Chocolate is Finally Put to the Test

Oct 10 Chocolate copy.jpeg

Botanically speaking, seeds are small embryonic plants--the whole plant stuffed into a tiny seed and surrounded by an outer layer packed with vitamins, minerals, and phytochemicals to protect the seedling plant's DNA from free radicals. No wonder they're so healthy. By seeds, using the formal definition, we're talking all whole grains; grains are seeds--you plant them and they grow. Nuts are just dry fruits with one or two seeds. Legumes (beans, peas, and lentils) are seeds, too, as are cocoa and coffee beans. So, finding health-promoting effects in something like cocoa or coffee should not be all that surprising. There is substantial evidence that increased consumption of all these little plants is associated with lower risk of cardiovascular disease.

Of course, much of chocolate research is just on how to get consumers to eat more. While it didn't seem to matter what kind of music people were listening to when it came to the flavor intensity, pleasantness, or texture of a bell pepper, people liked chocolate more when listening to jazz than classical, rock, or hip hop. Why is this important? So food industries can "integrate specific musical stimuli" in order to maximize their profits. For example, purveyors may play jazz in the background to increase consumers' acceptance of their chocolates. Along these lines, another study demonstrated that people rated the oyster eaten "more pleasant in the presence of the 'sound of the sea' than in the presence of 'farmyard noises.'"

You'd think chocolate would just sell itself, given that it's considered the most commonly craved food in the world. The same degree of interest doesn't seem to exist as to whether or not Brussels sprouts might provide similar cardiovascular protection. So, it's understandable to hope chocolate provides health benefits. Meanwhile, despite their known benefits, Brussels sprouts don't get the love they deserve.

One of the potential downsides of chocolate is weight gain, which is the subject of my Does Chocolate Cause Weight Gain? video. Though cocoa hardly has any calories, chocolate is one of the most calorie-dense foods. For example: A hundred calories of chocolate is less than a quarter of a bar, compared to a hundred calories of strawberries, which is more than two cups..

A few years ago, a study funded by the National Confectioners Association--an organization that, among other things, runs the website voteforcandy.com--reported that Americans who eat chocolate weigh, on average, four pounds less than those who don't. But maybe chocolate-eaters exercise more or eat more fruits and vegetables. The researchers didn't control for any of that.

The findings of a more recent study published in the Archives of Internal Medicine were less easy to dismiss and there were no apparent ties to Big Chocolate. The researchers reported that out of a thousand men and women they studied in San Diego, those who frequently consumed chocolate had a lower BMI--actually weighed less--than those who ate chocolate less often. And this was even after adjusting for physical activity and diet quality. But, it was a cross-sectional study, meaning a snapshot in time, so you can't prove cause and effect. Maybe not eating chocolate leads to being fatter, or maybe being fatter leads to not eating chocolate. Maybe people who are overweight are trying to cut down on sweets. What we need is a study in which people are followed over time.

There was no such prospective study, until now. More than 10,000 people were followed for six years, and a chocolate habit was associated with long-term weight gain in a dose-response manner. This means the greatest weight gain over time was seen in those with the highest frequency of chocolate intake. It appears the reason the cross-sectional studies found the opposite is that subjects diagnosed with obesity-related illnesses tended to reduce their intake of things like chocolate in an attempt to improve their prognosis. This explains why heavier people may, on average, eat less chocolate.

To bolster this finding came the strongest type of evidence--an interventional trial--in which you split people up into two groups and change half their diets. Indeed, adding four squares of chocolate to peoples' daily diets does appear to add a few pounds.

So, what do we tell our patients? In 2013, researchers wrote in the American Family Physician journal that "because many cocoa products are high in sugar and saturated fat, family physicians should refrain from recommending cocoa...." That's a little patronizing, though. You can get the benefits of chocolate without any sugar or fat by adding cocoa powder to a smoothie, for example. Too often, doctors think patients can't handle the truth. Case in point: If your patients inquire, one medical journal editorial suggest, ask them what type of chocolate they prefer. If they respond with milk chocolate, then it is best to answer that it is not good for them. If the answer is dark chocolate, then you can lay out the evidence.


Even better than dark chocolate would be cocoa powder, which contains the phytonutrients without the saturated fat. I've happily (and deliciously) created other videos on cocoa and chocolate, so check out Update on Chocolate, Healthiest Chocolate Fix, A Treatment for Chronic Fatigue Syndrome, and Dark Chocolate and Artery Function.

Whether with Big Candy, Big Chocolate, or some other player, you always have to be careful about conflict of interest. For more information, watch my Food Industry Funded Research Bias video.

In health,

Michael Greger, M.D.

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

Original Link

Chocolate is Finally Put to the Test

Oct 10 Chocolate copy.jpeg

Botanically speaking, seeds are small embryonic plants--the whole plant stuffed into a tiny seed and surrounded by an outer layer packed with vitamins, minerals, and phytochemicals to protect the seedling plant's DNA from free radicals. No wonder they're so healthy. By seeds, using the formal definition, we're talking all whole grains; grains are seeds--you plant them and they grow. Nuts are just dry fruits with one or two seeds. Legumes (beans, peas, and lentils) are seeds, too, as are cocoa and coffee beans. So, finding health-promoting effects in something like cocoa or coffee should not be all that surprising. There is substantial evidence that increased consumption of all these little plants is associated with lower risk of cardiovascular disease.

Of course, much of chocolate research is just on how to get consumers to eat more. While it didn't seem to matter what kind of music people were listening to when it came to the flavor intensity, pleasantness, or texture of a bell pepper, people liked chocolate more when listening to jazz than classical, rock, or hip hop. Why is this important? So food industries can "integrate specific musical stimuli" in order to maximize their profits. For example, purveyors may play jazz in the background to increase consumers' acceptance of their chocolates. Along these lines, another study demonstrated that people rated the oyster eaten "more pleasant in the presence of the 'sound of the sea' than in the presence of 'farmyard noises.'"

You'd think chocolate would just sell itself, given that it's considered the most commonly craved food in the world. The same degree of interest doesn't seem to exist as to whether or not Brussels sprouts might provide similar cardiovascular protection. So, it's understandable to hope chocolate provides health benefits. Meanwhile, despite their known benefits, Brussels sprouts don't get the love they deserve.

One of the potential downsides of chocolate is weight gain, which is the subject of my Does Chocolate Cause Weight Gain? video. Though cocoa hardly has any calories, chocolate is one of the most calorie-dense foods. For example: A hundred calories of chocolate is less than a quarter of a bar, compared to a hundred calories of strawberries, which is more than two cups..

A few years ago, a study funded by the National Confectioners Association--an organization that, among other things, runs the website voteforcandy.com--reported that Americans who eat chocolate weigh, on average, four pounds less than those who don't. But maybe chocolate-eaters exercise more or eat more fruits and vegetables. The researchers didn't control for any of that.

The findings of a more recent study published in the Archives of Internal Medicine were less easy to dismiss and there were no apparent ties to Big Chocolate. The researchers reported that out of a thousand men and women they studied in San Diego, those who frequently consumed chocolate had a lower BMI--actually weighed less--than those who ate chocolate less often. And this was even after adjusting for physical activity and diet quality. But, it was a cross-sectional study, meaning a snapshot in time, so you can't prove cause and effect. Maybe not eating chocolate leads to being fatter, or maybe being fatter leads to not eating chocolate. Maybe people who are overweight are trying to cut down on sweets. What we need is a study in which people are followed over time.

There was no such prospective study, until now. More than 10,000 people were followed for six years, and a chocolate habit was associated with long-term weight gain in a dose-response manner. This means the greatest weight gain over time was seen in those with the highest frequency of chocolate intake. It appears the reason the cross-sectional studies found the opposite is that subjects diagnosed with obesity-related illnesses tended to reduce their intake of things like chocolate in an attempt to improve their prognosis. This explains why heavier people may, on average, eat less chocolate.

To bolster this finding came the strongest type of evidence--an interventional trial--in which you split people up into two groups and change half their diets. Indeed, adding four squares of chocolate to peoples' daily diets does appear to add a few pounds.

So, what do we tell our patients? In 2013, researchers wrote in the American Family Physician journal that "because many cocoa products are high in sugar and saturated fat, family physicians should refrain from recommending cocoa...." That's a little patronizing, though. You can get the benefits of chocolate without any sugar or fat by adding cocoa powder to a smoothie, for example. Too often, doctors think patients can't handle the truth. Case in point: If your patients inquire, one medical journal editorial suggest, ask them what type of chocolate they prefer. If they respond with milk chocolate, then it is best to answer that it is not good for them. If the answer is dark chocolate, then you can lay out the evidence.


Even better than dark chocolate would be cocoa powder, which contains the phytonutrients without the saturated fat. I've happily (and deliciously) created other videos on cocoa and chocolate, so check out Update on Chocolate, Healthiest Chocolate Fix, A Treatment for Chronic Fatigue Syndrome, and Dark Chocolate and Artery Function.

Whether with Big Candy, Big Chocolate, or some other player, you always have to be careful about conflict of interest. For more information, watch my Food Industry Funded Research Bias video.

In health,

Michael Greger, M.D.

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

Original Link

Music as Medicine

Music as Medicine.jpeg

We've been playing music since the Paleolithic Era, 40,000 years ago. Music as therapy has been documented since at least biblical times. The first music therapy experiment was published in the Journal of the American Medical Association in 1914. As to why he placed a phonograph in the operating room as his patients lay fully conscious and awake during surgery, the surgeon explained it was "a means of calming and distracting my patients from the horror of the situation."

Now that we have anesthesia, music is used to calm nerves before surgery. Normally we use Valium-type drugs like midazolam (sold as Versed), but they can have a variety of side effects, including sometimes even making people more agitated. A study from Sweden sought to determine if relaxing music has a greater anxiety-reducing effect than a standard dose of midazolam. Researchers whipped out some Kenny G, and the music worked significantly better than the drug. Those listening to Mr. G had lower anxiety scores, heart rates, and blood pressures. This is perhaps the first report of any anti-anxiety therapy working not only as good as, but even better than, benzodiazepine drugs. The difference in side effects of relaxing music compared to the drug is obvious: There were none. Soft jazz causes no post-operative hangover. The researchers suggest we should start using music instead of midazolam.

Music may also reduce anxiety and pain in children undergoing minor medical and dental procedures, helping with blood draws and shots. It may even reduce the pain of spinal taps. However, Mozart is evidently powerless against the pain of circumcision.

It doesn't take a randomized controlled trial to demonstrate that listening to music can be relaxing. Tell me something I don't know. Well, if you take someone with a latex allergy and inject their skin with latex, they get a big, red, angry bump. But if you repeat the test after they've been listening to Mozart for 30 minutes, they develop a much smaller bump (as you can see in my video, Music as Medicine). That is, they have less of an allergic reaction. If you think that's wild, get ready for this: Beethoven didn't work. The subjects had the same reaction before and after listening to his music! Schubert, Hayden, and Brahms didn't work either, as all failed to reduce the allergic skin response. The reducing effect on allergic responses may be specific to Mozart.

So Mozart's looking pretty good, but what if he could be suppressing our immune systems in general? That would not be good. The same researchers also injected a chemical that causes reactions in everyone, not just in allergic people. Mozart had no effect. It seems Mozart suppresses only the pathological allergic reaction. If that isn't crazy enough for you, the researchers drew subjects' blood after the music, stuck their white blood cells in a petri dish with a little latex, and measured the allergic antibody response. The white blood cells from those exposed to Mozart had less of an allergic response even outside the body compared to cells taken from Beethoven blood. How cool is that?

Music may even impact our metabolism. This inquiry started with a 2012 study published in the journal Pediatrics, which found the resting energy expenditure (the number of calories burned when just lying around) was lower in preterm infants when researchers piped in Mozart. This may explain why infants exposed to music put on weight faster, so much so they are able to go home earlier.

Gaining weight faster is great for premature babies, but not necessarily for adults. Could listening to music slow our metabolism and contribute to weight gain? Well, one study found no effect on adults. But the researchers used Bach, not Mozart. Bach doesn't cause a drop in energy expenditure in babies either. These data suggest there may be "more a 'Mozart effect' than a universal 'music effect'."

What if we just listen to music of our choice? Does that affect our metabolism? We didn't know... until now. It turns out that listening to music appears to actually increase our metabolic rate, such that we burn an average of 27.6 more calories a day just lying in bed. That's only like six M&M's worth, though, so it's better to use music to get up and start dancing or exercising. Music can not only improve exercise enjoyment but also performance--a way to improve athletic performance that's legal.

Male bodybuilders may be less enthused music's effects. After listening to music for just 30 minutes, testosterone levels drop 14% in young men and go up 21% in young women. Do all kinds of music have this effect or just some types? Thirty minutes of silence had no effect on testosterone levels at all, while a half-hour of Mozart, jazz, pop, or Gregorian chants (no relation :) all suppressed testosterone. What about a half-hour of people's personal favorites? Testosterone levels were cut in half! Testosterone decreased in males under all music conditions, whereas testosterone increased in females. What is going on? Well, in men, testosterone is related to libido, dominance, and aggressiveness, whereas women get a bigger boost in testosterone from cuddling than from sex. So maybe we evolved using music as a way to ensure we all got along, like a melodious cold shower to keep everyone chill.

Is that crazy or what? I'm fascinated by the whole topic. For more, see Music for Anxiety: Mozart vs. Metal.

Sounds are the only sensory-stimulators that can have an effect on us--so can scents! See:

Exposure to industrial pollutants may also affect both allergic diseases and testosterone levels:

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

Music as Medicine

Music as Medicine.jpeg

We've been playing music since the Paleolithic Era, 40,000 years ago. Music as therapy has been documented since at least biblical times. The first music therapy experiment was published in the Journal of the American Medical Association in 1914. As to why he placed a phonograph in the operating room as his patients lay fully conscious and awake during surgery, the surgeon explained it was "a means of calming and distracting my patients from the horror of the situation."

Now that we have anesthesia, music is used to calm nerves before surgery. Normally we use Valium-type drugs like midazolam (sold as Versed), but they can have a variety of side effects, including sometimes even making people more agitated. A study from Sweden sought to determine if relaxing music has a greater anxiety-reducing effect than a standard dose of midazolam. Researchers whipped out some Kenny G, and the music worked significantly better than the drug. Those listening to Mr. G had lower anxiety scores, heart rates, and blood pressures. This is perhaps the first report of any anti-anxiety therapy working not only as good as, but even better than, benzodiazepine drugs. The difference in side effects of relaxing music compared to the drug is obvious: There were none. Soft jazz causes no post-operative hangover. The researchers suggest we should start using music instead of midazolam.

Music may also reduce anxiety and pain in children undergoing minor medical and dental procedures, helping with blood draws and shots. It may even reduce the pain of spinal taps. However, Mozart is evidently powerless against the pain of circumcision.

It doesn't take a randomized controlled trial to demonstrate that listening to music can be relaxing. Tell me something I don't know. Well, if you take someone with a latex allergy and inject their skin with latex, they get a big, red, angry bump. But if you repeat the test after they've been listening to Mozart for 30 minutes, they develop a much smaller bump (as you can see in my video, Music as Medicine). That is, they have less of an allergic reaction. If you think that's wild, get ready for this: Beethoven didn't work. The subjects had the same reaction before and after listening to his music! Schubert, Hayden, and Brahms didn't work either, as all failed to reduce the allergic skin response. The reducing effect on allergic responses may be specific to Mozart.

So Mozart's looking pretty good, but what if he could be suppressing our immune systems in general? That would not be good. The same researchers also injected a chemical that causes reactions in everyone, not just in allergic people. Mozart had no effect. It seems Mozart suppresses only the pathological allergic reaction. If that isn't crazy enough for you, the researchers drew subjects' blood after the music, stuck their white blood cells in a petri dish with a little latex, and measured the allergic antibody response. The white blood cells from those exposed to Mozart had less of an allergic response even outside the body compared to cells taken from Beethoven blood. How cool is that?

Music may even impact our metabolism. This inquiry started with a 2012 study published in the journal Pediatrics, which found the resting energy expenditure (the number of calories burned when just lying around) was lower in preterm infants when researchers piped in Mozart. This may explain why infants exposed to music put on weight faster, so much so they are able to go home earlier.

Gaining weight faster is great for premature babies, but not necessarily for adults. Could listening to music slow our metabolism and contribute to weight gain? Well, one study found no effect on adults. But the researchers used Bach, not Mozart. Bach doesn't cause a drop in energy expenditure in babies either. These data suggest there may be "more a 'Mozart effect' than a universal 'music effect'."

What if we just listen to music of our choice? Does that affect our metabolism? We didn't know... until now. It turns out that listening to music appears to actually increase our metabolic rate, such that we burn an average of 27.6 more calories a day just lying in bed. That's only like six M&M's worth, though, so it's better to use music to get up and start dancing or exercising. Music can not only improve exercise enjoyment but also performance--a way to improve athletic performance that's legal.

Male bodybuilders may be less enthused music's effects. After listening to music for just 30 minutes, testosterone levels drop 14% in young men and go up 21% in young women. Do all kinds of music have this effect or just some types? Thirty minutes of silence had no effect on testosterone levels at all, while a half-hour of Mozart, jazz, pop, or Gregorian chants (no relation :) all suppressed testosterone. What about a half-hour of people's personal favorites? Testosterone levels were cut in half! Testosterone decreased in males under all music conditions, whereas testosterone increased in females. What is going on? Well, in men, testosterone is related to libido, dominance, and aggressiveness, whereas women get a bigger boost in testosterone from cuddling than from sex. So maybe we evolved using music as a way to ensure we all got along, like a melodious cold shower to keep everyone chill.

Is that crazy or what? I'm fascinated by the whole topic. For more, see Music for Anxiety: Mozart vs. Metal.

Sounds are the only sensory-stimulators that can have an effect on us--so can scents! See:

Exposure to industrial pollutants may also affect both allergic diseases and testosterone levels:

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

Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

We've learned that exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression (in my video Exercise vs. Drugs for Depression). But how much is that really saying? How effective are antidepressant drugs in the first place?

A recent meta-analysis sparked huge scientific and public controversy by stating that the placebo effect can explain the apparent clinical benefits of antidepressants. But aren't there thousands of clinical trials providing compelling evidence for antidepressant effectiveness? If a meta-analysis compiles together all the best published research, how could it say they don't work much better than sugar pills?

The key word is "published."

What if a drug company decided only to publish studies that showed a positive effect, but quietly shelved and concealed any studies showing the drug didn't work? If you didn't know any better, you'd look at the published medical literature and think "Wow, this drug is great." And what if all the drug companies did that? To find out if this was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.

According to the published literature, the results of nearly all the trials of antidepressants were positive, meaning they worked. In contrast, FDA analysis of the trial data showed only roughly half of the trials had positive results. In other words, about half the studies showed the drugs didn't work. Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill. Not publishing negative results undermines evidence-based medicine and puts millions of patients at risk for using ineffective or unsafe drugs, and this was the case with these antidepressant drugs.

These revelations hit first in 2008. Prozac, Serzone, Paxil and Effexor worked, but so did sugar pills, and the difference between the drug and placebo was small. That was 2008. Where were we by 2014? Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect. And what's even worse, Freedom of Information Act documents show the FDA knew about it but made an explicit decision to keep this information from the public and from prescribing physicians.

How could drug companies get away with this?

The pharmaceutical industry is considered the most profitable and politically influential industry in the United States, and mental illness can be thought of as the drug industry's golden goose: incurable, common, long term and involving multiple medications. Antidepressant medications are prescribed to 8.7 percent of the U.S. population. It's a multi-billion dollar market.

To summarize, there is a strong therapeutic response to antidepressant medication; it's just that the response to placebo is almost as strong. Indeed, antidepressants offer substantial benefits to millions of people suffering from depression, and to cast them as ineffective is inaccurate. Just because they may not work better than fake pills doesn't mean they don't work. It's like homeopathy--just because it doesn't work better than the sugar pills, doesn't mean that homeopathy doesn't work. The placebo effect is real and powerful.

In one psychopharmacology journal, a psychiatrist funded by the Prozac company defends the drugs stating, "A key issue is disregarded by the naysaying critics. If the patient is benefiting from antidepressant treatment does it matter whether this is being achieved via drug or placebo effects?"

Of course it matters!

Among the side effects of antidepressants are: sexual dysfunction in up to three quarters of people, long-term weight gain, insomnia, nausea and diarrhea. About one in five show withdrawal symptoms when they try to quit. And perhaps more tragically, the drugs may make people more likely to become depressed in the future. Let me say that again: People are more likely to become depressed after treatment by antidepressants than after treatment by other means - including placebo.

So if doctors are willing to give patients placebo-equivalent treatments, maybe it'd be better for them to just lie to patients and give them actual sugar pills. Yes, that involves deception, but isn't that preferable than deception with a side of side effects? See more on this in my video Do Antidepressant Drugs Really Work?

If different treatments are equally effective, then choice should be based on risk and harm, and of all of the available treatments, antidepressant drugs may be among the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed.

Antidepressants may not work better than placebo for mild and moderate depression, but for very severe depression, the drugs do beat out sugar pills. But that's just a small fraction of the people taking these drugs. That means that the vast majority of depressed patients--as many as nine out of ten--are being prescribed medications that have negligible benefits to them.

Too many doctors quickly decide upon a depression diagnosis without necessarily listening to what the patient has to say and end up putting them on antidepressants without considering alternatives. And fortunately, there are effective alternatives. Physical exercise, for example can have lasting effects, and if that turns out to also be a placebo effect, it is at least a placebo with an enviable list of side effects. Whereas side effects of antidepressants include things like sexual dysfunction and insomnia, side effects of exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone and a longer life.


There are other ways meta-analyses can be misleading. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

More on the ethical challenges facing doctors and whether or not to prescribe sugar pills in The Lie That Heals: Should Doctors Give Placebos?

I've used the Freedom of Information Act myself to get access to behind the scenes industry shenanigans. See, for example, what I found out about the egg industry in Who Says Eggs Aren't Healthy or Safe? and Eggs and Cholesterol: Patently False and Misleading Claims.

This isn't the only case of the medical profession overselling the benefits of drugs. See How Smoking in 1956 is Like Eating in 2016, The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure (though if you're worried about your mood they might make you even more depressed!)

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: GraphicStock. This image has been modified.

Original Link

Are Sugar Pills Better than Antidepressant Drugs?

Do Antidepressant Drugs Really Work.jpg

We've learned that exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression (in my video Exercise vs. Drugs for Depression). But how much is that really saying? How effective are antidepressant drugs in the first place?

A recent meta-analysis sparked huge scientific and public controversy by stating that the placebo effect can explain the apparent clinical benefits of antidepressants. But aren't there thousands of clinical trials providing compelling evidence for antidepressant effectiveness? If a meta-analysis compiles together all the best published research, how could it say they don't work much better than sugar pills?

The key word is "published."

What if a drug company decided only to publish studies that showed a positive effect, but quietly shelved and concealed any studies showing the drug didn't work? If you didn't know any better, you'd look at the published medical literature and think "Wow, this drug is great." And what if all the drug companies did that? To find out if this was the case, researchers applied to the FDA under the Freedom of Information Act to get access to the published and unpublished studies submitted by pharmaceutical companies, and what they found was shocking.

According to the published literature, the results of nearly all the trials of antidepressants were positive, meaning they worked. In contrast, FDA analysis of the trial data showed only roughly half of the trials had positive results. In other words, about half the studies showed the drugs didn't work. Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over a sugar pill. Not publishing negative results undermines evidence-based medicine and puts millions of patients at risk for using ineffective or unsafe drugs, and this was the case with these antidepressant drugs.

These revelations hit first in 2008. Prozac, Serzone, Paxil and Effexor worked, but so did sugar pills, and the difference between the drug and placebo was small. That was 2008. Where were we by 2014? Analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits of antidepressants are due to the placebo effect. And what's even worse, Freedom of Information Act documents show the FDA knew about it but made an explicit decision to keep this information from the public and from prescribing physicians.

How could drug companies get away with this?

The pharmaceutical industry is considered the most profitable and politically influential industry in the United States, and mental illness can be thought of as the drug industry's golden goose: incurable, common, long term and involving multiple medications. Antidepressant medications are prescribed to 8.7 percent of the U.S. population. It's a multi-billion dollar market.

To summarize, there is a strong therapeutic response to antidepressant medication; it's just that the response to placebo is almost as strong. Indeed, antidepressants offer substantial benefits to millions of people suffering from depression, and to cast them as ineffective is inaccurate. Just because they may not work better than fake pills doesn't mean they don't work. It's like homeopathy--just because it doesn't work better than the sugar pills, doesn't mean that homeopathy doesn't work. The placebo effect is real and powerful.

In one psychopharmacology journal, a psychiatrist funded by the Prozac company defends the drugs stating, "A key issue is disregarded by the naysaying critics. If the patient is benefiting from antidepressant treatment does it matter whether this is being achieved via drug or placebo effects?"

Of course it matters!

Among the side effects of antidepressants are: sexual dysfunction in up to three quarters of people, long-term weight gain, insomnia, nausea and diarrhea. About one in five show withdrawal symptoms when they try to quit. And perhaps more tragically, the drugs may make people more likely to become depressed in the future. Let me say that again: People are more likely to become depressed after treatment by antidepressants than after treatment by other means - including placebo.

So if doctors are willing to give patients placebo-equivalent treatments, maybe it'd be better for them to just lie to patients and give them actual sugar pills. Yes, that involves deception, but isn't that preferable than deception with a side of side effects? See more on this in my video Do Antidepressant Drugs Really Work?

If different treatments are equally effective, then choice should be based on risk and harm, and of all of the available treatments, antidepressant drugs may be among the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed.

Antidepressants may not work better than placebo for mild and moderate depression, but for very severe depression, the drugs do beat out sugar pills. But that's just a small fraction of the people taking these drugs. That means that the vast majority of depressed patients--as many as nine out of ten--are being prescribed medications that have negligible benefits to them.

Too many doctors quickly decide upon a depression diagnosis without necessarily listening to what the patient has to say and end up putting them on antidepressants without considering alternatives. And fortunately, there are effective alternatives. Physical exercise, for example can have lasting effects, and if that turns out to also be a placebo effect, it is at least a placebo with an enviable list of side effects. Whereas side effects of antidepressants include things like sexual dysfunction and insomnia, side effects of exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone and a longer life.


There are other ways meta-analyses can be misleading. See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

More on the ethical challenges facing doctors and whether or not to prescribe sugar pills in The Lie That Heals: Should Doctors Give Placebos?

I've used the Freedom of Information Act myself to get access to behind the scenes industry shenanigans. See, for example, what I found out about the egg industry in Who Says Eggs Aren't Healthy or Safe? and Eggs and Cholesterol: Patently False and Misleading Claims.

This isn't the only case of the medical profession overselling the benefits of drugs. See How Smoking in 1956 is Like Eating in 2016, The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure (though if you're worried about your mood they might make you even more depressed!)

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: GraphicStock. This image has been modified.

Original Link

Flaxseeds for Diabetes

 

 

 

 

 

 

 

 

Drug companies hope to capitalize on the fact that the consumption of certain plants appears to lower the risk of diabetes by isolating these plants’ active components for use and sale as pharmacological agents. Though not as profitable, why don’t we just eat the plants themselves?

One plant in particular that’s now been tested is flax. We’ve known for 20 years that having ground flax in your stomach can blunt the blood sugar spike from a meal, but it’s never been tested in diabetics–until now. World Health Organization researchers published an open-label study on the effect of flax seed powder supplementation in the management of diabetes.

Diabetic subjects took a tablespoon of ground flax seeds every day for a month, and, compared to the control group, experienced a significant drop in fasting blood sugars, triglycerides, and cholesterol, as well as the most important thing, a drop in A1C level. If one’s sugars are already well controlled, though, there may be no additional benefit.

How does flax help control blood sugars? Flaxseeds may improve insulin sensitivity in glucose intolerant people. After 12 weeks of flax, researchers found a small but significant drop in insulin resistance, perhaps related to the drop in oxidant stress due to the antioxidant qualities of flaxseeds.

The study profiled in my 3-min video Flaxseed vs. Diabetes showing a tablespoon of daily ground flax seeds for a month appears to improve fasting blood sugars, triglycerides, cholesterol, and hemoglobin A1c levels in diabetics was a non-blinded, non-randomized small study. If it was some drug they were testing, I’d never prescribe it based on this one study, but this isn’t a drug. It’s just flaxseeds. There are just good side effects, so even if this study was a fluke or fraud, flaxseeds have other benefits. In the worst case scenario the seed would still end up benefiting patients who aren’t quite ready or able to reverse their diabetes completely with a plant-based diet.

Flaxseeds are calorically dense, but even adding a half cup of ground flax a day may not lead to weight gain. When 4 tablespoons a day were tested for 3 months the flax group ended up with a slimmer waist than the flaxseed oil or control group. Because of the potential of raw flax seeds to interfere with thyroid function at high doses, though, I would only recommend 2 tablespoons a day. And I would not recommend flaxseed supplementation during pregnancy.

The flaxseed study reminds me of the Prunes vs. Metamucil for Constipation one, or any of those talking about various foods that may control blood sugar (Amla Versus Diabetes), weight (Fat Burning Via Flavonoids), cholesterol (Dried Apples Versus Cholesterol), or sexual dysfunction (Watermelon as Treatment for Erectile Dysfunction). Yes, these foods may help, but why not get at the root of the problem and try to reverse the condition altogether with a healthier diet overall?

The three best books on reversing type 2 diabetes with diet are Defeating Diabetes, co-authored by my favorite dietician, Brenda Davis, and from two of my medical mentors: Dr. Neal Barnard’s Program To Reverse Diabetes Now and Dr. Joel Fuhrman’s The End of Diabetes.

-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 and More Than an Apple a Day.

Image credit: Jill A. Brown / Flickr

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The Best Nutrition Bar

There are a variety of healthier fruit and nut bars on the market now that boast dried fruit as a primary ingredient. Dried fruit is calorically dense, though. Should we be concerned that eating such bars may make us fat?

You may have noticed in the conclusion of the fig study I covered in Best Dried Fruit for Cholesterol that adding 14 figs to people’s daily diets did not lead to significant weight gain.

Wait a second.

That’s 300 calories of figs a day. Over 5 weeks that’s 10,000 calories. How did 10,000 calories disappear into thin air? Figs are so satiating and packed with fiber that even without trying people just end up eating less of other foods throughout the day. I get full just thinking about eating 14 figs!

Was that study just a fluke? Let’s look at the other new studies I covered. What about adding three quarters of a cup of dried apples to our diet every day for a year? Two hundred extra calories a day, but no significant change in weight. Two hundred extra calories of prunes a day for a year? No significant change in weight and same thing with a month of a daily 300 calorie load of dates.

In general, the 5-10% of Americans that average a tablespoon or more of dried fruit a day tend to be less overweight, less obese, and have a slimmer waist with less abdominal obesity. They tended to eat more, but weighed less.  Similar findings were found for those that eat nuts and nut butters, lower body mass index, slimmer waist, and significantly less excess weight and obesity. See my video Nuts and Obesity: The Weight of Evidence. The various mechanisms are summarized in Solving the Mystery of the Missing Calories and explored further in a four-video series:

What if you put dried fruit and nuts together? What would be the effect of adding daily fruit and nut bars on top of one’s regular diet for two months? Researchers took about a hundred folks who were overweight and randomized them into two groups. Half ate their regular diet, and the other half ate their regular diet plus two fruit and nut bars a day, totaling an extra 340 calories. But these weren’t candy calories; these were largely whole plant food calories, dried fruits and nuts.

Two daily fruit and nut bars for two months did not cause weight gain. And they had additional sugar in them (they were KIND brand bars). Maybe that may be why the participants’ cholesterol didn’t get better despite the nuts, which should have helped. I highlight some brands in my 3-min video Do Fruit & Nut Bars Cause Weight Gain? with no added sugar, but it’s even cheaper to just concoct one’s own trail mix and eat dried fruits and nuts on their own.

-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 and More Than an Apple a Day.

Image credit: miriamwilcox / Wikimedia Commons

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