michael greger
Is Keto an Effective Cancer Fighting Diet?
"Is Keto an Effective
Cancer-Fighting Diet?" Blood sugar, also known
as blood glucose, is the universal go-to fuel for
the cells throughout our bodies. Our brain burns through a
quarter pound of sugar a day, it’s preferred metabolic fuel. Our body can break down proteins
and make glucose from scratch, but most comes from our diet in
the form of sugars and starches. If we stop eating carbohydrates,
or stop eating altogether, most of our cells switch
over to burning fat, but fat has difficulty getting
through the blood-brain barrier.
But our brain has this constant
massive need for fuel, one organ accounting for up
to half of our energy needs. Without it, the lights
go out…permanently. To make that much
sugar from scratch, our body would
need to break down about a half pound
of protein a day. That means we’d cannibalize ourselves
to death within two weeks, but people can fast for months. The answer to the puzzle
was discovered in 1967. Harvard researchers
famously stuck catheters into the brains of obese
subjects who had been fasting for over a month and
discovered that ketones had replaced glucose as the
preferred fuel for the brain. Your liver can turn
fat into ketones, which can then breach
the blood-brain barrier and sustain your brain if you’re
not getting enough carbohydrates.
Switching fuels has such
an effect on brain activity that it has been used to
treat epilepsy since antiquity. The prescription of
fasting for the treatment of epileptic seizures
dates back to Hippocrates. In the Bible, Jesus
seems to have concurred. To this day it’s
unclear why switching from blood sugar to ketones
as a primary fuel source has such a dampening effect
on brain overactivity. How long can you fast though? To prolong the fasting therapy,
in 1921 a distinguished physician scientist at the Mayo
Clinic suggested trying what he called a “ketogenic diet,” a high-fat diet designed to be
so deficient in carbohydrates it could effectively
mimic the fasting state. “Remarkable improvement”
was noted the first time it was put to the test—efficacy
that was later confirmed in randomized, controlled, trials. Ketogenic diets started to
fall out of favor in 1938 with the discovery of
the anti-seizure drug which would become known as Dilantin, but ketogenic diets are still in use today as a third- or fourth-line treatment for drug-refractory epilepsy in children. Oddly, the success of ketogenic
diets against pediatric epilepsy seems to get conflated
by “keto diet” proponents into suggesting a ketogenic
diet is beneficial for everyone.
But you know what else sometimes
works for intractable epilepsy? Brain surgery. But I don't hear people
at the gym clamoring to get their skulls sawed open. Since when do medical therapies translate into healthy lifestyle choices? Scrambling brain activity
with electroshock therapy can be helpful in some
cases of major depression. So what…pass the electrodes? Ketogenic diets are
also being tested to see if they can slow the growth
of certain brain tumors. Even if it works, you know what else can help slow cancer growth? Chemotherapy. So why go keto when you
can just go chemo? Promoters of ketogenic diets for cancer, paid for by so-called
“ketone technology” companies that will send you salted
caramel bone broth powder for a hundred bucks a pound. Or companies that
market ketogenic meals report “extraordinary” anecdotal
responses in some cancer patients, but more concrete
evidence is simply lacking. Even the theoretical underpinnings
may be questionable. You know, a common refrain
is that “cancer feeds on sugar.” But all cells feed on sugar. Advocating ketogenic diets for cancer
is like saying Hitler breathed air— so let’s boycott oxygen.
Cancer can feed on ketones too. Ketones have been found to
fuel human breast cancer growth and drive metastases in
an experimental model, more than doubling tumor growth. Some have even speculated
that may be why breast cancer often metastasizes to the liver, the main site of ketone production. If you drip ketones
on breast cancer cells in a petri dish directly, the
genes that get turned on and off make for a much
more aggressive cancer, associated with a significantly lower five-year survival in
breast cancer patients. Researchers are even considering
designing ketone-blocking drugs to prevent further cancer growth
by halting ketone production. And think about what eating a
ketogenic diet might entail. High animal fat intake may
increase the mortality risk among breast cancer survivors
and potentially play a role in its development in the first
place through oxidative stress, hormone disruption, or inflammation.
Men, too. A strong association has been found between saturated fat intake
and prostate cancer progression. Those in the top
third of consumption of these kinds of
fat-rich animal foods appeared to triple their risk
of dying from prostate cancer. Not necessarily fat in general—
no difference in breast cancer death rates based
on total fat intake— but saturated fat intake
may negatively impact breast cancer survival,
a 50 percent increased risk of dying from breast cancer. There’s a reason the official
American Cancer Society and American Society of Clinical Oncology
Breast Cancer Survivorship Care Guidelines recommend a dietary pattern
for breast cancer patients that’s essentially the
opposite of a ketogenic diet: “high in vegetables, fruits,
whole grains, and legumes, meaning beans, split peas,
chickpeas and lentils, and low in saturated fats.” So far, not a single
clinical study has shown a measurable benefit
from a ketogenic diet for any human cancer.
There are currently at least
a dozen trials underway, however, and the hope is that at least
some cancer types will respond. Still, even then that
wouldn’t serve as a basis for recommending ketogenic diets
for the general population any more than recommending
everyone go out and get radiation, surgery, and chemo for kicks..
Video Transcript – As found on YouTube
Improving VO2 Max: A Look at Vegetarian and Vegan Athletes
This is the first of a three
video series about exercise. Do plant based diets have an
impact on fitness? What are the best times
to workout? Watch the series to find out. "Improving VO2 Max: A Look
at Vegetarian and Vegan Athletes" In my video about comparing vegetarian
and vegan athletic performance, endurance, and strength, I discussed
a 2020 study that found that vegan athletes—even though
they were significantly older— had significantly superior
aerobic capacity and endurance, lasting 25 percent longer on a
time-to-exhaustion cycling test.
The question is why? One potential mechanism
that could explain the greater level of endurance performance
in vegans may be a higher amount of carbohydrate intake, which could
lead to better endurance performance through higher
muscle glycogen storage. Other potential mechanisms
that may explain the better endurance performance in vegans could
be due to the anti-oxidant and anti-inflammatory
profiles of their diet. Maybe it’s even their hearts. Yet another study showing superior
VO2 max in vegan athletes, meaning superior
aerobic capacity: this time they also
did echocardiograms, looking at their hearts
in real-time using ultrasound, and the lower relative
wall thickness and better main ventricle
systolic and diastolic function in the vegans are most
likely positive findings. Now wait a second. Given
the higher VO2 max reached by the vegan athletes, maybe
they were just better trained than the nonvegan athletes,
and that’s why their hearts looked like they
were working better. However, the weekly training
frequency and running distance were similar in both groups,
suggesting benefits even with the same
amount of training. So, it’s important to educate
healthcare professionals; so they don’t try
to discourage a vegan diet and may even want to consider
telling folks implementing an exercise training
program to give it a try.
But you don’t know if it
has the same kinds of effects in nonathletes, until
you…put it to the test. A vegetarian vs. conventional
calorie-restricted diet: the effect on physical fitness
in response to aerobic exercise in patients with
type 2 diabetes. Diabetics were randomized
to the same caloric restriction, the same exercise, but just
vegetarian versus nonvegetarian. They provided all the meals
so they could ensure compliance and closely monitored
the exercising. VO2 max increased by 12 percent
in the vegetarian group, significantly better than in
the non-vegetarian group who didn’t significantly
improve at all. Maximal performance increased
by 21 percent in the vegetarian group, again, significantly better than in
the non-vegetarian group who didn’t significantly
improve at all. In other words, the results indicated
that more plant-based diets led more effectively to
improvement in physical fitness than less plant-based diets, after the same aerobic
exercise program.
Here’s what the graphs look like: significantly better power
output and aerobic capacity in the group that was randomized
to a vegetarian diet. It seems that those eating vegetarian were able to better burn off carbohydrates compared
to nonvegetarians, and had better insulin sensitivity, both markers of improved
metabolic flexibility, meaning the ability
to switch back and forth between burning sugar and fat. Besides physiological
mechanisms, there may also be
psychological factors. They observed reduced hunger
and reduced feelings of depression in the vegetarian group
which may have given them a more positive attitude
towards exercise. Here’s the psychological data. Those randomized to eat vegetarian
had a greater improvement in quality of life and mood. They felt less constrained,
meaning the calorie restriction didn’t seem as burdensome; they had less disinhibition, meaning less tendency
to binge and overeat, along with maybe
less feelings of hunger.
Not to mention the superior effects
of a vegetarian diet on body weight, glycemic control,
blood lipids, insulin sensitivity,
and oxidative stress. Wait, better body weight? I thought they were given
the same number of calories. Yes, both diets were isocaloric,
the same calories, yet just eating meat-free led
to significantly more weight loss— about six pounds more;
more waist loss, a slimmer waist; lower cholesterol, of course;
and less superficial fat, meaning the external jiggly fat; and most importantly, significantly
more visceral fat loss, the most metabolically
dangerous deep belly fat.
Same calories, yet more
loss of body fat. And not surprisingly,
better control of their diabetes. All in addition to leading
more effectively to improvements
in physical fitness..
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
How to Lower Blood Pressure Naturally with Lifestyle Changes
"How to Lower Blood Pressure
Naturally with Lifestyle Changes" Fasting has been practiced
for thousands of years, but only recently have we
started to put it to the test. I did a previous video series
about the studies on using fasting for weight loss back in the ‘70s. Was it safe? Was it effective? But what about fasting for treating
and preventing other diseases? One of the side effects noticed
in the early weight loss studies was a consistent fall in blood pressure,
so much so you typically have to stop taking blood pressure
medications while fasting or else your pressures fall too low. Once you start eating again,
your pressures go back up, but remarkably, not as high
as they were before.
But, of course, it depends on
what you start eating again. For example, a case report
of a woman who used fasting to drive her rheumatoid
arthritis into remission. Systolic blood pressure
started up around 170 despite multiple blood
pressure medications was put on a whole food plant-
based diet for eight weeks. That dropped her down
from 170 down to 130, off of all medications
before starting the fast, and then normalizing down
to 110 after the fast. But is that just because
of all the weight loss? She lost 22 pounds on the fast,
and 27 pounds on the plant-based diet. So yeah, it’s extraordinary to drop
your pressures from 170 to 110, but that was after
losing about 50 pounds. We’ve known for decades
that any kind of weight loss can lower blood pressure. Even minor weight loss can lower
blood pressures in obese persons, even if they remain
significantly overweight. But most of the drop in blood pressures
with severe caloric restriction happens within the first two days,
before significant loss of body fat; so, it may also be a reduction in
the fight-or-flight stress hormones, like adrenaline and noradrenaline
both before… and after exercise, after just two weeks of just a
few hundred calories a day.
So, that may be one reason
why a very-low-calorie diets have been found useful in
lowering blood pressures even in those for whom blood
pressure medications fail: the changes in those hormones. But, low calorie diets also
tend to be more plant-based; so, there’s fiber and potassium-
rich foods, less saturated fat. Even just adding fruits and vegetables
to the diets of hypertensives can lower their systolic blood pressure—
the top number—by 7 points. That’s the kind of blood pressure
improvement you might get losing 10 pounds, just by eating
more fruits and vegetables.
And, if you combine that with
a drop in meat consumption, not only doubling fruit and
vegetable intake but combining that with trying to slash
saturated fat and cholesterol, you can cut pressures by 11 points. What else can we do? Restricting alcohol intake in regular
daily drinkers can drop you 5 points. So, let’s keep track here:
alcohol restriction can drop your systolic
blood pressure 5 points, losing ten pounds can drop you 7,
as can just eating the recommended 8 to 10 servings of
fruits and vegetables a day. Regular aerobic exercise for
at least 3 months can drop you 9…. So, let’s add that on to the chart. Combine the fruits and
vegetables with meat reduction and you can drop it 11. Blood pressure medications
can have side effects, but on their own can
drop pressures by 15 points.
What about cutting down on salt? Note in the other diet study they
kept the sodium levels the same. Cut sodium enough and it
can edge out drugs at 16: the drugs 15, sodium restriction 16. Is that the best we can do with diet? Put people on a purely plant-based
diet, even one moderate in sodium, and you can drop
hypertensives by 18 points even after 9 out of 10 reduced
their blood pressure medications or stopped them entirely,
all within just 7 days. That’s pretty impressive. Now, what if you took that
same diet, but added fasting? 37 points! We’ll review that study
and others like it, next..
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
Plant-Based Diet for Treating and Reversing Stage 3 Kidney Disease
"Plant-Based Diet for Treating and
Reversing Stage 3 Kidney Disease" Is it possible to ameliorate
chronic kidney disease using a whole food,
plant-based diet? In my last video
on kidney disease, I talked about how randomizing
people to cut just around 10 grams of protein from their
daily diet could cut their risk of dialysis and death
by a whopping 77%. That was cutting protein
across the board. But while animal-based
protein ingestion — meat, dairy, and egg white
protein ingestion — promotes an acidic environment
in the kidneys, inflammation, and stresses the kidneys to what's
called hyperfiltration mode, plant-based protein can be
alkaline-producing and anti-inflammatory and contain
kidney-protective properties. So, what if you have kidney patients
eat a plant-dominant low-protein diet, abbreviated adorably as PLADO,
I guess for plant-dominant. If you fashion up a plant-based diet
index score where you get points for healthy plant foods and get points deducted
for eating animal foods, those with serious kidney disease
with higher scores were found to have lower systemic inflammation.
But does that actually translate
into living a longer life? Apparently so. Even a 10% increase in the
proportion of plant-based protein was associated with a significant
reduction in all-cause mortality. Even just eating more servings of
fruits and vegetables, like two a day compared to two a week,
is linked to living longer. Without fully functioning kidneys, there are concerns about
phosphorus and potassium overload, though, on a plant-based diet. But the phosphorus in plant-based
foods is not as much of a problem as the phosphorus additives
in processed and animal foods. And the risk of potassium overload
from plant-based diets appears overstated and not supported
by the evidence.
But you don't know about
ameliorating chronic kidney disease using a whole food, plant-based
diet until you put it to the test. Here's a case report of a 69-year-old
man with type 2 diabetes, high blood pressure, and
stage 3 chronic kidney disease, resulting in elevated phosphorus
and potassium in the blood, Interested in changing his diet
to improve his medical condition. That's my kind of patient! He was on 12 different medications,
eating a diet that may actually be slightly better than
the average American: some whole grains and beans, but then his doctor advised to try
eating whole food, plant-based.
So, oatmeal with fruit and flax,
beans and greens, whole wheat spaghetti and
veggies, fruit as snacks. Counselled to eat as much as he
wanted from whole healthy foods; no carb counting, no calorie counting,
no portion size restriction — improving the quality of food rather
than restricting the quantity of food. He adopted the whole food,
plant-based diet, packed with carbs, yet rapidly reduced his insulin
requirements by more than 50%, and subsequently saw
improvements in weight, blood pressure,
and cholesterol. Because eating healthy
can have such a rapid effect on improving your body's
insulin sensitivity, immediate adjustments
in insulin dosing were made. Within four days, his insulin dose
was able to be reduced from roughly 210 units of insulin
a day down to 70 units daily, and an oral blood-sugar lowering
medication had to be stopped due to rapidly improving blood sugar. He also was able to stop his
carvedilol, the hydrochlorothiazide, amlodipine, sitagliptin
within the first two months due to improving blood pressure
and blood sugars.
His insulin dose was
steadily titrated downward. His pravastatin dose was cut in half,
and he lost about 50 pounds. Okay, so what happened
to his stage 3 kidney failure? He was no longer in
stage 3 kidney failure! Doctors watching this will understand
what all these numbers mean. Here's a graph of his GFR, which
is a measure of kidney function, declining for years before shooting
up after he started eating healthy. He experienced an increase
in estimated GFR of 73%, suggesting that the improvement
in estimated kidney function was greater than what would be
expected from weight loss alone.
For example, lose about 60 pounds
from bariatric surgery, and you only get
about a 12 to 15% boost. Bottom line: for individuals
with chronic kidney disease, especially those with obesity,
hypertension, or diabetes, a strict, all-you-care-to-eat
whole food, plant-based diet may confer significant benefit. I mean, apart from the
kidney-specific outcomes, overall mortality is significantly
lower among kidney patients who eat more plants. And that's critical because most
kidney patients don't even make it to dialysis because they die first, most often from
cardiovascular disease.
Let's hear from the patient. "At the outset, it seemed like
this was going to be a difficult and restrictive way to eat, but I began feeling different
almost immediately and we had to decrease
my insulin after ONE day. It seemed like almost overnight I had
more energy than I'd had in years. Weight I'd been trying to lose for
a decade began dropping off. As the weight came off, I felt lighter,
and more able to move my body again. This lifestyle change has been
the greatest gift I've ever received. I am off most of my medications,
I've lost over 70 pounds, and I've regained control
over my health. I feel empowered
by this lifestyle change, and I finally feel like I'm
in charge of my health, not just an unlucky victim shuffling
from one specialist to the next.
My only regret was that
I didn't know about this sooner.".
Video Transcript – As found on YouTube
Do Vegans Have Lower Bone Mineral Density and Higher Risk of Osteoporosis?
How does a vegan or vegetarian
diet affect bone density, and what other factors contribute?
Watch the video to find out. "Do Vegans Have Lower Bone Mineral
Density and Higher Risk of Osteoporosis?" Osteoporosis is estimated to affect
200 million people worldwide. Literally meaning "porous bone ,"
osteoporosis is a disease characterized by reduced bone
formation, excessive bone loss, or a combination of both,
leading to bone fragility and increased risk of fractures. And bone mineral density is the
most robust and consistent predictor of osteoporotic fracture. What can
we eat to boost our bone density? Well, we know that increased
consumption of plant foods is associated with increased
bone mineral density. There's an extensive range of
micronutrients and phytochemicals packaged within plants that can be
powerful promoters of bone health, so healthcare professionals
should be encouraged to advise the increased
consumption of plant-based foods, particularly in mid-life, irrespective of the clients
underlying dietary pattern, meaning no matter how
much meat or junk they eat, adding more healthy plant
foods may help prevent the development of osteoporosis. On the other hand, a more
animal-source nutrient pattern has been associated with
a higher risk of fractures, suggesting that a more animal-based
diet is related to bone fragility.
So one would expect less osteoporosis
in those eating plant-based diets, but you don't know
until you put it to the test. "The Incidence of osteoporosis
in vegetarians and omnivores ," the first study published
nearly 50 years ago, and the density of the bones
that were measured was significantly greater in the
vegetarians than the omnivores. In fact, the average bone densities
of the vegetarians in their '70s was greater than the densities
of the meat eaters in their '50s. Bottom line, these results suggest
there's less likelihood of vegetarians developing osteoporosis in old age. Turns out, though, that
the researchers screwed up. DEXA scanning, which
is what we use now, didn't come online until the 1980s. So the researchers were
just using regular x-rays and they confused the readings,
such that darker bones on the x-ray got a higher score, but that
actually means less bone, so their conclusion should
have been the opposite of what they claimed.
So vegetarians had
worse bone mineral density. Fast-forward about 40 years,
by which time nine studies had been done on thousands
of individuals, and all in all, the results suggest that vegetarian
diets, particularly vegan diets, are associated with lower
bone mineral density, but the magnitude of the association
is clinically insignificant, meaning the difference was so small as to not
really matter out in the real world, reinforcing the fact
that vegetarian diets have no clinically detrimental
effect on bone health. And it is important to note
that the findings of lower bone mineral density didn't fully
control for key confounding factors, such as for differences
in body weight. We know that people who are
obese have stronger bones. Why? Because they're weight lifting 50 pounds
all day, every day, and maybe 100 pounds. If you walked around with a
100-pound backpack every day, your bones would grow stronger, too.
That's how you build strong
bones: weight-bearing exercise. So people who weigh
more have denser bones. And vegetarians, and especially
vegans, have such low rates of obesity that no wonder, on average they
would have lower bone density. The researchers didn't
take weight into account, but if the difference they found isn't
even clinically significant, who cares? As of 2009, the answer to the question, "Is vegetarianism a serious risk
factor for osteoporotic fracture?" the answer was no. Vegetarianism
is not a serious risk factor. By 2018, the latest meta-analysis
on veganism, vegetarianism, and bone mineral density,
was up to 20 studies, involving tens of thousands
of participants, and, again, lower bone mineral density
was found in studies of vegetarians and vegans
compared to meat eaters. The researchers conclude that
vegetarian and vegan diets need to be appropriately
planned to preserve their bones. But wait, did they account
for the obesity thing? No, they did not. They just used what are
called crude risk ratios, meaning no adjustments for
confounding factors like weight, so they didn't control for things
like age, smoking, obesity, exercise, and so their results
are really uninterpretable.
But no one had gone through
the trouble of going back through all those studies and making
the proper adjustments until now. The title gives it away: "Differences
in Bone Mineral Density between Vegetarians and Nonvegetarians
Become Marginal when Accounting for Differences
in Body Size Factors." Yes, bone mineral density values
were significantly lower among vegetarians
than among nonvegetarians, just like is the case
with nearly every study on bone mineral density
and excess body weight. But forget clinical significance;
these differences even lost statistical significance
upon adjustment for body size factors, suggesting that lower
bone mass among vegetarians is in larger parts explained by their
lower BMI and waist circumference. Thus, it's not so much the composition
of the diets of vegetarians and vegans as much as it is the fact that
they become so much slimmer.
Now a small but statistically
significant difference remained for total lower spine density,
a difference of 0.03. This was dismissed as having little
clinical relevance, but is that true? If you look at the reproducibility
of bone mineral density measurements in daily medical
practice, you can see how if you do repeat tests back-to-back,
there's some scatter in the measurements, and
so a significant difference really has to be more
than the inherent variation. And indeed, expressed as
the smallest detected difference, you really need a bone
mineral density disparity of at least 0.05 at the spine before it can be considered
a significant change, and so indeed, there does appear
to be little clinical relevance. However, even if vegetarians
and vegans basically have the same bone density
at the same weight, everyone who is skinny
is at risk. Low BMI is a risk factor for
fractures, so all persons in a low body weight category
consuming any kind of diet should be monitored
for osteoporosis.
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
Should Vegetarians Take Creatine to Normalize Homocysteine?
"Should Vegetarians Take Creatine
to Normalize Homocysteine?" Almost universally, research findings
show a poor vitamin B12 status among vegetarians because they're
not taking vitamin B12 supplements like they should. And this results in
an elevation of homocysteine levels that may explain why vegetarians
were recently found to have higher rates of stroke. Of course, plant-based eating is just
one of many ways to get B12 deficient. I mean, even laughing gas can
do it, in as short as two days, thanks to the recreational use
of whipped cream canister gas. That's something new I learned today.
Anyways, if you do eat plant-based, giving vegetarians and vegans
even as little as 50 micrograms once a day of cyanocobalamin, the
recommended, most stable form of vitamin B12 supplement,
and their homocysteine levels start up in the elevated
zone, and within 1 to 2 months their homocysteines normalize right
down into the safe zone under 10.
Or just 2000 micrograms of
cyanocobalamin once a week, and you get the same beautiful
result, but not always. In this study even 500 micrograms
a day, either as a sublingual chewable or swallowable regular B12 supplement, didn't normalize homocysteine
within a month. Now, presumably if they had kept it up, their levels
would have continued to fall like in the other study. But if you're
plant-based and have been taking your B12 and your homocysteine levels
are still too high, meaning above 10, is there anything else you can do? Now, inadequate folate intake
can also increase homocysteine, but folate comes from
the same root as foliage. It's found in leaves, concentrated
in greens, as well as beans. But if you're eating beans and
greens, taking your B12, and your homocysteine level is still
too high, then I'd suggest trying, as an experiment, taking
one gram of creatine a day and getting your homocysteine levels
retested in a month to see if it helped.
Creatine is a compound formed
naturally in the human body that is primarily involved in energy
production in our muscles and brain. It's also naturally formed in the
bodies of many animals we eat. And so when we eat their
muscles, we also can take in some creatine through our diet. We need about two grams a day,
so those who eat meat may get like one gram from their diet, and
their body makes the rest from scratch. There are rare birth defects where
you're born without the ability to make it, in which case you have to get it
from your diet, but otherwise our bodies make as
much as we need to maintain normal
concentrations in our muscles. When you cut out meat, the
amount of creatine floating around in your bloodstream goes down, but the
amount in your brain remains the same, showing dietary creatine doesn't
influence the levels of brain creatine, because your brain just makes
all the creatine you need. The level in vegetarian muscles is
lower, but that doesn't seem to affect performance, as both vegetarians
and meat-eaters respond to creatine supplementation with similar
increases in muscle power output.
And if vegetarian muscle
creatine was insufficient, then presumably they would
have seen an even bigger boost. So basically, all that happens
when you eat meat is that your body just doesn't
have to make as much. What does this all have
to do with homocysteine? Okay, in the process of making creatine,
your body produces homocysteine as a waste product. Now
normally this isn't a problem because your body
has two ways to detoxify it using vitamin B6 or using a
combination of vitamins B12 and folate. Now B6 is found in both plant and
animal foods; it's rare to be deficient. But B12 is mainly in animal
foods, and so can be too low in those eating plant-based who don't
supplement or eat B12 fortified foods. And folate is concentrated in plant
foods, so can be low in those who don't regularly eat greens or
beans or folic-acid fortified grains, and without that escape valve
homocysteine levels can get too high.
If, however, you're eating a healthy
plant-based diet and taking your B12 supplement, your homocysteine levels
should be fine, but what if they're not? One might predict that if you started
taking creatine supplements, the level of homocysteine might go
down since you're not going to have to be making so much of it from scratch,
producing homocysteine as a by-product. But you don't know until you put it
to the test, which we'll cover next.
Video Transcript – As found on YouTube
The Gladiator Diet How Vegetarian Athletes Stack Up
"The Gladiator Diet –
How Vegetarian Athletes Stack Up" Recently, the remains of
dozens of Roman gladiators were discovered in a mass grave. The clue to their identities
were the rather distinct types of mortal injuries they found, like being speared in
the head with a trident. Using just their skeletons
they were able to reconstruct the death blows, show just
how buff they really were, and even try to reconstruct
their diet of barley and beans. You can look at carbon isotopes and
see what kinds of plants they ate; nitrogen isotopes reflect any
intake of animal protein. You can also look at the
Sulphur in their bones and the amount of strontium,
leading commentators to submit that the best athletes
in ancient Rome ate largely plant-based diets. Then there were the legionnaires,
the Roman army troopers, famed for their abilities, also
eating a similar kind of diet, suggesting “the best fighters
in the ancient world were essentially vegetarian.” So, if the so-called
perfect fighting machines, the great sports heroes of the day,
were eating mostly grains and beans, should that tell us anything
about sports nutrition and the preferred diets
of elite athletes? Well, most of the Greeks and
Romans were basically vegetarian, centering their diets around
grains, fruit, vegetables and beans, so maybe the gladiators’ diets
weren’t that remarkable.
Plato, for example, pushed
plants, preferring plant foods for their health and efficiency. So yes, the Roman gladiators
were known as the ‘‘barley men,’’ but is that because barley
gives you strength and stamina, or was that just the basic food
that people ate at the time, not necessarily for performance,
but because it was just so cheap? Well, if you look at the modern
Spartans, the Tarahumara Indians, the ones that run races where
they kick a ball for oh, 75 miles just for the fun of it,
running all day, all night, and all day, maybe 150 miles
if they’re feeling in the mood. What do you get if you win? A special popularity with the ladies
(although how much of a reward that would actually prove to be
for a man who had been running for two days straight is questionable; though, maybe their endurance
extends to other dimensions). “Probably not since the
days of the ancient Spartans has a people achieved such a high
state of extreme physical conditioning.” And what did they eat? The same kind of 75 to
80 percent starch diet based on beans, corn, and squash. And, they had the cholesterol
levels to prove it, total cholesterol levels down at an
essentially heart attack proof 136.
And it’s not just some
special genetics they have— you feed them enough egg yolks and
their cholesterol creeps right up. Modern day Olympian runners
eat the same stuff. What are they eating over there in Kenya? A 99 percent vegetarian diet centered
mostly around various starches. But as in all these cases, is
their remarkable physical prowess because of their diets, or
in spite of their diets? Or have nothing to do with their diets? You don’t know…until
you put it to the test.
In spite of well-documented health
benefits of more plant-based diets, less is known regarding the effects
of these diets on athletic performance. So, they compared elite vegetarian
and omnivore endurance athletes for aerobic fitness and strength. So, comparing oxygen
utilization on the treadmill, and quad strength with leg extensions. And the vegetarians beat out
their omnivore counterparts for cardiorespiratory fitness,
but their strength didn’t differ. Suggesting, in the very least,
that vegetarian diets don’t compromise athletic performance. But this was a cross-sectional study. Maybe the veg athletes were just
fitter because they trained harder? Like in the National Runners' Health Study looking at thousands of runners:
vegetarian runners were recorded running significantly
more on a weekly basis; so, maybe that explains
their superior fitness.
Though, maybe their superior fitness
explains their greater distances. Other cross-sectional studies
have found no differences in physical fitness between
vegetarian and non-vegetarian athletes, or even worse performance, as in this
study of vegetarian athletes in India. Of course, there could be socioeconomic
or other confounding factors. That’s why we need interventional
studies to put different diets to the test and then compare
physical performance, which we’ll explore next..
Video Transcript – As found on YouTube
