In my experience, most medical students either vastly underestimate the health-promoting potential of plant-based nutrition or believe nutrition misinformation and misleading claims. Although the following studies don’t entirely fill the nutrition void in most medical education programs, they demonstrate the value of whole-food, plant-based (WFPB) nutrition in clinical practice.

1. A Way to Reverse Coronary Artery Disease
In this 2014 prospective cohort study, Caldwell Esselstyn, MD, and his team put 198 patients with cardiovascular disease on a WFPB diet. The researchers were interested in cardiac events and the degree of adherence to the nutritional intervention. Of the 198 participants, 177 were adherent (89 percent) and 21 were non-adherent (11 percent).

Over a mean duration of 3.7 years, 13 of the 21 non-adherent patients experienced cardiac events, while only one of the 177 diet-adherent patients experienced a cardiac event (stroke). The results “confirm[ed] the capacity of WFPB nutrition to restore health in ‘there is nothing further we can do’ situations,” the study authors wrote. Researchers included a before-and-after arteriogram (right) of one participant’s coronary artery showing clear stenotic reversal.

2. The Lifestyle Heart Trial
In this trial, lifestyle medicine pioneer Dean Ornish, MD, and his team randomized 48 participants with coronary heart disease to either an intensive lifestyle change group (including a WFPB diet) or a usual-care control group. After five years, the lifestyle change group saw a significant reversal of coronary atherosclerosis, while the usual-care group saw a progression of their disease. Eighty-two percent of patients who followed the lifestyle change program had some level of regression of atherosclerosis, and there was a 90 percent reduction in reported angina during the first month of the program. Compared to the usual-care group, the lifestyle change group saw significantly fewer cardiac events and a 400 percent improvement in myocardial perfusion over the five-year follow-up period. Because the program helped patients safely avoid revascularization and other cardiac procedures, the calculated net savings of the program was nearly $30,000 per patient after just one year.

3. Treating Type 2 Diabetes
In this 74-week trial, Neal Barnard, MD, and his research team randomized 99 participants with type 2 diabetes to a low-fat, vegan diet or a diet following American Diabetes Association (ADA) guidelines. They found the low-fat, vegan diet to be significantly more effective than the ADA dietary guidelines at achieving glycemic control. After controlling for changes in medication, compared to the conventional group, the vegan group saw significantly greater reductions in glycated hemoglobin (HbA1c) values and LDL-cholesterol. The same group of researchers also found that patient adherence and acceptability of the low-fat, vegan diet protocol were comparable to conventional nutrition protocols, indicating no barrier to its use in medical nutrition therapy.

4. Lifestyle Versus Genetics
With genomics research and the age of personalized medicine on the horizon, the medical profession is looking for more answers and more advanced treatments for our ailments. However, to most effectively prevent and reverse disease, current research suggests we ground our hope in lifestyle medicine. In this special viewpoint in Science, Walter Willett, MD, DrPH, discusses what we know about the relative importance of genetic and lifestyle factors for disease prevention. Of note, large cohorts have shown that while our genes play only a tiny role in predicting disease, modest changes in lifestyle—including diet—may prevent more than 90 percent of type 2 diabetes, 80 percent of coronary heart disease, and 70 percent of colon cancer.

5. Sick Individuals and Sick Populations
In a landmark 2001 paper published in the International Journal of Epidemiology, Geoffrey Rose, MD, helps explain why nutrition studies often underestimate the role of diet in disease: because they can’t detect homogenous exposures. As an example, Dr. Rose uses serum cholesterol and development of heart disease. If we conduct an observational study in a population where almost everyone has high serum cholesterol, we will fail to detect serum cholesterol as an important risk factor for heart disease. Instead, we will pick up what makes individuals more susceptible to heart disease given high serum cholesterol status, such as genetic or other lifestyle factors. The same is true in nutrition studies. Most of them fail to detect nutritional risk factors in health outcomes because the Standard American Diet is nearly ubiquitous. Only in sufficiently large studies or studies that include relatively strict interventions (e.g., a WFPB diet) do we begin to see the profound effect nutrition has on health.

6. Water Fasting and Plant-Based Eating for Hypertension
In this single-arm, interventional study, 174 patients with hypertension did an average 10- or 11-day, water-only fast followed by a six- or seven-day WFPB refeeding period with no added sugar, oil, or salt. Almost 90 percent of patients achieved blood pressure less than 140/90 mmHG, and those with the most severe hypertension had an average reduction in blood pressure of 60/17 mmHg. All patients on blood pressure medications were off those medications by the end of the protocol. This treatment protocol shows water-only fasting and subsequent WFPB diet is a safe and highly effective treatment for hypertension. Notably, blood pressure continued to decrease during the refeeding period, suggesting the sustainability of this intervention in normalizing blood pressure.

7. Lifestyle Changes and Progression of Prostate Cancer
In this trial, 97 men with prostate cancer were randomized to an intensive lifestyle change group (including a WFPB diet) or a usual care control group. After a year, the lifestyle group serum prostate specific antigen (PSA) concentration, one of the most useful indicators of prostate cancer, had decreased an average of 4 percent, while average PSA levels in the usual care group increased 6 percent. Furthermore, serum taken from participants in the lifestyle group was almost eight times as powerful at inhibiting the growth of prostatic cancer cells in vitro compared to the usual care group. The researchers found a dose-response relationship: the degree of adherence to the recommended lifestyle changes was correlated with the changes in serum PSA and cancer cell growth inhibition.

8. The Adventist Health Studies
These studies include large prospective cohort studies on Seventh-Day Adventists, a population with an unusually high proportion of strict vegetarians in an otherwise homogenous group. These studies have produced some remarkable findings: Compared to nonvegetarian diets, vegan diets were associated with half the risk of type 2 diabetes and about 7-point lower systolic and diastolic blood pressure, after controlling for relevant variables including BMI. This suggests that veganism was protective for these conditions beyond its association with lower body mass. Furthermore, compared to nonvegetarians, vegans had significantly fewer chronic diseases, were on fewer medications, had fewer allergies, and reported less health service use (hospitalizations, surgeries, etc.).

Evidence is Mounting
Although these studies are compelling, medical students know to look for consistency in the literature. Rest assured, hundreds of systematic reviews and meta-analyses provide evidence for even the most skeptical medical students and physicians. From lowering blood cholesterol, body weight, and inflammation to protecting against heart disease, cancer, and diabetes, systematic reviews and meta-analyses have consistently shown the benefits of plant-based nutrition.

Plant-Based Resources for Medical Students and Physicians
There are many resources available online to learn more. The American College of Lifestyle Medicine is the professional medical association devoted to the cause of lifestyle medicine and helps address the need for education and certification in the field. The Physicians Committee for Responsible Medicine provides great resources for physicians interested in making nutrition central to their practice. The T. Colin Campbell Center for Nutrition Studies partnered with eCornell to offer a Plant-Based Nutrition Certificate that will help you gain a deeper understanding of optimal health, and even counts for continuing education credits. Lastly, PlantBasedResearch.org is an online narrative review of over 700 peer-reviewed research articles related to plant-based nutrition. The site allows users to search and sort by research topic, study design, keywords, or other variables.

The post 8 Striking Nutrition Studies That Make the Case for Avoiding Meat appeared first on Forks Over Knives.

Humans evolved in a calorie-poor environment, meaning that finding dinner wasn’t as easy as ordering delivery. In fact, for more than 99.9 percent of human evolutionary history, our ancestors were dependent upon what they could find in nature for food. Without reliable agriculture, humans were at the mercy of mother nature and luck, experiencing periods of starvation and excess. It was during these periods that humans evolved adaptations to endure extreme starvation. Those who survived—that’s us—are remarkably resilient at enduring life-limiting hunger.

So when you attempt to lose a few pounds by reducing your caloric intake, the body responds the way it has done for millennia—by slowing the metabolism, increasing hunger, and doing everything possible to acquire more calories. One study found that dieters experienced a 15 percent reduction in resting metabolic rate after a few weeks of conventional dieting—even after adjusting for the weight they lost. For the average person, this could mean the body is now burning 250 to 400 calories less just to stay alive. This is like your laptop reducing the screen brightness to save energy when the battery runs low. To make matters worse, those who are obese have greater reductions in their resting metabolism compared to those who are not obese, which makes things harder for those with the most to lose.

But there’s more: The body responds to dieting by increasing levels of ghrelin, the hunger hormone, to drive you to eat more. Ghrelin levels rise with additional weight loss, which is why dieters experience such intense cravings for food. Hunger is a stimulus so strong that psychologists have observed it impairing performance on basic memory tests.

Even still, dieting affects the brain in other ways to thwart meaningful weight loss. Eerily reminiscent of the waning judgement of an alcoholic, dieting can cause you to pick out foods that are calorie-dense, underestimate how many calories are in a meal before eating it, and think you’ve eaten less than you actually have. With so much compensatory chicanery, it’s no surprise that more than 82 percent of dieters are unsuccessful.

So how are some people—despite all the odds—keeping the weight off? Research shows that one of the best strategies hinges on the concept of calorie density. Calorie density is the amount of calories in a gram of food, which is important because humans eat a consistent weight of food from day to day. Knowing this, one could surmise that by eating lots of foods that are low in calories, one could lose weight. And you can, which makes sense from an evolutionary perspective; humans have been eating mostly low-calorie fruits, leaves, tubers, and vegetables for the better part of our ancestral history.

Paradoxically, by eating more food with
fewer calories, dieters were able
to lose weight and feel full at the same time.

Studies of low-calorie-density diets have found that people can reduce the amount of calories they need to eat to achieve satiety. In the first study to test this hypothesis, in 1983, participants eating a low-calorie-density, plant-based diet took in a mean 1,570 calories a day while those on a high-calorie-density diet took in 3,000 calories per day before feeling full. A later study showed that those committed to low-calorie-density, plant-based diets (which, in this study, happened to be a Hawaiian fare) could lose weight at a remarkable clip: an average of 17 pounds over 21 days. Long-term studies have shown that these results are maintainable.

By eating so few calories per day, dieters should have gone hungry, but they circumvented this problem by eating a larger volume of low-calorie foods. Paradoxically, by eating more food with fewer calories, dieters were able to lose weight and feel full at the same time. Low-calorie-density foods like legumes, fruits, and vegetables can help dieters avoid the siren call of hunger that can doom the best of intentions.

The proportion of plant foods eaten is an important facet of success. Eating more plants further lowers the calorie density of a diet and results in additional weight lost. Studies have shown that vegetarians, for example, eat 363 fewer calories per day than omnivores and have higher resting metabolic rates—up to 11 percent higher in some cases, which may be why vegetarians weigh less too.

For those not ready to become vegetarian, you don’t have to overhaul your entire diet. By feeding as few as three apples a day to human volunteers, researchers have still been able to show weight reductions. With results like that, eating an apple a day might keep the doctor away, but it might also help you lose weight.

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I confess I don’t understand why hypothesizing by several cardiologists who have expressed this opinion before, involving no new research, citing review articles from two and three years ago on the causes of coronary artery disease should be worthy of publication in the peer-reviewed literature. Generally, it requires more than mere speculation, let alone repeating prior speculation, to clear that bar. I further don’t understand why, in light of all the new research coming out weekly, a commentary lacking both novel comments and new research should be newsworthy. But the media picked this one up just the same.

But perhaps we can account for it after all. The authors make a theoretical argument to contend that saturated fat is not a cause of heart disease. There is nothing we seem to like better in the nutrition space than hearing that everything we thought we knew was wrong, and renewing our license to procrastinate and eat whatever we want. This particular scientific journal’s parent has earned a dubious reputation for favoring dietary dissent over consensus, for whatever reasons. As for the media, there is nothing they tend to like better than an endless sequence of comforting the afflicted and afflicting the comfortable, because perpetual confusion means you will need to tune in tomorrow for the newest “truth” populating the most recent 20-minute news cycle.

There’s just one problem with all of this theorizing: there is nothing theoretical about coronary disease. Heart disease remains the leading cause of premature death among men and women alike in the U.S., and increasing portions of the world. Heart disease is not hypothetical—it is an almost entirely unnecessary epidemiological scourge siphoning years from lives and life from years.

The new commentary is, in a word, wrong. It is not necessarily wrong in every particular about saturated fat—there are some legitimate uncertainties there. It is wrong in the whole, because it commits the willful deception, or classic blunder, of conflating the part for the whole.

Saturated Fat and Heart Disease

Whatever the specific, mechanistic involvement of any given saturated fatty acid with atherogenesis and coronary disease, the reliably established fact is that diets high in the foods that are high in saturated fat lead to high rates of heart disease—while many variations on the theme of diets low in saturated fats, whether low high or middling in total fat, are associated with lower rates of heart disease, lower rates of all chronic disease, and lower rates of premature death.

The choice of citations in this commentary is highly selective, very limited, and the interpretation of the studies is flagrantly biased. These authors didn’t ‘happen upon’ this opinion because they just reviewed the literature and found a surprise. They are well established, even famous, for espousing exactly this opinion—so they knew the answer before ever they posed a question. Science tends to be better when the question precedes the answer.

Their conclusion that saturated fat is exonerated is based on straw-man arguments. For one thing, it is very hard to isolate the effects of saturated fat. This is because saturated fat is a diverse class of nutrients with differing effects; because saturated fat is consumed in foods, not by itself; and because more of THESE foods in one’s diet ineluctably means less of THOSE foods. Consequently, the attribution of health effects to just one dietary factor is very difficult. The more enlightened researchers in this space have long shifted their focus to overall dietary patterns, and there—the evidence is nothing short of overwhelming: dietary patterns that produce the best health outcomes overall, including less cardiovascular disease, may be high or low in total fat, but are invariably plant-predominant and low in saturated fat.

Best Diet For Preventing Heart Disease

The best evidence regarding the best diets all points to wholesome foods, predominantly plants, in sensible combinations—but provides no decisive evidence that any one level of total fat is best. What matters are the sources of that fat, with nuts, seeds, olives, extra virgin olive oil, avocado, fish, and seafood favored.

High-fat Mediterranean diets have shown great results, but so have vegan and vegetarian diets, and very low-fat omnivorous diets like that of the Tsimane, so recently in the news. The Tsimane reportedly derive up to 72 percent of their calories from carbohydrate; have very low dietary fat intake; experience inflammation on which the current authors blame coronary disease, but due to infections not eating sugar; and yet have the cleanest coronaries ever studied. Fat level, per se, simply does not appear to be a relevant consideration. But the kind of fat, and the sources of that fat, clearly are. Why would these authors conflate the two?

Why, in particular, would they fail even to mention the Tsimane if their commentary were aiming at illumination on this topic? The answer is—they would not. They failed to mention them, or any studies at odds with their predetermined conclusion, because their goal appears to be self-promotion born of controversy. Controversy sells.

To be fair, there are some valid points in the commentary, but they are so lost in a haze of obfuscation that they are devoid of all value.

Imagine a commentary arguing that, in theory, one particular compound or group of compounds in cigarettes is not responsible for emphysema, or lung cancer. We might already be convinced that these compounds are involved, based on the weight of evidence. We might have meaningful, residual doubts about the specific role of these compounds relative to other constituents of tobacco. But we know for sure that cigarettes, per se, are overwhelmingly linked to both emphysema and lung cancer.

But—not so fast!—our commenting theorists tell us. They remind us of the want of randomized controlled trials. They focus their discussion on this one compound, and point out the uncertainties and methodologic challenges in linking this particular moiety to lung cancer. They espouse theories about general mechanisms—random mutations and the inflammatory effects of psychological stress. They cite very impressive sounding work, such as papers in Science telling us that random mutations occur routinely. They systematically avoid citing any impressive research addressing less comfortable areas, such as the paper in Nature indicating that the majority of all cancer is preventable by modifying lifestyle, with avoidance of tobacco at the top of the list. And, they avoid any mention of staggering volumes of evidence establishing the association not between one chemical, but tobacco itself—with emphysema, lung cancer, and other highly undesirable fates.

Such an argument would be almost exactly analogous to the one now making news. The commentary is mostly wrong, but even when it isn’t wrong, it is profoundly misleading—unless you think uncertainties about which chemical in cigarettes is guilty of tobacco’s crimes against humanity, as a license to go back to smoking until the experts sort it all out.

In a paragraph in the middle of the new commentary, the authors all but declare their profound bias, and commitment to finding and citing only evidence in line with the opinion they owned at the start. They contrast a “low fat” diet deriving 37 percent of calories from fat, with a healthy Mediterranean diet deriving 41 percent of calories from fat, and use the favorable outcomes in the Mediterranean diet arm to dismiss and disparage “low fat” diets, and by insinuated extension, diets generously comprised of mostly vegetables, fruits, whole grains, beans, and lentils.

What isn’t preposterous about this reasoning is just plain mendacious. First, 37 percent of calories from fat is higher than the typical American diet; calling it low-fat is truly bewildering. This is like contrasting 37 cigarettes a day to 41 cigarettes a day. If you think lack of decisive benefit from those four fewer daily cigarettes means it makes no difference whether or how much you smoke, this commentary is for you!

Second, the paper was, as declared in its own title, about saturated fat—what does low total fat (whether described fairly or unfairly) have to do with it? Nutrition experts around the world all but uniformly emphasize the variety and balance of fats over the total quantity, a position formalized in the 2015 Dietary Guidelines Advisory Committee Report in the U.S. Personally, I have long concluded that total fat content is a very poor indicator of diet quality, just as total carbohydrate is. Avocado and wild salmon are high in fat, and so is pepperoni pizza. Lollipops are high in carbohydrate, and so are lentils. A focus on macronutrients is yesterday’s news, was yesterday’s news yesterday, and in the context of the new commentary, is a diversionary tactic.

Speaking of fats and carbohydrates, these authors go on to borrow a page from the playbook of every “it’s all about the carbs” iconoclast preceding them, suggesting that coronary disease is due to inflammation, and that, in turn, is due to refined carbohydrate and added sugar. The problem here is the obvious one: there is no need to choose. Those of us who know that beans are much better for you than bacon-cheeseburgers also know that water is much better for you than Kool-Aid, and steel-cut oats far better than Pop-Tarts. The idea that you need to pick a dietary scapegoat is one of the great boondoggles of modern public health, and only serves the interests of the junk food industry—ever ready to put lipstick on a new pig.

As for the authors’ references to the Mediterranean diet, I can only say I share their enthusiasm. But what the PREDIMED diet showed, and the Lyon Diet Heart Study before it—is the superiority of a diet high in unsaturated fat from olives and avocados, nuts and seeds, and to a lesser extent fish and seafood—to a diet high in sources of saturated fat. THERE WAS NO ‘LOW FAT’ DIET IN THE COMPARISON. That contention is either willfully misleading or an indication of plain ignorance.

I do have one hypothetical provocation of my own. Let’s imagine that a diet rich in beans, and a diet rich in beef, were comparably good for our coronaries.  The evidence indicates that is untrue, but let’s pretend. If we really had such options for health, we would still have no real option for the environment. The environmental argument for plant-predominant diets is, if anything, stronger than the health arguments. For academics in the public health space to offer dietary advice in the age of climate change and ignore the planetary impact of choices made by 8 billion hungry Homo sapiens is a sad abdication of an obvious responsibility we all share.

There is nothing hypothetical about coronary artery disease; it is a real, clear, and omnipresent danger. Its association with dietary patterns and key dietary components is reliably established by staggering volumes of evidence these commentators simply chose to ignore. If you are inclined to buy this misguided and misleading theorizing about diet, keep your credit card handy; I am confident that tobacco industry theorists have something to sell you, too.

The post Don’t Believe the Hype: Diets High in Saturated Fat DO Cause Heart Disease appeared first on Forks Over Knives.

If we could go back in time to see how humans lived, way before the era of iPhones and Twitter, we would find humans living—and eating—in their natural habitat. In this snapshot, of course, we would not find pizza boxes, potato chips, or Twinkies, but an earthy pantry of fruits, vegetables, and, seemingly, meat. I can’t argue against the need for more fruits and vegetables, but what irks me is the requirement for meat.

The necessity for meat is unsettling, especially red meat, which the Paleo diet features prominently, since red meat increases the risk of cancer, heart disease, diabetes, and death. But what about other types of meat? And how much? Should we be eating no meat?

And so, I’ve become a bit obsessed with finding the answer. And for good reason: every patient that has a lifestyle disease that I would come in contact with as a physician could be affected by how I answer this question, which is to say, nearly all of my patients. The answer wasn’t easy to come by, and at times wasn’t clear. There were even times when I nearly convinced myself that the Paleo diet was correct in its premise. After spending hundreds, if not thousands of hours, over the past several years understanding human biology, evolutionary medicine, and anthropology, I’ve arrived at the answer.

Ultimately, the Paleo diet is right in its intent but errs in its methodology and conclusion. The Paleo diet assumes that humans in the Paleolithic period, the era which Paleo pundits reference, spanning 2.5 million to 10,000 years ago, were living in a manner that was in harmony with their—and by extension our—“genetic makeup.” But the human genetic makeup has been evolving for millions of years, and drawing a conclusion from one particular time point neglects the evolutionary context that surrounds it.

Human evolution dates back to at least 40 million years ago: a messy process filled with dead-ends and detours extending from anthropoids to hominoids to hominins to, finally, Homo sapiens sapiens, better known as the modern human. During the bulk of this time, human ancestors were primarily herbivorous. True, meat in the evolutionary diet didn’t gain momentum until the Paleolithic period, but it wasn’t until later in the Paleolithic period—how late, however, is a matter of ongoing contention. Some have argued that significant meat consumption didn’t start until around 400,000 years ago, when the first spear was discovered. But spears aren’t particularly useful unless you have a spear-thrower, or atlatl, which wasn’t invented until 17,000 years ago. Through a combination of improved group-hunting tactics and the introduction of advanced weaponry, many agree that effective hunting was likely in full swing by 40,000 years ago.

Over the course of human evolution, our lineage didn’t have the resources or, more importantly, the life-or-death need to eat meat. When humans engaged in effective hunting 40,000 years ago, they did so because they had left their warm ancestral homelands in Africa, which would have been replete with plant-based sources for food, and were now dependent upon the resources available in the new and colder environs they would have encountered venturing through southeast Asia and Europe during the last Ice Age. Food wouldn’t have come easily to early humans and likely drove the need for sophisticated tools to hunt animals. Early humans survived by adapting to these harsh environments by eating meat.

This is, however, different than saying, “Humans evolved to eat meat.” These early humans made weapons, hunted, and ate venison because it was necessary to stave off starvation and not because this was in their “genetic makeup.” Had these early adventurers found pizza, doughnuts, or french fries lying around the glacial forests and tundras of yesteryear they would have consumed that too because those would have been sources of precious calories.

The early humans from 40,000 years ago, who are the same subspecies of humans as modern humans, were not significantly different in their biology or anatomy than the ancestors they evolved from, and they certainly didn’t have any specific evolutionary traits to help them eat meat, or doughnuts for that matter. Their biology was consistent with a 40-million-year evolutionary process that was suited to eating foliage, and not fauna.

The carnivorous departure is a fairly new phenomenon and only represents 1 percent of the human evolutionary timetable, even when considering the earliest time point for effective human hunting. Any diet that says we should eat meat overlooks the other 99 percent of human history when we weren’t eating meat. If we were to compress human evolution onto a single calendar day starting at midnight, humans would have only started eating meat on a regular basis at 11:45:36 PM.

Just because we have evidence that cavemen ate meat doesn’t mean we should make it the foundation of our diets. Just because it happened in the anthropological record, doesn’t mean we should replicate it with every meal for a lifetime, unless you wanted to specifically live like a caveman, but then you might as well toss out your cell phone and hair dryer.

Our biology is best suited for a plant-based diet. After 40 million years of evolution, we see that the human gut anatomy is remarkably similar to our closest extant relative: the chimpanzee, who share 99 percent of their DNA with us. Chimpanzees are also 99 percent herbivorous, eating primarily fruits and leaves. Only 1 percent of a chimp’s diet is meat, while the average American wolfs down about 27 percent, or more, of their daily calories from animal-based sources. It is easy to see how a lifetime of errant dietary habits can take their toll on human health.

And indeed, medical science proffers the final coup de grâce on the subject. For years, scientists have published studies on meat shortening human life expectancy. Most studies show an increase in life expectancy anywhere from 1.5 to 3.6 years in life, but in some cases the difference in life expectancy has been as great as a decade, the difference between the life expectancy of smokers and nonsmokers. Researchers have also shown a dose response with meat: the more meat in your diet, the higher the risk of dying.

Humans during the Paleolithic era ate meat for survival, not for long-term health. Fortunately, humans of today are living under less brutal, and more enlightened, conditions. It’s difficult to argue that the Paleolithic diet’s requirement for meat is in sync with our genetic footprint, and the oversight is proving fatal for both the Paleo diet and, perhaps, for those following it.

The post Why the Paleo Diet Doesn’t Make Sense appeared first on Forks Over Knives.

Modern lifestyles contribute to unbalanced, excessive, or deficient levels of sex hormones in men and women. This may result in unpleasant outcomes—such as low sex drive or infertility—as well as to dangerous diseases, including cancer and heart disease. Here’s key information you need to make choices to help keep your sex hormones balanced.

While there are multiple male and female sex hormones, I’m going to concentrate on the best-known: estrogen and testosterone. You might not be aware that women produce and use testosterone, and men produce and use estrogen. The bodies of both sexes can convert testosterone into estrogen. So all sex hormones are important to you, whether you are male or female.

Balancing Strategy One: Carefully Consider Before Taking Supplementary Hormones

Some people have diagnosed medical conditions that may be treated with supplementary estrogen, testosterone, or other sex hormones. Before deciding whether to use hormones if you have one of these conditions, be sure you thoroughly understand the potential benefits and risks—and weigh these carefully—since sex hormones influence your entire body. Consider if there are alternative evidence-based treatments, as well as the benefits and risks of these. If you use oral contraceptives, be sure to understand possible side effects.

Millions of men and women seek supplementary hormones for vague purposes, such as weight loss, low energy, or a quest to regain lost youthfulness. In this case, the risks are likely to outweigh potential benefits. This is true regardless of whether you use compounded bioidentical hormones or those approved by the Food and Drug Administration (FDA).

The National Toxicology Program of the Department of Health & Human Services classifies estrogen as a known human carcinogen, associated with both uterine and breast cancer. Supplementary or excessive estrogen has also been linked to ovarian cancer, prostate cancer, dementia, and stroke.

The dangers of testosterone supplements are not as well understood, with studies finding different outcomes. The FDA requires labeling of prescription testosterone products for safety risks affecting the heart and mental health, as well as the potential for abuse. If you take these supplements, benefits, if any, may be small and fleeting. A medical journal editorial titled “Testosterone and Male Aging: Faltering Hope for Rejuvenation” states that “the sole unequivocal indication for testosterone treatment is as replacement therapy for men with … organic disorders of the reproductive system.”

Balancing Strategy Two: Avoid Endocrine Disruptors in the Environment

Endocrine-disrupting chemicals (EDCs) are capable of altering the production and/or function of many hormones. Interference with estrogen is the most-studied impact. EDCs may be found everywhere in modern environments, including pesticides, plastics, flame retardants, food, clothes, fragrances, pharmaceuticals, cooking and eating items, and personal care and cleaning products. Adverse effects of EDCs can be developmental, reproductive, neurological, and immune-related. Even tiny amounts can be harmful.

Common-sense strategies to minimize endocrine disruptors include consuming organic food; avoiding pesticides; using stainless steel, glass, or ceramic cookware and storage containers; staying away from air pollution whenever possible; washing new clothes before you wear them; and avoiding personal care, cosmetics, and cleaning products with added fragrance (other than plant oils) and chemicals with long names you can’t pronounce.

One of the most important ways to keep endocrine disruptors out of your body is to not eat animal foods. This is because most endocrine disruptors are fat soluble and accumulate in magnified amounts in animal fat. For example, the Institute of Medicine states that, for the EDCs’ dioxins, “consumption of animal fats is thought to be the primary pathway for human exposure. In humans, dioxins are metabolized slowly and accumulate in body fat over a lifetime.” This brings me to strategy three.

Balancing Strategy Three: Avoid Eating Animal Foods

All animal foods contain sex hormones that are often identical to the human versions. This is true even for animals raised without added hormones. All animals—including mammals, birds, and fish—need hormones for their own functioning. The hormones they produce become part of their tissues and secretions, which you consume if you eat meat, poultry, fish, eggs, or dairy.

Typically, the sex hormones you consume in the highest quantities vary with the type of animal food. Dairy and eggs contain the largest amounts of estrogen. For dairy, the soaring estrogen levels are tied to the fact that modern dairy cows are pregnant most of the year, and during pregnancy females become major estrogen producers. Testosterone exposure is strongly related to eating both milk and eggs (remember that your body may convert the testosterone to estrogen).

Hormones in animal foods are absorbed into your body. One study had adult men and children who had not yet reach puberty drink about 20 ounces of cow’s milk. Both the men and the children had elevated levels of estrogen and progesterone (another female hormone) in both their blood and their urine after consuming the milk. Testosterone secretion was suppressed in the men.

A series of studies considered the changes in diet in Japan after World War II. In the 50 years from 1947 to 1997, intake of milk, meat, and eggs increased 20-, 10-, and 7-fold, respectively. During that time, the death rate from breast cancer roughly doubled, and ovarian cancer deaths increased by a factor of four. The death rate from prostate cancer increased 25-fold. The researchers consider that the estrogen in dairy may have been responsible for these dramatic increases in reproductive cancer death.

All three strategies to balance your sex hormones are important. Avoiding animal foods may be the most powerful—and the most overlooked.

(Additional references)

The post 3 Strategies to Keep Your Sex Hormones Balanced appeared first on Forks Over Knives.

The term “reducetarian” celebrates this large portion of the population that is choosing to eat fewer animal products, regardless of the degree of reduction or the motivation behind it. Reducetarians believe every plant-based meal is one worth celebrating.

I believe the consumption of animal products is a spectrum, with vegetarians and vegans being reducetarians, too—it’s just that they have reduced their consumption of animal products so effectively that they eat very little or none at all. Plus, those who reduce their meat consumption are more likely to become vegetarian, and those who become vegetarian are more likely to become vegan.

What Is Reducetarianism?

Reducetarianism is the practice of eating less red meat, poultry, and seafood (as well as less milk and cheese and fewer eggs). By supporting efforts to reduce the consumption of animal-based foods, the reducetarian campaign aims to create an inclusive community, shifting focus toward common ground—our shared commitment to decreasing societal consumption of animal products.

After all, we know vegans and vegetarians, the modern-day pioneers of plant-based eating, are on to something insightful. With less meat and more fruits and veggies, reducetarians live longer, healthier, and happier lives. A strong body of scientific evidence suggests that increased meat consumption is correlated with a higher risk of heart disease, stroke, type 2 diabetes, obesity, and certain cancers. Reducetarians know that eating less meat isn’t only good for them—it has environmental benefits as well.

The meat industry is responsible for about 18 percent of all global greenhouse gases emitted and a third of freshwater used. Moreover, livestock production is the world’s largest user of land resources. Perhaps most morally relevant, factory farming kills more than 20 billion animals a year—often in brutal and inhumane ways. Becoming a reducetarian is an easy and effective way to reduce one’s carbon and water footprint while sparing animals from the horrors of factory farms.

If you’re interested in becoming a reducetarian, work to set manageable and therefore actionable goals to gradually eat less meat.

One of your goals can be to participate in Meatless Mondays, or you can choose to only eat meat on the weekends. You might also abstain from eating meat for dinner if you had it for lunch. When preparing dinner at home, modify your favorite recipes by using half the meat and double the vegetables or swap out that beef burger on the grill for a veggie one.

If you have a setback, don’t despair—know that you can always get back on the reducetarian wagon by simply eating less meat at your next meal. And remember: Small acts lead to great impacts.

Finally, share your successes. If you’re a private reducetarian, then you can only influence one person: yourself. Making a public commitment and encouraging friends to join can multiply your impact.

Happy meatless eating!

(Brian Kateman is the editor of the new book The Reducetarian Solution, a compilation of more than 70 essays from thought leaders in the field, focusing on how our food choices affect our minds, bodies, and the planet in profound ways.)

The post Can’t Cut Meat 100 Percent Yet? “The Reducetarian Solution” Says Less Is Next Best appeared first on Forks Over Knives.

1. 7 Things That Happen When You Stop Eating Meat

With over 1.1M page views, this article by Michelle McMacken, MD went viral this year. It explains many of the reasons vegetarians and vegans live longer and have lower incidences of chronic diseases than meat-eaters.

2. Obesity: It’s Not About the Carbs

Dr. Garth Davis busts what is probably the most common health myth of today—that carbs make people fat and sick. “Traditional diets high in fruits, veggies and starches have worked for thousands of years, and continue to keep people slim and healthy. But our obsession with counting fat, carbs, and protein blinds us to this truth.”

3. Is It Possible to Eat Too Much Fruit?

People actually avoid fruit because they think any carbs will make them gain weight. In this NutritionFacts.org video, Dr. Michael Greger explores the research on how much fruit we can eat in one day.

4. What Do the Healthiest, Longest-Living People in the World Eat?

Scientists look at the traditional diets of the healthiest populations (based on both longevity and healthy aging) in the world for clues as to what we are doing wrong.

5. Plant-Based on a Budget: Eating Well on $5 a Day

Our chef shows you how to eat a whole-food, plant-based diet on a thrifty budget of $5 a day. Her practical and simple ten day menu is an example of the varied healthy meals you can make with limited resources and ingredients.

6. Is Coconut Oil Healthy or Hazardous?

For several years now, coconut oil has been marketed as the new wonder oil, a cure-all with health benefits. Drs. Pulde and Lederman break down the science.

7. The Smoke and Mirrors Behind Wheat Belly and Grain Brain

Wheat-free and grain-free diets are all the rage, and these two bestselling books are a big part of the current trend. John McDougall, MD, takes a hard look at their claims.

8. Myth of Complementary Protein

The “incomplete protein” myth was inadvertently promoted and popularized in the 1971 book, Diet for a Small Planet, by Frances Moore Lappé. Even though the author corrected her mistake in later editions, the myth of protein combining is still sometimes taught today.

9. These Three Kitchen Shortcuts Will Change the Way You Cook

Healthy eating starts at home, but most people don’t have the ability or energy to spend hours in the kitchen every day. The lead instructor of our online cooking course shares his favorite tips for home cooks to save time and mess in the kitchen.

10. How I Fuel Myself with a Plant-Based Diet as a Competitive Bodybuilder

Athlete Torre Washington talks about his life and diet as a plant-based athlete and bodybuilder;  people loved his compelling story.

Other Popular Stories of 2016

How to Cook Without Oil
7 Ways Milk and Dairy Products are Making You Sick
Top Tips for Plant-Based Athletes

The Most Popular Success Stories of 2016

How We Cured Our Cystic Acne on a Whole-Food, Plant-Based Diet
I Lost 300 Pounds and Regained My Life…and My Entire Family Joined Me
How My Daughter Got Off ADHD Meds, Reversed Prediabetes, and Started Thriving on a Plant-Based Diet
Ultrarecovery: From Depressed Addict to Pro Ultrarunner

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1. Rip’s Big Bowl

Rip’s Big Bowl is a combination of oats, whole-wheat cereals, raisins, walnuts and more. We love to pour our favorite plant-based milk on it (we rotate between rice, almond, and coconut milk) and then top it off with fresh fruit. In our version below, we used fresh organic strawberries and golden kiwi fruit! Get Rip’s own recipe or buy a pre-mixed one at Whole Foods Market.

2. Veggies and Dip

Keep some pre-sliced veggies or baby carrots stored in your fridge. Serve with low-fat hummus, plant-based ranch, or any other dip that your family loves.

3. An Apple (or Any Other Fruit!) a Day

We all know what they say about apples, but don’t forget about the simplest, purest form of energy out there: fresh fruit! Check out your local grocery store for in-season fruit and include it in your weekly shopping. To help you in grab-and-go situations, leave beautifully colored seasonal fruit like pears, peaches, nectarines, oranges, and apples out on top of the counter or in a nice bowl so you always see it. It’s easy to grab and you will always have a snack on standby when you’re in need!

4. Fruit Smoothies

Blend some frozen or fresh berries, a banana, and some plant-based milk for a quick and delicious snack or light meal.

5. Open-Faced Hummus Sandwich

Start with a piece of whole-grain bread, top with a nice layer of oil-free hummus, and finish with fresh avocado and cucumber slices. Pepitas optional!

6. Fruit and Veggie Salads

Eating salad doesn’t have to be boring! Having a nice greens base prepared ahead of time and stored in the fridge is a must. Start with a bed of greens (spinach, romaine, or spring mix) and pile the fresh ingredients high. In this salad, we used a combination of green grapes, heirloom tomatoes, freshly-cut pineapple chunks, and organic apples. Use any oil-free dressing you like—we like the Forks Over Knives sesame ginger dressing.

7. No-Bake Cookies With Dates

Dates pack an excellent punch when it comes to energy. With more potassium than a banana, dates are a bite-sized roll of goodness that can give you the whole-food energy you need. There are lots of recipes out there, but our favorite is Jane Esselstyn’s “Damn Good Cookies” recipe from Plant-Strong by Rip Esselstyn. In this no-bake recipe (pictured above), Jane mixes raw almonds, walnuts, dates, vanilla extract, old-fashioned oats, and dark chocolate chips for a wonderful combination of flavor that can serve as an on-the-go snack or a sweet treat after a meal.

You can also try these raw choco bites made of oats, dates, and carrots.

8. Fast Pita Pizzas

Top pita bread with tomato sauce, basil, oregano, and your favorite toppings and pop it into a 250°F toaster oven for five minutes. We love this idea by Mary McDougall.

9. Quick Bean Salads

Keep a big batch of bean salad in your fridge for snacking or as the base for a last-minute meal. Whether you make this quick black bean salad, our corn salad, Dreena Burton’s chickpea salad, or your own combination, these hearty bean salads are satisfying and easy to whip up.

10. Leftover Cooked Potatoes or Sweet Potatoes

These are great on their own or topped with salsa or leftover chili. Prepare extra potatoes when you’re cooking, or you can quickly microwave a few if you don’t have any leftovers in the fridge.

Stocking healthy snacks while keeping products with ingredients you can’t pronounce out of your pantry is the key to success in the whole-food, plant-based diet. Do this and you will be ready to take on the world, one healthy day at a time!

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The Healthiest Diet on the Planet offers a scientifically based alternative that immediately helps you lose weight, feel better, protects you against life-threatening disease, and even reverses most common chronic diseases. This is a simple and proven formula that I have been sharing with my patients for four decades, one that always yields life-changing results. These are the very foods that we as humans are designed to eat, these are the foods we crave, these are the foods that unbiased studies have proved to be the most health promoting.

Although human beings can survive on many different varieties of food, in order to function, feel, and look our best, we must lean heavily on our biological design as herbivores, plant eaters. But not just any plants. We are starch eaters, also referred to as starchivores or starchitarians. Starches are plant parts that store an abundance of energy, otherwise known as carbohydrates, to power our rocket-building brains and to sustain muscles that can run for days without stopping. That special fuel is sugar, which is stored as long chains in starchy plant parts often referred to as complex carbohydrates.

Starches that grow underground, such as potatoes and sweet potatoes, are so nutritionally complete that a person can live in excellent health on these foods alone. Starches provide an abundance of protein, vitamins, minerals, and dietary fiber, with just enough essential fat to meet all of our dietary needs. Grains and legumes, however, need a little help from fruits, like oranges, and green or yellow vegetables, like broccoli, in order to provide adequate vitamin A and C.

The most important evidence supporting my claim that the natural human diet is based on starches is a simple observation that you can easily validate for yourself: all large populations of trim, healthy, athletic, war-fighting people, throughout verifiable human history, have obtained the bulk of their calories from starch. Examples of once-thriving people include Japanese, Chinese, and other Asians, who ate sweet potatoes, buckwheat, and/or rice; Incas, in South America, who ate potatoes; Mayans and Aztecs, in Central America, who ate corn; and Egyptians, in the Middle East, who ate wheat.

There have been only a few small isolated populations of people, such as the Arctic Inuit Eskimos, living at the extremes of the environment who have eaten otherwise. Therefore, scientific written documentation of what people have eaten over the past thirteen thousand years convincingly supports my claim. Archaeological evidence shows we have been starch eaters for more than a hundred thousand years. Evidence of pre−Homo sapiens dates plant eating to 2.6 million years ago for humanoids.

Ready to get started? Check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path. To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer.

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NutritionFacts.org, Greger’s science-based website, provides the latest in nutrition research for free as a public service. We recently talked to him about how his work habits, what he eats, and how he manages to accomplish so much in so little time.

Why did you start NutritionFacts.org?

There’s so much in the nutrition world that is commercialized and driven by business interests. I wanted to go to the original sources and present people with the best, most objective nutrition research. NutritionFacts is nonprofit and noncommercial.

When I was a child, my grandmother was told she didn’t have long to live. She had undergone several bypass surgeries and was confined to a wheelchair. She reversed her advanced heart disease with a plant-based diet and lifestyle changes (based on the work of Nathan Pritikin), and went on to live 31 more years to the age of 96. She also enjoyed great health—she was out of the wheelchair in just three weeks of switching her diet and began walking ten miles a day. It was just amazing and wonderful for us kids to be able to play with her again. Her health transformation was what made me want to be a doctor.

So I was familiar with the power of plant-based nutrition. Years later, Dr. Dean Ornish published his pioneering Lifestyle Heart Trial in 1990, which showed that heart disease could be stopped and even reversed without drugs or surgery. It was scientific proof of what I had witnessed with my own eyes. I also started eating a whole-food, plant-based diet at this time.

When I was in medical school, I was disappointed that we didn’t learn anything about using diet and lifestyle changes to treat chronic diseases. I couldn’t believe such a large body of evidence was being ignored by the medical community and that millions of people were dying prematurely for no reason. That’s why I’ve made it my life’s mission to get this life-saving information out to the public, who will never find or hear about the research in the medical journals.

I’ve heard that you review hundreds of scholarly articles per week. Is that a typo? How is it possible for you to read it all and transform the scholarly articles into your watchable, easy-to-understand videos? What’s the process for getting all of this done?

It takes a team. We have 19 researchers on the staff and about 80 active volunteers. Our team scans through every issue of every English-language nutrition journal. Every week, an army of volunteers downloads and categorizes nearly 2,000 papers on the subjects of nutrition and disease for the research team to analyze.

For process, there’s the research phase and the writing phase. During the research phase, volunteers download the studies and put them in topical folders. When I’m in this phase, I skim through the studies and pull out the groundbreaking studies (or collections of studies). I’ve always been a fast reader and am able to sort through dense material and pick out important points. If I see links and/or some kind of narrative arc [to the important points], I will later write a video or series of videos around the topic.

During the writing phase, I do close reads of the material, write the scripts, and give some direction to the video team. Our video team puts together the video assets. Every nine weeks, I read through the scripts and click through the presentations to create our huge library of NutritionFacts videos.

In the beginning, I was doing it all myself. If you look at the videos from 2011, they are pitiful. Now, thanks to the generous support of so many people, I have the luxury to go deep. We’re like the Bernie Sanders of the nutrition movement. Our average donation is under $30, but we reach so many millions of people that even if one in a thousand people donates we are able to survive and thrive. I don’t make any money from the site or the videos, but we do have to pay the people that work here and pay for servers and image and research download costs.

We’re trying to replicate the Wikipedia model where the information is totally free, but people donate because they feel they’ve benefited from it and want to support it to help others.

It’s obviously a ton of work and you seem to have a rigorous travel schedule. How do you stay healthy?

I practice what I preach and have been eating a whole-food, plant-based diet for about 25 years.

I also have a treadmill desk. I started with a standing desk when I read all the research about the dangers of sitting all day. Then I figured I could also move a little bit. I walk really slowly, about two miles an hour, but I walk about 17 miles a day on average when I’m not sitting on my butt in some plane somewhere.

What are the most popular topics on NutritionFacts?

Every year, I do a “best of” summary and a Top 10 list of the “most popular” videos. I don’t try to appeal to the masses or do trends, and I am often surprised at what people find interesting. People respond to the Paleo videos, which is no surprise. But there are surprises like the public interest in vinegar. Other popular topics include breast cancer, Splenda, and controversial topics like gluten.

You’ve read more medical literature on nutrition than probably anyone on the planet. What do you want people to eat?

I want everyone to eat a diet centered around whole plant foods. I also have a “daily dozen” list of all the things I try to fit into my daily routine. It’s available as a free app on iPhone and Android (“Dr. Greger’s Daily Dozen). I go into [what to eat] in detail in How Not to Die. It includes beans, berries and other fruit, lots of veggies including leafy greens, whole grains, and flaxseeds. It also includes exercise and water.

When people are starting the transition to a whole-food, plant-based diet, what is the healthiest first step they can take?

For first steps that will make a big impact on your health, I recommend removing trans fats (i.e., donuts, Crisco) and processed meats and adding dark, leafy greens and beans to your diet.

Dr. Greger encourages everyone to go to your local library and grab a copy of How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease. All proceeds he receives from book sales go to charity.

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