disruptors and Allergies, as well as where they're found (Dietary Sources of Alkylphenol Endocrine Disruptors).

For more on sustaining male virility, see Male Fertility and Diet, The Role of Diet in Declining Sperm Counts, and Dairy Estrogen and Male Fertility.

I've talked about the role a plastics chemical may play in male sexual functioning (BPA Plastic and Male Sexual Dysfunction). But it's not just toxins, it's the total diet (Survival of the Firmest: Erectile Dysfunction and Death), and not only in men (Cholesterol and Female Sexual Dysfunction). My latest on the topic is Best Foods to Improve Sexual Function.

In health,

Michael Greger, M.D.

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

Image Credit: Sally Plank / Flickr. Image has been modified.

Original Link

Foods that Affect Testosterone Levels

Foods that Affect Testosterone Levels.jpeg

A number of studies suggest that exposure to industrial pollutants may affect sexual function, for example, loss of libido, sexual dysfunction, and impotence. This may be due to effects on testosterone levels. In a study of men who ate a lot of contaminated fish, an elevation in PCB levels in the blood was associated with a lower concentration of testosterone levels. These pollutants are found predominantly in fish, but also meat and dairy. The lowest levels are found in plants (see Dietary Pollutants May Affect Testosterone Levels).

Testosterone doesn't just play a role in the determination of secondary sex characteristics like facial hair at puberty. It also regulates normal sexual functioning and the overall physical and psychological well-being of adult men. Abnormally low levels of testosterone can lead to decreased physical endurance and memory capacity, loss of libido, drop in sperm count, loss of bone density, obesity, and depression.

Endocrine-disrupting compounds that build up in fish may be able to mimic or block hormone receptors, or alter rates of synthesis or breakdown of sex steroid hormones. In children, these pollutants may actually impair sexual development. Boys who are exposed may grow up with smaller penises (although only by about two-thirds of an inch shorter at most). Researchers have tried exposing cells from aborted fetal human penises to these kinds of dietary pollutants, and gene expression related to genital development is indeed affected at real-life exposure levels. We're not sure if the effects on penis length are due to the pro-estrogenic effects of the toxins, though, or the anti-testosterone effects.

You've heard of save the whales? Well, male reproductive organs may be at risk from environmental hazards as well.

I previously addressed how we discovered the endocrine disruptor phenomenon in Alkylphenol Endocrine Disruptors and Allergies, as well as where they're found (Dietary Sources of Alkylphenol Endocrine Disruptors).

For more on sustaining male virility, see Male Fertility and Diet, The Role of Diet in Declining Sperm Counts, and Dairy Estrogen and Male Fertility.

I've talked about the role a plastics chemical may play in male sexual functioning (BPA Plastic and Male Sexual Dysfunction). But it's not just toxins, it's the total diet (Survival of the Firmest: Erectile Dysfunction and Death), and not only in men (Cholesterol and Female Sexual Dysfunction). My latest on the topic is Best Foods to Improve Sexual Function.

In health,

Michael Greger, M.D.

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

Image Credit: Sally Plank / Flickr. Image has been modified.

Original Link

Antioxidant- and Folate-Rich Foods for Depression

Antioxidant- and Folate-Rich Foods for Depression.jpeg

According to the Centers for Disease Control and Prevention, the rates of all of our top 10 killers have fallen or stabilized except for one, suicide. As shown in my video, Antioxidants & Depression, accumulating evidence indicates that free radicals may play important roles in the development of various neuropsychiatric disorders including major depression, a common cause of suicide.

In a study of nearly 300,000 Canadians, for example, greater fruit and vegetable consumption was associated with lower odds of depression, psychological distress, self-reported mood and anxiety disorders and poor perceived mental health. They conclude that since a healthy diet comprised of a high intake of fruits and vegetables is rich in anti-oxidants, it may consequently dampen the detrimental effects of oxidative stress on mental health.

But that study was based on asking how many fruits and veggies people ate. Maybe people were just telling the researchers what they thought they wanted to hear. What if you actually measure the levels of carotenoid phytonutrients in people's bloodstreams? The same relationship is found. Testing nearly 2000 people across the United States, researchers found that a higher total blood carotenoid level was indeed associated with a lower likelihood of elevated depressive symptoms, and there appeared to be a dose-response relationship, meaning the higher the levels, the better people felt.

Lycopene, the red pigment predominantly found in tomatoes (but also present in watermelon, pink grapefruit, guava and papaya) is the most powerful carotenoid antioxidant. In a test tube, it's about 100 times more effective at quenching free radicals than a more familiar antioxidant like vitamin E.

Do people who eat more tomatoes have less depression, then? Apparently so. A study of about a thousand older men and women found that those who ate the most tomato products had only about half the odds of depression. The researchers conclude that a tomato-rich diet may have a beneficial effect on the prevention of depressive symptoms.

Higher consumption of fruits and vegetables has been found to lead to a lower risk of developing depression, but if it's the antioxidants can't we just take an antioxidant pill? No.

Only food sources of antioxidants were protectively associated with depression. Not antioxidants from dietary supplements. Although plant foods and food-derived phytochemicals have been associated with health benefits, antioxidants from dietary supplements appear to be less beneficial and may, in fact, be detrimental to health. This may indicate that the form and delivery of the antioxidants are important. Alternatively, the observed associations may be due not to antioxidants but rather to other dietary factors, such as folate, that also occur in plant-rich diets.

In a study of thousands of middle-aged office workers, eating lots of processed food was found to be a risk factor for at least mild to moderate depression five years later, whereas a whole food pattern was found to be protective. Yes, it could be because of the high content of antioxidants in fruits and vegetables but could also be the folate in greens and beans, as some studies have suggested an increased risk of depression in folks who may not have been eating enough.

Low folate levels in the blood are associated with depression, but since most of the early studies were cross-sectional, meaning a snapshot in time, we didn't know if the low folate led to depression or the depression led to low folate. Maybe when you have the blues you don't want to eat the greens.

But since then a number of cohort studies were published, following people over time. They show that a low dietary intake of folate may indeed be a risk factor for severe depression, as much as a threefold higher risk. Note this is for dietary folate intake, not folic acid supplements; those with higher levels were actually eating healthy foods. If you give people folic acid pills they don't seem to work. This may be because folate is found in dark green leafy vegetables like spinach, whereas folic acid is the oxidized synthetic compound used in food fortification and dietary supplements because it's more shelf-stable. It may have different effects on the body as I previously explored in Can Folic Acid Be Harmful?

These kinds of findings point to the importance of antioxidant food sources rather than dietary supplements. But there was an interesting study giving people high dose vitamin C. In contrast to the placebo group, those given vitamin C experienced a decrease in depression scores and also greater FSI. What is FSI? Frequency of Sexual Intercourse.

Evidently, high dose vitamin C improves mood and intercourse frequency, but only in sexual partners that don't live with one another. In the placebo group, those not living together had sex about once a week, and those living together a little higher, once every five days, with no big change on vitamin C. But for those not living together, on vitamin C? Every other day! The differential effect for non-cohabitants suggests that the mechanism is not a peripheral one, meaning outside the brain, but a central one--some psychological change which motivates the person to venture forth to have intercourse. The mild antidepressant effect they found was unrelated to cohabitation or frequency, so it does not appear that the depression scores improved just because of the improved FSI.

For more mental health video, see:

Anything else we can do to enhance our sexual health and attractiveness? 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 / Flickr. This image has been modified.

Original Link

Antioxidant- and Folate-Rich Foods for Depression

Antioxidant- and Folate-Rich Foods for Depression.jpeg

According to the Centers for Disease Control and Prevention, the rates of all of our top 10 killers have fallen or stabilized except for one, suicide. As shown in my video, Antioxidants & Depression, accumulating evidence indicates that free radicals may play important roles in the development of various neuropsychiatric disorders including major depression, a common cause of suicide.

In a study of nearly 300,000 Canadians, for example, greater fruit and vegetable consumption was associated with lower odds of depression, psychological distress, self-reported mood and anxiety disorders and poor perceived mental health. They conclude that since a healthy diet comprised of a high intake of fruits and vegetables is rich in anti-oxidants, it may consequently dampen the detrimental effects of oxidative stress on mental health.

But that study was based on asking how many fruits and veggies people ate. Maybe people were just telling the researchers what they thought they wanted to hear. What if you actually measure the levels of carotenoid phytonutrients in people's bloodstreams? The same relationship is found. Testing nearly 2000 people across the United States, researchers found that a higher total blood carotenoid level was indeed associated with a lower likelihood of elevated depressive symptoms, and there appeared to be a dose-response relationship, meaning the higher the levels, the better people felt.

Lycopene, the red pigment predominantly found in tomatoes (but also present in watermelon, pink grapefruit, guava and papaya) is the most powerful carotenoid antioxidant. In a test tube, it's about 100 times more effective at quenching free radicals than a more familiar antioxidant like vitamin E.

Do people who eat more tomatoes have less depression, then? Apparently so. A study of about a thousand older men and women found that those who ate the most tomato products had only about half the odds of depression. The researchers conclude that a tomato-rich diet may have a beneficial effect on the prevention of depressive symptoms.

Higher consumption of fruits and vegetables has been found to lead to a lower risk of developing depression, but if it's the antioxidants can't we just take an antioxidant pill? No.

Only food sources of antioxidants were protectively associated with depression. Not antioxidants from dietary supplements. Although plant foods and food-derived phytochemicals have been associated with health benefits, antioxidants from dietary supplements appear to be less beneficial and may, in fact, be detrimental to health. This may indicate that the form and delivery of the antioxidants are important. Alternatively, the observed associations may be due not to antioxidants but rather to other dietary factors, such as folate, that also occur in plant-rich diets.

In a study of thousands of middle-aged office workers, eating lots of processed food was found to be a risk factor for at least mild to moderate depression five years later, whereas a whole food pattern was found to be protective. Yes, it could be because of the high content of antioxidants in fruits and vegetables but could also be the folate in greens and beans, as some studies have suggested an increased risk of depression in folks who may not have been eating enough.

Low folate levels in the blood are associated with depression, but since most of the early studies were cross-sectional, meaning a snapshot in time, we didn't know if the low folate led to depression or the depression led to low folate. Maybe when you have the blues you don't want to eat the greens.

But since then a number of cohort studies were published, following people over time. They show that a low dietary intake of folate may indeed be a risk factor for severe depression, as much as a threefold higher risk. Note this is for dietary folate intake, not folic acid supplements; those with higher levels were actually eating healthy foods. If you give people folic acid pills they don't seem to work. This may be because folate is found in dark green leafy vegetables like spinach, whereas folic acid is the oxidized synthetic compound used in food fortification and dietary supplements because it's more shelf-stable. It may have different effects on the body as I previously explored in Can Folic Acid Be Harmful?

These kinds of findings point to the importance of antioxidant food sources rather than dietary supplements. But there was an interesting study giving people high dose vitamin C. In contrast to the placebo group, those given vitamin C experienced a decrease in depression scores and also greater FSI. What is FSI? Frequency of Sexual Intercourse.

Evidently, high dose vitamin C improves mood and intercourse frequency, but only in sexual partners that don't live with one another. In the placebo group, those not living together had sex about once a week, and those living together a little higher, once every five days, with no big change on vitamin C. But for those not living together, on vitamin C? Every other day! The differential effect for non-cohabitants suggests that the mechanism is not a peripheral one, meaning outside the brain, but a central one--some psychological change which motivates the person to venture forth to have intercourse. The mild antidepressant effect they found was unrelated to cohabitation or frequency, so it does not appear that the depression scores improved just because of the improved FSI.

For more mental health video, see:

Anything else we can do to enhance our sexual health and attractiveness? 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 / Flickr. 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.

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Are Sugar Pills Better than Antidepressant Drugs?

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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

Can Peppermint Improve Athletic Performance?

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Ever since smoking was prohibited in night clubs, customers have increasingly noticed other unpleasant smells present in the club--like body odors. So, researchers in Europe thought they'd try to cover them up. The researchers measured the effects of peppermint, for example, on dancing activity and asked people to rate their energy level. They found that with peppermint scent, people felt more cheerful and danced more, and so, concluded the researchers, "environmental fragrancing may be expected to have a positive effects on club revenue." Innovative nightclubs are already inviting "aroma jockeys" to smell the places up.

The business community caught whiff of this and thought maybe peppermint smell would get their secretaries to type faster. And it worked! There was improved performance on clerical tasks associated with the administration of peppermint odor.

In an age where athletic competitions are frequently won or lost by mere hundredths of a second, athletes are continually looking for new ways to excel in their sport. Researchers threw some collegiate athletes onto a treadmill and piped different smell into their nostrils, and those on peppermint reported feeling less fatigued, more vigorous, less frustrated, and felt they performed better. But did they actually perform better? See my video, Enhancing Athletic Performance with Peppermint.

A different study published in the Journal of Sport and Exercise Psychology measured actual performance, and participants were actually able to squeeze out one extra pushup before collapsing and cut almost two seconds off a quarter mile dash with an odorized adhesive strip stuck to their upper lip. Interestingly there was no significant difference in basketball free throws. The researchers think the reason is that free throws actually require some skill, and all the peppermint can do is really improve athlete's motivation.

Unfortunately follow-up studies were not able to replicate these results, showing no beneficial effect of smelling peppermint on athletic performance, so how about eating peppermint? Researchers measured the effects of peppermint on exercise performance before and after ten days of having subjects drink bottles of water with a single drop of peppermint essential oil in them. And all the subjects' performance parameters shot up, churning out 50 percent more work, 20 percent more power, and a 25 percent greater time to exhaustion. Improvements were found across the board in all those physiological parameters, indicating increased respiratory efficiency. They attribute these remarkable results to the peppermint opening up their airways, increasing ventilation and oxygen delivery.

Now, you can overdose on the stuff, but a few drops shouldn't be toxic. Why not get the best of both worls by blending fresh mint leaves in water rather than use the oil?

Sometimes aromatherapy alone may actually help, though:

Beet juice can also enhance athletic performance. See the dozen or so videos in the series starting with Doping With Beet Juice. Other ways healthy food can synergize with exercise:

I use peppermint in my Pink Juice with Green Foam recipe and talk about using the dried in Antioxidants in a Pinch. It can also help reduce IBS symptoms, as seen in Peppermint Oil for Irritable Bowel Syndrome.

Some other tea caveats, though:

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.

Image Credit: Cory Denton / Flickr

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