How Much Arsenic in Rice Is Too Much?

What are some strategies to reduce arsenic exposure from rice?

Those who are exposed to the most arsenic in rice are those who are exposed to the most rice, like people who are eating plant-based, gluten-free, or dairy-free. So, at-risk populations are not just infants and pregnant women, but also those who may tend to eat more rice. What “a terrible irony for the health conscious” who are trying to avoid dairy and eat lots of whole foods and brown rice—so much so they may not only suffer some theoretical increased lifetime cancer risk, but they may actually suffer arsenic poisoning. For example, a 39-year-old woman had celiac disease, so she had to avoid wheat, barley, and rye, but she turned to so much rice that she ended up with sky-high arsenic levels and some typical symptoms, including “diarrhea, headache, insomnia, loss of appetite, abnormal taste, and impaired short-term memory and concentration.” As I discuss in my video How Much Arsenic in Rice Is Too Much, we, as doctors, should keep an eye out for signs of arsenic exposure in those who eat lots of rice day in and day out.

As you can see at 1:08 in my video, in its 2012 arsenic-in-rice exposé, Consumer Reports recommended adults eat no more than an average of two servings of rice a week or three servings a week of rice cereal or rice pasta. In its later analysis, however, it looked like “rice cereal and rice pasta can have much more inorganic arsenic—a carcinogen—than [its] 2012 data showed,” so Consumer Reports dropped its recommendation down to from three weekly servings to a maximum of only two, and that’s only if you’re not getting arsenic from other rice sources. As you can see from 1:29 in my video, Consumer Reports came up with a point system so people could add up all their rice products for the week to make sure they’re staying under seven points a week on average. So, if your only source of rice is just rice, for example, then it recommends no more than one or two servings for the whole week. I recommend 21 servings of whole grains a week in my Daily Dozen, though, so what to do? Get to know sorghum, quinoa, buckwheat, millet, oatmeal, barley, or any of the other dozen or so common non-rice whole grains out there. They tend to have negligible levels of toxic arsenic.

Rice accumulates ten times more arsenic than other grains, which helps explain why the arsenic levels in urine samples of those who eat rice tend to consistently be higher than those who do not eat rice, as you can see at 2:18 in my video. The FDA recently tested a few dozen quinoa samples, and most had arsenic levels below the level of detection, or just trace amounts, including the red quinoas that are my family’s favorite, which I was happy about. There were, however, still a few that were up around half that of rice. But, overall, quinoa averaged ten times less toxic arsenic than rice. So, instead of two servings a week, following the Consumer Reports recommendation, you could have 20. You can see the chart detailing the quinoa samples and their arsenic levels at 2:20 in my video.

So, diversifying the diet is the number-one strategy to reduce exposure of arsenic in rice. We can also consider alternatives to rice, especially for infants, and minimize our exposure by cooking rice like pasta with plenty of extra water. We found that a 10:1 water-to-rice ratio seemed best, though the data suggest the rinsing doesn’t seem to do much. We can also avoid processed foods sweetened with brown rice syrup. Is there anything else we can do at the dining room table while waiting for federal agencies to establish some regulatory limits?

What if you eat a lot of fiber-containing foods with your rice? Might that help bind some of the arsenic? Apparently not. In one study, the presence of fat did seem to have an effect, but in the wrong direction: Fat increased estimates of arsenic absorption, likely due to the extra bile we release when we eat fatty foods.

We know that the tannic acid in coffee and especially in tea can reduce iron absorption, which is why I recommend not drinking tea with meals, but might it also decrease arsenic absorption? Yes, by perhaps 40 percent or more, so the researchers suggested tannic acid might help, but they used mega doses—17 cups of tea worth or that found in 34 cups of coffee—so it isn’t really practical.

What do the experts suggest? Well, arsenic levels are lower in rice from certain regions, like California and parts of India, so why not blend that with some of the higher arsenic rice to even things out for everybody?

What?!

Another wonky, thinking-outside-the-rice-box idea involves an algae discovered in the hot springs of Yellowstone National Park with an enzyme that can volatize arsenic into a gas. Aha! Researchers genetically engineered that gene into a rice plant and were able to get a little arsenic gas off of it, but the rice industry is hesitant. “Posed with a choice between [genetically engineered] rice and rice with arsenic in it, consumers may decide they just aren’t going to eat any rice” at all.


This is the corresponding article to the 11th in a 13-video series on arsenic in the food supply. If you missed any of the first ten videos, watch them here:

You may also be interested in Benefits of Turmeric for Arsenic Exposure.

Only two major questions remain: Should we moderate our intake of white rice or should we minimize it? And, are there unique benefits to brown rice that would justify keeping it in our diet despite the arsenic content? I cover these issues in the final two videos: Is White Rice a Yellow-Light or Red-Light Food? and Do the Pros of Brown Rice Outweigh the Cons of Arsenic?.

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:

Arsenic in Rice Milk, Rice Krispies, and Brown Rice Syrup

I recommend people switch away from using rice milk

For kids and teens, the amount of arsenic flowing through their bodies was found to be about 15 percent higher for each quarter cup of rice consumed per day, and a similar link was found in adults. A study of pregnant women found that consuming about a half cup of cooked rice per day could raise urine arsenic levels as much as drinking a liter of arsenic-contaminated water at the current upper federal safety limit. These findings “suggest that many people in the United States may be exposed to potentially harmful levels of arsenic through rice consumption.” which I explore in my video Arsenic in Rice Milk, Rice Krispies, and Brown Rice Syrup.

Do you know where Americans get most of their rice arsenic? From Rice Krispies, though brown rice crisps cereal may have twice as much, as I discuss in my video Arsenic in Rice Milk, Rice Krispies, and Brown Rice Syrup.

“Organic brown rice syrup (OBRS) is used as a sweetener in organic food products as an alternative to high-fructose corn syrup.” Big mistake, as organic brown rice syrup products “may introduce significant concentrations” of toxic arsenic into people’s diets. For example, two energy chews sweetened with brown rice syrup might hit the provisional upper daily arsenic intake based on the water standards.

“Toddler formulas with added organic brown rice syrup have 20 times higher levels of inorganic [toxic] arsenic than regular formulas,” and in older children, thanks to brown rice syrup, a few cereal bars a day “could pose a very high cancer risk.”

What about rice milk? A consensus statement of both the European and North American societies for pediatric nutrition recommends the “avoidance of rice drinks for infants and young children,” and, generally, toxic “inorganic arsenic intake in infancy and childhood should be as low as possible.”

To this end, the United Kingdom has banned the consumption of rice milk for young children, a notion with which Consumer Reports concurred, recommending no servings a week of rice milk for children and no more than half a cup a day for adults, as you can see at 1:56 in my video.

The arsenic in various brands of rice milk ranges wildly—in fact, there’s a 15-fold difference between the highest and lowest contamination, suggesting manufacturers could make low arsenic rice milk if they wanted. As you can see at 2:16 in my video, Consumer Reports found rice drinks from Pacific and Rice Dream brands were right about average, though, for Rice Dream, it appears the vanilla or chocolate flavors may be lower. It doesn’t seem we have anything to worry about with rice vinegar, but rice pasta and rice cakes end up similar to pure rice in terms of arsenic levels, which makes sense because that’s pretty much what they are—pure rice. However, pasta is boiled, so we’d expect the levels to be cut 40 to 60 percent, like when you boil and drain rice.

If you just couldn’t live without rice milk for some reason, you could make your own using lower arsenic rice, like brown basmati from India, Pakistan, or California, but then your homemade rice milk might have even less nutrition, as most of the commercial brands are at least fortified. Better options might be soy, oat, hemp, or almond milk, though you don’t want kids to be drinking too much almond milk. There have been a few case reports of little kids drinking four cups a day and running into kidney stone problems due to its relatively high oxalate content, which averages about five times more than soy milk. More on oxalates in my video series starting with Oxalates in Spinach and Kidney Stones: Should We Be Concerned?

I have about 40 videos that touch on soy milk, discussing such topics as how it may normalize development in girls and reduce breast cancer risk, as well reduce prostate cancer risk in men. Some of the latest science on soy milk includes an association with better knee x-rays, suggesting protection from osteoarthritis, and an interventional study suggesting improved gut health by boosting the growth of good bacteria. However, drinking 3 quarts a day, which is 10 to 12 daily cups, for a year may inflame your liver, but two cups a day can have an extraordinary effect on your cholesterol, causing a whopping 25 percent drop in bad cholesterol after just 21 days.

An ounce and a half of almonds, about a handful, each day, can drop LDL cholesterol 13 percent in six weeks and reduce abdominal fat, though a cup of almond milk only contains about ten almonds, which is less than a third of what was used in the study. So, it’s not clear if almond milk helps much, but there was a study on oat milk compared to rice milk. As you can see at 4:37 in my video, five weeks of oat milk lowered bad cholesterol, whereas rice milk didn’t, and even increased triglycerides and may bump blood pressure a bit. However, the oat milk only dropped LDL about 5 percent and that was with three cups a day. As plant-based alternatives go, it appears soy milk wins the day.

So, why drink rice milk at all when there are such better options? There really isn’t much nutrition in rice milk. In fact, there are case reports of severe malnutrition in toddlers whose diets were centered around rice milk due to multiple food allergies. Infants and toddlers have increased protein requirements compared to adults, so if the bulk of a child’s diet is rice milk, coconut milk, potato milk, or almond milk, they may not get enough, as you can see at 5:23 in my video. In fact, cases of kwashiorkor—that bloated-belly protein- and calorie-deficient state of malnutrition—due to rice milk have been reported in Ethiopia…and Atlanta, Georgia, because literally 99 percent of the child’s diet was rice milk. So, these malnutrition cases were not because they drank rice milk, but rather because they drank rice milk nearly exclusively. I just use these examples to illustrate the relative lack of nutrition in rice milk. If you’re going to choose a milk alternative, you might as well go for one that has less arsenic—and more nutrition.

I have released several videos on soy milk, but only one on almond milk video so far: Prostate Cancer and Organic Milk vs. Almond Milk. I plan on producing many more on choosing between various milk options, so stay tuned.


If you’ve missed any of the useful material on dietary arsenic I’ve also shared, please see:

The final four videos in this series take all of this information and try to distill it into practical recommendations:

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:

 

Arsenic in Infant Rice Cereal

When it comes to rice and rice-based products, pediatric nutrition authorities have recommended that arsenic intake should be as low as possible.

“The US Food and Drug Administration (FDA) has been monitoring the arsenic content in foods” for decades, yet despite the “well-established science describing the health risks associated with arsenic exposure, no standards have been set limiting the amount of arsenic allowable in foods” in the United States. In 2001, the EPA “adopted a new stricter standard for arsenic in drinking water,” and in 2013, the FDA proposed a legal limit for apple juice. “There are still no standards for arsenic in food products despite the fact that food sources are our main source of exposure.”

Unlike the United States, China has standards. As of 2014, China set a maximum threshold of inorganic arsenic at 150 parts per billion, stricter than the World Health Organization’s limit of 200 ppb. In the United States, a 200 ppb limit wouldn’t change the cancer risk much. If we had China’s safety limits of 150 ppb, though, cancer risk would be reduced up to 23 percent and a maximum threshold of 100 ppb would lower cancer risk up to 47 percent—but that could seriously affect the rice industry. In other words, U.S. rice is so contaminated with arsenic that if a safety standard that really cut down on cancer risk were set, it “would wipe out the U.S. rice market.” However, with no limits, what’s the incentive for the rice industry to change its practices? Setting arsenic limits would not only directly protect consumers but also encourage the industry to stop planting rice paddies on arsenic-contaminated land.

Those cancer estimates are based on arsenic-contaminated water studies. Might the arsenic in rice somehow have a different effect? You don’t know…until you put it to the test. We know rice has a lot of toxic arsenic that urine studies have shown we absorb into our body, but there hadn’t been any studies demonstrating “deleterious health impacts” specific to rice arsenic—until now. Since arsenic causes bladder cancer, the researchers figured they would see what kind of DNA mutations the urine of rice eaters can have on human bladder cells growing in a petri dish. And, indeed, they clearly demonstrated that eating a lot of arsenic-contaminated rice every day can “give rise to significant amounts of genetic damage,” the kind that‘s associated with cancer. Yes, but the study used pretty contaminated rice. However, only about 10 percent of the rice in certain parts of Asia might ever reach those levels of contamination, though a quarter of rice in parts of Europe might and more half in the United States, making for considerable public health implications.

So, “there remains little mystery surrounding the health risks associated with arsenic levels in rice. The remaining mystery is why long-overdue standards for arsenic levels in rice have not been set by the FDA” in the United States, but that may be changing. In 2016, the FDA proposed setting a limit on toxic arsenic—at least in infant rice cereal, which I discuss in my video Arsenic in Infant Rice Cereal.

As you can see at 3:24 in my video, infants and children under four years of age average the highest rice intake, in part because they eat about three times the amount of food in relation to their body size, so there’s an especially “urgent need for regulatory limits” on toxic arsenic in baby food.

Pediatric nutrition authorities have recommended that when it comes to rice and rice-based products, “arsenic intake should be as low as possible,” but how about as early as possible? Approximately 90 percent of pregnant women eat rice, which may end up having “adverse health effects” on the baby.

You can estimate how much rice the mother ate while pregnant by analyzing arsenic levels in the infant’s toenail clippings. “Specifically, an increase of 1/4 cup of rice per day was associated with a 16.9% increase in infants toenail [arsenic] concentration,” which indicates that arsenic in rice can be passed along to the fetus. What might that arsenic do? A quarter cup of rice worth of arsenic has been associated with low birth weight, increased respiratory infections, and, above that, a 5- to 6-point reduction in IQ, among other issues. So, “based on the FDA’s findings, it would be prudent for pregnant women to consume a variety of foods, including varied grains (such as wheat, oats, and barley),” which is code for cut down on rice. Saying eat less of anything, after all, is bad for business.

Once the baby is weaning, “what’s a parent to do?” Asks Consumer Reports, “To reduce arsenic risks, we recommend that babies eat no more than 1 serving of infant rice cereal per day on average. And their diets should include cereals made of wheat, oatmeal, or corn grits, which contain significantly lower levels of arsenic”—that is, rely on other grains, which are much less contaminated than rice. As the American Academy of Pediatrics has emphasized, “there is no demonstrated benefit of rice cereal over those made with other grains such as oat, barley, and multigrain cereals, all of which have lower arsenic levels than rice cereal.” As you can see at 5:28 in my video, reducing consumption of infant rice cereal to just two servings per week could have an even more dramatic effect on reducing risk.

 The proposed limit on toxic arsenic in infant rice cereals would end up removing about half of the products off the shelves. The FDA analyzed more than 500 infant and toddler foods, and the highest levels of toxic arsenic were found in organic brown rice cereals and “Toddler Puffs.” Based on the wording in the report, these puffs appear to be from the Happy Baby brand. Not-so-happy baby if they suffer brain damage or grow up to get cancer. A single serving could expose infants to twice the tolerable arsenic intake set by the EPA for water. I contacted the Happy Baby company and was told they “are not able to provide any comments” on the FDA’s results.

“Eliminating all rice and rice products from the diets of infants and small children up to 6 years old could reduce the lifetime cancer risk from inorganic arsenic in rice and rice products by 6% and 23% respectively.” That is, there would be a 6 percent lower chance of developing lung or bladder cancer later in life if infants stopped, and a 23 percent lower chance if young kids stopped. However, switching to other grains is a move described as “drastic and dramatic,” creating “a huge crisis”—for the rice industry, presumably—and therefore “not feasible at all.”

I was hoping Happy Baby, upon learning of the concerning FDA arsenic toddler puffs data (regardless of whether the data were about its brand or not) would have kicked its own testing and potential remediation into high gear like Lundberg did (see Which Brands and Sources of Rice Have the Least Arsenic?). But, unfortunately, in my email correspondence with the company, I got no sense that it did.


For more videos on this topic, see:

And here are five more:

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:

Two Women’s Health Policy Issues to Monitor in 2021

With President-elect Joe Biden and a new Congress taking office next month, newly updated KFF briefs examine two women’s health policy issues awaiting federal policymakers in 2021. President-elect Biden campaigned on reversing the Trump Administration’s regulations for the Title X family planning program, which require complete financial and physical separation from abortion services, including referrals,More

Analysis of Federal Bills to Strengthen Maternal Health Care

The bills in this table address a number of related maternity care issues, including extending Medicaid postpartum coverage from 60 days to one year, funding for clinical training on health equity and implicit bias, developing broader networks of maternity care providers in rural areas, and research on the potential benefits of Medicaid coverage for doula care.

The Effects of Too Much Arsenic in the Diet

Even at low-level exposure, arsenic is not just a class I carcinogen, but may also impair our immune function and increase our risk of cardiovascular disease and diabetes.

When people hear about arsenic, they think of it as an acute poison, and, indeed, a tiny amount—a hundred milligrams, about one-tenth the weight of a paperclip—could kill you in an hour. But, there is also chronic arsenic poisoning, where even a dose 10,000 times as small can be harmful if you’re exposed day-after-day for years at a time as I discuss in my video The Effects of Too Much Arsenic in the Diet. Chief among the concerns is cancer.

Arsenic is classified as a class I carcinogen, which is the highest level and includes things known to cause cancer in humans. Other class I carcinogens are asbestos, cigarette smoke, formaldehyde, plutonium, and processed meat (the consumption of bacon, ham, hot dogs, deli meat, and the like). So, arsenic is pretty bad, to say the least, implicated in tens of thousands—or even hundreds of thousands—of cancer cases worldwide every year.

Of course, cancer is our number-two killer. What about heart disease, our leading cause of death? “Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality,” meaning heart attacks and strokes.

Arsenic is also considered an immunotoxicant, meaning it’s toxic to our immune system. How do we know that? There’s a virus called varicella, which is what causes chickenpox—the first time we get it. Our immune system is able to stamp it down but not stamp it out. The virus retreats into our nerve cells where it lies in wait for our immune function to dip. And, when it does, the virus re-emerges and causes a disease called shingles. We’ve all been exposed to the virus, but only about one in three of us will get shingles because our immune system is able to keep it at bay. However, the virus can slip its muzzle as we get older or immunosuppressed, for instance, if we’re given arsenic chemotherapy. Shingles is a common side effect, because the arsenic drugs not only kill the cancer but also some of our immune cells, too. That’s at high doses, though. Might even low doses of arsenic, like the kind we’re exposed to in our daily diet, impact our immune function? Researchers tested the levels of arsenic in the urine of thousands of Americans, along with their levels of anti-virus antibodies, and, indeed, they found that the more arsenic the subjects had flowing through their bodies, the lower their defenses.

And, if you’re pregnant, arsenic can pass to your baby, possibly increasing the risk of miscarriage or infant mortality, and “may affect an infant’s immune development and susceptibility to infections early in life.” Indeed, a study out of New Hampshire on infant infections in relation to prenatal arsenic exposure found that the more arsenic the mom was exposed to during pregnancy, the higher the baby’s risk of infection during infancy. However, “it’s unknown whether arsenic-induced epigenetic changes are transgenerational”—that is, whether changes in gene expression can impact the health of not only your own children but your grandchildren as well. Regardless, arsenic exposure isn’t good for mom’s own health, as it is associated with increasing blood pressure.

Hold on. If arsenic suppresses immune system function, then, as a silver lining, would we, for example, have fewer allergies, which is a kind of over-reaction of the immune system? Apparently not. Those with higher arsenic levels tend to have higher rates of food allergies, tend not to sleep as well, and tend not to feel as well. When people were asked how they would rate their health, those reporting “excellent” or “very good” tended to have lower levels of arsenic, compared to those who reported their general health condition as “good,” “fair,” or “poor,” who tended to have higher arsenic levels.

What about diabetes? You can see the results of two dozen population studies on arsenic exposure and confirmed diabetes at 4:07 in my video. Any result above one suggests increased risk for diabetes, and any result below one suggests lower risk. The findings? “Our results support an association between ingested arsenic and DM [diabetes] in humans.” Population studies can’t prove cause and effect, though. “While it would be nice to demonstrate a cause and effect relationship…is it necessary?”

We know arsenic is a carcinogen. We know it causes cancer. What more do we need to take steps to decrease our exposure?

Where is arsenic found in our diet? See my videos Where Does the Arsenic in Chicken Come From?  and Where Does the Arsenic in Rice, Mushrooms, and Wine Come From?.


 Ready for a deep dive into the rice issue? 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:

 

 

 

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:

What can we learn from women’s health data?

Analysing real-world health data could help overcome the bias towards men in traditional medical research, says Sensyne Health’s Dr Lucy Mackillop.

Collecting and analysing anonymised patient data has the potential to generate valuable insights that can catalyse research, lead to improved patient care, and power the development of new treatments.

Being able to analyse large data sets can provide a better understanding of how some patients will respond to a treatment or predict who may develop a disease based on data collected during clinical care.

Medical research has often focused on men, meaning that the insights gained have not always been reflective of how women would react to a treatment or disease. Women are likely to have different symptoms to men for the same illness and do not necessarily have the same reactions to certain drugs or respond to the same doses as a male counterpart.

Therefore, it is important to increase the collection and analysis of women’s health data so better insights can be gained for supporting their care.

“The effect of failing to include women proportionately in clinical trials may have consequences for the quality of medical care women receive, with therapies, doses and risk assessment tools being tailored to the male population”

The impact of underrepresenting women

Research from the Allen Institute for Artificial Intelligence found that over the past 25 years, although women have made up nearly half (49%) of participants across drug trials, for many types of disease the proportion of female participants did not match the gender breakdown of real-world patients. In trials for cardiovascular, HIV, kidney disease and digestive diseases, women have especially been underrepresented.

The effect of failing to include women proportionately in clinical trials may have consequences for the quality of medical care women receive, with therapies, doses and risk assessment tools being tailored to the male population. The use of real-world medical data from women may change this – and more broadly, ensure that representative samples of data are used for the disease or issue.

What we can learn during pregnancy

As well as collecting more representative samples of data from women for conditions like cardiovascular disease, accurate data collected during pregnancy could offer a valuable information.

This is because typically, ‘real-world’ medical data is collected from patients who are ill. However, pregnancy is a unique time when large quantities of data are collected in otherwise ‘healthy’ women.

Pregnancy can also act as a cardiometabolic stress test for women and reveal underlying susceptibilities to conditions such as diabetes or hypertension.

Therefore, by analysing the data collected during a woman’s pregnancy, clinicians can view a window into future health risks and understand who is most at risk. This helps develop better preventative strategies and also prioritises care.

Last year it was estimated that 20% of pregnant women in the UK were affected by gestational diabetes, while each year, up to 15% of pregnancies are affected by hypertension. Developing therapeutic strategies and individual care pathways may allow for prevention or delay in these diseases, both for the mother and her offspring.

Improving health of future generations

Research has found that the environment in which a baby grows has a significant impact on its health throughout its life. This means that being able to improve the way we care for pregnant women through collecting and analysing data can also significantly influence the health of their offspring.

While collecting data from patients is important in development of new treatments, clinical research, and patient care, there must be a greater focus on ensuring that women are well represented in trials.

For pregnant women in particular, the information that their medical records can offer must be recognised, and databases that can be used to support the improvement of care and outcomes has the potential to provide important insights.

About the author

Dr Lucy Mackillop is a consultant obstetric physician at Oxford University Hospitals NHS Foundation Trust; honorary senior clinical lecturer, Nuffield Department of Women’s and Reproductive Health, University of Oxford; and chief medical officer at Sensyne Health.

The post What can we learn from women’s health data? appeared first on .

Vitamin C for Male Infertility and Lead Poisoning?

What is the clinical relevance of vitamin C among lead-exposed infertile men? Compared to controls, lead battery industry workers given 1,000 mg of vitamin C every workday for three months experienced “a significant increase in sperm motility and sperm count, as well as decrease in abnormal sperm,” and “a significant reduction in the incidence of sperm DNA fragmentation,” that is, damaged sperm DNA. Okay, but the ideal endpoint would be bouncing baby boys and girls. Enter this extraordinary little study from the University of Texas from more than 30 years ago.

Twenty-seven men with fertile wives had been trying to have kids for years to no avail. Twenty of them were given 1,000 mg of vitamin C a day for two months, and 7 acted as controls and didn’t get any vitamin C. The researchers followed up at the end of the 60 days. By then, every single one of the wives of each of the 20 men who had gotten the vitamin C had became pregnant—20 out of 20! After years of frustration, boom: 100-percent pregnant. What’s more, not a single one of the wives of men in the control group got pregnant. Rarely does one see these kinds of black-and-white results in the medical literature for any intervention.

Is the vitamin C lowering the oxidative stress from the lead, or is it actually lowering the level of lead? Sure, antioxidant supplementation can have antioxidant effects, but it may fail to actually lower lead levels in the blood. Now, this was in a group of workers who were breathing lead day in and day out, and the way vitamin C may work is by simply blocking the “intestinal absorption of lead.” An earlier study showed vitamin C supplementation apparently cut lead levels by a third within six months, but that was with a whopping dose of 2 g with added zinc. Another small study found the same 30 percent drop with just 500 mg a day, no zinc, and in only one month. But neither of those studies had a control group of subjects who didn’t take anything, so we don’t know if their levels would have fallen anyway.

Similarly, there is an almost too-good-to-be-true study on the role of vitamin C in scavenging lead toxicity from “biosystems,” by which they meant children. They got 250 to 500 mg a day of vitamin C for a few months, and shaved hair samples every month saw up to a 69 percent decline in lead levels. Researchers repeated it in two other small groups of kids and saw the same amazing kind of drops in every single child. But maybe lead levels were just dropping throughout the whole community during that time? Without measuring lead levels in a control group of kids not taking vitamin C, we can’t be sure.

As I illustrate from 3:17 in my video Yellow Bell Peppers for Male Infertility and Lead Poisoning?, with eight weeks of vitamin C, lead levels dropped in the blood and rose in the urine. One could conclude that the vitamin C was pulling lead out of the body, but the same thing happened in the placebo group: Blood levels dropped, and urine levels rose. So, it had nothing to do with the vitamin C at all. That’s why it’s always important to have a control group.

The same applies with studies that appeared to show no benefit. For example, 36 battery manufacturing workers were studied. Each was given vitamin C, yet there was no change in their lead levels. But, maybe their co-workers suffered a big increase in lead levels during that same time period, and the vitamin C was actually successful in keeping the subjects’ levels from rising. You don’t know without a control group.

That’s why studies like “The effects of vitamin C supplementation on blood and hair levels of cadmium, lead, and mercury” are so important. Vitamin C versus an identical-looking sugar pill placebo. The result? The vitamin C failed to help, which really put a damper on enthusiasm for using vitamin C for lead poisoning until a now-famous study was published in 1999 that showed that vitamin C supplementation could lead to a decrease in blood levels. As you can see at 4:32 in my video, after four weeks of taking a placebo, not much change occurred in blood lead levels in the control group, which is what we’d expect. In contrast, the vitamin C group started out at about the same blood lead level as the control group, but within one week of taking 1,000 mg of vitamin C a day, lead levels dropped 81 percent. So, supplementation of vitamin C “may provide an economical and convenient method of reducing blood-lead levels, possibly by reducing the intestinal absorption of lead.”

The urine lead levels didn’t change, so it’s not as if the subjects were excreting more lead in their urine to bring down their blood levels. However, most of the lead in our blood is in the red blood cells, which are recycled in the liver and discharged through the bile into the gut where the lead could just get reabsorbed—unless, perhaps, you’ve got a lot of vitamin C in there to block the re-absorption. But 1,000 mg is a lot of vitamin C. Would something like 200 mg, which is just about how much vitamin C you’d get in an orange and a cup of broccoli or strawberries, work? The researchers tested that, too. The 200 mg group started out the same as the control and the 1,000 mg group, but blood lead levels didn’t really budge. Bummer! So, 1,000 mg seemed to work, but 200 mg didn’t. Isn’t 1,000 mg of vitamin C a bit unnatural, though? The RDA is only 60 mg. Well, actually, we may have evolved for millions of years getting closer to 600 mg a day—ten times the current RDA—because we were eating so many fruits and greens. Okay, but could you reach 1,000 mg of vitamin C without having to take pills? Yes! That’s the amount of vitamin C, for example, that can be found in three yellow bell peppers.


Other videos in my series on lead include:

Note that there is nothing special about yellow bell peppers—other than their extraordinary vitamin C content, that is. I just used them as a practical way to get 1,000 mg of vitamin C in whole-food form. They’re certainly easier than eating ten oranges!

Though, remember my video Peppers and Parkinson’s: The Benefits of Smoking Without the Risks? So, one would expect to get all the benefits of the 1,000 mg of vitamin C with benefits. Why not just take vitamin C supplements? See Do Vitamin C Supplements Prevent Colds but Cause Kidney Stones?.

If hundreds of milligrams a day of vitamin C sounds like a lot, check out What Is the Optimal Vitamin C intake?.

You may be interested in my vitamin C and cancer series:

Finally, for more on male fertility, 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:

How to Treat Bacterial Vaginosis

Vitamin C is pitted head-to-head against antibiotics for bacterial vaginal infections.

A study published in 1999 raised the exciting possibility that “cheap, simple, innocuous and ubiquitous vitamin C” supplements could prevent a condition known as preeclampsia, but after a decade of research, we realized that was merely a false hope and that vitamin C supplements appear to play little role in women’s health. But this was in regard to oral vitamin C, not vaginal vitamin C, which has been found to be an effective treatment for bacterial vaginosis, an all too common gynecological disorder characterized by a foul-smelling, watery, gray discharge, which I discuss in my video Treating Bacterial Vaginosis with Vaginal Vitamin C.

Bacterial vaginosis “can best be described as an ‘ecological disaster’ of the vaginal microflora.” The good, normal, lactobacillus-type bacteria get displaced by an army of bad bacteria. Probiotics may help, repopulating the good bacteria, but the reason the bad bacteria took over in the first place was that the pH was off. I’ve talked before about the role diet may play in the development of the condition. (See my video Bacterial Vaginosis and Diet for more.) For example, saturated fat intake may increase vaginal pH, allowing for the growth of undesirable bacteria, so why not try to re-acidify the vagina with ascorbic acid, otherwise known as vitamin C? This isn’t just plain vitamin C tablets but specially formulated silicone-coated supplements that release vitamin C slowly, so as to not be irritating. How well do they work? One hundred women suffering from the condition were split into two groups, and the vaginal vitamin C beat out placebo. But how does vitamin C compare with conventional therapy, an antibiotic gel?

This is an important question. “Although perceived as a mild medical problem,” bacterial vaginosis may increase the risk of several gynecological complications, including problems during pregnancy, when you want to avoid taking drugs whenever possible. The vitamin C appeared to work as effectively as the antibiotic. So, vitamin C can really help, especially in the first trimester of pregnancy when you really don’t want to using drugs like topical antibiotics. And for women with recurrent episodes, using vitamin C for six days after each cycle appears to cut the risk of recurrence in half, as you can see at 2:36 in my video.


Another way to get vitamin C into the body is by dripping it directly into the vein. Does that actually do anything? See:

For those of us who prefer to get vitamin C the old-fashioned way, through the mouth and in foods rather than supplements, the question becomes What Is the Optimal Vitamin C Intake?

 If you’re considering taking oral vitamin C in supplements instead, make sure to watch this video first: Do Vitamin C Supplements Prevent Colds But Cause Kidney Stones?.

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 Guardian view on a women’s health scandal: under the skin | Editorial

An official review of vaginal mesh and medicines in pregnancy reveals systemic weaknesses, and sexism too

Greater openness about women’s bodies was one of the big themes of postwar feminism. Access to contraception and the right to terminate a pregnancy were crucial stepping stones on a path to liberation from a social order that for centuries constrained women. The right to choose whether to have children is now well established, along with access to education, employment and equal pay (although gender pay and pension gaps remain). But sexism has not gone away. Among the findings of the Independent Medical Devices and Medicines Safety Review set up to investigate vaginal mesh implants is that the UK’s health system has a habit of ignoring women.

One patient likened the search for a doctor who would take seriously her concerns about the implants, which were widely used to treat pelvic organ prolapse and stress urinary incontinence until 2018, to “traipsing through treacle”. A former doctor referred to an “unconscious negative bias” towards middle-aged women in chronic pain. The report described a culture in which “anything and everything” women said about their discomfort was put down to the menopause.

Continue reading…

The pelvic mesh scandal makes it clear: doctors must declare any funding | Margaret McCartney

We need a public register to show if healthcare professionals are in the pay of industry – or more patients will suffer

It was never “just women’s problems”. After decades of having their suffering dismissed, many patients will have been relieved about the publication of the Independent Medicines and Medical Devices Safety Review yesterday. Led by Julia Cumberlege, the review has spent two years investigating three medical interventions: pelvic mesh, used in prolapse surgery, which resulted in chronic, life-changing pain for many women; Primodos, a hormonal pregnancy test, used up until 1978; and sodium valproate, an epilepsy treatment. The latter two have both been linked with birth defects.

Related: Denial of women’s concerns contributed to decades of medical scandals, says inquiry

Continue reading…

Are the BPA-Free Plastics Like Tritan Safe?

Do BPA-free plastics such as Tritan, have human hormone-disrupting effects? And what about BPS and BPF?

Recent human studies indicate that exposure to the plastics chemical BPA may be associated with infertility, miscarriage, premature delivery, reduced male sexual function, polycystic ovaries, altered thyroid and immune function, diabetes, heart disease, and more. Yet, “[a]s recently as March 2012, FDA stated that low levels of BPA in food are considered safe.” However, just months later, to its credit, the agency banned the use of BPA plastics in baby bottles and sippy cups. Regulators standing up to industry? Maybe I shouldn’t be so cynical! But, wait. The ban was at the behest of the plastics industry. It had already stopped using BPA in baby bottles so it was their idea to ban it.

The industry had switched from BPA to similar compounds like BPF and BPS. So, our diets now contain everything from BPA to BPZ, and the majority of us have these new chemicals in our bodies as well. Are they any safer?

As I discuss in my video Are the BPA-Free Alternatives Safe?, based on the similarities of their chemical structures, they are all predicted to affect testosterone production and estrogen receptor activity, as you can see at 1:40 in my video. However, they were only recently put to the test.

As you can see at 1:50 in my video, we’ve known BPA significantly suppresses testosterone production, and, from “the first report describing BPS and BPF adverse effects on physiologic function in humans,” we know those compounds do, too. Well, kind of. The experiments were performed on the testicles of aborted human fetuses. But, the bottom line is that BPS and BPF seem to have “antiandrogenic anti-male hormone effects that are similar to those of BPA.” So when you’re assured you shouldn’t worry because your sales slip is BPA-free, the thermal paper may just contain BPS instead. What’s more, BPS receipts may contain up to 40 percent more BPS than they would have contained BPA. So BPA-free could be even worse. In fact, all BPA-replacement products tested to date released “chemicals having reliably detectable EA,” estrogenic activity.

This includes Tritan, which is specifically marketed as being estrogen-activity-free. As you can see at 3:06 in my video, however, researchers dripped an extract of Tritan on human breast cancer cells in a petri dish, and it accelerated their growth. This estrogenic effect was successfully abolished by an estrogen blocker, reinforcing it was an estrogen effect. Now, the accelerated growth of the cancer cells from the Tritan extract occurred after the plastic was exposed to the stressed state of simulated sunlight. Only one out of three Tritan products showed estrogen activity in an unstressed state, for instance when they weren’t exposed to microwaving, heat, or UV rays. “Because there would be no value in trading one health hazard for another, we should urgently focus on the human health risk assessment of BPA substitutes.”

In the meanwhile, there are steps we can take to limit our exposure. We can reduce our use of polycarbonate plastics, which are usually labeled with recycle codes three or seven, and we can opt for fresh and frozen foods over canned goods, especially when it comes to tuna and condensed soups. Canned fruit consumption doesn’t seem to matter, but weekly canned vegetable consumption has been associated with increased BPA exposure. If you do use plastics, don’t microwave them, put them in the dishwasher, leave them in the sun or a hot car, or use once they’re scratched. But using glass, ceramic, or stainless steel containers is probably best.


For more on BPA, check out my videos:

Unfortunately, BPA isn’t the only plastics chemical that may have adverse health effects. 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:

Eating Seaweed Salad May Boost Immune Function

Eating seaweed salad may boost the efficacy of vaccinations and help treat cold sores, herpes, Epstein-Barr virus, and shingles.

Billions of pounds of seaweed are harvested each year, the consumption of which “has been linked to a lower incidence of chronic diseases,” both physical and mental. For example, women who eat more seaweed during pregnancy appear to be less depressed and experience fewer seasonal allergy symptoms. There’s a problem with these cross-sectional, correlational studies, however, in that they can’t prove cause and effect. Maybe seaweed consumption is just an indicator that people generally are following “traditional Japanese dietary customs,” which have lots of different aspects that could protect against disease. To know for certain whether seaweed can modulate immune function, you have to put it to the test.

As I discuss in my video How to Boost Your Immune System with Wakame Seaweed, typically, researchers start out with in vitro studies, meaning in a test tube or a petri dish, which make for quicker, cheaper, and easier experiments. One study, for example, took eight different types of seaweed and essentially made seaweed teas to drip onto human immune system cells in a petri dish. Studies like these showed that the seaweed wakame, which is the kind you find in seaweed salad, can quadruple the replication potential of T cells, which are an important part of our immune defense against viruses like herpes simplex virus.

No one actually gave seaweed to people with herpes until a study published in 2002. Researchers gave people suffering from various herpes infections about two grams a day of pure powdered wakame, which is equivalent to about a quarter cup of seaweed salad. “All fifteen patients with active Herpetic viral infections”—including herpes virus 1, the cause of oral herpes, which causes cold sores; herpes virus 2, which causes genital herpes; herpes virus 3, which causes shingles and chicken pox; and herpes virus 4, also known as Epstein-Barr virus, which causes mono—“experienced significant lessening or disappearance of symptoms,” as you can see at 2:06 in my video. There was no control group in the study, but with no downsides to eating seaweed, why not give it a try?

Researchers also found that wakame boosted antibody production, so could it be useful to boost the efficacy of vaccines? The elderly are particularly vulnerable to suffering and dying from influenza. While the flu vaccine can help, ironically, the elderly are less likely to benefit from it because immune function tends to decline as we get older. So, researchers took 70 volunteers over the age 60. As you can see at 2:50 in my video, their baseline level of antibodies against a flu virus was about 10 GMT. What you’re looking for in a vaccination is to get a two-and-a-half-fold response, so we’d like to see that antibody level get up to at least 25 GMT to consider it an effective response. The vaccine only boosted levels to 15 to 20 GMT, though. What happened after the subjects were given some wakame extract every day for a month before the vaccination? Their levels jumped up to 30 to 35 GMT. The researchers used an extract in a pill rather than the real thing, though, so they could perform this randomized placebo-controlled study. After all, it’s kind of hard to make a convincing placebo seaweed salad.

“It is hoped that the popular seaweeds eaten daily in Japan, though almost unknown around the world outside of Japanese restaurants, will be consumed…for possible immunopotentiation”—that is, immune-boosting potential—“and for attenuating the burden of infectious diseases in the elderly.”

What else can seaweed salad do (other than taste delicious)? See my video Wakame Seaweed Salad May Lower Blood Pressure.

In general, sea vegetables are good sources of iodine, as I discuss in Iodine Supplements Before, During, and After Pregnancy, and may also be one reason Japanese women have historically had such low rates of breast cancer, which I cover in Which Seaweed Is Most Protective Against Breast Cancer?.


What else can we do to boost our immunity? Check out my videos:

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: