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The Amount of Vitamin D Supplementation I Recommend

The Amount of Vitamin D Supplementation I Recommend

Randomized, controlled clinical trials have found that vitamin D supplements extend one’s lifespan. What is the optimal dose? What blood level is associated with living longest? In my nine-part video series on vitamin D from 2011, I noted that the relationship between vitamin D levels and mortality appeared to be a U-shaped curve, meaning low levels of vitamin D were associated with increased mortality, but so were levels that were too high, with the apparent sweet spot around 75 or 80 nmol/L based on individual studies. (See Vitamin D and Mortality May Be a U-Shaped Curve for more on this.)

Why might higher vitamin D levels be associated with higher risk? Well, the study I profile in my video How Much Vitamin D Should You Take? was a population study, so we can’t be sure which came first. Maybe the higher vitamin D higher risk, or perhaps higher risk led to higher vitamin D levels, meaning maybe those who weren’t doing as well were prescribed vitamin D. Maybe it’s because it was a Scandinavian study, where individuals tend to take a lot of cod liver oil as a vitamin D supplement, one spoonful of which could exceed the tolerable upper daily limit of intake for vitamin A, which could have negative consequences.

Anyway, the U-shaped curve is old data. An updated meta-analysis has shown that as population vitamin D levels go up, mortality appears to go down and stay down, which is good because then we don’t have to test to see if we’re hitting just the right level. Routine testing of vitamin D levels is not recommended. Why? Well, it costs money, and, in most people, levels come right up to where you want them with sufficient sun or supplementation, so what’s the point? As well, the test is not very good: Results can be all over the place. What happens when you send a single sample to a thousand different laboratories around the world? You’d perhaps expect a little variation, but results from the same sample ranged anywhere from less than 20 to over 100 nmol/L. Depending on what laboratory your doctor sent your blood sample to, the results could vary dramatically, so one could argue the test isn’t necessarily very helpful.

So, what’s a safe dose that will likely get us to the purported optimal level? A thousand units a day should get most people up to the target 75 nmol/L (which is 30 ng/mL), but by most people, researchers mean 50 percent of people. To get around 85 percent of the U.S. population up to 75 nmol/L would require 2,000 IU a day. Two thousand IU a day would shift the curve so that the average person would fall into the desired range without fear of toxicity. We can take too much vitamin D, however, but problems don’t tend to be seen until blood levels get up around 250 nmol/L, which would take consistent daily doses in excess of 10,000 IU.

Note that if you’re overweight, you may want to take 3,000 IU and even more than that if you’re obese. If you’re over age 70 and not getting enough sun, it may take 3,500 IU to get that same 85 percent chance of bumping up your levels above the target. Again, there’s no need for the average person to test and retest, since a few thousand IU per day should bring up almost everyone without risking toxicity.

Given this, why then did the Institute of Medicine set the Recommended Daily Allowance at 600 to 800 IU? In fact, official recommendations are all over the map, ranging from just 200 IU a day all the way up to 10,000 IU a day. I’ll try to cut through the confusion in my next post.


After all that work plowing through the new science, the same 2,000 IU per day recommendation I made in 2011 remains (for those not getting enough sun): http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/.

The other videos in this series include:

I also explore Vitamin D as it relates to specific diseases:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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How Much Do Vitamin D Supplements Affect Lifespan?

How Much Do Vitamin D Supplements Affect Lifespan?

In 1822, a Polish physician was the first to publish that sunlight could cure the vitamin D deficiency disease rickets. His work was ignored by mainstream medicine for a century, not coming into widespread use until the 20th century, when wire cages were actually affixed to tenement buildings so babies could benefit from the sun. In my video Will You Live Longer If You Take Vitamin D Supplements?, I explore whether we’re in a similar situation now, where the medical profession has just not caught up with the science.

Researchers have documented correlations between higher vitamin D levels and all sorts of positive outcomes like decreases in cardiovascular disease, weight gain, infectious diseases, and declining cognitive function, and even tested whether vitamin D supplementation might reduce the adverse effects of earthquakes. It seems to help with everything else, so why not? It’s actually not as silly as it sounds because traumatic events like natural disasters can have a significant psychological impact that might be affected by vitamin D status.

But when researchers put supplements to the test, the purported links often didn’t pan out. This lack of effect may exist in part because low vitamin D levels may just be a marker for things like aging, obesity, smoking, and inactivity. Or, maybe low vitamin D didn’t lead to disease, but disease led to low vitamin D, because inflammation can drop D levels within the body. So, just because low D levels and disease seem to be correlated, it doesn’t mean that vitamin D deficiency is the cause.

While the majority of observational studies may show a link, where you simply measure vitamin D levels and disease rates, in only a handful of conditions have interventional studies—where you give people D supplements or placebos then see what happens—proven vitamin D to be effective. One of the conditions for which vitamin D supplements appear to genuinely work, however, is helping to prevent premature death.

Fifty-six randomized clinical trials involving nearly 100,000 people (mostly women) between the ages of 18 and 107 were randomized to four years of vitamin D supplements or sugar pills. Putting all the studies together showed those given vitamin D supplements lived longer and specifically had a lower risk of dying from cancer. This effect appeared limited to vitamin D3, though, which is the type derived from plants and animals, not vitamin D2, which is the type derived from yeast and mushrooms.

How large an effect was it? It would take 150 people taking vitamin D supplements for five years to save one life. If we were talking about a drug, we’d need to weigh that against the cost and side effects of dosing so many people. But when we’re talking about something as safe and cheap as vitamin D supplements, it seems like a bargain to me. A similar analysis pegged the benefit at 11 percent in terms of reduction of total mortality, which is pretty substantial, potentially offering a life extension benefit on par with exercise. Though, no, it does not seem to reduce the adverse impacts of earthquakes.

The only concern is that it may give people license to order an extra doughnut or something. We still have to eat healthfully because any longevity benefit from vitamin D would just be a small adjunct to a healthy lifestyle. But, for those of us who want all the help we can get, the question then becomes how much should we take? I address that in my videos How Much Vitamin D Should You Take? and The Optimal Dose of Vitamin D Based on Natural Levels.


For an exploration of the purported links between vitamin D and obesity, diabetes, and hypertension, see my video Do Vitamin D Supplements Help with Diabetes, Weight Loss, and Blood Pressure?.

The “extra doughnut” effect can explain How Diet Soda Could Make Us Gain Weight.

You may also be interested in:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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Where Vitamin D Supplements Fail

Where Vitamin D Supplements Fail

As I discuss in my video Do Vitamin Supplements Help with Diabetes, Weight Loss, and Blood Pressure?, review articles continue to be published touting vitamin D as a veritable cure-all. The vitamin D receptor is found in most tissues in the body, including the brain, and upwards of 2,000 genes may be regulated by vitamin D. Within 24 hours of vitamin D exposure, we can change the expression of hundreds of genes.

The term vitamin is a misnomer, though, because vitamins by definition cannot be synthesized within our body, but we can make all the D we need with sufficient sun exposure. So, rather than a vitamin, D is actually a hormone that’s produced by our skin in response to sunlight exposure. D is not just a hormone of calcium regulation and bone health; it’s also a hormone of fertility, immunity, and brain function. But is it a panacea or a false prophet?

Remember when vitamin E was the vitamin du jour, touted as a “curative for many clinical disorders”? Supplement sales of vitamin E, the “radical protector,” created a billion-dollar business that capitalized on the public’s fears. After all, those with low levels of vitamin E in their blood had a 50 percent higher cancer risk. Similar attention was directed towards vitamin A or beta-carotene. People who eat lots of greens, sweet potatoes, and other beta-carotene-rich foods have lower risk of cancer, so maybe we should give people beta-carotene pills? When they were put to the test, however, beta-carotene pills actually increased cancer rates. In fact, beta-carotene, vitamin A, and vitamin E supplements all may increase mortality, so when we buy these supplements, we’re potentially paying to shorten our lifespans. As such, I imagine you can understand the skepticism in the medical community regarding claims about vitamin D, which is now enjoying its moment in the sun.

Having a half-billion-dollar vitamin D supplement industry doesn’t help matters in terms of getting at the truth. And there’s also a highly lucrative vitamin D testing industry that loves to talk about the studies suggesting that having higher vitamin D levels may reduce the risk of heart disease, cancer, diabetes, autoimmune diseases, and infections. Most of this research, however, stems from observational studies, meaning studies that correlate higher D levels in the blood with lower disease risk, but that doesn’t mean vitamin D is the cause. It’s like the early beta-carotene data: Higher levels in the blood may have just been a marker of healthy eating. Who has high beta-carotene levels? Those who eat lots of greens and sweet potatoes. Similarly, higher levels of vitamin D may just be a marker of healthy behaviors. Who has high vitamin D levels? Those who run around outside, and those who run around outside, run around outside. Indeed, higher vitamin D levels may just be a sign of higher physical activity.

So, for instance, when you see studies showing significantly lower diabetes rates among those with higher vitamin D levels, it doesn’t mean giving people vitamin D will necessarily help. You have to put it to the test.  And, when you do, vitamin D supplements fall flat on their face, showing no benefit for preventing or treating type 2 diabetes.

So, when supplement companies wave around studies suggesting vitamin D deficiency plays a role in obesity, because most population studies show that obese individuals have lower vitamin D levels in their blood, is that simply because they’re exercising less or because it’s a fat-soluble vitamin so it’s just lodged in all that fat? We might expect obese sunbathers to make more vitamin D, since they have more skin surface area, but the same exposure level for them leads to less than half the D bioavailability, because it gets socked away in the fat. This is why obese people may require a dose of vitamin D that’s two to three times higher than normal weight individuals, although they may get it back if they lose weight and release it back into their circulation. This would explain the population data. Indeed, when you put vitamin D to the test as a treatment for obesity, it doesn’t work at all.

It’s a similar story with artery health. Those with low vitamin D levels have worse coronary blood flow, more atherosclerosis, and worse artery function, but if you actually put it to the test in randomized controlled trials, the results are disappointing. Vitamin D is also ineffective in bringing down blood pressures.

This all adds to the growing body of science “casting doubt on the ability of vitamin D supplementation to influence health outcomes beyond falls, fractures, and possibly respiratory tract infection and all-cause mortality.” Wait. What? Vitamin D supplements may make you live longer? That’s kind of important, don’t you think? I talk about that in my video Will You Live Longer If You Take Vitamin D Supplements?.


Explore the other videos in my series on vitamin D, including:

And check out these other videos on vitamin D’s potential benefits:

For additional videos on supplements, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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Changing Protein Requirements

Changing Protein Requirements

There has been a history of enthusiasm for protein in the nutrition world. A century ago, the protein recommendations were more than twice what we know them to be today. This enthusiasm peaked in the 1950s with the United Nations identifying protein deficiency as a serious, widespread, global problem. According to them, there was a worldwide protein gap that needed to be filled. This was certainly convenient for the U.S. dairy industry, who could then “dump” their postwar surplus of dried milk “in developing countries than to have to just bury it in the United States as was contemplated by the Department of Agriculture at one point.” But all of this led to the phenomena I cover in my video The Great Protein Fiasco.

It started in the 1930s with a disease of malnutrition called kwashiorkor, which was assumed to be caused by protein deficiency. The disease was famously discovered by Dr. Cicely Williams, who then spent the latter part of her life debunking the very condition she had first described. It turns out “there is no real evidence of dietary protein deficiency.” The actual “cause of kwashiorkor remains obscure,” but fecal transplant studies suggest changes in gut flora may be a causal factor. How could the field of nutrition have gotten it so spectacularly wrong? 

A famous editorial about the nutrition profession started with these words: “The dispassionate objectivity of scientists is a myth. No scientist is simply involved in the single-minded pursuit of truth, he [or she] is also engaged in the passionate pursuit of research grants and professional success. Nutritionists may wish to attack malnutrition, but they also wish to earn their living in ways they find congenial.”

“This inevitably encourages researchers to ‘make a case’ for the importance of their own portion of the field and ‘their nutrient,’” which in this case was protein.

Science did eventually prevail. There was a “massive recalculation of human protein requirements in the 1970s which ‘at the stroke of a pen’ closed the ‘protein gap’ and destroyed the theory of pandemic ‘protein malnutrition.’” Infant protein requirements went from a recommended 13 percent of daily calories down to 10 percent, 7 percent, and then down to 5 percent. To this day, however, there are still those obsessing about protein. For example, those promoting Paleolithic diets try to make the case for protein from an evolutionary perspective.

Okay, so what is the perfect food for human beings that has been fine-tuned over millions of years to contain the perfect amount of protein just for us?

Human breast milk.

“If high-quality protein was the ‘nutrient among nutrients’” that helped us build our big brains over the last few million years, “one would expect that importance to be resoundingly reflected in the composition of human breast milk,” especially because infancy is the time of our most rapid growth. But this is patently not the case. “In fact, human breast milk is one of the lowest-protein milks in the mammalian world…” Indeed, it may have the lowest protein concentration of any animal in the world, at less than 1 percent protein by weight. This is one of the reasons why feeding straight cow’s milk to babies can be so dangerous. And, although the protein content in human milk has been described as extremely low, it’s exactly where it needs to be—at the natural, normal level for the human species, fine-tuned over millions of years.

Adults require no more than 0.8 or 0.9 grams of protein per healthy kilogram of body weight per day, which is about your ideal weight in pounds multiplied by four and then divided by ten. So, someone whose ideal weight is 100 pounds may require up to 40 grams of protein a day. On average, they probably only need about 30 daily grams of protein, which is 0.66 grams per kilogram, but we round it up to 0.8 or 0.9 grams because everyone’s different and we want to capture most of the bell curve. 

People are actually more likely to suffer from protein excess than protein deficiency. “The adverse effects associated with long-term high protein/high meat intake” diets may include disorders of bone and calcium balance, disorders of kidney function, increased cancer risk, disorders of the liver, and worsening of coronary artery disease. Considering all of these potential disease risks, there is currently no reasonable scientific basis to recommend protein consumption above the current recommended daily allowance.


The “low” protein level in human breast milk (about 6 percent of calories) doesn’t mean adults only need that much. A 15-pound infant can suck up to 500 calories a day, but an adult who’s ten times heavier doesn’t typically consume ten times more food (5,000 calories). Although we weigh ten times more, we may only eat four or five times more. So, our food does need to be more concentrated in protein. Nevertheless, people tend to get way more than they need. See my video Do Vegetarians Get Enough Protein?.

Plant protein sources are preferable. See, for example:

But what about protein quality? Should we try to mix certain foods together at meals? See The Protein Combining Myth.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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The Downside of Curcumin Supplements

The Downside of Curcumin Supplements

Supplement manufacturers often fall into the same reductionist trap as the drug companies. Herbs are assumed to have only one main active ingredient, so, as the thinking goes, if you can isolate and purify it into a pill, you can boost its effects. Curcumin is described as the active ingredient in turmeric, but is it the active ingredient or just an active ingredient? It is just one of many different components—more than 300, in fact—of the whole food spice.

“Only limited studies have compared the potential of turmeric with curcumin.” Some, however, suggest turmeric, the whole food, may work even better—and not just against colon cancer cells. As I discuss in my video Turmeric or Curcumin: Plants vs. Pills, researchers at the Anderson Cancer Center in Texas pitted both curcumin and turmeric against seven different types of human cancer cells in vitro.

The study found that curcumin kicks tush against breast cancer cells, but turmeric, the whole food, kicks even more. In addition to breast cancer, the researchers found that turmeric was more potent compared to curcumin against pancreatic cancer, colon cancer, multiple myeloma, myelogenous leukemia, and colorectal cancer cells, “suggesting that components other than curcumin can also contribute to anti-cancer activities.”

Most clinical studies treating diseases in people have used curcumin supplements, as opposed to turmeric, but none has tried using turmeric components other than curcumin, even though curcumin-free turmeric exhibits anti-inflammatory and anticancer activities.

“Although curcumin is believed to account for most activities of turmeric, research over the past decade has indicated that curcumin-free turmeric”—that is, turmeric with the so-called active ingredient removed—“is as effective as or even more effective than curcumin-containing turmeric.” There are turmerones, for example, in turmeric, which may exhibit both anticancer activities, as well as anti-inflammatory activities, but these turmerones are processed out of curcumin supplements. So, I assumed this review would conclude by stating we should stop giving people curcumin supplements and instead just give them the whole food spice turmeric, but instead the researchers proposed that we make all sorts of different turmeric-derived supplements!


That’s quite a rebut to reductionism. For more on this flawed nutritional philosophy, see my video Reductionism and the Deficiency Mentality.

Similar videos in this vein include:

Interested in learning more about turmeric and cancer? See:

And for more on turmeric and everything else:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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The Disconnect Between Science and Policy

The Disconnect Between Science and Policy

Back in 1912, when hardly anyone smoked cigarettes, lung cancer was like a museum curiosity: extremely rare. In the next few decades, however, it rose dramatically around the world, roughly fifteen-fold. But researchers had already nailed it way back then. By mid-century, the evidence linking lung cancer and tobacco was considered overwhelming. Says who? Says the tobacco industry’s own research scientists in an internal memo. We now know that “senior scientists and executives within the cigarette industry knew about the cancer risks of smoking at least as early as the 1940s.”

Publically, though, they said things like, “Sure there are statistics associating lung cancer and cigarettes. There are statistics associating lung cancer with divorce, and even with lack of sleep. But no scientist has produced clinical or biological proof that cigarettes cause the diseases they are accused of causing.”

What was the government saying? My video American Medical Association Complicity with Big Tobacco includes several real cigarette advertisements, including one in which a leading U.S. Senator advises readers to smoke Lucky Strikes. Who wouldn’t want to “give [their] throat a vacation,” as another ad proclaimed? Others assured “not one single case of throat irritation,” and how could your throat and nose be adversely affected when cigarettes “are just as pure as the water you drink”? What if you do feel irritation from smoking? No problem—your doctor can write you a prescription for cigarettes, according to an ad from the Journal of the American Medical Association. After all, “don’t smoke” is advice hard for patients to swallow, as we’re told in another ad.

This reminds me of the recent survey of doctors that found the number-one reason doctors don’t prescribe heart-healthy diets was their perception that patients fear being deprived of all the junk they’re eating. After all, Philip Morris reminded doctors in an ad that we want to keep our patients happy and to “make a radical change in habit…may do harm.”

The tobacco industry gave medical journals big bucks to run ads like the ones I’m sharing with you. Should we be concerned about a conflict of interest? Not if we listen to Philip Morris, who assured us their “claims come from completely reliable sources” based on studies conducted by “recognized authorities…whose findings have been published in leading medical journals.” They even kindly offered to send free packs of cigarettes to doctors so they can test them out themselves and invited physicians to “make the doctors’ [smoking] lounge your club” at the American Medical Association convention.

What did the AMA have to say for itself? Like most other medical journals, they accepted tobacco ads but asserted that “[p]ostmortem examinations do not reveal lesions in any number of cases that could be definitely traced to the smoking of cigarettes.” So, as far as the AMA was concerned, case closed.

In fact, even after the Surgeon General’s Report on Smoking and Health came out, the American Medical Association, American Cancer Society, and Congress continued to drag their feet. The government was still subsidizing tobacco, just as our tax dollars subsidize the sugar and meat industries today. The AMA actually went on record refusing to endorse the Surgeon General’s report. Could that have been because they had just been handed ten million dollars from the tobacco industry?

Today the money is coming from big food. The American Academy of Family Physicians has accepted large sums of money from Coca-Cola “to fund patient education on obesity prevention.” I wonder what that pamphlet will say.

Who was featured as a top partner on Coca Cola’s website? The American College of Cardiology.

Just as it would have been hazardous to your health to take the medical profession’s advice on your smoking habits in the 1950s, it may be hazardous to your health today to take the medical profession’s advice on your eating habits.


If the balance of scientific evidence favors plant-based eating, why isn’t the medical profession at the forefront of encouraging people to eat healthier? That’s the question this video tries to answer. Looking back to smoking in the 1950s, we can see how all of society, the government, and even the medical profession itself could be in favor of habits that decades of science had already overwhelmingly condemned as harmful.

For more on the influence industry can have on food policy, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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Consequences of Prostate Cancer Treatment

Consequences of Prostate Cancer Treatment

A cancer diagnosis is seen as a teachable moment in medicine where we can try to get people to eat healthier, but “research has suggested that male cancer patients may be reluctant to introduce dietary modification…This has been attributed to dietary modifications often being viewed as mimicking “feminine” eating behaviours, such as emphasizing an increase in fruit and vegetables.” 

As I discuss in my video Changing a Man’s Diet After a Prostate Cancer Diagnosis, “[a]lthough healthy eating might enhance long-term survival, few men with prostate cancer make diet changes to advance their well-being.” Many of the cancer survival trials require adherence to strict plant-based diets, and though researchers tried providing extensive nutrition education and counseling programs, dietary adherence was still a challenge.

Apparently the way Dean Ornish was able to reverse the progression of prostate cancer with a plant-based diet was by home-delivering prepared meals to the subjects’ doors, figuring men are so lazy they’ll just eat whatever’s put in front of them. After all, male culture tends to encourage men to drink beer and eat convenience food and meat.

Take Men’s Health magazine, for example. Included in the list of things men should never apologize for were liking McDonald’s, not offering a vegetarian alternative, and laughing at people who eat trail mix. The magazine features articles with such titles as “Vegetables Are for Girls” and sections like “Men and Meat: There’s Only One Kind of Flesh We Like Better and Even Then She’d Better Know How to Grill.”

To appeal to male sensibilities, doctors are advised to use ‘body as machine’ metaphors, framing “men’s health in terms of mechanical objects, such as cars, requiring tuning.” But if men are so concerned about their masculinity and manhood, maybe we instead should share a bit about what prostate cancer treatment entails. The prostate is situated at the base of the penis, so when you core it out with a radical prostatectomy, you lose about an inch off your penis, if it gets erect at all. Only 16 percent of men undergoing the procedure will regain their pre-surgery level of erectile functioning.

Patients are typically quoted erectile dysfunction rates around 60 to 70 percent, but studies have generally considered erectile function recovery “as the ability to maintain an erection hard enough for penetration about 50% of the time…” So, occasionally being able to get an erection is considered recovery, but when a surgeon tells patients they will recover function, the patients probably assume that means the kind of function they had prior to surgery, which only happens 16 percent of the time and only 4 percent of the time in men over 60. Only 1 in 25 gets his baseline sexual function back.

Erections aren’t the only issue. Patients experience other problems like orgasm-associated pain even years later and urinary incontinence during foreplay, stimulation, or orgasm. The vast majority of couples overestimate how much function they’re going to recover. Couples reported feeling loss and grief. Having cancer is bad enough without the additional losses. You’d think that would be enough to motivate men to improve their diets, but almost a fourth of the men newly diagnosed with prostate cancer state they would prefer to have their lives cut short rather than live with a diet that prohibits beef and pork. More men would rather be impotent than improve their diet. It appears pleasures of the flesh may sometimes even trump pleasures of the flesh.


Did I say reverse the progression of cancer? See Cancer Reversal Through Diet? and my overview video How Not to Die from Cancer.

For more on prostate cancer prevention and survival, check out:

Interested in more information on maintaining male sexual function? See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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The Best Diet for Angina

The Best Diet for Angina

The Dean Ornish program that led to improved arterial function and the dramatic drop in angina attacks—a 91 percent reduction in reported frequency of angina—is not just about putting people on a plant-based diet. It also involves recommendations for moderate exercise and stress management. We know exercise alone can improve endothelial function, so how do we know diet had anything to do with it? This is the subject of my video Plant-Based Treatment for Angina.

Going back to Ornish’s first publication, he put cardiac patients on a quasi-vegan diet, with no added exercise—just diet and stress management—and got the same 91 percent reduction in angina attacks within just 24 days. And Dr. Esselstyn was able to improve angina using a plant-based diet as the only lifestyle intervention. There are published case series going back to the 1970s documenting this. One study participant, Mr. F.W., had chest pain so severe he had to stop every nine or ten steps. He couldn’t even make it to his mailbox. He started on a strictly plant-based diet, and, a few months later, he was climbing mountains with no pain.

We know plant-based diets can reverse heart disease, dissolving away plaque and opening up arteries—in some cases without drugs or surgery—but that doesn’t happen in 24 days. “[T]he improvements in anginal symptoms are too rapid in onset and [too great] in magnitude to be explained by the gradual regression” of the atherosclerotic plaque. So, maybe it’s this improvement in function as well as structure.

What is it about plant-based diets that improves our arteries’ ability to dilate? Is it macronutrient differences? Simply the lack of the deleterious effect of meat? Maybe it’s the drop in cholesterol. Endothelial function improves if we lower our cholesterol low enough, by any means necessary. One study took PET scans measuring blood flow to the heart before and after three radically different ways to lower cholesterol. The first method used drugs, and the second used a low-fat diet—a really low-fat diet with less than 2 percent of calories from fat. And the third? No diet at all—that is, 90 days without food; the researchers had a central line placed to basically drip enriched sugar water straight into the subjects’ blood stream for three months. These researchers were not messing around. The treatment protocol didn’t include any exercise or stress management, either. They wanted to isolate out the effect of cholesterol lowering on cardiac blood flow.

The study participants started out with miserable cholesterol levels and with diminished blood flow to their hearts, so-called perfusion deficits, areas of the heart muscle that aren’t getting adequate blood flow. After cholesterol lowering, their cholesterol levels were still terrible, but, with the improvement, there was an improvement in blood flow and their angina attacks were cut in half. When they stopped the treatment and their cholesterol went back up, the blood flow to their heart muscle went back down. So, cholesterol lowering itself appears to improve blood flow to the heart, and the researchers think it’s because when cholesterol goes down, endothelial function improves.

There’s a new category of anti-angina drugs, but before committing billions of dollars of public and private monies to dishing them out, maybe “we should take a more serious and respectful look at dietary strategies that are demonstrably highly effective for treating angina and that have also been shown to reduce subsequent cardiac morbidity. To date, these strategies have been marginalized by the ‘drug pusher’ mentality of orthodox medical practice; presumably, doctors feel that most patients will be unwilling or unable to make the substantial dietary changes required…While this may be true for many patients, it certainly is not true for all. And, in any case, angina patients deserve to be offered the very-low-fat diet alternative”—the Ornish or Esselstyn diet alternative— “before being shunted to expensive surgery or to drug therapies that can have a range of side effects and never really get to the root of the problem.”

In response, a drug company executive wrote in to the medical journal, “Although diet and lifestyle modifications should be a part of disease management for patients with cardiovascular disease and diabetes, many patients may not be able to comply with the substantial dietary changes required to achieve a vegan diet…” So, of course, everyone should go on their fancy new drug, Ranolazine. It costs thousands of dollars a year to take it, but it works. Collectively, the studies show that at the highest dose, Ranolazine may prolong exercise duration as long as 33.5 seconds.

It does not look like those choosing the drug route will be climbing mountains anytime soon.


See a comparison of the arterial function of vegetarians versus omnivores in my Plant-Based Diets and Artery Function video. How about comparing the Arteries of Vegans vs. Runners? If those on plant-based diets aren’t getting a regular, reliable source of vitamin B12, though, their artery health can suffer. See Vitamin B12 Necessary for Arterial Health.

Cholesterol may do more than just impair the function of our arteries. Check out the images in my video Cholesterol Crystals May Tear Through Our Artery Lining. For even more, watch How Do We Know that Cholesterol Causes Heart Disease? and Optimal Cholesterol Level.

Does Cholesterol Size Matter? Watch the video to find out.

Three things increase our cholesterol level: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. What about moderation? Well, how moderate do you want your disease? See Everything in Moderation? Even Heart Disease? to learn more. And, be sure to check out How Not to Die from Heart Disease.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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Cancer-Causing Caramel Color

Cancer-Causing Caramel Color

Caramel coloring may be the most widely consumed food coloring in the world.  Unfortunately, its manufacture can sometimes lead to the formation of a carcinogen called methylimidazole, which was identified as a cancer-causing chemical in 2007. For the purposes of its Proposition 65 labeling law, California set a daily limit at 29 micrograms a day. So, how much cancer might caramel-colored soft drinks be causing? We didn’t know…until now… My video Which has more Caramel Coloring Carcinogens: Coke or Pepsi? explores these questions and more.

Researchers tested 110 soft drink samples off store shelves in California and around the New York metropolitan area, including Connecticut and New Jersey. None of the carcinogen was found in Sprite, which is what you’d expect since Sprite isn’t caramel-colored brown. Among sodas that are, the highest levels were found in a Goya brand soda, while the lowest levels were in Coke products, which were about 20 times less than Pepsi products. Interestingly, California Pepsi was significantly less carcinogenic than New York Pepsi. “This supports the notion that [labeling laws like] Proposition 65…can incentivize manufacturers to reduce foodborne chemical risks…” To protect consumers around the rest of the country, federal regulations could be a valuable approach to reducing excess cancer risk—but how much cancer are we talking about?

Johns Hopkins researchers calculated the cancer burden, an estimate of the number of lifetime excess cancer cases associated with the consumption of the various beverages. So, at the average U.S. soda intake, with the average levels of carcinogens found, Pepsi may be causing thousands of cancer cases, especially non-California Pepsi products, which appear to be causing 20 times more cancer than Coke. Of course, there’s no need for any of them to have any these carcinogens at all “as caramel colorings serve only a cosmetic purpose [and] could be omitted from foods and beverages…” But we don’t have to wait for government regulation or corporate social responsibility; we can exercise personal responsibility and just stop drinking soda altogether.

Cutting out soda may reduce our risk of becoming obese and getting diabetes, getting fatty liver disease, suffering hip fractures, developing rheumatoid arthritis, developing chronic kidney disease, and maybe developing gout, as well.

In children, daily soda consumption may increase the odds of asthma five-fold and increase the risk of premature puberty in girls, raising the likelihood they start getting their periods before age 11 by as much as 47 percent.

If we look at the back of people’s eyes, we can measure the caliber of the arteries in their retina, and the narrower they are, the higher the risk of high blood pressure, diabetes, and heart disease. Researchers performed these kinds of measurements on thousands of 12-year-olds and asked them about their soda drinking habits. Their findings? Children who consume soft drinks daily have significantly narrower arteries. “The message to patients can no longer remain the simplistic mantra ‘eat less, exercise more.’” It matters what you eat. “[S]pecific dietary advice should be to significantly reduce the consumption of processed food and added sugar and to eat more whole foods.”


Prop 65 is lambasted by vested interests, but, as I mentioned, it may push manufacturers to make their products less carcinogenic. Other Prop 65 videos include:

For more background on caramel coloring, see my video Is Caramel Color Carcinogenic?.

There are other soda additives that are potentially toxic, too. See my three-part series on phosphates:

Other coloring agents are less than healthy. For more on this, see Artificial Food Colors and ADHD and Seeing Red No. 3: Coloring to Dye For.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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What to Feed Your Gut Bacteria

What to Feed Your Gut Bacteria

For many years, it was believed that the main function of the large intestine was just to absorb water and dispose of waste, but “[n]owadays it is clear that the complex microbial ecosystem in our intestines should be considered as a separate organ within the body,” and that organ runs on a MAC, microbiota-accessible carbohydrates. In other words, primarily fiber.

One reason we can get an increase of nearly two grams of stool for every one gram of fiber is that the fiber fermentation process in our colon promotes bacterial growth. The bulk of our stool by weight is pure bacteria, trillions and trillions of bacteria, and that was on a wimpy, fiber-deficient British diet. People who take fiber supplements know that a few spoonfuls of fiber can lead to a massive bowel movement, because fiber is what our good gut bacteria thrive on. When we eat a whole plant food like fruit, we’re telling our gut flora to be fruitful and multiply.

From fiber, our gut flora produce short-chain fatty acids, which are an important energy-source for the cells lining our colon. So, we feed our flora with fiber and then they turn around and feed us right back. These short-chain fatty acids also function to suppress inflammation and cancer, which is why we think eating fiber may be so good for us. When we don’t eat enough whole plant foods, though, we are in effect starving our microbial selves, as I discuss in my video Gut Dysbiosis: Starving Our Microbial Self. On traditional plant-based diets, we get lots of fiber and lots of short-chain fatty acids, and enjoy lots of protection from Western diseases like colon cancer. In contrast, on a standard American diet filled with highly processed food, there’s nothing left over for our gut flora. It’s all absorbed in our small intestine before it even makes it down to the colon. Not only may this mean loss of beneficial microbial metabolites, but also a loss in the beneficial microbes themselves.

Research shows the biggest issue presented by a Western diet is that not leaving anything for our bacteria to eat results in dysbiosis, an imbalance wherein bad bacteria can take over and increase our susceptibility to inflammatory diseases or colon cancer, or maybe even lead to metabolic syndrome, type 2 diabetes, or cardiovascular disease.

It’s like when astronauts return from space flights having lost most of their good bacteria because they’ve had no access to real food. Too many of us are leading an “astronaut-type lifestyle,” not eating fresh fruits and vegetables. For example, the astronauts lost nearly 100 percent of their lactobacillus plantarum, which is one of the good guys, but studies reveal most Americans don’t have any to begin with, though those who eat more plant-based are doing better.

So it’s use it or lose it. If people are fed resistant starch, a type of MAC found in beans, within days the bacteria that eat resistant starch shoot up and then die back off when you stop. Eating just a half can of chickpeas every day may “modulate the intestinal microbial composition to promote intestinal health” by increasing potentially good bacteria and decreasing pathogenic and putrefactive bacteria. Unfortunately, most Americans don’t eat beans every day or enough whole grains, enough fruits, or enough vegetables. So, the gut flora—the gut microbiota—of a seemingly healthy person may not be equivalent to a healthy gut flora. It’s possible that the Western microbiota is actually dysbiotic in the first place just because we’re eating such fiber-deficient diets compared to populations that may eat five times more fiber and end up with about 50 times less colon cancer.


This is one of the reasons I recommend three daily servings of legumes (beans, split peas, chickpeas, and lentils) in my Daily Dozen checklist.

The microbiome connection may explain the extraordinary results in the study I featured in my video Is It Worth Switching from White Rice to Brown?.

More on the musical fruit:

More on the microbiome revolution in medicine:

For more on bowel health, check out:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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The content for this post was sourced from www.NutritionFacts.org

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