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

Lipotoxicity: How Saturated Fat Raises Blood Sugar

NF-Nov24 Lipotoxicity How Saturated Fat Raises Blood Sugar copy.jpg

The reason those eating plant-based diets have less fat buildup in their muscle cells and less insulin resistance may be because saturated fats appear to impair blood sugar control the most.

The association between fat and insulin resistance is now widely accepted. Insulin resistance is due to so-called ectopic fat accumulation, the buildup of fat in places it's not supposed to be, like within our muscle cells. But not all fats affect the muscles the same. The type of fat, saturated vs. unsaturated, is critical. Saturated fats like palmitate, found mostly in meat, dairy and eggs, cause insulin resistance, but oleate, found mostly in nuts, olives and avocados may actually improve insulin sensitivity.

What makes saturated fat bad? Saturated fat causes more toxic breakdown products and mitochondrial dysfunction, and increases oxidative stress, free radicals and inflammation, establishing a vicious cycle of events in which saturated fat induces free radicals, causes dysfunction in the little power plants within our muscle cells (mitochondria), which then causes an increase in free radical production and an impairment of insulin signaling. I explain this in my video Lipotoxicity: How Saturated Fat Raises Blood Sugar.

Fat cells filled with saturated fat activate an inflammatory response to a far greater extent. This increased inflammation from saturated fat has been demonstrated to raise insulin resistance through free radical production. Saturated fat also has been shown to have a direct effect on skeletal muscle insulin resistance. Accumulation of saturated fat increases the amount of diacyl-glycerol in the muscles, which has been demonstrated to have a potent effect on muscle insulin resistance. You can take muscle biopsies from people and correlate the saturated fat buildup in their muscles with insulin resistance.

While monounsaturated fats are more likely to be detoxified or safely stored away, saturated fats create those toxic breakdown products like ceramide that causes lipotoxicity. Lipo- meaning fat, as in liposuction. This fat toxicity in our muscles is a well-known concept in the explanation of trigger for insulin resistance.

I've talked about the role saturated and trans fats contribute to the progression of other diseases, like autoimmune diseases, cancer and heart disease, but they can also cause insulin resistance, the underlying cause of prediabetes and type 2 diabetes. In the human diet, saturated fats are derived from animal sources while trans fats originate in meat and milk in addition to partially hydrogenated and refined vegetable oils.

That's why experimentally shifting people from animal fats to plant fats can improve insulin sensitivity. In a study done by Swedish researchers, insulin sensitivity was impaired on the diet with added butterfat, but not on the diet with added olive fat.

We know prolonged exposure of our muscles to high levels of fat leads to severe insulin resistance, with saturated fats demonstrated to be the worst, but they don't just lead to inhibition of insulin signaling, the activation of inflammatory pathways and the increase in free radicals, they also cause an alteration in gene expression. This can lead to a suppression of key mitochondrial enzymes like carnitine palmitoyltransferase, which finally solves the mystery of why those eating vegetarian have a 60 percent higher expression of that fat burning enzyme. They're eating less saturated fat.

So do those eating plant-based diets have less fat clogging their muscles and less insulin resistance too? There hasn't been any data available regarding the insulin sensitivity or inside muscle cell fat of those eating vegan or vegetarian... until now. Researchers at the Imperial College of London compared the insulin resistance and muscle fat of vegans versus omnivores. Those eating plant-based diets have the unfair advantage of being much slimmer, so they found omnivores who were as skinny as vegans to see if plant-based diets had a direct benefit, as opposed to indirectly pulling fat out of the muscles by helping people lose weight in general.

They found significantly less fat trapped in the muscle cells of vegans compared to omnivores at the same body weight, better insulin sensitivity, better blood sugar levels, better insulin levels and, excitingly, significantly improved beta-cell function (the cells in the pancreas that make the insulin). They conclude that eating plant-based is not only expected to be cardioprotective, helping prevent our #1 killer, heart disease, but that plant-based diets are beta-cell protective as well, helping also to prevent our seventh leading cause of death, diabetes.

This is the third of a three-part series, starting with What Causes Insulin Resistance? and The Spillover Effect Links Obesity to Diabetes.

Even if saturated fat weren't associated with heart disease, its effects on pancreatic function and insulin resistance in the muscles would be enough to warrant avoiding it. Despite popular press accounts, saturated fat intake remains the primary modifiable determinant of LDL cholesterol, the #1 risk factor for our #1 killer-heart disease. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

How low should we shoot for in terms of saturated fat intake? As low as possible, according to the U.S. National Academies of Science Institute of Medicine: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

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: Andrew Malone / Flickr

Original Link

Lipotoxicity: How Saturated Fat Raises Blood Sugar

NF-Nov24 Lipotoxicity How Saturated Fat Raises Blood Sugar copy.jpg

The reason those eating plant-based diets have less fat buildup in their muscle cells and less insulin resistance may be because saturated fats appear to impair blood sugar control the most.

The association between fat and insulin resistance is now widely accepted. Insulin resistance is due to so-called ectopic fat accumulation, the buildup of fat in places it's not supposed to be, like within our muscle cells. But not all fats affect the muscles the same. The type of fat, saturated vs. unsaturated, is critical. Saturated fats like palmitate, found mostly in meat, dairy and eggs, cause insulin resistance, but oleate, found mostly in nuts, olives and avocados may actually improve insulin sensitivity.

What makes saturated fat bad? Saturated fat causes more toxic breakdown products and mitochondrial dysfunction, and increases oxidative stress, free radicals and inflammation, establishing a vicious cycle of events in which saturated fat induces free radicals, causes dysfunction in the little power plants within our muscle cells (mitochondria), which then causes an increase in free radical production and an impairment of insulin signaling. I explain this in my video Lipotoxicity: How Saturated Fat Raises Blood Sugar.

Fat cells filled with saturated fat activate an inflammatory response to a far greater extent. This increased inflammation from saturated fat has been demonstrated to raise insulin resistance through free radical production. Saturated fat also has been shown to have a direct effect on skeletal muscle insulin resistance. Accumulation of saturated fat increases the amount of diacyl-glycerol in the muscles, which has been demonstrated to have a potent effect on muscle insulin resistance. You can take muscle biopsies from people and correlate the saturated fat buildup in their muscles with insulin resistance.

While monounsaturated fats are more likely to be detoxified or safely stored away, saturated fats create those toxic breakdown products like ceramide that causes lipotoxicity. Lipo- meaning fat, as in liposuction. This fat toxicity in our muscles is a well-known concept in the explanation of trigger for insulin resistance.

I've talked about the role saturated and trans fats contribute to the progression of other diseases, like autoimmune diseases, cancer and heart disease, but they can also cause insulin resistance, the underlying cause of prediabetes and type 2 diabetes. In the human diet, saturated fats are derived from animal sources while trans fats originate in meat and milk in addition to partially hydrogenated and refined vegetable oils.

That's why experimentally shifting people from animal fats to plant fats can improve insulin sensitivity. In a study done by Swedish researchers, insulin sensitivity was impaired on the diet with added butterfat, but not on the diet with added olive fat.

We know prolonged exposure of our muscles to high levels of fat leads to severe insulin resistance, with saturated fats demonstrated to be the worst, but they don't just lead to inhibition of insulin signaling, the activation of inflammatory pathways and the increase in free radicals, they also cause an alteration in gene expression. This can lead to a suppression of key mitochondrial enzymes like carnitine palmitoyltransferase, which finally solves the mystery of why those eating vegetarian have a 60 percent higher expression of that fat burning enzyme. They're eating less saturated fat.

So do those eating plant-based diets have less fat clogging their muscles and less insulin resistance too? There hasn't been any data available regarding the insulin sensitivity or inside muscle cell fat of those eating vegan or vegetarian... until now. Researchers at the Imperial College of London compared the insulin resistance and muscle fat of vegans versus omnivores. Those eating plant-based diets have the unfair advantage of being much slimmer, so they found omnivores who were as skinny as vegans to see if plant-based diets had a direct benefit, as opposed to indirectly pulling fat out of the muscles by helping people lose weight in general.

They found significantly less fat trapped in the muscle cells of vegans compared to omnivores at the same body weight, better insulin sensitivity, better blood sugar levels, better insulin levels and, excitingly, significantly improved beta-cell function (the cells in the pancreas that make the insulin). They conclude that eating plant-based is not only expected to be cardioprotective, helping prevent our #1 killer, heart disease, but that plant-based diets are beta-cell protective as well, helping also to prevent our seventh leading cause of death, diabetes.

This is the third of a three-part series, starting with What Causes Insulin Resistance? and The Spillover Effect Links Obesity to Diabetes.

Even if saturated fat weren't associated with heart disease, its effects on pancreatic function and insulin resistance in the muscles would be enough to warrant avoiding it. Despite popular press accounts, saturated fat intake remains the primary modifiable determinant of LDL cholesterol, the #1 risk factor for our #1 killer-heart disease. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

How low should we shoot for in terms of saturated fat intake? As low as possible, according to the U.S. National Academies of Science Institute of Medicine: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

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: Andrew Malone / Flickr

Original Link

The Natural Human Diet

NF-Nov15 The Problem with the Paleo Diet Argument copy.jpg

Our epidemics of dietary disease have prompted a great deal of research into what humans are meant to eat for optimal health. In 1985, an influential article highlighted in my video The Problem With the Paleo Diet Argument was published proposing that our chronic diseases stem from a disconnect between what our bodies ate while evolving during the Stone Age (about 2 million years ago) and what we're stuffing our face with today. The proposal advocated for a return towards a hunter-gatherer type diet of lean meat, fruits, vegetables, and nuts.

It's reasonable to assume our nutritional requirements were established in the prehistoric past. However, the question of which prehistoric past we should emulate remains. Why just the last 2 million? We've been evolving for about 20 million years since our last common great ape ancestor, during which our nutrient requirements and digestive physiology were set down. Therefore our hunter-gatherer days at the tail end probably had little effect. What were we eating for the first 90% of our evolution? What the rest of the great apes ended up eating--95 percent or more plants.

This may explain why we're so susceptible to heart disease. For most of human evolution, cholesterol may have been virtually absent from the diet. No bacon, butter, or trans fats; and massive amounts of fiber, which pulls cholesterol from the body. This could have been a problem since our body needs a certain amount of cholesterol, but our bodies evolve not only to make cholesterol, but also to preserve it and recycle it.

If we think of the human body as a cholesterol-conserving machine, then plop it into the modern world of bacon, eggs, cheese, chicken, pork, and pastry; it's no wonder artery-clogging heart disease is our #1 cause of death. What used to be adaptive for 90% of our evolution--holding on to cholesterol at all costs since we weren't getting much in our diet--is today maladaptive, a liability leading to the clogging of our arteries. Our bodies just can't handle it.

As the editor-in-chief of the American Journal of Cardiology noted 25 years ago, no matter how much fat and cholesterol carnivores eat, they do not develop atherosclerosis. We can feed a dog 500 eggs worth of cholesterol and they just wag their tail; a dog's body is used to eating and getting rid of excess cholesterol. Conversely, within months a fraction of that cholesterol can start clogging the arteries of animals adapted to eating a more plant-based diet.

Even if our bodies were designed by natural selection to eat mostly fruit, greens and seeds for 90% of our evolution, why didn't we better adapt to meat-eating in the last 10%, during the Paleolithic? We've had nearly 2 million years to get used to all that extra saturated fat and cholesterol. If a lifetime of eating like that clogs up nearly everyone's arteries, why didn't the genes of those who got heart attacks die off and get replaced by those that could live to a ripe old age with clean arteries regardless of what they ate? Because most didn't survive into old age.

Most prehistoric peoples didn't live long enough to get heart attacks. When the average life expectancy is 25 years old, then the genes that get passed along are those that can live to reproductive age by any means necessary, and that means not dying of starvation. The more calories in food, the better. Eating lots of bone marrow and brains, human or otherwise, would have a selective advantage (as would discovering a time machine stash of Twinkies for that matter!). If we only have to live long enough to get our kids to puberty to pass along our genes, then we don't have to evolve any protections against the ravages of chronic disease.

To find a population nearly free of chronic disease in old age, we don't have to go back a million years. In the 20th century, networks of missionary hospitals in rural Africa found coronary artery disease virtually absent, and not just heart disease, but high blood pressure, stroke, diabetes, common cancers, and more. In a sense, these populations in rural China and Africa were eating the type of diet we've been eating for 90% of the last 20 million years, a diet almost exclusively of plant foods.

How do we know it was their diet and not something else? In the 25 year update to their original paleo paper, the authors tried to clarify that they did not then and do not now propose that people adopt a particular diet just based on what our ancient ancestors ate. Dietary recommendations must be put to the test. That's why the pioneering research from Pritikin, Ornish, and Esselstyn is so important, showing that plant-based diets can not only stop heart disease but have been proven to reverse it in the majority of patients. Indeed, it's the only diet that ever has.

For more on the absence of Western diseases in plant-based rural populations, see for example:

I've touched on "paleo" diets in the past:

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: Nathan Rupert / Flickr

Original Link

The Natural Human Diet

NF-Nov15 The Problem with the Paleo Diet Argument copy.jpg

Our epidemics of dietary disease have prompted a great deal of research into what humans are meant to eat for optimal health. In 1985, an influential article highlighted in my video The Problem With the Paleo Diet Argument was published proposing that our chronic diseases stem from a disconnect between what our bodies ate while evolving during the Stone Age (about 2 million years ago) and what we're stuffing our face with today. The proposal advocated for a return towards a hunter-gatherer type diet of lean meat, fruits, vegetables, and nuts.

It's reasonable to assume our nutritional requirements were established in the prehistoric past. However, the question of which prehistoric past we should emulate remains. Why just the last 2 million? We've been evolving for about 20 million years since our last common great ape ancestor, during which our nutrient requirements and digestive physiology were set down. Therefore our hunter-gatherer days at the tail end probably had little effect. What were we eating for the first 90% of our evolution? What the rest of the great apes ended up eating--95 percent or more plants.

This may explain why we're so susceptible to heart disease. For most of human evolution, cholesterol may have been virtually absent from the diet. No bacon, butter, or trans fats; and massive amounts of fiber, which pulls cholesterol from the body. This could have been a problem since our body needs a certain amount of cholesterol, but our bodies evolve not only to make cholesterol, but also to preserve it and recycle it.

If we think of the human body as a cholesterol-conserving machine, then plop it into the modern world of bacon, eggs, cheese, chicken, pork, and pastry; it's no wonder artery-clogging heart disease is our #1 cause of death. What used to be adaptive for 90% of our evolution--holding on to cholesterol at all costs since we weren't getting much in our diet--is today maladaptive, a liability leading to the clogging of our arteries. Our bodies just can't handle it.

As the editor-in-chief of the American Journal of Cardiology noted 25 years ago, no matter how much fat and cholesterol carnivores eat, they do not develop atherosclerosis. We can feed a dog 500 eggs worth of cholesterol and they just wag their tail; a dog's body is used to eating and getting rid of excess cholesterol. Conversely, within months a fraction of that cholesterol can start clogging the arteries of animals adapted to eating a more plant-based diet.

Even if our bodies were designed by natural selection to eat mostly fruit, greens and seeds for 90% of our evolution, why didn't we better adapt to meat-eating in the last 10%, during the Paleolithic? We've had nearly 2 million years to get used to all that extra saturated fat and cholesterol. If a lifetime of eating like that clogs up nearly everyone's arteries, why didn't the genes of those who got heart attacks die off and get replaced by those that could live to a ripe old age with clean arteries regardless of what they ate? Because most didn't survive into old age.

Most prehistoric peoples didn't live long enough to get heart attacks. When the average life expectancy is 25 years old, then the genes that get passed along are those that can live to reproductive age by any means necessary, and that means not dying of starvation. The more calories in food, the better. Eating lots of bone marrow and brains, human or otherwise, would have a selective advantage (as would discovering a time machine stash of Twinkies for that matter!). If we only have to live long enough to get our kids to puberty to pass along our genes, then we don't have to evolve any protections against the ravages of chronic disease.

To find a population nearly free of chronic disease in old age, we don't have to go back a million years. In the 20th century, networks of missionary hospitals in rural Africa found coronary artery disease virtually absent, and not just heart disease, but high blood pressure, stroke, diabetes, common cancers, and more. In a sense, these populations in rural China and Africa were eating the type of diet we've been eating for 90% of the last 20 million years, a diet almost exclusively of plant foods.

How do we know it was their diet and not something else? In the 25 year update to their original paleo paper, the authors tried to clarify that they did not then and do not now propose that people adopt a particular diet just based on what our ancient ancestors ate. Dietary recommendations must be put to the test. That's why the pioneering research from Pritikin, Ornish, and Esselstyn is so important, showing that plant-based diets can not only stop heart disease but have been proven to reverse it in the majority of patients. Indeed, it's the only diet that ever has.

For more on the absence of Western diseases in plant-based rural populations, see for example:

I've touched on "paleo" diets in the past:

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: Nathan Rupert / Flickr

Original Link

How to Treat Prediabetes with Diet

NF-May3 Lifestyle Medicine Is the Standard of Care for Prediabetes.jpeg

For people with prediabetes, lifestyle modification is considered "the cornerstone of diabetes prevention." Diet-wise, this means individuals with prediabetes or diabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. Too many of us consume a diet with too many solid fats and added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.

Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, and the official standards of care for the American Diabetes Association. Dietary strategies include reducing intake of fat and increasing intake of fiber (meaning unrefined plant foods, including whole grains).

The recommendation to consume more whole grains is based on research showing that eating lots of whole grains is associated with reduced risk of developing type 2 diabetes. New research even suggests that whole grains may protect against prediabetes in the first place.

According to the American Diabetes Association's official standards of care (which you can see in my video Lifestyle Medicine Is the Standard of Care for Prediabetes), dietary recommendations should focus on reducing saturated fat, cholesterol and trans fat intake (meat, dairy, eggs and junk food). Recommendations should also focus on increasing omega 3's, soluble fiber and phytosterols, all three of which can be found together in flax seeds; an efficient, but still uncommon, intervention for prediabetes. In one study, about two tablespoons of ground flax seed a day decreased insulin resistance (the hallmark of the disease).

If the standards of care for all the major diabetes groups say that lifestyle is the preferred treatment for prediabetes because it's safe and highly effective, why don't more doctors do it? Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about one in three patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.

It may be because doctors aren't getting paid to do it. Why haven't reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns.

"The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?"

How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education "has not changed since 1910."


I hope my work is helping to fill the gap that medical professionals are not getting during training about preventing and treating chronic disease. That's actually how this all started. I would make trips to Countway at the beginning of every month in medical school to read all the new journal issues. I felt I had a duty to my patients to stay on top of the literature. But hey, since I'm doing so much work, might as well share it! So what started as an email newsletter morphed into a medical school speaking tour into a DVD series and then now all online for everyone.

For more on preventing and treating prediabetes/diabetes, see:

For more on lifestyle medicine:

And for insight into the sad state of nutrition in medical training, Doctors Know Less Than They Think About Nutrition and Medical School Nutrition Training.

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: Alden Chadwick / Flickr

Original Link

How to Treat Prediabetes with Diet

NF-May3 Lifestyle Medicine Is the Standard of Care for Prediabetes.jpeg

For people with prediabetes, lifestyle modification is considered "the cornerstone of diabetes prevention." Diet-wise, this means individuals with prediabetes or diabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. Too many of us consume a diet with too many solid fats and added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.

Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, and the official standards of care for the American Diabetes Association. Dietary strategies include reducing intake of fat and increasing intake of fiber (meaning unrefined plant foods, including whole grains).

The recommendation to consume more whole grains is based on research showing that eating lots of whole grains is associated with reduced risk of developing type 2 diabetes. New research even suggests that whole grains may protect against prediabetes in the first place.

According to the American Diabetes Association's official standards of care (which you can see in my video Lifestyle Medicine Is the Standard of Care for Prediabetes), dietary recommendations should focus on reducing saturated fat, cholesterol and trans fat intake (meat, dairy, eggs and junk food). Recommendations should also focus on increasing omega 3's, soluble fiber and phytosterols, all three of which can be found together in flax seeds; an efficient, but still uncommon, intervention for prediabetes. In one study, about two tablespoons of ground flax seed a day decreased insulin resistance (the hallmark of the disease).

If the standards of care for all the major diabetes groups say that lifestyle is the preferred treatment for prediabetes because it's safe and highly effective, why don't more doctors do it? Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about one in three patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.

It may be because doctors aren't getting paid to do it. Why haven't reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns.

"The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?"

How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education "has not changed since 1910."


I hope my work is helping to fill the gap that medical professionals are not getting during training about preventing and treating chronic disease. That's actually how this all started. I would make trips to Countway at the beginning of every month in medical school to read all the new journal issues. I felt I had a duty to my patients to stay on top of the literature. But hey, since I'm doing so much work, might as well share it! So what started as an email newsletter morphed into a medical school speaking tour into a DVD series and then now all online for everyone.

For more on preventing and treating prediabetes/diabetes, see:

For more on lifestyle medicine:

And for insight into the sad state of nutrition in medical training, Doctors Know Less Than They Think About Nutrition and Medical School Nutrition Training.

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: Alden Chadwick / Flickr

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The #1 Dietary Risk Factor is Not Eating Enough Fruit

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The Global Burden of Disease Study published in 2012, is the most comprehensive and systematic analysis of causes of death undertaken to date, involving nearly 500 researchers from more than 300 institutions in 50 countries, and starting with almost 100,000 data sources. What did the researchers find? Here in the U.S., they determined that our biggest killer was our diet. Number 1 on their list of the most important dietary risks was not eating enough fruit, responsible for an estimated 4.9 million deaths a year around the world.

According to the Union of Concerned Scientists: "If Americans ate just one more serving of fruits or vegetables per day, this would save more than 30,000 lives and $5 billion in medical costs each year." One antidote for individuals is easy, painless, and even pleasurable: exploit the multiple nutritional and protective benefits of fruits and vegetables.

One way plants protect us may be their antiplatelet effects. Platelets are what trigger the blood clots that cause heart attacks and most strokes. And beyond their obvious function in blood clotting, platelets are now considered to play a pivotal inflammatory role in the hardening of the arteries in the first place, and in allergies, rheumatoid arthritis, and even cancer.

Normally, under healthy conditions, platelets circulate in a quiescent, inactive state. But once they become activated, they can emerge as culprits in inflammation. Platelets transport a vast amount of inflammatory chemicals, and upon activation they release these chemicals, which can recruit the inflammatory cells that form the pus pockets within our arterial walls that can eventually burst and kill us.

This involvement of platelet activation in atherosclerosis development is well established. We've long recognized the platelets' role in the final stages; however, a growing body of data indicates that platelets may also play an important role in the initiation and propagation of atherosclerosis in the first place. How can we prevent the excessive activation of platelets? It's generally recognized that platelet hyper-reactivity is associated with high levels of cholesterol circulating in the blood; so we can cut down on foods that have trans fats, saturated fats, and dietary cholesterol.

We can also eat more fruits and vegetables. For example, different varieties of strawberries have shown a significant antiplatelet effect in a petri dish and in people. How did researchers figure it out? In my video, Inhibiting Platelet Aggregation with Berries, you can see a platelet in a resting state, packed with little round granule grenades of inflammatory chemicals, which fuse together and are released when the platelet gets activated. Because resting and activated platelets look so different, we can just take blood from people and count how many are resting and how many are activated before and after people eat more than a pint of strawberries every day for a month. From just adding strawberries to people's diets, there's a small but significant drop in the percentage of activated platelets circulating throughout their bodies.

Other berries had a similar effect, even at a more modest two servings a day. Drinking orange or grapefruit juice doesn't seem to help, but purple grape juice successfully reduces platelet activity on the same order that aspirin does.

Studies have shown that daily aspirin can reduce heart attacks and strokes; however, aspirin can also cause severe gastrointestinal disturbances and bleeding problems, and so should not be used for the primary prevention of heart attacks and stroke as the benefits don't clearly outweigh the serious risks. It's nice to have safe, side-effect free alternatives.


One of the ways plants help keep platelets in their place may actually be their aspirin content! See Aspirin Levels in Plant Foods. Why would a plant make a human drug? It's so cool, check out Appropriating Plant Defenses.

Is the Standard American Diet really so bad that we could save 100,000 people by just getting up to minimum fruit and veggie recommendations? Even cynics might be surprised: Nation's Diet in Crisis. Even more plants may cut deaths even more, though. See One in a Thousand: Ending the Heart Disease Epidemic.

For more on lowering cholesterol see my video Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. And it's never too early to start eating healthier. Check out: Heart Disease Starts in Childhood. Heart disease may be a choice. See: Cavities and Coronaries: Our Choice.

Berries are the healthiest fruits, shown to maintain our brain power (How to Slow Brain Aging By Two Years) and improve our immune function (Boosting Natural Killer Cell Activity). That's one of the reasons we want to eat Antioxidant Rich Foods With Every Meal.

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: Michael Stern / Flickr

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Food Manufacturers Get to Decide if Their Own Additives Are Safe

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In 2013, the U.S. Food and Drug Administration announced their plans to all but eliminate trans fats from processed foods, citing a CDC statistic that the elimination of partially hydrogenated oils from the food supply could prevent more than 10,000 heart attacks and thousands of deaths every year. Up until that point, trans fats enjoyed their so-called "GRAS" status: "Generally Recognized As Safe." How did these killer fats get labeled as safe?

Who decides what's safe? Currently, a "generally recognized as safe" determination is made when the manufacturer of a food substance evaluates the safety of the substance themselves and concludes that the use of the substance is safe. In other words, the company that manufactures the substance gets to determine if it is safe or not. This approach is commonly referred to as "GRAS self-determination." To make matters worse, not only do companies not have to inform the public, they don't even have to inform the FDA. A company may voluntarily tell the FDA they just came up with a new food additive that they've decided is safe, but are not required to do so.

The cumulative result is that there are an estimated 6,000 current affirmative safety decisions which allow for more than an estimated 10,000 substances to be used in food (See Who Determines if Food Additives are Safe?). In addition, an estimated 1,000 manufacturer safety decisions are never reported to FDA or the public. "Manufacturers and a trade association made the remaining decisions without FDA review by concluding on their own that the substances that they themselves were selling were safe."

While manufacturers are not required to notify the FDA of a "safe determination," sometimes they do voluntarily notify the agency. From these notifications, researchers have been able to see which individuals companies select to make these determinations. Of the 451 GRAS notifications voluntarily submitted to the FDA, 22.4% were made by someone directly employed by the company; 13.3% were made by someone directly employed by a firm hand-picked by the company; and 64.3% were made by a panel hand-picked by the corporation or the firm the corporation hired. Are you doing the math? Yes, that means zero safety decisions were made independently.

An astonishing 100% of the members of expert panels worked directly or indirectly for the companies that manufactured the food additive in question. And those are just the ones the food companies let the FDA know about. The companies also used the same in-the-pocket rent-a-scientist "experts" over and over, leading food industry watchdog Marion Nestle to ask "How is it possible that the FDA permits manufacturers to decide for themselves whether their food additives are safe?" It may be because many of the companies providing our daily food are corporate giants with "political muscles that national governments would envy." PepsiCo alone spent more than $9 million in a single year to lobby Congress. The fact that food additives like trans fats have been allowed to kill thousands of Americans year after year comes as less of a surprise to those who realize that "three of Washington's largest lobbying firms reportedly now work for the food industry."

I've got three dozen videos on food additives. Here are a few highlights:

Artificial Colors:

Phosphates:

Preservatives:

Sweeteners:

Others:

Just as the food additive industry gets to decide which food additives are safe, the food industry holds sway over which foods are considered safe. See, for example, my video The McGovern Report.

-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: John Fischer / Flickr

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