Health Journal Online

Category: Nutrition

  • A Surprising Vegetable Approach to Insomnia

    A Surprising Vegetable Approach to Insomnia

    Lactucin, the hypnotic component of lettuce, is put to the test in a randomized, double-blind, placebo-controlled trial of lettuce seeds.

    “There is a perception that time spent asleep is time wasted,” but it’s widely recognized that insufficient sleep is linked to multiple acute and chronic conditions and increases the risks of death and disease.

    As I discuss in my video Natural Dietary Remedy for Insomnia, forcing people to get only six hours of sleep per night for one week can change the expression of more than 700 genes. The most dire effect may be endothelial dysfunction. The endothelium is the thin layer of cells that lines the inside of blood vessels and is responsible for allowing our arteries to relax and dilate properly. Randomizing people to get five instead of seven hours of sleep for about a week results in a significant impairment in artery function from just that two-hour nightly difference.

    How bad is a week of getting only five hours a night? Sleep deprivation is no joke. “The magnitude of impairment…is similar to that reported in people who smoke, or have diabetes, or who have coronary artery disease.” No wonder people who sleep less than seven hours a night may experience a 12% to 35% increased risk of premature death compared to those who get a full seven hours. Yet a significant portion of the population—28% of adults in the United States, for instance—may routinely get less than that. “Sufficiently long, restful sleep sessions each night are an indisputable cornerstone of good health.” So, what can we do about it?

    Those who have sleep apnea, a common consequence of obesity that interferes with sleep, benefit from the use of CPAP machines while they’re losing weight to hopefully treat the underlying cause. But what if apnea isn’t your problem? What if you just have trouble falling asleep or staying asleep? In my book How Not to Diet, there’s a whole section on sleep enhancement, where I go through the Four Rules of Sleep Conditioning and the Four Rules of Sleep Hygiene, as you can see below and at 2:04 in my video. What if you follow those guidelines but still can’t get to sleep? Are there any natural dietary remedies?

    I’ve previously talked about using kiwifruit and tart cherries to fight insomnia. Are there any vegetables that might help? Lactuca sativa is a plant that has traditionally been used to treat insomnia. What is this exotic-sounding leafy vegetable? Lettuce! Evidently, lettuce extracts have been used for their sedative and sleep-inducing properties since the Roman Empire. Lettuce actually does have a hypnotic substance in it called lactucin, which is what makes lettuce taste a little bitter. But you don’t know if it actually works until you put it to the test.

    And it does work…in toads. It also works in rodents. Sleep for both mice and rats is enhanced by romaine lettuce. Researchers used romaine since it has a higher lactucin content compared to other lettuces.

    But does it work in people? About 10 years ago, a study was published in which insomnia sufferers were randomized to receive lettuce seed oil, which is oil extracted from lettuce seeds. Within a week, about 70% of those in the lettuce seed oil group said their insomnia “very much or much improved,” compared to just 20% in the placebo control group. The researchers concluded that lettuce seed oil was found to be a useful, safe sleeping aid in geriatric patients with sleeping difficulties. They chose to study older individuals because insomnia affects about 20% to 40% of older adults at least a few nights a month.

    You think that’s a lot? Sleep disturbances can plague as many as nearly 8 out of 10 women during pregnancy. Of course, there are lots of different sleeping pills, but they may endanger the fetus or mother. For example, doctors frequently prescribe Ambien for pregnant women who have trouble sleeping, but Ambien use is associated with a wide range of adverse pregnancy outcomes, such as low-birth-weight babies, premature birth, and cesarean section. And the use of valium during pregnancy has been linked to birth defects including limb deficiencies. There has to be a better way. What about trying lettuce?

    The lettuce seed oil study had a number of limitations. For example, it was only single-blind, meaning the researchers knew who was on the lettuce supplements and who was on placebo, which could have introduced some bias. But the researchers essentially said, Give us a break. Big pharma has billions to spend on research. No one wants to fund studies on lettuce.

    However, researchers finally performed a double-blind, placebo-controlled study, but this time on a whole food, not just a lettuce seed extract. But how does one come up with a placebo lettuce? How is it possible to hide who gets lettuce and who doesn’t? Well, a head of lettuce can’t fit into a capsule, but whole lettuce seeds can. In a double-blind, randomized, placebo-controlled trial on lettuce seeds for pregnancy-related insomnia, 100 pregnant women with insomnia were randomized to receive capsules containing either a quarter teaspoon of ground lettuce seeds or a placebo for two weeks. Those on the lettuce seeds saw a significant improvement in a sleep quality index score compared to placebo with no reported side effects.

    Doctor’s Note

    The insomnia videos I mentioned are Kiwifruit for Insomnia and Tart Cherries for Insomnia.

    For the Four Rules of Sleep Conditioning and the Four Rules of Sleep Hygiene, go to your local public library or independent bookstore and pick up How Not to Diet. (All proceeds I receive from my books are donated to charity.)



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  • Protect Your Arteries from Saturated Fat with These Foods

    Protect Your Arteries from Saturated Fat with These Foods

    If you’re going to have something unhealthy, is there anything you can eat with it to help mitigate the damage it may cause?

    If you compare the artery function of vegetarians and meat-eaters, the healthy ability of arteries to dilate and let more blood flow is significantly better among those eating a vegetarian diet. And not just by a little—we’re talking four times better, as you can see below and at 0:24 in my video Foods to Help Protect Your Arteries from Saturated Fat.

    Vegetarians do tend to be younger, smoke less, be slimmer, and have lower rates of diabetes, high cholesterol, high blood pressure, and heart disease. But the researchers controlled for all that and only let healthy nonsmokers into the study. They also recruited a group of meat eaters who were similarly slim, with comparable blood pressure and nearly identical cholesterol levels. Yet the really healthy cohort of omnivores still got their arteries handed to them by the vegetarians, and the longer someone was meat-free, the better. The degree of superior artery function correlated with the number of years eating meat-free. Instead of their artery function worsening over time as they aged, it got better the longer they ate that way, as you can see below and at 1:03 in my video.

    This suggests that vegetarian diets, on their own, have a direct beneficial effect on artery function and may help explain the lower rates of atherosclerosis and cardiovascular mortality.

    Since researchers were able to control for other known risk factors, they figured it must be the food. But what aspect of the food? Is it simply the absence of meat’s harmful effects? Or could it also be that the vegetarians are eating more whole, healthy plant foods? For example, they could be eating up to a serving more vegetables per day.

    Researchers compared two junky meals—an Egg McMuffin, Sausage McMuffin, and hash brown patties to Frosted Flakes—and found the fatty fast-food meal impaired artery function within hours, but the sugary cereal meal didn’t. They blamed the fat, but it may just be the animal fat, since high-fat whole plant foods like nuts don’t have the same effect. In fact, a systematic review of all the randomized controlled trials on the effect of nut consumption on artery function shows that nuts actually result in significant improvements over time.

    Enough to counter the artery-crippling effects of a salami sandwich? The answer is yes for walnuts, but no for almonds.

    Just like some fruits are better than others, like blueberries over bananas, some nuts are better than others. Walnuts appear to be the blueberries of nuts.

    What about the blueberry of berries? That would be blueberries themselves. A randomized, controlled crossover trial tested the effects of cooked blueberries, raw blueberries, or no blueberries at all. Researchers fed people buns made out of white flour, eggs, butter, and salt—filled with mostly sugar and eggs—and saw a gradual drop in artery function over the next six hours. But when the equivalent of a cup of wild blueberries was added to that same bun, there was a big boost in artery function, almost as if the blueberries had been just mixed with water, as you can see below and at 2:57 in my video.

    About the same amount of strawberries failed to rescue artery function from the likes of two cheese blintzes, whipped cream, sugary syrup, egg, and bacon, but that is quite the heavy load to bear.

    What about testing açai berries against a meal with a similar amount of fat? One and a half frozen açai smoothie packs blended with half a small banana in water significantly rehabilitated arterial function compared to a control smoothie with the same banana and water, colored to look like the açai version. (Though, obviously, it would have tasted different.) You can see the results below and at 3:20 in my video.

    Another group of researchers went all out and performed a double-blind, randomized, controlled trial with raspberries. They measured artery function at 2 hours and again at 24 hours after participants drank either a smoothie made with frozen red raspberries (about ¾ cup or about 1½ cups, blended with water) or a placebo drink designed to match both color and taste. The fake berry drink had no effect on artery function, but both raspberry drinks did, as you can see below and at 3:56 in my video.

    Note the ¾ cup dose seemed to work just as well as the 1½ cups dose, which is what you see with blueberries: The benefits plateau after about a cup.

    The bottom line is that consuming “dietarily achievable amounts of red raspberries acutely improves” artery function for up to 24 hours. Yes, that’s true, but by the end of the day, you may only be up by about 1%. At a population level, however, each 1% increase is associated with a 12% reduction in risk of a cardiovascular event like a heart attack or stroke. All from just having a berry smoothie.

    What about berry juice? Researchers tested five different concentrations of cranberry juice, along with a placebo control evidently indistinguishable in color and taste. The 25% cranberry juice drink gave a little bump to artery function at two hours; the 50% juice was still working eight hours later. The other three—the 75% juice, the one that was nearly pure juice, and the ultraconcentrated juice—also improved artery function within hours of consumption, as you can see below and at 4:52 in my video.

    But this, like that last raspberry study, just involved straight berries without some artery-crushing meal.

    Would berry juice be able to stop artery dysfunction caused by a high-fat meal, which can reduce artery function within hours? Researchers created a cocktail of grapes, blueberries, strawberries, lingonberries, and black aronia berries, but found no significant change after the high-fat meal. (Of course, drinking the berries alone would likely improve artery function, but it’s better than nothing.)

    Well, what about drinking something a little less exotic than black aronia berries, like orange juice? Study participants were given a high-fat meal of ham and cheese croissants, along with either a cup of water, orange juice, green tea, or red wine. Their arteries didn’t much like the croissants, and orange juice was useless, as was a cup of green tea and the red wine, so, it’s probably best not to eat ham and cheese croissants in the first place.

    In fact, drinking orange juice with a fatty meal could actually make things worse. When study participants were given bacon and cheese muffins with or without orange juice, researchers found that the orange juice led to a longer period of elevated fat levels in the blood. This may be because the body preferentially burns for energy all the rapidly absorbed free sugars in the juice—meaning sugars not encased in cell walls as they are in whole fruit.

    Doctor’s Note

    This is the third in a three-video series on fast food. If you missed the first two, check out How a Single Meal Can Cripple Your Arteries and Lungs and Can Exercise Counteract a High-Fat Meal?.

    If you want to go deeper into the effects of specific foods, see the related posts below.

     



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  • Can Exercise Counteract a High-Fat Meal?

    Can Exercise Counteract a High-Fat Meal?

    There is a window of time in which sufficient physical activity can help mediate some of the damage caused by eating an unhealthy meal.

    I’ve previously discussed studies that show a single meal high in saturated fat can impair artery function in men, as measured in the arm, but what is more concerning is blood flow to the wall of the heart. Researchers randomized men to eat either a high-fat meal that was more than 60% fat, half of it saturated, with more than an egg’s worth of cholesterol, or a low-fat meal that was mostly carbs, less than 10% fat, and had 50 times less cholesterol.

    Below and at 0:47 in my video Exercising to Protect Your Arteries from Fast Food, you can see a Doppler recording of the left anterior descending coronary artery, known as the widow-maker, before the high-fat meal (top). Its nice strong signal was squeezed down within hours after eating; the image (bottom) was taken five hours after the high-fat meal.

    The coronary flow reserve decreased after a single high-fat meal, but not after a low-fat meal with the same number of calories.

    What does “coronary reserve” mean? When part of a coronary artery is blocked for any reason, the surrounding vessels expand. That extra expansion capacity is called the coronary flow reserve, and it’s clamped down within hours of eating a fatty meal, undermining the heart’s ability to compensate for clogged arteries. That’s how a high-fat meal affects blood flow to the heart.

    In extreme cases, you can even witness it in the back of someone’s eye. Below are before-and-after images of a retina, which you can also see at 1:34 in my video.

    The first image shows milky-colored blood vessels, and the second shows what happens after a low-fat diet and drugs help clear the fat from the bloodstream. Can you see the difference? In the first photo, the blood looked like a milkshake.

    What happens if you exercise right after eating that high-fat meal? Post-meal inflammation following the extended elevation of fat in the blood after high-fat meals is a likely explanation for increased cardiovascular disease risk, but substantial evidence suggests that acute exercise is an effective way to clear out some of that fat after a meal. However, the beneficial effects of acute exercise on postprandial lipemia (after-the-meal fatty blood) appear to be relatively short-lived. Going a few days without exercising may completely negate any benefit, no matter how fit you are. The time window appears to be between 18 hours before the meal and around 90 minutes after the meal. And how much exercise do we need? About an hour of moderate-intensity exercise should do it.

    In another study, it only took 20 minutes of stair climbing, broken up into five-minute intervals every hour for four hours after a McDonald’s breakfast of hash browns, eggs, pancakes, an English muffin, sausage, and a milkshake. Following such a meal, artery function significantly decreased when the subjects just sat around after eating, but not when they did the hourly stair-climbing exercises. So, hourly exercise may attenuate the negative effects not only of prolonged sitting but also of eating a high-fat meal, “suggesting that stair climbing should be incorporated as an easily accessible lifestyle strategy to protect vascular [artery] function.” Of course, it goes without saying that the other way you can protect artery function is to not to eat breakfast at McDonald’s in the first place.

    Such a meal would also have more than 2,000 mg of sodium. That’s more than the 1,500 mg the American Heart Association recommends we stay under for an entire day. Give someone a meal with less salt, even a third less, and that alone can still impair artery function within an hour of consumption, even independent of the increase in blood pressure.

    When it comes to blood pressure, some people are “salt-sensitive,” meaning they suffer a large bump in blood pressure when they eat salt, but others are said to be “salt-resistant.” Their blood pressure doesn’t really depend much on their salt intake. So, is salt okay for these people? No. High dietary sodium intake reduces artery function regardless of whether your blood pressure is salt-sensitive or salt-resistant. Your artery function is impaired either way, going from a low-salt diet to a high-salt diet, which you can see below and at 3:53 in my video.

    There is an influence of dietary salt beyond blood pressure. Despite the “seemingly unanimous consensus,” some researchers (too often funded by the salt industry) claim that it’s actually not good to cut down on salt, but the evidence is against these dissenters. Like the saturated fat in meat, dairy, and junk, the science indicates that sodium—not sodium reduction—is “the real villain.”

    Doctor’s Note

    This is the second in a three-part series on saturated fat and artery health. The first was How a Single Meal Can Cripple Your Arteries and Lungs. Up next is Protect Your Arteries from Saturated Fat with These Foods.

    Still not sold on the dangers of salt? Check out The Evidence That Salt Raises Blood Pressure.



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  • How a Single Meal Can Cripple Your Arteries and Lungs

    How a Single Meal Can Cripple Your Arteries and Lungs

    What happens within hours of eating a high-fat meal?

    We are only as old as our arteries. What can we do to preserve arterial function as we age? A poor diet and sedentary behavior can lead to adverse aging processes, like impairment of the little power plants in our cells, which can result in free radical formation, oxidative stress, and inflammation, which lead to the artery dysfunction that can end in cardiovascular disease that ends us.

    In a series of videos I did about a decade ago, I discussed landmark research showing that a single high-fat meal could cripple artery function within hours of consumption, compared to no change with a low-fat meal, as you can see below and at 1:04 in my video Saturated Fat Causes Artery and Lung Inflammation.

    In the study, the high-fat meal that so crippled artery function included Sausage and Egg McMuffins from McDonald’s. How do we know the sausage, egg, or cheese was to blame? What about the crappy carbohydrates in the biscuits or something else? Because the low-fat meal that didn’t impair artery function was a sugary mess of carby Frosted Flakes.

    Just when your artery function finally starts to recover, five or six hours later—it’s lunchtime! Then, your arteries may get whacked with another load of meat, eggs, dairy, or oil. Why does it matter so much what happens after a meal within your body? Because most of us spend about 16 hours a day in that after-a-meal state, constantly hammering our arteries. No wonder cardiovascular disease is our number one killer.

    And it doesn’t just inflame the arteries in our heart but our lungs as well. “A high-fat challenge increases airway inflammation and impairs bronchodilator recovery in asthma.” When people with asthma coughed up sputum from their lungs four hours after the same kind of high-fat meal, inflammatory cells shot up in the high-fat meal group, as you can see below and at 2:12 in my video.

    In terms of lung function, when given two hits of their inhalers (containing a drug called albuterol or Ventolin), their airways open up as they should after a low-fat meal. But after the high-fat meal, the same inhaler doses don’t work as well, crapping out after a few hours because of all the extra inflammation in their lungs, as you can see below and at 2:29 in my video.

    What you eat can determine how well you breathe.

    But those study participants were people with asthma. Well, researchers found that even people without asthma have that same spike in inflammatory cells in sputum coughed out of their lungs four hours after eating what was, in this case, “a Jimmy Dean’s Meat Lover’s breakfast bowl.”

    And there aren’t only more inflammatory cells; there is a doubling of the amount of pro-inflammatory oxidized LDL cholesterol sucked up by the type of white blood cells that go on to form foam cells. Those are the cells that build up the inflamed pus in your artery wall that leads to heart attacks. All this happens within just hours of eating pizza, in this case. The fat in your blood goes up, and so do your endotoxin levels, as you can see below and at 3:16 in my video.

    Endotoxins are the components of bacterial cell walls, and foods like meat can be so contaminated with bacteria—alive and dead—that they accumulate endotoxins. We’re talking about both red meat and white meat, as you can see below and at 3:28 in my video.

    But recent research (published in 2020) suggests the main culprit may not be endotoxins after all, but the fat itself. The saturated fat floating in your blood after an unhealthy meal may be inducing the inflammation more directly. Either way, we are responsible for what we eat, meal by meal, in shaping the risk factors for chronic metabolic disease.

    Doctor’s Note

    This topic is the first in a three-part series on saturated fat and fast food. The next two are Exercising to Protect Your Arteries from Fast Food and Foods to Help Protect Your Arteries from Saturated Fat.

    What about the “butter is back” studies? See the related posts below.



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  • What Is the Best Poop Position?

    What Is the Best Poop Position?

    The Squatty Potty is put to the test.

    Previously, I’ve talked about the potential efficacy of prunes and dried figs to keep us regular. What influence does body position have on defecation? While squatting continues to be the traditional position for people in Asia and Africa, Westerners have become accustomed to sitting on toilet seats. When we do that, we sit upright, and our poop is forced to make a nearly 90-degree turn, the “anorectal angle,” which you can see below and at 0:37 in my video The Best Poop Position for Constipation.

    Now, that’s a good thing in terms of keeping us from pooping our pants every time we sit down. But when it comes to doing our business, toilet posture defeats the purpose of our body’s brilliant design—like trying to drive a car without releasing the parking brake. Yet, many physicians are hesitant to discuss “such an unmentionable bodily function,” or they may just be ignorant. Doctors don’t know squat.

    Of course, this is coming from someone who owns a company selling people squatting platforms for their toilets. In a previous video, I talked about those little footstools you can use to raise your knees when you assume a pooping position, but they were not found to make a difference in terms of self-described difficulty in defecating or the average time spent emptying one’s bowels. Those stools give only a measly four-inch boost, though, while the Squatty Potty is twice that height. What happened when it was put to the test?

    Researchers implemented a “Defecation Posture Modification Device,” i.e., Squatty Potty, and it worked! Participants reported increased feelings of bowel emptiness, reduced straining, and about a minute less of on-the-pot reading time. The only downside is the discomfort. Even just a six-inch riser was found to cause such extreme discomfort in research participants in a previous trial that they abandoned trying to study it.

    How else can we get that same change in angle you get from raising your feet? How about just tipping forward, as shown below and at 2:14 in my video?

    Look familiar? It is like that famous sculpture by Rodin, The Thinker. And indeed, Cleveland Clinic researchers set out to study “The Thinker” position for defecation. They were able to show the anorectal angle, as measured using cinedefecography—your SAT word for the day, basically meaning x-ray poop movie—opening to more than 130 degrees. That’s better than simply raising your feet, which opens the angle to only around 90 degrees. So, “The Thinker” position may be a more efficient method for defecation. It may also help with constipation, but it has not yet been formally put to the test.

    As an aside, you can imagine how the worst position might be flat on your back using a bedpan. Because of the spike in blood pressure in the heart and brain when bearing down, straining while passing stool is associated with sudden death from a heart attack and stroke. In fact, it has been found to be the daily activity most often occurring at the time of death in Japan, and those who can’t get out of bed would seem to be especially at risk. That’s why, if at all possible, it can help to sit people up in bed to cause less strain on the system.

    It’s important to take a step back, though, in this sitting versus squatting debate, as a nearly 50-year-old commentary did. Yes, the squatting position is called natural since it is used by so-called primitive peoples who easily pass large stools, such that squatting advocates blame the porcelain throne for all manner of Western maladies. But does the position really make a difference if you’re eating the right foods? “The man who squats because he has no modern plumbing also tends to eat food that is less refined”—that is, more natural foods that haven’t had their fiber processed out. Adding fiber to the diet can enable constipated patients to poop effortlessly without having to squat over a hole in the ground. So, maybe if we just change the design of our diets, we don’t have to change the design of our plumbing.

    Doctor’s Note

    The video on prunes that I referred to is Prunes: A Natural Remedy for Constipation.

    I previously talked about poop position in Should You Sit, Squat, or Lean During a Bowel Movement?.

    How Many Bowel Movements Should You Have Every Day? Check out the video to find out.



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  • Can Ultra-Processed Foods Be Fixed by Tweaking Their Nutrients?

    Can Ultra-Processed Foods Be Fixed by Tweaking Their Nutrients?

    What happened when ultra-processed foods were matched for calories, sugar, fat, and fiber content in the first randomized controlled trial?

    In the United States, “junk food” is often used to describe less-healthy foods, like candy, ice cream, and chips, but there isn’t a consistent definition, so nutrition researchers came up with the concept of ultra-processed.

    The term “ultra-processed food”—if you want to call it that—describes industrial formulations that are typically seen in those long list of ingredients, which, besides salt, sugar, and fat, aren’t typically found in any cookbook, like various flavors, sweeteners, colors, emulsifiers, and other additives used to imitate real foods or to hide undesirable qualities of the final product. This roughly corresponds to my idea of “red light foods” in my traffic light system, in which, ideally, we should maximize intake of green light foods, minimize yellow light foods, and avoid red light foods. Indeed, most of what people eat are red light foods: soda, ice cream, candy, cakes, most bread and breakfast cereals, TV dinner-type ready-to-heat products, chicken nuggets, fish sticks, sausages, burgers, and hot dogs. There has been a dramatic rise in ultra-processed foods. In fact, the U.S. food supply is dominated by them. More than 200,000 products were assessed, and 71% were classified as ultra-processed.

    And, of course, they aren’t only in grocery stores. Sugary drinks and processed junk are ubiquitous even at non-food retailers, sending pervasive cues to consume products that are dense in calories but poor in nutrition. As a former head executive of Coca-Cola put it, the soda should be kept within an “arm’s reach of desire.” A major candy brand boasted, “We put them everywhere: grocery stores and supermarkets, gas stations and chiropractors’ offices, bowling alleys and grocery stores, which we already mentioned. Not sorry.”

    So, this is where we are today. What proportion of food consumed by U.S. children and adolescents is classified as junk? An unbelievable 56% to 70% of what our children and teens eat over the entire day is junk. But kids will be kids, right? In the United States, more than half of the calories taken in across the board are junk. In fact, around the world, ultra-processed foods consistently account for more than 50% of the dietary caloric intake in the higher-income countries. No wonder unhealthy diets are humanity’s greatest killer, the leading risk factor for death globally, as you can see below and at 2:25 in my video Ultra-Processed Junk Food Put to the Test.

    What exactly are the health consequences? The biological effects of modern foods have been studied using rats, showing they gorge themselves into dramatic weight gain, inflammation, and cognitive and metabolic abnormalities. And just as ultra-processed foods were taking over, binge eating was recognized as a new eating disorder, and it grew into the most common form of eating disorder. And not surprisingly, binge foods were found to be 100% ultra-processed. That’s no surprise—these foods are engineered so you can’t have just one. People don’t tend to binge on broccoli.

    About 9 out of 10 studies found that ultra-processed food consumption was associated with adverse health outcomes—and not just obesity, but cancer, cardiovascular diseases, type 2 diabetes, irritable bowel syndrome, depression, frailty, and all-cause mortality (meaning living a shorter life). Studies on youth add asthma to the list and also report higher DNA damage. Not a single study reported a link between ultra-processed foods and beneficial health outcomes.

    In contrast, populations with low meat consumption, high fiber intake, and low intake of minimally processed foods have far fewer chronic diseases, enjoy lower obesity rates, and live longer disease-free. But most of the findings were based on observational studies. You don’t know for sure if ultra-processed foods themselves are to blame until you put it to the test.

    In the first randomized controlled trial on ultra-processed foods, 20 people were essentially locked in a hospital ward and received both ultra-processed and unprocessed diets for 14 days each. Here’s the kicker: The diets were designed to provide the same calories, sugar, fiber, fat, and macronutrients. Why? In response to criticism, manufacturers are now proposing reformulating their products, keeping them ultra-processed but tweaking them by adding some fiber, for instance, or reducing the sugar, fat, or salt. So, the researchers wanted to try to tease out the effect of ultra-processing by giving the study participants the same amount of calories, sugar, fat, fiber, carbs, and protein in each of the two diets. So, for instance, for breakfast in the ultra-processed weeks, the participants would get Cheerios and a muffin, or an egg and cheese muffin with turkey bacon and orange juice. When it was time for the less-processed breakfasts, people would get, say, oatmeal with blueberries and almonds. The meals had the same amount of overall sugar and fat, but the unprocessed option was presented more in whole food form. For lunch, the ultra-processed group might get a turkey sandwich with nonfat Greek yogurt, canned peaches, baked potato chips, and sugar-free Crystal Light Lemonade, versus a Southwest entrée salad with black beans, carrots, corn, avocados, and nuts, along with grapes and apples on the unprocessed diet. The same calories were offered, with the instruction to eat as much or as little as they wanted.

    So, what happened? On the ultra-processed diet, people ate about 500 more calories a day and, unsurprisingly, gained about two pounds on the processed diet, or actively lost two pounds on the less-processed diet, as you can see below and at 5:31 in my video.

    So, the problem wasn’t just the unbalanced nutrient profile of ultra-processed foods. Simply tweaking them wouldn’t magically make them healthy, but that’s what the industry would rather do. Reformulation is referred to as the “unobtrusive strategy,” creating “the prospect of nutritional improvement without dietary change.” But what this study showed is that it may be better to limit the consumption of ultra-processed foods altogether.

    Why does the industry love them so much? They’re made with dirt-cheap ingredients, like taxpayer-subsidized corn syrup, allowing for huge corporate profit margins. But at what cost? The food industry takes in more than a trillion dollars every year, yet most of our healthcare dollars go to treat chronic diseases exacerbated by these very same foods, like diabetes and heart disease. So, you could argue “we lose triple what the food industry makes.” The food industry argues that these days, it’s “unrealistic” to tell people to avoid ultra-processed food, given societal time constraints and the difficulties of food prep, but this may just be acquiescing to the same propaganda and disinformation campaign that the processed food industry has used to co-opt families for decades. Those who think healthy foods can’t be convenient have never met an apple.

    That was a response to Dr. Lustig’s essay on processed food as a failed experiment, in which he said: “One-third of American mothers today don’t even know what real food is or how to cook; they and their children are destined to remain hostages to the processed food industry.” I don’t like his mother-blaming, but I do appreciate his prescription: “There’s only one recourse—real food, which is low in sugar and high in fiber.” We need to start thinking outside the box.

    Doctor’s Note

    It’s no surprise processed foods are wreaking havoc on our health. Learn about The Role of Processed Foods in the Obesity Epidemic. Is there a solution? Yes. Cut the Calorie-Rich-And-Processed Foods.

    This is the third video in a series on junk food. If you missed the first two, check out Do Healthy Fast Food Options Lead to Healthier Choices? and How We Won the Fight to Ban Trans Fat.

    I mentioned my traffic light system for choosing the healthiest foods. Learn all about it in Dining by Traffic Light: Green Is for Go, Red Is for Stop.



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  • How the Fight to Ban Trans Fat Was Won

    How the Fight to Ban Trans Fat Was Won

    What was the secret to the public health community’s triumph when past attempts to regulate the food industry failed?

    There are three broad approaches to mediating the ruin of risky choices: inform people (like using labeling), nudge people (for example, by offering financial incentives), or directly intervene to make the activity less harmful. Which do you think prevented more car fatalities: mandating driver education, labeling cars about crash risk, or removing the human element altogether by just making sure airbags are installed? There are public education nutrition campaigns, ranging from “sugar pack” ads on public transit that inform consumers about the amount of sugar in soft drinks to “Hot Dogs Cause Butt Cancer” billboards that educate about the link between processed meat and colorectal cancer, as shown here and at 0:52 in my video How We Won the Fight to Ban Trans Fat.

    But is there a way to make products nutritionally safer in the first place?

    The ban on trans fats offers a useful lesson. In 1993, the Harvard Nurses’ Study found that high intake of trans fat may increase the risk of heart disease by 50%. That’s where the trans fat story started in Denmark, and it ended there a decade later with a ban on added trans fats in 2003. It took another 10 years, though, before the United States even started considering a ban. All the while, trans fats were killing an estimated tens of thousands of Americans every year, resulting in as many years of healthy life lost to conditions like meningitis, cervical cancer, and multiple sclerosis. If so many people were suffering and dying, why did it take so long for the United States to even suggest taking action?

    One can look at the fight over New York City’s trans fat ban for a microcosm of the national debate. Opposition came down hard from the food industry, complaining about “government intrusion,” likening the city to a “nanny state.” Since trans fats can be naturally found in meat and dairy, the livestock industry echoed the Institute of Shortening and Edible Oils’ argument that everything should be eaten in moderation. Critics styled such proposals as the “rise of food fascism.” But it was the restaurant and food industry that limited consumer choice by so broadly fouling the food supply with these dangerous fats.

    If “food zealots” get their wish in banning added trans fats, another argument went, what’s next? Vested corporate interests tend to rally around these kinds of “slippery slope” arguments to try to distract from the very real fact that people are dying. I mean, what if the government tries to make us eat broccoli?! This actually came up in a Supreme Court case over Obamacare. Chief Justice John Roberts suggested Congress could start “ordering everyone to buy vegetables,” a fear Justice Ruth Bader Ginsburg dubbed “the broccoli horror.” Technically, Congress could compel the American public to eat more plant-based food, Justice Ginsburg wrote, yet one can’t “offer the ‘hypothetical and unreal possibility’…of a vegetarian state as a credible reason.” As one legal scholar put it, “Judges and lawyers live on the slippery slope of analogies; they are not supposed to ski it to the bottom.”

    New York City finally won its trans-fat fight, preserving its status as a public health leader. For example, New York banned lead paint 18 years before federal action was taken, despite decades of unequivocal evidence of its harm. Comparing stroke and heart attack rates before and after the rollout of the trans-fat ban in different New York counties, researchers estimate it successfully reduced cardiovascular death rates by about 5%. This then became the model for the nationwide ban years later. How was the public health community able to triumph when attempts in the past to regulate the food industry failed? If you had asked me about the odds of a national trans-fat ban, I would have said, “Fat chance.”

    In Denmark, as a leading Danish cardiologist put it, “Instead of warning consumers about trans fats and telling them what they are, we’ve [the Danes] simply removed them.” But we’re Americans! “As they say in North America: ‘You can put poison in food if you label it properly.’” If people know the risks, the argument goes, they should be able to eat whatever they want. But that’s assuming they’re given all the facts, which isn’t always the case given the food industry’s “model of systemic dishonesty,” as one health ethics professor put it. Given the predilection for predatory deception and manipulation, government intervention was deemed necessary, but how was it going to get passed?

    First, there was a labeling requirement. Manufacturers had to start adding trans-fat content to products’ nutrition facts labeling. This was ostensibly to influence consumers, but it may have had a bigger impact on producers. Now that they had to divulge the truth, companies scrambled to reformulate their products to gain a “no trans fat” competitive edge.

    Within years of the mandatory disclosure, more than 5,000 products were introduced touting low or zero trans fats on their labels. Kentucky Fried Chicken went from being sued for having some of the highest trans-fat levels to running an ad campaign where mom tells dad in front of kids that KFC now has zero grams of trans fat, and the father yells, “Yeah baby! Whoooo!!” and begins eating fried chicken by the bucketful. That was the secret to passing the ban. Once the major food industry players had already reformulated their products and bragged about it—once there wasn’t so much money at stake—then there was insufficient political will to block the ban, and added trans fats were taken off the playing field.

    Doctor’s Note

    It’s important to note that the ban on trans fats didn’t affect the trans fats found in meat and dairy. See Banning Trans Fat in Processed Foods but Not Animal Fat.

    If you missed it, in the video Do Healthy Fast Food Options Lead to Healthier Choices?, I discussed how listing calories on menus doesn’t actually get people to choose healthier options.

    Stay tuned for Ultra-Processed Junk Food Put to the Test.



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  • Why Healthy Fast-Food Menu Options Can Backfire

    Why Healthy Fast-Food Menu Options Can Backfire

    Adding a healthy option can actually drive people to make even worse choices, thanks to a mind-blowing glitch of human psychology.

    In 2017, and to much fanfare, menu labeling for calorie counts began to be mandated in national chain restaurants. Consumers should have the information needed to make healthy food choices outside the home, right? It makes sense that caloric information on menus will help people limit their food intake to stay within their daily energy needs. But it didn’t work. It turns out calorie labels are not effective, shaving off an average of eight insignificant calories per meal.

    You could have totally predicted that. Why? Just as one might divine the value of front-of-pack traffic light labeling from the ferocity of the industry response against it, one could probably gauge the futility of calorie labeling by the ease with which some regulations have been passed. McDonald’s voluntarily started publishing calorie information nationally back in 2012 after a labeling mandate in New York City was found to have no overall effect on consumer behavior. Studies suggest such labeling could boost “perceptions of the restaurant’s concern for consumers’ well-being” while carefully not undermining any Big Mac attacks.

    At the same time, McDonald’s announced plans to add seasonal produce to its menu. How cynical do you have to be not to at least recognize that as a good thing? Ironically, adding a healthy option can actually drive people to make even worse choices. Ready to have your mind blown?

    As I discuss in my video Do Healthy Fast-Food Options Lead to Healthier Choices?, if people are offered a choice of side dishes—something unhealthy like French fries or something more neutral like a baked potato—only about 10% of them will splurge for the fries. If an even healthier third option—like a side salad—is added, instead of choosing between an indulgent choice and the more neutral baked potato, people would have their pick of the indulgent choice, the neutral choice, or an even healthier choice. Even if everyone doesn’t choose the salad, more will go for the middle-ground baked potato over the fries, right? So, how much farther does French–fry–fancying fall by adding the salad option to the mix? It shoots up, tripling to 33%. Without the salad option, only 1 in 10 chose the fries, but that jumped to a third of people just at the sight of salad.

    The same thing happens when you offer people the choice between a bacon cheeseburger, a chicken sandwich, or a veggie burger. In a “No Healthy Option” scenario, where people were offered the cheeseburger, a chicken sandwich, or a fish sandwich, 17% chose the burger. Swap out the fish sandwich for a veggie burger, and the bacon cheeseburger preference doubled to 37%. How can just seeing a healthy option push people to make unhealthier choices?

    The paper describing this series of experiments was entitled “Vicarious Goal Fulfillment: When the Mere Presence of a Healthy Option Leads to an Ironically Indulgent Decision.” The thought is that seeing the salad or veggie burger, people make the mental note to choose that at some nebulous next time, thereby giving them the excuse to indulge now.

    There is this fascinating glitch of human psychology called self-licensing. This is when we unwittingly justify doing something that draws us away from our goals after we’ve just done something that brings us towards them, like justifying eating a donut because of last week’s weight loss. We reward ourselves with an indulgence that sets us back.

    If you give smokers “vitamin C” supplements, they subsequently smoke more cigarettes than if you give smokers what you explain are “placebo” pills (even though both groups were given identical sugar pills). The smokers who thought they were taking supplements smoked nearly twice as much, perhaps subconsciously thinking that since they had just done something good for their health, they could afford to “live a little,” which may have, in effect, caused them to live a little…less.

    You can see how this could translate into other lifestyle arenas. Those given placebo pills, which they believed to be dietary supplements, not only expressed less desire to subsequently engage in exercise, but they also followed through by walking about a third less. Compared to those who were told the pills were placebos, the misled participants were also more likely to choose a buffet over what was described as a “healthy, organic meal.” Would they eat more, too? A seminal study entitled “The Liberating Effect of Weight Loss Supplements on Dietary Control” put that to the test.

    Participants were randomized to take a known placebo or a purported weight-loss supplement (which was actually just the same placebo) and later covertly observed at a buffet. Not only did the “supplement” subjects eat more food, but they chose less healthy items. They also ate about 30% more candy in a bogus “taste test” and ordered more sugary drinks. “Hence,” the investigators concluded, “people who rely on dietary supplements for health protection may pay a hidden price: the curse of licensed self-indulgence.”

    Circling back, what the vicarious goal fulfillment studies discovered is that not only does making progress towards a goal rationalize decision-making that undermines us, but even just considering making progress can have a similar licensing effect. Note that the study participants were not only moved to make the unhealthier choice, but the unhealthiest choice. One might assume that even if people didn’t go for the salad or veggie option, the presence of a healthier alternative may have encouraged them to choose something in between—not the healthiest option, but at least not the unhealthiest choice. Instead, it moved people in the opposite direction.

    In another “No Healthy Option” scenario of chocolate-covered Oreos, regular Oreos, or golden Oreos, researchers found that adding a “lower-calorie” Oreo option doubled the likelihood that the study participants would go straight for the most indulgent chocolate-covered option. (See below and 6:10 in my video.)

    This is attributed to another illogical quirk of human psychology, indelicately named the “what the hell effect.” This is when one forbidden cookie can lead dieters to eat the whole bag. Once you’ve already strayed from your goals, well, why not go all the way? So, once people decide they are going to get that salad next time and spoil themselves just this once, they might as well go for the most indulgent choice.

    The halo of healthy foods can even warp our perceptions. Show weight-conscious people a burger and nothing else, then ask them to estimate the calories, and the average answer is 734 calories. Okay, now show folks the exact same burger accompanied by three celery sticks, and they guess the total comes out to 619 calories. Did they think the celery had negative calories? No, most knew the celery had calories, too, but just the juxtaposition of the burger with the celery made the burger seem healthier. The same thing happens when you add an apple to a bacon-and-cheese waffle sandwich, a side salad to beef chili, or some carrots next to a cheesesteak—about a hundred calories appear to disappear, as shown here and at 7:27 in my video.

    Health halo effects may explain why people are more likely to order a dessert and more sugary drinks with a “healthier” sub at Subway versus a Big Mac at McDonald’s, even though the sub used in the study (filled with ham, salami, and pepperoni) had 50% more calories to begin with.

    Even just a reference to healthy foods can do it. Show people a picture of a Big Mac, and people estimate it has 646 calories. Just add the text “For your health, eat at least five fruits and vegetables per day,” and all of a sudden, the same burger in the same ad was thought to only have 503 calories. Merely offering and even promoting salads and fruit can bring McDonald’s accolades and bolster consumer loyalty without, ironically, helping their health.

    Doctor’s Note

    If you enjoyed this blog, you might also like a video I did on optimism bias: Why Don’t People Eat Healthier?

    For more on junk food, see How We Won the Fight to Ban Trans Fat and Ultra-Processed Junk Food Put to the Test.



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  • Which Beans Best Block the Spread of Cancer?

    Which Beans Best Block the Spread of Cancer?

    Which legumes are best at inhibiting the matrix metalloproteinase enzymes that allow cancer to become invasive?

    Although we’re spending billions of dollars on fancy new types of chemotherapy, the overflowing sink that is cancer treatment is expected to rise by about 70% over the next two decades because drugs are being used to merely mop up the mess rather than turn off the faucet. You can’t really give drugs to people to prevent cancer because of the side effects and cost, but there is said to be “overwhelming…evidence that the dietary bioactive compounds found in whole plant-based foods have significant anticancer and chemopreventive [cancer-preventing] properties.”

    I’ve previously talked about the impact of diet and nutrition on the 10 hallmarks of cancer. The bottom line is that evidence points to a diet that includes minimal animal products and, perhaps more importantly, maximal plant foods. Some foods that seem to be especially beneficial include fruits (especially berries), vegetables (especially greens), legumes (beans, split peas, chickpeas, and lentils), nuts and seeds (especially flaxseeds), onions, garlic, mushrooms, herbs and spices (for example, turmeric), and, as a beverage, green tea.

    Chemotherapy may not even be particularly good at mopping up the mess. “Cancer drugs often impair quality of life and fail to extend patient survival.” Let me say that another way: You’re paying for drugs—maybe selling your house to pay for drugs—that may just be making your life worse for no benefit. Some have suggested we demand at least three months of extended life from pharmaceuticals, but if we demand that chemo actually works, would companies give up testing new cancer drugs altogether? On the other hand, by requiring clinically important benefits—what a concept—maybe Big Pharma would reallocate resources toward targeting the more critical cancer processes like metastatic spread, since it’s the tumor metastasis that accounts for 90% of cancer-related deaths. Who cares if some drug shrinks your primary tumor if it’s spreading and cutting your life just as short?

    What about controlling metastatic cancer with some of those natural bioactive compounds in plants? Evidently, “it has been proven that [plant] phytochemicals are able to inhibit nearly every step of the invasion-metastasis cascade,” at least in vitro (in a petri dish). Below is a list of some purported dietary sources of antimetastatic phytochemicals, which you can also see at 2:27 in my video Blocking the Cancer Metastasis Enzyme MMP-9 with Beans and Chickpeas.

    All of these foods are shown to block all sorts of cancer-signaling pathways, but let me focus on one: matrix metalloproteinases (MMPs). Since about 90% of cancer disability and death is due to cancer spreading (metastasis), let’s talk about MMPs, which “actively participate in the whole metastatic journey.” Matrix metalloproteinases are enzymes that allow the cancer to tunnel through the surrounding flesh and invade the lymph or blood vessels, and then enable it to burrow in and grow somewhere else.

    So, Big Pharma developed matrix metalloproteinase inhibitor drugs, which worked great in animal models but caused severe side effects in humans. So, what about using food? There are special proteins in legumes (beans, split peas, chickpeas, and lentils) that reduce MMP activity. But which is the leading legume? Researchers tested eight different kinds: lupin beans, chickpeas, split peas, black-eyed peas, lentils, more common beans (like kidney, black, or pinto), fava beans, and soybeans. Which do you think worked best?

    Without any beans, the matrix metalloproteinase activity churned away at around 100%, and dripping on some protein from split peas didn’t seem to help much, but the black-eyed peas, lentils, common beans, and fava beans cut enzyme activity by more than 50%. Guess what slashed activity by more than 90%? Lupin beans, chickpeas, and soybeans, as you can see below and at 4:08 in my video.

    But does this translate into slowing down the cancer’s spread?

    Researchers plated a layer of human colon cancer cells in a petri dish and then took a razor blade to clear a strip down the middle. Within 48 hours, the cancer quickly converged to fill the gap. But when a little protein from lupin beans, chickpeas, or soybeans was dripped on, it looked like the cancer cells struggled to close the distance, as you can see below and at 4:33 in my video.

    Okay, but they used raw beans. You don’t know if these anti-cancer proteins are destroyed by cooking until you put it to the test. Researchers found that the matrix metalloproteinase inhibitors in soybeans, at least, did remain active after cooking.

    So, maybe it’s no wonder that eating legumes reduces the risk of colorectal cancer. Yes, but colon cancer, which sprouts from the inner lining of the colon, could potentially come in contact with some of these bean proteins. Presumably, they wouldn’t get into the bloodstream.

    Those eating a vegetarian diet do seem to have significantly lower levels of matrix metalloproteinases, but this is just thought to be due to their lower levels of inflammation, similar to the way non-smokers also have lower MMP levels. This is good because this enzyme isn’t just a cancer biomarker, but also may be involved in autoimmune diseases and cardiovascular disease. The machete-type nature of this enzyme can hack through the inflamed, cholesterol-filled atherosclerotic lesions lining diseased arteries and cause the plaque to rupture. People know that those eating a more plant-based diet tend to have less heart disease, but may not realize they harbor significantly less cancer risk, too, particularly among those eating strictly plant-based diets.

    Doctor’s Note

    The video I mentioned is Fighting the Ten Hallmarks of Cancer with Diet.

    For other videos on cancer metastasis, check the related posts.



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  • A Persistent Pesticide Is Linked to Alzheimer’s Risk

    A Persistent Pesticide Is Linked to Alzheimer’s Risk

    How can we avoid the breakdown products of pesticides that may increase the risk of Alzheimer’s disease as much as if you carried APOE e4, the so-called Alzheimer’s gene?

    Although there is a growing list of Alzheimer’s disease susceptibility genes, those genes account for less than half of all Alzheimer’s cases. Here is the “single most compelling” piece of data on the potential control we have over the disease: When it comes to identical twins with the exact same genes, if one gets Alzheimer’s, the other usually does not. So, we have to think about all the other contributing factors beyond just genetics.

    There’s a list of chlorinated pesticides, including DDE (a metabolite of DDT), that the U.S. Environmental Protection Agency has classified as probable human carcinogens. But in a study—which I’ve mentioned in a video on pesticides and cancer—blood levels of DDE and other pesticides were associated not with increased cancer mortality, but increased risk of other-cause mortality. This led researchers to speculate that this may be due to an associated increased risk of diabetes or dementia. I’ve talked previously about the diabetes link. What about dementia?

    A research team at Rutgers found significantly higher blood levels of DDE in Alzheimer’s disease patients compared to controls, as you can see below and at 1:22 in my video Pesticides (DDT) and Alzheimer’s Disease.

    Autopsy studies show blood levels are a good proxy for brain levels. Those patients with the highest levels were at about four times the odds of having dementia from Alzheimer’s. And in a petri dish, DDE increases amyloid precursor protein levels in human brain cells, providing a potential mechanism. Below and at 1:48 in my video, you can see the levels of the sticky protein implicated in the development of Alzheimer’s disease before and after DDE is added at the levels one finds circulating in highly exposed individuals among the general population.

    Put all these studies together, and there does indeed seem to be a link, consistent with data showing about a doubling of risk for developing dementia among those acutely pesticide-poisoned, as you can see below and at 2:01 in my video.

    Among U.S. elders, DDT and its breakdown product DDE are also associated with increased risk of cognitive decline in general, which is shown below and at 2:08 in my video.

    DDT was used extensively in the United States from the 1940s through the early 1970s. At its peak, we were churning out about 180 million pounds a year. And it is still in our bodies to this day, contaminating the bloodstreams of more than 90% of Americans, with DDE—the pesticide linked to quadrupling the odds of Alzheimer’s—found at the highest levels of all.

    It’s still in our bodies because it’s still in the food supply. In a previous video on the topic, I noted that the levels of DDT, DDE, and other banned pesticides and pollutants were much lower in the breast milk from a vegetarian mother compared to breast milk of her non-vegetarian sister. The largest difference was noted for DDE, which was four times lower in the vegetarian sister. This is what you see across the board for these kinds of pollutants. Below and at 3:20 in my video, you can see the levels of dioxins and PCBs found in beef, chicken, pork, processed meat, eggs, fish, dairy products, and all plant foods put together when food samples were collected from supermarkets across the United States.

    These toxins build up in the food chain, so it makes sense that the most contaminated foods are meat, fish, and dairy products. The toxin levels were found to be 5 to 10 times higher in meat, eggs, fish, and dairy compared to plant foods. Unfortunately, cooking doesn’t destroy pollutants like DDE—in fact, it may make them even more concentrated. And this is for a pesticide that may increase the risk of Alzheimer’s disease as much as if you carried the so-called Alzheimer’s gene APOE e4.

    Doctor’s Note

    The video I mentioned is Pesticides and Cancer Risk.

    For more videos on Alzheimer’s disease, check out the Alzheimer’s topic page.



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