Optimal Bowel Movement Frequency

Optimal Bowel Movement Frequency.jpeg

Lasting for 3,000 years, ancient Egypt was one of the greatest ancient civilizations--with a vastly underestimated knowledge of medicine. They even had medical subspecialties. The pharaohs, for example, had access to dedicated physicians to be "guardian[s] of the royal bowel movement," a title alternately translated from the hieroglyphics to mean "Shepherd of the Anus." How's that for a resume builder?

Today, the primacy of the bowel movement's importance continues. Some have called for bowel habits to be considered a vital sign on how the body is functioning, along with heart rate, blood pressure, and breathing rate. Medical professionals may not particularly relish hearing all about their patients' bowel movements, but it is a vital function that nurses and doctors need to assess.

Surprisingly, the colon has remained relatively unexplored territory, one of the body's final frontiers. For example, current concepts of what "normal" stools are emanated primarily from the records of 12 consecutive bowel movements in 27 healthy subjects from the United Kingdom, who boldly went where no one had gone before. Those must have been some really detailed records.

It's important to define what's normal. When it comes to frequency, for example, we can't define concepts like constipation or diarrhea unless we know what's normal. Standard physiology textbooks may not be helpful in this regard. One text implies that anything from one bowel movement every few weeks or months to 24 in just one day can be regarded as normal. Once every few months is normal?

Out of all of our bodily functions, we may know the least about defecation. Can't we just ask people? It turns out people tend to exaggerate. There's a discrepancy between what people report and what researchers find when they record bowel habits directly. It wasn't until 2010 when we got the first serious look. In my video, How Many Bowel Movement's Should You Have Everyday? you'll see the study that found that normal stool frequency was between three per week and three per day, based on the fact that that's where 98% of people tended to fall. But normal doesn't necessarily mean optimal.

Having a "normal" salt intake can lead to a "normal" blood pressure, which can help us to die from all the "normal" causes like heart attacks and strokes. Having a normal cholesterol level in a society where it's normal to drop dead of heart disease--our number-one killer--is not necessarily a good thing. Indeed, significant proportions of people with "normal bowel function" reported urgency, straining, and incomplete defecation, leading the researchers of the 2010 study to conclude that these kinds of things must be normal. Normal, maybe, if we're eating a fiber-deficient diet, but not normal for our species. Defecation should not be a painful exercise. This is readily demonstrable. For example, the majority of rural Africans eating their traditional fiber-rich, plant-based diets can usually pass without straining a stool specimen on demand. The rectum may need to accumulate 4 or 5 ounces of fecal matter before the defecation reflex is fully initiated, so if we don't even build up that much over the day, we'd have to strain to prime the rectal pump.

Hippocrates thought bowel movements should ideally be two or three times a day, which is what we see in populations on traditional plant-based diets. These traditional diets have the kind of fiber intakes we see in our fellow Great Apes and may be more representative of the type of diets we evolved eating for millions of years. It seems somewhat optimistic, though, to expect the average American to adopt a rural African diet. We can, however, eat more plant-based and bulk up enough to take the Hippocratic oath to go two or three times a day.

There's no need to obsess about it. In fact, there's actually a "bowel obsession syndrome" characterized in part by "ideational rambling over bowel habits." But three times a day makes sense. We have what's called a gastrocolic reflex, which consists of a prompt activation of muscular waves in our colon within 1 to 3 minutes of the ingestion of the first mouthfuls of food to make room for the meal. Even just talking about food can cause our brains to increase colon activity. This suggests the body figured that one meal should be about enough to fill us up down there. So maybe we should eat enough unprocessed plant foods to get up to three a day--a movement for every meal.

I know people are suckers for poop videos--I'm so excited to finally be getting these up! There actually is a recent one--Diet and Hiatal Hernia--that talks about the consequences of straining on stool. Hernias are better than Bed Pan Death Syndrome, though, which is what I talk about in in my video, Should You Sit, Squat, or Lean During a Bowel Movement?

Here are some older videos on bowel health:

For more on this concept of how having "normal" health parameters in a society where it's normal to drop dead of heart attacks and other such preventable fates, see my video When Low Risk Means High Risk.

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

Diet and Hiatal Hernia

Diet and Hiatal Hernia.jpeg

In terms of preventing acid reflux heartburn, high-fat meals cause dramatically more acid exposure in the esophagus in the hours after a meal. I talked about this in Diet and GERD Acid Reflux Heartburn. High fiber intake decreases the risk, but why? One typically thinks of fiber as helping out much lower in the digestive tract.

A systematic review and meta-analysis published in 2013 found a highly significant protective association between esophageal adenocarcinoma and dietary fiber intake, suggesting that individuals with the highest fiber intakes have an approximately 30% lower risk of cancer. This could be because of the phytates in high-fiber foods slowing cancer growth, fiber's anti-inflammatory effects, or even fiber removing carcinogens. But those are all generic anti-cancer effects of whole plant foods. Specific to this type of acid irritation-induced esophageal cancer, fiber may reduce the risk of reflux in the first place. But how?

As you can see in my video, Diet and Hiatal Hernia, hiatus hernia occurs when part of the stomach is pushed up through the diaphragm into the chest cavity, which makes it easy for acid to reflux into the esophagus and throat. Hiatus hernia affects more than 1 in 5 American adults. In contrast, in rural African communities eating their traditional plant-based diets, the risk wasn't 1 in 5; it was closer to 1 in 1,000--almost unheard of. Hiatus hernia is almost peculiar to those who consume western-type diets. Why are plant-based populations protected? Perhaps because they pass such large, soft stools, three or four times the volume as Westerners.

What does the size and consistency of one's bowel movement have to do with hiatal hernia? A simple model may be helpful in illustrating the mechanism that produces upward herniation of the stomach through the hole (called the esophageal hiatus) in the diaphragm, which separates the abdomen from the chest. If a ball with a hole in its wall is filled with water and then squeezed, the water is pushed out through the hole. If we liken the abdominal cavity to the ball, the esophageal hiatus in the diaphragm corresponds with the hole in the ball. Abdominal straining during movement of firm feces corresponds to squeezing the ball and may result in the gradual expulsion of the upper end of the stomach from the abdominal cavity up into the chest. It's like when we squeeze a stress ball. Straining at stool raises pressures inside our abdominal cavity more than almost any other factor.

In effect, straining at stool puts the squeeze on our abdomen and may herniate part of our stomach up. "Consistent with this concept is the observation that in Africans the lower esophageal sphincter is entirely subdiaphragmatic, whereas it usually straddles the diaphragm in Westerners and is above the diaphragm in the presence of hiatus hernia."

This same abdominal pressure from straining may cause a number of other problems, too. Straining can cause herniations in the wall of the colon itself, known as diverticulosis. That same pressure can backup blood flow in the veins around the anus, causing hemorrhoids, and also push blood flow back into the legs, resulting in varicose veins.

Hiatal hernia is not the only condition that high-fiber diets may protect against. See:

I also have a load of other bowel movement videos:

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

Diet and Hiatal Hernia

Diet and Hiatal Hernia.jpeg

In terms of preventing acid reflux heartburn, high-fat meals cause dramatically more acid exposure in the esophagus in the hours after a meal. I talked about this in Diet and GERD Acid Reflux Heartburn. High fiber intake decreases the risk, but why? One typically thinks of fiber as helping out much lower in the digestive tract.

A systematic review and meta-analysis published in 2013 found a highly significant protective association between esophageal adenocarcinoma and dietary fiber intake, suggesting that individuals with the highest fiber intakes have an approximately 30% lower risk of cancer. This could be because of the phytates in high-fiber foods slowing cancer growth, fiber's anti-inflammatory effects, or even fiber removing carcinogens. But those are all generic anti-cancer effects of whole plant foods. Specific to this type of acid irritation-induced esophageal cancer, fiber may reduce the risk of reflux in the first place. But how?

As you can see in my video, Diet and Hiatal Hernia, hiatus hernia occurs when part of the stomach is pushed up through the diaphragm into the chest cavity, which makes it easy for acid to reflux into the esophagus and throat. Hiatus hernia affects more than 1 in 5 American adults. In contrast, in rural African communities eating their traditional plant-based diets, the risk wasn't 1 in 5; it was closer to 1 in 1,000--almost unheard of. Hiatus hernia is almost peculiar to those who consume western-type diets. Why are plant-based populations protected? Perhaps because they pass such large, soft stools, three or four times the volume as Westerners.

What does the size and consistency of one's bowel movement have to do with hiatal hernia? A simple model may be helpful in illustrating the mechanism that produces upward herniation of the stomach through the hole (called the esophageal hiatus) in the diaphragm, which separates the abdomen from the chest. If a ball with a hole in its wall is filled with water and then squeezed, the water is pushed out through the hole. If we liken the abdominal cavity to the ball, the esophageal hiatus in the diaphragm corresponds with the hole in the ball. Abdominal straining during movement of firm feces corresponds to squeezing the ball and may result in the gradual expulsion of the upper end of the stomach from the abdominal cavity up into the chest. It's like when we squeeze a stress ball. Straining at stool raises pressures inside our abdominal cavity more than almost any other factor.

In effect, straining at stool puts the squeeze on our abdomen and may herniate part of our stomach up. "Consistent with this concept is the observation that in Africans the lower esophageal sphincter is entirely subdiaphragmatic, whereas it usually straddles the diaphragm in Westerners and is above the diaphragm in the presence of hiatus hernia."

This same abdominal pressure from straining may cause a number of other problems, too. Straining can cause herniations in the wall of the colon itself, known as diverticulosis. That same pressure can backup blood flow in the veins around the anus, causing hemorrhoids, and also push blood flow back into the legs, resulting in varicose veins.

Hiatal hernia is not the only condition that high-fiber diets may protect against. See:

I also have a load of other bowel movement videos:

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

How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That's the topic of How to Treat High Blood Pressure with Diet.

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend lifestyle modification as the first-line treatment. If that doesn't work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What's wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don't treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one's weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it's not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not vegetarian? We've known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I've talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. In rural Africa, the elderly have perfect blood pressure as opposed to hypertension. What both diets share in common is that they're plant-based day-to-day, with meat only eaten on special occasion.

How do we know it's the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low were those eating strictly plant-based diets, coming out about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it "palatable" to the general public.

You can see what they were thinking. Just like drugs never work--unless you actually take them. Diet never work--unless you actually eat them. So what's the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with a compromise diet you can imagine how they were thinking that on a population clae they might be doing more good. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it's time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it's the added plant foods--not the changes in oil, sweets, or dairy--that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we're already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you'd have to eat around 2 pounds a day. Sounds like my kind of medicine, but it's hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don't seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.

The DASH diet is one of the best studied, and it consistently ranks as US News & World Report's #1 diet. It's one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I've talked about the patronizing attitude many doctors have that patients can't handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, see:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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

Original Link

How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That's the topic of How to Treat High Blood Pressure with Diet.

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend lifestyle modification as the first-line treatment. If that doesn't work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What's wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don't treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one's weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it's not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not vegetarian? We've known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I've talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. In rural Africa, the elderly have perfect blood pressure as opposed to hypertension. What both diets share in common is that they're plant-based day-to-day, with meat only eaten on special occasion.

How do we know it's the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low were those eating strictly plant-based diets, coming out about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it "palatable" to the general public.

You can see what they were thinking. Just like drugs never work--unless you actually take them. Diet never work--unless you actually eat them. So what's the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with a compromise diet you can imagine how they were thinking that on a population clae they might be doing more good. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it's time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it's the added plant foods--not the changes in oil, sweets, or dairy--that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we're already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you'd have to eat around 2 pounds a day. Sounds like my kind of medicine, but it's hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don't seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.

The DASH diet is one of the best studied, and it consistently ranks as US News & World Report's #1 diet. It's one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I've talked about the patronizing attitude many doctors have that patients can't handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, see:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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

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

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

Can Oatmeal Reverse Heart Disease?

Can Oatmeal Reverse Heart Disease?.jpeg

Fiber continues to be singled out as a nutrient of public health concern. We're getting only about half the minimum recommended intake on average. There is a fiber gap in America. Less than 3 percent meet the recommended minimum. This means that less than 3 percent of all Americans eat enough whole plant foods, the only place fiber is found in abundance. If even half of the adult population ate 3 more grams a day--a quarter cup of beans or a bowl of oatmeal--we could potentially save billions in medical costs. And that's just for constipation! The consumption of plant foods, of fiber-containing foods, may reduce the risk for diabetes, heart disease, stroke, cancer, and obesity as well.

The first to make this link between fiber intake and killer disease was probably Dr. Hugh Trowell. He spent 30 years practicing medicine in Africa and suspected it was the Africans high consumption of corn, millet, sweet potatoes, greens, and beans that protected them from chronic disease. This twisted into the so-called "fiber hypothesis," but Trowell didn't think it was the fiber itself, but the high-fiber foods themselves that were protective. There are hundreds of different substances in whole plant foods besides fiber that may have beneficial effects. For example, the fiber in oatmeal can lower our blood cholesterol levels so that less gets stuck in our arteries, but there also are anti-inflammatory and antioxidant phytonutrients in oats that can prevent atherosclerotic build-up and then help maintain arterial function (see Can Oatmeal Reverse Heart Disease?).

Visionaries like Trowell were not entrapped by the reductionist "simple-minded" focus on dietary fiber and insisted that the whole plant foods should receive the emphasis. Fiber intake was just a marker for plant food intake. Those with the highest fiber intake and the lowest cholesterol were those whose who ate exclusively plant-based diets.

Risk factors like cholesterol are one thing, but can these individual foods actually affect the progression of heart disease, the #1 killer of Americans? We didn't know until 2005. Hundreds of older women were subjected to coronary angiograms, where we inject dye into the coronary arteries of the heart to see how wide open they are. Each participant got an angiogram at the beginning of the study and one a few years later, all while researchers analyzed their diets. The arteries of women eating less than a serving of whole grains a day significantly narrowed, whereas the arteries of women who ate just a single serving or more also significantly narrowed, but they narrowed less. These were all women with heart disease eating the standard American diet, so their arteries were progressively clogging shut. But there was significantly less clogging in the women eating more whole grains, significantly less progression of their atherosclerosis. A similar slowing of their disease might be expected from taking cholesterol-lowering statin drugs. But do we want to just slow the rate at which we die from heart disease, or do we want to not die from heart disease at all?

A strictly plant-based diet has been shown to reverse the progression of heart disease, opening up arteries back up. Yes, whole grains, like drugs, can help counter the artery-clogging effects of the rest of the diet. Having oatmeal with bacon and eggs is better than just eating bacon and eggs, but why not stop eating an artery-clogging diet altogether?

Oatmeal offers a lot more than fiber, though. See Oatmeal Lotion for Chemotherapy-Induced Rash and Can Oatmeal Help Fatty Liver Disease?

Trowell's work had a big influence on Dr. Denis Burkitt. See Dr. Burkitt's F-Word Diet.

This reminds me of other interventions like hibiscus tea for high blood pressure (Hibiscus Tea vs. Plant-Based Diets for Hypertension) or amla for diabetes (Amla Versus Diabetes). Better to reverse the disease completely.

And for an overview of how whole plant foods affect disease risks, be sure to check out the videos on our new Introduction page!

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: Rachel Hathaway / Flickr. This image has been modified.

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Can Oatmeal Reverse Heart Disease?

Can Oatmeal Reverse Heart Disease?.jpeg

Fiber continues to be singled out as a nutrient of public health concern. We're getting only about half the minimum recommended intake on average. There is a fiber gap in America. Less than 3 percent meet the recommended minimum. This means that less than 3 percent of all Americans eat enough whole plant foods, the only place fiber is found in abundance. If even half of the adult population ate 3 more grams a day--a quarter cup of beans or a bowl of oatmeal--we could potentially save billions in medical costs. And that's just for constipation! The consumption of plant foods, of fiber-containing foods, may reduce the risk for diabetes, heart disease, stroke, cancer, and obesity as well.

The first to make this link between fiber intake and killer disease was probably Dr. Hugh Trowell. He spent 30 years practicing medicine in Africa and suspected it was the Africans high consumption of corn, millet, sweet potatoes, greens, and beans that protected them from chronic disease. This twisted into the so-called "fiber hypothesis," but Trowell didn't think it was the fiber itself, but the high-fiber foods themselves that were protective. There are hundreds of different substances in whole plant foods besides fiber that may have beneficial effects. For example, the fiber in oatmeal can lower our blood cholesterol levels so that less gets stuck in our arteries, but there also are anti-inflammatory and antioxidant phytonutrients in oats that can prevent atherosclerotic build-up and then help maintain arterial function (see Can Oatmeal Reverse Heart Disease?).

Visionaries like Trowell were not entrapped by the reductionist "simple-minded" focus on dietary fiber and insisted that the whole plant foods should receive the emphasis. Fiber intake was just a marker for plant food intake. Those with the highest fiber intake and the lowest cholesterol were those whose who ate exclusively plant-based diets.

Risk factors like cholesterol are one thing, but can these individual foods actually affect the progression of heart disease, the #1 killer of Americans? We didn't know until 2005. Hundreds of older women were subjected to coronary angiograms, where we inject dye into the coronary arteries of the heart to see how wide open they are. Each participant got an angiogram at the beginning of the study and one a few years later, all while researchers analyzed their diets. The arteries of women eating less than a serving of whole grains a day significantly narrowed, whereas the arteries of women who ate just a single serving or more also significantly narrowed, but they narrowed less. These were all women with heart disease eating the standard American diet, so their arteries were progressively clogging shut. But there was significantly less clogging in the women eating more whole grains, significantly less progression of their atherosclerosis. A similar slowing of their disease might be expected from taking cholesterol-lowering statin drugs. But do we want to just slow the rate at which we die from heart disease, or do we want to not die from heart disease at all?

A strictly plant-based diet has been shown to reverse the progression of heart disease, opening up arteries back up. Yes, whole grains, like drugs, can help counter the artery-clogging effects of the rest of the diet. Having oatmeal with bacon and eggs is better than just eating bacon and eggs, but why not stop eating an artery-clogging diet altogether?

Oatmeal offers a lot more than fiber, though. See Oatmeal Lotion for Chemotherapy-Induced Rash and Can Oatmeal Help Fatty Liver Disease?

Trowell's work had a big influence on Dr. Denis Burkitt. See Dr. Burkitt's F-Word Diet.

This reminds me of other interventions like hibiscus tea for high blood pressure (Hibiscus Tea vs. Plant-Based Diets for Hypertension) or amla for diabetes (Amla Versus Diabetes). Better to reverse the disease completely.

And for an overview of how whole plant foods affect disease risks, be sure to check out the videos on our new Introduction page!

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: Rachel Hathaway / Flickr. This image has been modified.

Original Link

Best Foods for Acid Reflux

Best Foods for Acid Reflux.jpeg

Gastroesophageal reflux disease (GERD) is one of the most common disorders of the digestive tract. The two most typical symptoms are heartburn and regurgitation of stomach contents into the back of the throat, but GERD is not just burning pain and a sour taste in your mouth. It causes millions of doctor visits and hospitalizations every year in the United States. The most feared complication is cancer.

You start out with a normal esophagus. If the acid keeps creeping up, your esophagus can get inflamed and result in esophagitis. Esophagitis can transform into Barrett's esophagus, a precancerous condition which can then turn into adenocarcinoma (a type of cancer). To prevent all that, we need to prevent the acid reflux in the first place.

In the last three decades, the incidence of this cancer in the US has increased six-fold, an increase greater than that of melanoma, breast, or prostate cancer. This is because acid reflux is on the rise. In the United States, we're up to about 1 in 4 people suffering at least weekly heartburn and/or acid regurgitation, compared to around 5% in Asia. This suggests that dietary factors may play a role.

In general, high fat intake is associated with increased risk, whereas high fiber foods appear to be protective. The reason fat intake may be associated with GERD symptoms and erosive esophagitis is because when we eat fatty foods, the sphincter at the top of the stomach that's supposed to keep the food down becomes relaxed, so more acid can creep up into the esophagus. In my video Diet & GERD Acid Reflux Heartburn, you can see a study in which researchers fed volunteers a high-fat meal--a McDonald's sausage and egg McMuffin--compared to a low-fat meal (McDonald's hot cakes), and there was significantly more acid squirted up in the esophagus after the high-fat meal.

In terms of later stages of disease progression, over the last twenty years 45 studies have been published in the association between diet and Barrett's esophagus and esophageal cancer. In general, they found that meat and high-fat meals appeared to increase cancer risk. Different meats were associated with cancers in different locations, thoughj. Red meat was more associated with cancer in the esophagus, whereas poultry was more associated with cancer at the top of the stomach. Plant-based sources of protein, such as beans and nuts, were associated with a significantly decreased risk of cancer.

Those eating the most antioxidant-rich foods have half the odds of esophageal cancer, while there is practically no reduction in risk among those who used antioxidant vitamin supplements, such as vitamin C or E pills. The most protective produce may be red-orange vegetables, dark green leafies, berries, apples, and citrus. The benefit may come from more than just eating plants. Eating healthy foods crowds out less healthy foods, so it may be a combination of both.

Based on a study of 3,000 people, the consumption of non-vegetarian foods (including eggs) was an independent predictor of GERD. Egg yolks cause an increase in the hormone cholecystokinin, which may overly relax the sphincter that separates the esophagus from the stomach. The same hormone is increased by meat, which may help explain why plant-based diets appear to be a protective factor for reflux esophagitis.

Researchers found that those eating meat had twice the odds of reflux-induced esophageal inflammation. Therefore, plant-based diets may offer protection, though it's uncertain whether it's attributable to the absence of meat in the diet or the increased consumption of healthy foods. Those eating vegetarian consume greater amounts of fruits and vegetables containing innumerable phytochemicals, dietary fiber, and antioxidants. They also restrict their consumption of animal sources of food, which tend to be fattier and can thus relax that sphincter and aggravate reflux.

GERD is common; its burdens are enormous. It relapses frequently and can cause bleeding, strictures, and a deadly cancer. The mainstay of treatment is proton pump inhibitor drugs, which rake in billions of dollars. We spend four billion dollars on Nexium alone, three billion on Prevacid, two billion on Protonix, one billion on Aciphex. These drugs can cause nutrient deficiencies and increase the risk for pneumonia, food poisoning, and bone fractures. Thus, it is important to find correctable risk factors and correct them. Known correctable risk factors have been things like obesity, smoking and alcohol consumption. Until recently, though, there hadn't been studies on specifically what to eat and what to avoid, but now we have other correctable factors to help prevent this disease.

For more on GERD, see: Diet & Hiatal Hernia, Coffee & Mortality, and Club Soda for Stomach Pain & Constipation.

I also have a video about esophageal cancer, detailing the extraordinary reversal of the kinds of precancerous changes that lead to the devastating condition--with nothing but strawberries: Strawberries versus Esophageal Cancer.

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: PDPics / Pixabay. Image has been modified.

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