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 at 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 and 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, and 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% report 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, and sweaty and nauseous?
Well, speaking of cheap, safe, and effective, just drinking water can prevent it.
So if you know needles make you woozy, 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 have 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, or injections
could pose a particularly serious threat
if people neglect to seek medical care
when necessary, but all one may have to do
is just 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.
So, 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. I mean, case reports are 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% at one year, 90% 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 in bloody stool during hospitalization.
Fantastic! Okay, but here's the really exciting part. Then they followed
the patients for 5 years, and 81% were able to remain in remission
the whole time, and 98% were able to keep the disease at bay for at least a year.
I mean 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% 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, they were still eating more plant-based
even 6 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.
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. Side effects include...
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 1 year of only like 17 to 34%.
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, hey, at least over half the hospitals met
at least over half the guidelines.
And hey, they’re so stringent anyway.
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;
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, 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, 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% of daily menus exceeding the
American Heart Association’s recommendation
for staying under 1500 mg 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 becomes prepackaged within the food.
Check it out. Switch people to a low sodium diet and sure,
they use their saltshakers 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 they can 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.
This wasn’t from the 1950’s, but from the 1980’s.
Yet, the irony of hospitals allowing the sale
of a 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 the 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.
We would love it if you could share with us your stories
about reinventing your health through evidence-based nutrition.
Go to nutritionfacts.org/testimonials.
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To see any graphs, charts, graphics, Images, or studies mentioned here,
please go to the Nutrition Facts Podcast landing page.
There you’ll find all the detailed information you need –
plus links to all of the sources we cite for each of these topics.
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