michael greger
The Best Diet for Crohn’s Disease Treatment
"The Best Diet for Crohn's
Disease Treatment" Important to our understanding
and prevention of the global increase in inflammatory bowel disease, we know
that dietary fiber appears to reduce risk, whereas dietary fat, animal protein,
and sugar may increase risk. "Despite the recognition of the
westernization of lifestyle as a major driver of the growing incidence
of inflammatory bowel disease, no countermeasures against such lifestyle
changes have been recommended, except that patients with Crohn's
disease shouldn't smoke." Look, we know consuming
whole, plant-based foods is synonymous with an
anti-inflammatory diet. Here's a list of foods
with inflammatory effects; here's a list of foods with
anti-inflammatory effects. So how about putting a
plant-based diet to the test? Just cutting down on red and
processed meat didn't work, but what about cutting
down on all meat? A 25-year-old guy diagnosed
with Crohn's disease, but failed to enter clinical remission
despite standard medical therapy.
But after switching to a diet based
exclusively on grains, legumes— like beans, split peas, chickpeas,
and lentils—vegetables, and fruits, he entered clinical remission,
without the need for medication and showed no signs of Crohn's
disease on follow-up colonoscopy. It's worth delving into
some of the details. The conventional treatment they started
him on is infliximab, sold as REMICADE, which can cause a stroke, and may
increase your chances of getting lymphoma and other cancers—but
it's a bargain for only $35,000 a year. And it may not even work
in 35 to 40% of patients, and that seemed to be the case
here, so they upped the dose after 37 weeks, and still suffering
after two years on the drug— until he tried completely eliminating
animal products and processed foods from his diet—finally experiencing
a complete resolution of his symptoms. Prior to this, his diet had
been a typical American diet. But having experienced complete
clinical remission for the first time since his diagnosis, he decided
to switch to a whole-food, plant-based diet permanently, severely
reducing his intake of processed food and limiting animal products
to one serving, or less, per week.
And whenever his diet started to slip,
symptoms started coming back. But he could always wipe
them out by eating healthier. After six months of implementing
these changes in diet and lifestyle, including stress relief and exercise,
a follow-up demonstrated complete mucosal healing of the gut lining with
no visible evidence of Crohn's disease. We know a diet consisting of whole
grains, legumes, fruits, and vegetables has been shown to be helpful in the
prevention and treatment of heart disease, obesity, diabetes,
hypertension, gallbladder disease, rheumatoid arthritis,
and many cancers. Although further research is required,
this case report suggests that Crohn's disease might be
added to this list of conditions. But that further research
has already been done! About 20 patients with Crohn's disease
were placed on a semi-vegetarian diet, meaning no more than a half-
serving of fish once a week and a half-serving of meat
once every two weeks, and achieved 100% remission rate
at one year, and 90% at two years. Some strayed from the diet though.
Let's see what happened to them.
After a year, half had relapsed, and at
year two only 20% remained in remission. But those that stuck with
it had remarkable success. It was a small study with
no formal control group, but represents the best reported
result in Crohn's relapse prevention published in the medical
literature to date. Nowadays, Crohn's patients are often
treated with so-called biologic drugs, expensive injected antibodies that
suppress your immune system and have effectively induced
and maintained remission in Crohn's disease,
but not in everyone. The current remission rate in Crohn's
with early use of REMICADE: 64%. So 30 to 40% of patients are likely to
experience a disabling disease course even after treatment.
So what
about adding a plant-based diet? Remission rates jumped up to 100%
for those who didn't have to drop out due to drug side effects. Even
if you exclude the milder cases, 100% of those with serious, even severe
fulminant disease achieved remission. But if you look at gold standard
systematic reviews, they conclude that the effects of dietary interventions
on inflammatory bowel diseases, Crohn's disease and ulcerative
colitis, are uncertain. This is because only randomized
controlled trials were considered. Totally understandable, as that's
the most rigorous study design. Nevertheless, people with inflammatory
bowel disease deserve advice based on the 'best available evidence'
rather than no advice at all. And switching to a plant-based diet
has been shown to achieve far better outcomes than those
reported on conventional treatments in both active and quiescent stages
in both Crohn's and ulcerative colitis. For example, here's one-year
remission rates in Crohn's disease: 100% compared to budesonide, an
immunosuppressant corticosteroid drug; a half elemental diet, meaning
like at-home tube feedings; the $35,000 a year drug REMICADE;
or the $75,000 a year drug Humira. Safer, cheaper, and more effective? Maybe we should recommend plant-based
diets for inflammatory bowel disease.
It would seem clear that treatment
based on treating the cause of the disease is optimal. Spreading the word about healthier
diets could help halt the scourge of inflammatory bowel, but how
are people going to hear about this amazing research without some
kind of public education campaign? That's what NutritionFacts.org
is all about..
Video Transcript – As found on YouTube
The Best Diet for Hypothyroidism and Hyperthyroidism
"The Best Diet for Hypothyroidism
and Hyperthyroidism" There are several autoimmune diseases
that affect the thyroid gland, the most common being Graves' disease
and Hashimoto's thyroiditis. Graves' disease results in hyperthyroidism,
an overactive thyroid gland. Though slaughterhouses are
supposed to remove thyroid glands, should some neck meat slip in,
you can suffer a similar syndrome called hamburger thyrotoxicosis. But that's not from your body making
too much thyroid hormone; that's from your body eating
too much thyroid hormone. Graves' disease is much more common,
and meat-free diets may be able to help with both, as plant-based diets
may be associated with a low prevalence
of autoimmune disease in general, as observed, for example,
in rural sub-Saharan Africa.
Maybe it's because plants
are packed with antioxidants, which are possible protective factors
against autoimmune diseases. Maybe it's because plants are packed
with anti-inflammatory compounds. After all, a whole food plant-based diet
is basically synonymous with an anti-inflammatory diet. But you
don't know until you put it to the test. It turns out the exclusion of all
animal foods was associated with half the prevalence of hyperthyroidism
compared with omnivorous diets. Lacto-ovo vegetarian and
fish-only diets were associated with intermediate protection, but
a 52% lower odds of hyperthyroidism among those eating strictly
plant-based diets. This apparent protection may be due
to the exclusion of animal foods, the benefits of plant foods, or both. Animal foods, like meat, eggs,
and dairy products, may contain high estrogen concentrations,
for example, which have been linked to
autoimmunity in preclinical studies. Or the decrease in animal protein
may downregulate IGF-1, which is not just a cancer-
promoting growth hormone, but may play a role in
autoimmune diseases as well. Or it could be the good stuff in
plants that may protect cells, like the polyphenol phytochemicals,
such as flavonoids found in plant foods.
Maybe it's the environmental toxins
that build up in the food chain. For example, fish contaminated with
industrial pollutants, like PCBs, are associated with increased
frequency of thyroid disorders. Okay, what about the other autoimmune
thyroid disease, Hashimoto's thyroiditis, which, assuming you're getting
enough iodine, is the primary cause of hypothyroidism, an underactive
thyroid gland. Graves' disease wasn't the only autoimmune disorder
that was rare or virtually unknown among those living in rural sub-Saharan
Africa, eating near-vegan diets. They also appeared to have less
Hashimoto's. There's evidence that those with Hashimoto's have
compromised antioxidant status, but we don't know if
it's cause or effect. But if you look at the dietary factors
associated with blood levels of autoimmune anti-thyroid antibodies,
animal fats seem to be associated with higher levels, whereas vegetables and other plant
foods are associated with lower levels.
So again, anti-inflammatory
diets may be useful. No surprise, as Hashimoto's
is an inflammatory disease. That's what thyroiditis means:
inflammation of the thyroid gland. Another possibility is the reduction
in methionine intake, an amino acid concentrated in animal protein, thought
to be one reason why the consumption of whole plant foods is likely to have
a favorable influence on longevity, through decreasing the risk of cancer,
heart disease, and diabetes. And methionine restriction improves
thyroid function in mice, but it has yet to be put to the test
for Hashimoto's in humans. If you compare the poop of patients
with Hashimoto's to controls, the condition appears to be
related to a clear reduction in the concentration of Prevotella
species. Prevotella are good fiber-eating bugs known to enhance
anti-inflammatory activities. Decreased Prevotella levels
are also something you see in other autoimmune conditions, such as
multiple sclerosis and type 1 diabetes. How do you get more Prevotella?
Eat more plants.
But put a vegetarian on a diet
of meat, eggs, and dairy, and within as few as four days
you can drive down levels. So one would expect those eating plant-
based diets to have less Hashimoto's, but in a previous video I expressed
concern about insufficient iodine intake, which could also lead to hypothyroidism. So, which is it?
Let's find out. Vegan diets tended to be
associated with lower, not higher, risk of hypothyroid disease.
Why the word "tended"? Because the associated protection against
hypothyroidism incidence and prevalence studies did not reach
statistical significance. It wasn't just because they were slimmer. The lower risk existed even after controlling for body weight, so
they think maybe it's because animal products may induce inflammation. The question I have, though, is: if
someone who already has Hashimoto's, I mean, what happens
if you change their diet? That's exactly what I'll explore next..
Video Transcript – As found on YouTube
Update on Vegetarian Stroke Risk
"Update on Vegetarian Stroke Risk" Healthy plant-based diets
have been associated with lower all-cause mortality,
up to a 34 percent lower risk of death from any cause over an average
of an eight-year period, just being in the top
versus bottom quarter of healthy plant-based consumption. If sustained, that could translate
into more than four extra years of life. A meta-analysis of a dozen studies
prospectively following more than a half a million people
for up to 25 years similarly found significantly lower
heart disease and overall death rates among those eating more plant-based.
No surprise,
a systematic review concluded since plant-based diets
may arrest or even reverse our number one killer—
cardiovascular disease. Those eating wholly plant-based
tend to be significantly slimmer with lower LDL cholesterol, triglycerides,
blood sugars, blood pressures, significantly less inflammation,
and less carotid artery wall thickening (a sign of atherosclerosis measured
via ultrasound in the neck), as good as what you see
in endurance athletes who’ve run an average of 50,000 miles,
which is like twice around the globe. And changes in risk factors
can happen fast, as evidenced by results
from one to three-week ad libitum (eat-all-you-want)
plant-based “kickstart” programs. For example, the results from the first
few hundred participants of the at-home
15-day Jumpstart program created by the nonprofit Rochester
Lifestyle Medicine Institute were recently published. On a whole food plant-based diet,
obese patients lost an average of 7 pounds without controlling portions
or counting calories or carbs.
Diabetics saw their fasting blood sugars
drop 28 points. Those with LDL cholesterol
over 100 experienced a 33-point drop (comparable to some statin drugs), and hypertensive individuals
experienced a 17-point drop in systolic blood pressure,
which is better than drugs, and all within just two weeks! Studies dating back nearly 40 years
show those eating meat-free diets also have improved blood “rheology,”
meaning fluidity or flowability, which may play a role
in cardiovascular protection. Subsequent interventional studies putting
the cross-sectional findings to the test, show that switching people
to a plant-based diet can improve rheology measurements
within three to six weeks. But might the blood of vegetarians flow
a bit too well, though? In 2019, a study of thousands
of British vegetarians called EPIC-Oxford found that they were at higher risk
of hemorrhagic (bleeding) stroke. They had such a lower risk
of heart disease that they still had less
cardiovascular disease overall (and a half dozen studies show no overall
increased risk of stroke mortality), but why the greater stroke incidence? I suggested it might be vitamin B12
deficiency, which can lead to excessive levels
of a stroke- associated metabolite called homocysteine
which is normally detoxified by B12. This is thought to be the reason
why vitamin B12 supplementation can improve artery function
of vegetarians.
Vitamin B12 supplements
or fortified foods are critical for anyone eating plant-based,
but my 12-part video series on vegetarians and stroke risk
triggered by the 2019 publication was all in vain. It turns out vegetarians don’t appear
to have higher stroke risk after all. In response to the EPIC-Oxford results,
researchers around the world scrambled to see if the findings
were merely a fluke. In 2020, UK Biobank, a massive study
following more than 400,000 volunteers, confirmed that vegetarians
had lower cardiovascular disease rates and importantly,
no increased incidence of stroke. And two studies from Taiwan
found vegetarians had significantly
lower risk of stroke. Following tens of thousands
of vegetarians for up to ten years, they only had about half the stroke risk
compared to nonvegetarians (including a 64 percent lower risk
specifically of hemorrhagic stroke). By 2021, Harvard researchers
had finished and published their analyses of the 200,000+ participants
of the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals
Follow-Up Study. They too found no increased stroke risk
for vegetarians and indeed a decreased risk of stroke among those eating
healthy plant-based diets.
A meta-analysis putting all the studies
together found that indeed the EPIC-Oxford data appeared
to be a fluke after all, finding, if anything, a lower risk
of stroke in a subgroup analysis. A 2022 systematic review
concluded that vegetarian and low-animal product diets are associated with a significantly
lower risk of bleeding strokes, a significantly lower risk
of clotting strokes, and a significantly lower risk
of total strokes across the board..
Video Transcript – As found on YouTube
The Impacts of Plant-Based Diets on Breast Cancer and Prostate Cancer
"Impacts of Plant-Based Diets
on Breast Cancer and Prostate Cancer" There appears to be
a significant protective effect of a vegetarian diet for heart disease
and all cancers combined, particularly for those eating vegan,
but that’s for total cancer. What about breast cancer
and prostate cancer specifically? There’s been about a half dozen studies
on breast cancer risk and various plant-based dietary patterns,
and they all found lower risk, as expected. In some studies, vegetarians
had less than half the odds of breast cancer
compared to nonvegetarians, suggesting vegetarian diets
show a protective role against breast cancer risk. In another study, eating
a nonvegetarian diet was one of the important risk factors, nearly tripling the odds
of breast cancer. In the California Teachers Study, a more plant-based pattern was associated
with a significant reduction in breast cancer risk as well.
So, even trending in that direction
towards a greater consumption of, for example, fruits
and vegetables is associated with a reduced
breast cancer risk, particularly for the hardest
to treat tumors, which is interesting, offering a potential
avenue for prevention. Some of the reductions in risk
were only statistically significant if you included the weight loss benefits
of plant-based eating and associated lifestyle factors
and other reductions of risk, not statistically significant regardless. Lower risk but not significant. Lower risk but not significant,
meaning like in half of these studies, the lower risk may have just been
statistical flukes by chance.
Okay, but this, for example,
was for vegetarians. Do vegan women do any better? Vegetarian diets seem to offer
protection from cancers of the gastrointestinal tract;
whereas vegan diets seem to confer lower risk of all cancers
put together and female-specific cancers,
in particular, which included breast cancer
but also included cervical, endometrial, and ovarian cancer. After a few more years, they were able
to tease out the breast cancer data, and vegans showed consistently
lower risk estimates, but not statistically significantly. So, one study in India even suggested
that vegetarians who eat eggs have lower risk
than vegetarians who don’t.
But, put all the studies on egg intake
and breast cancer together, and eating like one egg a day—
five or more eggs a week— appears to increase
breast cancer risk compared to not eating
any eggs at all. An increase of five eggs
a week was also associated with a 47 percent increase
in fatal prostate cancer. In general, if you look
at the effect of plant- and animal-based foods
on prostate cancer risk, most studies showed that plant-based
foods are associated with either decreased
or neutral risk of prostate cancer, whereas animal-based foods,
particularly dairy products, are associated with either
increased or neutral risk. The dairy and eggs may be why all
three studies on prostate cancer in vegans found decreased risk, but half of the vegetarian
studies showed no change. It’s not just about avoiding
meat, though. Vegetables and beans specifically
were also associated with lower risk, and the same
with breast cancer. High intakes of vegetables and pulses,
like beans, lentils, and chickpeas, were associated with protection
against breast cancer. We’re talking about half
the odds of breast cancer eating four or more
vegetable dishes a day or a daily serving
of beans or lentils, regardless of whether you eat meat.
Note this is one of the studies
that only showed that non-statistically significant drop
in risk among vegetarians; so, it may be better
to be a meat-eater who eats lots of greens and beans
compared to a vegetarian who instead eats lots of junk. Now, diet recommendations should go
beyond just pushing a specific array of foods and really just
promote the overall benefits of eating more
whole plant foods in general. But what happens if you do
just push more veggies? You don’t know…until
you put it to the test: "Effect of a Behavioral Intervention
to Increase Vegetable Consumption on Cancer Progression Among Men
With Early-Stage Prostate Cancer." Oh, that’s exciting, trying
increased vegetable intake to not just prevent
but treat cancer. Men with biopsy-proven prostate cancer
were randomized to an encouragement to eat seven
or more servings of vegetables a day.
Nice! And the control group
was just given some generic dietary info. And…among men with early-stage
prostate cancer under active surveillance,
a behavioral intervention that increased vegetable consumption
did not significantly reduce the risk of prostate cancer progression. Bummer. But wait a second. The trial wasn’t testing
increased vegetable consumption, but the effect of advice
to eat more vegetables. Did they actually do it? The behavioral intervention
in this study produced robust, sustained increases in
vegetable intake for two years, the researchers wrote. But alas,
it still didn’t work. At the end of those two years,
they were eating two more servings. Wait, just two, not seven? And so, the difference
between the vegetable group and the control group
was less than two servings.
They were also supposed to get at least
two servings of tomatoes a day, and two servings of broccoli-
type cruciferous vegetables every day; yet, they ended up only eating
about an ounce of cruciferous, and less than a tenth
of a serving of tomatoes. So, with so little dietary change,
it’s no wonder there was so little change
in the cancer. Though it’s possible
you also have to cut down on animal foods. In this three-month study for men
who had prostate cancer come back after surgery
and radiation, they were able to boost plant foods,
restrict animal foods, actually eat some more tomatoes. And the average PSA
doubling time (meaning how fast
the tumor was growing) slowed from about 22 months
to 59 months. So, doubling in less than two years
to then taking nearly five years.
All just from a three-
month dietary intervention, whereas the control group
didn’t change. Now, slowing down
a tumor is nice, but how about reversing its growth
or shrinking it down? Are strict vegetarians protected
against prostate cancer? Yes, those eating strictly plant-
based diets have only a fraction of the risk of getting it
in the first place, but that’s not the half of it. Yes, the Ornish study. I’ve talked about this before, notable in my How Not
to Die from Cancer video. Randomize men with prostate cancer
to a diet packed with fruits, vegetables,
whole grains, and beans and tumors on average
appeared to shrink, as noted by PSA trending down, while the control group’s cancer
continued to grow. Drip some blood from the plant-
based group on some prostate cancer growing in a petri dish,
and the plant-based blood suppressed the cancer growth
almost eight times better.
And the more
they stuck to their diet, the more their bloodstream
suppressed the cancer growth..
Video Transcript – As found on YouTube
Plant-Based Protein: Are Pea and Soy Protein Isolates Harmful?
"Plant-Based Protein: Are Pea
and Soy Protein Isolates Harmful?" So, are these plant-based
burgers healthy or not? And the answer is…
compared to what? Eating is kind of a zero-sum game;
every food has an opportunity cost. I mean, every time we
put something in our mouth it’s a lost opportunity to put
something even healthier in our mouth. So, if you want to know
if something is healthy, you have to compare it to
what you’d be eating instead. So, for example,
are eggs healthy? Compared to a breakfast
link sausage? Yes! But compared to oatmeal?
Not even close. But look, sausage is considered
a group 1 carcinogen. In other words, we know consumption
of processed meat causes cancer. Each 50-gram serving a day,
that’s a single breakfast link, was linked to an 18% higher
risk of colorectal cancer. So, the risk of getting colorectal
cancer eating one link a day is about the same as the increased
risk of lung cancer you’d get breathing secondhand smoke all
day living with a smoking spouse.
So, compared to sausage,
eggs are healthy, but compared to oatmeal,
eggs are not. So, when it comes to Beyond Meat
and Impossible Burger, yeah, they may be better in
that they have less saturated fat, but, hey, you want
less saturated fat? Plant-based meat
alternatives are no match for unprocessed plant foods,
such as beans or lentils. And a bean burrito or lentil
soup could certainly fill the same culinary niche
as a lunchtime burger. But if you are going to
have some kind of burger, it’s easy to argue that the
plant-based versions are healthier. There is a sodium issue, and
it’s not that much, if any, lower, in saturated fat, since
they use coconut oil, which is basically just
as bad as animal fat; there’s not much
advantage on that front. Though the total protein is
similar across the board, does this matter? Or Is there any
advantage to eating plant protein over animal protein?
Let’s look at the association between animal and plant
protein intake and mortality.
In the twin Harvard cohorts,
following more than 100,000 men and women over decades, “…after
adjusting for other dietary and lifestyle factors, animal
protein intake was associated with a higher risk [of] mortality,
particularly [dying from cardiovascular disease], whereas
higher plant protein intake was associated with
[a] lower all-cause mortality”, meaning a lower risk of dying
from all causes put together. So, “replacing animal protein
of various origins with plant protein was associated
with lower mortality”, especially if you’re replacing
processed meat and egg protein, which were the worst. But when
it comes to living a longer life, plant protein sources beat out
each and every animal protein source. Not just better
than bacon and eggs, but better than burgers, chicken,
turkey, fish, and dairy protein. Together with other studies, these
“findings support the importance of protein sources for the
long-term health outcome and suggest plants constitute
a preferred protein source compared [to] animal foods.” Why? Well, unlike animal protein, plant
protein has not been associated with increased levels
of the cancer-promoting growth hormone IGF-1, for example.
Now, soy protein is similar
enough to animal protein that at high enough doses, like eating
two Impossible Burgers a day, you may bump your IGF-1. But the only reason we care
about IGF-1 is cancer risk, and if anything, higher soy
intake is associated with a decreased risk of cancer. For example, a recent systematic
review and meta-analysis found that soy protein intake was
associated with a decreased risk in breast cancer mortality;
we’re talking “a 12 percent reduction in breast cancer death
[associated with] each 5-gram-a-day increase in soy protein intake.” But the high soy groups
in these studies were on the order of
more than 16 grams a day, associated with a
whopping 62% lower risk of dying from breast cancer.
More than 10 grams of soy
protein a day may be good, associated with cutting
breast cancer mortality risk nearly in half, and getting
more than 16 grams a day may be better, which is like
one Impossible Burger a day. But we simply don’t know what happens at consumption levels far above that. Plant protein has also been
linked to lower blood pressure, reduced LDL cholesterol, and
improved insulin sensitivity. No wonder “substitution of
plant protein for animal protein has been related to a lower incidence of cardiovascular disease
and type 2 diabetes.” Indeed, 21 different studies following
nearly a half million people, and “high… animal protein
intakes [were] associated with an increased risk of [type 2 diabetes], whereas [even just] moderate
plant protein intake is associated with a decreased
risk of [type 2 diabetes].” OK, but these were just
observational studies. They all tried to control for other
dietary and lifestyle factors, but you can’t prove cause-and-effect,
until…you put it to the test.
The “Effect of Replacing Animal
Protein with Plant Protein on [blood sugar] Control in
Diabetes: A Systematic Review and Meta-Analysis of
Randomized Controlled Trials.” Even just switching out about
a third of your protein from animal to plant sources
yielded significant improvements in long-term blood sugar control,
and fasting blood sugars, and insulin. You can do the same thing
looking at cholesterol.
Here’s a systematic review and
meta-analysis of randomized controlled trials on the effect
of plant protein on blood fats. And indeed, swapping in plant
protein for animal protein decreases LDL cholesterol,
and this benefit occurs whether you start out at high
cholesterol or low cholesterol, whether you’re swapping out
dairy, or meat, and eggs, and whether you’re swapping in
soy or other plant proteins. We’ve known about the beneficial
effects of soy on cholesterol going back nearly 40 years, but
other sources of plant protein can do it as well. Yeah, but
we’re not swapping beans for beef. These products are mostly
just isolated plant proteins, mostly pea protein isolate
in the case of Beyond, and concentrated soy protein
in the case of Impossible.
If you just isolate out
the plant proteins themselves are you still going to get benefits? Yes, surprisingly. Check it out. Interestingly, the researchers
concluded, that they did not find a significant difference between
protein isolate products and whole food sources, “suggesting
that the cholesterol-lowering effects are at least, in part, attributable to the plant protein
itself rather than just the associated nutrients.” So, it’s not just because
plant protein travels with fiber or less saturated fat. Plant proteins break down
into a different distribution of amino acids; and so, it’s
like if you give people arginine, an amino acid found
more in plant foods, that alone can bring
down people’s cholesterol. And even plant protein concentrates
used in these products aren’t pure protein, retaining
a few active compounds such as phytosterols and antioxidants, which also can have beneficial effects..
Video Transcript – As found on YouTube
Can Alzheimer’s Disease Be Reversed with a Plant Based Diet?
"Can Alzheimer's Disease Be Reversed
with a Plant Based Diet?" Dr. Dean Ornish was
the first to show, in a randomized
controlled trial, that a plant-based diet
and lifestyle program could apparently reverse
the progression of our number one killer,
heart disease. Opening up arteries without
drugs, without surgery. Then, he showed the same
plant-based program could potentially
reverse the course of early-stage
prostate cancer and also elongate
telomeres, suggesting an anti-
aging effect as well. But when he told me
he was going to see if he could reverse the progression
of Alzheimer's disease, I was skeptical. Surely, he was biting off a little
more than he could chew. Dementia is the most
feared condition of later life. There’s a common
misconception that we have no control over whether we
develop dementia, but the good news is that although Alzheimer’s
may be incurable, at least it is preventable. There is an emerging consensus that “what’s good for our hearts
is also good for our heads,” because clogging of the
arteries inside the brain with atherosclerotic plaque
is thought to play a role in the development of
Alzheimer’s dementia.
This is what our cerebral
arteries should look like: open, clean, and
allowing blood to flow throughout our brain. This is what atherosclerosis
in our head looks like: clogged with cholesterol,
closing off our arteries, and clamping down
on blood flow. What kind of brain arteries do
you want in your head? Too much cholesterol
in our blood is unanimously recognized
to be a risk factor for the development
of Alzheimer’s disease. Those with a total cholesterol
of 225 mg/dL or more may have nearly
25 times the odds of ending up with amyloid
plaques in their brain 10 to 15 years later. After all, what is the
Alzheimer’s gene, APOE? It codes for the major cholesterol
carrier inside the brain. This may explain the
so-called Nigerian paradox: They have among the highest
rates of the Alzheimer’s gene but some of the lowest
rates of Alzheimer’s disease. How is that possible? Genes load the gun,
but lifestyle pulls the trigger. The paradox may be explained
by their low cholesterol levels, probably due to their
diets low in animal fat. So, in terms of dietary guidelines
for the prevention of Alzheimer’s, we should center our
diets around vegetables, legumes, fruits,
and whole grains.
In other words, the dietary
pillar of lifestyle medicine: whole food,
plant-based nutrition. Or, if that’s too complicated,
"plants, plants, and more plants." That may help explain
why vegetarians may be up to three times less likely
to become demented later in life. But it’s not all-or-nothing. Even just substituting 5%
of animal protein with plant protein appears to significantly reduce
the risk of dying from dementia. But prevention isn’t sexy. When prevention works,
nothing happens, but the same diet and lifestyle
that helps prevent heart disease was proven to
help reverse it. Until then, it was believed
that heart disease progression could only be slowed,
not stopped or reversed, similar to how Alzheimer’s
disease is viewed today. So, what if you put
people with Alzheimer’s on the same plant-
based program? You don’t know until
you put it to the test. A randomized,
controlled, phase 2 clinical trial to see if the progression
of Alzheimer’s disease may be slowed, stopped,
or perhaps even reversed.
They randomized about
50 men and women diagnosed with early-
stage Alzheimer’s to either make no lifestyle
changes for 20 weeks or eat a whole food,
plant-based diet (with supplements
like vitamin B12), moderate exercise (like walking half
an hour a day), stress management (like relaxing with
breathing exercises), and getting group
support (over Zoom). They measured
standard tests of cognition and function
before and after in each group, as well as objective
experimental biomarkers of disease progression. On the Clinical Dementia
Rating Global scale, which is used to stage
the severity of dementia, the control group
continued to get worse, but the diet and lifestyle
group started to get better. People diagnosed with
Alzheimer’s getting better? The same seemed to
happen when measured with the Alzheimer’s Disease
Assessment Scale, though this did not reach
statistical significance. Using what’s called the Clinical Dementia Rating
Sum of Boxes scoring, both groups
continued to deteriorate, but the decline was significantly
less in the healthy living group. Overall, using
what’s called the Clinical Global Impression
of Change scoring, most of the people in the
control group kept getting worse and none showed any improvement,
which is what you'd expect with Alzheimer's, whereas about 40% of those
in the diet and lifestyle group appeared to be getting
better within five months of eating and
living healthier.
Why did some get
better and others not? Well, the more they complied
with the recommendations, the greater the beneficial impact
on their cognition and function. This helps to
explain why studies of less-intensive
lifestyle interventions were not sufficient to
stop disease progression, let alone actually improve
cognition and function. The biggest limitation
of the study is that, unlike drug trials where
you can give people a disguised placebo
sugar pill, when a study involves major
diet and lifestyle changes, you can’t rule out
the placebo effect, especially for self-
reported, subjective “How’s your memory been?”
type-questions. But the researchers
also measured objective investigational biomarkers
of disease progression and saw the same
trajectory— improvements in the
interventional group and worsening in
the control group, with the same apparent
dose-response effect, meaning the more they improved
their diet and lifestyle, the more dramatic the effect.
Compare that to the
latest Alzheimer’s drugs, which may not
even work at all. All you may get
for your $56,000 is a one-in-three chance of
swelling or bleeding in your brain. When the U.S. Food
and Drug Administration approved the
drug anyway, the head of the American
Geriatrics Society replied, “My head just exploded.” The bottom line is
there is only one diet that's ever been shown to help
reverse our leading cause of death, heart disease,
in the majority of patients: a plant-based diet. If that’s all a plant-
based diet could do— reverse the number one
killer of men and women, then shouldn’t that be the default
diet until proven otherwise? And the fact that it
can also be so effective in preventing, arresting,
and reversing the progression of
other leading killers, like high blood pressure,
type 2 diabetes, and now maybe even early-
stage Alzheimer’s disease would seem to make the
case for plant-based eating simply overwhelming..
Video Transcript – As found on YouTube
Flashback Friday: The Best Diet for Diabetes
"The Best Diet for Diabetes" There are all sorts of different scoring
systems to rate diet quality. My favorite, for its simplicity, is the
dietary phytochemical index: a fancy name for a simple concept. It's just the percentage of your calories
from whole plant foods, so 0 to 100. The average American diet
has a score of 12. Twelve out of a hundred; so, like on a
scale of one to ten, our diet is a one. You can split people up based on how they
score, and show how the higher you score the better your metabolic markers
when it comes to diabetes risk. There appears to be like this stepwise
drop in insulin resistance and insulin-producing beta-cell dysfunction
as you eat more and more plant-based.
And that highest group was
only scoring about 30, less than a third of their diet
was whole plant foods, but better than the lowest, which was
down around the standard American diet. No wonder diets centered around
plants, emphasizing legumes— beans, split peas,
chickpeas and lentils— whole grains, vegetables,
fruits, nuts and seeds, and discouraging most or all animal
products are especially potent in preventing type 2 diabetes, and as a little bonus has been associated
with much lower rates of obesity, hypertension, hyperlipidemia,
cardiovascular mortality, and cancer. And not just preventing type 2 diabetes
but treating it as well. A systematic review and meta-analysis
found that the consumption of vegetarian diets is associated
with improved blood sugar control, but how much improved?
Here's one of the latest trials. The effect of a strictly plant-based diet
centered around brown rice—it was done in Asia—versus the conventional
diabetic diet on blood sugar control of patients with type 2 diabetes:
a 12-week randomized clinical trial. For the diabetic control diet, they set
up food exchanges and calculated specific calorie and portion controls,
whereas on the plant-based diet people could eat much as they want;
that's one of the benefits.
The emphasis is on food
quality rather than quantity, and they still actually
lost more weight. But even after controlling for
the greater abdominal fat loss in the plant-based group,
they still won out. Of course, it only works
if you actually do it, but those that pretty much stuck
to the healthier diet dropped their A1c levels 0.9%, which is what you
get taking the leading diabetes drug, but of course only
with good side effects. Yeah, but would it work in
an underserved population? The impact of a plant-based diet support
program on mitigating type 2 diabetes in San Bernadino, the poorest
city of its size in California. A randomized controlled trial,
but not of a plant-based diet itself as the title suggests,
but of just an education program telling people about the benefits
of a plant-based diet for diabetes, and then it was up to them. And still got a significant improvement
in blood sugar control. Here are the numbers. Got a little better
in the control group, but way better in the plant-based
instruction and support group. And more plant-based diets
are not just effective in the prevention and management of
diabetes, but also its complications.
Check this out. One of the most devastating complications
of diabetes is kidney failure. This shows the decline in kidney
function in eight diabetics in the one or two years
before switching their diets. They all showed this steady,
inexorable decline on a fast track to complete
kidney failure and dialysis. But then they switched to a
special supplemented vegan diet, and their kidney decline
was stopped in its tracks. Imagine if they had switched
a year or two earlier! Most diabetics don't actually end up on
dialysis though because they die first. Cardiovascular disease is the major cause
of premature mortality among diabetics; that's why plant-based diets are perfect.
There is a general scientific consensus that the elements of a whole-foods
plant-based diet— legumes, whole grains, fruits,
vegetables, and nuts, with limited or no intake of processed
foods and animal products— are highly beneficial for preventing
and treating type 2 diabetes.
Equally important, plant-based
diets address the bigger picture by simultaneously treating cardiovascular
disease, our #1 killer, along with obesity, high blood
pressure, lowering inflammation, and we can throw cancer
into the mix too, our #2 killer. The bottom line is that the case
for using a plant-based diet to reduce the burden of diabetes
and improve overall health has never been stronger..
Video Transcript – As found on YouTube
Update on Vegetarian Stroke Risk
"Update on Vegetarian Stroke Risk" Healthy plant-based diets
have been associated with lower all-cause mortality,
up to a 34 percent lower risk of death from any cause over an average
of an eight-year period, just being in the top
versus bottom quarter of healthy plant-based consumption. If sustained, that could translate
into more than four extra years of life. A meta-analysis of a dozen studies
prospectively following more than a half a million people
for up to 25 years similarly found significantly lower
heart disease and overall death rates among those eating more plant-based.
No surprise,
a systematic review concluded since plant-based diets
may arrest or even reverse our number one killer—
cardiovascular disease. Those eating wholly plant-based
tend to be significantly slimmer with lower LDL cholesterol, triglycerides,
blood sugars, blood pressures, significantly less inflammation,
and less carotid artery wall thickening (a sign of atherosclerosis measured
via ultrasound in the neck), as good as what you see
in endurance athletes who’ve run an average of 50,000 miles,
which is like twice around the globe. And changes in risk factors
can happen fast, as evidenced by results
from one to three-week ad libitum (eat-all-you-want)
plant-based “kickstart” programs.
For example, the results from the first
few hundred participants of the at-home
15-day Jumpstart program created by the nonprofit Rochester
Lifestyle Medicine Institute were recently published. On a whole food plant-based diet,
obese patients lost an average of 7 pounds without controlling portions
or counting calories or carbs. Diabetics saw their fasting blood sugars
drop 28 points. Those with LDL cholesterol
over 100 experienced a 33-point drop (comparable to some statin drugs), and hypertensive individuals
experienced a 17-point drop in systolic blood pressure,
which is better than drugs, and all within just two weeks! Studies dating back nearly 40 years
show those eating meat-free diets also have improved blood “rheology,”
meaning fluidity or flowability, which may play a role
in cardiovascular protection. Subsequent interventional studies putting
the cross-sectional findings to the test, show that switching people
to a plant-based diet can improve rheology measurements
within three to six weeks.
But might the blood of vegetarians flow
a bit too well, though? In 2019, a study of thousands
of British vegetarians called EPIC-Oxford found that they were at higher risk
of hemorrhagic (bleeding) stroke. They had such a lower risk
of heart disease that they still had less
cardiovascular disease overall (and a half dozen studies show no overall
increased risk of stroke mortality), but why the greater stroke incidence? I suggested it might be vitamin B12
deficiency, which can lead to excessive levels
of a stroke- associated metabolite called homocysteine
which is normally detoxified by B12.
This is thought to be the reason
why vitamin B12 supplementation can improve artery function
of vegetarians. Vitamin B12 supplements
or fortified foods are critical for anyone eating plant-based,
but my 12-part video series on vegetarians and stroke risk
triggered by the 2019 publication was all in vain. It turns out vegetarians don’t appear
to have higher stroke risk after all. In response to the EPIC-Oxford results,
researchers around the world scrambled to see if the findings
were merely a fluke. In 2020, UK Biobank, a massive study
following more than 400,000 volunteers, confirmed that vegetarians
had lower cardiovascular disease rates and importantly,
no increased incidence of stroke.
And two studies from Taiwan
found vegetarians had significantly
lower risk of stroke. Following tens of thousands
of vegetarians for up to ten years, they only had about half the stroke risk
compared to nonvegetarians (including a 64 percent lower risk
specifically of hemorrhagic stroke). By 2021, Harvard researchers
had finished and published their analyses of the 200,000+ participants
of the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals
Follow-Up Study. They too found no increased stroke risk
for vegetarians and indeed a decreased risk of stroke among those eating
healthy plant-based diets.
A meta-analysis putting all the studies
together found that indeed the EPIC-Oxford data appeared
to be a fluke after all, finding, if anything, a lower risk
of stroke in a subgroup analysis. A 2022 systematic review
concluded that vegetarian and low-animal product diets are associated with a significantly
lower risk of bleeding strokes, a significantly lower risk
of clotting strokes, and a significantly lower risk
of total strokes across the board..
Video Transcript – As found on YouTube
The Efficacy and Safety of Creatine for High Homocysteine
"The Efficacy and Safety of Creatine
for High Homocysteine" The average blood levels
of homocysteine in men is about one and a half points
higher than in women. Maybe that's one of the reasons
why men tend to be at higher risk for cardiovascular disease. Women don't need to make
as much creatine as men since they tend to have
less muscle mass, and that may help explain the
gender gap in homocysteine levels. If you remember from my last video,
in the process of making creatine, your body produces homocysteine
as a by-product. So maybe for people with stubbornly high homocysteine
levels that don't sufficiently respond to B vitamins, perhaps creatine
supplementation may represent a practical strategy to draw homocysteine
levels down into the normal range.
It seemed to work in rats, but in humans,
it worked in one study, this one, but didn't seem to work in another
study, this one, or this one, and in this study homocysteine
levels were even driven up. So this whole suggestion that
taking creatine supplements would lower homocysteine
was called into question. But all those studies were done
in non-vegetarians, so they were effectively already supplementing
with creatine every day in the form of muscle meat, so they were basically just testing
higher versus lower supplementation. Those eating strictly plant-based
make all their creatine from scratch, so may be more sensitive
to an added creatine source, but there were never any studies
on creatine supplementation in vegans for homocysteine
lowering until now.
They took a bunch of vegans
who were not supplementing their diets with vitamin B12,
so some of their homocysteine levels were through the roof,
a few as high as 50 when the ideal is more like under 10,
but after taking some creatine for a few weeks all of their homocysteine
levels normalized. Before… …and after. Now they didn't really normalize,
which would have been under 10, but that's presumably because
they weren't taking any B12. Give vegetarians and vegans
vitamin B12 supplements, either daily dosing or once a week,
and their levels really normalize in a matter of months, but the
fact that even without B12, that you could bring down homocysteine
levels with creatine alone suggests— to me at least—that if your homocysteine
is elevated on a plant-based diet, meaning above 10, despite
taking B12 supplements, and eating greens and beans to get
enough folate, well then it may be worth experimenting with
supplementing with a gram of creatine for a few weeks and see if your
homocysteine levels come down.
Why one gram? That's approximately
how much nonvegetarians are not having to make themselves; that's how much
erased vegetarian discrepancies in blood and muscle, and how much has
been shown to be safe in the longer-term. How safe exactly is it? Well, one
can take a bit of comfort in the fact that it's one of the world's
best-selling dietary supplements, with literally billions of servings taken,
and the only consistently reported side effect has been weight gain,
presumed to be from water retention. The only serious side effects
appear to be among those with pre-existing kidney diseases taking
whopping doses like 20 grams a day. A concern was raised that creatine
could potentially form a carcinogen, known as N-nitrososarcosine,
when it hits the acid bath of the stomach, but when actually put to the test this
does not appear to be a problem. Bottomline, doses of up 3 grams
a day are unlikely to pose any risk provided high purity creatine is used, and as we all know dietary supplements
are not regulated by the FDA and may contain contaminants or not
actually contain what's on the label, contaminants generated during
the industrial production.
When researchers looked at 33
samples of creatine supplements made in the U.S. and Europe, they all did
actually contain creatine, which is nice, but about half exceeded the
maximum level recommended by food safety authorities
for at least one contaminant. The researchers recommend that
consumers give their preference to products obtained by producers
that ensure the highest quality control. Easier said than done. Because of the potential risks
I don't think people should be taking creatine supplements willy-nilly,
but the potential benefits may exceed the potential risks, if again, you're
on a healthy plant-based diet, taking B12 and your homocysteine
levels are still not under 10, I would suggest giving a gram a day of
creatine a try to see if it brings it down.
The reason I did this whole video
series all goes back to this study, which found that although the
overall cardiovascular disease risk is lower in vegetarians
and vegans combined, they appeared to be at slightly
higher stroke risk. I went through a list of potential causes, arrived
at elevated homocysteine, and the solution? A regular,
reliable source of vitamin B12. The cheapest, easiest method
that I personally use is one 2500 mcg chewable
tablet of cyanocobalamin. In fact you can just use
2000 mcg once a week, and cyanocobalamin is the
most stable source of B12.
Take that once a week. And then as I detailed in this video,
a back-up plan for those doing that and still having elevated
homocysteine, is an empirical trial of one gram a day of
creatine supplementation, which has been shown to improve
at least capillary blood flow in those who started out with
high homocysteine levels. The bottom line is that plant-based
diets appear to markedly reduce our risk of multiple
leading killer diseases— heart disease, type 2 diabetes, and
many common types of cancer— but an increased risk of stroke
may represent an Achilles heel. Nonetheless, they have the potential to
achieve a truly exceptional health span if they face this problem forthrightly
by restricting salt intake and taking other practical measures
that promote brain artery health.
Nonetheless, these considerations
do not justify nutritional nihilism. On balance, even strictly plant-based
diets offer such versatile protection to long-term health that they
remain highly recommendable. Most likely, the optimum strategy
is to eat plant-based, along with going out of the way
to eat particularly protective foods as I talked about before,
regular aerobic exercise, and most importantly
taking your vitamin B12. Oh, and try not to huff whipped
cream charged in canister gas..
Video Transcript – As found on YouTube
Type 1 Diabetes Treatment: A Plant-Based Diet
"Type 1 Diabetes Treatment:
A Plant-Based Diet" The brand-new International Journal
of Disease Reversal and Prevention had its share of typical plant-
based miraculous disease reversals. After having not one but two
heart attacks within two months, a whole food, plant-based diet
and no more chest pain, controlling his cholesterol,
blood pressure, and blood sugars while losing 50 pounds as
a neat little side-bonus. Yet the numbers don’t capture the
transformation, the resurrection from feeling like a “dead man walking”
to getting his life back. I already discussed the cases of
autoimmune inflammatory disease reversal, the psoriasis, the lupus,
nephritis (kidney inflammation); and speaking of autoimmune-
diseases-we-didn’t-think- we-could-do-anything-
about, type 1 diabetes.
In contrast to type 2 diabetes,
which is a lifestyle disease that can be prevented and reversed
with a healthy enough diet and lifestyle, type 1 diabetes is an autoimmune
disease in which your body attacks your own pancreas, killing off
your insulin-producing cells condemning you to a
life of insulin injections— unless, perhaps, you
catch it early enough. Maybe if we can switch people early
enough to a healthy enough diet, we can reverse the course by
blunting that autoimmune inflammation.
Now, we know patients with type 1
may be able to reduce insulin requirements and achieve better
blood sugar control with healthier diets. For example, randomize children
and teens to a nutritional intervention in which they boost the whole
plant food density of their diet, meaning eating more whole grains,
whole fruit, vegetables, legumes (which are beans, split peas, chickpeas,
and lentils), nuts, and seeds. And the more whole plant foods,
the better the blood sugar control. The fact that more whole
fruits was associated with better blood sugar control has
important clinical implications for nutrition education in
those struggling with type 1. We should be educating them
on the benefits of fruit intake and allaying “erroneous concerns that
fruit may adversely affect blood sugar". But this case series went beyond just
proposing better control of the symptom of diabetes—high blood sugars—but
better control of the disease itself, suggesting the anti-inflammatory
effects of whole healthy plant foods may slow or prevent further destruction
of the insulin-producing cells of the pancreas, if the dietary
intervention is initiated early enough.
Where are they getting this
from? Check it out. One patient who began a vegetable-
rich diet at age three immediately following diagnosis of type 1
diabetes, but three years later still has yet to require insulin
therapy, while experiencing a steady decline in autoantibody levels,
markers of insulin cell destruction. Another child, who didn’t start
eating healthier until several months after diagnosis, maintains a
low dose of insulin with good control. And even if the insulin-producing
cells have been utterly destroyed, type 1 diabetics can still enjoy
dramatically reduced insulin requirements and reduced inflammation and
reduced cardiovascular risk, which is the #1 cause of death for
type 1 diabetics over the age of 30.
Type 1’s have 11 to 14 times the risk
of death from cardiovascular disease compared to the general population,
and it’s already the #1 killer among the public, so it’s like
11 to 14 times more important for type 1 diabetics to be on
the only diet and lifestyle program ever proven to reverse heart
disease in the majority of patients— one centered around whole plant foods. And the fact that it may also
help control the disease itself is just sugar-free icing on the cake. All this exciting new research was
just from the first issue of the journal! As a bonus there’s a companion
publication called the Disease Reversal and Prevention Digest,
a companion publication to the International Journal of
Disease Reversal and Prevention for the lay public with the
belief I wholeheartedly share that everyone has a right
to understand the science that could impact their health. And so, you can go behind the
scenes and hear directly from the author of the lupus series,
with bonus interviews from luminaries like Dean Ornish, practical
tips from dietitians on making the transition towards a healthier
diet, complete with recipes. The second issue continued
to feature practical tips like how to eat plant-based on
a budget, what Dr.
Klaper is doing to educate medical students, what
Audrey Sanchez from Balanced is doing to help change school lunches,
and if you think that’s hard, Dr. Ostfeld got healthy foods
served in a hospital. What a concept! And, what magazine would be
complete without an article to improve your sex life. Now, while the journal itself is
free, downloadable at IJDRP.org, the companion digest, available
at diseasereversaldigest.com, carries a subscription fee, but I,
for one, am a proud subscriber..
Video Transcript – As found on YouTube
