Nutrition Facts

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Vegetarians and Stroke Risk Factors—Vegan Junk Food?

"Vegetarians and Stroke Risk Factors
—Vegan Junk Food?" Plant-based diets are
associated with a lower risk of cardiovascular disease, mortality, and
dying from all causes put together. This study of a diverse sample
of 12,000 Americans found that “progressively increasing
the intake of plant foods by reducing the intake of
animal foods may be associated with benefits on cardiovascular
health and mortality…”, but when it comes to plant-based diets
for cardiovascular disease prevention, all plant foods are not created equal. Were the vegetarians in the
British study that found the higher stroke risk just
eating a lot of vegan junk food? Any diet devoid of certain
animal food sources can be claimed to be a
vegetarian or vegan diet; so, it’s important to see
what they’re actually eating. One of the first things I look
at when I’m trying to see how serious a population is
about healthy eating is look at something undeniably, uncontroversially
bad: soda, liquid candy. Anyone drinking straight
sugar water obviously doesn’t have health top of mind. In the big study of plant-based
eaters in America, where people tend to cut down
on meat for health reasons far more than ethics… flexitarians
drink fewer sugary beverages than regular meat-eaters, as do
pescatarians, vegetarians, and vegans.

In the UK study, though, where the
increased stroke risk was found, where folks are more likely to go
veg or vegan for ethical reasons, the pescatarians are drinking less soda, but the vegetarians and
vegans are drinking more. I’m not saying that’s
why they had more strokes; it just might give us an idea of
how healthy the people were eating. In the UK study, the vegetarians and
vegan men and women were eating about the same amount of
desserts, cookies, and chocolate, and about the same total sugar.

In the U.S. study, the average
non-vegetarian is nearly obese, even the vegetarians
are a little overweight, and the vegans were the
only ideal weight group. In this analysis of the UK study, though,
everyone was about the same weight— in fact the meat-eaters
were skinnier than the vegans. The EPIC-Oxford study seems to
have attracted a particularly health conscious group of meat-eaters weighing substantially less
than the general population. Let’s look at some particular
stroke-related nutrients. Dietary fiber appears beneficial
for the prevention of cardiovascular disease
including stroke, and it appears the more the better. Based on studies of nearly a half
a million men and women there doesn’t seem to be any
upper threshold of benefit; so, the more, the better. More than
25 grams of soluble fiber, 47 grams of insoluble dietary
fiber and you can really start seeing a significant drop
in associated stroke risk. So, one could consider these
as the minimal recommendable daily intakes to prevent
stroke at a population level. That’s what you see in people
eating diets centered around minimally processed plant foods.
Dean Ornish got up around there with his whole food plant-based diet.

Maybe not as much as
we were designed to eat, based on the analyses of fossilized feces, but that’s the kind of neighborhood
where we might expect significantly lower stroke risk. How much were the
UK vegetarians getting? 22.1. Now, in the UK they measure
fiber a little differently; so, that may actually
be closer to 30 grams, but not the optimal level
for stroke prevention. So little fiber that the vegetarians
and vegans only beat out the meat-eaters by about 1
or 2 bowel movements a week, suggesting they were eating
lots of processed foods.

The vegetarians were only
eating about a half serving more of fruits and vegetables,
thought to reduce stroke risk in part because of
their potassium content, yet the UK vegetarians at
higher stroke risk were evidently eating so few greens and beans they
couldn’t even match the meat-eaters, not even reaching the
recommended minimum daily potassium intake of 4700 mg a day. And what about sodium? The vast
majority of the available evidence indicates that elevated salt intake is
associated with higher stroke risk. There’s like a straight-line
increase in the risk of dying from a stroke
the more salt you eat. Even just lowering sodium intake
by a tiny fraction every year could prevent tens of
thousands of fatal strokes. Reducing sodium intake to prevent stroke:
time for action, not hesitation, but the UK vegetarians and
vegans appeared to be hesitating, as did the other dietary groups.
All groups exceeded the advised less than 2400 mg daily sodium intake—
and that doesn’t even account for salt added at the table, and
the American Heart Association recommends under just 1500 a day;
so, they were all eating lots of processed foods.

So, no wonder
the vegetarian blood pressures were only 1 or 2 points lower;
high blood pressure is perhaps the single most important modifiable
risk factor for stroke. What evidence do I have that if the
vegetarians and vegans ate better their stroke risk would go down?
Well, in rural Africa where they were able to nail the fiber intake that
our bodies were designed to get by eating so many whole healthy plant
foods— fruits, vegetables, grains, greens and beans, their protein
almost entirely from plant sources, not only was heart disease, our
#1 killer, almost non-existent, so apparently, was stroke, surging
up from out of nowhere with the introduction of salt
and refined foods to their diet. Stroke also appears to be
virtually absent in Kitava, a quasi-vegan island culture
near Australia where diet was very low in salt and
very rich in potassium, because it was a vegetable-based diet.
They ate fish a few times a week, but the other 95% or so
of their diet was lots of vegetables, fruits, corn, and beans,
and they had an apparent absence of stroke, even despite their
ridiculous rates of smoking.

After all, we evolved eating
as little as less than an 8th of a teaspoon a day of salt
and our daily potassium consumption is thought to have been
as high as like 10,000 mg. We went from an unsalted, whole-food
diet to salty processed foods depleted of potassium
whether we eat meat or not. Caldwell Esselstyn at the
Cleveland Clinic tried putting about 200 patients with established
cardiovascular disease on a whole food plant-based diet. Of the 177 that stuck with the diet
only one went on to have a stroke in the subsequent few years
compared to a hundred-fold greater rate of adverse events—
including multiple strokes and deaths in those that
strayed from the diet.

“This is not vegetarianism,”
Esselstyn explains. Vegetarians can eat a lot
of less-than-ideal foods. This new paradigm is exclusively whole
food, plant-based nutrition. Now this entire train of thought,
that the reason typical vegetarians don’t have better stroke statistics
is because they’re not eating particularly stellar diets, may
explain why they don’t have significantly lower strokes rates,
but that still doesn’t explain why they might have higher stroke rates.

Even if they’re eating similarly
crappy, salty, processed diets at least they’re not eating meat,
which we know increases stroke risk; so, there must be something
about vegetarian diets that so increases stroke risk that
it offsets their inherent advantages? We’ll continue our hunt, next..

Video Transcript – As found on YouTube

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How to Cultivate a Healthy Gut Microbiome with Food

Check out this new video
on the microbiome. And if you want more, just go to
NutritionFacts.Org/Topics/Microbiome for all my videos on good gut health. "How to Cultivate a Healthy
Gut Microbiome with Food" When we eat meat,
dairy, eggs, seafood, our gut flora can take certain
components in them (carnitine and choline)
and produce something that ends up as a toxic
compound called TMAO, which may set us up for a
heart attack, stroke, and death.

So, give people two eggs,
and you get a spike of TMAO in your bloodstream
within hours of consumption. Because gut bacteria play a critical
role in this process, though, if you then give them a week
of antibiotics to wipe out their gut flora and refeed them
two more eggs, nothing happens. No TMAO in their bloodstream
because they have no egg-eating
bacteria to make it. But give it a month for their gut
bacteria to start to grow back, and the eggs start to cause
TMAO production once again. The same thing with meat. Give people the equivalent
of an 11-ounce steak, and TMAO levels shoot
up in the blood.

But feed them the same amount
after a week of antibiotics and nothing happens. So to run into problems, you need both the meat and
the meat-eating bugs. That's why you can
feed a vegan a sirloin, and they don't produce
TMAO within their body. They just don't have the
meat-eating bugs in their gut. Okay, now this should all be
old news for those who've been following the science. The
reason for this video is to show that this phenomenon happens
the other way around, too. When we eat whole plant
foods, like fruits, vegetables, whole grains, and beans,
along with nuts and seeds, our gut flora can take
certain components in them (fiber and resistant starch) and
produce short-chain fatty acids which can set us up for the
prevention of human diseases.

Short-chain fatty acids like butyrate
can help seal up a leaky gut, fight inflammation, prevent weight
gain, improve insulin sensitivity, accelerate weight loss,
and fight cancer. But these benefits
rely on two things: eating fiber and having
fiber-feeding bugs, just like the detrimental effects
from TMAO required not only eggs, dairy, or meat, but also the eggs, dairy,
or meat-munching bugs. Check this out. If you give people whole
intact grains — in this case barley kernels,
also known as barley groats — three servings a day, like I recommend in
my Daily Dozen app, within just three days of eating
that extra 30+ grams of fiber and resistant starch, their gut bugs were so happy
and produced so many short-chain fatty acids that people's
insulin levels improved by 25%, which means their bodies
needed to produce less insulin to take care of the same amount
of white bread, while still dampening the blood sugar spike.
But this was on average.

Some people responded to all that
extra fiber with beautiful dips in blood sugar and insulin responses,
but in others, the same amount of fiber and resistant
starch didn't work at all. Why? Because you don't just
need fiber, but fiber-feeding bugs like Prevotella.
How do you get more Prevotella so you can take full advantage
of the health benefits of plants? Eat more plants. Prevotella
abundance is associated with long-term fiber intake.
If you look at rural African children eating 97%
whole food, plant-based diets, their Prevotella is off the charts
compared to kids eating standard Western diets,
and this is reflected in the amount of short-chain
fatty acids they are churning out in their poop. In the industrialized world,
it's those habitually eating vegetarian and vegan that
promotes the enrichment of fiber-eating bacteria
in the gut. Here's the relative Prevotella
abundance between those who eat meat,
no meat, or all plants. This may help explain the
worse inflammatory profile in omnivores
than in vegetarians. Based on the findings relative
to bacteria abundance, the researchers suggest
that exposure to animal foods may favor an intestinal
environment which could trigger systemic inflammation and
insulin resistance-dependent metabolic disorders
such as type 2 diabetes.

And it's the reduced levels
of inflammation that may be the key factor linking a
plant-based gut microbiota with protective health benefits. Yeah, but can't meat-eaters
eat lots of plants, too? Omnivores have constraints
on diet-dependent gut microbiome metabolite
production. In other words, it's the flip side of the
vegan eating a steak. They can eat all the fiber
they want but may be lacking in fiber-munching machinery.
At low levels of fiber intake, the more you eat, the more
of the beneficial short-chain fatty acids are made. But at a certain point,
your available fiber-feeders are maxed out, and there's
only so much you can benefit. But those habitually eating
a plant-based diet have been cultivating the growth
of these fiber-feeders, and the sky's the limit,
unless, of course, you're eating vegan junk. But a whole food, plant-based diet
should be effective in promoting a diverse ecosystem of
beneficial bacteria to support both our gut microbiome
and our overall health..

Video Transcript – As found on YouTube

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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

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The Best Diet for Weight Loss and Disease Prevention

"The Best Diet for Weight Loss
and Disease Prevention" Why are vegetarian diets so effective
in preventing and treating diabetes? Maybe it's because of the weight loss.
Those eating more plant based tend to be significantly slimmer,
and not just based on like looking at a cross-section of the population,
but you can do interventional trials and put it to the test: a randomized,
controlled community-based trial of a whole food plant-based diet. The key difference between plant-based
nutrition and other approaches to weight loss is that participants
were informed to eat the whole food plant-based diet ad libitum,
meaning eat as much as you want, no calorie counting,
no portion control. Just eat. It's about improving
the quality of food rather than restricting
the quantity of food. And then in this study, they
had people just focus on diet rather than increasing exercise,
just because they wanted to isolate out the effects of eating
healthier. So, what happened? No restrictions on portions, eat
all the healthy foods you want. Here's where they started out: on
average obese at nearly 210 pounds; the average height was about 5'5". Three months in they were
down about 18 pounds; 6 months in, more
like 26 pounds down.

But you know how these
weight loss trials go. I mean, this wasn't
an institutional study where they locked people up and
fed them; no meals were provided. They just informed people about
the benefits of plant-based eating and encouraged them to do it in
their own lives, their own families, and their own homes and communities.
And so, yeah, typically what you see in these so-called "free-living"
studies is weight loss at six months, but then by a year the weight
creeps back or even worse. But in this study, they were able to
maintain that weight loss all year. And of course, their cholesterol got
better too, but their claim to fame is that they achieved greater weight loss
at 6 and 12 months than any other trial that does not limit calorie intake
or mandate regular exercise.

That's worth repeating. A whole
food plant-based diet achieved the greatest weight loss ever
recorded at 6 and 12 months compared to any other such intervention
published in the medical literature. Now obviously with very
low-calorie starvation diets you can drop people
down to any weight. However, these medically supervised
liquid diets are obviously just short-term fixes, associated
with high costs, high attrition rates, and a high probability of
regaining most of the weight, whereas the whole point of
whole food plant-based nutrition is to maximize long-term
health and longevity. I mean, even if, for example, low
carb diets were as effective, the point of weight loss is not
to fit into a skinnier casket. Studies on the effects of
low-carbohydrate diets have shown higher rates
of all-cause mortality— meaning a shorter lifespan—
decreased artery function, worsening of coronary artery disease,
and increased rates of constipation, headaches, bad breath, muscle
cramps, general weakness and rash. And yet, still not as effective
as the diet that actually has all the good side effects, like decreasing risk of diabetes,
beyond just the weight loss. Yes, the lower risk of type 2
diabetes among vegetarians may be explained in part
by improved weight status.

However, the lower risk also may
be explained by higher amounts of ingested dietary fiber and
plant protein, the absence of meat- and egg-derived
protein and heme iron, and lower intake
of saturated fat. Most studies report the lowest risk
of type 2 diabetes among those who adhere to strictly
plant-based diets. This may be explained by the fact
that vegans, in contrast to vegetarians, do not eat eggs, which appear to
be linked to higher diabetes risk. Maybe it's eating lower on the food
chain, so you avoid the highest levels of persistent organic pollutants like
dioxins, PCBs, DDT in animal products, which have been implicated
as a diabetes risk factor. Maybe it has to do with the gut
microbiome. With all that fiber, no surprise that there'd be
less disease-causing bugs and more protective gut flora,
which can lead to less inflammation throughout the body, that may be the
key feature linking the heathier gut with beneficial health effects— including the metabolic dysfunction
you can see in type 2 diabetes. And it's that multiplicity
of benefits that can help with compliance and family buy-in.
Whereas a household that includes people who do not have diabetes
may be unlikely to enthusiastically follow a "diabetic diet,"
a healthy diet is not disease-specific and can improve
other chronic conditions too.

So while the diabetic patient
will likely see improvement in their blood sugar control, a
spouse suffering from constipation or high blood pressure may
also see improvements, as may overweight children if you make
healthy eating a family affair..

Video Transcript – As found on YouTube

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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

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Vegetarians and Stroke Risk Factors—Vegan Junk Food?

"Vegetarians and Stroke Risk Factors
—Vegan Junk Food?" Plant-based diets are
associated with a lower risk of cardiovascular disease, mortality, and
dying from all causes put together. This study of a diverse sample
of 12,000 Americans found that “progressively increasing
the intake of plant foods by reducing the intake of
animal foods may be associated with benefits on cardiovascular
health and mortality…”, but when it comes to plant-based diets
for cardiovascular disease prevention, all plant foods are not created equal. Were the vegetarians in the
British study that found the higher stroke risk just
eating a lot of vegan junk food? Any diet devoid of certain
animal food sources can be claimed to be a
vegetarian or vegan diet; so, it’s important to see
what they’re actually eating.

One of the first things I look
at when I’m trying to see how serious a population is
about healthy eating is look at something undeniably, uncontroversially
bad: soda, liquid candy. Anyone drinking straight
sugar water obviously doesn’t have health top of mind. In the big study of plant-based
eaters in America, where people tend to cut down
on meat for health reasons far more than ethics… flexitarians
drink fewer sugary beverages than regular meat-eaters, as do
pescatarians, vegetarians, and vegans. In the UK study, though, where the
increased stroke risk was found, where folks are more likely to go
veg or vegan for ethical reasons, the pescatarians are drinking less soda, but the vegetarians and
vegans are drinking more. I’m not saying that’s
why they had more strokes; it just might give us an idea of
how healthy the people were eating.

In the UK study, the vegetarians and
vegan men and women were eating about the same amount of
desserts, cookies, and chocolate, and about the same total sugar. In the U.S. study, the average
non-vegetarian is nearly obese, even the vegetarians
are a little overweight, and the vegans were the
only ideal weight group. In this analysis of the UK study, though,
everyone was about the same weight— in fact the meat-eaters
were skinnier than the vegans. The EPIC-Oxford study seems to
have attracted a particularly health conscious group of meat-eaters weighing substantially less
than the general population. Let’s look at some particular
stroke-related nutrients.

Dietary fiber appears beneficial
for the prevention of cardiovascular disease
including stroke, and it appears the more the better. Based on studies of nearly a half
a million men and women there doesn’t seem to be any
upper threshold of benefit; so, the more, the better. More than
25 grams of soluble fiber, 47 grams of insoluble dietary
fiber and you can really start seeing a significant drop
in associated stroke risk. So, one could consider these
as the minimal recommendable daily intakes to prevent
stroke at a population level. That’s what you see in people
eating diets centered around minimally processed plant foods.
Dean Ornish got up around there with his whole food plant-based diet. Maybe not as much as
we were designed to eat, based on the analyses of fossilized feces, but that’s the kind of neighborhood
where we might expect significantly lower stroke risk. How much were the
UK vegetarians getting? 22.1. Now, in the UK they measure
fiber a little differently; so, that may actually
be closer to 30 grams, but not the optimal level
for stroke prevention.

So little fiber that the vegetarians
and vegans only beat out the meat-eaters by about 1
or 2 bowel movements a week, suggesting they were eating
lots of processed foods. The vegetarians were only
eating about a half serving more of fruits and vegetables,
thought to reduce stroke risk in part because of
their potassium content, yet the UK vegetarians at
higher stroke risk were evidently eating so few greens and beans they
couldn’t even match the meat-eaters, not even reaching the
recommended minimum daily potassium intake of 4700 mg a day. And what about sodium? The vast
majority of the available evidence indicates that elevated salt intake is
associated with higher stroke risk. There’s like a straight-line
increase in the risk of dying from a stroke
the more salt you eat. Even just lowering sodium intake
by a tiny fraction every year could prevent tens of
thousands of fatal strokes. Reducing sodium intake to prevent stroke:
time for action, not hesitation, but the UK vegetarians and
vegans appeared to be hesitating, as did the other dietary groups.
All groups exceeded the advised less than 2400 mg daily sodium intake—
and that doesn’t even account for salt added at the table, and
the American Heart Association recommends under just 1500 a day;
so, they were all eating lots of processed foods.

So, no wonder
the vegetarian blood pressures were only 1 or 2 points lower;
high blood pressure is perhaps the single most important modifiable
risk factor for stroke. What evidence do I have that if the
vegetarians and vegans ate better their stroke risk would go down?
Well, in rural Africa where they were able to nail the fiber intake that
our bodies were designed to get by eating so many whole healthy plant
foods— fruits, vegetables, grains, greens and beans, their protein
almost entirely from plant sources, not only was heart disease, our
#1 killer, almost non-existent, so apparently, was stroke, surging
up from out of nowhere with the introduction of salt
and refined foods to their diet. Stroke also appears to be
virtually absent in Kitava, a quasi-vegan island culture
near Australia where diet was very low in salt and
very rich in potassium, because it was a vegetable-based diet.
They ate fish a few times a week, but the other 95% or so
of their diet was lots of vegetables, fruits, corn, and beans,
and they had an apparent absence of stroke, even despite their
ridiculous rates of smoking.

After all, we evolved eating
as little as less than an 8th of a teaspoon a day of salt
and our daily potassium consumption is thought to have been
as high as like 10,000 mg. We went from an unsalted, whole-food
diet to salty processed foods depleted of potassium
whether we eat meat or not. Caldwell Esselstyn at the
Cleveland Clinic tried putting about 200 patients with established
cardiovascular disease on a whole food plant-based diet. Of the 177 that stuck with the diet
only one went on to have a stroke in the subsequent few years
compared to a hundred-fold greater rate of adverse events—
including multiple strokes and deaths in those that
strayed from the diet. “This is not vegetarianism,”
Esselstyn explains. Vegetarians can eat a lot
of less-than-ideal foods. This new paradigm is exclusively whole
food, plant-based nutrition. Now this entire train of thought,
that the reason typical vegetarians don’t have better stroke statistics
is because they’re not eating particularly stellar diets, may
explain why they don’t have significantly lower strokes rates,
but that still doesn’t explain why they might have higher stroke rates.

Even if they’re eating similarly
crappy, salty, processed diets at least they’re not eating meat,
which we know increases stroke risk; so, there must be something
about vegetarian diets that so increases stroke risk that
it offsets their inherent advantages? We’ll continue our hunt, next..

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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..

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The First Studies on Vegetarian Athletes

"The First Studies on Vegetarian Athletes" In 1896, the aptly named
James Parsley evidently led a successful vegetarian
cycling club to victory, their competitors evidently having
to "eat crow with their beef." Evidently some Belgian
put it to the test in 1904, with those eating more plant-based
supposedly lifting some weight like 80 percent more times, but I couldn't find the
primary source in English. This I could find though: a famous
series of experiments at Yale, published more than a century ago, on the
influence of flesh-eating on endurance. Forty-nine people were compared:
regular athletes (mostly Yale students), vegetarian athletes, and then
just sedentary vegetarians.

"The experiment furnished a severe test
of the claims of those flesh-abstainers." Much to the researchers' surprise,
the results seemed to vindicate the vegetarians, suggesting that
not eating meat leads to far greater endurance compared to those accustomed
to the ordinary American diet. Check it out: the first endurance test was
how many minutes straight you could hold out your arms horizontally:
flesh-eaters versus flesh abstainers. The regular Yale athletes were
able to keep their hands out for about 10 minutes on average. It's harder than it sounds;
give it a try… OK, but those eating vegetarian
did like five times better. The meat-eater maximum was only
half that of the vegetarian average. Only two meat eaters
even hit 15 minutes, whereas more than two-thirds
of the meat-avoiders did. None of the regular diet
folks hit a half hour, whereas nearly half of
the healthier eaters did, including nine that exceeded an
hour, four that exceeded two hours, and one guy going for
more than three hours.

How many deep knee
bends can you do? One athlete could do more
than 1,000—averaging 383— but they got creamed even
by the sedentary plant-eaters. That's the crazy thing; even
the sedentary abstainers surpassed the exercising flesh-eaters. The sedentary abstainers were, in most cases, physicians
who sat on their butts all day. I want a doctor that that can do
a thousand deep knee bends! And then in terms of recovery, all those
deep knee bends left everyone sore, but more so among those eating meat. Among the vegetarians, of two that
did like 2,000 knee bends, one went straight off to the track to run and
another went on to their nursing duties. On the other hand, among the
meat-eaters one guy reached 254, went down once more and couldn't
get back up, had to be carried away, and was incapacitated for days; another
impaired for weeks after fainting. It may be inferred without reasonable
doubt, concluded the once skeptical Yale researcher, that the meat-eating
group of athletes was very far inferior in endurance to the vegetarians,
even the sedentary ones.

What could account for
this remarkable difference? Some claimed that flesh foods contained
some kind of "fatigue poisons," but one German researcher who detailed
his own experiments with athletes offered a more prosaic answer.
In his book on what looks like physiological studies of
uber-driving vegetarians— I told you I only know English— he conjectured that the apparent
vegetarian superiority was just due to their tremendous determination
to prove their point and spread their propaganda,
so they just make a greater effort in any contest than do
their meat-eating rivals. The Yale researchers were worried
about this, and so special pains were taken to stimulate the flesh-eaters
to the utmost, appealing to their college pride. Don't let those lousy
vegetarians beat the "Yale spirit." The experiments made it
into The New York Times. Yale's flesh-eating athletes—
sounds like a zombie movie— beaten in severe endurance tests.
Yale professor believes that he has shown definitely the inferiority
in strength and endurance tests of meat eaters compared to
those who do not eat meat. Some of Yale's most successful
athletes took part in the strength tests, and Professor Fisher declares they
were obliged to admit their inferiority.

How has the truth of this result
been so long obscured? One reason, Professor Fisher
suggested, is that vegetarians are their own worst enemy.
In their fanaticism, they jump from the premise that meat eating
is wrong—often based on scripture or some kind of dogma—and jump
from that to meat-eating is unhealthy. That's not how science works
and such logical leaps get them dismissed as zealots and prevent
any genuine scientific investigation. Lots of science, even back then,
was pointing a distinct trend towards more plant-based eating,
and yet the word vegetarian— even 110 years ago—had
such a bad, preachy rap that many were loath to concede
the science in its favor. The proper scientific attitude is to study
the question of meat-eating in precisely the same manner as one would
study the question of anything else.

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Dr. Gundry’s The Plant Paradox Is Wrong

Dr. Gundry's THE PLANT PARADOX is Wrong Earlier this year, I started
getting emails about this book, The Plant Paradox, purporting
to expose the "hidden dangers" in healthy foods that cause
disease and weight gain, foods like beans, and whole
grains, and tomatoes. Why? Because of lectins,
which is a rehashing of the discredited Blood Type
Diet from decades ago; they just keep coming back. Yeah, but this was
written by an MD, which— if you've seen
my medical school videos— you'll know is effectively an
anti-credential when it comes to writing diet books, basically
advertising to the world that you've received likely little
or no formal training in nutrition.

Dr. Atkins was, after
all, a cardiologist. But look, you want to give
the benefit of the doubt. The problem is that it doesn't
even seem to pass the sniff test. I mean if lectins are bad, then
beans would be the worst, and so bean counters
would presumably find that bean eaters cut
their lives short, whereas the exact opposite
may be true with legumes— beans, split peas,
chickpeas, and lentils— found to be perhaps the most
important dietary predictor of survival in older people in
countries around the world. As Dan Buettner points
out in his Blue Zones work, lectin-packed foods are
the cornerstone of the diets of all the healthiest, longest-
lived populations on the planet.

Plant-based diets in general,
and legumes in particular, are a common thread among
longevity Blue Zones around the world—the most
lectin lush food there is. And if lectins are bad, then whole
grain consumers should be riddled with disease, when in fact whole
grain intake is associated with a reduced risk of
coronary heart disease, the number 1 killer
of men and women. Strokes, too, and total cancer, and
mortality from all causes put together, meaning people who eat whole
grains tend to live longer, and get fewer respiratory diseases,
infectious diseases, diabetes, and all non-cardiovascular,
non-cancer causes to boot. And not just in
population studies. As I've shown, you can randomize
people into whole grain interventions and prove cause-
and-effect benefits.

The same with tomatoes. You randomize women to a cup
and a half of tomato juice or water every day, and all that
nightshade tomato lectin reduces systemic inflammation,
or has waist-slimming effects, reducing cholesterol as well
as inflammatory mediators. So when people told me about
this book, I was like, let me guess: he sells a line of lectin-
blocking supplements. And what do you know: assist your
body in the fight against lectins for only $79.95 a month. That's only like a
thousand bucks a year— a bargain for pleasant
bathroom visits. And then, of course, there's
10 other supplements. So for only 8 or 9 thousand dollars
a year, you can lick those lectins. Oh, did I not mention
his skincare line? Firm and sculpt
for an extra $120, all so much more affordable
when you subscribe to his VIP club. But you still want to give him
the benefit of the doubt. People ask me all the time to
comment on some new blog or book or YouTube video, and
I have to sadly be like, look, there are a hundred thousand
peer-reviewed scientific papers on nutrition published in the
medical literature every year, and we can barely
keep up with those.

Ah, but people kept emailing
me about this book; so, I was like, fine, I'll
check out the first citation. Chapter 1, citation 1: "Forget everything you
thought you knew was true" (diet books love saying that). For example, "Eating
shellfish and egg yolks dramatically reduces
total cholesterol." What?! Egg yolks
reduce cholesterol? What is this citation? This is the paper he cites. And here it is. By now, you know
how these studies go. How do you show a food
decreases cholesterol? You remove so much
meat, cheese, and eggs that overall your saturated fat
falls, in this case, about 50%.

If you cut saturated
fat in half, of course cholesterol
levels are going to drop. So they got a drop
in cholesterol removing meat, cheese,
and egg yolks. Yet, that's the paper he uses to
support his statement that egg yolks dramatically reduce cholesterol. I mean it's unbelievable. That's the opposite of the truth. Add egg yolks to people's diets
and their cholesterol goes up. I mean, how dare
he say this? And it's not like some
harmless foolishness, like saying the Earth
is flat or something. Heart disease is the number
one killer of men and women. This can actually
hurt people. So much for my
benefit of the doubt..

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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..

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