Treating Kidney Stones with Diet

Treating Kidney Stones with Diet.jpeg

Studies suggest that excessive consumption of animal protein poses a risk of kidney stone formation, likely due to the acid load contributed by the high content of sulfur-containing amino acids in animal protein, a topic I explore in my video, Preventing Kidney Stones with Diet. What about treating kidney stones, though? I discuss that in How to Treat Kidney Stones with Diet. Most stones are calcium oxalate, formed like rock candy when the urine becomes supersaturated. Doctors just assumed that if stones are made out of calcium, we simply have to tell people to reduce their calcium intake. That was the dietary gospel for kidney stone sufferers until a 2002 study published in the New England Journal of Medicine pitted two diets against one another--a low-calcium diet versus a diet low in animal protein and salt. The restriction of animal protein and salt provided greater protection, cutting the risk of having another kidney stone within five years in half.

What about cutting down on oxalates, which are concentrated in certain vegetables? A recent study found there was no increased risk of stone formation with higher vegetable intake. In fact, greater dietary intake of whole plant foods, fruits, and vegetables were each associated with reduced risk independent of other known risk factors for kidney stones. This means we may get additional benefits bulking up on plant foods in addition to just restricting animal foods.

A reduction in animal protein not only reduces the production of acids within the body, but should also limit the excretion of urate, uric acid crystals that can act as seeds to form calcium stones or create entire stones themselves. (Uric acid stones are the second most common kidney stones after calcium.)

There are two ways to reduce uric acid levels in the urine: a reduction of animal protein ingestion, or a variety of drugs. Removing all meat--that is, switching from the standard Western diet to a vegetarian diet--can remove 93% of uric acid crystallization risk within days.

To minimize uric acid crystallization, the goal is to get our urine pH up to ideally as high as 6.8. A number of alkalinizing chemicals have been developed for just this purpose, but we can naturally alkalize our urine up to the recommended 6.8 using purely dietary means. Namely, by removing all meat, someone eating the standard Western diet can go from a pH of 5.95 to the goal target of 6.8--simply by eating plant-based. As I describe in my video, Testing Your Diet with Pee & Purple Cabbage, we can inexpensively test our own diets with a little bathroom chemistry, for not all plant foods are alkalinizing and not all animal foods are equally acidifying.

A Load of Acid to Kidney Evaluation (LAKE) score has been developed to take into account both the acid load of foods and their typical serving sizes. It can be used to help people modify their diet for the prevention of both uric acid and calcium kidney stones, as well as other diseases. What did researchers find? The single most acid-producing food is fish, like tuna. Then, in descending order, are pork, then poultry, cheese (though milk and other dairy are much less acidifying), and beef followed by eggs. (Eggs are actually more acidic than beef, but people tend to eat fewer eggs in one sitting.) Some grains, like bread and rice, can be a little acid-forming, but pasta is not. Beans are significantly alkaline-forming, but not as much as fruits or even better, vegetables, which are the most alkaline-forming of all.

Through dietary changes alone, we may be able to dissolve uric acid stones completely and cure patients without drugs or surgery.

To summarize, the most important things we can do diet-wise is to drink 10 to 12 cups of water a day, reduce animal protein, reduce salt, and eat more vegetables and more vegetarian.

Want to try to calculate their LAKE score for the day? Just multiply the number of servings you have of each of the food groups listed in the graph in the video times the score.

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

Original Link

Treating Kidney Stones with Diet

Treating Kidney Stones with Diet.jpeg

Studies suggest that excessive consumption of animal protein poses a risk of kidney stone formation, likely due to the acid load contributed by the high content of sulfur-containing amino acids in animal protein, a topic I explore in my video, Preventing Kidney Stones with Diet. What about treating kidney stones, though? I discuss that in How to Treat Kidney Stones with Diet. Most stones are calcium oxalate, formed like rock candy when the urine becomes supersaturated. Doctors just assumed that if stones are made out of calcium, we simply have to tell people to reduce their calcium intake. That was the dietary gospel for kidney stone sufferers until a 2002 study published in the New England Journal of Medicine pitted two diets against one another--a low-calcium diet versus a diet low in animal protein and salt. The restriction of animal protein and salt provided greater protection, cutting the risk of having another kidney stone within five years in half.

What about cutting down on oxalates, which are concentrated in certain vegetables? A recent study found there was no increased risk of stone formation with higher vegetable intake. In fact, greater dietary intake of whole plant foods, fruits, and vegetables were each associated with reduced risk independent of other known risk factors for kidney stones. This means we may get additional benefits bulking up on plant foods in addition to just restricting animal foods.

A reduction in animal protein not only reduces the production of acids within the body, but should also limit the excretion of urate, uric acid crystals that can act as seeds to form calcium stones or create entire stones themselves. (Uric acid stones are the second most common kidney stones after calcium.)

There are two ways to reduce uric acid levels in the urine: a reduction of animal protein ingestion, or a variety of drugs. Removing all meat--that is, switching from the standard Western diet to a vegetarian diet--can remove 93% of uric acid crystallization risk within days.

To minimize uric acid crystallization, the goal is to get our urine pH up to ideally as high as 6.8. A number of alkalinizing chemicals have been developed for just this purpose, but we can naturally alkalize our urine up to the recommended 6.8 using purely dietary means. Namely, by removing all meat, someone eating the standard Western diet can go from a pH of 5.95 to the goal target of 6.8--simply by eating plant-based. As I describe in my video, Testing Your Diet with Pee & Purple Cabbage, we can inexpensively test our own diets with a little bathroom chemistry, for not all plant foods are alkalinizing and not all animal foods are equally acidifying.

A Load of Acid to Kidney Evaluation (LAKE) score has been developed to take into account both the acid load of foods and their typical serving sizes. It can be used to help people modify their diet for the prevention of both uric acid and calcium kidney stones, as well as other diseases. What did researchers find? The single most acid-producing food is fish, like tuna. Then, in descending order, are pork, then poultry, cheese (though milk and other dairy are much less acidifying), and beef followed by eggs. (Eggs are actually more acidic than beef, but people tend to eat fewer eggs in one sitting.) Some grains, like bread and rice, can be a little acid-forming, but pasta is not. Beans are significantly alkaline-forming, but not as much as fruits or even better, vegetables, which are the most alkaline-forming of all.

Through dietary changes alone, we may be able to dissolve uric acid stones completely and cure patients without drugs or surgery.

To summarize, the most important things we can do diet-wise is to drink 10 to 12 cups of water a day, reduce animal protein, reduce salt, and eat more vegetables and more vegetarian.

Want to try to calculate their LAKE score for the day? Just multiply the number of servings you have of each of the food groups listed in the graph in the video times the score.

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

Original Link

The Best Diet to Prevent Kidney Stones

The Best Diet to Prevent Kidney Stones.jpeg

In my video How to Prevent Kidney Stones With Diet you can see what the jagged surface of a kidney stone looks like under a microscope. Imagine one of those scraping down your urinary canal! Kidney stones affect approximately 1 in 11 people in the United States. Twenty years ago it was only 1 in 20, representing a dramatic increase in the prevalence of the disease that started rising after World War II. Our first clue as to why was a study published in the 70's, which found a striking relationship between stone incidence and the consumption of animal protein. This was a population study, though, so it couldn't prove cause and effect.

That study inspired researchers in Britain to do an interventional study, adding animal protein to subjects' diets, such as an extra can of tuna fish a day, and measuring stone-forming risk factors in their urine. Participants' overall probability of forming stones increased 250% during those days they were eating that extra fish. And the so-called "high animal protein diet" was just enough to bring intake up to that of the average American. So Americans' intake of meat appears to markedly increase the risk of kidney stones.

What about consuming no meat at all? By the late 70's we knew that the only dietary factor consistently associated with kidney stones was animal protein. The higher the intake of animal protein, the more likely the individual was to not only get their first kidney stone, but to then suffer from subsequent multiple stones. This effect was not found for high protein intake in general, but specifically high animal protein intake. Conversely, a diet low in animal protein may dramatically reduce the overall probability of forming stones. This may explain the apparently low incidence of stones in vegetarian societies, so researchers advocated "a more vegetarian form of diet" as a means of reducing the risk.

It wasn't until 2014 that vegetarian kidney stone risk was studied in detail, though. Using hospital admissions data, researchers found that vegetarians were indeed at a lower risk of being hospitalized for kidney stones. It's not all or nothing, though. Among meat-eaters, increasing meat intake is associated with a higher risk of developing kidney stones, whereas a high intake of fresh fruit, fiber, and magnesium may reduce the risk.

Which animal protein is the worst? People who form kidney stones are commonly advised to restrict the intake of red meat to decrease stone risk, but what about chicken and fish? Despite compelling evidence that excessive animal protein consumption enhances the risk of stone formation, the effect of different sources of animal protein had not been explored until another study in 2014. Researchers compared the effects of salmon and cod, chicken breast meat, and burger and steak. In terms of uric acid production, they found that gram for gram fish may actually be worse. However, the overall effects were complex. Basically, stone formers should be counseled to limit the intake of all animal proteins, and not by just a little bit. Only those who markedly decrease their animal protein intake may expect to benefit.

Making our urine more alkaline can also help prevent the formation of kidney stones (and even dissolve and cure uric acid stones). How can you tell the pH of your urine? See my video Testing Your Diet with Pee & Purple Cabbage.

For more on kidney stones, see How to Treat Kidney Stones with Diet and Do Vitamin C Supplements Prevent Colds but Cause Kidney Stones?. And check out my overview of kidney health in How Not to Die from Kidney Disease.

Uric acid can also crystallize in our joints, but the good news is that there are natural treatments. See Gout Treatment with a Cherry on Top and Treating Gout with Cherry Juice.

Kidney stones are just one more reason that Plant Protein is Preferable.

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

The Best Diet to Prevent Kidney Stones

The Best Diet to Prevent Kidney Stones.jpeg

In my video How to Prevent Kidney Stones With Diet you can see what the jagged surface of a kidney stone looks like under a microscope. Imagine one of those scraping down your urinary canal! Kidney stones affect approximately 1 in 11 people in the United States. Twenty years ago it was only 1 in 20, representing a dramatic increase in the prevalence of the disease that started rising after World War II. Our first clue as to why was a study published in the 70's, which found a striking relationship between stone incidence and the consumption of animal protein. This was a population study, though, so it couldn't prove cause and effect.

That study inspired researchers in Britain to do an interventional study, adding animal protein to subjects' diets, such as an extra can of tuna fish a day, and measuring stone-forming risk factors in their urine. Participants' overall probability of forming stones increased 250% during those days they were eating that extra fish. And the so-called "high animal protein diet" was just enough to bring intake up to that of the average American. So Americans' intake of meat appears to markedly increase the risk of kidney stones.

What about consuming no meat at all? By the late 70's we knew that the only dietary factor consistently associated with kidney stones was animal protein. The higher the intake of animal protein, the more likely the individual was to not only get their first kidney stone, but to then suffer from subsequent multiple stones. This effect was not found for high protein intake in general, but specifically high animal protein intake. Conversely, a diet low in animal protein may dramatically reduce the overall probability of forming stones. This may explain the apparently low incidence of stones in vegetarian societies, so researchers advocated "a more vegetarian form of diet" as a means of reducing the risk.

It wasn't until 2014 that vegetarian kidney stone risk was studied in detail, though. Using hospital admissions data, researchers found that vegetarians were indeed at a lower risk of being hospitalized for kidney stones. It's not all or nothing, though. Among meat-eaters, increasing meat intake is associated with a higher risk of developing kidney stones, whereas a high intake of fresh fruit, fiber, and magnesium may reduce the risk.

Which animal protein is the worst? People who form kidney stones are commonly advised to restrict the intake of red meat to decrease stone risk, but what about chicken and fish? Despite compelling evidence that excessive animal protein consumption enhances the risk of stone formation, the effect of different sources of animal protein had not been explored until another study in 2014. Researchers compared the effects of salmon and cod, chicken breast meat, and burger and steak. In terms of uric acid production, they found that gram for gram fish may actually be worse. However, the overall effects were complex. Basically, stone formers should be counseled to limit the intake of all animal proteins, and not by just a little bit. Only those who markedly decrease their animal protein intake may expect to benefit.

Making our urine more alkaline can also help prevent the formation of kidney stones (and even dissolve and cure uric acid stones). How can you tell the pH of your urine? See my video Testing Your Diet with Pee & Purple Cabbage.

For more on kidney stones, see How to Treat Kidney Stones with Diet and Do Vitamin C Supplements Prevent Colds but Cause Kidney Stones?. And check out my overview of kidney health in How Not to Die from Kidney Disease.

Uric acid can also crystallize in our joints, but the good news is that there are natural treatments. See Gout Treatment with a Cherry on Top and Treating Gout with Cherry Juice.

Kidney stones are just one more reason that Plant Protein is Preferable.

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

Benefits of Nutritional Yeast to Prevent the Common Cold

Benefits of Nutritional Yeast to Prevent the Common Cold.jpeg

Natural immunomodulators that can help regulate our immune system without side-effects have been sought for centuries, and all the while they've been sitting in the produce aisle. Plants produce thousand of active compounds, many of which modulate our immune system, but we can't forget the fungi (see Boosting Immunity While Reducing Inflammation).

Mushrooms have used for centuries as folk remedies, and for good reason. Some have been shown to boost immune function, so much so that a type of fiber found in shiitake mushrooms is approved for use as adjunct chemotherapy, injected intravenously to help treat a variety of cancers by rallying our immune defenses.

More than 6,000 papers have been published on these so-called beta glucans, but almost all of the data about preventing infections had come from petri dish or lab animal studies, until a few years ago when a series of experiments on athletes showed beneficial effects in marathon runners (see Preserving Immune Function in Athletes With Nutritional Yeast). What about the rest of us? We didn't know... until now.

As I explore in my video, Nutritional Yeast to Prevent the Common Cold, beta glucan fiber found in baker's, brewer's and nutritional yeast helps to maintain our body's defense against pathogens even in nonathletes, according to a double-blind, randomized, placebo-controlled trial. The recurrence of infections with the common cold was reduced by 25% in those that ate the equivalent of about a spoonful of nutritional yeast a day, and had fewer cold-related sleeping difficulties when they did get sick.

What about half a spoonful a day? Still worked! Subjects experienced a big drop in common cold incidence and a reduction in symptoms as well. Why is this? This study found that not only were upper respiratory infection symptoms diminished, but that mood states appeared to improve, for example a significant boost in feelings of "vigor." So the researchers suggest that maybe the yeast fiber is able to counteract the negative effects of stress on the immune system.

In terms of side-effects, two folks reported stomachaches, but they were both in the placebo group.

Unlike antibiotics and antivirals, which are designed to kill the pathogen directly, these yeast compounds instead appear to work by stimulating our immune defenses, and as such don't share the same antibiotic side effects. They stimulate our immune defenses presumably because our body recognizes them as foreign. But if it's treated like an invader, might it trigger an inflammatory response? Turns out these fiber compounds may actually have an anti-inflammatory effect, suggesting nutritional yeast may offer the best of both worlds, boosting the infection fighting side of the immune system while suppressing inflammatory components.

Yeast is high in purines, so those with gout, uric acid kidney stones, and new organ transplant recipients may want to keep their intake to less than a teaspoon a day. But is there any downside for everyone else? In California some packages of nutritional yeast are slapped with prop 65 warning stickers, suggesting there's something in it exceeding cancer or birth defect safety limits. I called around to the companies and it turns out the problem is lead. California state law says a product cannot contain more than half of a microgram of lead per daily serving, so I contacted the six brands I knew about and asked them how much lead was in their products.

KAL originally said "<5 ppm," but when we called back they said "<3 ppm." Even if it's 3, that translates into less than 45 micrograms per serving, nearly a 100 times more than the California limit. But perhaps that's better than Bob's Red Mill or Frontier Coop, who evidently don't test at all. But at least they got back to me. Redstar brand failed to respond to multiple attempts to contact them. Now Foods said they test for lead and claim that at least their recent batches meet the less than a half a microgram California standard. Unfortunately, despite repeated requests they would not provide me with documentation to substantiate their numbers. My favorite response was from Bragg's who sent me the analysis certificate from the lab showing less than 0.01 ppm, which means at most less than half the California standard, which I believe is the most stringent in the world. To put the numbers in context, in determining how much lead manufacturers can put into candy likely to be frequently consumed by small children, the Food and Drug Administration would allow about 2 micrograms a day in the form of lollipops, but as far as I'm concerned the less lead the better.

I was so frustrated by the lack of transparency I decided to test them for lead myself. NutritionFacts.org hired an independent lab to conduct our own tests for lead and shipped out 8 samples of nutritional yeast in their original package. The lab used standard practices for lead testing known as Official Methods of Analysis set by AOAC International. Lab technicians determined the lead values based on California Prop 65 standards. Here are the results from the brands we tested:

Bob's Red Mill - Test report shows no detectable lead (<0.01 ppm).

Bragg - Test report shows no detectable lead (< 0.01 ppm).

Dr. Fuhrman - Test report shows no detectable lead (< 0.01 ppm).

Frontier Coop - Test report shows lead levels at 0.021 ppm. It would take six tablespoons a day (based on the manufacture's listed density) to exceed the California Office of Environmental Health Hazard Assessment Maximum Allowable Dose Level (MADL) for chemicals causing reproductive toxicity.*

KAL - Test report shows lead levels at 0.011 ppm. It would take seven tablespoons a day to exceed the MADL.*

NOW Foods - Test report shows no detectable lead (< 0.01 ppm).

Red Star - Test report shows no detectable lead (< 0.01 ppm).

Whole Foods - Test report shows lead levels at 0.012 ppm. It would take six tablespoons a day to exceed the MADL.*

So what do all those numbers mean? None of the brands tested exceeded California prop 65 standards. No matter what brand, consuming a typical serving (2 tablespoons) per day is still well within safe limits.

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:

* The Maximum Allowable Dose Level for lead as a developmental toxin is 0.5 micrograms a day. How are MADL's calculated? Basically scientists figure out what the "no observable effect level" is, the level at which no birth defects or reproductive toxicity can be found, and then introduce a 1000-fold safety buffer. So for example, let's say there's some chemical that causes birth defects if expectant moms are exposed to two drops of the chemical a day, but there's no evidence that one drop a day is harmful. Do they set the Maximum Allowable Dose Level at one drop? No, they set it at 1/1000th of a drop to account for scientific uncertainty and to err on the side of caution. So by saying six tablespoons a day of nutritional yeast may exceed the MADL is in effect saying that the level of lead found in 6,000 tablespoons of nutritional yeast may cause birth defects. Like mercury, though, as far as I'm concerned the less lead exposure the better. I hope this will inspire companies to do further testing to see if the levels we found were just flukes.

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

Original Link

Benefits of Nutritional Yeast to Prevent the Common Cold

Benefits of Nutritional Yeast to Prevent the Common Cold.jpeg

Natural immunomodulators that can help regulate our immune system without side-effects have been sought for centuries, and all the while they've been sitting in the produce aisle. Plants produce thousand of active compounds, many of which modulate our immune system, but we can't forget the fungi (see Boosting Immunity While Reducing Inflammation).

Mushrooms have used for centuries as folk remedies, and for good reason. Some have been shown to boost immune function, so much so that a type of fiber found in shiitake mushrooms is approved for use as adjunct chemotherapy, injected intravenously to help treat a variety of cancers by rallying our immune defenses.

More than 6,000 papers have been published on these so-called beta glucans, but almost all of the data about preventing infections had come from petri dish or lab animal studies, until a few years ago when a series of experiments on athletes showed beneficial effects in marathon runners (see Preserving Immune Function in Athletes With Nutritional Yeast). What about the rest of us? We didn't know... until now.

As I explore in my video, Nutritional Yeast to Prevent the Common Cold, beta glucan fiber found in baker's, brewer's and nutritional yeast helps to maintain our body's defense against pathogens even in nonathletes, according to a double-blind, randomized, placebo-controlled trial. The recurrence of infections with the common cold was reduced by 25% in those that ate the equivalent of about a spoonful of nutritional yeast a day, and had fewer cold-related sleeping difficulties when they did get sick.

What about half a spoonful a day? Still worked! Subjects experienced a big drop in common cold incidence and a reduction in symptoms as well. Why is this? This study found that not only were upper respiratory infection symptoms diminished, but that mood states appeared to improve, for example a significant boost in feelings of "vigor." So the researchers suggest that maybe the yeast fiber is able to counteract the negative effects of stress on the immune system.

In terms of side-effects, two folks reported stomachaches, but they were both in the placebo group.

Unlike antibiotics and antivirals, which are designed to kill the pathogen directly, these yeast compounds instead appear to work by stimulating our immune defenses, and as such don't share the same antibiotic side effects. They stimulate our immune defenses presumably because our body recognizes them as foreign. But if it's treated like an invader, might it trigger an inflammatory response? Turns out these fiber compounds may actually have an anti-inflammatory effect, suggesting nutritional yeast may offer the best of both worlds, boosting the infection fighting side of the immune system while suppressing inflammatory components.

Yeast is high in purines, so those with gout, uric acid kidney stones, and new organ transplant recipients may want to keep their intake to less than a teaspoon a day. But is there any downside for everyone else? In California some packages of nutritional yeast are slapped with prop 65 warning stickers, suggesting there's something in it exceeding cancer or birth defect safety limits. I called around to the companies and it turns out the problem is lead. California state law says a product cannot contain more than half of a microgram of lead per daily serving, so I contacted the six brands I knew about and asked them how much lead was in their products.

KAL originally said "<5 ppm," but when we called back they said "<3 ppm." Even if it's 3, that translates into less than 45 micrograms per serving, nearly a 100 times more than the California limit. But perhaps that's better than Bob's Red Mill or Frontier Coop, who evidently don't test at all. But at least they got back to me. Redstar brand failed to respond to multiple attempts to contact them. Now Foods said they test for lead and claim that at least their recent batches meet the less than a half a microgram California standard. Unfortunately, despite repeated requests they would not provide me with documentation to substantiate their numbers. My favorite response was from Bragg's who sent me the analysis certificate from the lab showing less than 0.01 ppm, which means at most less than half the California standard, which I believe is the most stringent in the world. To put the numbers in context, in determining how much lead manufacturers can put into candy likely to be frequently consumed by small children, the Food and Drug Administration would allow about 2 micrograms a day in the form of lollipops, but as far as I'm concerned the less lead the better.

I was so frustrated by the lack of transparency I decided to test them for lead myself. NutritionFacts.org hired an independent lab to conduct our own tests for lead and shipped out 8 samples of nutritional yeast in their original package. The lab used standard practices for lead testing known as Official Methods of Analysis set by AOAC International. Lab technicians determined the lead values based on California Prop 65 standards. Here are the results from the brands we tested:

Bob's Red Mill - Test report shows no detectable lead (<0.01 ppm).

Bragg - Test report shows no detectable lead (< 0.01 ppm).

Dr. Fuhrman - Test report shows no detectable lead (< 0.01 ppm).

Frontier Coop - Test report shows lead levels at 0.021 ppm. It would take six tablespoons a day (based on the manufacture's listed density) to exceed the California Office of Environmental Health Hazard Assessment Maximum Allowable Dose Level (MADL) for chemicals causing reproductive toxicity.*

KAL - Test report shows lead levels at 0.011 ppm. It would take seven tablespoons a day to exceed the MADL.*

NOW Foods - Test report shows no detectable lead (< 0.01 ppm).

Red Star - Test report shows no detectable lead (< 0.01 ppm).

Whole Foods - Test report shows lead levels at 0.012 ppm. It would take six tablespoons a day to exceed the MADL.*

So what do all those numbers mean? None of the brands tested exceeded California prop 65 standards. No matter what brand, consuming a typical serving (2 tablespoons) per day is still well within safe limits.

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:

* The Maximum Allowable Dose Level for lead as a developmental toxin is 0.5 micrograms a day. How are MADL's calculated? Basically scientists figure out what the "no observable effect level" is, the level at which no birth defects or reproductive toxicity can be found, and then introduce a 1000-fold safety buffer. So for example, let's say there's some chemical that causes birth defects if expectant moms are exposed to two drops of the chemical a day, but there's no evidence that one drop a day is harmful. Do they set the Maximum Allowable Dose Level at one drop? No, they set it at 1/1000th of a drop to account for scientific uncertainty and to err on the side of caution. So by saying six tablespoons a day of nutritional yeast may exceed the MADL is in effect saying that the level of lead found in 6,000 tablespoons of nutritional yeast may cause birth defects. Like mercury, though, as far as I'm concerned the less lead exposure the better. I hope this will inspire companies to do further testing to see if the levels we found were just flukes.

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

Original Link

Why Some Like Cilantro and Others Hate It

The Cilantro Gene.jpg

One sign of changing U.S. demographics is that salsa has replaced ketchup as America's #1 table condiment. One of the popular salsa ingredients is cilantro, described as one of the "most polarizing and divisive food ingredients known." Some people love it; some people hate it. What's interesting is that the lovers and the haters appear to experience the taste differently. Individuals who like cilantro may describe it as "fresh, fragrant or citrusy, whereas those who dislike cilantro report that it tastes like soap, mold, dirt, or bugs." I don't know how people know what bugs taste like, but rarely are polarizing opinions about flavors so extreme. Maybe it's genetic.

Different ethnic groups do seem to have different rates of cilantro dislike, with Ashkenazi Jews scoring highest on the cilantro hate-o-meter (see The Cilantro Gene). Another clue came from twin studies, that show that identical twins tend to share cilantro preferences, whereas regular fraternal twins do not have such a strong correlation. Our genetic code is so big, though, containing about three billion letters, that to find some cilantro gene you'd have to analyze the DNA of like 10,000 people, and obviously genetic researchers have better things to do...or maybe not.

Researchers performed a genome-wide association study among 14,000 participants who reported whether cilantro tasted soapy, with replication in a distinct set of 11,000 people who declared whether they liked cilantro or not. And lo and behold they found a spot on chromosome 11 that seemed to be a match. What's there? A gene called OR6A2 that enables us to smell certain chemicals like E-(2)-Decenal, a primary constituent of cilantro and also...the defensive secretions of stink bugs. So maybe cilantro does taste like bugs! But, cilantro lovers may be genetic mutants that have an inability to smell the unpleasant compound.

That may actually be an advantage, though, since cilantro is healthy stuff. In fact, that's the justification to do these kinds of studies: to see why some people don't like the taste of healthy foods.

Are the cilantro haters really missing out on much, though? Mother nature has been described as the "oldest and most comprehensive pharmacy of all time," and cilantro--called coriander around most of the world--is one of nature's oldest herbal prescriptions, credited with anti-microbial, anti-oxidant, anti-diabetic, anti-anxiety, and anti-epilepsy properties. However, these are all from preclinical studies, meaning studies done on cells in a test tube or lab animals. Studies like the "Anti-Despair Activity of Cilantro..." in which researchers placed animals in a "despair apparatus" (you don't want to know).

Finally, though, there was a human study, on the anti-arthritis potential of cilantro. There was an earlier study performed in Germany of a lotion made out of cilantro seeds showing it could decrease the redness of a sunburn, demonstrating it had some anti-inflammatory effects )though not as much as an over-the-counter steroid, hydrocortisone, or prescription strength steroid cream). If the cilantro plant is anti-inflammatory, why nto give it to people with osteoarthritis and see if it helps? Researchers gave about 20 sprigs of cilantro daily for two months, and reported a significant drop in ESR--a nonspecific indicator of inflammation--in the cilantro group. How did the patients do clinically, though? The study didn't say, but it did report a rather remarkable 50% drop in uric acid levels, suggesting that huge amounts of cilantro may be useful for those suffering from gout.


The cilantro lovers/haters factoid reminds me of the video Pretty in Pee-nk about the phenomenon of "beeturia," pink urine after beet consumption seen in some people.

For those that don't mind the taste of bugs, I have some nutritional info in Good Grub: The Healthiest Meat and Bug Appétit: Barriers to Entomophagy.

As an Ashkenazim myself, I'm excited to have narrowly escaped a cilantro-less existence!

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

Why Some Like Cilantro and Others Hate It

The Cilantro Gene.jpg

One sign of changing U.S. demographics is that salsa has replaced ketchup as America's #1 table condiment. One of the popular salsa ingredients is cilantro, described as one of the "most polarizing and divisive food ingredients known." Some people love it; some people hate it. What's interesting is that the lovers and the haters appear to experience the taste differently. Individuals who like cilantro may describe it as "fresh, fragrant or citrusy, whereas those who dislike cilantro report that it tastes like soap, mold, dirt, or bugs." I don't know how people know what bugs taste like, but rarely are polarizing opinions about flavors so extreme. Maybe it's genetic.

Different ethnic groups do seem to have different rates of cilantro dislike, with Ashkenazi Jews scoring highest on the cilantro hate-o-meter (see The Cilantro Gene). Another clue came from twin studies, that show that identical twins tend to share cilantro preferences, whereas regular fraternal twins do not have such a strong correlation. Our genetic code is so big, though, containing about three billion letters, that to find some cilantro gene you'd have to analyze the DNA of like 10,000 people, and obviously genetic researchers have better things to do...or maybe not.

Researchers performed a genome-wide association study among 14,000 participants who reported whether cilantro tasted soapy, with replication in a distinct set of 11,000 people who declared whether they liked cilantro or not. And lo and behold they found a spot on chromosome 11 that seemed to be a match. What's there? A gene called OR6A2 that enables us to smell certain chemicals like E-(2)-Decenal, a primary constituent of cilantro and also...the defensive secretions of stink bugs. So maybe cilantro does taste like bugs! But, cilantro lovers may be genetic mutants that have an inability to smell the unpleasant compound.

That may actually be an advantage, though, since cilantro is healthy stuff. In fact, that's the justification to do these kinds of studies: to see why some people don't like the taste of healthy foods.

Are the cilantro haters really missing out on much, though? Mother nature has been described as the "oldest and most comprehensive pharmacy of all time," and cilantro--called coriander around most of the world--is one of nature's oldest herbal prescriptions, credited with anti-microbial, anti-oxidant, anti-diabetic, anti-anxiety, and anti-epilepsy properties. However, these are all from preclinical studies, meaning studies done on cells in a test tube or lab animals. Studies like the "Anti-Despair Activity of Cilantro..." in which researchers placed animals in a "despair apparatus" (you don't want to know).

Finally, though, there was a human study, on the anti-arthritis potential of cilantro. There was an earlier study performed in Germany of a lotion made out of cilantro seeds showing it could decrease the redness of a sunburn, demonstrating it had some anti-inflammatory effects )though not as much as an over-the-counter steroid, hydrocortisone, or prescription strength steroid cream). If the cilantro plant is anti-inflammatory, why nto give it to people with osteoarthritis and see if it helps? Researchers gave about 20 sprigs of cilantro daily for two months, and reported a significant drop in ESR--a nonspecific indicator of inflammation--in the cilantro group. How did the patients do clinically, though? The study didn't say, but it did report a rather remarkable 50% drop in uric acid levels, suggesting that huge amounts of cilantro may be useful for those suffering from gout.


The cilantro lovers/haters factoid reminds me of the video Pretty in Pee-nk about the phenomenon of "beeturia," pink urine after beet consumption seen in some people.

For those that don't mind the taste of bugs, I have some nutritional info in Good Grub: The Healthiest Meat and Bug Appétit: Barriers to Entomophagy.

As an Ashkenazim myself, I'm excited to have narrowly escaped a cilantro-less existence!

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.

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Using Cherries to Treat Gout

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Over the last 40 years, the burden of gout, a painful inflammatory arthritis, has risen considerably, now affecting millions of Americans. In fact, gout is now the most common inflammatory arthritis in men and older women.

In my video, Gout Treatment with a Cherry on Top, I profiled new research, suggesting that even as few as a half of a cup of cherries a day may significantly lower the risk of gout attacks. Fresh cherries aren't always in season, though. There are some alternatives. Frozen cherries appeared second-best and cherry juice concentrate is the runner-up. But does concentrated cherry juice actually help prevent attacks of gout?

The first pilot study was a randomized controlled trial cherry juice concentrate with pomegranate juice concentrate as a control for the prevention of attacks in gout sufferers who were having as many as four attacks a month. The cherry group got a tablespoon of cherry juice concentrate twice a day for four months, and the control group got a tablespoon of pomegranate juice concentrate twice a day for four months.

The number of gout flares in the cherry group dropped from an average of five down to two, better than the pomegranate group, which only dropped from about five to four. And about half of those in the cherry group who were on prescription anti-inflammatory drugs were able to stop their medications within two months after starting the cherry juice, as opposed to none of the patients in the pomegranate group.

The second study, highlighted in my video, Treating Gout with Cherry Juice, was a retrospective investigation over a longer term. Twenty-four gout patients went from having about seven attacks a year, down to two. The researchers concluded that cherry juice concentrate is efficacious for the prevention of gout flares. Large, long-term randomized controlled trials are needed to further evaluate the usefulness of cherries and cherry juice concentrate for gout flare prophylaxis.

So, are cherries now ripe for use as a complementary therapeutic in gout? One commentator "is of the opinion that the current state of evidence remains insufficient to formally recommend cherry fruit or cherry products as complementary therapeutic remedy for gout." This commentator is also a paid consultant of nine different drug companies, all of which manufacture gout medications. I understand how the pharmaceutical industry can get nervous seeing studies where half of patients were able to stop taking their gout drugs given the billions of dollars at stake, but what's the downside of eating a half cup of cherries a day, or worst comes to worst a few spoonfuls of cherry juice?

Here are the other videos I've done on the power of cherries to control inflammation:

Tart cherries (the kind people make pies out of, not the sweet kind) may also help with sleep (Tart Cherries for Insomnia).

What do you do with frozen cherries? I just eat them straight--suck on them like popsicles, but they're also an integral part of my Healthy Chocolate Milkshakes.

Another way to help treat gout is to drink lots of water and keep one's urine alkaline by eating lots of dark green leafy vegetables (see Testing Your Diet with Pee & Purple Cabbage).

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: Benson Kua / Flickr

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How to Treat Gout With Diet

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The Washington State Fruit Commission, our largest cherry producer, can fund reviews that cherry-pick studies on the anti-inflammatory effects of cherries in a petri dish and animal models. But what we've needed are human studies. For example, if we stuff the human equivalent of up to a thousand cups of cherries down the throats of rats, it appears to have an anti-inflammatory effect, but we could never eat that many. (In fact, if we tried, it could end badly. One poor guy who ate 500 cherries whole--without spitting out the pits--ended up fatally obstructing his colon.)

A decade ago, we didn't have many human studies, but thankfully now we do. A study published in The Journal of Nutrition had men and women eat about 45 cherries a day for a month (I wouldn't mind being part of that study!). The researchers found a 25% drop in C-reactive protein levels (a marker of inflammation), as well as an inflammatory protein with an inelegant acronym RANTES ("Regulated on, Activation, Normal, T cell, Expressed and, Secreted"). Even a month after the study ended there appeared to be residual anti-inflammatory benefit from the cherry fest.

These subjects were all healthy, with low levels of inflammation to begin with, but a follow-up study, highlighted in my video, Gout Treatment with a Cherry on Top, on folks with higher levels found similar results for C-reactive protein and for a number of other markers for chronic inflammatory diseases. Do cherries then help people who actually have a chronic inflammatory disease?

Back in 1950, in an obscure Texas medical journal, "observations made by responsible physicians" suggested that in a dozen patients with gout, eating half a pound of fresh or canned cherries helped prevent flares of gout. But the issue had never seriously been tested, until recently. Gout is an excruciatingly painful inflammatory arthritis caused by the crystallization of uric acid within joints. Based on the National Health and Nutrition Examination Survey 2007-2008, the prevalence of gout in the US is estimated to be 3.9% among US adults, which translates into 8.3 million people.

Hundreds of gout sufferers were studied, and cherry intake was associated with a 35% lower risk of gout attacks, with over half the risk gone at three servings measured over a two day period (about 16 cherries a day). That's the kind of efficacy the researchers saw with a low-purine diet (uric acid is a break-down product of purines). This same research group found that purine intake of animal origin increased the odds for recurrent gout attacks by nearly five-fold. Heavy alcohol consumption isn't a good idea either.

There are some high-purine non-animal foods, like mushrooms and asparagus, but they found no significant link to plant sources of purines. So the researchers recommended eliminating meat and seafood from the diet. This may decrease risk substantially, and adding cherries on top may decrease risk of gout attacks even further. Same thing with the leading drug: allopurinol works, but adding produce appears to work even better.

Often, dietary changes and cherries may be all patients have, as doctors are hesitant to prescribe uric acid-lowering drugs like allopurinol due to rare but serious side-effects.

In addition to fighting inflammation, cherries may also lower uric acid levels. Within five hours of eating a big bowl of cherries, uric acid levels in the blood significantly drop. At the same time, antioxidant levels in the blood go up. So is it just an antioxidant effect? Would other fruit work just as well? No. Researchers tried grapes, strawberries, and kiwi fruit, and none significantly lowered uric acid levels, supporting a specific anti-gout effect of cherries.

There are some new gout drugs out now, costing up to $2,000 per dose and carry a "risk of toxicity that may be avoided by using nonpharmacologic treatments or prevention in the first place." Given the potential harms and high costs, attention ought to be directed to dietary modification, reducing alcohol and meat intake, particularly sardines and organ meats. "If life serves up a bowl of cherries (consumed on a regular basis), the risk of a recurrent gout attack may be meaningfully reduced."

More about the inflammation fighting effects of sweet cherries in my video Anti-inflammatory Life is a Bowl of Cherries.

I've previously mentioned gout and controlling uric acid levels in my videos:

Other foods that may help tamp down inflammation:

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: Valdemar Fishmen / Flickr

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