Doctor's Note

Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. And check out theother “HHH” videos (Harmful, Harmless, or Helpful?). Also, there are over a thousand subjects covered in the rest of my videos–please feel free to explore them as well!

For some context, please check out my associated blog posts: Soymilk: shake it up! and Eating To Extend Our Lifespan.

  • Michael Greger M.D.

    Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. And check out the other “HHH” videos (Harmful, Harmless, or Helpful?). Also, there are over a thousand subjects covered in the rest of my videos–please feel free to explore them as well!

  • Tracy Franks Gillespie

    As far as weight loss goes, L-arginine and white bean extract were mentioned on the Dr. Oz show recently and I’m wondering what your opinion is on these supplements? As a dietitian, I’m hesitant to recommend any type of supplement because we are always taught “food first” but if something is safe and effective in blocking the absorption of (some) carbs or increasing metabolism, it could potentially be another tool in our arsenal to help people who are trying to lose weight. It would take some significant data to convince me to actually recommend supplements for weight loss, but just curious what your opinion is. Thanks!

  • DrDons

    I share your concern about recommending supplements especially as it relates to weight loss. I recommend the only diet shown to work over time… the “ad libitum” low fat plant based diet with B12 supplementation. I particularly like and often cite the study, Shintani et al., The Hawaii Diet: Ad Libitum High Carbohydrate, Low Fat Diet for reduction of Chronic Disease Risk Factors: Obesity, Hypertension, Hypercholesterolemia, and Hyperglycemia, Hawaii Med J 60: 69-73; Mar 2001. I think the key concept for patients to understand is “calorie density” and not “calories”. I recommend and keep loaner copies on hand of Jeff Novick’s DVD, “Calorie Density: How to Eat More, Weigh Less and Live Longer”. He discusses the important concepts of satiety and calorie density and ties the latter to the amount of exercise a patient does. He shows how folks can lose “weight” without exercising. I also recommend John McDougall’s newsletter article (12/08), The Fat Vegan, so folks who adopt a plant based diet can avoid some of the behaviors that will thwart their efforts. Neal Barnard’s “Breaking the Food Seduction” is also helpful for many of my patients to help understand that the issue is “addiction” not weak will… it is available as a book or DVD. Resources beyond that depend on the patients individual circumstances. I’ve been practicing primary care medicine for over 30 years and the science is clear on the best approach. I’ve seen many diets come and go and many “supplement” recommendations come and go. I don’t recommend any of them. Calorie restricted diets don’t work in the long run except for a very small % of patients. Diets like the Atkins Diet have been shown not to be healthy. We can avoid chemicals see http://nutritionfacts.org/videos/obesity-causing-pollutants-in-food/ and start adopting the best overall diet see.. http://nutritionfacts.org/videos/thousands-of-vegans-studied/. I am a fan of understanding the science and the complexity to help us understand what works for patients see… http://nutritionfacts.org/videos/how-to-upregulate-metabolism/ but we have to be able to give our patients straight forward practical information and avoid jumping on the latest bandwagon whether that is a supplement or the newest fad diet. For example I believe the best practical starter handout is PCRM’s Vegetarian Starter Kit available as free download on their website. Keep tuned to NutritionFacts.org as the science keeps changing..

    • WholeFoodChomper

      Where can I find a PCP like you? 

      Out of curiosity, do you have any “primal” or “Paleo” folks coming to your practice these days?  It seems like this another diet trend/fad that is taking hold of the public and medical profession as well (our local news show even -uncritically- featured this type of diet for a week in its medical/health segment). 

  • Lngao

    Dr. Greger,
    I’ve got 3 questions on vitamin supplements that I couldn’t find answers (or should I say, reliable answers) on the internet.
    1.       Many supplements contain magnesium stearate, which acts as a lubricant to prevent tablet and capsule contents from sticking to the machinery during production. Some say it is harmless, some say harmful. What’s your take on this issue?
    2.       Are “whole food vitamins” really better than “synthetic vitamins”? They do sound better, but if you consider how the manufactures would have to do to extract those nutrients from food… No one has looked into how those are extracted or made, which might add potential contaminations. Am I thinking too much?
    3.       What does “organic vitamin” really mean? If it is synthetic (looks so to me from reading their labels, if whole food is used, they sure would mention it), how can it be “organic?
    Thank you!

  • Aaron Hollander

    At a minimum, isn’t taking an all natural vegetarian supplement a good way to get some of the trace micro-nutrients into our bodies? I see many ingredients on the label that I would not get otherwise. I take Solgar Earth Source Multi-Nutrient Tablets ($45 for 180 tablets…so, it’s like $90/year (one a day) and it is full of things that you recommend. Granted it is all mixed together.

    • Toxins

      Eating whole unrefined plant foods will not result in vitamin deficiencies other then b12. What vitamins do you think you are missing? Also, you can put in your food for the day and see how much of each nutrient you are getting. I typically surpass recommendations eating only whole plant foods. Use this website run by the USDa for that purpose.
      http://cronometer.com/

  • Russell

    It would have been interesting to tease out those people who had the lowest intake of animal products from those with the highest. An argument could be made that vegans, who tend to be low or deficient in B12, protein, and iron, may have benefitted from multivitamins. In the absence of evidence, its hard to argue with your points, but I’d say the jury is still out on this question.

    • Toxins

      Vegans are actually not low in protein, this would entail caloric deficiency
      http://nutritionfacts.org/video/do-vegetarians-get-enough-protein/

      In addition, appropriate iron status is not difficult for most people as long as they consume a diet based on whole ,unrefined plant foods. Please see here for details on enhancing absorption other then vitamin c.
      http://nutritionfacts.org/video/new-mineral-absorption-enhancers-found/

      • Russell

        The study you provided suggests that 3% of people actually are protein deficient, so clearly it can be a problem, as it was for me. I was at 25 grams a day protein because I had dropped most grains as a result of becoming pre-diabetic on an Ornish-style diet for 30 years (despite being slender/fit). Dropping grains brought my glucose down to normal levels, thankfully, and I’ve since learned to add back large quantities of daily tofu and some seitan so I’m finally stable re protein.

        However, it is a very difficult challenge to maintain sufficient B12 or iron on a plant-based diet, so I’ve had to add in a multi-vitamin for those. Please see this meta-study on B12 deficiency. It outlines how serious the B12 problem may be:

        http://www.nature.com/ejcn/journal/v68/n5/full/ejcn201446a.html

  • Derrek

    Would if you fast or are deficient in nutrients? Just supplement with the micronutrients?