Did you ever wonder if the food you eat has a direct effect on your health, well-being – and longevity? Well, I’m here to end that mystery. You ARE the foods you eat. Welcome to the Nutrition Facts podcast – I’m your host, Dr. Michael Greger.
It’s time for the Nutrition Facts grab bag, where we look at the latest science on a whole variety of topics.
In our first story, we look how a condition called Syncope – also known as fainting – is triggered and prevented.
Syncope is the sudden, brief loss of consciousness caused by diminished blood flow to our brain that occurs at least once in about one in five people, and in about one in ten may happen over and over, responsible for millions of emergency room visits and hospitalizations. Though sometimes fainting can be caused by heart problems, most often it’s triggered just by standing (because blood pools in our legs) or strong emotions, which are called vasovagal reactions. Under certain circumstances, such as blood donation, syncope has important medical and societal significance. More than 150,000 people experience fainting spells or near-fainting spells each year when they’re giving blood. So, it would be good to find a way to avoid it. But, if you think that has medical and societal significance, what about fainting when you’re driving? It goes without saying that losing consciousness while driving can pose a serious threat to the patient and society. Of a group of folks getting tested for it, 9% reported they had lost consciousness while driving.
When it happens over and over, drugs and surgery are used, installing a pacemaker. But such therapy is expensive, efficacy is questionable, and adverse effects are common. In fact, results of most drug treatment trials have been disappointing, and the value of implanting pacemakers has been repeatedly questioned, and now there is evidence for their lack of effectiveness. So, what do we do?
Well in Italy, evidently the older generation of general practitioners advised patients prone to fainting to carry a wooden egg (used in the old days for darning socks) and to apply muscle tension by gripping the wooden egg forcefully as soon as a faint was imminent. These folklore stories inspired an Italian cardiologist to apply arm muscle tensing to combat vasovagal fainting, but it wasn’t put to the test, until now.
About a minute before losing consciousness, most about to faint experience so-called prodromal symptoms—they feel dizzy, queasy, or break out into a sweat, signaling they’re just about to black-out. When that happens, there are a number of maneuvers shown to successfully abort the impending episode. One is called isometric arm counter-pressure, where you grip one hand in the other and exert pressure trying to pull your arms apart, and you keep it up until the symptoms go away. How successful is it? Patients were shown how to do it, and reported it was successful 99% of the time. Safe and effective, proposed to be the new first-line treatment for those who start to feel faint.
Leg crossing and muscle tensing has also been shown to work, where you cross your legs, squeezing them together as you tense your leg, stomach, and butt muscles. Safe, inexpensive, effective—they propose having patients try this before having a cardiac pacemaker surgically implanted. Squatting down is another maneuver, if all else fails.
Is there anything we can do to prevent the symptoms in the first place? Do we have to wait until we’re all dizzy, clammy, sweaty, and nauseous? Well, speaking of cheap, safe, and effective, just drinking water can prevent it. So, if you know needles make you whoozy, five minutes before you get stuck, chug down two cups of water, which can dramatically bring pressures up within minutes in people who are predisposed to fainting, and has similar effects in normal healthy adults. The fact that water exerts such profound effects can be exploited by blood donation programs, for example, to help prevent people from fainting. It’s also the currently recommended treatment for so-called blood, injury, or injection phobia, which is actually pretty common, affecting about 1 in 25 people, 75% of which report a history of fainting in response. The problem is not just that they won’t donate blood. Avoiding anything related to blood, injury, and injections could pose a particularly serious threat if people neglect to seek medical care when necessary, but all one has to do is preload with two cups of water. The knowledge that such simple self-help maneuvers are readily available and could be lifesaving, should prove valuable and helpful in everyday life.
In our next story – Plant-based diets can be 98 percent effective in keeping ulcerative colitis patients in remission, blowing away other treatments.
One of the most common questions physicians treating patients with inflammatory bowel disease (IBD) are asked is whether changing one’s diet can positively affect the course of their disease. Traditionally, our answer had been “We have no clue,” but this may now be changing, given the evidence that hydrogen sulfide may be playing a role in ulcerative colitis. And since the sulfur-containing amino acids concentrated in meat cause an increase in colonic levels of this rotten egg gas, maybe we should take off the meat. See, animal protein isn’t just associated with an increased risk of getting inﬂammatory bowel disease in the first place, but also IBD relapses once you have the disease.
This is a recent development. Because the concept of IBD as a lifestyle disease mediated mainly by a Westernized diet is not widely appreciated, an analysis of diet in the follow-up period after diagnosis in relation to a relapse of inflammatory bowel disease has been ignored. But not any longer. Ulcerative colitis patients in remission and their diets were followed for a year to see which foods were linked to the bloody diarrhea coming raging back. And the strongest relationship between a dietary factor and an increased risk of relapse observed in this study was for a high intake of meat.
What if you have people lower their sulfur-containing amino acid intake by decreasing their consumption of animal products? They tried it on four ulcerative colitis patients, and without any change in meds, they experienced like a four-fold improvement in their loose stools. In fact, they felt so much better that they didn’t think it ethical to try switching them back. Since sulfur-containing amino acids are the primary source of dietary sulfur, a “low sulfur” diet essentially means a shift from a typical diet high in animal protein and fat, and low in ﬁber, to more of a plant-based diet. Westernized diets are pro-inflammatory, and plant-based diets are anti-inflammatory.
Let’s see what treatment with a plant-based diet can do, after the onset of ulcerative colitis during a low-carbohydrate weight-loss diet. A 36-year-old man lost 13 pounds on a low-carb diet, but also lost his health, diagnosed with ulcerative colitis. Put him on a diet centered around whole plant foods, though, and poof—symptoms resolved without medication. Okay, but this is just one case. Case reports are just like glorified anecdotes. The value of case reports lies in their ability to inspire researchers to put it to the test, and that’s exactly what they did.
There had never been a study published focusing on using plant-based diets for the treatment of ulcerative colitis, until now. Considering the lack of a suitable diet to be the biggest issue faced in the current treatment of inflammatory bowel disease, and regarding it as a lifestyle disease caused mainly by our omnivorous diet, a group of Japanese gastroenterologists have been providing a plant-based diet to all patients with IBD for over a decade and publishing extraordinary results—far better than have to date been reported in the medical literature, found to be effective in the maintenance of remission in Crohn’s disease by 100 percent at one year and 90 percent at two years. So, how about a plant-based diet for relapse prevention in ulcerative colitis?
Educational hospitalization meant bringing patients into the hospital to control their diet and educate them about the benefits of plant-based eating, so they’d be more motivated to continue it at home. Most patients—about three-quarters—experienced improvements such as disappearance or decrease of bloody stool during hospitalization. Fantastic!
Okay, but here’s the really exciting part. Then, they followed the patients for five years, and 81 percent were able to remain in remission the whole time, and 98 percent were able to keep the disease at bay for at least a year. That blows other treatments away. Those relapse rates are far lower than those reported with medication. Under conventional treatment, other studies found that about half relapse, compared to only 2 percent among those taught to eat healthier.
A plant-based diet was previously shown to be effective in both the active and quiescent stages of Crohn’s disease. The current study has shown that a plant-based diet is effective in both the active and quiescent stages of ulcerative colitis as well. And so, they did another study on even more severely affected cases with active disease and found the same thing, far beating out conventional drug therapy. People felt so much better that they were still eating more plant-based even six years later. The researchers conclude that a plant-based diet is effective for treating ulcerative colitis to prevent a relapse.
Why? Well, plant-based diets are rich in fiber, which feeds our good gut bugs. That might partly explain why a plant-based diet prevents a variety of chronic diseases. And so, that’s what we may be seeing with inflammatory bowel disease, suggesting that replacing an omnivorous diet with a plant-based diet is the right approach.
It’s like using plant-based diets to treat the cause of heart disease, our #1 killer. It’s not just safer and cheaper, but works better. No adverse side effects noted for plant-based eating. Let’s compare that to the side effects of immunosuppressants used for ulcerative colitis, like cyclosporine.
And now, we have even fancier drugs that cost about $60,000 a year (that’s $5,000 a month), and they don’t even work very well, with clinical remission at one year of only like 17 to 34 percent. And instead of no adverse side effects, they can give you a stroke. They can give you heart failure. They can even give you cancer, including a rare type of cancer that often results in death. Or how about a serious brain disease known as progressive multifocal leukoencephalopathy, which can kill you, and for which there is no known treatment or cure? Yeah, yeah increased risk of death, but did we mention how nice and small the pill was and the easy-to-open bottle?
Finally today, we look at what hospitals have to say for themselves for feeding people meals that appear to be designed to inspire repeat business?
Hospital food needs a revolution. I was surprised to find out that most inpatient meals served in hospitals are not required to meet any sort of national nutrition standards for a healthy diet. And indeed, an analysis on the nutritional value of food served to patients in teaching hospitals found that many did not meet dietary recommendations. “Warning,” read the headline, “Hospital food bad for health.”
A registered dietitian wrote in to defend the hospitals, saying that at least over half the hospitals met at least over half the guidelines. And hey, they’re so stringent anyway. A little eggs and dairy, and you could blow through your limits. “The provocative conclusions of [their analysis] only lead the media and the public to conclude that we are a bunch of dunces who have no understanding of the relation between nutrition and disease prevention.”
Well, if the white coat fits…
Look, we spend a fortune on training doctors; so, you’d think we could follow through on some of the simplest things, like food. “Good diet is as necessary to recovery of health as [anything else], and it is folly to pretend that it is beyond the power of our profession to change this,” a line written 75 years ago.
And still, there’s pushback. “Perhaps, we should question whether a ‘healthy diet’ given to a helpless patient during a 2- to 10-day hospital stay benefits anyone or anything other than the dietitian’s sense of ‘doing good’,” responded one doctor, adding he is always bothered when patients are deprived of a desired morning egg because a “healthy” diet has been ordered. I mean, what’s a few days of a little heart-unfriendly diet in the scheme of things?
But it’s the message we’re sending. “The presence of foods on the [hospital] tray sends a message to patients as to what is healthy and acceptable for them to eat,” responded the researchers that did the hospital foods analysis. “We still can think of no better place or opportunity to set an example of good nutrition than when patients are in hospitals.”
After all, public schools in California have banned the sale of soda for over a decade. Why not children’s hospitals? In a study of California healthcare facilities serving children, three-quarters of foods and drinks wouldn’t have been allowed in schools. We’re talking soda and candy. Having unhealthy items in healthcare facilities and seeing staff consume these products contradicts the hypercritical nutrition and health messages children may get from healthcare providers.
On adult menus, nearly all meals contained excess salt, with 100 percent of daily menus exceeding the American Heart Association’s recommendation for staying under 1500mg of sodium a day. This means meals offered to patients may actually contribute to the exacerbation of the very conditions that may have led them to the hospitalization.
But if hospitals stuck to the recommended limits of salt, the food wouldn’t taste as good, responded an executive from the Salt Institute, to which the researchers replied: Taste as good? We’re talking about hospital food—it doesn’t taste good no matter how much salt you put on it.
At the very least, we should prepare all meals low-sodium and then, if they want to add salt, it’s their choice. If they want to get someone to wheel them out into the parking lot and smoke, that’s their business, but we shouldn’t be blowing cigarette smoke into people’s rooms three times a day, whether they want it or not. Interestingly, studies suggest that when individuals are allowed to salt food to taste, they rarely add as much as often comes prepackaged within the food. Switch people to a low-sodium diet, and sure, they use their salt shakers more, but overall, their salt intake dips way down. And the study subjects said it tasted just as salty, because salt added to the surface of foods makes it taste saltier. But when a hospital meal comes to you pre-salted to the hilt, inpatients may not even have the option to consume healthier levels.
In defense of their unhealthy food, one hospital food service provider explained that they’re just giving people what they want. Are we really going to deny people who are going through difficult times any small comfort that they may get?
Hospitals used to sell cigarettes, primarily for “patient convenience.” “I don’t think I can deny a paying patient the right to smoke a cigarette,” said one administrator, “I will have to insist we have cigarette machines in the hospital, as a service to the patient.”
But some made the radical suggestion that tobacco products should not be sold in the hospital. And this wasn’t from the 1950s, but from the 1980s. Yet, the irony of hospitals allowing the sale of the major cause of preventable illness and death in this country had rarely been discussed in the medical literature, and it’s especially ironic that smoking was, of course, permitted in the doctors’ lounges.
To their credit, though, U.S. hospitals underwent the first industry-wide ban on smoking in the workplace by the mid-90s. Well, now “[h]ospitals again have the opportunity to take the lead and create food environments that are consistent with their mission to cure the sick and to promote health. Through the simple act of serving food that meets national nutritional standards, our hospitals will act in the best health interests of their patients, and their staff, and will undoubtedly again be leaders in our ongoing dialogue on how to improve our food supply, which, in turn, will improve the health of us all.”
Strict antismoking regulations were often criticized as being too harsh, as if disease and premature death brought on by smoking were any easier. Think my smoking-diet parallel is hyperbole? Well, guess what. Today, the major cause of preventable illness and death in this country is no longer tobacco. The leading cause of death in America is now the American diet. Hospitals in the United States serve millions of patient meals each day and are optimally positioned to model a healthy diet.
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