Health Journal Online

Category: Nutrition

  • Do Pomegranates Live Up to Health Claims?

    Do Pomegranates Live Up to Health Claims?

    Pomegranates are put to the test for weight loss, diabetes, COPD, prostate cancer, osteoarthritis, and rheumatoid arthritis.

    The case of POM Wonderful (the pomegranate juice company) vs. Federal Trade Commission made it all the way up to the U.S. Court of Appeals before being denied review by the Supreme Court. In that landmark case, a panel of judges concluded that many of POM’s ads made false or misleading claims and the company “touted medical studies ostensibly showing that daily consumption of its products could treat, prevent, or reduce the risk of various ailments, including heart disease, prostate cancer, and erectile dysfunction.” The U.S. First Amendment does not protect misleading and deceptive ads. Striking a blow to its billionaire owners, the Court ruled that at least one randomized clinical trial would be required to substantiate claims of treating or preventing disease.

    If you look at the medical literature on pomegranate in general, you’ll see reviews touting its many benefits, with diagrams like the one below on the medicinal effects of pomegranates (which you can also see at 1:01 in my video Pomegranate: A Natural Treatment for Rheumatoid Arthritis).

    But if you dig a little deeper, you see this is based on studies like one that talks about the “antiobesity effects of pomegranate leaf extract in a mouse model.” First of all, who eats pomegranate leaves? And second, who’s a mouse?

    Does pomegranate consumption affect weight in humans? If you look at all the randomized controlled clinical trials (meaning human trials), pomegranates have no significant effect on body weight, BMI, belly fat, or even body fat percentage in those randomized to consume pomegranate products. What about the prevention and treatment of cardiovascular diseases? Researchers reviewed 25 clinical trials, looking at cholesterol, blood pressure, artery function, atherosclerotic plaque formation, and platelet function, and did not find significant indications of benefit even in the best studies.

    POM Wonderful helped fund a study on pomegranate juice and erectile dysfunction, but it failed as well. Other studies found no benefit for diabetes markers and observed no benefit for chronic obstructive pulmonary diseases, such as emphysema. They were banking on the antioxidant activity of pomegranate juice to help, but that’s antioxidant activity in vitro (meaning in a test tube or petri dish). To my surprise, a meta-analysis of data from 11 randomized controlled trials “did not support convincing evidence” of pomegranate intake having a significant effect on increasing the total antioxidant capacity in the bloodstream because some of the most potent antioxidants don’t even seem to be absorbed into the human body. No wonder pomegranate supplementation didn’t seem to affect oxidative stress in tissue samples taken from prostate cancer patients. But, of course, what we care about is whether it affects the cancer itself.

    The strongest evidence for the anticancer activity of pomegranates is said to come from studies on prostate cancer. Unfortunately, early promising results were not confirmed when they were actually put to the test. For example, daily pomegranate intake was found in a randomized controlled trial to have no impact on PSA levels, a marker of tumor progression. Additionally, a randomized, double-blind, placebo-controlled trial found essentially no difference when it came to prostate cancer disease progression, as you can see below and at 3:19 in my video.

    They were banking on the anti-inflammatory activity of pomegranate juice to help, but again, that had been demonstrated in vitro. In people, a meta-analysis based on five randomized controlled trials published in 2016 concluded that pomegranate juice did not have a significant effect on C-reactive protein levels, a key marker of inflammation. If you look at the forest plot, though, you’ll see all five trials tended towards lower C-reactive protein levels such that the data combined almost reached statistical significance, as you can see below and at 3:53 in my video.

    Indeed, an updated meta-analysis published in 2020 based on seven studies crossed the threshold into statistical significance and found a significant drop in two other inflammatory markers as well.

    Perhaps pomegranate juice could help in the control of inflammatory diseases after all. But you don’t know until you put it to the test.

    Osteoarthritis involves the degeneration of the cushioning cartilage within joints, particularly the knees. Dripping a pomegranate extract on human osteoarthritic cartilage samples appears to show cartilage-protective effects. As you can see below and at 4:43 in my video, compared to baseline levels of cartilage disintegration, adding inflammation triples the damage. However, with increasing amounts of pomegranate extract, the breakdown starts to calm down.

    But again, that’s in a petri dish. How do we know that when we eat pomegranates, the active components actually get into our bloodstream so they can find their way into our joints? Cartilage-protecting components were found to be bioavailable (at least in rabbits), raising the possibility that pomegranates could be a safe and non-toxic treatment with no side effects, as opposed to the drugs currently in use. But is it effective?

    The first clinical trial on pomegranate juice and osteoarthritis was not a placebo-controlled trial, but instead randomized people to pomegranate juice or nothing at all. Those drinking the juice did report less stiffness and impairment of physical function, but not significantly better than just doing nothing. Shoot.

    Just as I was about to give up on pomegranates, I saw a study titled “Consumption of Hydrolyzable Tannins-Rich Pomegranate Extract Suppresses Inflammation and Joint Damage in Rheumatoid Arthritis.” But it turned out to be from the POM “Not-So-Wonderful” company, inducing joint damage in a mouse as a model of rheumatoid arthritis. Come on!

    There was an open-label study, where the patients knew what they were getting. Eight people with active rheumatoid arthritis took pomegranate extract every day, and the six who stuck with it reported fewer tender joints. But as we learned from the osteoarthritis study, if you don’t have a control group, you have no sense of what role, if any, the treatment actually plays.

    Finally, we come to this randomized, double-blind, placebo-controlled trial. It’s about time! Half the study participants unknowingly got some pomegranate extracts; the other half unknowingly got the equivalent of a sugar pill. There appeared to be a significant improvement in the number of swollen joints, tender joints, pain intensity, a disease activity score, a health assessment questionnaire, and morning stiffness compared to placebo. So, if you have rheumatoid arthritis, I would indeed recommend you start eating pomegranates. Why not just pop pomegranate pills? After all, it was a pomegranate extract that alleviated disease activity. One good reason to stick to the fruit is that when 19 pomegranate supplements were tested in a laboratory, most didn’t actually appear to have any pomegranate in them at all! Only 6 out of 19 appeared to be authentic.

    Doctor’s Note

    I previously reported on POM Wonderful back in 2011 in my video Is Pomegranate Juice That Wonderful?. My other video on this fruit is Flashback Friday: Pomegranate vs. Placebo for Prostate Cancer.

    What’s one way you can eat them? Check out my cooking video for Cran-Chocolate Pomegranate BROL Bowl.



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  • Beyond Elimination Diets | Dietitian Connection

    Beyond Elimination Diets | Dietitian Connection


    Welcome to a special Gut Health Month episode of The Dietitian Connection Podcast. This March, we’re celebrating Gut Health Month 2026 by bringing dietitians together to deepen our knowledge, strengthen our confidence, and amplify our voice to create meaningful impact in practice and beyond.

    In this episode, we’re joined by leading gut health dietitian Nicole Dynan to explore how dietitians can build confidence in this rapidly growing space. Tune in for practical insights and inspiration to help you feel empowered in your gut health practice.

    Hosted by Kate Agnew

    Biography

    Nicole Dynan is the founder of The Gut Health Dietitian (established in 2014) and one of Australia’s leading gut health experts. After a decade in corporate chronic disease management, Nicole saw first-hand how gut health impacts energy, stress, mood, and overall well-being. Since then, and together with her team, she’s helped over 40,000 people improve their gut health, feel more comfortable, and regain control of their overall health through science-backed nutrition. 


    In this episode, we discuss:

    • How dietitians can build confidence and credibility in gut health through targeted upskilling and staying across emerging research and trends
    • The shift in gut health care from restriction to focusing on foundations
    • Why it’s important for dietitians to raise their voice, strengthen their influence and work together to lead evidence-based gut health conversations
    • The importance of recognising what stage of behaviour change a client is in and adapting your approach to meet them where they are

    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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  • Fighting Cancer with Whole Plant Foods

    Fighting Cancer with Whole Plant Foods

    The foundation of cancer prevention is plants, not pills.

    “The vast majority of cancer research is devoted to finding cures, rather than finding new ways to prevent disease. The results of these skewed priorities are plain to see.” It’s been nearly 55 years since President Richard Nixon declared war on cancer, yet deaths from the most common cancers in the United States have continued unabated.

    “We have been looking at the very nature of cancer in the wrong way. Breast cancer doesn’t begin when a lump is first felt or detected by a mammogram. All the common epithelial cancers (lung, colorectal, breast, prostate, pancreas and ovary), which account for the majority of deaths, have a long latency period—often 20 years or more.” So, it’s not like you were healthy one day, then got cancer the next. You haven’t been healthy—you’ve had cancer growing in you for decades. Indeed, there’s a “bizarre misperception that people are ‘healthy’ until they have actual symptoms of invasive cancer,” but “the barn in which hay is smoldering before it bursts into flames is not a safe place.”

    So, what does this professor of pharmacology I’ve been quoting recommend? Drugs, of course. Chemoprevention—putting people on drugs to prevent cancer. The pharmaceutical industry spends tons of money promoting chemoprevention of heart disease and strokes with statins and blood thinners, so why shouldn’t people take drugs every day for the rest of their lives to protect against cancer?

    There has to be a better way.

    What about using diet and nutrition to prevent and treat cancer? Well, what kind of cancer? There are more than 200 types. But here’s the key: They all share the same hallmarks. In a series of papers cited more than 40,000 times in the biomedical literature, 10 hallmarks of cancer have been identified:

    • Increased sensitivity to growth factors
    • Evading your body’s tumor suppressors
    • Dodging your immune system
    • Being able to grow forever
    • Tumor-promoting inflammation
    • The ability to invade and spread
    • The ability to hook up its own blood supply
    • The accumulation of DNA mutations
    • Disarming the self-destruct mechanisms in place
    • Hijacking the cell’s metabolism

    And, of course, there are classes of drugs to try to counter each one—chemotherapy agents designed to target each piece of the cancer puzzle. You can see them below and at 2:27 in my video Fighting the Ten Hallmarks of Cancer with Food.

    Now, ideally, there would be drugs able to target multiple hallmarks at one time, but that’s not how drugs tend to work. Indeed, “this need to target multiple hallmarks is one of the major reasons why, in the context of cancer research, there are many proponents of investigating plant foods as they can deliver a cocktail of bioactive compounds” that may target most, if not all, of the hallmarks of cancer. Below and at 3:00 in my video, you can see a sampling of compounds found in fruits and vegetables—such as berries, greens, and broccoli—shown to be able to target each of the 10 hallmarks of cancer, at least in a petri dish.

    Furthermore, they have the qualities of an ideal chemopreventive agent. If you were to design the perfect candidate, you’d want them to be selective to cancerous or precancerous cells while leaving normal cells alone, be side-effect-free, target most types of cancers, be able to be consumed in a daily diet, be conveniently available almost everywhere, and be relatively inexpensive to boot. Plants meet all these criteria. No wonder people who eat more plant-based foods tend to have lower cancer rates.

    To be clear, we aren’t talking about taking supplements containing extracts or purified phytochemicals, but rather eating whole plant foods themselves—more of a food system–based approach to targeting the hallmarks of cancer. Foods contain thousands of substances that result in vast numbers of possible interactions, yet much of nutritional science “has long been directed towards the impact of single dietary components.” Yes, this kind of reductionist approach can uncover the role of foods or even individual nutrients in disease development, but let’s think about what the optimal research strategy would be to study the effects of bioactive natural plant compounds on disease prevention. Instead of using isolated phytochemicals to manage cancer, why not try whole foods? Sometimes the whole can be greater than the sum of its parts, a concept known as food synergy.

    Check out this study involving the simultaneous inhibition of a series of cancer stages in breast cancer cells using a phytochemical supercocktail. Two breast cancer cell lines were treated with six different plant compounds individually, and then all together, at levels typically found in the bloodstream after eating foods like broccoli, grapes, soybeans, and turmeric. And while the compounds were ineffective individually, together they significantly suppressed breast cancer cell proliferation by more than 80%, inhibited cancer cell invasion and migration, stopped the cancer cells in their tracks, and eventually killed them all off. The plant compounds did all this without having any deleterious effects on the normal noncancerous cells used as control.

    No wonder the foundation of cancer prevention—based on an update of the most extensive report on diet and cancer ever published—is not pills, but plants, as you can see below and at 5:28 in my video.

    In other words, cut down on alcohol, soda, meat, and processed junk, and center your diet around whole grains, vegetables, fruits, and beans.

    Doctor’s Note

    I have dozens of videos on cancer prevention and treatment. Check the related posts below. 



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  • Can It Lower Your Cancer Risk?

    Can It Lower Your Cancer Risk?

    Does choosing organic over conventional foods protect against cancer? What are the effects of pesticides on cancer risk?

    In a review updating the evidence on human exposure and toxicity of pesticides, the body of evidence linking pesticide exposure and cancer is said to be so massive that pesticides’ role in the development of cancer “cannot be doubted.” However, most of the evidence that shows DNA damage from pesticides is from occupational exposure among farmers and workers in the fields, the pesticide industry itself, or those living in high-spray areas, as you can see at 0:35 in my video Pesticides and Cancer Risk.

    There is evidence linking non-occupational pesticide exposure to DNA damage—in this case, single- and double-stranded DNA fragmentation in the sperm of men with higher levels of pesticides flowing through their bodies—but that was in China, where the average pesticide concentrations are as much as four times higher than in some other parts of the world.

    Another way pesticides could potentially facilitate tumor growth is through adverse effects on anticancer immunity. Natural killer (NK) cells are our body’s first line of white blood cell defense against cancer cells and virus-infected cells. Pesticides have been shown to induce harmful effects on these defender cells, reducing their ability to kill off tumor cells. For example, if you put a bunch of NK cells in a petri dish along with human leukemia cells without any pesticide, your natural killer cells can clean house and wipe out more than half the cancer. But if you drip a tiny bit of pesticide on them, the NK cells are so disabled that the cancer wins the day, as you can see below and at 1:37 in my video.

    But how much pesticide are we talking about? The researchers used the maximum level found in people actively spraying pesticides. But what about looking at just the residual pesticides left on conventional produce? Is choosing organic for cancer prevention worth the investment?

    Pesticides are detectable in the blood and urine of more than 90% of the U.S. population, regardless of where they work or live. We know it’s from the food we eat because crossover trials where people are switched between consuming conventionally grown foods and organic foods show you can turn on and off urinary concentrations of pesticide metabolites like a light switch. But that doesn’t necessarily mean the pesticides are harming us.

    The health consequences of ingesting pesticide residues from conventionally grown foods remain unknown, but a recent study did find that people who self-reported the highest frequency of organic food consumption had about a 25% lower risk of getting cancer. The study is the first of its kind to evaluate the association between frequency of organic food consumption and cancer risk, controlling for a wide array of other factors. Doesn’t it matter that consumers eating organic are younger? The researchers controlled for that and still found significantly lower cancer risk. But maybe organic consumers get less cancer because they are more affluent or more highly educated or skinnier, or maybe they exercise more or eat less meat or smoke less. No, the researchers controlled for all that and still found significantly lower cancer risk in organic consumers. Maybe their diets were different in other ways, though—more fruits and vegetables overall, or less junk food? No, they still found significantly lower cancer risk. The researchers concluded, “Our results indicate that higher organic food consumption is associated with a reduction in the risk of overall cancer.”

    That was the most sophisticated study of its type to date, but there was an earlier study that was even bigger, and little evidence was found for a decrease in the incidence of all cancers except for perhaps one kind of blood cancer—non-Hodgkin lymphoma. You can see the data below and at 3:59 in my video.

    The data show no difference in cancer overall between those who never choose organic and those who usually or always do; the only significant findings were a lower risk of non-Hodgkin lymphoma and an increased risk of breast cancer. Is it possible that women who choose organic food are more conscientious about getting screened for breast cancer, and that explains the higher diagnosis rate? We really don’t know.

    Of course, what we care about the most is not just cancer but all-cause mortality—the risk of dying prematurely. As it turns out, higher blood levels of a pesticide known as beta-hexachlorocyclohexane are associated with living a significantly shorter life. How do we cut down on our levels? Decades ago, there was a study that found that the breast milk of a vegetarian mother had less beta-hexachlorocyclohexane than the milk of her non-vegetarian sister, who was also breastfeeding at the time. The vegetarian sister apparently had levels of that pesticide that were lower by about a third, compared with her omnivorous sibling, as you can see below and at 4:48 in my video.

    That’s no surprise, since this class of chlorinated pesticides is fat-soluble, so they’re found most frequently in foods of animal origin.

    A more recent study failed to look at beta-hexachlorocyclohexane, but it examined polychlorinated biphenyls (PCBs) and found that they were linked to increased mortality risk. Again, the toxins were found in the same kinds of foods: eggs, dairy products, and animal fats. So, it’s no surprise that the blood of those eating vegan was found to be “significantly less polluted than omnivores” in terms of a whole series of PCBs, including those found in the study to be associated with increased mortality; but the vegans did not have lower levels of beta-hexachlorocyclohexane.

    The bottom line: If you’re worried about the adverse health effects of pesticides and pesticide-type compounds, you may want to lower your intake of animal products. But when it comes to fruits and vegetables, the benefits of eating conventionally grown produce likely outweigh any possible risks from pesticide exposure. So, concerns about pesticide risks shouldn’t discourage us from stuffing our faces with as many fruits and vegetables as possible. That would give us a huge health benefit, whereas the potential lifelong damage of any pesticides on those same fruits and veggies has been estimated to cut only a few minutes off a person’s life, on average, which is nothing compared to the nutritional benefits of eating more fruits and vegetables.

    Doctor’s Note

    For more on organic foods, see related posts below.



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  • What Does Personalized Nutrition Actually Deliver?

    What Does Personalized Nutrition Actually Deliver?

    There’s a lot of focus on personalized nutrition, but maybe we should focus on taking personal responsibility for our health.

    “Personalized nutrition (PN) is rooted in the concept that one size does not fit all,” and who doesn’t want to think they’re special? The idea of personalized nutrition is inherently appealing to our ego; that’s why simple messages recognizing individuality deeply resonate with us and why such messages are popular in marketing and sales. This focus on uniqueness has spurred the creation of personalized foods, along with the suggestion that “3D Food Printing seems to be a good candidate for food customization.”

    Now, there certainly are some legitimate differences between people. Some have a peanut allergy and keel over if they eat a peanut, others have celiac disease and need to avoid gluten, and some are genetically lactose-intolerant. There’s an enzyme mutation common in some parts of Asia that protects against alcoholism because people with the altered enzyme don’t metabolize alcohol as efficiently, so toxic metabolites build up. I published a fascinating video about fast versus slow caffeine metabolizers and the difference in health benefits that actually extends to athletic performance. Caffeine is ergogenic—performance-enhancing—but only in fast metabolizers, shaving more than a minute off 10 kilometers (about 6 miles) of cycling, whereas slower metabolizers either got no benefit or the caffeine actually slowed them down, adding two minutes to their cycling time, depending on which kinds of genes they have that code the enzyme that breaks it down. You can see these results below and at 1:24 in my video How Useful Is Personalized Nutrition?.

    But for most people, in most situations, we are more similar than different.

    While there is a specific minority of people who need a more personalized approach to nutrition, there is currently insufficient evidence to support truly personalized nutrition for most people. Yet a surprising number of direct-to-consumer genetic testing companies have proliferated, offering personalized nutrition advice. For example, there are supplement-hawking companies that claim to help consumers optimize micronutrient status based on a handful of genetic variants, even though most variants explain just a few percent of the difference in levels between people.

    Personalized nutrition is part of a broader push towards personalized medicine, also known as precision medicine. There is a “massive cultural allure” of personal control over diagnosis, treatment of disease, and prevention, spurring demand and intense commercialization. But unlike monogenetic diseases—which are rare genetic diseases caused by a single malfunctioning gene, like hemophilia or sickle cell anemia—most diseases are caused by a complex interaction between multiple genes and environmental factors, which pose a “major challenge for the realization of personalized medicine.”

    Take something like adult stature, for example. Researchers have found at least 40 locations on our chromosomes that have been associated with human height, which is strongly inherited. The genes from parents account for about 80% of the difference in height between people, yet those dozens of identified genes explain only about 5% of height variation between individuals.

    Researchers find those genetic links by using genome-wide association studies, in which all the chromosomes are scanned to look for statistical associations between diseases and any particular stretches of DNA. That’s interesting, but companies marketing genetic susceptibility tests are reinterpreting these data as if they predict individual risks. But all you’re really getting are modest genetic associations with a slight increase in disease risk and with little predictive power when compared to more significant contributions of things we already know, like lifestyle behaviors. Currently, the practice of using a person’s DNA to predict disease “has been judged to provide little to no useful information.”

    For example, let’s say a person’s genetic analysis says they’re at slightly greater risk for some grave condition compared to others in their ancestral group. This person was advised to exercise, keep their weight down, not drink too much alcohol, and eat fruits, vegetables, and whole grains. It’s sound advice, but we should be living this way regardless of our genetic risk. And we know—at least we should know—these simple, basic strategies to reduce risks of common chronic diseases. “The problem, of course, is that very few individuals live this way. Actually, to be more precise, almost nobody lives this way.” That’s not just hyperbole—nationwide surveys show that nearly everyone in the United States consumes a diet that’s not on par with even the wimpy recommendations of the Dietary Guidelines.

    Indeed, almost “no one in the United States is eating a healthy diet.” Findings like that remind us that when it comes to public health, “worrying about personalizing our preventive strategies based on genetic risk information borders on the absurd.”

    Doctor’s Note

    Here’s the video I mentioned about fast versus slow caffeine metabolizers and the difference in health benefits extending to athletic performance: Friday Favorites: Do the Health Benefits of Coffee Apply to Everyone?.

    For more about lifestyle approaches, check out related posts below.



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  • The Link Between Milk and Parkinson’s Disease

    The Link Between Milk and Parkinson’s Disease

    Is the brain damage associated with milk consumption due to the banned pesticide heptachlor or the milk sugar galactose?

    Parkinson’s disease is a neurodegenerative brain disorder that affects millions of people. What causes it? Well, if you look at lifestyle factors associated with Parkinson’s disease, dairy consumption is the strongest dietary factor associated with an increased risk of Parkinson’s disease. In fact, dairy products are the only food group consistently linked with a high risk of developing Parkinson’s. Five large prospective studies have confirmed the link. This includes the two Harvard cohorts, the Nurses’ Health Study and the Health Professionals Follow-up Study, which followed more than 100,000 people combined for decades in “the largest analysis of dairy and PD [Parkinson’s disease] to date,” analyzing more than 1,000 newly diagnosed cases. All the studies found a link between dairy and Parkinson’s, with most finding a significant link—about a 50% increase in risk overall in those drinking the most milk compared to those drinking the least, at a p-value below 0.00001, meaning there’s less than a 1 in 100,000 chance you’d randomly get a finding that extreme. You can see this in the chart below and at 1:13 in my video, The Role Milk May Play in Triggering Parkinson’s Disease.

    Okay, but why is there a link at all? “Despite clear-cut associations between milk intake and” incidence of Parkinson’s, “there is no rational explanation,” concluded one review. A year later, though, we got a clue: “Midlife milk consumption and substantia nigra neuron density at death.” What does that mean? Parkinson’s is caused primarily by the loss of a certain type of nerve cells in a critical part of the brain, with symptoms first appearing once most of these neurons have died. So one study looked at how much milk people drank when they were in their 40s, 50s, and 60s, and then examined their brains at autopsy and counted how many of those critical neurons they had left. In every single quadrant, neuron density was highest “in those who consumed no milk and lowest in those who consumed the most milk.” Even after removing the Parkinson’s cases, those drinking two cups (473 mL) of milk a day had up to 40% fewer nerve cells in most quadrants of that critical brain region. What’s in milk that could be wiping out brain cells? Among the people who drank the most milk, residues of the pesticide “heptachlor epoxide were found in 9 out of 10 brains.” So, maybe the finding of pesticide residues more commonly in the brains of those who drank the most milk could explain how milk could be cause-and-effect related to Parkinson’s disease risk.

    Now, that’s not the only potential explanation. In one of my videos, I talked about how meat contains that clumpy neurotoxic protein alpha-synuclein. Well, dairy products may contain trace amounts as well, but we don’t have confirmation of that. Could the milk sugar “galactose be the missing link?” Galactose is what the lactose in milk breaks down into once it’s in the body. It’s also what’s used to induce aging—to experimentally cause aging—in the brain. When you drink it, the galactose is picked up by your brain within a few hours, and for doses above 100 mg/kg, it appears that galactose can cause pathological alterations in brain cells, similar to those observed in Parkinson’s disease. This amount “can be reached and surpassed” by simply drinking two glasses (473 mL) of milk (the main dietary source of galactose) each day. And of all your brain cells, those dopaminergic neurons—the ones that you need to retain to prevent Parkinson’s—may be more vulnerable to galactose-induced damage because they are more vulnerable to oxidative stress.

    Galactose may also explain the findings linking milk drinking with higher death rates. You may be thinking, “Well, duh—the saturated butterfat is just cutting people’s lives short,” but higher mortality with high milk consumption has been observed regardless of the milk fat content. Skim milk might be fat-free, but it’s not lactose-free.

    Can’t you just drink lactose-free milk, like Lactaid? That has the lactase enzyme added to make lactose-free milk. But it just breaks down lactose into galactose in the carton rather than in your gut, so you’re still ingesting the same amount of galactose. Perhaps it’s no wonder that more milk intake at midlife may be linked to a greater rate of cognitive decline. Remember, researchers use galactose to create brain aging in the laboratory. D-galactose, a metabolic derivative of lactose, has been extensively used in animal models “to mimic cognitive aging” through oxidative stress. Compared to those who said they “almost never” drink milk, those drinking more than one glass (237 mL) a day appear more likely to suffer a decline in global cognitive function.

    Doctor’s Note

    Here’s the meat video I mentioned: The Role Meat May Play in Triggering Parkinson’s Disease.

    You may remember that I’ve explored this before in Could Lactose Explain the Milk and Parkinson’s Disease Link?. Uric acid may also be a contender—see Parkinson’s Disease and the Uric Acid Sweet Spot.

    For more on Parkinson’s disease, check out related posts below.



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  • Can Onions Help with Weight Loss, Cholesterol, and PCOS?

    Can Onions Help with Weight Loss, Cholesterol, and PCOS?

    Let’s talk about treating weight loss, cholesterol, and PCOS with diet. What can an eighth of a teaspoon a day of onion powder do for body fat, and what can raw red onion do for cholesterol?

    In one of my previous videos about onions, I talked about the data supporting—or not supporting—the role of onions in boosting testosterone in men, protecting bone health, controlling allergies, and dealing with the side effects of chemotherapy. What about weight loss? Enter the “Effect of Steamed Onion (ONIRO) Consumption on Body Fat and Metabolic Profiles in Overweight Subjects.” Researchers used steamed onions, which aren’t as spicy and have a weaker smell, so they could better disguise them as a placebo. They dried them into onion powder and gave people a minuscule amount—about an eighth of a teaspoon (300 mg) a day. Surely, a little daily dusting of onion powder wouldn’t affect people’s weight. But check out the results reported in the abstract: Measurements using a DEXA scan showed a significant reduction in body fat mass, and a CT scan revealed a significant decrease in whole, visceral, and subcutaneous fat areas.

    Hold on. If a little onion powder is so effective for weight loss, why wasn’t it featured in my book How Not to Diet? Because, as so often happens in studies, the spin in the abstract doesn’t accurately represent the actual data. The DEXA scan results measured no significant change of fat in the group that got the placebo capsules. They only appeared to lose about a spoonful (7 g) of fat, whereas the group unknowingly taking an eighth of a teaspoon of onion powder stuffed into capsules lost nearly one and a half pounds (0.64 kg) of body fat—a significant drop from baseline, but not a statistically significant drop compared to the placebo group, meaning the loss could have just been due to chance. Same thing with the CT scan results: 5 times more loss of overall fat and over 30 times more loss of the dangerous visceral fat, but the results did not reach statistical significance compared to placebo.

    A more recent study tried four teaspoons (9 g) of onion powder a day and similarly failed to accelerate the loss of visceral, total, or subcutaneous fat compared to placebo—but the placebo was also four teaspoons (9 g) of onion powder a day. They used yellow onions versus white onions, and it seems they both may have caused a loss of abdominal body fat, without a significant difference between them. Either way, you might look at these two studies and think, sure, but what are the downsides? It’s only an eighth of a teaspoon of onion powder a day, so why not give it a try? It can’t hurt, but we just don’t have enough evidence to be confident it will actually help.

    Let’s talk about polycystic ovary syndrome, also known as PCOS. It’s one of the most common hormone disorders, affecting 5% to 10% of reproductive-aged women. In addition to causing symptoms like irregular periods, “PCOS is a pre-diabetic state, with decreased insulin sensitivity.” PCOS treatment is challenging due to medication side effects. So, are there dietary options? How about a randomized controlled clinical trial of raw red onion intake?

    Why onions? Well, onion extracts can evidently improve blood sugar and insulin sensitivity in rats with diabetes and, more importantly, were found to reduce blood sugar levels in humans with diabetes, but evidently not in non-diabetic humans. People with PCOS are kind of pre-diabetic, so would it work for them? First, let’s look at those other two studies. To study the “Metabolic Effects of Onion and Green Beans,” people with diabetes spent a week eating either a small onion (60 g) each day or the same diet with about six cups (600 g) of green beans instead—and both approaches worked. The onion lowered people’s blood sugar levels by about 10% compared to a non-onion control diet, while the green beans lowered them by roughly 15% compared to the control.

    Here’s the study that supposedly shows no blood sugar benefits for people without diabetes. It’s true—onions don’t seem to lower normal blood sugar levels, which is a good thing, but check out what happens when you feed people sugar. Have people consume about two and a half tablespoons (50 g) of corn syrup, and their blood sugar levels shoot up over the next two hours before their body can tamp it back down. But give people the exact same amount of sugar along with more and more onion extract, and the blood sugar spike is significantly dampened, almost as much as if you had instead given them an antidiabetic drug, as you can see below and at 4:00 in my video Onions Put to the Test for Weight Loss, Cholesterol, and PCOS Treatment.

    We see the same blunting effect on blood sugar when people get a shot of adrenaline and eat onion extract, compared to receiving adrenaline without the onion extract, as you can see below and at 4:11 in my video.

    So, are there blood sugar benefits for both people with and without diabetes? No difference was found in blood sugar levels or other markers of insulin resistance between the high-onion and low-onion groups of PCOS patients, nor were there any differences in a marker of inflammation between the two groups. But women with PCOS aren’t just at higher risk for diabetes and inflammation—they are also at higher risk for high cholesterol.

    Women with PCOS are over seven times more likely to have a heart attack and develop heart disease, the number one killer of women. But consuming raw red onion appears to be effective in lowering cholesterol, though the group that ate more onions only dropped their LDL cholesterol about 5 points (5 mg/dL), which was not significantly different than the group that ate fewer onions.

    I did find this study from 50 years ago where researchers fed people nearly an entire stick (100 g) of butter, and their cholesterol shot up about 30 points within hours of consumption but by only 9 points or 3 points when combined with about a third of a cup (50 g) of raw or boiled onion. The moral of the story: Don’t eat a stick of butter.

    Doctor’s Note

    Check out the previous video I mentioned: Friday Favorites: Are Onions Beneficial for Testosterone, Osteoporosis, Allergies, and Cancer?.



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  • Weight-Loss Devices to the Extreme

    Weight-Loss Devices to the Extreme

    Let’s discuss the safety and efficacy of various weight-loss methods, ranging from Botox and corsets to siphons and tapeworms.

    A moderately obese person doing moderately intense physical activity, like biking or brisk walking, would burn off approximately 350 calories an hour, but most drinks, snacks, and other processed junk are consumed at a rate of about 70 calories (293 kJ) per minute. Therefore, it only takes five minutes to wipe out a whole hour of exercise.

    Enter the AspireAssist siphon assembly.

    It’s a percutaneous gastrostomy device, meaning surgeons cut a hole in a person’s stomach and tunnel a fistula out through the abdominal wall. So, after each meal, the person can attach a suction gadget to the hole and directly drain out their stomach contents, as you can see below and at 0:47 in my video Extreme Weight-Loss Devices.

    This means you could gorge on donuts, spew them out through the hole in your stomach, then gorge on more donuts. Have your cake, and eat it, too…and two, three, and four times!

    It seems to be the quintessential American invention, straight from the land that brought us Jell-O salads, spray cheese, and deep-fried Snickers bars. Patients do lose weight, perhaps in part because the fistula may interfere with the relaxation of the stomach wall during a meal. The process also requires drinking lots of water and thoroughly chewing food, both of which may help with weight loss by increasing hydration and slowing the eating rate. Patients also started making healthier choices to avoid the unpleasant sight of gastric aspirate from unhealthy foods. (The tubing is clear, and, evidently, fried foods look particularly gross as they are pumped out.)

    All patients need to take supplemental potassium, since it’s sucked out in stomach juices. Otherwise, they risk becoming potassium-deficient (a common complication in bulimia), but most side effects are just minor wound complications. Serious adverse effects, like abdominal abscesses, are rare. The big selling point is that the siphon device doesn’t change the gastrointestinal tract’s anatomy. That seems like a low bar, but in today’s Wild West world of weight-loss procedures, you can’t take anything for granted. Take the duodenal-jejunal bypass liner, for example.

    Gastric bypass surgery works in part by cutting out a portion of the small intestine so it’s no longer in the flow of food, thereby helping to prevent the absorption of calories. Instead of major surgery, how about just dropping down a couple of feet of plastic tubing to line the intestinal walls? The problem with the EndoBarrier is that it has to be anchored in the digestive tract. This is accomplished with 10 barbed hooks that cause lacerations, accounting for the majority of the 891 adverse effects reported in 1,056 patients—nearly 9 out of 10 people. Severe penetrating trauma, resulting in esophageal perforation or liver abscesses, is rarer (occurring in only about 1 in 27 patients).

    Concern has been raised about the “palatability” of the AspireAssist stomach pump, but the most cringeworthy endoscopic procedure I discovered in my research was intestinal “resurfacing.” Why cover the inside of your intestines with plastic to prevent absorption when you can just “thermally ablate the superficial duodenal mucosa”? In other words, have your intestinal lining burned off—or rather, “resurfaced.”

    Surgeons have tried injecting Botox into the stomach walls of obese individuals, hoping it would partially paralyze their gastric muscles, slow stomach emptying, make people feel fuller longer, and lose weight. It didn’t work.

    Researchers in Sweden tried randomizing people to wear corsets for 12 to 16 hours a day, seven days a week, for nine months. And it didn’t work. The study participants just didn’t wear the corsets—they were “perceived as uncomfortable.” Duh.

    “Sanitized tapeworms” have evidently been widely advertised as a weight-loss remedy since back in the early 1900s. The fact that living tapeworms have been discovered during bariatric surgery operations suggests that infesting yourself with parasites may not be particularly effective either.

    Speaking of disgusting strategies, how about disgust itself? A study entitled “Harnessing the Power of Disgust: A Randomized Trial to Reduce High-Calorie Food Appeal Through Implicit Priming” tried using subliminal messages to ruin people’s appetite. Just before showing images of healthy foods, researchers briefly flashed happy images—such as a group of kittens—for 20 milliseconds. That’s too quick to consciously register, but the hope was to plant a positive imprint on the brain. Before showing images of high-calorie foods like ice cream, they flashed negative scenes, like a cockroach on a pizza slice, vomit in a dirty bathroom, and a burn wound. Apparently, it worked! Subjects subsequently reported a reduced desire to eat high-calorie foods, though this wasn’t tested directly. The researchers concluded that subliminal revulsion might be “a successful tactic to combat the onslaught of food cues that promote unhealthy eating….”

    The rest of the world looks on, bemused by American machinations, penning commentaries like “Don’t Let Them Eat Cake! A View from Across the Pond.” A paper in the journal Obesity Surgery entitled “What Are the Yanks Doing?” reviewed “The U.S. Experience with Implantable Gastric Stimulation,” inserting electrodes into the muscular layer of the stomach wall. When that didn’t work, colon electrical stimulation was tried.

    Even more shocking were studies like “Repetitive electric brain stimulation reduces food intake in humans.” Though placing deep-brain electrodes is considered a complication-prone operation, scientists have long pondered whether “placing an electrode somewhere in the brain could make people eat less.” Holes were drilled through the skulls of five obese individuals, and wires were pushed into their brains for “electrostimulatory exploration.” Once the researchers poked around and found spots where they were able to elicit convincing hunger responses, they sent in enough juice to fry out electro-coagulatory lesions. It seemed to work in cats and monkeys, but the researchers found that burning holes in people’s brains did not result in weight loss in obese humans. Thankfully, as I explained in my book How Not to Diet, healthy, sustainable weight loss isn’t brain surgery.

    Doctor’s Note

    Check out Is Gastric Balloon Surgery Safe and Effective for Weight Loss?.

    What about drugs? See Are Weight Loss Pills Safe? and Are Weight Loss Pills Effective?.

    So, what’s the best way to lose weight? I wrote a whole book about it! How Not to Diet is focused exclusively on sustainable weight loss. Borrow it from your local library or pick up a copy from your favorite bookseller. (All proceeds from my books are donated to charity.) To whet your appetite, take a peek: Trailer for How Not to Diet: Dr. Greger’s Guide to Weight Loss.

    For more on this topic, check out related posts below.



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  • When the Fix Is an Illusion

    When the Fix Is an Illusion

    Sham surgery trials have shown that some of our most popular surgeries are themselves shams.

    Intragastric balloons “arrived with much fanfare in the 1980s,” since they could be implanted into the stomach and inflated with air or water to fill much of the space. Unfortunately, surgical devices are often brought to the market before there is adequate evidence of effectiveness and safety, and the balloons were no exception.

    The “gastric bubble” had its bubble burst when a study at the Mayo Clinic found that 8 out of 10 balloons “spontaneously deflated,” which is potentially dangerous because they could pass into the intestines and cause an obstruction, as you can see below and at 0:40 in my video Is Gastric Balloon Surgery Safe and Effective for Weight Loss?.

    Before balloons deflated, however, they apparently caused gastric erosions in half the patients, damaging their stomach lining. The kicker is that, in terms of inducing weight loss, they didn’t even work when compared to diet and other behavior modification strategies. Eventually, intragastric balloons were pulled from the market. But now, balloons are back.

    After a 33-year hiatus, the U.S. Food and Drug Administration started approving a new slew of intragastric balloons in 2015, which immediately resulted in the placement of more than 5,000 devices. By then, the Sunshine Act had passed. It forced drug companies and the surgical and medical device industry to disclose any payments made to physicians, shining a disinfecting light on industry enticements. By now, most people know about the overly cozy financial relationships doctors can have with Big Pharma, but fewer may realize that surgeons can also get payments from the companies for the devices they use. The 100 top physician recipients of industry payments received an unbelievable $12 million from device companies in a single year. Yet outrageously, when they published papers, only a minority disclosed the blatant conflict of interest.

    The benefit of balloons over most types of bariatric surgery is that they’re reversible, but that doesn’t mean they’re benign. The FDA has released a series of advisories about the risks, which include death. But how could someone suffer a stomach perforation with a smooth, rounded object? By that smooth, rounded object causing the patient to vomit so much that they rupture their stomach and die. Nausea and vomiting are unsurprisingly “very common side effects,” affecting the majority of those who have balloons placed inside of them. Persistent vomiting likely also explains cases of life-threatening nutrient deficiencies after balloon implantation.

    Some complications, such as bowel obstruction, are due to the balloons deflating, but others, oddly enough, are due to the balloons suddenly overinflating, causing pain, vomiting, and abdominal distention, as you can see below and at 2:45 in my video.

    This issue was first noticed in breast implants, as documented in reports such as “The Phenomenon of the Spontaneously Autoinflating Breast Implant.” Out of nowhere, the implants can just start growing, increasing breast volume by an average of more than 50%. “It remains an underreported and poorly understood phenomenon,” one review noted. (Interestingly, breast implants were actually used as some of the first failed experimental intragastric balloons.)

    As with any medical decision, though, it’s all about risks versus benefits. Industry-funded trials display “notable weight loss,” but it’s hard to tease out the effect of the balloon on its own from the accompanying “supervised diet and lifestyle changes” prescribed in the studies. In drug trials, you can randomize study participants to sugar pills, but how do you eliminate the placebo effect of undergoing a procedure? Perform sham surgery.

    In 2002, a courageous study was published in The New England Journal of Medicine. The most common orthopedic surgery—arthroscopic surgery of the knee—was put to the test. Billions of dollars are spent on sticking scopes into knee joints and cutting away damaged tissue in osteoarthritis and knee injuries, but does that actually work? People suffering from knee pain were randomized to get the actual surgery versus a sham surgery, in which surgeons sliced into people’s knees and pretended to perform the procedure—even splashing saline—without actually treating the joint.

    The trial caused an uproar. How could anyone randomize people to get cut open for fake surgery? Professional medical associations questioned the ethics of the surgeons as well as “the sanity” of the patients who agreed to be part of the trial. Guess what happened? The surgical patients got better, but so did the placebo patients, as you can see below and at 4:42 in my video.

    The surgeries had no actual effect. Currently, rotator cuff shoulder surgery is facing the same crisis of confidence.

    When intragastric balloons were put to the test, sham-controlled trials showed that both older and newer devices sometimes fail to offer any weight-loss benefit. Even when they do work, the weight loss may be temporary because balloons are only allowed to stay in for six months (at which point the deflation risk gets too great). Why can’t you keep putting new ones in? That’s been tried; it failed to improve long-term weight outcomes. A sham-controlled trial showed that any effects of the balloon on appetite and satiety may vanish with time, perhaps as your body gets used to the new normal.

    What sham surgery trials have shown us is that some of our most popular surgeries are themselves shams. Doctors like to pride themselves on being men and women of science. For example, we rightly rail against the anti-vaccination movement. Many of us in medicine have been troubled by the political trend in which people “choose their own facts.” But when I read that some of these still-popular surgeries are not only useless but may actually make matters worse (for example, increasing the risk of progression to a total knee replacement), I can’t help but think we are hardly immune to our own versions of fake news and alternative facts.

    Doctor’s Note

    Next in this two-part series is Extreme Weight-Loss Devices.

    For more on bariatric surgery, check out related posts below.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Borrow it from your local library or pick up a copy from your favorite bookseller. (All proceeds from my books are donated to charity.)



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  • Nuts, Sperm, and Sex: The Surprising Connection

    Nuts, Sperm, and Sex: The Surprising Connection

    Walnuts, almonds, and hazelnuts are put to the test for erectile and sexual function, sperm count, and semen quality.

    In 2013, I posted a video based on a study that found that men with erectile dysfunction who ate 100 grams of pistachios (a little more than three handsful) a day for three weeks had “a significant improvement in erectile function.” It’s always nice to see a whole-food intervention have clinical effects, and I was curious to revisit the topic and see what’s been published since.

    Even if you ignore all the lab animal studies on hazelnuts improving the function of rat testicles—really, there’s a study titled “Hazelnut Consumption Improves Testicular Antioxidant Function and Semen Quality in Young and Old Male Rats”—you still never know what you’ll find searching the medical literature for nuts and sexual function. I found “a case of penile strangulation with a metal hex nut” in which someone put one on his penis “for sexual pleasure” but couldn’t remove it. (I guess some kinds of nuts can sometimes make things worse.) They tried the Dundee technique, which involves creating 20 puncture holes to relieve the pressure, but that didn’t work, so then they tried a diamond disk cutter. It slipped a few times, but the hex nut was successfully removed. All’s well that ends well.

    That got me curious. Evidently, penile entrapment is so common that there is an entire grading system that emergency room doctors can use, as you can see here and at 1:21 in my video Mixed Nuts Put to the Test for Erectile Dysfunction. If a drill isn’t available, the surgeons advised, “a hammer and chisel may be used to remove nuts.”

    A drill? Oh, they mean a dental drill. Doctors describing one case bragged about the “precisely cut edges,” but it looks pretty jagged to me. You can see for yourself below and at 1:38 in my video.

    To “preserve the penis from fatal outcomes” (that’s a strange way to put it), urologists should be aware of all the available tools and approaches, and if you don’t know how to operate the saw, you can always call in the local blacksmith—but only if “special consent [is] taken from the patient”!

    But how are you going to remove an iron barbell or steel sledgehammer head? “With a heavy-duty air grinder provided by the fire department,” requiring six hours of cutting and fire coats to protect the patient from the sparks. Use whatever it takes—hack saw, “cement eater.” You can even use the silk winding method pioneered by Dong et al.

    Back to the task at hand! Consuming “at least one serving of vegetables a day and more than two servings of nuts a week was associated with a more than 50% decrease in the probability of ED” [erectile dysfunction] in a snapshot-in-time cross-sectional study. But such observational studies can’t prove cause and effect. It’s like finding that men who eat healthier have better sperm motility. Maybe men who eat nuts are just health nuts, and the improvement is due to some other factor, like exercise. What we need is an interventional trial.

    And there is one: a randomized controlled trial studied the “effect of nut consumption on semen quality and functionality.” Healthy men were fed the standard American diet with or without a mixture of nuts—a handful (30 grams) of walnuts and half a handful (15 grams) each of almonds and hazelnuts. Individuals in the nut group experienced significant improvements in their total sperm count, vitality, motility, and shape, perhaps because those “in the nut group showed a significant reduction in SDF”—sperm DNA fragmentation. The nuts appeared to protect their sperm DNA. It’s too bad that the researchers didn’t measure the men’s erectile and sexual dysfunction while they were at it. Oh, but they did!

    What is the effect of nut consumption on erectile and sexual function from that same study? The researchers report that those in the nut group saw a significant increase in orgasmic function and sexual desire, but what about erectile function? Any time you see this kind of selective glass-half-full reporting, you suspect some kind of industry funding, and, indeed, that was the case here; the study was partially funded by the International Nut and Dried Fruit Council. Yes, there was a marginal increase in orgasmic function and sexual desire of questionable clinical significance, but there was no improvement in erectile function, intercourse satisfaction, or overall satisfaction. As with so many comparisons, even the so-called significant findings may not even be statistically significant.

    But why did the pistachios I talked about back in 2013 work, while these other nuts didn’t? Well, the original study was done on men mostly in their 40s and 50s who already had chronic erectile dysfunction for at least one year, whereas the average age of participants in the newer study was 24. So, the individuals in the later study may have started out with near-maximum circulation, not leaving much room for the nuts to work any magic.

    Doctor’s Note

    Sorry for that crazy tangent! I just wanted to give people a taste of what it can be like when you dive deep into the medical literature.

    The 2013 video I mentioned is Pistachio Nuts for Erectile Dysfunction.

    What about walnuts for arterial blood flow? See Walnuts and Artery Function.

    More on fertility and sexual function in the related posts below.

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