I’m Dr. Michael Greger and this is Nutrition Facts.
There’s one thing we’ve been thinking about a lot lately, and that’s how to stay healthy in the middle of a global pandemic. Especially since we’ve learned that those with underlying health problems like obesity, hypertension, diabetes, and heart disease are more likely to have serious complications if they contract COVID-19. So what do we do? We try to stay healthy with evidence-based nutrition.
It’s time for the Nutrition Facts Grab Bag where we look at the latest science on a whole variety of topics. First up, plant-based diets are put to the test for treating migraine headaches.
Headaches are one of the top five reasons people end up in emergency rooms, and one of the leading reasons for which people see their doctors in general. One of the things you can do to try to prevent them is to identify the triggers and avoid them. Common triggers for migraines include stress, smoke, hunger, sleep issues, certain trigger foods, like chocolate, cheese, and alcohol, your menstrual cycle, or certain weather patterns.
In terms of dietary treatments, the father of modern medicine, William Osler, suggested trying “a strict vegetable diet.” After all, the nerve inflammation associated with migraines may be reduced by a strictly plant-based diet, as many plant foods are high in anti-inflammatory compounds and antioxidants, and likewise, meat products may have pro-inflammatory properties. But it wasn’t put to the test for another 117 years.
Among those given a placebo supplement, half said they got better; half said they didn’t. But when put on a strictly plant-based diet, they did much better, experiencing a significant drop in the severity of their pain. Now, “it is possible that the pain reducing effects of the plant-based diet may be, at least in part, due to weight reduction.” They lost about nine more pounds in their vegan month.
Even just lowering the fat content of the diet may help. Those placed on a month of consuming less than 30 grams of fat a day, like less than two tablespoons of oil all day, experienced highly significant decreases in headache frequency, intensity, duration, and the need to take medications––a six-fold decrease in the frequency and intensity. From three migraine attacks every two weeks down to just one a month. And by low-fat, they didn’t mean SnackWells; they meant more fruits, vegetables, beans. Before the food industry co-opted and corrupted the term, eating low-fat meant like eating an apple, not Apple Jacks.
Now this was a really low-fat diet, like 10% fat, for someone eating 2,500 calories a day. What about just less than 20% fat, compared to a more normal, but still relatively lower-fat diet than average? Same significant drops in headache frequency and severity, including a five-fold drop in attacks of severe pain. Since the intervention involved at least a halving of saturated fat intake, mostly found in meat, dairy, and junk, the researchers concluded that a reduction of saturated fat intake may help control migraine attacks. But it’s not necessarily something that they’re getting less of. There are compounds present in live green real veggies that might bind to a migraine-triggering peptide known as CGRP. Drug companies have been trying to come up with something that binds to it, but the drugs have failed to be effective, and are also toxic, a problem you don’t see with cabbage.
Green vegetables also have magnesium. Found throughout the food supply, but mostly concentrated in green leafy vegetables, beans, nuts, seeds, and whole grains. It is the central atom to chlorophyll. So, you can see how much magnesium foods have in the produce aisle by the intensity of their green color. Magnesium supplements do not appear to decrease migraine severity, but may reduce the number of attacks you get in the first place. You can ask your doctor about starting 600mg of magnesium dicitrate every day, but note that magnesium supplements can cause adverse effects, such as diarrhea. So, I recommend getting it in the way nature intended.
Any foods that may particularly help? I’ve talked about ground ginger. Combining caffeine with over-the-counter pain killers like Tylenol, aspirin, or ibuprofen may boost their efficacy––about 130 milligrams for tension-type headaches, and 100 mg for migraines, about what you might expect to get in three cups of tea. Though I believe it is just a coincidence that the principal investigator was named Lipton.
Note: you can overdo it. If you take kids and teens who have headaches, drinking one and a half liters of cola a day, and cut the cola, you can cure 90% of them. Though, this may be a Coca-Cola effect rather than a caffeine effect.
In our next story, we take a close look at our ability to pick out the subtle distinctions in calorie dense foods, but only within the natural range.
The traditional medical view on obesity, as summed up nearly a century ago: “All obese persons are alike in one fundamental respect—they literally overeat.” While this may be true in a technical sense, this is in reference to overeating calories, not food. Our primitive urge to overindulge is selective. People don’t tend to lust for lettuce. We have a natural inborn preference for sweet, starchy, fatty foods, because that’s where the calories are concentrated.
Think about hunting and gathering efficiency. We used to have to work hard for our food. Prehistorically, it doesn’t make sense to spend all day collecting types of food that, on average, don’t provide at least a day’s worth of calories. You would have been better off staying back at the cave. So, we evolved to crave foods with the biggest caloric bang for their buck.
If you were able to steadily forage a pound of food an hour, and it had 250 calories per pound, it might take you 10 hours just to break even on your calories for the day. But if you were gathering something with 500 calories a pound, you could be done in five hours, and spend the next five practicing your wall paintings. So, the greater the energy density, the more calories per pound, the more efficient the foraging. So, we developed an acute ability to discriminate foods based on calorie density and to instinctively desire the densest.
If you study the fruit and vegetable consumption of four-year-old children, their liking correlates with calorie density. They prefer bananas over berries; carrots over cucumbers. Well duh, isn’t that just a preference for sweetness? No, they also prefer potatoes over peaches, and green beans over melon, just like monkeys prefer avocados over bananas. We appear to have an inborn drive to maximize calories per mouthful.
All the foods the researchers tested were naturally less than 500 calories per pound (bananas topped the chart at about 400). Something funny happens when you start going over that. We lose our ability to differentiate. Over the natural range of calorie densities, we have an uncanny aptitude to pick out the subtle distinctions. However, once you start heading towards bacon, cheese, and chocolate territory, which can reach thousands of calories per pound, our perceptions become relatively numb to the differences. No wonder, since these foods were unknown to our prehistoric brains. It’s like the dodo bird failing to evolve a fear response because they had no natural predators (and we all know how that turned out––or sea turtle hatchlings crawling in the wrong direction towards artificial light, rather than the moon). Aberrant behavior explained by an evolutionary mismatch.
The food industry exploits our innate biological vulnerabilities by stripping crops down into almost pure calories; straight sugar, oil (which is pretty much pure fat), and white flour (which is mostly refined starch). First, they have to remove the fiber, because it effectively has zero calories. Run brown rice through a mill to make white, and you lose about two-thirds of the fiber. Turn whole wheat flour into white, and lose 75 percent. Or, you can run crops through animals (to make meat, eggs and dairy,), and remove 100 percent of the fiber. What you’re left with is CRAP (an acronym used by one of my favorite dieticians, Jeff Novick): Calorie-Rich And Processed foods.
Calories are condensed in the same way plants are turned into addictive drugs like opiates and cocaine: concentration, crystallization, distillation, and extraction. They even appear to activate the same reward pathways in the brain. Put people with “food addiction” in an MRI scanner and show them a picture of a chocolate milkshake, and the areas that light up in their brains are the same as when cocaine addicts are shown a video of crack smoking.
“Food” addiction is a misnomer. People don’t suffer out-of-control eating behaviors to food in general. We don’t tend to compulsively crave carrots. Milkshakes are packed with sugar and fat: two of the signals to our brains of calorie density. When people are asked to rate different foods in terms of cravings and loss of control, most incriminated was a load of CRAP—highly processed foods, like doughnuts, along with cheese and meat. Those least related to problematic eating behaviors? Fruits and vegetables. Calorie density may be the reason people don’t get up in the middle of the night and binge on broccoli.
Animals don’t tend to get fat when they are eating the foods they were designed to eat. There is a confirmed report of free-living primates becoming obese, but that was a troop of baboons who evidently stumbled across some dumpsters at a tourist lodge. The “garbage-feeding animals” weighed 50 percent more than their wild-feeding counterparts. Sadly, we can suffer the same mismatched fate, and become obese eating garbage too. For millions of years, before we learned how to hunt, our biology evolved largely on leaves, roots, fruits, and nuts. Maybe it would help if we went back to our roots and cut out the CRAP.
Finally today, some research on how healthier plant-based foods compare to unhealthy plant foods and animal foods on diabetes risk.
In my video on flexitarians, I talk about how the benefits of eating a plant-based diet are not all-or-nothing. “Simple advice to increase the consumption of plant-derived foods with parallel reductions in the consumption of foods from animal sources was found to confer a survival advantage,” a live-longer advantage. They call it a pro-vegetarian eating pattern, just moving in that direction, as a more gradual, gentle, doable approach.
If you’re dealing with a serious disease, though, like diabetes, avoiding some problem foods completely may be easier than attempting to moderate their intake. It’s like clinicians would never tell alcoholics to simply cut down on alcohol. Avoiding alcohol entirely is more effective and, ironically, easier for a problem drinker.
“Paradoxically, asking patients to make a large change may be more effective than making a slow transition. Diet studies show that recommending more significant changes increases the changes that patients actually accomplish. It may help to replace the common advice, ‘all things in moderation’ with ‘big changes beget big results.’ Success breeds success. After a few days or weeks of major dietary changes, patients are more likely to see improvements in weight and blood sugar levels—improvements that reinforce the dietary changes. Furthermore, they may enjoy other health benefits of plant-based eating” that may give them further motivation.
Those who choose to eat plant-based for their health say it’s mostly for general wellness and disease prevention, or to improve their energy levels or immune function. They felt it gave them a sense of control over their health, helps them feel better emotionally, improves their overall health, and makes them feel better. Most felt it was very important for maintaining their health and well-being. For the minority that used it for a specific health problem, it was mostly for high cholesterol or weight loss, followed by high blood pressure and diabetes. With most reported they felt it helped a great deal.
But others choose plant-based diets for other reasons, like animal welfare or global warming, and it looks like they’re more likely to be eating things like vegan doughnuts, and sugary and fatty foods, compared to those eating plant-based because of religious or health reasons.
I mean the veganist vegan could bake a cake (using soda instead of eggs), with frosting, covered in marshmallow fluff and chocolate syrup, topped with Oreos, with a side of Doritos dipped in, vegan bacon grease. But fruit for dessert in the form of Pop Tarts and Krispy Kreme pies? This is a vegan meal.
Yes, plant-based diets have been recommended to reduce the risk of type 2 diabetes. However, not all plant foods are necessarily beneficial. Like in that pro-vegetarian scoring system, you got points for eating potato chips and French fries, just because they were technically plant-based, but Harvard researchers wanted to examine the association of not only an overall plant-based diet, but both healthy and unhealthy versions. So, they created the same kind of pro-vegetarian scoring system weighted towards any sort of plant-based foods, and against animal foods, and then also created a healthful plant-based diet index, where at least some whole plant foods took precedence, and Coca-Cola was no longer considered a plant. Then lastly, they created an unhealthful plant-based diet index by assigning positive scores to processed plant-based junk, and negative scoring healthier foods and animal foods.
And, they found that a more plant-based diet in general was good for reducing diabetes risk, but eating especially healthy plant-based foods did better––nearly cutting risk in half, while those eating more unhealthy plant foods did worse. Now, but is that because they were also eating more animal foods? People often eat burgers with their fries; so, they separated out the effects of healthy plant foods, less healthy plant foods, and animal foods. And, healthy plant foods were protectively associated, animal foods were detrimentally associated, and less-healthy plant foods were more neutral when it came to diabetes risk. Here’s what the graph looks like: higher diabetes risk with more and more animal foods, no protection whatsoever with junky plant foods, and lower and lower diabetes risk associated with more and more healthy whole plant foods in the diet. So, they conclude that yes, plant-based diets are associated with substantially lower risk of developing type 2 diabetes risk. But it may not be enough to just lower the intake of animal foods, but also less healthy plant foods as well.
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To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts Podcast landing page. There you’ll find all the detailed information you need – plus links to all of the sources we cite for each of these topics.
For recipes, check out my How Not to Die Cookbook. It’s beautifully designed, with more than 100 recipes for delicious and nutritious meals. Speaking of new books, I have a new book just out – How to Survive a Pandemic – now out in audiobook, read by me, and e-book with physical copies out in August. Pre-order the physical copy now or download the e-book and audiobook now as well.
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Thanks for listening to Nutrition Facts. I’m your host, Dr. Michael Greger.