9 out of 10 That Die From it Never Knew They Even Had This Preventable Disease

9 out of 10 That Die From it Never Knew They Even Had This Preventable Disease.jpeg

Diverticula are out-pouchings of our intestine. Doctors like using a tire analogy: high pressures within the gut can force the intestines to balloon out through weak spots in the intestinal wall like an inner tube poking out through a worn tire tread. You can see what they actually look like in my video, Diverticulosis: When Our Most Common Gut Disorder Hardly Existed. These pockets can become inflamed and infected, and, to carry the tire analogy further, can blow out and spill fecal matter into the abdomen, and lead to death. Symptoms can range from no symptoms at all, to a little cramping and bloating, to "incapacitating pain that is a medical emergency." Nine out of ten people who die from the disease never even knew they had it.

The good news is there may be a way to prevent the disease. Diverticular disease is the most common intestinal disorder, affecting up to 70% of people by age 60. If it's that common, though, is it just an inevitable consequence of aging? No, it's a new disease. In 1907, 25 cases had been reported in the medical literature. Not cases in 25% of people, but 25 cases period. And diverticular disease is kind of hard to miss on autopsy. A hundred years ago, in 1916, it didn't even merit mention in medical and surgical textbooks. The mystery wasn't solved until 1971.

How did a disease that was almost unknown become the most common affliction of the colon in the Western world within one lifespan? Surgeons Painter and Burkitt suggested diverticulosis was a deficiency disease--i.e., a disease caused by a deficiency of fiber. In the late 1800s, roller milling was introduced, further removing fiber from grain, and we started to fill up on other fiber-deficient foods like meat and sugar. A few decades of this and diverticulosis was rampant.

This is what Painter and Burkitt thought was going on: Just as it would be easy to squeeze a lump of butter through a bicycle tube, it's easy to move large, soft, and moist intestinal contents through the gut. In contrast, try squeezing through a lump of tar. When we eat fiber-deficient diets, our feces can become small and firm, and our intestines have to really squeeze down hard to move them along. This buildup of pressure may force out those bulges. Eventually, a low-fiber diet can sometimes lead to the colon literally rupturing itself.

If this theory is true, then populations eating high­-fiber diets would have low rates of diverticulosis. That's exactly what's been found. More than 50% of African Americans in their 50s were found to have diverticulosis, compared to less than 1% in African Africans eating traditional plant-based diets. By less than 1%, we're talking zero out of a series of 2,000 autopsies in South Africa and two out of 4,000 in Uganda. That's about one thousand times lower prevalence.

What, then, do we make of a new study concluding that a low-fiber diet was not associated with diverticulosis. I cover that in my video Does Fiber Really Prevent Diverticulosis?

For more on bowel health, see:

What if your doctor says you shouldn't eat healthy foods like nuts and popcorn because of your diverticulosis? Share with them my Diverticulosis & Nuts video.

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: Sean T Evans / Flickr. This image has been modified.

Original Link

9 out of 10 That Die From it Never Knew They Even Had This Preventable Disease

9 out of 10 That Die From it Never Knew They Even Had This Preventable Disease.jpeg

Diverticula are out-pouchings of our intestine. Doctors like using a tire analogy: high pressures within the gut can force the intestines to balloon out through weak spots in the intestinal wall like an inner tube poking out through a worn tire tread. You can see what they actually look like in my video, Diverticulosis: When Our Most Common Gut Disorder Hardly Existed. These pockets can become inflamed and infected, and, to carry the tire analogy further, can blow out and spill fecal matter into the abdomen, and lead to death. Symptoms can range from no symptoms at all, to a little cramping and bloating, to "incapacitating pain that is a medical emergency." Nine out of ten people who die from the disease never even knew they had it.

The good news is there may be a way to prevent the disease. Diverticular disease is the most common intestinal disorder, affecting up to 70% of people by age 60. If it's that common, though, is it just an inevitable consequence of aging? No, it's a new disease. In 1907, 25 cases had been reported in the medical literature. Not cases in 25% of people, but 25 cases period. And diverticular disease is kind of hard to miss on autopsy. A hundred years ago, in 1916, it didn't even merit mention in medical and surgical textbooks. The mystery wasn't solved until 1971.

How did a disease that was almost unknown become the most common affliction of the colon in the Western world within one lifespan? Surgeons Painter and Burkitt suggested diverticulosis was a deficiency disease--i.e., a disease caused by a deficiency of fiber. In the late 1800s, roller milling was introduced, further removing fiber from grain, and we started to fill up on other fiber-deficient foods like meat and sugar. A few decades of this and diverticulosis was rampant.

This is what Painter and Burkitt thought was going on: Just as it would be easy to squeeze a lump of butter through a bicycle tube, it's easy to move large, soft, and moist intestinal contents through the gut. In contrast, try squeezing through a lump of tar. When we eat fiber-deficient diets, our feces can become small and firm, and our intestines have to really squeeze down hard to move them along. This buildup of pressure may force out those bulges. Eventually, a low-fiber diet can sometimes lead to the colon literally rupturing itself.

If this theory is true, then populations eating high­-fiber diets would have low rates of diverticulosis. That's exactly what's been found. More than 50% of African Americans in their 50s were found to have diverticulosis, compared to less than 1% in African Africans eating traditional plant-based diets. By less than 1%, we're talking zero out of a series of 2,000 autopsies in South Africa and two out of 4,000 in Uganda. That's about one thousand times lower prevalence.

What, then, do we make of a new study concluding that a low-fiber diet was not associated with diverticulosis. I cover that in my video Does Fiber Really Prevent Diverticulosis?

For more on bowel health, see:

What if your doctor says you shouldn't eat healthy foods like nuts and popcorn because of your diverticulosis? Share with them my Diverticulosis & Nuts video.

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: Sean T Evans / Flickr. This image has been modified.

Original Link

Does Sugar Cause Diabetes?

The recent film What the Health raised the question as to whether sugar or other carbohydrates cause diabetes. Because blood sugar levels are high in diabetes, a common notion has held that eating sugar somehow triggers the disease process.  The... Read more

Original Link

Big Sugar Takes on the World Health Organization

Big Sugar Takes on the World Health Organization.jpeg

The World Health Organization (WHO) recommends we reduce our consumption of salt, trans fats, saturated fats, and added sugars. Why? Because consumption of such foods is the cause of at least 14 million deaths every year from chronic diseases.

"Several decades ago, it was heresy to talk about an impending global pandemic of obesity." Today, we're seeing chronic disease rates skyrocket around the world. The Western diet has been exported to the far reaches of the planet, with white flour, sugar, fat, and animal-based foods replacing beans, peas, lentils, other vegetables, and whole grains.

In order to understand the reasons underlying this trend toward greater consumption of animal products, sugar, and oils, and reduced consumption of whole plant foods, we need to begin by understanding the purposeful economic manipulations that have occurred since World War II relating to agricultural policies around the world. For example, since early in the last century, the U.S. government "has supported food production through subsidies and other policies, resulting in large surpluses of food commodities, meat, and calories. In this artificial market, large food producers and corporations-Big Agriculture and Big Food-became very profitable." Their profitability may be part of the problem.

Dr. Margaret Chan, the Director-General of the World Health Organization, gave the opening address at the 8th Global Conference on Health Promotion. One of the biggest challenges facing health promotion worldwide, she said, is that the efforts to prevent our top killers "go against the business interests of powerful economic operators." It is not just Big Tobacco anymore. "Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation and protect themselves by using the same tactics...front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt."

And the World Health Organization should know. In 2003, the organization released a draft report that outlined a global strategy to address issues of diet. Although many of the WHO's recommendations were rather tame, a remarkable series of events was spurred by six words in the report: "limit the intake of 'free' sugars" (added sugar). Within days, the sugar industry, through the Sugar Association, enlisted the support of officials high in the U.S. government and led a vigorous attack on both the report and the World Health Organization itself, culminating in a threat to get Congress to withdraw U.S. funding to the WHO. The WHO, the organization that "deals with AIDS, malnutrition, infectious disease, bioterrorism, and more, threatened because of its stance on sugar." At the same time, the U.S. went to bat for American tobacco companies and led the charge against the World Health Organization's Framework Convention on Tobacco Control.

As discussed in my video, Big Sugar Takes on the World Health Organization, the threat from the sugar industry was described by WHO insiders as worse than any pressure they ever got from the tobacco lobby. As revealed in an internal memo, the U.S. government apparently had a list of demands. These included deletion of all references to the science that WHO experts had compiled on the matter and the removal of all references to fat, oils, sugar, and salt.

The threats failed to make the WHO withdraw their report. Entitled "Diet, Nutrition and the Prevention of Chronic Disease," it "concluded that a diet low in saturated fat, sugar and salt and high in fruit and vegetables was required to tackle the epidemic rise in chronic diseases worldwide." They did end up watering it down, though. Gone was reference to the comprehensive scientific report, and gone was its call for its recommendations to be actually translated into national guidelines.

History has since repeated. At the last high-level United Nations meeting to address chronic diseases, representatives from some Western countries, including the United States, helped block a consensus on action after lobbying from the alcohol, food, tobacco, and drug industries. When asked why Michelle Obama's successful childhood obesity programs in the U.S. should not be modeled around the world, a U.S. official responded that they might harm American exports.

See also: How Much Added Sugar Is Too Much?

If sugar is bad, then what about all the sugar in fruit? See If Fructose Is Bad, What About Fruit? and How Much Fruit Is Too Much?.

For more on the corrupting political and economic influences in nutrition, see videos such as:

And because of that, check out a couple of my introductory videos: Why You Should Care about Nutrition and Taking Personal Responsibility for Your Health.

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

Big Sugar Takes on the World Health Organization

Big Sugar Takes on the World Health Organization.jpeg

The World Health Organization (WHO) recommends we reduce our consumption of salt, trans fats, saturated fats, and added sugars. Why? Because consumption of such foods is the cause of at least 14 million deaths every year from chronic diseases.

"Several decades ago, it was heresy to talk about an impending global pandemic of obesity." Today, we're seeing chronic disease rates skyrocket around the world. The Western diet has been exported to the far reaches of the planet, with white flour, sugar, fat, and animal-based foods replacing beans, peas, lentils, other vegetables, and whole grains.

In order to understand the reasons underlying this trend toward greater consumption of animal products, sugar, and oils, and reduced consumption of whole plant foods, we need to begin by understanding the purposeful economic manipulations that have occurred since World War II relating to agricultural policies around the world. For example, since early in the last century, the U.S. government "has supported food production through subsidies and other policies, resulting in large surpluses of food commodities, meat, and calories. In this artificial market, large food producers and corporations-Big Agriculture and Big Food-became very profitable." Their profitability may be part of the problem.

Dr. Margaret Chan, the Director-General of the World Health Organization, gave the opening address at the 8th Global Conference on Health Promotion. One of the biggest challenges facing health promotion worldwide, she said, is that the efforts to prevent our top killers "go against the business interests of powerful economic operators." It is not just Big Tobacco anymore. "Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation and protect themselves by using the same tactics...front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt."

And the World Health Organization should know. In 2003, the organization released a draft report that outlined a global strategy to address issues of diet. Although many of the WHO's recommendations were rather tame, a remarkable series of events was spurred by six words in the report: "limit the intake of 'free' sugars" (added sugar). Within days, the sugar industry, through the Sugar Association, enlisted the support of officials high in the U.S. government and led a vigorous attack on both the report and the World Health Organization itself, culminating in a threat to get Congress to withdraw U.S. funding to the WHO. The WHO, the organization that "deals with AIDS, malnutrition, infectious disease, bioterrorism, and more, threatened because of its stance on sugar." At the same time, the U.S. went to bat for American tobacco companies and led the charge against the World Health Organization's Framework Convention on Tobacco Control.

As discussed in my video, Big Sugar Takes on the World Health Organization, the threat from the sugar industry was described by WHO insiders as worse than any pressure they ever got from the tobacco lobby. As revealed in an internal memo, the U.S. government apparently had a list of demands. These included deletion of all references to the science that WHO experts had compiled on the matter and the removal of all references to fat, oils, sugar, and salt.

The threats failed to make the WHO withdraw their report. Entitled "Diet, Nutrition and the Prevention of Chronic Disease," it "concluded that a diet low in saturated fat, sugar and salt and high in fruit and vegetables was required to tackle the epidemic rise in chronic diseases worldwide." They did end up watering it down, though. Gone was reference to the comprehensive scientific report, and gone was its call for its recommendations to be actually translated into national guidelines.

History has since repeated. At the last high-level United Nations meeting to address chronic diseases, representatives from some Western countries, including the United States, helped block a consensus on action after lobbying from the alcohol, food, tobacco, and drug industries. When asked why Michelle Obama's successful childhood obesity programs in the U.S. should not be modeled around the world, a U.S. official responded that they might harm American exports.

See also: How Much Added Sugar Is Too Much?

If sugar is bad, then what about all the sugar in fruit? See If Fructose Is Bad, What About Fruit? and How Much Fruit Is Too Much?.

For more on the corrupting political and economic influences in nutrition, see videos such as:

And because of that, check out a couple of my introductory videos: Why You Should Care about Nutrition and Taking Personal Responsibility for Your Health.

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

White Meat May Be as Cholesterol-Raising as Red

White Meat May Be as Cholesterol-Raising as Red.jpeg

In light of recommendations for heart healthy eating from national professional organizations encouraging Americans to limit their intake of meat, the beef industry commissioned and co-wrote a review of randomized controlled trials comparing the effects of beef versus chicken and fish on cholesterol levels published over the last 60 years. They found that the impact of beef consumption on the cholesterol profile of humans is similar to that of fish and/or poultry--meaning that switching from red meat to white meat likely wouldn't make any difference. And that's really no surprise, given how fat we've genetically manipulated chickens to be these days, up to ten times more fat than they had a century ago (see Does Eating Obesity Cause Obesity?).

There are a number of cuts of beef that have less cholesterol-raising saturated fat than chicken (see BOLD Indeed: Beef Lowers Cholesterol?), so it's not so surprising that white meat was found to be no better than red, but the beef industry researchers conclusion was that "therefore you can eat beef as part of a balanced diet to manage your cholesterol."

Think of the Coke versus Pepsi analogy. Coke has less sugar than Pepsi: 15 spoonfuls of sugar per bottle instead of 16. If studies on blood sugar found no difference between drinking Coke versus Pepsi, you wouldn't conclude that "Pepsi may be considered when recommending diets for the management of blood sugars," you'd say they're both equally as bad so we should ideally consume neither.

That's a standard drug industry trick. You don't compare your fancy new drug to the best out there, but to some miserable drug to make yours look better. Note they didn't compare beef to plant proteins, like in this study published in the American Journal of Clinical Nutrition. As I started reading it, though, I was surprised that they found no benefit of switching to a plant protein diet either. What were they eating? You can see the comparison in Switching from Beef to Chicken & Fish May Not Lower Cholesterol.

For breakfast, the plant group got a kidney bean and tomato casserole and a salad, instead of a burger. And for dinner, instead of another burger, the plant protein group just got some boring vegetables. So why was the cholesterol of the plant group as bad as the animal group? They had the plant protein group eating three tablespoons of beef tallow every day--three tablespoons of straight beef fat!

This was part of a series of studies that tried to figure out what was so cholesterol-raising about meat--was it the animal protein or was it the animal fat? So, researchers created fake meat products made to have the same amount of saturated fat and cholesterol by adding extracted animal fats and cholesterol. Who could they get to make such strange concoctions? The Ralston Purina dog food company.

But what's crazy is that even when keeping the saturated animal fat and cholesterol the same (by adding meat fats to the veggie burgers and making the plant group swallow cholesterol pills to equal it out), sometimes they still saw a cholesterol lowering advantage in the plant protein group.

If you switch people from meat to tofu, their cholesterol goes down, but what if you switch them from meat to tofu plus lard? Then their cholesterol may stay the same, though tofu and lard may indeed actually be better than meat, since it may result in less oxidized cholesterol. More on the role of oxidized cholesterol can be found in my videos Does Cholesterol Size Matter? and Arterial Acne.

Just swapping plant protein for animal protein may have advantages, but if you really want to maximize the power of diet to lower cholesterol, you may have to move entirely toward plants. The standard dietary advice to cut down on fatty meat, dairy, and eggs may lower cholesterol 5-10%, but flexitarian or vegetarian diets may drop our levels 10 to 15%, vegan diets 15 to 25%, and healthier vegan diets can cut up to 35%, as seen in this study out of Canada showing a whopping 61 point drop in LDL cholesterol within a matter of weeks.


You thought chicken was a low-fat food? It used to be a century ago, but not anymore. It may even be one of the reasons we're getting fatter as well: Chicken Big: Poultry and Obesity and Infectobesity: Adenovirus 36 and Childhood Obesity.

Isn't protein just protein? How does our body know if it's coming from a plant or an animal? How could it have different effects on cardiovascular risk? See Protein and Heart Disease, another reason why Plant Protein [is] Preferable.

Lowering cholesterol in your blood is as simple as reducing one's intake of three things: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

What about those news stories on the "vindication" of saturated fat? See the sneaky science in The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

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: CDC/Debora Cartagena via Freestockphotos.biz. This image has been modified.

Original Link

White Meat May Be as Cholesterol-Raising as Red

White Meat May Be as Cholesterol-Raising as Red.jpeg

In light of recommendations for heart healthy eating from national professional organizations encouraging Americans to limit their intake of meat, the beef industry commissioned and co-wrote a review of randomized controlled trials comparing the effects of beef versus chicken and fish on cholesterol levels published over the last 60 years. They found that the impact of beef consumption on the cholesterol profile of humans is similar to that of fish and/or poultry--meaning that switching from red meat to white meat likely wouldn't make any difference. And that's really no surprise, given how fat we've genetically manipulated chickens to be these days, up to ten times more fat than they had a century ago (see Does Eating Obesity Cause Obesity?).

There are a number of cuts of beef that have less cholesterol-raising saturated fat than chicken (see BOLD Indeed: Beef Lowers Cholesterol?), so it's not so surprising that white meat was found to be no better than red, but the beef industry researchers conclusion was that "therefore you can eat beef as part of a balanced diet to manage your cholesterol."

Think of the Coke versus Pepsi analogy. Coke has less sugar than Pepsi: 15 spoonfuls of sugar per bottle instead of 16. If studies on blood sugar found no difference between drinking Coke versus Pepsi, you wouldn't conclude that "Pepsi may be considered when recommending diets for the management of blood sugars," you'd say they're both equally as bad so we should ideally consume neither.

That's a standard drug industry trick. You don't compare your fancy new drug to the best out there, but to some miserable drug to make yours look better. Note they didn't compare beef to plant proteins, like in this study published in the American Journal of Clinical Nutrition. As I started reading it, though, I was surprised that they found no benefit of switching to a plant protein diet either. What were they eating? You can see the comparison in Switching from Beef to Chicken & Fish May Not Lower Cholesterol.

For breakfast, the plant group got a kidney bean and tomato casserole and a salad, instead of a burger. And for dinner, instead of another burger, the plant protein group just got some boring vegetables. So why was the cholesterol of the plant group as bad as the animal group? They had the plant protein group eating three tablespoons of beef tallow every day--three tablespoons of straight beef fat!

This was part of a series of studies that tried to figure out what was so cholesterol-raising about meat--was it the animal protein or was it the animal fat? So, researchers created fake meat products made to have the same amount of saturated fat and cholesterol by adding extracted animal fats and cholesterol. Who could they get to make such strange concoctions? The Ralston Purina dog food company.

But what's crazy is that even when keeping the saturated animal fat and cholesterol the same (by adding meat fats to the veggie burgers and making the plant group swallow cholesterol pills to equal it out), sometimes they still saw a cholesterol lowering advantage in the plant protein group.

If you switch people from meat to tofu, their cholesterol goes down, but what if you switch them from meat to tofu plus lard? Then their cholesterol may stay the same, though tofu and lard may indeed actually be better than meat, since it may result in less oxidized cholesterol. More on the role of oxidized cholesterol can be found in my videos Does Cholesterol Size Matter? and Arterial Acne.

Just swapping plant protein for animal protein may have advantages, but if you really want to maximize the power of diet to lower cholesterol, you may have to move entirely toward plants. The standard dietary advice to cut down on fatty meat, dairy, and eggs may lower cholesterol 5-10%, but flexitarian or vegetarian diets may drop our levels 10 to 15%, vegan diets 15 to 25%, and healthier vegan diets can cut up to 35%, as seen in this study out of Canada showing a whopping 61 point drop in LDL cholesterol within a matter of weeks.


You thought chicken was a low-fat food? It used to be a century ago, but not anymore. It may even be one of the reasons we're getting fatter as well: Chicken Big: Poultry and Obesity and Infectobesity: Adenovirus 36 and Childhood Obesity.

Isn't protein just protein? How does our body know if it's coming from a plant or an animal? How could it have different effects on cardiovascular risk? See Protein and Heart Disease, another reason why Plant Protein [is] Preferable.

Lowering cholesterol in your blood is as simple as reducing one's intake of three things: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

What about those news stories on the "vindication" of saturated fat? See the sneaky science in The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

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: CDC/Debora Cartagena via Freestockphotos.biz. This image has been modified.

Original Link

Can You Eat Too Much Fruit?

Can You Eat Too Much Fruit?.jpeg

In my video If Fructose is Bad, What About Fruit?, I explored how adding berries to our meals can actually blunt the detrimental effects of high glycemic foods, but how many berries? The purpose of one study out of Finland was to determine the minimum level of blueberry consumption at which a consumer may realistically expect to receive antioxidant benefits after eating blueberries with a sugary breakfast cereal. If we eat a bowl of corn flakes with no berries, within two hours, so many free radicals are created that it puts us into oxidative debt. The antioxidant power of our bloodstream drops below where we started from before breakfast, as the antioxidants in our bodies get used up dealing with such a crappy breakfast. As you can see in How Much Fruit is Too Much? video, a quarter cup of blueberries didn't seem to help much, but a half cup of blueberries did.

What about fruit for diabetics? Most guidelines recommend eating a diet with a high intake of fiber-rich food, including fruit, because they're so healthy--antioxidants, anti-inflammatory, improving artery function, and reducing cancer risk. However, some health professionals have concerns about the sugar content of fruit and therefore recommend restricting the fruit intake. So let's put it to the test! In a study from Denmark, diabetics were randomized into two groups: one told to eat at least two pieces of fruit a day, and the other told at most, two fruits a day. The reduce fruit group indeed reduce their fruit consumption, but it had no effect on the control of their diabetes or weight, and so, the researchers concluded, the intake of fruit should not be restricted in patients with type 2 diabetes. An emerging literature has shown that low-dose fructose may actually benefit blood sugar control. Having a piece of fruit with each meal would be expected to lower, not raise the blood sugar response.

The threshold for toxicity of fructose may be around 50 grams. The problem is that's the current average adult fructose consumption. So, the levels of half of all adults are likely above the threshold for fructose toxicity, and adolescents currently average 75. Is that limit for added sugars or for all fructose? If we don't want more than 50 and there's about ten in a piece of fruit, should we not eat more than five fruit a day? Quoting from the Harvard Health Letter, "the nutritional problems of fructose and sugar come when they are added to foods. Fruit, on the other hand, is beneficial in almost any amount." What do they mean almost? Can we eat ten fruit a day? How about twenty fruit a day?

It's actually been put to the test.

Seventeen people were made to eat 20 servings a day of fruit. Despite the extraordinarily high fructose content of this diet, presumably about 200 g/d--eight cans of soda worth, the investigators reported no adverse effects (and possible benefit actually) for body weight, blood pressure, and insulin and lipid levels after three to six months. More recently, Jenkins and colleagues put people on about a 20 servings of fruit a day diet for a few weeks and found no adverse effects on weight or blood pressure or triglycerides, and an astounding 38 point drop in LDL cholesterol.

There was one side effect, though. Given the 44 servings of vegetables they had on top of all that fruit, they recorded the largest bowl movements apparently ever documented in a dietary intervention.


Cutting down on sugary foods may be easier said than done (see Are Sugary Foods Addictive?) but it's worth it. For more on the dangers of high levels of fructose in added sugars, see How Much Added Sugar Is Too Much?.

What's that about being in oxidative debt? See my three part series on how to pull yourself out of the red:

Ironically, fat may be more of a problem when it comes to diabetes than sugar, 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

Can You Eat Too Much Fruit?

Can You Eat Too Much Fruit?.jpeg

In my video If Fructose is Bad, What About Fruit?, I explored how adding berries to our meals can actually blunt the detrimental effects of high glycemic foods, but how many berries? The purpose of one study out of Finland was to determine the minimum level of blueberry consumption at which a consumer may realistically expect to receive antioxidant benefits after eating blueberries with a sugary breakfast cereal. If we eat a bowl of corn flakes with no berries, within two hours, so many free radicals are created that it puts us into oxidative debt. The antioxidant power of our bloodstream drops below where we started from before breakfast, as the antioxidants in our bodies get used up dealing with such a crappy breakfast. As you can see in How Much Fruit is Too Much? video, a quarter cup of blueberries didn't seem to help much, but a half cup of blueberries did.

What about fruit for diabetics? Most guidelines recommend eating a diet with a high intake of fiber-rich food, including fruit, because they're so healthy--antioxidants, anti-inflammatory, improving artery function, and reducing cancer risk. However, some health professionals have concerns about the sugar content of fruit and therefore recommend restricting the fruit intake. So let's put it to the test! In a study from Denmark, diabetics were randomized into two groups: one told to eat at least two pieces of fruit a day, and the other told at most, two fruits a day. The reduce fruit group indeed reduce their fruit consumption, but it had no effect on the control of their diabetes or weight, and so, the researchers concluded, the intake of fruit should not be restricted in patients with type 2 diabetes. An emerging literature has shown that low-dose fructose may actually benefit blood sugar control. Having a piece of fruit with each meal would be expected to lower, not raise the blood sugar response.

The threshold for toxicity of fructose may be around 50 grams. The problem is that's the current average adult fructose consumption. So, the levels of half of all adults are likely above the threshold for fructose toxicity, and adolescents currently average 75. Is that limit for added sugars or for all fructose? If we don't want more than 50 and there's about ten in a piece of fruit, should we not eat more than five fruit a day? Quoting from the Harvard Health Letter, "the nutritional problems of fructose and sugar come when they are added to foods. Fruit, on the other hand, is beneficial in almost any amount." What do they mean almost? Can we eat ten fruit a day? How about twenty fruit a day?

It's actually been put to the test.

Seventeen people were made to eat 20 servings a day of fruit. Despite the extraordinarily high fructose content of this diet, presumably about 200 g/d--eight cans of soda worth, the investigators reported no adverse effects (and possible benefit actually) for body weight, blood pressure, and insulin and lipid levels after three to six months. More recently, Jenkins and colleagues put people on about a 20 servings of fruit a day diet for a few weeks and found no adverse effects on weight or blood pressure or triglycerides, and an astounding 38 point drop in LDL cholesterol.

There was one side effect, though. Given the 44 servings of vegetables they had on top of all that fruit, they recorded the largest bowl movements apparently ever documented in a dietary intervention.


Cutting down on sugary foods may be easier said than done (see Are Sugary Foods Addictive?) but it's worth it. For more on the dangers of high levels of fructose in added sugars, see How Much Added Sugar Is Too Much?.

What's that about being in oxidative debt? See my three part series on how to pull yourself out of the red:

Ironically, fat may be more of a problem when it comes to diabetes than sugar, 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

What Not to Add to White Rice, Potatoes, or Pasta

What Not to Add to White Rice, Potatoes, or Pasta.jpeg

Rice currently feeds almost half the human population, making it the single most important staple food in the world, but a meta-analysis of seven cohort studies following 350,000 people for up to 20 years found that higher consumption of white rice was associated with a significantly increased risk of type 2 diabetes, especially in Asian populations. They estimated each serving per day of white rice was associated with an 11% increase in risk of diabetes. This could explain why China has almost the same diabetes rates as we do.

Diabetes rates in China are at about 10%; we're at about 11%, despite seven times less obesity in China. Japan has eight times less obesity than we do, yet may have a higher incidence of newly diagnosed diabetes cases than we do--nine per a thousand compared to our eight. They're skinnier and still may have more diabetes. Maybe it's because of all the white rice they eat.

Eating whole fruit is associated with lower risk of diabetes, whereas eating fruit processed into juice may not just be neutral, but actually increases diabetes risk. In the same way, eating whole grains, like whole wheat bread or brown rice is associated with lower risk of diabetes, whereas eating white rice, a processed grain, may not just be neutral, but actually increase diabetes risk.

White rice consumption does not appear to be associated with increased risk of heart attack or stroke, though, which is a relief after an earlier study in China suggested a connection with stroke. But do we want to eat a food that's just neutral regarding some of our leading causes of death, when we can eat whole foods that are associated with lower risk of diabetes, heart attack, stroke, and weight gain?

If the modern diabetes epidemic in China and Japan has been linked to white rice consumption, how can we reconcile that with low diabetes rates just a few decades ago when they ate even more rice? If you look at the Cornell-Oxford-China Project, rural plant-based diets centered around rice were associated with relatively low risk of the so-called diseases of affluence, which includes diabetes. Maybe Asians just genetically don't get the same blood sugar spike when they eat white rice? This is not the case; if anything people of Chinese ethnicity get higher blood sugar spikes.

The rise in these diseases of affluence in China over the last half century has been blamed in part on the tripling of the consumption of animal source foods. The upsurge in diabetes has been most dramatic, and it's mostly just happened over the last decade. That crazy 9.7% diabetes prevalence figure that rivals ours is new--they appeared to have one of the lowest diabetes rates in the world in the year 2000.

So what happened to their diets in the last 20 years or so? Oil consumption went up 20%, pork consumption went up 40%, and rice consumption dropped about 30%. As diabetes rates were skyrocketing, rice consumption was going down, so maybe it's the animal products and junk food that are the problem. Yes, brown rice is better than white rice, but to stop the mounting Asian epidemic, maybe we should focus on removing the cause--the toxic Western diet. That would be consistent with data showing animal protein and fat consumption associated with increased diabetes risk.

But that doesn't explain why the biggest recent studies in Japan and China associate white rice intake with diabetes. One possibility is that animal protein is making the rice worse. If you feed people mashed white potatoes, a high glycemic food like white rice, you can see in my video If White Rice is Linked to Diabetes, What About China? the level of insulin your pancreas has to pump out to keep your blood sugars in check. But what if you added some tuna fish? Tuna doesn't have any carbs, sugar, or starch so it shouldn't make a difference. Or maybe it would even lower the mashed potato spike by lowering the glycemic load of the whole meal? Instead you get twice the insulin spike. This also happens with white flour spaghetti versus white flour spaghetti with meat. The addition of animal protein makes the pancreas work twice as hard.

You can do it with straight sugar water too. If you do a glucose challenge test to test for diabetes, where you drink a certain amount of sugar and add some meat, you get a much bigger spike than without meat. And the more meat you add, the worse it gets. Just adding a little meat to carbs doesn't seem to do much, but once you get up to around a third of a chicken breast's worth, you can elicit a significantly increased surge of insulin. This may help explain why those eating plant-based have such low diabetes rates, because animal protein can markedly potentiate the insulin secretion triggered by carbohydrate ingestion.

The protein exacerbation of the effect of refined carbs could help explain the remarkable results achieved by Dr. Kempner with a don't-try-this-at-home diet composed of mostly white rice and sugar. See my video, Kempner Rice Diet: Whipping Us Into Shape.

Refined grains may also not be good for our blood pressure (see Whole Grains May Work As Well As Drugs).

What should we be eating to best decrease our risk of diabetes? See:

And check out my summary video, How Not to Die from Diabetes.

In health,
Michael Greger, M.D.

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

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