What are the effects of ketogenic diets on nutrient sufficiency, gut flora, and heart disease risk? 

Given the decades of experience using ketogenic diets to treat certain cases of pediatric epilepsy, a body of safety data has accumulated. Nutrient deficiencies would seem to be the obvious issue. Inadequate intake of 17 micronutrients, vitamins, and minerals has been documented in those on strict ketogenic diets, as you can see in the graph below and at 0:14 in my video Are Keto Diets Safe?

Dieting is a particularly important time to make sure you’re meeting all of your essential nutrient requirements, since you may be taking in less food. Ketogenic diets tend to be so nutritionally vacuous that one assessment estimated that you’d have to eat more than 37,000 calories a day to get a sufficient daily intake of all essential vitamins and minerals, as you can see in the graph below and at 0:39 in my video. 

That is one of the advantages of more plant-based approaches. As the editor-in-chief of the Journal of the American Dietetic Association put it, “What could be more nutrient-dense than a vegetarian diet?” Choosing a healthy diet may be easier than eating more than 37,000 daily calories, which is like putting 50 sticks of butter in your morning coffee. 
 
We aren’t just talking about not reaching your daily allowances either. Children have gotten scurvy on ketogenic diets, and some have even died from selenium deficiency, which can cause sudden cardiac death. The vitamin and mineral deficiencies can be solved with supplements, but what about the paucity of prebiotics, the dozens of types of fiber, and resistant starches found concentrated in whole grains and beans that you’d miss out on? 
 
Not surprisingly, constipation is very common on keto diets. As I’ve reviewed before, starving our microbial self of prebiotics can have a whole array of negative consequences. Ketogenic diets have been shown to “reduce the species richness and diversity of intestinal microbiota,” our gut flora. Microbiome changes can be detected within 24 hours of switching to a high-fat, low-fiber diet. A lack of fiber starves our good gut bacteria. We used to think that dietary fat itself was nearly all absorbed in the small intestine, but based on studies using radioactive tracers, we now know that about 7 percent of the saturated fat in a fat-rich meal can make it down to the colon. This may result in “detrimental changes” in our gut microbiome, as well as weight gain, increased leaky gut, and pro-inflammatory changes. For example, there may be a drop in beneficial Bifidobacteria and a decrease in overall short-chain fatty acid production, both of which would be expected to increase the risk of gastrointestinal disorders. 
 
Striking at the heart of the matter, what might all of that saturated fat be doing to our heart? If you look at low-carbohydrate diets and all-cause mortality, those who eat lower-carb diets suffer “a significantly higher risk of all-cause mortality,” meaning they live, on average, significantly shorter lives. However, from a heart-disease perspective, it matters if it’s animal fat or plant fat. Based on the famous Harvard cohorts, eating more of an animal-based, low-carb diet was associated with higher death rates from cardiovascular disease and a 50 percent higher risk of dying from a heart attack or stroke, but no such association was found for lower-carb diets based on plant sources.  
 
And it wasn’t just Harvard. Other researchers have also found that “low-carbohydrate dietary patterns favoring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favored plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain bread, were associated with lower mortality…” 
 
Cholesterol production in the body is directly correlated to body weight, as you can see in the graph below and at 3:50 in my video. 

Every pound of weight loss by nearly any means is associated with about a one-point drop in cholesterol levels in the blood. But if we put people on very-low-carb ketogenic diets, the beneficial effect on LDL bad cholesterol is blunted or even completely neutralized. Counterbalancing changes in LDL or HDL (what we used to think of as good cholesterol) are not considered sufficient to offset this risk. You don’t have to wait until cholesterol builds up in your arteries to have adverse effects either; within three hours of eating a meal high in saturated fat, you can see a significant impairment of artery function. Even with a dozen pounds of weight loss, artery function worsens on a ketogenic diet instead of getting better, which appears to be the case with low-carb diets in general.  

For more on keto diets, check out my video series here. 

And, to learn more about your microbiome, see the related videos below.

Might the appetite-suppressing effects of ketosis improve dietary compliance? 

The new data are said to debunk “some, if not all, of the popular claims made for extreme carbohydrate restriction,” but what about ketones suppressing hunger? In a tightly controlled metabolic ward study where the ketogenic diet made things worse, everyone ate the same number of calories, but those on a keto diet lost less body fat. But, out in the real world, all of those ketones might spoil your appetite enough that you’d end up eating significantly less overall. On a low-carb diet, people end up storing 300 more calories of fat every day. Outside of the laboratory, though, if you were in a state of ketosis, might you be able to offset that if you were able to sustainably eat significantly less? 
 
Paradoxically, as I discuss in my video Is Weight Loss on Ketosis Sustainable?, people may experience less hunger on a total fast compared to an extremely low-calorie diet. This may be thanks to ketones. In this state of ketosis, when you have high levels of ketones in your bloodstream, your hunger is dampened. How do we know it’s the ketones? If you inject ketones straight into people’s veins, even those who are not fasting lose their appetite, sometimes even to the point of getting nauseated and vomiting. So, ketones can explain why you might feel hungrier after a few days on a low-calorie diet than on a total zero-calorie diet—that is, a fast.
 
Can we then exploit the appetite-suppressing effects of ketosis by eating a ketogenic diet? If you ate so few carbs to sustain brain function, couldn’t you trick your body into thinking you’re fasting and get your liver to start pumping out ketones? Yes, but is it safe? Is it effective? 
 
As you can see below and at 1:58 in my video, a meta-analysis of 48 randomized trials of various branded diets found that those advised to eat low-carb diets and those told to eat low-fat ones lost nearly identical amounts of weight after a year.

Obviously, high attrition rates and poor dietary adherence complicate comparisons of efficacy. The study participants weren’t actually put on those diets; they were just told to eat in those ways. Nevertheless, you can see how even just moving in each respective direction can get rid of a lot of CRAP (which is Jeff Novick’s acronym for Calorie-Rich And Processed foods). After all, as you can see in the graph below and at 2:37 in my video, the four largest calorie contributors in the American diet are refined grains, added fats, meat, and added sugars. 

Low-carb diets cut down on refined grains and added sugars, and low-fat diets tend to cut down on added fats and meat, so they both tell people to cut down on donuts. Any diet that does that already has a leg up. I figure a don’t-eat-anything-that-starts-with-the-letter-D diet could also successfully cause weight loss if it caused people to cut down on donuts, danishes, and Doritos, even if it makes no nutritional sense to exclude something like dill. 

The secret to long-term weight-loss success on any diet is compliance. Diet adherence is difficult, though, because any time you try to cut calories, your body ramps up your appetite to try to compensate. This is why traditional weight-loss approaches, like portion control, tend to fail. For long-term success, measured not in weeks or months but in years and decades, this day-to-day hunger problem must be overcome. On a wholesome plant-based diet, this can be accomplished thanks in part to calorie density because you’re just eating so much food. On a ketogenic diet, it may be accomplished with ketosis. In a systematic review and meta-analysis entitled “Do Ketogenic Diets Really Suppress Appetite,” researchers found that the answer was yes. Ketogenic diets also offer the unique advantage of being able to track dietary compliance in real-time with ketone test strips you can pee on to see if you’re still in ketosis. There’s no pee stick that will tell you if you’re eating enough fruits and veggies. All you have is the bathroom scale. 

Keto compliance may be more in theory than practice, though. Even in studies where ketogenic diets are being used to control seizures, dietary compliance may drop below 50 percent after a few months. This can be tragic for those with intractable epilepsy, but for everyone else, the difficulty in sticking long-term to ketogenic diets may actually be a lifesaver. I’ll talk about keto diet safety next. 

The keto diet is in contrast to a diet that would actually be healthful to stick to. See, for example, my video series on the CHIP program here. 
 
This was the fourth video in a seven-part series on keto diets. If you haven’t yet, be sure to watch the others listed in the related videos below. 

Let’s dive into ketogenic diets and their $33-billion gimmick.

The carbohydrate–insulin model of obesity, the underlying theory that ketogenic diets have some sort of metabolic advantage, has been experimentally falsified. Keto diet proponents’ own studies showed the exact opposite: Ketogenic diets actually put you at a metabolic disadvantage and slow the loss of body fat. How much does fat loss slow down on a low-carb diet?  

As I discuss in my video Keto Diet Results for Weight Loss, if you cut about 800 calories of carbohydrates from your diet a day, you lose 53 grams of body fat a day. But if you cut the same number of fat calories, you lose 89 grams of fat a day. Same number of calories cut, but nine butter pats’ worth of extra fat melting off your body each day on a low-fat diet, compared to a low-carb one. Same number of calories, but about 80 percent more fat loss when you cut down on fat instead of carbs. You can see a graph of these results below and at 1:07 in my video. The title of the study speaks for itself: “Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss Than Carbohydrate Restriction in People with Obesity.” 

Just looking at the bathroom scale, though, would mislead you into thinking the opposite. After six days on the low-carb diet, study subjects lost four pounds. On the low-fat diet, they lost less than three pounds, as you can see in the graph below and at 1:40 in my video. So, according to the scale, it looked like the low-carb diet wins hands down. You can see why low-carb diets are so popular. What was happening inside their bodies, however, tells the real story. The low-carb group was losing mostly lean mass—water and protein. This loss of water weight helps explain why low-carb diets have “been such a persistent theme for authors of diet books and such ‘cash cows’ for publishers,” going back more than the last 150 years. That’s their secret. As one weight-loss expert noted, “Rapid water loss is the $33-billion diet gimmick.” 

When you eat carbohydrates, your body bulks up your muscles with glycogen for quick energy. Eat a high-carbohydrate diet for three days, and you may add about three pounds of muscle mass onto your arms and legs, as you can see below and at 2:34 in my video. Those glycogen stores drain away on a low-carb diet and pull water out with it. (The ketones also need to be flushed out of the kidneys, pulling out even more water.) On the scale, that can manifest as four more pounds coming off within ten days, but that “was all accounted for by losses in total body water”—that is water loss. 

The bottom line: Keto diets just don’t hold water. 

The thrill of seeing the pounds come off so quickly on the scale keeps many coming back to the low-carb altar. When the diet fails, the dieters often blame themselves, but the intoxication of that initial, rapid weight loss may tempt them back, like getting drunk again after forgetting how terrible the last hangover was. This has been dubbed the “false hope syndrome.” “The diet industry thrives for two reasons—big promises and repeat customers,” something low-carb diets were built for, given that initial, rapid water loss. 

What we care about is body fat. In six days, the low-fat diet extracted a total of 80 percent more fat from the body than the low-carb diet. It’s not just one study either. As you can see below and at 3:54 in my video, you can look at all of the controlled feeding trials where researchers compared low-carb diets to low-fat ones, swapping the same number of carb calories for fat calories or vice versa. If a calorie is just a calorie, then all of the studies should have crossed that zero line in the middle, straddling “favors low-fat diet” and “favors low-carb diet,” and indeed six did. One study showed more fat loss on a low-carb diet, but every other study favored the low-fat diet—more loss of body fat eating the same number of calories. When you put all of the studies together, we’re talking 16 more grams of daily body fat lost on the low-fat diets. That’s like four more pats of butter melting off your body on a daily basis. Less fat in the mouth means less fat on the hips, even when you’re taking in the same number of calories. 

This is the third installment of my seven-part series on keto diets. 

This keto research came from the deep dive I took for my book How Not to Diet. (All proceeds I receive from my books are donated to charity.) You can learn more about How Not to Diet and order it here. Also please feel free to check out some of my popular weight-loss videos in related videos below. 

Do low-carb and ketogenic diets have a metabolic advantage for weight loss? 

When you don’t eat enough carbohydrates, you force your body to burn more fat. “However, this rise in fat oxidation [burning] is often misconstrued as a greater rate of net FM [fat-mass] reduction” in the body, ignoring the fact that, on a ketogenic diet, your fat intake shoots up, too. What happens to your overall body fat balance? You can’t empty a tub by widening the drain if you’re opening the faucet at the same time. Low-carb advocates had a theory, though, the “carbohydrate–insulin model of obesity,” which I discuss in my video Keto Diet Theory Put to the Test.  

Proponents of low-carb diets, whether a ketogenic diet or a more relaxed form of carbohydrate restriction, suggested that decreased insulin secretion would lead to less fat storage, so even if you were eating more fat, less of it would stick to your frame. We’d burn more and store less, the perfect combination for fat loss—or so the theory went. To their credit, instead of just speculating about it, they decided to put it to the test. 

Gary Taubes formed the Nutrition Science Initiative (NuSI) to sponsor research to validate the carbohydrate–insulin model. He’s the journalist who wrote the controversial 2002 New York Times Magazine article “What If It’s All Been a Big Fat Lie?” which attempted to turn nutrition dogma on its head by arguing in favor of the Atkins diet with its bunless bacon cheeseburgers based on the carbohydrate–insulin model. (Much of Nina Teicholz’s book The Big Fat Surprise is simply recycled from Taubes’ earlier work.)  

In response, some of the very researchers Taubes cited to support his thesis accused him of twisting their words. One said, “The article was incredibly misleading…I was horrified.” Said another, “He took this weird little idea and blew it up, and people believed him…What a disaster.” It doesn’t matter what people say, though. All that matters is the science. 

Taubes attracted $40 million in committed funding for his Nutrition Science Initiative to prove to the world that you could lose more body fat on a ketogenic diet. NuSI contracted noted researcher Kevin Hall from the National Institutes of Health to perform the study. Seventeen overweight or obese men were effectively locked in what’s called a metabolic ward for two months to allow researchers total control over their diets. For the first month, they were placed on a typical high-carbohydrate diet (50 percent carbs, 35 percent fat, 15 percent protein), then were switched to a low-carb ketogenic diet (only 5 percent of calories from carbohydrates and 80 percent fat) for the second month. Both diets had the same number of daily calories. So, if a calorie is a calorie when it comes to weight loss, there should be no difference in body fat loss on the regular diet versus the ketogenic diet. If Taubes was right, though, if fat calories were somehow less fattening, then body fat loss would become accelerated on a keto diet. Instead, in the very study funded by the Nutrition Science Initiative, researchers found that body fat loss slowed during the ketogenic diet. 

Why do people think the keto diet works if it actually slows fat loss? Well, as you can see in the graph below and at 3:40 in my video, if you looked only at the readings on bathroom scales, the ketogenic diet would seem like a smashing success. Participants went from losing less than a pound a week on the regular diet during the first two weeks of the study to losing three and a half pounds within seven days after switching to the ketogenic diet. What was happening inside their bodies, however, told a totally different story: Their rate of body fat loss was slowed by more than half. So, most of what they were losing was just water weight. It’s presumed the reason they started burning less fat on a ketogenic diet was because, without the preferred fuel of carbohydrates, their bodies started burning more of their own protein—and that’s exactly what happened. Switching to a ketogenic diet made them lose less fat mass and more fat-free mass. Indeed, they lost more lean mass. That may help explain why the leg muscles of CrossFit trainees placed on a ketogenic diet may shrink as much as 8 percent. The vast lateralis, the biggest quad muscle in your leg, shrunk in thickness by 8 percent on a ketogenic diet. 

Yes, the study subjects started burning more fat on the ketogenic diet, but they were also eating so much more fat on the keto diet that they ended up retaining more fat in their body, despite the lower insulin levels. This is “diametrically opposite” to what the keto crowd predicted, and this is from the guy Nutrition Science Initiative paid to support its theory. In science-speak, “the carbohydrate–insulin model failed experimental interrogation.” 

In light of this “experimental falsification” of the low-carb theory, the Nutrition Science Initiative effectively collapsed but, based on its tax returns, not before Taubes and his co-founder personally pocketed millions of dollars in compensation. 

This is the second installment in my seven-part series on keto diets. In case you missed them, check out the other related videos below.  

The more things change, the more they stay the same. I created a whole website about the Atkins Diet, but, sadly, people keep falling into the low-carb trap. You can find some of my older videos on low-carb diets listed below. 

What does the science say about the clinical use of ketogenic diets for epilepsy and cancer? 

Blood sugar, also known as blood glucose, is the universal go-to fuel for the cells throughout our bodies. Our brain burns through a quarter pound of sugar a day because “glucose is the preferred metabolic fuel.” We can break down proteins and make glucose from scratch, but most comes from our diet in the form of sugars and starches. If we stop eating carbohydrates (or stop eating altogether), most of our cells switch over to burning fat. Fat has difficulty getting through the blood-brain barrier, though, and our brain has a constant, massive need for fuel. Just that one organ accounts for up to half of our energy needs. Without it, the lights go out…permanently. 

To make that much sugar from scratch, our body would need to break down about half a pound of protein a day. That means we’d cannibalize ourselves to death within two weeks, but people can fast for months. What’s going on? The answer to the puzzle was discovered in 1967. Harvard researchers famously stuck catheters into the brains of obese subjects who had been fasting for more than a month and discovered that ketones had replaced glucose as the preferred fuel for the brain. Our liver can turn fat into ketones, which can then breach the blood-brain barrier and sustain our brain if we aren’t getting enough carbohydrates. Switching fuels has such an effect on brain activity that it has been used to treat epilepsy since antiquity. 

In fact, the prescription of fasting for the treatment of epileptic seizures dates back to Hippocrates. In the Bible, even Jesus seems to have concurred. To this day, it’s unclear why switching from blood sugar to ketones as a primary fuel source has such a dampening effect on brain overactivity. How long can one fast? To prolong the fasting therapy, in 1921, a distinguished physician scientist at the Mayo Clinic suggested trying what he called “ketogenic diets,” high-fat diets designed to be so deficient in carbohydrates that they could effectively mimic the fasting state. “Remarkable improvement” was noted the first time it was put to the test, efficacy that was later confirmed in randomized, controlled trials. Ketogenic diets started to fall out of favor in 1938 with the discovery of the anti-seizure drug that would become known as Dilantin, but they’re still being used today as a third- or fourth-line treatment for drug-refractory epilepsy in children. 

Oddly, the success of ketogenic diets against pediatric epilepsy seems to get conflated by “keto diet” proponents into suggesting a ketogenic diet is beneficial for everyone. Know what else sometimes works for intractable epilepsy? Brain surgery, but I don’t hear people clamoring to get their skulls sawed open. Since when do medical therapies translate into healthy lifestyle choices? Scrambling brain activity with electroshock therapy can be helpful in some cases of major depression, so should we get out the electrodes? Ketogenic diets are also being tested to see if they can slow the growth of certain brain tumors. Even if they work, you know what else can help slow cancer growth? Chemotherapy. So why go keto when you can just go chemo? 

Promoters of ketogenic diets for cancer are paid by so-called ketone technology companies that offer to send you salted caramel bone broth powder for a hundred bucks a pound or companies that market ketogenic meals and report “extraordinary” anecdotal responses in some cancer patients. But more concrete evidence is simply lacking, and even the theoretical underpinnings may be questionable. A common refrain is that “cancer feeds on sugar.” But all cells feed on sugar. Advocating ketogenic diets for cancer is like saying Hitler breathed air so we should boycott oxygen. 

Cancer can feed on ketones, too. Ketones have been found to fuel human breast cancer growth and drive metastases in an experimental model, more than doubling tumor growth. Some have even speculated that this may be why breast cancer often metastasizes to the liver, the main site of ketone production. As you can see below and at 4:59 in my video Is Keto an Effective Cancer-Fighting Diet?, if you drip ketones directly onto breast cancer cells in a petri dish, the genes that get turned on and off make for much more aggressive cancer, associated with significantly lower five-year survival in breast cancer patients, as you can see in the following graph and at 5:05 in my video. Researchers are even considering designing ketone-blocking drugs to prevent further cancer growth by halting ketone production.  

Let’s also think about what eating a ketogenic diet might entail. High animal fat intake may increase the mortality risk among breast cancer survivors and potentially play a role in the development of breast cancer in the first place through oxidative stress, hormone disruption, or inflammation. This applies to men, too. “A strong association” has been found “between saturated fat intake and prostate cancer progression and survival.” Those in the top third of consumption of these kinds of fat-rich animal foods appeared to triple their risk of dying from prostate cancer. This isn’t necessarily fat in general either. No difference has been found in breast cancer death rates based on total fat intake. However saturated fat intake specifically may negatively impact breast cancer survival, increasing the risk of dying from it by 50 percent. There’s a reason the official American Cancer Society and American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline recommend a dietary pattern for breast cancer patients that’s essentially the opposite of a ketogenic diet. It calls for a diet that’s “high in vegetables, fruits, whole grains, and legumes [beans, split peas, chickpeas, and lentils]; low in saturated fats; and limited in alcohol consumption.” 

“To date, not a single clinical study has shown a measurable benefit from a ketogenic diet in any human cancer.” There are currently at least a dozen trials underway, however, and the hope is that at least some cancer types will respond. Still, even then, that wouldn’t serve as a basis for recommending ketogenic diets for the general population any more than recommending everyone get radiation, surgery, and chemo just for kicks. 

“Keto” has been the most-searched keyword on NutritionFacts.org for months, and I didn’t have much specific to offer…until now. Check out my other videos on the topic in related videos below. 

 For an overview of my cancer work, watch How Not to Die from Cancer. 

Meet Chef Lois Ellen Frank, Ph.D. We had the pleasure of talking with her about food history, health, and culture. Read on and enjoy her recipe for Three Sisters Stew.

Tell us a little about your work.

Chef Walter Whitewater and I are based in Santa Fe, New Mexico, at Red Mesa Cuisine, a catering company specializing in the revitalization of ancestral Native American cuisine with a modern twist, using ingredients and preparing foods focused on health and wellness.

Together, we have worked with Native American communities in the Southwest of the United States for more than 30 years. I was honored to be the recipient of the Local Hero Olla Award, which recognizes an exceptional individual for the work they do to create healthy, innovative, vibrant, and resilient local sustainable food systems in New Mexico. Chef Walter and I work with the New Mexico Department of Health by providing training to cooks who work in Native communities. We also work with the Physicians Committee for Responsible Medicine (PCRM) on The Power to Heal Diabetes: Food for Life in Indian Country program. See www.nativepowerplate.org for more.

What are the Three Sisters, and what significance do they have for Native Americans?

The Three Sisters are corn, beans, and squash. They are believed by a number of tribes to be gifts from the great spirit. The way these vegetables grow in the garden exemplifies the notion of interconnectedness, as do the nutrients they provide. They are three ingredients that Chef Walter and I use regularly and a foundation to a healthy ancestral Native American diet.

We recently learned about the “Magic Eight” from you. Could you describe what the “Magic Eight” foods are and their history?

The Magic Eight are corn, beans, squash, chiles, tomatoes, potatoes, vanilla, and cacao. They are eight foods that did not exist anywhere outside of the Americas prior to European contact in 1492. If we deconstruct that, it means that the Italians did not have the tomato, the Irish did not have the potato, there were no chiles in any Asian, East Indian, or African cuisine, and there was no confection using either vanilla or chocolate. These are truly indigenous Native American foods that were given to the rest of the world and are now woven into the identities of so many cuisines. The Magic Eight are the focus of our cookbook, Seed to Plate, Soil to Sky: Modern Plant-Based Recipe Using Native American Ingredients, which was published by Hachette Book Group this summer.

What are your go-to favorite whole food, plant-based, oil-free meals? 

Yesterday, I made a Three Sisters enchilada. I combined savory refried pinto beans with zucchini squash and corn kernels, which I put into a corn tortilla and topped with a red chile sauce, green onions, and some of the sautéed squash and corn. It was delicious. Another favorite is a poblano chile stuffed with quinoa, mushroom, and spinach, which I serve with an heirloom tomato sauce that I can myself every year so I can use it throughout the winter months. Chef Walter loves to use corn and makes a traditional dish called Navajo Kneel Down Bread (Nitsidigo’i), which is sweet corn baked inside a fresh or dried corn husk. Chef Walter’s modern version adds dried currants, raisins, and fresh apples, foods that are readily accessible on the Navajo Nation in his community of Pinon, where he grew up.

Can you please tell us a little bit about your work with PCRM and its Native Food for Life program?

We have done a lot of work over the years with PCRM and its Native Food for Life program. Under its Native American resources, there are plant-based recipe booklets by Chef Walter and myself, as well as a lot of videos, other information, and recipes on healthy foods that are easy to make.

What message do you have for the Native American population regarding reclaiming their health through heritage?

I think that we all—all nations, all ethnicities, and all people—need to reclaim our health and wellness. In Native American communities, there is a movement to re-indigenize, reclaim, and revitalize the ancestral diet for health and wellness. This is a good thing, because when you eat the Magic Eight and other foods from the region of your own ancestors, you revitalize everything associated with those foods, including the land, techniques surrounding the foods, and agricultural practices, so that the knowledge surrounding these practices can be passed on from generation to generation.

Three Sisters Stew

makes 4 to 6 servings

Chef Walter and I originally made this recipe on the Navajo Reservation in the town of Pinon, Arizona, where he was raised. It has been made for numerous family gatherings and ceremonies. For this version, I’ve added zucchini instead of meat. The squash makes this stew hearty without being heavy. This recipe is great because you can make it to feed four to six people, or you can add to it and make enough to feed sixty to six hundred.

1 tablespoon bean juice
½ large yellow onion, chopped (approximately 1 cup)
½ green bell pepper, seeded and chopped (approximately ½ cup)
1 zucchini, cut into small cubes (approximately 1½ cups)
2 teaspoons blackened garlic
1 can (14.5 ounces) diced tomatoes,
no salt added if possible
1½ cups cooked organic dark red kidney beans (or one 15-ounce can)
1½ cups cooked organic pinto beans (or one 15-ounce can)
1 cup corn kernels, fresh or frozen
1½ tablespoons New Mexico red chile powder, mild
1 teaspoon New Mexico red chile powder, medium (optional, for a slightly hotter stew)
¼ teaspoon black pepper, or to taste
¼ teaspoon dried thyme
¼ teaspoon dried oregano
4 cups water or bean juice

Preheat a cast-iron soup pot or heavy bottomed metal soup pot over medium-high heat. Add the bean juice and heat until hot. Add the onions, sauté for approximately 3 minutes until translucent, stirring to prevent burning. Add the bell pepper and sauté for another 3 minutes, stirring to prevent burning. 

Add the zucchini and sauté for another 3 minutes. You want the vegetables to caramelize and begin to turn brown. The bottom of the pan may begin to turn brown, but this is part of the caramelization process. Add the garlic and cook for another minute, stirring to prevent burning and to incorporate into the other ingredients.

Add the tomatoes. Cook for another 2 minutes, stirring constantly. Add the kidney beans, pinto beans, corn, mild chile powder, and medium chile powder (if you want a spicier stew), black pepper, thyme, and oregano, then mix well. Add the water, bring to a boil, then reduce heat and let simmer for 25 minutes, stirring occasionally. Taste and adjust seasonings, if desired. Remove from heat and serve immediately.

Note: Fresh thyme and fresh oregano can be used if available. Simply double the amount from ¼ teaspoon of each to ½ teaspoon of each. I usually buy herbs fresh if they are available, and if I have leftover herbs from whatever I am cooking, I dry them on a sheet tray in my pantry and then put them into glass jars for future use.

Excerpted from Seed to Plate, Soil to Sky: Modern Plant-Based Recipes Using Native American Ingredients by Lois Ellen Frank. Copyright © 2023. Available from Hachette Go, an imprint of Hachette Book Group, Inc.

You can find Chef Lois Ellen Frank here.

Studies show that many doctors either tend to overestimate the amount of weight that can be lost with obesity drugs or are simply clueless.

Current options for weight-loss medications include the ridiculously named Qsymia, a combination of phentermine (the phen in fen-phen) and topiramate, a drug that can cause seizures if you stop it abruptly. Qsymia was “explicitly rejected” multiple times for safety reasons in Europe “because of concerns about the medicine’s long-term effects on the heart and blood vessels” but, at the time of making my video Are Weight Loss Pills Effective?, remains available for sale in the United States. Belviq is in a similar boat—allowed in the United States but not in Europe due to “concerns about possible cancers, psychiatric disorders, and heart valve problems…”  

Belviq is sold in the United States for about $200 a month. If you think that’s a lot, there’s Saxenda, which requires daily injections and is listed at the low, low price of only $1,281.96 for a 30-day supply. It carries a black box warning, the FDA’s strictest caution about potentially life-threatening hazards, for thyroid cancer risk. Paid consultants and employees of the company that makes it argue the greater number of breast tumors found among drug recipients may be due to “enhanced ascertainment,” meaning easier breast cancer detection just due to the drug’s effectiveness. 

Contrave is another option if you ignore its black box warning about a potential increase in suicidal thoughts. Then there’s Alli, the drug that causes fat malabsorption, thereby resulting in side effects “including fecal urgency, oily stool, flatus with discharge, and fecal incontinence”—Alli can be your ally in anal leakage. The drug evidently “forces the patient to use diapers and to know the location of all the bathrooms in the neighborhood in an attempt to limit the consequences of urgent leakage of oily fecal matter.” A Freedom of Information Act exposé found that although company-sponsored studies claimed that “all adverse events were recorded,” one trial apparently conveniently failed to mention 1,318 of them. 

What’s a little bowel leakage, though, compared to the ravages of obesity? As with anything in life, it’s all about risks versus benefits. However, in an analysis of more than a hundred clinical trials of anti-obesity medications that lasted up to 47 weeks, drug-induced weight loss never exceeded more than nine pounds. That’s a lot of money and a lot of risk for just a few pounds. Since you aren’t treating the underlying cause—a fattening diet—when people stop taking these drugs, the weight tends to come right back, so you’d have to take them every day for the rest of your life. But people do stop taking them. Using pharmacy data from a million people, most Alli users stopped after the very first purchase and most Meridia users didn’t even make it three months. Taking weight-loss meds is so disagreeable that 98 percent of users stopped taking them within the first year. 

Studies show that many doctors tend to overestimate the amount of weight that can be lost with these drugs or are simply clueless. One reason may be that some clinical practice guidelines go out of their way to advocate prescribing medications for obesity. Are they seriously recommending drugging a third of Americans—more than 100 million people? You may not be surprised to learn that the principal author of the guidelines has a “significant financial interest or leadership position” in six separate pharmaceutical companies that all (coincidently) work on obesity drugs. In contrast, independent expert panels, like the Canadian Task Force on Preventive Health Care, explicitly recommend against weight-loss drugs, given their poor track record of safety and efficacy. 

In case you missed my related video, check out Are Weight Loss Pills Safe?.

As with all lifestyle diseases, it’s better to treat the underlying cause, which, in the case of obesity, is a fattening diet. For an example of what’s possible with a healthy diet intervention, see Flashback Friday: The Weight Loss Program That Got Better with Time. 

Check out the related videos below for more about weight loss. 

Why don’t more people take the weight-loss medications currently on the market? 

Despite the myriad menus of FDA-approved medications for weight loss, they’ve only been prescribed for about 1 in 50 patients with obesity. We tend to worship medical magic bullets in the United States, so what gives? As I discuss in my video Friday Favorites: Are Weight-Loss Supplements Safe and Effective?, one of the reasons anti-obesity drugs are so “highly stigmatized” is that, historically, they’ve been anything but magical and the bullets have been blanks—or worse.

To date, most weight-loss drugs that were initially approved as safe have since been pulled from the market for unforeseen side effects that turned them into a “threat to public health.” As you may remember from my video Brown Fat: Losing Weight Through Thermogenesis, it all started with DNP, a pesticide with a promise to safely melt away fat that melted away people’s eyesight instead. (That actually helped lead to the passage of the landmark Food, Drug, and Cosmetic Act in 1938.) Thanks to the internet, DNP has made a comeback with “predictably lethal results.” 

Then came the amphetamines. Currently, more than half a million Americans may be addicted to amphetamines like crystal meth, but the “original amphetamine epidemic was generated by the pharmaceutical industry and medical profession.” By the 1960s, drug companies were churning out about 80,000 kilos of amphetamines a year, which is nearly enough for a weekly dose for every man, woman, and child in the United States. Billions of doses a year were prescribed for weight loss, and weight-loss clinics were raking in huge profits. A dispensing diet doctor could buy 100,000 amphetamine tablets for less than $100, then turn around and sell them to patients for $12,000.  

At a 1970 Senate Hearing, Senator Thomas Dodd (father of “Dodd-Frank” Senator Chris Dodd) suggested that America’s speed freak problem “was no by means an ‘accidental development’: ‘Multihundred million dollar advertising budgets, frequently the most costly ingredient in the price of a pill, have, pill by pill, led, coaxed and seduced post-World War II generations into the ‘freaked-out’ drug culture…’” I’ll leave drawing the Big Pharma parallels to the current opioid crisis as an exercise for the viewer.  

Aminorex was a widely-prescribed appetite suppressant before it was pulled for causing lung damage. Eighteen million Americans were on fen-phen before it was pulled from the market for causing severe damage to heart valves. Meridia was pulled for heart attacks and strokes, Acomplia was pulled for psychiatric side effects, including suicide, and the list goes on, as you can see below and at 2:51 in my video. 

The fen-phen debacle resulted in “some of the largest litigation pay-outs ever seen in the pharmaceutical industry, with individual amounts of up to US$200,000 and a total value of ~US$14 billion,” but that’s all baked into the formula. If you read the journal PharmacoEconomics (and who doesn’t!), you may be aware that a new weight-loss drug may injure and kill so many that “expected litigation cost” could exceed $80 million, but Big Pharma consultants estimate that if it’s successful, the drug could bring in more than $100 million, so do the math. 

What does work for weight loss? I dive deep into that and more in How Not to Diet.  For more of my videos on weight loss, check out the related videos below. 

There are disinfection byproducts in tap water. What happened when Brita, PUR, ZeroWater, and refrigerator water filters were put to the test? 

Though many distrust the safety of tap water, a study of 35 brands of bottled water did not find them to be necessarily safer, cleaner, or of a higher quality than water straight out of the faucet. How much is that saying, though? Two studies published in the 1970s “changed forever the earlier perspective that drinking water safety was only about waterborne disease.” In fact, it was our fight against microbial contaminants that led to a new kind of contamination—in the form of disinfection byproducts.  

The two landmark papers in 1974 solved the mystery of the source of chloroform in drinking water: We met the enemy, and he is us. The chlorination of drinking water—“disinfection [that] is crucial for maintaining the microbiological safety of water”—was interacting with natural organic matter from the water’s source and creating chlorinated compounds that can not only result in off-flavors and smells but also pose a potential public health risk. More than 600 disinfection byproducts have been identified so far. 

After decades of research into the matter, it appears that the life-long ingestion of chlorinated drinking water results in “clear excess risk” for bladder cancer. There is also some evidence of increased risk of certain types of birth defects, but most of the concern has focused on the bladder cancer link. Forty years of exposure may increase your odds of bladder cancer by 27 percent. The Environmental Protection Agency estimated that 2 to 17 percent of bladder cancer cases in the United States are due to these disinfection byproducts in drinking water. However, this assumes the link is one of cause and effect, which has yet to be firmly established. 

The best way to reduce risk is to treat the cause. Countries could prevent the formation of disinfection byproducts in the first place through the better initial removal of source water’s “natural organic matter” (what my grandmother would have called schmutz). Some countries in Europe, such as Switzerland, the Netherlands, Austria, and Germany, have newer, well-maintained drinking water systems that can distribute tap water free from residual disinfectants, but the cost to upgrade the infrastructure of even a small city in the United States could run in the tens of millions of dollars. As the tragedy in Flint, Michigan, revealed, we seem to have trouble keeping even frank toxins out of the tap. 

Nearly 40 percent of Americans use some sort of water purification device. I look at the comparisons of these devices in my video Is It Best to Drink Tap, Filtered, or Bottled Water?. Tap water from Tucson, Arizona, was pitted head-to-head against two of the most common purification approaches—pour-through pitchers and refrigerator filters. As you can see in the graph below and at 2:53 in my video, both fridge filters (GE and Whirlpool) did similarly well, removing more than 96 percent of trace organic contaminants, and edging out the three pitcher filters. ZeroWater caught 93 percent, and PUR pitchers got 84 percent. By the time the filters needed to be replaced, Brita was only catching 50 percent. A similar discrepancy was found between filters from PUR and Brita tested specifically against disinfection byproducts. They both started out about the same at the beginning, but by the end of the filter’s life, PUR appeared to do better, as you can see below and at 3:15 in my video. Reverse osmosis systems can work even better, but the cost, water waste, and loss of trace minerals don’t seem worth it.  

As you can see below and at 3:40 in my video, the annual cost for purifying your water with a pitcher or fridge filter was calculated to be about the same, at only around a penny per cup—with the exception of the ZeroWater brand, which is up to four times more expensive. 

I always figured the “change by” dates on filters were just company scams to get you to buy more replacements, but I was wrong. Because I drink filtered water mostly just for taste, I used to wait until the water started tasting funky. Bad idea. Not only do the filters eventually lose some of their removal capacity, but bacterial growth can build up inside them, resulting in your “filtered” water having higher bacterial counts than water straight out of the tap. You’d be actually making your water dirtier rather than cleaner, so it is important to replace filters regularly. 

As an aside, I used to think the same about the advice to change your toothbrush every three months. Which Big Brush executive thought that one up? But, no, I was wrong again. Toothbrushes can build up biofilms of tooth decay bacteria or become breeding grounds for bacteria to flume into the air with each toilet flush before going back into our mouths. Fun fact: A single flush can spew up “millions of bacteria into the atmosphere” that can settle on your nice, moist toothbrush. The good news is that rather than buying new brushes, you can disinfect the head of your toothbrush with as little as a ten-minute soak in white vinegar or, even more frugally, vinegar diluted by half with water.  

Hydration is important. See related videos below for more information. 

Avoiding waterborne pollutants if possible is also important. See my videos Lead in Drinking Water and Friday Favorites: Benefits of Turmeric for Arsenic Exposure. 

How Many Glasses of Water Should We Drink a Day? Watch the video to find out. 

Advisories telling pregnant women to cut down on fish consumption may be too late for certain persistent pollutants.

If you intentionally expose people to mercury by feeding them fish (like tuna) for 14 weeks, the level of mercury in their bloodstream goes up, as you can see in the graph below and at 0:14 in my video Avoiding Fish for Five Years Before Pregnancy. As soon as they stop eating fish, it drops back down such that they can detox by half in about 100 days. (So, the half-life of total mercury in our blood is approximately 100 days.) Even if you eat a lot of fish, within a few months of stopping, you can clear much of the mercury out of your blood. But what about your brain? 

The results from modeling studies are all over the place, providing “some extreme estimates (69 days vs. 22 years).” When put to the test, though, autopsy findings suggest the half-life may be even longer still at 27.4 years. Once mercury gets in our brains, it can be decades before our body can get rid of even half of it. So, better than detoxing is not “toxing” in the first place. 

That’s the problem with advisories that tell pregnant women to cut down on fish intake. For pollutants with long half-lives, such as PCBs and dioxins, “temporary fish advisory-related decreases in daily contaminant intake will not necessarily translate to appreciable decreases in maternal POP [persistent organic pollutant] body burdens,” which help determine the dose the baby gets. 

Consider this: As you can see in the graph below and at 1:32 in my video, an infant may be exposed to a tumor-promoting pollutant called PCB 153 if their mom ate fish. But if mom ate only half the fish or no fish at all for one year, levels wouldn’t budge much. A substantial drop in infant exposure levels may only be seen if the mom had cut out all fish for five years before getting pregnant. That is the “fish consumption caveat.” “[T]he only scenarios that produced a significant impact on children’s exposures required mothers to eliminate fish from their diets for 5 years before their children were conceived. The model predicted that substituting produce for fish would reduce prenatal and breastfeeding exposures by 37% each and subsequent childhood exposures by 23%.” So, “a complete ban on fish consumption may be preferable to targeted, life stage–based fish consumption advisories…” 

If you are going to eat fish, though, which is less polluted—wild-caught or farmed fish? In a recent study, researchers measured the levels of pesticides, such as DDT, PCBs, polycyclic aromatic hydrocarbons, and toxic elements, such as mercury and lead, in a large sample of farmed and wild-caught seafood. In general, they found that farmed fish were worse. Think of the suspect as farmed and dangerous. The measured levels of most organic and many inorganic pollutants were higher in the farmed seafood products and, consequently, so were the intake levels for the consumer if such products were consumed. For example, as you can see in the graphs below and at 3:09 in my video, there was significantly more contamination by polycyclic hydrocarbons, persistent pesticides, and PCBs in all of the farmed fish samples, including the salmon and seabass (though it didn’t seem to matter for crayfish), and the wild-caught mussels were actually worse. If you split adult and child consumers into those only eating farmed seafood or only eating wild-caught seafood, the level of pollutant exposure was significantly worse with the farmed seafood.  

Overall, the researchers, who were Spanish, investigated a total of 59 pollutants and toxic elements. They concluded: “Taking all these data as a whole, and based on the rates of consumption of fish and seafood of the Spanish population, our results indicate that a theoretical consumer who chose to consume only aquaculture [farmed] products would be exposed to levels of pollutants investigated about twice higher than if this theoretical consumer had chosen only products from extractive fisheries [wild-caught fish].” So, when it comes to pollutants, you could eat twice the amount of fish if you stuck to wild-caught. That’s easier said than done, though. Mislabeling rates for fish and other seafood in the United States are between 30 and 38 percent, so the average fraud rate is around one in three.  

In my previous video on this topic, How Long to Detox from Fish Before Pregnancy, I mentioned a study that suggests detoxing from fish for one year to lower mercury levels, but other pollutants take longer to leave our system. 

For optimum brain development, consider a pollutant-free source of omega-3 fatty acids. Check out Should Vegan Women Supplement with DHA during Pregnancy?. 

Aside from pollutants, there are other reasons we may want to avoid excessive amounts of animal protein. See Flashback Friday: The Effect of Animal Protein on Stress Hormones, Testosterone, and Pregnancy.

What are the effects of chewing gum on hunger and appetite?  

“Horace Fletcher,” proclaimed one of his obituaries in 1919, “taught the world to chew.” Also known as the “Great Masticator,” Fletcher was a health reformer who popularized the idea of chewing each mouthful more than 32 times—“once for every tooth.” It wasn’t put to the test, though, until nearly a century later. In that study, participants were told to eat pasta until they felt “comfortably full” and were randomized to chew each mouthful either 10 times or 35 times before swallowing. The subjects were told the study was about the effects of chewing on mood, but that was just a ruse. The researchers really wanted to know whether prolonged chewing reduced food intake. And, as it turned out, those who chewed more felt full earlier than those who chewed less, such that they ended up eating about a third of a cup less pasta overall. 

If chewing suppresses the appetite in some way, what about chewing gum as a weight-loss strategy? As I discuss in my video How Many Calories Do You Burn Chewing Gum?, an article entitled “Benefits of Chewing Gum” suggested as much by saying that it “may be a useful behavior modification tool in appetite control and weight management,” but it was co-written by the executive director of The Wrigley Science Institute and a senior manager at the Wm Wrigley Jr Company. Why don’t we see what the unbiased science says? 

Big Gum likes to point to a letter published in 1999 in The New England Journal of Medicine. In it, Mayo Clinic researchers claimed that chewing gum could burn 11 calories an hour. Critics pointed to the fact that they didn’t really test “typical” gum chewing; they instead tested chewing the equivalent of four sticks of gum “at a very rapid cadence.” Specifically, the participants were told to chew at a frequency of exactly 100 Hertz (Hz) “with the aid of a metronome” for 12 minutes. That seemed to burn 2.2 calories, hence, potentially 11 calories an hour. 

One might have had more confidence in the Mayo scientists’ conclusion had they not lacked a fundamental understanding of basic units. As defined by Merriam-Webster, hertz is a unit of frequency equal to one cycle per second, so 100 Hz would mean 100 chews per second. (That would be a very rapid cadence!) If it’s true that 11 calories may be burned an hour, though, that means you could burn more calories actively chewing gum while sitting in a chair than you would if you weren’t chewing gum while upright at a standing desk. 

In fact, as you can see in the graph below and at 2:24 in my video, chewing one small piece of gum at your own pace may only burn about three calories an hour, which would approximate the calorie content of the sugar-free gum itself. However, chewing off the calories of a piece of sugar-sweetened gum might take all day. What about the purported appetite-suppressing effect of all that chewing, though? 

The results from studies on the effects of chewing gum on hunger are all over the place. For example, as you can see in the graph below and at 2:50 in my video, one showed decreased appetite, another showed no effect, and yet another even showed significantly increased hunger in women after chewing gum. The more important question, though, is whether there are any changes in subsequent calorie intake. Again, the findings are mixed. 

One study, as you can see in the graph below and at 3:12 in my video, even found that while chewing gum didn’t impact M&M consumption much, it did appear to decrease the consumption of healthy snacks. Interesting, but the researchers used mint gum, and the healthy snacks included mandarin orange slices. So, that may have just been an orange juice-after-tooth-brushing effect.  

It can take an hour before the residual taste effect of mint toothpaste dissipates. This is bad if it cuts your fruit intake, but what about harnessing this power against Pringles? An international group of researchers had people eat Pringles potato chips for 12 minutes, interrupting them every 3 minutes to swish with a menthol mouthwash. As you can see in the graph below and at 3:50 in my video, compared to those in the control groups (swishing with water or nothing at all), the minty mouthwash group cut their consumption by 29 percent. The researchers concluded: “If a consumer finds themselves snacking on too many crisps [potato chips] during a given eating occasion, one potential strategy could be intervening by having a peppermint tea, menthol flavoured chewing gum, or brushing their teeth, to slow down or stop snacking.” 

What we’re wondering about, though, is weight loss. Even if a little tweak like chewing gum can affect the consumption of a single snack, your body could just compensate by eating more later in the day. The only way to know for sure if chewing gum can be used as a weight-loss hack is to put it to the test, which I cover in my video Does Chewing Gum Help with Weight Loss? 

For more information on calories and weight loss, check out related videos below. 

Pregnant and breastfeeding women should probably be advised to either decrease or, when possible, cease cannabis use entirely, and couples trying to conceive may also want to consider cutting down. 

Approximately one in six couples “are unable to conceive after a year and are labeled infertile, with a male factor identified in up to half of all cases.” Several lifestyle factors have been associated with diminished sperm production, such as smoking cigarettes, but what about smoking cannabis? 

“Regular marijuana smoking more than once per week was associated with a 28%…lower sperm concentration,” as well as a lower total sperm count based on a study of more than a thousand men, but “no adverse association was found for irregular use” of less than once a week.  

As I discuss in my video The Effects of Marijuana on Fertility and Pregnancy, this wasn’t a randomized study, so other factors that go along with regular marijuana use may have been to blame. Researchers did take into account cigarettes, alcohol, other drugs, STDs, and things like that, but there’s always a possibility there was something else for which they didn’t control. 

Findings were similar for women. Hundreds of infertile couples were studied in California, and, just as men had about a quarter fewer sperm, a quarter fewer eggs were retrieved from women who used cannabis more than 90 times in their lifetime or had been using the year before. Again, there could have been confounding factors, but until we know more, couples who are trying to conceive may want to make the joint decision to turn over a new leaf.  

What about during pregnancy? As you can see below and at 1:39 in my video, medical authorities recommend that “women who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use” and not use it during pregnancy or lactation, though the Academy of Breastfeeding Medicine suggests the known benefits of breastmilk currently outweigh any potential harms for women who continue to smoke it. Despite these warnings from authorities, marijuana use has increased among pregnant women in recent years, going up by more than 60 percent, but that’s only from about 2.5 percent up to less than 4 percent, which is less than half the frequency of nonpregnant women. 

Why are OB/GYNs so down on getting high? Scary articles appear in the American Journal of Obstetrics and Gynecology, like one making claims that a “large study conducted by the US National Birth Defects Prevention Center documented a significantly increased risk for anencephaly [a serious birth defect] when the fetus is exposed to marijuana during the first month of gestation.” But, if you don’t just take their word for it and pull up the actual study, you’ll see that the association wasn’t statistically significant after all. As one letter to the editor was titled, “Marijuana and Pregnancy: Objective Education Is Good, but Biased Education Is Not.”  

Some risks have been identified: Infants “were more likely to be anemic, and…have lower birth weight and to require placement in neonatal intensive care than infants of mothers who did not use marijuana.” However, it’s “difficult to determine the direct effects of maternal cannabis use on the developing fetus” because of a variety of confounding factors for which studies may not be able to completely control. 

Studies also show links between prenatal marijuana exposure and learning problems later in life—manifesting years later in school—and that’s where the greater concern lies, on the potential long-term effects on brain development. So, even after “weeding out the myths,” there is enough concern that “pregnant and breastfeeding cannabis users should be identified early and advised to either decrease or where possible cease cannabis use entirely.” 

When do I mean by cut down “when possible?” Check out my video Natural Treatments for Morning Sickness to see how marijuana use during pregnancy can sometimes be a lifesaver. 

I originally released several videos on cannabis in a webinar and downloadable digital DVD. If you missed any of them, they are listed in the related videos below.  

For more on fertility, check out Male Fertility and Diet and Dairy Estrogen and Male Fertility. 

If extra chewing is effective in suppressing your appetite when it comes to food, what about chewing gum as a weight-loss strategy? 

As I discuss in my video Does Chewing Gum Help with Weight Loss?, chewing gum may only burn about three calories an hour, but the calorie expenditure isn’t only working your little jaw muscles. For some reason, chewing gum revs up your heart rate as much as 12 extra beats per minute after chewing two sticks of gum, even if you’re just sitting quietly, as you can see in the graph below and at 0:21 in my video. It also works while walking, increasing your heart rate by about three more beats per minute (and proving scientifically that people can indeed walk and chew gum at the same time). 

Does this translate into weight loss? Researchers at the University of Buffalo asked study participants to either chew gum before every single eating occasion or not chew any gum at all for a number of weeks. On the gum-chewing weeks, the subjects didn’t just have to chew gum before each meal, but also before each snack or drink that contained any calories. That may have been too much, so the participants actually ended up eating on fewer occasions, switching from four meals a day on average down closer to three. They ended up eating more calories at each of those fewer meals, though, and had no overall significant change in caloric intake and, no surprise, had no change in weight. See the charts below and at 1:08 in my video. 

University of Alabama researchers tried a different tack, randomizing people to chew gum after and between meals. After two months, compared to those randomized to avoid gum entirely, no improvements were noted in weight, body mass index (BMI), or waist circumference. However, some studies have suggested that chewing gum has an appetite-suppressing effect. For example, as you can see below and at 1:51 in my video, in one study, people ate 68 fewer calories of pasta at lunch after 20 minutes of chewing gum, but other studies have shown differently. 

Whenever there are conflicting findings, instead of just throwing up our hands, it can be useful to try to tease out any study differences that could potentially account for the disparate results. The obvious consideration is the funding source. That failed University of Alabama weight-loss study was funded by a gum company, so the outcomes are not necessarily predetermined. 

As well, different types of gum using different sweeteners may have contributed to the diversity of findings. As you can see in the graphs below and at 2:35 in my video, a study that found that chewing gum may actually increase appetite was done with aspartame-sweetened gum. People reported feeling hungrier after chewing the sweetened gum—and not only compared to no gum, but compared to chewing the same gum with no added aspartame. It’s true that not one randomized controlled trial has ever shown a benefit to “chewing gum as a strategy for weight loss,” but they all used gum containing artificial sweeteners.

There was a landmark study that showed that the size of a sip matters when it comes to reducing the intake of sweet beverages. When study participants took one sip every two seconds or a quadruple-sized gulp every eight seconds, but with the same ingestion rate of 150 grams per minute, the smaller sip group won out, satiating after about one-and-a-half cups compared to two cups when taking larger gulps, as you can see in the graph below and at 3:13 in my video. This is thought to be because of increased oro-sensory exposure, so our brain picks up the more frequent pulses of flavor and calories. But repeat the experiment with an artificially sweetened diet drink, and the effect appears to be blunted, as you can see in the graph below and at 3:38 in my video. So, might a different type of gum have a different effect? The positive pasta study I discussed earlier was performed using gum sweetened mainly with sorbitol, a sweet compound that’s found naturally in foods like prunes, and, like prunes, can have a laxative effect.

Case reports like “An Air Stewardess with Puzzling Diarrhea” unveil what can happen when you have 60 sticks of sorbitol-sweetened sugar-free gum a day. Another report was entitled “Severe Weight Loss Caused by Chewing Gum.” A 21-year-old woman ended up malnourished after suffering up to a dozen bouts of diarrhea a day for eight months due to the 30 grams of sorbitol she was getting chewing sugar-free gum and candies every day. Most people suffer gas and bloating at 10 daily grams of sorbitol, which is about eight sticks of sorbitol-sweetened gum, and, at 20 grams, most get cramps and diarrhea. So, you want to be careful how much you get. 

The bottom line is that we have no good science showing that chewing gum results in weight loss. Could that be because the studies used artificial sweeteners that “may have counteracted” any benefits? Maybe, but the most obvious explanation for the results to date “is that chewing gum simply is not an efficacious weight-loss strategy”—and that’s coming from researchers funded by the gum company itself. 

How Many Calories Do You Burn Chewing Gum? Watch the video to find out. For information on both artificial and natural low-calorie sweeteners, check out the related videos below.

Plant-based diets are the single most important—yet underutilized—opportunity to reverse the pending obesity and diabetes-induced epidemic of disease and death.

Dr. Kim Williams, immediate past president of the American College of Cardiology, started out an editorial on plant-based diets with the classic Schopenhauer quote: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” In 2013, plant-based diets for diabetes were in the “ridiculed” stage in the official endocrinology practice guidelines and placed in the “Fad Diets” section. The guidelines acknowledged that strictly plant-based diets “have been shown to reduce the risk for T2DM [type 2 diabetes] and improve management of T2DM” better than the American Diabetes Association recommendations, then inexplicably went on to say that it “does not support the use of one type of diet over another” with respect to diabetes or in general. “The best approach for a healthy lifestyle is simply the ‘amelioration of unhealthy choices’”—whatever that means. 

But, by 2015, the clinical practice guidelines from the same professional associations explicitly endorsed a plant-based diet as its general recommendation for diabetic patients. The times they are a-changin’! 

As I discuss in my video Plant-Based Diets Recognized by Diabetes Associations, the American Diabetes Association itself is also now on board, listing plant-based eating as one of the dietary patterns acceptable for the management of the condition. The Canadian Diabetes Association, however, has really taken the lead. “Type 2 diabetes mellitus is considered one of the fastest growing diseases in Canada, representing a serious public health concern,” so it isn’t messing around and recommends plant-based diets for disease management “because of their potential to improve body weight and A1C [blood sugar control], LDL-cholesterol, total cholesterol and non-HDL-cholesterol levels, in addition to reducing the need for diabetes medications.” The Canadian Diabetes Association uses the Kaiser Permanente definition for that eating pattern: “a regimen that encourages whole, plant-based foods and discourages meats, dairy products and eggs, as well as all refined and processed foods,” that is, junk. 

It recommends that diabetes education centers in Canada “improve patients’ perceptions of PBDs [plant-based diets] by developing PBD-focused educational and support as well as providing individualized counseling sessions addressing barriers to change.” The biggest obstacle identified to eating plant-based was ignorance. Nearly nine out of ten patients interviewed “had not heard of using a plant-based diet to treat or manage T2DM.” Why is that? “Patient awareness of (and interest in) the benefits of a plant-based diet for the management of diabetes…may be “influenced by the perception of diabetes educators and clinicians.” Indeed, most of the staff were aware of the benefits of plant-based eating for treating diabetes, yet only about one in three were recommending it to their patients.  

Why? One of the common reasons given was they didn’t think their patients would eat plant-based, so they didn’t even bring it up, but “[t]his notion is contrary to the patient survey results that almost two-thirds of patients were willing” to at least give it a try. The researchers cite the PCRM Geico studies I’ve covered in other videos, in which strictly plant-based diets were “well accepted with over 95% adherence rate,” presumably because the study participants just felt so much better, reporting “increased energy level, better digestion, better sleep, and increased satisfaction when compared with the control group.” 

A number of staff members also expressed they were unclear about the supportive scientific evidence as their second reason for not recommending this diet, but it’s been shown to be more effective than an American Diabetes Association–recommended diet at reducing the use of diabetes medications, long-term blood sugar control, and cholesterol. It’s therefore possible that the diabetes educators were simply behind the times, as there is “a lag-time” in the dissemination of new scientific findings from the literature to the clinician and finally to the patient. Speeding up this process is one of the reasons I started NutritionFacts.org. 

As Dr. Williams put it, “the ‘truth’ (i.e., evidence) for the benefits of plant-based nutrition continues to mount. This now includes lower rates of stroke, hypertension, diabetes mellitus, obesity, myocardial infarction, and mortality [heart attacks and cardiac death], as well as many non-cardiac issues that affect our patients in cardiology, ranging from cancer to a variety of inflammatory conditions.” We’ve got the science. The bigger challenge is overcoming the “inertia, culture, habit, and widespread marketing of unhealthy foods.” He concludes, “Reading the existing literature and evaluating the impact of plant-based nutrition, it clearly represents the single most important yet underutilized opportunity to reverse the pending obesity and diabetes-induced epidemic of morbidity and mortality,” disease and death. 

I highlighted the PCRM Geico studies in my videos Slimming the Gecko and Plant-Based Workplace Intervention. 

Aren’t plant-based diets high in carbs? Get the “skinny” by checking out my video Flashback Friday: Benefits of a Macrobiotic Diet for Diabetes. 

To learn more about diet’s effect on type 2 diabetes, see the related videos below. 

If sugar consumption is considered to be the one and only cause of cavities, can we have any sugar? How much is too much? 

Dental cavities may be humanity’s most prevalent disease, affecting 35 percent of the global population. The average number of decayed, missing, and filled teeth has been estimated at more than two by the age of 12. In the United States, the oral health of our elderly may also be in a state of decay, with one in four missing all of their teeth. “In terms of economic costs,” it is estimated that $100 billion is spent on dental diseases due to sugar consumption.  

As I discuss in my video How to Stop Tooth Decay, sugar consumption is considered to be the one and only cause of cavities. It is often referred to as a multifactorial condition, with other factors including bacteria, plaque, saliva, brushing, and flossing. However, those factors appear to have only mitigating influences. All of those other factors simply modify the speed by which sugar causes cavities. “Without sugars, the chain of causation is broken, so the disease does not occur.” 

“Numerous studies from decades ago showed that in countries where sugar consumption was very low, dental caries [cavities] was almost non-existent,” and “new analyses show that the life-long burden of caries increases as sugar intakes increase from 0%E [zero]…The most comprehensive national data are from…Japan…before, during and after World War II,” where the incidence of cavities tracked per capita sugar intake as it dropped from about 8 percent of calories down to just 0.1 percent, which is less than a teaspoon a week, before rebounding up to about 14 percent. Such studies show that cavities continued to occur even when sugar intake comprised only 2 to 3 percent of caloric intake. Given that more extensive disease in adults doesn’t appear to manifest if sugar intakes are limited to less than 3 percent of caloric intake, a public health goal to limit sugar intake to below 3 percent has been recommended. This led to the suggestion that traffic-light food labels be used to mark anything above 2.5 percent added sugars as “high.” That would make even comparatively low-sugar breakfast cereals such as Cheerios “red-light” foods. 

The recommended 3 percent cap on total daily intake of added sugars wouldn’t even allow for young children to have a single average serving of any of the top ten breakfast cereals most heavily advertised to them, which you can see below and at 2:21 in my video. Obviously, soda is off the table. One can of soda has nearly two days’ worth of added sugar. 

The American Academy of Pediatric Dentistry adopted the more pragmatic goal of recommending sugar intake stay below 5 percent for children and adolescents, matching the World Health Organization’s conditional recommendations for both children and adults. That’s about where added sugar consumption dropped in Iraq when they were under sanctions, and cavity rates were cut in half within just a few years. Of course, the sanctions may have cut other things, too, like the lifespan of children, though that was apparently fake news—a consequence of the “government of Iraq cleverly manipulating survey data to fool the international community.” 

If we were really interested in minimizing disease, the ideal goal would be to drop the intake of free sugars (meaning added sugars) to zero. These are not the sugars naturally found in breast milk or the intrinsic sugars in fruits. When it comes to the intake of added sugars, there does not seem to be a “threshold for sugars below which there are no adverse effects.” An exponential increase in cavity rates can begin for sugar intakes starting as low as 1 percent.  

A Kellogg’s-funded researcher agreed that we might be able to get rid of cavities if there was no sugar in the diet, but suggested that “this ideal is impractical.” The “dictatorial use of foods ‘friendly to the teeth’…might promote a philosophy of dietary celibacy…[that] would not be applicable or acceptable to all individuals.”  

“Instead of recommending draconian reductions in the amount of sugars intake,” the sugar industry responded that “attention would be better focused on…fluoride toothpaste.”  

That’s the perfect metaphor for medicine’s approach to lifestyle diseases in general. Why treat the cause when you can just treat the consequences? Why eat more healthfully to prevent and treat heart disease when we have all of these statins and stents? 

Not all sugars are created equal. To explore this topic, see my videos Flashback Friday: If Fructose Is Bad, What About Fruit? and Flashback Friday How Much Fruit Is Too Much?.

To gain a sense of how powerful the sugar industry is, check out my video Big Sugar Takes on the World Health Organization. 

For more on dental and oral health, see the related videos below. 

Strokes are one of the leading causes of death and disability in the world. They are the most common cause of seizures in the elderly, the second most common cause of dementia, and a frequent cause of major depression. In short, stroke is a burdensome—but preventable––brain disorder.

 

What Causes a Stroke?

Strokes can kill instantly and without warning. Most can be thought of as “brain attacks”—like heart attacks, but with the rupturing plaques in our arteries cutting off blood flow to parts of the brain rather than parts of the heart.

Nearly 90 percent of strokes are ischemic, from the Latin ischaemia, meaning “stopping blood.” Blood flow to part of the brain gets cut off, depriving it of oxygen and killing off the part fed by the clogged artery. A small minority of strokes are hemorrhagic, caused by bleeding into the brain when a blood vessel bursts. People who experience a brief stroke may only contend with arm or leg weakness, while those who suffer a major stroke may develop paralysis, lose the ability to speak, or die.

The blood clot may last only a moment—not long enough to notice but still long enough to kill off a tiny portion of our brain. These “silent strokes” can multiply and slowly reduce cognitive function until dementia fully develops.

 

How to Prevent a Stroke

According to the Global Burden of Disease Study, the largest study of risk factors for human disease in history, funded in part by the Bill and Melinda Gates Foundation, more than 90 percent of the stroke burden is attributable to modifiable risk factors. For example, about 10 percent of all healthy years of life lost due to stroke may be due to ambient air pollution. Moving away from a city to a more rural area with cleaner air is an option to modify that risk factor, but it may be easier to quit smoking, which accounts for 18 percent of the stroke death and disability. As I discuss in my video What to Eat for Stroke Prevention, diets high in salt are as bad as smoking when it comes to stroke burden, but not as harmful as inadequate fruit and vegetable consumption. Other factors, like sedentary lifestyles, are at play, but they aren’t as bad as not eating enough whole grains, for instance.

As with heart disease, a plant-based diet can reduce stroke risk by reducing cholesterol and blood pressure, while improving blood flow and antioxidant capacity. Most of the studies on plant-based dietary patterns have found a protective effect against stroke, whereas those looking at Westernized eating habits based more on animal foods, added sugars, and fats have found a detrimental effect.

Yes, wrote the director of the Stroke Prevention & Atherosclerosis Research Centre, “learning to make vegetarian meals every other day is a tall order for most North Americans, but is feasible given tasty recipes and a positive attitude.”

  What Foods Prevent a Stroke?

Fruit and vegetable consumption is associated with lower risk of about a dozen different diseases, including stroke. There appears to be a linear dose-response relationship, a straight-line association between eating more fruits and vegetables and lowering stroke risk. Researchers have suggested that the risk of stroke decreases by 32 percent for every 200-gram increase in fruit consumption, which is about one apple a day, and by 11 percent for each equivalent amount of vegetables eaten. Particularly potent are citrus fruits, apples, pears, and dark green leafy veggies, including one you can drink: the green leaves of green tea. Drinking three cups of green tea a day is associated with an 18 percent lower stroke risk.

Garlic was tested head-to-head against a sugar pill and beat out placebo for preventing CIMT progression, the thickening of the major artery walls in the neck going up to the brain, a key predictor of stroke risk. For those in the placebo group, it continued to worsen, but not so for study participants in the garlic group who had been taking just a quarter teaspoon of garlic powder a day, which costs about a penny.

What about nuts? The original PREDIMED study found that an ounce a day of nuts, which is what I recommend in my Daily Dozen, helped to cut stroke risk nearly in half. When it was republished (after correcting for some irregularities in their randomization procedures), the reanalysis found the same results—the same 46 percent fall in stroke risk in the added nuts group, dropping the ten-year risk of stroke from about 6 percent down to 3 percent.

High fiber intake may also help ward off stroke. Fiber is naturally concentrated in only one place: whole plant foods. Processed foods have less, and animal-derived foods have no fiber at all. Increasing fiber intake by just seven grams a day may be associated with a 7 percent reduction in stroke risk.

Though stroke is considered an older person’s disease, risk factors may begin accumulating in childhood. Hundreds of kids were followed for 24 years, from junior high school to adulthood, and low fiber intake early on was associated with stiffening of the arteries leading up to the brain—a key risk factor.

 

Foods to Avoid to Prevent a Stroke

As I discuss in my video What Not to Eat for Stroke Prevention, when it comes to stroke risk, the worst foods appear to be meat and soda. Eating two sausage links for breakfast, a burger for lunch, and a pork chop for dinner and drinking a 20-ounce bottle of soda may increase stroke risk by 60 percent. Reviewers suggest the meat effect may be its saturated fat, cholesterol, iron-mediated oxidized fat, salt, or the TMAO. The carnitine in meat and the choline in dairy, seafood, and especially eggs are converted by our gut bacteria into trimethylamine, which is oxidized by our liver into TMAO, which may then contribute to heart attacks, stroke, and death.

A 2019 study published in the Journal of the American Medical Association following tens of thousands of Americans for a median of about 17 years up to a maximum of 31 years found that “higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD [cardiovascular disease] and all-cause mortality, in a dose-response manner.” Those who ate more eggs or consumed more cholesterol in general appeared to live significantly shorter lives, on average, and the more eggs eaten, the worse it was, including for stroke risk.

And dairy? The bottom line is that dairy fat may be better than other animal fats, such as those found in meat, but something like whole grains would be better still. But you wouldn’t be doing yourself many favors if you simply swapped out dairy in favor of refined grains or added sugar. When it comes to stroke risk, vegetable fat is better than dairy fat, meat fat is the worst, whole grains are better, and fish fat, added sugars, or refined grains are statistically about the same.

 

Food for Thought

The good news is that stroke risk can be reduced substantially by an active lifestyle, cessation of smoking, and a healthy diet. All we have to do now is educate and convince people about the benefits that can be expected from healthy lifestyle and nutrition.

Meet Sylvia Klinger. We had the pleasure of interviewing her about food history and culture. Read on and enjoy her recipe for Jicama Mango Salad.  

 

As an expert in cross-cultural Hispanic nutrition and health issues, how have you found food to tell a story and shape culture?
In our Hispanic culture, food is the essence of our life. It is what keeps us together. We are obsessed with the flavors, colors, and textures of our cuisine. Although our typical Hispanic cuisine includes different preparation and cooking methods, and ingredients and flavors vary from county to country, we quickly adapt and love all of the variations.

How do you inform people about the intersection of food, history, health, and culture?
I love teaching families and health professionals in the community how to cook our favorite dishes. It helps me to share the history of our cuisine and demonstrate the nutritional value of the foods we love. I teach them how to incorporate our favorite foods in a way that combines flavors and nutrition in quantities (portion sizes) for our age, gender, and activity level. 

What are some plant-based foods that are the foundations of Hispanic food traditions?
Plant-based foods are the foundation to our Latin foods, including all types of beans (for example, black, pinto, garbanzo, red, pigeon pea), vegetables (yuca, calabaza or pumpkin, zucchini, plantains, corn, tomatoes), fruits (tropical fruits, citrus fruits, passion fruit, coconut), grains (corn, amaranth, rice, tortillas), and nuts. It is my job as a dietitian-nutritionist to teach our communities about the amazing health benefits of our foods and the roles they play in the prevention of chronic disease. It’s easy, healthful, and delicious to season savory Latin foods with more onions, garlic, chiles, and fresh herbs instead of too much salt, and to flavor Latin desserts with more “canela” (cinnamon), vanilla, ginger, and citrus juices instead of adding too much sugar.

Do these foods or dishes have any significant meaning or history?
Absolutely! Many of our staple ingredients originated in Latin countries. Corn was first domesticated in Mexico by their native indigenous people hundreds of years ago, and chocolate’s history also began in Mexico, where the first cacao plants were found. No wonder many of the famous dishes in Mexico and neighboring countries have corn and chocolate! 

What do you envision as the way forward to encourage people to eat more fruits and vegetables and, in the West especially, return to traditional Hispanic eating patterns?
My mission is to encourage my Hispanic communities to continue eating the foods they love since a lot of them are highly nutritious and to add the foods and nutrients they are lacking. For example, Mexicans love fruits and vegetables, and even their snacks consist of fresh fruits and veggies. 

Please tell us a little bit about your work and career.
I am a dynamic global nutrition expert and a sought-after bilingual consultant, international speaker, communications professional, business owner, award-winning author, mentor, and board advisor for several associations and Fortune 500 companies. I am driven to empower communities toward better health outcomes through professional relationship building, health/nutrition program development, and strategic planning.

I have a relentless passion for understanding dietary behaviors, diet quality, and dietary patterns, as well as generating science-based evidence to develop timely strategies that promote a healthy lifestyle through dissemination of culturally relevant nutrition and health education programs for disease prevention and management. I draw my energy from my compassionate, family focus to help low-income communities establish healthy eating habits within their budget. 

Please tell us a little bit about your books.
I’ve published two books on providing a tasty, healthy, culturally-appropriate lifestyle for Hispanic populations, who face mounting health problems today. The award-winning Hispanic Family Nutrition: Complete Counseling Tool Kit for the Academy of Nutrition and Dietetics provides optimal wellness and nutrition counseling tools, and The Little Book of Simple Eating is filled with practical tips in both English and Spanish for achieving everyday optimal health.  

Jicama Mango Salad

1 garlic clove, minced
¼ cup fresh lemon juice
½ cup cilantro, chopped
2 cups jicama, peeled and julienned
3 cups mangos, peeled and sliced
1 jalapeno, seeded and diced
1 cup red onion, peeled and minced
Zest of 1 orange
Orange pieces to taste
Lemon zest to taste
Lemon pepper to taste
Black pepper to taste
Sliced radishes (optional garnish)

Preparation

1. Mix the garlic, lemon juice, and cilantro. Season with lemon pepper and black pepper to taste.
2. Add the remaining ingredients, toss lightly, and serve. Garnish with sliced radishes, if desired.

Servings: 4 – 8 people

 

You can find Sylvia on her website here and Instagram here.

What would happen within just two weeks after swapping the diets of Americans with those of healthier eaters? 

Colon cancer is our second leading cancer killer, but some places, like rural Africa, have more than ten times lower rates than we do in the United States. How do we know it isn’t genetic? “Migrant studies, such as those in Japanese Hawaiians, have demonstrated that it only takes one generation for the immigrant population to assume the colon cancer incidence of the host western population.” The change in diet is considered “most probably responsible for this,” but all sorts of changes occur when you move from one culture to another. “For example, cigarettes, chemicals, infections, and antibiotics might be equally responsible for the change in colon cancer risk.” You don’t know if it’s the diet until you put it to the test.

It’s rare that I do a whole video on a single study, but I think you’ll agree the one that I cover in The Best Diet for Colon Cancer Prevention is worth it. An international group of researchers was trying to figure out why colon cancer rates were an order of magnitude higher in African Americans and Caucasians in the United States than in rural South Africans. As you can see below and at 1:09 in my video, if you look at American colons, they’re a mess with polyps and diverticulosis, not to mention hemorrhoids, whereas the African colons were “remarkably pristine.” And more importantly, the Africans had sevenfold lower colonic epithelial proliferation rates, a characteristic of precancerous conditions. The researchers measured everything the study participants were eating and concluded that the higher colorectal cancer risk and proliferation rates in African Americans were most closely “associated with higher dietary intakes of animal products and higher colonic populations of potentially toxic hydrogen [acid] and secondary bile-salt-producing bacteria.”  

When put to the test, higher rates of colon cancer were indeed found to be associated with higher intake of animal protein and animal fat, lower fiber consumption, more of those bad bile acids, less of those good short-chain fatty acids like butyrate, and higher mucosal proliferation. But how do we know the diet is what’s mucking things up? We don’t—until an interventional study is performed.  

How about we just swap their diets? Feed the Americans a high-fiber African-style diet, and give the rural Africans the standard American diet. On day one of the experiment, the rural Africans were given sausage and white flour pancakes for breakfast, a burger and fries for lunch, and some meatloaf and white rice for supper, whereas the African Americans ate fruits, vegetables, corn, and beans. To help with compliance, the researchers included some more familiar foods like veggie dogs. Note, though, that it was not a vegan diet, just generally plant-based. You can see the day one menu below and at 2:31 in my video. 

Also, note that the food exchanges weren’t for years. They only swapped for two weeks. Could changes be seen that fast? Indeed, the dietary changes “resulted in remarkable reciprocal changes” in the lining of the participants’ colons in terms of cancer risk and their microbiome. Switching to a more plant-based diet boosted their fiber fermentation and suppressed their carcinogenic bile acid synthesis. The researchers took biopsies and looked under a microscope at the colon lining of African Americans. Before the diet swap, their colon lining was in overdrive with rapidly dividing cells, a sign of premalignancy that is a risk factor for cancer. But, after just two weeks of eating a healthier diet, their colons calmed right down. You can see some before and after pictures below and at 3:07 in my video. The brown dots in the before photo for the African Americans represent dividing cells. In the after photo, they’re nearly gone. In contrast, the rural Africans started out with some proliferation, but it got worse on the American diet. 

Below and at 3:44 in my video, you can also see a different marker measuring inflammation. Each of the brown dots represents an inflammatory cell. In the African Americans, there was rife inflammation on their typical diet that calmed way down after just two weeks on a healthier one, and the opposite happened for the rural Africans who switched to the standard American diet.  

We know that when our friendly flora ferment fiber, they produce beneficial compounds like butyrate, which is anti-inflammatory and anti-cancer. “Impressively, ‘Africanization’ of the diet” more than doubled butyrate production, increasing total quantities, “whereas ‘westernization’ reduced quantities by half.” And in terms of toxic metabolites, there was a significant drop in the healthier diet, whereas the “meatloafy” standard American diet increased the levels of these carcinogens by 400 percent within just two weeks. So, the bottom line is that just by changing the food you eat, you can remarkably change your risk. In fact, that’s how the lead investigator put it. “O’Keefe’s advice is simple, ‘change your diet, change your cancer risk!’” It may never be too late to start eating healthier. 

Based on these kinds of data, “adopting a whole-food vegan or near-vegan diet rich in fruits and vegetables, exercising regularly, and avoiding tobacco, could have a stunningly positive impact on the cancer risks not only of black Americans but of all peoples.” The researchers concluded: “While it would be unrealistic to expect rapid and profound lifestyle changes in the general population, it is gratifying to have sound, effective advice to offer to those who are willing to take the steps needed to optimize their healthful longevity.” 

This is the follow-up to Best Foods for Colon Cancer Prevention. As I mentioned, it’s rare I do a whole video on a single study, but I hope you’ll agree this one is worth it. For more on keeping our colonic colleagues thriving, check out the related videos below.   

A low-fiber diet is a key driver of microbiome depletion, the disappearance of diversity in our good gut flora. 

We have a hundred trillion microorganisms residing in our gut, give or take a few trillion, but the “spread of the Western lifestyle has been accompanied by microbial changes,” which may be contributing to our epidemics of chronic disease. The problem is that we’re eating meat-sweet diets, “characterized by a high intake of animal products and sugars, the use of preservatives, and a low intake of plant-based foods, such as fruits, vegetables, and whole grain cereals.” 

Contrary to the fermentation of the carbohydrates that make it down to our colon, where the fiber and resistant starch benefit us through the generation of magical short-chain fatty acids like butyrate, when excess protein is consumed, “microbial protein fermentation generates potentially toxic and pro-carcinogenic metabolites involved in CRC,” colorectal cancer. So, what we eat can cause an imbalance in our gut microbiome and potentially create “a ‘recipe’ for colorectal cancer,” where a high-fat, high-meat, high-processed food diet tips the scale towards dysbiosis and colorectal cancer, as you can see below and at 1:04 in my video Best Foods for Colon Cancer Prevention. On the other hand, a high-fiber and starch, lower-meat diet can pull you back into symbiosis with your friendly flora and away from cancer. 

“Evidence from recent dietary intervention studies suggest adopting a plant-based, minimally processed high-fiber diet may rapidly reverse the effects of meat-based diets on the gut microbiome.” So, what may be “a new form of personalized (gut microbiome) medicine for chronic diseases”? It’s called food, which can “rapidly and reproducibly” alter the human gut microbiome. As shown in the graph below and at 1:52 in my video, if you switch people between a whole food, plant-based diet to more of an animal-based diet, you can see dramatic shifts within two days, resulting in toxic metabolites. 

And, after switching to an animal-based diet, levels go up of deoxycholic acid, a secondary bile acid known to promote DNA damage and liver cancers. Why do levels go up? Because the bad bacteria that produce it triple in just two days, as you can see in the graph below and at 2:10 in my video. 

Over time, the richness of the microbial diversity in our gut has been disappearing. Below and at 2:22 in my video, you can see a graphic of our bacterial tree of life and how it’s being depleted. Why is this happening? It is because of “The Fiber Gap.” “A low-fiber diet is a key driver of microbiome depletion.” Sure, there are factors like antibiotics, cesarean sections, and indoor plumbing that have contributed to the gut microbiome diversity decline, but “the only factor that has been empirically shown to be important is a diet low in microbiota-accessible carbohydrates (MACs),” not Big Macs. That’s just a fancy name for fiber found in whole plant foods and resistant starch found mostly in beans, peas, lentils, and whole grains. 

Our intake of dietary fiber and whole plant foods “is negligibly low in the Western world” when compared to what we evolved to eat over millions of years. “Such a low-fiber diet provides insufficient nutrients for the gut microbes,” which leads not only to the loss of bacterial diversity and richness but also to a reduction in the production of those beneficial fermentation end products that they make with the fiber. We are, in effect, “starving our microbial self.”  

What are we going to do about the “deleterious consequences” of a diet deficient in whole plant foods? Create new-fangled “functional foods,” of course, and supplements and drugs—prebiotics, probiotics, synbiotics. Think how much money there is to be made! Or, we can just eat the way our bodies were meant to eat, but what kind of value is that going to earn your stockholders? Don’t you know probiotic pills may be “the next big source of income” for Big Pharma?  

Why eat healthfully when you can just have someone else eat healthfully for you, then get a fecal transplant from a vegan? Researchers compared the microbiomes of vegans versus omnivores and found the vegans’ friendly flora were churning out more of the good stuff, showing that a plant-based diet may result in more beneficial metabolites in the bloodstream and less of the bad stuff like TMAO. But while the impact of a vegan diet on what the bacteria were making was large, “its effect on the composition of the gut microbiome [was] surprisingly modest.” The researchers only found “slight differences between the gut microbiota of omnivores and vegans.” Really? “The very modest difference between the gut microbiota of omnivores relative to vegans juxtaposed to the significantly enhanced dietary consumption of fermentable plant-based foods” was a shocker to the researchers. The vegans were eating nearly twice the fiber. Can anyone guess the problem here? The vegans just barely made the minimum daily intake of fiber. Why? Because Oreos are vegan. Cocoa Pebbles are vegan. French fries, Coke, potato chips. There are vegan Doritos and Pop-Tarts. You can eat a terrible vegan diet.  

Burkitt showed that we need to get at least 50 grams of fiber a day to prevent colon cancer, and that’s only half of what our bodies were designed to get. We evolved getting about 100 grams a day, which is the amount you see in modern populations immune to epidemic colorectal cancer. So, instead of feeding people a vegan diet, what if you just fed people that kind of diet, one centered around whole plant foods? For an answer to that, check out my video The Best Diet for Colon Cancer Prevention. 

What can millions of dollars in the hands of the lobbying industry do to shut down efforts to protect children?  

For nearly half a century, there have been calls to ban the advertising of sugary cereals to children, a product that Harvard nutrition professor Jean Mayer referred to as “sugar-coated nothings.” In a Senate hearing on nutrition education, he said, “Properly speaking, they ought to be called cereal-flavored candy, rather than sugar-covered cereals.” 

As I discuss in my video A Political Lesson on the Power of the Food Industry, the Senate committee invited the major manufacturers of children’s cereals to testify, and they initially said yes—until they heard what kinds of questions were going to be asked. One cereal industry representative candidly admitted why the decision was made to boycott the hearing: They simply didn’t have “persuasive answers” to why they were trying to sell kids breakfast candy. 

In the Mad Men age before the consumer movement was in bloom, ad “company executives were more willing to talk frankly about the purpose of their ads and how they felt about aiming the ads at the ‘child market.’” Said an executive of the Kellogg’s ad firm: “Our primary goal is to sell products to children, not educate them. When you sell a woman on a product and she goes into the store and finds your brand isn’t in stock, she’ll probably forget about it. But when you sell a kid on your product, if he can’t get it, he will throw himself on the floor, stamp his feet and cry. You can’t get a reaction like that out of an adult.”  

Sugary cereals are the number one food advertised to kids, but don’t worry—the industry will just self-regulate. “In response to public health concerns about the amount of marketing for nutritionally poor food directed to children, the Council of Better Business Bureaus launched the Children’s Food and Beverage Advertising Initiative” in which all the big cereal companies “pledged to market only healthier dietary choices in child-directed advertising.” The candy industry signed on, too. Despite pledging not to advertise to kids, after the initiative went into effect, kids actually saw more candy ads. Take Hershey, for example. It doubled its advertising to children “at the same time it pledged to not advertise to children.”  

The cereal companies got to decide for themselves their own definitions of “healthier dietary choices.” That should give us a sense of how serious they are at protecting children. For example, they classified “Froot Loops and Reese’s Peanut Butter Puffs consisting of up to 44% sugar by weight…as ‘healthier dietary choices.’” In that case, what are their unhealthy choices? It seems that the Children’s Food and Beverage Advertising Initiative basically just “based its maximal nutrient levels more on the current products marketed by its members than on a judgment about what was best for children.”  

Now, they’ve since revised that to allow only cereals that are 38 percent sugar by weight. But even if they are only one-third sugar, that means kids are effectively eating “one spoonful of sugar in every three spoons of cereal”—not exactly a healthier dietary choice. 

The Federal Trade Commission tried stepping in back in 1978, but the industry poured in so many millions of dollars in lobbying might that Congress basically threatened to yank the entire agency’s funding should the FTC mess with Big Cereal, demonstrating just “how powerful market forces are compared to those that can be mobilized on behalf of children.” The political “post-traumatic stress induced by the aggressive attacks on the FTC led to a twenty-five-year hiatus in federal efforts to rein in food marketing aimed at children.”  

Finally, enter the Interagency Working Group with members from four federal agencies—the FTC, CDC, FDA, and USDA. The group developed a set of “voluntary principles [that] are designed to encourage stronger and more meaningful self-regulation by the food industry and to support parents’ efforts to get their kids to eat healthier foods.” It proposed the radical suggestion of not marketing to children cereals that are more than 26 percent pure sugar.  

As you can see below and at 4:02 in my video, the top ten breakfast cereals marketed to children are Cinnamon Toast Crunch, Lucky Charms, Honey Nut Cheerios, Froot Loops, Reese’s Puffs, Trix, Frosted Flakes, Fruity Pebbles, Cocoa Puffs, and Cookie Crisp—and not a single one would meet that standard. General Mills shot back: “The Proposal’s nutrition standards are arbitrary, capricious, and fundamentally flawed.” No surprise since “literally all cereals marketed by General Mills would be barred from advertising”—not a single one would make the cut. To suggest voluntary standards “unconstitutionally restrains commercial speech in violation of the First Amendment,” to which the FTC basically replied: Let me get you a dictionary. How could suggesting voluntary guidelines violate the Constitution? But that’s how freaked out the industry is at even the notion of meaningful guidelines. One grocer’s association actually called the proposed nutrition principles the “most bizarre and unconscionable” it had ever seen. 

So, what happened? Again, agency funding was jeopardized, so the FTC called off the interagency proposal.  

“At every level of government, the food and beverage industries won fight after fight….They have never lost a significant political battle in the United States…” Said a director of one of the child advocacy organizations: “We just got beat. Money wins.” And it took a lot of money—$175 million of Big Food lobbying funds. It was apparently enough to buy the White House’s silence as the interagency proposal got killed off. As one Obama advisor put it, “You can tell someone to eat less fat, consume more fiber, more fruits and vegetables, and less sugar. But if you start naming foods, you cross the line.”  

“‘I’m upset with the White House,’ said Senator Tom Harkin (D-Iowa), chairman of the Senate Health Committee. ‘They went wobbly in the knees, and when it comes to kids’ health, they shouldn’t go wobbly in the knees.’”  

For more on breakfast cereals, click here. And click here for more on sugar.  

I am all in favor of Taking Personal Responsibility for Your Health, but the strong-arm tobacco-style tactics of the multitrillion-dollar food industry are contributing to the deaths of an estimated 14 million people every year. 

On a brighter note, check out How We Won the Fight to Ban Trans Fat. 

For more on sugar specifically, see Flashback Friday: Sugar Industry Attempts to Manipulate the Science. 

Check out my other videos on breakfast cereals: Flashback Friday: The Worst Food for Tooth Decay and How to Stop Tooth Decay. Are there any healthy cereals? A few make the cut. See Flashback Friday: The Five-to-One Fiber Rule.