Culinary Medicine: Food Cons & Food Conversations

Turmeric: It can kill youTurmeric is from the root of a flowering plant (Curcuma longa of the ginger family Zingiberaceae), known for being anti-inflammatory. Because of its anti-inflammatory nature, turmeric is one of the most common supplements I am asked about during my TikTok live sessions. This is because people like a "natural" anti-inflammatory supplement rather than over-the-counter medications.SupplementsSupplements are excluded from "black box warnings." Those warnings you see in the package inserts in pharmaceuticals. This article is meant to provide references for those interested in doing more research about Tumeric to realize it is not benign.Turmeric has many potential applications for cancer, brain injury, and many other diseases. The key is knowing what dose of turmeric is toxic, what dose is effective, and what dose is ineffective. We also need to know how to mitigate potential dangers.Contrast with AspirinAspirin is a known anti-inflammatory agent with many uses. Since aspirin is regulated, we know the dose effect of aspirin. If you have a headache, the 81 mg dose of aspirin will not relieve your headache. But the 325 mg dose will decrease headache. And you know that taking two hundred tablets of aspirin is a toxic dose.A single aspirin can cause a bleeding ulcer, which may lead to death. Some people are allergic to aspirin, and an allergic reaction can lead to death.What we don't know is the effective dose of Turmeric or the lethal dose of it in that supplement bottle. But we know that turmeric, curcumin can lead to liver injury and death.Turmeric and Liver InjuryToxicity is always in the dose. High curcumin levels, the active ingredient in turmeric, have caused liver damage (Ref 1-13). To quote from one of the references:Liver injury due to turmeric appears to be increasing in the United States, perhaps reflecting usage patterns or increased combination with black pepper. (2)Turmeric and CookingThere is no danger in using turmeric as a spice in cooking. First, because your intestines do not absorb turmeric well. Unlike a supplement, which has high doses of curcumin. In addition, supplements also have black pepper, which increases absorption. Since turmeric has a mild anti-inflammatory component, this might have limited benefits as part of a healthy diet. Tumeric belongs in the cabinet, not in a capsule.TEXT FROM THE PODCASTYou probably have some turmeric in your herb and spice drawer.You've probably heard that Turmeric's active ingredient Curcumin has anti-inflammatory properties and has been used for centuries as an “ancient” medicine.That yellow powder comes from the root of the Curcuma longa plant, a member of the ginger family.Turmeric has a warm, bitter taste, and I use it in Paella, curry, and add it to salads, rice, or other starches like pearl barley.But what you haven't heard is that too much Turmeric can kill you.Today we will make sense of the madness surrounding Turmeric. From its promise as an anti-cancer agent to its toxicity, and who should avoid it for daily use.FORK UI'm Dr. Terry Simpson, and THIS is FORK UFork UniversityWhere we make sense of the madnessBust a few myths!And teach you a little bit about food as medicine.InflammationInflammation is a complex biochemical, physiological, and even pathological process. Inflammation is the basis of our immune system, and acute inflammation allows us to rid our bodies of cancer, viruses, bacteria, yeasts, mold, and parasites. Without the inflammatory process, we would end up being a pile of goo in twenty-four hours – dead as dead can be. Inflammation allows us

Ozempic, Wegovy, Monjaro, and a host of other drugs – the GLP-1 agonists and near miracles weight loss drugs, and soon a more potent pill form coming.These drugs have known side effects, and there have been increased visits to the emergency rooms. Often because people were not told foods to avoid.As with any new drug, there are the grifters. After all, since it is a prescription, you will have supplement salesmen that promise a natural solution. What about those who claim they can "compound" the drug for you in their compound pharmacy?Weight Watchers and SequenceWas it a coincidence that Weight Watchers (WW) bought Sequence? Sequence is a company that prescribes these drugs through a network of physicians that you contact via telemedicine. Sequence, as it turns out, is one of the more legitimate telemedicine companies, not only trying to get you a prescription but providing a diet plan with it.Weight Watchers purchased Sequence for over 100 million dollars. One thing missing from the frequent prescription of the new drugs is a diet plan. Weight Watchers does this.And Weight Watchers is partially owned by Oprah Winfrey, who has been open about her weight loss struggles. Now, Oprah reports she has been on semaglutide and lost over 45 pounds.Thus Oprah proved that the drugs, with a good diet, are a powerful tool against obesity.It is More Than Willpower - Ask OprahAs a weight loss surgeon, I am constantly asked about willpower and obesity. For example, Oprah Winfrey a person with more willpower than probably anyone you know. Given her resources to have people cook for her, provide her with a workout plan, and any assistance. She even bought a major portion of Weight Watchers. What made the difference? The injectable drug, semaglutide (Wegovy).Obesity Management is more than a diet - ask Weight WatchersThe Weight Watchers diet plan has evolved over the years. Even with the Weight Watchers diet plan ranking among the best diets in the world, they purchased Sequence. Thus repositioning themselves to use their diet with the drugs to provide optimal health.Keeping you out of the Emergency Room - Side Effects of the New DrugsEmergency room physicians have noted an increase in patients coming to the ER after using these drugs. I was recently interviewed about this, and you can find it here.Common side effects include nausea, vomiting, bloating, constipation, and diarrhea. Up to eighty percent of people who take these drugs have symptoms. Many of those problems can be avoided by following a few simple rules: Avoid fatty foods. Fatty foods increase bloating and discomfort with these drugs. Fried chicken has sent many to the emergency room Alcohol should be limited to one drink per day. Although best to avoid alcohol altogether with these medications. Junk food with lots of sugar, like candy, cookies, and donuts, should be avoided while on these drugs. Foods to concentrate on are fruits, vegetables, whole grains, and brothy soups like Minestrone or Dahl.Compound Pharmacies and "generic Ozempic"Many compound pharmacies have offered these drugs for sale. They are often at a greatly reduced price. But they are not the same drugs approved and tested by the FDA.There is no "generic" form of Ozempic, Wegovy, or Mounjaro.Compound pharmacies are telling their customers that, since there is a shortage of these drugs, they can compound the drug and sell it to the public.Many of these compound pharmacies import semaglutide from overseas. It is illegal to import a drug from overseas without FDA approval. Furthermore, the drugs they import are not the same formula...

Seed Oils, Omega 6, and InflammationJust about everyone in the low-carb community is talking about how bad seed oils are. They claim the medical community has it wrong. The conspiracy-minded folks claim doctors want to keep people sick. Thus dependent on medicine for pills and surgery. Hence, seed oils are the new evil part of the picture.The New Sugar ConspiracySeed oils, hydrogenated oils, and omega-6 fatty acids have replaced sugar as the new reason for ill health in America.Their logic goes like this:Seed oils are high in omega-6 fatty acids. They claim that high Omega 6 fatty acids are pro-inflammatory. Therefore, if you have more seed oils in your diet, you will have more inflammation. Inflammation is the root cause of heart disease.Their argument is logical, partially true, and the conclusion is incorrect. They are selling you snake oil (well, usually supplements).It is Peanut ButterThe keto crowd will say how "real" peanut butter is made with peanuts and salt. Claiming this peanut butter is "candy" or "full of garbage" and isn't fit to be eaten. But is it? Let's break this down.Added SugarFirst, the added sugar, which according to the label is 3 grams per serving (two tablespoons), so the whole thing is 190 calories, of which 12 of those calories come from sugar, the rest from fat.Here is the label from Sprouts Pure Peanut Butter. Nothing but ground peanuts. No salt, no oils, no sugar. There are 200 calories from two tablespoons.Of the 200 calories from all peanut butter, with no added sugar, you get the same number of calories from the peanut butter with sugar in it. How much sugar? Well, about 3 grams per serving of sugar. How much is that? Not much. To exceed the recommended dose of sugar from the American Heart Association, you would need to have more than 6% of your calories. In Skippy, it is 1.5% added sugar.Low Carb Sugar ConspiracySugar was the "evil" that low carbohydrate folks said caused obesity. If you read their literature from twenty-plus years ago, it blamed sugar for obesity. Not just sugar, but any carb that was sugar, they claimed, would become fat. They even had their alternative view of history of obesity in the country.They stated that the world was not obese until Ancel Keys blamed heart disease on fat. Then the US government promoted a low-fat diet. The result was obesity bloomed because they replaced fat with sugar. That evil food pyramid caused people to turn away from fat, substituting sugar. That sugar substitution led to obesity.It sounds so logical. If you ever go on a low-carb diet (Atkins, South Beach, Paleo, Keto, Carnivore), you stop eating junk food and eat steak. You feel satisfied eating lots of meat. Then you get tired of steak. You lose weight because you are in a calorie deficit, not because of ketosis. But that weight loss leads to confirmation of the theory that sugar made you fat.You go off the restrictive diet. Now you gain weight. You gain weight because you are eating more. But you blame the slice of bread. What you forget is now you are eating more steak because you have more flavors in your mouth. That slice of bread is 100 calories, but you think an 18-ounce Porterhouse (1260 calories) is a diet food? So you blame the bread or the lava cake. But not the extra calories.Where It Falls ApartBut something about your low-carb diet doesn't make sense. You notice that obesity has increased in the United States. But...

Implementing the Mediterranean Diet: VegetablesThe increase of vegetables in the diet is one way to reduce inflammation.Vegetables are an important part of the Mediterranean diet, providing essential nutrients. A diet rich in vegetables that contain antioxidants. As a result, the Med diet reduces the risk of heart disease, cancer, dementia, and anti-inflammatory diseases.Vegetables are low in calories, but high in nutrient density. In addition to providing high nutrient value, they provide satiety. Thus making vegetables the cornerstone for weight loss and maintenance.How Much is a Serving?One serving of vegetables is 3 ounces (85 grams) of raw or double that cooked. Three servings of vegetables a day is the daily goal. Without a doubt, the more vegetables, the better.Meal IdeasBreakfast ideas for vegetables include what you might put in an omelet: tomatoes, spinach, onions, and chives. Even the breakfast bites can have multiple vegetables in them.While salads are great for lunch, filled with kale, radishes, and carrots, don't forget that you can pile a sandwich with lettuce, cucumbers, sprouts, and tomato.Need a snack during the middle of the day, plan on carrots for the afternoon and for the drive home. You can't fall asleep while chewing on carrots.Broccoli might be a great snack before dinner. Raw, even if you have a bit of ranch dressing. Buy packets of dry ranch dry ingredients and add to Greek yogurt.Don't forget that dinner salad. Make it large and beautiful.Supplements Are Not the SameVegetables contain nutrients that your body needs. They are rich in magnesium, potassium, and folate.There is no supplement that can replace vegetables.Do Vegetables Have Anti-nutrients?Every study has shown that an increase in vegetables decreases heart disease, cancer, and inflammation.People who sell supplements often point out that vegetables have anti-nutrients in them. I have talked about this in a previous podcast and post (here). Of the various supplement salesmen out there, from the self-described Carnivore and his business partner Liver King to Dr. Gundry.LectinsLegumes like beans and lentils are nutrient-rich, protein-, and fiber-rich foods whose benefits outweigh any lectin. High doses of lectins, when fed to animals, lead to diarrhea, inflammation, and other problems. These problems have never been seen in human studies with normal foods. The main lectins are destroyed by cooking, soaking, sprouting, fermenting, boiling, and canning.All human trials show that diets rich in legumes, and whole grains, lead to better health.OxalatesOxalates can be absorbed from the gut, bind to calcium, and cause calcium kidney stones. They will also bind other minerals, such as zinc. This has led some to avoid healthy foods like spinach, swiss chard, amaranth, taro, sweet potatoes, beets, rhubarb, and sorrel.Cooking greatly decreases the oxalate content. In addition, cooking increases the nutrients of the vegetables available for absorption. The higher the vegetable content, the higher the mineral content of the diet, the fewer kidney stones are formed. People who consume a DASH diet have a 40-50% decreased risk of kidney stones (reference). The DASH diet is the American version of the...

Do You Need A Liver Cleanse?Fatty liver disease is the most common reason for liver transplantation. Fatty liver disease replaced alcoholic liver disease a decade ago.The rise of obesity has contributed to fatty liver disease, and fat, like alcohol, is deadly to your liver.So can you clean out your liver? Simple answer - no. But that doesn't stop the world from making dubious claims.History of Liver ScamsThe most famous was Carter's Little Liver pills. They promised to increase the flow of bile in the liver. This would rid the body of toxins.Even when it was marketed in 1868, it was known as a "patent" medicine. Thus a medicine without merit was sold by quacks.In 1959, the name was changed to "Carter's Little Pills." The FDA, in 1951, filed suit that the pills had nothing to do with the liver.The phrase "Someone has more (fill in the blank) than Carter has pills" comes from this product.The Master CleanserStanley Burroughs, a lumber salesman, invented the "master" liver cleanse. The formula was tea or lemonade with cayenne pepper and maple syrup. There was no clinical data this ever worked. In spite of the lack of evidence, it continues to be recycled in the pseudoscience world.Burroughs first published the book in 1946, "The Master Cleanse," and re-released it in 1976 under the title "The Master Cleanser".Burroughs was convicted of manslaughter in California and fined for practicing medicine without a license.This "juice" or "liver cleanse" or liver detoxification program keeps coming around with different ingredients. Some of the latest include olive oil.Gallbladder FlushThe gallbladder flush is the same formula. People will defecate small round balls of fecal material. Then they are told that these represent gallbladder stones, but they are not. Thus, the flush is useless.The Liver's JobAll the blood from the stomach and small bowel is filtered through the liver. Hence, the liver can be considered a filter.Once the food you eat is broken down and digested by the gut, those nutrients go to the liver. Then the liver determines if you need to use the nutrients, store the nutrients, or get rid of the nutrients.The liver gets the first pass at the medicines you take. Many medicines require the liver to process them to be effective. Those drugs are called "pro-drugs." Aspirin, for example, is a drug whose active ingredient is salicylic acid.Liver and AlcoholThe liver can also take harmful substances and render them harmless. In spite of the liver's ability to deactivate harmful products, a person can overcome the liver's ability to detoxify substances. The classic case is alcohol.Once alcohol is ingested, the liver begins to change it into acetaldehyde. Acetaldehyde is both toxic to the liver and responsible for most hangovers. Acetaldehyde is metabolized into harmless products.If a person consumes more alcohol than the liver can metabolize, they will become intoxicated. In addition, they will develop both acute fatty liver and chronic fatty liver. A fatty liver can lead to cirrhosis and liver failure.Milk Thistle and The LiverSince there are multiple complex metabolic pathways in the liver, there is no one agent that will fix the liver.Supplements touted to help the liver include:Milk Thistle. The active ingredient is silymarin. Silymarin has been extensively studied in alcoholic liver disease, fatty liver disease, hepatitis, Tylenol poisoning, and...

Erythritol and Heart Attacks: Is It Hype?Does the artificial sweetener erythritol increase the risk of heart attacks? In fact, some say that this is just hype.The article abstract can be found here.Erythritol is an artificial sweetenerIt has been used for years in food as a "non-nutritive sweetener." Erythritol is used in many processed foods, replacing the calories from sugar. The Food and Drug Administration considers erythritol a food additive (GRAS). As a food additive, erythritol has never been tested for its toxicity or long-term use.The case for artificial sweetenersWhile artificial sweeteners decrease calories, do they decrease obesity? They have been shown to decrease obesity among teenagers (ref here). By reducing calories, it seems obvious that obesity would decrease. And yet, this has not been a consistent resultA study showed that increased erythritol led to increased obesity. And that was just the erythritol your body makes.But your body makes erythritolSince your body makes erythritol. Does that mean it must be safe?The human body produces many toxic substances. For example, formaldehyde. Humans produce about 1.5 ounces of formaldehyde a day.Acetaldehyde is a breakdown product of ethanol. Drink too much alcohol, and you will produce enough acetaldehyde to kill you.The case against artificial sweetenersThere have been a number of peer-reviewed journal articles showing that artificial sweeteners have adverse consequences:Weight gain and obesity (ref)Insulin resistance (ref)Type 2 Diabetes (ref)Stroke, heart disease, and all-cause mortality (ref)Increased heart deaths in women (ref)How much we makeWe have about ten micromoles per liter of blood. That would be the baseline level. Blood levels with 1000 times as much erythritol are found in people who consume it as a sweetener.One study showed that erythritol led to improved blood vessel function after drinking erythritol for a month (ref). But this was in healthy young adults. What about people with underlying heart disease?It's not hype - the studyThe Erythritol study was done by the highly regarded Cleveland Clinic and published in the journal Nature Medicine. It was peer-reviewed, meaning many other scientists looked at that data and concluded the study was worthy of being included in this prestigious journal.What this study examined was the correlation of erythritol with people prone to heart disease. They studied people at risk for heart disease. Such as those with high blood cholesterol, diabetes, obesity, or hypertension. They looked at the blood levels of erythritol. Data divided the patients according to how much erythritol was in their blood. What they found was that those with the highest levels of erythritol had the highest incidence of heart disease, strokes, and cardiac...

Don't Fear the Fruit, Enjoy ItAre you afraid that eating fruit will cause your blood sugar to spike? Let us bust that myth right now.Only ten percent of adults eat enough whole fruit daily despite the clear benefits of fruit.Eating fruit and Living Longer My 98-year-old dad eats fruit with breakfast for as long as I have known him. We would have grapefruit every morning. We even had those cute grapefruit spoons to wrestle the goodness out of the half grapefruit.Now, dad enjoys a mixed bit of fruit.In 28 studies with over 1.6 million people, each serving of fruit led to a 5% lower incidence of death (reference).Each serving of fruit8% less risk of heart disease3% lower risk of cancer200 grams (7 ounces) showed the lowest risk of cancer rates and deaths from cancer.Even the Low Carb Community is coming aroundThirty years ago, the low-carb community advised against whole fruits. Their rationale was that fruits spiked blood sugar, which caused insulin to rise, which caused fat storage. They even cautioned against eating carrots for the same reason. But now, even the most extreme members of that community proudly eat fruit.What 5 servings looks likeBreakfast with 1/2 cup of blueberriesMorning snack of one medium bananaLunch with one appleAfternoon snack of 1/2 cup of grapes (about 16)Evening snack of 1 clementineDon't forget the tomatoThe tomato is a fruit. Yes, the Supreme Court said, for taxation purposes, it is a vegetable, but it isn't.Other Benefits of Fruitpromoting long-term weight managementreducing the risk of heart diseasereducing the risk of type 2 diabetesdecreasing the risk of colon and lung cancerlowering the risk of depressionsuccessful aging (like dad)higher bone mineral densitydecreasing incidence of seborrheic dermatitisless constipationless irritable bowelless inflammatory bowelless diverticular diseaseless hemorrhoidsless stressFruit is not the enemy - but it is one of the easiest of the nine food groups to add to your Mediterranean Diet and one of the easiest and most delicious to add to the DASH diet. -----Produced by Simpler Media

Salt: Toxicity is in the DoseFor the human body, salt is both an essential metal and toxic at a high dose. The most common form of sodium comes from sodium chloride, a salt. However, too much salt and arteries become stiff, and the risk of heart disease and cardiovascular disease increases. The majority of dietary salt comes from processed foods.Salt Toxcity DeniersProbably the most famous book is The Salt Fix. A rambling book claiming low salt is responsible for everything from lower sex drive to insulin resistance. The book is logical and simplistic, with abundant citations taken out of context. In summary, the book is almost completely incorrect.Salt and HypertensionOne of the classic studies about salt and hypertension is the DASH sodium study. In these studies, the study participants were fed the diet with varying amounts of salt. These studies are expensive and often not done, but powerful. Additionally, the lower levels of salt, the lower the blood pressure. In fact, a low-sodium DASH diet led to a reduction of blood pressure equivalent to one blood pressure pill.In contrast, "The Salt Fix" states that decreasing levels of salt led to increasing blood pressure and heart disease. The Salt Fix explanation is that lower salt leads to increased levels of renin, angiotensin, and aldosterone (hormones that would increase blood pressure). His conclusion is the opposite of hundreds of articles and much analysis. Such as here, here, and here.Salt and CholesterolAnother false claim, "The Salt Fix," stated the DASH study showed an increase in LDL, cholesterol, and triglycerides.The DASH diet showed no significant impact at all.More of "The Salt Fix" MisinformationOur ancestors ate more saltThe primitive argument for which there is no proof. Since our ancestors ate mostly plants and no processed foods, this is easily debunked. Meat eaters know that a one-pound chicken contains about 150 mg of salt. A double patty of hamburger has 500 mg. He makes up numbers that don't make sense.He states our ancestors ate from salt licks, but there are few in Africa (he makes up stuff)Other countries have higher salt intake and lower heart diseaseHe cites Korea (which has 50% hypertension or pre-hypertension), Japan (highest incidence of stomach cancer related to salt), and France (hypertension is high, but low levels of heart disease related to the Mediterranean diet practiced by most).Salt doesn't lower blood pressure by a significant amount and makes food bland.The DASH diet studies show significant reductions in blood pressure, and the food is not bland.Lower salt leads to increased death.The opposite has been shown. Increased levels of sodium in the diet show increased levels of death.Lower salt leads to lower iodine levels.Iodized salt was introduced in the US because of the low iodine

Why you should ditch your gas stoveDid you ever wonder what the controversy is about gas stoves? There is no controversy. Gas range tops are responsible for high levels of indoor pollution. But what should we do? The answer, change to an induction cooking topTypes of Indoor CookingYou can imagine the first time cooking was brought indoors. Probably a fire inside a cave. It turns out that wasn't all that safe. The particulate matter from the wood not only increased the risk of lung disease, but also increased the transmission of respiratory illness.Community houses, like this one for the Tlingit Nation from Southeast Alaska, had a fire pit in the center of the house. Your status in the community determined how close you would sit by the fire.While the opening in the roof provided some ventilation, it was not enough.Particulate Matter and Disease in Native Americans has been well studied. The lung damage from particulate matter predisposed Native Americans to pneumonia, tuberculosis, influenza, and smallpox.Wooden StovesThe use of wooden stoves with a chimney, and contained fire, were the most popular stoves in America until after the Great Depression.America was excited to go electric. But there is something primal about gas and electric cooking.Cooking with GasThe phrase cooking with gas was from the gas companies competing with electric companies for the new kitchen. The idea that gas was less expensive, faster, and you could see the flame became the basis for their campaign.They were trying to compete with "clean electric"Indoor pollutants with gas range topsProducts from indoor gas ranges are highly toxic to lung tissue. Those products include:Nitrogen dioxideCarbon dioxideMethane emissionBenzeneEven with the range off, gas escapes and pollutes the air indoors. Good ventilation decreases the exposure to gas. Most people do not like continuous fans. In addition to the methane, there is also benzene that escapes.Culture WarsAs soon as the United States Consumer Product Safety announced it was considering regulations for indoor gas cooking the vitriole started.A Wall Street Journal Editorial stated "Don't believe for a second Consumer Product Safety Commission member Richard Trumka Jr.'s slippery claim that they aren't coming for your stove." She also went on to state that the research was paid for.Jim Jordan, the Republican Congressman from Ohio tweeted, "God, Guns, and Gas Stoves."Sean Hannity, that famous high school graduate stated that "Biden is coming for your gas stove."On my tiktok channel I had lots of people parrot this.I never knew so many old white men knew where the stove was? Let alone what it used for fuelResearchWe have known about the dangers of nitrogen dioxide since the 1960's. (see here, here, here). Experimental data showed it cause lung damage in animal models, then it was associated with human studies. None of these researchers were concerned about climate change.What can you do?Even ventilation to the outdoor with a powerful hood may not decrease the nitrogen dioxide enough. And often you won't have the ventilation fan on when the stove is not on.Converting to induction stovetop might be...

Whole Grains Reduce ObesityWhile the low-carb world and its extremists will tell you that grains are evil, they are wrong. There is a significant difference between refined and whole grains.The differenceWhole grains contain the bran, a fiber-rich outer sheath. Further whole gains have the germ cell and the endosperm. But the refined grain is just the endosperm.Compare whole grain bread, which contains substantially more fiber and vitamins than the white bread. Consuming refined grains increases the risk of heart disease. But consuming whole grains decreases risks of heart disease, diabetes, and cancer.The BranBran is rich in fiber. Additionally, bran is a source of B vitamins, iron, copper, zinc, magnesium, and phytochemicals.Fiber is EssentialFiber is an “essential nutrient.” An essential nutrient is defined as a nutrient your body cannot make and must get from your diet.But carnivore aficionados disagree; they believe fiber is not an essential nutrient. Carnivores note that you really don't digest fiber. And they opine that people can live without fiber. However, they forget one key, the microbiome.The MicrobiomeThe microbiome are the trillions of bacteria, yeast, and fungi that live in your gut. Many scientists consider the gut microbiota another “organ” of our body.There is a clear difference in the type and number of bacteria that occupy the guts of people with obesity compared to those who are not obese.Some bacteria will increase hunger hormones. Those same bacteria also decrease satiety hormones, need more food to feel "full." Finally, they increase the ability of fat cells to increase in size, leading to obesity.Interesting Functions of Gut BacteriaSynthesize vitamins K and BMake Conjugated Linoleic Acid (CLA) that reduces obesityCLA decreases inflammationIngestion of some fiber promotes the growth of bacteria that decrease the secretion of ghrelin in obese humans.In the microbiome, what feeds the bacteria that decrease obesity includes the fiber from whole grains. The bran of whole grains contains powerful fibers like oligosaccharides.How much to eat?What is a serving of whole grains? It seems confusing, especially since some products are a mix of both whole and refined grains. In the Mediterranean Diet, you might notice 9 ounces, but is that grain when it is dry or wet or both?So it turns out there is a whole grain council that has done the work for you, and they tell you right on the package. This makes your math simple. You either need three stickers of the 100% whole grain or six of the other stickers.

Are Vegetables BS?If you have ever seen Paul Saldino, his famous line is that Kale is BS. He even sells the shirt. But are they? Saldino isn't the only one who proposes this.Dr. Gundry, a former heart surgeon, has his own take. Gundry claims modern health problems come from eating lectins. Lectins are compounds found in beans that are natural pesticides. Thus, Gundry claims lectins harm people. Copying destroys lectins.Toxins in VegetablesPlants make compounds to protect them against predators - other plants, pests, and the like. But do they harm humans?It turns out that some plant defense compounds are beneficial to humans. Take coffee. Yes, coffee - the caffeine is a defense mechanism. Some people will tell you that coffee is bad for you - but they don't get up in the early morning or have kids.List of the "Toxins"GlutenPeople who don't have celiac disease or gluten sensitivity do not need gluten-free diets (ref).OxalatesPotassium-rich vegetables such as Brussels sprouts, broccoli, and kale reduce calcium loss and prevent kidney stones from forming. These vegetables are rich in antioxidants that decrease the risk of bladder, prostate, and kidney cancer. Check with your local dietician for a diet based on the type of kidney stone you have. (ref)CaffeineIf you don't drink coffee, you will lose all joy in life. (reference is me)Polyphenols Plant polyphenols have antioxidant, anti-inflammatory, anti-allergic, anti-atherogenic, anti-thrombotic, and anti-mutagenic effects - they are healthy for you (ref)PhytatesConsuming a phytate-rich diet, such as a colorful, plant-based diet, the benefits exceed the impacts on mineral absorption. In addition, phytates are anti-oxidants. (ref)SaponinsThese compounds are among the most well-studied compounds to decrease risk and help treat cardiovascular diseases. (ref)IsothiocyanatesBrassica vegetables contain many valuable metabolites that are effective in chemoprevention of cancer (ref)salicylatesThese anti-inflammatory compounds are the basis of aspirinPhytosterolsphytoestrogen-containing foods, such as legumes, grains, seeds, nuts, fruits, and vegetables, are rich sources of vitamins, minerals, fiber, and other health-promoting phytochemicals.LectinsCooking destroys lectins. Lectin-rich foods, legumes, and whole grains show reduced inflammatory biomarkers in both animals and humans (ref).What the literature saysWhat do human trials say about vegetables? They improve health, reduce the risk of heart disease, and reduce the risk of cancer.Do some of them contain anti-nutrients? Well, some do bind them, but health benefits outweigh any potential harm.Who to believe?You can believe a shirtless salesman of supplements and scams. Someone who was trained as a psychiatrist, who goes into a grocery store shirtless and yells at kale - or you can believe science.Fiber as an essential nutrientFiberThe most abundant solid ingredient in breast milk is a fiber. That fiber is human milk...

The term vitamin was coined by the chemist Casimir Funk as he revealed the Thiamine structure to the world. So while you may think – isn't vitamin A (it is the alphabet) the first vitamin – we take our poetic license here to point out that the first compound to be called a vitamin was Thiamine, now known as vitamin B1. But the story of that vitamin was made possible by two individuals – but the most noteworthy was Takaki Kanehiro.Our podcast today discusses the education of Kanehiro and how that influenced his view. But let's work backward a bit.Vitamin B1 and BeriberiBeriberi is caused by a lack of vitamin B1 (thiamin) in the diet. This vitamin is essential in the biochemical process of utilizing fats, carbohydrates, and proteins for energy. The nerves are particularly affected because of their metabolic pathways – hence, a wide range of symptoms from difficulty with walking (motor function) then sensory function of the legs, and finally, it affects the conduction in the heart, which leads to death.White Rice and BeriberiWhite polished rice was the fad food not only in the cities of Japan but also in China. To polish the rice, the husk and germ are removed, but this is also where the vitamins are. When people eat just one food item, they are likely to develop a deficiency disease, and this was the case with sailors and white polished rice.The officers would not only eat rice but were given a variety of foods and thus avoided beriberi. But the crew typically only ate white rice.Beriberi in Mid-1800's JapanIn Japan in the mid-1800s, especially in the city, polished white rice was the calorie source of choice. White rice is easy to store, looks clean, is faster to cook, and eating it is less chewy. White rice was considered what the wealthy people ate – it was beautifully displayed, and unlike brown rice, did not go rancid. What they didn't know was the processing of the rice led to stripping the rice of the vitamin-rich portion. In the rural areas of Japan, there was little beriberi as they mostly ate brown rice (barley rice). This led to a major problem in their Navy, where beriberi was endemic. White polished rice was the caloric source for the Navy, and often one third of the crew would develop beriberi and be unable to carry out their duties.There were many thoughts as to the cause of beriberi, but none of them had panned out well.Eastern Traditional Cures for BeriberiOn occasion, Eastern healers would recommend various teas and herbs. But, some would recommend barley rice. Some of these cures are retrospective, meaning once the traditional Japanese medical folks learned that barley rice was a cure for beriberi, they stated that they had prescribed it for years. Barley rice does have vitamin B1 (1 cup contains a day's supply). But during the time, the cures from these village doctors were rare and not enough for the Japanese Navy, in spite of losing more people to beriberi than to war – would adopt. Also, note that barley rice is not as transportable as white polished rice and has a shorter shelf life. During this time, Japan was becoming westernized, and they were working on importing medical ideas from Germany, although they had a fair bit of influence from the British method. Kanehiro's trainingWhen Kanehiro was being trained, his initial training was from the Eastern Medicine part of his province. This training was apprentice-like, and he heard someone say that “There are no good doctors in Sustama.” When William Wills opened a medical school in his province, he jumped at the chance – but Wills encouraged him to go to London for further training.In order to do this, Kanehiro joined the Navy in 1872. He remained in the Japanese Navy for the rest of his...

The Green Mediterranean DietImagine being able to improve the Mediterranean Diet with a few changes. Is the new "Green" Mediterranean Diet the ultimate hack? The Green Mediterranean Diet (Green-Med) has become the hottest version of the MED diet yet.Advantages of the Green Mediterranean DietThere are three advantages to Green-MedLess Fatty LiverDecreased risk of heart diseaseLess Visceral FatFatty LiverNon-alcoholic fatty liver disease is the number one cause of liver failure in the United States. It surpassed alcoholic liver disease as the number one reason for liver transplants. But how do you get fatty liver?Is fatty liver caused by sugar or fat or both?Low-Carb enthusiasts blame fructose, or almost any sugar, as the cause of fatty liver disease. Although the latest boogyman is "seed oils." On the other hand, vegans will blame saturated fats.But sugars in mice are not the same as sugars in men.Fatty liver appears to be a byproduct of obesity, excess calories, and genetics.Reducing fatty liverAfter weight loss surgery, people rapidly lose weight, including in their liver.But people on the Green Mediterranean Diet lost more weight in their liver than those with the standard Mediterranean diet.Visceral FatBelly fat is one of the hardest fats to get rid of. As people age, belly fat increases. So when women go through menopause, they increase belly fat. And lowering belly fat is best done through weight loss with a high-fiber diet and cardiovascular exercise. But Green-Med appears to lower it even more.Cardiovascular Risk FactorsAlthough MED is known for reducing the risk of heart disease, Green-Med seems superior.Implementing the green Mediterranean DietThe difference between the green and standard Mediterranean diet28 grams of walnuts a day - about one ounce3-4 cups of green tea per day100 grams per day of frozen MankaiReduction in red meatGreen Tea is EasyThere are more polyphenols in it than in black tea - so it's easier to drink.Adding walnuts is easy; they are also a great source of omega-3 fatty acids.Decreasing red meat isn't difficult.Finding Mankai or duckweed - well, you can't in the United StatesNo one has reproduced the data about the Green Mediterranean Diet - perhaps because they can't find those frozen cubes of duckweed.

LiverKing Falls From GraceNot that anyone was surprised the so-called Liverking was using steroids. But he fooled many people that his diet and intense training led to this frame. The diet he recommended was some form of an "ancestral" diet. We have covered the carnivore-type diet before. So how did this all happen?The Rise of LiverKingLiverKing's rise was meteoric. He began posting on Instagram in 2021 and now has almost 2 million followers.His trademark was showing off his abdominal muscles on his five-foot-five-inch frame. All the time advocating eating raw liver.Isn't that a hook? Eat raw liver, get abdominal muscles, and look like him.But his rise was anything but an accident.Powering up the MediaIn his emails, he whines about how he wants to build his following but was concerned that the steroids he had were not enough. So he was begging for help from someone in the UK. He was taking thousands of dollars of steroids a month.His plan? Getting over a million followers and selling supplements.He had a "live-in" video recorder to follow his antics.Guess who his partner was in supplements?The Supplement IndustryHow do most scam artists in the medical field make money? Selling supplements. Be that Joseph Mercola, or Mark Hyman, or Ken Berry. All people who make millions a year selling supplements.So what to do if you are trained in psychiatry but don't want to see people? You sell supplements. So the business partner is one Dr. Paul Saldino - aka Carnivore MD.Since the revelation about Brian Johnson's (LiverKing) steroid use Saldino said he would have to distance himself from him. Good friend, eh? That is a business decision. If you are a friend of mine and have a fall from grace, I will be at your door to help, not distance.This was pure theater and pure business - well, not so pure.Supplements can kill.But so can their diet.The Diet They Don't EatMake a following eating raw liver. Yell at the dinner table about how raw liver is good for you. Makes great content for your videos. Eating raw liver can kill you.Carnivores and extreme keto types always like pointing to hunter-gatherer societies for optimal "primal health." But my cousins in Alaska don't eat liver.There is enough vitamin A in polar bear's liver to kill 52 people. But the biggest outbreak of trichinellosis in the United States came from eating grizzly bear liver.Wait, can I get sick from too much Vitamin A?Vitamin A toxicity symptoms include drowsiness, irritability, abdominal pain, nausea, and vomiting. Then you lose your hair; then your skin starts to peel. Not to mention it can damage your liver - ironic, eh?The tolerable limit of vitamin A is 10,000 units a day. Beef liver has 15,000 units in 3 ounces.But LiverKing didn't eat liver in real life. What did he eat?The Maple Syrup and Hormone DietLiverKing ate 120 grams of maple syrup, 50 grams of dextrose, and ONLY 2 ounces of red meat a day.Why - he was taking insulin and needed to take a lot of sugar.He said he was super strict, working out - and his emails had his diet. Almost none of it was organ meat. He was specific and precise.-----Produced by Simpler Media

Leaky Gut: Facts and FadsThe latest fad of supplement makers is to talk about "gut health." The latest boogyman for the gut is the "leaky gut." The other name for leaky gut is intestinal permeability.A Surgeon's ViewAs a surgeon, a "leaky gut" is a devastating surgical emergency. Surgeons emergently operate to remove the gut that no longer has a barrier function.The dark gut is dead and needs to be surgically removed. This gut has no barrier function and will allow bacteria from the inside of the small bowel to easily enter the patient's bloodstream. Leading to septic shock and death.The Non-Surgical Emergency or Chronic Leaky GutBut a leaky gut doesn't have to be so dramatic. Not leading to septic shock or needing to be removed. In this model, the intestinal barrier is "leaky," not to the point of causing sepsis. But the leaky gut enables small molecules to leak out of the gut into the bloodstream. Thus producing chronic inflammation.Chronic inflammation may cause obesity. Emphasis on "may."Emulsifiers and ObesityRodent studies have provided fascinating insights. Certain emulsifiers, when added to the diet of mice or rats, lead to obesity. In one experiment, rodents were fed identical amounts of kibble. But one group, emulsifiers, was added to their water. These emulsifiers, like polysorbate 80, not only produced obesity but also disrupted the microbiome of the gut (ref). But mice are not men.When dietary emulsifiers are examined in humans, high levels cause disruption of the gut. However, there is little evidence that small amounts found in the food supply cause issues. (ref 4)Non-Humans and Leaky GutWhile animal models are interesting, human studies provide useful information. That a rat or mouse has a leaky gut based on some intervention is not an equivalence in humans.Functional Medicine and Leaky GutIf you searched "leaky gut," you will find a host of "functional medicine" doctors providing supplements, bone broth, probiotics, and other scams. On the shelves of drug stores and "health food stores," you will find abundant supplements to "support gut health."Disease States and Leaky GutFunctional medicine physicians associate many disease states with leaky gut. The following have little or no good evidence to be caused by a leaky gut:Alcoholic cirrhosisAsthmaAutismChronic fatigue syndromeDepressionEczemaEnvironmental enteropathyEosinophilic esophagitisFibromyalgiaKwashiorkorMetabolic syndromeMultiple sclerosisNon-alcoholic fatty liver disease (NAFLD)ObesityPancreatitisParkinson's diseasePsoriasisRheumatoid arthritisNon-Controversial Causes of Leaky GutThere is no doubt celiac disease, Crohn's disease, radiation, and ulcers from non-steroidal anti-inflammatory drugs; certain bacteria can cause a change in intestinal permeability (another name for leaky gut). Celiac disease and Crohn's disease have been studied for years (ref 2, ref 3). While we know gluten exacerbates the auto-immune function of those with Celiac disease, we do not yet have a mechanism for Crohn's disease.Gut Barrier Anatomy and FunctionThe small bowel's purpose is primarily for the absorption...

The Beer and Sausage DietThere are a lot of crazy diets out there. All of them you can lose weight with. Weight loss has many advantages. But the beer and sausage diet was fun. Here is what we learned:A calorie is just a calorieBeing in calorie deficit is difficultMeticulous journaling is importantYour lab values will improve with weight lossA beer is a good unit measureWeighing your food is importantEpisode Sponsor: Modifyhealth.com I'm The DoctorIf you hear Evo Terra on national television talking about the beer diet, you will hear my name. I'm the doctor.Late one September, I get a call from my friend, Evo Terra. He said, "October is coming; I want to lose some weight and want to do a beer fast. "So we devise a diet, not just beer - but let's add sausages. After all, what is beer without sausages?Careful SupervisionThis was a medically supervised diet. It ran for the month of October every year for four years. Every week he would come into my clinic. Every week he would have blood draws. cholesterol levels liver enzymesWeekly weightWe would check muscle mass vs. fat mass inflammatory markersWe were prepared to stop the experiment and return him to a normal diet. For Evo, a normal diet is maybe not your diet. Since Evo likes the food I make, I assume he has a great diet. For many years, one of my great joys in Phoenix was when Evo and his wife would come over for dinner Sunday nights. Damn, I miss those days.There are advantages to beer and sausagesA beer is a single unit. There is little variation in terms of caloric intake.Sausage can easily be weighed, and Evo was strict regarding the weight of his sausages.We added vitamins and fiber to his regimen.He had six beers a day, and a designated driver at all times.Science WinsFor those who say grains are evil and you can never lose weight or you would have horrible inflammation, well, Evo didn't fit with that. Because no one does. The idea that grains are evil is a myth of the low-carb community.Vegans didn't like the idea of Evo eating sausages: "Pure processed meat will lead to inflammation and all the evils associated with eating meat."It didn't happen.Calorie deficit led to weight loss, despite drinking beer and eating sausages.His inflammatory markers didn't rise; they went down.His cholesterol went down.His liver enzymes decreased - not that they were high to begin with.Every year he kept his weight off - we are now over ten years past the last experiment.Conclusions:I don't recommend this as a weight loss method. I do recommend weight loss by the simple principles of calorie restriction, a well-rounded diet, and vigorous exercise. Which diet, you ask? Either the Mediterranean or the DASH diet.Evo wrote a book, and you can buy it here.

Losing Weight With AppsCan a phone app help you lose weight? How about with your cholesterol, blood pressure, or waist size?Perhaps you've heard the latest Noom ads, where they boast forty publications showing that their app will help you lose weight.Apple is coming out with more ways to have their new watch track your heart rate and steps, with apps even looking at your yoga workout and eventually telling your blood glucose.Episode Sponsor: Modifyhealth.com What the Studies ShowA recent meta-analysis of randomized controlled trials showed that the average weight loss in the first three months was slightly below five pounds (2.18 kg).Unfortunately, the weight loss didn't last. Nine months later, they had regained a pound and a half for a total loss of 3.5 pounds (1.63 kg).Blood Pressure, Cholesterol, and CaloriesThere was a slight improvement in blood pressure at three months. But cholesterol and total energy intake, as well as waist circumference and blood glucose, remained the same.The Proliferation of AppsThere are over 500,000 applications on Android and Apple phones to track various health data points. In addition, there are other devices just measuring fitness. The theory of measuring fitness behaviors with calorie tracking to provide feedback to improve health is appealing.Many Apps With Poor QualityMany apps had a lack of behavioral coaching and poor quality of scientific information. Tracking over a three-day period found that the accuracy of energy intake among apps was only fair in terms of total calories and amounts of macro- and micronutrients.What About NoomNoom is one of the more popular paid apps. They boast over 40 peer-reviewed articles. A quick glance at the articles showed some surprising flaws:One article compared Noom in pancreatic cancer patients to a control group who received no coaching.Another article used Noom data for their references.Article after article that Noom sites are little more than using Noom's data without dropout rates. References:Chen J, Cade JE, Allman-Farinelli M. The Most Popular Smartphone Apps for Weight Loss: A Quality Assessment. JMIR Mhealth Uhealth. 2015 Dec 16;3(4):e104. doi: 10.2196/mhealth.4334. PMID: 26678569; PMCID: PMC4704947.Chew HSJ, Koh WL, Ng JSHY, Tan KK. Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes. J Med Internet Res. 2022 Sep 21;24(9):e40141. doi: 10.2196/40141. PMID: 36129739; PMCID: PMC9536524.Keum J, Chung M, Kim Y, Ko H, Sung M, Jo J, Park J, Bang S, Park S, Song S, Lee HUsefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial JMIR Mhealth Uhealth 2021;9(8):e21088 URL: https://mhealth.jmir.org/2021/8/e21088 DOI: 10.2196/21088Pohl, M. "325,000 mobile health apps available in 2017—Android now the leading mHealth platform. Research 2 Guidance." (2017).

Decreasing cholesterol: drugs and dietThere is a persistent belief that lifestyle can take care of all cholesterol problems. Lifestyle can make things worse, but once things are worse, it cannot make things better. Once you have disease, or cholesterol is higher, you need treatment often beyond lifestyle management. This distresses many people, who wish to have control over their fate. High https://www.yourdoctorsorders.com/2012/05/hdl-the-good-cholesterol-isnt-good/ (cholesterol) is one of the main causes of heart attacks, strokes, and peripheral vascular disease. You can lower cholesterol through diet and exercise by as much as 15 percent. Lifestyle changes are the first choice to decrease cholesterol. Modern drugs, however, will lower cholesterol levels far more than diet or exercise. The progressive changes of a vesselThe normal artery, as shown below, is a free-flowing https://www.yourdoctorsorders.com/2022/08/inflammation-and-the-mediterranean-diet/ (blood) vessel. When a person is in their late teens, there is already fatty formation on the inside of the vessel wall. As more fat is deposited in the vessel wall, blood flow decreases, leading to ischemia in the end organ. Angina, or heart pain, occurs when there is insufficient blood flow to the heart secondary to an artery narrowed by plaque.Factors contributing to atherosclerotic plaque formationDamage to the blood vessel begins the process of Smoking Hypertension High blood sugars Diets rich in saturated fats and refined grains However, the lower the level of LDL, the less risk those factors become, as you shall see. Anatomy of the Blood VesselIf you examine the autopsy specimen of the coronary artery above, the blood flows through that lumen. The inner wall, the wall the blood comes into contact with, is called the endothelium. There are three layers to the wall of an artery: Tunica intima Tunica Media Tunica Adventicia Atherosclerosis begins when the cholesterol transport protein enters the wall of the tunica media, whose first layer is the endothelium. Discovery of LDLIn 1954, Dr. John Gofman https://pubmed.ncbi.nlm.nih.gov/13197415/ (reported) the discovery of LDL and HDL. These were the particles found when he separated plasma cholesterol-carrying lipoproteins with an ultracentrifuge. Gofman was the first to note that heart attack patients had high LDL https://pubmed.ncbi.nlm.nih.gov/21291675/ (levels). The correlation of high LDL and heart attacks has been called “https://www.cell.com/cell/fulltext/S0092-8674(15)00079-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867415000793%3Fshowall%3Dtrue#bib31 (one of the most profound epidemiologic correlations in all of medicine).” High LDL levels have been shown to correlate with atherosclerosis in all species studied. High LDL and AtherosclerosisThe higher the LDL level, the faster atherosclerosis develops. Factors that increase atherosclerosis are those which injure blood vessels: smoking, hypertension, hyperglycemia, and genetic factors that predispose endothelium to early injury. High LDL levels can lead to heart attacks in children as young as 6 years old. This rare form of homozygous familial hypercholesterolemia inspired Brown and Goldstein to elucidate the genetic defect in the receptor for LDL. Discovery of the LDL receptor defecthttps://pubmed.ncbi.nlm.nih.gov/3513311/ ( Brown and Goldstein) discovered that when LDL receptors are defective, it leads to the following: LDL particles circulate for a long time This leads to an increase in plasma levels of LDL As a result, more deposits are made into the arteries Creating atherosclerotic plaques Lowering LDL by feedbackTo keep blood LDL constant, your body uses a feedback mechanism. As your LDL levels increase, the target tissues produce more receptors to take up the LDL. If the LDL receptor is defective, the liver continues to increase...

Alcohol and the Mediterranean Diethttps://www.yourdoctorsorders.com/2018/09/is-there-no-safe-level-of-alcohol/ (Alcohol) consumption is controversial.  No one disputes that excess alcohol consumption leads to dire consequences. But what about moderate alcohol consumption? Can we define moderate alcohol consumption? Is there a safe and therapeutic level of alcohol consumption? Alcohol is a component of the Mediterranean Diet. However, the consumption is limited to 10 ounces of red wine for men, which translates to 14 grams of alcohol. Half that amount for women. In a number of https://pubmed.ncbi.nlm.nih.gov/25207479/ (articles), this amount of alcohol is beneficial. Bias from AuthorsConfirmation bias is ingrained in all humans.  Treatment programs for alcohol addiction teach that there is no safe level of alcohol consumption.  Fundamentalist Christians, Muslims, and other organized religions have taboos regarding alcohol consumption. Finally, consumers of alcohol will be biased against abstinence. Components of WineIn their article, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468969/ (Wine, Polypenols and Mediterranean Diet), the authors note that one can get polyphenols from other sources in the diet, and thus the alcohol may be unnecessary.  They conclude that moderate consumption is likely an important component of a mechanistic as well as social norm. Dose Dependent Effects of Polyphenols on the BodyDecreased risk of cardiovascular disease Dose-dependent reduction of LDL-C Increase HDL-C and decrease triglycerides in patients with diabetes Reduction of Blood Pressure Increase production of nitric oxide (NO), which increases blood flow and reduces blood pressure Improve LDL/HDL ratio Resveratrol inhibition of pro-inflammatory agents lower risk of type 2 diabetes Resveratrol improves glucose homeostasis Modulate gut microbiota Improvement in blood vessel wall function (endothelial function) Reduction of drugs in diabetic patients Mechanistic vs HolisticThe issue with the Mediterranean Diet is always those who approach from a mechanistic view versus those who approach nutrition and lifestyle from a holistic view. The original data from the Mediterranean Diet came from thehttps://www.yourdoctorsorders.com/2022/08/the-modern-mediterranean-diet/ ( Seven Countries Study). This was a holistic examination, not only of their diet but also their lifestyle. Alcohol Toxicity is in the DoseA bit of wine is good, a lot of wine is not. If you look at every improvement in human physiology with alcohol listed above, the opposite effect happens when the dose is beyond about 50 grams of alcohol. ----- Produced by https://podcastlaunch.pro (Simpler Media)

Mediterranean Diet after weight loss surgerySuccess after weight loss surgery doesn't end with an operation. It just gets started. The most recalcitrant people to diets are those who undergo weight loss surgery. Weight loss surgery patients were on multiple diets prior to surgical intervention.  The https://www.yourdoctorsorders.com/2022/08/the-modern-mediterranean-diet/ (Mediterranean) Diet is the best post-operative diet one can have. Weight Loss and the Mediterranean DietThe Med Diet is favorable for health. Multiple https://pubmed.ncbi.nlm.nih.gov/32386663/ (studies) have shown decreased risk of cardiovascular disease, cancer, and autoimmune disease. What about weight loss? Systematic reviews have shown the Med Diet is equal or superior to other diets for weight loss. However, we found no post-operative program to adopt the Med Diet after weight loss surgery. Preoperative Med DietWe began coaching patients with the Med Diet before surgery. Many insurance companies require a preoperative, physician-supervised diet. In 2010, we began to use the Mediterranean Diet as a template for our patients using the 9-point scale.  Contrary to weight loss plans, our emphasis was learning the Med Diet. Weight Loss Surgery Protocol Liquid PhaseThe immediate post-operative diet emphasized soups and smoothies rich in legumes, vegetables, and fruits. Modular, unflavored protein supplements (whey or pea-based) were used to augment the protein content during this time, as were standard chewable vitamins.  Thus, the beginning of the post-operative plan was already a rich Mediterranean-style diet. Early Solid Food PhaseLegumes and fish were emphasized during the early solid food phase, which were universally easy to digest. One of the favorite Mediterranean-style foods were tacos.  Contrary to popular belief, the Med Diet is not foods commonly eaten in the Mediterranean. Instead, it consists of foods rich in whole grains (corn tacos), fruits (homemade salsa), legumes (lentils), some dairy products (cheese), and fish. We noted lettuce was problematic for some in the early phase, but spinach was easy to digest. Thus salads were based upon spinach rather than lettuce. Later Solid Food PhaseAs the stomach continued to heal, we stressed the increase in food with multiple fiber types.  We de-emphasized red meats, cautioned against excess alcohol, and worked on olive oil as the primary source for fats. Follow upCooking classes were a constant feature of our support group, often bringing in guest chefs from the area and the Food Network. We emphasized the importance of patients learning to cook.  Many of our patients believed that cooking was the most important aspect of their postoperative care. We found that those who learned to cook their meals had better weight loss than those who did not. Validated Food Frequency Questionnaires (FFQ) were used to follow a group of patients. The FFQ were https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926524/ (validated) using dietary logs during follow-up with patients. Getting in that quantity of foodStomach capacity after weight loss surgery is limited. How, then, does one get in the required amount of food? It is not difficult. All food is measured pre-cooked. Take broccoli. If you take nine ounces of broccoli and bake it, you end up with a small amount of volume but still have the one Mediterranean Diet point. The increase of vegetables in the diet is one way to reduce inflammation. Food increases over timeFood volume increases over time with both the Gastric Sleeve, Lap-Band, and RNY gastric bypass. The answer is not to eat less or take more protein shakes. The answer is to eat better. To have a balanced diet. Putting someone on yet another low-carb plan does not provide a healthy long-term solution.  Protein DeficiencySince meat is not emphasized in the Mediterranean Diet, some patients were concerned about protein intake. Lab tests did not show any patient...

Implementing the Med Diet - Part OneDo you think you eat enough plants in your diet? How many plants do you eat in a week? Not refined grains, but plants. You can cook them, boil, bake, microwave, roast them or even eat them raw. How many? Further, it's not just eating more volume of plants, it's diversity. Mediterranean Diet and PlantsAdherence to the https://www.yourdoctorsorders.com/2022/08/the-modern-mediterranean-diet/ (Mediterranean) diet depends more on plants. Vegetables Fruits, Tree Nuts, Seeds Legumes Whole Grains Olive oil When it comes to plants, more is https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918790/ (better). But not just in quantity of plants, but also diversity. Think about this: there is no one plant that can provide all the micronutrients and macronutrients a person needs. We tell vegetarians to use several plant sources for complete proteins, the same is true for any nutrient. Gut Bugs and PlantsYour gut contains a trillion bugs. There are more of them than of us. But what do they eat? It turns out, most of what they eat are the things we don't. Gut bugs eat plant parts. Without them eating those plant parts, we would be far worse off. Thus, the gut microbiome is an exciting research field. Guts break down fiber to chemicals shown to: Decrease the risk of colon cancer Lower cholesterol Decrease blood sugar spikes Decrease depression Allow absorption of polyphenols Fiber is an Essential NutrientPlants provide vitamins, minerals, macro and micronutrients. A single source of plants cannot provide the nutrients a person requires, which has been the main reason we recommend a diversified diet. Fiber is also a nutrient, an essential nutrient, one that humans cannot make, but without it there is clearly an increase in disease. While those on the extreme of low-carb diets will disagree, the literature is unambiguous. MythFiber supplements are not a substitute. Some are expensive, one selling for over $150 a month. But no supplement gives you the diversity of nutrients that you can get from your diet. Mother Nature gives you a better deal. So, eat your fiber, don't buy a supplement. Now begin to chart your diversityToday's assignment is simple: begin to chart the diversity in your diet, so that you increase the sources of your plants. One of my favorite dieticians, Dr. Megan Rossie, suggests a person has 30 plant-based foods per week. Sound impossible? Let's try it using the Meditereanean Diet. Why 30?It isn't that difficult to implement, but consider that you want to consume the vitamins, minerals, antioxidants, and other nutrients, and there is no one plant that does this. But many will. Vegetables:One Mediterranean diet point is achieved by consuming 9 ounces of vegetables per day.  Run through the list of vegetables that you can add to your diet in any given week. Asparagus Beets Bok Choi Broccoli Brussels Sprouts Cabbage Cauliflower Carrots Celery Cucumbers Eggplant Jicama Kale Leeks Lettuce Onions Parsnips Peppers Spinach Squash Tomatillos Zucchini Fruits:Apples Apricots Avocado Bananas Blueberries Cherries Coconuts Dates Grapes Grapefruit Jackfruit Kiwi Lemon Lime Mangos Melons Nectarines Peaches Pears Pineapple Pomegranates Plumbs Prunes Oranges Tomato Watermelon Legumes:Black beans Butter beans Chickpeas Green beans Kidney beans Navy beans Pinto beans Navy beans Lentils Peanuts Whole Grains:Barley Brown Rice Buckwheat Bulgur Corn Millet Oatmeal Whole wheat Red rice Nuts:Acorns Almonds Brazil nuts Cashews Chesnuts Hazelnuts Macadamias Pecans Pine nuts Pistachios Walnuts Seeds:Chia Flax seeds Hemp Pomegranate Poppy seeds Pumpkin Sesame seeds Squash seeds Sunflower These provide a diversity of micronutrients, macronutrients and fiber. All of which provide a healthy diet. But let's not forget one of the most important plants:  Perhaps the most important part of the...

Mediterranean Diet - FatsPerhaps the most important part of the Mediterranean Diet is this plant. Olive oil is the single ingredient most associated with the Mediterranean Diet. It is the one single food substitution you can do that will improve your health immediately and have great consequences. But not all https://www.yourdoctorsorders.com/2022/08/the-modern-mediterranean-diet/ (olive oil) is the same. Olive oil and your heartThere are many types of fat that you can find in your diet. Saturated fat will raise your LDL level, increasing your risk of heart disease and stroke. Olive oil, which is unsaturated, decreases the risk of https://pubmed.ncbi.nlm.nih.gov/29141571/ (heart disease). Types of FatFats are confusing. You will hear saturated, poly unsaturated, monounsaturated, and trans fats. First, we won't look at the chemical structure of fats. Second, we will look at the evidence that the food is associated with fat and how it influences our bodies. Finally, we will dismantle some bad arguments against certain fats. Saturated Fats - it's the source, not the ingredientSources: butter, red meat, dairy. What the Mediterranean Diet showed us what that the total diet mattered more than the individual ingredient. In spite of the revolutionary approach to using https://www.yourdoctorsorders.com/2022/08/ancel-keys-and-revisionist-history/ (cohort) studies with complete diets, many have insisted on pulling that apart to find out if one ingredient is "bad." For years, saturated fat was considered the "bad" part of what we ate. The American Heart Association recommended limiting saturated fat to just ten percent of what you eat.  The AHA recommended changing from saturated fat to polyunsaturated fat or monounsaturated fat. There has never been a question about olive oil, but a few concerns have been raised about some polyunsaturated fat. But it isn't as simple as the saturated fat molecule. We don't eat pure saturated fat, it turns out we eat food containing that fat. Depending on the food, it depends on how saturated fat affects you. Dairy and Fish vs Red MeatAdding more fish and dairy to your diet decreases the risk of heart disease. Adding more red meat to your diet increases your risk of heart disease. This https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9075396/ (study), from the https://pubmed.ncbi.nlm.nih.gov/12639222/ (EPIC) group, was impressive in its size, and its ability to factor out other issues that might increase heart disease. Once again, cohort studies show it isn't as important. CheeseBesides heart disease, cheese decreased the risk of dementia among a https://pubmed.ncbi.nlm.nih.gov/35217900/ (cohort) of Finnish men followed for 22 years. Perhaps the greatest snack of all time (my opinion - not science). Another cohort https://pubmed.ncbi.nlm.nih.gov/34245355/ (study) found that cheese was associated with a lower risk of pre-diabetes. Other forms of dairy products did not have this same benefit. This flies in the face of some vegans, who insist diabetes comes from saturated fat. Finally, non-dairy cheese is not a great source of https://pubmed.ncbi.nlm.nih.gov/35334904/ (nutrients). I know my fellow vegans want to find a good alternative for cheese, but there simply isn't one. Proving again that the whole food is greater than its parts, fish.Fatty fish have been shown to decrease not only cardiovascular mortality, but all causes of mortality. But not https://www.yourdoctorsorders.com/2021/09/fish-oil-and-atrial-fibrillation/ (fish oil.) Who doesn't love a good salmon? Fish consumption has been associated with a lower risk of heart disease. Further, fatty fish decreases the risk of all-cause https://pubmed.ncbi.nlm.nih.gov/35108375/ (mortality). Fatty fish contain high quantities of omega-3 fatty acids.  Our body cannot make these fats, we must get them from our diet. Here are the fish that are high in omega-3 fatty acids: salmon sardines mackerel herring lake trout canned light...

Inflammation and the Mediterranean DietThe https://www.yourdoctorsorders.com/2022/08/the-modern-mediterranean-diet/ (Mediterranean) Diet is the most anti-inflammatory diet studied. The inflammatory response is the body's mechanism to fight infection, repair itself and rid itself of cancer.  Inflammation is a coordinated response to trauma, infection, and cancer. Without inflammation, we would be dead within twenty-four hours. Too little or too muchToo much inflammation results in wanton destruction of tissues, pain, fevers, and misery. It is associated with heart disease, cancer, aging. It is that delicate balance of inflammation we need. Does diet play a role with inflammation? The answer is "sort of." Short Course about InflammationInflammation is involved in: Wound healing, removing dead cells - breaking them down into components so they can be recycled Removing and destroying bacteria Inactivating and eliminating viruses Destroying cells that have changed into cancer cells Repairing injury from infection Destroying parasites Removes toxic chemicals The immune system is one branch of the inflammatory response. Five Signs of InflammationThe five signs of acute inflammation and their Latin names: Redness - in Latin this is called rubor. Swelling - in Latin this is called tumor. Fever - in Latin this is called calor Pain - in Latin this is called dolor Secretion - in Latin this is called https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(89)92957-7/fulltext (fluor) Medical school teaches inflammation as one of the first series of lectures. Simple InflammationYour finger was hit with a hammer. You have an injury to your finger. Some cells are injured. The cells send a distress signal, and immediately white blood cells begin to swarm into the area to help the injured cells.  All that extra blood flowing to the area will lead to redness (rubor) and swelling (tumor). Soon, the finger will feel a bit hot (calor) and will have pain (dolor). Some cells are so badly injured that they are no longer viable. Your inflammatory reaction breaks down these cells, removes the debris, and recycles the parts to create new tissue in the area. Unwanted InflammationI love nature walks but like to avoid Poison Ivy. Sometimes, we want to decrease the immune response. Inflammation is the response of our skin to poison ivy.  We reduce the immune response by reducing hives and itching. Rheumatoid arthritis is another example of unwanted inflammation.  Rheumatoid arthritis is an auto-immune disease.  The resulting inflammation leads to pain, fever, and joint destruction. The aim of the treatment is to reduce the inflammatory response that saves joints and improves well-being. The inflammatory response of COVID, influenza, or the common cold is reduced by the use of non-steroidal anti-inflammatory drugs, such as aspirin or Motrin. Acute Disease and InflammationHeart disease is partially the result of inflammation. When you have a heart attack, the coronary arteries are blocked. As a result, a part of your heart muscle is without oxygen. The cells send out inflammatory signals, and you begin to feel pain (dolor). If the blood flow is restored, your cells can heal, but if it takes too long, some of those cells will die. Then your body will get rid of those dead cells and replace them with scar tissue. The result is that your heart becomes less effective. Cardiovascular disease and inflammationPlaque formation in the arteries is the result of genetics, https://www.yourdoctorsorders.com/2022/08/the-modern-mediterranean-diet/ (diet), and inflammation. The increased cholesterol, either from the genetics or from a diet high in saturated fat, is deposited in the arteries.  When cholesterol enters the artery wall, the body's inflammatory response tries to get rid of it, causing inflammation in the arteries. Did you know that 18-year-olds already have signs of early plaque formation in...

Adherence to the Mediterranean Diet decreases the risk of cardiovascular disease. The Seven Country Cohort Study clearly showed https://www.yourdoctorsorders.com/2022/08/the-modern-mediterranean-diet/ (this). But what about cancer? Does the Mediterranean Diet impact cancer or cancer prevention? To study this, another cohort study began called the https://epic.iarc.fr/index.php (EPIC) study. Uniquely, the EPIC showed not only a decreased risk of cancer but also mortality from cancer. All vegetables, even the green ones, have nitrates. It turns out that the components of The Mediterranean Diet decreases the risk of cancer, decreases the risk of cancer recurrence, improves survival from cancer, and decreases overall mortality. EPIC StudyThe European Prospective Investigation into Cancer and Nutrition (EPIC) is a large cohort study involving over 521,000 individuals from 23 centers from ten countries. Adherence to the Mediterranean Diet and LongevityThe EPIC researchers developed a simple scoring system to determine adherence to the Mediterranean Diet.  Greater adherence to the Mediterranean Diet was associated with https://pubmed.ncbi.nlm.nih.gov/12826634/ (longevity). The Scoring SystemThe Mediterranean Diet is scored on a scale of one to nine. Nine being a perfect Mediterranean Diet Score, and zero being poor. Great adherence to the Mediterranean Diet is a score of seven points or more. Eating more of these foods gives you pointsThe Mediterranean diet is rich with vegetables, legumes, fruits and nuts, whole grains, and fish. You get a point for consuming 9 ounces or more of vegetables a day. If you consume less than nine ounces, you get a score of zero. Legumes will net you a point if you consume two ounces or more per day. Fruits and nuts are one point for nine ounces or more. Likewise, whole grains are worth a point for nine ounces or more. Fish is an average of an ounce a day, or two main meals per week. Thus,  by consuming a diet rich in these five components can score five points. The weight is based on pre-cooked food. Lentils are a legume, and if you consume more than 2 ounces per day, you will score one Mediterranean Diet point. They are high in protein and fiber and low in saturated fat. Eat Less for MorePeople from the Mediterranean didn't eat much meat or dairy.  By consuming less of these, you can achieve Mediterranean Diet points. Eating less than  4 ounces of meat a day  is worth one point Consuming 1.5 ounces of hard cheese a day or LESS is worth one point Consuming less than 8 ounces of dairy is worth one point (mostly consume yogurt). Thus by eating less dairy and meat, or none, you can score two additional points. You might think that 6-ounce burger is small, but if you eat less than four ounces of meat a day, you get one Mediterranean Diet point. Eat more than four ounces, and you get zero points. AlcoholAlcohol is a component of the Mediterranean Diet but in moderation. For ethanol, a value of 1 was assigned to men who consumed between 10 and 50 g per day and to women who consumed between 5 and 25 g per day. This corresponds to 5 ounces of wine for women or 10 ounces for men. Olive OilOlive oil is an important component of the Mediterranean Diet. The type of fat in olive oil is mainly monounsaturated. The ideal ratio of olive oil or monounsaturated fats to saturated fats should be at least 60%. The best olive oils come from the US. Interventions in the Mediterranean DietIncreasing the score in the Mediterranean Diet by two points in the Mediterranean diet led to an 8% reduction in https://pubmed.ncbi.nlm.nih.gov/12826634/ (mortality). Imagine a simple dietary intervention leading to a decrease in mortality. Colorectal Cancer and the Mediterranean Diet ComponentsIn a recent update of the Mediterranean Diet they found a higher consumption of fruits and vegetables combined led to a decrease in colorectal https://pubmed.ncbi.nlm.nih.gov/34684583/...

Was Ancel Keys responsible for the modern epidemic of obesity? If you have read any low carb blog lately, you would think so. Their revisionist history is broken down to this: Ancel Keys was an influential scientist who thought fat was to blame for heart disease He did a study of diet and correlated fat and heart disease in those people of the seven countries But Dr. Keys left out countries that would have proven his hypothesis wrong The influence of Dr. Keys work turned the US away from saturated fat and to sugar Sugar causes obesity and all the lifestyle illness of the world Dr. Keys brought us snackwells instead of pork rinds and we are all obese with diabetes You will find versions of this in blogs, books, and videos.  Low-carb bloggers plagiarize one another. Nor have they never the primary source material. The Mediterranean Diet Founder and the StudyKeys is the founder of the https://www.yourdoctorsorders.com/2022/08/the-modern-mediterranean-diet/ (Mediterranean Diet). He was a pioneer physiologist, one of the first to show that diet was an important component of heart disease. In the 1950's few considered diet an important component of heart disease. Rich People and Diets "In 1952 when Margaret and I were making surveys in Naples and then Madrid. It seemed quite clear that there was some relationship between diet and the incidence of coronary heart disease. Rich people had different diets and different blood cholesterols, and they had the only heart attacks in town. When those findings were written up and presented at a meeting in Amsterdam, some people were impressed and some didn't believe anything about it. " - Ancel Keys This early observation by Keys  was the impetus for  the Seven Country Study. That diet was responsible for heart disease was contrary to the prevailing theory: in the 1950's heart disease was hypothesized to be phenomenon of aging.  Dr. Keys meticulous research revealed the strong correlation between heart disease and a diet rich in saturated fat. The First GraphThe graph below is a result of looking at macro dietary statistics of a country compared with death rates from heart disease. Keys presented this data at a WHO meeting in the early 1950's. The conclusion about fat and heart disease,  was met with a great deal of skepticism. Diet was not considered a factor in heart disease. While this data points to a potential cause, to examine this hypothesis one must perform a cohort study. Some assume that Keys collected country wide data about diet and heart disease, but he did not. Bloggers probably assume this based on this graph, as well as the name, Seven Countries Study. But the Seven Country Study was far more precise. The Study was a Cohort type study. Cohort StudiesA cohort study follows subjects for a long period of time. The Seven Countries Study followed over 12,000 men for nearly 50 years. Following these men involved yearly physical examinations, blood work, hospital and death records, as well as very specific dietary follow up. Of all the factors examined, saturated fat and blood cholesterol were most correlated with  heart disease. One of the more common myths about the Seven Country Study was that sugar was not examined. In fact, sugar was examined as an independent dietary factor. Sugar was not an primary variable for heart disease, unless combined with saturated fat. Testing both low and high fat countriesThe low-carb bloggers assume that Keys only tested those countries whose diet was rich in carbs, and low in fat. Keys chose his cohorts based on different diets, from those who were low fat, to high fat. Total fat, as it turns out, was not a factor for heart disease. Greeks had 40% of their dietary calories from fat but a low heart disease rate.Most of their fat came from monounsaturated fat,  olive oil. The Finish CohortThe Finland cohort was chosen precisely because of their high fat diet: "Loggers' lunches, even...

Scientists and dieticians consistently  rank The Modern Mediterranean Diet (MED https://www.yourdoctorsorders.com/2018/09/the-mediterranean-diet/ (diet)) as the diet most recommended.  But often people don't know what the MED diet is. This post will  define the Med diet. Critics of the Med Diet Critics  argue that there is no uniform MED diet. They make these assertions based on one of these three arguments: That there is no uniform diet of the Mediterranean Region. There are over 20 countries on the 26,000 miles of coastline of the Mediterranean Sea. Each country with their own unique diets. Many of which have adopted a more modern American style diet. The diet is simply made up and therefore should be ignored. Finally some point out that there are many Med Diets as the literature. Heart disease and Diet Ancel Keys is the scientist most responsible for not only the Med diet but the relationship of heart disease to diet. In the 1950's, heart disease was thought to be a disease of aging, and smoking but not diet or lifestyle. In the 1950's, much like today, heart disease was the number one cause of death among of middle aged executives. While there was a clear association between smoking and heart disease, there were far more deaths than could be explained from smoking.  Then an Italian scientist told Dr. Keys about the low incidence of cardiovascular deaths of men in https://www.sevencountriesstudy.com/about-the-study/history/ (Naples). Heart Disease and Diet in EuropeKeys confirmed this claim when he took a sabbatical in Oxford in 1952.  Keys found there was a difference of heart disease between the poor and the executives of Italy. He developed the hypothesis that diet might explain difference  between the two groups.  To confirm this Keys, and his wife, then traveled throughout Europe catalog different diets and rates of heart disease. In 1955 Keys presented his data to the World Health Organization, concluding  that diet played a significant role in heart disease.  Many members of the WHO mocked his  "diet-heart theory."  Keys then organized the seven countries study (click https://pubmed.ncbi.nlm.nih.gov/5226858/ (here)). Seven Countries StudyThe seven countries study was an observational study looking at biomarkers, lifestyles and their relationship to heart disease.  Those countries were Greece, Italy, former Yugoslavia, Finland, The Netherlands, Japan, and the United States. The cohorts were chosen because of diverse diets, lifestyle, and risk factors. Dietary and lifestyle influence on cardiovascular disease was unknown at the time. The seven country study was to answer the question about dietary influence and heart disease. The French ParadoxLow-carb bloggers accuse the seven country study of leaving out France. They cite the https://pubmed.ncbi.nlm.nih.gov/1351198/ (French Paradox,) that the French eat a diet high in saturated fat but have a low incidence of heart disease. However, France was not left out of the study.  French investigators were present at the original pilot study in Nicotera Italy, but ultimately decided not to participate in the study.  France was recovering from World War 2 and simply didn't have the resources to commit to such a study. In fact, The French Paradox was "coined" in the 1980s, over twenty years after the  start of the seven country study. The investigators didn't have access to that data, or the term. Low-carb bloggers  didn't read the seven country study or the French paradox. French Paradox ExplainedTwo factors explain the French Paradox. The high fat diet was not widely adopted by the French prior to the mid 1970's. It  takes time for a  habit to have an effect on cardiovascular disease. For example, one doesn't develop heart disease after the first cigarette. The primary French diet in the 1950's through 70's was a Mediterranean Diet.  Thus, the effect...

If you don't have diabetes, should you even consider a blood glucose monitor? Well, here is the science behind this new tiktok trend and why these Continuous Blood Glucose Monitors (CGM) are here to stay and what we know about them. The device First, the device – a continuous blood glucose monitor is a device that you place on your body and it measures the blood glucose level and reports that data typically to an application on your phone. The first blood glucose monitors were used to help patients with type 1 diabetes regulate their blood sugar. They were revolutionary, but expensive, not covered by many insurance companies, and cumbersome. As the technology has improved, the price has decreased, the comfort level has improved, and the accuracy of the monitoring has improved. As with most technology, blood glucose monitors are now less expensive, better, and widely available. You can read more about the history of the blood glucose monitor https://www.dropbox.com/s/cpaspiemmu2nmhh/Glucose%20monitors.m4a?dl=0 (here). Most diabetics use a fingerstick to see what their blood glucose is, and use that information to determine the medicine they need to help regulate their blood glucose. The CGM allows real-time data which can be checked against food logs to allow a person to see impact of their diet on their regulation of food. As the epidemic of diabetes grows, about 55 million predicted with diabetes by 2030, we know that the less variability in glucose, the better long-term outcome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360429/ ((reference here)) and https://www.yourdoctorsorders.com/2015/09/increasing-diabetes-mirrors-obesity-surgery-best-option/ (here). Variability in blood glucose with non-diabetics It turns out that even people who are not diabetic, have wide variations of blood glucose (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296129/ (reference here)). Further, the variations in blood glucose have real time effects and we should care about those https://pubmed.ncbi.nlm.nih.gov/21525442/ (effects).  For example, high glucose spikes lead to inflammation of the arteries, even in non-diabetics, which lead to atherosclerosis, heart disease, strokes and peripheral vascular disease (click https://pubmed.ncbi.nlm.nih.gov/21940510/ (here)). A study published in Journal of the American Medical Association (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2723644?resultClick=3 (here)) concluded “Providing individuals with tools to manage their glycemic responses to food based on personalized predictions of their PPGRs may allow them to maintain their blood glucose levels within limits associated with good health.” What is best? Avoiding the large variability in blood glucose is clearly important to health whether one has diabetes or not. Trying to predict what variability will be based on fasting blood glucose or hemoglobin A1C cannot be done. Using a healthy diet like the Mediterranean or https://pubmed.ncbi.nlm.nih.gov/29333199/ (DASH) diet – this has been found in studies with CGM on young people with type 1 diabetes (https://pubmed.ncbi.nlm.nih.gov/35276957/ (reference ) ) Even variations of the Mediterranean Diet and CGM have found improvement in glucose https://pubmed.ncbi.nlm.nih.gov/35277067/ (variability). Economies of Scale Continuous Glucose monitors are getting less expensive, more accurate, and more comfortable to wear. This is good news for patients who have diabetes, and as demand raises among all to use these tools the price will drop further. The economies of scale work with medical devices. Consider the pulse oximeter that you can purchase from a local pharmacy for $25 – they used to cost over $900 and were used to manage patients with lung disease. Now, for less than a copay, you can have one of these devices and they not only help manage patients with lung disease, but also keep people with COVID out of the hospital when they are doing well, or provide a warning to

About 15 years ago physician came to me telling me that she was opening a new venture, distributing plant-based bioidentical hormones, and surgically implanting those hormones as pellets. She wanted me to send her all of my patients who presented in menopause because "with bioidentical hormones they won't need weight loss surgery." She went on to say how every woman would be tested for their hormones and then a compounding pharmacy would make up the exact hormones to replace the ones the person was not producing enough of. This would, "almost reverse aging and cause weight loss." In fact, those bioidentical hormones cause weight gain. Bioidentical hormones, from whatever source, cause weight gain, not weight loss (https://pubmed.ncbi.nlm.nih.gov/23924704/ (reference)) . In spite of a number of "advertisement" from providers who wish to provide you with "compounded" bioidentical hormones that propose they will cause weight loss - they don't.  This physician was not an Ob-Gyn, nor was she a board certified endocrinologist, in fact her specialty was about as far from treatment of complex menopausal hormone replacement or obesity as one could imagine. The red flags for this clinic were (a) proposing weight loss (b) associating with a compound pharmacy (c) offering anti aging treatments (d) a provider that is not an expert in the field of endocrinology or gynecology. Bioidentical hormones made by any compounding pharmacies do not meet rigorous FDA standards. In fact, compounded forms of bio-identical hormones are similar to supplements, and have the same issues that supplement industries have had that we have outlined https://www.yourdoctorsorders.com/2015/04/vitamins-supplements-lables-that-lie/ (previously). Menopausal Hormone Replacement is Medicine, Compounded bioidentical hormones are ? With every scam there is a separation of the chaff from the wheat. Here is the current evidence about hormones and changes that occur as women enter menopause. Accepted sources for this information include The Menopause Society as well as The American College of Obstetrics and Gynecology. Women undergoing menopause they decrease their production of certain hormones. This can lead to severe symptoms of menopause that hormone replacement therapy can alleviate. Symptoms of menopause such as hot flashes, sleep disturbances, joint aches and pains, mood changes, vaginal dryness. That is undisputed and the improvement in quality of life is why many seek hormone replacement therapy. There is also potential benefit to decreasing risk of cardiovascular disease, if started within ten years of symptoms and before the age of 60 years. The major concern of hormone replacement therapy came from the https://jamanetwork.com/journals/jama/fullarticle/195120 (study) published in 2002, the Women's Health Initiative, showing that hormone replacement, with the most commonly prescribed medicine, Prempro, led to an increase in heart attacks, strokes, deep venous thrombosis and pulmonary embolism as well as breast cancer. The concern among gynecologists led to a rapid decrease in the prescription of Prempro by nearly 70%. This also led to a decrease in the quality of life by women going through menopause. Some gynecologists and endocrinologists continued to prescribe hormone replacement therapy. Compound Pharmacies Filling the Gap Bioidentical hormones made by any compounding pharmacies do not meet rigorous FDA standards. In fact, compounded forms of bio-identical hormones are similar to supplements, and have the same issues that supplement industries have had that we have outlined https://www.yourdoctorsorders.com/2015/04/vitamins-supplements-lables-that-lie/ (previously). To quote from the FDA "Compounded drugs are not FDA-approved. This means that FDA does not verify the safety or effectiveness of compounded drugs. Consumers and health professionals rely on the drug approval process for verification of safety, effectiveness, and quality....

  The US Preventative Task Force updated their recent recommendations about vitamins and supplements in The Journal of the American Medical Association - reference https://jamanetwork.com/journals/jama/fullarticle/2793447?guestAccessKey=f8ea1de7-fbe9-4561-832e-7ea18d6579ce&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=062122 (here). Their conclusion was: "Conclusions and Relevance Vitamin and mineral supplementation was associated with little or no benefit in preventing cancer, cardiovascular disease, and death, with the exception of a small benefit for cancer incidence with multivitamin use. Beta carotene was associated with an increased risk of lung cancer and other harmful outcomes in persons at high risk of lung cancer." We have published about how misleading labels of supplements are before - click https://www.yourdoctorsorders.com/2015/04/vitamins-supplements-lables-that-lie/ (here). The appeal of vitamins and supplements is the ability to extract the vital chemicals (like vital amines) antioxidants, and anti-inflammatory ingredients, place them into a pill so you can avoid having a healthy diet. Trust me, a healthy diet is clinically proven to work but it is a lot easier to eat a burger and pop a pill than to remember to eat some vegetables (I like Habit Burger). [caption id="attachment_9745" align="aligncenter" width="640"]V Yes, I do love a good burger - Habit is my favorite[/caption] But let's go back in history for a second and let you know that surgeons love vitamins. If you haven't listened to one of my favorite stories- listen to this about the first vitamin - click https://www.yourdoctorsorders.com/2019/05/the-first-vitamin/ (here). And let us not forget that the first evidence based study in the history showed that citrus fruits prevented scurvy - who was that person that showed that - was it a "nutritionist" or was it a surgeon? Oh yes, it was Dr. James Lind - a surgeon. Why the appeal of vitamins, besides my fantasy about eating burgers and popping a pill? First there is the "natural" fallacy - I don't know, I think natural is more eating fruits and vegetables than pills. People tend to think of vitamins as "good" or healthy, and they are. They seem to think of a vitamin as "natural" even though they were brought to us from the golden age of biochemistry. It is clear that the vitamin and supplement companies have taken advantage of that and use terms like "support gut health" or "support immune function" or "good for cardiovascular health, " - even if those statements are meaningless. Second, it is easier to think of things we believe we understand. Heart disease and cancer are complex topics (not that the true chemistry of vitamins aren't but they seem easy). We want to make things easy - like take vitamins and supplements for prevention or cure of cancer or heart disease, because if we start talking about scary statins or chemotherapy not only are there real side-effects but bad press. Of course with vitamins and supplements there can be real side effects - check https://www.yourdoctorsorders.com/2015/10/bad-supplements-23000-er-admissions-a-year/ (here). My aunt's son, a Ph.D. in nuclear physics, died after taking a supplement that was to help him be "fit." But the simple truth is this: however the polychemistry there is in fruits, vegetables, legumes, whole grains, as well as balancing dairy, meats, fats and alcohol has proven effect - we call that the Mediterranean Diet (for more see https://www.yourdoctorsorders.com/the-mediterranean-diet-the-good-the-overhyped/ (here)) [caption id="attachment_9746" align="aligncenter" width="640"]i Instead of vitamins and supplements from a pill - eat this[/caption] For whatever reason, eating a Mediterranean Diet or DASH diet continue to be the proven way to maintain your health. References 1. Mishra S, Stierman B, Gahche JJ, Potischman N. Dietary Supplement...

It turns out that the juice from beets may lower blood pressure in a sustained and lovely manner. Beets, you see, besides being a colorful vegetable, contain a high level of Nitrate (NO3-). And this is absorbed by the body and converted into nitric oxide. Nitric oxide is that amazing molecule that relaxes blood vessels and improves blood flow. How Your Body Gets Nitric Oxide The conversion of nitrate into nitrite, which is then converted into nitric oxide is a fun pathway. When you eat your greens (yes even lettuce has nitrates) your intestines absorb it and then it is secreted back into saliva where those bacteria in your mouth digest the nitrate (NO3-) into nitrite (NO2-)

Common Collagen Claims (taken from actual websites selling collagen supplements): “improves skin elasticity,” “support bone and joint health,” “strengthen hair, skin, and nails,”  “may benefit the bodies cellular structure,” “support healthy skin, bone, and joints.” “will feed your skin health” “will improve nail appearance and strength” “lead to a noticeable hair thickness” Collagen as a supplement is not regulated by the Drug division of The Food and Drug Administration If you look at the bottom of the websites, or on the bottles, you will see a disclaimer that the claims “have not been evaluated by the U.S. Food and Drug Administration. ” More telling is “these products are not intended to treat, diagnose, cure, or prevent any disease.” Such a disclaimer is provided by the lawyers because if one claims to cure, treat, or diagnose an actual medical condition then it must have passed a rigorous FDA approval. To be clear, there have been no FDA studies that show collagen as a supplement treats any disease. Supplements commonly will use “support xyz health” – where you can fill in the blank with hair, nails, joints, skin – in the case of collagen. One of the main issues with supplements is “If the composition and quality of ingredients cannot be reliably ensured, the validity of research on dietary supplements is questionable. Moreover, the health of the US public is put at risk.” Starr RR. Too little, too late: ineffective regulation of dietary supplements in the United States. Am J Public Health. 2015;105(3):478-485. doi:10.2105/AJPH.2014.302348 As such, even when you look at the studies which promote collagen, or collagen byproducts, they do not meet the most basic of studies which are done to evaluate pharmaceuticals. In order to have an evaluation of a pharmaceutical you must have three phases in the trial: phase one is determining the dose for safety. While the supplement industry is happy if you think all supplements are good and all pharmaceuticals are evil – everything, every drug, every chemical from water to salt to formaldehyde has a toxic dose phase two is to test the drug for efficacy and side effects. Some people will react poorly to a supplement just as they will a drug. WE need to know what those side effects are. With a supplement people who don't feel well often just stop it – or, like my cousin, die (yes, I had a cousin who died from a supplement). phase three testing is to determine if there is truly efficacy, what is the effectiveness and what is the safety. phase four is post-marketing surveillance in the public because even though you have gone through trials with a number of phases and under strict supervision when a drug is released to the public you have the chance to see millions of reactions. Thalidomide, for example, was released in Europe and even had two drug trials in the United States but was NEVER approved in the United States by the FDA because of insufficient data. Vioxx was a drug used worldwide and was taken off the market in 2004 because of the risk of a fatal heart attack, but was taken off after it had passed multiple drug tests previously. FDA testing is rigorous and specific, with the highest standards in the world. Collagen has NEVER had such rigorous testing performed. These tests have not risen to the level and in 2022 one report noted “More research is needed to establish knowledge of the effects and physiologic mechanism of collagen supplementation. Dermatologists should be aware of the unsubstantiated proclamations of collagen made by companies and in social media, as well as what evidence is established thus far, to be equipped to discuss collagen supplementation with patients.” Rustad AM, Nickles MA, McKenney JE, Bilimoria SN, Lio PA. Myths and media in oral collagen supplementation for the skin, nails, and hair: A review. J Cosmet Dermatol. 2022 Feb;21(2):438-443. doi: 10.1111/jocd.14567. Epub 2021 Oct 25. PMID: 34694676. One of the most...

Diets. They work for some, but not for others. "You're just not on the right diet," purveyors of the latest trend will tell you. "You're just not on the right diet for your blood type, ethnicity, age, hair color," says another set of true believers. So what's right and what's wrong? Today on Fork U, a conversation between Dr. Terry Simpson, weight loss physician, and https://twitter.com/CaloriesProper (Dr. Bill Lagakos), nutritional biochemist and physiologist, where they expose the truth behind diets and why they may, and may not, work for you. And check out Bill's book, https://twitter.com/CaloriesProper (The Poor Misunderstood Calorie). TRANSCRIPT:Terry Simpson: Bill, there are a lot of weight loss programs out there. The one that I'm hearing the most about most often is the Keto movement, which says that they're going to cure everything from heart disease and cancer. Bill Lagakos: I think from a 30,000-foot view, Keto works for a lot of people. So does low fat. I like some of the recent work, the studies showing it's more about the level of processing of the food. So you can have a vegan diet or you can have a Ketogenic diet and as long as it is excluding a lot of processed foods, it tends to not be over eaten. And people that tout the magical benefit effects of any of these diets, 99% of the time it's due to weight loss. Terry Simpson: We actually had an experiment with Evo, who you met. He uhh did it several years, three or four years in a row for one month, Evo would go on a beer and sausage diet, rigorously kept his calories to 1500. We measured his liver function tests, his lipid panel. Every year he lost weight, kept it off, and every year his liver function was fine, surprising with the number of beers he had a day, which was limited to six. But it was, he had weight loss and he had sustained weight loss over the year with a, kind of this funky diet we sort of made up. Bill Lagakos: Well, that's terrific. And that's an awesome diet. I'm jealous. But, uh, yeah, that, that basically proves the point. I mean, even if it's not a lot of weight he lost, I think a weight loss is a major driver in a lot of the health improvements that people like to attribute to particular dietary trends. Terry Simpson: There doesn't seem to be a lot of long-term data in these diets. When I look at the sort of metadata, I see that if you eat really high on the low-fat side, you have a little lower lifespan. If you eat really high on the high-fat side, you have a little lower lifespan. If you have your carbs at about 55%, you seem to have a little longer lifespan. Is there much good data saying one diet versus another, other than the Mediterranean, has great long-term results? Bill Lagakos: I don't think so. I don't think it comes down to macros at all. I think that there's the confounding in those studies is so deep that I don't think the macronutrient composition of your diet is going to be what kills you in the end. Terry Simpson: Part of your job is helping people lose weight. What are sort of the big messages you try and get through to people? Bill Lagakos: One of the biggest things is the importance of adherence, which is why I try to say, you know, what do I know that, that you can adhere to 100%? It's what you've been doing because you've been doing it. So let's try and find the lowest hanging fruit that we can change so it doesn't turn your whole world upside down, which is something that would probably never work. Terry Simpson: So in other words, you're not going to change a Keto into a vegan or a vegan into a Keto. Bill Lagakos: Correct. However, I don't like to put those two at odds because there is, there have been a few studies on the vegan Ketogenic diet. Terry Simpson: So give me an example of some of the things for our audience, some of the things that they can do to incorporate it in their life now to help them lose weight and just feel a little better about themselves. Bill Lagakos: Well,

In science, we don't look to confirm what we know; we want to find out something that we don't know. We love it when science proves us wrong. If your doctor told you that you have heart disease, were pre-diabetic, or said you should eat healthier, they likely will tell you to follow the Mediterranean Diet. When I introduce the Mediterranean Diet to my patients I get a response like this: “Sounds great!  Who doesn't love red wine, olive oil, and fresh Italian tomatoes?” This is followed by asking for a recommendation of a book of recipes from the Mediterranean. The Mediterranean Diet seems to invoke sitting on a rooftop restaurant in Positano sipping wine while munching on fruit and waiting for pasta. The food and wine are part of the lifestyle, as is relaxing and breathing in the surroundings. You might not be on a rooftop restaurant in Positano (lucky if you are). You might be looking in your yard and seeing a squirrel or rabbit or flowers, and taking in that time to breathe and relax and maybe the glass of wine and thus transporting that lifestyle to your home. Which do you think is better for your heart and your brain: rushing home from a stressful day at work, grabbing a martini and letting the alcohol calm you or going outside, taking a deep breath of fresh air, maybe having a glass of wine? In the original Greek, the word “diata” was used to describe how one should live, what one should eat, how to maintain a healthy body. It is from diata that our word “diet” derives. There is no doubt what you eat impacts your health. While the origin of the Mediterranean Diet is what ‘some' people in the Mediterranean ate, but that isn't what we (doctors, scientists, registered dieticians) mean today.   Over the last fifty years over 150 foods have been studied to see their effect on humans, for better or for ill.   Years of research, studied on millions of people, and yet most people have the view of the Mediterranean lifestyle as hummus and fish. So let me introduce this diet, and this lifestyle to you, and why it may be the most important lifestyle you should understand. In spite of all the noise on the internet about low carb/keto, vegan, or other diets/lifestyles you will find that the Mediterranean Diet is consistently ranked as the number one or two diet in the United States.  That is based on many studies showing how the diet leads to a decrease in heart disease, lower blood pressure, better control of diabetes, fewer strokes, and lowering the risk of dementia. The Mediterranean diet is neither low carbohydrate (it is about 50% carbohydrate) nor low fat (it is about 30% fat). It is not high protein (it is about 20% protein). Improvement in your health comes from eating certain foods, and not from counting macros (proteins, carbs, fats, and alcohol). Weight loss and better health are both touted from those who profess “low carb” or “low fat” and yet weight loss with the Mediterranean lifestyle is equal to or better than the low fat or low carb “diets”. Those who claim low-carbohydrate diets are the best for diabetes are often stunned that the Mediterranean diet provides superior long-term results for diabetes and insulin resistance. While they rightly point out that a diet rich in whole grains and fruits, will produce transient spikes in blood glucose levels, the long-term results from the Mediterranean lifestyle are superior to avoiding those foods – providing better control for diabetes. Back to those categories: Vegetables, Fruit and nuts, legumes, whole grains, meats, dairy, fats and oils, fish, and alcohol. Each one of those categories is worth a point, so you have a chance to get nine points total. For some categories, you get a point for eating a given quantity of food (more for some, less for others). We determine adherence to the diet based on how many points a day a person gets on average. The closer to nine points a person has on a daily basis, the healthier they are over...

In Vino, Veritas – or In Wine, Truth – by Pliny the Elder When the Holy Roman Empire was forming Charlemagne gave lands to the monks in order for them to plant vineyards to make wine for the Eucharist. Those first vineyards, planted by Benedictine monks, make some of the classic wines of all time.  Wine was in France centuries prior to Charlemagne, but it was those monks that we have a provenance of today's wine. It was also from those Monks that we got the concept of terroir. Today terroir is the “in” thing that wine sommeliers will talk about. One of the myths is that you can taste the soil of the wine.  This traces back to those monks who would taste the soil in order to determine where the best wines would come from. What those monks didn't know was that the vines get their ingredients from carbon dioxide and sunlight. Wine geology is complex, and recently Alex Maltman, a distinguished professor emeritus of geology, published a book about the geology of wine.  His book: Vineyards, Rocks, and Soils The Wine Lover's Guide to Geology is a reference guide for those who want to know more about the geology of the wines they are drinking. Dr. Maltman was also a guest on the podcast where we talked about wine geology and dispelled the myth about tasting the soil. Dr. Maltman notes that the chalk of Champagne is the soil, and the soil is important to drainage of the vine, but the plant doesn't take up chalk (which is a silicate compound), and when the inorganic compounds of chalk are broken down, and some of those minerals are taken up they are tasteless. What people taste are the many organic compounds that the plant makes from the carbon from carbon dioxide through photosynthesis and coded on the vineyards DNA. You also taste the byproducts of fermentation – as those compounds are put through yeast, bacteria. Where the confusion lies is that some of the organic compounds of the soil smell like some of the products of fermentation of the wine. The monks didn't know about photosynthesis, nor did they know about DNA encoding for the proteins and organic chemicals, nor did they understand the complex chemistry of fermentation. They just knew wine is delicious- and sometimes the soil tastes a bit like the wine, so they assumed that the vine took up the soil and put it into the grape (the wine takes up the water, not the soil). Today Sommeliers everywhere love to talk about the geology of where the wine you are buying came from. They love telling you a story – because we love stories about our food. As Maltman points out, we love to know the provenance of our food, and in an era of large multinational corporations, wine is one of the few places you can know about where a grape was grown, harvested, what were the conditions that year, what is the makeup of the land – even what side of the mountain that wine came from. But what you cannot taste, is the soil from the rocks. That, my friends, is not only impossible because of how and what the plant takes from the soil (water and ionic forms of inorganic compounds, as Maltman points out in his book) but ignores the most glorious and complex part of wine. In our conversation, Maltman talks about the grapes that no one has heard of that are making a comeback in Greece, Croatia, and Eastern Europe. Oh, and we bust the myths of resveratrol and people who want to add this as a supplement for weight loss, long life, etc. ----- http://forku.com (Fork U) is part of the https://your-doctors-orders.captivate.fm (Your Doctors Orders network of podcasts) and is hosted by noted physician and surgeon Dr. Terry Simpson. https://www.tiktok.com/@drterrysimpson? (Follow Dr. Terry Simpson on TikTok) for bite-sized content on  healthy eating Visit https://terrysimpson.com/ (TerrySimpson.com) for additional details on Dr. Simpson https://twitter.com/drterrysimpson?lang=en (Follow @DrTerrySimpson on Twitter) for skepticism, travel, and much more. Fork U is produced by...

This episode originally aired for the holidays in 2018. But it's solid advice, so we're playing it again, Sam! Diet season is soon upon us, but what happens if we have a system where you can lose weight during the times when you are most vulnerable: holidays, vacations, new relationships. Not a “lifestyle” or “long term” diet - but a simple ten-day plan to lose weight during the times when you need it. Full details: https://www.yourdoctorsorders.com/2018/12/10-day-holiday-diet/ ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

The term "microplastics" was originally described in 2004 for plastic particles that are less than 5 millimeters in diameter, originally being seen on beaches. But everywhere scientists have looked on planet earth, they have been found. From fruit, vegetables, nuts, beer, baby bottles, in the air, in our water. Some have estimated that we ingest 100,000 microplastic particles per day or the equivalent of a credit card of microplastic in a year. That number will only increase, as we are producing over 400 million tons of plastics a year, and we have over 5 billion tons of plastics in landfills. Plastic degrades over time, from sunlight, from ocean water, from wind. Some of those plastics become so small they cross the blood-brain barrier in humans. These plastics come in all shapes and sizes. As they are exposed to the environment and degrade, they become smaller and smaller. They come with different types of plastics with different reactions, but mostly we don't know. The problem is we don't know what these plastics are doing to us. We don't know what the toxic levels of microplastics are. We don't know what, if any, physiological systems that microplastics would interfere with. We don't know if they increase cancer, heart disease, auto-immune disease, dementia, liver cirrhosis - we just don't know. We don't know if they inhibit the growth of children if they cause the loss of fetuses in women who are pregnant. We do know on larger levels; plastics cause issues with marine mammals. Shopping bags in the water look like the turtle's favorite feast, a jellyfish, and they will consume those, and those plastics become stuck in the turtle's digestive system clogging up their intestines and leading to their death. Most have seen the turtle whose nose was stuffed with a plastic straw. What we don't know is what happens when the small microplastics enter into cells, or cross the blood-brain barrier, or land in our lungs. Those finds led to the laws to decrease plastic one-use bags and plastic straws, but that is just the tip of what might be a more serious problem. We know that mice fed microplastics had lower sperm counts, smaller offspring, but again, mice are not men. We also don't know what the different types of microplastics will do - one type might be harmful, another type might be benign. Some plastics might pass through us like fiber, indigestible matter that has no consequence other than moving stool along. What can you do if you are worried? If you feed your child formula, use bottles instead of plastic. If you use your microwave, don't reheat food in plastic containers. Try not to use plastic containers for storage, and don't dispose of them so quickly. Water bottles - well, time to use reusable water bottles made of metal or glass. For now, we can do a small part, but it isn't the entire part. It is a problem that may be a larger problem or less of a problem. But it probably is an issue. We already know that some plastics do cause endocrine disruption, and those products have been outlawed. But it isn't just a marine problem; whether you are a vegan, pescatarian, vegetarian, omnivore, or carnivore, there will be plastics in everything you eat. ----- http://forku.com (Fork U) is part of the https://your-doctors-orders.captivate.fm (Your Doctors Orders network of podcasts) and is hosted by the noted physician and surgeon Dr. Terry Simpson. https://www.tiktok.com/@drterrysimpson? (Follow Dr. Terry Simpson on TikTok) for bite-sized content on  healthy eating Visit https://terrysimpson.com/ (TerrySimpson.com) for additional details on Dr. Simpson https://twitter.com/drterrysimpson?lang=en (Follow @DrTerrySimpson on Twitter) for skepticism, travel, and much more. Fork U is produced by http://simpler.media (Simpler Media) and is recorded in the studios of https://myproducergirl.wixsite.com/producergirl (ProducerGirl Productions).

Ever since the YouTube video of Dr. Lustig and the evils of fructose went viral in 2010, many have advocated that fructose is the single most common cause of obesity in the United States. The video had metabolic pathways that had the hypothesis that most fructose either becomes fat in the liver, or that it might go down a pathway to cause joint issues, leaky gut, and inflammation causing obesity. Here are the two chemical structures of glucose, also known as the "good sugar" and fructose, or the bad sugar. I cannot help but thinking of the good witch and the bad witch on the Wizard of Oz. Dr. Lustig's hypothesis was based on studies done in mice and rats. In those studies, published two years before the viral video, found that high fructose diets in mice lead to increased "gut leak" and led to liver damage (1). This was even confirmed with a small study of 8 men (2) who had their complex carbohydrates replaced by fructose and fed normal caloric diets - meaning, these eight men had increased liver fat, more de novo fat formation (de novo lipogenesis) . This all makes that logical sense since sugar-sweetened beverages are associated with chronic inflammation and these days everything to do with chronic inflammation increases the risk of obesity, diabetes, heart disease, and aging. Then came a double-blinded, randomized, crossover study where a group of people were fed a standard diet but drank 25% of their calories as either fructose (the evil sugar), or glucose (the good one) or a high fructose corn syrup sweetened beverage. Oddly, there was no difference in any of those groups with regard to markers of inflammation, intestinal permeability, or inflammation in the fat tissue. To quote from the study: "Excessive amounts of fructose, HFCS, and glucose from SSBs consumed over 8 d did not differentially affect low-grade chronic systemic inflammation in normal-weight to obese adults." SSB = sugar sweetened beverages. There have been a number of human trials looking at sugar-sweetened beverages and inflammation, and the results are not consistent. Even finding that people who drink large amounts of either glucose of fructose didn't find changes in inflammation or visceral fat. Mice are not men, and the link between gut permeability, leading to systemic and chronic inflammation, occurs in mice, but not men. And while in mice fructose can lead to inflammation and liver issues, this doesn't happen in human beings. (4) The key may not be fructose itself, but increased caloric intake.  If you eat more, you will increase in weight, but it is not fructose alone. It is, in fact, high caloric intake combined with sugars. Meaning, that great tasting snack with the high levels of sugars and fats act in concert with the increased calories consumed to give you that portly look. To be fair, all of the studies were short term, less than a couple of weeks. Fructose, over the long term, may still be a bad actor. What about fruit? It is exceedingly difficult to eat enough whole fruits to make this a problem. To eat the excess amount in some of these studies you would have to eat several pounds of apples, and most people simply cannot do that in a day. And whole fruit consumption, as a part of the Mediterranean diet reduces the burden of cardiovascular disease, diabetes, and even erectile dysfunction.(5) In fact less than 10% of most Western dieters have adequate levels of fruit (6) leading to a serious threat to human health. Maybe a couple of apples a day will keep the doctor away. ----- http://forku.com/ (Fork U) is part of the https://your-doctors-orders.captivate.fm/ (Your Doctors Orders network of podcasts) and is hosted by noted physician and surgeon Dr. Terry Simpson. https://www.tiktok.com/@drterrysimpson? (Follow Dr. Terry Simpson on TikTok) for bite-sized content on  healthy eating Visit https://terrysimpson.com/ (TerrySimpson.com) for additional details on Dr. Simpson https://twitter.com/drterrysimpson?lang=en...

On my tiktok channel (@drterrysimpson or terrysimpson309) putting up a review of red meat the comments are reflective of the polarization that makes politics look like gentle disagreements. Nutrition is nuanced - meaning, it is rare that something is good or bad for us, except for Death Cap Mushrooms, they will kill you, although I hear they are delicious. The same is true for red meat. What we have are rarely the types of nutrition studies where we feed people precise amounts of food and see the results (the DASH diet studies were great with this -ref 1 ). Instead we rely on what people tell us, which can be accurate, or not - and we look at markers for disease instead of the disease itself (looking at end points of heart disease we look at LDL, cholesterol, C-reactive protein, and rather non-specific markers. Red Meat and Glycemic Control and Inflammation In this study (ref 2) they examined the premise that red meat's has an effect on inflammatory markers and glycemic control. So the study  was a meta analysis of randomized control of glycemic control and inflammatory markers. Adults that were studied were given various quantities of red meats and then checked for glycemic control and inflammation. The end result "Total red meat consumption, for up to 16 weeks, does not affect changes in biomarkers of glycemic control or inflammation for adults free of, but at risk for, cardiometabolic disease. " Does this put this to bed - not really, but the proposed ill effect of red meat is not something that is seen in these studies.  Here are the markers they studied: glucose, insulin levels, HOMA-R, Hemoglobin A1c, C-reactive protein, IL-6, and TNF-alpha. This was a group of studies that went to about 16 weeks (four months) so any longer term issues with red or even red processed meats, were not seen. But there were clearly no indication found in these studies. What about other markers for heart disease? So the next question is the effect of red meat on lipids, lipoproteins and blood pressure(ref 3)? It turned out that increasing red meat did not affect those variables for heart disease. What if you check not just red meat, but "red meat with diets that replaced red meat with a variety of foods. We stratified comparison diets into high-quality plant protein sources (legumes, soy, nuts); chicken/poultry/fish; fish only; poultry only; mixed animal protein sources (including dairy); carbohydrates (low-quality refined grains and simple sugars, such as white bread, pasta, rice, cookies/biscuits); or usual diet. We performed random-effects meta-analyses comparing differences in changes of blood lipids, apolipoproteins, and blood pressure for all studies combined and stratified by specific comparison diets."- from ref 4.  They found that changing red meat for plant protein had a minimal effect, and yet other studies (ref 2) found that plant protein had no significant difference at all. Those short term studies, which are clear changes with specific amounts over a short period of time, appear to contrast with the studies of various groups where they look at the risk of type 2 diabetes and red meat consumption. Take reference 5, where they looked at the increase of diabetes in different groups based on self-reporting of red meat intake. These studies are not as powerful as the controlled trials above, and they are confounded by other variables - people who eat more red meat have higher caloric intake and more obesity, they also tend to drink more and to smoke more. It is not easy to isolate, statistically, those variables out and this is always the issue with large cohort studies. Take the many studies of the Seventh Day Adventist group, who are considered America's Blue Zone in Loma Linda, California. They don't eat meat, they live longer -- but there is more, that group tends to exercise more, they do not smoke, they do not drink, and they have a strong sense of community. When studied (reference 6) it appears to

The Carnivore diet is the most extreme of the low-carbohydrate diets, with its expressed point that humans did great on a diet of flesh and evolved to eat a diet high in fats. While we cannot make up what people ate in the past, we can see about the diet of the Yupik's of Alaska.  These people have been studied extensively by the https://canhr.uaf.edu/ (Center for Alaska Native Health Research) (CANHR) at the University of Alaska in Fairbanks who partnered with https://www.ahajournals.org/doi/full/10.1161/circresaha.115.306566 (Genetics of Coronary Artery Disease) in Alaska Native people. First the CANHR found that Alaska Natives who ate processed meats (hot dogs, lunch meat, fried chicken) had higher triglycerides. Those Yupik's who consumed lots of omega-3 fatty acids and ate lots of meats with saturated fats developed coronary artery disease. As much as we like to get our omega-3 fatty acids from the sources, and few in the world eat as many as the Yupik's, that cannot protect you from coronary artery disease in the presence of the over-consumption of saturated and trans fatty acids. It further showed that, at least for the Yupik's, consuming processed meats, and meats high in saturated fats like beef, pork, lamb and chicken with skin was not healthy for the Alaska Natives. The Carnivore diet excludes greens and berries, however sea greens and berries are a large part of the traditional Yupik diet. The diet that they have is high in marine mammals, fish, game animals, greens and berries that provide high levels of fat soluble vitamins (A,D,E, and K) as well as iron. The Biotruth of the Carnivore Diet:A biotruth is a logical fallacy, usually found to be a misunderstanding of evolution. In this case the idea that early human ancestors were meat eaters and that the adaptation of cultivation of crops led to chronic disease. When CT scans were looked at from 137 mummified remains from four geographical regions, ancient Egypt, Peru, the Pueblo, and Unangan from the Aleutian Islands were examined they found atherosclerosis in all of them.  “Interpretation: Atherosclerosis was common in four preindustrial populations including preagricultural hunter-gatherers. Although commonly assumed to be a modern disease, the presence of atherosclerosis in premodern human beings raises the possibility of a more basic predisposition to the disease.” It should be noted that those were diverse diets from those who ate primarily marine mammals and fish to those whose diet was composed primarily of vegetation with little meat. The Myths of LDLThe low carbohydrate community propose that LDL isn't an issue with heart disease. This flies in the face of the recent article in JAMA looking at 34 clinical trials and finding that lowering LDL-C not only decreased the risk of heart disease, but all causes of mortality. While the low-carb crowd likes to point out how sugar indeed has a role in development of heart disease, they quietly forget to point out that diets rich in meats are overwhelmingly an issue. ----- http://forku.com/ (Fork U) is part of the https://your-doctors-orders.captivate.fm/ (Your Doctors Orders network of podcasts) and is hosted by noted physician and surgeon Dr. Terry Simpson. https://www.tiktok.com/@drterrysimpson? (Follow Dr. Terry Simpson on TikTok) for bite-sized content on  healthy eating Visit https://terrysimpson.com/ (TerrySimpson.com) for additional details on Dr. Simpson https://twitter.com/drterrysimpson?lang=en (Follow @DrTerrySimpson on Twitter) for skepticism, travel, and much more. Fork U is produced by http://simpler.media/ (Simpler Media) and is recorded in the studios of https://myproducergirl.wixsite.com/producergirl (ProducerGirl Productions).   ----- REFERENCESBrand-Miller JC, Griffin HJ, Colagiuri S. The carnivore connection hypothesis: revisited. J Obes. 2012;2012:258624. doi: 10.1155/2012/258624. Epub 2011 Dec 22. PMID: 22235369; PMCID: PMC3253466. Bersamin A, Luick...

A recent study puts another nail in the coffin for fish oil - while fish is healthy, it appears fish oil can lead to a dangerous heart condition. Produced by Simpler Media and recorded in the studios of ProducerGirl productions.   Follow on Twitter - @drterrysimpson 

Welcome to Fork U, the latest podcast from Dr. Terry Simpson. If you enjoyed the previous episodes of https://www.yourdoctorsorders.com/category/culinary-medicine/ (Culinary Medicine) and https://www.yourdoctorsorders.com (Your Doctors Orders), you'll love these quick, impactful bits of information that are easily digestible. (See what I did there?) No need to adjust your podcast or subscribe to anything new, you are already here! With that, here is the first episode of the new podcast, Fork U, where you can learn a bit about food and medicine.

Full details:  https://www.yourdoctorsorders.com/2020/12/covid-vaccine-myths/ Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

mRNA vaccines represent the most   Full details:  https://www.yourdoctorsorders.com/2020/12/mrna-vaccines-a-new-hope/  ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

Monoclonal antibodies are an exciting new treatment which have now been applied to COVID19.  Full details:  https://www.yourdoctorsorders.com/2020/12/antibodies/ ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

Part five - we can open the economy today  https://www.yourdoctorsorders.com/covid19-how-to-open-the-economy/ ‎ ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

Part four - mythbusting cures- things that don’t work and   https://www.yourdoctorsorders.com/2020/04/covid-part-4-mythbusting/ ‎ ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

Part three - how masks and tests will allow us to open up our economy https://www.yourdoctorsorders.com/2020/03/covid19-the-o-ring-of-the-economy/ ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

Part two is about slowing down Covid19 - Full details:  https://www.yourdoctorsorders.com/2020/03/covid19-flattening-the-curve/ ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

Part one is the bad news about Covid19 - just the facts along with a few tips to help you keep safe. Full details:  https://www.yourdoctorsorders.com/2020/03/covid19-part-one/ ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

Cooking a turkey is filled with myths, some can make you sick. But at the best it is difficult to cook, but there are two methods you can use to cook it. Plus we debunk the myths of trytophan and rinsing the turkey. Full details:  https://www.yourdoctorsorders.com/2019/11/talking-turkey/ ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter

Chocolate contains compounds that are healthy, but that has to be balanced by the high caloric content. Chocolate can provide a lot of healthy benefits, and is even better for you than tea. Full details:  https://www.yourdoctorsorders.com/2019/10/chocolate-myths/ ----- Produced and distributed by Simpler Media Follow Dr. Terry Simpson on Twitter