The Best Diet for Rheumatoid Arthritis

The Best Diet for Rheumatoid Arthritis.jpeg

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting millions. It is characterized by persistent pain, stiffness, and progressive joint destruction leading to crippling deformities, particularly in the hands and feet. What can we do to prevent and treat it?

In my video Why Do Plant-Based Diets Help Rheumatoid Arthritis?, I show a famous 13-month randomized controlled trial of plant-based diets for rheumatoid arthritis where patients were put on a vegan diet for three and a half months and then switched to an egg-free lactovegetarian diet for the remainder of the study. Compared to the control group (who didn't change their diet at all), the plant-based group experienced significant improvements starting within weeks. Their morning stiffness improved within the first month, cutting the number of hours they suffered from joint stiffness in half. Their pain level dropped from 5 out of 10 down to less than 3 out of 10. Disability levels dropped, and subjects reported feeling better; they had greater grip strength, fewer tender joints, less tenderness per joint, and less swelling. They also had a drop in inflammatory markers in their blood, such as sedimentation rate, C-reactive protein, and white blood cell count. As a bonus, they lost about 13 pounds and kept most of that weight off throughout the year.

What does diet have to do with joint disease?

Rheumatoid arthritis is an autoimmune disease, in which our own body attacks the lining of our joints. There's also a different autoimmune disease called rheumatic fever, in which our body attacks our heart. Why would it do that? It appears to be a matter of friendly fire.

Rheumatic fever is caused by strep throat, which is itself caused by a bacterium that has a protein that looks an awful lot like a protein in our heart. When our immune system attacks the strep bacteria, it also attacks our heart valves, triggering an autoimmune attack by "molecular mimicry." The protein on the strep bacteria is mimicking a protein in our heart, so our body gets confused and attacks both. That's why it's critical to treat strep throat early to prevent our heart from getting caught in the crossfire.

Researchers figured that rheumatoid arthritis might be triggered by an infection as well. A clue to where to start looking was the fact that women seem to get it three times more frequently than men. What type of infection do women get more than men? Urinary tract infections (UTIs). So researchers started testing the urine of rheumatoid arthritis sufferers and, lo and behold, found a bacterium called Proteus mirabilis. Not enough to cause symptoms of a UTI, but enough to trigger an immune response. And indeed, there's a molecule in the bacterium that looks an awful lot like one of the molecules in our joints.

The theory is that anti-Proteus antibodies against the bacterial molecule may inadvertently damage our own joint tissues, leading eventually to joint destruction. Therefore, interventions to remove this bacteria from the bodies of patients, with consequent reduction of antibodies against the organism, should lead to a decrease in inflammation.

As we saw in my video Avoiding Chicken to Avoid Bladder Infections, urinary tract infections originate from the fecal flora. The bacteria crawl up from the rectum into the bladder. How might we change the bugs in our colons? By changing our diet.

Some of the first studies published more than 20 years ago to fundamentally shift people's gut flora were done using raw vegan diets, figuring that's about as fundamental a shift from the standard Western diet as possible. Indeed, within days researchers could significantly change subjects' gut flora. When researchers put rheumatoid arthritis sufferers on that kind of diet, they experienced relief, and the greatest improvements were linked to greatest changes in gut flora. The diet was considered so intolerable, though, that half the patients couldn't take it and dropped out, perhaps because they were trying to feed people things like "buckwheat-beetroot cutlets" buttered with a spread made out of almonds and fermented cucumber juice.

Thankfully, regular vegetarian and vegan diets work too, changing the intestinal flora and improving rheumatoid arthritis. However, we didn't specifically have confirmation that plant-based diets brought down anti-Proteus antibodies until 2014. Subjects that responded to the plant-based diet showed a significant drop in anti-Proteus mirabilis antibodies compared to the control group. Maybe it just dropped immune responses across the board? No, antibody levels against other bugs remained the same, so the assumption is that the plant-based diet reduced urinary or gut levels of the bacteria.

A shift from an omnivorous to a vegetarian diet has a profound influence on the composition of urine as well. For example, those eating plant-based had higher levels of lignans in their urine. Up until now, it was thought that they only protected people from getting cancer, but we now know lignans can also have antimicrobial properties. Perhaps they help clear Proteus mirabilis from the system. Either way, these data suggest a new type of therapy for the management of rheumatoid arthritis: anti-Proteus measures including plant-based diets.


I have to admit I had never even heard of Proteus mirabilis. That's why I love doing work--I learn as much as you do!

I explored another unconventional theory as to why plant-based diets are so successful in treating inflammatory arthritis in Potassium and Autoimmune Disease.

There's another foodborne bacteria implicated in human disease, the EXPEC in chicken leading to urinary tract infections--another game-changer: Avoiding Chicken To Avoid Bladder Infections.

I have a bunch of videos on gut flora--the microbiome. They include:

In health,

Michael Greger, M.D.

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

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

Original Link

The Best Diet for Rheumatoid Arthritis

The Best Diet for Rheumatoid Arthritis.jpeg

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting millions. It is characterized by persistent pain, stiffness, and progressive joint destruction leading to crippling deformities, particularly in the hands and feet. What can we do to prevent and treat it?

In my video Why Do Plant-Based Diets Help Rheumatoid Arthritis?, I show a famous 13-month randomized controlled trial of plant-based diets for rheumatoid arthritis where patients were put on a vegan diet for three and a half months and then switched to an egg-free lactovegetarian diet for the remainder of the study. Compared to the control group (who didn't change their diet at all), the plant-based group experienced significant improvements starting within weeks. Their morning stiffness improved within the first month, cutting the number of hours they suffered from joint stiffness in half. Their pain level dropped from 5 out of 10 down to less than 3 out of 10. Disability levels dropped, and subjects reported feeling better; they had greater grip strength, fewer tender joints, less tenderness per joint, and less swelling. They also had a drop in inflammatory markers in their blood, such as sedimentation rate, C-reactive protein, and white blood cell count. As a bonus, they lost about 13 pounds and kept most of that weight off throughout the year.

What does diet have to do with joint disease?

Rheumatoid arthritis is an autoimmune disease, in which our own body attacks the lining of our joints. There's also a different autoimmune disease called rheumatic fever, in which our body attacks our heart. Why would it do that? It appears to be a matter of friendly fire.

Rheumatic fever is caused by strep throat, which is itself caused by a bacterium that has a protein that looks an awful lot like a protein in our heart. When our immune system attacks the strep bacteria, it also attacks our heart valves, triggering an autoimmune attack by "molecular mimicry." The protein on the strep bacteria is mimicking a protein in our heart, so our body gets confused and attacks both. That's why it's critical to treat strep throat early to prevent our heart from getting caught in the crossfire.

Researchers figured that rheumatoid arthritis might be triggered by an infection as well. A clue to where to start looking was the fact that women seem to get it three times more frequently than men. What type of infection do women get more than men? Urinary tract infections (UTIs). So researchers started testing the urine of rheumatoid arthritis sufferers and, lo and behold, found a bacterium called Proteus mirabilis. Not enough to cause symptoms of a UTI, but enough to trigger an immune response. And indeed, there's a molecule in the bacterium that looks an awful lot like one of the molecules in our joints.

The theory is that anti-Proteus antibodies against the bacterial molecule may inadvertently damage our own joint tissues, leading eventually to joint destruction. Therefore, interventions to remove this bacteria from the bodies of patients, with consequent reduction of antibodies against the organism, should lead to a decrease in inflammation.

As we saw in my video Avoiding Chicken to Avoid Bladder Infections, urinary tract infections originate from the fecal flora. The bacteria crawl up from the rectum into the bladder. How might we change the bugs in our colons? By changing our diet.

Some of the first studies published more than 20 years ago to fundamentally shift people's gut flora were done using raw vegan diets, figuring that's about as fundamental a shift from the standard Western diet as possible. Indeed, within days researchers could significantly change subjects' gut flora. When researchers put rheumatoid arthritis sufferers on that kind of diet, they experienced relief, and the greatest improvements were linked to greatest changes in gut flora. The diet was considered so intolerable, though, that half the patients couldn't take it and dropped out, perhaps because they were trying to feed people things like "buckwheat-beetroot cutlets" buttered with a spread made out of almonds and fermented cucumber juice.

Thankfully, regular vegetarian and vegan diets work too, changing the intestinal flora and improving rheumatoid arthritis. However, we didn't specifically have confirmation that plant-based diets brought down anti-Proteus antibodies until 2014. Subjects that responded to the plant-based diet showed a significant drop in anti-Proteus mirabilis antibodies compared to the control group. Maybe it just dropped immune responses across the board? No, antibody levels against other bugs remained the same, so the assumption is that the plant-based diet reduced urinary or gut levels of the bacteria.

A shift from an omnivorous to a vegetarian diet has a profound influence on the composition of urine as well. For example, those eating plant-based had higher levels of lignans in their urine. Up until now, it was thought that they only protected people from getting cancer, but we now know lignans can also have antimicrobial properties. Perhaps they help clear Proteus mirabilis from the system. Either way, these data suggest a new type of therapy for the management of rheumatoid arthritis: anti-Proteus measures including plant-based diets.


I have to admit I had never even heard of Proteus mirabilis. That's why I love doing work--I learn as much as you do!

I explored another unconventional theory as to why plant-based diets are so successful in treating inflammatory arthritis in Potassium and Autoimmune Disease.

There's another foodborne bacteria implicated in human disease, the EXPEC in chicken leading to urinary tract infections--another game-changer: Avoiding Chicken To Avoid Bladder Infections.

I have a bunch of videos on gut flora--the microbiome. They include:

In health,

Michael Greger, M.D.

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

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

Original Link

What Are the Benefits of Organic?

What Are the Benefits of Organic?.jpeg

The medical literature has been historically hostile to organic foods, blaming in part erroneous information supplied by the health food movement for our ignorance of nutrition. But until just a few generations ago, all food was organic. It's kind of ironic that what we now call conventional food really isn't very conventional for our species.

By eating organic we can reduce our exposure to pesticides, but it remains unclear whether such a reduction in exposure is clinically relevant. In my video, Are Organic Foods Safer?, I talked about some of the test tube studies comparing health-related properties of organic versus conventional foods. Organic produce was found to have higher antioxidant and antimutagenic activity combined with better inhibition of cancer cell proliferation, but in terms of studies on actual people rather than petri dishes, there isn't much science either way.

Why can't you just compare the health of those who buy organic to those who don't? Organic consumers do report being significantly healthier than conventional consumers, but they also tend to eat more plant foods in general and less soda and alcohol, processed meat, or milk, and just eat healthier in general. No wonder they feel so much better!

Therefore, there is an urgent need for interventional trials, or studies following cohorts of people eating organic over time like the Million Women Study in the UK, which was the first to examine the association between the consumption of organic food and subsequent risk of cancer. The only significant risk reduction they found, though, was for non-Hodgkin's lymphoma. This is consistent with data showing a higher risk of developing lymphoma in those who have higher levels of pesticides stored in their butt fat, a study undertaken because farmworkers have been found to have higher rates of lymphoma.

Parental farmworker exposure is also associated with a birth defect of the penis called hypospadias, and so researchers decided to see if moms who failed to choose organic were at increased risk. Indeed they found that frequent consumption of conventional high-fat dairy products was associated with about double the odds of the birth defect. This could just be because those that choose organic have other related healthy behaviors, or it could be that high-fat foods like dairy products bioamplify the fat-soluble toxins in our environment.

In my video, Are Organic Foods Healthier?, you can see two other general population pesticide studies that have raised concerns. One study found about a 50 to 70% increase in the odds of ADHD among children with pesticide levels in their urine, and another that found triple the odds of testicular cancer among men with higher levels of organochlorine pesticides in their blood. 90% of such pollutants come from fish, meat, and dairy, which may help explain rising testicular cancer rates in many western countries since World War II.

What about interventional trials? All we have in the medical literature so far are studies showing organically grown food provides health benefits to fruit flies raised on diets of conventional versus organic produce when subjected to a variety of tests designed to assess overall fly health. And what do you know--flies raised on diets made from organically grown produce lived longer. Hmm, insects eating insecticides don't do as well. Not exactly much of a breakthrough!


For how to best get pesticides off of conventional produce, see my video How to Make Your Own Fruit and Vegetable Wash.

Pesticides are one thing, but Are Organic Foods More Nutritious?

Overall, Are the Benefits of Organic Food Underrated or Overrated?

For more on the impact of food contaminants during pregnancy, 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 / Flickr. This image has been modified.

Original Link

What Are the Benefits of Organic?

What Are the Benefits of Organic?.jpeg

The medical literature has been historically hostile to organic foods, blaming in part erroneous information supplied by the health food movement for our ignorance of nutrition. But until just a few generations ago, all food was organic. It's kind of ironic that what we now call conventional food really isn't very conventional for our species.

By eating organic we can reduce our exposure to pesticides, but it remains unclear whether such a reduction in exposure is clinically relevant. In my video, Are Organic Foods Safer?, I talked about some of the test tube studies comparing health-related properties of organic versus conventional foods. Organic produce was found to have higher antioxidant and antimutagenic activity combined with better inhibition of cancer cell proliferation, but in terms of studies on actual people rather than petri dishes, there isn't much science either way.

Why can't you just compare the health of those who buy organic to those who don't? Organic consumers do report being significantly healthier than conventional consumers, but they also tend to eat more plant foods in general and less soda and alcohol, processed meat, or milk, and just eat healthier in general. No wonder they feel so much better!

Therefore, there is an urgent need for interventional trials, or studies following cohorts of people eating organic over time like the Million Women Study in the UK, which was the first to examine the association between the consumption of organic food and subsequent risk of cancer. The only significant risk reduction they found, though, was for non-Hodgkin's lymphoma. This is consistent with data showing a higher risk of developing lymphoma in those who have higher levels of pesticides stored in their butt fat, a study undertaken because farmworkers have been found to have higher rates of lymphoma.

Parental farmworker exposure is also associated with a birth defect of the penis called hypospadias, and so researchers decided to see if moms who failed to choose organic were at increased risk. Indeed they found that frequent consumption of conventional high-fat dairy products was associated with about double the odds of the birth defect. This could just be because those that choose organic have other related healthy behaviors, or it could be that high-fat foods like dairy products bioamplify the fat-soluble toxins in our environment.

In my video, Are Organic Foods Healthier?, you can see two other general population pesticide studies that have raised concerns. One study found about a 50 to 70% increase in the odds of ADHD among children with pesticide levels in their urine, and another that found triple the odds of testicular cancer among men with higher levels of organochlorine pesticides in their blood. 90% of such pollutants come from fish, meat, and dairy, which may help explain rising testicular cancer rates in many western countries since World War II.

What about interventional trials? All we have in the medical literature so far are studies showing organically grown food provides health benefits to fruit flies raised on diets of conventional versus organic produce when subjected to a variety of tests designed to assess overall fly health. And what do you know--flies raised on diets made from organically grown produce lived longer. Hmm, insects eating insecticides don't do as well. Not exactly much of a breakthrough!


For how to best get pesticides off of conventional produce, see my video How to Make Your Own Fruit and Vegetable Wash.

Pesticides are one thing, but Are Organic Foods More Nutritious?

Overall, Are the Benefits of Organic Food Underrated or Overrated?

For more on the impact of food contaminants during pregnancy, 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 / Flickr. This image has been modified.

Original Link

The Food Safety Risk of Organic versus Conventional

The Food Safety Risk of Organic versus Conventional.jpeg

The stated principles of organic agriculture are "health, ecology, fairness, and care," but if you ask people why they buy organic, the strongest predictor is concern for their own health. People appear to spend more for organic foods for selfish reasons, rather than altruistic motives. Although organic foods may not have more nutrients per dollar (see my video Are Organic Foods More Nutritious?), consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria.

Food safety-wise, researchers found no difference in the risk for contamination with food poisoning bacteria in general. Both organic and conventional animal products have been found to be commonly contaminated with Salmonella and Campylobacter, for example. Most chicken samples (organic and inorganic), were found to be contaminated with Campylobacter, and about a third with Salmonella, but the risk of exposure to multidrug-resistant bacteria was lower with the organic meat. They both may carry the same risk of making us sick, but food poisoning from organic meat may be easier for doctors to treat.

What about the pesticides? There is a large body of evidence on the relation between exposure to pesticides and elevated rate of chronic diseases such as different types of cancers, diabetes, neurodegenerative disorders like Parkinson's, Alzheimer's, and ALS, as well as birth defects and reproductive disorders--but these studies were largely on people who live or work around pesticides.

Take Salinas Valley California, for example, where they spray a half million pounds of the stuff. Daring to be pregnant in an agricultural community like that may impair childhood brain development, such that pregnant women with the highest levels running through their bodies (as measured in their urine) gave birth to children with an average deficit of about seven IQ points. Twenty-six out of 27 studies showed negative effects of pesticides on brain development in children. These included attention problems, developmental disorders, and short-term memory difficulties.

Even in urban areas, if you compare kids born with higher levels of a common insecticide in their umbilical cord blood, those who were exposed to higher levels are born with brain anomalies. And these were city kids, so presumably this was from residential pesticide use.

Using insecticides inside your house may also be a contributing risk factor for childhood leukemia. Pregnant farmworkers may be doubling the odds of their child getting leukemia and increase their risk of getting a brain tumor. This has lead to authorities advocating that awareness of the potentially negative health outcome for children be increased among populations occupationally exposed to pesticides, though I don't imagine most farmworkers have much of a choice.

Conventional produce may be bad for the pregnant women who pick them, but what about our own family when we eat them?

Just because we spray pesticides on our food in the fields doesn't necessarily mean it ends up in our bodies when we eat it, or at least we didn't know that until a study was published in 2006. Researchers measured the levels of two pesticides running through children's bodies by measuring specific pesticide breakdown products in their urine. In my video, Are Organic Foods Safer?, you can see the levels of pesticides flowing through the bodies of three to 11-year olds during a few days on a conventional diet. The kids then went on an organic diet for five days and then back to the conventional diet. As you can see, eating organic provides a dramatic and immediate protective effect against exposures to pesticides commonly used in agricultural production. The study was subsequently extended. It's clear by looking at the subsequent graph in the video when the kids were eating organic versus conventional. What about adults, though? We didn't know... until now.

Thirteen men and women consumed a diet of at least 80% organic or conventional food for seven days and then switched. No surprise, during the mostly organic week, pesticide exposure was significantly reduced by a nearly 90% drop.

If it can be concluded that consumption of organic foods provides protection against pesticides, does that also mean protection against disease? We don't know. The studies just haven't been done. Nevertheless, in the meantime, the consumption of organic food provides a logical precautionary approach.

For more on organic foods:

For more on the infectious disease implications of organic versus conventional, see Superbugs in Conventional vs. Organic Chicken. Organic produce may be safer too. See Norovirus Food Poisoning from Pesticides. Organic eggs may also have lower Salmonella risk, which is an egg-borne epidemic every year in the US. See my video Who Says Eggs Aren't Healthy or Safe?

More on Parkinson's and pesticides in Preventing Parkinson's Disease With Diet.

Those surprised by the California data might have missed my video California Children Are Contaminated.

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: IFPRI -IMAGES / Flickr. This image has been modified.

Original Link

The Food Safety Risk of Organic versus Conventional

The Food Safety Risk of Organic versus Conventional.jpeg

The stated principles of organic agriculture are "health, ecology, fairness, and care," but if you ask people why they buy organic, the strongest predictor is concern for their own health. People appear to spend more for organic foods for selfish reasons, rather than altruistic motives. Although organic foods may not have more nutrients per dollar (see my video Are Organic Foods More Nutritious?), consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria.

Food safety-wise, researchers found no difference in the risk for contamination with food poisoning bacteria in general. Both organic and conventional animal products have been found to be commonly contaminated with Salmonella and Campylobacter, for example. Most chicken samples (organic and inorganic), were found to be contaminated with Campylobacter, and about a third with Salmonella, but the risk of exposure to multidrug-resistant bacteria was lower with the organic meat. They both may carry the same risk of making us sick, but food poisoning from organic meat may be easier for doctors to treat.

What about the pesticides? There is a large body of evidence on the relation between exposure to pesticides and elevated rate of chronic diseases such as different types of cancers, diabetes, neurodegenerative disorders like Parkinson's, Alzheimer's, and ALS, as well as birth defects and reproductive disorders--but these studies were largely on people who live or work around pesticides.

Take Salinas Valley California, for example, where they spray a half million pounds of the stuff. Daring to be pregnant in an agricultural community like that may impair childhood brain development, such that pregnant women with the highest levels running through their bodies (as measured in their urine) gave birth to children with an average deficit of about seven IQ points. Twenty-six out of 27 studies showed negative effects of pesticides on brain development in children. These included attention problems, developmental disorders, and short-term memory difficulties.

Even in urban areas, if you compare kids born with higher levels of a common insecticide in their umbilical cord blood, those who were exposed to higher levels are born with brain anomalies. And these were city kids, so presumably this was from residential pesticide use.

Using insecticides inside your house may also be a contributing risk factor for childhood leukemia. Pregnant farmworkers may be doubling the odds of their child getting leukemia and increase their risk of getting a brain tumor. This has lead to authorities advocating that awareness of the potentially negative health outcome for children be increased among populations occupationally exposed to pesticides, though I don't imagine most farmworkers have much of a choice.

Conventional produce may be bad for the pregnant women who pick them, but what about our own family when we eat them?

Just because we spray pesticides on our food in the fields doesn't necessarily mean it ends up in our bodies when we eat it, or at least we didn't know that until a study was published in 2006. Researchers measured the levels of two pesticides running through children's bodies by measuring specific pesticide breakdown products in their urine. In my video, Are Organic Foods Safer?, you can see the levels of pesticides flowing through the bodies of three to 11-year olds during a few days on a conventional diet. The kids then went on an organic diet for five days and then back to the conventional diet. As you can see, eating organic provides a dramatic and immediate protective effect against exposures to pesticides commonly used in agricultural production. The study was subsequently extended. It's clear by looking at the subsequent graph in the video when the kids were eating organic versus conventional. What about adults, though? We didn't know... until now.

Thirteen men and women consumed a diet of at least 80% organic or conventional food for seven days and then switched. No surprise, during the mostly organic week, pesticide exposure was significantly reduced by a nearly 90% drop.

If it can be concluded that consumption of organic foods provides protection against pesticides, does that also mean protection against disease? We don't know. The studies just haven't been done. Nevertheless, in the meantime, the consumption of organic food provides a logical precautionary approach.

For more on organic foods:

For more on the infectious disease implications of organic versus conventional, see Superbugs in Conventional vs. Organic Chicken. Organic produce may be safer too. See Norovirus Food Poisoning from Pesticides. Organic eggs may also have lower Salmonella risk, which is an egg-borne epidemic every year in the US. See my video Who Says Eggs Aren't Healthy or Safe?

More on Parkinson's and pesticides in Preventing Parkinson's Disease With Diet.

Those surprised by the California data might have missed my video California Children Are Contaminated.

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: IFPRI -IMAGES / Flickr. This image has been modified.

Original Link

What Animal Protein Does in Your Colon

What Animal Protein Does in Your Colon.jpeg

There's a take-off of the industry slogan, "Beef: It's What's For Dinner" - "Beef: It's What's Rotting in Your Colon." I saw this on a shirt once with some friends and I was such the party pooper--no pun intended--explaining to everyone that meat is fully digested in the small intestine, and never makes it down into the colon. It's no fun hanging out with biology geeks.

But I was wrong!

It's been estimated that with a typical Western diet, up to 12 grams of protein can escape digestion, and when it reaches the colon, it can be turned into toxic substances like ammonia. This degradation of undigested protein in the colon is called putrefaction, so a little meat can actually end up putrefying in our colon. The problem is that some of the by-products of this putrefaction process can be toxic.

It's generally accepted that carbohydrate fermentation--the fiber and resistant starches that reach our colon--results in beneficial effects because of the generation of short-chain fatty acids like butyrate, whereas protein fermentation is considered detrimental. Protein fermentation mainly occurs in the lower end of colon and results in the production of potentially toxic metabolites. That may be why colorectal cancer and ulcerative colitis tends to happen lower down--because that's where the protein is putrefying.

Probably the simplest strategy to reduce the potential harm of protein fermentation is to reduce dietary protein intake. But the accumulation of these toxic byproducts of protein metabolism may be attenuated by the fermentation of undigested plant matter. In my video, Bowel Wars: Hydrogen Sulfide vs. Butyrate, you can see a study out of Australia showed that if you give people foods containing resistant starch you can block the accumulation of potentially harmful byproducts of protein metabolism. Resistant starch is resistant to small intestine digestion and so it makes it down to our colon where it can feed our good bacteria. Resistant starch is found in cooked beans, split peas, chickpeas, lentils, raw oatmeal, and cooled cooked pasta (like macaroni salad). Apparently, the more starch that ends up in the colon, the less ammonia that is produced.

Of course, there's protein in plants too. The difference is that animal proteins tend to have more sulfur-containing amino acids like methionine, which can be turned into hydrogen sulfide in our colon. Hydrogen sulfide is the rotten egg gas that may play a role in the development of the inflammatory bowel disease, ulcerative colitis (see Preventing Ulcerative Colitis with Diet).

The toxic effects of hydrogen sulfide appear to be a result of blocking the ability of the cells lining our colon from utilizing butyrate, which is what our good bacteria make from the fiber and resistant starch we eat. It's like this constant battle in our colon between the bad metabolites of protein, hydrogen sulfide, and the good metabolites of carbohydrates, butyrate. Using human colon samples, researchers were able to show that the adverse effects of sulfide could be reversed by butyrate. So we can either cut down on meat, eat more plants, or both.

There are two ways hydrogen sulfide can be produced, though. It's mainly present in our large intestine as a result of the breakdown of sulfur-containing proteins, but the rotten egg gas can also be generated from inorganic sulfur preservatives like sulfites and sulfur dioxide.

Sulfur dioxide is used as a preservative in dried fruit, and sulfites are added to wines. We can avoid sulfur additives by reading labels or by just choosing organic, since they're forbidden from organic fruits and beverages by law.

More than 35 years ago, studies started implicating sulfur dioxide preservatives in the exacerbation of asthma. This so-called "sulfite-sensitivity" seems to affect only about 1 in 2,000 people, so I recommended those with asthma avoid it, but otherwise I considered the preservative harmless. I am now not so sure, and advise people to avoid it when possible.

Cabbage family vegetables naturally have some sulfur compounds, but thankfully, after following more than a hundred thousand women for over 25 years, researchers concluded cruciferous vegetables were not associated with elevated colitis risk.

Because of animal protein and processed food intake, the standard American diet may contain five or six times more sulfur than a diet centered around unprocessed plant foods. This may help explain the rarity of inflammatory bowel disease among those eating traditional whole food, plant-based diets.

How could companies just add things like sulfur dioxide to foods without adequate safety testing? See Who Determines if Food Additives are Safe? For other additives that may be a problem, see Titanium Dioxide & Inflammatory Bowel Disease and Is Carrageenan Safe?

More on this epic fermentation battle in our gut in Stool pH and Colon Cancer.

Does the sulfur-containing amino acid methionine sound familiar? You may remember it from such hits as Starving Cancer with Methionine Restriction and Methionine Restriction as a Life Extension Strategy.

These short-chain fatty acids released by our good bacteria when we eat fiber and resistant starches are what may be behind the second meal effect: Beans and the Second Meal Effect.

I mentioned ulcerative colitis. What about the other inflammatory bowel disease Crohn's? See Preventing Crohn's Disease With Diet and Dietary Treatment of Crohn's Disease.

In health,

Michael Greger, M.D.

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

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

Original Link

What Animal Protein Does in Your Colon

What Animal Protein Does in Your Colon.jpeg

There's a take-off of the industry slogan, "Beef: It's What's For Dinner" - "Beef: It's What's Rotting in Your Colon." I saw this on a shirt once with some friends and I was such the party pooper--no pun intended--explaining to everyone that meat is fully digested in the small intestine, and never makes it down into the colon. It's no fun hanging out with biology geeks.

But I was wrong!

It's been estimated that with a typical Western diet, up to 12 grams of protein can escape digestion, and when it reaches the colon, it can be turned into toxic substances like ammonia. This degradation of undigested protein in the colon is called putrefaction, so a little meat can actually end up putrefying in our colon. The problem is that some of the by-products of this putrefaction process can be toxic.

It's generally accepted that carbohydrate fermentation--the fiber and resistant starches that reach our colon--results in beneficial effects because of the generation of short-chain fatty acids like butyrate, whereas protein fermentation is considered detrimental. Protein fermentation mainly occurs in the lower end of colon and results in the production of potentially toxic metabolites. That may be why colorectal cancer and ulcerative colitis tends to happen lower down--because that's where the protein is putrefying.

Probably the simplest strategy to reduce the potential harm of protein fermentation is to reduce dietary protein intake. But the accumulation of these toxic byproducts of protein metabolism may be attenuated by the fermentation of undigested plant matter. In my video, Bowel Wars: Hydrogen Sulfide vs. Butyrate, you can see a study out of Australia showed that if you give people foods containing resistant starch you can block the accumulation of potentially harmful byproducts of protein metabolism. Resistant starch is resistant to small intestine digestion and so it makes it down to our colon where it can feed our good bacteria. Resistant starch is found in cooked beans, split peas, chickpeas, lentils, raw oatmeal, and cooled cooked pasta (like macaroni salad). Apparently, the more starch that ends up in the colon, the less ammonia that is produced.

Of course, there's protein in plants too. The difference is that animal proteins tend to have more sulfur-containing amino acids like methionine, which can be turned into hydrogen sulfide in our colon. Hydrogen sulfide is the rotten egg gas that may play a role in the development of the inflammatory bowel disease, ulcerative colitis (see Preventing Ulcerative Colitis with Diet).

The toxic effects of hydrogen sulfide appear to be a result of blocking the ability of the cells lining our colon from utilizing butyrate, which is what our good bacteria make from the fiber and resistant starch we eat. It's like this constant battle in our colon between the bad metabolites of protein, hydrogen sulfide, and the good metabolites of carbohydrates, butyrate. Using human colon samples, researchers were able to show that the adverse effects of sulfide could be reversed by butyrate. So we can either cut down on meat, eat more plants, or both.

There are two ways hydrogen sulfide can be produced, though. It's mainly present in our large intestine as a result of the breakdown of sulfur-containing proteins, but the rotten egg gas can also be generated from inorganic sulfur preservatives like sulfites and sulfur dioxide.

Sulfur dioxide is used as a preservative in dried fruit, and sulfites are added to wines. We can avoid sulfur additives by reading labels or by just choosing organic, since they're forbidden from organic fruits and beverages by law.

More than 35 years ago, studies started implicating sulfur dioxide preservatives in the exacerbation of asthma. This so-called "sulfite-sensitivity" seems to affect only about 1 in 2,000 people, so I recommended those with asthma avoid it, but otherwise I considered the preservative harmless. I am now not so sure, and advise people to avoid it when possible.

Cabbage family vegetables naturally have some sulfur compounds, but thankfully, after following more than a hundred thousand women for over 25 years, researchers concluded cruciferous vegetables were not associated with elevated colitis risk.

Because of animal protein and processed food intake, the standard American diet may contain five or six times more sulfur than a diet centered around unprocessed plant foods. This may help explain the rarity of inflammatory bowel disease among those eating traditional whole food, plant-based diets.

How could companies just add things like sulfur dioxide to foods without adequate safety testing? See Who Determines if Food Additives are Safe? For other additives that may be a problem, see Titanium Dioxide & Inflammatory Bowel Disease and Is Carrageenan Safe?

More on this epic fermentation battle in our gut in Stool pH and Colon Cancer.

Does the sulfur-containing amino acid methionine sound familiar? You may remember it from such hits as Starving Cancer with Methionine Restriction and Methionine Restriction as a Life Extension Strategy.

These short-chain fatty acids released by our good bacteria when we eat fiber and resistant starches are what may be behind the second meal effect: Beans and the Second Meal Effect.

I mentioned ulcerative colitis. What about the other inflammatory bowel disease Crohn's? See Preventing Crohn's Disease With Diet and Dietary Treatment of Crohn's Disease.

In health,

Michael Greger, M.D.

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

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

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Antioxidant- and Folate-Rich Foods for Depression

Antioxidant- and Folate-Rich Foods for Depression.jpeg

According to the Centers for Disease Control and Prevention, the rates of all of our top 10 killers have fallen or stabilized except for one, suicide. As shown in my video, Antioxidants & Depression, accumulating evidence indicates that free radicals may play important roles in the development of various neuropsychiatric disorders including major depression, a common cause of suicide.

In a study of nearly 300,000 Canadians, for example, greater fruit and vegetable consumption was associated with lower odds of depression, psychological distress, self-reported mood and anxiety disorders and poor perceived mental health. They conclude that since a healthy diet comprised of a high intake of fruits and vegetables is rich in anti-oxidants, it may consequently dampen the detrimental effects of oxidative stress on mental health.

But that study was based on asking how many fruits and veggies people ate. Maybe people were just telling the researchers what they thought they wanted to hear. What if you actually measure the levels of carotenoid phytonutrients in people's bloodstreams? The same relationship is found. Testing nearly 2000 people across the United States, researchers found that a higher total blood carotenoid level was indeed associated with a lower likelihood of elevated depressive symptoms, and there appeared to be a dose-response relationship, meaning the higher the levels, the better people felt.

Lycopene, the red pigment predominantly found in tomatoes (but also present in watermelon, pink grapefruit, guava and papaya) is the most powerful carotenoid antioxidant. In a test tube, it's about 100 times more effective at quenching free radicals than a more familiar antioxidant like vitamin E.

Do people who eat more tomatoes have less depression, then? Apparently so. A study of about a thousand older men and women found that those who ate the most tomato products had only about half the odds of depression. The researchers conclude that a tomato-rich diet may have a beneficial effect on the prevention of depressive symptoms.

Higher consumption of fruits and vegetables has been found to lead to a lower risk of developing depression, but if it's the antioxidants can't we just take an antioxidant pill? No.

Only food sources of antioxidants were protectively associated with depression. Not antioxidants from dietary supplements. Although plant foods and food-derived phytochemicals have been associated with health benefits, antioxidants from dietary supplements appear to be less beneficial and may, in fact, be detrimental to health. This may indicate that the form and delivery of the antioxidants are important. Alternatively, the observed associations may be due not to antioxidants but rather to other dietary factors, such as folate, that also occur in plant-rich diets.

In a study of thousands of middle-aged office workers, eating lots of processed food was found to be a risk factor for at least mild to moderate depression five years later, whereas a whole food pattern was found to be protective. Yes, it could be because of the high content of antioxidants in fruits and vegetables but could also be the folate in greens and beans, as some studies have suggested an increased risk of depression in folks who may not have been eating enough.

Low folate levels in the blood are associated with depression, but since most of the early studies were cross-sectional, meaning a snapshot in time, we didn't know if the low folate led to depression or the depression led to low folate. Maybe when you have the blues you don't want to eat the greens.

But since then a number of cohort studies were published, following people over time. They show that a low dietary intake of folate may indeed be a risk factor for severe depression, as much as a threefold higher risk. Note this is for dietary folate intake, not folic acid supplements; those with higher levels were actually eating healthy foods. If you give people folic acid pills they don't seem to work. This may be because folate is found in dark green leafy vegetables like spinach, whereas folic acid is the oxidized synthetic compound used in food fortification and dietary supplements because it's more shelf-stable. It may have different effects on the body as I previously explored in Can Folic Acid Be Harmful?

These kinds of findings point to the importance of antioxidant food sources rather than dietary supplements. But there was an interesting study giving people high dose vitamin C. In contrast to the placebo group, those given vitamin C experienced a decrease in depression scores and also greater FSI. What is FSI? Frequency of Sexual Intercourse.

Evidently, high dose vitamin C improves mood and intercourse frequency, but only in sexual partners that don't live with one another. In the placebo group, those not living together had sex about once a week, and those living together a little higher, once every five days, with no big change on vitamin C. But for those not living together, on vitamin C? Every other day! The differential effect for non-cohabitants suggests that the mechanism is not a peripheral one, meaning outside the brain, but a central one--some psychological change which motivates the person to venture forth to have intercourse. The mild antidepressant effect they found was unrelated to cohabitation or frequency, so it does not appear that the depression scores improved just because of the improved FSI.

For more mental health video, see:

Anything else we can do to enhance our sexual health and attractiveness? 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 / Flickr. This image has been modified.

Original Link

Antioxidant- and Folate-Rich Foods for Depression

Antioxidant- and Folate-Rich Foods for Depression.jpeg

According to the Centers for Disease Control and Prevention, the rates of all of our top 10 killers have fallen or stabilized except for one, suicide. As shown in my video, Antioxidants & Depression, accumulating evidence indicates that free radicals may play important roles in the development of various neuropsychiatric disorders including major depression, a common cause of suicide.

In a study of nearly 300,000 Canadians, for example, greater fruit and vegetable consumption was associated with lower odds of depression, psychological distress, self-reported mood and anxiety disorders and poor perceived mental health. They conclude that since a healthy diet comprised of a high intake of fruits and vegetables is rich in anti-oxidants, it may consequently dampen the detrimental effects of oxidative stress on mental health.

But that study was based on asking how many fruits and veggies people ate. Maybe people were just telling the researchers what they thought they wanted to hear. What if you actually measure the levels of carotenoid phytonutrients in people's bloodstreams? The same relationship is found. Testing nearly 2000 people across the United States, researchers found that a higher total blood carotenoid level was indeed associated with a lower likelihood of elevated depressive symptoms, and there appeared to be a dose-response relationship, meaning the higher the levels, the better people felt.

Lycopene, the red pigment predominantly found in tomatoes (but also present in watermelon, pink grapefruit, guava and papaya) is the most powerful carotenoid antioxidant. In a test tube, it's about 100 times more effective at quenching free radicals than a more familiar antioxidant like vitamin E.

Do people who eat more tomatoes have less depression, then? Apparently so. A study of about a thousand older men and women found that those who ate the most tomato products had only about half the odds of depression. The researchers conclude that a tomato-rich diet may have a beneficial effect on the prevention of depressive symptoms.

Higher consumption of fruits and vegetables has been found to lead to a lower risk of developing depression, but if it's the antioxidants can't we just take an antioxidant pill? No.

Only food sources of antioxidants were protectively associated with depression. Not antioxidants from dietary supplements. Although plant foods and food-derived phytochemicals have been associated with health benefits, antioxidants from dietary supplements appear to be less beneficial and may, in fact, be detrimental to health. This may indicate that the form and delivery of the antioxidants are important. Alternatively, the observed associations may be due not to antioxidants but rather to other dietary factors, such as folate, that also occur in plant-rich diets.

In a study of thousands of middle-aged office workers, eating lots of processed food was found to be a risk factor for at least mild to moderate depression five years later, whereas a whole food pattern was found to be protective. Yes, it could be because of the high content of antioxidants in fruits and vegetables but could also be the folate in greens and beans, as some studies have suggested an increased risk of depression in folks who may not have been eating enough.

Low folate levels in the blood are associated with depression, but since most of the early studies were cross-sectional, meaning a snapshot in time, we didn't know if the low folate led to depression or the depression led to low folate. Maybe when you have the blues you don't want to eat the greens.

But since then a number of cohort studies were published, following people over time. They show that a low dietary intake of folate may indeed be a risk factor for severe depression, as much as a threefold higher risk. Note this is for dietary folate intake, not folic acid supplements; those with higher levels were actually eating healthy foods. If you give people folic acid pills they don't seem to work. This may be because folate is found in dark green leafy vegetables like spinach, whereas folic acid is the oxidized synthetic compound used in food fortification and dietary supplements because it's more shelf-stable. It may have different effects on the body as I previously explored in Can Folic Acid Be Harmful?

These kinds of findings point to the importance of antioxidant food sources rather than dietary supplements. But there was an interesting study giving people high dose vitamin C. In contrast to the placebo group, those given vitamin C experienced a decrease in depression scores and also greater FSI. What is FSI? Frequency of Sexual Intercourse.

Evidently, high dose vitamin C improves mood and intercourse frequency, but only in sexual partners that don't live with one another. In the placebo group, those not living together had sex about once a week, and those living together a little higher, once every five days, with no big change on vitamin C. But for those not living together, on vitamin C? Every other day! The differential effect for non-cohabitants suggests that the mechanism is not a peripheral one, meaning outside the brain, but a central one--some psychological change which motivates the person to venture forth to have intercourse. The mild antidepressant effect they found was unrelated to cohabitation or frequency, so it does not appear that the depression scores improved just because of the improved FSI.

For more mental health video, see:

Anything else we can do to enhance our sexual health and attractiveness? 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 / Flickr. This image has been modified.

Original Link