Clostridium difficile in the Food Supply

Clostridium difficile in the Food Supply.jpeg

Clostridium difficile is one of our most urgent bacterial threats, sickening a quarter million Americans every year, and killing thousands at the cost of a billion dollars a year. And it's on the rise.

As shown in C. difficile Superbugs in Meat, uncomplicated cases have been traditionally managed with powerful antibiotics, but recent reports suggest that hypervirulent strains are increasingly resistant to medical management. There's been a rise in the percentage of cases that end up under the knife, which could be a marker of the emergence of these hypervirulent strains. Surgeons may need to remove our colon entirely to save our lives, although the surgery is so risky that the operation alone may kill us half the time.

Historically, most cases appeared in hospitals, but a landmark study published in the New England Journal of Medicine found that only about a third of cases could be linked to contact with an infected patient.

Another potential source is our food supply.

In the US, the frequency of contamination of retail chicken with these superbugs has been documented to be up to one in six packages off of store shelves. Pig-derived C. diff, however, have garnered the greatest attention from public health personnel, because the same human strain that's increasingly emerging in the community outside of hospitals is the major strain among pigs.

Since the turn of the century, C. diff is increasingly being reported as a major cause of intestinal infections in piglets. C. diff is now one of the most common causes of intestinal infections in baby piglets in the US. Particular attention has been paid to pigs because of high rates of C. diff shedding into their waste, which can lead to the contamination of retail pork. The U.S. has the highest levels of C. diff meat contamination tested so far anywhere in the world.

Carcass contamination by gut contents at slaughter probably contributes most to the presence of C. diff in meat and meat products. But why is the situation so much worst in the US? Slaughter techniques differ from country-to-country, with those in the United States evidently being more of the "quick and dirty" variety.

Colonization or contamination of pigs by superbugs such as C. difficile and MRSA at the farm production level may be more important than at the slaughterhouse level, though. One of the reasons sows and their piglets may have such high rates of C. diff is because of cross-contamination of feces in the farrowing crate, which are narrow metal cages that mother pigs are kept in while their piglets are nursing.

Can't you just follow food safety guidelines and cook the meat through? Unfortunately, current food safety guidelines are ineffective against C. difficile. To date, most food safety guidelines recommend cooking to an internal temperature as low as 63o C-the official USDA recommendation for pork-but recent studies show that C. diff spores can survive extended heating at 71o. Therefore, the guidelines should be raised to take this potentially killer infection into account.

One of the problems is that sources of C. diff food contamination might include not only fecal contamination on the surface of the meat, but transfer of spores from the gut into the actual muscles of the animal, inside the meat. Clostridia bacteria like C. diff comprise one of the main groups of bacteria involved in natural carcass degradation, and so by colonizing muscle tissue before death, C. diff can not only transmit to new hosts that eat the muscles, like us, but give them a head start on carcass break-down.

Never heard of C. diff? That's the Toxic Megacolon Superbug I've talked about before.

Another foodborne illness tied to pork industry practices is yersiniosis. See Yersinia in Pork.

MRSA (Methicillin-resistant Staph aureus) is another so-called superbug in the meat supply:

More on the scourge of antibiotic resistance and what can be done about it:

How is it even legal to sell foods with such pathogens? See Salmonella in Chicken & Turkey: Deadly But Not Illegal and Chicken Salmonella Thanks to Meat Industry Lawsuit.

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: USDA / Flickr. This image has been modified.

Original Link

Clostridium difficile in the Food Supply

Clostridium difficile in the Food Supply.jpeg

Clostridium difficile is one of our most urgent bacterial threats, sickening a quarter million Americans every year, and killing thousands at the cost of a billion dollars a year. And it's on the rise.

As shown in C. difficile Superbugs in Meat, uncomplicated cases have been traditionally managed with powerful antibiotics, but recent reports suggest that hypervirulent strains are increasingly resistant to medical management. There's been a rise in the percentage of cases that end up under the knife, which could be a marker of the emergence of these hypervirulent strains. Surgeons may need to remove our colon entirely to save our lives, although the surgery is so risky that the operation alone may kill us half the time.

Historically, most cases appeared in hospitals, but a landmark study published in the New England Journal of Medicine found that only about a third of cases could be linked to contact with an infected patient.

Another potential source is our food supply.

In the US, the frequency of contamination of retail chicken with these superbugs has been documented to be up to one in six packages off of store shelves. Pig-derived C. diff, however, have garnered the greatest attention from public health personnel, because the same human strain that's increasingly emerging in the community outside of hospitals is the major strain among pigs.

Since the turn of the century, C. diff is increasingly being reported as a major cause of intestinal infections in piglets. C. diff is now one of the most common causes of intestinal infections in baby piglets in the US. Particular attention has been paid to pigs because of high rates of C. diff shedding into their waste, which can lead to the contamination of retail pork. The U.S. has the highest levels of C. diff meat contamination tested so far anywhere in the world.

Carcass contamination by gut contents at slaughter probably contributes most to the presence of C. diff in meat and meat products. But why is the situation so much worst in the US? Slaughter techniques differ from country-to-country, with those in the United States evidently being more of the "quick and dirty" variety.

Colonization or contamination of pigs by superbugs such as C. difficile and MRSA at the farm production level may be more important than at the slaughterhouse level, though. One of the reasons sows and their piglets may have such high rates of C. diff is because of cross-contamination of feces in the farrowing crate, which are narrow metal cages that mother pigs are kept in while their piglets are nursing.

Can't you just follow food safety guidelines and cook the meat through? Unfortunately, current food safety guidelines are ineffective against C. difficile. To date, most food safety guidelines recommend cooking to an internal temperature as low as 63o C-the official USDA recommendation for pork-but recent studies show that C. diff spores can survive extended heating at 71o. Therefore, the guidelines should be raised to take this potentially killer infection into account.

One of the problems is that sources of C. diff food contamination might include not only fecal contamination on the surface of the meat, but transfer of spores from the gut into the actual muscles of the animal, inside the meat. Clostridia bacteria like C. diff comprise one of the main groups of bacteria involved in natural carcass degradation, and so by colonizing muscle tissue before death, C. diff can not only transmit to new hosts that eat the muscles, like us, but give them a head start on carcass break-down.

Never heard of C. diff? That's the Toxic Megacolon Superbug I've talked about before.

Another foodborne illness tied to pork industry practices is yersiniosis. See Yersinia in Pork.

MRSA (Methicillin-resistant Staph aureus) is another so-called superbug in the meat supply:

More on the scourge of antibiotic resistance and what can be done about it:

How is it even legal to sell foods with such pathogens? See Salmonella in Chicken & Turkey: Deadly But Not Illegal and Chicken Salmonella Thanks to Meat Industry Lawsuit.

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: USDA / Flickr. This image has been modified.

Original Link

Deep Breathing Exercise for Nausea

Deep Breathing Exercise for Nausea.jpeg

One of the most common fears patients express when facing surgery is postoperative nausea, which can range from minor queasiness to protracted periods of vomiting. Feeling sick to one's stomach and throwing up after surgery is a common problem, affecting between a quarter and a half of those placed under general anesthesia, and more than half of those at high risk (women who don't smoke and have a history of motion sickness).

I've explored the science behind treating nausea with ginger (see Natural Nausea Remedy Recipe), but if you're too nauseous to eat, what do you do? Well, people are often sent home with anti-nausea rectal suppositories. Surveys, however, show that cultural and sexual attitudes may make a number of people sensitive to anything involving the rectum. Though the wording of the question researchers asked was, "are you happy to have a drug put in your back passage?" I can imagine many of the respondents thinking "well, maybe I wouldn't so much mind, but wouldn't exactly be happy about it," especially when you're feeling sick and throwing up.

For women who've had a C-section, they might not want to take drugs at all if they're breastfeeding, so researchers decided to put aromatherapy to the test. Research has shown that essential oils of both spearmint and peppermint are effective in reducing nausea and vomiting after chemotherapy, but this was after swallowing them.

Would just the smell of peppermint help with nausea? I explore this in my video Peppermint Aromatherapy for Nausea. Researchers had women take deep whiffs of peppermint extract (like you'd buy at a store) and it seemed to work. Eighty percent of the mint-sniffers felt better within just a few minutes, compared to no improvement in the placebo group who sniffed water with green food coloring, or the control group who didn't sniff anything.

The study was criticized for being small and for not using pure peppermint oil. Peppermint extract is peppermint oil plus alcohol. Maybe it was the smell of alcohol that made people better? And that's actually not too much of a stretch. In 1997, researchers reported a simple, innocuous, and inexpensive treatment for postoperative nausea and vomiting--the smell of isopropyl alcohol, which is what is found in those alcohol wipes, the little prep pads that nurses swab you with before shots. They found that they could just effectively tear one open and wave it under someone's nose and relieve nausea and vomiting in more than 80% of folks after surgery. It has been since shown to work as well as a leading anti-nausea drug, and may even work faster, cutting nausea in half within 10 to 15 minutes, rather than 20 or 25.

So was it the alcohol, the peppermint, or both? Researchers decided to put it to the test. They instructed patients to take three slow, deep breaths, smelling alcohol, peppermint, or nothing. The smell of peppermint cut nausea in half within five minutes, and so did the alcohol. But so did smelling nothing! So maybe it had nothing to do with the scent; maybe it was just the instruction to take slow, deep breaths. That would make it a really cost-effective intervention. Maybe it shouldn't be so surprising, given the proximity of the vomiting and breathing centers within the brain.

And indeed, controlled breathing was found effective with or without any scent. So next time you feel nauseous, inhale deeply through your nose to the count of three, hold your breath to the count of three, and exhale out the mouth to the count of three. Do that three times.

Ironically, the researchers continued to advocate using those nasty smelling alcohol pads even though they themselves showed they weren't any more effective than breathing alone. Why? Since isopropyl alcohol has a readily detectable odor, patients are more likely to think that their post-operation nausea and vomiting is being actively treated when they inhale alcohol vapors rather than just engaging in breathing exercises.


What do you think of still using the alcohol pads even though they were shown to offer no additional benefit? I have a whole video on such questions: The Lie That Heals: Should Doctors Give Placebos?

For those who can swallow, I offer more about powdered ginger in my video Dangerous Advice From Health Food Store Employees.

There's more on aromatherapy here:

What about actually eating the peppermint?

Of course, the best way to avoid postsurgical nausea is to try to avoid surgery in the first place. Those that eat healthy may be less likely to go under the knife. See Say No to Drugs by Saying Yes to More Plants.

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

Deep Breathing Exercise for Nausea

Deep Breathing Exercise for Nausea.jpeg

One of the most common fears patients express when facing surgery is postoperative nausea, which can range from minor queasiness to protracted periods of vomiting. Feeling sick to one's stomach and throwing up after surgery is a common problem, affecting between a quarter and a half of those placed under general anesthesia, and more than half of those at high risk (women who don't smoke and have a history of motion sickness).

I've explored the science behind treating nausea with ginger (see Natural Nausea Remedy Recipe), but if you're too nauseous to eat, what do you do? Well, people are often sent home with anti-nausea rectal suppositories. Surveys, however, show that cultural and sexual attitudes may make a number of people sensitive to anything involving the rectum. Though the wording of the question researchers asked was, "are you happy to have a drug put in your back passage?" I can imagine many of the respondents thinking "well, maybe I wouldn't so much mind, but wouldn't exactly be happy about it," especially when you're feeling sick and throwing up.

For women who've had a C-section, they might not want to take drugs at all if they're breastfeeding, so researchers decided to put aromatherapy to the test. Research has shown that essential oils of both spearmint and peppermint are effective in reducing nausea and vomiting after chemotherapy, but this was after swallowing them.

Would just the smell of peppermint help with nausea? I explore this in my video Peppermint Aromatherapy for Nausea. Researchers had women take deep whiffs of peppermint extract (like you'd buy at a store) and it seemed to work. Eighty percent of the mint-sniffers felt better within just a few minutes, compared to no improvement in the placebo group who sniffed water with green food coloring, or the control group who didn't sniff anything.

The study was criticized for being small and for not using pure peppermint oil. Peppermint extract is peppermint oil plus alcohol. Maybe it was the smell of alcohol that made people better? And that's actually not too much of a stretch. In 1997, researchers reported a simple, innocuous, and inexpensive treatment for postoperative nausea and vomiting--the smell of isopropyl alcohol, which is what is found in those alcohol wipes, the little prep pads that nurses swab you with before shots. They found that they could just effectively tear one open and wave it under someone's nose and relieve nausea and vomiting in more than 80% of folks after surgery. It has been since shown to work as well as a leading anti-nausea drug, and may even work faster, cutting nausea in half within 10 to 15 minutes, rather than 20 or 25.

So was it the alcohol, the peppermint, or both? Researchers decided to put it to the test. They instructed patients to take three slow, deep breaths, smelling alcohol, peppermint, or nothing. The smell of peppermint cut nausea in half within five minutes, and so did the alcohol. But so did smelling nothing! So maybe it had nothing to do with the scent; maybe it was just the instruction to take slow, deep breaths. That would make it a really cost-effective intervention. Maybe it shouldn't be so surprising, given the proximity of the vomiting and breathing centers within the brain.

And indeed, controlled breathing was found effective with or without any scent. So next time you feel nauseous, inhale deeply through your nose to the count of three, hold your breath to the count of three, and exhale out the mouth to the count of three. Do that three times.

Ironically, the researchers continued to advocate using those nasty smelling alcohol pads even though they themselves showed they weren't any more effective than breathing alone. Why? Since isopropyl alcohol has a readily detectable odor, patients are more likely to think that their post-operation nausea and vomiting is being actively treated when they inhale alcohol vapors rather than just engaging in breathing exercises.


What do you think of still using the alcohol pads even though they were shown to offer no additional benefit? I have a whole video on such questions: The Lie That Heals: Should Doctors Give Placebos?

For those who can swallow, I offer more about powdered ginger in my video Dangerous Advice From Health Food Store Employees.

There's more on aromatherapy here:

What about actually eating the peppermint?

Of course, the best way to avoid postsurgical nausea is to try to avoid surgery in the first place. Those that eat healthy may be less likely to go under the knife. See Say No to Drugs by Saying Yes to More Plants.

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

Medical Care: The Third Leading Cause of Death

NF-Nov10 Why Prevention is Worth.jpg

An ounce of prevention is worth a pound of cure, but a pound isn't that heavy. Why change our diet and lifestyle when we can just wait and let modern medicine fix us up? In my video The Actual Benefit of Diet vs. Drugs, I noted that patients tend to wildly overestimate the ability of cancer screening and cholesterol-lowering medications to prevent disease. Surveyed patients report they were told the truth about how little they'd benefit, 90% said they wouldn't even bother.

The reason we should eat healthier, rather than just counting on a medical technofix, is that we may hold this same overconfidence for treatment, too. In a massive study of more than 200,000 trials, researchers discovered that pills and procedures can certainly help, but genuine, very large effects with extensive support from substantial evidence appear to be rare in medicine. Further, large benefits for mortality--making people live significantly longer--are almost entirely nonexistent. Modern medicine is great for acute conditions--broken bones and curing infections--but for chronic disease, our leading causes of death and disability, we don't have much to offer. In fact, we sometimes do more harm than good.

In my Uprooting the Leading Causes of Death presentation, I noted that side-effects from prescription drugs kill an estimated 100,000 Americans every year, making medical care the sixth leading cause of death in the United States. There are another 7,000 deaths from getting the wrong medicine by mistake and 20,000 deaths from other errors in hospitals. Hospitals are dangerous places. An additional 99,000 of us die from hospital-acquired infections. But can we really blame doctors for those deaths, though? We can when they don't wash their hands.

We've known since the 1840's that the best way to prevent hospital-acquired infections is through handwashing, yet compliance rates among healthcare workers rarely exceeds 50%, and doctors are the worst, as highlighted in my video Why Prevention is Worth a Ton of Cure. Even in a medical intensive care unit with a "contact precautions" sign, signaling a particularly high risk patient, less than a quarter of doctors were found to wash their hands. Many physicians greeted the horrendous mortality data due to medical error with disbelief and concern that the information would undermine public trust. But if doctors still won't even wash their hands, how much trust do we deserve?

We could go in for a simple operation and come out with a life-threatening infection, or not come out at all. 12,000 more die from surgeries that were unnecessary in the first place. For those keeping score, that's 225,000 people dead from iatrogenic ("relating to medical care") causes. And that's mostly just for patients in a hospital. In an outpatient setting, side-effects from prescription drugs send millions to the hospital and result in perhaps 199,000 additional deaths. This is not including all those non-fatally injured (such as the case where doctors accidentally amputated the tip of a man's penis. Oops).

These estimates are on the low end. The Institute of Medicine estimated that deaths from medical errors may kill up to 98,000 Americans. That would bump us up to 284,000 dead. Even if we use the lower estimate, the medical profession constitutes the third leading cause of death in the United States. It goes heart disease, cancer, then... me.

One respondent pointed out that it was misleading to call medicine the third leading cause of death since many of those we kill also had heart disease or cancer. It's not like doctors are out there gunning down healthy people. Only people on medications are killed by medication errors or side-effects. You have to be in the hospital to be killed by a hospital error.

To which I respond: Exactly.

That's why lifestyle medicine is so important. The most common reasons people are on drugs and in hospitals is for diseases that can be prevented with a healthy diet and lifestyle. The best way to avoid the adverse effects of medical care is to not get sick in the first place.

For more background on how scandalous our handwashing history has been, see my Q&A: What about Semmelweis and medicine's shameful handwashing history? It's truly an unbelievable story.

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: Portal PBH / Flickr

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Antibiotic-Resistant "Superbugs" in Meat

NF-Mar10 MRSA Superbugs in Meat.jpeg

As a rule, "high-ranking public-health officials try to avoid apocalyptic descriptors. So it's worrying to hear those like the Director of the CDC warn of a coming health 'nightmare' and a 'catastrophic threat.'" A number of prominent publications recently warned of the threat of antibiotic resistance. The CDC estimates that at a minimum, more than two million people are sickened every year with antibiotic-resistant infections in the United States, with at least 23,000 dying as a result (See MRSA Superbugs in Meat).

We may be at the dawn of a post-antibiotic era. Achievements in modern medicine that we today take for granted, such as surgery and the treatment of preterm babies, would not be possible without access to effective treatment for bacterial infections. For example, without antibiotics, the rate of postoperative infection after a procedure like a hip replacement would be 40-50% and about one in three of those patients would die. So the so-called worst case scenarios where resistant infections could cost $50 billion a year might still be an underestimate. "From cradle to grave, antibiotics have become pivotal in safeguarding the overall health of human societies."

So the dire phrasing from head officials may be warranted. There are now infections like carbapenem-resistant enterobacter that are resistant to nearly all antibiotics, even to so-called drugs of last resort. Worryingly, some of these last resort drugs are being used extensively in animal agriculture.

According to the World Health Organization, more antibiotics are fed to farmed animals than are used to treat disease in human patients. Doctors overprescribe antibiotics, but huge amounts of antibiotics are used in fish farming and other intensive animal agriculture, up to four times the amount used in human medicine. Why? "Suboptimum growth to slaughter weight caused by unsanitary conditions can be compensated with the addition of antibiotics to feed." Instead of relieving any stressful overcrowded unhygienic conditions, it may be cheaper to just dose the animals with drugs.

In this way, factory farms are driving the growth of antibiotic-resistant organisms that cause human diseases. "This may help bolster the industry's bottom line, but in the process, bacteria are developing antimicrobial resistance, which affects human health."

In the United States, the FDA reports that 80% of antimicrobial drugs in the United States are used in food animals, mainly to promote growth in this kind of high-density production. This can select for antibiotic-resistant bacteria like methicillin-resistant Staph aureus, or MRSA, considered a serious threat in the United States.

These industrial pig operations may provide optimal conditions for the introduction and transmission of MRSA. U.S. pork producers are currently permitted to use 29 antibiotic drugs in feed--all without a prescription. Antiobitics are currently added to about 90% of pigs starter feeds.

When animals receive unnecessary antibiotics, bacteria can be come resistant to the drugs, then travel on meat to the store, and end up causing hard-to-treat illnesses in people.

MRSA present in retail raw meat may serve as a possible source of bacterial infections of food preparers in the food industry and the hands of consumers in the home. Once MRSA gets into our homes on meat, it can transfer to our cutting boards, knives, and onto our skin at a rate similar to the rate of transmission from touching an infected patient contaminated with MRSA. Washing of hands after touching raw pork is advised.

I know I've already covered this topic before, but it never fails to shock me that the meat industry can get away with something so forcefully and universally condemned by the public health community. What other industrial sector could get away with putting people at such risk? It speaks to the combined might of the livestock industry and the pharmaceutical industry in holding sway over our democratic process, no matter what the human health consequences.

If you've missed my other MRSA videos, check out:

And for more on this critical issue in general:

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: Jellaluna / Flickr

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Dr. Greger’s 2015 Live Year-in-Review Presentation

Food as Medicine

View my new live presentation here: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet

Every year I scour the world's scholarly literature on clinical nutrition, pulling together what I find to be the most interesting, practical, and groundbreaking science on how to best feed ourselves and our families. I start with the thousands of papers published annually on nutrition (27,000 this year--a new record!) and, thanks to a crack team of volunteers (and now staff!), I'm able to whittle those down (to a mere 8,000 this year). They are then downloaded, categorized, read, analyzed, and churned into the few hundred short videos. This allows me to post new videos and articles every day, year-round, to NutritionFacts.org. This certainly makes the site unique. There's no other science-based source for free daily updates on the latest discoveries in nutrition. The problem is that the amount of information can be overwhelming.

Currently I have more than a thousand videos covering 1,931 nutrition topics. Where do you even begin? Many have expressed their appreciation for the breadth of material, but asked that I try to distill it into a coherent summary of how best to use diet to prevent and treat chronic disease. I took this feedback to heart and in 2012 developed Uprooting the Leading Causes of Death, which explored the role diet may play in preventing, arresting, and even reversing our top 15 killers. Not only did it rise to become one of the Top 10 Most Popular Videos of 2012, it remains my single most viewed video to date, watched over a million times (NutritionFacts.org is now up to more than 1.5 million hits a month!).

In 2013 I developed the sequel, More Than an Apple a Day, in which I explored the role diet could play in treating some of our most common conditions. I presented it around the country and it ended up #1 on our Top 10 Most Popular Videos of 2013. Then in 2014 I premiered the sequel-sequel, From Table to Able, in which I explored the role diet could play in treating some of our most disabling diseases, landing #1 on our Top 10 Most Popular Videos of 2014.

Every year I wonder how I'm going to top the year before. Knowing how popular these live presentations can be and hearing all the stories from folks about what a powerful impact they can have on people's lives, I put my all into this new 2015 one. I spent more time putting together this presentation than any other in my life. It took me an entire month, and when you see it I think you'll appreciate why.

This year, I'm honored to bring you Food as Medicine, in which I go through our most dreaded diseases--but that's not even the best part! I'm really proud of what I put together for the ending. I spend the last 20 minutes or so (starting at 56:22) going through a thought experiment that I'm hoping everyone will find compelling. I think it may be my best presentation ever. You be the judge.

You can watch it at no cost online, but it is also available on DVD through my website or on Amazon. If you want to share copies with others, I have a five for $40 special (enter coupon code 5FOR40FAM). All proceeds from the sales of all my books, DVDs, downloads, and presentations go to the 501c3 nonprofit charity that keeps NutritionFacts.org free for all, for all time. If you want to support this initiative to educate millions about eradicating dietary diseases, please consider making a donation.

After you've watched the new presentation, make sure you're subscribed to get my video updates daily, weekly, or monthly to stay on top of all the latest.

-Michael Greger

Original Link

Why Do Heart Doctors Favor Surgery and Drugs Over Diet?

NF-June2 Fully Consensual Heart Disease Treatment.jpg

When he was a surgeon at the Cleveland Clinic, Dr. Caldwell Esselstyn Jr. published a controversial paper in the American Journal of Cardiology, highlighted in my video, Fully Consensual Heart Disease Treatment, noting that heart bypass operations carry significant risks including the potential to cause further heart damage, stroke, and brain dysfunction. Angioplasty isn't much better, also carrying significant mortality and morbidity, and often doesn't work (in terms of decreasing the risk of subsequent heart attack or death). "So," he writes, "it seems we have an enormous paradox. The disease that is the leading killer of men and women in Western civilization is largely untreated." The benefits of bypass surgery and angioplasty "are at best temporary and erode over time, with most patients eventually succumbing to their disease." In cancer management, we call that palliative care, where we just kind of throw up our hands, throw in the towel, and give up actually trying to treat the disease.

Why does this juggernaut of invasive procedures persist? Well one reason he suggests is that performing surgical interventions has the potential for enormous financial reward. Conversely, lack of adequate return is considered one of the barriers to the practice of preventive cardiology. Diet and lifestyle interventions lose money for the physician.

Another barrier is that doctors don't think patients want it. Physician surveys show that doctors often don't even bring up diet and lifestyle options because they assume that patients would prefer to be on cholesterol-lowering drugs every day for the rest of their lives rather than change their eating habits. That may be true for some, but it's up to the patient, not the doctor, to decide.

According to the official AMA Code of Medical Ethics, physicians are supposed to disclose all relevant medical information to patients. "The patient's right of self-decision can be effectively exercised only if the patient possesses enough information to enable an informed choice. The physician's obligation is to present the medical facts accurately to the patient." For example, before starting someone at moderate risk on a cholesterol-lowering statin drug, a physician might ideally say something like:

"You should know that for folks in your situation, the number of individuals who must be treated with a statin to prevent one death from a cardiovascular event such as a heart attack or stroke is generally between 60 and 100, which means that if I treated 60 people in your situation, 1 would benefit and 59 would not. As these numbers show, it is important for you to know that most of the people who take a statin will not benefit from doing so and, moreover, that statins can have side effects, such as muscle pain, liver damage, and upset stomach, even in people who do not benefit from the medication. I am giving you this information so that you can weigh the risks and benefits of drugs versus diet and then make an informed decision."

Yet, how many physicians have these kinds of frank and open discussions with their patients? Non-disclosure of medical information by doctors--that kind of paternalism is supposed to be a thing of the past. Today's physicians are supposed to honor informed consent under all but a very specific set of conditions (such as the patient is in a coma or it's an emergency). However, too many physicians continue to treat their patients as if they were unconscious.

At the end of this long roundtable discussion on angioplasty and stents, the editor-in-chief of the American Journal of Cardiology reminded us of an important fact to place it all in context. Atherosclerosis is due to high cholesterol, which is due to poor dietary choices, so if we all existed on a plant-based diet, we would not have even needed this discussion.

The lack of nutrition training in medical school is another barrier. See, for example, my videos Doctors' Nutritional Ignorance and Doctors Know Less Than They Think About Nutrition.

Shockingly, mainstream medical associations actively oppose attempts to educate physicians about clinical nutrition. See my 4-part video series:

  1. Nutrition Education Mandate Introduced for Doctors
  2. Medical Associations Oppose Bill to Mandate Nutrition Training
  3. California Medical Association Tries to Kill Nutrition Bill
  4. Nutrition Bill Doctored in the California Senate

For more on why doctors don't make more dietary prescriptions, see my video The Tomato Effect, Lifestyle Medicine: Treating the Cause of Disease, and Convincing Doctors to Embrace Lifestyle Medicine.

Heart disease may be a choice. See Cavities and Coronaries: Our Choice and One in a Thousand: Ending the Heart Disease Epidemic.

-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: Leandro Ciuffo / Flickr

Original Link

Obesity: Supporting satisfaction instead of surgery

Obesity Surgery.jpg

Hot news from down under - a couple of surgeons who perform bariatric (stomach-stapling) operations would like to perform more of them on us, and would like tax money to fund their work. The media is running their advertisement as if it were a public health statement.

I've battled weight problems for my adult life, and I know there is no magic bullet for maintaining a healthy weight. Neither is there a magic scalpel. Cutting open your body to reduce your stomach capacity and all that could mean for your future is not a tenable general treatment.

Battling obesity en masse

New Zealand is, like most developed countries, guilty of more reporting than acting on the growing obesity problem. While this is always a sensitive subject, a recent longterm study showed that while there are obese healthy people, they are much less likely to remain healthy over the years.

So is it true that "Surgery still remains the most capable strategy for inducing robust and long-term weight loss"? May I see the source please? The (US) National Weight Control Registry research does not mention surgery at all in their summary of how most of their participants lost long-term weight.

But I am even more interested that New Zealand's tax money supports industries that support obesity. Fatty cholesterol-rich foods like beef, pork, chicken, eggs, and dairy. "Added-value" processed foods, which take natural raw foods and package them for the highest profit and shelf life instead of fiber and nutrients. Food technology trumps food quality.

Calorie density

Why does this matter? Jeff Novick, RD, MS explains in this article and this video presentation, but in short, calorie density reigns supreme in how much people eat.

Steak doesn't fill you up like oatmeal. Potato chips won't fill you up like potatoes.

Where the money goes

So if we're going to tweak our economic contribution to solve the obesity epidemic, let's not psych everyone into thinking we have to catch up with the Aussies in dangerous life-altering surgery rates.

Let's at least stop being part of the problem, and remove tax funding from those industries harming our national health. Restrict their advertising which often reports positive health benefits or just plain fun...and often arrives in our schools to advertise to our children.

Help make healthy food cheaper, more available, and more acceptable instead.

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We Can End the Heart Disease Epidemic

NF-Nov11 We Can End The Heart Disease Epidemic.jpg

Many of the diseases that are common in United States are rare or even nonexistent in populations eating mainly whole plant foods.

These so-called Western Diseases are some of our most common conditions:

  • Obesity, the most important nutritional disease
  • Hiatal hernia, one of the most common stomach problems
  • Hemorrhoids and varicose veins, the most common venous disorders
  • Colorectal cancer, the number two cause of cancer death
  • Diverticulosis, the #1 disease of the intestine
  • Appendicitis, the #1 cause for emergency abdominal surgery
  • Gallbladder disease, the #1 cause for nonemergency abdominal surgery
  • Ischemic heart disease, the #1 cause of death

These diseases are common in the West, but are rarities among plant-based populations.

A landmark study in 1959 I profiled in my video Cavities and Coronaries: Our Choice, for example, suggested that coronary heart disease was practically non-existent among those eating traditional plant-based diets in Uganda.

"Doctors in sub-Saharan Africa during the '30s and '40s recognized that certain diseases commonly seen in Western communities were rare in rural African peasants. This hearsay talk greeted any new doctor on arrival in Africa. Even the teaching manuals stated that diabetes, coronary heart disease, appendicitis, peptic ulcer, gallstones, hemorrhoids, and constipation were rare in African blacks who eat foods that contain many skins and fibers, such as beans and corn, and pass a bulky stool two or three times a day. Surgeons noticed that the common acute abdominal emergencies in Western communities were virtually absent in rural African peasants."

But did they have hard data to back it up? Yes.

Major autopsy series were performed. In one thousand Kenyan autopsies, there were "no cases of appendicitis, not a single heart attack, only three cases of diabetes, one peptic ulcer, no gallstones, and no evidence of high blood pressure" (which alone affects one out of three Americans).

Maybe the Africans were just dying early of other diseases and so never lived long enough to get heart disease? No. In the video One in a Thousand: Ending the Heart Disease Epidemic, you can see the age-matched heart attack rates in Uganda versus St. Louis. Out of 632 autopsies in Uganda, only one myocardial infarction. Out of 632 Missourians--with the same age and gender distribution--there were 136 myocardial infarctions. More than 100 times the rate of our number one killer. In fact, researchers were so blown away that they decided to do another 800 autopsies in Uganda. Still, just that one small healed infarct (meaning it wasn't even the cause of death) out of 1,427 patients. Less than one in a thousand, whereas in the U.S., it's an epidemic.

If heart disease is so rare in rural Africa, how do the local doctors even know what to look for? Though practically unheard of among the native population, the physicians are quite familiar with heart disease because of all the Westerners that immigrate to the country.

The famous surgeon Dr. Denis Burkitt insisted that modern medicine is treating disease all wrong:

"A highly unacceptable fact--that is rarely considered yet indisputable--is that, with rare exceptions, there is no evidence that the incidence of any disease was ever reduced by treatment. Improved therapies may reduce mortality but may not reduce the incidence of the disease."

Take cancer, for example, where the vast majority of effort is devoted to advances in treatment, and second priority is given to screening programs attempting early diagnosis. Is there any evidence that the incidence of any form of cancer has been reduced by improved treatment or by early detection? Early diagnosis may reduce mortality rates, and medical services can have a profoundly beneficial effect on sick people, but neither have little (if any) effect on the number of people becoming ill. No matter how fancy heart disease surgery gets, it's never going to reduce the number of people falling victim to the disease.

Dr. Burkitt compared the situation to an engine left out in the rain:

"If an engine repeatedly stops as a consequence of being exposed to the elements, it is of limited value to rely on the aid of mechanics to detect and remedy the fault. Examination of all engines would reveal that those out in the rain were stopping, but those under cover were running well. The correct approach would then be to provide protection from the offending environment. However, considering the failing engine as the ailing patient, this is seldom the priority of modern medicine."

Dr. Burkitt sums it up with the analogy of The Cliff or the Ambulance:

"If people are falling over the edge of a cliff and sustaining injuries, the problem could be dealt with by stationing ambulances at the bottom or erecting a fence at the top. Unfortunately, we put far too much effort into the provision of ambulances and far too little into the simple approach of erecting fences."

And of course there are all the industries enticing people to the edge, and profiting from pushing people off.

If all plant-based diets could do is reverse our number one killer, then shouldn't that be the default diet until proven otherwise? The fact that it also appears to reverse other leading killers like diabetes and hypertension appears to make the case for plant-based eating overwhelming. So why doesn't the medical profession embrace it? It may be because of The Tomato Effect. Why don't many individual doctors do it? It may be because lifestyle medicine hurts the bottom line (see Lifestyle Medicine: Treating the Causes of Disease). Why doesn't the federal government recommend it? It may be because of the self-interest of powerful industries (see The McGovern Report). But you can take your destiny into your own hands (mouth?) and work with your doctor to clean up your diet and maximize your chances of living happily ever after.

-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: Sinn Fien / Flickr

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