Have you ever wondered if there’s a natural way to lower your high blood pressure, guard against Alzheimer's, lose weight, and feel better? Well as it turns out there is. Michael Greger, M.D. FACLM, founder of NutritionFacts.org, and author of the instant New York Times bestseller “How Not to Die” celebrates evidence-based nutrition to add years to our life and life to our years.

Nutrition Facts Grab Bag 17

It’s a cornucopia of nutrition information today on the Nutrition Facts podcast with stories on fasting for rheumatoid arthritis, how to reverse heart failure with diet and the benefits of pole walking.

This episode features audio from Fasting for Rheumatoid Arthritis, How to Reverse Heart Failure with Diet, and Are There Benefits of Pole Walking for Weight Loss?. Visit the video pages for all sources and doctor’s notes related to this podcast.

Discuss

It’s time for the NutritionFacts grab bag, where we look at the latest science on a whole variety of topics.

In our first story – fasting, followed by a plant-based diet, is put to the test for treating autoimmune inflammatory joint disease.

Alan Goldhamer is the founder of the TrueNorth Health Center in Santa Rosa, California, which has fasted 10,000 people for conditions ranging from diabetes and cardiovascular disease to autoimmune diseases. He noted that conditions that seem to be tied to dietary excess tend to respond predictably to the use of fasting followed by a health-promoting diet, which he describes as a low-salt, all-plant, high-fiber, low-fat, low-protein, and low-sugar diet.

This approach offers people an option to eliminate the cause of lifestyle diseases, often to the point where the medication is no longer needed, in contrast to conventional medicine, which is more about the suppression of the symptoms associated with the disease rather than removing the underlying root cause.

Goldhamer put it this way: If you treat high blood pressure or type 2 diabetes or autoimmune disease medically, they’ll tell you, “You’ll be on these medications the rest of your life.” That’s them in effect promising you, if you follow their advice to the letter, “you will be sick the rest of your life.”

Preliminary data suggests fasting may benefit metabolic diseases, pain syndromes, high blood pressure, chronic inflammatory diseases, allergic diseases, and psychosomatic disorders, but the highest level of evidence we have for the benefits of fasting are in regard to rheumatic diseases: autoimmune inflammatory joint diseases, like rheumatoid arthritis.

Nearly a century ago, it was written that “diet treatment is not generally recognized by the medical profession…as one of the weapons with which to attack [such diseases].” This attitude persisted until relatively recently, but a systematic review of controlled trials has since “shown a statistically and clinically significant beneficial long-term effect.”

Rheumatoid arthritis has a well-known genetic component, but the concordance rate, the chance that a pair of identical twins both get it when one has it is probably under 30 percent, despite having the same genes––leaving 70 percent to be explained by nongenetic factors.

Even if we don’t know exactly what those factors are, “fasting [has been compared] to rebooting the hard drive in a computer. Sometimes, the [drive] gets corrupted, and you don’t know exactly where the problem is. But if you just turn it off and reboot it,…that corruption [may get] cleared out.”

The evidence base started with case reports, fasting followed by a plant-based diet, remarkable reports of years of pain and stiffness… gone within a week, and, more importantly, stayed gone on the healthier diet. One after another like that, but case reports are just glorified anecdotes. There have been studies going back decades suggesting fasting may represent the most rapid, available way to induce relief of arthritic pain and swelling for patients who have rheumatoid arthritis. But the studies often failed to have control for the placebo effect, which is especially important when it comes to relying on self-reported subjective symptoms, such as pain and general well-being. But there are objective measures, lab tests of inflammation that don’t appear to be affected by placebos, and that’s what you can see in controlled trials, starting immediately and remaining down for at least a year.

Ten different measures of inflammation significantly decreased after the fasting and subsequent meat- and egg-free diet, whereas none of the parameters budged in those disease victims that continued to eat their regular diets. And this squelching of inflammation translated into a significant reduction in pain, morning stiffness, loss of grip strength, and number of tender and swollen joints.

Even a year after the trial was over, those who benefited from the diet continued to benefit in terms of pain, stiffness, and tender and swollen joints, presumably because they stuck with it. There is little doubt that while fasting both inflammation and pain are relieved. But if you go back to the same diet you were on before, the inflammation returns—unless, evidently, the fasting period is followed by a vegetarian diet. Why might that be? It could be due to changes in the microbiome; the improvement in symptoms coincided with a significant alteration of the intestinal flora, which may somehow be beneficial––perhaps by strengthening the gut barrier. We know fasting can decrease the leakiness of the gut in rheumatoid arthritis patients, but we don’t yet know what role, if any, this plays in the disease process.

It could be as simple as eicosanoids, the mediators of inflammation that are formed from arachidonic acid. Arachidonic acid is a long-chain inflammatory omega-6 fatty acid found in animal fats. The biggest contributors are chicken and eggs, which together contribute nearly half of American intake. That’s been suggested as an explanation of why those eating more plant-based appear to have better mental health; they’re not suffering the “cascade of neuroinflammation” caused by arachidonic acid, why removing eggs, chicken and other meat was shown in a randomized controlled trial to improve mood, suggesting the arachidonic acid might be negatively impacting mood states, and may help explain the impact of more plant-based diets on inflammatory diseases like rheumatoid arthritis.

So, that may help explain why maintaining a plant-based diet appears to be necessary “after the fast to prevent the recurrence of symptoms and inflammatory activity,” or, as one popular press article put it, fasting may just be a tool to get you to radically kickstart a change in the way you e

Next up – we look at how to reverse heart failure with diet.

It is a hopeful sign of the times when entire issues of cardiology journals are not just dedicated to nutrition, but to plant-based diets in particular. Dr. Williams, past president of the American College of Cardiology, starts out with a quote attributed to Schopenhauer. “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as [like, well, duh.]” And, “the truth…for the benefits of plant-based diets, plant-based nutrition continues to mount.” The evidence, we got; the problem is the “inertia, culture, habit, and widespread marketing of unhealthy foods. Our goal must be to get the data out to the medical community and the public where it can actually change lives….” That’s like my personal life’s mission in four words: Get the data out. Based on what we already know in the existing medical literature, plant-based nutrition “clearly represents the single most important yet underutilized opportunity to reverse the pending obesity and diabetes-induced epidemic of morbidity and mortality,” meaning disease and death.

The issue included your typical heart disease reversal cases: a 77-year old woman with heart disease so bad she couldn’t walk more than a half-block or go up a single flight of stairs, severe blockages in all three of her main arteries, and referred to open heart surgery for a bypass. She chose, however, instead “to adopt a whole-food plant-based diet, which included all vegetables, fruits, whole grains, potatoes, beans, legumes, and nuts.” Even though she said she was trying to eat pretty healthy before, within a single month of going plant-based, her symptoms had nearly resolved, and forget about a block, “she was able to walk on a treadmill for up to 50 minutes without chest discomfort or [becoming out of breath].” Her cholesterol dropped about a hundred points, from around 220 down to 120, with an LDL under 60. But then, a few months later, she must have started missing her chicken, fish, and low-fat dairy, and went back to her prior eating habits. Within a few weeks, with no change in her meds or anything, her chest pain was back, and she went on to have her chest sawed in half after all. Then, she continued to eat the same diet that contributed to cause her disease in the first place, and went on to have further disease progression.

This one, though, has a happier ending. It started out the same: a 60-year-old man with severe chest pain after as little as a half-block. Decided to take control of his health destiny, and switched to a whole food plant-based diet from his quote-unquote “healthy” diet of skinless chicken, fish, low-fat dairy that had been choking off his heart. Within a few weeks, the same amazing transformation. From not being able to exercise at all to walking a mile, to then being able to jog more than four miles, completely asymptomatic, off all drugs, no surgery, off to live happily ever after.

Now, of course, case reports are really just glorified anecdotes. What we need is a randomized controlled trial to prove heart disease can be reversed with lifestyle changes alone. And, guess what? There was one, published literally 30 years ago, proving angiographic reversal of heart disease in 82 percent of the patients––opening up arteries without drugs and without surgery. So, these case reports are just to remind us that hundreds of thousands of Americans continue to needlessly die every year from what was proven to be a reversible condition decades ago.

The conventional use of case reports, though, is to present some novel results in hopes of inspiring trials to put it to the test. For example, a case report on a plant-based diet for congestive heart failure. So, not just coronary artery disease, but the heart muscle itself was so weakened it couldn’t efficiently pump blood––only able to eject about 35 percent of the blood in the main heart chamber with every beat, whereas normally the heart can pump out at least half; which is exactly what his heart was able to do just six weeks after switching to a whole food plant-based diet, instead of choosing to get his chest cracked open. The first report of an improvement in heart failure following adoption of a plant-based diet, but not the last.

A 54-year-old woman, obese, type 2 diabetic, presenting with swelling ankles due to her heart failure. She switched from her chicken and fish to whole plant foods. She started out eating healthier and lost 50 pounds, reversed her diabetes—meaning normal blood sugars on a normal diet without the use of diabetes medications—and her heart function normalized, from an abysmal ejection fraction of just 25 percent up to normal. Since it’s not a randomized controlled trial, all we can say is that her improvements coincided with her adoption of a whole food plant-based diet. But given the burden of heart failure as a leading cause of death, how it usually just gets progressively worse, and the overall evidence to date, a plant-based diet should be considered as part of heart failure care. And look, we already know it can reverse her coronary artery disease, and so, any heart failure benefits would just be a bonus.

Now, we just need good strategies for healthcare “practitioners to support patients in plant-based eating.” Here are some excellent suggestions to pause and reflect on. For example, doctors can use the Plantrician Project’s prescription pads and prescribe a good website or two.

“While it is certainly true that many people would be resistant to fundamental dietary changes, it is equally true that millions of intelligent people motivated to preserve their health are now taking half-way measures that may provide only modest benefit—choosing leaner cuts of meat, using reduced-fat dairy products.” “Most of these people have neither the time nor the training” to actually see what the science shows themselves. Don’t they deserve honest, forthright advice when their lives are at stake? Those who wish to ignore that advice, or implement it only partially, are certainly at liberty to do so. You want to go smoke cigarettes, go bungee jumping? It’s your body, your choice. It’s up to each of us to make our own decisions as to what to eat, how to live. But we should make these choices consciously, educating ourselves about the predictable consequences of our actions.

Finally, today – we look at the health benefits of pole-walking. Let me explain.

Exercise recommendations for obesity have been referred to as “the mysterious case of the public health guideline that is (almost) entirely ignored.” Governmental, scientific, and professional organizations call for at least an hour of exercise a day for weight management, but almost no obese adults meet this target. Surveys suggest American men, and women, watch TV ten times more than they exercise, and for obese Americans, it may be even worse. Just 2 percent even reach 30 minutes a day, and the percentage exceeding an hour a day is expected to be close to zero.

Why don’t obese individuals exercise more? How about we just ask them? When questioned, obese adults typically describe exercise as being “unpleasant, uncomfortable and unenjoyable.” How can we break this vicious cycle, where inactivity can lead to weight gain, which can lead to further inactivity, and even more weight gain? The first thing to recognize is that “it is normal and natural to be physically lazy.”

“Nothing in biology makes sense except in the light of evolution” is the title of a famous essay written by a noted geneticist. Laziness is in our genes. We evolved to instinctually avoid unnecessary exertion to conserve energy for survival and reproduction. These days, there’s no shortage of available fuel, yet the hardwired inertia remains. Our ancient ancestors exercised only when it was necessary, or when it was fun––as a form of play. Just like dietary change for weight control, the only way exercise is going to work long-term if it becomes a stable lifelong habit. Exercise is really only effective if it’s sustainable. So, we need to restructure our surroundings to require more physical activity, like using a treadmill desk, and figure out how to make exercise more enjoyable. It should just be a walk in the park—literally, perhaps!

Wise advice from a 1925 medical journal entry: “The best prescription to be written for a walk is to take a dog…and a friend.” Listening to your favorite music might also help. Music has been described as a “legal method” for improving peak performance and, more importantly, the enjoyment of high intensity interval training. During exercise, listening to a preferred playlist can significantly reduce your “rate of perceived exertion,” which is how hard you feel your body is working. Put severely obese youth on a treadmill, and have them go until exhaustion with or without music, and those listening to their favorite tunes tended to make it about 5 percent longer. This was chalked up to “attentional distraction”––the music may have helped them keep their mind off of the feelings of fatigue. If that’s the case, maybe listening to a podcast or audio book might have a similar effect.

One way to up your walking game is with walking poles. So-called Nordic walking, also known as exerstriding or Viking hiking, was originally developed in Scandinavia to maintain cross-country ski athletes’ training in the summer, but has since gained in popularity worldwide as a general fitness activity. The augmented engagement of the upper body musculature may result in an 18 to 22 percent increased calorie expenditure over walking alone (depending, in part, on your pole-handling technique). The question I wanted to know for my new book, though, is: Does that actually translate into accelerated weight loss?

Before-and-after studies demonstrate weight loss with pole walking, compared to a sedentary control, but what about compared to regular walking? Of the four such studies I could locate, comparing thrice weekly 40 to 60-minute sessions of Nordic walking compared to regular walking, every single one found no significant difference in body fat measures after 8 weeks… 12 weeks… 12 weeks… or 13 weeks. There are certainly other benefits over regular walking, such as increased upper body muscle bulk, muscular endurance, and strength (though not as much as resistance band training), but to date there’s no evidence for a weight-loss enhancing effect, which is why Nordic walking didn’t make the cut for my new book. But, just as we were going to press, this study was published: the first ever to combine Nordic walking with diet, compared to the same dietary program with regular walking. And, once again, no significant difference in body weight or anything else. Now, there was a hint that those in the pole group enjoyed it more, and in the end, exercise only works if you do it.

And, there may be other benefits. Nordic walking beat out regular walking in terms of reducing symptoms of depression and improving sleep quality. Perhaps this should not be surprising, given the greater exercise intensity of Nordic walking––even approaching that of jogging at higher speeds. And that’s where I see the role of walking poles—to fill the intensity gap between people who are ready to graduate from walking, but not yet ready for more rigorous activities such as running. The only potential downsides are the added expense and, reminded of Monty Python’s “ministry of silly walks” sketch, the indignity of looking a bit ridiculous.

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