Do the Pros of Brown Rice Outweigh the Cons of Arsenic?

Are there unique benefits to brown rice that would justify keeping it in our diet despite the arsenic content?

For years, warnings had been given about the arsenic levels in U.S. rice potentially increasing cancer risk, but it had never been put to the test until a study out of Harvard. The finding? “Long-term consumption of total rice, white rice or brown rice[,] was not associated with risk of developing cancer in US men and women.” This was heralded as good news. Indeed, no increased cancer risk found even among those eating five or more servings of rice per week. But, wait a second: Brown rice is a whole grain, a whole plant food. Shouldn’t brown rice be protective and not just neutral? I discuss this in my video Do the Pros of Brown Rice Outweigh the Cons of Arsenic?.

If you look at whole grains in general, there is “a significant inverse”—or protective—“association between total whole-grain intake and risk of mortality from total cancers,” that is, dying from cancer. My Daily Dozen recommendation of at least three servings of whole grains a day was associated with a 10 percent lower risk of dying from cancer, a 25 percent lower risk of dying from heart attacks or strokes, and a 17 percent lower risk of dying prematurely across the board, whereas rice consumption in general was not associated with mortality and was not found to be protective against heart disease or stroke. So, maybe this lack of protection means that the arsenic in rice is increasing disease risk, so much so that it’s cancelling out some of the benefits of whole-grain brown rice.

Consumer Reports suggested moderating one’s intake of even brown rice, but, given the arsenic problem, is there any reason we should go out of our way to retain any rice in our diet at all? With all of the other whole grain options out there, should we just skip the rice completely? Or, are there some unique benefits we can get from rice that would justify continuing to eat it, even though it has ten times more arsenic than other grains?

One study showed that “a brown rice based vegan diet” beat out the conventional Diabetes Association diet, even after adjusting for the extra belly fat lost by the subjects on the vegan diet, but that may have been due to the plant-based nature of their diet rather than just how brown rice-based it was.

Another study found a profound improvement in insulin levels after just five days eating brown rice compared to white rice, but was that just because the white rice made people worse? No, the brown rice improved things on its own, but the study was done with a South Indian population eating a lot of white rice to begin with, so this may have indeed been at least in part a substitution effect. And yet another study showed that instructing people to eat about a cup of brown rice a day “could significantly reduce weight, waist and hip circumference, BMI, Diastole blood pressure,” and inflammation—and not just because it was compared to white. However, a larger, longer study failed to see much more than a blood pressure benefit, which was almost as impressive in the white-rice group, so, overall, not too much to write home about.

Then, another study rolled around—probably the single most important study on the pro-rice sideshowing a significant improvement in artery function after eight weeks of eating about a daily cup of brown rice, but not white, as you can see at 3:18 in my video, and sometimes even acutely. If you give someone a meal with saturated fat and white rice, you can get a drop in artery function within an hour of consumption if you have some obesity-related metabolic derangements. But, if you give brown rice instead of white, artery function appears protected against the adverse effects of the meal. Okay, so brown rice does show benefits in interventional studies, but the question is whether it shows unique benefits. Instead, what about oatmeal or whole wheat?

Well, first, researchers needed to design an artery-crippling meal, high in saturated fat. They went with a Haagen Daaz, coconut cream, and egg milkshake given with a bowl of oatmeal or “a comparable bowl of whole rolled wheat.” What do you think happened? Do you think these whole grains blocked the artery-damaging effects like the brown rice did? The whole oats worked, but the whole wheat did not. So, one could argue that brown rice may have an edge over whole wheat. Do oats also have that beneficial long-term effect that brown rice did? The benefit was of a similar magnitude but did not reach statistical significance.

So, what’s the bottom line? Until we know more, my current thinking on the matter is that if you really like rice, you can moderate your risk by cutting down, choosing lower arsenic varieties, and cooking it in a way to lower exposure even further. But, if you like other whole grains just as much and don’t really care if you have rice versus quinoa or another grain, I’d choose the lower arsenic option.

Tada! Done with arsenic in the food supply—for now. Should the situation change, I’ll produce another video on the latest news. Make sure you’re subscribed so you don’t miss any updates.


Here are all 13 videos in the series, in case you missed any or want to go back and review:

And you may be interested in Benefits of Turmeric for Arsenic Exposure.

In health,

Michael Greger, M.D.

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

The Obesity Pandemic: What can we do about it?

Obesity today is a global crisis; the number of cases is on a continuous rise. As per the WHO,  “during the years 1975 to 2016, the prevalence of overweight or obese children and adolescents aged 5–19 years increased more than four-fold from 4% to 18% globally”. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these, over 650 million were obese. 

Overweight or obesity is a chronic health condition that leads to abnormal or excessive fat accumulation in adipose tissue. The excess fat around the waist and trunk (abdominal, central, or android obesity) or peripherally around the body (gynoid obesity) can have severe complications. The disease is significantly increasing and surpassing traditional conditions such as undernutrition, infectious diseases, and many others. A particular trend related to obesity is that the number of people with the disease is slowly increasing even in the low- and middle-income countries, particularly in the urban areas, which earlier was mainly confined to the higher income countries. 

How is Obesity Measured? 

Obesity is divided into three classes. Among the various methods, the most basic and standard procedure is the body mass index (BMI). BMI considers a person’s weight and height to calculate the level of adiposity. Accordingly, the three classes of obesity are Overweight (not obese), Class 1 (low-risk) obesity, Class 2 (moderate-risk) obesity, and Class 3 (high-risk), obesity. 

Some other methods such as Bioelectric Impedance (BIA), Waist Circumference, Air-Displacement Plethysmography, Waist-to-Hip Ratio, Skinfold Thickness, and others also used to measure Obesity. 

Why is obesity a problem?

According to the global burden of disease (2017), over the years, Obesity has grown to epidemic proportions, with around 4 million people dying each year due to being overweight or obese. Overweight and obesity are considered big health problems as they can lead to many potentially life-threatening conditions or diseases if ignored for an extended period. Obesity is a risk factor for many health complications such as pulmonary embolism, joint osteoarthritis (OA), cardiovascular disease, and certain types of cancer

Besides these, it is linked to other health problems, including strokes, sleep apnea, fatty liver disease, kidney disease, pregnancy problems, etc. Obesity can hamper day-to-day physical activity, impact cognitive abilities, and lead to psychological issues such as depression, stress, and many others.

What causes obesity?

An Individual’s metabolic activity, genetics, environmental factors, behavior, and hormones can supposedly cause overweight and obesity. Primarily, the intake of more calories than the body requires is considered the leading cause of obesity. Over time if calories are not burned, the body stores the extra calories as body fat. Physical inactivity and a sedentary lifestyle increase the risk of obesity many times.

obesity-causes-diagnosis-risk-factors-epidemiology-therapies-pipeline-treatment-market
Obesity Pandemic

What are the risk factors for obesity?

Apart from calorie and physical activity, some of the genetic and social factors also influence the prevalence of obesity. Among various factors, some of the most common risk factors include:

Genes – The genes are supposed to have a small role in obesity. The gene, along with unhealthy diets and lifestyles, enhances the risk of obesity. The appetite pattern, calories burning time, and eating habits impact the risks of obesity.

Medical conditions– Certain medical conditions such as Cohen syndrome, Prader-Willi syndrome, Cushing syndrome, and other disorders are directly associated with the weight increase.

Age – As per the CDC, in the united states, in 2017–2018, “the prevalence of obesity was 40.0% among young adults aged 20 to 39 years, 44.8% among middle-aged adults aged 40 to 59 years and 42.8% among adults aged 60 and older”. With age, specific hormonal changes, and an inactive lifestyle increase risk of obesity.

Socio-economic conditions – The socioeconomic conditions such as education level, income, and ethnicity directly relate to obesity. As per the CDC, in the US, men and women with college degrees had lower obesity prevalence than those with less education. Also, among women, a higher prevalence was observed in the middle and low-income groups than in the higher income group.

Sex – A person’s sex can have an impact on obesity. For example, in the united states, black or Hispanic women are more obese than black or Hispanic men.

Some of the other factors, such as stress, depression, ceasing smoking, low sleep pattern, and pregnancy, also increase the risk of obesity.

Obesity Treatment Market 

Depending upon the cause and severity, the treatment option for obesity includes a lifestyle intervention, pharmacotherapy, and weight-loss procedures (including bariatric surgery). Significant progress has occurred in all three modalities in recent years, which has improved people’s lives with obesity. 

The lifestyle intervention focuses on a weight reduction program that includes healthy eating programs, physical activity, and healthy sleep patterns. Pharmacological treatments are recommended to reduce the intake or absorption of nutrients. These medications act on specific body parts. The aim of the interventions is to block the absorption of fat from foods or in some cases to regulate the urge to eat and to decrease the appetite. Pharmacological treatment is recommended with lifestyle changes. These interventions are followed only after recommended by doctors and can have some side effects also. During the last decades, many weight-loss interventions have entered clinical trials. Still, the majority have been withdrawn or ceased, not all because of lack of efficacy, but due to safety issues. 

Today, at the global level, some of the key companies such as Rhythm Pharmaceuticals, Gelesis, Novo Nordisk, Saniona, Medix, MedImmune, AstraZeneca, Boehringer Ingelheim, Gubra Pharma, and others are involved in developing therapies for obesity. The launch of the treatments in the coming years will significantly improve people’s lives affected by obesity. 

Similarly, surgical intervention is recommended to extremely obese patients if the lifestyle changes and medicines fail to produce a desirable outcome. The surgical intervention includes gastrectomy, gastric bypass surgery, and others. However, these surgeries are quite risky options as these can also cause infection, bleeding, and in some cases, even death.

What lies ahead

As discussed earlier, the prevalence of obesity has increased significantly over the decades. It has a particular impact on national productivity, economy, healthcare infrastructure, even though it is preventable. Obesity and its related illnesses take a large chunk of an individual’s income (for medical care and prescription needs), apart from time and productivity. Similarly, it causes unnecessary burdens such as higher insurance premiums, lower wages in certain fields, social bias and discrimination, limited opportunities (particularly in the areas requiring physical activity such as armed services), and many others. 

The WHO’s World Health Assembly in 2004 and again in 2011, through its political declaration on the non-communicable disease (NCDs), has described the need for actions to support healthy diets and regular physical activity patterns at the population level. Similarly, the governments, NGOs, health groups, are also promoting healthy lifestyle habits and environments at their level to reduce the burden of obesity and its related diseases. People are also getting self-conscious and taking these diseases seriously. Among all, the younger generation is actively adopting a healthy lifestyle that includes regular exercise, yoga, and a healthy diet. Although the number is quite low, in the coming year with regular promotion the number is likely to increase.

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Humana Taps Vida Health to Power Virtual Diabetes Management for Kentucky’s Medicaid Population

Humana Taps Vida Health to Power Virtual Diabetes Management for Kentucky’s Medicaid Population

What You Should Know:

 Humana Healthy Horizons™ in Kentucky announced it has selected Vida Health’s virtual diabetes management program to serve Kentucky’s Medicaid population.

– Vida’s diabetes management program
achieves lasting results for participants. Because chronic conditions like diabetes,
obesity, and hypertension often occur simultaneously, Vida’s unique program was
built from the ground up to treat multiple conditions at the same time.

– The new partnership, which will launch in
January of 2021, allows eligible individuals access to Vida’s group diabetes
coaching, in-app peer group support, digital therapeutics for diabetes and
co-occurring chronic conditions, and more to help them manage their diabetes
and their whole health.

Kentucky has the seventh highest prevalence of diabetes of any state with 13.7% of the
adult population reporting having the disease, well above the U.S. average of
10.9%. The percent of Kentuckians with diabetes has more than doubled since
2000 when only 6.5% of the population reported having been diagnosed.
Additionally, about two thirds of adult Kentuckians are considered overweight or obese
which increases the risk of Type II Diabetes among other chronic illnesses.

– The mobile-first experience is uniquely
personalized to each user through a combination of provider expertise and
machine learning algorithms that utilize data from 100+ app and device
integrations, as well as biometric data, and more to personalize the program
and content. The program addresses the root causes behind an individual’s
diabetes, and, using the power of human connection, psychology, and nutritional
expertise, Vida drives long-term behaviors that shift the course of the
disease.

Digital Diabetes Market to Reach $1.5B by 2024, Research Finds

Diabetes Management Apps Global Mobile Health Solutions_7 Best Practices for Developing Successful Diabetes Mobile Apps

What You Should Know:

– The digital diabetes market is on track to reach $1.5
billion dollars by 2024, according to a new report by Research2Guidance.

– The confident growth of digital diabetes care will be driven by the growth of the global addressable market for digital diabetes services. Between 2019 and 2024, the number of diagnosed diabetics with access to smart devices is set to increase from 109 million to 180 million. 

– Digital diabetes solutions have disrupted the diabetes
care market and are changing overall chronic care, targeting not only diabetes
but also its various comorbidities, such as obesity, hypertension, and
depression.

– The report, The
Global Digital Diabetes Care Market 2020: Going Beyond Diabetes Management focuses
on the continued expansion of
digital diabetes providers into other chronic conditions (vertical expansion)
and new service opportunities (horizontal expansion), highlighting the market’s
strategic direction in the next few years. This expansion will create new
revenue opportunities, improve payer acceptance, and grow user bases beyond the
diagnosed diabetes audience.

– In the report, the Top 10 market players LifeScan Inc., Ascensia Diabetes Care, Informed Data Systems (One Drop), mySugr (Roche), H2 Inc., Livongo Health, Omada Health, Abbott, Dexcom, and Dario Health are profiled with their offerings, mobile app portfolio performance, and strategy analysis, as well as Top 10 country profiles (market opportunity size, number of solutions, downloads, number of users, Top 5 players).

How Care Coordination Technology Addresses Social Isolation in Seniors

How Care Coordination Technology Addresses Social Isolation in Seniors
Jenifer Leaf Jaeger, MD, MPH, Senior Medical Director, HealthEC

Senior isolation is a health risk that affects at least a quarter of seniors over 65. It has become recognized over the past decade as a risk factor for poor aging outcomes including cognitive decline, depression, anxiety, Alzheimer’s disease, obesity, hypertension, heart disease, impaired immune function, and even death.

Physical limitations, lack of transportation, and inadequate health literacy, among other social determinants of health (SDOH), further impair access to medical and mental health treatment and preventive care for older adults. These factors combine to increase the impact of chronic comorbidities and acute issues in our nation’s senior population.

COVID-19 exacerbates the negative impacts of social isolation. The consequent need for social distancing and reduced use of the healthcare system due to the risk of potential SARS-CoV-2 exposure are both important factors for seniors. Without timely medical attention, a minor illness or injury quickly deteriorates into a life-threatening situation. And without case management, chronic medical conditions worsen. 

Among Medicare beneficiaries alone, social isolation is the source of $6.7 billion in additional healthcare costs annually. Preventing and addressing loneliness and social isolation are critically important goals for healthcare systems, communities, and national policy.

Organizations across the healthcare spectrum are taking a more holistic view of patients and the approaches used to connect the most vulnerable populations to the healthcare and community resources they need. To support that effort, technology is now available to facilitate analysis of the socioeconomic and environmental circumstances that adversely affect patient health and mitigate the negative impacts of social isolation. 

Addressing Chronic Health Issues and SDOH 

When we think about addressing chronic health issues and SDOH in older adults, it is usually after the fact, not focused on prevention. By the time a person has reached 65 years of age, they may already be suffering from the long-term effects of chronic diseases such as diabetes, hypertension or heart disease. Access points to healthcare for older adults are often in the setting of post-acute care with limited attention to SDOH. The focus is almost wholly limited to the treatment and management of complications versus preventive measures.  

Preventive outreach for older adults begins by focusing on health disparities and targeting patients at the highest risk. Attention must shift to care quality, utilization, and health outcomes through better care coordination and stronger data analytics. Population health management technology is the vehicle to drive this change. 

Bimodal Outreach: Prevention and Follow-Up Interventions

Preventive care includes the identification of high-risk individuals. Once identified, essential steps of contact, outreach, assessment, determination, referral, and follow-up must occur. Actions are performed seamlessly within an organization’s workflows, with automated interventions and triggered alerts. And to establish a true community health record, available healthcare and community resources must be integrated to support these actions. 

Social Support and Outreach through Technology 

Though older adults are moving toward more digitally connected lives, many still face unique barriers to using and adopting new technologies. So how can we use technology to address the issues?

Provide education and training to improve health literacy and access, knowledge of care resources, and access points. Many hospitals and health systems offer day programs that teach seniors how to use a smartphone or tablet to access information and engage in preventive services. For example, connecting home monitoring devices such as digital blood pressure reading helps to keep people out of the ED. 

Use population health and data analytics to identify high-risk patients. Determining which patients are at higher risk requires stratification at specific levels. According to the Centers for Disease Control and Prevention, COVID-19 hospitalizations rise with age, from approximately 12 per 100,000 people among those 65 to 74 years old, to 17 per 100,000 for those over 85. And those who recover often have difficulty returning to the same level of physical and mental ability. Predictive analytics tools can target various risk factors including:

– Recent ED visits or hospitalizations

– Presence of multiple chronic conditions

– Depression 

– Food insecurity, housing instability, lack of transportation, and other SDOH 

– Frailty indices such as fall risk

With the capability to identify the top 10% or the top 1% of patients at highest risk, care management becomes more efficient and effective using integrated care coordination platforms to assist staff in conducting outreach and assessments. Efforts to support care coordination workflows are essential, especially with staffing cutbacks, COVID restrictions, and related factors. 

Optimal Use of Care Coordination Tools

Training and education of the healthcare workforce is necessary to maximize the utility of care coordination tools. Users must understand all the capabilities and how to make the most of them. Care coordination technology simplifies workflows, allowing care managers to: 

– Risk-stratify patient populations, identify gaps in care, and develop customized care coordination strategies by taking a holistic view of patient care. 

– Target high-cost, high-risk patients for intervention and ensure that each patient receives the right level of care, at the right time and in the right setting.

– Emphasize prevention, patient self-management, continuity of care and communication between primary care providers, specialists and patients.

This approach helps to identify the resources needed to create community connections that older adults require. Data alone is insufficient. The most effective solution requires a combination of data analytics to identify patients at highest risk, business intelligence to generate interventions and alerts, and care management workflows to support outreach and interventions. 


About Dr. Jenifer Leaf Jaeger 

Dr. Jenifer Leaf Jaeger serves as the Senior Medical Director for HealthEC, a Best in KLAS population health and data analytics company. Jenifer provides clinical oversight to HealthEC’s population health management programs, now with a major focus on COVID-19. She functions at the intersection of healthcare policy, clinical care, and data analytics, translating knowledge into actionable insights for healthcare organizations to improve patient care and health outcomes at a reduced cost.

Prior to HealthEC, Jenifer served as Director, Infectious Disease Bureau and Population Health for the Boston Public Health Commission. She has previously held executive-level and advisory positions at the Massachusetts Department of Public Health, New York City Department of Health and Mental Hygiene, Centers for Disease Control and Prevention, as well as academic positions at Harvard Medical School, Boston University School of Medicine, and the Warren Alpert Medical School of Brown University.


Price cut leads NICE to back Novo Nordisk’s obesity drug Saxenda

Novo Nordisk’s Saxenda has been recommended by NICE as a treatment for obesity, ending a 10-year drought in new drug therapies for weight management.

The cost-effectiveness agency for England and Wales has recommended Saxenda (liraglutide) as a treatment option for people with a body mass index (BMI) of 35 or more, and who are also pre-diabetic with a high risk of developing cardiovascular disease because of risk factors such as high blood pressure or high cholesterol levels.

NICE tuned down the GLP-1 agonist earlier this year, but changed its stance after Novo Nordisk offered a confidential discount to the NHS.

Saxenda – which comes as prefilled self-injection pen – will be used as part of a programme based on a reduced-calorie diet and increased physical activity, according to NICE, and treatment should be discontinued if patients don’t lose at least 5% of their body eight within 12 months.

“Our independent committee was presented with clinical evidence which showed that people lose more weight with liraglutide plus lifestyle measures than with lifestyle measures alone,” said Meindert Boysen, NICE’s deputy chief executive.

“Liraglutide may also delay the development of type 2 diabetes and cardiovascular disease and this is the main benefit of treatment,” he added. It will be prescribed in secondary care, by a specialist multidisciplinary tier 3 weight management service.

Denmark-based Novo Nordisk said there are 13 million obese people in England with obesity, placing them at risk not only of diabetes and heart disease but also severe COVID-19 symptoms if infected with SARS-CoV-2.

The NICE recommendation coincided with Novo Nordisk’s third quarter results statement, which showed modest 3% growth for Saxenda in the first nine months of the year to DKK 4.2 billion ($661 million), held back by the impact of the pandemic on patients accessing healthcare.

That also put a brake on Novo Nordisk’s other products, which are mainly use for chronic diseases like diabetes, although it said a “gradual recovery” occurred in the third quarter. All told, sales grew 7% in the nine months to just under DKK 95 billion ($14.9 billion).

Saxenda continues to develop a dominant position in obesity pharmacotherapy however, and Novo Nordisk said the drug currently has a market share of 63% worldwide.

The company’s GLP-1 agonists for diabetes grew strongly, thanks to its once-weekly injectable Ozempic (semaglutide) which grew  119% to DKK 15 billion ($2.35 billion), overtaking Novo Nordisk’s older Victoza (liraglutide) product which requires dosing by injection every day.

Ozempic is squaring off in the market against Eli Lilly’s Trulicity (dulaglutide), which grew 22% to $3.57 billion in the same period.

Novo Nordisk also recorded DKK 1 billion ($156 million) in sales for its new oral formulation of semaglutide – Rybelsus – which started to roll out this year.

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What White Blood Cell Count Should We Shoot for?

At the start of my video What Does a Low White Blood Cell Count Mean?, you can see what it looks like when you take a drop of blood, smear it between two pieces of glass, and view at it under a microscope: a whole bunch of little, round, red blood cells and a few big, white blood cells. Red blood cells carry oxygen, while white blood cells are our immune system’s foot soldiers. We may churn out 50 billion new white blood cells a day. In response to inflammation or infection, that number can shoot up to a 100 billion or more. In fact, pus is largely composed of: millions and millions of white blood cells.

Testing to find out how many white blood cells we have at any given time is one of the most common laboratory tests doctors order. It’s ordered it hundreds of millions of times a year. If, for example, you end up in the emergency room with abdominal pain, having a white blood cell count above about 10 billion per quart of blood may be a sign you have appendicitis. Most Americans fall between 4.5 and 10, but most Americans are unhealthy. Just because 4.5 to 10 is typical doesn’t mean it’s ideal. It’s like having a “normal” cholesterol level in a society where it’s normal to die of heart disease, our number-one killer. The average American is overweight, so if your weight is “normal,” that’s actually a bad thing.

In fact, having excess fat itself causes inflammation within the body, so it’s no surprise that those who are obese walk around with two billion more white cells per quart of blood. Given that, perhaps obese individuals should have their own “normal” values. As you can see at 2:06 in my video, if someone with a 47-inch waist walks into the ER with a white blood cell count of 12, 13, or even 14, they may not have appendicitis or an infection. That may just be their normal baseline level, given all the inflammation they have in their body from the excess fat. So, normal levels are not necessarily healthy levels.

It’s like smoking. As you can see at 2:31 in my video, if you test identical twins and one smokes but the other doesn’t, the smoker is going to end up with a significantly higher white cell count. In Japan, for example, as smoking rates have steadily dropped, so has the normal white count range. In fact, it’s dropped such that about 8 percent of men who have never smoked would now be flagged as having abnormally low white counts if you used a cut-off of 4. But, when that cut-off of 4 was set, most people were smoking. So, maybe 3 would be a better lower limit. The inflammation caused by smoking may actually be one of the reasons cigarettes increase the risk of heart attacks, strokes, and other inflammatory diseases. So, do people who have lower white counts have less heart disease, cancer, and overall mortality? Yes, yes, and yes. People with lower white blood cell counts live longer. Even within the normal range, every one point drop may be associated with a 20 percent drop in the risk of premature death.

As you can see at 3:39 in my video, there is an exponential increase in risk in men as white count goes up, even within the so-called normal range, and the same is found for women. The white blood cell count is a “stable, well-standardized, widely available and inexpensive measure of systemic inflammation.” In one study, half of the women around 85 years of age who had started out with white counts under 5.6 were still alive, whereas 80 percent of those who started out over 7 were dead, as you can see at 4:05 in my video—and white blood cell counts of 7, 8, 9, or even 10 would be considered normal. Being at the high end of the normal range may place one at three times the risk of dying from heart disease compared to being at the lower end.

The same link has been found for African-American men and women, found for those in middle age, found at age 75, found at age 85, and found even in our 20s and 30s: a 17 percent increase in coronary artery disease incidence for each single point higher.

As you can see at 5:00 in my video, the higher your white count, the worse your arterial function may be and the stiffer your arteries may be, so it’s no wonder white blood cell count is a useful predictor of high blood pressure and artery disease in your heart, brain, legs, and neck. Even diabetes? Yes, even diabetes, based on a compilation of 20 different studies. In fact, it may be associated with everything from fatty liver disease to having an enlarged prostate. And, having a higher white blood cell count is also associated with an increased risk of dying from cancer. So, what would the ideal range be? I cover that in my video What Is the Ideal White Blood Cell Count?.

A higher white blood cell count may be an important predictor for cardiovascular disease incidence and mortality, decline in lung function, cancer mortality, all-cause mortality, heart attacks, strokes, and premature death in general. This is no surprise, as the number of white blood cells we have circulating in our bloodstreams are a marker of systemic inflammation. Our bodies produce more white blood cells day to day in response to inflammatory insults.

We’ve known about this link between higher white counts and heart attacks since the 1970s, when we found that higher heart attack risk was associated with higher white blood cell counts, higher cholesterol levels, and higher blood pressures, as you can see at 0:53 in my video What Is the Ideal White Blood Cell Count?. This has been found in nearly every study done since then. There are decades of studies involving hundreds of thousands of patients showing dramatically higher mortality rates in those with higher white counts. But why? Why does white blood cell count predict mortality? It may be because it’s a marker of inflammation and oxidation in the body. In fact, it may even be a biomarker for how fast we are aging. It may be more than just an indicator of inflammation—it may also be an active player, contributing directly to disease via a variety of mechanisms, including the actual obstruction of blood flow.

The average diameter of a white blood cell is about seven and a half micrometers, whereas our tiniest vessels are only about five micrometers wide, so the white blood cell has to squish down into a sausage shape in order to squeeze through. When there’s inflammation present, these cells can get sticky. As you can see at 2:20 in my video, a white blood cell may plug up a vessel as it exits a small artery and tries to squeeze into a capillary, slowing down or even momentarily stopping blood flow. And, if it gets stuck there, it can end up releasing all of its internal weaponry, which is normally reserved for microbial invaders, and damage our blood vessels. This may be why in the days leading up to a stroke or heart attack, you may find a spike in the white cell count.

Whether white count is just a marker of inflammation or an active participant, it’s better to be on the low side. How can we reduce the level of inflammation in our body? Staying away from even second-hand smoke can help drop your white count about half of a point. Those who exercise also appear to have an advantage, but you don’t know if it’s cause and effect unless you put it to the test. In one study, two months of Zumba classes—just one or two hours a week—led to about a point and a half drop in white count. In fact, that may be one of the reasons exercise is so protective. But is that just because they lost weight?

Fitness and fatness both appear to play a role. More than half of obese persons with low fitness—51.5 percent—have white counts above 6.6, but those who are more fit or who have less fat are less likely to have counts that high, as you can see at 3:47 in my video. Of course, that could just be because exercisers and leaner individuals are eating healthier, less inflammatory diets. How do we know excess body fat itself increases inflammation, increases the white count? You’d have to find some way to get people to lose weight without changing their diet or exercise habit. How’s that possible? Liposuction. If you suck about a quart of fat out of people, you can significantly drop their white count by about a point. Perhaps this should get us to rethink the so-called normal reference range for white blood cell counts. Indeed, maybe we should revise it downward, like we’ve done for cholesterol and triglycerides.

Until now, we’ve based normal values on people who might be harboring significant background inflammatory disease. But, if we restrict it to those with normal C-reactive protein, another indicator of inflammation, then instead of “normal” being 4.5 to 10, perhaps we should revise it closer to 3 to 9.

Where do the healthiest populations fall, those not suffering from the ravages of chronic inflammatory diseases, like heart disease and common cancers? Populations eating diets centered around whole plant foods average about 5, whereas it was closer to 7 or 8 in the United States at the time. How do we know it isn’t just genetic? As you can see at 5:38 in my video, if you take those living on traditional rural African diets, who have white blood cell counts down around 4 or 5, and move them to Britain, they end up closer to 6, 7, or even 8. Ironically, the researchers thought this was a good thing, referring to the lower white counts on the “uncivilized” diet as neutropenic, meaning having too few white blood cells. They noted that during an infection or pregnancy, when more white cells are needed, the white count came right up to wherever was necessary. So, the bone marrow of those eating traditional plant-based diets had the capacity to create as many white cells as needed but “suffers from understimulation.”

As you can see at 6:26 in my video, similar findings were reported in Western plant eaters, with an apparent stepwise drop in white count as diets got more and more plant based, but could there be non-dietary factors, such as lower smoking rates, in those eating more healthfully? What we need is an interventional trial to put it to the test, and we got one: Just 21 days of removing meat, eggs, dairy, alcohol, and junk affected a significant drop in white count, even in people who started out down at 5.7.

What about patients with rheumatoid arthritis who started out even higher, up around 7? As you can see at 7:03 in my video, there was no change in the control group who didn’t change their diet, but there was a 1.5 point drop within one month on whole food plant-based nutrition. That’s a 20 percent drop. That’s more than the drop-in inflammation one might get quitting a 28-year pack-a-day smoking habit. The most extraordinary drop I’ve seen was in a study of 35 asthmatics. After four months of a whole food plant-based diet, their average white count dropped nearly 60 percent, from around 12 down to 5, though there was no control group nor enough patients to achieve statistical significance.

If white blood cell count is such a clear predictor of mortality and is so inexpensive, reliable, and available, why isn’t it used more often for diagnosis and prognosis? Maybe it’s a little too inexpensive. The industry seems more interested in fancy new risk factors it can bill for.

I touch on the health of the rural Africans I discussed in How Not to Die from Heart Disease.


For more on fighting inflammation, see:

In health,

Michael Greger, M.D.

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

No Purveyor of Unhealthy Products Wants the Public to Know the Truth

In 2011, Denmark introduced the world’s first tax on saturated fat. “After only 15 months, however, the fat tax was abolished,” due to massive pressure from farming and food company interests. “Public health advocates are weak in tackling the issues of corporate power…A well-used approach for alcohol, tobacco, and, more recently, food-related corporate interests is to shift the focus away from health. This involves reframing a fat or soft drinks tax as an issue of consumer rights and a debate over the role of the state in ‘nannying’ or restricting people’s choices.” I discuss this in my video The Food Industry Wants the Public Confused About Nutrition.

“The ‘Nanny State’ is a term that is usually used in a pejorative way to discourage governments from introducing legislation or regulation that might undermine the power or actions of industry or individuals…Public health advocacy work is regularly undermined by the ‘Nanny State’ phrase.” But those complaining about the governmental manipulation of people’s choices hypocritically tend to be fine with corporations doing the same thing. One could argue that “public health is being undermined by the ‘Nanny Industry’…[that] uses fear of government regulation to maintain its own dominance, to maintain its profits and to do so at a significant financial and social cost to the community and to public health.”

The tobacco industry offers the classic example, touting “personal responsibility,” which has a certain philosophical appeal. As long as people understand the risks, they should be free to do whatever they want with their bodies. Now, some argue that risk-taking affects others, but if you have the right to put your own life at risk, shouldn’t you have the right to aggrieve your parents, widow your spouse, and orphan your children? Then, there’s the social cost argument. People’s bad decisions can cost the society as a whole, whose tax dollars may have to care for them. “The independent, individualist motorcyclist, helmetless and free on the open road, becomes the most dependent of individuals in the spinal injury ward.”

But, for the sake of argument, let’s forget these spillover effects, the so-called externalities. If someone understands the hazards, shouldn’t they be able to do whatever they want? Well, “first, it assumes individuals can access accurate and balanced information relevant to their decisions…but deliberate industry interference has often created situations where consumers have access only to incomplete and inaccurate information…For decades, tobacco companies successfully suppressed or undermined scientific evidence of smoking’s dangers and down played the public health concerns to which this information gave rise.” Don’t worry your little head, said the nanny companies. “Analyses of documents…have revealed decades of deception and manipulation by the tobacco industry, and confirmed deliberate targeting of…children.” Indeed, it has “marketed and sold [its] lethal products with zeal…and without regard for the human tragedy….”

“The tobacco industry’s deliberate strategy of challenging scientific evidence undermines smokers’ ability to understand the harms smoking poses” and, as such, undermines the whole concept that smoking is a fully informed choice. “Tobacco companies have denied smokers truthful information…yet held smokers [accountable] for incurring diseases that will cause half of them to die prematurely. In contexts such as these, government intervention is vital to protect consumers from predatory industries….”

Is the food industry any different? “The public is bombarded with information and it is hard to tell which is true, which is false and which is merely exaggerated. Foods are sold without clarity about the nutritional content or harmful effects.” Remember how the food industry spent a billion dollars making sure the easy-to-understand traffic-light labeling system on food, which you can see at 4:26 in my video, never saw the light of day and was replaced by indecipherable labeling? That’s ten times more money than the drug industry spends on lobbying in the United States. It’s in the food industry’s interest to have the public confused about nutrition.

How confused are we about nutrition? “Head Start teachers are responsible for providing nutrition education to over 1 million low-income children annually…” When 181 Head Start teachers were put to the test, only about 4 out of the 181 answered at least four of the five nutrition knowledge questions correctly. Most, for example, could not correctly answer the question, “What has the most calories: protein, carbohydrate, or fat?” Not a single teacher could answer all five nutrition questions correctly. While they valued nutrition education, 54 percent “agreed that it was hard to know which nutrition information to believe,” and the food industry wants to keep it that way. A quarter of the teachers did not consume any fruits or vegetables the previous day, though half did have french fries and soda, and a quarter consumed fried meat the day before. Not surprisingly, 55 percent of the teachers were not just overweight but obese.

When even the teachers are confused, something must be done. No purveyor of unhealthy products wants the public to know the truth. “An interesting example comes from the US ‘Fairness Doctrine’ and the tobacco advertising experience of the 1960s. Before tobacco advertising was banned from television in the US, a court ruling in 1967 required that tobacco companies funded one health ad about smoking for every four tobacco TV advertisements they placed. Rather than face this corrective advertising, the tobacco industry took their own advertising off television.” They knew they couldn’t compete with the truth. Just “the threat of corrective advertising even on a one-to-four basis was sufficient to make the tobacco companies withdraw their own advertising.” They needed to keep the public in the dark.

The trans fat story is an excellent example of this. For more on that, see my videos Controversy Over the Trans Fat Ban and Banning Trans Fat in Processed Foods but Not Animal Fat.

Isn’t the Fairness Doctrine example amazing? Just goes to show how powerful the truth can be. If you want to support my efforts to spread evidence-based nutrition, you can donate to our 501c3 nonprofit here. You may also want to support Balanced, an ally organization NutritionFacts.org helped launch to put this evidence into practice.


More tobacco industry parallels can be found in Big Food Using the Tobacco Industry Playbook, American Medical Association Complicity with Big Tobacco, and How Smoking in 1959 Is Like Eating in 2016.

Want to know more about that saturated fat tax idea? See Would Taxing Unhealthy Foods Improve Public Health?.

Also check:

In health,

Michael Greger, M.D.

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

Rural Hospital Execs Can Beat COVID-19 By Shifting From Reactive to Proactive Care

The COVID-19 virus is ravaging the planet at a scale not seen since the infamous Spanish Flu of the early 1900s, inflicting immense devastation as the U.S. loses more than 200,000 lives and counting. According to CDC statistics, 94% of patient mortalities associated with COVID-19 were simultaneously suffering from preexisting conditions, leaving a mere 6% of victims with COVID-19 as their sole cause of death. However, while immediate prospects for a mass vaccine might not be until 2021, there is some hope among rural hospital health information technology consultants where the pandemic has hit the hardest. 

The fact that four in ten U.S. adults have two or more chronic conditions indicates that our most vulnerable members of the population are also the ones at the greatest risk of succumbing to the pandemic. From consultants laboring alongside healthcare administrators and providers, all must pay close attention to patients harboring 1 of 13 chronic conditions believed to play major roles in COVID-19 mortality, particularly chronic kidney disease, hypertension, diabetes, and COPD.

Vulnerable rural populations must be supervised due to their unique challenges. The CDC indicates 80% of older adults in remote regions have at least one chronic disease with 77% having at least two chronic diseases, significantly increasing COVID-19 mortality rates compared to their urban counterparts.

Health behaviors also play a role in rural patients who have decreased access to healthy food and physical activity while simultaneously suffering high incidences of smoking. These lifestyle choices compound with one another, leading to increased obesity, hypertension, and many other chronic illnesses. Overall, rural patients that fall ill to COVID-19 are more likely to suffer worsened prognosis compared to urban hubs, a problem only bolstered by their inability to properly access healthcare. 

Virus Helping Push New Technologies

COVID-19 has shown the cracks in the U.S. healthcare technology system that must be addressed for the future. As the pandemic unfolds, it’s worth noting that not all lasting effects will be negative. Just as the adoption of the Affordable Care Act a decade ago spurred healthcare organizations to digitize their records, the COVID-19 pandemic is accelerating overdue technological shifts crucial to providing better care.

Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that connect patients with both urgent and preventive care without their having to leave home. Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that use video to connect patients with both urgent and preventive care without their having to leave home.

Even if COVID-19 were to fade away on its own, the next pandemic may not. Furthermore, seasonal influenza serves as a reminder that healthcare is not a skirmish, but a prolonged war against disease. Rather than doom future generations to suffer the same plight our generation has with the pandemic, now is the time to develop innovative IT strategies that focus on protecting our most vulnerable citizens by leveraging existing healthcare initiatives to focus on proactive responses instead of reactive responses.

On the Right Road

While some of the most vulnerable people are the elderly, rural residents, and the poor, the good news for them is that CMS has long advocated the use of preventive care initiatives such as Chronic Care Management (CCM) and Remote Physiologic Monitoring (RPM) to track these geriatric patients. To encourage innovation in this sector, CMS preventive care initiatives provide generous financial incentives to healthcare providers willing to shift from conventional reactive care strategies to a more proactive approach focused on prevention and protection. This should attract rural hospital CEOs who have been struggling even more than usual because of the virus.

These factors led to the creation of numerous patient CCM programs, allowing healthcare executives and providers to remotely track the health status of geriatric patients suffering from numerous chronic conditions. The tracking is at a rate and scope unseen previously through the use of electronic media. Interestingly enough, the patients already being monitored by CCM programs overlap heavily with populations susceptible to COVID-19. To adapt existing infrastructure for the COVID-19 pandemic is a relatively simple task for hospital CIOs. 

As noted earlier, one growing CCM program that could be retrofitted to deal with the COVID-19 pandemic are the use of telehealth services in rural locations. Prior to the pandemic, telehealth services were one of the many strategies advocated by the CDC to address the overtaxed healthcare systems found in rural locations. 

Better Access, Funding and User Experience for Telehealth

Today, telehealth is about creating digital touchpoints when no other contact is possible or safe. It offers the potential to expand care to people in remote areas who might have limited or nonexistent access, and it could let other health workers handle patient screening and post-care follow-up when a local facility is overwhelmed. As a study published last year in The American Journal of Emergency Medicine affirms, virtual care can cut the cost of healthcare delivery and relieve strain on busy clinicians.

Telehealth has also gotten a boost from the $2 trillion CARES Act stimulus fund, which provides $130 billion to healthcare organizations fighting the pandemic. The effort also makes it easier for providers to bill for remote services.

The reason for the CDC and hospital administrators’ interest in telehealth was that telehealth meetings could outright remove the need for patients to travel and allow healthcare providers to monitor patients at a fraction of the time. By simply coupling existing telehealth services with CMS preventive care initiatives focused on COVID-19, rural healthcare providers could detect early warning signs of COVID-19. 

Integration Key to Preemptive Detection

This integration at a faster and far greater scale could mean much greater preemptive virus detection through routine telehealth meetings. The effect of telehealth would be twofold on hospitals serving rural and urban health communities. It could slow the spread of COVID-19 to a crawl due to decreased patient travel and improved patient prognosis through early and intensive treatment for vulnerable populations with two or more chronic health conditions.

This integrated combination would shift standard reactive care to patient infections to a new monitoring methodology that proactively seeks out infected patients and rapidly administers treatment to those most at risk of mortality. This new combination of preventive care and telehealth services would not only improve patient and community health but would relieve the financial burden incurred from the pandemic due to the existing CMS initiatives subsidizing such undertakings.

In conclusion, preventative care targeting patients with pre-conditions in rural locations are severely lacking in the context of the COVID-19 pandemic. By leveraging CMS preventive care initiatives along with telehealth services, healthcare providers can achieve the following core objectives.

First, there are financial incentives with preventive care services that will relieve the burden on healthcare systems. Second, COVID-19 vulnerable populations will receive the attention and focus from healthcare providers that they deserve to slow the spread through the use of early detection systems and alerts to their primary health provider. Third, by combining with telehealth service, healthcare providers can efficiently and effectively reach out to rural populations that were once inaccessible to standard healthcare practices.

How to Treat Polycystic Ovary Syndrome (PCOS) with Diet

Given the role that oxidant free radicals are thought to play in aging and disease, one reason fruits and vegetables may be so good for us is that they contain antioxidant compounds. As you can see at 0:20 in my video Benefits of Marjoram for Polycystic Ovary Syndrome (PCOS), different vegetables and herbs have different antioxidant content. When making a salad, for example, spinach, arugula, or red leaf lettuce may provide twice the antioxidants as butterhead lettuce, and choosing purple cabbage over green, or red onions over white can also boost the salad’s antioxidant power.

Fresh herbs are so powerful that even a small amount may double or even quadruple the antioxidant power of the entire meal. For instance, as you can see at 0:50 in my video, the total antioxidants in a simple salad of lettuce and tomato jump up by adding just a tablespoon of lemon balm leaves or half a tablespoon of oregano or mint. Adding marjoram, thyme, or sage not only adds great flavor to the salad, but effectively quadruples the antioxidant content at the same time, and adding a little fresh garlic or ginger to the dressing ups the antioxidant power even more.

Herbs are so antioxidant-rich that researchers decided to see if they might be able to reduce the DNA-damaging effects of radiation. Radioactive iodine is sometimes given to people with overactive thyroid glands or thyroid cancer to destroy part of the gland or take care of any remaining tumor cells after surgery. For days after the isotope injection, patients become so radioactive they are advised not to kiss or sleep close to anyone, including their pets, and if they breathe on a phone, they’re advised to wipe it “carefully” or cover it “with an easily removed plastic bag.” Other recommendations include “avoid[ing] splatter of radioactive urine,” not going near your kids, and basically just staying away from others as much as possible.

The treatment can be very effective, but all that radiation exposure appears to increase the risk of developing new cancers later on. In order to prevent the DNA damage associated with this treatment, researchers tested the ability of oregano to protect chromosomes of human blood cells in vitro from exposure to radioactive iodine. As you can see at 2:25 in my video, at baseline, about 1 in 100 of our blood cells show evidence of chromosomal damage. If radioactive iodine is added, though, it’s more like 1 in 8. What happens if, in addition to the radiation, increasing amounts of oregano extract are added? Chromosome damage is reduced by as much 70 percent. Researchers concluded that oregano extract “significantly protects” against DNA damage induced by the radioactive iodine in white blood cells. This was all done outside the body, though, which the researchers justified by saying it wouldn’t be particularly ethical to irradiate people for experimental research. True, but millions of people have been irradiated for treatment, and researchers could have studied them or, at the very least, they could have just had people eat the oregano and then irradiate their blood in vitro to model the amount of oregano compounds that actually make it into the bloodstream.

Other in vitro studies on oregano are similarly unsatisfying. In a comparison of the effects of various spice extracts, including bay leaves, fennel, lavender, oregano, paprika, parsley, rosemary, and thyme, oregano beat out all but bay leaves in its ability to suppress cervical cancer cell growth in vitro while leaving normal cells alone. But people tend to use oregano orally—that is, they typically eat it—so the relevance of these results are not clear.

Similarly, marjoram, an herb closely related to oregano, can suppress the growth of individual breast cancer cells in a petri dish, as you can see at 3:53 in my video, and even effectively whole human breast tumors grown in chicken eggs, which is something I’ve never seen before. Are there any clinical trials on oregano-family herbs on actual people? The only such clinical, randomized, control study I could find was a study on how marjoram tea affects the hormonal profile of women with polycystic ovary syndrome (PCOS). The most common cause of female fertility problems, PCOS affects up to one in eight young women and is characterized by excessive male hormones, resulting in excess body or facial hair, menstrual irregularities, and cysts in one’s ovaries that show up on ultrasounds.

Evidently, traditional medicine practitioners reported marjoram tea was beneficial for PCOS, but it had never been put to the test…until now. Drinking two daily cups of marjoram tea versus a placebo tea for one month did seem to beneficially affect the subjects’ hormonal profiles, which seems to offer credence to the claims of the traditional medicine practitioners. However, the study didn’t last long enough to confirm that actual symptoms improved as well, which is really what we care about.

Is there anything that’s been shown to help? Well, reducing one’s intake of dietary glycotoxins may help prevent and treat the disease. Over the past 2 decades there has been increasing evidence supporting an important contribution from food-derived advanced glycation end products (AGEs)…[to] increased oxidative stress and inflammation, processes that play a major role in the causation of chronic diseases,” potentially including polycystic ovary syndrome (PCOS). Women with PCOS tend to have nearly twice the circulating AGE levels in their bloodstream, as you can see at 0:33 in my video Best Foods for Polycystic Ovary Syndrome (PCOS). 

PCOS may be the most common hormonal abnormality among young women in the United States and is a common cause of infertility, menstrual dysfunction, and excess facial and body hair. The prevalence of obesity is also higher in women with PCOS. Since the highest AGE levels are found in broiled, grilled, fried, and roasted foods of “mostly animal origin,” is it possible that this causal chain starts with a bad diet? For instance, maybe eating lots of fried chicken leads to obesity, which in turn leads to PCOS. In that case, perhaps what we eat is only indirectly related to PCOS through weight gain. No, because the same link between high AGE levels and PCOS was found in lean women as well.

“As chronic inflammation and increased oxidative stress have been incriminated in the pathophysiology [or disease process] of PCOS, the role of AGEs as inflammatory and oxidant mediators, may be linked with the metabolic and reproductive abnormalities of the syndrome.” Further, the buildup of AGE inside polycystic ovaries themselves suggests a potential role of AGEs contributing to the actual disease process, beyond just some of its consequences.

RAGE is highly expressed in ovarian tissues. The receptor in the body for these advanced glycation end products, the “R” in RAGE, is concentrated in the ovaries, which may be particularly sensitive to its effect. So, AGEs might indeed be contributing to the cause of PCOS and infertility.

Does this mean we should just cut down on AGE-rich foods, such as meat, cheese, and eggs? Or hey, why not come up with drugs that block AGE absorption? We know AGEs have been implicated in the development of many chronic diseases. Specifically, food-derived AGEs play an important role because diet is a major source of these pro-inflammatory AGEs. Indeed, cutting down on these dietary glycotoxins reduces the inflammatory response, but the “argument is often made that stewed chicken would be less tasty than fried chicken…” Why not have your KFC and eat it, too? Just take an AGE-absorption blocking drug every time you eat it to reduce the absorption of the toxins. What’s more, it actually lowers AGE blood levels. This oral absorbent drug, AST-120, is just a preparation of activated charcoal, like what’s used for drug overdoses and when people are poisoned. I’m sure if you took some ipecac with your KFC, your levels would go down, too.

There’s another way to reduce absorption of AGEs, and that’s by reducing your intake in the first place. It’s simple, safe, and feasible. The first step is to stop smoking. The glycotoxins in cigarette smoke may contribute to increased heart disease and cancer in smokers. Then, decrease your intake of high-AGE foods, increase your intake of foods that may help pull AGEs out of your system, like mushrooms, and eat foods high in antioxidants, like berries, herbs, and spices. “Dietary AGE intake can be easily decreased by simply changing the method of cooking from a high dry heat application to a low heat and high humidity…” In other words, move away from broiling, searing, and frying to more stewing, steaming, and boiling.

What we eat, however, may be more important than how we cook it. At 4:00 in my video, I include a table showing the amounts of AGEs in various foods. For instance, boiled chicken contains less than half the glycotoxins of roasted chicken, but even deep-fried potatoes have less than boiled meat. We can also eat foods raw, which doesn’t work as well as for blood pudding, but raw nuts and nut butters may contain about 30 times less glycotoxins than roasted, and we can avoid high-AGE processed foods, like puffed, shredded, and flaked breakfast cereals.

Why does it matter? Because study after study has shown that switching to a low-AGE diet can lower the inflammation within our bodies. Even just a single meal high in AGEs can profoundly impair our arterial function within just two hours of consumption. At 4:54 in my video, you can see the difference between a meal of fried or broiled chicken breast and veggies compared with steamed or boiled chicken breast and veggies. Same ingredients, just different cooking methods. Even a steamed or boiled chicken meal can still impair arterial function, but significantly less than fried or broiled.

“Interestingly, the amount of AGEs administered [to subjects] during the HAGE [high-AGE] intervention was similar to the average estimated daily intake by the general population,” who typically follow the standard American diet. This is why we can decrease inflammation in people by putting them on a low-AGE diet, yet an increase in inflammation is less apparent when subjects switch from their regular diet to one high in AGEs. Indeed, they were already eating a high-AGE diet with so many of these glycotoxins.

Do we have evidence that reducing AGE intake actually helps with PCOS? Yes. Within just two months, researchers found differences from subjects’ baseline diets switched to a high-AGE diet and then to a low-AGE diet, with parallel changes in insulin sensitivity, oxidative stress, and hormonal status, as seen at 5:54 in my video. The take-home learning? Those with PCOS may want to try a low-AGE diet, which, in the study, meant restricting meat to once a week and eating it only boiled, poached, stewed, or steamed, as well as cutting out fast-food-type fare and soda.

What if instead of eating steamed chicken, we ate no meat at all? Rather than measuring blood levels, which vary with each meal, we can measure the level of glycotoxins stuck in our body tissues over time with a high-tech device that measures the amount of light our skin gives off because AGEs are fluorescent. And, not surprisingly, this turns out to be a strong predictor of overall mortality. So, the lower our levels, the better. The “one factor that was consistently associated with reduced [skin fluorescence]: a vegetarian diet.” This “suggests that a vegetarian diet may reduce exposure to preformed dietary AGE…potentially reduc[ing] tissue AGE,” as well as chronic disease risk


What’s so great about antioxidants? See my videos:

Just how many antioxidants do we need? Check out:

For a few simple tips on how to quickly boost the antioxidant content of your food with herbs and spices, see my video Antioxidants in a Pinch.

I touched on the benefits of spearmint tea for PCOS in Enhancing Athletic Performance with Peppermint. Another sorely under-recognized gynecological issue is endometriosis, which I discuss in How to Treat Endometriosis with Seaweed.

Because of AGEs, I no longer toast nuts or buy roasted nut butters, which is disappointing because I really enjoy those flavors so much more than untoasted and unroasted nuts. But, as Dr. McDougall likes to say, nothing tastes as good as healthy feels. For more on why it’s important to minimize our exposure to these toxic compounds, see:

In health,
Michael Greger, M.D.

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

 

 

Virta Expands Offerings to Treat New Group of Chronic Illnesses

Virta Expands Offerings to Treat New Group of Chronic Illnesses

What You Should Know:

– Virta is expanding its suite of treatment options to
include prediabetes reversal, obesity reversal, and type 2 diabetes management.

– By making this crucial expansion, Virta can scale its
treatment to support the tens of millions of additional patients with
prediabetes and obesity, as provide an on-ramp to reversal for those with T2D
that aren’t yet ready to reverse. 


Virta Health, the
leader in type 2 diabetes reversal, today introduced the addition of new
services including prediabetes reversal, obesity treatment, and provider-led
management for type 2 diabetes. The expansion provides payers and covered
beneficiaries a single, full-service virtual clinic that offers
industry-leading outcomes for the most critical needs in metabolic health.

Virta’s fully-virtual, high-touch model demonstrates hope
for change, and stands in stark contrast to approaches that only slow the
diabetes downward spiral, as opposed to reversing it. Virta provides
individualized guidance from medical providers and behavioral specialists,
whenever and wherever it is needed. Patients interact with their dedicated
clinical team often multiple times per day. This novel telehealth
approach—called Continuous Remote Care—ensures successful adoption of Virta’s
individualized medical nutrition therapies and long-lasting results.


Why It Matters

Nearly half of adults in the United States suffer from obesity,
prediabetes, or type 2 diabetes. Thirty people die per hour of diabetes-related causes. The
economic burden continues to grow, and people with diabetes incur nearly $17,000
in medical expenses
per year. They are also at high risk for severe illness
from COVID-19, and risk of dying from the disease is twice as high compared to
those without diabetes.

Obesity and prediabetes patients will benefit from the same
treatment that delivers the sustained type 2 diabetes reversal outcomes in Virta’s
clinical trial and commercially-covered population. Patients receiving type 2
diabetes management will receive support from a provider-led care team, with
personalized guidance and an option for a seamless transition to Virta’s
reversal treatment. All patients will receive individualized care via Virta’s
provider-led Continuous Remote Care platform.

Virta Type 2 Diabetes Reversal Results

Virta’s results in type 2 diabetes reversal have fueled continued triple-digit year-over-year growth for the company while creating strong demand to bring Virta’s evidence-based approach to other metabolic conditions. In Virta’s peer-reviewed clinical trial results, 60% of people at one-year reverse type 2 diabetes, and 94% reduce insulin use or eliminate it altogether.

Additionally, patients completing one year of the Virta
Treatment experience 14% weight loss. This figure exceeds the goal of the
National Diabetes Prevention Program and the FDA benchmark for weight loss
drugs by nearly 200%.

“This expansion provides our commercial partners and patients with the transformational outcomes they’ve come to expect from Virta, but don’t receive from other solutions on the market,” said Sami Inkinen, CEO & co-founder of Virta Health. “We can now meet every patient wherever they are on their metabolic health journey, while uniquely offering a path to reversing their chronic disease.”

Accounting for the Social Determinants of Health During the COVID-19 Pandemic

Accounting for the Social Determinants of Health During the COVID-19 Pandemic
Andy Aroditis, CEO, NextGate

The COVID-19 pandemic is not just a medical crisis.  Since the highly contagious disease hit American shores in early 2020, the virus has dramatically changed all sectors of society, negatively impacting everything from food supply chains and sporting events to the nation’s mental and behavioral health.

For some people, work-from-home plans and limited access to entertainment are manageable obstacles.  For others, the shuttered schools, lost wages, and social isolation spell disaster – especially for individuals already living with socioeconomic challenges.

The social determinants of health have always been important for understanding why some populations are more susceptible to increased rates of chronic conditions, reduced healthcare access, and shorter lifespans.  COVID-19 is throwing the issue into high relief.

Now more than ever, healthcare providers need to gain full visibility into their populations and the non-clinical challenges they face in order to help individuals maintain their health and keep their communities as safe as possible during the ongoing pandemic.

Exploring correlations between socioeconomic circumstances and COVID-19 vulnerability

Clinicians and researchers have worked quickly to identify patterns in the spread of COVID-19.  Early results have emphasized the danger posed by advanced age and preexisting chronic conditions such as obesity, diabetes, and heart disease. 

Further, data from the Johns Hopkins University and American Community Survey indicates that the infection rate in predominantly black counties is three times higher than in mostly white counties. The death rate is six-fold higher.

Data from the Centers for Medicare and Medicaid Services (CMS) confirms the trend: black Medicare beneficiaries are hospitalized at a rate of 465 per 100,000 compared to just 123 per 100,000 white beneficiaries. Hispanic Medicare beneficiaries had 258 hospitalizations per 100,000, more than double the white population’s hospitalization rate.

Researchers suggest that the social determinants of health may be largely responsible for these disconnects in infection and mortality rates.  Racial, ethnic, and economic factors are strongly correlated with increased health concerns, including longstanding disparities in access to care, higher rates of underlying chronic conditions, and differences in health literacy and patient education.

Leveraging data-driven tools to identify vulnerable patients

Healthcare providers will need to take a proactive role in identifying which of their patients may be at enhanced risk of contracting the virus and experiencing worse outcomes from the disease.  

They will also need to ensure that person gets adequate treatment and participate in contact tracing efforts after a positive test.  Lastly, providers will have to ensure their public health reporting data is accurate to inform local and regional efforts to contain the disease.

The process begins by developing confidence in the identity of each individual under the provider’s care.  Healthcare organizations often struggle with unifying multiple electronic health record (EHR) systems and other health IT infrastructure, resulting in medical records that are incomplete, inaccurately duplicated, or incorrectly merged.

Access to current and complete medical histories is key for highlighting at-risk patients.  An enterprise master patient index (EMPI) can provide the underlying technical foundation for initiating this type of population health management.  

EMPIs help organizations create and manage reliable unique patient identifiers to ensure that records are always associated with the correct individual as they move throughout the healthcare system.

When paired with claims data feeds, health information exchange (HIE) results, and interoperability connections with other healthcare partners, EMPIs can bring a patient’s complete healthcare status into focus.

This approach ensures that providers stay informed about past and present clinical issues and service utilization rates.  It can also support a deeper dive into the social determinants of health.

Combining EHR data with standardized data about socioeconomic needs can help providers develop more comprehensive and detailed portraits about their patients’ holistic health status.  

By including this information in EHRs and population health management tools, providers can develop condition-specific registries to guide outreach activities.  Providers can deploy improved care management strategies, close gaps in care, and connect individuals with the resources they need to stay healthy.

Healthcare organizations can acquire socio-economic data about their communities in a variety of ways, including integrating public data sources into their population health management tools and collecting individualized data using standardized questionnaires.

Once providers start to understand their patients’ non-clinical challenges, including the ability to avoid situations that may expose them to COVID-19, they can begin to prioritize patients for outreach and develop personalized care plans.

Conducting effective outreach and interventions for high-needs patients

COVID-19 has taken a staggering economic toll on many families, including those who may have been financially secure before the pandemic.  Routine healthcare, prescription medications, and even some urgent healthcare needs are often the first to fall by the wayside when finances get tight. 

Healthcare providers have gotten creative about staying connected to patients through telehealth, drive-in consults, and other contactless strategies.  But they must also ensure that their vulnerable patients are aware of these options – and that they are taking advantage of them.

Contacting a large number of patients can be challenging since phone numbers, emails, and home addresses change frequently and are prone to data entry errors during intake. Organizations with EMPIs can leverage their tools to ensure contact information is up to date, accurate, and associated with the correct individual.

Care managers should prioritize outreach to patients with complex medical histories and known clinical risks for vulnerability to COVID-19.  These conversations are a prime opportunity to collect social determinants of health information or refresh existing data profiles.

Looking to the future of healthcare in a COVID-19 world

Combining technology-driven strategies with targeted outreach will be essential for healthcare organizations aiming to provide holistic support for their populations during – and after – the COVID-19 pandemic.

By developing certainty about patient identities and synthesizing that information with data about the social determinants of health, providers can efficiently and effectively connect with their patients to offer much-needed resources.

Taking a proactive approach to addressing the social determinants of health during the outbreak will help providers maintain relationships with high-needs patients while building new connections with those facing unanticipated challenges.

With a combination of population health management strategies and innovative technology tools, healthcare providers and public health officials can begin to view the social determinants of health as a fundamental component of the fight against COVID-19


Andy Aroditis, is CEO of NextGate, the global leader in healthcare enterprise identification.

4 Ways Businesses Will Adapt Their Healthcare Landscape

 Four ways businesses will adapt their healthcare landscape
Dr. Donald Brown, CEO and founder of LifeOmic

The coronavirus pandemic has affected every aspect of our lives, from how we work to how we get our health care. The crisis has put the creativity of many small businesses to the test after being forced to move operations online once social distancing became the norm. As economies reopen, many aspects of our life that changed in response to the virus will likely return to the way they were.

However,  we have the opportunity to emerge stronger from this crisis if the salient shortcomings from our economic system are addressed. Regarding health care, the virus has exposed deep flaws in the way services are provided and has shown us how businesses and people can be better prepared when the next pandemic hits.

1. The way companies insure their workers will change 

One trend we will likely see occurring is the decentralization of healthcare. Before the pandemic, there had been growing signs of American businesses becoming tired of a rigged system where costs to keep employees insured often spiraled out of control. One example of this dissatisfaction was the partnership between Amazon, JP Morgan, and Berkshire Hathaway, who more than 2 years ago announced the formation of their own joint venture to provide healthcare coverage to their employees. 

The pandemic is going to introduce a long term change in healthcare and especially the relationship between companies and healthcare providers. More companies will make the switch to self-funded insurance and assume the healthcare expenses of their employees while being reimbursed for claims that exceed a certain amount through stop-loss insurance. Businesses will also start to hire their own physicians to offer services to their employees directly to reduce their dependence on the healthcare system.

Given our early struggle to increase our virus testing capabilities, companies may take steps to avoid waiting for the federal or local governments to step in during a pandemic.  Businesses may start partnering with local labs to design their own diagnostic tools and serological tests which would allow them to react more quickly and successfully to an outbreak. Businesses will value knowing which of their employees have been exposed, how many might be immune, and which might be more susceptible to infection based on parameters such as BMI or blood pressure readings.  

2. Businesses and people will take charge of their own health

Although the United States spends close to 20% of its GDP on healthcare, diseases that put people at higher risk for severe COVID-19 illness, including obesity, diabetes, and heart disease, are still prevalent in the population. 

This crisis exposed the need for businesses to help employees maintain a healthy lifestyle in order to protect themselves and their jobs. Businesses may start promoting behaviors proven to strengthen the immune system and improve overall health, including taking active breaks at work to increase physical activity or encouraging healthy eating by offering healthy food choices. Companies may also start to offer testing equipment in office locations to help employees keep track of their health. Businesses may start investing in mini-physiology lab stations that include equipment to measure blood pressure, lung function, and heart health. They may also invest in blood tests that measure important biomarkers that allow employees to make better health choices that reduce their risk of disease.

3. Telehealth solutions will become widely available 

The pandemic has amplified the need for a technology-driven transformation of healthcare. Companies can invest in built-in telemedicine capabilities so that employees have an easy way to get online care when they need it.  The regulatory barriers that have delayed widespread use of telehealth should start to disappear. Hospitals can benefit from offering these services and implementing them now will better equip them for future crises. Doctors can remotely provide care to vulnerable patients so they don’t have to be exposed by going to a hospital, and physicians and nurses who have to quarantine themselves can still see patients through telehealth means so that hospitals don’t have to face staff shortages when they believe they might have been exposed. 

4. Artificial Intelligence will change everything

The use of AI in healthcare will combine with the trends described above to completely disrupt healthcare, especially in terms of corporate wellness. Skyrocketing costs and disillusionment with the governmental response to COVID-19 will convince organizations of all sizes to take more direct responsibility for the health and wellness of their employees. Cloud-based systems can aggregate everything from electronic medical records to whole-genome sequences. Fitness trackers and other inexpensive devices can add real-time physiologic data that can be tracked over time.

All this data would be overwhelming for human physicians, but it’s perfect for AI-based systems. For example, an AI can continuously calculate the probabilities of dozens of diseases for each employee and generate automatic recommendations when a probability exceeds a certain threshold. Such systems can also give employees personalized advice to help them reduce such probabilities and return to a healthy state. The advice can range from lifestyle changes (nutrition, exercise, etc.) to supplements or further testing. These AI-based systems will grow in sophistication over time to rival – and even exceed – the capabilities of human physicians.

Summary

The American healthcare system was clearly dysfunctional even before COVID-19. However, the pandemic has put the flaws into sharp relief and will almost certainly push companies and other organizations to seek better solutions. Those solutions will leverage many recent developments including:

  • Cloud platforms with nearly limitless storage and compute capacity
  • Engaging mobile apps
  • Direct-to-consumer molecular and genetic testing
  • Fitness trackers and other medical devices
  • Artificial intelligence

Together, these trends will usher in lasting change that will transform the healthcare landscape for all businesses.


About Dr. Don Brown

Don is a serial software entrepreneur (founder of 4 companies), life-long learner (4 degrees: a bachelor’s in physics, a master’s in computer science +  biotechnology and an MD) and philanthropist (donated  $30 million for the establishment of the Brown Immunotherapy Center at the Indiana University School of Medicine).  Prior to LifeOmic, Don founded Software Artistry which became the first software company in Indiana ever to go public and was later acquired by IBM for $200 million. Don then founded and served as CEO of Interactive Intelligence which went public and was acquired by Genesys Telecommunications Laboratories in 2016 for $1.4 billion.

FDA, Syapse Expand Research to Generate Real-World Data Related to COVID-19 and Cancer

FDA, Syapse Expand Research to Generate Real-World Data Related to COVID-19 and Cancer

What You Should Know:

The FDA and Syapse announce research collaboration expansion
to address urgent public health challenges including supporting FDA’s goal of
rapid understanding of COVID-19.

As part of the research, Syapse is partnering with FDA’s
Oncology Center of Excellence to investigate methods to derive RWD from
multiple sources including electronic health records, registries and molecular
data


Syapse, a real-world
evidence company accelerating the delivery of precision medicine through the
Syapse Learning Health NetworkTM, and the U.S.
Food and Drug Administration (FDA) Oncology Center of Excellence (OCE)
have
expanded an existing multi-year Research Collaboration Agreement (RCA) focused
on the use of real-world data (RWD) to support clinical and regulatory
decision-making.

Research Collaboration Details

Through a multi-year collaboration, Syapse is partnering with
FDA’s Oncology Center of Excellence to:

– Investigate methods to derive RWD from multiple sources
including electronic health records, registries and molecular data;

– Enhance understanding of how patients respond to therapies
outside of clinical trials to improve care and outcomes; and

– Understand the impact of COVID-19 on
cancer care.

Based on their collaboration efforts, Syapse and
the FDA have highlighted results from rapid analyses of real-world
data involving cancer patients with COVID-19. Recently, the FDA’s OCE
and Syapse presented data at a virtual medical meeting of an analysis
of more than 200,000 health records of people living with cancer across two
major health systems. Data suggest that patients with cancer who also had
COVID-19, compared to those who did not have COVID-19, are more likely to have
other health conditions such as kidney failure, obesity and heart disease, in
addition to increased rates of hospitalization and invasive mechanical
ventilation, along with 16 times greater risk of death. Syapse and
its Learning Health Network collaborators presented these findings at the AACR
Virtual Meeting on COVID-19 and Cancer on July 22, 2020. The full presentation
can be found on the Syapse website.

Thomas Brown, MD, Syapse’s chief medical officer, stated, “Understanding how a patient’s medical history influences their treatment outcomes in a real-world setting is critical for clinicians, researchers and regulatory agencies to appropriately weigh the risk-benefit profile of a drug for a given patient.”

Syapse’s global network of healthcare providers shares
real-world data to support clinical decisions and foster collaborations among
participants. Healthcare providers, including doctors and nurses, share and
learn which cancer treatments produced better real-world outcomes in clinically
and molecularly similar patients. 

Epidemia de obesidad en los Estados Unidos amenaza la eficacia de una vacuna contra COVID

Para un mundo paralizado por el coronavirus, la salvación depende de una vacuna.

Pero en los Estados Unidos, en donde al menos 4,6 millones de personas se han infectado y casi 155,000 han muerto, la promesa de esa vacuna se ve obstaculizada por otra epidemia anterior a COVID-19: la de la obesidad.

Los científicos saben que las vacunas diseñadas para proteger al público de la gripe, la hepatitis B, el tétanos y la rabia pueden ser menos efectivas en adultos obesos que en la población general, dejándolos más vulnerables a infecciones y enfermedades.

Agregan que hay pocas razones para creer que será diferente con una vacuna contra COVID-19.

“¿Tendremos el año que viene una vacuna para COVID adaptada a los obesos? Seguro que no”, dijo Raz Shaikh, profesor asociado de Nutrición en la Universidad de Carolina del Norte-Chapel Hill.

“¿La vacuna funcionará en personas obesas? Nuestra predicción es que no”.

Más de 107 millones de adultos estadounidenses son obesos, y su capacidad para volver de manera segura al trabajo, cuidar a sus familias y reanudar la vida diaria podría verse afectada si la vacuna contra el coronavirus les proporciona una inmunidad débil.

En marzo, al comienzo de la pandemia mundial, un estudio de China que pasó inadvertido descubrió que los pacientes de ese país ​con COVID-19 que pesaban más tenían más probabilidades de morir que los más delgados, un pronóstico peligroso para los Estados Unidos, cuya población se encuentra entre las más pesadas del mundo.

Entonces, llegó el futuro.

Mientras las terapias intensivas en Nueva York, Nueva Jersey y otros lugares se colmaban de pacientes, los Centros para el Control y Prevención de Enfermedades (CDC) advirtieron que las personas obesas con un índice de masa corporal de 40 o más, conocido como obesidad mórbida o con un sobrepeso de aproximadamente 100 libras, estaban entre los grupos con mayor riesgo de enfermarse gravemente por COVID-19.

Alrededor del 9% de los adultos estadounidenses están en esa categoría.

A medida que pasaron las semanas y se tuvo una imagen más clara de quiénes estaban siendo internados, los funcionarios federales ampliaron su advertencia para incluir a las personas con un índice de masa corporal de 30 o más.

Eso amplió enormemente las filas de las personas consideradas vulnerables a los casos más graves de la infección: el 42,4% de los adultos estadounidenses.

Se sabe desde hace tiempo que la obesidad es un factor de riesgo significativo de muerte por enfermedad cardiovascular y cáncer. Pero los científicos en el campo emergente del inmunometabolismo están descubriendo que la obesidad también interfiere con la respuesta inmune del cuerpo, poniendo a las personas obesas en mayor riesgo de infección por patógenos como la influenza y el nuevo coronavirus. En el caso de la gripe, la obesidad se ha convertido en un factor que hace que sea más difícil vacunar a los adultos contra la infección. La pregunta es si eso será válido también para COVID-19.

Un sistema inmunitario saludable activa y desactiva la inflamación según sea necesario, “llamando” a los glóbulos blancos y liberando proteínas para combatir las infecciones. Las vacunas aprovechan esa respuesta inflamatoria. Pero los análisis de sangre muestran que las personas obesas, con hipertensión o niveles elevados de azúcar en sangre, experimentan un estado de inflamación leve crónica; la inflamación se enciende y permanece encendida.

El tejido adiposo (o grasa) en el abdomen, el hígado y otros órganos no es inerte; contiene células especializadas que liberan moléculas, como la hormona leptina, que los científicos sospechan que inducen este estado crónico de inflamación.

Si bien todavía se están investigando los mecanismos biológicos precisos, la inflamación crónica parece interferir con la respuesta inmune a las vacunas, posiblemente exponiendo a las personas obesas a enfermedades prevenibles incluso después de la vacunación.

La evidencia de que las personas obesas tienen una respuesta distinta a las vacunas comunes se observó por primera vez en 1985 cuando los empleados obesos de un hospital que recibieron la vacuna contra la hepatitis B mostraron una disminución significativa en la protección 11 meses después, algo que no ocurió con los empleados que no tenían obesidad.

El hallazgo se repitió en un estudio de seguimiento que utilizó agujas más largas para garantizar que la vacuna se inyectara en el músculo y no en la grasa.

Los investigadores encontraron problemas similares con la vacuna contra la hepatitis A, y otros estudios han registrado disminuciones significativas en la protección de anticuerpos inducida por las vacunas contra el tétanos y la rabia en personas obesas.

“La obesidad es un problema global grave, y las respuestas inmunes bajas ante una vacuna observadas en la población obesa no pueden ignorarse”, dijeron miembros del Grupo de Investigación de Vacunas de la Clínica Mayo en un estudio de 2015 publicado en la revista Vaccine.

También se sabe que las vacunas son menos efectivas en adultos mayores, razón por la cual las personas  de más de 65 años reciben una vacuna anual contra la gripe sobrealimentada que contiene muchos más antígenos del virus de la gripe para ayudar a aumentar su respuesta inmune.

Por el contrario, la protección disminuida de la población obesa, tanto adultos como niños, ha sido ignorada en gran medida.

“No estoy completamente segura de por qué la eficacia de la vacuna en esta población no se ha informado mejor”, dijo Catherine Andersen, profesora asistente de Biología en la Universidad de Fairfield que estudia la obesidad y las enfermedades metabólicas. “Es una oportunidad perdida para una mayor intervención de salud pública”.

En 2017, científicos de UNC-Chapel Hill proporcionaron una pista crítica sobre las limitaciones de la vacuna contra la gripe. En un artículo publicado en el International Journal of Obesity, mostraron por primera vez que los adultos obesos vacunados tenían el doble de probabilidades que los adultos con un peso saludable de desarrollar gripe o una enfermedad similar.

Curiosamente, descubrieron que los adultos con obesidad producían un nivel protector de anticuerpos contra la vacuna de la influenza, pero aún así respondían mal.

“Ese era el misterio”, dijo Chad Petit, virólogo expert en influenza de la Universidad de Alabama.

Petit dijo que una hipótesis es que la obesidad puede desencadenar una desregulación metabólica de las células T, las células blancas de la sangre críticas para la respuesta inmune. “No es insuperable”, dijo Petit, quien está investigando COVID-19 en pacientes obesos. “Podemos diseñar mejores vacunas que puedan superar esta discrepancia”.

Históricamente, las personas con un índice de masa corporal alto a menudo han sido excluidas de los ensayos farmacológicos porque con frecuencia tienen afecciones crónicas relacionadas que pueden enmascarar los resultados.

Los ensayos clínicos en curso para evaluar la seguridad y la eficacia de una vacuna para el nuevo coronavirus incluirán a personas con obesidad, dijo el doctor Larry Corey, del Centro de Investigación del Cáncer Fred Hutchinson, quien supervisa los ensayos de fase 3 patrocinados por los Institutos Nacionales de Salud.

Aunque los coordinadores de ensayos no se centran específicamente en la obesidad como una posible complicación, dijo Corey, el índice de masa corporal de los participantes será documentado y los resultados evaluados.

El doctor Timothy Garvey, endocrinólogo y director de investigación de diabetes en la Universidad de Alabama, fue uno de los que enfatizó que, a pesar de los interrogantes, siempre es más seguro que las personas obesas se vacunen a que no lo hagan.

“La vacuna contra la influenza funciona en pacientes con obesidad, aunque no tan bien”, dijo Garvey. “Pero todavía queremos que se vacunen”.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine

For a world crippled by the coronavirus, salvation hinges on a vaccine.

But in the United States, where at least 4.6 million people have been infected and nearly 155,000 have died, the promise of that vaccine is hampered by a vexing epidemic that long preceded COVID-19: obesity.

Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that COVID-19 vaccines will be any different.

“Will we have a COVID vaccine next year tailored to the obese? No way,” said Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill.

“Will it still work in the obese? Our prediction is no.”

More than 107 million American adults are obese, and their ability to return safely to work, care for their families and resume daily life could be curtailed if the coronavirus vaccine delivers weak immunity for them.

In March, still early in the global pandemic, a little-noticed study from China found that heavier Chinese patients afflicted with COVID-19 were more likely to die than leaner ones, suggesting a perilous future awaited the U.S., whose population is among the heaviest in the world.

And then that future arrived.

As intensive care units in New York, New Jersey and elsewhere filled with patients, the federal Centers for Disease Control and Prevention warned that obese people with a body mass index of 40 or more — known as morbid obesity or about 100 pounds overweight — were among the groups at highest risk of becoming severely ill with COVID-19. About 9% of American adults are in that category.

As weeks passed and a clearer picture of who was being hospitalized came into focus, federal health officials expanded their warning to include people with a body mass index of 30 or more. That vastly expanded the ranks of those considered vulnerable to the most severe cases of infection, to 42.4% of American adults.

Obesity has long been known to be a significant risk factor for death from cardiovascular disease and cancer. But scientists in the emerging field of immunometabolism are finding obesity also interferes with the body’s immune response, putting obese people at greater risk of infection from pathogens such as influenza and the novel coronavirus. In the case of influenza, obesity has emerged as a factor making it more difficult to vaccinate adults against infection. The question is whether that will hold true for COVID-19.

A healthy immune system turns inflammation on and off as needed, calling on white blood cells and sending out proteins to fight infection. Vaccines harness that inflammatory response. But blood tests show that obese people and people with related metabolic risk factors such as high blood pressure and elevated blood sugar levels experience a state of chronic mild inflammation; the inflammation turns on and stays on.

Adipose tissue — or fat — in the belly, the liver and other organs is not inert; it contains specialized cells that send out molecules, like the hormone leptin, that scientists suspect induces this chronic state of inflammation. While the exact biological mechanisms are still being investigated, chronic inflammation seems to interfere with the immune response to vaccines, possibly subjecting obese people to preventable illnesses even after vaccination.

An effective vaccine fuels a controlled burn inside the body, searing into cellular memory a mock invasion that never truly happened.

Evidence that obese people have a blunted response to common vaccines was first observed in 1985 when obese hospital employees who received the hepatitis B vaccine showed a significant decline in protection 11 months later that was not observed in non-obese employees. The finding was replicated in a follow-up study that used longer needles to ensure the vaccine was injected into muscle and not fat.

Researchers found similar problems with the hepatitis A vaccine, and other studies have found significant declines in the antibody protection induced by tetanus and rabies vaccines in obese people.

“Obesity is a serious global problem, and the suboptimal vaccine-induced immune responses observed in the obese population cannot be ignored,” pleaded researchers from the Mayo Clinic’s Vaccine Research Group in a 2015 study published in the journal Vaccine.

Vaccines also are known to be less effective in older adults, which is why those 65 and older receive a supercharged annual influenza vaccine that contains far more flu virus antigens to help juice up their immune response.

By contrast, the diminished protection of the obese population — both adults and children — has been largely ignored.

“I’m not entirely sure why vaccine efficacy in this population hasn’t been more well reported,” said Catherine Andersen, an assistant professor of biology at Fairfield University who studies obesity and metabolic diseases. “It’s a missed opportunity for greater public health intervention.”

In 2017, scientists at UNC-Chapel Hill provided a critical clue about the limitations of the influenza vaccine. In a paper published in the International Journal of Obesity, they showed for the first time that vaccinated obese adults were twice as likely as adults of a healthy weight to develop influenza or flu-like illness.

Curiously, they found that adults with obesity did produce a protective level of antibodies to the influenza vaccine, but they still responded poorly.

“That was the mystery,” said Chad Petit, an influenza virologist at the University of Alabama.

One hypothesis, Petit said, is that obesity may trigger a metabolic dysregulation of T cells, white blood cells critical to the immune response. “It’s not insurmountable,” said Petit, who is researching COVID-19 in obese patients. “We can design better vaccines that might overcome this discrepancy.”

Historically, people with high BMIs often have been excluded from drug trials because they frequently have related chronic conditions that might mask the results. The clinical trials underway to test the safety and efficacy of a coronavirus vaccine do not have a BMI exclusion and will include people with obesity, said Dr. Larry Corey, of the Fred Hutchinson Cancer Research Center, who is overseeing the phase 3 trials sponsored by the National Institutes of Health.

Although trial coordinators are not specifically focused on obesity as a potential complication, Corey said, participants’ BMI will be documented and results evaluated.

Dr. Timothy Garvey, an endocrinologist and director of diabetes research at the University of Alabama, was among those who stressed that, despite the lingering questions, it is still safer for obese people to get vaccinated than not.

“The influenza vaccine still works in patients with obesity, but just not as well,” Garvey said. “We still want them to get vaccinated.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Merck & Co to repurpose failed obesity drug for NASH

Merck & Co is to pay $10 million to Hanmi to repurpose an obesity drug discarded by Johnson & Johnson, into a therapy for the fatty liver disease known as NASH.

Non-alcoholic steatohepatitis, as the disease is also known, has been a target for pharma for years but is proving a tough nut to crack as there are no drugs yet approved to treat it.

Intercept was previously the front runner but its obeticholic acid has run into trouble with the FDA, which rejected a filing at the end of June.

Now US-based Merck wants to see if it can get Hanmi’s drug, known as efinopegdutide, to work in NASH after J&J walked away from developing it in obesity.

Metabolic diseases is already a focus area for Merck & Co – it markets several diabetes drugs including Januvia (sitagliptin) and last year exercised an option to develop NGM313, an antibody developed by NGM that could be used in NASH and type 2 diabetes.

J&J handed back rights to Hanmi after efinopegdutide, a once-weekly glucagon-like peptide-1 (GLP-1)/glucagon receptor dual agonist, failed to produce convincing data in clinical trials in obese patients with or without diabetes.

As well as the up front $10 million payment, South Korea’s Hanmi could receive milestone payments up to $860 million if certain development, regulatory and commercial targets are met.

Hanmi could also get double digit royalties on sales if the product is approved and retains an option to market it in Korea.

Dr Sam Engel, associate vice president, Merck clinical research, diabetes and endocrinology, Merck Research Laboratories, said: “Data from phase 2 studies has provided compelling clinical evidence that warrants further evaluation of efinopegdutide for the treatment of NASH.”

NASH is predicted to be an important source of revenues for pharma. Drugs to treat the condition could become blockbusters and the market is expected to be worth $84 billion worldwide according to latest estimates from ResearchAndMarkets.com.

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The Crowding Out Strategy to Eating Healthier

It may be more expedient politically to promote an increase in consumption of healthy items rather than a decrease in consumption of unhealthy items, but it may be far less effective.

The World Health Organization has estimated that more than a million deaths “worldwide are linked to low fruit and vegetable consumption.” What can be done about it? I explore this in my video Is it Better to Advise More Plants or Less Junk?

There’s always appealing to vanity. A daily smoothie can give you a golden glow as well as a rosy glow, both of which have been shown to “enhance healthy appearance” in Caucasian, Asian, and African skin tones, as you can see at 0:24 in my video.

What about giving it away for free?

A free school fruit scheme was introduced in Norway for grades 1 through 10. Fruit consumption is so powerfully beneficial that if kids ate only an additional 2.5 grams of fruit a day, the program would pay for itself in terms of saving the country money. How much is 2.5 grams? The weight of half of a single grape. However, that cost-benefit analysis assumed this minuscule increased fruit consumption would be retained through life. It certainly seemed to work while the program was going on, with a large increase in pupils eating fruit, but what about a year after the free fruit program ended? The students were still eating more fruit. They were hooked! Three years later? Same thing. Three years after they had stopped getting free fruit, they were still eating about a third of a serving more, which, if sustained, is considerably more than necessary for the program to pay for itself.

There were also some happy side effects, including a positive spillover effect where not only the kids were eating more fruit, but their parents started eating more, too. And, although the “intention of these programs was not to reduce unhealthy snack intakes,” that’s exactly what appeared to happen: The fruit replaced some of the junk. Increasing healthy choices to crowd out the unhealthy ones may be more effective than just telling kids not to eat junk, which could actually backfire. Indeed, when you tell kids not to eat something, they may start to want it even more, as you can see at 2:20 in my video.

Which do you think worked better? Telling families to increase plants or decrease junk? Families were randomly assigned to one of two groups, either receiving encouragement to get at least two servings of fruits and veggies a day, with no mention of decreasing junk, or being encouraged to get their junk food intake to less than ten servings a week, with no mention of eating more fruits and veggies. What do you think happened? The Increase Fruit and Vegetable intervention just naturally “reduced high-fat/high-sugar intake,” whereas those in the Decrease Fat and Sugar group cut back on junk but didn’t magically start eating more fruits and vegetables.

This crowding out effect may not work on adults, though. As you can see at 3:12 in my video, in a cross-section of over a thousand adults in Los Angeles and Louisiana, those who ate five or more servings of fruits and veggies a day did not consume significantly less alcohol, soda, candy, cookies, or chips. “This finding suggests that unless the excessive consumption of salty snacks, cookies, candy, and sugar-sweetened beverages”—that is, junk—“is curtailed, other interventions…[may] have a limited impact….It may be politically more expedient to promote an increase in consumption of healthy items rather than a decrease in consumption of unhealthy items, but it may be far less effective.” In most public health campaigns, “messages have been direct and explicit: don’t smoke, don’t drink, and don’t take drugs.” In contrast, food campaigns have focused on eat healthy foods rather than cut out the crap. “Explicit messages against soda and low-nutrient [junk] foods are rare.”

In the United States, “if one-half of the U.S. population were to increase fruit and vegetable consumption by one serving each per day, an estimated 20,000 cancer cases might be avoided each year.” That’s 20,000 people who would not have gotten cancer had they been eating their fruits and veggies. The U.S. Department of Agriculture recommends we “fill half [our] plate with colorful fruits and vegetables,” but less than 10 percent of Americans hit the recommended daily target. Given this sorry state of affairs, should we even bother telling people to strive for “5 a day,” or might just saying “get one more serving than you usually do” end up working better? Researchers thought that “the more realistic ‘just 1 more’ goal would be more effective than the very ambitious ‘5 a day’ goal,” but they were wrong.

As you can see at 4:56 in my video, those told to eat one more a day for a week, ate about one more a day for a week, and those told to eat five a day for a week did just that, eating five a day for a week. But here’s the critical piece: One week after the experiment was over, the group who had been told to eat “5 a day” was still eating about a serving more, whereas the “just 1 more” group went back to their miserable baseline. So, more ambitious eating goals may be more motivating. Perhaps this is why “in the US ‘5 a day’ was replaced by the ‘Fruits and Veggies—More Matters’ campaign…in which a daily consumption of 7–13 servings of fruits and vegetables – FVs –  is recommended.” However, if the recommendation is too challenging, people may just give up. So, instead of just sticking with the science, policy makers evidently need to ask themselves questions like “How many servings are regarded as threatening?”


For more on appealing to vanity to improve fruit and vegetable consumption, see my videos Eating Better to Look Better and Beauty Is More Than Skin Deep.

What does the science say about smoothies? See:

The flipside of free fruit programs is to tax instead of subsidize. Learn more by checking out my video Would Taxing Unhealthy Foods Improve Public Health?

For more on the paternalistic attitude that you don’t care enough about your health to be told the truth, see my videos Everything in Moderation? Even Heart Disease? and Optimal Diet: Just Give It to Me Straight, Doc.

I explore this same patronizing attitude when it comes to physical activity in How Much Should You Exercise?

In health,

Michael Greger, M.D.

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

 

How to Foster a Healthy Gut Flora

What’s more important: probiotics or prebiotics? And where can we best get them?

“Virtually every day we are all confronted with the activity of our intestine, and it is no surprise that at least some of us have developed a fascination for our intestinal condition and its relation to health and disease.”

“Over the last years the intestinal microbiota [our gut flora] has been identified as a fascinating ‘new organ’” with all sorts of functions. Well, if the bacteria in our gut make up an entire, separate organ inside our body, what about doing an organ transplant? I discuss this in my video How to Become a Fecal Transplant Super Donor.

What would happen if you transferred intestinal bacteria from lean donors into obese subjects? Researchers figured that rebalancing the obesity-causing bacteria with an infusion of gut bacteria from a lean donor might help. They had wanted the study to be placebo-controlled, which, for drugs is easy, because the control subjects can just be given a sugar pill. But, when you’re inserting a tube down people’s throats and transplanting feces, what do you use as the placebo—or poocebo, if you will? Both the donors and the subjects brought in fresh stools, and the subjects were randomized to either get a donor’s stool or their own collected feces. So, the placebo was simply getting their own stool back.

What happened? As you can see at 1:32 in my video, the insulin sensitivity of the skinny donors was up around 50, which is a good thing. High insulin sensitivity means a low level of insulin resistance, which is the cause of both type 2 diabetes and prediabetes. The obese subjects started out around 20 and, after an infusion of their own feces, stayed around 20. The group of obese donors getting the skinny fecal infusion similarly started out low but then shot up near to where the slim folks were.

It’s interesting that not all lean donors’ stools conveyed the same effect on insulin sensitivity. Some donors, the so-called super-fecal donors, had very significant effects, whereas others had little or no effect, as you can see at 2:02 in my video. It turns out this super-donor effect is most probably conveyed by the amounts of short-chain fatty acid-producing intestinal bacteria in their feces. These are the food bacteria that thrive off of the fiber we eat. The short-chain fatty acids produced by fiber-eating bacteria may contribute to the release of gut hormones that may be the cause of this beneficial, improved insulin sensitivity.

“The use of fecal transplantation has recently attracted considerable attention because of its success in treatments as well as its capacity to provide cause–effect relations,” that is, cause-and-effect evidence that the bacteria we have in our gut can affect our metabolism. Within a few months, however, the bacterial composition returned back to baseline, so the effects on the obese subjects were temporary.

We can get similar benefits by just feeding what few good gut bacteria we may already have. If you have a house full of rabbits and feed them pork rinds, all the bunnies will die. Yes, you can repopulate your house by infusing new bunnies, but if you keep feeding them pork rinds, they’ll eventually die off as well. Instead, even if you start off with just a few rabbits but if you feed them what they’re meant to eat, they’ll grow and multiply, and your house will soon be full of fiber-eating bunnies. Fecal transplants and probiotics are only temporary fixes if we keep putting the wrong fuel into our guts. But, by eating prebiotics, such as fiber, which means “increasing whole plant food consumption,” we may select for—and foster the growth of—our own good bacteria.

However, such effects may abate once the high-fiber intake ceases. Therefore, our dietary habits should include a continuous consumption of large quantities of high-fiber foods to improve our health. Otherwise, we may be starving our microbial selves.


The microbiome is one of the most exciting research areas in medicine these days. For more information, see, for example:

For more on health sources of prebiotics, check out:

In health,

Michael Greger, M.D.

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