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was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.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 Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill.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 Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect.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

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

Original Link

Ciguatera Poisoning & Chronic Fatigue Syndrome

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Ciguatera is one of the most common forms of food poisoning, which occurs after the consumption of fish contaminated with neurotoxins produced by certain microalgae that build up the food chain. Just a few bites can be sufficient to induce the condition. Disturbingly, affected fish looks, smells, and tastes normal, and ciguatoxins are resistant to all forms of cooking. So, there is no straightforward method to predict whether a seafood meal can turn into a ciguatera nightmare.

It literally can cause nightmares; about one in six may experience signs of hallucinatory poisoning: lack of coordination, hallucinations, depression, and nightmares. Most suffer some kind of neurological symptoms such as tingling, numbness, and a burning cold sensation. Sometimes a reversal of temperature sensation occurs, where cold objects feel hot and vice versa. For instance, ciguatera sufferers have reported that a refreshing dive in the ocean actually caused burning pain, or that drinking cool beer felt like too hot coffee.

The toxin may also be apparently sexually transmitted, or as one of my favorite public health bloggers put it, "when hot sex turns cold and painful, blame it on dinner."

As seen in my video Ciguatera Poisoning & Chronic Fatigue Syndrome, the symptoms can persist for months or even years. Ongoing research has shown that people with chronic fatigue syndrome may actually be suffering the long-term effects of this fish food poisoning or a condition called polymyositis, which causes diffuse muscle aches, pains, and inflammation. Some individuals intoxicated by fish consumption 25 years previously experience a recurrence of the main neurological disturbances during periods of overwork, fatigue, or stress. You can still find the toxins stuck in your body decades later.

Recent outbreaks in New York City have drawn attention to the problem. For example, a man ate grouper at a Manhattan restaurant and went from swimming two miles a day to having difficulty walking that lasted for months. But these aren't just rare anecdotes. Ciguatera fish poisoning affects an estimated 15,000 Americans every year, causing hundreds of hospitalizations and even a few deaths. Because the toxins are colorless, odorless, tasteless, and not destroyed by cooking, CDC scientists suggest "education aimed at the prevention of seafood intoxication by avoidance of high-risk fish altogether."

The AMA put out a similar advisory, suggesting that the only way to prevent it is to avoid eating fish like red snapper or grouper, but the problem is that a third of fish sold in the United States is mislabeled, so we don't know what we're getting. Some suggest first feeding a portion of the fish meal to a cat, treating them like a court tester, and if they're okay six hours later, we can dig in -- but this was considered inhumane. But if it's inhumane to feed it to your cat, how is it not inhumane to feed it to other members of the family?

Many more are killed by more conventional food poisoning bugs (Chicken Salmonella Thanks to Meat Industry Lawsuit), but how scary that you can get these toxins stuck in you and ruin your life? Reminds me of my Amnesic Seafood Poisoning video.

Other neurotoxin videos include Preventing Parkinson's Disease With Diet and Essential Tremor and Diet.

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: Pen Waggener / Flickr

Original Link

Dietary Estrogens and Male Fertility

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In my video, The Role of Diet in Declining Sperm Counts, I discussed the association between high saturated fat intake and reduced semen quality. But what's the connection? One of the most recent papers on the topic found that a significant percentage of the saturated fat intake in the study was derived from dairy products. Residues of industrial chemicals may bioaccumulate up the food chain into animal fat, and some of these lipophilic (fat-loving) chemicals may have hormone-disrupting abilities.

The U.S. Environmental Protection Agency performed a national survey of persistent, bioaccumulative, and toxic pollutants in the U.S. milk supply (highlighted in my video, Dairy Estrogen and Male Fertility). The EPA team noted that since milk fat is likely to be among the highest dietary sources of exposure to these pollutants, it's important to understand the levels in the dairy supply. The team tested milk from all over the country and found a veritable witches brew of chemicals. They estimate that dairy products alone contribute about 30% to 50% of our dioxin exposure. And "like dioxin, other toxic pollutants tend to be widely dispersed in the environment, bioaccumulated through the food chain and ultimately result in low-level contamination in most animal fats."

This may explain higher pollutant concentrations in fish eaters. Xenoestrogens like polychlorinated biphenyls (PCBs) are associated with the fats of fish or animal flesh and cannot be fully removed by washing and cooking, and so can accumulate in our fat, too. Xenoestrogens are chemicals with demasculinizing or feminizing effects. But even in a non-polluted world, animal foods also have actual estrogen, which are unavoidable constituents of animal products. All foodstuff of animal origin contains estradiol, which is at least 10,000-fold more potent than most xenoestrogens. Dietary exposure--meat, dairy products and eggs--to these natural sex steroids is therefore highly relevant, as the hormones in these animals are identical to our own.

Estrogens are present in meat and eggs, but the major sources are milk and dairy products. By drinking a glass of milk, a child's intake of estradiol is 4,000 times the intake of xenoestrogens in terms of hormone activity. Modern genetically-improved dairy cows can lactate throughout their pregnancy. The problem is that during pregnancy, estrogen levels can jump as much as 30-fold.

Cheese intake has specifically been associated with lower sperm concentration, whereas dairy food intake in general has been associated with abnormal sperm shape and movement. Lower sperm concentrations by themselves may just represent a potential suppression of sperm production due to higher estrogen levels, but abnormal shape and movement suggests that dairy intake may be implicated in actual direct testicular damage.

While milk products supply most of our ingested female sex steroids, eggs are a considerable source as well, contributing about as much as meat and fish. This could be expected, as eggs are produced directly in the hens' ovaries.

Meat may also contain added hormones. In the U.S. anabolic sex steroids may be administered to animals for growth promotion, a practice banned in Europe twenty-five years ago. A study in New York found progressively lower sperm counts associated with processed meat consumption. However, similar studies in Europe after the ban found the same thing, so it may not be the implanted hormones, but rather a consequence of other meat components, such as the saturated fat raising cholesterol levels.

We've known for decades that men with high cholesterol levels show abnormalities in their "spermiograms": decreased sperm concentration, about a third of the normal sperm movement, and half the normal sperm shape. Twenty-five years later, we're finding the same thing. In the largest study to date, higher blood cholesterol levels were associated with a significantly lower percentage of normal sperm. Cholesterol was also associated with reductions in semen volume and live sperm count. These results highlight the role of fats in the blood in male fertility, and should be of concern given the rising prevalence of obesity and cholesterol problems. Although a healthier diet may be associated with healthier sperm counts, cholesterol-lowering statin drugs do not seem to help.

What about the phytoestrogens in soy? See The Effect of Soy on Precocious Puberty.

More on hormones in dairy in:

Neurotoxic chemicals in the dairy supply have been blamed for neurological conditions as well. See my video Preventing Parkinson's Disease with Diet.

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: Taber Andrew Bain / Flickr

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Exploiting Autophagy to Live Longer

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Thanks to advances in modern medicine, we are living longer lives, but we're doing it by lengthening the morbidity phase. In other words, we live longer, but sicker, lives (see my video: Americans Are Live Longer, but Sicker Lives). So, traditional medicine increases the number of old people in bad health. Ideally, though, we'd extend lifespan by slowing aging to delay the onset of deterioration, rather than extending the period of deterioration.

That's exactly what a new compound appears to do. It sounds like science fiction. A bacteria in a vial of dirt taken from a mysterious island creating a compound that prolongs life. And not in the traditional medical sense. Researchers in a study profiled in my video, Why Do We Age?, called it rapamycin--named after the bacteria's home, Easter Island, which is known locally as Rapa Nui. Rapamycin inhibits an enzyme called TOR, or "target of rapamycin." TOR may be a master determinant of lifespan and aging. The action of TOR has been described as the engine of a speeding car without brakes.

Rather than thinking of aging as slowly rusting, a better analogy may be a speeding car that enters the low-speed zone of adulthood and damages itself because it does not and cannot slow down. Why don't living organisms have brakes? Because they've never needed them. In the wild, animals don't live long enough to experience aging. Most die before they even reach adulthood. The same used to be true for humans. For example, just a few centuries ago, average life expectancy in London was less than 16 years old.

Therefore, living beings need to grow as fast as possible to start reproduction before they die from external causes. The best evolutionary strategy may be to run at full speed. However, once we pass the finish line, once we win the race to pass on our genes, we're still careening forward at an unsustainable pace, all thanks to this enzyme TOR. In our childhood, TOR is an engine of growth, but in adulthood, it is the engine of aging. "Nature simply selects for the brightest flame, which in turn casts the darkest shadow."

Sometimes, though, even in our youth, our bodies need to turn down the heat. When we were evolving, there were no grocery stores; periodic famine was the norm. So sometimes even young people had to slow down or they might never even make it to reproductive age. So we did evolve one braking mechanism: caloric restriction. Caloric restriction may extend lifespan mainly through the inhibition of TOR.

When food is abundant, TOR activity goes up, prompting the cells in our body to divide. When TOR detects that food is scarce, it shifts the body into conservation mode, slowing down cell division and kicking in a process called autophagy, from the Greek auto meaning "self," and phagy meaning "to eat." Autophagy essentially means eating yourself. Our body realizes there isn't much food around and starts rummaging through our cells looking for anything we don't need. Defective proteins, malfunctioning mitochondria, stuff that isn't working anymore, and cleans house. Clears out all the junk and recycles it into fuel or new building materials, renewing our cells.

So caloric restriction has been heralded as a fountain of youth. The potential health and longevity benefits of such a diet regimen may be numerous, but symptoms may include dropping our blood pressure too low, loss of libido, menstrual irregularities, infertility, loss of bone, cold sensitivity, loss of strength, slower wound healing, and psychological conditions such as depression, emotional deadening, and irritability. And you walk around starving all the time! There's got to be a better way, and there is. Check out my video Caloric Restriction vs. Animal Protein Restriction.

More tips for preserving youthful 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: Arian Zwegers / Flickr

Original Link

Alkylphenol Endocrine Disruptors and Allergies

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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

What’s Driving America’s Obesity Problem?

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Currently, nearly two-thirds of Americans are overweight. By 2030 it is estimated more than half our population may be clinically obese. Childhood obesity has tripled, and most children will grow up to be overweight as well. The United States may be in the midst of raising the first generation since our nation's founding that will have a shorter predicted life span than that of the previous generation.

The food industry blames inactivity. We just need to move more, they say. But what is the role of exercise in the treatment of obesity?

"There is considerable debate in the medical literature today about whether physical activity has any role whatsoever in the epidemic of obesity that has swept the globe since the 1980s." The increase in calories per person is more than sufficient to explain the U.S. epidemic of obesity. In fact, if anything, the level of physical activity over the last few decades has actually gone up in both Europe and North America.

This has important policy implications. We still need to exercise more, but the priorities for reversing the obesity epidemic should focus on the overconsumption of calories (See How Much Exercise to Sustain Weight Loss?). American children are currently eating about an extra 350 calories (equal to about a can of soda and small fries), and adults are eating about an extra 500 calories (equal to about a Big Mac). We'd have to walk two hours a day, seven days a week to burn off those calories. So exercise can prevent weight gain, but the amount required to prevent weight gain may be closer to twice the current recommendations. It's more effective to stick to foods rich in nutrients but poor in calories: see my video Calculate Your Healthy Eating Score. It's cheaper too, see Best Nutrition Bang For Your Buck.

Public health advocates have been experimenting with including this kind of information. One study found that fast food menus labeled with calories and the number of miles to walk to burn those calories appeared the most effective in influencing the selection of lower calorie meals.

Exercise alone may have a small effect, and that small effect can make a big difference on a population scale. A 1% decrease in BMI nationwide might prevent millions of cases of diabetes and heart disease and thousands of cases of cancer. But why don't we lose more weight from exercise? It may be because we're just not doing it enough. "The small magnitude of weight loss observed from the majority of exercise interventions may be primarily due to low doses of prescribed exercise."

People tend to overestimate how many calories are burned by physical activity. For example, there's this myth that a bout of sexual activity burns a few hundred calories. So may think, "Hey, I could get a side of fries with that." But if we actually hook people up and measure energy expenditure during the act (and the study subjects don't get too tangled up with all the wires and hoses) it may be only close to the metabolic equivalent of calisthenics. Given that the average bout of sexual activity only lasts about six minutes, a young man might expend approximately 21 calories during sexual intercourse. Due to baseline metabolic needs, he would have spent roughly one third of that just lying around watching TV, so the incremental benefit is plausibly on the order of 14 calories. So maybe he could have one fry with that.

I previously touched on this in my video Diet or Exercise, What's More Important For Weight Loss?

Don't get me wrong--exercise is wonderful! Check out, for example:

-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: Glamhag / Flickr

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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

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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

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