Category: Nutrition

  • Let’s talk IBS | Dietitian Connection

    Let’s talk IBS | Dietitian Connection


    April is IBS Awareness Month – the perfect time to spotlight a condition that affects millions worldwide yet is often misunderstood. In this episode, gut health dietitian Chelsea McCallum joins us to unpack the complexities of IBS and share her empowering, food-positive approach to care.

    Hosted by Brooke Delfino

    Biography

    Chelsea McCallum is a digital dietitian with a special interest in gut health and the founder of the IBS Relief Program, a private coaching program to support people with IBS. Chelsea helps people with IBS take control of their symptoms without endless food restrictions. With a background in recipe development and a deep understanding of the science, Chelsea takes an empowering, practical approach to IBS care that’s all about what we can add to the diet, not just take away.

    In this episode, we discuss:

    • Why IBS is often missed or misunderstood
    • When (and when not) to use the low-FODMAP diet
    • How to guide clients through reintroduction with confidence
    • Strategies to reduce food fear and overwhelm
    • Tips to simplify IBS education in clinical consults


    Additional resources

     

    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.


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  • Why Aren’t Angioplasty Heart Stents More Effective? 

    Why Aren’t Angioplasty Heart Stents More Effective? 

    Most heart attacks are caused by nonobstructive plaques that infiltrate the entire coronary artery tree. There is no such thing as “1-vessel disease,” “2-vessel disease,” or “left main disease.” Atherosclerotic plaque is continuous throughout the coronary arteries of heart attack victims. 

    In angioplasty, a tiny balloon is inserted into a narrowed coronary artery that feeds the heart to force it to open wider to improve blood flow. It wasn’t put to the test in a randomized controlled trial until 1992. It not only failed to prevent heart attacks, but it also failed to show any survival benefit. However, the researchers only followed patients for six months and included people with relatively minor diseases who might not have been sick enough to benefit from the procedure. Enter the MASS trial. Researchers enrolled those with severe blockage high up in their left anterior descending coronary artery—the widow-maker or widower-maker (since coronary artery disease is also the number one killer of women)—and followed them for years. The findings? There was no difference in subsequent mortality or heart attack rates. There were only about 200 patients in that trial, though. Maybe the benefit was so subtle that a greater number of patients were needed to tease out the effect. Enter the RITA-2 study, which randomized more than a thousand patients. Researchers did indeed find a clear difference in the risk of future death and heart attack, but it was in the wrong direction. The angioplasty group suffered twice the risk compared to those randomized to forgo surgery, as shown below and at 1:18 in my video Why Angioplasty Heart Stents Don’t Work Better

    This was all before stents came into vogue, though. Instead of just ballooning up the artery, how about permanently inserting a stent, a metal mesh tube, to prop open the artery, as you can see here and at 1:33 in my video? Surely, that’s got to help. 

    Enter the MASS-II trial, which, again, saw no benefit after one year—but no benefit was seen after five years or even ten years. Then came the Courage Trial, which randomized thousands of patients, and it, too, fell flat on its face. 

    Those mostly used bare metal stents, though, not the newer “drug-eluting” ones that release drugs slowly. And what about high-risk groups, such as those diagnosed with diabetes and other more serious diseases, or those who have 100 percent blocked arteries days after having a heart attack? In meta-analysis after meta-analysis, looking at five trials with 5,000 patients, there was no reduction in death, heart attack, or even angina pain. In ten trials with more than 6,000 patients, there was no benefit for survival, heart attacks, or pain relief. Now, we’re up to more than a dozen major trials and nothing: no benefit from angioplasty and stents. “Furthermore, multiple analyses have failed to identify a single high-risk subset that benefits…” How is that possible? You’re physically opening up blood flow.

    The reason it doesn’t work is that the majority of heart attacks in real life are caused by narrowings less than 70 percent—“i.e., most likely non-flow-limiting lesions”—so the plaques in our arteries that kill us tend not to be the ones that are restricting blood flow. Shown below and at 3:21 in my video are two atherosclerotic plaques. The one circled in green and labeled “Flow-limiting lesion” is squeezing off the blood flow so much that it can be seen on an angiogram and doctors can go after it with a stent. 

    Problem solved and life saved, right? No, because it was the invisible one (circled in yellow below) that wasn’t even impeding blood flow that was going to kill us all along, as you can see here and at 3:27.

    Indeed, most heart attacks are caused by nonobstructive plaques that don’t even cut blood flow by 50 percent, as seen below and at 3:40 in my video

    There’s a misconception, a “clogged pipe analogy of stable coronary heart disease [that] has been particularly difficult to dislodge,” in which cholesterol plaques slowly and inexorably encroach on blood flow, eventually cutting it off completely and triggering a heart attack. In reality, “coronary artery disease…is an inflammatory disease in which cholesterol from the blood is deposited in artery walls, causing an inflammatory reaction, like a pimple. When those pimples pop, they cause the blood in the arteries to clot at the site…Before rupture, these plaques often do not limit flow and may be invisible to angiography and stress tests. They are, therefore, not amenable to percutaneous coronary intervention (PCI),” that is, to angioplasty and stents. Old plaques are like “scarred old pimples.”

    The tightest blockages are made up of mostly calcified and dense fibrous scar tissue. They can still rupture and kill us, but there are so many more of the smaller lesions brewing, which are hidden from view. The way we visualize coronary arteries is with an angiogram. X-rays are taken after a black-looking dye is injected into the arteries, so we can only see plaques that encroach on the blood flow. That’s why we get these kinds of tip-of-the-iceberg illustrations, the point of which “is to emphasize that most of the atherosclerotic plaque in the coronary arteries is not seen well by angiography,” as you can see below and at 4:49 in my video. To really understand what’s going on in people’s arteries, we must turn to autopsy. William Clifford Roberts is probably the most pre-eminent cardiovascular pathologist in the world. What did he learn after studying coronary arteries for 50 years? After examining nearly 2,000 bodies, he learned that atherosclerosis is a systemic disease. 

    “In patients with fatal coronary artery disease…the quantity of plaque is enormous. There is not just 1 plaque here, another plaque there, with normal lumen [clean arteries] between plaques. Plaques are continuous! Not a single 5-mm segment is devoid of plaque” in the entire coronary artery tree. So, says Dr. Roberts: “Isolated coronary disease is a myth. There are no such things as ‘1-vessel disease,’ and ‘2-vessel disease.’ Plaque is in all of the epicardial coronary arteries if it is in 1 of them.”

    Four main coronary arteries feed the heart—the right coronary artery, the left main coronary artery, the circumflex coronary artery, and the left anterior descending coronary artery, as seen here and at 6:00 in my video

    If we add up their lengths, that’s about 11 inches (28 cm) of coronary arteries, which, for examination, can be cut into about 50 quarter-inch (5-mm) slices. Shown below and at 6:17 in my video is what is seen: Plaque isn’t gunking up one or two slivers but throughout all the coronary arteries. If we look at more than a thousand of these slices from dozens of patients who died of heart attacks, “not a single segment was devoid of plaque.” So, it’s no wonder that stenting open in just one area has no impact on heart attacks or death.



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  • The Effectiveness of Angioplasty and Heart Stent Procedures 

    The Effectiveness of Angioplasty and Heart Stent Procedures 

    There are demonstrably no benefits to the hundreds of thousands of angioplasty and stent procedures performed outside of an emergency setting. They don’t prevent heart attacks, enable you to live longer, or even help with symptoms any more than placebo (sham) surgery. 

    Large national cardiology conferences may attract the majority of cardiologists across an entire country, convening them in one place. “While at the large cardiology conventions…[it’s been] joked that the convention center would be the safest place in the world to have a heart attack.” And, indeed, that’s when the American Heart Association president had his, within hours of his presidential address. With so many of the nation’s top cardiologists at a conference, that may be a bad time to go into cardiac arrest anywhere else, though. You don’t know until you put it to the test.

    To much surprise, researchers found substantially lower mortality among those going into cardiac failure or cardiac arrest during the dates of national cardiology meetings. Why is the death rate lower when most of the cardiologists are away? “‘One explanation for these findings is that the intensity of care provided during meeting dates is lower and that…the harms of this care may unexpectedly outweigh the benefits,’ the researchers wrote.” Their results “echo paradoxical findings documented during a labor strike by Israeli physicians in 2000, in which hundreds of thousands of outpatient visits and elective surgical procedures were canceled, but by many accounts mortality rates dramatically fell during the year.” And it wasn’t just one strike. “Doctors’ strikes and mortality” have been looked at multiple times. In all reported cases, “mortality either stayed the same or decreased during, and in some cases, after the strike.” In four of the seven cases, “mortality dropped as a result of the strike, and three observed no significant change in mortality during the strike or in the period following the strike.”

    The fact is that many current medical practices have been found to offer no benefit and present potential harm. Even physicians themselves estimate that about one-fifth of medical care is unnecessary. A national summit was convened by The Joint Commission, which accredits hospitals, and the American Medical Association to identify areas of overuse, “described as the provision of treatments that provide zero or negligible benefit to patients, potentially exposing them to the risk of harm.” Five practices were called out, including prescribing antibiotics for viral upper respiratory tract infections and spending a billion dollars prescribing drugs that don’t work (and, if anything, make things worse). Another overused practice identified was elective percutaneous coronary intervention (PCI)—in other words, angioplasty and stents, as I discuss in my video Do Angioplasty Heart Stent Procedures Work?.

    To get everyone on the same page before we dive in: Coronary artery disease, the number one killer of men and women, involves blockages in the blood vessels that supply the heart muscle itself. Low blood flow can lead to angina, a type of chest pain, or, if it’s severe enough, to a heart attack. Plant-based diets and lifestyle programs have been shown to reverse these blockages by treating the cause of why our arteries are clogging up in the first place, but for those unable or unwilling to change their diets, there are drugs that can help, as well as more invasive treatments, such as open-heart surgery to try to bypass the blockage or percutaneous coronary intervention, when “doctors insert small balloons or tunnels (stents) attached to flexible tubes (catheters) into the large blood vessels in the patient’s groin and thread them up into the heart. The stent and catheter are passed through the blocked vessels, a process that opens up the vessels.” In this way, they can get inside the blocked vessels and try to open them up and keep them propped open. During a heart attack, this can be lifesaving, but hundreds of thousands of these procedures are performed every year for stable angina, meaning on a non-emergency basis. It can relieve angina symptoms “but it does not reduce a person’s chances of having or dying of a heart attack.”

    However, not everyone knows that. “Some patients and doctors mistakenly believe that PCI does more than just reduce symptoms.” That’s one of the reasons I’ve created a video series on the topic. As Harvard put it: “Stents are for pain, not protection.” Then, unbelievably, it was discovered that stents may not even help with pain, as revealed in a double-blind, randomized controlled trial. People can be blinded to the active treatment in a drug trial by receiving a placebo sugar pill, but wouldn’t they notice if they had surgery? If a doctor cut into their groin? Not if they had sham surgery—placebo surgery. “In both groups, doctors threaded a catheter through the groin or wrist of the patient…up to the blocked artery. Once the catheter reached the blockage, the doctor inserted a stent or, if the patient was getting the sham procedure, simply pulled the catheter out.” The results? Those who underwent the fake surgery did just as well as those who had the regular PCI surgery.

    There are no benefits to angioplasty and stents outside of an emergency setting. They don’t prevent heart attacks, they don’t enable us to live longer, and they don’t even help with symptoms. “Since the procedure carries some risks, including death, stents should be used only for people who are having heart attacks…” How are hundreds of thousands of people getting these operations for nothing? How do the doctors justify it? Is it just greed? How do they get patients to consent to it? Do they just not tell them the truth? And why doesn’t it work? After all, a blocked artery is being opened up. There are just so many questions, which we’ll start addressing next.



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  • What About Millet and Diabetes? 

    What About Millet and Diabetes? 

    What were the remarkable results of a crossover study randomizing hundreds of people with diabetes to one and a third cups of millet every day? 

    How does millet come to the help of people with diabetes? A substantial portion of the starch in millet is resistant starch, meaning it’s resistant to digestion in our small intestine so it provides a bounty for the good bugs in our colon. Below and at 0:28 in my video The Benefits of Millet for Diabetes is a table showing how the various millets do. As you can see, they’re all much higher in resistant starch than more common grains, like rice or wheat, but proso and kodo millets lead the pack. 

    What’s going on? The protein matrix in millet not only acts as a physical barrier but also partially sequesters our starch-munching enzyme, and the polyphenols in millet can also act as starch blockers themselves.

    Millet has markedly slower stomach emptying times than other starchy foods, too. When we eat white rice, boiled potatoes, or pasta, our stomach takes about an hour to digest it, before it begins to slowly release it into our intestines, and it takes about two or three hours to empty about halfway. When we eat sorghum or millet, though, stomach emptying doesn’t even start for two or three hours and it may take five hours to empty just halfway, as you can see below and at 1:22 in my video

    Note that this was the case with both a thick millet porridge and a millet couscous. “The non-viscous millet couscous meal was also equally slow in [stomach] emptying. This suggests that there is an intrinsic property” of millet itself that helps slow down the rate of stomach emptying, which should blunt the blood sugar spike. What happened when it was put to the test? 

    Indeed, millet caused about a 20 percent lower surge in blood sugar than the same amount of carbohydrates in the form of rice. Remember how excited I was to show you how it only took the body about half the insulin to handle sorghum compared to a grain like corn? Well, millet did even better, as seen here and at 2:07 in my video.

    When a group of prediabetic individuals were given about three quarters of a cup of millet a day, within six weeks, their insulin resistance dropped so much that their prediabetic fasting blood sugars turned into non-prediabetic blood sugars, as shown below and at 2:22 in my video

    This “self-controlled clinical trial,” with the same subjects before and after, is just a sneaky way of saying it’s an uncontrolled trial. There was no control group in which participants either didn’t add the millet or added something else, and we know that just being under scrutiny in a study can cause people to eat better in other ways. So, we don’t know what role, if any, the millet itself played. What we need is a randomized, controlled, crossover trial where the same people eat diets with and without millet so we can see which works better. And here we go: a randomized, crossover study with hundreds of patients following an American Diabetes Association-type diet with and without about one and a third cups of millet every day. Researchers found that the millet-based diet lowered hemoglobin A1C levels, meaning there was an improvement in long-term blood sugar control, as well as the achievement of some side benefits like lowering cholesterol. 

    The target for good blood sugar control recommended by the American Diabetes Association is an A1C of less than 7. The participants started out at 8.37, but after a few months on millet, their A1C dropped to an average of 6.77, as seen here and at 3:35 in my video

    Is it just because they lost weight? No, which suggests it was an effect specific to the millet. The researchers didn’t just give them millet, though. They mixed the millet with split black lentils and spices, and we know from dozens of randomized, controlled experimental trials in people with and without diabetes that consuming pulses—beans, split peas, chickpeas, and lentils—can improve long-term measures of blood sugar control like A1C levels. So, while the researchers “concluded that millets do have a potential for a protective role in the management of diabetes,” a more accurate conclusion might be a mix of millets and lentils can be protective. The spices may have helped, too. The researchers didn’t say which spices were used, and I couldn’t get in contact with the authors, but a similar study done by one of the same researchers included about a daily tablespoon of a mixture of fenugreek, coriander, cumin, and black pepper, with a fifth spice, perhaps cinnamon or turmeric. 



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  • The dietitian’s role in Responsive Feeding Therapy

    The dietitian’s role in Responsive Feeding Therapy


    In this episode, leading paediatric dietitian, Deb Blakley, shares her knowledge and expertise in Responsive Feeding Therapy (RFT), a respectful, relationship-based approach to supporting children and families through feeding challenges. Through evidence-informed insights and clinical experience, Deb unpacks what RFT looks like in practice, how dietitians can confidently implement it and the unique value they bring to multidisciplinary care.

    Hosted by Rebecca Sparrowhawk

    Biography

    Deb Blakley is an Accredited Practicing Dietitian and Founder & Director of paediatric and family dietetics practice, Kids Dig Food in Brisbane. As an APD and mum to a neurodivergent teenager, Deb is passionate about supporting all children and their families to build a peaceful relationship with food. Deb and her team’s clinical practice is guided by the principles of Responsive Feeding, Neurodiversity Affirming Care, Trauma Informed Care and Weight Neutral Care. Deb’s approach to food and eating is to support parents, caregivers, families and educators to make decisions about nutrition and health from a place of care and consideration rather than control. 

    In this episode, we discuss:

    • What sets RFT apart from traditional feeding methods
    • How to translate the research to everyday practice
    • Practical strategies to navigate feeding challenges
    • Elevating the role of dietitians in multidisciplinary paediatric feeding care

     


    Additional resources

     

    Connect with Deb at kidsdigfood.com.au/, on LinkedIn or Facebook

    Resources for further information:

    • Responsive Feeding Therapy: Values and Practice v2
    • Paper under review: Responsive Feeding Therapy: A Novel, Value-Driven Treatment Approach to Pediatric Avoidant Eating. Author: Cormack et al, click here
    • Useful resources for parents, caregivers and teens that are consistent with RF values and goals can be found here.

     

    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.


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  • Is Millet a Nutritious Grain? 

    Is Millet a Nutritious Grain? 

    Millet isn’t the name of a specific grain, but a generic term that applies to a number of totally different plants. Which is the most healthful

    “Millets are highly nutritious but vastly ignored as a main source of food primarily due to lack of awareness.” Have you heard of ancient grains? Millets aren’t messing around. Arguably, they are the first grains cultivated by humankind—dating back not only 5,000 years, but maybe 10,000.

    Why millets and not just millet? I had no idea that “millet” wasn’t the name of a specific grain. In fact, millet is a generic term that doesn’t just apply to different species but to a number of totally different plants. There are “major and minor millets,” pearl millet, which is what most people think of as millet, and also proso, foxtail, and finger millets, which are all completely different grains. Although they look similar, they aren’t the same, as you can see below and at 1:05 in my video Studies on Millet Nutrition: Is It a Healthy Grain?.

    Fiber is one of the main things we look for in whole grain, and Kodo millet’s fiber content is off the charts. But, compared to other grains, finger and foxtail millets also beat out the bunch. Note, though, that pearl millet (the one most people think of as millet) is really on the low side. But looking at the polyphenol content, even plain millet beats out the other grains, including sorghum, which I previously hyped for how much polyphenol it contains. But, again, Kodo millet seems to win the day, as you can see below and at 1:39 in my video

    When it comes to total antioxidants, though, Kodo and finger millets are comparably high, as shown here and at 1:43.

    When it comes to nutrition, finger millet is said to have eight times more calcium than other grains, but, to me, it looks like it has ten times the calcium. It’s just off the charts, as you can see here and at 1:55 in my video

    It also has three times as much calcium as milk. Some of the millets are exceptionally high in iron too. Regular millet is high, but barnyard millet has about five times more iron than steak. 

    So, it’s nutritious, but what about specific potential health benefits? In the medical literature, you can read statements like: Millets “may prevent cardiovascular disease by reducing plasma triglycerides in hyperlipidemic rats.” But who cares whether food reduces cardiovascular disease in rodents except for those with pet rats or mice?

    An epidemiological study in China found lower esophageal cancer mortality rates in areas where residents ate more millet and sorghum, compared to corn and wheat. That may have been due more to avoiding a contaminating carcinogenic fungus than to the benefits of millet itself, though. Studies have shown that millets may be effective against cancer cell proliferation in a petri dish, with Kodo and proso millets rapidly inhibiting cancer cell growth, compared to pearl or foxtail millet, as shown below and at 3:02 in my video, knocking down the growth of cancer cells, but leaving normal cells alone. Also, millets were found to reduce the growth of colon cancer cells, human breast cancer cells, and human liver cancer cells, and also potentially help to prevent metastases by inhibiting cancer cell migration. My patients are neither pets nor petri dishes, though, and to date, there have been no clinical cancer trials with millet. 

    Are there any unique health-promoting attributes? Some know finger millet for its health benefits, such as lowering blood sugar and cholesterol and having anti-ulcer characteristics, but the anti-ulcer study researchers cite just notes that some of the areas with a low incidence of ulcers also happened to be regions where residents eat millet, as shown here and at 3:49 in my video, and that’s far from establishing cause-and-effect. 

    And the cholesterol-lowering study cited? It explores what happens when you take tail tendons from rats and soak them in sugar and millet! The blood-sugar-lowering benefits are legitimate, though. “Apart from the fact that millets do not contain gluten,” which is good for the 1 or 2 percent of people who have celiac disease or non-celiac gluten sensitivity, “millets can also be exploited in the management of type II diabetes due to their hypoglycemic [blood-sugar-lowering] property, as reported by several studies on millets and millet-based foods”—done with actual people, which we’ll cover next. 

    Isn’t it mind-blowing that millet isn’t actually a grain but a generic term? I learn something new every day—and make videos about it for you.

    I have a few millet recipes in The How Not to Diet Cookbook, including Millet Risotto with Mushrooms, White Beans, and Spinach. Find it at your local library or wherever you get your books. (As always, all proceeds from my books are donated to charity.) You can also substitute millet for the barley and/or rye in my Basic BROL Bowl.

    This is part of an extended series, which includes another three videos listed in the related posts below. 



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  • Does Processed Meat Affect Our Lung Function? 

    Does Processed Meat Affect Our Lung Function? 

    If the nitrites in foods like ham and bacon cause lung damage, what about “uncured” meat with “no nitrites added”?

    “Recently, the World Health Organization (WHO) classified processed meat as carcinogenic to humans.” Also known as cured meat, such as bacon, ham, hot dogs, lunch meat, and sausage, processed meat is definitively cancer-causing. What’s more, “high processed meat consumption has also been associated with increased risk of all-cause mortality”—that is, dying prematurely from all causes put together—“and is a risk factor for several major chronic diseases, such as type 2 diabetes, coronary heart disease, and stroke.” What about lung issues like asthma?

    As I discuss in my video Does Processed Meat Affect Our Lung Function?, nitrites are added to processed meats as preservatives to preserve their pink hue (so the meat products don’t turn gray), keep them less rancid-tasting, and prevent the growth of diseases like botulism. But, if that same sodium nitrite is put into the drinking water of lab animals, they develop emphysema. Nearly all of them develop emphysema. That was the extent of the scientific knowledge we had on the subject going into 2007, then this study was published: “Cured Meat Consumption, Lung Function, and Chronic Obstructive Pulmonary Disease Among United States Adults.” It found that frequent consumption of cured meat is associated with an increased risk of people developing diseases like emphysema, a form of chronic obstructive pulmonary disease (COPD). As you can see below and at 1:32 in my video, eating it every other day appeared to triple the odds of severe COPD. 

    Since it was a snapshot-in-time study, we don’t know which came first, the sausage or the COPD. For that, we need prospective studies that follow people over time, and the big twin Harvard studies in women and men both found that “the risk of newly diagnosed COPD increased with a greater consumption of cured meats after adjustment for many important confounders.” 

    We now have studies involving hundreds of thousands of people showing that higher consumption of processed meat is associated with a 40 percent increased risk of COPD. It comes out to about an 8 percent higher risk of COPD for each hot dog eaten in a week or each weekly breakfast link sausage. What is going on?

    Yes, there are advanced glycation end-products (AGEs), so-called glycotoxins that “occur naturally in meat and are formed through heat processing,” that may be pro-inflammatory, as well as saturated fat that can also trigger inflammation in the airways. And there’s the high salt content that can present a potential risk for lung inflammation, and the suggestion that processed meat intake may increase systemic inflammation in general. However, the reason attention has focused on the nitrites is because nitrites themselves may be “one of the mechanisms by which tobacco smoke causes COPD” and other diseases like emphysema. “Cured meats are the principal source of dietary nitrites,” but “nitrites are also byproducts of tobacco smoke.” One of the main constituents in cigarettes, besides carbon monoxide and nicotine, are nitrogen oxides that are converted in the lungs to nitrites.

    The way nitrites appear to cause lung damage is by affecting connective tissue proteins like collagen and elastin, which are what help keep the airspaces in our lungs open. But nitrite can modify these proteins in ways that “mimic age-related damage, including elastin fragmentation.”

    With that much lung injury, it’s logical to assume that processed meat consumption could also exacerbate the disease of those who already have it. And, indeed, cured meat consumption increases the risk of people with COPD ending back in the hospital; those eating more cured meat on average have about twice the risk of readmission. It appears the more you eat, the worse it is, as seen here and at 3:56 in my video.

    “Regarding lung health, processed meat intake has been associated with a likely increased risk of lung cancer, decline in lung function and chronic obstructive pulmonary diseases (COPD),” but what about asthma? High consumption of processed meat has also been “associated with higher asthma symptoms.” 

    We know that “higher maternal intake of meat before pregnancy may increase the risk of wheezing” in her children later on, based on a study of more than a thousand mother-child pairs. (And we aren’t talking about aspirating meat into our lungs and getting misdiagnosed with asthma.) In fact, “those who ate the most cured meats were 76% more likely to experience worsening asthma than those who ate the least.” Since obesity is a likely risk factor for asthma, might meat’s influence be indirect, by contributing to weight gain? That may be a small part of it, but the main effect appears to be direct, “suggesting a deleterious role of cured meat independent of BMI,” body mass index, a weight measurement. Put all the studies together, and “processed meat intake appears to be an important target for primary prevention of adult asthma.”

    Even if you don’t have any lung issues, processed meat consumption was negatively associated with measures of normal lung function, while fruit and vegetable consumption and dietary total antioxidant capacity were associated with better lung function.

    Can we just eat all-natural, uncured hot dogs, with “NO NITRATES OR NITRITES ADDED,” like these see here and at 5:35 in my video

    If you use a magnifying glass and peer at the small print, it says “except those naturally occurring in sea salt and cultured celery juice.”

    See, to avoid saying “added nitrites,” food manufacturers may add something that has a lot of nitrates, like celery, and also bacteria, “a starter culture to convert the nitrate to nitrite.” So, nitrites are being added and consumers are being duped.

    The European Union doesn’t allow this kind of consumer fraud and “considers the use of plant extracts containing high levels of nitrate with an intended technological purpose of preservation to be a deliberate use of a food additive,” and manufacturers must explicitly label their products as “containing nitrate or nitrite.” You can’t even call it natural. “In the European Union, ‘natural’ claims are also not permitted….”

    When Consumer Reports put it to the test, it found the nitrite levels in all the products were essentially the same, so “‘no nitrites’ doesn’t mean no nitrites.” Consumer Reports and the Center for Science in the Public Interest have petitioned the U.S. Food Safety and Inspection Service of the Department of Agriculture to stop this misleading practice. Nitrites are nitrites, and “their chemical composition is absolutely the same, and so are the health effects.”

    Yes, processed meat is a known carcinogen, but How Much Cancer Does Lunch Meat Cause? 

    I have many videos on both nitrites and nitrates. I know it can be confusing, so be sure to check them out. 



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  • Is There a Limit to How Many Lychee Fruit We Should Eat? 

    Is There a Limit to How Many Lychee Fruit We Should Eat? 

    There is a toxin in lychee fruit that can be harmful, but is it harmful only under certain circumstances?

    Lychee fruits have been widely used in many cultures for the folk medicine treatment of everything from farting to testicular swelling. (Arsenic, mercury, and lead are also included in many “traditional” remedies.) Lychees have also apparently “been shown to exhibit numerous health benefits,” but the studies cited include ones like this: “Protective Effect of a Litchi [Lychee]…-Flower-Water-Extract on Cardiovascular Health in a High-Fat/Cholesterol-Dietary Hamsters.” What are we supposed to get from that? We don’t eat lychee flowers…and we aren’t hamsters. Hard to argue with this, though: “Flavor is sweet, fragrant, and delicious,” which is why I love them so much. I then saw this: “A child-killing toxin emerges from shadows. Scientists link mystery deaths…to the consumption of lychees.”

    In Vietnam, it’s called “nightmare” encephalitis. There were unexplained outbreaks in children coinciding with lychee harvesting. Children go to bed feeling fine, but they wake up the next morning “seriously ill with brain function derangement and seizures”—if they wake up at all. The same in India, killing up to nearly two out of three kids affected in some places. We’re talking about thousands of kids, so it became “one of the most pressing public health emergencies in India.” It was one of the “three long-standing mystery diseases listed in Wikipedia” and remained a mystery for more than two decades.

    All clinical samples were negative for known brain viruses. So, some investigators thought it was caused by an unknown virus, while others thought it might have been due to the pesticides used in the orchards. All we knew was that it seemed to coincide with the lychee harvest. So, might the fruits have attracted fruit bats, then mosquitos could have fed on the infected bats and transferred some new virus from bats to people? Maybe, but why would toddlers and babies be mostly spared? Mosquitoes bite infants, too.

    So, were kids swapping spit with the fruit bats by eating half-eaten fruits? “The investigators noted colonies of fruit-eating bats and the tendency of children eating fruits to fall to the ground and suggested the possibility of a bat virus (through saliva contamination on fruits) as a cause of the disease.” Or maybe it was because it was summertime, and they were all just getting heat stroke? Maybe, but why weren’t the pesticides or the heat affecting adults, too?

    One of the clues that finally helped investigators tease out the mystery was that the children consistently had low blood sugars—in some cases, fatally low blood sugars. That kind of sounds like “Jamaican vomiting sickness.” Two children “were perfectly well” when they went to bed, but, by “the next morning, they started to vomit and were weak,” then unconscious, then both dead within 48 hours. That was all due to eating unripe ackee fruit, which contains a toxin known as hypoglycin, which prevents our liver from churning out blood sugar all night long to keep our brains alive while we sleep. Ackee is a member of the soapberry family, just like the lychee is. Aha!

    As I discuss in my video Lychee Fruit and Hypoglycin: How Many Are Too Many?, Muzaffarpur is a leading lychee producer, and experts at the National Center for Litchi claim they “completely refuted” the lychee link. Nevertheless, independent researchers found it: Lychee fruit contains methylene cyclopropyl-glycine, nearly the same hypoglycin toxin “present in ackee fruits, popular in Jamaica.”

    So, in the setting of malnourished children who already have depleted energy stores in their livers “(due to missed meals and poverty-related starvation),” low blood sugar sets in, and, due to the excessive consumption of lychee fruits, the production of new energy is blocked, and the trouble starts. “It is a social tragedy that children have to die in the 21st century due to…hypoglycemia [low blood sugar], which is an easily treatable condition and involves minimal costs.” It’s just as tragic that hungry children are forced to binge on lychees falling on the ground to get a meal. It’s like something out of Grapes of Wrath.

    The happy ending, though, is that rather than just focusing on better treatments, local public health workers instead sought to treat the cause by educating people “that no child should go to bed at night without eating a cooked meal and for parents to restrict children eating litchis in the evening to none or very few.” Thankfully, “by applying these recommendations, the disease incidence had been dramatically reduced and death almost completely prevented.” In hindsight, it appears China had already started warning citizens about the dangers of lychees a decade earlier, but word had apparently not gotten around. 

    What are the implications in the West? In the United States, the Food and Drug Administration tried to protect people against poisoning with this toxin (which is not destroyed by heating) by mandating that canned ackee fruits coming into the country test below a certain level, but there are no such regulations when it comes to importing lychees. “Fortunately, the high cost of these imported fruits and the likelihood that [they] would be eaten in small quantities by well-nourished consumers, suggests there is little reason for concern in the USA.” That’s quite an assumption. Small quantities? You don’t know how I eat lychees. I used to sneak big bags of them—pounds of them—into movie theaters to snack on during the film. How many are too many to eat?

    In a series of a few hundred poisoning cases, people reported eating 300 grams to a kilogram of lychee fruits. Each lychee is about 10 grams, so that’s 30 to 100 fruits. Most of the cases were children, though, so we can probably safely say 30 to 100 lychees are too many at one time for kids. What about adults? In a self-experiment, a researcher ate some lychees and measured the hypoglycin levels in his blood and urine, which stayed below the levels seen in the affected children. He ate 5 grams of canned lychee for each kilogram of his body weight, equivalent to about 45 lychee for the average American male, and didn’t suffer any ill symptoms. 

    What a fascinating story! A lot of research went into just this one topic, but it was all news to me, so I wanted to share it with you.

    In general, Is Canned Fruit as Healthy? And, given the sugar content, How Much Fruit Is Too Much? Check out the videos to find out. 



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  • Heme Iron and Cancer 

    Heme Iron and Cancer 

    Laboratory models suggest that extreme doses of heme iron may be detrimental, but what about the effects of nutritional doses in humans?

    In muscle meat, there is a heme protein that contributes to, well, the meaty taste of meat. There’s also a heme protein in the roots of soybean plants that can be churned out to provide a similar flavor and aroma in plant-based meat, which is used to make the Impossible Burger possible. The question is: Are there any downsides?

    When the European Food Safety Authority was considering the safety of adding heme iron to foods, its main concern was a potential increased risk of colon cancer. As you can see below and at 1:00 in my video Does Heme Iron Cause Cancer?, we know meat causes cancer. Processed meat—bacon, ham, hot dogs, sausages, and lunch meat—is considered a Group 1 carcinogen, meaning we know it causes cancer in people with the same level of certainty that something like smoking causes cancer, whereas something like a burger probably causes cancer in people, kind of like DDT. But what’s the role of heme iron? 

    There are all sorts of potential mechanisms to explain the cancer risk. Meat has the pro-inflammatory long-chain omega-6 arachidonic acid and more of the aging- and cancer-associated methionine, trans fat, and endogenous hormones like IGF-1, not to mention the ones that are implanted in animals as “exogenous hormonal growth-promoters.” Then there are all the toxic pollutants that build up the food chain, like pesticides and formaldehyde.

    According to the prestigious IARC, the International Agency for Research on Cancer, “there is strong evidence that HAAs [heterocyclic aromatic amines], by causing DNA damage, contribute to carcinogenic mechanisms associated with the consumption of red meat.” These DNA-damaging compounds are formed when muscle tissue is exposed to high, dry heat like grilling, roasting, baking, and broiling—basically anything above steaming or stewing. There is also “strong evidence” that the formation of so-called N-nitroso compounds contributes to the cancer-causing mechanism. Those are carcinogens that can form inside our gut when we eat meat. However, there is also “strong evidence that haem [heme] iron contributes to the carcinogenic mechanisms associated with red and processed meat.”

    Normally I might leave it there, but other authoritative bodies I respect, like the American Institute for Cancer Research and the World Cancer Research Fund, are more tentative. While they agree there is some evidence that the “consumption of foods containing haem iron might increase the risk of colorectal cancer,” they consider the evidence suggesting such a connection to be limited.

    Much of the available evidence is based on data from lab animals, such as the study titled “Dietary Heme Induces Gut Dysbiosis, Aggravates Colitis, and Potentiates the Development of Adenomas in Mice,” in which dietary heme was found to disrupt the gut flora, aggravate inflammation, and potentiate the development of intestinal tumors in mice. But it’s critical to note that, in all the laboratory animal models that have been used, the rodents ingested meat or heme equivalent to humans eating up to 40,000 pounds (18,000 kilograms) of meat a day. Even the smallest dose would be about a dozen daily Impossible Burgers.

    In another study, ascribing “a central role for heme iron” in the development of colon cancer associated with meat intake, the authors claimed they “aimed at determining, at nutritional doses, which is the main factor involved and proposing a mechanism of cancer promotion by red meat.” So, heme “doses were chosen to mimic red meat consumption,” and, indeed, there was a significant increase in tumor load, as you can see here and at 3:41 in my video

    The researchers concluded that their “results strongly suggest that at concentrations that are in line with human red meat consumption, heme iron is associated with the promotion of colon carcinogenesis,” that is, cancer development. However, if you look at the actual diet given to the participants and do the math, it was 500 times the level of heme found in people’s diets, in excess of about 20 pounds of meat a day. Of course, even if they really did use the right doses, they’re still going to end up with data on the wrong species, which brings us to clinical studies that we’ll explore next. 

    This is part of a nine-video series on plant-based meats. If you missed any of the other earlier installments, check out the related posts below.

    The final two videos in the series are coming up next. See Heme-Induced N-Nitroso Compounds and Fat Oxidation and Is Heme the Reason Meat Is Carcinogenic?.



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  • How to grow your GP referral network

    How to grow your GP referral network

    Reaching out to busy GPs can feel intimidating – but with the right strategies, you can build authentic relationships, work collaboratively and become a trusted referral choice. In this episode, GP Dr Angela Kwong shares expert insights to help dietitians confidently connect with doctors, stand out and secure repeat referrals.

    Hosted by Brooke Delfino

    Biography

    Dr Angela Kwong is a General Practitioner from Sydney and the NSW State Lead for the Specific Interests Group in Obesity Management with the RACGP. She is the Founder of Enlighten Me, an online multidisciplinary weight loss program integrating medical care, nutrition education and exercise. Passionate about reducing weight stigma and increasing access to evidence-based weight management options, she organised The Australian Weight Loss Summit, bringing together health professionals and the public for education and open discussion.

    In this episode, we discuss:

    • How to confidently introduce yourself and build trust with GPs
    • Why personal connections matter more than email outreach
    • Practical ways to stay top-of-mind without being pushy
    • The biggest mistakes dietitians make when networking with GPs
    • The power of niching and clear communication in GP referrals

     


    Additional resources

    Connect with Angela at enlightenme.com.au, on LinkedIn or on Instagram @drangelakwong

    Click here for Dietitians Unite 2025 tickets in Melbourne on 30 May

     

    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.



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