Health Journal Online

Category: Nutrition

  • The Protein Debate: Why Source Matters More Than Amount

    The Protein Debate: Why Source Matters More Than Amount

    I discuss a public health case for modernizing the definition of protein quality.

    In 2019, Dr. David Katz and colleagues, including one of my favorite researchers, David Jenkins, published a “public health case for modernizing the definition of protein quality.” The prevailing definition seems to have more to do with biochemistry than the overall effects on human health. The common belief that protein is “good,” and the more the better, combined with a definition of protein quality that favors animal protein, gives the impression that eating more meat, eggs, and dairy is desirable and preferable. But this is directly opposed to nutrition guidelines that are instead trying to push more plants. Although protein malnutrition is still common in many areas of the world, it is extremely rare in the industrialized world, where “the most formidable public health threats…are from chronic diseases,” not something like kwashiorkor, severe protein and calorie malnutrition.

    In 2016, a landmark study was published out of Harvard, involving more than 100,000 people, that found that replacing animal protein with plant protein was associated with lower risk of dying prematurely. The worst offenders seemed to be processed meat like bacon, as well as egg protein (the egg whites). But swapping in even just 3% plant protein for any of the animal proteins, such as processed meat, unprocessed meat, chicken, fish, eggs, or dairy, was associated with a significantly lower risk of arguably the most important endpoint of all: death. See below and at 1:32 in my video Animal Protein vs. Plant-Based Protein.

    But how do we know it’s the protein? The researchers adjusted for factors such as saturated fat intake, which suggested it wasn’t just the animal fat. But how can our body differentiate between protein from a plant and protein from an animal? Isn’t protein…protein? No. Generally, plant protein is low in branched-chain amino acids, unlike animal protein, and decreased consumption of branched-chain amino acids improves metabolic health. It could be the IGF-1, a cancer-promoting growth hormone that is boosted by so-called high-quality animal protein intake, though. We suspect the IGF-1 connection is cause and effect, since people born with higher IGF-1 levels, regardless of what they eat, appear to suffer higher rates of killers like type 2 diabetes and heart disease. Or, it could be something the Harvard researchers didn’t control for, such as toxic pollutants like dioxins and polychlorinated biphenyls (PCBs), since they tend to accumulate up the food chain into cattle, pigs, chickens, and fish and therefore end up on our plates. So, “plant-based protein, besides other health benefits, stands as an important step to lower the body burden of harmful pollutants of dietary animal-protein origin.”

    If you don’t think a study with 100,000 people is enough, how about 400,000 people? The U.S. National Institutes of Health–AARP Diet and Health Study is the largest diet cohort study in history, and, again, researchers found that simply replacing 3% of calories from animal protein with plant protein was associated with a 10% lower overall mortality—and you get even twice that benefit if you get rid of eggs, too. That’s not a surprise, since egg consumption is associated with a higher risk of developing cardiovascular disease.

    Put all the studies together on dietary protein intake and mortality, and people who eat more protein tend to live shorter lives. But this is “mainly driven by a harmful association of animal protein.” Plant protein intake is actually inversely associated with mortality, meaning those who eat more plant protein tend to live longer lives. More animal protein may mean more mortality, whereas more plant protein is correlated with less mortality, as you can see below and at 3:30 in my video.

    So, the best of both worlds would be to increase the intake of plant protein instead of animal protein. In other words, as another meta-analysis concluded, “Persons should be encouraged to increase their plant protein intake to potentially decrease their risk of death.”

    Doctor’s Note

    The benefits of calorie restriction may arise from the drop in animal protein intake. See Caloric Restriction vs. Animal Protein Restriction for more on this.

    I also discuss branched-chain amino acids in Are BCAA (Branched Chain Amino Acids) Healthy?.

    Do you need to combine plant proteins, like rice and beans? See The Protein Combining Myth.

    How much protein do we need? See Do Vegetarians Get Enough Protein?.

    What about plant-based meats? Are Beyond Meat and the Impossible Burger Healthy?

     



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  • Are Potassium Chloride Salt Substitutes Safe and Effective?

    Are Potassium Chloride Salt Substitutes Safe and Effective?

    Healthy kidneys are required for potassium excretion. If you aren’t sure if you’re at risk, ask your doctor about getting your kidney function tested.

    Based on how we evolved, the optimum dietary potassium intake likely greatly exceeds current and even recommended intakes. The problem is we replaced many of the potassium-rich plant foods that used to fill our diets—fruits, vegetables, leafy greens, roots, tubers—with calorie-dense junk heavy with added fats and sugars, and stripped not only of fiber but also potassium.

    In a traditional, mostly plant-based diet, potassium intake is high and sodium intake is low. But now, high blood pressure is the second leading risk factor for death worldwide, killing more than 10 million people each year. Only unhealthy diets rank higher among global risk factors for death, as you can see below and at 0:41 in my video Potassium Chloride Salt Substitute Side Effects.

    We can improve both by eating more whole, healthy plant foods like greens and beans, which are packed with potassium and help lower blood pressure. But since most of us are getting too much sodium along with too little potassium, what about using salt substitutes? Potassium chloride is the most common salt substitute, so you’d be swapping out sodium for potassium.

    And it works. Based on a meta-analysis of more than a dozen randomized controlled trials, replacing sodium chloride with potassium chloride lowers blood pressure. Most of the trials involved swapping out regular salt for substitutes with less than 30% potassium chloride, and they still got results. And at less than 30% potassium chloride, most people can’t even tell the difference between regular salt and the potassium salt. So, it can taste the same yet still lower blood pressure? What’s the catch?

    Potassium chloride is “generally regarded as safe” (GRAS) by the U.S. Food and Drug Administration. The only major concern for healthy people is that if you go 100% sodium-free and use potassium chloride salt substitutes exclusively, you may find it can taste kind of funny, adding a bitter or metallic taste. I’ve found that it depends on what I’m seasoning. Potassium chloride works perfectly well on some dishes and snacks, but I find it makes other foods inedible. When I learned about the sodium science and threw out my salt shaker for good, within a few weeks, my palate totally changed. Everything tasted fine without salt—except pesto. For some reason, pesto without salt didn’t have the same taste that I loved. So, I tried the potassium chloride salt substitute, and it worked perfectly. I couldn’t tell the difference at all! So, I had the best of both worlds. Then, I remembered how, as a kid, I used to put a tiny sprinkle of salt on watermelon like they do in the South to make it even sweeter. I tried it with the potassium salt and almost gagged. The salt substitute is definitely not for everything.

    The reason healthy people don’t have to worry about getting too much potassium is that they just pee out the excess, thanks to the kidneys. But that’s with the potassium in food—what about supplements? No adverse effects have been shown with long-term potassium supplementation at doses as high as 3,000 mg a day. In fact, blood levels of potassium are maintained in the normal range by healthy kidneys even when potassium intake is increased to about 15,000 mg a day. That’s no surprise since we evolved eating so many potassium-rich plant foods that the natural intake of potassium for the human species may have been on the order of 15,000 mg a day.

    Basically, the normal range for potassium levels in the blood is between 3.5 and 5.0 mmol/L; it becomes concerning when it starts creeping up towards 6 mmol/L. But give people potassium supplements—like the salt substitution trials where participants receive an average of about 2,000 daily milligrams—and blood levels only increase by 0.14 mmol/L. So, they might go from 4 to 4.14 mmol/L, not something that would push levels into the danger range.

    Now, there is a limit. Someone with a “massive banana eating habit” could bump their potassium from a normal level to above 6 mmol/L, but this specific case was evidently the result of eating little else besides up to 20 bananas a day for years. Eating 10 pounds of carrots every day is also probably not a good idea. That’s like 75 carrots in one day—only really possible with a juicer, which is what one person attempted as part of a quack cancer cure. What about overdoing salt substitutes?

    A 1940s report focused on lithium poisoning from the use of salt substitutes. Why? Because lithium chloride was used as a salt substitute. Yikes! But what about potassium chloride, which is what’s used today? There is one case where someone committed suicide by taking a little more than a tablespoon of a potassium chloride salt substitute. That doesn’t seem like a lot—just a tablespoon? I mean, how can we keep that on the shelves if only a tablespoon will kill you? Well, even smaller amounts of regular salt, if taken all at once, can kill you, too. In fact, ingesting salt water was evidently a traditional suicide method in ancient China.

    Having said all that, a small number of the population may run into problems, primarily people with severely impaired kidney function. That’s why there’s been such a reluctance to push potassium‐based salt substitutes on a population level. If your kidneys can’t regulate potassium, then it can definitely become a serious issue. We’re talking about folks with known kidney disease, diabetes (since diabetes can lead to kidney damage), severe heart failure, those on medications that impair potassium excretion, older adults, and people with adrenal insufficiency. If you aren’t sure if you’re at risk, ask your doctor about getting your kidney function tested.

    Ironically, potassium is so good at reducing deaths from high blood pressure—even among those with kidney disease—that using potassium chloride salt substitutes would probably still save more lives despite the risk, as you can see below and at 5:45 in my video.

    Traditional dietary recommendations to kidney patients limited the consumption of fruits and vegetables because they were high in potassium. However, this paradigm is changing quickly given the many benefits of a fundamentally plant-based diet. A whole food, plant-based diet may even ameliorate chronic kidney disease. For example, there’s increasing evidence that a whole food, plant-based diet may help slow the progression of chronic kidney disease and delay kidney failure. So, the practice of restricting dietary potassium in kidney patients should really be reserved for patients with documented hyperkalemia, a potassium level of 6 or higher, because the key to halting the progression of chronic kidney disease might in fact lie in the produce aisle.

    Doctor’s Note

    If you are in crisis, you can call the National Suicide Prevention Lifeline 24 hours a day, seven days a week, at 800-273-8255.

    This is the final blog in a three-part series. If you missed the first two, check out The Mineral Intake Recommendations Only 1 in 6,000 U.S. Adults Meet and Are Potassium Chloride Salt Substitutes Worth Trying?.



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  • Are Potassium Chloride Salt Substitutes Worth Trying?

    Are Potassium Chloride Salt Substitutes Worth Trying?

    Is potassium chloride a win-win by decreasing sodium intake and increasing potassium intake?

    Of all the terrible things about our diets, high dietary sodium intake—high salt intake—is the leading risk. It’s estimated to be causing millions of deaths every year, killing mainly through adverse effects on blood pressure and increased risk of stroke, heart attack, and kidney damage. Hypertension (high blood pressure) is still called the “silent and invisible killer” because it rarely causes symptoms, but it’s one of the most powerful independent predictors of some of our leading causes of death.

    We evolved eating a diet very rich in potassium and low in sodium, but today that pattern has been completely reversed. This flip reflects a shift away from traditional plant-based diets high in potassium and low in sodium—a shift away from fruits, greens, roots, and tubers—and a move towards salty processed foods stripped of potassium, which is considered a “nutrient of public health concern” because 98% of the U.S. population doesn’t even reach the recommended minimum daily intake. As I’ve mentioned previously, low potassium intake itself is implicated in high blood pressure and cardiovascular disease. However, few physicians actually consider telling their patients to eat more potassium-rich foods, like fruits and vegetables, to better control blood pressure, even though several meta-analyses have confirmed that high potassium intake appears to reduce stroke risk.

    There is even a reduction in stroke risk independent of blood pressure effects, consistent with other protective effects of potassium, such as reducing clot formation, reducing arterial stiffening, and reducing the generation of free radicals. Higher sodium intake is associated with a 20% increased risk of dying prematurely, while higher potassium intake is associated with a 20% reduced risk of dying prematurely. Since sodium is found in junky processed foods, while potassium is concentrated in healthy foods like beans and greens, could having low sodium intake and high potassium intake just be a marker for a healthier diet—meaning more plant foods and less junk? How do we know sodium is cause-and-effect bad? Because randomized controlled trials show that sodium reduction leads to blood pressure reduction, just like randomized controlled trials show that if people are given extra potassium, their blood pressure can be lowered as well. So, what about using potassium chloride to salt your food, rather than sodium chloride? That’s what’s found in these zero-sodium salt substitutes, which you can see below and at 2:28 in my video Are Potassium Chloride Salt Substitutes Effective?.

    Potassium chloride is considered a naturally occurring mineral salt, obtained in the same way as regular sodium salt. Since we get too much sodium and not enough potassium, this would seem to make potassium chloride a win-win solution.

    Whole healthy plant foods would be the best way to increase potassium intake, especially since fruits and vegetables have all sorts of other good things in them. But we now have 10 studies, comprised of 11 randomized controlled trials, showing that just swapping in some potassium chloride for regular salt can lead to significant reductions in blood pressure in people with hypertension, suggesting that salt substitutes may even help prevent hypertension as well. We know that salt substitutes can lower blood pressure, but does it actually decrease the incidence of hypertension, and more importantly, disease endpoints like stroke and mortality? You don’t know until you put it to the test.

    In a randomized controlled trial, households had their salt replaced with just a quarter potassium chloride. At that level, most people either couldn’t tell the difference or even preferred the salt with the potassium mixed in. But did it actually do any good? The use of even the quarter salt substitute was associated with cutting the risk of developing hypertension in half.

    But what about actually following people out to see if there’s any change in the risk of dying from cardiovascular disease? Five kitchens in a veterans’ retirement home were randomized into two groups for about two and a half years, salting meals with regular salt or, unbeknownst to the cooks and the diners, a 50/50 blend of potassium chloride. Those in the half potassium group cut their risk of dying from cardiovascular disease by about 40% and lived up to nearly a year longer. The life expectancy difference at age 70 was “equivalent to that which would have naturally occurred in 14 [years],” meaning that just switching to half potassium salt appeared to effectively make people more than a decade younger when it came to risk of death. In a recent massive randomized controlled trial in China involving 600 villages and more than 20,000 people over five years, participants received either a salt substitute made of a quarter potassium chloride, or they received regular salt. Not only did the salt substitute reduce strokes, and cardiovascular events in general, but it also reduced the risk of death from all causes put together!

    China is a perfect setting for this study because up to 75% of the population’s sodium intake comes from salt added in the home kitchen or dining room, whereas most sodium in the American diet comes prepackaged in the meat and processed foods we buy, though certainly the food companies could switch over themselves. Why haven’t they? And why haven’t more people embraced these salt substitutes if they work well and can taste just as good? We could be “Achieving the Benefits of a High-Potassium, Paleolithic Diet, Without the Toxicity,” says the title of a Mayo Clinic review. So, “Is Salt Substitution Ready for Prime Time?” a commentary asks. What about safety? There are convincing arguments about the benefits, but what about the risks, like the “inclusion of potentially fatal salt substitutes in the food supply”? Wait, what? We’ll talk about the potential downsides next.

    Doctor’s Note

    This is the second in a three-part series on salt and potassium. If you missed the first video, see The Mineral Intake Recommendations Only 1 in 6,000 U.S. Adults Meet. We finish the series with Are Potassium Chloride Salt Substitutes Safe and Effective?.

    I talk about the randomized controlled trials for sodium in The Evidence That Salt Raises Blood Pressure.

     



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  • The Mineral Intake Recommendations Only 1 in 6,000 U.S. Adults Meet

    The Mineral Intake Recommendations Only 1 in 6,000 U.S. Adults Meet

    A staggering 99.99% of Americans fail to get the minimum recommended potassium intake (despite it being perhaps only half of our natural intake) and stay below the recommended sodium intake (even though it may be twice our natural intake).

    Worldwide, physical inactivity accounts for more than 10 million years of healthy life lost, but what we eat accounts for nearly 20 times that. Unhealthy diets shave hundreds of millions of disability-free years off people’s lives every year.

    What are the worst aspects of our diets? Four out of the five deadliest dietary traps involve not eating enough of certain foods—not eating enough whole grains, fruits, nuts and seeds, and not eating enough vegetables. But our most fatal flaw is too much salt—about 15 times deadlier than diets too high in soda, for example, just to help put things in perspective. You can see the breakdown below and at 1:12 in my video Fewer Than 1 in 5,000 Meet Sodium and Potassium Recommended Intakes.

    “There remains no single more effective public health action related to nutrition than the reduction of sodium in the diet,” said a former commissioner of the U.S. Food and Drug Administration.

    This is why national and international health organizations have called for warning labels on salt packets and salt shakers, with such messages as: “Too much sodium in the diet causes high blood pressure and increases risk of stomach cancer, stroke, heart disease, and kidney disease. Limit your use.”

    Salt also increases inflammation. For example, sodium intake is linked to increased disease activity in multiple sclerosis (MS), an inflammatory autoimmune nerve condition, with about three to four times the exacerbation rate in those with medium or high sodium intakes compared to those getting less than a teaspoon of salt per day.

    Just as you can see higher sodium levels in the tissues of those who suffer from lupus, another serious inflammatory autoimmune disease, you can correlate high sodium levels in the spinal cord of MS patients with the disease and decreased structural integrity.

    Where is sodium found, though? In really crappy foods. So, it’s hard to know if increased salt intake is just a marker for a bad diet overall. We do know that salt and high blood pressure are cause-and-effect. How? More than a hundred randomized controlled trials have demonstrated that cutting down on added salt makes blood pressure fall, and the more salt is cut, the better. Part of the mechanism might actually be the damage salt may do to the microbiome, the friendly flora in the gut.

    And no wonder. Our bodies evolved only to handle about 750 mg a day. The American Heart Association says we should stay under at least twice that amount, but we’re eating more than four times what’s natural. And it’s only getting worse, increasing over the last decade. Care to guess what percentage of Americans exceed the 1,500 mg upper limit recommendation? It turns out to be a whopping 98.8%. And that was more than a decade ago!

    The vast majority of adults in the United States consume too much sodium and, at the same time, too little potassium, a mineral that lowers blood pressure. Less than 2% of U.S. adults consumed the recommended daily minimum intake of potassium. So, more than 98% of Americans eat potassium-deficient diets. This deficiency becomes even more striking when our current intake is compared with that of our ancestors, who consumed large amounts of dietary potassium. We evolved probably getting more than 10,000 mg a day. The recommendation is to get at least around half that, yet most of us don’t come anywhere close, as you can see below and at 3:51 in my video.

    Put the two guidelines together, and sodium and potassium goals are currently met by fewer than 0.015% of people in the United States. That’s close to 99.99% noncompliance—only 1 in 6,000 Americans even hits the recommended guidelines.

    What about using potassium-based salt substitutes, like the ones shown below and at 4:15 in my video?

    Instead of using sodium chloride, also known as salt, why not shake on some potassium chloride? Seems a little too good to be true. It has the same salty taste while reducing sodium and increasing potassium intake? Is there a catch? Are potassium-based salt substitutes safe? Are they effective? Stay tuned to find out.

    Doctor’s Note

    This is the first video in a three-part series on sodium, potassium, and a salt substitute. Stay tuned for Are Potassium Chloride Salt Substitutes Worth Trying? and Are Potassium Chloride Salt Substitutes Safe and Effective?.

    What about those who claim salt isn’t a problem? Don’t believe them. See related posts below.



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  • Do Cranberries and Pumpkin Seeds Help an Enlarged Prostate?

    Do Cranberries and Pumpkin Seeds Help an Enlarged Prostate?

    Cranberries and pumpkin seeds are put to the test for benign prostatic hypertrophy.

    More than 50% of men in their 50s and at least 70% of men over age 60 suffer from benign prostatic hypertrophy, or BPH, otherwise known as enlarged prostate. This can result in burdensome lower urinary tract symptoms, such as having to get up frequently at night to pee. While current medical treatments are clinically effective, side effects and low compliance rates compromise their efficacy. Symptoms include sexual dysfunction, high-grade prostate cancer, and depression. No wonder there’s poor compliance. And when medication treatment fails, surgical procedures—such as transurethral resection of the prostate—are considered. There has got to be a better way.

    Population studies suggest that low intake of animal protein and high intake of fruits and vegetables may be protective, but this is not just about cutting down on any animal protein. Eggs and poultry seem to be the worst, along with refined grains, but no association was found for red meat or dairy. Population studies aside, are there any foods that have been put to the test? In fact, there have been more than 30 randomized controlled trials on the herb saw palmetto. And it’s been found to be…totally useless.

    Evidently, cranberries were used by Native Americans to treat urinary ailments. Were they effective? You don’t know until you put them to the test. Study participants consuming about a teaspoon a day (around 3 g) of powdered whole cranberries—not those sugary, oily “craisins”—experienced significant improvements in BPH symptoms, quality of life, and all urination parameters.

    So, we know a teaspoon works, but what about a third of a teaspoon or a sixth of a teaspoon? They also helped, as you can see below and at 2:05 in my video Natural Dietary Treatments for Enlarged Prostate BPH. (The results from the one teaspoon of powdered cranberries in the previous study are represented by the bottom green line.)

    Now, this study (with the graph) used a supplement, because it was funded by the supplement company, but the supplement is just straight cranberry powder. So, you might as well buy it in bulk for much cheaper and just add it to a smoothie or something.

    What about a tastier option, like drinking purple grape juice? No benefit whatsoever.

    Previously, I’ve talked about the use of flaxseeds, which may have a therapeutic efficacy comparable to that of commonly used drugs—and only good side effects. So, what about other seeds? Pumpkin seeds have evidently been used for centuries in folk medicine as a remedy for prostate disorders, and in a petri dish, they can cut the growth of BPH prostate cells in half, as you can see below and at 2:48 in my video.

    Scientists have also injected pumpkin seed extracts into rabbits, but what about people?

    Pumpkin seed oil appears to help with prostate issues. When pitted head-to-head against the drug Prazosin, it seemed to work as well as the pill. The same thing happened when it went head-to-head against the drug Terazosin. But what the study didn’t have was a placebo group. It would have been nice to see how well the pumpkin seed oil supplement did against placebo. Or better yet—whole pumpkin seeds. In fact, there is such a study! More than a thousand men were randomized to take either pumpkin seed extract, a placebo, or just about a tablespoon a day (about 7.5 g) of plain pumpkin seeds.

    The study was funded by the drug company that made the supplement, but the supplement flopped; it was no better than placebo. The pumpkin seeds themselves, however, did work. The supplement appeared to reduce symptoms, but not better than placebo. However, just the plain old seeds did. So, it wasn’t just some compound extracted from the oil. In fact, we’ve since learned that even an oil-free extract seemed to work. The bottom line, the researchers concluded, is that pumpkin seeds could be recommended for patients with mild-to-moderate BPH symptoms. This conclusion was echoed by the European equivalent of the U.S. Food and Drug Administration: Pumpkin seeds can be used to relieve lower urinary tract symptoms related to an enlarged prostate after more serious conditions have been ruled out by a medical doctor.

    Doctor’s Note

    The flaxseed video I mentioned is Flaxseeds vs. Prostate Cancer.

    What about cranberries and prostate cancer? See Cranberries vs. Cancer.

    Can Cranberry Juice Treat Bladder Infections? Watch the video to find out.



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  • The Science Behind Oatmeal and Diabetes

    The Science Behind Oatmeal and Diabetes

    Before Insulin, There Was Oatmeal

    Before the discovery of insulin, the lives of many people with diabetes were saved or prolonged by Carl von Noorden’s oatmeal diet. As I discuss in my video Is Oatmeal Good for People with Diabetes?, he published his findings in 1903, which were received with a great deal of skepticism. But the critics were overcome in the following years by the weight of the evidence.

    Acclaimed doctor James B. Herrick began to try the oatmeal diet on his patients. Initially very doubtful, he became astonished by the results, which led to the 1909 proclamation that no case of juvenile or adolescent diabetes should be deprived of the benefits of the oatmeal cure.

    The great Elliott Joslin, founder of the oldest and largest diabetes clinic in the world, described the effects of oatmeal as “sometimes magical,” calling the oatmeal cure an unsolved mystery, referred to back then as “one of the greatest puzzles in diabetes.” They did have some clues, though. They found that animal protein had to be strictly excluded, as it annihilates the favorable action of oatmeal-type diets.

    And now we know, more than a century later, that, indeed, animal protein intake intensifies insulin resistance, which is the cause of prediabetes and type 2 diabetes, whereas plant-based foods enhance insulin sensitivity, which is the opposite.

     

    Is Oatmeal Good for People with Diabetes?

    We’ve long known that higher consumption of whole grains, including oats, is associated with a lower risk of diabetes. As I discuss in my video How Does Oatmeal Help with Blood Sugars?, more than a dozen randomized controlled trials found that oats significantly improved both short-term and long-term blood sugar control, in addition to lowering cholesterol levels.

    We think the benefits arise from a fermentable fiber in oats called beta-glucan. We know one of the underlying cholesterol-lowering mechanisms of oatmeal consumption might be its microbiome-manipulating ability––in other words, having a beneficial effect on our intestinal bacteria.

     

    What’s So Great About the Fiber in Oatmeal?

    A little fiber goes a long way. Our good gut flora uses fiber to make short-chain fatty acids that have anti-inflammatory effects. There are dozens of randomized controlled trials showing the types of fiber found in oats and beans can improve long-term blood sugar control in people with diabetes. Why? Because the gut bacteria selectively promoted by dietary fiber intake can help alleviate type 2 diabetes.

    The oat fiber itself has been shown to act as a prebiotic, boosting the growth of beneficial bacteria like Lactobacillus and Bifidobacteria. So, between the lack of animal protein, lack of animal fat, and bursting at the seams with prebiotic fiber, it’s no wonder that oatmeal diets grew to become part of the clinical routine in the treatment of diabetes.

     

    How Soon Can You See Results?

    As I discuss in my video Oatmeal Diet Put to the Test for Diabetes Treatment, several studies have suggested that a few days of eating oatmeal could have beneficial effects for about a month afterward. In a randomized, controlled, crossover trial, not only did insulin needs drop by about 40% in just two days, compared to just restricting calories alone with a hypocaloric diabetic diet, but a measure of long-term blood sugar control taken four weeks later reflected the benefit.

    Other new studies have shown the same thing. Two days of oatmeal significantly reduced the required amount of insulin and improved blood sugar levels, with beneficial effects noted for up to four weeks. Consider this: Patients with uncontrolled type 2 diabetes on the two-day oatmeal diet experienced a 40% reduction of insulin dose, accompanied by almost normalization of average blood sugars. Although the intervention only lasted for two days, researchers observed a lasting significant reduction of insulin dosage and ameliorated mean blood sugars for weeks after the participants were dismissed from the study—and that was after they resumed their regular diets.

    chart showing the reduction in blood sugar and insulin dosage after 2 days of eating oatmeal, immediately after, and 4 weeks later

    Put people on a diet packed with oats, beans, fruits, vegetables, and nuts, and the number of their gut fiber-feeders churning out beneficial short-chain fatty acids shoots up, and fasting diabetic blood sugars drop by about 25% within one month. The more fiber-feeders they fostered, the better their blood sugar control. When the fiber-promoted short-chain fatty acid producers were present in greater diversity and abundance, participants had better improvement in their hemoglobin A1c levels (which is a measure of longer-term blood sugar control).

    charts showing how high-fiber diets can alter the gut microbiome and improve blood sugars in those with type 2 diabetes

     

    Are There Any Downsides to Oatmeal?

    If you try an oatmeal diet, your physician should be ready to rapidly deprescribe your blood sugar drugs or else you could become dangerously overmedicated. Oatmeal interventions should not be performed in patients who might have difficulties in reporting symptoms of low blood sugar. The downside of trying oatmeal days is that it may work a little too well, so it must be done under close medical supervision.

     

    The Glycemic Index of Oatmeal

    Whole grains are good, but intact whole grains are better. The wholiest of grains: groats.

    Oat groats have their inedible outer husks removed during processing. They can then be sliced into two to four pieces to make steel-cut (also known as pinhead or Irish) oats, which are considered a low-glycemic-index food, averaging under 55.

    Oat groats can also be coarsely ground into Scottish oatmeal or steamed and flattened into “old-fashioned” rolled oats, which have a glycemic index of 55.

    Instant oats are steamed longer and rolled even more thinly. Scoring 79, it’s considered a high-glycemic-index food, but not as bad as some breakfast cereals, which can get into the 80s or 90s.

     

    Jazzing Up Oatmeal

    Oatmeal is a classic whole-grain breakfast, and there are plenty of ways to enjoy it.

    • Of course, fruit and nuts are popular additions. A berry banana oatmeal bowl is quick and easy, and cinnamon baked apples make for a cozy breakfast. Assemble overnight oats or baked carrot cake oatmeal the night before to simplify your morning.
    • To add another type of fiber for your gut flora, mash cannellini beans into your oatmeal—my friend Paul swears you can’t even see or taste them.
    • I like to start my mornings with what I call my BROL bowl. BROL stands for barley, rye, oats, and lentils. I use oat groats (also called hull-less and hulled oats). I premix all the ingredients in a 1:1:1:1 ratio and then cook one scoop of dry BROL and two scoops of water in an electric pressure cooker. That makes a base with great texture. 

    Once you have your BROL base, pick your toppings. When I feel like something sweet, my go-to is a chocolate-covered-cherry sensation. I make it with frozen dark red cherries, cocoa powder, dates, and walnuts or pumpkin seeds.

    You can easily turn that BROL bowl savory; here’s a version made with sautéed greens. Google “savory oatmeal” for all sorts of interesting dishes involving mushrooms, herbs, curry, roasted vegetables—you name it!



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  • 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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