How Not to Hurt—Live Presentation

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Pain is such an epidemic that at its height, U.S. doctors were handing out 250 million opioid prescriptions a year, in a country where the entire adult population was only 240 million, contributing to the opioid crisis that may have killed hundreds of thousands of people. It was a story of good intentions gone bad, a drug industry gone rogue, and government watchdog agencies gone to sleep.

What I discovered, writing How Not to Hurt, is that this same story sadly applies to much of modern pain management: A litany of drugs, devices and procedures that sometimes do more harm than good—acknowledged to be worse than useless, yet continue to this day. Allow me to run through a few examples before getting to the good news: that there are some safe, simple, side-effect free strategies that we were just never taught about in medical school, because there was no corporate budget driving their promotion.

We can start with over-the-counter pain-killers like ibuprofen, which may collectively kill tens of thousands of Americans every year from ulcers, strokes, and heart attacks. Tylenol is considerably safer, yet remains the only over-the-counter drug that leads reliably to death at overdose, from liver failure, though even at so-called safe-doses, in healthy volunteers, about a third experience clinically significant liver damage. And, surprisingly, Tylenol may cause similar amounts of gastrointestinal bleeding to NSAID drugs like ibuprofen, naproxen, aspirin. Stick a scope down people’s throats, and you can see extensive damage in the lining of the stomach and intestines in 90% percent of individuals taking aspirin, buffered or not, at the recommended doses. How many hours does it take for damage to occur? None. It can happen within five minutes.

No wonder, 10 to 30 percent of people who regularly take NSAIDs develop stomach ulcers. If deaths from the gastrointestinal toxic effects from NSAIDs were tabulated separately, they would constitute the 15th leading cause of death in the United States. Something you can buy at any corner store!

Okay, so even over-the-counter drugs can be risky, but we’re willing to swallow risks for effective treatments. The question is: How effective are they? For back pain, for example, the amount of relief from NSAIDS compared to a sugar pill is considered not clinically relevant, and they may actually increase the risk of chronic pain. Treating acute pain with anti-inflammatory drugs like ibuprofen may ironically prolong the pain. In other words: “Anti-inflammatory drugs could cause chronic pain.”

Acute inflammation is a natural process that triggers healing and actually protects against the development of chronic pain, which may explain why back pain patients treated with NSAIDs appear to have a 76 percent increased risk of developing chronic back pain. Anti-inflammatory drugs could cause chronic pain.

We’ve long prescribed anti-inflammatory drugs on the very premise that if we allow pain to persist, it could become chronic, but as a renowned Harvard neuroscientist noted, this new research suggests the complete unexpected opposite, which is that the inflammation is actually helping.

So: risky, no appreciable back pain relief—and, in fact, may even make pain worse in the long run, yet these are the recommended drugs. Effectively all risk, no benefit, yet these drugs are recommended in 90% of clinical practice guidelines for acute low back pain. That’s the kind of thing that started clueing me in to the state of modern pain management.

Surely prescription drugs work, though. When a senior executive at drug giant GlaxoSmithKline admitted the dirty little secret, that the “vast majority of drugs” in general don’t work for most people, it set off a media firestorm. “But this is of course no news to doctors,” the editor of a leading medical journal wrote, acknowledging the open secret that most drugs are ineffective for most patients. And it’s even worse in the field of pain management.

You know it’s bad when the coordinator of gold standard reviews on “Evidence-Based Pain Management” starts off by quoting, Colonel Jessup from A Few Good Men: “You can’t handle the truth,” which is, that “failure is the norm….” Failure rates of painkillers for osteoarthritis range from 71 to 86 percent. Those are the failure rates for individual patients. For chronic low back pain, from 82 to 87 percent failure. For painful neuropathies, 70 to 87 percent failure rate. And fibromyalgia drugs failed 87 to 95 percent of the time to reduce pain even by 50 percent after months of treatment, compared to taking placebo sugar pills. 90% of the time they couldn’t even do that. The analysis concluded that the field of pain medicine needs to “confront its failings…” and acknowledge that drugs cannot successfully treat more than a minority of people with painful conditions.

What about Suzetrigine, the first non-opioid painkiller approved in over 25 years? It was approved under the same expedited FDA fast-track approval process as oxycontin, and it’s worth noting that the last new class of painkillers included Vioxx, which was pulled from the market after causing maybe 100,000 cases of serious heart disease. This was after years of the drug giant Merck trying to silence critics, drawing up lists of doctors daring to question the drug’s safety, to be neutralized, or discredited. As one executive VP wrote, “we may need to seek them out and destroy them where they live.” Nice.

But hey, Suzetrigine works, according to the press release, causing a clinically meaningful reduction in pain. An executive VP is quoted: “Suzetrigine has again demonstrated its potential to fill an important unmet need in the treatment of pain.” After all, on the drug, sciatica pain started at a six out of 10 and highly significantly dropped down to a four, whereas in the sugar pill placebo group, pain started at a six out of 10 and highly significantly dropped down to a four. Wait, so the drug didn’t work at all. The drug, sold as Journavx for $200, appeared to offer exactly zero benefit. The press release could have just as accurately touted a “clinically meaningful reduction in pain” from sugar pills, bragging, that, once again… Smarties have demonstrated their potential to fill an important unmet need in the treatment of pain.

What about compounded drugs? Compounding has become an increasingly lucrative industry over the past two decades. Compounding pharmacies prepare custom-made medications like topical pain creams typically costing thousands of dollars. After spending six million dollars per day on these medicines, the U.S. Department of Defense decided to put them to the test. Hundreds of patients were randomized to pain creams compounded for all sorts of different pain conditions and… they did not work any better than a placebo cream, so basically millions of dollars wasted every year on something that couldn’t beat out moisturizer.

We inject millions of arthritic knees with steroids that ultimately offer only harm, making you more likely to end up having to get a total knee replacement, due to greater cartilage degeneration.

Any extremely short-term pain relief cannot possibly outweigh the long-term harms. The best time to have stopped using them was years ago. The second-best time to stop is now, yet we continue to harm millions of patients with them.

The same with arthroscopic surgery. Only documented long-term harms without benefits. The only actual reason to keep recommending steroid injections and arthroscopic surgery is the “status quo,” But there is something badly wrong with the status quo, in that the treatment is the leading cause of physical disability in older adults.

The same with steroid injections for tennis elbow, resulting in worse clinical outcomes, and a quadrupling of the rate of recurrence. So your doctor is not only making it worse, but quadrupling the chances it comes back—now that’s a business model.

 Stop injecting corticosteroids into patients with tennis elbow. You’re actively slowing down the healing.

And a common surgery for tennis elbow is a sham too, compared to sham surgery—placebo surgery, where they cut you open but don’t actually do anything.

The same with shoulders. Steroid injections for shoulder pain may actually have deleterious effects on rotator cuff healing… associated with up to 7 times the risk of subsequent tendon tearing…. Yes, a small transient pain relief, but the potential to ultimately make the disease worse. So why to doctors keep doing them? Their wide use may be attributable to habit, under-appreciation of the placebo effect, incentive to satisfy rather than discuss a patient’s drive toward physical intervention, or because they get paid to do it.

And, rocking the shoulder surgeon’s world, the most common surgery for shoulder pain, found to be useless, compared with placebo surgery, fake surgery. No improvement in pain, function or quality of life, and, actually worse than useless, since there’s always the risk for rare but serious side effects.

Even surgery journal editorials started to say the surgery should no longer even be offered to patients because truly informed patients… offered no benefit and only harm, would avoid it. We first learned the surgery was effectively useless back in 1993, so surely surgery rates plummeted. But no, surgery rates just shot right up, remaining one of the most frequently performed shoulder surgeries in the world. How is that possible? Why would surgeons continue to do all-risk-no-reward surgeries—by the millions? Why would surgeons be allowed to do them?

Well there’s “confirmation bias” (the tendency to ignore evidence that doesn’t support your beliefs), a “lack of science literacy,” some kind of magical thinking, as well as “perverse incentives” to operate that are just built into the system.

Of all the thought put into disentangling surgeons’ conflicts of interest, the most fundamental conflict may be the one most-seldom discussed: Surgeons like surgery, and the more they operate, the more most get paid. And hey, if they do want to be ethical and refuse to operate unnecessarily, they’ll just miss out, because another surgeon will just step in.

A long-time editor of a prestigious medical journal started his editorial on conflicts of interest by describing a fantasy: “Doctors treat patients using simply the best evidence, and their experience. They are not influenced by money or self-interest.” “This is, of course, nonsense.”

Consider this survey of Orthopods: “Do Surgeons Treat Their Patients Like They Would Treat Themselves?” Presented with the same case… they were 80% more likely to recommend surgery for a patient than they would choose to undergo the same procedure for themselves.

The bottom line, is that “every year,” wrote the editor-in-chief of the journal of the Association of Bone and Joint Surgeons, “hundreds of thousands of patients undergo unnecessary, unhelpful, painful procedures, and a subset of those patients will experience serious and sometimes catastrophic complications” for operations they never should have had in the first place.

And don’t even get me started on how we treat back pain. A “magnum opus” regarding the evidence on low back pain in one of the most prestigious medical journals in the world highlighted the massive gap that exists between what the evidence shows, when it comes to low back pain, and the actual management delivered in everyday care. It was a devastating critique… offering the “dramatic and disturbing messages”… that “much of modern back care is ineffective or outright harmful,” leading to a “massive wave of disabling over-treatment, and mistreatment.” Strong evidence that drugs, devices, diagnostics, syringes and surgeries, can be hazardous for most patients with low back pain. causing “harm… to millions across the world….” Sadly, even when treatments are overwhelmingly proven to be unhelpful or even harmful, it often takes decades for practices to change.

Why, do these medical malpractices continue? Back pain is the single costliest chronic condition—in other words, it’s the most profitable. Key challenges providing evidence-based care may be the financial interests of payers, providers, and corporate profiteers. For example, Pfizer’s illegal marketing of gabapentin, the drug they sold as Neurontin. Internal documents show the campaign involved the systematic use of deception and misinformation to create a biased evidence base and manipulate physicians’ beliefs and behaviors.” They pled guilty, but drug sales continue to soar. They paid a few hundred million in criminal fines; no biggie, as the drug was pulling in a few billion a year. The use of these so-called gabapentinoids—gabapentin or pregabalin, sold as Neurontin and Lyrica, continue to be prescribed to treat low back pain, even though they demonstrate a significant risk of adverse effects without any demonstrated benefit….

It’s the same with muscle relaxants like Flexeril, which continue to be among the most commonly prescribed drugs for low back pain, which makes sense based on the, published data. But when researchers included the unpublished trials drug companies tried to sweep under the rug, about 90% of the benefit vanished into thin air, turning a respectable drop in pain of about 20 points on a 0 to 100 scale down to an clinically insignificant two points out of a hundred. So, appreciable risk with no appreciable benefit, yet years after this revelation, we’re still prescribing tens of millions of these drugs every year.

To which you say fine. If I ever have back pain I’m going to a back pain specialist. Cue this paper: “Doctors with a Special Interest in Back Pain Have Poorer Knowledge About How to Treat Back Pain.” What?! Physicians who expressed particular interest in the subject were more likely to harbor back pain management beliefs “contrary to the best available evidence.” “These findings raise serious concerns about how back pain is currently being managed….”

Medical device companies pay out more largesse to doctors than even the drug companies. Even though it’s a much smaller industry, device manufacturers may annually pay out a total of $900 million to 200,000 U.S. physicians, compared to drug pushers who may only “gift” physicians around $800 million a year. And the top recipients on their list—edging out even the orthopedic surgeons, who get all the money from the hip-and-knee-replacement companies—are the neurosurgeons, who implant the spinal cord stimulators for back pain, that appear to offer no benefit, for back pain, function, or quality of life—stimulating only revenue.

A surprisingly candid mea culpa editorial recently described the “overwhelming influence of industry” as a defining feature of interventional pain medicine, a field increasingly seen as one “driven more by industry, than evidence, and by expedience rather than inquiry.”

On a payola-per-device basis, only coronary stents may beat out implantable spinal cord stimulators. And based on sham trials, angioplasty and stents have been shown to unequivocally offer no benefits for stable angina chest pain.

Wait, how do doctors convince patients to sign up for these procedures when they don’t lower the risk of death or heart attack, or offer long-term symptom relief? Apparently, by conveniently failing to inform their patients that they don’t lower the risk of death or heart attack or offer long-term symptom relief. What they do do is cause bleeding complications or damage to a blood vessel in two out of 100 people. And one poor schmuck will suffer a serious complication, such as a heart attack, stroke, or death. And, during the first year after the stent, three will have a bleeding event due to the blood thinners that have to be taken because there’s foreign material in your body. The blood thinners don’t always work, though, so two people will have their stent clog up, leading to a heart attack.

But you don’t have to wait to suffer damage. During the stent procedure itself, as many as 28 percent suffer irreversible damage to the heart muscle, as evidenced by MRI. Perhaps of even greater concern are silent mini-strokes. About one in seven stent patients come away with new brain lesions. And these so-called silent infarcts may not be so silent, potentially contributing to memory loss, cognitive decline, and dementia.

For stable angina, stents are all risk, no reward. Who in their right mind would get them? Who in their right mind would do them? Yet even now, after all the evidence is in, hundreds of thousands of these procedures are performed unnecessarily every year in the United States at a cost of billions of dollars. But billions in cost means billions in revenue. Risky, worse than useless interventions, generate large revenue streams for hospital systems.

It’s like wait… why are hysterectomies such a popular solution for a range of female problems? used as the treatment of first resort, for fibroids, for instance…. Hospitals are businesses. It’s like an open secret. They have a quota to meet every month, and the hysterectomy, a “well-priced procedure,” may seem a reasonable direction for the income boost.

But back to stents: “It has been difficult for physicians to accept the evidence that actually, there is no benefit…compared to a fake procedure in this post-truth science era.” But that’s how they figured it out: compared to a fake procedure, compared to sham surgery. Fake placebo pills test whether drugs are effective; fake placebo surgeries test whether procedures are effective. There have been twenty-five trials involving thousands of patients comparing various invasive procedures with sham procedures for the treatment of pain—most commonly low back pain, arthritis, and angina. The conclusion? “It seems prudent that invasive procedures for chronic pain be avoided….”

When a former FDA commissioner was asked at an American Heart Association meeting whether sham controls should be required for the approval of all devices, he replied, “Do you want to get the truth or not?”

Physical therapists also use all sorts of questionable devices that most clinical practice guidelines recommend strongly against. Like traction for low back pain, for which there is overwhelming evidence that it lacks clinically significant benefit, yet three quarters of physical therapists in the U.S. may use it.

Similarly, chiropractic manipulation is not all its, cracked, up to be.

Manual therapies, like chiropractic, osteopathic, don’t seem to do much better than sham manual therapies. Or even, frankly, compared to doing nothing at all…. But hey, manual therapy is safer than opioids. The fact that so many other back pain treatments are worse than useless is actually a pretty decent selling point. I mean just worthless? I’ll take it!

Back pain patients going to physical therapists or chiropractors experience reduced risks from spinal injections and surgery, so the primary benefit may be avoiding the more harmful medical mismanagement of back pain (in which case, of course, you could get the same benefit sending people to a, witch doctor).

The bottom line, concluded the editorial board of one of the most prestigious medical journals in the world: “Over-reliance on drugs or devices may be spurred on by aggressive industry marketing… and perverse financial incentives for shorter visits, drug prescribing, and invasive interventions.”

*Sigh*…. Are you ready for the good news?

One of the success stories in pain medicine was the development in the 1990s of abortive therapies for migraine headaches. Drugs like sumatriptan, sold as Imitrex, only fail 57 percent of the time.

Guess what was shown to work just as well in a randomized, double-blind, placebo-controlled clinical trial? Just an eighth of a teaspoon of ginger powder. You can hardly tell the ginger curve from the drug curve. In response to the billion-dollar blockbuster drug, 44% of patients were pain-free within two hours. In response to less than a penny’s worth of the ground ginger you can buy at any store, 44% were pain-free within two hours. There was, one significant difference, though… fewer side effects in the ginger group.

Cinnamon can help prevent migraines in the first place, based on a randomized, double-blind, placebo-controlled trial that found that quarter-teaspoon doses could significantly decrease migraine frequency, severity, and duration. For example, in the placebo group, pain dropped from about an eight out of 10, down to a seven, whereas in the group secretly slipped some cinnamon hidden in capsules, pain dropped from an eight out of 10 down to a three. And, no… it was not funded by Big Bark.

Prescription drugs may kill more than 100,000 Americans every year, making medications a leading cause of death. That’s why doctors are rightly resistant to changing their clinical practice based on a some single small new suggestive study. But when it comes to something as safe, simple, and side effect-free as cinnamon, what’s the downside to telling our migraine patients to give it a try? They probably even have it sitting in their pantry right now.

Even if this cinnamon study was a total fluke, what’s the worst that can happen? Tastier oatmeal?

This is just one of many examples you’ll find throughout my new book of simple foods that are safer, cheaper, and sometimes even more effective than drugs. The reason your doctor hasn’t said anything about these natural remedies is probably because they never heard of them. The clinical trials were published in the peer-reviewed medical literature, but more than a million papers are published every year. Which of those million do you think most doctors hear about? The ones, with corporate budgets. The ones the drug reps tell us about over their “free” lunch.

Plants aren’t profitable because plants aren’t patentable. The latest migraine drugs can cost more than $100 per pill and don’t even work as well as the common migraine medication sumatriptan. Patients at risk pay more for less-effective drugs because they’re safer. (Triptan drugs have artery-constricting effects… and may triple one’s odds of having a heart attack or stroke.) Whereas ground ginger could work just as well, without the same risks, and be literally a thousand times cheaper.

But that’s the problem. There’s no money to be made. No company is going to thrill their stockholders selling something that costs less than a penny per day.

There are fruits that fight pain, like figs for painful periods. There are vegetables that fight pain, like comforting cruciferous, comparing the painkilling effects of kale versus ibuprofen after wisdom tooth surgery––a randomized, double-blind split-mouth clinical trial, and, the equivalent of a quarter-cup of cooked kale worked better than taking two ibuprofen.

Even some weeds work. Anyone recognize this plant?

Purslane is one of the most common weeds in the world, growing out of cracks in the sidewalk everywhere you look once you start noticing it. Pitted against an inflammatory autoimmune condition called oral lichen planus, in which our immune system attacks the lining of the mouth, a randomized, double-blind, placebo-controlled trial, found that 83 percent of those in the purslane group experienced partial or complete clinical improvement, compared to 83 percent in the placebo group either not responding at all or getting worse. In a comparison of the safety and efficacy of nine treatments, including immunosuppressants and steroids, this simple common weed appears to be both the safest and most effective treatment available.

There are beans that can balm. A significant improvement in the joint-and-muscle pains of menopause… comparable to that of hormone therapy….

How about cocoa for claudication? (Cocoa’s kind of a bean.) Claudication is the crampy calf pain due to peripheral artery disease. In the six-minute walk distance test, 34 meters is considered a large meaningful change. Those randomized to three tablespoons of cocoa a day got about 43 meters farther compared to a fake chocolate placebo powder. And it wasn’t just due to improved blood flow. Muscle biopsies showed the cocoa actually improved mitochondrial function, the little power plants within our cells.

Cardiologist commentators concluded such studies are insufficient to advocate “widespread prescription of cocoa” to peripheral artery disease patients. Though they concede the “negligible risk, low costs and potential benefit,” they demand “further proof.” That makes sense if we were talking about some new drug, but what’s the downside of making your life just a little more chocolatey by adding some natural cocoa powder to your daily diet? They stress the “therapeutic pleasure” of cocoa consumption must not replace established standards such as exercise, smoking cessation and vigorous optimization of cardiovascular risk.” I agree, but who said anything about replacing? We can do all of the above. That’s the nice thing about dietary approaches—they can be done in addition to however else we’re being treated.

There are even grains for pains. Less than a quarter-teaspoon of wheat germ hidden in capsules taken every six hours after vaginal delivery significantly reduced postpartum pain and the need for painkillers, compared to placebo. That’s another single cent strategy.

I go through dozens of different foods and beverages shown to help in randomized controlled trials with each specific condition, but certain foods came up over and over, in chapter after chapter. In particular, there are seven—and only seven—that have been shown to each help with three or more different diseases. I call them the Soothing Seven. I talk about the dosing for each, the good side effects, and the caveats. I already touched on cinnamon for one of the four conditions it can help.

Garlic powder is another single cent solution. Endometriosis affects millions of women. What happened when women in pain were randomized to a daily eighth of a teaspoon of garlic powder hidden in pills compared to placebo? They experienced significant relief of back pain, pelvic pain, painful sex, and painful periods. The overall pain of the placebo group started out at about a six or seven out of 10, and didn’t budge throughout the study. Whereas those secretly slipped just a pinch of garlic powder a day started out about the same, but the pain dropped month after month down to a two out of 10.

Same thing with pelvic pain. Same thing with back pain. Same thing with painful periods. Same thing with painful sex. A penny a day’s worth of a spice that you may already have in your kitchen.

Garlic also protects against two other pain conditions—and, against those you vant to suck your blood…— literally! A study conducted by the Swedish military found a significant reduction in… tick bites in soldiers randomized to garlic.

I talked about ginger for migraines. Less than a quarter of a teaspoon of ground ginger a day can also beat out placebo for joint pain. Researchers conclude ginger is to be recommended as a “safe drug” for these patients. But by “drug” they just mean a couple pinches of the ground ginger you can buy at any store. There was even a study on topical ginger—at least, when applied to the scrotum. Paper-thin slices of ginger applied over the inflamed testicles—and, the researchers were, on the ball… Healing nearly three times faster than the control group.

Next up is turmeric, the golden spice taking the gold for the broadest pain-fighting effects, with randomized controlled trials showing significant benefit against nine different pain conditions. if I had to pick just one to highlight, a multicenter, randomized, double-blind, placebo-controlled trial of patients with ulcerative colitis that were not responding to a maximum dose of an anti-inflammatory drug. So what about adding, an anti-inflammatory spice? A month later, the disease kept raging in 100% of the placebo group, zero percent remission––whereas in the group given the turmeric pigment curcumin, more than half were in remission.

Berries! There are studies showing significant pain relief from strawberries, cranberries, bilberries, barberries. Here’s one on blueberries, and what we used to call juvenile rheumatoid arthritis. Two hundred affected kids randomized to receive a biologic drug with or without blueberry juice, equivalent to about a third cup of blueberries a day.

Significantly more kids had reductions in disease activity in the blueberry juice group compared to the drug only or placebo-juice groups. This resulted in significantly less joint pain, tenderness, swelling, stiffness, and fatigue, but not only fewer symptoms, fewer side effects from the drug…. Compared to the placebo berry group on the drug, those getting the real blueberries suffered significantly fewer adverse psychological effects, nerve inflammation, weight gain, infections, blood vessel inflammation, less diarrhea, eye inflammation, bone marrow failure, and less weakness, chest pain, and chronic cough—so, about thirty blueberries a day made the treatment significantly safer and more effective. This is a great example of how dietary approaches aren’t either/or, but can support whatever else we’re doing.

Flaxseeds! A soothing seed against four pain conditions, including cyclic mastalgia—menstrual breast pain. A tablespoon of ground flaxseeds versus a ground wheat placebo. Women in both groups started out with about a week of breast pain every month, down to six days in the placebo group, but cut in half down three days in the flaxseed group, and in terms of pain severity: 20% drop in the placebo group versus a 70% drop in the flaxseed group. There’s been four such studies to date, such that the official guidelines of the Society of OB/GYNs of Canada, dating back 20 years, recommends flaxseed as a first-line therapy for menstrual breast pain.

Flaxseed oil can even be used topically. Five drops to the front of the wrist twice a day versus a placebo oil for carpal tunnel syndrome not only yielded significant improvements in pain and function, but an improvement in nerve conduction velocity, suggesting it’s more than just symptomatic relief. Also works rubbed on arthritic knees; significant improvement in pain, function, and quality of life… recommended in traditional medical texts going back to the middle ages, but took a thousand years before it was finally put to the test.

I have a bunch of recipes throughout the book for both topical and oral remedies that tie multiple natural treatments together—but, no guarantees they aren’t gonna smell or taste disgusting.

And finally, while I talk about the benefits of camomile tea, and nettle tea, and rose and lavender teas—soymilk, for specific conditions, the only beverage I could find that could help at least three different pain conditions was green tea. Uterine fibroids, for example…. Over a period of four months, fibroid volume increased by 24 percent in the placebo group. That’s what fibroids do; they continue to grow.

However, those randomized to the green tea showed a 32% shrinkage of their fibroids. This then translated into a significant decrease in symptom severity and improvements in both quality of life and anemia, an increase in blood counts due to the reduction in heavy flow. The dose used in the extract to disguise the tea in capsules would be equivalent to about five cups of green tea a day, or a few teaspoons of matcha.

Plants are powerful. Where do you think morphine came from? The opium poppy… Aspirin grows on trees! (Originally derived from willow tree bark.) We open up nature’s medicine cabinet every time we pull out the crisper in our fridge.

What if our entire diet was centered around whole healthy plant foods? Well, for chronic migraines, “a whole food plant-based diet may offer a safe, effective and permanent treatment for reversing chronic migraines, particularly in those with refractory disease.”

Prescribing optimal nutrition is also suggested as a first-line intervention for osteoarthritis: a diet centered around whole plant foods. But it wasn’t put to the test until 2015, resulting in a significant reduction of pain starting within two weeks.

What happened after the study ended though? In the “Plants for Joints” trials, hip and knee osteoarthritis patients randomized to advice to eat a whole food plant-based diet experienced significant improvements in pain, stiffness, function, and overall symptoms, and saw similar benefits. For rheumatoid arthritis… a significant reduction in disease activity, including nearly five times greater odds of achieving remission.

Now after 16 weeks, both studies were over. But eight months later, the researchers followed up, and at the end of a year, improvements in disease activity in both rheumatoid arthritis and osteoarthritis patients were largely maintained because many stuck with the diet on their own, such that half of the rheumatoid patients… and two-thirds of the osteoarthritis patients… were able to decrease or stop their pain medications altogether. Plants for joints.

And arthritis patients tend to be at higher risk of getting cardiovascular disease… and dying from cardiovascular disease…. And so, as a bonus, the extraordinary 60% drop in LDL cholesterol you can get, switching arthritis patients to a plant-based diet—in U.S. units, an 80-point drop over control from dietary change alone… An 80-point drop in LDL would be expected to cut the risk of cardiovascular disease over a dozen years in half. So for arthritis patients, plant-based diets can be a lifesaver in more ways than one.

And for those with heart disease, a plant-based diet and lifestyle program can reduce the frequency of chest pain angina attacks by 90%. In contrast to the control group patients, who were instead told to follow diet and lifestyle advice from their personal physicians, suffering a 165 percent increase in angina attacks. The marked reduction in frequency, severity, and duration of angina, was comparable to that of open-heart surgery, but without a bone saw bisecting our breast bone.

Dr. Ornish later reflected that he had thought that his studies would have a meaningful effect on the practice of mainstream cardiology, but he underestimated how much influence the business of medicine has on the practice of medicine, realizing that reimbursement may sometimes be a much more powerful determinant of medical practice than research.

Peripheral vascular disease too, impaired walking capacity from inadequate blood flow, boosted 5,000% in a plant-based diet and exercise group over exercise alone, including a patient who couldn’t walk a hundred yards without extreme-pain going on to run marathons.

What about neuropathic pain? Twenty-one diabetics suffering from painful neuropathy for up to ten years were placed on a whole food, plant-based diet, and after years of suffering, 17 out of the 21 patients reported that they experienced complete relief from their pain—within days.

Now the study was a live-in program that provided meals. What happened after they were sent home, back into the real world? These 17 were followed for years, and in all cases but one, the relief from their painful neuropathy continued—or improved even further. How were the researchers able to achieve such a high degree of dietary compliance even in an uncontrolled setting? “Pain and ill health,” the researchers wrote, “are strong motivating factors.” In other words: Because the diet worked.

Think about it. Patients hobble in with one of the most painful, frustrating, and hard-to-treat conditions in all of medicine, and three-quarters seemed cured in a handful of days using a natural, nontoxic treatment—namely, a diet centered around whole healthy foods. Should have been front-page news. As one commentator wrote, “The neglect of this important work by the broader medical community is little short of unconscionable.”

Of course the best way to get rid of diabetic neuropathy may be to get rid of the diabetes. There’s a new diagnostic code in town: Type 2 diabetes in remission…, and an expert consensus statement put out by the American College of Lifestyle Medicine co-sponsored by the Endocrine Society, endorsed by the American Association of Clinical Endocrinology, concluded that diet as a primary intervention for Type 2 diabetes can achieve remission in many, and that diet is most effective in achieving remission when emphasizing whole plant-based foods, with minimal consumption of meat and other animal products.

Trigeminal neuralgia. Some of the worst of the worst. For an average of eight years, most had severe daily attacks of nine out of 10 or 10 out of 10 pain, despite medications, and nearly a third had already gone through dozens of failed surgeries. They even included a set of patients with atypical trigeminal neuralgia, with “continuous never ending discomfort” and put them all on a low-saturated-fat diet—not vegan––they could eat as much, like, skim milk and Jell-O as they wanted.

But within one month of cutting down on saturated fat, 96 percent of those with typical trigeminal neuralgia, had their pain levels drop to lower than two out of 10. And this was after most of them reduced or stopped their medications altogether.

They went from an average pain of more than nine out of 10, to an average pain of less than one within an average of 16 days, after suffering for an average of eight years…. Even the continuous pain patients went from about nineout of 10 pain down to two, in a matter of weeks. The post-surgical patients, after a total of dozens of failed surgeries still suffering severe pain? Same thing. More than nine out of 10—excruciating pain—down to less than one out of 10, which is like what, a little paper cut or something?

Now the post-surgical group took 20 days to get better, instead of 16 days, but they had been suffering for 11 years straight. Years of extreme suffering and then 20 days later, gone. They apparently had the power all along, but no one had told them about a plant-based diet. Every day of that decade they were just 20 days away—at any time, from being free.

By the time the study was sent for publication, patients had been on the low saturated fat diet for an average of 20 months, and the only reported side effect was, losing up to 75 pounds.

The researchers recognize placebo effects could not be excluded, “although dramatic and sustained improvement even in the post-surgical group with severe and intractable pain does make it unlikely.” They acknowledge that the results seem too good to be true and call for further trials to be performed.

Yet, no such studies have been forthcoming. How is that possible? They reported some of the most striking findings in the entire field of pain medicine, originally presented in the single most widely-read and highly cited peer-reviewed neurology journal in the world, but their study was lost down the memory hole. The only reference to it that I could find in the medical literature was a single mention in a dental journal back in 2014. Plants are powerful, but there’s just no money to be made.

What about inflammatory bowel disease? Mitsuro Chiba, IBD Chief at a hospital in Japan, noting a correlation between the increase in animal foods…and the 400-fold explosion of Crohn’s disease in his country decided to put plant-based diets to the test and found they appeared to beat out everything else out there…. Not only did they find plant-based diets were effective for all degrees of severity, in both Crohn’s disease and ulcerative colitis, they achieved far better outcomes in both ulcerative colitis and Crohn’s disease, compared to the current standard therapy in both the induction and quiescent phases of the two diseases.

Lower relapse rates for ulcerative colitis, compared to conventional treatment…. Higher induction of remission with biologics in Crohn’s disease, compared to conventional treatment, and higher relapse-free-rates 10 years later, compared to conventional treatment…. Plant-based diets, they conclude, are “unreservedly recommended for Inflammatory Bowel Disease.”

Of course plant-based diets would be advisable, even if they didn’t help at all, since cardiovascular disease is the leading cause of death of IBD patients—in fact disproportionately so…. And the heart-healthiest diet, the one capable of even reversing the progression of cardiovascular disease, is a plant-based diet. So, the bar isn’t just low for recommending IBD patients follow a plant-based diet; it’d have to be actively harmful to justify not endorsing it.

Instead, it’s not just helpful; there is evidence to suggest eating plant-based may be the single most effective IBD treatment ever published, in all of medicine.

A real-world study of advanced therapies, for severe ulcerative colitis using some of the latest biologic drugs described their efficacy rate of 30 percent as “satisfactory.” Dr. Chiba published a response in the journal, noting his plant-based protocol was far more effective (not to mention safer and cheaper). In reply, the lead author of the study, for which the conflicts of interest with Big Pharma took up nearly an entire page, countered that patients should be able to decide forthemselves on the content of their meals based on their own preferences.

Of course, patients should be able to decide on what to put in their stomachs—and lungs, for that matter. The question is what we, as doctors, should be recommending. If these researchers were truly interested in patient autonomy, they would disclose all the available options and let patients decide for themselves.

One of the wonderful things about lifestyle improvements is they aren’t either/or. We can eat more healthfully in addition to whatever other interventions we may choose. But patients are robbed of choice if they’re never fully informed about the power of their fork. Dr. Chiba laments that it may take a few decades to accept plant-based diets for IBD in the guidelines. “It’s a pity that the majority of patients are not told about eating plant-based and are suffering from the disease.”

Now not all responses in the medical literature to Dr. Chiba’s groundbreaking work were as defensive. The authors of a landmark special report on lifestyle medicine, published in the journal of the largest nonprofit healthcare organization in the U.S., wrote: “Dr Chiba and colleagues have made a major contribution to moving healthcare forward with their extensive work in the field of IBD. We are totally in concurrence with their conclusion that dietary guidelines, focusing on a whole food, plant-based diet as treatment for chronic diseases is not only needed, but must be implemented.”

Let me close with an amazing fact about the human body. Nearly every year, we are reborn. We destroy, and create anew, our entire body weight in cells about every year and a half. Every second of every day, about four million of our cells die and four million new cells are born. Every second! We replace about 300 billion cells every day. Now some cells, like heart cells, can last for years, and a few, like some of the cells in our brain or the lens of our eye, may last a lifetime, but the other 99.5 percent of the cells in our body are continuously re placed.

What, are they replaced with? Every new cell in our body is ultimately made up of only three things: air, water, and food. Those are essentially the only inputs: the air we breathe, the water we drink, and the food we eat. We are what we eat—literally, physically. No wonder our dietary choices can have such a powerful impact on the functioning of our bodies.

In a sense, our body has to re-form itself every eighteen months with the building materials we deliver to it through our stomach. Our mouths are like the access road to the continual construction site that is our body. Trucks roll in three times a day. What do we want them to deliver?

Do we want to buy some cheap, shoddy building materials at the drive-through? Or do we want to build our foundation solid?

Each one of us lives inside the greatest known architectural structure in the universe. Let’s not ruin such grand blueprints by consuming crap.

The power to live a long healthy pain-free life may lie in our pantry. And the nice thing about side effect-free strategies is that you can just give ‘em a try and see if they help. You have nothing to lose but your pains.

Okay. So I was only able to cover about 60 studies. How Not to Hurt ended up with over 6,000 citations… So I’ve only been able to only cover about 1% of the book. For the other 99%, please feel free to check it out from your local public library. It goes on sale in December, but you can pre-order it now, and if you do choose to buy it, know that all proceeds I receive—every penny from the sales of all my books goes directly to charity—I just want you and your loved ones, to live long healthy lives, free of suffering.

Thank you.

Before I go, if you would like me to come speak in your city, at your hospital, to your community group, please reach out, I am booking my 2027 book tour now and would love to reach your neighbors and colleagues. Go to see.nf/speaking. 

Please consider volunteering to help out on the site.

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